", "cop": 4, "opa": "Organoaxial gastric volvulus", "opb": "Large Gastric adenocarcinoma at antral end", "opc": "Rolling type of hiatus hernia", "opd": "Mesenteroaxial gastric volvulus", "subject_name": "Medicine", "topic_name": "All India exam", "id": "1eb01c1b-3453-4cfb-be85-4b032274cce8", "choice_type": "single"}
+{"question": "Water shed zone in spinal cord is", "exp": "(B) T4-T8 > It is generally accepted that the gray matter in the watershed area of the midthoracic level of the spinal cord is the ischemic watershed zone of the spinal cord. Historically, the literature has supported the notion of a spinal cord \"watershed zone\" of ischemic vulnerability centered at the mid-thoracic level (T4 to T6 level). This assumption was based largely on anatomic studies and case reports describing the relative hypovascularity of the midthoracic region from approximately T4 to T8. Because of the anatomic distribution of the spinal cord arteries with the relative paucity of radicular arteries in the thoracic region, the midthoracic level (T4 to T8) has been recognized as the ischemic watershed zone of the spinal cord.", "cop": 2, "opa": "L4-S5", "opb": "T4-T8", "opc": "T12-L1", "opd": "L3-L5", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "94596c93-6d53-4973-9f16-e62097e8fbda", "choice_type": "single"}
+{"question": "Migraine is due to", "exp": "K.D Tripathy essentials of medical pharmacology 7th edition . *Neurogenic theory consider it to be spreading depression of coical electrical activity followed by vascular phenomena.", "cop": 3, "opa": "Dilatation of cranial aeries", "opb": "Constriction of cranial aeries", "opc": "Coical spreading dissociation", "opd": "Meningial inflammation", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "49678267-3670-4ad0-b0c8-141539207654", "choice_type": "single"}
+{"question": "Protein losing enteropathy with mucosal erosion is seen in", "exp": "Causes of protein losing enteropathy with mucosal erosion are Crohn's disease, ulcerative colitis, radiation damage and lymphoma. Coeliac disease, Menetrier's disease and systemic lupus erythematosus can cause protein losing enteropathy without mucosal erosion. Ref: Davidson's Principles and Practice of Medicine, 22nd edition, p886", "cop": 1, "opa": "Lymphoma", "opb": "Coeliac disease", "opc": "Menetrier's disease", "opd": "Systemic lupus erythematosus", "subject_name": "Medicine", "topic_name": "All India exam", "id": "d3c9aeb4-b00b-419f-a6c6-241fd8bcef35", "choice_type": "single"}
+{"question": "A patient with suspected subarachnoid haemorrhage presents with blood isolated in the fouh ventricle on a CT scan. Aneurysmal rupture is likely to have resulted from", "exp": "*Saccular aneurysm at size of >7mm and at top of basilar aery and at origin of posterior communicating aery are at greater risk of rupture . Ref Harrison20th edition pg 2445", "cop": 3, "opa": "Posterior Inferior Cerebellar Aery Aneurysm", "opb": "Anterior Communicating Aery Aneurysm", "opc": "Posterior Communicating Aery Aneurysm", "opd": "Basilar Aery Tip Aneurysm", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "0fe69853-983a-4e6b-931d-d552f7777928", "choice_type": "single"}
+{"question": "Drug of choice for resistant macrophage activation syndrome", "exp": "Macrophage activation syndrome (MAS) is a life-threatening complication of rheumatic diseases, requiring immediate and appropriate treatment. MAS is a disorder related to hemophagocytic lymphohistiocytosis (HLH), which is divided into primary and secondary HLH. The most common autoimmune diseases associated with MAS are systemic juvenile idiopathic ahritis (SJIA), followed by systemic lupus erythematosus (SLE), Kawasaki disease (KD), and juvenile dermatomyositis (JDM). The symptoms of MAS are quite similar to those of many active autoimmune diseases or severe sepsis; therefore, it is quite difficult to make a diagnosis. MAS is still underrecognized, and its treatment is usually delayed, which then leads to high morbidity and moality. The classical signs and symptoms of patients with MAS are a persistent high-grade fever, hepatosplenomegaly, lymph-adenopathy, and hemorrhagic manifestations. The mainstay of MAS treatment is glucocoicoid therapy. Most of the physicians sta with an intravenous methylprednisolone 30 mg/kg/dose (maximum 1 g) for 1-3 days. If the patients respond well to the high dose of methylprednisolone, this is decreased to 2-3 mg/kg/day in a divided dose. If the clinical status of the patients is stable, the physicians change the dosage to oral prednisolone, thus, preparing for a discharge, as well. For the nonresponders, an additional therapy with cyclosporin A 2-7 mg/kg/day is recommended.", "cop": 3, "opa": "Tacrolimus", "opb": "Methylprednisolone", "opc": "Cyclosporine", "opd": "Tocilizumab", "subject_name": "Medicine", "topic_name": "JIPMER 2019", "id": "050ead81-1a4b-45a0-9fed-41d342068996", "choice_type": "single"}
+{"question": "Pinpoint pupils are seen in haemorrhage of", "exp": "In pontine haemorrhages, deep coma with quadriplegia often occurs over a few minutes. Typically, there is prominent decerebrate rigidity and \"pinpoint\" (1 mm) pupils that react to light. There is impairment of reflex horizontal eye movements evoked by head turning (doll's-head or oculocephalic maneuver) or by irrigation of the ears with ice waterHyperpnea, severe hypeension and hyperhidrosis are commonRef: Harrison 19e pg: 2583", "cop": 2, "opa": "Putamen", "opb": "Pons", "opc": "Thalamus", "opd": "Cerebellum", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "aafc7226-1cdf-4fb3-a281-5da39e58b1f4", "choice_type": "single"}
+{"question": "Treatment of 42 year old obese man with blood glucose 450 mg, urine albumin 2+sugar 4+ketone 1+ is", "exp": "Answer is A (Insulin): Presence of sugar and ketones in urine and the presence of hyperglycemia (400 mg Glucose) suggests a diagnosis of Diabetic ketoacidosis. The treatment of choice in Diabetic ketoacidosis is Insulin.", "cop": 1, "opa": "Insulin", "opb": "Glibenclamide", "opc": "Glipizide", "opd": "Metformin", "subject_name": "Medicine", "topic_name": null, "id": "4ef46dc7-4fb7-4b86-8ffb-3b1cd2bf7c7b", "choice_type": "single"}
+{"question": "Galactorrhoea due to ectopic prolactin is seen in a) Malignant thymoma b) Bronchogenic carcinoma c) Medullary carcinoma thyroid d) Hypemephroma", "exp": null, "cop": 2, "opa": "abc", "opb": "bd", "opc": "bcd", "opd": "cd", "subject_name": "Medicine", "topic_name": null, "id": "03466028-c851-4195-9180-af8923114028", "choice_type": "single"}
+{"question": "Normal asymptomatic case of myocardial infarction previously treated with antiplatelet and thrombolytic therapy. Secondary prophylaxis for this patients with", "exp": "(Beta- blockers) (324- CMDT-08) (1543-H17th)Secondary prevention of MI* b -blockers improve survival rates, primarily by reducing the incidence of sudden death in high -risk subjects of patients through their value may be less in patients without complications with small infection and normal exercise tests* b -blockade should be avoided in patients with decompensated heart failure, decompensated asthma or high degrees of AV block* Antiplatelet agent - aspirin and clopidogrel are recommended", "cop": 1, "opa": "Beta - blockers", "opb": "Calcium channel blockers", "opc": "Nitrates", "opd": "Aldosterone antagonists", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "36a7812c-ad80-41ec-88fb-75df4b4b527e", "choice_type": "single"}
+{"question": "Drug induced lupus can be identified by", "exp": "Ref Harrison's internal medicine 20e p2517", "cop": 1, "opa": "Anti-histone antibodies", "opb": "Double stranded DNA antibodies", "opc": "Antinuclear antibodies", "opd": "Anti-SM antibodies", "subject_name": "Medicine", "topic_name": "Immune system", "id": "44c675b9-8ba2-40dc-a4fb-af8c2554e866", "choice_type": "single"}
+{"question": "Most common test for HIV is", "exp": "Ans:- a (ELISA) Ref: Harrison 17/edp.I165Most common test for HIV is definitely ELISAAntibodies to HIV usually appear within 6 weeks and almost invariably within 12weeks of primary infection.This antibody detection forms the basis of most diagnostic screening tests for HIV infection such as ELISA and Western blot.Before 6weeks, diagnosis depends on direct detection of HIV by p24 antigen Capture assay.HIVClinical features1. Primary infectionIt is symptomatic in 70-80% of cases and usually occurs 2-4 weeks after exposure. The major clinical manifestations of primary infection are fever. The appearance of specific anti HIV antibodies in serum (Serocinversion) takes place at 3-12 weeks (median 8 weeks)Any HIV infected individual with CD4 T cell count less than 200/cu.mm has AIDS by definition.2. Asymptomatic infectionAsymptomatic infection is a period during which the individual remains well with no evidence of disease except for the possible presence of persistent generalized lymphadenopathy.3. Mildly symptomatic disease.It indicates some impairment of the cellular immune system. These diseases corresponds to AIDS related complex conditions, but by definition are not AIDS defining.Acquired Immunodeficiency SyndromeIt is defined by the development of specified opportunistic infections tumors etc. e.g, esophageal candidiasis, cryptococcal meningitis.Correlation between CD 4 count and HIV associated diseases are given below.>500cells/cu.mm1. Acute primary infection2. Progressive generalized lymphadenopathy3. Recurrent vaginal candidiasis200-500cells/cumm1. Pulmonary tuberculosis2. Herpes zoster3. Oropharyngeal candidiasis4. Oral hairy leucoplakia5. Salmonellosis6. Kaposi's sarcoma7. HIV associated idiopathic thrombocytopenia8. Cervical intra epithelial neoplasia 1 and 29. Lymphoid interstitial pneumonitis<200cells/cu.mm1. Pneumocystis carinii pneumonia2. Mucocutaneous herpes simplex3. Cryptosporidium4. Microsporidium5. Esophageal candidiasis6. Miliary/extra pulmonary tuberculosis7. HIV associated wasting8. Peripheral neuropathy<100 cells/cu.mm1. Cerebral toxoplasmosis2. Cryptococcal meningitis3. Primary CNS lymphoma4. Non-Hodgkin's Lymphoma5. HIV-associated Dementia6. Progressive multi focal leukoencephalopathy.<50cells/cu.mm1. CMV Retinitis/gastro intestinal disease2. Disseminated Mycobacterium avium intacellulare", "cop": 1, "opa": "ELISA", "opb": "Western blot", "opc": "Northern blot", "opd": "Virus isolation", "subject_name": "Medicine", "topic_name": "Infection", "id": "a660eb7c-8b21-467e-af1d-46b98215c37a", "choice_type": "single"}
+{"question": "Clinical features of Erythema nodosum Leprosum a) Fever b) Hepatitis c) Joint pain d) Pancreatitis e) Skin eruptions", "exp": null, "cop": 1, "opa": "abc", "opb": "bcd", "opc": "cde", "opd": "bde", "subject_name": "Medicine", "topic_name": null, "id": "80efb90e-ad5b-49f8-af2b-ff859f0465a9", "choice_type": "single"}
+{"question": "Antibodies against acetylcholine receptors are seen in September 2009", "exp": "Ans. D: Myasthenia gravis Myasthenia gravis (MG) is a relatively rare autoimmune disorder of peripheral nerves in which antibodies form against acetylcholine (ACh) nicotinic postsynaptic receptors at the myoneural junction. A reduction in the number of ACh receptors results in a characteristic pattern of progressively reduced muscle strength with repeated use of the muscle and recovery of muscle strength following a period of rest. The bulbar muscles are affected most commonly and most severely, but most patients also develop some degree of fluctuating generalized weakness.", "cop": 4, "opa": "Lambe-Eaton-myasthenic syndrome", "opb": "Hypehyroidism", "opc": "Botulism", "opd": "Myasthenia gravis", "subject_name": "Medicine", "topic_name": null, "id": "954a4d81-c6a6-4f69-abab-89f05919cadb", "choice_type": "single"}
+{"question": "The following ECG with ST elevation on VI V2 is associated with the diagnosis of", "exp": "(A) Hyperkalemia # ST Elevation:> Most important cause of ST segment elevation is acute Ischemia.> Other causes are: Early repolarization Acute pericarditis: ST elevation in all leads except aVR Pulmonary embolism: ST elevation in V1 and aVR Hypothermia: ST elevation in V3-V6, II, III and aVF Hypertrophic cardiomyopathy: V3-V5 (sometimes V6) High potassium (hyperkalemia): V1-V2 (V3) During acute neurologic events: all leads, primarily V1-V6 Acute sympathetic stress: all leads, especially V1-V6 Brugada syndrome Cardiac aneurysm Cardiac contusion Left ventricular hypertrophy Idioventricular rhythm including paced rhythm", "cop": 1, "opa": "Hyperkalemia", "opb": "Hypokalemia", "opc": "Hyperthermia", "opd": "Hypercalcemia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "331f242a-cd2d-4010-8218-c62e3c33a630", "choice_type": "single"}
+{"question": "Acute hyponatremia becomes symptomatic at", "exp": "Severe symptoms (e.g., coma, seizures) typically occur when the sodium level falls below 120 mEq per L, but can occur at less than 125 mEq per L. Severe symptomatic hyponatremia must be corrected promptly because it can lead to cerebral edema, irreversible neurologic damage, respiratory arrest, brainstem herniation, Ref Davidson 23rd edition pg 350", "cop": 2, "opa": "<135 mEq", "opb": "<125 mEq", "opc": "<120 mEq", "opd": "<115 mEq", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "52afb2fa-3f59-4fb2-9116-39700817ce87", "choice_type": "single"}
+{"question": "Carey coomb murmur is seen in", "exp": "Answer is B (Acute Rheumatic carditis) Carey coombs murmur is delayed diastolic murmur seen in acute rheumatic carditis and is attributed to excessive left atrial blood flow due to mitral regurgitation. It is not seen in MR, AR or severe pulmonary Hypeension.", "cop": 2, "opa": "Severe mitral stenosis", "opb": "Acute rheumatic carditis", "opc": "Pure aoic regurgitation", "opd": "Severe pulmonary HT", "subject_name": "Medicine", "topic_name": null, "id": "493f2940-c9a4-4467-ab05-55ab50c9555f", "choice_type": "single"}
+{"question": "The commonest intrabronchial cause of haemopysis is", "exp": "Answer is A (Carcinoma lung): The two most common causes for hemoptysis are bronchitis and bronchogenic carcinoma. Bronchitis is not provided amongst the options and hence bronchogenic carcinoma is the single best answer of choice. Although the relative frequency of the different etiologies of hemoptysis varies from series to series, most recent studies indicate that bronchitis and bronchogenic carcinoma are the two most common causes (in the United States)'- Harrisons Facts to Remember The most common cause of Hemoptysis Bronchitis and Bronchogenic CAe (Bronchitis > Bronchogenic CA)Q The most common causes of Hemoptysis in India TuberculosisQ The most common cause of Massive Haemoptysis Bronchectasis (World wide)e Tuberculosis (India)Q", "cop": 1, "opa": "Carcinoma lung", "opb": "Adenoma lung", "opc": "Emphysema", "opd": "Bronchiectasis", "subject_name": "Medicine", "topic_name": null, "id": "e189520a-12e9-41ff-8496-59cb62b824aa", "choice_type": "single"}
+{"question": "Bronchiectasis sicca is seen with", "exp": "Bronchiectasis sicca is a dry bronchiectasis seen in tuberculosis Bronchiectasis sicca or dry bronchiectasis is a very rare condition in which there are all the features of bronchiectasis except for the absence of copious amount of sputum which is usually a hall mark of bronchiectasis Dry bronchiectasis is rare condition in which abnormal dilataion of trachea bronchial tree Ref Davidson 23rd edition pg 586", "cop": 1, "opa": "TB", "opb": "Peusis", "opc": "Cystic fibrosis", "opd": "Pneumonia", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "dc51a0cd-5bde-4103-978a-ab2a8b9e3309", "choice_type": "single"}
+{"question": "Most common symptom seen in pulmonary tuberculosis is", "exp": "(D) Chronic Cough # Constitutional symptoms associated with Pulmonary tuberculsosi include Chronic productive cough for atleast 2 or 3 weeks Low grade evening raise of temperature Loss of apetite Significant weight loss Night cries in bone and joint tuberculosis", "cop": 4, "opa": "Chest pain", "opb": "Breathlessness", "opc": "High temperature", "opd": "Chronic Cough", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "800b8fa4-83ba-412c-9c43-050f17da13cd", "choice_type": "single"}
+{"question": "Low QRS voltage on ECG with left ventricular hyperophy on Echocardiography suggests a diagnosis of", "exp": "Ans. is 'b' i.e., Cardiac Amyloidosis Low QRS voltage on ECG with left ventricular hyperophy on Echocardiography suggests a diagnosis of infiltrative cardiomyopathy like amyloidosis. Low QRS voltage along with thick left ventricle on echocardiogram suggests infiltrative cardiomyopathy such as amyloidosis or tumour. Causes of low voltage QRS complexes Adrenal insufficiency Anasarca Aifactual or spurious, eg, unrecognized standardization of ECG at one-half the usual gain (i.e., 5 mm/mv) Cardiac infiltration or replacement (e.g., amyloidosis, tumor) Cardiac transplantation, especially with acute or chronic rejection Cardiomyopathy, idiopathic or secondary Chronic obstructive pulmonary disease Constrictive pericarditis Hypothyroidism, usually with sinus bradycardia Left pneumothorax (mid-left chest leads) Myocardial infarction, extensive Myocarditis, acute or chronic Normal varian Obesity Pericardial effusion Pericardial tamponade, usually with sinus tachycardia Pleural effusions", "cop": 2, "opa": "Pericardial effusion", "opb": "Cardiac Amyloidosis", "opc": "Corpulmonale", "opd": "Infective endocarditis", "subject_name": "Medicine", "topic_name": null, "id": "d1ac348f-e41c-44ef-9d36-b53f552bfece", "choice_type": "single"}
+{"question": "Features of shock", "exp": "In early clinical septic shock, renal function was lower, which was accompanied by renal vasoconstriction, a lower renal oxygen delivery, impaired renal oxygenation, and tubular sodium reabsorption at a high oxygen cost compared with controls decrease or decline in the GFR implies progression of underlying kidney disease or the occurrence of a superimposed insult to the kidneys. This is most commonly due to problems such as dehydration and volume loss. An improvement in the GFR may indicate that the kidneys are recovering some of their function Ref Davidson 23rd edition pg 460", "cop": 1, "opa": "Decreased GFR", "opb": "Increased renin", "opc": "Decreased rennin", "opd": "Decreased Coisol", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "596565b9-1e3c-4555-83d6-1fac5f979d26", "choice_type": "single"}
+{"question": "Best and most successful treatment of bronchial asthma is", "exp": "(A) Avoidance of antigen # Elimination of the causative agent(s) from the environment of an allergic individual with asthma is the most successful means available for treating this condition (for details on avoidance, Desensitization or immunotherapy with extracts of the suspected allergens has enjoyed widespread favor, but controlled studies are limited and have not proved to be highly effectiv.", "cop": 1, "opa": "Avoidance of antigen", "opb": "Bronchodilators", "opc": "Corticosteroids", "opd": "Anticholinergics", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "3787dcd3-2aa6-413f-92e2-bfc2e638178e", "choice_type": "single"}
+{"question": "Massive bleeding per rectum in a 70years patient is seen most commonly in", "exp": "Hemorrhage from a colonic diveiculum is the most common cause of hematochezia in patients >60 years, yet only 20% of patients with diveiculosis will have gastrointestinal bleeding. Patients at increased risk for bleeding tend to be hypeensive, have atherosclerosis, and regularly use aspirin and nonsteroidal anti-inflammatory agents. Most bleeds are self-limited and stop spontaneously with bowel rest. The lifetime risk of rebleeding is 25%.Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 353; Diveicular Disease and Common Anorectal Disorder", "cop": 3, "opa": "Carcinoma", "opb": "Colitis", "opc": "Diveiculosis", "opd": "Polyps", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "e6dd6e5b-2ef8-417a-9e0e-f49b0a5055ec", "choice_type": "single"}
+{"question": "Antidote of paracetamol is", "exp": "N-acetylcysteine is the antidote of paracetamolParacetamol is extensively metabolized in the liver to form principally the sulfate and glucuronide conjugates which are excreted in the urine. A small fraction of an ingested dose is metabolized in the liver by isozyme CYP2E1 of the cytochrome P-450 mixed function oxidase enzyme system to form a reactive, potentially toxic, intermediate metabolite. The toxic metabolite preferentially conjugates with hepatic glutathione to form nontoxic cysteine and mercapturic acid derivatives, which are then excreted by the kidney.However, following ingestion of a large overdose, the glucuronide and sulfate conjugation pathways are saturated resulting in a larger fraction of the drug being metabolized the cytochrome P-450 pathway and therefore, the amount of acetaminophen metabolized to the reactive intermediate increases. The increased formation of the reactive metabolite may deplete the hepatic stores of glutathione with subsequent binding of the metabolite to protein molecules within the hepatocyte resulting in cellular necrosis.N-acetylcysteine replenishes the glutathione stores of liver and prevents binding of the toxic metabolite to other cellular constituents(ref: Goodman Gilman 11/e p694)", "cop": 1, "opa": "N-acetylcysterine", "opb": "Methylene blue", "opc": "EDTA", "opd": "No effective antidote known", "subject_name": "Medicine", "topic_name": "All India exam", "id": "e3195208-728c-4411-bd8d-93cf0dc3f870", "choice_type": "single"}
+{"question": "Most specific test for SLE", "exp": "Ans.(c) Anti- smith antibodyTest Description* ANA Screening test has sensitivity 95% not diagnostic without clinical features* Anti-dsDNA Antibody: High specificity, sensitivity only 70% and levels are variable based on disease activity* Anti-Sm antibody: Most specific antibody for SLE* AntiSSA (Ro) or Anti-SSB (La) Present in 15% of patients with SLE and other connective tissue disease such as Sjogren syndrome* Lupus anticoagulant* Direct Russell viper venom test to screen for inhibitors in the clotting cascade in antiphospholipid antibody syndrome* Direct Coombs test* Anti-histone : Drug-induced lupus (e.g with procainamide or hydralazine)", "cop": 3, "opa": "ss DNA", "opb": "ds- DNA", "opc": "Anti- smith antibody", "opd": "Histone", "subject_name": "Medicine", "topic_name": "SLE", "id": "1691a7c3-331c-4426-80e7-7df249bd3e18", "choice_type": "single"}
+{"question": "The most common inherited from of aplastic anaemia", "exp": "Answer- A. Fanconi anaemiaMost common inherited congenital anemia is Fanconis anemia.", "cop": 1, "opa": "Fanconi anaemia", "opb": "Schwachman-Diamond syndrome", "opc": "Diamond-Blackfan anaemia", "opd": "Dyskeratosis Congenita", "subject_name": "Medicine", "topic_name": null, "id": "2973fd7c-1152-41cd-ae1e-1600465b47e1", "choice_type": "single"}
+{"question": "Most common parotid gland tumour is", "exp": "(A) Pleomorphic adenoma # Parotid tumours> Most common is pleomorphic adenoma (80-90%)> Low-grade malignant tumours cannot be distinguished from benign neoplasms> High-grade tumours grow rapidly are usually painful and often have lymph node involvement of presentation> CT and MRI are useful> Fine-needle aspiration is better than open biopsy> Tumours should be excised, not enucleated", "cop": 1, "opa": "Pleomorphic adenoma", "opb": "Monomorphic adenoma", "opc": "Primary lymphoma", "opd": "Adeno carcinoma", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "fcbde8da-3e01-49e3-b983-5862c83e5300", "choice_type": "single"}
+{"question": "In severe liver failure, Anaesthetic of choice is", "exp": "(Isoflurane) (134-Lee's 13th) (373 - KDT 6th)ISOFLURANE - Repeated iso flurane administration have failed to produce measurable changes in liver function Renal and hepatic toxicity has not been encountered.* Anaesthetic choice in - Neurosurgery and safer in myocardial ischaemiaSEVOFLURANE - anaesthetic choice in Liver / Kidney diseases* It may trigger malignant hyperpyrexia in susceptible individuals* Well tolerated in both children and adults* Muscle relaxant of choice in hepatic & renal failure - cisatracurium**", "cop": 2, "opa": "Halothane", "opb": "Isoflurane", "opc": "Methoxyflurane", "opd": "Enflurane", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "4e40f291-00bb-4187-a8e6-28ae29bfc6fb", "choice_type": "single"}
+{"question": "Investigation of choice for diagnosis of bronchiectasis", "exp": "HRCT is investigation of choice for diagnosis of bronchiectasis. High Resolution Computed tomography (HRCT) HRCT uses very thin 1-2 mm thin slices Q .\nHRCT is used primarily to diagnose: Bronchiectasis Q Interstitial lung disease Q (Fibrosing alveolitis, asbestosis) Bronchiectasis Abnormal and permanent dilatation of bronchi Q .\nThe bronchial dilatation of bronchiectasis of is associated with destructive and inflammatory changes in the walls of medium sized airways,\noften at the level of segmental or subsegmental bronchi.", "cop": 2, "opa": "Bronchoscopy with bronchoalveolar lavage", "opb": "HRCT", "opc": "Chest X-ray", "opd": "MRI", "subject_name": "Medicine", "topic_name": null, "id": "be3e032b-2e90-4983-8e06-5538d0f1aad1", "choice_type": "single"}
+{"question": "Ibalizumab was approved by FDA in 2018 April for", "exp": "Ibalizumab was approved for HIV in 2018 Ibalizumab belongs to a new class of HIV drugs called post-attachment inhibitors. Post-attachment inhibitors work by attaching to the CD4 receptor on the surface of the immune cells. When ibalizumab attaches to the CD4 receptor, HIV cannot attach to, enter, or infect the cell. Ref - Harrisons 203 pg 1457 , pubmed.com", "cop": 1, "opa": "HIV", "opb": "TB", "opc": "Leprosy", "opd": "Malaria", "subject_name": "Medicine", "topic_name": "Infection", "id": "61001997-aa61-4b8f-98a4-7c4e751f6378", "choice_type": "single"}
+{"question": "Petechiae in scurvy is due to", "exp": "Vitamin C deficiency causes defective formation of collagen with impaired healing of wounds, capillary haemorrhage and reduced platelet adhesiveness (normal platelets are rich in ascorbate) . Petechiae are formed due to minor bleeds from capillary vessels due to endothelial disintegration . Ref - Davidson 23e p716", "cop": 4, "opa": "Platelet dysfunction", "opb": "Thrombocytopenia", "opc": "Clotting factor deficiency", "opd": "Endothelial disintegration", "subject_name": "Medicine", "topic_name": "Nutrition", "id": "4e504059-149d-497f-95d1-8aab5009ec39", "choice_type": "single"}
+{"question": "Adenocarcinoma of esophagus is commonly found in", "exp": "Answer is B (Barret's esophagus) Adenocarcinoma is seen in Barret's esophagus Barret's esophagus is a metaplastic change in the lining mucosa of oesophagus in response to chronic gastroesophagus reflex. In Barret's esophagus the junction between oesophageal mucosa (squammous) and gastric mucosa (columnar) moves proximally such that the lower pa of esophagus now becomes lined with different types of gastric mucosa. This pa of oesophagus has an increased risk for adenocarcinoma i.e. Adenocarcinoma is seen in Barrets esophagus.", "cop": 2, "opa": "Achlasia acardia", "opb": "Barret's oesophagus", "opc": "Plummer vinson syndrome", "opd": "Chronic smoking", "subject_name": "Medicine", "topic_name": null, "id": "4874143c-4fc8-4543-a57c-a214945d9f19", "choice_type": "single"}
+{"question": "A patient has prottitetic valve replacement and he develops endocarditis 8 months later. Organism responsible Is", "exp": "Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:161 Infective Endocarditis (IE) It is the colonisation of the hea valves with microbiologic organisms, leading to the formation of friable, infected vegetations and frequently valve injury. Types 1. Acute infective endocarditis: Caused by highly virulent organisms mainly S. aureus (20-30%), seeding a previously normal valve. 2. Subacute infective endocarditis: Caused by organisms of moderate or low virulence mainly Streptococci (60-70%), seeding an abnormal or previously injured valve. 3. Endocarditis occurring in IV drug abusers: Caused predominantly by organisms found on the skin (S. aureus, Candida) and affecting the valves on the right side of the hea. 4. Prosthetic valve endocarditis: This may be early (symptoms appearing within 60 days of valve inseion), due to intraoperative infection of the valve or inseion of an infected valve or late (symptoms appearing after 60 days of valve inseion), due to late bacteraemia or earlier infection with microorganisms having a long incubation period. Prosthetic aoic valve is more prone for infective endocarditis than the mitral valve. Right sided IE has a more ourable prognosis than the left sided IE. However, when right sided IE vegetation size exceeds 2 cm, the moality increases.", "cop": 3, "opa": "Stahylococcus aureus", "opb": "Streptococcus viridans", "opc": "Staphylococcus epidermidis", "opd": "HACEK", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "ec47bfd1-0864-49f2-ad1a-bd6c92918979", "choice_type": "single"}
+{"question": "Dawson's fingers are seen in", "exp": "Answer- A. Multiple sclerosisDawson's fingers on MRI scans are diagnostic of Multiple Scerlosis", "cop": 1, "opa": "Multiple sclerosis", "opb": "Multiple myeloma", "opc": "Freidreich's ataxia", "opd": "SACD", "subject_name": "Medicine", "topic_name": null, "id": "50f113e9-68e8-4945-ab23-89b6e8f92a0e", "choice_type": "single"}
+{"question": "A year old degbest 'nate presents with fullness of Alt upper quad, a of abdomen. Her medical histoi ant tor type 2 diabetes mellitus f /1", "exp": "Ans. a. Non-alcoholic steatohepatitis", "cop": 1, "opa": "Non-alcoholic steatohepatitis", "opb": "Peliosis hepatis", "opc": "Autoimmune hepatitis", "opd": "Primary biliary sclerosis", "subject_name": "Medicine", "topic_name": null, "id": "6638124b-fd5e-43f7-9712-42ec0de4954e", "choice_type": "single"}
+{"question": "Hydrogen breath test is/ae used for", "exp": "Davidson&;s principles and practice of medicine 22nd edition. *The lactose hydrogen breath test is an useful non invasive confirmatory investigation.
", "cop": 1, "opa": "Lactose intolerance", "opb": "GERD", "opc": "H.Pylori", "opd": "Irritable bowel syndrome", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "311660a0-eb32-458b-bf2d-4535e0b83e69", "choice_type": "single"}
+{"question": "Antibody found in patients of myaesthenia gravis is directed against", "exp": "*myasthenia gravis is an autoimmune disease,most commonly caused by antibodies to acetylcholine receptors in the post junctional membrane of the neuromuscular junction ,which are found in around 80%of affected patients. Ref Harrison20th edition pg 2378", "cop": 2, "opa": "Acetycholine", "opb": "Acetycholine receptors", "opc": "Acetycholine vesicles in nerve terminal", "opd": "Actin-myosin complex of the muscle", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "1f4a594c-c7ca-4253-b07c-fd3e5e94c2f6", "choice_type": "single"}
+{"question": "Hyponatremia is seen in", "exp": "Hypothyroidism is one of the causes of hyponatremia, thus thyroid-stimulating hormone determination is mandatory during the evaluation of patients with reduced serum sodium levels. .Patients with moderate to severe hypothyroidism and mainly patients with myxedema may exhibit reduced sodium levels (<135 mmol/L) Ref Davidson 23rd edition pg 370", "cop": 2, "opa": "Hypehyroidism", "opb": "Hypothyroidism", "opc": "DM", "opd": "Increased insensible loss", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "c28cef40-7c75-4833-a31b-884e22264746", "choice_type": "single"}
+{"question": "Daily temperature variation in remmitent fever is", "exp": null, "cop": 1, "opa": "< 0.5 C", "opb": ">1.0 C", "opc": "<1.0 C", "opd": ">2 C", "subject_name": "Medicine", "topic_name": null, "id": "aab3ace9-5d6f-4f11-ae76-3bc9d8d2669b", "choice_type": "single"}
+{"question": "Type 5 Hypersensitivity mimics", "exp": "Ans. is 'b' i.e., Type 2 Type V hypersensitivity reactions were additionally added to the scheme originally described by Coombs and Gell. Contrary to type IV and in agreement with types I, 11 and III respectively, they are mediated by antibodies too. The type V reactions are sometimes considered as a subtype of the type II hypersensitivity. As its mechanisms do not destroy target cells, they are responsible for induction of organ/tissue dysfunctions only most of authors prefer it to be and independent, the 5' type of hypersensitivity reactions", "cop": 2, "opa": "Type 1", "opb": "Type 2", "opc": "Type 3", "opd": "Type 4", "subject_name": "Medicine", "topic_name": null, "id": "d65a535a-ce15-4d95-9667-4eb6b2bf8d18", "choice_type": "single"}
+{"question": "Epidemiological studies of H. pylori are done by using", "exp": "Answer is B (Serological markers) An enzyme linked immuno-sorhant assay (ELISA) is the most commonly used serological method. `Compared with endoscopic detection of H.Pyloric infection, ELISA has proved to be sensitive and specific and is paicularly suited for Epidemiological studies'. Diagnostic Tests for Helicobacter pylori Test Sensitivity Comments Serology 95 Does not differentiate between active and remote infection; epidemi()Imjc too i ; titer decreases slowly after eradication Urease assay Breath Biopsy 90-95 90-98 Simple ; may be used to monitor therapy Requires endoscopy Histology Requires endoscopy; may be essential if antibiotic resistance emerges Culture 70-95 Requires endoscopy; may be essential if antibiotic resistance emerges", "cop": 2, "opa": "Urea-breath test", "opb": "Serological markers", "opc": "Culture", "opd": "Gastric-biopsy urease test", "subject_name": "Medicine", "topic_name": null, "id": "70d8e3ad-5057-4307-8b12-0b4405c91e5e", "choice_type": "single"}
+{"question": "A patient presented with fever for 8 days and difficulty in breathing for two days, on examination there is red painless rash found on the left side of the chest. Treatment will be", "exp": "(c) DoxycyclineRef: Harrison 18th ed.,pg. 14081,1413The presence of rash over the chest is typically an eschar, which is black necrotic, painless. Usually it is present in axilla, groin region.INFECTIOUS AGENTSRickettsial infections are caused by various bacterial species from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma. Rickettsia spp. are classically divided into the typhus group and spotted fever group (SFG). Orientia spp, make up the scrub typhus group. The rickettsial pathogens most likely to be encountered during travel outside the United States include R. africae (African tick- bite fever), R. conorii (Mediterranean spotted fever), R. rickettsii (known as both Rocky Mountain spotted fever and Brazilian spotted fever), O. tsutsugamushi (scrub typhus), and R. typhi (murine or fleaborne typhus).TRANSMISSIONMost rickettsial pathogens are transmitted by ectoparasites such as fleas, lice, mites, and ticks. Organisms can be transmitted by bites from these ectoparasites or by inoculating infectious fluids or feces from the ectoparasites into the skin. Inhaling or inoculating conjunctiva with infectious material may also cause infection for some of these organisms. Transmission of some rickettsial diseases after transfusion or organ transplantation is rare but has been reported.EPEDIMIOLOGYEhrlichia, Neorickettsia, Neoehrlichia, and Anaplasma are not seen in Indian subcontinent.Rickettsial infections have been reported in India for several decades. During the World War II era, there were many deaths due to scrub typhus in this region. It was thought that these infections declined over time; however, several reports in the past decade indicate the presence of disease in various parts of India, such as the Himalayan region, the northeast, and the south.TREATMENTThe drug most commonly used is doxycycline or tetracycline, but Azithromycin or chloramphenicol is an alternative. As Rickettsial spp. Lack specific cell wall, so beta lactams and cephalosporins are not indicated in management of Rickettsial diseases.", "cop": 3, "opa": "Oseltamivir", "opb": "Streptomycin", "opc": "Doxycycline", "opd": "Ceftriaxone", "subject_name": "Medicine", "topic_name": "Infection", "id": "c86b6dbf-71c9-4fc8-9b1e-8fe9445b5307", "choice_type": "single"}
+{"question": "Use of spironolactone in liver cirrhosis is", "exp": "Spironolactone(aldosterone antagonist) - potassium sparing diuretic is staed as a Single dose of 100-200mg/day,in cirrhotic patients who have peripheral edema . In moderate ascites, Spironolactone is given along with furosemide . Side effects -gynecomastia is an impoant side effect ,amiloride can be alternatively used in place of Spironolactone. Ref:Harrison 20 th edition pg no 2412", "cop": 1, "opa": "Decrease edema", "opb": "Improves liver function", "opc": "Decrease afterload", "opd": "Decrease intravascular volume", "subject_name": "Medicine", "topic_name": "Kidney", "id": "ac779fc0-2a36-450a-a260-85509f90205c", "choice_type": "single"}
+{"question": "Diagnostic test for group A streptococcal erythroderma is", "exp": "GAS grow readily on routine media, but they can be isolated more easily using selective media that inhibit the growth of normal pharyngeal flora. Most laboratories inoculate throat swabs on 5% sheep blood agar containing trimethoprim-sulfamethoxazole. A bacitracin disk that contains 0.04U of bacitracin is also placed at the initial inoculation of the swab. After overnight incubation at a temperature of 35-37degC, beta-hemolytic colonies that grow despite inhibition of the antibiotic disk are presumed to be composed of GAS. Cultures that are negative for GAS after 24 hours are held for another overnight incubation and reexamined. Ref - Harrison's principles of internal medicine 20e , medscape.com", "cop": 4, "opa": "Bile solubility test", "opb": "Catalase test", "opc": "Optochin sensitivity", "opd": "Bacitracin sensitivity", "subject_name": "Medicine", "topic_name": "Infection", "id": "b324b0bd-c250-457f-925a-28a470a46062", "choice_type": "single"}
+{"question": "Sarcodiosis can be associated with", "exp": "Causes of Central Diabetes insipidus Ref - pubmed.com", "cop": 1, "opa": "Cranial diabetes insipidus", "opb": "Psychogenic polydypsia", "opc": "Nephrogenic diabetes insipidus", "opd": "SAIDH", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "6e626164-62f3-4515-9a72-186325119563", "choice_type": "single"}
+{"question": "MELD score includes", "exp": "Model For End-Stage Liver Disease (MELD) for Ages 12 and Older * The Model for End Stage Liver Disease (MELD) predicts survival for patients with advanced liver disease. * The United Network for Organ Sharing (UNOS) made a policy change regarding a revision in the MELD scoring system on January 11, 2016 that is related to transplant listing. * The new MELD scores are calculated first by determining the traditional MELD score as an initial score (MELD(i)); * If the initial MELD(i) scores is 12 or greater, the score is adjusted by incorporating the serum sodium value. * Score: 6 in healthy person to 40 in severe ESLD * Score <15 should not undergo liver transplantation 3- Month Moality based on MELD scores :-", "cop": 4, "opa": "Alkaline phosphatase", "opb": "Albumin", "opc": "Transaminase", "opd": "Serum creatinine", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "13c06ff5-63b7-4a74-a1e5-521573bc4447", "choice_type": "single"}
+{"question": "Distinguishing cervical transverse myelitis with spinal shock from Guillian Barre syndrome is that in the", "exp": "(A) Sharp level of demarcation of sensory and motor symptoms existb> Well defined transverse level on trunk - below which there is sensory and motor loss is a feature of spinal cord lesion.> Transverse myelitis is sometimes manifested as rapid-onset, severe paraparesis or quadriparesis with areflexia, which may lead to diagnostic con-fusion with other causes of ascending weakness,such as the Guillain-Barre syndrome; otherwise, hyperreflexia and Babinski signs are present, con-firming a central rather than a peripheral cause of the muscle weakness. A well-defined truncal sensory level, below which the sensation of pain and temperature is altered or lost, distinguishes myelopathy from cerebral lesions and peripheral neuropathies.> Neuropathic pain may occur in the midline (an aching, deep pain) or in a dermatomal distribution (radicular or lancinating pain or a sensation of burning or itching), with the latter pattern providing a clue to the anatomical level of the lesion.", "cop": 1, "opa": "Sharp level of demarcation of sensory and motor symptoms exist.", "opb": "Hypotonia", "opc": "Decreased stretch and superficial reflexes", "opd": "Absent Neuropathic pain", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "6210b3bc-efbc-432b-b634-d6d27ad24b18", "choice_type": "single"}
+{"question": "For the following cardiac abnormalities, select the characteristic JVP finding.Complete heart block", "exp": "Large a waves occur with increased resistance to filling (tricuspid stenosis, pulmonary hypertension) or when the right atrium contracts against a tricuspid valve closed by right ventricular systole (Cannon a waves) in complete heart block or other arrhythmias.", "cop": 1, "opa": "Cannon a wave", "opb": "prominent x descent", "opc": "Kussmaul's sign", "opd": "slow y descent", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "36760ab9-3ce7-4a9d-ab79-f38f4f701b01", "choice_type": "single"}
+{"question": "Pan acinar emphysema is seen in", "exp": "Centriancinar - Smokers, chronic bronchitis.\nPan acinar - α1 - antitrypsin deficiency.", "cop": 3, "opa": "Smoking", "opb": "Chronic bronchitis", "opc": "α1 - antitrypsin deficiency", "opd": "Spontaneous pneumothorax", "subject_name": "Medicine", "topic_name": null, "id": "c2e0f099-ce09-4dad-bb44-be8e4a5e09d7", "choice_type": "single"}
+{"question": "Net protein utilization of egg is", "exp": null, "cop": 1, "opa": "96", "opb": "81", "opc": "79", "opd": "45 - 50", "subject_name": "Medicine", "topic_name": null, "id": "cdce7f5d-eec9-4de2-9bcd-4355f9a98af9", "choice_type": "single"}
+{"question": "Dominant cell type in grey hepatization stage of community acquired pneumonia is", "exp": "In the third phase grey hepatisation, no new erythrocytes are extravasating, and those already present have been lysed and degraded. \nThe neutrophil is the predominant cell, fibrin deposition is abundant, and bacteria have disappeared. This phase corresponds with successful containment of the infection and improvement in gas exchange.", "cop": 2, "opa": "Eosinophils", "opb": "Neutrophils", "opc": "Macrophages", "opd": "Monocytes", "subject_name": "Medicine", "topic_name": null, "id": "1458ec75-7090-4681-a33f-e353c835d448", "choice_type": "single"}
+{"question": "Causes of pulsus bisferiens", "exp": "Pulsus bisferiens(2 systolic peaks) is seen in\n\nAortic regurgitation +/aortic stenosis \nHypertrophic cardiomyopathy", "cop": 3, "opa": "LV failure", "opb": "Cardiac tamponade", "opc": "Hypertrophic cardiomyopathy", "opd": "Constrictive pericarditis", "subject_name": "Medicine", "topic_name": null, "id": "6548a2f6-20ab-4fa9-8d60-2150686b6e20", "choice_type": "single"}
+{"question": "Invariably involved site in ulcerative colitis;", "exp": "Most common site involved in ulcerative colitis is the rectum. Rectum is usually spared in Crohn's disease.", "cop": 4, "opa": "Sigmoid colon", "opb": "Transverse colon", "opc": "Ileum", "opd": "Rectum", "subject_name": "Medicine", "topic_name": "Inflammatory Bowel Disease", "id": "d8ebf915-6602-400f-889e-b02c06008994", "choice_type": "single"}
+{"question": "Paradoxical breathing is seen in", "exp": "Two of the symptoms of flail chest are chest pain and shoness of breath. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a pa of the chest wall moves independently. This so-called \"paradoxical breathing\" is painful and increases the work involved in breathing Ref Davidson 23rd edition pg 579", "cop": 4, "opa": "Pneumonia", "opb": "Pneumothorax", "opc": "Atelectasis", "opd": "Flial chest", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "91835f36-07e4-486b-85e8-4090ae44b025", "choice_type": "single"}
+{"question": "Carcinoid syndrome produces valvular disease primarily involving", "exp": null, "cop": 2, "opa": "Pulmonary valves", "opb": "Tricuspid valves", "opc": "Mitral valve", "opd": "Aortic valve", "subject_name": "Medicine", "topic_name": null, "id": "accde9f6-e858-4918-979b-b564437d3380", "choice_type": "single"}
+{"question": "The pulmonary function test done on this patient of asthma would be", "exp": "The patient is having atopic asthma.Pulmonary function tests in asthma show an obstructive pattern with reduced FEV1,FEV1/FVC ratio.Reversibility is demonstrated by a >12% and 200 ml increase in FEV1 15 minutes after an inhaled sho acting beta2 agonist or in some patients by a 2 to 4 week trial of oral coicosteroids. Ref:Harrison's medicine-18th edition,page no:2109.", "cop": 2, "opa": "Non-infarmative", "opb": "Obstructive pattern", "opc": "Restrictive pattern", "opd": "Destructive pattern", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "8f2472b9-84d1-4132-8d15-3aa051b8169a", "choice_type": "single"}
+{"question": "The following set of finding is seen in DIVC", "exp": "In disseminated intravascular coagulation (DIC), coagulation is usually activated when blood is exposed to tissue factor. Severe, rapid-onset DIC causes severe thrombocytopenia, prolonged PT and PTT, a rapidly declining plasma fibrinogen level, and a high plasma d-dimer level Fibrinogen degradation product (FDP) testing is commonly used to aid in the diagnosis of disseminated intravascular coagulation (DIC). Increases in serum FDP levels can be caused by the following : DIC. Post fibrinolytic therapy. Ref Davidson 23rd edition pg 876", "cop": 4, "opa": "Increased fibrinogen, increased antithrombin III increased thrombin-antithrombin III comolexes", "opb": "Increased FDP, decreased PT, increased antithrombin III", "opc": "hicreased FDP, prolonged PT, increased thrombin- antithrombin complexes", "opd": "Increased FDP, prolonged PT, reduced platlets", "subject_name": "Medicine", "topic_name": "Haematology", "id": "b6d2ff6c-ae57-453d-a46c-481be54ea957", "choice_type": "single"}
+{"question": "A failure of synthesis of ceruloplasmin is seen in", "exp": "Wilson's disease (hepatolenticular degeneration) is a rare but impoant autosomal recessive disorder of copper metabolism caused by a variety of mutations in the ATP7B gene on chromosome 13. Total body copper is increased, with excess copper deposited in, and causing damage to, several organs. Normally, dietary copper is absorbed from the stomach and proximal small intestine and is rapidly taken into the liver, where it is stored and incorporated into caeruloplasmin, which is secreted into the blood. The accumulation of excessive copper in the body is ultimately prevented by its excretion, the most impoant route being bile. In Wilson's disease, there is almost always a failure of synthesis of caeruloplasmin; however, some 5% of patients have a normal circulating caeruloplasmin concentration and this is not the primary pathogenic defect. The amount of copper in the body at bih is normal but thereafter it increases steadily; the organs most affected are the liver, basal ganglia of the brain, eyes, kidneys and skeleton . Ref - Davidsns internal medicine 23e p896", "cop": 3, "opa": "Hemochromatosis", "opb": "Weil's disease", "opc": "Wilson's disease", "opd": "Wernicke's encephalopathy", "subject_name": "Medicine", "topic_name": "Immune system", "id": "9adac9d5-8258-4496-9133-0eec11aa43e7", "choice_type": "single"}
+{"question": "Treatment of Torsades de pointes is intravenous", "exp": null, "cop": 1, "opa": "magnesium", "opb": "sodium bicarbonate", "opc": "Saline", "opd": "Glucose", "subject_name": "Medicine", "topic_name": null, "id": "c89c2371-41d7-4741-9fc9-b34e5db13216", "choice_type": "single"}
+{"question": "Keshan disease is due to deficiency of", "exp": "(A) Selenium # Keshan disease is an endemic cardiomyopathy found in children and young women residing in regions of China where dietary intake of selenium is low (<20 pg/dl).Concomitant deficiencies of iodine and selenium may worsen the clinicalnr attestations of cretinism.> Keshan disease: is a congestive cardiomyopathy caused by a combination of dietary deficiency of selenium and the presence of a mutated strain of Coxsackievirus, named after Keshan County of Heilongjiang province, Northeast China, where symptoms were first noted.> Often fatal, the disease afflicts children and women of child bearing age, characterized by Heart failure and Pulmonary edema.> Over decades, Supplementation with selenium reduced this affliction.> It has previously been linked to the coxsackie B virus.> Current research suggests that the lack of selenium results in a more virulent strain of the coxsackievirus becoming the dominant viral species present in the population of virus, but the mechanism of this selection event is presently unclear", "cop": 1, "opa": "Selenium", "opb": "Chromium", "opc": "Copper", "opd": "Manganese", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "e64e8bc1-4202-431e-928c-d27fa720fa98", "choice_type": "single"}
+{"question": "Commonest etiological factor in acute exacerbations of COPD is", "exp": "Exacerbations are a prominent feature of the natural history of COPD. Exacerbations are episodes of increased dyspnea and cough and change in the amount and character of sputum.Studies suggest that acquiring a new strain of bacteria is associated with increased near-term risk of exacerbation and that bacterial infection/superinfection is involved in over 50% of exacerbations. Viral respiratory infections are present in approximately one-third of COPD exacerbations.In a significant minority of instances (20-35%), no specific precipitant can be identifiedRef: Harrison 19e pg: 1707", "cop": 2, "opa": "Viral infections", "opb": "Bacterial infections", "opc": "Paiculate air pollutants", "opd": "Idiopathic", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "70288ba0-16d4-4008-9d70-24e046448833", "choice_type": "single"}
+{"question": "Kyasanur Forest Disease (KFD) is transmitted by", "exp": "KFD is a tick-borne viral hemorrhagic fever endemic to South AsiaThe disease is caused by a virus belonging to family Flaviviridae, which also includes yellow fever and dengue feverThe vector for KFD is Haemophysalis spinigera, a forest tickHumans contract infection from the bite of nymphs of the tickReservoir hosts are porcupines, rats, squirrels, mice and shrewsRef: Harrison's 18/e p1236, table 189-4", "cop": 3, "opa": "Fleas", "opb": "Mosquitoes", "opc": "Ticks", "opd": "Mites", "subject_name": "Medicine", "topic_name": "All India exam", "id": "08d6cd19-c93f-407a-9d61-2fa8ff70d9f2", "choice_type": "single"}
+{"question": "A 36 year old male with Cavitatory Lung lesions, Sinusitis, Ulcers in the mouth. RBC casts in the urine can be seen. Diagnosis is", "exp": "Wegener's also called Granulomatosis with polyangitis.", "cop": 1, "opa": "Granulomatosis with polyganitis", "opb": "Eosinophilic with Polyangitis", "opc": "IgA Vasculitis", "opd": "Microscopic polyangitis", "subject_name": "Medicine", "topic_name": null, "id": "188e096a-5966-4d86-bc04-22eace12ce0d", "choice_type": "single"}
+{"question": "Following is a clinical feature of cerebellar disease", "exp": ". *Dysmetria and ataxia are the two impoant symptoms of cerebellar disease. Cerebellar ataxia can occur as a result of many diseases and may present with symptoms of an inability to coordinate balance, gait, extremity and eye movements.Lesions to the cerebellum can cause dyssynergia, dysmetria, dysdiadochokinesia, dysahria and ataxia of stance and gait. Deficits are observed with movements on the same side of the body as the lesion (ipsilateral). Clinicians often use visual observation of people performing motor tasks in order to look for signs of ataxia Ref Harrison20th edition pg 2756", "cop": 3, "opa": "Paralysis", "opb": "Sensory deficit", "opc": "Ataxia", "opd": "Resting tremors", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "7a10e05d-f20e-4a3f-8e3c-b6835c8e1b6b", "choice_type": "single"}
+{"question": "A sho statured boy with rhizomelic limbs and brachydactyly is a feature of", "exp": "Features of Achondroplasia Ref image - Researchgate.net", "cop": 1, "opa": "Achondroplasia", "opb": "Laron dwarfism", "opc": "Hypothyroidism", "opd": "Morquio disease", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "0d9ca034-0713-4406-aef4-e903d8e72d02", "choice_type": "single"}
+{"question": "Treatment of choice for Kawasaki Disease", "exp": "Answer is A (Immunoglobulins) : The treatment of choice for Kawasaki disease is intravenous immunoglobulins", "cop": 1, "opa": "Immunoglobulins", "opb": "Coicosteroids", "opc": "Azathioprine", "opd": "Methotrexate", "subject_name": "Medicine", "topic_name": null, "id": "6e1628d0-a0dc-467a-8f07-6e549ec5caa0", "choice_type": "single"}
+{"question": "The most common presentation of endemic goiter is", "exp": "Answer is B (Diffuse Goiter) : 'Euthyroid state is generally the rule' - Robbins Endemic goiter :occurs in geographical areas where the soil, water and food supply contains only low levels of iodine. The lack of the iodine leads to decreased synthesis of thyroid hormones and a compensatory increase in TSH, which in turn leads to follicular cell hyperophy and hyperplasia and goitrous enlargement - Diffuse hyperplastic goitre. 'Euthyroid state is generally the rule' 'Rare patients are hypehyroid'", "cop": 2, "opa": "Hypothyroid", "opb": "Diffuse goiter", "opc": "Hypehyroid", "opd": "Solitary nodule", "subject_name": "Medicine", "topic_name": null, "id": "f264d241-3dee-49e6-a68e-21f7a7c19add", "choice_type": "single"}
+{"question": "A dissociated sensory loss is seen in", "exp": "Impairment of pinprick and temperature appreciation but relative preservation of light touch, position sense and vibration senseA dissociated sensory loss can reflect spinothalamic tract involvement in the spinal cord, especially if the deficit is unilateral and has an upper level on the torsoBilateral spinothalamic tract involvement occurs with lesions affecting the center of the spinal cord, such as in syringomyeliaRef: Davidson's 21/e p1157", "cop": 1, "opa": "Syringomyelia", "opb": "Vitamin B12 deficiency", "opc": "Transverse myelitis", "opd": "Pellagra", "subject_name": "Medicine", "topic_name": "All India exam", "id": "8b48a1ac-b1f5-43e5-b1c7-8d2944f93598", "choice_type": "single"}
+{"question": "Senile plaques in brain is a feature of", "exp": null, "cop": 3, "opa": "Multiple sclerosis", "opb": "Parkinsonism", "opc": "Alzheimer's disease", "opd": "Wilson's disease", "subject_name": "Medicine", "topic_name": null, "id": "7abb0528-c707-4533-b84f-f25801c7eea1", "choice_type": "single"}
+{"question": "Pontine harmorrhage is characterized by", "exp": "(A) Pin point pupil reacting to light # Pontine hemorrhage (sudden onset, pinpoint pupils, loss of reflex eye movements and corneal responses, ocular bobbing, posturing, hyperventilation, and excessive sweating);", "cop": 1, "opa": "Pin point pupil reacting to light", "opb": "Hypothermia", "opc": "Hemisensory disturbances", "opd": "Hypotension", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "01be32c6-dc83-4c86-8576-848c0c2e3b8c", "choice_type": "single"}
+{"question": "Most common cause of idiopathic interstitial pneumonia is", "exp": "Idiopathic pulmonary fibrosis is the most common form of idiopathic interstitial pneumonia.It is characterised by exeional dyspnea,non productive cough,inspiratory crackles with or without digital clubbing.HRCT show patchy,predominantly basilar,subpleural reticular opacities,traction bronchiectasis and honeycombing.Pulmonary function tests often reveal a restrictive pattern. Reference:Harrison' s medicine-18th edition,page no:2165.", "cop": 3, "opa": "Sarcoidosis", "opb": "Organizing pneumonia", "opc": "Idiopathic pulmonary fibrosis", "opd": "Lipoid pneumonia", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "5dedc621-eddc-412e-b88b-dbe5103ba920", "choice_type": "single"}
+{"question": "A patient with congestive heart failure was started on digoxin and diuretics. He later presents with bradycardia and GIT upset and visual disturbances. His K+ was found to be 2.5 The reason for these feature is", "exp": "(B) Digoxin toxicity > Digitalis is effective in patients with systolic HF complicated by atrial flutter and fibrillation and a rapid ventricular rate, who benefit both from slowing of the ventricular rate and from the positive inotropic effect.> Although digitalis does not improve survival in patients with systolic HF and sinus rhythm, it reduces symptoms of HF and the need for hospitalization.> Digitalis is of little or no value in patients with HF, sinus rhythm, and the following conditions: hypertrophic cardiomyopathy, myocarditis, mitral stenosis, chronic constrictive pericarditis, and any form of diastolic HF.> Digoxin, which has a half-life of 1.6 days, is filtered n the glomeruli and secreted by the renal tubules. Significant reductions of the glomerular filtration rate reduce the elimination of digoxin and, therefore, may prolong digoxin's effect, allowing it to accumulate to toxic levels, unless the dose is reduced.> DIGITALIS INTOXICATION: This is a serious and potentially fatal complication. Advanced age, hypokalemia, hypomagnesemia, hypoxemia, renal insufficiency, hypercalcemia, and acute myocardial infarction all may reduce tolerance to digitalis. Chronic digitalis intoxication may be insidious in onset and is characterized by anorexia, nausea, and vomiting, exacerbations of HF, weight loss, cachexia, neuralgias, gynecomastia, yellow vision, and delirium. The most frequent disturbances of cardiac rhythm are ventricular premature beats, bigeminy, ventricular tachycardia, and, rarely, ventricular fibrillation. Atrioventricular block and nonparoxysmal atrial tachycardia with variable atrioventricular block are characteristic of digitalis intoxication; withdrawal of the drug and treatment with li-adrenocepior blocker or lidocaine are indicated. If hypokalemia is present, potassium should be administered cautiously by the oral route. Fab fragments of purified, intact digitalis antibodies are a potentially lifesaving approach to the treatment of severe intoxication.> The administration of quinidine, verapamil, amiodarone, and propafenone to patients receiving digoxin raises the serum concentration of the latter, increasing the propensity to digitalis intoxication.> The dose of digitalis should be reduced by half in patients receiving these drugs.", "cop": 2, "opa": "Left ventricular aneurysm", "opb": "Digoxin toxicity", "opc": "Viral gastroenteritis", "opd": "Hypokalemia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "8b4f3b5d-4219-403f-9dad-468e216885c2", "choice_type": "single"}
+{"question": "Mycobacterium causing lung infection are a) Mycobacterium Tuberculosis b) Mycobacterium Kansasii c) Mycobacterium Fortuitum d) Mycobacterium avium intracellularae e) Mycobacterium Scrofuloceuml", "exp": null, "cop": 1, "opa": "abd", "opb": "abc", "opc": "acd", "opd": "bcd", "subject_name": "Medicine", "topic_name": null, "id": "d28f9925-ea63-4563-ae60-a14c0f851f17", "choice_type": "single"}
+{"question": "Cause of nephrocalcinosis in granulomatous disorders", "exp": "Hypercalcemia occurs in most granulomatous disorders. High serum calcium levels are seen in about 10% of patients with sarcoidosis; hypercalciuria is about three times more frequent. Tuberculosis, fungal granulomas, berylliosis, and lymphomas are other conditions that are associated with disorders of calcium metabolism. These abnormalities of calcium metabolism are due to dysregulated production of 1,25-(OH2)D3 (calcitriol) by activated macrophages trapped in pulmonary alveoli and granulomatous inflammation. Undetected hypercalcemia and hypercalciuria can cause nephrocalcinosis, renal stones, and renal failure. Coicosteroids cause prompt reversal of the metabolic defect. Chloroquine, hydroxychloroquine, and ketoconazole are the drugs that should be used if the patient fails to respond or develops dangerous side effects to coicosteroid therapy. Ref - pubmed.com", "cop": 1, "opa": "Increased calcium in diet", "opb": "Dysregulated production of 1,25-(OH2)", "opc": "Dystrophic calcification", "opd": "Mutation in calcium sensing receptor", "subject_name": "Medicine", "topic_name": "Immune system", "id": "53f4ccf7-dae3-460a-b660-2a4a871193c0", "choice_type": "single"}
+{"question": "Egg is a poor source of", "exp": "Egg is a poor source of Vitamin C and carbohydrates.", "cop": 3, "opa": "Vitamin A", "opb": "Vitamin B12", "opc": "Vitamin C", "opd": "Vitamin E", "subject_name": "Medicine", "topic_name": null, "id": "39a13103-4809-494c-9252-e8af9bd4d8ea", "choice_type": "single"}
+{"question": "The typical CSF profile in cases of viral meningitis after 48 hours of onset is", "exp": "harrison's principles and practices of medicine 17th edition. * typical profile in viral meningitis is lymphocytic pleocytosis (25-500cells/microL),normal or slightly elevated protein concentration, normal glucose concentration,normal or mildly elevated opening pressure .", "cop": 1, "opa": "Lymphocytic pleocytosis, normal glucose level, normal or slightly elevated protein level", "opb": "Neutrophilic pleocytosis, raised glucose level normal protein level", "opc": "Lymphocytic pleocytosis, low glucose level, low protein level", "opd": "Neutrophilic pleocytosis, normal glucose level, elevated protein level -", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "be8d534e-2a24-4d17-ab48-c3c8a11040b2", "choice_type": "single"}
+{"question": "A patient has IDDM diagnosed at age of 15 years. The most reliable indicator for diabetic nephropathy is", "exp": "Answer is B (Urinary protein > 550 mg/day for 3 consecutive sample): The most reliable indicator for diabetic nephropathy is presence of ove proteinuria. Urinary protein > 550 mg/day in 3 consecutive samples confirms the diagnosis of ove proteinuria, reflects irreversible pathological changes in kidneys and confirms progression to end stage renal disease (diabetic nephropathy) This is evident from the following lines from Harrisons text: Once ove proteinuria is present there is steady state decline in G.F.R. and -50% of individuals reach end stage renal disease in 7-10 days. Once nephropathy becomes ove the pathological changes are irreversible. Stages of diabetic nephropathv: (IDDM) Year Stage Findings 0 I Raised GFR, increase in Renal size and plasma flow 2 II Thickening in glomerular capillary basement membrane 6-10 III Microalbuminuria 10-15 IV Ove proteinuria, Clinical nephropathy, changes become irreversible. 16-25 V End stage renal disease.", "cop": 2, "opa": "Urine albumin", "opb": "Urinary protein >550 mg per day for 3 consecutive samples", "opc": "Development of diabetic retinopathy", "opd": "Hematuria", "subject_name": "Medicine", "topic_name": null, "id": "bead13f7-0c43-4968-922a-4383736b7014", "choice_type": "single"}
+{"question": "Most common vessels involved in cutaneous vasculitis", "exp": "Cutaneous Vasculitis also called hypersensitivity vasculitis involves Post-Capillary Venules.", "cop": 4, "opa": "Arteries", "opb": "Arterioles", "opc": "Capillaries", "opd": "Post-Capillary venules", "subject_name": "Medicine", "topic_name": null, "id": "94ecfad0-b231-43bf-80a5-4046d085436e", "choice_type": "single"}
+{"question": "Saddle back fever can be seen in", "exp": "(B) Dengue fever # Saddle back or Biphasic fevers are those that are constant for several days, spontaneously reduce for 1 to 2 days, & then increase again. Saddle back fevers can be seen in such infections as Dengue, Yellow fever & Influenza. Dengue virus infection typically presents with two febrile periods separated by an afebrile interval of one to three days (saddle back fever).> Malaria fever: Fevers that occur at regular intervals of 42-78 hours are virtually pathognomonic otP.vivax, P.ovale, P.malariae infections.> Although untreated Typhoid fever classically presents with a continued fever associated with relative bradycardia, almost any fever pattern can develop.> Pel-Ebstein fever is one that occurs daily for a period of about one week, resolves for about an equal time, and then recurs, Pel-Ebstein fevers are often seen in Lymphomas. Intermittent fever is one with wide fluctuations, usually normal in the morning and peaking in the afternoon or evening. This fever pattern can be seen in many viral diseases as well as Endocarditis or Localized Pyogenic infections such as an Abscess. Diurnal pattern also known as Typhus inversus, is the reverse of normal circadian pattern in which the highest temperature is in the morning. It can be found in Milliary TB, Hepatic Abscesses & Endocarditis. Jarisch-Herxheimer reaction is a fever (and sometimes more systemic symptoms such as hypotension) that occurs several hours after treatment with antibiotics. It is a classic reaction for Syphilis, but can also be seen in Leptospirosis, Relapsing fever & Brucellosis.>Dengue fever: Break-bone fever; a virus (togavirus, flavivirus) disease conveyed by mosquito Aedes aegypti, & characterized by a 5 to 7 day pyrexia with a saddle-back course, a measly rash & severe pains in back & limbs. Exposure 7-10 days before onset. Sudden onset of high fever, chills, severe aching, headache, sore throat, prostration, & depression.> Biphasic fever curve: Initial phase 3-7 days; remission, few hours to 2 days; second phase, 1-2 days.> The rash is biphasic: First evanescent, followed by maculopapular, scarlatiniform, morbilliform, or petechial changes from extremities to torso. Leukopenia and thrombocytopenia in hemorrhagic form.", "cop": 2, "opa": "Brucellosis", "opb": "Dengue fever", "opc": "Malaria fever", "opd": "Typhoid fever", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "fd6aa385-9241-4a12-82a2-e9e6fa566df9", "choice_type": "single"}
+{"question": "Anticipation phenomenon is seen in", "exp": "Anticipation - Phenomenon wherein clinical features worsen with each successive generation.", "cop": 4, "opa": "Duchenne muscular dystrophy", "opb": "Emery - Dreifuss", "opc": "Fascio scapulo humeral", "opd": "Mytonic", "subject_name": "Medicine", "topic_name": null, "id": "c6761e31-48b4-4bb3-81b4-11514e8c998a", "choice_type": "single"}
+{"question": "Shock lung synonym is used for", "exp": "Ans. C. ARDSShock Lung/ARDS is a clinical syndrome caused by diffuse alveolar capillary and epithelial damage. There is usually rapid onset of life-threatening respiratory insufficiency, cyanosis, and severe arterial hypoxemia that is refractory to oxygen therapy and that may progress to multisystem organ failure. The histologic manifestation of ARDS in the lungs is known as diffuse alveolar damage.", "cop": 3, "opa": "COPD", "opb": "Alveolar proteinosis", "opc": "ARDS", "opd": "HMD", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "382dd98d-650d-40ee-82a2-bfa73949ce88", "choice_type": "single"}
+{"question": "Shy Dragor Syndrome is", "exp": "Shy Drager syndrome (SDS) is a rare condition that causes progressive damage to the autonomic nervous system.\nA neurological syndrome associated with orthostatic hypotension.\nThe autonomic nervous system controls vital involuntary body function such as heart rate, breathing, and intestinal, urinary, and sexual functions. The autonomic nervous system also controls skin body temperature, and how the body responds to stress. Shy-Drager syndrome leads to dizziness or fainting when standing up, urinary incontinence, impotence, and muscle twitches.", "cop": 2, "opa": "Vasovagal syncope", "opb": "Orthostatic hypotension", "opc": "Intestinal polyp", "opd": "Acute adrenergic shock", "subject_name": "Medicine", "topic_name": null, "id": "f377b980-c15f-4dae-ac02-7a60c7c2e7bd", "choice_type": "single"}
+{"question": "Upturned Moustache sign or Antler sign is seen in", "exp": "Mitral stenosis leads to increased left atrial and hence pulmonary venous pressures. The prominence of pulmonary veins on chest X-rays leads to Upturned Moustache sign or Antler sign.", "cop": 4, "opa": "Mitral regurgitation", "opb": "Aortic stenosis", "opc": "Aortic regurgitation", "opd": "Mitral stenosis", "subject_name": "Medicine", "topic_name": null, "id": "3ad352b2-0397-4e3d-9160-29dfa78847d3", "choice_type": "single"}
+{"question": "Milk maid grip is seen in", "exp": "Milk maid grip is seen in chorea.", "cop": 1, "opa": "Chorea", "opb": "Myoclonus", "opc": "Athetosis", "opd": "Cerebral palsy", "subject_name": "Medicine", "topic_name": null, "id": "27a3caf5-c7e6-4461-8b95-5721f61e3727", "choice_type": "single"}
+{"question": "Chronic diarrhea results in the following acid base imbalance", "exp": "(A) Normal anion gap metabolic acidosis # Causes of Non-Anion-Gap Acidosis# Gastrointestinal bicarbonate loss> Diarrhea> External pancreatic or small-bowel drainage> Ureterosigmoidostomy, jejunal loop, ileal loop> Drugs1 Calcium chloride (acidifying agent)2. Magnesium sulfate (diarrhea)3. Cholestyramine (bile acid diarrhea)> Hypokalemia1. Proximal RTA (type 2)2. Distal (classic) RTA (type 1)> Hyperkalemia# Generalized distal nephron dysfunction (type 4 RTA)> Mineralocorticoid deficiency> Mineralocorticoid resistance> Na+ delivery to distal nephron> Tubulointerstitial disease> Ammonium excretion defect# Drug-induced hyperkalemia (with renal insufficiency)> Potassium-sparing diuretics (amiloride, triamterene, spironolactone)> Trimethoprim> Pentamidine> Angiotensin-converting enzyme inhibitors and AT-II receptor blockers> Nonsteroidal anti- inflammatory drugs> Cyclosporine# Other> Acid loads (ammonium chloride, hyperalimentation)> Loss of potential bicarbonate: ketosis with ketone excretion> Expansion acidosis (rapid saline administration)> Cation exchange resins", "cop": 1, "opa": "Normal anion gap metabolic acidosis", "opb": "Metabolic alkalosis", "opc": "Increased anion gap metabolic acidosis", "opd": "Respiratory acidosis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "ca917f3c-0d59-4ac5-8426-ac9c9d0c95e5", "choice_type": "single"}
+{"question": "The microvascular complication of diabetes is", "exp": "Complications of diabetes", "cop": 3, "opa": "Peripheral neuropathy", "opb": "Coronary circulation", "opc": "Retinopathy", "opd": "Autonomic neuropathy", "subject_name": "Medicine", "topic_name": null, "id": "718f507b-ec24-4e5d-b804-0c49cd07e5d8", "choice_type": "single"}
+{"question": "Bronchial asthma is associated with raised levels of", "exp": "Acute asthma attacks are often triggered by allergens or exercise. Inflammatory molecules called leukotrienes are one of several substances which are released by mast cells during an asthma attack, and it is leukotrienes which are primarily responsible for the bronchoconstriction Ref Davidson edition23rd pg 575", "cop": 1, "opa": "Leukotrienes", "opb": "PGI2", "opc": "PGE2", "opd": "Thromboxane", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "b244e303-c9ee-4c9b-b147-5882eebc81e2", "choice_type": "single"}
+{"question": "Caplan Syndrome is Pneumoconiosis with", "exp": "Answer is C (Rheumatoid Ahritis): Caplan's syndrome refers to the association of Pneumoconiosis and Rheumatoid Ahritis. Caplan's Syndrome is a rare subset of pulmonary nodulosis characterized by the development of nodules and pneumoconiosis following silica exposure in patients with Rheumatoid Ahritis. Caplan's Syndrome first described in coal miners but subsequently found in patients with silicosis includes seropositive Rheumatoid ahritis with charachteristic pneumoconiotic nodules. Silica has immunoadjuvant propeies and is often present in anthractic coal dust.", "cop": 3, "opa": "Lymphadenopathy", "opb": "Congestive Cardiac Failure", "opc": "Rheumatoid Ahritis", "opd": "HIV", "subject_name": "Medicine", "topic_name": null, "id": "691b6162-2d81-429e-81b7-cf1dec87a2c2", "choice_type": "single"}
+{"question": "Rheumatoid Ahritis is best diagnosed by", "exp": "Answer is A (Anti-CCP Antibodies): 'Anti CCP antibodies are the most specific blood test for rheumatoid ahritis (specificity -95%)' - CMDT 09/727 Anti-cyclic citrullinated peptide (anti-CCP) antibody testing is paicularly useful in the diagnosis of rheumatoid ahritis, with high specificity, presence early in the disease process, and ability to identify patients who are likely to have severe disease and irreversible damage. Anti-CCP antibodies have not been found at a significant frequency in other diseases to date, and are more specific than rheumatoid factor for detecting rheumatoid ahritis.", "cop": 1, "opa": "Anti-CCP Antibodies", "opb": "IgA Rheumatoid Factor", "opc": "IgG Rheumatoid Factor", "opd": "IgM Rheumatoid Factor", "subject_name": "Medicine", "topic_name": null, "id": "2df04a06-a8a7-4a96-b6e0-34339a9d7a7b", "choice_type": "single"}
+{"question": "Platelets in stored blood do not live after", "exp": "Ans. is 'c' i.e., 72 hours Platelets are provided as a pooled preparation from one or several donors, usually as a 6-unit bag, which is the usual amount given to an average-sized adult. Each unit contains approximately 8 x 101deg platelets and should increase the platelet count by about 7000-10,000/ pL in a 75kg adult. Platelets stored at room temperature can be used for up to 5 days and have a life span of 8 days. Those stored at 4degC are useful for only 24 hours (only 50-70% of total platelet activity is present at 6 hours) and have a life span of only 2-3 days. ABO compatibility should be observed for platelets, but is not essential. For each donor used, there is a similar risk of transmitting hepatitis and HIV as for one unit of blood. Platelet should be administered through a 170pm filter.", "cop": 3, "opa": "24 hours", "opb": "48 hours", "opc": "72 hours", "opd": "96 hours", "subject_name": "Medicine", "topic_name": null, "id": "3110facf-3a67-4a68-a82d-fd0b1f2001a1", "choice_type": "single"}
+{"question": "The most likely cause of fluctuating jaundice in a middle aged or elderly man is", "exp": null, "cop": 1, "opa": "Peri-ampullary carcinoma", "opb": "Liver fluke", "opc": "Choledochal cyst", "opd": "Carcinoma of pancreas", "subject_name": "Medicine", "topic_name": null, "id": "78e7903e-917e-4cdd-bd36-f2cc8dd52caf", "choice_type": "single"}
+{"question": "For Contralateral weakness and sensory loss, worse in face and arm; homonymous hemianopsia; aphasia or neglect syndrome select the site of the lesion of cerebrovascular disease,", "exp": "Sudden, painless monocular blindness is a sign of carotid disease. The symptom is also called amaurosis fugax . The patient may describe a shade dropping in front of the eye or describe vision like looking through ground glass. If a thrombus propagates up the carotid to the middle cerebral aery, then symptoms seen in middle cerebral aery occlusion or embolization (hemiparesis with sensory symptoms, aphasia depending on hemispheric dominance) will also occur. Midbasilar aery disease produces weakness and sensory loss with diplopia, loss of facial sensation or movement, and ataxia. Branches of the basilar aery supply the base of the pons and superior cerebellum. The symptoms described suggest disease in the posterior circulation, whichincludes paired veebral aeries, the basilar aery, and the paired posterior cerebral aeries. The basilar aery divides into two posterior cerebral aeries that provide branches to the cerebellum, medulla, pons, midbrain, thalamus, and temporal and occipital lobes. A midbasilar aery occlusion could cause ataxia of limbs by involving pontine nuclei; paralysis of the face, arm, and leg by involving coicospinal tracts; and impairment of facial sensation by involvement of fifth nerve nucleus. Occlusion of the entire middle cerebral aery results in contralateral hemiplegia, hemianesthesia, and homonymous hemianopsia. When the dominant hemisphere is involved, aphasia is present. When the nondominant hemisphere is involved, apraxia and neglect are produced. When only a penetrating branch of the middle cerebral aery is affected, the syndrome of pure motor hemiplegia is produced, as the infarct involves only the posterior limb of the internal capsule, involving only motor fibers to the face, arm, and leg (lacunar infarct).", "cop": 2, "opa": "Internal carotid aery", "opb": "Middle cerebral aery", "opc": "Midbasilar aery", "opd": "Penetrating branch, middle cerebral aery", "subject_name": "Medicine", "topic_name": null, "id": "f0d3845c-ad05-45d6-ac63-a34de7112c52", "choice_type": "single"}
+{"question": "\"Reward pathway\" is associated with", "exp": "(A) Nucleus accumbens# NUCLEUS ACCUMBENS has a significant role in the cognitive processing of motivation, pleasure, and reward and reinforcement learning, and hence has significant role in addiction.", "cop": 1, "opa": "Nucleus accumbens", "opb": "Nucleus ambiguous", "opc": "Dentate nucleus", "opd": "Substantia nigra", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "c51c4278-1071-420f-92a4-7d9e0baeaca9", "choice_type": "single"}
+{"question": "Wernicke's hemianopic pupillary response is seen in the lesion of", "exp": "Wernick's hemianopic pupil is caused by the division of the optic tract that results in a contralateral homonymous hemianopiaPrimary lesions of the optic tract are very rare and the tract is usually disturbed by compression. The common causes areChordomasPituitary adenomasTentorial meningiomasTemporal lobe gliomasAneurysms of upper basilar distribution or on the superior cerebellar aeries or posterior cerebral aeriesRef: Parson 19/e p528,120", "cop": 1, "opa": "Optic tract", "opb": "Optic chiasma", "opc": "Optic radiation", "opd": "Lateral geniculate body", "subject_name": "Medicine", "topic_name": "All India exam", "id": "92e72a04-102c-4cbb-9251-c402e3893c9a", "choice_type": "single"}
+{"question": "Cavitatory lesions in lung are seen in", "exp": "Causes of cavitation include infections malignancies tuberculosis but not primary ptb pulmonary abscess septic emboli nontb mycobacterium infection aspergillosis systemic diseases like granulomatosis with polyangitis, sarcoidosis.", "cop": 2, "opa": "Primary pulmonary Tuberculosis", "opb": "Staphylococcal pneumonia", "opc": "Pneumoconiosis", "opd": "Interstitial Lung disease", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "8925db0a-565b-46c6-9056-5cc82488353c", "choice_type": "single"}
+{"question": "Noninfectious cause of Chronic meningitis is associated with Drug hypersensitivity of", "exp": "(B) Ibuprofen # Noninfectious Causes of Chronic Meningitis: Drug hypersensitivity: Exposure to NSAIDS (ibuprofen), sulfonamides, isoniazid, tolmetin, ciprofloxacin, Penicillin; Carbamazaepine; Lamotrigine; IV Immunoglobulin; OKT3 antibodies; phenazopyridine; improvement after discontir uation of drug; recurrent episodes with recurrent exposure. CSF formula: Shows PMNs; occasionally mononuclear cells or eosinophilsHelpful diagnostic tests: CBC (Esinophilia)INFECTIOUS CAUSES OF CHRONIC MENINGITISCausative AgentRisk Factors and Systemic ManifestationsCommon Bacterial Causes Partially treated suppurative meningitisHistory consistent with acute bacterial meningitis and incomplete treatmentParameningeal infectionOtitis media, pleuropulmonary infection, right-to-left cardiopulmonary shunt for brain abscess; focal neurologic signs; neck, back, ear, or sinus tendernessMycobacterium tuberculosisExposure history; previous tuberculous illness; immunosuppressed or AIDS; young children; fever, meningismus, night sweats, miliary TB on x-ray or liver biopsy; stroke due to arteritisLyme disease (Bannwarth's syndrome) Borrelia burgdorferiHistory of tick bite or appropriate exposure history; erythema chronicum migrans skin rash; arthritis, radiculopathy, Bell's palsy, meningoencephalitis-multiple sclerosis-like syndromeSyphilis (secondary, tertiary) Treponema pallidumAppropriate exposure history; HIV- seropositive individuals at increased risk of aggressive infection; \"dementia\"; cerebral infarction due to endarteritisUncommon Bacterial Causes ActinomycesParameningeal abscess or sinus tract (oral or dental focus); pneumonitisNocard iaAssociated brain abscess may be presentBrucellaIntake of unpasteurized dairy products; exposure to goats, sheep, cows; fever, arthralgia, myalgia, vertebral osteomyelitisWhipple's disease Tropheryma whippeliiDiarrhea, weight loss, arthralgias, fever; dementia, ataxia, paresis, ophthalmoplegia, oculomasticatory myoclonusRare Bacterial CausesLeptospirosis (occasionally if left untreated may last 3-4 weeks)Fungal CausesCryptococcus neoformansAIDS and immune suppression; pigeon exposure; skin and other organ involvement due to disseminated infectionCoccidioides immitisExposure history--southwestern US; increased virulence in dark-skinned racesCandida sp.IV drug abuse; post surgery; prolonged intravenous therapy; disseminated candidiasisHistoplasma capsulatumExposure history--Ohio and central Mississippi River Valley; AIDS; mucosal lesionsAspergillus sp.Sinusitis; granulocytopenia or immunosuppressionSporothrix schenckiiTraumatic inoculation; IV drug use; ulcerated skin lesionRare Fungal CausesXylohypha (formerly Cladosporium) trichoides and other dark-walled (demateaceous) fungi such as Curvularia, Drechslera; Mucor, and, after water aspiration, Pseudoallescheria boydiiProtozoal CausesToxoplasma gondiiUsually with intracerebral abscesses; common in HIV-seropositive patientsTrypanosomiasis Trypanosoma gambiense, T. rhodesienseEndemic in Africa; chancre, lymphadenopathy; prominent sleep disorderRare Protozoal CausesAcanthamoeba sp. causing granulomatous amebic encephalitis and meningoencephalitis in immunocompromised and debilitated individuals. Balamuthia mandrillaris causing chronic meningoencephalitis in immunocompetent hosts.Helminthic CausesCysticercosis (infection with cysts of Taenia solium)Usually with multiple cysts in basal meninges and hydrocephalus; cerebral cysts, muscle calcificationGnathostoma spinigerumHistory of eating raw fish; common in Thailand and Japan; subarachnoid hemorrhage; painful radiculopathyAngiostrongylus cantonensisHistory of eating raw shellfish; common in tropical Pacific regions; often benignBaylisascaris procyonis (raccoon as-carid)Infection follows accidental ingestion of B. procyonis eggs from raccoon feces; fatal meningoencephalitisRare Helminthic CausesTrichinella spiralis (trichinosis); Fasciola hepatica (liver fluke), Echinococcus cysts; Schistosoma sp. The former may produce a lymphocytic pleocytosis whereas the latter two may produce an eosinophilic response in CSF associated with cerebral cysts (Echinococcus) or granulomatous lesions of brain or spinal cordViral causesMumpsNo prior mumps or immunization; may produce meningoencephalitis; may persist for 3--4 weeksLymphocytic choriomeningitisContact with rodents or their excreta; may persist for 3-4 weeksEchovirusCongenital hypogammaglobulinemia; history of recurrent meningitisHIV (acute retroviral syndrome)HIV risk factors; rash, fever, lymphadenopathy; lymphopenia in peripheral blood; syndrome may persist long enough to be considered as \"chronic meningitis\"; or chronic meningitis may develop in later stages (AIDS) due to HIVHerpes simplex (HSV)Recurrent meningitis due to HSV-2 (rarely HSV-1) often associated with genital recurrences; EBV associated with myeloradiculopathy, CMV with polyradiculopathy", "cop": 2, "opa": "Acetaminophen", "opb": "Ibuprofen", "opc": "Acyclovir", "opd": "Beta-lactams", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "cf966907-7bde-42d5-bc60-ad97571168b7", "choice_type": "single"}
+{"question": "Pseudotumor cerebri is seen in", "exp": "* Pseudotumour cerebri(idiopathic intracranial hypeension) usually occur in obese young women . Ref Harrison20th edition pg 2456", "cop": 1, "opa": "Obese women in the age group 20-40 yrs", "opb": "Obese males 20-40 yrs.", "opc": "Thin females 50-60 yrs.", "opd": "Thin males 50-60 yrs.", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "b8fbf315-07b4-4587-8b4a-d9cb786bf049", "choice_type": "single"}
+{"question": "Severity of Mitral Regurgitation may be judged by", "exp": "Answer is C (Left Ventricular S3) The severity of Mitral Regurgitation may be judged clinically by the presence of left ventricular dilatation and the presence of third hea sound (Left Ventricular SJ? . These features indicate a more severe disease 'A third hea sound (S3) in chronic mitral regurgitation is usually indicative of severe regurgitation' Severity of Mitral Regurgitation: . If the murmur is harsher and has a lot of low and medium frequencies. It usually indicates a lot of flow and therefore will imply significant regurgitation. A harsh decrescendo mitral regurgitation murmur is usually indicative of severe regurgitation because the decrscendo effect is caused by early buildup of a very high v wave pressure in the left atrium resulting from a severe degree of regurgitation. Thus decreasing the gradient in late systole (If the murmur, on the other hand, is all pure high frequency and confined only to late systole. Then it must indicate a high pressure difference between the left ventricle and the left atrium and therefore only mild regurgitation). When the mitral regurgitation is severe, the volume overload on the left ventricle will be high, resulting in an enlarged left ventricle. This may be reflected in a displaced hyperdynamic wide -area left ventricular apical impulse. In addition, the hyperdynamic left ventricle will have rapid ejection. This will make the A2 occur early. Resulting in a wide-split S2. Thus, a wide -split S2 in the presence of mitral regurgitation is a sign of severe regurgitation if the wide split is not caused by P2 delay. In addition, severe regurgitation because of the volume load effect will have a torrential inflow through the mitral valve during diastole. This will set up the necessary conditions for the production of an S3 or a mid -diastolic inflow rumble. The presence of an S3 or an inflow rumble at the apex will, therefore, be a sign of significant mitral regurgitation as well. Severity of Mitral Regurgitation : Features indicating increased severity: Presence of Left ventricular S3 or an inflow rumble at the apex Harsh Decrescendo murmur with lot of low and medium frequencies Wide split S, due to early A2 (not caused by P2 delay) in presence of MR Note : Loudness and duration of Mitral regurgitation murmur does not always correlate with the severity of the regurgitation", "cop": 3, "opa": "Intensity of murmur", "opb": "Duration of murmur", "opc": "Left ventricular S3", "opd": "Loud S1", "subject_name": "Medicine", "topic_name": null, "id": "e3c7a267-3706-4601-8231-6a77d9dd9d7c", "choice_type": "single"}
+{"question": "Hyperkeratosis of palm and sole is seen in", "exp": null, "cop": 4, "opa": "Carcinoma colon", "opb": "Hepatoma", "opc": "Adenocarcinoma lung", "opd": "Ca oesophagus", "subject_name": "Medicine", "topic_name": null, "id": "59b89ba7-242e-44ca-b899-8ceba0952493", "choice_type": "single"}
+{"question": "ECG finding in Hypokalemia is", "exp": "(Prominent 'U' wave): (439-Davidson 21st)HyperkalemiaHypokalemia1. Earliest changes increased T wave amplitude**- Early changes flattening or inversion of T wave **2. Prolong PR interval and QRS duration- Prominent 'U' wave**3. AV conduction delay, loss of P wave- ST segment depression, prolong QU interval4. Sin wave pattern** (progressive widening of the QRS complex merging with T wave)- Prolonged PR interval, decreased voltage and widening of the QRS complex** Prolong QT interval - Hypocalcemia, SAH** Short QT interval - Hypercalcemia, digitalis glycosides", "cop": 2, "opa": "Absent P wave", "opb": "Prominent U wave", "opc": "ST elevation", "opd": "T wave tnting", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "39ca2e0e-2ab8-449d-82a1-e69c39d9982c", "choice_type": "single"}
+{"question": "Early reversible shock is characterised by", "exp": "The presentation of shock is variable with some people having only minimal symptoms such as confusion and weakness. While the general signs for all types of shock are low blood pressure, decreased urine output, and confusion, these may not always be present.While a fast hea rate is common, those on b-blockers, those who are athletic, and in 30% of cases of those with shock due to intra abdominal bleeding may have a normal or slow hea rate.Specific subtypes of shock may have additional symptoms. Dry mucous membrane, reduced skin turgor, prolonged capillary refill time, weak peripheral pulses and cold extremities can be early signs Ref Davidson 23rd edition pg 355", "cop": 4, "opa": "Decreased BP", "opb": "Decreased hea rate", "opc": "Oliguria", "opd": "Cold clammy extremities and increased peripheral resistance", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "650443df-7c55-4369-b871-90d0bc3a55a8", "choice_type": "single"}
+{"question": "Mucosal candidiasis is caused by", "exp": "(A) Candida albicans # Mucosal Candidiasis> Candidosis describes a group of yeastlike fungal infections involving the skin and mucous membranes.> Infection is caused by Candida species, typically, Candida albicans.> Acute pseudomembranous candidiasis (thrush)> Thrush may be observed in healthy neonates or in persons in whom antibiotics, corticosteroids, or xerostomia disturb the oral microflora.> Oropharyngeal thrush occasionally complicates the use of corticosteroid inhalers.> Immune defects, especially HIV infection, immunosuppressive treatment, leukemias, lymphomas, cancer, and diabetes, may predispose patients to candidal infection.", "cop": 1, "opa": "Candida albicans", "opb": "Candida tropicalis", "opc": "Candida guilliermondi", "opd": "Candida krusei", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "50dba6ee-35b2-44a3-880b-8e1fe35777af", "choice_type": "single"}
+{"question": "Pa of brain involved in narcolepsy", "exp": "Harrison's principles of internal medicine 17th edition *Recently several convergent lines of evidence suggest that hypothalamic neuropeptide hypocretin(orexin) is involved in the pathogenesis of narcolepsy.", "cop": 2, "opa": "Neocoex", "opb": "Hypothalamus", "opc": "Cerebellum", "opd": "Putamen", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "06c60b4e-a5b2-42eb-b052-64c6ad88b8ac", "choice_type": "single"}
+{"question": "Drug of choice for NSAID resistant Rheumatoid Arthritis", "exp": "(A) Methotrrexate # Usual approach to Rheumatoid Arthritis: is to attempt to alleviate the patient's symptoms with NSAIDs or Coxibs. Some patients may have mild disease that requires no additional therapy. However, if the patient has any evidence of aggressive disease, initiation of DMARD therapy should be considered as early as feasible. This group of agents includes methotrexate, gold compounds.D-penicillamine, the antimalarials, and sulfasalazine. Despite having no chemical or pharmacologic similarities, in practice these agents share a number of characteristics Methotrexate has emerged as the DMARD of choice because of its relatively rapid onset of action, its capacity to elfect sustained improvement with ongoing therapy, and the higher level of patient retention on therapy.", "cop": 1, "opa": "Methotrrexate", "opb": "Sulphasalezine", "opc": "Corticosteroid", "opd": "Salicylic acid", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "ca470674-3cc2-44d9-bced-6b49ab82abff", "choice_type": "single"}
+{"question": "Left sided facial weakness and right hemisphere site of lesion is", "exp": "(A) Internal capsule # Most common LACUNAR SYNDROMES are the following: Pure motor hemiparesis from an infarct in the posterior limb of the internal capsule or basis pontis; the face, arm, and leg are almost always involved; Pure sensory stroke from an infarct in the ventrolateral thalamus; Ataxic hemiparesis from an infarct in the base of the pons; Dysarthria and a clumsy hand or arm due to infarction in the base of the pons or in the genu of the internal capsule; and Pure motor hemiparesis with \"motor (Broca's) aphasia\" due to thrombotic occlusion of a lenticulostriate branch supplying the genu and anterior limb of the internal capsule and adjacent white matter of the corona radiata.> Ischemia within the genu of the internal capsule causes primarily facial weakness followed by arm then leg weakness as the ischemia moves posterior within the capsule. Alternatively, the contralateral hand may become ataxic and dysarthria will be prominent (clumsy hand, dysarthria lacunar syndrome).", "cop": 1, "opa": "Internal capsule", "opb": "Pons", "opc": "Medulla", "opd": "Amygdala", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "cfb24d31-cfcf-426a-88c5-cfe22155f042", "choice_type": "single"}
+{"question": "Most common symptom of Orthostatic Hypotension is", "exp": "(B) Lightheadedness # Orthostatic hypotension: Reduction in systolic BP of at least 20 mmHg or diastolic BP of at least 10 mmHg within 3 min of standing or head-up tilt on a tilt table, is a manifestation of sympathetic vasoconstrictor (autonomic) failure.> Characteristic symptoms include light headedness, dizziness, & presyncope (near-faintness) occurring in response to sudden postural change.> Nonspecific Symptoms include generalized weakness, fatigue, cognitive slowing, leg buckling, or headache.> Visual blurring may occur, likely due to retinal or occipital lobe ischemia.> Coat-hanger headache: Neck pain, typically in the suboccipital, posterior cervical, and shoulder region, most likely due to neck muscle ischemia, may be the only symptom.> Orthostatic dyspnea (thought to reflect ventilation-perfusion mismatch due to inadequate perfusion of ventilated lung apices) or angina (attributed to impaired myocardial perfusion even with normal coronary arteries).> Symptoms may be exacerbated by exertion, prolonged standing, increased ambient temperature, or meals.> Syncope is usually preceded by warning symptoms, but may occur suddenly, suggesting the possibility of a seizure or cardiac cause.> Supine hypertension is common in patients with orthostatic hypotension due to autonomic failure, affecting over 50% of patients.", "cop": 2, "opa": "Vertigo", "opb": "Light headedness", "opc": "Palpitations", "opd": "Blurred vision", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "de491bd2-c8be-4439-a8ba-cac39c67248f", "choice_type": "single"}
+{"question": "Y descent in jugular venous pulsation is due to", "exp": "Y descent is due to passive movement of blood from atria to ventricles i.e. early diastolic filling", "cop": 4, "opa": "Ventricular systole", "opb": "Atrial systole", "opc": "Atrial filling", "opd": "Ventricular filling", "subject_name": "Medicine", "topic_name": null, "id": "a13e4404-e52c-4c6f-9b84-85b79de388de", "choice_type": "single"}
+{"question": "Tiger skin appearance of colonic mucosa is seen in", "exp": "Melanosis coli is a condition associated with chronic laxative abuse.\nImparts a brown discoloration to colonic mucosa - Tiger skin.", "cop": 1, "opa": "Melanosis coli", "opb": "Ulcerative colitis", "opc": "Environmental enteropathy", "opd": "Carcinoid syndrome", "subject_name": "Medicine", "topic_name": null, "id": "7a375877-8a94-42af-9979-c7756fc5b0e2", "choice_type": "single"}
+{"question": "Penumococcal meningitis is associated with the following CSF findings", "exp": "Harrison's textbook of internal medicine 17th edition . *Typical finding of CSF in pneumococcal meningitis is increased WBC count (500-10000cells /microL) with _>85%PMNs,an elevated protein level(100-500mg/DL)and decreased glucose level(<30mg/DL).", "cop": 2, "opa": "Pleocytosis with low protein and low sugar", "opb": "Pleocytosis with high protein and low sugar", "opc": "Lymphocytosis low protein and low sugar", "opd": "Lymphocytosis high protein and low sugar", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "5f83345e-7893-4b4f-9377-729c9049b5e5", "choice_type": "single"}
+{"question": "Tertiary syphilis most frequently involves the", "exp": null, "cop": 1, "opa": "CNS", "opb": "Liver", "opc": "Testes", "opd": "Aorta", "subject_name": "Medicine", "topic_name": null, "id": "58407dfb-1d8e-4f84-8bdc-c21b518e97b7", "choice_type": "single"}
+{"question": "Not useful in clostridium difficile colitis", "exp": "Clindamycin cause C.difficile colitis.", "cop": 1, "opa": "Clindamycin", "opb": "Metronidazole", "opc": "Fidaxomycin", "opd": "Fecal microbiota transplantation", "subject_name": "Medicine", "topic_name": null, "id": "c451396c-75e2-4044-9df9-a44ed13261fa", "choice_type": "single"}
+{"question": "Lung volume reduction operations have been developed as a method of managing patients with", "exp": "In a patient with diffuse severe emphysema, resection or pa of the damaged lung may allow the patient's residual lung to function more efficiently. This technique may serve either as an alternative to lung transplantation or as a bridge until an appropriate donor organ is available. ref - Harrisons internal medicine 20e pg 1997", "cop": 2, "opa": "Asbestosis", "opb": "Emphysema", "opc": "Bronchiectasis", "opd": "Amyloidosis", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "90ad43b2-a3bd-4080-a9ac-10083e2fcb15", "choice_type": "single"}
+{"question": "Circinate balanitis is a feature of", "exp": "Circinate balanitis and Keratoderma Blennorrhagica is a feature of Reactive arthritis.", "cop": 3, "opa": "Osteoarthritis", "opb": "Psoariatic arthritis", "opc": "Reactive arthritis", "opd": "Ankylosing spondylitis", "subject_name": "Medicine", "topic_name": null, "id": "16ef2924-0663-4a63-b43b-2ce69527e637", "choice_type": "single"}
+{"question": "Shrinking lung syndrome is seen in", "exp": "Shrinking lung syndrome is a rare manifestation/complication of SLE Characterised by diaphragmatic weakness or dysfunctionAssociated with restrictive physiology and abnormalities of ventilation The restriction is due to the selective weakness of muscles of respiration including the diaphragmThe absence of ove parenchymal or vascular diseaseAnti-Ro antibodies may be present, but not offer an additional diagnostic aidPrognosis of this syndrome is often goodRef: Davidson 20/e p723", "cop": 4, "opa": "Tuberous sclerosis", "opb": "Scleroderma", "opc": "Diabetes mellitus", "opd": "Systemic lupus erythematosus", "subject_name": "Medicine", "topic_name": "All India exam", "id": "94038cb0-6084-4558-8813-3e846479045e", "choice_type": "single"}
+{"question": "Specific role of endoplasmic reticulum", "exp": null, "cop": 1, "opa": "Lipid biosynthesis", "opb": "Lipid catabolism", "opc": "Maintenance of calcium store", "opd": "Pentose phosphate pathway", "subject_name": "Medicine", "topic_name": null, "id": "996395f6-e952-4777-a0c2-08c0fecc7f65", "choice_type": "single"}
+{"question": "Hyperchloremic acidosis with hypokalemia is a feature of", "exp": "Ans. a (Renal tubular acidosis). (Ref. Harrison's Medicine 16th/pg. 265, 1702)METABOLIC ACIDOSIS: There are two major categories of clinical metabolic acidosis:# High anion-gap (AG) and# Normal-AG, or hyperchloremic acidosis:Hyperchloremic (nongap) metabolic acidosis# Alkali can be lost from the gastrointestinal tract in diarrhea or from the kidneys (renal tubular acidosis, RTA). In these disorders, reciprocal changes in and result in a normal AG.# In pure hyperchloremic acidosis, therefore, the increase in above the normal value approximates the decrease in . The absence of such a relationship suggests a mixed disturbance.# Metabolic acidosis due to gastrointestinal losses with a high urine pH can be differentiated from RTA because urinary NH4 excretion is typically low in RTA and high with diarrhea.# Urinary NH4 -levels can be estimated by calculating the urine anion gap (UAG):- UAG = -.# When > , and the urine gap is negative, the urine ammonium level is appropriately increased, suggesting an extrarenal cause of the acidosis.# Conversely, when the urine anion gap is positive, urine ammonium level is low, sugg. renal acidosis.The typical findings in classic distal RTA (type 1 RTA) include:# Hypokalemia,# Hyperchloremic acidosis,# Low urinary NH4\"# Excretion (positive uag, low urine [NH4U, and# Inappropriately high urine pH (pH -5.5).# Most have hypocitraturia and hypercalciuria, so nephrolithiasis, nephrocalcinosis, bone ds common.# Proximal RTA (type 2 RTA) is most often due to generalized proximal tubular dysfunction manifested by glycosuria, generalized aminoaciduria, and phosphaturia (Fanconi syndrome).# In type 4 RTA, hyperkalemia is disproportionate to the reduction in GFR because of coexisting dysfunction of potassium and acid secretion.FindingType 1 RTAType 2 RTAType 4 RTAGI Bicarbonate LossNormal anion-gap acidosisYesYesYesYesMinimum urine pH>5.5<5.5<5.55 to 6% Filtered bicarbonate excreted<10>15<10<10Serum potassiumLowLowHighLowFanconi syndromeNoYesNoNoStones/nephrocalcinosisYesNoNoNoDaily acid excretionLowNormalLowHighUrine anion gapPositiveNegativePositiveNegativeDaily bicarbonate replacement needs<4 mmol/kg>4 mmol/kg<4 mmol/kgVariableTable: COMPARISON OF NORMAL ANION-GAP ACIDOSISAlso remember:FUNCTIONAL CONSEQUENCES OF TUBULOINTERSTITIAL DISEASEDefectCause(s)1Reduced GFRObliteration of microvasculature and obstruction of tubules2Fanconi syndromeDamage to proximal tubular reabsorption of glucose, amino acids, phosphate, and bicarbonate3Hyperchloremic acidosis1. Reduced ammonia production2. Inability to acidify the collecting duct fluid (distal renal tubular acidosis).3. Proximal bicarbonate wasting4Tubular/small-molecular weight proteinuriaFailure of proximal tubule protein reabsorption5Polyuria, isothenuriaDamage to medullary tubules and vasculature6HyperkalemiaPotassium secretory defects including aldosterone resistance7Salt wastingDistal tubular damage with impaired sodium reabsorptionPRIMARY HYPERALDOSTERONISM (Conn's syndrome)# Conn's adenoma is very sensitive to ACTH as is glucocorticoid suppressible hyperaldosteronism, hence morning levels of ACTH and aldosterone are low.# Idiopathic bilateral adrenal hyperplasia is common than adrenal adenoma,# K+ levels are normal in 70% cases.# Increased plasma and urinary aldosterone.# Decreased plasma renin activity.6# Its dexamethasone suppressive hyperaldosteronism.# 18 OH cortisol levels are very high in Conn's adenoma and glucocorticoid suppressible hyperplasia.# Spironolactone is drug of choice.Secondary hyperaldosteronism results from:# Nephritic syndrome,# Cirrhosis,# Heart failure and# Barter's syndrome.'Spirolactone bodies' are seen in ATCH secreting adrenal adenomas treated with Spironolactone.", "cop": 1, "opa": "Renal tubular acidosis", "opb": "Addison's disease", "opc": "Pyloric stenosis", "opd": "Primary hyperaldosteronism", "subject_name": "Medicine", "topic_name": "Kidney", "id": "fdb51ec0-bf33-484f-9a29-c8648e9c14ba", "choice_type": "single"}
+{"question": "Most common nerve involved in intracranial Aneurysm is", "exp": "*in Subarachinoid hemorrhage ,a third nerve palsy may be present due to local pressure from an aneurysm of posterior communicating aery. *85% of SAH are caused by saccular or berry aneurysm. Ref Harrison20th edition pg 2345", "cop": 4, "opa": "IIICN", "opb": "VI CN", "opc": "VCN", "opd": "VI CN", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "e186e583-adca-4108-807a-c4d4d0fce90f", "choice_type": "single"}
+{"question": "Most common Primary Brain tumor is", "exp": "(A) Glioma", "cop": 1, "opa": "Glioma", "opb": "Glioblastoma", "opc": "Meningioma", "opd": "Medulloblastoma", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "3ae78a1f-7d5e-47fb-8714-586f8e2074ae", "choice_type": "single"}
+{"question": "\"Gottron sign\" seen in", "exp": "(Dermatomyositis) (760-CMDT-10, 2696-H 17th)* \"Gottron sign\" - scaly patches over of the dorsum of PIP and MCP joints are highly suggestive of dermatomyositisDERMATOMYOSITIS - the characteristic rash is dusky red and may appear in a malar distribution mimicking the classic rash of SLE* Facial erythema beyond the malar distribution is also characteristic of dermatomyositis (Shawl's sign)* Periorbital edema and a purplish (heliotrope) suffusion over the eyelids are typical signs, periungual erythema, dilations of nailbed capillaries* Bilateral proximal muscle weakness*** *** Increased risk of malignancy** - in descending order of frequency are ovarian, lung, pancreatic, stomach, colorectal and NHL)* Biopsy of clinically involved muscle is the only specific diagnostic test*** A pathologic hall mark of dermatomyositis is perifascicular atrophy. In polymyositis - endomysical infiltration of the inflammatory infiltrate**** Various auto antibodies against nuclear antigens (antinuclear antibodies) and cytoplasmic antigens are found in upto 20% of patients with inflammatory myopathies* Glucocorticoids: oral prednisone is the initial treatment of choice* Myositis may also be associated with other connective tissue diseases especially - Scleroderma, lupus, mixed connective tissue disease and Sjogren syndrome, overlap syndrome* Antisvnthetase syndrome - polymyositis and dermatomyositis develops- inflammatory arthritis, Raynaud phenomenon, interstitial lung disease, auto antibodies (eg anti Jo I antibodies)* Most common myositis-specific antibody -anti Jo-I antibody** (ILD)* Anti Mi-2 associated with dermatomyositis* Anti SRP (anti- signal recognition particle) associated with polymyositisPolymyositis can occur as a complication of HIV or HTLV-1 infection and with zidovudine therapy as well**** Anti-endomysial antibody - Celiac sprue*** Anti mitochondrial antibody - Primary biliary cirrhosis*** Anti-smooth muscle antibody - Auto immune hepatitis* Anti centromere antibody - CREST syndrome (limited scleroderma)* Histidyl-t-RNA antibody - Inflammatory myopathy * Anti DNA topoisomerase antibody (Scl-70)- Systemic sclerosis * Antibodies of ribonucleoprotein antigen containing ULRNP- Mixed connective tissue disease * SSb(La)* SSb(La)}Antibodies to ribo nucleoprotein antigen- Sjogren syndrome", "cop": 2, "opa": "Polymyositis", "opb": "Dermatomyositis", "opc": "Polymyositis + Sjogren's syndrome", "opd": "Polymyositis + SLE", "subject_name": "Medicine", "topic_name": "Immunology and Rheumatology", "id": "5f005c30-a409-446d-9e59-ad256d2db458", "choice_type": "single"}
+{"question": "Diarrhoea with acantholysis in urine", "exp": "Harrison's principles of internal medicine 17th edition. *Steatorrheal cause of chronic diarrhea is a mucosal malabsorption caused by celiac disease,whipple's disease and abetalipoproteinemia. Abetalipoproteinemia is a rare defect is a defect of chylomicron formation and fat malabsorption in children associated with acantholytic erythrocytes,,ataxia and retinitis pigmentosa.", "cop": 3, "opa": "Whipples disease", "opb": "Celiac sprue", "opc": "Abetalipoproteinemia", "opd": "Ulcerative colitis", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "23c3322b-0f6c-468b-a06d-49a016cf2e65", "choice_type": "single"}
+{"question": "Female menstrual cycle is diagnosed by", "exp": null, "cop": 1, "opa": "Sex steroid profile", "opb": "Basal body temperature", "opc": "Vaginal cell cytology", "opd": "Cervical mucus test", "subject_name": "Medicine", "topic_name": null, "id": "9b8efdec-6066-4ae4-9246-7408d64319a2", "choice_type": "single"}
+{"question": "It is considered as the bluntly rounded portion of the heart", "exp": "B: The blunt, rounded point of the heart is the apex.\nA: The aorta is the largest artery that carries blood from the left ventricle to the body.\nC: The larger, flat portion at the opposite is the base.\nD. The pericardium is also called the pericardial sac. It has a fibrous outer layer and a thin inner layer that surrounds the heart.", "cop": 2, "opa": "Aorta", "opb": "Apex", "opc": "Base", "opd": "Pericardium", "subject_name": "Medicine", "topic_name": null, "id": "df563907-9f49-4084-aaf3-572571c5f03e", "choice_type": "single"}
+{"question": "Feature of severe diarrhea", "exp": "Diarrhea can cause Non anion gap acidosis. Ref: Harrison&;s 19thE", "cop": 1, "opa": "Metabolic acidosis", "opb": "Metabolic alkalosis", "opc": "High anion gap", "opd": "Increased anion gap", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "bb9e48b2-0cfd-40dc-8555-60c30b214b58", "choice_type": "single"}
+{"question": "One of the following condition Is not associated with clubbing", "exp": "Chronic bronchitis does not cause clubbing Pulmonary causes of clubbing: primary and metastatic lung cancer bronchiectasis asbestosis sarcoidosis lung abscess cystic fibrosis tuberculosis mesothelioma other causes include inflammatory bowel disease,infective endocarditis,cyanotic congenital hea disease ,hepatic cirrhosis etc", "cop": 2, "opa": "Primary biliary cirrhosis", "opb": "Chronic bronchitis", "opc": "Ciyptogenic fibrosing alvcolitis", "opd": "Central bronchiectasis", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "5f0eb8ce-52e3-4ce8-961a-2bd416bf178e", "choice_type": "single"}
+{"question": "A Patient with history of shoness of breath has Decreased FEV1/FVC Ratio, Normal DLCO. A 200 ml increase in baseline FEVI is observed 15 minutes after administration of bronchodilators. The likely diagnosis is", "exp": "Ans. is 'a' i.e., Asthma", "cop": 1, "opa": "Asthma", "opb": "Chronic Bronchitis", "opc": "Emphysema", "opd": "Interstitial Lung Disease", "subject_name": "Medicine", "topic_name": null, "id": "33d23960-2b26-44d6-897a-3cd6d3f3d1e4", "choice_type": "single"}
+{"question": "Commonest cause of sustained severe hypeension in children", "exp": "The chief causes of severe sustained hypeension identified included chronic glomerulonephritis , obstructive uropathy , reflux nephropathy , thrombotic microangiopathy and renovascular disease . ref:Harrison&;s principles of internal medicine,ed 18,pg no", "cop": 3, "opa": "Endocrine causes", "opb": "Coarctation of aoa", "opc": "Renal parenlchyma disease", "opd": "Pheochromocytoma", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "c69cc126-c7a0-41c8-8af5-f75304717cf0", "choice_type": "single"}
+{"question": "Barrett's esophagus is", "exp": "Barrett's esophagus is specialized columnar metaplasia that replaces the normal squamous mucosa of the distal esophagus in some persons with GERD. Barrett's epithelium is a major risk factor for adenocarcinoma of the esophagus and is readily detected endoscopically, due to proximal displacement of the squamocolumnar junction.Ref: Harrison; 19th edition; Page no: 1895", "cop": 1, "opa": "Lower esophagus lined by columnar epithelium", "opb": "Upper esophagus lined by columnar epithelium", "opc": "Lower esophagus lined by ciliated epithelium", "opd": "Lower esophagus lined by pseudo stratified epithelium", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "f23c0cc4-f74d-4a85-8f96-b4cd8fbcce51", "choice_type": "single"}
+{"question": "Most common organism associated with reactive ahritis is", "exp": "Reactive (spondylo)ahritis (ReA) is a 'reaction' to a number of bacterial triggers with clinical features in keeping with all SpA conditions. The known triggers are Chlamydia, Campylobacter, Salmonella, Shigella and Yersinia. Notably, non-SpA-related reactive ahritis can occur following infection with many viruses, Mycoplasma, Borrelia, streptococci and mycobacteria, including M. leprae, which causes leprosy (Hansen's disease); however, the 'reaction' in these instances consists typically of myoahralgias, is not associated with HLA-B27 and is generally not chronic. The ahritis associated with rheumatic fever is also an example of a reactive ahritis that is not associated with HLA-B27.Sexually acquired reactive ahritis (SARA) is predominantly a disease of young men, with a malepreponderance of 15 : 1. This may reflect a difficulty in diagnosing the condition in young women, in whom Chlamydia infection is often asymptomatic and is hard to detect in practical terms. Between 1% and 2% of patients with non-specific urethritis seen at genitourinary medicine clinics have SARA. The syndrome of chlamydial urethritis, conjunctivitis and reactive ahritis was formerly known as Reiter's disease. Ref Davidsons 23e p1031", "cop": 3, "opa": "Staphylococcus", "opb": "Shigella", "opc": "Chlamydia", "opd": "Yersinia", "subject_name": "Medicine", "topic_name": "Immune system", "id": "c882c767-7a0c-4b5c-a181-052f06684185", "choice_type": "single"}
+{"question": "rtPA is NOT a contraindication in stroke with", "exp": "(C) Coma # rtPA (Alteplase) is indicated in pulmonary embolism, myocardial infarction, and stroke.> rtPA therapy in patients with stroke is contraindicated in certain situations like suspicion of subarachnoid hemorrhage on pretreatment evaluation, recent (within 3 months) intracranial or intraspinal surgery, history of intracranial hemorrhage, uncontrolled hypertension at time of treatment, active internal bleeding, known bleeding diathesis (eg, current use of oral anticoagulants, administration of heparin within 48 hours of onset of stroke), platelet count <100,000/mm3.", "cop": 3, "opa": "BP >185/110 mm Hg", "opb": "Heparin in the past 24 hrs", "opc": "Coma", "opd": "Lesion occupying >1/3 of middle cerebral artery territory", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "90ae5e0b-b093-4cfd-bbc4-7610a8c4d048", "choice_type": "single"}
+{"question": "Itch sensation from skin is carried by", "exp": "(C) C-nerve fibre # Itch Pathway: from Skin - C- Nerve Fibers - Dorsal Horn - Spinal Cord - Thlamus - Insula# Itch or Pruritus, is the major symptom in skin diseases with a variety of etiologies and pathophysiologies.> Significant progress has been achieved in understanding the pathophysiology of itch in the last 5 years.> Neurophysiological experiments in humans and animals have revealed that itch is carried by specific C nerve fibers.> Peripheral mediators other than histamine are involved in induction of itch.> Mast cell tryptase seems to be an important mediator in itch by its activation of proteinase activated receptor 2 in the sensory nerves.", "cop": 3, "opa": "A alpha", "opb": "A gamma", "opc": "C-nerve fibre", "opd": "Central itch centre", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "52522013-9f81-485a-8238-e7c3ced5cdb5", "choice_type": "single"}
+{"question": "The most sensitive test for the diagnosis of ' myasthenia gravis is", "exp": "*Tensilon (edrophonium) test: a sho-acting anticholinesterase--look for rapid and transient improvement of strength; false-positive (placebo response, motor neuron disease) and false-negative tests occur. Atropine IV should be on hand if symptoms such as bradycardia occur. Ref Harrison20th edition pg 2378", "cop": 3, "opa": "Elevated serum ACH-receptor binding antibodies", "opb": "Repetitive nerve Stimulation test", "opc": "Positive edrophonium test", "opd": "Measurement of jitter by Single fibre electromyography", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "6ea8a16e-958f-4701-9ad7-0484c197c2cd", "choice_type": "single"}
+{"question": "Treatment of choice in Wegner's granulomatosis is", "exp": "Answer- B. CyclophosphamideCyclophosphamide alongwith glucocoicoids is the treatment of choice, For selected patients whose disease is not immediately life threatening or in those patients who have experienced significant cyclophosphamide toxicity, methotrexate together with glucocoicoids may be considered as an alternative", "cop": 2, "opa": "Cyclosporine", "opb": "Cyclophosphamide", "opc": "Steroids", "opd": "Radiotherapy", "subject_name": "Medicine", "topic_name": null, "id": "334940a0-5f86-4fb5-9ea4-bc7bf047ef14", "choice_type": "single"}
+{"question": "Most common cause of spontaneous SAH", "exp": "*85%of SAH are caused by saccular or 'berry' aneurysms arising from the bifurcation of cerebral aeries paicularly in region of the circle of willis . Ref Harrison20th edition pg 2445", "cop": 2, "opa": "Trauma", "opb": "Aneurysm", "opc": "AV malformation", "opd": "Hypeension", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "5309cf9e-13b9-424f-b80a-9da2b069882f", "choice_type": "single"}
+{"question": "Drug for management of hypeension in Phaeochromocytoma", "exp": "Ans. is 'a' i.e., Phenoxybenzamine Once a pheochromocytoma is diagnosed, all patients should undergo a resection of the pheochromocytoma following appropriate medical preparation. Resetting a pheochromocytoma is a high-risk surgical procedure and an experienced surgeon/anesthesiologist team is required. Some form of preoperative pharmacologic preparation is indicated for all patients with catecholamine-secreting neoplasms. Preoperative medical therapy is aimed at: Controlling hypeension (including preventing a hypeensive crisis during surgery) o Volume expansion In patients with undiagnosed pheochromocytomas who undergo surgery for other reasons (and who therefore have not undergone preoperative medical therapy), surgical moality rates are high due to lethal hypeensive crises, malignant arrhythmias, and multiorgan failure. Combined alpha- and beta-adrenergic blockade Combined alpha- and beta-adrenergic blockade is the most common approach to control blood pressure and prevent intraoperative hypeensive crises. Alpha-adrenergic blockade An alpha-adrenergic blocker is given 10 to 14 days preoperatively to normalize blood pressure and expand the contracted blood volume. Phenoxybenzamine is the preferred drug for preoperative preparation to control blood pressure and arrhythmia in most centers in the United States. It is an irreversible, long-acting, nonspecific alpha-adrenergic blocking agent. The initial dose is 10 mg once or twice daily, and the dose is increased by 10 to 20 mg in divided doses every two to three days as needed to control blood pressure and spells. The final dose of phenoxybenzamine is typically between 20 and 100 mg daily. Beta-adrenergic blockade After adequate alpha-adrenergic blockade has been achieved, beta-adrenergic blockade is initiated, which typically occurs two to three days preoperatively. The beta-adrenergic blocker should never be staed first because blockade of vasodilatory peripheral betaadrenergic receptors with unopposed alpha-adrenergic receptor stimulation can lead to a fuher elevation in blood pressure. The alternatives to a and 13 adrenergic agents are calcium channel blockers and metyrosine. Calcium channel blockers Although perioperative alpha-adrenergic blockade is widely recommended, a second regimen that has been utilized involves the administration of a calcium channel blocker. Nicardipine is the most commonly used calcium channel blocker in this setting; the staing dose is 30 mg twice daily of the sustained release preparation. Metyrosine Another approach involves the administration of metyrosine (alpha-methyl Para-tyrosine), which inhibits catecholamine synthesis.", "cop": 1, "opa": "Phenoxybenzamine", "opb": "Phentolamine", "opc": "Labetalol", "opd": "Esmolol", "subject_name": "Medicine", "topic_name": null, "id": "9a768f6f-3411-489c-b49b-3428cefa9732", "choice_type": "single"}
+{"question": "Patient presents with recurrent duodenal ulcer of 2.5 cm size; procedure of choice", "exp": "Answer is A (Truncal vagotomy and antrectomy): The question here Strictly specifies recurrence as the major problem 'Recurrent duodenal ulcer'. Hence a procedure with the minimum recurrence rate, would logically be, the best operation. Truncal vagotomy and antrectomy are associated with minimum recurrence rate and is the answer of choice. Note: Operation with maximum Operation with minimum The most widely used procedure in India reduction in acid production operative moality Truncal vagotomy and Highly selective vagotomy Truncal vagotomy plus a drainage procedure Gasirojejunostomy antrectomy is at present the most widely used procedure. Highly selective vagotomy: - In highly selective vagotomy nerves of Latarjet supplying the antrum are preserved.Q- A drainage procedure is not required Q - Operation moality is lower than in any other definitive operation for duodenal ulceration. Q", "cop": 1, "opa": "Truncal vagotomy and antrectomy", "opb": "Truncal vagotomy and gastrojejunostomy", "opc": "Highly selective vagotomy", "opd": "Laparoscopic vagotomy and gastrojejunostomy", "subject_name": "Medicine", "topic_name": null, "id": "2e3711b9-2475-48a9-9c9b-9019706ee195", "choice_type": "single"}
+{"question": "The most common cause of acute cor pulmonale is", "exp": null, "cop": 2, "opa": "Pneumonia.", "opb": "Pulmonary thromboembolism.", "opc": "Chronic obstructive pulmonary disease.", "opd": "Primary spontaneous pneumothorax.", "subject_name": "Medicine", "topic_name": null, "id": "47f04c0c-a913-4040-8bba-82de9c3d1268", "choice_type": "single"}
+{"question": "Most common neurological finding in whipple's disease", "exp": "M/C neurological - supranuclear opthalmoplegia and cerebellar ataxia.", "cop": 1, "opa": "Cerebellar ataxia", "opb": "Convulsions", "opc": "Quadriplegia", "opd": "Dementia", "subject_name": "Medicine", "topic_name": null, "id": "95b919ed-014e-4f06-8b40-e4e54a1c88c1", "choice_type": "single"}
+{"question": "Henoch Schonlein Purpura presents with deposition of", "exp": "Answer is C (IgA) The most common class of antibodies deposited in immune complexes of Henoch Schonlein Purpura is IgA.", "cop": 3, "opa": "IgG", "opb": "IgM", "opc": "IgA", "opd": "IgE", "subject_name": "Medicine", "topic_name": null, "id": "7b769ac2-f64a-4167-b8d9-a386edb7d036", "choice_type": "single"}
+{"question": "Most characteristic lesion in diabetic nephropathy is", "exp": "Most common - Diffuse Glomerulosclerosis.\nMost characteristic - Kimmelsteil Wilson nodules.", "cop": 4, "opa": "Diffuse Glomerulosclerosis", "opb": "Fibrin caps", "opc": "Capsular drops", "opd": "Kimmelsteil Wilson nodules", "subject_name": "Medicine", "topic_name": null, "id": "81c1851c-3f1e-43e5-8b87-2a1708d82366", "choice_type": "single"}
+{"question": "A Young boy presents with multiple flaccid bullous lesions over trunk with some oral mucosal lesions. Most likely finding on immunofluorescence study of the biopsy specimen would be", "exp": "Pemphigus Vulgaris Bullous pemphigoid Autoantibodies against Desmosomal proteins Hemidesmosomal proteins Age 40-60 yrs 60-75 yrs Initial site Oral mucosa Lower extremities Bullae Flaccid Tense Pruritus Mild/- Nonexistent or severe Nikolsky's sign + - Mucosal involvement +(in almost all patients) - (10-40% only) HPE Suprabasal acantholytic blisters (Tombstone appearance) Q Subepidermal blisters (eosinophil-rich dermal infiltrate) DIF IgG & C3 deposits at the intercellular substance of epidermis (\"Fishnet appearance\")Q IgG, C3, and IgA/IgM at BM zone. IIF Circulating IgG antibodies to the intercellular substance of epidermis. Anti-BM zone antibodies IgG Rx Steroids + immunosuppressants Dapsone Gold Steroids Immunosuppressants Dapsone Postinflammatory Hyperpigmentation + - (Ref. Harrison's 19th ed. Table 55-1)", "cop": 1, "opa": "'Fishnet' IgG deposits in epidermis", "opb": "Linear IgG in Deposits", "opc": "Linear IgA in dermal papillae", "opd": "Granular IgA in reticular dermis", "subject_name": "Medicine", "topic_name": "Immune system", "id": "719d27d5-9e6c-43a3-879c-4d5191cf71d2", "choice_type": "single"}
+{"question": "Universal finding in Asthma is", "exp": "Answer is A (Hypoxia) Hypoxia is a universal finding during acute exacerbation's Hypoxia is a universal finding during acute exacerbations. Most Asthmatics have hypocapnia and respiratory alkalosis. - Harrison Hvpoxia is the universal finding in Asthma Hypocapnia and respiratory alkalosis is seen in most asthmatic patients Hypercarbia and Respiratory acidosis are very late features of Asthma and sign severe obstruction and respiratory failure. These are not universal findings in Asthma. Metabolic acidosis is not a feature of Asthma.", "cop": 1, "opa": "Hypoxia", "opb": "Hypercarbia", "opc": "Respiratory acidosis", "opd": "Metabolic Acidosis", "subject_name": "Medicine", "topic_name": null, "id": "0955868d-5ec0-4f46-8deb-e42ebb05e911", "choice_type": "single"}
+{"question": "Reversed splitting of S2 heart sound is heard in", "exp": "Reversed splitting of heart sound S2 is seen in:\n\nAortic stenosis\nPDA\nComplete LBBB\nWPW syndrome\nChronic ischemic heart disease\nPost stenotic dilation of aorta secondary to aortic stenosis", "cop": 4, "opa": "Ventricular septal defect", "opb": "RBBB", "opc": "Acute pulmonary embolism", "opd": "LBBB", "subject_name": "Medicine", "topic_name": null, "id": "a9e161cf-f16c-47b8-95be-6e167fb1cfde", "choice_type": "single"}
+{"question": "A 25 yr old female has recurrent headaches for past 3 years. Headache is episodic throbbing in nature and is associated with nausea and vomiting, preceded by visual aura .The patient is suffering from", "exp": "Headache described is characteristic of migraine. The one with aura is classical, the one without aura is common migraine", "cop": 2, "opa": "Common migraine", "opb": "Classical migraine", "opc": "Cluster headache", "opd": "Tension headache", "subject_name": "Medicine", "topic_name": null, "id": "33142a30-cbb5-42db-9d90-8db474601b18", "choice_type": "single"}
+{"question": "Raspberry tongue is a feature of", "exp": "Strawberry or raspberry tongue is seen in kawasaki disease and scarlet fever.", "cop": 2, "opa": "Yellow fever", "opb": "Scarlet fever", "opc": "Katayama fever", "opd": "Mamba's disease", "subject_name": "Medicine", "topic_name": null, "id": "d71bb548-8335-46ce-982f-d248a8f4dbe3", "choice_type": "single"}
+{"question": "Severe malnutrition is defined in adults with BMI less than", "exp": "Body mass index (BMI) BMI = wt (kg)/ ht (m)2 Example: an adult of 70 kg with a height of 1.75 m has a BMI of 70/1.752= 22.9 kg/m2 * BMI is a useful way of identifying under- or over-nutrition but cannot discriminate between lean body or muscle mass and fat mass ![](\")
Ref Harrison 20th edition pg 76", "cop": 2, "opa": "18.5", "opb": "16", "opc": "13", "opd": "11", "subject_name": "Medicine", "topic_name": "Nutrition", "id": "2ceae270-cfa7-495b-a0f8-e1757891266d", "choice_type": "single"}
+{"question": "Fredrickson&;s type II hyperlipoproteinemia is due to excess amounts of", "exp": "Defective LDL receptors, Elevated LDL cholesterol which is derived from VLDL, Has coronary high risk and atherosclerosis.", "cop": 2, "opa": "VLDL remnants", "opb": "VLDL", "opc": "Floating LDL", "opd": "HDL", "subject_name": "Medicine", "topic_name": "All India exam", "id": "9a01ef5d-7f13-4d78-99ca-916377e8e186", "choice_type": "single"}
+{"question": "A 26 year old man died suddenly during spoing activity. At autopsy the hea revealed chamber and septum Hyperophy. The most likely diagnosis is", "exp": "Answer is A. (HOCM): Sudden death following competitive spos in young individuals is characteristic of hyperophic obstructive cardiomyopathy (HOCM). The presence of chamber and septal hyperophy on autopsy confirms the suspected diagnosis of HOCM", "cop": 1, "opa": "HOCM", "opb": "DCM", "opc": "Arrhythmogenic cardiac problem", "opd": "Restrictive cardiomyopathy", "subject_name": "Medicine", "topic_name": null, "id": "ca6fa22b-e904-47ea-9fbc-b3890aed6a70", "choice_type": "single"}
+{"question": "Rupture of berry aneurysm most commonly results in", "exp": "Ans. is 'a' i.e., Subarachnoid hemorrhage Most common cause of subarachnoid hemorrhage Trauma Most common cause of spontaneoussubarachnoid hemorrhage Rupture of Berry aneurysm (or Saccular aneurysm) Also know Mycotic aneurysm ? Mycotic aneurysm is caused by a septic embolus that weakens the wall of the vessel in which it lodges.", "cop": 1, "opa": "Subarachnoid hemorrhage", "opb": "Subdural hemorrhage", "opc": "Extradural hemorrhage", "opd": "Intra-parenchymal hemorrhage", "subject_name": "Medicine", "topic_name": null, "id": "a4b03808-3330-4896-ae62-5801ca148769", "choice_type": "single"}
+{"question": "Commonest type of bronchogenic carcinoma is", "exp": null, "cop": 1, "opa": "Adenocarcinoma", "opb": "Oat cell carcinoma", "opc": "Squamous cell carcinoma", "opd": "Large cell carcinoma", "subject_name": "Medicine", "topic_name": null, "id": "563d252b-d794-4964-8c41-a321020ce894", "choice_type": "single"}
+{"question": "Least common symptoms in Friedrich's ataxia is", "exp": "(A) Moderate mental retardation # Neurologic examination reveals nystagmus, loss of fast saccadiceye movements, truncal titubation, dysarthria, dysmetria, and ataxia of trunk and limb movements. Extensor plantar responses (with normal tone in trunk and extremities), absence of deep tendon reflexes, and weakness (greater distallythan proximally) are usually found. Loss of vibratoryand proprioceptive sensation occurs.> Median age of death is 35 years. Women have a significantly better prognosis than men. Cardiac involvement occurs in 90% of patients. Cardiomegaly, symmetric hypertrophy, murmurs, and conduction defects are reported. Moderate mental retardation or psychiatric syndromes arepresent in a small percentage of patients.> High incidence of diabetes mellitus (20%) is found and is associated with insulin resistance and pancreatic -cell dysfunction. Musculoskeletal deformities are common and include pes cavus, pes equinovarus, and scoliosis. MRI of the spinal cord shows atrophy", "cop": 1, "opa": "Moderate mental retardation", "opb": "Scoliosis", "opc": "Cardiac abnormality", "opd": "Diabetes mellitus", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "1af28fbf-0897-493f-8462-a2a771d02c1e", "choice_type": "single"}
+{"question": "Epworth questionaries used in", "exp": "i.e. (Obstructive sleep apnea syndrome): (J666-H17th )Epworth Sleepness score - for obstructive sleep apnea / hypopnea syndromeEPWORTH SLEEPNESS SCOREHow open are you likely to doze off or fall asleep in the following situations in contrast to feeling just tired? This refer to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you. Use the following scale to choice the most appropriate number foreach situation0 = Would never doze1 = slight change of dozing2 = moderate chance of dozing3 = high chance of dozing* Setting and reading* Watching TV* Sitting, inactive in a public place (eg a theater or meeting)* Asa passenger in a ear for an hour without a break* Lying down to rest in the afternoon when circumstances permit* Sitting and talking to someone* Sitting quietly after lunch without alcohol* In a ear, while stopped for a few minutes in trafficSleep apnoea is defined as an intermittent cessation of airflow at the nose and mouth during sleep. By convention the apnea should be of at least 10 second durationSleep anea causes excessive day time sleepinessObstructive sleep apneaCentral sleep apneaApnea occurs due to occlusion of upper airway usually at the level of oropharynxApnea occurs due to transient stoppage of neural drive tothe ventilatory muscle* Most common age group for obstructive sleep apnea - male aged 30 - 60 yearsC/F of obstructive sleep apnea1. Systemic hypertension2. Pulmonary hypertension3. Heart failure (right & left)4. Personality changes5. Behaviour changes", "cop": 4, "opa": "COPD", "opb": "Emphysema", "opc": "Bronchial asthma", "opd": "Obstructive sleep apnea syndrome", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "d81ab90f-71c3-46d2-b70d-f806d490d2a5", "choice_type": "single"}
+{"question": "Low calcium and high phosphate is seen in", "exp": null, "cop": 2, "opa": "Hyperparathyroidism", "opb": "Hypoparathyroidism", "opc": "Hyperthyroidism", "opd": "Hypothyroidism", "subject_name": "Medicine", "topic_name": null, "id": "be2837b8-dac4-405b-85e9-3d2b68bf1e52", "choice_type": "single"}
+{"question": "AIDS infect", "exp": null, "cop": 2, "opa": "B cells", "opb": "Helper T cells", "opc": "Killer T cells", "opd": "Regular T cells", "subject_name": "Medicine", "topic_name": null, "id": "a68a4292-19a6-4b48-a404-8a6b1aa187b0", "choice_type": "single"}
+{"question": "GTT post 1 hour sugar for gestational diabetes is >mg %", "exp": "Ans. is 'c' i.e., 180mg%", "cop": 3, "opa": "140", "opb": "150", "opc": "180", "opd": "200", "subject_name": "Medicine", "topic_name": null, "id": "0d3d779e-4eb0-470f-bab3-229dcee3756e", "choice_type": "single"}
+{"question": "Commonest presentation of neurocysticerocosis is", "exp": "Neurocysticercosis typically is first seen with seizures (70% to 90% of acutely symptomatic patients) and headache.Headache usually indicates the presence of hydrocephalus, meningitis, or increased intracranial pressure. Dementia,radiculopathy,focal neurologic defecits are less common presentations Ref Harrison20th edition pg 2445", "cop": 1, "opa": "Seizures", "opb": "Focal neurological deficits", "opc": "Dementia", "opd": "Radiculopathy", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "ed439125-7055-4585-9565-1eb90965163d", "choice_type": "single"}
+{"question": "Stoke Adam's associated with", "exp": "(C) High degree AV Block # Those with syncope due to high degree AV block (Stokes-Adams-Morgagni syndrome) may have evidence of conduction system disease (e.g., prolonged PR interval, bundle branch block).> Bradyarrhythmias may occur as a result of an abnormality of impulse generation (e.g., sinoatrial arrest) or impulse conduction (e.g., AV block).> Syncope due to a tachyarrhythmia is usually preceded by palpitation or light-headedness but may occur abruptly with no warning symptoms.> Patients with aortic valvular stenosis and hypertrophic obstructive cardiomyopathy are also at risk for ventricular tachycardia. Individuals with abnormalities of ventricular repolarization (prolongation of the QT interval) are at risk to develop polymorphic ventricular tachycardia (torsades de pointes).", "cop": 3, "opa": "Sinoatrial arrest", "opb": "Tachyrhythmias", "opc": "High degree AV Block", "opd": "Polymorphic ventricular tachycardia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "5422becb-68b8-4687-bf6a-ccba263b206b", "choice_type": "single"}
+{"question": "Hibernating myocardium is", "exp": "Hibernating myocardium refers to a state of chronic reversible myocardial contractile dysfunction, that is almost completely restored after myocardial repercussion. Recovery occurs after revascularization, not spontaneous. Acute coronary occlusion results in stunned myocardium. Whereas chronic occlusion results in hibernating myocardium.", "cop": 3, "opa": "irreversible", "opb": "Recovery is spontaneous", "opc": "Seen in chronic severe coronary stenosis", "opd": "Mismatch between flow and function", "subject_name": "Medicine", "topic_name": null, "id": "9d98e46c-d244-439d-aa36-eb092e435374", "choice_type": "single"}
+{"question": "Not associated with thymoma is", "exp": "Hypogammaglobulinemia is seen in thymoma not Hypergammaglobulinemia . ref harrisons internal medicine 20e p2496 , 729 ,3232, 3237", "cop": 3, "opa": "Red cell aplasia", "opb": "Myasthenia gravis", "opc": "Hypergammaglobulinemia", "opd": "Compression of the mediastinum", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "4c2ebad4-562d-4239-b672-a053400cd9ca", "choice_type": "single"}
+{"question": "Delusion is", "exp": "(Thought) (60- 61- Neeraj Ahuja 6th)* Delusion is a disorder with disturbed content of thought* Hallucination & Illusion are disorders of perception* Delirium & dementia are disorders of cognition* Insight is disturbed in psychosisDELUSION - False belief based on in correct inference about external reality; not consistent with patient's intelligence and cultural back ground that cannot be corrected by reasoning", "cop": 2, "opa": "Perception", "opb": "Thought", "opc": "Insight", "opd": "Depression", "subject_name": "Medicine", "topic_name": "Psychiatry", "id": "d20c6544-aede-4195-b5d5-09200b7ab9ce", "choice_type": "single"}
+{"question": "Urticarial lesions are best described as", "exp": null, "cop": 3, "opa": "nonpruritic", "opb": "Linear", "opc": "evanescent", "opd": "macular", "subject_name": "Medicine", "topic_name": null, "id": "976334e1-e76a-4e88-95c4-cbdda17ea1c1", "choice_type": "single"}
+{"question": "Aseptic meningitis caused by", "exp": "Ans. is 'b' i.e., Ibuprofen Medications known to cause aseptic meningitis Medications Medication Common Uncommon NSAIDs Ibuprofen Sulindac Naproxen Diclofenac Rofecoxib Antimicrobials Trimethoprim/sulfamethoxazole Sulfonamides Immunomodulating agents Monoclonalantibody OKT3Intravenous IgG Azathioprine Intrahecal agents Metrizamide Cytarabine Methylprednisolone acetate Other Carbamazepine Causes of acute aseptic meningitis Infectious cases Bacterial Lyne disease Leptospirosis Mycobacterium tuberculosis infection Subacute bacterial endocarditis Parameningeal infection (epidural subdural abcess, sinus or ear infection) Paially treated bacterial meningitis Viral Echovirus infection Coxaackie virus infection Mumps St. Louis encephalitis Eastern equine encephalitis Western equine encephalitis Calcifornia encerphalitis Herpes simplex virus type 2 infection HIV infection Lymphocytic choriomeningitis Poliovirus infection", "cop": 2, "opa": "Indomethacin", "opb": "Ibuprofen", "opc": "Aspirin", "opd": "Icatibant", "subject_name": "Medicine", "topic_name": null, "id": "54e5a086-bbd6-4b70-acc0-14db789faa54", "choice_type": "single"}
+{"question": "Least common cause of endocarditis is", "exp": null, "cop": 1, "opa": "A.S.D.", "opb": "P.D.A.", "opc": "T.O.F.", "opd": "V.S.D.", "subject_name": "Medicine", "topic_name": null, "id": "fb42356c-927c-4055-8c71-f2c98dc5341d", "choice_type": "single"}
+{"question": "Best test for lung fibrosis", "exp": "Ans. is 'c' i.e., HRCT Lung fibrosis is a diffuse parenchymal lung disease. Idiopathic pulmonary fibrosis is the most common form of idiopathic interstitial pneumonia. We have already discussed that best investigation for interstitial lung disease is HRCT Estimated relative frequency of the interstitial lung disease Diagnosis Relative frequency, % Idiopathic interstitial pneumonias 40 Idiopathic pulmonary fibrosis 55 Nonspecific interstitial pneumonia 25 Respiratory bronchiolitis-ILD and 15 Cryptogenic organizing pneumonia 3 Acute interstitial pneumonia <1 Occupational and environmental 26 Sarcoidosis 10 Connective tissue diseases 9 Drug and radiation 1 Pulmonary hemorrhage syndromes <1 Other 13", "cop": 3, "opa": "Chest x-ray", "opb": "MRI", "opc": "HRCT", "opd": "Biopsy", "subject_name": "Medicine", "topic_name": null, "id": "25108e19-f12c-4015-a21e-a3958259835f", "choice_type": "single"}
+{"question": "Cubital tunnel syndrome", "exp": null, "cop": 2, "opa": "Radial nerve", "opb": "Ulnar nerve", "opc": "popliteal nerve", "opd": "brachial nerve", "subject_name": "Medicine", "topic_name": null, "id": "5938cc02-882f-48df-8c7c-d3e7ed7c0b95", "choice_type": "single"}
+{"question": "Cause of sudden loss of vision in alcoholic pancreatitis is", "exp": "Putscher's retinopathy is a disease where pa of the eye (retina) is damaged. Usually associated with severe head injuries, it may also occur with other types of trauma, such as long bone fractures, or with several non-traumatic systemic diseases. However, the exact cause of the disease is not well understood. There are no treatments specific for Puscher's retinopathy, and the prognosis varies. The disease can threaten vision, sometimes causing temporary or permanent blindness. Puscher's retinopathy is a rare condition that is associated with complement-activating systemic diseases such as acute pancreatitis Ref Davidson edition23rd pg 840", "cop": 3, "opa": "Central retinal aery obstruction", "opb": "Acute congestive glaucoma", "opc": "Puscher retinopathy", "opd": "Sudden alcohol withdrawl", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "ae986999-00b8-4bcb-b7b1-7af59e33c56d", "choice_type": "single"}
+{"question": "Most common myeloproliferative disorder is", "exp": "Examples of Myeloproliferative diseases are Polycythemia rubra vera, Myelofibrosis, and Essential thrombocytopenia. Here CML and CLL are not Myeloproliferative diseases and out the rest two Polycythemia is more common. Reference : Davidaon, 23rd Edition, page no : 969.", "cop": 1, "opa": "Polycythemia rubra vera", "opb": "CML", "opc": "CLL", "opd": "Myelofibrosis", "subject_name": "Medicine", "topic_name": "Haematology", "id": "802c1417-366e-40c9-9a0e-02d52632f710", "choice_type": "single"}
+{"question": "Defect seen in Bartter syndrome is", "exp": "(D) Thick ascending limb of loop of Henle[?]Bartter Syndrome:-An inborn autosomal recessive defect, in the Na+-K+-2C- cotransporter in the thick ascending limb of the loop of Henle, leading to NaCl and water wasting.-Symptoms are polyuria, polydipsia, episodes of dehydration, faltering growth and constipation.-There may be maternal polyhydramnios with an affected fetus.-The resultant ECF volume contraction causes secondary renin secretion and raised aldosterone levels, with avid Na+ and water reabsorption in the distal tubule and reciprocal K+ and H+ secretion into the urine.-The blood pressure is normal; the hyperreninaemia is a compensatory response to maintain normal blood pressure in the presence of chronic ECF volume depletion.-There is also increased renal prostaglandin E2 production.[?]Fanconi Syndrome:oDiffuse proximal tubular dysfunction, leading to excess urinary loss of:-Glucose - glycosuria with normal blood glucose-Phosphate - hypophos- phataemia, rickets-Amino acids - no obvious clinical consequence-HCO3- - leading to proximal RTA-K+ - causing hypokalae- mia-Na+Cl- & water - leading to polyuria & polydipsia, chronic ECF volume depletion, faltering growth.-Tubular proteinuria - loss of low molecular weight proteins including retinol binding protein.", "cop": 4, "opa": "Distal Convoluted Tubule", "opb": "Proximal Convoluted Tubule", "opc": "Thin descending limb of loop of Henle", "opd": "Thick ascending limb of loop of Henle", "subject_name": "Medicine", "topic_name": "Kidney", "id": "1f95a0cd-1304-4649-a59f-1a2ada340255", "choice_type": "single"}
+{"question": "Recurrent aspiration pneumonia caused by", "exp": "Answer- C. Progressive systemic sclerosisEsophageal hypomotility and incompetence of the lower esophageal sphincter disease causes chronic gastroesophageal reflux and recurrent episodes of aspiration in systemic sclerosis.", "cop": 3, "opa": "Dermatomyostis/polymyositis", "opb": "Rheumatoid ahritis", "opc": "Progressive systemic sclerosis", "opd": "Systemic lupus erythrematosus", "subject_name": "Medicine", "topic_name": null, "id": "f8c83602-75e6-465c-9cb9-df8742e0c419", "choice_type": "single"}
+{"question": "Shirmer's test is done for", "exp": "Answer is C (Facial nerve): Shirmer's test is done to assess the lacrimation function of the Facial Nerve (Greater Superficial Petrosal Nerve).", "cop": 3, "opa": "Occulomotor nerve", "opb": "Optic nerve", "opc": "Facial nerve", "opd": "Hypoglossal nerve", "subject_name": "Medicine", "topic_name": null, "id": "9690b763-3faa-4fbb-b16d-66b949526f6f", "choice_type": "single"}
+{"question": "Standing increases murmur intensity in", "exp": "The classic ECG finding in hyperophic obstructive cardiomyopathy is large dagger-like \"septal Q waves\" in the lateral -- and sometimes inferior -- leads due to the abnormally hyperophied interventricular septum.. Wolff-Parkinson-White, or WPW, syndrome can be associated with HOCM The murmur that is pathognomonic for HCM is a crescendo-decrescendo holosystolic murmur best heard at the left sternal boarder. The murmur classically increases with standing and valsalva, while it decreases with squatting, hand-grip, and passive leg lift . Ref Davidson edition23rd pg 463", "cop": 3, "opa": "Aoic stenosis", "opb": "Aoic regurgitation", "opc": "Hyperophic obstructive cardiomyopathy", "opd": "Mitral stenosis", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "a6c6a2f7-8614-4871-a218-982d019dbe69", "choice_type": "single"}
+{"question": "Nucleotide repeat in Spinocerebellar ataxia type 6.", "exp": "Fragile X - CGG\nFreidrich ataxia - GAA\nMyotonic dystrophy - CTG", "cop": 1, "opa": "CAG", "opb": "CGG", "opc": "GAA", "opd": "CTG", "subject_name": "Medicine", "topic_name": null, "id": "04cd9a0a-526b-4c02-acbf-d5f87c0885f0", "choice_type": "single"}
+{"question": "Characteristic pathological feature of pneumococcal pneumonia", "exp": "The characteristic pathological feature of pneumococcal pneumonia is radiographic evidence of lobar/segmental consolidation.Consolidation may be associated with a small pleural effusion or empyema in complicated cases.In children,\"round pneumonia\", a distinctly spherical consolidation is associated with pneumococcal pathology.Non specific findings include elevated polymorphonuclear leukocytes(>15 000/micro Litre in most cases & upward of 40,000/micro Litre in some),elevated liver function tests,etc. Reference:Harrison' s medicine-18th edition,page no:1156.", "cop": 1, "opa": "Consolidation of airway", "opb": "Interstitial pneumonitis", "opc": "Increased eosinophils", "opd": "Hilar lymphadenopathy", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "adf25fd9-7d3f-4941-9ec3-85aa8506f57f", "choice_type": "single"}
+{"question": "Warm antibody in autoimmune hemolytic anemia", "exp": "Warm antibody is IgG.", "cop": 2, "opa": "IgM", "opb": "IgG", "opc": "IgE", "opd": "IgA", "subject_name": "Medicine", "topic_name": null, "id": "dfdd0c26-e619-4340-a1b6-806b0101fe35", "choice_type": "single"}
+{"question": "In gastric outlet obstruction in a peptic ulcer patient, the site of obstruction is most likely to be", "exp": "The common complications of peptic ulcer are perforation, bleeding and stenosis.The most common site for a peptic ulcer is the first pa of the duodenum.The most common site of bleeding from a peptic ulcer is the posterior aspect of the duodenum. Gastroduodenal aery is the common source ofmajor bleeding.The most common site of perforation is the anterior aspect of the duodenum.Bailey and Love 27e pg: 1127", "cop": 2, "opa": "Antrum", "opb": "Duodenum", "opc": "Pylorus", "opd": "Pyloric canal", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "2aeeb5fc-2a4a-4b56-a275-be9ab99ebed6", "choice_type": "single"}
+{"question": "Blood loss in class III hemorrhagic shock", "exp": "Class I - < 750 mL\nClass II - 750 - 1500mL\nClass III - 1500 - 2000mL\nClass IV - 2000mL.", "cop": 3, "opa": "< 750 mL", "opb": "750 - 1500 mL", "opc": "1500 - 2000 mL", "opd": "> 2000 mL", "subject_name": "Medicine", "topic_name": null, "id": "58123203-0382-402b-bedb-48fde85da14f", "choice_type": "single"}
+{"question": "Becks triad is seen in", "exp": "Components of Beck's Triad Hypotension with a Narrowed Pulse Pressure Jugular Venous Distention Muffled hea Sounds it is a pathognomic feature of cardiac tamponade Ref Harrison 20th edition pg 1546", "cop": 3, "opa": "Constrictive pericarditis", "opb": "Restrictive cardiomyopathy", "opc": "Cardiac tamponade", "opd": "HOCM", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "5ebb43e8-cdae-4700-b9bf-613daf883baa", "choice_type": "single"}
+{"question": "Gerstmann's syndrome is due to involvement of", "exp": "(B) Left parietal lobe # GERSTMANN SYNDROME: Combination of acalculia (impairment of simple arithmetic), dysgraphia (impaired writing), finger anomia (inability to name individual fingers as the index or thumb) & right-left confusion (inability to tell when a hand, foot or arm of the patient or examiner is on the right or left side of the body).> When this syndrome is in isolation, it is commonly associated with damage to the inferior parietal lobule (especially the angular gyrus) in the left hemisphere.", "cop": 2, "opa": "Right parietal lobe", "opb": "Left parietal lobe", "opc": "Upper brain stem", "opd": "Cerebellum", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "959e6ba6-e100-415b-aeb1-77791408f0e8", "choice_type": "single"}
+{"question": "Treatment of AIDS include", "exp": "(2 Reverse transcriptase inhibitors + 1 Protease inhibitors) (1124-H) (1197-1201-300-CMDT-09) (1190- H17th)Currently licenced drugs for the treatment of HIV infections fall into three categories: those that inhibit the viral reverse transcriptase enzyme: those that inhibit the viral protease enzymes, and those that interfere with viral entry (1124-H)Reverse transcriptase inhibitors include(i) Nucleoside analogues - Zidovudine, Zalcitabine, Didanosine, Zalcitabine, Stavudine, Lamivudine, abacavir, and emtricibine(ii) Nucleotide analogues - tenofovirNon-nucleoside reverse transcriptase inhibitors - nevirapine, delavirdine and efavirenzProtease inhibitors (PIs) Saquinavir, Ritonavir, Indinavir, Nelfinavir, Amprenavir, Fosamprenavir, Lopinavir, AtazanavirEntry inhibitors (Fusion inhibitors) - Enfuvirtide* The combination of Zidovudine, Lamivudine and indinavir was the first \"triple combination\" shown to have a profound effect on HIV replication (1134-H)Symptomatic HIV disease or asymptomatic disease and CD4 < 200/pL or asymptomatic disease and special circumstances | Best first line treatment{CombivirEfavirenz Common altemativeregimens once a day regimens |||||* Tenofovir +Lamivudine +Efavirenz Tenofovir +Efavirenz +Afazanavir +Ritonavir + | | Intolerance to regimen Progression of disease or viral load does not decrease by > 0.5 log with initiation of treatment or increase of viral load by > 0.5 log while on treatmentLow pill burden regimens Combivir +Neviripine Trizivir | Change to alternative first line regimens High potency regimens| | Perform resistance testing and change to a regimen with three drugs to which the patient is not resistant. If possible Combivir +Lopinavir withRitonavir Approach to antiretroviral therapy", "cop": 2, "opa": "3 Reverse transcriptase inhibitors", "opb": "2 Reverse transcriptase inhibitors + 1 Protease inhibitors", "opc": "2 Reverse transcriptase inhibitors + 2 Protease inhibitors", "opd": "3 Reverse transcriptase inhibitors + 1 Protease inhibitors", "subject_name": "Medicine", "topic_name": "Infection", "id": "6e47c395-02bd-4822-95e9-94efb2447db8", "choice_type": "single"}
+{"question": "Drug of choice for Chronic Myeloid Leukaemia is", "exp": "(B) Imatinib TRASTUZUMABMechanismMonoclonal antibody against HER-2 (erb-B2). Helps kill breast cancer cells that over express HER-2, possibly through antibody-dependent cytotoxicity.Clinical useMetastatic breast cancerToxicityCardiotoxicityIMATINIBMechanismMonoclonal antibody against the Philadelphia chromosome brc-abl tyrosine kinaseClinical useCML, Gl stromal tumorsToxicityCardiotoxicityVINCRISTINE, VINBLASTINEMechanismM-phase-specific alkaloids that bind to tubulin and block polymerization of microtubules so that mitotic spindle cannot formClinical usePart of the MOPP (Oncovin ) regimen for lymphoma, Wilms tumor, ChoriocarcinomaToxicityVincristine-neurotoxicity (areflexia, peripheral neuritis), paralytic ileus. Vinblastine blasts bone marrow (suppression)PACLITAXEL, OTHER TOXOIDSMechanismM-phase-specific agents that bind to tubulin and hyper stabilize polymerized microtubules so that mitotic spindle cannot break down (anaphase cannot break down (anaphase cannot occur)Clinical useOvarian and breast carcinomaToxicityMyelosuppression and hypersensitivity", "cop": 2, "opa": "Hydroxyurea", "opb": "Imatinib", "opc": "Infliximab", "opd": "IFN beta", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "d86f4bd1-ffbb-4203-86ed-73848c41a519", "choice_type": "single"}
+{"question": "Feature of exudates pleural effusion is", "exp": "According to Light's criteria for distinguishing pleural transudate from exudate,exudate is likely if one or more of the following criteria are met-Pleural fluid protein:serum protein ratio>0.5;Pleural fluid LDH:serum LDH ratio>0.6;Pleural fluid LDH>2/3 rds of the upper limit of normal serum LDH. Reference:Davidson's medicine-22nd edition,page no:662.", "cop": 1, "opa": "Pleural fluid protein: Serum protein ratio> 0.5", "opb": "Pleural fluid protein: Serum protein ratio> 0.8", "opc": "Pleural fluid protein: Serum protein ratio<0.5", "opd": "Pleural fluid protein: Serum protein ratio> 1.0", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "1a9bb77b-52eb-4368-ab90-ed9b6d0fc06c", "choice_type": "single"}
+{"question": "Adenocarcinoma of oesophagus is associated with", "exp": "(D) Barret's oesophagus # Geographical variation of oesophageal cancer> Adenocarcinoma now accounts for 60-75% of all oesophageal cancers in several countries.> The reason for the change is not understood, but may be due to a changed incidence of Barret's oesophagus.# Complications of Barret's Oesophagus> Oesophageal ulcers: Barret's ulcer - pain, bleeding, perforation.> Oesophageal stricture: Usually located in middle or upper oesophagus. Peptic stricture occur in the distal oesophagus.> Dysplasia and Adenocarcinoma.", "cop": 4, "opa": "Achalasia", "opb": "Stricture", "opc": "Corrosive bums", "opd": "Barret's oesophagus", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "e82b5bd0-d768-4201-8a94-17a5948cc234", "choice_type": "single"}
+{"question": "The most common cause of Pulmonary thromboembolism is", "exp": "A late effect of DVT is a postphlebitic syndrome, which eventually occurs in more than one-half of DVT patients. Postphlebitic syndrome (also known as a post-thrombotic syndrome or chronic venous insufficiency) is a delayed complication of DVT that causes the venous valves of the leg to become incompetent and exude interstitial fluid. Patients complain of a chronic ankle or calf swelling and leg aching, especially after prolonged standing.Ref: Harrison's 18/e p2170, 17/e p1651", "cop": 3, "opa": "DIC", "opb": "Coagulation Disorder", "opc": "DVT", "opd": "Venous Hypeension", "subject_name": "Medicine", "topic_name": "All India exam", "id": "5c1c359e-1491-4ce0-858f-fa8adb2cd443", "choice_type": "single"}
+{"question": "Natural elements having anticancer properties a) Nitrosoamines b) Vit. C c) Vit. D d) Carotene e) Selenium", "exp": null, "cop": 2, "opa": "de", "opb": "bde", "opc": "be", "opd": "ab", "subject_name": "Medicine", "topic_name": null, "id": "bfe37139-268f-4af4-98a5-5679e9a15482", "choice_type": "single"}
+{"question": "Disease due to deficiency of B Complex vitamins is", "exp": "Pellagra Niacin deficiency (B complex)Night blindnessVitamin A deficiencyOsteomalacia Vitamin D deficiencySpinocerebellar ataxiaVitamin E deficiency(ref:Harrison's 17/e p442)", "cop": 1, "opa": "Pellagra", "opb": "Night blindness", "opc": "Osteomalacia", "opd": "Spinocerebellar ataxia", "subject_name": "Medicine", "topic_name": "All India exam", "id": "149e6f77-b575-4a7e-adca-7273ebd10d10", "choice_type": "single"}
+{"question": "Not seen idiopathic pulmonary hemosiderosis", "exp": "Answer is A (Eosinopenia): Eosinopenia is not a feature of Idiopathic Pulmonary Hemosiderosis Idiopathic Pulmonary Hemosiderosis (IPH) IPH is a disorder of unknown etiology characterized by recurrent episodes of Diffuse Alveolar Hemorrhage (DAH) It has been classically characterized by the triad of iron deficiency anemia, hemoptysis and alveolar infiltrates on chest radiographs.", "cop": 1, "opa": "Eosinopenia", "opb": "Iron deficiency anemia", "opc": "Diffuse alveolar hemorrhage", "opd": "Hemoptysis", "subject_name": "Medicine", "topic_name": null, "id": "57853c0e-8e08-4937-b92f-333d1ada6b26", "choice_type": "single"}
+{"question": "Double density sign in Mitral stenosis is a sign of enlargement of", "exp": "Answer- B. Left AtriumDouble density is seen on frontal chest radiograph in the presence of left atrial enlargement and occurs when the right side of the left atrium pushes behind the right cardiac shadows indenting the lung and forming its own district sihhouette.", "cop": 2, "opa": "Right Atrium", "opb": "Left Atrium", "opc": "Left Auricle", "opd": "Right Auricle", "subject_name": "Medicine", "topic_name": null, "id": "f4aa5f95-5d7c-4f98-a654-bb194f6f0f03", "choice_type": "single"}
+{"question": "Coloboma is a defect in", "exp": null, "cop": 4, "opa": "Cornea", "opb": "Lens", "opc": "Choroid", "opd": "Iris", "subject_name": "Medicine", "topic_name": null, "id": "30a95c60-98ed-48e6-b407-bb8095053a41", "choice_type": "single"}
+{"question": "A boy is suffering from acute pyelonephritis", "exp": "Ans. a. WBC casts", "cop": 1, "opa": "WBC casts", "opb": "Leucocyte esterase test", "opc": "Nitrite", "opd": "Bacteria in gram stain", "subject_name": "Medicine", "topic_name": null, "id": "87e1fb27-72e6-4a4f-bb16-cd7615c09050", "choice_type": "single"}
+{"question": "Following is characteristic neurologic finding in primary amyloidosis", "exp": "Ans. is 'a' i.e., Peripheral motor and sensory neuropathy ATTR usually presents as a syndrome of familial amyloidotic polyneuropathy or familial amyloidotic cardiomyopathy. Peripheral neuropathy usually begins as a lower-extremity sensor and motor neuropathy and progresses to the upper extremities. Autonomic neuropathy is manifest by gastrointestinal symptoms of diarrhea with weight loss and ohostatic hypotension.", "cop": 1, "opa": "Peripheral motor and sensory neuropathy", "opb": "Peripheral neuropathy associated with cerebral manifestation", "opc": "Guillain - Barre type of syndrome", "opd": "Spinal cord compression in thoracic region", "subject_name": "Medicine", "topic_name": null, "id": "09a30d28-a847-4899-8ad3-5680c4073e91", "choice_type": "single"}
+{"question": "Half life of alteplase", "exp": "Ref Harrison 19 th ed pg 758 Atleplase has a plasma half-life of 4-6 minutes.", "cop": 2, "opa": "3 min", "opb": "6 min", "opc": "9 min", "opd": "12 min", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "001add39-8df4-421a-8f78-95493b56728e", "choice_type": "single"}
+{"question": "Wenckebach's phenomenon is seen in", "exp": "Second-degree AV block is subclassified as Mobitz type I (Wenckebach) or Mobitz type II.In type I, the PR interval has a progressive prolongation until finally the atrial impulse is completely blocked and does not produce a QRS electrical impulse.Once the p-wave is blocked and no QRS is generated, the cycle begins again with the prolongation of the PR interval.One of the main identifying characteristics of second-degree AV block (Type 1) is that the atrial rhythm will be regular. Type II second-degree AV block is characterized by intermittent failure of conduction of the P wave without changes in the preceding PR or RR intervals.Harrison 19e pg: 1472", "cop": 2, "opa": "I degree hea block", "opb": "II degree hea block type I", "opc": "II degree hea block type II", "opd": "III degree hea block", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "4f182fee-2734-4715-8ecb-71e359a08f85", "choice_type": "single"}
+{"question": "Digoxin is contraindicated in", "exp": "A. i.e. (Hypertrophic cardiomyopathy) (1485 - H17th)Hypertrophic CMP - Digitalis, diuretics, nitrates, dihydropyridine calcium blockers, vasodilators and b- adrenergic agonists are best avoided, particularly in patients with know LV out flow tract pressure gradients - (1485 - H17th)Dose reduction in Digitalis in following conditions* Hypokalemia** Advanced age** Hypomagnesemia* Hypoxia** **Renal failure* Hypothyroidism* Hypercalcemia* Myocarditis* Electrical - cardioversion* Lidocaine is the drug of choice in digoxin induced arrhythmias* **Diuretics & Hemodialysis are NOT used for treatment of digitalis toxicity* Major electrophysiological effect of digitalis1. Hyperpolarization2. Shortening of atrial action potential3. Increase in AV node refractoriness", "cop": 1, "opa": "Hypertrophic cardiomyopathy", "opb": "Supraventricular tachycardia", "opc": "Congestive heart failure", "opd": "Atrial flutter", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "8af36b96-0146-4baa-81bd-ccc3a94ea5bb", "choice_type": "single"}
+{"question": "Acute metabolic acidosis", "exp": "It is seen in low anion gap acidosis. Other features seen: low serum albumin (nephrotic syndrome.) High immunoglobulins (multiple myeloma) Increaed Li Increaed : K+, Ca2+, Mg2+ Ref: Harrison&;s 19thE", "cop": 3, "opa": "Has biphasic effect on K+ exceion", "opb": "Does not effect K+ excretion significantly", "opc": "Decreases urinary K+ exceion", "opd": "Increases urinary K+ excretion", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "cb7d1830-1c31-418d-81cd-f7ab65c496b8", "choice_type": "single"}
+{"question": "Hypophosphatemia is a caused by", "exp": null, "cop": 2, "opa": "Primary hypothyroidism", "opb": "Primary hyperparathyroidism", "opc": "Primary hyperthyroidism", "opd": "Hypoparathyroidism", "subject_name": "Medicine", "topic_name": null, "id": "c10f86ef-e260-48a1-baae-2befb4bc36db", "choice_type": "single"}
+{"question": "Intetion tremor, druken gait and scanning speech together point towards involvement of", "exp": "Answer- A. CerebellumClinical features of Cerebellar lesions:Incordination of rapid alternating movements - dysdiadokokinesiaInaccuracy of purposeful movements - dysmetriaIrregular variations in the volume and rhythm ofspeech - scanning speechBroad based reeling gait - like a drunken sailorQuasirhythmical rocking of the head and trunk - titubationHypotoniaNystagmus", "cop": 1, "opa": "Cerebellum", "opb": "Coex", "opc": "Medulla", "opd": "Micihreio", "subject_name": "Medicine", "topic_name": null, "id": "e4249525-580a-4fa7-999c-3b2288bee5c3", "choice_type": "single"}
+{"question": "A hypeensive diabetic is having proteinuria , antihypeensive of choice is", "exp": "Ref Harrison 19 th ed pg 1625 In patients with type 2 diabetes, treatment with an ACEI, an ARB, or aliskiren decreases proteinuria and delays the progres- sion of renal disease. In experimental models of hypeension and diabetes, renal protection with aliskiren is comparable to that with ACEIs and ARBs. However, in patients with type 2 diabetes, addition of aliskiren to an ACEI provides no additional protection against cardiovascular or renal disease and may be associated with more adverse outcomes. Among African Americans with hypeension- related renal disease, ACEIs appear to be more effective than beta blockers or dihydropyridine calcium channel blockers in slowing, although not preventing, the decline of glomerular filtration rate. The renoprotective effect of these renin-angiotensin blockers, com- pared with other antihypeensive drugs, is less obvious at lower blood pressures.", "cop": 3, "opa": "Propanolol", "opb": "Clonidine", "opc": "Enalaprilat", "opd": "Alpha methyldopa", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "2d54873a-8464-4374-b6cd-34dcc7ec44ca", "choice_type": "single"}
+{"question": "According to Misch bone density classification D2 is", "exp": null, "cop": 3, "opa": "> 1250 Hounsfield units", "opb": "350 — 850 Hounsfield units", "opc": "850 — 1250 Hounsfield units", "opd": "150 — 350 Hounsfield units", "subject_name": "Medicine", "topic_name": null, "id": "c7a6faa5-926e-4bfb-993e-321fafa51194", "choice_type": "single"}
+{"question": "Most common lymph node involved in Hodgkin's lymphoma is", "exp": "Answer is B (Cervical) The most common lymph nodes involved in Hodgkins Lymphoma are the cervical lymph nodes. The most common lymph nodes involved in Hodgkin's Lymphoma are cervical lymph nodes and supraclavicular lymph nodes (60-70%) 'Detection of an unusual mass or swelling in the superficial, supra-diaphragmatic lymph nodes (60-70% cervical and supraclavicular, 15-20% axillary) is the most common presentation of Hodgkin's Lymphoma. Only 15 to 20 percent of patients have sub-diaphragmatic disease at presentation' -- William's Manual of Hematology", "cop": 2, "opa": "Inguinal", "opb": "Cervical", "opc": "Axillary", "opd": "Sub-clavicular", "subject_name": "Medicine", "topic_name": null, "id": "a85ca78f-375f-4641-a7d9-ea805d4cc3f5", "choice_type": "single"}
+{"question": "Drugs of choice in diffuse pan bronchioltis is", "exp": "(Erythromycin): (1489-1490 - H18th edition)Low dose erythromycin is the D.O.C. in the treatment of diffuse panbronchiolitis.Macrolides have to be taken orally for an extended period of time -2-3 yrs.M.O.A - ImmunomodulationThe antibiotic effects of marolides are not involved in their beneficial effects toward reducing inflammation in DPB. They are especially effective at inhibiting the proliferation of neutrophils, by diminishing the ability of interleukin 8 and leukotriene B4 to attract them. They also reduce lymphocyte activity and obstructive mucus and water secretions in airways.Diffuse panbronchiolitis (DPB) is an idiopathic progressive inflammatory obstructive lung diseaseIt tends to present in middle aged (~ 30-60 year old) adults, often non smokers. There is a high prevalence rate in males with a M:F ratio of ~ 2:1.PathologyDiffuse panbronchiolitis is characterized by centrilobularperibronchiolar infiltrates of acute and chronic inflammatory cells, which occur principally at the level of the respiratory bronchioles. There can be bronchiolar dilatation and intra-luminal inflammatory exudates.Radiographic featuresPlain filmNon specific and may show bilateral, diffuse, small nodular shadows with pulmonary hyper inflation.HRCT ChestA periphero-basilar predilection may be present. Features are generally non specific and include:* Centrilobular opacities with branching lines (tree-in-bud pattern)* Bronchiolectasis* Expiratory air trapping", "cop": 1, "opa": "Erythromycin", "opb": "Tetracyclines", "opc": "Predsnilone", "opd": "Cyclophosphamide", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "453d83f6-ef7a-458c-a77e-3635416cab72", "choice_type": "single"}
+{"question": "DOC of GTCS in pregnancy", "exp": "Ans. is 'a' i.e., Lamotrigine", "cop": 1, "opa": "Lamotrigine", "opb": "CBZ", "opc": "Levetiracetam", "opd": "Valproate", "subject_name": "Medicine", "topic_name": null, "id": "aad11664-5f83-44ac-926e-b56c35c9642d", "choice_type": "single"}
+{"question": "Shifting dullness is the characteristic sign of", "exp": "Hydropneumothorax is collection of both fluid(lower pa) and air(upper pa) in the pleural cavity.The hallmark diagnosis in hydropneumothorax is 3 'S':Shifting dullness(due to the presence of free fluid & air within the pleural cavity,dullness of fluid shifts from one place to other within chest with the change of posture of the patient),Succussion splash,and Straight fluid level(upper limit of dullness is horizontal).", "cop": 1, "opa": "Hydropneumothorax", "opb": "Pneumothorax", "opc": "Consolidation", "opd": "Collapse", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "ae792c9f-f026-4110-b409-9fdb9c7c12c3", "choice_type": "single"}
+{"question": "Burst suppression of EEG is sees in", "exp": ". * In SSPE ,EEG demonstrates characteristic periodic bursts of triphasic waves. Ref Harrison20th edition pg 2567", "cop": 2, "opa": "Herpes", "opb": "SSPE", "opc": "Prions disease", "opd": "Epilepsy", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "bc8c4222-c1cd-4ed6-b59b-aa6166691c11", "choice_type": "single"}
+{"question": "An otherwise healthy athlete complaints of chest pain and dyspnea during routine training, on examination has a double impulse at the apex, undergoes sudden death. Likely diagnosis", "exp": "(A) HOCM # Symptoms of chest pain and dyspnea and findings of double impulse at the apex with sudden death suggest features of HYPERTROPHIC CARDIOMYOPATHY (HCM).> Hypertrophic cardiomyopathy (HCM) clinical features:> The clinical course of HCM is highly variable.> Many patients are asymptomatic or mildly symptomatic and may be relatives of patients with known disease.> Unfortunately, the first clinical manifestation of the disease may be sudden death, frequently occurring in children and young adults, often during or after physical exertion.> In symptomatic patients, the most common complaint is dyspnea, largely due to increased stiffness of the left ventricular walls, which impairs ventricular filling and leads to elevated left ventricular diastolic and left atrial pressures.> Other symptoms include angina pectoris, fatigue, and syncope.> Symptoms are not closely related to the presence or severity of an outflow pressure gradient.> Most patients with gradients demonstrate a double or triple apical precordial impulse, a rapidly rising carotid arterial pulse, and a fourth heart sound.", "cop": 1, "opa": "HOCM", "opb": "Marfan syndrome", "opc": "Myocardial Infarction", "opd": "Valvular heart disease", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "1795b258-75b3-431c-bd20-0456eb467aae", "choice_type": "single"}
+{"question": "\"Setting Sun\" sign is seen in", "exp": "(A) Hydrocephalus # Setting sun sign:> Retraction of the upper lid without upgaze so that the iris seems to \"\"set\"\" below the lower lid; suggestive of neurologic damage in the newborn, but usually clears up without sequelae> The setting-sun phenomenon is an ophthalmologic sign in young children resulting from upward-gaze paresis. In this condition, the eyes appear driven downward, the sclera may be seen between the upper eyelid and the iris, and part of the lower pupil may be covered by the lower eyelid. Pathogenesis of this sign is not well understood, but it seems to be related to aqueductal distention with compression of periaqueductal structures secondary to increased intracranial pressure.> However, it can also be transiently elicited in healthy infants up to 7 months of age by changes of position or removal of light (benign setting-sun phenomenon). The benign form might represent immaturity of the reflex systems controlling eye movements.> When persistent, this sign is one of the most frequent markers of elevated intracranial pressure, appearing in 40% of children with hydrocephalus (of any cause) and in 13% of patients with ventriculoperitoneal shunt dysfunction. It is an earlier sign of hydrocephalus than enlarged head circumference, full fontanelle, separation of sutures, irritability or vomiting. Consequently, this sign is a valuable early warning of an entity requiring prompt neuroimaging and urgent surgical intervention.", "cop": 1, "opa": "Hydrocephalus", "opb": "Meningitis", "opc": "Brain abscess", "opd": "CNS tumor", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "5f132ae5-1b49-485a-a957-7e9d239c2a38", "choice_type": "single"}
+{"question": "Most common cause of pleural effusion in AIDS patients", "exp": "Ans. is 'a' i.e., Kaposi sarcoma Ophthalmological diseases The most common abnormal findings on fundoscopic examination are cotton wool spots. CMV retinitis is the most severe ocular complication and occurs when CD4 T-cells count is less than 50/ml. It typical presents as perivascular hemorrhage and exudae with Cottage-Cheese appearance. Acute retinal necrosis syndrome, also called progressive outer retinal necrosis (PORN) is caused by HSV and VZV Other manifestations are chorioretinitis by toxoplasma and P carinii, kaposi sarcoma of eyelid, and lymphoma.", "cop": 1, "opa": "Kaposi sarcoma", "opb": "TB", "opc": "Pneumocystis Jiroveci", "opd": "Mycoplasma", "subject_name": "Medicine", "topic_name": null, "id": "83fc2e10-f8ed-4274-bef7-aa57a86072e1", "choice_type": "single"}
+{"question": "The current drug of choice in paroxysmal Sypraventricular Tachycardia (PAVT ) is", "exp": "adenosine is the drug of choice for PSVT. Immediate electrical cardioversion is indicated if the arrhythmia is associated with hemodynamic collapse. Adenosine is the preferred drug in those patients in whom verapamil has failed or may cause adverse effects, such as those with hea failure or wide-complex tachycardia In most patients, the drug of choice for acute therapy is either adenosine or verapamil. The use of intravenous adenosine or the calcium channel blocker verapamil are considered safe and effective therapies for controlling SVTs Ref Harrison 20th edition pg 1465", "cop": 4, "opa": "Digoxin", "opb": "Dilantoin", "opc": "Propranolol", "opd": "Adenosine", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "227a228f-4e6d-49c8-bb59-a7c24add78c7", "choice_type": "single"}
+{"question": "In a patient with myocardial infraction the valvular lesion commonly seen in", "exp": "Reg Harrison 19 th ed pg 1524 The most common valvular lesion seen in MI is mitral regurgitation.", "cop": 2, "opa": "Aoic stenosis", "opb": "Mitral regurgitation", "opc": "Aoic regurgitation", "opd": "Septal defect", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "b3be0717-b777-46bd-933c-07078f5f0e7b", "choice_type": "single"}
+{"question": "Complications of lobar pneumonia does not include", "exp": null, "cop": 2, "opa": "Lung abscess", "opb": "Amyloidosis", "opc": "Suppurative arthritis", "opd": "Infective endocarditis", "subject_name": "Medicine", "topic_name": null, "id": "c221a31f-ae2c-4802-a7ef-aac9517b9261", "choice_type": "single"}
+{"question": "Cabergoline is the drug of choice for", "exp": "(C) Prolactinoma # Cabergoline:> Cabergoline is an ergot derivative.> FDA-approved for the treatment of hyperprolactinemia.> Cabergoline has been linked to valvular heart disease, an effect proposed to reflect agonist activity at the serotonin 5-HT2B receptor.> Dopamine agonist, bromocriptine mesylate, is often the initial drug of choice and may require high doses to achieve clinical improvement and shrinkage of prolactinomas.> It can lower the prolactin level in 70-100% of patients. While the evidence supporting the use of medication therapy first is largely based on uncontrolled observational studies, they do strongly support the use of these medications.> Agents other than bromocriptine have been used (Eg, Cabergoline, Quinagolide).> Cabergoline, in particular, probably is more effective and causes fewer adverse effects than bromocriptine. However, it is much more expensive.> Cabergoline is often used in patients who cannot tolerate the adverse effects of bromocriptine or in those who do not respond to bromocriptine.", "cop": 3, "opa": "Parkinsonism", "opb": "Alzheimer's disease", "opc": "Prolactinoma", "opd": "Galactorrhea", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "50e63c05-c3a8-4390-a65e-c8e96788d99e", "choice_type": "single"}
+{"question": "Mechanism of hypoxemia in asthma is", "exp": "Pathophysiology Airway hyper-reactivity (AHR) - the tendency for airways to narrow excessively in response to triggers that have little or no effect in normal individuals is integral to the diagnosis of asthma and appears to be related, although not exclusively, to airwayinflammation . Other factors likely to be impoant in the behaviour of airway smooth muscle include the degree of airway narrowing and neurogenic mechanisms. The relationship between atopy (the propensity to produce IgE) and asthma is well established and in many individuals there is a clear relationship between sensitisation and allergen exposure, as demonstrated by skin-prick reactivity or elevated serum-specific IgE. Common examples of allergens include house dust mites, pets such as cats and dogs, pests such as cockroaches, and fungi. Inhalation of an allergen into the airway is followed by an early and late-phase bronchoconstrictor response . Allergic mechanisms are also implicated in some cases of occupational asthma . In cases of aspirin-sensitive asthma, the ingestion of salicylates results in inhibition of the cyclo-oxygenase enzymes, preferentially shunting the metabolism of arachidonic acid through the lipoxygenase pathway with resultant production of the asthmogenic cysteinyl leukotrienes. In exercise-induced asthma, hyperventilation results in water loss from the pericellular lining fluid of the respiratory mucosa, which, in turn, triggers mediator release. Heat loss from the respiratory mucosa may also be impoant. In persistent asthma, a chronic and complex inflammatory response ensues, characterised by an influx of numerous inflammatory cells, the transformation and paicipation of airway structural cells, and the secretion of an array of cytokines, chemokines and growth factors. Examination of the inflammatory cell profile in induced sputum samples demonstrates that, although asthma is predominantly characterised by airway eosinophilia, neutrophilic inflammation predominates in some patients while in others scant inflammation is observed: so-called 'pauci- granulocytic' asthma. Ref Davidson edition23rd pg 568", "cop": 4, "opa": "Hypoventilation", "opb": "Diffusion decreased", "opc": "Shunting", "opd": "Ventilation perfusin mismatch", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "d5578ae7-8a16-4944-a3f0-d6c5304488e0", "choice_type": "single"}
+{"question": "The most impoant factor that influences the outcome of penetrating cardiac injuries is", "exp": "Multiple studies in the literature confirm that injuries to the coronary aeries are the most impoant factor in determining outcome after a penetrating cardiac injury. Tangential injuries are the least serious. Injury to a single chamber--even if comminuted--or to multiple chambers is less likely to be fatal than are injuries that involve a major coronary aery. ref - Harrisons 20th ed", "cop": 3, "opa": "Comminuted tear of a single chamber", "opb": "Multiple-chamber injuries", "opc": "Coronary aery injury", "opd": "Tangential injuries", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "6b890823-33c9-49f7-b68c-c1f58e51be8b", "choice_type": "single"}
+{"question": "Liver is darkly pigmented in", "exp": "Dubin Johnson syndrome\nAutosomal recessive\nLiver darkly pigmented.", "cop": 1, "opa": "Dubin Johnson syndrome", "opb": "Gilbert syndrome", "opc": "Rotor syndrome", "opd": "Crigler - Najar syndrome", "subject_name": "Medicine", "topic_name": null, "id": "ba0ae859-26ab-4d7b-b7ca-64aa24869e6f", "choice_type": "single"}
+{"question": "Obesity is associated with decreased risk of", "exp": "Answer- C. Osteoporosis", "cop": 3, "opa": "Hypeension", "opb": "Hyperuricemia", "opc": "Osteoporosis", "opd": "Hea disease", "subject_name": "Medicine", "topic_name": null, "id": "f0a5314c-e8b1-4663-bef2-fbec637dcdf1", "choice_type": "single"}
+{"question": "Shirmer's test is used to assess", "exp": "Answer is A (Greater superficial petrosal nerve): Shirmer's test is done to assess the integrity of Greater Superficial Petrosal Nerve (Branch of Facial Nerve) by assessing the Lacrimation function. Topographical Test for Facial Nerve Function Branch / Nerve assessed Shirmer's test Greater Superficial Petrosal Nerve (GSPN) Stapedial Reflex Accoustic Reflex Stapedial branch (Branch to stapedius) Electrogustometry (Taste testing) Chorda Tympani Branch Salivary Flow Rate Chorda Tympani Branch", "cop": 1, "opa": "Greater superficial petrosal nerve", "opb": "Stapedial branch", "opc": "Chorda tympani nerve", "opd": "Stylohyoid branch", "subject_name": "Medicine", "topic_name": null, "id": "94f59639-3aa4-4965-b881-de0a02f72a60", "choice_type": "single"}
+{"question": "Alternative parenteral drug for multi drug resistant malaria is", "exp": "Multidrug-resistant P. falciparum malaria : Either aemether-lumefantrinec (1.5/9 mg/kg bid for 3 days with food) or Aesunatec (4 mg/kg qd for 3 days) plus Mefloquine (25 mg of base/kg--either 8 mg/kg qd for 3 days or 15 mg/kg on day 2 and then 10 mg/kg on day 3) Aemisinin and derivatives (aemether, aesunate) : Good oral absorption, slow and variable absorption of IM aemether; aesunate and aemether biotransformed to active metabolite dihydroaemisinin; all drugs eliminated very rapidly; t1/2: <1 h (Harrison's Principles of internal medicine, 20th edition, page 1699)", "cop": 3, "opa": "Mefloquine", "opb": "Sulfamethoxazole", "opc": "Aemisinin", "opd": "Dihydroaemesin", "subject_name": "Medicine", "topic_name": "Infection", "id": "260a9d36-47fa-4529-83bb-5070ca355dd0", "choice_type": "single"}
+{"question": "Thyroid carcinoma associated with hypocalcemia is", "exp": "Answer is B (Medullary Carcinoma) Medullary carcinoma of thyroid secretes calcitonin and this causes reduction in calcium levels.", "cop": 2, "opa": "Follicular carcinoma", "opb": "Medullary carcinoma", "opc": "Anaplastic carcinoma", "opd": "Papillary carcinoma", "subject_name": "Medicine", "topic_name": null, "id": "8ba15321-64eb-47d5-8b73-6e9e087a39bc", "choice_type": "single"}
+{"question": "Massive haemoptysis in mitral stenosis originates from", "exp": "Ans. a (Pulmonary veins). (Ref. Harrison, Principles of Medicine, 18th ed./Chapter 237.)# Haemoptysis in mitral stenosis results from rupture of pulmonary-bronchial venous connections secondary to pulmonary venous hypertension.# It occurs most frequently in patients who have elevated LA pressure without marked increase in pulmonary venous resistance and is almost never fatal.# But as severity of MS pogresses, PVR increases or when TR/TS develops, episodes of edema and hemoptysis decrease in frequency and severity.# Recurrent pulmonary emboli, sometimes with infarction, are an important cause of morbidity and mortality rates late in the course of MS. Pulmonary infections, i.e., bronchitis, bronchopneumonia, and lobar pneumonia, commonly complicate untreated MS, especially during the winter months.# In general, the bronchial artery is the source of hemoptysis in about 90% of cases, and in remain ing 10% (who don't respond to BAE by polyvinyl alcohol), the source may be Rassmussen's aneurysm (arising from pulmonary arteries)# BAE is a life-saving interventional procedure for massive hemoptysis.", "cop": 1, "opa": "Pulmonary veins", "opb": "Pulmonary artery", "opc": "Bronchial veins", "opd": "Bronchial artery", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "f8b7b217-bcbc-4d29-a656-182f627bd3cc", "choice_type": "single"}
+{"question": "Severity of spreading of plague is detected by", "exp": "Cheopis index:- It is average number of X. Cheopis / rat.", "cop": 1, "opa": "Cheopis index", "opb": "Total Flea index", "opc": "Burrow's index", "opd": "Chandler's index", "subject_name": "Medicine", "topic_name": null, "id": "81e3f87b-fdb9-481c-b500-e537dcd2d3c1", "choice_type": "single"}
+{"question": "In type II respiratory failure, there is", "exp": null, "cop": 2, "opa": "Low pO2 and low pCO2", "opb": "Low pO2 and high pCO2", "opc": "Normal pO2 and high pCO2", "opd": "Low pO2 and normal pCO2", "subject_name": "Medicine", "topic_name": null, "id": "95d4207d-50a5-40d1-a494-06c7fd0339d3", "choice_type": "single"}
+{"question": "A 34 years old male patient presents with symptoms of headache nausea and vomiting and intermittent focal seizures. On investigation patient is diagnosed to be suffering from neurocysticercosis. Antiparasitic drug used in the management of these patients are given for a duration of", "exp": "Answer- A. 15 - 30 daysFor the treatment of patients with brain parenchl.mal cysticerci. most authorities or antiparasitic drugs, including albendazole (15 mdkgper dayforS-28 days) orpraziquantel (50-100 mdkgdailyinthree divideddoses for 15-30 days).", "cop": 1, "opa": "15 - 30 days", "opb": "60 - 90 days", "opc": "3 - 4 months", "opd": "6 months", "subject_name": "Medicine", "topic_name": null, "id": "6b107888-298e-4f12-a51f-948283719eee", "choice_type": "single"}
+{"question": "For the following explanations for hirsutism, select the most likely cause.Can be associated with anovulation, obesity, and amenorrhea.", "exp": "The most severe form of PCOD, Stein-Leventhal syndrome, is associated with chronic anovulation, hirsutism, enlarged cystic ovaries, obesity, and amenorrhea. The spectrum of disease, however, is quite wide, and some patients have only mild hirsutism.", "cop": 3, "opa": "drugs", "opb": "adrenal tumor", "opc": "polycystic ovarian disease (PCOD)", "opd": "idiopathic hirsutism", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "c32256eb-14e8-4ff1-b397-fb08560bfe51", "choice_type": "single"}
+{"question": "Remitting and relapsing features are associated with", "exp": "(A) Multiple Sclerosis # Classification of Multiple Sclerosis> Progression of MS subtypes> Several subtypes, or patterns of progression, have been described. Subtypes use the past course of the disease in an attempt to predict the future course. They are important not only for prognosis but also for therapeutic decisions. In 1996 the United States National Multiple Sclerosis Society standardized four subtype definitions Relapsing remitting Secondary progressive Primary progressive Progressive relapsing> Relapsing-remitting subtype is characterized by unpredictable relapses followed by periods of months to years of relative quiet (remission) with no new signs of disease activity. Deficits suffered during attacks may either resolve or leave sequelae, the latter being more common as a function of time.> This describes the initial course of 85-90% of individuals with MS.> When deficits always resolve between attacks, this is sometimes referred to as benign MS.> The relapsing-remitting subtype usually begins with a clinically isolated syndrome (CIS). In CIS, a patient has an attack suggestive of demyelination, but does not fulfill the criteria for multiple sclerosis.> However only 30 to 70% of persons experiencing CIS later develop MS.> Guillain-Barre syndrome is an acute inflammatory demyelinating polyneuropathy (AIDP), an autoimmune disorder affecting the peripheral nervous system, usually triggered by an acute infectious process. It is included in the wider group of peripheral neuropathies.", "cop": 1, "opa": "Multiple Sclerosis", "opb": "Guillain-Barre syndrome", "opc": "Parkinson's disease", "opd": "Subdural haematoma", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "7cde590a-aecb-4060-ac55-6ac3c06d4646", "choice_type": "single"}
+{"question": "The most common cause of sudden arrhythmic", "exp": null, "cop": 1, "opa": "Myocardial infarction", "opb": "Aortic stenosis", "opc": "Dilated cardiomyopathy", "opd": "Electrolyte abnormalities", "subject_name": "Medicine", "topic_name": null, "id": "910f982a-5f7b-49b3-a3bc-48cde930c1ab", "choice_type": "single"}
+{"question": "A Cluld brought with bleeding nostrils. H/o viral infection 3 months back & treated with aspirin. The diagnosis is", "exp": "(B) Reye's syndrome # Reye's syndrome is a rare and severe illness affecting children.> Reye's syndrome is associated with viral infection and aspirin use.> Patients with Reye's syndrome present with vomiting and mental-status changes.> Diagnosing Reye's syndrome primarily depends on the clinical history of symptoms.> Most common abnormal laboratory tests with Reye's syndrome include elevated liver enzymes, elevated ammonia levels, and low serum glucose levels.> Treatment is supportive, and even with treatment, severe cases result in permanent brain damage and death.", "cop": 2, "opa": "ITP", "opb": "Reyes syndrome", "opc": "Epistaxis", "opd": "DIC", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "fedb6219-0490-44a4-b10a-1949593b8dd3", "choice_type": "single"}
+{"question": "The most strongly implicated premalignant condition of the oral cavity is", "exp": "ConditionUsual locationClinical featuresCourseFordyce spotsBuccal and labial mucosaNumerous small yellowish spots just beneath the mucosa; no symptoms; due to hyperplasia of sebaceous glandsbenignErythroplakiaFloor of mouth in men; tongue and buccal mucosa in womenVelvety, reddish plaqueHigh risk for squamous cell cancerMedian rhomboid glossitisMedian posterior poion of tongueCongenital abnormality of tongue with ovoid, denuded areabenignErythema multiformeOral mucosa Intraoral ruptured bullae surrounded by inflammatory areas; lips may show hemorrhagic crustsNot a premalignant condition(Ref: Harrison's 18/e p217, table 32.1-32.4)", "cop": 2, "opa": "Fordyce spots", "opb": "Erythroplakia", "opc": "Median rhomboid glossitis", "opd": "Erythema multiforme", "subject_name": "Medicine", "topic_name": "All India exam", "id": "7c07a937-5c8c-4289-a6f7-14d994d2383a", "choice_type": "single"}
+{"question": "Xanthogranulomatous pyelonephritis is most often due to", "exp": "Xanthogranulomatous pyelonephritis occurs when a chronic urinary obstruction (often by staghorn calculi), together with chronic infection, leads to the suppurative destruction of renal tissue.Proteus infection is associated with staghorn formation.Ref: Harrison; 19th edition; Page no: 1033", "cop": 2, "opa": "E. coli", "opb": "Proteus", "opc": "Pseudomonas", "opd": "Klebsiella", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "20144664-568a-434d-b3da-c5810bb056d0", "choice_type": "single"}
+{"question": "Apart from dental caries, streptococcus mutans can cause", "exp": null, "cop": 1, "opa": "Endocarditis", "opb": "Food poisioning", "opc": "Urinary tract infection", "opd": "Pharyngitis", "subject_name": "Medicine", "topic_name": null, "id": "96d37d16-aed6-46d5-8896-c5e29b1b4a34", "choice_type": "single"}
+{"question": "These ECG changes are seen in ", "exp": "Electrocardiographic changes in hypokalemia include broad flat T waves, ST depression, prominent U waves (best seen in the precordial leads) and QT prolongation; these are most marked when serum K+ is <2.7 mmol/L. Ref: Harrison 19e pg: 307", "cop": 3, "opa": "Hyponatremia", "opb": "Hypernatremia", "opc": "Hypokalemia", "opd": "Hyperkalemia", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "3e71535a-de17-4f02-a41e-744fdefffa90", "choice_type": "single"}
+{"question": "Routine use of recombinant erythropoietin in patients of chronic kidney disease obtes the chances of", "exp": "Answer- A. Regular blood transfusionsRecombinant human EPO and modified EPO products, such as darbepoetin- alpha, has been one of the most significant advances in the care of renal patients since the introduction of dialysis and renal transplantation.The routine use of these products has obted the need for regular blood transfusions in severely anemic CKD patients.Frequent blood transfusions in dialysis patients also leads to the development of allo-antibodies that could sensitize the patient to donor kidney antigens and make renal transplantation difficult.Adequate bone marrow iron stores should be available before treatment with EPO is initiated.For patients on hemodialysis, IV iron can be administered during dialysis.", "cop": 1, "opa": "Regular blood transfusions", "opb": "Iron supplementation", "opc": "Dialysis", "opd": "Hyperkalemia", "subject_name": "Medicine", "topic_name": null, "id": "94eff78f-0758-4db4-adbb-33375535e9aa", "choice_type": "single"}
+{"question": "Increased serum amylase in pleural effusion is seen in", "exp": "(Malignancy) (269- CMDT-08) (1658-H17th)Serum amylase level in PE - suggest pancreatits, pancreatic pseudocyst, adenocarcinoma of the lung or pancreas or esophageal rupture, - MalignancyGlucose < 60 mg/ dL - occurs in Malignancy, Bacterial infections, Rheumatoid pleuriticIncreased amvlase acids are found in perforated duodenal ulcers acute cholecystitis. High intestinal obstruction, acute mesenteric vascular occlusion, DKA leaking aortic aneurysm, mumps, ectopic pregnancy after administration of narcotics, after abdominal surgery* Bacterial pneumonia and cancer are the most common cause of exudative effusion* High concentration of cholesterol in most rheumatoid effusions", "cop": 3, "opa": "Rheumatoid arthritis", "opb": "Tuberculosis", "opc": "Malignancy", "opd": "Pulmonary embolism", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "9b6f8e62-54e1-4b6d-9ec7-1acd174bdd71", "choice_type": "single"}
+{"question": "Antibody seen in neonatal Lupus with conduction abnormalities in heart", "exp": "Anti-Ro (SSa) - \nSubacute Cutaneous Lupus.\nNeonatal Lupus.\nCongenital heart block.", "cop": 2, "opa": "Anti-nuclear", "opb": "Anti-Ro", "opc": "Anti-La", "opd": "Anti-Histone", "subject_name": "Medicine", "topic_name": null, "id": "10334e19-a393-4b7a-b905-96c04390d985", "choice_type": "single"}
+{"question": "Strong correlation with colorectal cancer is seen in", "exp": "NON NEOPLASTIC POLYPSPOLYPSLOCATIONHISTOLOGICAL TYPERISK OF MALIGNANCYASSOCIATED LESIONSHyperplastic polypscolonHyperplastic colonic epithelial celssRareJuvenile polypsLarge and small intestine, stomachHamaomasrarePeutz jeghers syndromeJejunum(mainly)hamaomasrarePigmentation in the mouth.tumours of the ovary, breast, endometrium, and pancreas.NEOPLASTIC POLYPSTubular adenomatous polypsLarge and small intestine, stomachadenoma1-3%Villous adenomasLarge intestineadenoma40%Familial polyposis coliLarge intestineadenoma100%Gardner's syndromeLarge and small intestineadenoma100%Bone and soft tissue lesions, ampullary cancer, congenital hyperophy of pigment epitheliumTurcot's syndromeLarge intestineadenoma100%Brain tumors(Ref: Harrison's 18/e768,769,7770)", "cop": 2, "opa": "Peutz-Jegher's polyp", "opb": "Familial polyposis coli", "opc": "Juvenile polyposis", "opd": "Hyperplastic polyp", "subject_name": "Medicine", "topic_name": "All India exam", "id": "4bb4e158-6349-412c-b907-fe6639638608", "choice_type": "single"}
+{"question": "Trinucleotide repeat sequence defect is not seen in", "exp": "(B) Alzhiemer's disease # Alzheimer's disease (AD), also known simply as Alzheimer's, is a neurodegenerative disease that, in its most common form, is found in people over age 65. Approximately 24 million people worldwide have dementia of which the majority (-60%) is due to Alzheimer's.> The ultimate cause of Alzheimer's is unknown.> Genetic factors are clearly indicated as evidenced by dominant mutations in three different genes have been identified that account for the small number of cases of familial, early-onset AD.> For the more common form of late onset AD (LOAD), ApoE is the only clearly established susceptibility gene. All four genes can contain mutations or variants that confer increased risk for AD, but account for only 30% of the genetic picture of AD.> These four genes have in common the fact that mutations in each lead to the excessive accumulation in the brain of Ab, the main component of the senile plaques that litter the brains of AD patients> Huntington disease is caused by a defect in the gene (an inherited unit which contains a code for a protein) of unknown function called Huntington. The nucleotide codes (building blocks of genes arranged in a specific code which chemically forms into proteins), contain CAG repeats (40 or more of these repeat sequences).> The extra building blocks in the Huntington gene cause the protein that is made from it to contain an extra section as well. It is currently thought that this extra protein section, or portion, interacts with other proteins in brain cells where it occurs, and that this interaction ultimately leads to cell death.> The HD gene is a dominant gene, meaning that only one copy of it is needed to develop the disease. HD affects both males and females. The gene may be inherited from either parent, who will also be affected by the disease. A parent with the HD gene has a 50% chance of passing it on to each offspring. The chances of passing on the HD gene are not affected by the results of previous pregnancies.# Trinucleo Repeat Syndrome: Category I: Huntington disease and spinocerebellar ataxia Category II: Phenotypically diseases with expansions which all heterogenous small in magnitude but also found in exons of genes Category III: Fragile X syndrome, myotonic dystrophy, two of spirocerebellar ataxias, Juvenile myoclonic epilepsy, friedrich's ataxia. Have typically larger repeat expansions, located outside protein coding regions of genes.> Spinocerebellar ataxia type 2 is a minor cause of familial parkinsonism.", "cop": 2, "opa": "Huntington's chorea", "opb": "Alzhiemer's disease", "opc": "Freidrick's ataxia", "opd": "Fragile X-syndrome", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "2f30ee76-5c12-45ce-9dc9-88a829f2e9c7", "choice_type": "single"}
+{"question": "Sinus Bradycardia is defined as hea rate of", "exp": "Ans. is 'c' i.e., Less than 60/min", "cop": 3, "opa": "Less than 40/min", "opb": "Less than 50/min", "opc": "Less than 60/min", "opd": "Less than 70/min", "subject_name": "Medicine", "topic_name": null, "id": "0dcd6966-8f1d-40c4-8dc0-0efbf4b4bcf2", "choice_type": "single"}
+{"question": "JVP wave with absent y descent and prominent X wave is seen in", "exp": "JVP: the y descent is abolished due to an increase in intrapericardial pressure, preventing diastolic filling of the ventricles (cardiac tamponade causes an increase in both central venous pressure and pulmonary aery occlusion pressure). Cyanosis and pulmonary oedema may occur. Ref Davidson 23rd edition pg 334", "cop": 2, "opa": "Restrictive cardiomyopathy", "opb": "Cardiac tamponade", "opc": "Constrictive pericarditis", "opd": "Right ventricular failure", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "dabd4eea-758f-48b0-b0ad-dfc19d26f5a6", "choice_type": "single"}
+{"question": "Hypotonia with brisk tendon reflexes are seen in", "exp": "Ghai essential paediatrics 8th edition. *In hypotonic cerebral palsy despite pyramidal involvement patients are atonic or hypotonic. Tendon reflexes are normal or brisk and Babinski response is positive.", "cop": 1, "opa": "Hypotonic cerebral palsy", "opb": "GBS", "opc": "Spinal muscle atropy", "opd": "Infantile tremor", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "ce739159-735c-4e7d-8411-1f96b12c223f", "choice_type": "single"}
+{"question": "Persistent priapism is due to", "exp": "Ans. is 'a' i.e., Sickle cell anemia Priapism is defined as erection lasting for > 4 hours. Low-flow priapism may be due to any of the following: An excessive release of neurotransmitters Blockage of draining venules (eg, mechanical interference in sickle cell crisis, leukemia, or excessive use of intravenous parenteral lipids) Paralysis of the intrinsic detumescence mechanism Prolonged relaxation of the intracavernous smooth muscles (most often caused by the use of exogenous smooth-muscle relaxants such as injectable intra-cavernosal prostaglandin E I) Prolonged low-flow priapism leads to a painful ischemic state, which can cause fibrosis of the corporeal smooth muscle and cavernosal aery thrombosis. The degree of ischemia is a function of the number of emissary veins involved and the duration of occlusion", "cop": 1, "opa": "Sickle cell anaemia", "opb": "Hairy cell leukaemia", "opc": "Paraphimosis", "opd": "Urethral stenosis", "subject_name": "Medicine", "topic_name": null, "id": "fa03ce33-6fc7-4a15-8a71-6290fe45d06d", "choice_type": "single"}
+{"question": "A 12 years old girl with tremors and emotional liability has golden brown discolouration in escement's membrane. The most likely diagnosis", "exp": null, "cop": 2, "opa": "Fabry's disease", "opb": "Wilson's disease", "opc": "Glycogen storage disease", "opd": "Acute Rheumatic fever", "subject_name": "Medicine", "topic_name": null, "id": "9606058f-5992-4556-919d-ec9151355d89", "choice_type": "single"}
+{"question": "The diagnosis of gout is best established by the presence of", "exp": "Gout / Hyperuricemia Gout refers to the disease that occurs in response to the presence of monosodium urate (MSU) crystals in joints, bones, and soft tissues.Causes of GoutIncreased productionDecreased renal excretionHypoxanthine-guanine phosphoribosyltransferase (HGP) deficiencyPhosphoribosylpyrophosphate (PRPP) synthetase overactivityGlucose -6-phosphatase deficiencyMyeloproliferative disorderLymphoproliferative disorderMalignanciesHemolytic disorderPsoriasisObesityEthanol abuseExcessive dietary purine ingestionCytotoxic drugsInherited isolated renal tubular defectRenal failureLead poisoningDiabetic ketoacidosisLactic acidosisHypothyroidismDrugs- thiazides, pyrazinamide, cyclosporineClinical featuresDiagnosisAcute gout -ahritis ( MP joint of big toe), bursitis (olecranon bursa )Chronic gout - increase in frequency of acute gouty attacksTophi - collection of solid urate in connective tissues, irregular firm painless nontender nodules on extensor surfaces of finger, hand, and elbow.Polarizing microscopy - identification of monosodium urate crystals Histology - birefringent urate crystals on biopsy Elevated uric acid levels24-hour urinary uric acid excretion Radiology - narrowing of joint space, sclerosis, cysts, osteophytes & calcified tophi.Treatment:Acute attack - NSAIDsChronic stage - Allopurinol, Probenecid, benzbromarone Definitive diagnosis of gout requires aspiration of the involved joint and demonstration of intracellular monosodium urate crystals in synol fluid. Under polarized light, these are demonstrated as \"strongly negative birefringent needle-shaped crystals.\"(Refer: Harrison's Principles of Internal Medicine, 18th edition, pg no: 2836-2839)", "cop": 2, "opa": "Synol uric add crystals", "opb": "Intracellular uric acid crystals", "opc": "Elevated serum uric acid", "opd": "Involvement of the first metatarsal phalangeal joint", "subject_name": "Medicine", "topic_name": "All India exam", "id": "0f3af128-25e2-4000-8ad7-1b3078efe483", "choice_type": "single"}
+{"question": "Drug of Choice for absence seizure in children < 3 years of age is", "exp": "Answer- A. EthosuximideEthosuximide is the DOC for absence seizures in children below 3 years of age as Na valproate may cause fulminant hepatitis in children below 3 years of age. Broadly. Na valproate is the DOC for absence seizures.", "cop": 1, "opa": "Ethosuximide", "opb": "Carbamazepine", "opc": "Lamtrigine", "opd": "Phenytain", "subject_name": "Medicine", "topic_name": null, "id": "317dc19e-ae9b-4d18-8c77-31171ff78dbc", "choice_type": "single"}
+{"question": "Commonest presentation of MEN I", "exp": "Ans. a (Primary hyperparathyroidism) (Ref. H-17th/2359; 2361)# MEN1 is the most common multiple endocrine neoplasia syndrome.# Primary hyperparathyroidism is the most common manifestation of MEN1.# Parathyroid hyperplasia is the most common cause of hyperparathyroidism in MEN1.# Enteropancreatic tumors are the second most common manifestation of MEN1.# Gastrinomas are the most common enteropancreatic tumors observed in MEN 1.# Insulinomas are the second most common enteropancreatic tumors in patients who suffer from MEN 1.# MTC is the most common manifestation of MEN2A.MEN SYNDROMEMEN1 (Wermer's syndrome)MEN2Mixed SyndromesParathyroid hyperplasia or adenomaIslet cell hyperplasia, adenoma, or carcinomaPituitary hyperplasia or adenomaOther less common manifestations: foregut carcinoid, pheochromo- cytoma, subcutaneous or visceral lipomasMEN2AMTCPheochromocytomaParathyroid hyperplasia or adenomaMEN2A with cutaneous lichen amyloidosisMEN2A with Hirschsprung diseaseFamilial MTCMEN2BMTCPheochromocytomaMucosal and gastrointestinal neuromasMarfanoid featuresVon Hippel-Lindau syndromePheochromocytomaIslet cell tumorRenal cell carcinomaHemangioblastoma of central nervous systemRetinal angiomasNeurofibromatosis with features of MEN1 or 2Carney complexMyxomas of heart, skin, and breastSpotty cutaneous pigmentationTesticular, adrenal, and GH-producing pituitary tumorsPeripheral nerve schwannomas", "cop": 1, "opa": "Primary hyperparathyroidism", "opb": "Hyperprolactinemia", "opc": "Hypergastrenemia", "opd": "Acromegaly", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "120ca4a6-a2ff-4893-89fc-940578912262", "choice_type": "single"}
+{"question": "The following is an example of atypical antipsychotic", "exp": "K.D Tripathy essentials of medical pharmacology 7th edition . *atypical antipsychotics are olanzapine,clozapine,risperidone,quetiapine,aripiprazole *haloperidol belongs to butyrophenones antipsychotic *amitriptyline is TCAs *zuclopenthixol belongs to thioxanthene antipsychotics.", "cop": 1, "opa": "Olanzapine", "opb": "Haloperidol", "opc": "Amitriptyline", "opd": "Zuclopenthixol", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "1690e8a7-8f47-4f62-8fcd-cd8d4b302de0", "choice_type": "single"}
+{"question": "According to American Psychiatric Association, criteria for prolonged seizure after ECT, if the seizure lasts more than", "exp": "Answer- D. 180 secProlonged seizure is defined as one that lasts for more than 3 minutes\"\"Duration of more than 3 minutes is the criterion for prolonged seizures according to the American psychiatric association (1990)\"", "cop": 4, "opa": "140 sec", "opb": "150 sec", "opc": "160 sec", "opd": "180 sec", "subject_name": "Medicine", "topic_name": null, "id": "d6233904-9c88-45f4-90e1-b198b0e6220d", "choice_type": "single"}
+{"question": "Rheumatic activity involves mosfly......valves", "exp": "Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:147 Valve Involvement in Rheumatic Hea Disease Mitral valve alone 50% Aoic valve alone 15-20% Mitral and Aoic valves together 35-40% Mitral, Aoic and Tricuspid valves 2-3% Pulmonary valve is viually never involved. In RHD, mitral valve is most commonly involved followed by involvement of the aoic valve as the pressure gradient across the mitral valve is the greatest, followed by that across the aoic valve. So, the mitral valve is more susceptible to develop pathological changes than the aoic valve", "cop": 4, "opa": "Aoic & tricuspid", "opb": "Aoic & pulmonary", "opc": "Mitral & tricuspid", "opd": "Mitral & aoic", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "75af14c0-1bb8-4c84-a334-210540b1ddfa", "choice_type": "single"}
+{"question": "Risk factor for development of gastric Ca", "exp": "Risk factors are:Long-term ingestion of high concentration of nitrates.H.pyloriIntestinal metaplasia in patients with atrophic gastritis.Gastric ulcers and adenomatous polyps.Menetrier's disease.Patients with blood group A have a higher incidence of Ca stomach than blood group O.Note: duodenal ulcers are not associated with gastric cancer.", "cop": 4, "opa": "Blood group O", "opb": "Duodenal ulcer", "opc": "Intestinal hyperplasia", "opd": "Intestinal metaplasia type III", "subject_name": "Medicine", "topic_name": "All India exam", "id": "4b23f681-6ee3-4348-a110-2d93d9c2d3c5", "choice_type": "single"}
+{"question": "The vaccine currently used against hepatitis B infection is", "exp": null, "cop": 3, "opa": "Killed pooled serum", "opb": "Live attenuated", "opc": "Recombinant", "opd": "Synthetic vaccine", "subject_name": "Medicine", "topic_name": null, "id": "077d4a7e-0de2-4e29-b0e1-b116be33c1c2", "choice_type": "single"}
+{"question": "In MVP, you would expect the ejection click to be more accentuated and the murmur to move closer the first hea sound in a patient", "exp": "Anxiety, with an increase in hea rate or decreasing venous return to the hea (standing), causes the click and murmur to occur earlier in systole (closer to S1). Lying down, squatting, sustained hand grip exercise, or passive leg lifting in the supine position increase venous return and cause the click and murmur to occur later in systole (less gravity and more venous return). The diagnosis is best made by echocardiography. -adrenergic blocking agents are frequently used for treatment of supraventricular tachycardias. Calcium channel blockers are also used in symptomatic cases. Ref - Harrison's internal medicine 20e pg 1821,1697", "cop": 1, "opa": "With marked anxiety", "opb": "Who is pregnant", "opc": "Who is passive leg lifting in the supine position", "opd": "On a beta blocker", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "701710e5-217f-42c3-8bb4-2494f74a4094", "choice_type": "single"}
+{"question": "A patient presents with a cavitatory lesion in right upper lobe of Lung. The best investigation is", "exp": null, "cop": 1, "opa": "Branchoscopy, lavage and brushing", "opb": "C. T. scan", "opc": "X ray", "opd": "FNAC", "subject_name": "Medicine", "topic_name": null, "id": "c6faf1f6-248b-480c-b4a3-dd3f28de459c", "choice_type": "single"}
+{"question": "Reactivation of TB affects", "exp": "Reactivation of TB tends to involve apical and posterior segments of upper Lobe and Superior segments of lower lobe.", "cop": 2, "opa": "Anterior segment of upper Lobe", "opb": "Apical and posterior segments of upper Lobe", "opc": "Posterior segments of lower Lobe", "opd": "Posterior and inferior segments of lower lobe", "subject_name": "Medicine", "topic_name": null, "id": "b662cf66-c27d-4b76-992f-c4359efb24da", "choice_type": "single"}
+{"question": "Mill Wheel Murmur heard in case of", "exp": "Mill WHEEL murmur: constant machine like sound, late sign, heard over precordium heard in cases of air embolism.", "cop": 1, "opa": "Air embolism", "opb": "Aoic dissection", "opc": "Coarctation of aoa", "opd": "Abdominal aoic aneurysm", "subject_name": "Medicine", "topic_name": "All India exam", "id": "31e47470-33c8-49f5-9759-f51ca33d6d6e", "choice_type": "single"}
+{"question": "Hypokalemia is defined as a plasma potassium concentration of", "exp": "Hypokalemia, defined as a plasma K+ concentration of <3.5 mM, Hyperkalemia is defined as a plasma potassium level of 5.5 mM Ref: Harrison 19e pg: 305", "cop": 1, "opa": "< 3.5 mmol/L", "opb": "< 3.6 mmol/L", "opc": "< 3.7 mmol/L", "opd": "< 3.8 mmol/L", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "6023e7d9-19ba-4e59-a7c5-3d58ad2dee58", "choice_type": "single"}
+{"question": "Extradural haemorrhage is due to", "exp": "A. i.e. (Middle meningeal artery) (2597 - HI 7th)* Extradural (epidural) haemorrhageMiddle meningeal artery* Subdural haemorrhageSuperior cerebral artery vein* Sub arachnoid haemorrhageBerry aneurysm* Intracerebral haemorrhageHypertension* Contusions are easily visible on CT and MRI scans, appearing as in homogeneous hyperdensities On CT and as hyperintensities on MRI (2597 - HI7th).", "cop": 1, "opa": "Rupture of middle meningeal artery", "opb": "Rupture of anterior meningeal artery", "opc": "Rupture of posterior meningeal artery", "opd": "Rupture of middle cerebral artery", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "5e2f9e53-14b4-462b-912e-44bfc2ac4393", "choice_type": "single"}
+{"question": "Most sensitive method for detecting low density microfilaraemia", "exp": null, "cop": 3, "opa": "Mass blood survey", "opb": "DEC Provocation test", "opc": "Membrane filter concentration method", "opd": "Xenodiagnosis", "subject_name": "Medicine", "topic_name": null, "id": "d7448225-1b62-4ed5-9ffa-acc294862ab0", "choice_type": "single"}
+{"question": ". Angloid streaks occur in", "exp": "Angioid streaks are bilateral, narrow, irregular lines deep to the retina configured in a radiating fashion emanating from the optic disc, which result from breaks in a weakened Bruch's membrane. common associations is PEPSI: Pseudoxanthoma elasticum, Ehler-Danlos syndrome, Paget's disease of bone, Sickle cell disease and other hemoglobinopathies, Idiopathic. Ref Harrison20th edition pg 2456", "cop": 2, "opa": "Sturge-Weber's syndrome", "opb": "Sickle cell disease (SS)", "opc": "Pseudoexfoliation syndrome", "opd": "Septo-optic dysplasia", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "c1e6521c-12a5-45f7-b593-e1392b1c62af", "choice_type": "single"}
+{"question": "Most common cause of lung abscess", "exp": "Ans. is 'b' i.e., Oral Anaerobes According to Harrison Most nonspecific lung abscesses are presumed to be due to anaerobic bacteria.", "cop": 2, "opa": "Staph aureus", "opb": "Oral anaerobes", "opc": "Klebsiella", "opd": "Tuberculosis", "subject_name": "Medicine", "topic_name": null, "id": "a8e60412-926a-4b13-843c-7f3e08d3a6b3", "choice_type": "single"}
+{"question": "Patient came with complaints of Polydipsia, hypercalciurea, nephrolithiasis, metabolic alkalosis. Possible cause is", "exp": "Answer- A. Baters syndromeBater syndrome is an autosomal recessive disorder caused by mutation in gene coding for basolateral chloride channel (ClC-kb). There is loss of sodium, chloride, potassium and calcium in urine.The major clinical findings are hyponatremia, hypokalemia, polyurea, polydipsia, metabolic alkalosis, normal to lowBP, hypomagnesemia (only in some patients), hypochloremia, hypercalciuria (causing nephrocalcinosis), and growth", "cop": 1, "opa": "Baters syndrome", "opb": "Gittlemans syndrome", "opc": "Addisons disease", "opd": "Chronic diuretic use", "subject_name": "Medicine", "topic_name": null, "id": "ea554870-34ff-4fde-b59d-f05a9e1ddaf3", "choice_type": "single"}
+{"question": "'C' wave in JVP is due to", "exp": "Ans. is 'b' i.e., Tricuspid valve bulging into right atrium The Jugular venous pulse (JVP) reflects phasic pressure changes in the right atrium and it consists of three positive waves and two negative troughs.It will be useful to keep in mind the events of the cardiac cycle while evaluating Jugular venous pulse.JUGULAR VENOUS PULSE. a waveIt is the positive presystolic wave produced by right atrial contraction.x descenta wave is followed by the negative systolic wave the 'x' descent.The x descent is produced due to atrial relaxation Q.The atrial relaxation is produced as a result of ventricular contraction.c waveThe x descent is interrupted by second positive wave the 'c' wave.It is produced by bulging of the tricuspid valve into the right atrium Q during RV isovolumetric contraction.v waveIt is the positive systolic wave.It result from increase in the blood volume in the vena cava during systole, when the tricuspid valve is closed Q.y descentFollowing the \"v wave\" this is a negative descending limb referred to as the y descent or diastolic collapse Q.It is due to tricuspid valve opening and rapid inflow of blood into the right ventricle.So there areThree visible major positive waves (a, c and v) andTwo negative waves (x and y).", "cop": 2, "opa": "Atrial contraction", "opb": "Tricuspid valve bulging into right atrium", "opc": "Right atrial filling", "opd": "Rapid ventricular filling", "subject_name": "Medicine", "topic_name": "General", "id": "fa2d1a70-f610-4706-b14e-e9dd9e69f31f", "choice_type": "single"}
+{"question": "Most common site of intracranial hemorrhage is", "exp": "The most common locations of hypeensive ICH are: 1) Basal ganglia (putamen or caudate), 2) Thalamus, 3) Pons and 4) Cerebellum. Within the basal ganglia region, it is rare for an ICH to specifically affect one area; Ref Harrison20th edition pg 2334", "cop": 1, "opa": "Basal ganglia", "opb": "Brainstem", "opc": "Cerebellum", "opd": "Hippocampus", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "46a9e800-f3b1-461d-a949-fea43b185a59", "choice_type": "single"}
+{"question": "A crisis in a patient with sickle cell disease is most likely to be caused by", "exp": "A crisis in sickle cell disease occurs when deoxygenated HbS precipitates, deforming (sickling) red blood cells and .blocking capillaries. Variables that increase the propoion of ofHbS in the \"deoxy\" state tend to increase the probability of a crisis by increasing the extent of sickling. The \"deoxy\" form of hemoglobin is ored by a decrease in pH (acidosis). An increase in pH (alkalosis), increased oxygen concentration, decreased CO2 concentration and decreased 2,3-bisphosphoglycerate concentration would all or the\" oxy\" form of hemoglobin. Ref - Harrison's internal medicine 20e pg 692-93", "cop": 2, "opa": "Alkalosis", "opb": "Acidosis", "opc": "Increased oxygen concentration", "opd": "Decreased CO2 concentration", "subject_name": "Medicine", "topic_name": "Haematology", "id": "ebbfc0ca-0d1e-45c1-a118-2c73bbfbf13d", "choice_type": "single"}
+{"question": "The number of cafe au lait macules as one of the diagnostic criteria for adult neurofibromatosis is", "exp": "Answer- D. 6l.5 cm orlarger in individuals past pubey0.5 cm or larger in individuals before pubey.", "cop": 4, "opa": "1", "opb": "2", "opc": "4", "opd": "6", "subject_name": "Medicine", "topic_name": null, "id": "be91d67b-32ac-4b34-b0a0-3d77b2ac81c9", "choice_type": "single"}
+{"question": "Dose of streptokinase to be used in MI is", "exp": "Ref Harrison 19 th ed pg 758 The adult dose of streptokinase for acute myocardial infraction is 1.5 million units IV over 60 minutes .", "cop": 2, "opa": "0.15 million units", "opb": "1.5 million units", "opc": "15 millions units", "opd": "150 million units", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "5bd16ca8-b1ae-4e6c-8964-60bc2d2d4fe5", "choice_type": "single"}
+{"question": "Anticoagulant used for osmotic fragility test", "exp": "Heparin - osmotic fragility test.\nEDTA - Blood cell counts.\n3.2% trisodium citrate - ESR, platelet studies.", "cop": 3, "opa": "EDTA", "opb": "3.2 % Trisodium citrate", "opc": "Heparin", "opd": "Warfarin", "subject_name": "Medicine", "topic_name": null, "id": "8958881e-c46e-4fd8-82ef-54b3b4529449", "choice_type": "single"}
+{"question": "Carcinoid syndrome produces valvular disease primarily of the", "exp": "Answer is B (Tricuspid valve); The most common site of involvement is the - Ventricular surface of Tricuspid valve. 'Cardiac manifestations in carcinoid syndrome are due to fibrosis involving the endocardium, primarily on the right side although left side lesions also occur. Dense fibrous deposits are most commonly on the ventricular aspect of the tricuspid valve and less commonly on the pulmonary valve cusps.' They can result in either constriction of valves (stenosis) or fixation of valves in open (regurgitation) - Abnormality produced due to tricuspid valve involvement - Tricuspid regurgitation Q - Abnormality produced due to pulmonary valve involvement - Pulmonary stenosis Q", "cop": 3, "opa": "Venous valves", "opb": "Tricuspid valve", "opc": "Mitral valve", "opd": "Aoic valve", "subject_name": "Medicine", "topic_name": null, "id": "ff6336be-790d-4bb2-b5d2-1e16bcd4f8ac", "choice_type": "single"}
+{"question": "Perioperative respiratory failure is", "exp": "TYPE III RESPIRATORY FAILUREThis form of respiratory failure results from lung atelectasis. Because atelectasis occurs so commonly in the perioperative period, this form is also called perioperative respiratory failure. After general anaesthesia, decreases in functional residual capacity lead to the collapse of dependent lung units. Such atelectasis can be treated by frequent changes in position, chest physiotherapy, upright positioning, and control of incisional and/or abdominal pain.Noninvasive positive-pressure ventilation may also be used to reverse regional atelectasis.Harrison 19e pg:1732", "cop": 3, "opa": "Type I respiratory failure", "opb": "Type II respiratory failure", "opc": "Type III respiratory failure", "opd": "Type IV respiratory failure", "subject_name": "Medicine", "topic_name": "All India exam", "id": "1162576e-466b-44dc-82f4-15106e2794fd", "choice_type": "single"}
+{"question": "Plasmapheresis is treatment of choice for", "exp": null, "cop": 3, "opa": "Henoch scholien purpura", "opb": "Wegener's granulomatosis", "opc": "Good Pasture's syndrome", "opd": "Acute renal transplant rejection", "subject_name": "Medicine", "topic_name": null, "id": "e4e4fdd0-4ad8-4371-926d-c15adf07665f", "choice_type": "single"}
+{"question": "Antibodies to calcium channel are seen in", "exp": "Lambe-Eaton syndrome presents with proximal muscle weakness that improves with exercise & is caused by the development of antibodies to presynaptic calcium channels. Myasthenia gravis is autoimmune disease caused by the development of antibodies to postsynaptic acetylcholine receptors.Polymyositis & Dermatomyositis are related disorders that are characterised by an inflammatory process affecting skeletal muscle. In dermatomyositis,characteristic skin changes also occur. Davidson's Medicine-22nd edition,page no:272,1114,1226,1227", "cop": 1, "opa": "Eaton lambe syndrome", "opb": "Dermatomyositis", "opc": "Myaesthenia gravis", "opd": "Polymyositis", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "8b1c6faf-065d-415e-bb0b-1b992d7ab3bf", "choice_type": "single"}
+{"question": "Find the disease by analysing pedigree chart.", "exp": "Rule of dominance - If the child is diseased, one of the parent must be diseased.\nRule of X-linked - Father never transmits to son.\nIn the image - Father transmits to son.\nCrouzon syndrome is autosomal dominant.", "cop": 4, "opa": "Sickle cell anaemia", "opb": "Diabetes insipidus", "opc": "Hunter syndrome", "opd": "Crouzon syndrome", "subject_name": "Medicine", "topic_name": null, "id": "39f0e60a-e0f0-49fa-9b22-6913012ef747", "choice_type": "single"}
+{"question": "Lymphnode metastasis is seen with", "exp": "Stages II and III soft tissue sarcoma They tend to grow and spread quickly. Some stage III tumors have already spread to nearby lymph nodes. Even when these sarcomas have not yet spread to lymph nodes, the risk of spread (to lymph nodes or distant sites) is very high Ref Harrison 20th edition pg 543", "cop": 4, "opa": "Liposarcoma", "opb": "Neurofibrosarcoma", "opc": "Histiocytoma", "opd": "Angiosarcoma", "subject_name": "Medicine", "topic_name": "Oncology", "id": "65cdcd80-9f2e-4267-80f2-956c2dd440bf", "choice_type": "single"}
+{"question": "In Beta thalassemia, the most common gene mutation is", "exp": "Ans. is 'a' i.e., Intron 1 inversion Thalassemias are autosomal recessive disorder The most common mutation causing 13 thalassemias is intron/inversion Also know: Synthesis of alpha chain is controlled by 2 gene clusters on - Chromosome 16 Synthesis of beta chain is controlled by 2 gene clusters on - Chromosome 11 Thalassemia mutations in India Multations Frequency IVS1-5 (G -->C) 48% 619 bp defection 18% IVS-1 (G T) 9% FR41/42(TCTT) 9% FR8/9 (+G) 5% Codonl5 (G --> A) 6% Others 100%", "cop": 1, "opa": "Intron 1 inversion", "opb": "Intron 22", "opc": "619 bp deletion", "opd": "3.7 bp deletion", "subject_name": "Medicine", "topic_name": null, "id": "12ec877b-e783-40af-aa92-f05bae1dd707", "choice_type": "single"}
+{"question": "Treatment of asymptomatic bradycardia is", "exp": "Ans. is 'a' i.e., No treatment is required", "cop": 1, "opa": "No treatment is required", "opb": "Give atropine", "opc": "Isoprenaline", "opd": "Cardiac pacing", "subject_name": "Medicine", "topic_name": null, "id": "96b207a4-f971-420d-b57f-1f4a37492dab", "choice_type": "single"}
+{"question": "A 30 year old patient presents with odynophagia, there no h/o drug intake. On endoscopy there are multiple ulcers in the esophagus diagnosis is", "exp": null, "cop": 2, "opa": "Cytomegalo virus infection", "opb": "Herpes simplex virus infection", "opc": "Candidiasis", "opd": "Achalasia.", "subject_name": "Medicine", "topic_name": null, "id": "3dddfd8a-1198-4d31-82ce-28058e3bc1c1", "choice_type": "single"}
+{"question": "In a patient with cystic fibrosis, high fever with productive cough. Most common causative organism is", "exp": "Pseudomonas aeruginosa is the key bacterial agent of cystic fibrosis (CF) lung infections, and the most impoant pathogen in progressive and severe CF lung disease. Once these sticky biofilms are formed, inflammation results and, in some cases, leads to chronic infections that can last for months or years with productive cough and fever Ref Robbins 9/e pg 178", "cop": 1, "opa": "Pseudomonas aerugenosa", "opb": "H influenzae", "opc": "Staph aureus", "opd": "Streptococcus", "subject_name": "Medicine", "topic_name": "Genetics", "id": "55b4e2ce-1d40-4be2-a923-5404674e5059", "choice_type": "single"}
+{"question": "Most common cause of hematochezia in children is", "exp": "Serious causes of hematochezia in the neonate include necrotizing enterocolitis and midgut volvulus. A wide variety of causes of hemorrhage occur as children grow older. Causes relatively unique to children are intussusception, Meckel's diveiculum, and juvenile polyps Ref Davidson edition23rd pg 809", "cop": 2, "opa": "Rectal polyp", "opb": "Meckel's diveiculum", "opc": "Necrotizing enterocolitis", "opd": "Acute gastritis", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "9cf5ec31-ad91-4a79-83ec-d5efaf40c222", "choice_type": "single"}
+{"question": "Round pneumonia is seen with", "exp": "Ans. is 'a' i.e., Streptococcal pneumonia Grainger & Allison's Diagnostic Radiology Essentials (Elsevier Health Sciences) 2013/38; ('MDT 2014 270] Streptococcus Pneumoniae (pneumococcus) is the most common organism responsible for round pneumonia. Round Pneumonia is a spherical pneumonia that is usually seen in children due to the lack of collateral air drift. Streptococcus Pneumoniae (pneumococcus) is the most common organism responsible for round pneumonia. Round pneumonias are impoant as they may simulate a tumor mass from which they must be differentiated", "cop": 1, "opa": "Streptococcal pneumonia", "opb": "Kerosene oil aspiration", "opc": "Lung cancer", "opd": "Mendelson syndrome", "subject_name": "Medicine", "topic_name": null, "id": "662f5c93-b88d-49a5-afc0-2fcda7d58a60", "choice_type": "single"}
+{"question": "Patients with atrial fibrillation have", "exp": null, "cop": 2, "opa": "Regular irregular pulse", "opb": "Irregularly irregular pulse", "opc": "Anacrotic pulse", "opd": "Pulsus alternans", "subject_name": "Medicine", "topic_name": null, "id": "fbc4f88b-cbe0-4738-bbda-8bd7d963a480", "choice_type": "single"}
+{"question": "In an old patient, the best indicator of probability of developing cardiovascular disease can be calculated by", "exp": "Good cholesterol ratio vs. bad cholesterol ratio High-density lipoprotein, or HDL, is considered \"good\" cholesterol. It makes up 20-30 percent of a person's total cholesterol level. Low-density lipoprotein, or LDL, is considered \"bad\" cholesterol and makes up 60-70 percent of the total in the body. A high HDL cholesterol number lowers your risk for coronary hea disease. A high LDL cholesterol number raises your risk for coronary hea disease. By comparing your total cholesterol number with your HDL cholesterol number, your healthcare provider can get another number called your total-cholesterol-to-HDL ratio Ref Davidson 23rd edition pg 556", "cop": 1, "opa": "LDL/HDLratio", "opb": "Triglycerides", "opc": "Total cholesterol", "opd": "Serum LDL", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "758c2b8f-55f4-46d3-8618-502cd2797e64", "choice_type": "single"}
+{"question": "In essential lhypeension the drug prescribed with least cardiovascular effect", "exp": "Aldosterone Antagonists Spironolactone is a nonselective aldosterone antagonist that may be used alone or in combination with a thiazide diuretic. It may be a paicularly effective agent in patients with low-renin essential hypeension, resistant hypeension, and primary aldosteronism. ref:Harrison&;s principles of internal medicine,ed 18,pg no 3079", "cop": 4, "opa": "Clonidine", "opb": "Alpha blocker", "opc": "Beta blocker", "opd": "ACE inhibitor", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "e7182257-9ada-4342-94fd-bc225ff2ba64", "choice_type": "single"}
+{"question": "A Myocardial infarcted patients presented with nausea, vomiting, epigastric pain, with bradycardia. ECG records first degree heart block infraction. Most common involvment is", "exp": "(Right coronary artery) (315- CMDT-08) (320- Harsh Mohan 5th) (1533-H17th)* Belching or vomiting and bradycardia is usually associated with Inferior wall infarction**1.Stenosis of the left anteriorMost common (40-50%), region of infarction descending coronary arteryis Anterior part of the left ventricle**including the apex and the anterior 2/3 of interventricular septum2.Stenosis of the right coronary artery30 - 40% - Involves Posterior {Inferior)Bmd the posterior 1/3 of the interventricular septum3.Stenosis of the left circumflex15-20% - Involves lateral wall of the left coronary arteryVentricle", "cop": 2, "opa": "Left anterior descending artery", "opb": "Right coronary artery", "opc": "Oblique artery", "opd": "Left circumflex coronary artery", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "1537096e-b8ce-4b05-8e1d-ee517467c33a", "choice_type": "single"}
+{"question": "Caplan's syndrome of rheumatoid arthritis with pneumoconiosis is characterized by", "exp": "Ans. a (Lung nodules and diffuse pulmonary fibrosis). (Ref. Harrison, Medicine, 16th ed., 1524)CAPLAN'S SYNDROME# Caplan's syndrome is characterized by triad of- Pulmonary nodules,- Pneumoconiosis (progressive massive fibrosis), and/in- Rheumatoid disease (seropositive).# The immuno-pathological mechanism involves:- Direct cytotoxicity of inorganic dust- Stimulation of reactive oxygen- Activation of macrophages to produce cytokines and TNF alpha (fibrogenic factor)- Increased protease activity- Increased activation of alpha 1 antitrypsin and leucocyte elastase activity.", "cop": 1, "opa": "Lung nodules and diffuse pulmonary fibrosis", "opb": "Bilateral symmetrical lung cavitations with pulmonary fibrosis.", "opc": "Air-space consolidation with patchy pulmonary fibrosis.", "opd": "Interstitial pneumonitis with hilar adenopathy.", "subject_name": "Medicine", "topic_name": "Immunology and Rheumatology", "id": "1e31e21c-6733-43c3-949d-6fd1ac0bc151", "choice_type": "single"}
+{"question": "Serum ACE levels are reduced in", "exp": "(B) COPD# Elevated levels of ACE are found in sarcoidosis, and are used in diagnosing and monitoring this disease.> Elevated levels of ACE are also found in leprosy, hyperthyroidism, acute hepatitis, primary biliary cirrhosis, diabetes mellitus, multiple myeloma, osteoarthritis, amyloidosis, Gaucher disease, pneumoconiosis, histoplasmosis, miliary tuberculosis.> Serum levels are decreased in renal disease, obstructive pulmonary disease, and hypothyroidism.", "cop": 2, "opa": "Sarcoidosis", "opb": "COPD", "opc": "DM", "opd": "Hisoplasmosis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f61d36a7-c03e-404d-b7d7-b15da3c094cf", "choice_type": "single"}
+{"question": "Gorlins formula is used to calculate", "exp": "Answer-A. Area of stenotic aoic valveThe stenotic valve orifice are is derived fromthe pressure gradient and cardiac output with the formula developed by Gorlin and Gorlin, which involves the fundamental hydraulic relationships, linking the a.ea of an orifice to the flow and pressure drop across the orifice.", "cop": 1, "opa": "Area of stenotic aoic valve", "opb": "Amount of daily calorie intake", "opc": "Body mass index", "opd": "Basal metabolic rate", "subject_name": "Medicine", "topic_name": null, "id": "c0520222-c126-4a9d-a2b4-cd9285d8e734", "choice_type": "single"}
+{"question": "The most common type of Glomerulonephritis occurs in HIV infection is", "exp": "(A) FSGS GLOMERULONEPHRITISCINICAL FEATURESETIOLOGY* ADP-GN* Nephritic syndrome* Post-streptococcal (2/3rd cases)Diffuse proliferative GN* Gross hematuria + edema + hypertension* Leprosy, ABE, SBEAcute GN* Oliguria* RBC cast: most specific* RPGN (Crescentic GN)* Sub acute RF* Nephritic syndrome* Complement level Normal* Respiratory symptoms (hemoptysis in GPS)* RPGN Type* I - Idiopathic, Goodpasture syndrome* II-ldiopathic, SLE, post infectious* III-WG, PAN Churg-Strauss syndrome* Minimal Change Disease (MCD) (Lipoid nephrosis/Nil deposit disease)* Lipiduria and lipid cast in urine* Membranous GN (Hymmens GN)* Most common cause of Nephrotic syndrome in children* Good response to steroids* Most common cause of Nephrotic syndrome in adults* Idiopathic drugs (Rmp, NSAIDS,* IRON-dextran, IFN-a) HIV* Idiopathic (in primary)* SLE and infections (HBV, HCV, Syphilis, P. malariae)* Drugs (penicillamine Gold, Captopril, NSAIDS)* Membranoproliferative GN (MPGN) Mesangiocapiilary GN* Nephrotic (type-I)* Type-II associated with partial lipodystrophy,* Hypocomplementamia* MPGN Type-I (H.o recent URI)* MPGN type-II (dense deposit ds)* MPGN type-III", "cop": 1, "opa": "FSGS", "opb": "RPGN", "opc": "ADP-GN", "opd": "MPGN", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "63a3532b-aa46-4f77-9d24-11c35067f829", "choice_type": "single"}
+{"question": "A patient underwent Bhadrenalectomy in views of B/L pheochromocytoma 1 day later developed lethargy fatigue low BP and pulse normal No signs of volume deficit likely course", "exp": "ref harissons 21st ed", "cop": 1, "opa": "Addisonian Crisis", "opb": "SIADH", "opc": "DI", "opd": "Cerebral salt wasting DISEASE", "subject_name": "Medicine", "topic_name": "Haematology", "id": "6e1263bf-4a76-47f9-aaf0-f11fbd8fdf32", "choice_type": "single"}
+{"question": "The most common cause of embolic stroke", "exp": "Ans. is 'a' i.e., Non rheumatic atrial fibrillation No rheumatic atrial fibrillation leads to clot formation in left atrial appendage that can embolize to the brain leading to neurological dificits", "cop": 1, "opa": "Non rheumatic atrial fibrillation", "opb": "Carotid aery atherosclerosis", "opc": "Paradoxical embolism", "opd": "LV aneurysm", "subject_name": "Medicine", "topic_name": null, "id": "6d54941e-b50c-4c96-a8a4-e30039d1d909", "choice_type": "single"}
+{"question": "Intention tremor is seen in", "exp": "(B) Cerebellar disease > The degree of tremor should be assessed in four positions. The tremor can then be classified by which position most accentuates the tremor.TREMORSTypeEssential TremorResting TremorPhysiologic (Postural) TremorCharacteristicsAppearing or Worsening at onset of movementAppearing in Rest, vanishing in movementAppearing in a Static stateEtiologyWilson Disease: FamiliarParkinson Disease,Parkinson Plus SyndromesAnxietiesTherapyPropranolol, Primidon, Gabapentin, AtenololDopamin Agonists, Levodopa, Amantadin, DBS (Vim, Zona Incerta)Propranolol, Clonazepam", "cop": 2, "opa": "Head injury", "opb": "Cerebellar disease", "opc": "Parkinsonism", "opd": "Wilson's disease", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "dafa928e-e284-4df0-8a06-f3a3671f8ae6", "choice_type": "single"}
+{"question": "On the basis of BMI obesity is labeled at", "exp": "Body mass index (BMI) or Quetelet index:Defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2BMIWeight status< 18.5 Underweight18.5-24.9 Healthy25.0-29.9Overweight>= 30.0Obese30.00-34.99 Obese class I35.00-39.99 Obese class II>= 40 Obese class IIIRef: Harrison's 18/e p608, 622, 630", "cop": 3, "opa": "20", "opb": "25", "opc": "30", "opd": "18", "subject_name": "Medicine", "topic_name": "All India exam", "id": "5427f97d-40f6-4a32-b617-db9de0c864d7", "choice_type": "single"}
+{"question": "Comment on presentation of this patient.", "exp": "Chunky pink gelatinous plug in sputum - Pulmonary alveolar proteinosis Blood in the sputum - Angioinvasive A.nigar Hamman crunch sign - associate with pneumothorax/ pneumomediastinum Horner syndrome - associate with Pancoast tumor Fungal ball Aspergilloma - A. Nigar CT- | Angioinvasive | So, Blood in sputum", "cop": 2, "opa": "Chunky pink gelatinous plugs in sputum", "opb": "Blood in the sputum", "opc": "Horner syndrome with wasting of intrinsic muscles of hand", "opd": "Hamman Crunch sign with subcutaneous emphysema", "subject_name": "Medicine", "topic_name": "Pleural effusion & Pulmonary alveolar proteinosis", "id": "53a43c48-2aee-446d-ab3d-42038760851b", "choice_type": "single"}
+{"question": "Restrictive and constrictive pericarditis occurs together in", "exp": "Ans. is 'a' i.e., Radiation", "cop": 1, "opa": "Radiation", "opb": "Adriamycin", "opc": "Amyloidosis", "opd": "Post cardiotomy syndrome", "subject_name": "Medicine", "topic_name": null, "id": "0d2a85b6-a7db-4f65-861b-d5198a5fa751", "choice_type": "single"}
+{"question": "Dyslipidemia associated with alcohol consumption", "exp": null, "cop": 2, "opa": "Decreased HDL", "opb": "Increased HDL", "opc": "Decreased triglycerase", "opd": "Decreased lipoprotein", "subject_name": "Medicine", "topic_name": null, "id": "3639e2a6-9c7a-4e05-a2d1-b2fae973626a", "choice_type": "single"}
+{"question": "The characteristic \"sulfur grains\"of actinomycosis are composed chiefly of", "exp": null, "cop": 1, "opa": "Organisms", "opb": "Neutrophils and monocytes", "opc": "Monocytes and lymphocytes", "opd": "Eosinophils", "subject_name": "Medicine", "topic_name": null, "id": "b8fee47a-5b07-472a-bf12-a5388a1d68ea", "choice_type": "single"}
+{"question": "Fractional excretion of sodium (FENa) is calculated as", "exp": "The fractional excretion of sodium (FeNa) is the fraction of the filtered sodium load that is reabsorbed by the tubules FENa relates sodium clearance to creatinine clearance. As such, it depends on sodium intake, effective intravascular volume, GFR, diuretic intake, and intact tubular reabsorptive mechanisms. With prerenal azotemia, the FeNa may be below 1%, suggesting avid tubular sodium reabsorption. FENa may be >1.0% in prerenal ARF if patients are on diuretics or with pre-existing CKD, salt-wasting syndromes or adrenal insufficiency. Ref: Harrison 19e 1807", "cop": 4, "opa": "x 100", "opb": "x 100", "opc": "x 100", "opd": "x 100", "subject_name": "Medicine", "topic_name": "Kidney", "id": "d6def6af-e0e0-42f4-a227-7084ca04f77b", "choice_type": "single"}
+{"question": "The drug of choice for the treatment of Pneumocystis jiroveci (Pneumocystis carinii) pneumonia is", "exp": null, "cop": 2, "opa": "Lamivudine", "opb": "Cotrimoxazole (TMP-SMX)", "opc": "Doxycycline", "opd": "Itraconazole", "subject_name": "Medicine", "topic_name": null, "id": "bacb17e7-5177-4c22-a000-572d281d8ad5", "choice_type": "single"}
+{"question": "The treatment for CNS leukaemia is", "exp": "Intrathecal methotrexate is a chemotherapy drug which is given to prevent leukaemia cells entering the cerebrospinal fluid (CSF) around the spine and brain. This drug is also used to treat leukaemia found in the CSF for CNS leukemias Ref Davidson 23rd edition pg 788", "cop": 1, "opa": "Intrathecal methotrexate", "opb": "Vincristine and prednisolone", "opc": "Intrathecal vincristine", "opd": "IV prednisolone", "subject_name": "Medicine", "topic_name": "Haematology", "id": "05b56ce8-295f-456e-afaf-e5007d62e33a", "choice_type": "single"}
+{"question": "Serum amylase level is raised in A/E", "exp": null, "cop": 3, "opa": "Blocked salivary duct", "opb": "Ruptured ectopic", "opc": "Appendicitis", "opd": "Pancreatitis", "subject_name": "Medicine", "topic_name": null, "id": "37799ff2-585f-44b4-b0a1-6f944731ad68", "choice_type": "single"}
+{"question": "Fatal complication of sodium polystyrene sulfonate", "exp": "Intestinal necrosis, typically of colon or ileum is a rare but fatal complication of Sps.", "cop": 4, "opa": "Cardiac arrest", "opb": "Stroke", "opc": "Respiratory depression", "opd": "Intestinal necrosis", "subject_name": "Medicine", "topic_name": null, "id": "08dffe12-087b-42a9-a881-8e8816cbc06b", "choice_type": "single"}
+{"question": "In relation to type 1A DM, honeymoon period is", "exp": "After the initial clinical presentation of type 1 DM, a \"honeymoon\" phase may ensue during which time glycemic control is achieved with modest doses of insulin or, rarely, insulin is not needed.However, this fleeting phase of endogenous insulin production from residual beta cells disappears and the individual becomes insulin deficient.Ref: Harrison 19e pg: 2403", "cop": 2, "opa": "Glycemic control achieved by OHA", "opb": "Insulin requirement is nil or modest", "opc": "Weight gain after insulin treatment", "opd": "Weight loss after insulin treatment", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "fa6da342-fc57-4920-887d-10a0b3630c50", "choice_type": "single"}
+{"question": "Drug of choice associated with pheochromocytoma", "exp": "Drugs used in management of pheochromocytoma DOC is Phenoxybenzamine Ref- pubmed.com Ref", "cop": 1, "opa": "Phenoxybenzamine", "opb": "Phentolamine", "opc": "Labetalol", "opd": "Esmolol", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "70b4659c-8811-442d-9951-61a0dc59cef4", "choice_type": "single"}
+{"question": "Neoplastic cells in Franklin disease express", "exp": "Answer- D. CD79aIn classic Franklin disease, neoplastic lymphocytes, plasmacytoid lymphocytes and plasma cells can be found in lymph nodes, Waldeyer ring, gastrointestinal tract and other extranodal sites, spleen, liver, bone marrow.Systemic symptoms- fever, weight loss, weakness, anorexia, recurrent bacterial infections.Neoplastic cells in Franklin disease, are believed to represent post germinal center B cells. The neoplastic cells contain gamma heavy chains in the cytoplasm ofcells (without light chains) and express CD 79a.Neoplastic lpnphocytes in this disorder express CD20, neoplastic plasma cells in this disorder express CD 138.", "cop": 4, "opa": "CD5", "opb": "CD10", "opc": "CD55", "opd": "CD79a", "subject_name": "Medicine", "topic_name": null, "id": "a52ab839-dcfd-4e72-bc77-42432b053029", "choice_type": "single"}
+{"question": "The most common location of hypeensive intracranial hemorrhage is", "exp": "The most common locations of hypeensive ICH are: 1) Basal ganglia (putamen or caudate), 2) Thalamus, 3) Pons and 4) Cerebellum. Within the basal ganglia region, it is rare for an ICH to specifically affect one area; Ref Harrison20th edition pg 2345", "cop": 2, "opa": "Subarachnoid space", "opb": "Basal ganglia", "opc": "Cerebellum", "opd": "Brainstem", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "037118cc-8285-4236-886c-9f598a18ac46", "choice_type": "single"}
+{"question": "Most common presentation of Neurocysticercosh is", "exp": "(A) Seizures # NEUROCYSTICERCOSIS is the most common parasitic disease of the CNS worldwide.> Humans acquire cysticercosis by the ingestion of food contaminated with the eggs of the parasite T. solium,\\> Eggs are contained in under cooked pork or in drinking water or other foods contaminated with human feces.> T. gondii is a parasite that is acquired from the ingestion of undercooked meat and from handling cat feces.> In cysticercosis, the clinical manifestations are variable.> Cysticerci can be found anywhere in the body but are most commonly detected in the brain, skeletal muscle, subcutaneous tissue, or eye> Clinical presentation of cysticercosis depends on the number and location of cysticerci as well as the extent of associated inflammatory responses or scarring.> Neurologic manifestations are the most common. Seizures are associated with inflammation surrounding cysticerci in the brain parenchyma. These seizures may be generalized, focal, or Jacksonian.> Hydrocephalus results from obstruction of cerebrospinal fluid (CSF) flow by cysticerci and accompanying inflammation or by CSF outflow obstruction from arachnoiditis.> Signs of increased intracranial pressure, including headache, nausea, vomiting, changes in vision, dizziness, ataxia, or confusion, are often evident.", "cop": 1, "opa": "Seizures", "opb": "Focal neurological deficits", "opc": "Dementia", "opd": "Radiculopathy", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "758e68b0-a44b-4fd3-a1a1-dc15182f0735", "choice_type": "single"}
+{"question": "Hepatitis B virus is NOT present in", "exp": "(ref: Harrison's 18/e p2108)", "cop": 4, "opa": "Milk", "opb": "Sweat", "opc": "Stool", "opd": "Lymph", "subject_name": "Medicine", "topic_name": "All India exam", "id": "cdb2d02d-eb8a-4707-ab9c-ed0a9248c687", "choice_type": "single"}
+{"question": "Ipsilateral Homogeneous opacification and contralateral mediastinal shift is seen in", "exp": null, "cop": 3, "opa": "Collapse", "opb": "Consolidation", "opc": "Hydrothorax", "opd": "Hemothorax", "subject_name": "Medicine", "topic_name": null, "id": "8a72999f-ac26-4a13-930d-356cf09deb09", "choice_type": "single"}
+{"question": "Posterolateral lesions of ventral spinal cord leads to", "exp": "(C) Loss of pressure, touch", "cop": 3, "opa": "Pyramidal signs", "opb": "loss of joint sense", "opc": "Loss of pressure,touch", "opd": "Loss of pain temperature", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f009c1ea-e7f9-4e88-a1a4-b4a5fae31e48", "choice_type": "single"}
+{"question": "Intake of exogenous steroid causes.", "exp": "Ans is option 2. Cushing&;s syndrome The most common cause of Cushing&;s syndrome is iatrogenic administration of steroids for a variety of reasons. Ref Harrison 17/e p. 2254-2255", "cop": 2, "opa": "Addison's disease", "opb": "Cushing's syndrome", "opc": "Pheochromocytoma", "opd": "Conn's syndrome", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "714c128f-10ae-4a38-a439-a220a1473d2e", "choice_type": "single"}
+{"question": "Clinical features of pneumonia are", "exp": "Chest signs of consolidation in pneumonia include increased vocal fremitus,dull note on percussion,and as conduction of sound is enhanced,auscultation reveals increased breath sounds,bronchial breathing,aegophony & whispering pectoriloquy;crackels are heard through out. Reference:Davidson's medicine-22nd edition,page no:683.", "cop": 2, "opa": "Tracheal shift", "opb": "Increased breath sounds", "opc": "Decreased vocal fremitus", "opd": "Absence of Egophony", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "74a2342c-948c-4389-8dad-e0d3e82db917", "choice_type": "single"}
+{"question": "Select the neurologic disorder not associated with antiphospholipid antibodies.", "exp": "In Antiphospholipid Ab patient can develop antibody induced cerebritis. Antiphospholipid antibodies is a hypercoagulable state -patient will develop ischemic stroke not hemorrhagic. Demyelinating disease: Ab can be attacking myelin sheath & nerve get demylinating. Headache and seizures can also occur in pt. with antiphospholipid antibodies.", "cop": 2, "opa": "Demyelinating disease", "opb": "Hemorrhagic stroke", "opc": "Headache", "opd": "Seizures", "subject_name": "Medicine", "topic_name": "Stroke and TIA", "id": "68bceb79-c195-4aef-bbdf-67bc64e130bb", "choice_type": "single"}
+{"question": "Beck's triad of cardic tamponade includesa) Hypotensionb) Neck vein distensionc) Silent heartd) Tachycardia", "exp": null, "cop": 3, "opa": "acd", "opb": "abd", "opc": "abc", "opd": "ab", "subject_name": "Medicine", "topic_name": null, "id": "ae01e7fa-b245-4b0e-9b05-4686eb87db65", "choice_type": "single"}
+{"question": "Delta waves in ECG are characteristic of", "exp": "(A) Wolf Parkinson White syndrome# DELTA WAVES are quite rare and represent a slurring of the QRS complex associated with Wolff-Parkinson-White syndrome. This may lead to tachycardias, and should be evaluated. Intermittent delta waves are certainly possible and often imply that the accessory pathway does not conduct very rapidly. This situation is relatively rare.> Wolff-Parkinson-White Preexcitation> Although not a true IVCD, this condition causes widening of QRS complex and, therefore, deserves to be considered here QRS complex represents a fusion between two ventricular activation fronts:> Early ventricular activation in region of the accessory AV pathway (Bundle of Kent)> Ventricular activation through the normal AV junction, bundle branch system ECG criteria include all of the following: Short PR interval (<0.12s) Initial slurring of QRS complex (delta wave) representing early ventricular activation through normal ventricular muscle in region of the accessory pathway Prolonged QRS duration (usually >0.10s) Secondary ST-T changes due to the altered ventricular activation sequence", "cop": 1, "opa": "Wolf Parkinson White syndrome", "opb": "RBBB", "opc": "Trifascicular disease", "opd": "Bifascicular disease", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "a975ce51-f4c9-4d69-904c-b214c07b2a75", "choice_type": "single"}
+{"question": "Chronic renal failure with inappropriately high haemoglobin levels may be seen with", "exp": "Clinical features Haemoglobin and erythropoietin levels in polycystic kidney disease increases Common clinical features are shown in Box 15.21. Affected people are usually asymptomatic until later life but hypeension usually occurs from the age of 20 onwards. One or both kidneys may be palpable and the surface may feel nodular. About 30% of patients with PKD also have hepatic cysts (see Fig. 22.39, p. 893) but disturbance of liver function is rare. Sometimes (almost always in women) this causes massive and symptomatic hepatomegaly, usually concurrent with renal enlargement but occasionally with only minor renal involvement. Berry aneurysms of cerebral vessels are an associated feature in about 5% of patients with PKD. This feature appears to be largely restricted to ceain families (and presumably specific mutations). Mitral and aoic regurgitation is frequent but rarely severe, and colonic diveicula and abdominal wall hernias may occur. Investigations The diagnosis is usually based on family history, clinical findings and ultrasound examination. Ultrasound demonstrates cysts in approximately 95% of affected patients over the age of 20 and is the screening method of choice, but may not detect small developing cysts in younger subjects. Cysts may also be identified by other imaging modalities, such as MRI (Fig. 15.15). Simple renal cysts may occur in normal individuals but are uncommon below the age of 30. The following criteria exist for an ultrasound diagnosis of PKD in patients with a family history but unknown genotype: * 15-39 years of age: at least three unilateral or bilateral kidney cysts * 40-59 years of age: at least two cysts in each kidney * 60 years or older: at least four cysts in each kidney. It is now possible to make a molecular diagnosis by mutation screening of PDK1 or PDK2 but this is seldom used in routine clinical practice because the PKD1 gene is so large and has many possible mutations. Next-generation sequencing allows faster and simpler genetic screening for PKD1 and PKD2. This is likely to be used in cases with an unceain diagnosis (young patients, few cysts, lack of family history), for workup of living kidney donors, or for screening for mutations associated with a worse prognosis (see below). Screening for intracranial aneurysms is not generally indicated but can be done by MR angiography in families with a history of subarachnoid haemorrhage. The yield of screening is low, however, and the risk:benefit ratio of intervention in asymptomatic aneurysms in this disease is not clear. Ref Harrison20th edition pg 288", "cop": 4, "opa": "Hypeensive nephropathy", "opb": "Ischaemic nephropathy", "opc": "Diabetic nephropathy", "opd": "Polycystic renal disease", "subject_name": "Medicine", "topic_name": "Kidney", "id": "ce358f4e-7b36-46f6-8948-990c3c417734", "choice_type": "single"}
+{"question": "Primary Tuberculosis most commonly involves", "exp": "Answer is A (Lungs): The most common primary site for primary tuberculosis is the Lung. 'Primary site is the Lung in upto 95% of cases' - Oski's Pediatrics 'For both primary and reactivation tuberculosis the lungs are the most commonly affected site.' Most common primary site for Primary Tuberculosis is LungsQ Most common site for Post-Primary Reactivation Tuberculosis is Lune Most common primary site for congenital tuberculosis is Liverdeg Most common site /organ involved in congenital tuberculosis in Lune Principles of Pulmonary Medicine (Elsevier) 547107 Primary tuberculosis: It is the first infection with tubercle bacilli in individuals who have not been previously exposed to the organisms Seen in children Q Primary complex is characteristic Primary (Ghon) complex Unilateral enlarged hi lar lymph nodes Q Ghon focus Epitheloid-cell granulomatous inflammation (consolidation) at site of parenchymal infection. Usually small and subpleural most commonly located under pleura in lower pa of upper lobe Usually a symptomatic Q or manifested by a mild tlu like illness at time of tuberculin conversion Lesion heal by fibrosis Q and may calcify Q Radiological evidence of healed primary infection may or may not be present Q Effects of primary tuberculosis Tuberculin positivity Q Paial immunity to tuberculosisQ: individual requires a higher dose to be reinfected by tubercle bacilli Presence of dormant tubercle bacilli", "cop": 1, "opa": "Lungs", "opb": "Liver", "opc": "Brain", "opd": "Intestine", "subject_name": "Medicine", "topic_name": null, "id": "a234c991-7147-47fe-8f6d-097807a8228c", "choice_type": "single"}
+{"question": "Bristol cha is used fore", "exp": "Answer- A. Stool consistencyThe Bristol stool scale(Bristol stool cha (BsC)) is a diagnostic medical tool designed to classifr the form of human feces into seven categories.The seven types ofstcol areType 1 Separate hard lumps, like nuts (hard to pass); also known as goat faecesType 2: Sausage-shaped but lumpyType 3: Like a sausage but with cracks on its surfaceType 4: Like a sausage or snake, smooth and softType 5: Soft blobs with clear cut edges (passed easily)Type 6: Fluft pieces with ragged edges, a mushy stoolType 7: Watery, no solid pieces, entirely liquid", "cop": 1, "opa": "Stool consistency", "opb": "Nocturnal enuresis", "opc": "Mental retardation", "opd": "Cognitive development", "subject_name": "Medicine", "topic_name": null, "id": "799f4b03-5e03-48b1-aa94-8028613d63b0", "choice_type": "single"}
+{"question": "Mild MR.features are", "exp": "Most people with mitral regurgitation (MR) have no symptoms. People with mild tomoderate MR may never develop symptoms or serious complications Mitral regurgitation (MR), mitral insufficiency, or mitral incompetence, is a form of valvular hea disease in which the mitral valve does not close properly when the hea pumps out blood. It is the abnormal leaking of blood backwards from the left ventricle, through the mitral valve, into the left atrium, when the left ventricle contracts, i.e. there is regurgitation of blood back into the left atrium. MR is the most common form of valvular hea disease.", "cop": 2, "opa": "Present in 5-10% population", "opb": "Incidence in low socioeconomic group", "opc": "Presents in 2 years", "opd": "Genetic background Present", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "a8e2907d-b5e9-4878-9b66-07619ca4d009", "choice_type": "single"}
+{"question": "A patient comes with sudden respiratory distress, on examination, bilateral basal crepts are present over chest suggestive of pulmonary edema with normal alveoler wedge pressure. The likely cause is", "exp": null, "cop": 1, "opa": "Narcotic overdose", "opb": "Congestive heart failure", "opc": "Myocardial infarction", "opd": "Cardiogenic shock", "subject_name": "Medicine", "topic_name": null, "id": "dbf63f03-2c82-4c2a-b7a6-8efa3f7d9d44", "choice_type": "single"}
+{"question": "Rytand's murmur is heard in", "exp": "Rytand's murmur is mid diastolic murmur in complete heart block.", "cop": 3, "opa": "Mitral Stenosis", "opb": "PDA", "opc": "Complete AV block", "opd": "Acute rheumatic fever", "subject_name": "Medicine", "topic_name": null, "id": "2834e2da-20a0-47c4-ab2d-b350de81c6c6", "choice_type": "single"}
+{"question": "Hypotension while on dialysis is due to", "exp": "(A) Excessive ultrafiltration # INTRADIALYTIC HYPOTENSION is the presence of a decrease in systolic blood pressure PS20 mmHg or a decrease in mean arterial pressure by 10 mmHg.> Dialysis hypotension is the result of an inadequate cardiovascular response to the reduction in blood volume that occurs when a large volume of water is removed during a short period of time.", "cop": 1, "opa": "Excessive ultrafiltration", "opb": "Hypertensives", "opc": "Renal disease", "opd": "Diabetes", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "fae303ef-518e-4bcb-8911-b68e2d25f36e", "choice_type": "single"}
+{"question": "Most common presentation of SLE is", "exp": "Ahritis in SLE Ahralgia is a common symptom, occurring in 90% of patients, and is often associated with early morning stiffness. Tenosynovitis may also occur but clinically apparent synovitis with joint swelling is rare. Joint deformities may arise (Jaccoud's ahropathy) as the result of tendon damage but joint erosions are not a feature. Ref Davidsons 23e p1035", "cop": 1, "opa": "Ahralgia", "opb": "Erosive polyahritis", "opc": "Butterfly rash", "opd": "AIHA", "subject_name": "Medicine", "topic_name": "Immune system", "id": "0ff05b4b-d785-45b5-8943-6674f847be38", "choice_type": "single"}
+{"question": "Genetic risk factor for COPD is", "exp": "Severe a1 Antitrypsin deficiency is a proven genetic risk factor for COPDAlthough only approximately 1% of COPD patients are found to have severe a1AT deficiency as a contributing cause of COPD, these patients demonstrate that genetic factors can have a profound influence on the susceptibility for developing COPDSpecific treatment in the form of a1AT augmentation therapy is available for severe a1AT deficiency as a weekly IV infusion Patients with cystic fibrosis develop bronchiectasisRef: Harrison 19e pg: 1704", "cop": 1, "opa": "a1 Antitrypsin Deficiency", "opb": "Cystic fibrosis", "opc": "Marfan syndrome", "opd": "Severe combined immunodeficiency", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "142b007f-bab2-4749-b3c1-bca4c9565607", "choice_type": "single"}
+{"question": "Multiple sclerosis is a", "exp": "(A) Demyelinating disease # MULTIPLE SCLEROSIS (MS) is characterized by a triad of inflammation, demyelination, and gliosis (scarring); the course can be relapsing-remitting or progressive.> Lesions of MS are typically disseminated in time and location.> Demyelinating disorders are characterized by inflammation and selective destruction of central nervous system myelin.> Peripheral nervous system is spared, and most patients have no evidence of associated systemic illness.", "cop": 1, "opa": "Demyelinating disease", "opb": "Infective lesion", "opc": "Peripheral nervous system disorder", "opd": "Associated with systemic illness", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "3612f1ec-3071-47a3-aa4b-2856bffc7935", "choice_type": "single"}
+{"question": "A patient has diarrhea, malabsorption, Abdominal pain and Arthralgia. On intestinal biopsy PAS + organisms present inside macrophage. Most likely diagnosis is", "exp": "PAS+ Organisms inside macrophage clearly s/o whipple's disease.", "cop": 2, "opa": "Celiac sprue", "opb": "Whipple's disease", "opc": "Zollinger - ellison syndrome", "opd": "Chron's disease", "subject_name": "Medicine", "topic_name": null, "id": "fc4cbd36-a8a8-45ff-9610-f046aef96799", "choice_type": "single"}
+{"question": "Ophthalmoplegic migraine is characterized by", "exp": "Ophthalmoplegic migraine is a rare neurologic syndrome characterized by recurrent bouts of head pain and ophthalmoplegia. The third cranial nerve is most commonly affected, in which case mydriasis and ptosis can also be observed Ophthalmoplegic migraine is a rare neurologic syndrome characterized by recurrent bouts of head pain and ophthalmoplegia. The third cranial nerve is most commonly affected, in which case mydriasis and ptosis can also be observed. Most patients recover completely within days to weeks, but a minority are left with persistent neurologic deficits Ref Harrison20th edition pg 1234", "cop": 3, "opa": "Transient diplopia", "opb": "Headache with vomiting episodes", "opc": "Headache with benign recurrent 3 rd N. palsy", "opd": "Headache with complete vision loss", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "933f8561-ed3e-4207-89c7-931394efa340", "choice_type": "single"}
+{"question": "Sensitive and specific marker for MI", "exp": "Cardiac troponin I or T, which are specific, sensitive, and the preferred markers of myocardial necrosis. The MB isoform of creatine kinase (CK-MB) is a less sensitive alternative.Ref: Harrison 19e pg: 1594", "cop": 2, "opa": "CK-MB", "opb": "Troponin", "opc": "Myoglobulin", "opd": "LDH", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "022e7f65-f55d-441b-a327-59dbe78a49cc", "choice_type": "single"}
+{"question": "Swollen neurons that contain numerous lysosomes filled with lipid are typical of", "exp": "Swollen neurons that exhibit marked vacuolization of the perikaryon and contain lysosomes filled with lipid are found in TaySachs disease but could occur in other lipid-storage diseases as well. The correct diagnosis can be established by biochemical analysis of the stored material or identification of intermediary metabolites and missing enzymes. The other diseases listed do not produce such neuronal changes. Ref - Harrison's internal medicine 20e pg 3007", "cop": 4, "opa": "Amyloidosis", "opb": "Huntington Disease", "opc": "Kuru", "opd": "Tay-Sachs Disease", "subject_name": "Medicine", "topic_name": "Genetics", "id": "89a98398-b131-4bea-a707-abe37af05e8d", "choice_type": "single"}
+{"question": "Pulsus paradoxus is characteristic feature of", "exp": "Ref Harrison 19 th ed pg 1574 Paradoxical Pulse This impoant clue to the presence of cardiac tamponade consists of a greater than normal (10 mmHg) inspiratory decline in systolic aerial pressure. When severe, it may be detected by palpating weakness or disappearance of the aerial pulse during inspiration, but usually sphygmomanometric measurement of systolic pressure during slow respiration is required.", "cop": 2, "opa": "Constrictive pericarditis", "opb": "Cardiac tamponade", "opc": "Hyperophic obstructive cardiomyopathy", "opd": "Restrictive cardiomyopathy", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "923639ba-b4d8-46a9-9416-59b57b458ac4", "choice_type": "single"}
+{"question": "A 14 year female on strenuous exercise presented with muscle pains, and voiding red colored urine. The diagnosis is", "exp": "(A) Glycolytic pathway defect # Disorders of Glycolysis Causing Exercise Intolerance Several glycolytic defects are associated with recurrent myoglobinuria: myophosphorylase deficiency (type V glycogenosis), phosphofructokinase deficiency (type VII glycogenosis), phosphoglycerate kinase deficiency (type IX glycogenosis), phosphoglycerate mutase deficiency (type X glycogenosis), lactate dehydrogenase deficiency (glycogenosis type XI), and beta-enolase deficiency. Clinical muscle manifestations in these conditions usually begin in adolescence. Symptoms are precipitated by brief bursts of high-intensity exercise, such as running or lifting heavy objects. A history of myalgia and muscle stiffness usually precedes the intensely painful muscle contractures, which may be followed by myoglobinuria. Acute renal failure accompanies significant pigmenturia.> Carnitine Palmitoyltransferase Deficiency In contrast to disorders caused by defects in glycolysis, in which muscle cramps follow short, intense bursts of exercise, the muscle pain in CPTII deficiency does not occur until the limits of utilization have been exceeded and muscle breakdown has already begun.> Hypokalemic Periodic Paralysis (HypoKPP) Men are more often affected because of decreased penetrance in women. Attacks are often provoked by meals high in carbohydrates or sodium and may accompany rest following prolonged exercise. Weakness usually affects proximal limb muscles more than distal. Ocular & bulbar muscles are less likely to be affected. Mitochandrial myopathies more often affect ocular muscles.", "cop": 1, "opa": "Glycolytic pathway defect", "opb": "Carnitine acyltransferase deficiency", "opc": "Mitochondrial deficiency myopathy", "opd": "Hypokalemic periodic paralysis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "5de1b830-0d00-4605-a27f-f4e09c3f1366", "choice_type": "single"}
+{"question": "NOT a feature of ventilator associated pneumonia", "exp": "(B) Tachycardia> Tachycardia: Clinical criteria for diagnosis of ventilator pneumonia include (fever, Leucotyosis, New changing radiographic infiltrates, development of purulent secretions change in oxygen requirement/ventilator settings, which have high sensitivity but low specificity.", "cop": 2, "opa": "Fever", "opb": "Tachycardia", "opc": "New shadows on chest X-ray", "opd": "Leucocytosis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "d832a522-36e5-4b7a-beb2-cba3eb5b3471", "choice_type": "single"}
+{"question": "Norepinephrine is produced by", "exp": "(D) Adrenal medulla # Adrenal Cortex> The adrenal cortex synthesizes three different types of steroids:> Glucocorticoids (principally cortisol), which are synthesized primarily in the zona fasciculata with a small contribution from the zona reticularis.> Mineralocorticoids, the most important being aldosterone, which is generated in the zona glomerulosa.> Sex steroids (estrogens and androgens), which are produced largely in the zona reticularis.> The adrenal medulla is composed of chromaffin cells, which synthesize and secrete catecholamines, mainly epinephrine.\\> Catecholamines have many effects that allow rapid adaptations to changes in the environment.> Norepinephrine, epinephrine, and dopamine are secreted by the adrenal medulla.", "cop": 4, "opa": "Zona fasiculata", "opb": "Zona glomerulosa", "opc": "Zona reticularis", "opd": "Adrenal medulla", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "eabc7055-90e1-4485-be64-8eab77ed4434", "choice_type": "single"}
+{"question": "Thermoregulatory response activated by cold is", "exp": null, "cop": 3, "opa": "Cutaneous vasodilatation", "opb": "Anorexia", "opc": "Increased voluntary activity", "opd": "Increased respiration", "subject_name": "Medicine", "topic_name": null, "id": "0fbadef5-c894-431e-b847-ba183a628d1f", "choice_type": "single"}
+{"question": "Pseudo P Pulmonale seen in", "exp": "Ans. a. HypokalemiaRef: Oxford Handbook of Clinical Medicine; Page No-90P WAVENormally precedes each QRS complex and upright in II, III and aVF but inverted in aVR.Absent P wave: AF, Sinoatrial block, Junctional (AV nodal) rhythm.Complete heart block indicates; dissociation between P waves and QRS complex.P. mitrale: Bifid P wave, it indicates left arterial hypertrophy.P. Pulmonale: Peaked P wave, it indicates right atrial hypertrophy.Pseudo P. Pulmonale seen if K+ decreases.ELECTROCARDIOGRAPHIC FINDINGS IN ELECTROLYTE DISTURBANCESHypokalemia related with ECGHyperkalemia related with ECG*. U and T wave fuse*. Increased QRS amplitude*. Increased QRS duration*. Increased P wave amplitude,*. Increased P wave duration*. ST segment depression*. PR interval slightly prolonged*. T wave inversion*. Prominent U waves*. Long QU intervalMild Hyperkalemia*. P wave Normal*. QRS Normal*. T wave: Tall and tented, often symmetric with narrow base; usually best seen in leads II. Ill, V2 and V4. The corrected QT interval not prolongedSevere Hyperkalemia*. P wave: Amplitude decreases, duration increases until it eventually disappears*. QRS: Broadens, wide S waves in the left precordial leads*. QRS axis: Superior (left axis deviation).*. ST segment: The terminal S waves become continuous with the tall tented T wave ECG changes in HypocalcaemiaECG Changes in Hypercalcaemia*. Hypocalcaemia causes QTc prolongation primarily by prolonging the ST segment*. The T wave is typically left unchanged*. Dysrhythmias are uncommon, although atrial fibrillation has been reported.*. Torsades de pointes may occur, but is much less common than with hypokalaemia or hypomagnesaemia*. The main ECG abnormality seen with hypercalcaemia is shortening of the QT interval*. In severe hypercalcaemia, Osborn waves (J waves) may be seen*. Ventricular irritability and VF arrest has been reported with extreme hypercalcaemia ECG changes in HypomagnesaemiaECG changes in Hypermagnesaemia*. The primary ECG abnormality seen with hypomagnesaemia is a prolonged QTc*. Atrial and ventricular ectopy, atrial tachyarrhythmias and torsades de pointes are seen in the context of hypomagnesaemia*. Tall T wave*. Depressed ST segment*. Prolonged PR interval*. Widened QRS complex", "cop": 1, "opa": "Hypokalemia", "opb": "Hyperkalemia", "opc": "Hypomagnesemia", "opd": "Hypercalcemia", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "9dfc53b5-4d35-4fb6-a079-6054404d4f02", "choice_type": "single"}
+{"question": "Most common heavy chain disease is", "exp": "Ans. is 'b' i.e., Seligmann Disease (Alpha heavy chain disease)", "cop": 2, "opa": "Franklin disease", "opb": "Seligmann disease", "opc": "Mu heavy chain disease", "opd": "Waldenstrom cryoglobulinemia", "subject_name": "Medicine", "topic_name": null, "id": "a516a0ef-8be4-4192-9985-6f00a94d1f11", "choice_type": "single"}
+{"question": "Reversal of shunt is not possible in the natural history of", "exp": "Eisenmenger's syndrome or reversal of shunt is seen in the ventricular septal defect, atrial septal defect, or less commonly, patent ductus aeriosus. ref - Harrisons internal medicine 20e pg 393,1838", "cop": 2, "opa": "ASD", "opb": "TOF", "opc": "VSD", "opd": "PDA", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "39aca9b3-5c94-4c09-be61-2c2d526fce36", "choice_type": "single"}
+{"question": "HbH is characterized by", "exp": "Answer- A. Deletion of three alpha genesHbH disease- Deletion of three alpha genes (--/-alpha)- hemolytic anemia", "cop": 1, "opa": "Deletion of three alpha genes", "opb": "Deletion of three alpha and one beta gene", "opc": "Deletion of two alpha and two beta genes", "opd": "Deletion of four alpha genes", "subject_name": "Medicine", "topic_name": null, "id": "dcde993a-cec8-4c38-b86e-3954f1595339", "choice_type": "single"}
+{"question": "Rasmussen's aneurysm is a", "exp": "In tuberculosis,hemoptysis can occur due to rupture of a dilated vessel in a tuberculous cavity.It is known as Rasmussen's aneurysm. Ref:Harrison's medicine-18th edition,page no:1345.", "cop": 1, "opa": "Dilated vessel in a tubercular lung cavity", "opb": "Dilated of the root of aoa in valvular stenosis", "opc": "Dilated aoa in syphilitic affection", "opd": "Dilated renal vessel in hypeensive renal disease", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "2b5537b5-eace-4304-bf2b-522ea7894467", "choice_type": "single"}
+{"question": "Angiotensin converting enzyme inhibitors are not used in congestive heart failure resulting from", "exp": null, "cop": 4, "opa": "Mitral stenosis", "opb": "Aortic regurgitation", "opc": "Alcoholic cardiomyopathy", "opd": "Aortic stenosis", "subject_name": "Medicine", "topic_name": null, "id": "9ebd2070-82cc-457c-a68e-71dd18bf2242", "choice_type": "single"}
+{"question": "Sensory neural deafness associated with hereditary nephritis is seen in", "exp": "Clinically patients with Alpos syndrome develop hematuria, thinning and splitting of GBM's,mild proteinuria (<1-2g/24hrs) which appears late in the course followed by chronic glomerulosclerosis leading to renal failure associated with sensorineural deafness. There r four forms of alpos syndrome Type 1 classic As -x linked disorder with Hematuria,sensorineural deafness ,lenticonus Type 2-x linked form associated with diffuse leiomymomatosis T3 -autosomal recessive ,T4autosomal dominant -both forms can cause renal disease without deafness or lenticonus. Ref:Harrison 20 th edition pg no 2146,2977", "cop": 4, "opa": "Fanconi syndrome", "opb": "Berger's disease", "opc": "Albright syndrome", "opd": "Alpo's syndrome", "subject_name": "Medicine", "topic_name": "Kidney", "id": "30ec7899-eda9-489e-a1b3-33420bfd38b1", "choice_type": "single"}
+{"question": "The first plasma protein to be generated after severe protein deficiency", "exp": null, "cop": 3, "opa": "Albumin", "opb": "Globulin", "opc": "Fibrinogen", "opd": "Thrombin", "subject_name": "Medicine", "topic_name": null, "id": "b62c9458-0cf3-427b-a445-6a785b7c4e22", "choice_type": "single"}
+{"question": "Patient on risperidone may have", "exp": "Adverse effects of Risperidone: Weight gainHyperpigmentationRise in prolactin levelsNeuroleptic malignant syndromeRef: Harrison's 18/e Page no: 144, 3333", "cop": 2, "opa": "Weight loss", "opb": "Neuroleptic malignant syndrome", "opc": "Hypopigmentation", "opd": "Prolactin deficiency", "subject_name": "Medicine", "topic_name": "All India exam", "id": "418110a7-1c1a-4292-8f91-2a7f170cd82e", "choice_type": "single"}
+{"question": "Not a feature of maintenance phase of acute kidney injury", "exp": "Hypercalcemia not a feature of maintenance phase.\nHypocalcema Occurs in maintenance phase.", "cop": 4, "opa": "Hyperuricemia", "opb": "Hypermagnesemia", "opc": "Hypernatremia", "opd": "Hypercalcemia", "subject_name": "Medicine", "topic_name": null, "id": "619575b4-629f-45e2-b350-448c849e0109", "choice_type": "single"}
+{"question": "Endoscopy is contraindicated in", "exp": "Endoscopy is C/I in regurgitant lesions like Achalasia and Zenker's diverticulum as it carries the risk of rupture in mediastinum (Very risky).", "cop": 1, "opa": "Achalasia", "opb": "Peptic stricture", "opc": "Esophageal carcinoma", "opd": "Esophageal web", "subject_name": "Medicine", "topic_name": null, "id": "91c83d8e-cd81-4868-8338-6d73f9181984", "choice_type": "single"}
+{"question": "Well's grading of puimonary embolism is based ona) Dopplerb) Clinical symptomsc) Hemoptysisd) Heart Rate > 100 beats per min", "exp": null, "cop": 4, "opa": "abc", "opb": "acd", "opc": "ac", "opd": "bcd", "subject_name": "Medicine", "topic_name": null, "id": "b6f75a23-5d42-44d0-99bf-02ed2e857b50", "choice_type": "single"}
+{"question": "Pain insensitive structure", "exp": "The cranium, brain parenchyma, ependymal lining of the ventricles, and choroid plexus are all pain insensitive Ref Harrison20th edition pg 2345", "cop": 2, "opa": "Middle cerebral aery", "opb": "Choroid plexus", "opc": "Dural sheath", "opd": "Falx cerebri", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "e1a28e9c-72a7-4ced-ac67-67b7fa914280", "choice_type": "single"}
+{"question": "An example of chronic myeloproliferative disorder is", "exp": "According to WHO classification of myeloid neoplasms,the diseases under myeloproliferative group are chronic myeloid leukemia ,chronic neutrophilic leukemia ,chronic eosinophilic leukemia ,polycythemia vera & essential thrombocytopenia.
Reference :Harsh mohan textbook of pathology sixth edition pg no 357.
", "cop": 2, "opa": "Neutrophilic leukemoid reaction", "opb": "Essential thrombocythemia", "opc": "Plasmacytosis", "opd": "Hairy cell leukemia", "subject_name": "Medicine", "topic_name": "Haematology", "id": "81d43b05-3190-477f-ad98-7c443e3aa4c9", "choice_type": "single"}
+{"question": "Heyde's syndrome is", "exp": "Heyde's syndrome: GIT bleeding Angiodysplasia Aoic stenosis Caused by the induction of Von Willebrand disease type IIA (vWD-2A) by depletion of vWF in blood flowing through the narrowed valvular stenosis. ref - pubmed.com ", "cop": 3, "opa": "Mitral stenosis, ahritis, and biliary cirrhosis", "opb": "Mitral regurgitation, hiatus hernia, and cirrhosis", "opc": "Aoic stenosis, gastrointestinal bleeding and angiodysplasia of colon", "opd": "Pulmonary aerial hypeension, tricuspid regurgitation, and cirrhosis", "subject_name": "Medicine", "topic_name": "All India exam", "id": "2455a900-b833-4812-a8af-0219f1b0c5e2", "choice_type": "single"}
+{"question": "Mcdonald’s criteria is used in diagnosis of", "exp": "Multiple sclerosis is diagnosed by Mcdonald’s criteria", "cop": 3, "opa": "Friedreich ataxia", "opb": "Multiple myeloma", "opc": "Multiple sclerosis", "opd": "Lateral sclerosis", "subject_name": "Medicine", "topic_name": null, "id": "e36fb797-a721-4120-80b5-0de7f90689d2", "choice_type": "single"}
+{"question": "Shilling's test is used to determine deficiency of", "exp": "Answer is A (Vitamin B12) Shilling's test is done to determine the cause of cyanocobalamine deficiency (Vitamin B12). Schilling test is abnormal in conditions that affect cobalamine absorption including Pernicious anemia, Chronic Pancreatitis, Bacterial overgrowth syndrome and Heal dysfunction. Conditions with Abnormal Schilling's Test (Abnormal Cobalamine Absorption) Pernicious anemia Chronic Pancreatitis Achlorhydria Bacterial overgrowth syndrome Beal dysfunction Schilling Test: Schilling test is performed to determine the cause of cobalamine malabsorption (Vit B12 malabsorption). Since cobalamine absorption requires multiple steps including gastric, pancreatic and ileal processes, the Schilling test can also be used to assess the integrity of these other organs. The Schilling test is performed by administering Co58-labeled cobalamin orally and collecting urine for 24h 1 mg of cobabmine is administed intramuscularly one hour after ingestion of the Radiolabelled cobalamine. This is done to ensure saturation of cobalamine binding sites in the liver as urinary excretion of cobalamine will reflect cobalamine absorption only provided that intrahepatic binding sites of cobalamine are fully occupied. Once intrahepatic binding sites of cobalamine are saturated all absorbed radiolabelled cobalamine will be excreted in urine. The Schilling test may be abnormal (defined as less than 10 percent excretion in 241i) in conditions that affect cobalamine absorption including Pernicious anemia, Chronic Pancreatitis, Bacterial overgrowth syndrome and Heal dysfunction. The etiology for an abnormal Schilling test may be deduced by administering Co58-labeled cobalamin with intrinsic factor, pancreatic enzymes or after 5 day course of antibiotics. Differential Results of Schilling Test in various diseases associated with cobalamin malabsorption may thus help establish the diagnosis. Diagnosis 58Co-Chl With Intrinsic Factor With Pancreatic Enzymes After 5 Days of Antibiotics Pernicious anemia Reduced Normal Reduced Reduced Chronic pancreatitis Reduced Reduced Normal Reduced Bacterialovergrowth Reduced Reduced Reduced Normal Ileal disease Reduced Reduced Reduced Reduced", "cop": 1, "opa": "Vitamin B12", "opb": "Vitamin B6", "opc": "Folic Acid Deficiency", "opd": "Vitamin D Deficiency", "subject_name": "Medicine", "topic_name": null, "id": "bcab342f-651d-4789-b874-9b4b36dfec8a", "choice_type": "single"}
+{"question": "Not seen in primary pulmonary hypertension", "exp": null, "cop": 2, "opa": "Left parasternal heave", "opb": "Right parasternal heave", "opc": "Single S2", "opd": "Pulmonary ejection click", "subject_name": "Medicine", "topic_name": null, "id": "0a3cb897-0e59-4eea-9290-9e4b1aeae735", "choice_type": "single"}
+{"question": "In a patient with ischaemic stroke, intravenous recombinant tissue has mainly been found to be useful during the initia", "exp": "Ischemic stroke occurs when a blood clot blocks or plugs an aery leading to the brain. A blood clot often forms in aeries damaged by the buildup of plaques (atherosclerosis). It can occur in the carotid aery of the neck as well as other aeries. Ref Harrison20th edition pg 1123", "cop": 1, "opa": "3 hours", "opb": "6 hours", "opc": "12 hours", "opd": "24 hours", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "fc4b1f48-7940-4688-8b28-9cfcb9350579", "choice_type": "single"}
+{"question": "Mutation in sickle cell anemia is", "exp": "Missense mutation - Sickle cell anaemia.\nNon-sense mutation - Beta thalassemia.", "cop": 2, "opa": "Silence", "opb": "Missense", "opc": "Non-sense", "opd": "Frame-shift", "subject_name": "Medicine", "topic_name": null, "id": "0deb1182-e7de-4185-81dd-d1cd78887a9e", "choice_type": "single"}
+{"question": "POEMS syndrome is associated with", "exp": null, "cop": 3, "opa": "Aplastic anemia", "opb": "RA", "opc": "Polyneuropathy", "opd": "Hemolytic anemia", "subject_name": "Medicine", "topic_name": null, "id": "d4f089cc-cd1d-41d7-a574-ba7d291bd488", "choice_type": "single"}
+{"question": "Lifespan of RBCs in premature neonate", "exp": "Adults - 120 days.\nTerm infant - 60 - 90 days.\nPremature neonate - 35 - 50 days.", "cop": 4, "opa": "120 days", "opb": "60 days", "opc": "90 days", "opd": "40 days", "subject_name": "Medicine", "topic_name": null, "id": "89a53b03-bd40-46f7-ba75-2c2296e31401", "choice_type": "single"}
+{"question": "Reversible cause of Dementia includes", "exp": "(C) Normal pressure hydrocephalus # There are several clearly reversible causes of dementia that are remembered by the mnemonic DEMENTIA. D- Drugs (any drug with anticholinergic activity) E- Emotional- depression M- Metabolic (hypothyroid) E- Eyes and ears declining N- Normal pressure hydrocephalus T- Tumor or other space-occupying lesion I- Infection (syphilis, AIDS) A-Anemia (vitamin B12 or folate deficiency).> Major syndromes with progressive dementia include: Alzheimer disease (AD), vascular dementia (VaD), dementia with lewy bodies (DLB) and frontotemporal dementia (FTD).", "cop": 3, "opa": "Alzheimer's disease", "opb": "Dementia pugilistica", "opc": "Normal pressure hydrocephalus", "opd": "Multi-infarct dementia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "1f13ee26-951f-4ef7-8d77-89307dfe4ac4", "choice_type": "single"}
+{"question": "Cardiac defect in William's syndrome is", "exp": "(D) Supravalvular aortic stenosis # WILLIAMS SYNDROME shares some features with autism (such as difficulty understanding the state of mind of conversational partners) and Fetal alcohol syndrome (e.g., certain facial features, possible mental retardation, and negative potential outbursts), although persons with Williams generally possess very good social skills, such that this condition is sometimes called \"cocktail- party syndrome. Supravalvular aortic stenosis is common", "cop": 4, "opa": "ASD", "opb": "PS", "opc": "VSD", "opd": "Supravalvular aortic stenosis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "1adc3844-4f64-4931-a233-405fc1b6a0e8", "choice_type": "single"}
+{"question": "Post renal transplant lymphoma is mostly associated with", "exp": "EBV is a very common virus: about 9 in 10 adults have been infected with it. EBV infects B lymphocytes. Some cases of PTLD are not related to EBV (EBV-negative PTLD). They tend to occur months or years after transplant, when the risk of lymphoma is usually lower than it is in the early months after transplant. Ref Harrison20th edition pg 267", "cop": 1, "opa": "EBV", "opb": "CMV", "opc": "Herpes simplex", "opd": "HHV-6", "subject_name": "Medicine", "topic_name": "Kidney", "id": "34efef6e-9bd4-49c1-b7d1-12a0ee264be8", "choice_type": "single"}
+{"question": "The biochemical marker for primary hyperparathyroidism is", "exp": null, "cop": 1, "opa": "Hypercalcemia", "opb": "Hypophosphatemia", "opc": "Increased alkaline phosphatase levels", "opd": "Increased ACTH", "subject_name": "Medicine", "topic_name": null, "id": "765e1e14-fb73-4926-a0ce-143a1be2580e", "choice_type": "single"}
+{"question": "Chyluria is due to", "exp": "Chyluria is described as the passage of milky appearing white urine due to the presence of chyle composed of albumin, emulsified fats and fibrins in varying proportion that are absorbed by intestinal lacieals. \n\nChvluria is associated with filariasis :- \n\nChronic filaria can lead to renal involvement:- Chyluria is associated with abnormal retrograde or lateral flow of lymph from intestinal lymphatics of the kidney ureter or bladder allowing chylous material to be discharged into urinary collecting system.\nIntestinal lymph may be intermittently discharged into the renal pelvis, causing lymph fluid to pass into the urine.\nThis is known as chyluria and it results in milky appearance of the urine\nSince large amounts of fat and protein can be lost in the urine in individuals with chyluria this condition can lead to nutritional deficiencies including anemia and hvpoproteinemia.", "cop": 1, "opa": "Filaria", "opb": "Carcinoma", "opc": "Tuberculosis", "opd": "Malaria", "subject_name": "Medicine", "topic_name": null, "id": "614800d6-9ae3-4f27-b926-edbffe76074d", "choice_type": "single"}
+{"question": "Duroziez sign seen in", "exp": "Duroziez's sign : Systolic and diastolic bruits while compressing femoral aery. A similar sign is Traube's sign. Reference : Davidson, 23rd page no : 524.", "cop": 1, "opa": "AR", "opb": "AS", "opc": "MS", "opd": "MR", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "3d4144df-bc6a-4b78-86e4-be7f66420010", "choice_type": "single"}
+{"question": "Pulsus alternans occurs in", "exp": "Ans. Answer is D (MI) Pulsus alternans indicates severe impairment in LV function and may be seen in conditions causing severe LV dysfunction such as Myocardial Infarction Pulsus Alternans Pulsus alterans is charachterized by regular alteration of the pressure pulse amplitude despite a regular rhythm It is defined by beat to beat variation of the pulse amplitude but with a single peak and independent of the respiratory cycle. In pulsus bigeminus there is also a regular beat to beat variation but it is caused by a premature ventricular contraction that follows each regular beat. Pulsus alterans is charachteristically seen in Left ventricular failure and conditions causes LVF ( including MI) Causes of Pulsus Alternans 1. In patients with Hea Disease Left ventricular Failure and conditions causing LVF Presence of pulsus alterans usually indicates severe impairment of LV function. 2. In patients without Hea Diesease During or following paroxysmal tachycardia For several beats following a premature beat", "cop": 4, "opa": "Constrictive pericarditis", "opb": "Viral myocarditis", "opc": "Hypokalemia", "opd": "MI", "subject_name": "Medicine", "topic_name": null, "id": "dc8bb2c6-71fe-46fb-94fe-a45d842774b1", "choice_type": "single"}
+{"question": "Hypocalcemia with hyperphosphatemia are seen in.", "exp": "Improved medical management of chronic kidney disease now allows many patients to survive for decades and hence time enough to develop features of renal osteodystrophy, which must be controlled to avoid additional morbidity. Impaired production of 1,25(OH) 2 D is now thought to be the principal factor that causes calcium deficiency, secondary hyperparathyroidism, and bone disease; hyperphosphatemia typically occurs only in the later stages of CKD. Low levels of 1,25(OH) 2 D due to increased FGF23 production in bone are critical in the development of hypocalcemia. The uremic state also causes impairment of intestinal absorption by mechanisms other than defects in vitamin D metabolism. Nonetheless, treatment with supraphysiologic amounts of vitamin D or calcitriol corrects the impaired calcium absorption. Since increased FGF23 levels are seen even in early stages of renal failure in some patients, and have been repoed to correlate with increased moality, there is current interest in methods (lowering phosphate absorption) to lower FGF23 levels and concern as to whether vitamin D supplementation (known physiologically to increase FGF23) increases FGF23 in CKD. Hyperphosphatemia in renal failure lowers blood calcium levels by several mechanisms, including extraosseous deposition of calcium and phosphate, impairment of the bone-resorbing action of PTH, and reduction in 1,25(OH) 2 D production by remaining renal tissue(harrison 18 pg 3116)
", "cop": 1, "opa": "CRF", "opb": "Pseudobypoparathyoidsm", "opc": "Vit-D deficiency", "opd": "Vit-D deficiency", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "deb53386-ca4b-48e0-b6de-489537df647b", "choice_type": "single"}
+{"question": "A synchronous cardioversion is given in", "exp": null, "cop": 2, "opa": "AF", "opb": "Ventricular fibrillation", "opc": "Atrial flutter", "opd": "Ventricular tachycardia", "subject_name": "Medicine", "topic_name": null, "id": "38c05330-1414-4363-8197-c1fcc08b928b", "choice_type": "single"}
+{"question": "A seven year old girl presents with repeated episodes of bleeding into joints. APTT is prolonged and PT is normal. The most likely diagnosis is.", "exp": "Answer is C (Von Willebrand disease) Bleeding into joints along with normal PT and prolonged APTT iii a girl/female suggest a diagnosis of Von Willebrand disease Bleeding into joints along with prolonged APTT and normal PT may be seen in Factor VIII deficiency (Hemophilia A) and Von Willebrand disese. Hemophilia A is an X Linked disorder that alfects only boys and 11107 (Women who carry a single mutated gene are asymptomatic).- The patient in question is a seven year old girl and is hence unlikely to have hemophilia A. Von Willebrand Disease is an Autosomally inherited condition and may affect both boys and girls. This condition may present with bleeding into joints and is associated with prolonged APTT and normal PT. VWF disease is therefore the single best answer of choice Von Willebrand disease and Hemophilia A may both present nN ith bleeding into joints, prolonged APTT and normal PT I RUT Hemophilia A is a sex linked disorder that primarily involves males /boys alone. Features of VWF and differences with Haemophilia A Feature Hemophilia A Von Willebrand Disease Inheritance Sex linked Clinical disease limited to Men /boys (Extremely rare in females) Antosontal (Most eonttnonly A-dominant) Clinical disease may be seen in both boys & girls Factor Ville Decreased . Decreased VWF Normal Decreased Ristocetin cofactor Normal Decreased Common Presentation Features of clotting disorder Skin/Mucosal bleeding Hemahrosis ++ Features of bleeding disorder +- clotting disorder Skin/Mucosal bleeding + Hemahrosis+ Bleeding Time Normal Prolonged APTT Prolonged Prolonged (may be normal) PT Normal Normal Thrombin Time Normal Normal Fibrinogen Normal Normal Platelet aggregation in Response to Ristocetin Normal Decreased Factor VII deficiency is associated N1 ith an isolated prolon2ation of PT (APTT is normal) Causes of isolated prolongation of PT (CMDT): Factor VII deficiency Vitamin K deficiency Warfarin therapy Liver disease Factor XI I deficiency may present with an isolated prolon2ation of APTT (normal PT) associated N% it h clinical Bleedintl tendencies (Nelson/Clinical Hem:twiny) 'Factor XII deficiency is a rare hereditary deject of coagulation factors ill which no clinical apparent' - Clinical Hematology but this condition is not bleeding tendancies are Isolated elongation of APTT with bleeding manifestations Isolated prolongation of APTT without bleeding manifestations Factor VIII detect Factor 11I detect Factor IX defixt Prekallekrein defect Factor XI detect HAIN' Kininogen defect", "cop": 3, "opa": "Factor VIII deficiency (Hemophilia A)", "opb": "Factor VII deficiency", "opc": "Von Willebrand Disease", "opd": "Factor XII deficiency", "subject_name": "Medicine", "topic_name": null, "id": "d9379946-e9cb-4ceb-b6b0-e5cee50bd71b", "choice_type": "single"}
+{"question": "Mesial temporal lobe epilepsy is associated with", "exp": "harrison's principle of internal medicine 17th edition *mesial temporal lobe epilepsy is the most common syndrome associated with complex paial seizures Mesial temporal lobe epilepsy (MTLE) involves the medial or internal structures of the temporal lobe. Seizures often begin in a structure of the brain called the hippocampus or surrounding area. MTLE accounts for almost 80% of all temporal lobe seizures", "cop": 3, "opa": "Simple paial", "opb": "Generalised Tonic Clonic", "opc": "Complex paial", "opd": "Atonic seizures", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "596731b1-8671-42fe-b6da-ca3e2fad3aaf", "choice_type": "single"}
+{"question": "Thyroid Opthalmopathy", "exp": "The question is on unilateral ptosis whereas thyroid opthalmopathy has PROPTOSIS. \n\nIn myasthenia gravis, due to anti-Ach-receptor blocking antibodies there is ptosis which can be unilateral or asymmetrical which will again appear unilateral.\nMarfan syndrome has congenital Ptosis.\nPancoast tumor causes horner syndrome in which unilateral sympathetic chain is compressed leading to Ptosis, Miosis, Anhidrosis, Enopthalmos and loss of Cilio-spinal reflex.", "cop": 3, "opa": "Myasthenia Gravis", "opb": "Marfan syndrome", "opc": "Thyroid Opthalmopathy", "opd": "Pancoast tumor", "subject_name": "Medicine", "topic_name": null, "id": "8ac2bc42-c7c0-4a61-bf94-82e28ec49279", "choice_type": "single"}
+{"question": "Herpes simplex encephalitis affects ………………………….. lobe", "exp": null, "cop": 1, "opa": "Temporal", "opb": "Parietal", "opc": "Occipital", "opd": "Frontal", "subject_name": "Medicine", "topic_name": null, "id": "b576546d-b43e-403b-ae3c-79252d01c88a", "choice_type": "single"}
+{"question": "Fluent Aphasia with preserved comprehension and impaired repetition is", "exp": "(D) Conduction COMPREHENSIONREPETITION OF SPOKEN LANGUAGENAMINGFLUENCY* Wernicke'sImpairedImpairedImpairedPreserved or Increased* Broca'sPreserved (except grammar)ImpairedImpairedDecreased* GlobalImpairedImpairedImpairedDecreased* ConductionPreservedImpairedImpairedPreserved* Non fluent (motor) transcorticalPreservedPreservedImpairedImpaired* Fluent (sensory) transcorticalImpairedPreservedImpairedPreserved* IsolationImpairedEcholaliaImpairedNo purposeful speech* AnomicPreservedPreservedImpairedPreserved except for word-finding pauses* Pure word deafnessImpaired only for spoken languageImpairedPreservedPreserved* Pure AlexiaImpaired only for readingPreservedPreservedPreserved# CONDUCTION APHASIA (Associative aphasia), is a relatively rare form of aphasia.> An acquired language disorder, it is characterized by intact auditory comprehension, fluent speech production, but poor speech repetition.> They are fully capable of understanding what they are hearing, but show significant difficulty repeating phrases, particularly as the phrases increase in length and complexity and as they stumble over words they are attempting to pronounce.> Typical lesion location for conduction aphasia is on the supramarginal gyrus of the parietal lobe, posterior to the primary seriscry cortex and just above Wernicke's area.> Classical explanation for conduction aphasia is that of a disconnection between the brain areas responsible for speech comprehension (Wernicke's area) and speech production (Broca's area), due specifically to damage to the arcuate fasciculus, a deep white matter tract.", "cop": 4, "opa": "Broca's Aphasia", "opb": "Wernicke's Aphasia", "opc": "Anomic Aphasia", "opd": "Conduction Aphasia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "7e91b578-246c-47c0-9ac7-c4372ddbbe23", "choice_type": "single"}
+{"question": "Sickle cell Anemia leads to resistance towards", "exp": "Ans. is 'a' i.e., P. Falciparum Red cell surface antigen that offer protection against P. fakiparum Duffy blood group system ABO (H) blood group system Glycophorins Gerbich antigen Complement receptor type I Knops blood group Abnormalities of the red cell cvtoskeleton which may offer protection against Rfalciparum South-east asia ovalocytosis Hereditary elliptocytosis Hereditary spherocytosis Sickle cell HbA/S", "cop": 1, "opa": "P. Falciparum", "opb": "P. Ovale", "opc": "P. Malariae", "opd": "P. Vivax", "subject_name": "Medicine", "topic_name": null, "id": "5a4b4430-0483-403e-96e7-2cfdbdbccff0", "choice_type": "single"}
+{"question": "A 70 year old man develops pneumonia and septicemia. Patient goes into renal failure and has a BP of 70/50 mm of Hg. Drug that should be used to maintain BP is", "exp": null, "cop": 4, "opa": "Adrenaline", "opb": "Ephedrine", "opc": "Phenylephrine", "opd": "Nor epinephrine", "subject_name": "Medicine", "topic_name": null, "id": "f8012030-a084-4a51-a358-23dc5735e358", "choice_type": "single"}
+{"question": "Pancreatic pseudocyst most commonly occurs after", "exp": "Answer is B (Pancreatitis) Most common cause of pancreatic pseudocyst is Pancreatitis (90%). The second most common cause is trauma (10%).", "cop": 2, "opa": "Trauma", "opb": "Pancreatitis", "opc": "Pancreatic surgery", "opd": "Pancreatic malignancy", "subject_name": "Medicine", "topic_name": null, "id": "805af85f-4df9-49c7-91b7-da405cdfa4be", "choice_type": "single"}
+{"question": "RBBB with left Axis Detion Is characteristic of", "exp": "Left axis detion may occur as a normal variant but is more commonly associated with left ventricular hyperophy, a block in the anterior fascicle of the left bundle system (left anterior fascicular block or hemiblock), or inferior myocardial infarction. In ostium primum ASD, the RV conduction defect is accompanied by left superior axis detion and counterclockwise rotation of the frontal plane QRS loop. ( Harrison&;s principle of internal medicine,18th edition,pg no.1834 )", "cop": 1, "opa": "Ostium Primum ASD", "opb": "Mitral valve prolapse", "opc": "Patent Ductus Aeriosus", "opd": "Ventricular Septal Defect", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "3c2cebf4-2c73-412b-b909-af7037b2e7d7", "choice_type": "single"}
+{"question": "Management of uncomplicated essential hypeension is", "exp": "Ref Harrison 19 th ed pg 1617 Management of uncomplicated essential hypeension includes health promoting lifestyle modifications (includes dietary modification and exercise) and pharmacological therapy (drugs).", "cop": 3, "opa": "No need to treat", "opb": "Diet modification and exercise", "opc": "Diet modification, exercise and drugs", "opd": "Drugs alone", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "252249d8-a1f2-412e-ae75-33034f8695dd", "choice_type": "single"}
+{"question": "QT interval is shoens in", "exp": "Hypocalcemia typically prolongs the QT interval (ST poion), whereas hypercalcemia shoens it . Digitalis glycosides also shoen the QT interval, often with a characteristic \"scooping\" of the ST-T-wave complex (digitalis effect). Ref Harrison 20th edition pg 1567", "cop": 3, "opa": "Hypocalcaemia", "opb": "Hypokalemia", "opc": "Hypercalcaemia", "opd": "Hyperkalemia", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "217d1776-2a3d-4f58-a96e-e73c784f9bcc", "choice_type": "single"}
+{"question": "Cause of transudate pleural effusionn is", "exp": "Causes of transudative effusion includes Nephrotic syndrome,congestive hea failure,cirrhosis,pulmonary embolization, myxedema,etc.Causes of exudative effusion includes neoplasms;infections like pneumonia,TB,collagen vascular diseases,Meigs syndrome,etc. Most common cause of exudative pleural effusion is bacterial pneumonia. Reference:Davidson's Medicine-22nd edition,page no:661.", "cop": 1, "opa": "Nephrotic syndrome", "opb": "Tuberculosis", "opc": "Pneumonia", "opd": "Pulmonary infarction", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "b33c2d4e-967e-4aae-895b-d07d1910cbb3", "choice_type": "single"}
+{"question": "Most common site of sub ependymal astrocytoma (giant cell)", "exp": "Subependymal giant cell astrocytoma (SEGA, SGCA, or SGCT) is a low-grade astrocytic brain tumor (astrocytoma) that arises within the ventricles of the brain. It is most commonly associated with tuberous sclerosis complex (TSC). Although it is a low-grade tumor, its location can potentially obstruct the ventricles and lead to hydrocephalus Subependymal giant cell astrocytoma (SEGA) is a slowly growing tumor of unknown histogenesis mainly arising in the periventricular regions adjacent to the foramen of Monro which causes increased intracranial pressure, seizures, and focal neurologic signs Ref Harrison20th edition pg 2456", "cop": 2, "opa": "Trigone of lateral ventricle", "opb": "Foramen of munro", "opc": "Temporal horn of lateral ventricle", "opd": "4th ventricle", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "50e4979d-15d7-42d9-b07b-07565295344a", "choice_type": "single"}
+{"question": "Menke's disease\" is a disease of", "exp": "Ans. is 'b' i.e., Impaired copper transpo Menke's disease is caused due to defect in the copper transpo. There is defect in the transpo of copper present in the intestinal mucosa to the blood stream. The mucosal lining of intestine contains high level of copper bound to metallothionein protein. Rather than being transporated to bloodstream, the copper remained in the mucosa and was lost when intestinal cells were naturally soughed off. Menkes disease is caused due to defect in the \"MNK\" gene. The protein normally function by moving copper from the intestinal mucosal cells into the blood stream, where it is hound by proteins such as albumin and transpoed to organs and tissues. Serum copper is critical for the functioning of several enzymes Lysyl oxidase - It is impoant for the cross linking of collagen and elastin such that deficiencies lead to problems in connective tissues such as bones Cytochrome oxidase - Involved in temperature maintenance Tyrosinase - Necessary for pigmentation Clinical features of menkes disease Growth retardation Coarse hair, brittle and ivory white (result of depigmentations). The hair fibres are twiisted and broken helically (kinky hair). Seizures Cerebral and cerebellar degeneration (postmoem analysis) Hypothermia Thrombosis Poor bone development Increased tendency towards aneurysms", "cop": 2, "opa": "Impaired zinc transpo", "opb": "Impaired copper transpo", "opc": "Impaired magnesium transpo", "opd": "Impaired molybdenum transpo", "subject_name": "Medicine", "topic_name": null, "id": "d9b6a810-8203-45b9-bef6-c8e4f04175ff", "choice_type": "single"}
+{"question": "Human leukocyte antigen (HLA) DR4 occurs in about 70% of patients with rheumatoid ahritis HLA DR4 encoded in the major histocompatibility complex (MHC) region on", "exp": "Rheumatoid ahritis (RA) is a common form of inflammatory ahritis, occurring throughout the world and in all ethnic groups. The prevalence of RA is approximately 0.8-1.0% in Europe and the Indian subcontinent, with a female-to-male ratio of 3 : 1. The prevalence is lower in South-east Asia (0.4%). The highest prevalence in the world is in Pima Indians (5%). It is a chronic disease characterised by a clinical course of exacerbations and remissions . RA is a complex disease with both genetic and environmental components. The impoance of genetic factors is demonstrated by higher concordance of RA in monozygotic (12-15%) compared with dizygotic twins (3%), and an increased frequency of disease in first-degree relatives of patients. Genome-wide association studies have detected nearly 100 loci that are associated with the risk of developing RA. The strongest association is with variants in the HLA region. Recent studies have shown that the association with HLA is determined by variations in three amino acids in the HLA-DRb1 molecule (positions 11, 71 and 74) and single variants HLA-B (at position 9) and HLA-DPb1 (at position . The HLA locus is located on the sho arm of chromosome 6 and covers a 7.6 Mb region that contains over 250 highly polymorphic genes. The region is organized in three sub-regions: class I, class II and class III, which all have different functions. Both class I and II regions encode for glycoproteins that are expressed as cell surface receptors, whereas the class III region contains genes that encode for a variety of secreted immune system proteins, including complement factors and cytokines. The class I region encodes for three main subsets of HLA molecules; HLA-A, HLA-B and HLA-C. Class I HLA molecules are composed of an HLA-coded heavy a-chain and an invariant light chain, beta-2 microglobulin (b2m), which is essential for functional expression of the HLA molecule at the cell surface. The a-chain is folded to form a peptide-binding cleft that is \"closed\" and can accommodate sho antigenic peptides, typically 8-10 amino acids long. These class I molecules are expressed on all nucleated cells and specialize in presentation of intracellular antigens, including viral antigens, to cytotoxic (CD8+) T cells. Genes in the class II region encode for HLA-DR, HLA-DP and HLA-DQ molecules as well as a few other related proteins. Class II HLA molecules are composed of an a-chain and a b-chain, both coded by the HLA class II region. Unlike the class I molecules, the peptide-binding cleft of class II molecules are \"open\" which allows the accommodation of larger peptides of 15-20 amino acids long. Class II molecules are initially expressed on the cell surface of immune cells, in paicular antigen presenting cells such as macrophages or dendritic cells, as well as B cells and activated T cells. These molecules present antigens from outside the cell to (CD4+) T cells which in turn stimulate B cells to produce antibodies towards that specific antigen. This results in an antigen specific immune response. After activation of the immune system, the HLA class II molecules can be expressed on other cells. Ref - pubmed.com , Davidsons 23e p1044", "cop": 1, "opa": "Chromosome 6", "opb": "Chromsome 9", "opc": "Chromosome 18", "opd": "Choromosome 22", "subject_name": "Medicine", "topic_name": "Immune system", "id": "f6a19c83-3655-40a0-9c45-5111cc508c7b", "choice_type": "single"}
+{"question": "An elderly female presents to the emergency depament with history of fever, headache and double vision. Biopsy of temporal aery revealed panaeritis. The most likely diagnosis is", "exp": "Answer is D i.e. (Temporal Aeritis): The clinical complex of fever, headache and diplopia together with panaeritis on biopsy of temporal aery suggests the diagnosis of temporal aeritis.", "cop": 4, "opa": "Nonspecific Aeritis", "opb": "Polyaeritis Nodosa", "opc": "Wegener's Granulomatosis", "opd": "Temporal Aeritis", "subject_name": "Medicine", "topic_name": null, "id": "d40e2e94-126f-42fc-bc70-33863ac0a684", "choice_type": "single"}
+{"question": "Pulmonary fibrosis is associated with the use of", "exp": "question repeated", "cop": 1, "opa": "Bleomycin", "opb": "Cisplatin", "opc": "Methotrexate", "opd": "Actinomycin D", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "e7abf668-1cfd-40ec-bbbe-11bee127d7d2", "choice_type": "single"}
+{"question": "Pulsus paradoxus is a characteristic feature of", "exp": null, "cop": 2, "opa": "Constrictive pericarditis", "opb": "Cardiac Tamponade", "opc": "Hypertrophic obstructive cardiomyopathy", "opd": "Restrictive cardiomyopathy", "subject_name": "Medicine", "topic_name": null, "id": "340d9118-6a27-4282-b46b-06d63f1fd425", "choice_type": "single"}
+{"question": "Toxic shock syndrome caused by staphylococcus is due to", "exp": "Staphylococcal infections Staphylococci are usually found colonising the anterior nares and skin. Some staphylococci produce coagulase, an enzyme that conves fibrinogen to fibrin in rabbit plasma, causing it to clot. Staph. aureus is coagulase-positive, and most other species are coagulase-negative. In modern laboratory practice, however, the identification of Staph. aureus rarely involves the coagulase test. Staph. aureus is the main cause of staphylococcal infections. Staph. intermedius is another coagulase-positive staphylococcus, which causes infection following dog bites. Among coagulase- negative organisms, Staph. epidermidis is the predominant commensal organism of the skin, and can cause severe infections in those with central venous catheters or implanted prosthetic materials. Staph. saprophyticus is pa of the normal vaginal flora and causes urinary tract infections in sexually active young women. Others implicated in human infections include Staph. lugdunensis, Staph. schleiferi, Staph. haemolyticus and Staph. caprae. Coagulase-negative staphylococci are not usually identified to species level. Staphylococci are paicularly dangerous if they gain access to the blood stream, having the potential to disseminate widely . In any patient with staphylococcal bacteraemia, especially injection drug-users, the possibility of endocarditis must be considered . Growth of Staph. aureus in blood cultures should not be dismissed as a 'contaminant' unless all possible underlying sources have been excluded and repeated blood culture is negative. Any evidence of spreading cellulitis indicates the urgent need for an antistaphylococcal antibiotic, such as flucloxacillin (unless there is a likely risk of MRSA). This is paicularly true for mid-facial cellulitis, which can result in cavernous sinus thrombophlebitis. In addition, Staph. aureus can cause severe systemic disease due to the effects of toxin produced at superficial sites in the absence of tissue invasion by bacteria. Skin infections Staphylococcal infections cause ecthyma, folliculitis, furuncles, carbuncles, bullous impetigo and the scalded skin syndrome . They may also be involved in necrotising infections of the skin and subcutaneous tissues . Wound infections Many wound infections are caused by staphylococci, which may significantly prolong post-operative hospital stays Prevention involves careful attention to hand hygiene, skin preparation and aseptic technique, and the use of topical and systemic antibiotic prophylaxis. Treatment is by drainage of any abscesses plus adequate dosage of antistaphylococcal antibiotics, done early, paicularly if prosthetic implants have been inseed. Cannula-related infection Staphylococcal infection associated with cannula sepsis and thrombophlebitis is an impoant and common reason for morbidity following hospital admission. The Visual Infusion Phlebitis (VIP) score aids cannula evaluation . Ref Harrison20th edition pg 1077", "cop": 2, "opa": "Hemolytic antigen", "opb": "Super antigens", "opc": "Hyaluronidase", "opd": "Coagulase", "subject_name": "Medicine", "topic_name": "Infection", "id": "91a573ad-6d70-4da9-8a82-fc962b10e9e0", "choice_type": "single"}
+{"question": "Spur cell anaemia is seen in", "exp": "Spur cell anemia (SCA) is an acquired hemolytic anemia, characterized by an increase in the percentage of spur cells (acanthocytes) associated with liver cirrhosis . The presence of >=5% spur cells on peripheral blood smears has been observed in 31% of patients with liver cirrhosis Ref Davidson 23rd edition pg 891", "cop": 4, "opa": "Drug induced anaemia", "opb": "Hepatocellular disease", "opc": "Renal disease", "opd": "Alcoholism", "subject_name": "Medicine", "topic_name": "Haematology", "id": "156f690a-3bbb-4ad0-94ca-35085d97adc5", "choice_type": "single"}
+{"question": "A patient Shweta with raised serum alkaline phosphatase and raised parathormone level along with low calcium and low phosphate level is likely to have", "exp": "Answer is D (Vitamin D deficiency) Serum Ca Serum phosphorus Alkaline phosphatase PTH * Osteomalacia (Rickets) (|iNit. D) | | | | * Primary hyperparathyroidism bone disease | | , | | * Bone disease in renal failure with secondary hyperparathyroidism N/| | | | * Lytic bone neoplasms N/| N/| N/| N * Osteoporosis N N N N * Paget's disease N N | N", "cop": 4, "opa": "Primary hyperparathyroidism", "opb": "Paget's disease", "opc": "Osteoporosis", "opd": "Vitamin D deficiency", "subject_name": "Medicine", "topic_name": null, "id": "a6958436-9471-4225-b5d2-c477192da91d", "choice_type": "single"}
+{"question": "The term post traumatic epilepsy refers to seizures occurring", "exp": "Posttraumatic epilepsy (PTE) is a recurrent seizure disorder that apparently results from injury to the brain. This injury may be due to multiple types of head insults often labled traumatic brain injury (TBI). There is an increase in PTE due to increasing TBI. PTE must be differentiated from posttraumatic seizures (PTS), which is a broader-spectrum term and signifies seizures that occur as a sequel to brain injury. Seizures that occur within 24 hours after brain injury are called immediate PTS. PTS that occur within 1 week after injury are termed early PTS, and seizures that occur more than 1 week after injury are termed late PTS. About 20% of people who have a single late posttraumatic seizure never have any fuher seizures, and these people should not be labeled as having PTE. The former definition of epilepsy required 2 unprovoked seizures, but the updated definition of epilepsy can be met with 1 unprovoked seizure and high likelihood of another. This blurrs the definition of PTS and PTE, but it is impoant to differentiate between the two. As PTS is a provoked seizure it is different than unprovoked seizure, but late PTS may be hard to differentiate from PTE Ref - Harrison's internal medicine 20e , medscape.com", "cop": 3, "opa": "Within moments of head injury.", "opb": "Within 7 days of head injury.", "opc": "Within several weeks to months after head injury.", "opd": "Many years after head injury.", "subject_name": "Medicine", "topic_name": "All India exam", "id": "6d34742b-5bcd-4b4e-b5b8-c4a24d625e9c", "choice_type": "single"}
+{"question": "Vitamin K is given to a patient with jaundice, but PT remains unchanged. Probable cause is", "exp": "An elevated prothrombin time indicates either vitamin K deficiency due to prolonged jaundice and malabsorption of vitamin K or significant hepatocellular dysfunction. The failure of the prothrombin time to correct with parenteral administration of vitamin K indicates severe hepatocellular injuryReference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 58; Jaundice", "cop": 2, "opa": "Obstructive Jaundice", "opb": "Cirrhosis", "opc": "Hemolytic Jaundice", "opd": "Pre-renal Failure", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "42f9d9bc-482d-4c51-b590-7689c4359504", "choice_type": "single"}
+{"question": "Plasma ACTH levels are high between these following hours", "exp": "(B) 4 AM and 10 AM # ACTH the primary stimulator of adrenal cortisol production is synthesized by pituitary in response to CRH, which is released by hypothalamus.> Plasma ACTH and cortisol levels exhibit peaks at 6-8 AM and nadirs at 11 PM.> Referene values: 10-60 pg for AM values. No established reference values for PM.", "cop": 2, "opa": "4 PM and 8 PM", "opb": "4 AM and 10 AM", "opc": "10 AM and 3 PM", "opd": "10 AM and 2 PM", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "c6e16b30-7db2-439d-818c-fcb84c642b37", "choice_type": "single"}
+{"question": "Incidence of Down's syndrome is directly proportional to", "exp": "Ans. c (Maternal age). (Ref. Harrison, Internal Medicine, 16th ed., 383)The incidence of Down ys syndrome is highly correlated to maternal age.QUADRUPLE TEST FOR DOWN'S SYNDROME# AFP |# beta-HCG |# Unconjugated estriol |# Human placental lactogen/placental protein A |", "cop": 3, "opa": "Parity", "opb": "Consanguinity", "opc": "Maternal age", "opd": "Mutations", "subject_name": "Medicine", "topic_name": "Genetics", "id": "389faeed-bd76-4b6e-96ab-bb8ddf4c35bd", "choice_type": "single"}
+{"question": "Gold standard for diagnosis of pulmonary embolism", "exp": "CT-pulmonary angiography (CTPA) is the gold standard test for pulmonary embolism.It has the advantages of visualising the distribution & extent of the emboli,or highlighting an alternative diagnosis,such as,consolidation,pneumothorax, or aoic dissection.A definitive diagnosis of PE depends on visualisation of an intraluminal filling defect in more than one projection.Secondary signs of PE include abrupt occlusion (\"cut-off\") of vessels,segmental oligemia or avascularity,a prolonged aerial phase with slow filling, and touous,tapering peripheral vessels. Reference:Harrison's medicine-18th edition,page no:2174.", "cop": 2, "opa": "Chest X-ray", "opb": "Pulmonary angiography", "opc": "Ventilation perfusion scintiscan", "opd": "CT", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "5f998565-aa9a-4562-ac91-2e8f33c336f5", "choice_type": "single"}
+{"question": "The Investigation of choice for diagnosing Zollinger Ellison syndrome includes", "exp": "(D) Endoscopic ultrasound # Endoscopic ultrasound (EUS) permits imaging of the pancreas with a high degree of resolution (<5 mm).> EUS modality is particularly helpful in excluding small neoplasms within the pancreas & in assessing the presence of surrounding lymphnodes & vascular involvement.SENSITIVITY OF IMAGING STUDIES IN ZOLLINGER ELLISON SYNDROMEStudySensitivity, %Primary GastrinomaMetastatic GastrinomaUltrasound21-2814CT scan35-5935-72Selective angiography35-6833-86Portal venous sampling70-90N/ASASI55-7841MR!30-6071Octreoscan67-8680-100EUS80-100N/A", "cop": 4, "opa": "CT scan", "opb": "Selective angiography", "opc": "MRI", "opd": "Endoscopic ultrasound", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "5aee10d0-4a3c-4b2e-909d-ba3438550914", "choice_type": "single"}
+{"question": "Prosopognosia is", "exp": "(A) Inability to recognise face> Prosopognosia is a face-blindness (inability to recognise face) can be a developmental disorder, rather than one induced by strokes or lesions. Indeed, it turns out to be relatively common, affecting around 2 percent of the population.", "cop": 1, "opa": "Inability to recognise face", "opb": "Associated with Grestman syndrome", "opc": "Inability to do fine movement", "opd": "Seen in Balint syndrome", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "d372f4f8-b040-4d58-bb82-9bcf55912dda", "choice_type": "single"}
+{"question": "Not a feature of Riboflavin deficiency", "exp": null, "cop": 3, "opa": "Angular Stomatitis", "opb": "Magenta Coloured tongue", "opc": "Peripheral Neuropathy", "opd": "Sore throat", "subject_name": "Medicine", "topic_name": null, "id": "12db4f29-7ece-4d68-975c-a764edac4f7e", "choice_type": "single"}
+{"question": "Needle biopsy of solitary thyroid nodule in a young woman with palpable cervical lymph nodes on the same sides demonstrates amyloid in stroma of lesion. Likely diagnosis is", "exp": "Answer is A (Medullary Carcinoma thyroid) Presence of thyroid nodule along with palpable cervical lymph nodes and amyloid histologically is clearly indicative of Medullary variety of Carcinoma Thyroid. Medullary Carcinoma thyroid : It is a neuroendocrine carcinoma rising from parafollicular 'C' cells of thyroid Parafollicular 'C' cells are derived from neural crest and secrete calcitonin. Medullary carcinoma should be suspected whenever : a. High level of serum calcitoninQ are discovered b. Cervical lymph node are discovered at time of presentation. Q - Involvement of lymph nodes occurs early.Q - Thyroid and blood born metastasis occurs early.Q c. DiarrheaQ is a presentation d. AmyloidQ is present in stroma histologically. e. MEN setting : Evidence of Pheochromocytoma / Hyperparathyroidism / Thyroid cancer in family. (Discovery of medullary carcinoma thyroid makes family surveillance advisable).ef Hypocalcemia is associated: These cancers are associated with HypocalcemiaQ because calcitonin is secreted. Medullary carcinoma thyroid is seen as ? Sporadic : 80% Familial : 20% - Non MEN setting / MEN II a / MEN II b", "cop": 1, "opa": "Medullary carcinoma thyroid", "opb": "Follicular carcinoma thyroid", "opc": "Thyroid adenoma", "opd": "Multi nodular goitre", "subject_name": "Medicine", "topic_name": null, "id": "209078e5-a840-4b20-9289-93cf0428890c", "choice_type": "single"}
+{"question": "A male patient presents with headache , profuse sweating and palpitations with a blood pressure of 180/120 mmHg . The drug of choice would be", "exp": "Ref Harrison 19 th ed pg 1627 Symptomatic hypeension with diastolic pressure of 120 suggests a diagnosis of hypeensive emergency . Labetalol (IV) is the drug of choice for management of hypeensive emergency.", "cop": 2, "opa": "Nifedipine", "opb": "Labetalol", "opc": "Prazocin", "opd": "Phenoxy benzamine", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "ba303ad9-5b1c-4a37-b630-6293588e2b07", "choice_type": "single"}
+{"question": "Most common manifestation of severe hemophilia A is", "exp": "Recurrent heamarthrosis is a common manifestation of moderate / severe disease.", "cop": 2, "opa": "Retroperitoneal hemorrhages", "opb": "Recurrent heamarthrosis", "opc": "Recurrent muscle bleeding", "opd": "Recurrent bleeding from gums", "subject_name": "Medicine", "topic_name": null, "id": "0e4a74ea-ee41-4a90-9b0e-29a6d9692671", "choice_type": "single"}
+{"question": "HIV RNA by PCR can detect as low as", "exp": "Ans. is 'b' i.e., 40 copies viral RNA/ml of blood", "cop": 2, "opa": "30 copies viral RNA/ml of blood", "opb": "40 copies viral RNA/ml of blood", "opc": "50 copies of viral RNA/ml of blood", "opd": "60 copies of viral RNA/ml of blood", "subject_name": "Medicine", "topic_name": null, "id": "aa466fad-c105-48e7-a1cc-b390b4b50cd3", "choice_type": "single"}
+{"question": "Beck's triad of cardiac tamponade doesn't includes", "exp": "Ref Harrison 19 th ed pg 1573 The three principal features of tamponade (Beck's triad) are hypo- tension, soft or absent hea sounds, and jugular venous distention with a prominent x descent but an absent y descent. The limitations of ventricular filling are responsible for a reduction of cardiac output. The quantity of fluid necessary to produce cardiac tamponade may be as small as 200 mL when the fluid develops rapidly to as much as >2000 mL in slowly developing effusions when the pericardium has had the oppounity to stretch and adapt to an increasing volume.", "cop": 4, "opa": "Hypotension", "opb": "Neck vein distension", "opc": "Paradoxical pulse", "opd": "Silent hea", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "fd836d4a-128c-4ea0-8bb9-be2466a3f3b2", "choice_type": "single"}
+{"question": "Uhthoff's phenomenon is seen in", "exp": "(B) Multiple sclerosis # UHTHOFF'S PHENOMENON (Uhthoff's syndrome or Uhthoff's's sign or Uhthoff's Symptom) is the worsening of neurologic symptoms in multiple sclerosis (MS) and other neurological, demyelinating conditions when the body gets overheated from hot weather, exercise, fever, or saunas and hot tubs. It is possibly due to the effect of increased temperature on nerve conduction.> With an increased body temperature, nerve impulses are either blocked or slowed down in a damaged nerve but once the body temperature is normalized, signs and symptoms may disappear or improve.> In multiple sclerosis -- Heat sensitivity refers to neurologic symptoms produced by an elevation of the body's core temperature. For example, unilateral visual blurring may occur during a hot shower or with physical exercise (Uhthoff's symptom).", "cop": 2, "opa": "Tuberous sclerosis", "opb": "Multiple sclerosis", "opc": "Lupus erythematosus", "opd": "Leprosy", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "f993e82d-4988-4205-b439-5a227015c974", "choice_type": "single"}
+{"question": "Most common cause of Euvolemic hyponatremia is", "exp": "(C) SIADH # Euvolemic Hyponatremia can occur in moderate to severe hypothyroidism, with correction after achieving a euthyroid state.> Severe hyponatremia can also be a consequence of secondary adrenal insufficiency due to pituitary disease; whereas the deficit in circulating aldosterone in primary adrenal insufficiency causes hypovolemic hyponatremia, the predominant glucocorticoid deficiency in secondary adrenal failure is associated with euvolemic hyponatremia.> Glucocorticoids exert a negative feedback on A VP release by the posterior pituitary such that hydrocortisone replacement in these patients will rapidly normalize the A VP response to osmolality, reducing circulating A VP.> Syndrome of Inappropriate Anti Diuresis (SIAD) is the most frequent cause of Euvolemic Hyponatremia.> Generation of hyponatremia in SIAD requires an intake of free water, with persistent intake at serum osmolalities that are lower than the usual threshold for thirst; as one would expect, the osmotic threshold and osmotic response curves for the sensation of thirst are shifted downward in patients with SIAD.", "cop": 3, "opa": "Gastrointestinal loss", "opb": "Vomiting", "opc": "SIADH", "opd": "Water intoxication", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "3d78e385-f2d8-45c6-83ab-5293b1da96e0", "choice_type": "single"}
+{"question": "Cryoprecipitate contains", "exp": "Answer: a) Factor VIII and fibrinogen CryoprecipitateMade from fresh plasma by cooling the plasma to 4degC and collecting the supernatant layerContents: Fibrinogen, factor VIII, vWF, factor XIII", "cop": 1, "opa": "Factor VIII and fibrinogen", "opb": "Factor VII and fibrinogen", "opc": "Factor V and Factor VII", "opd": "Factor VII and Factor VIII", "subject_name": "Medicine", "topic_name": "Blood", "id": "48f71f76-4318-4660-ac37-7393c7c56098", "choice_type": "single"}
+{"question": "Ice pack test is due for", "exp": "Answer- A. Myesthenia gravisThe ice pack test is a bedside test to help in the diagnosis of myethenia gravis", "cop": 1, "opa": "Myesthenia gravis", "opb": "Multiple system atrophy", "opc": "Hyperparathyroidism", "opd": "Hypokalemic periodic paralysis", "subject_name": "Medicine", "topic_name": null, "id": "a5027311-6d37-479c-96b6-bb6e35ad6650", "choice_type": "single"}
+{"question": "Chronic fibrosing mediastinitis is seen ina) Tuberculosisb) Histoplasmosisc) Plagued) Sarcoidosis", "exp": null, "cop": 4, "opa": "acd", "opb": "bcd", "opc": "abc", "opd": "abd", "subject_name": "Medicine", "topic_name": null, "id": "8b4ec886-2c1d-454b-b999-97ddc0c7a50b", "choice_type": "single"}
+{"question": "Metabolic acidosis is compensated by", "exp": "i.e. (Hyperventilation): (289-90-H17th) (860-CMDT-l1)Metabolic acidosis is a condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body.Those in metabolic acidosis may exhibit deep, rapid breathing called Kussmaul respirations which is classically associated with diabetic ketoacidosis. Rapid deep breaths increase the amount of carbon dioxide exhaled,Arterial blood gas sampling is essential for the diagnosis. If the pH is low (under 7.35) and the bicarbonate levels are decreased (<24mmol/l), metabolic acidemia is present, and metabolic acidosis is presumed. Due to respiratory compensation (hyperventilation), carbon dioxide is decreased and conversely oxygen is increased, thus lowering the serum carbon dioxide levels, resulting in some degree of compensation.Compensatory mechanismsMetabolic acidosis is either due to increased generation of acid or an inability to generate sufficient bicarbonate.The body regulates the acidity of the blood by four buffering mechanisms.* bicarbonate buffering system* intracellular buffering by absorption of hydrogen atoms by various molecules, including proteins, phosphates and carbonate in bone.* Respiratory compensation* Renal compensationBufferThe decreased bicarbonate that distinguishes metabolic acidosis is therefore due to two separate processes the buffer (from water and carbon dioxide) and additional renal generation. The buffer reactions are:H+ + HCO3' - H2CO3 - CO2 + H2OThe Henderson - Hasselbalch equation mathematically describes the relationship between blood pH and the components of the bicarbonate buffering system.", "cop": 1, "opa": "Hyper ventilation", "opb": "|HCO3 loss", "opc": "|Cl- loss", "opd": "|ammonia excretion in kidney", "subject_name": "Medicine", "topic_name": "Fluid & Electrolyte", "id": "630d8d98-4139-410a-9af7-8848b1bd834b", "choice_type": "single"}
+{"question": "\"Kussmaul's sign\" is", "exp": "(Increase in the JVP during inspiration) (1306-H) (1384-H17lh)Kussmaul's sign - an increase rather than the normal decrease in the JVP during inspiration-is most often caused by severe right-sided heart failure, it is a frequent finding in patients with constrictive pericarditis or right ventricular infarction**", "cop": 1, "opa": "Increase in the JVP during inspiration", "opb": "Decrease in the JVP during inspiration", "opc": "Change in the blood pressure during exercise", "opd": "Epigastric pulsation during running", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "c94545d3-a346-4536-a8e0-cfc4d686e6fd", "choice_type": "single"}
+{"question": "Treatment of Acute Hyperkalemia", "exp": "reference : ", "cop": 1, "opa": "Ca gluconate given", "opb": "Insulin & Glucose reduces hyperkalemia within 4 hrs", "opc": "Dialysis not useful", "opd": "Resin shows the response within minutes", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "9dc73ce4-39fb-4c56-8b5b-53f4204ddef2", "choice_type": "single"}
+{"question": "Acrodermatitis hemorrhagica is due to deficiency of", "exp": "Ans. is 'a' i.e., Zinc Symptoms of Zinc Deficiency Mild deficiency Severe dificiency Growth retardation Dwarfism Cardiomyopathy Hypogonadism Infeility Loss of taste Poor wound healing Deformed bones Diarrhoea Alopecia Night blindness Skin striae Nail changes Acrodermatitis enteropathica is an inherited autosomal recessive disorder with imapired intestinal disorder and transpo of Zinc. Patient suffers with pustular and bullous dermatitis, alopecia, growth retardation diarrhoes, secondary infection, lethargy, irritability and depression. Oral Zinc supplementation leads to remission. Zinc 2nd most abundant trace element in the body. Most common catalytic metal ion in the cell cytoplasm. Component of more than 100 enzymes like DNA polymerase, RNA polymerase, transfer RNA synthetase. It plays role in all stages of insulin metabolism.", "cop": 1, "opa": "Zinc", "opb": "Manganese", "opc": "Copper", "opd": "Selenium", "subject_name": "Medicine", "topic_name": null, "id": "48cbc370-e89c-4281-b7d8-041c26e9c74e", "choice_type": "single"}
+{"question": "Klebsiella pneumonia is", "exp": "Klebsiella pneumonia :\n\nAir bronchogram sign positive.\nInvolves upper lobe.\nCavitations and pleural effusion is common.", "cop": 3, "opa": "Lobar pneumonia with absent air bronchogram sign", "opb": "Involves lower lobe predominantly", "opc": "Cavitation is common", "opd": "Pleural effusion is not commonly seen", "subject_name": "Medicine", "topic_name": null, "id": "d4658cbc-2293-4fe2-9f1d-861feda3ae1f", "choice_type": "single"}
+{"question": "Unilateral diaphragmatic paralysis cause", "exp": "Hemi diaphrogm palsy results in : \n\n↓ TLC\n↓ FVC\n↓ IRV\n↓ Normal FEV1 and FRC", "cop": 3, "opa": "No change is total Lung capacity", "opb": "Increase in forced vital capacity", "opc": "Decrease in inspiratory reserve volume", "opd": "No change in maximum breathing capacity", "subject_name": "Medicine", "topic_name": null, "id": "021b90d3-58cd-4eba-bd37-8bf3d60c7845", "choice_type": "single"}
+{"question": "A child presents with sho episodes of vacant stare several times a day. The vacant episode begins abruptly and the child remains unresponsive during the episode. There is no associated history of aura or postictal confusion and the child is otherwise normal, The likely diagnosis is", "exp": "*Sudden, brief lapses of consciousness without loss of postural control.*Consciousness lasts for only seconds, and returns, and there is no postictal confusion.*Bilateral motor signs such as rapid blinking of the eyelids, chewing movements, or small-amplitude, clonic movements of the hands.*Usually in childhood (ages 4-8 years) or early adolescence and the first clue to absence epilepsy is often unexplained \"daydreaming\" and a decline in school performance recognized by a teacher.*EEG shows generalized, symmetric, 3-Hz spike-and-wave discharge that begins and ends suddenly, superimposed on a normal EEG background.", "cop": 2, "opa": "Grandmal seizures", "opb": "Absence seizures", "opc": "Complex paial seizures", "opd": "Day dreaming", "subject_name": "Medicine", "topic_name": "All India exam", "id": "e79f26ee-7464-4d1e-a8f5-8390875f3c0d", "choice_type": "single"}
+{"question": "Interstitial nephritis is common with", "exp": "Ans. (a) NSA1DRef: Harrison 19th ed. /1856Choices B,C,D lead to acute tubular necrosis and hence by exclusion the answer is A.Causes of Acute Interstitial Nephritis* Drugs like beta lactams, quinolones, NSAID,COX-2 inhibitors, phenytoin, valproate and P.P.I* Infections like streptococcus, staphylococcus* Connective tissue disorder like SLE, Sjogren* Light chain nephropathy* Urate nephropathyCauses of Chronic Interstitial Nephritis* V.U.R* Sickle cell disease* Hypokalemic nephropathy", "cop": 1, "opa": "NSAID", "opb": "Black water fever", "opc": "Rhabdomyolysis", "opd": "Tumor lysis syndrome", "subject_name": "Medicine", "topic_name": "Glomerular Diseases", "id": "6554bcf8-c8a9-424f-82c4-9d9d3132ba4a", "choice_type": "single"}
+{"question": "Function of infliximab used in Crohn&;s is", "exp": "Infliximab, a chimeric IgG1 antibody against TNF-a, is approved for treatment of moderately to severely active UC.Infliximab is also effective in CD patients with refractory perianal and enterocutaneous fistulasAdalimumab and ceolizumab, golimumab are other Anti-TNF therapies approved for IBDInfliximab is also approved for psoriasis, psoriatic ahritis, ankylosing spondylitis, and rheumatoid ahritisRef: Harrison 19e pg: 1961", "cop": 1, "opa": "Inhibit TNF-a", "opb": "Inhibit IL-2", "opc": "EGFR inhibitor", "opd": "Inhibit VEGF", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "f6b5efe5-4989-4580-9f67-4d1c396f3746", "choice_type": "single"}
+{"question": "A patient with engorged neck veins, BP 80/50 and pulse rate of 100 following blunt trauma to the chest . Diagnosis of", "exp": "Ref Harrison 19 th ed pg 1573-1574 Cardiac tamponade should be suspected in any patient who has a rapid down hill course and exhibits the features of rising venous pressure and falling aerial pressure following blunt trauma to the chest.", "cop": 3, "opa": "Pneumothorax", "opb": "Right ventricular failure", "opc": "Cardiac tamponade", "opd": "Hemothorax", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "08b0d350-bf40-4796-9163-9400c7cfba31", "choice_type": "single"}
+{"question": "Investigation of choice for ureteric stones for ureteric stone", "exp": "Ans. is `a' i.e., CT scan CT scan has become the diagnosis of choice for ureteric stones The \"gold standars\" diagnostic test is holical CT without contrast. All of routine methods have become less usefull with the advent of more sensitive and specific nonenhanced computed tomography (CT) scanning. When CT is available, it is now considered the examination of choice for the detection and localization of urinary stones", "cop": 1, "opa": "CT scan", "opb": "USG", "opc": "MIBG scan", "opd": "DMSA scan", "subject_name": "Medicine", "topic_name": null, "id": "de9a7c03-4857-4b72-89c1-83737f409e81", "choice_type": "single"}
+{"question": "Rate of IV infusion of potassium in severe hypokalemia should not exceed", "exp": "Rate of K+ infusion should not exceed 20 mmol/hour unless paralysis or malignant ventricular arrhythmias are present. The use of intravenous administration should be limited to patients unable to use the enteral route or in the setting of severe complications (e.g., paralysis, arrhythmia). Intravenous K+-Cl- should always be administered in saline solutions, rather than dextrose, because the dextrose-induced increase in insulin can acutely exacerbate hypokalemia. The peripheral intravenous dose is usually 20-40 mmol of K+-Cl- per liter; higher concentrations can cause localized pain from chemical phlebitis, irritation, and sclerosis. If hypokalemia is severe (<2.5 mmol/L) and/or critically symptomatic, intravenous K+-Cl- can be administered through a central vein with cardiac monitoring in an intensive care setting, at rates of 10-20 mmol/h; higher rates should be reserved for acutely life-threatening complications. Ref: Harrison 19e pg: 308", "cop": 1, "opa": "20 mmol/hour", "opb": "40 mmol/hour", "opc": "60 mmol/hour", "opd": "80 mmol/hour", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "b0d268e2-b69c-4d6b-ba1b-9ca68cdff4f1", "choice_type": "single"}
+{"question": "The most sensitive test for the diagnosis of myasthenia Gravis is", "exp": "Answer is D (Single Fiber Electromyography (SFEMG)) : Single Fiber Electromyography (SFEMG) is the single most sensitive assay of neuromuscular function dysfunction in myasthenia gravis `SFEMG is the single most sensitive assay of neuromuscular function dysfunction in myasthenia gravis having a sensitivity of greater than 95% when applied to clinically affected muscle' - Merrit's Neurology 12th(2009) /389 `Single fiber electromyography is the most sensitive diagnostic test for MG, but abnormalities are not specific'. - 'Neuromuscular Junction Disorders: Diagnosis & Treatment (2003)/109 `Single fiber EMG is the most sensitive electrophysiological test for myasthenia gravis' - Adult Neurology' 2nd (Blackwell publishing) /299 Taken from 'Neuromuscular Junction Disorder's: Diagnosis & Treatment (2003) /109 Edrophonium test / Tensilon test Highly sensitive test with 85% sensitivity in ocular and 95% sensitivity in systemic myasthenia -Kanski Diagnosis is highly probable if test in unequivocally positive An initial dose of 2mg of edrophonium is given intravenously. If improvement occurs the test is considered positive and terminated. If there is no change an additional 8mg are given intravenously . Acetylcoline Receptor antibodies Sensitivity of 80-90% in systemic myasthenia - CMDT Highly specific and presence of Anti ACH Receptor Antibodies is viually diagnostic of M. gravis 85% positive in generalized M.G. 50% positive in ocular M.G. Definitive if positive Negative test does not exclude M.G. 40% of Anti antibody negative patients have Anti-Musk antibodies. Repetitive nerve stimulation / Electrodiagnostic test Helpful diagnostic evidence Best when weak muscles/ proximal ms. groups are tested Amplitude of evoked muscle end potential is measured - No change in normal patients - Reduction by > 10-15 % in myasthenic patients. Single fiber electromyography Demonstrates blocking and jitter with normal fiber density Most sensitive diagnostic test for MG with sensitivity of greater than 95% Confirmatory but not specific Often performed in conjunction with repetitive nerve stimulation test (Oxford handbook)", "cop": 4, "opa": "Elevated ACH Receptor Antibodies (ACHR Antibodies)", "opb": "Repetitive Nerve Stimulation test (RNS)", "opc": "Positive Edrophonium test (Tensilon test)", "opd": "Single Fiber Electromyography (SFEMG)", "subject_name": "Medicine", "topic_name": null, "id": "2b30dcb2-d015-4653-868a-7baea608a05f", "choice_type": "single"}
+{"question": "HIV infects most commonly", "exp": "Ans. is 'a' i.e CD4+ helper cells CD4+ T lymphocytes and CD4+ cells of monocyte lineage are the principal targets of HIV.Virtually any cell that expresses the CD4+molecule together with Coreceptor molecules can potentially be infected with H.I.V. e.g.Dendritic cellsLangerhans cellsEven Megakaryocytes, eosinophilis, Astrocytes, oligodendrocytes, microglial cells, CD4+ T cells can also be infected with HIV.", "cop": 1, "opa": "CD4+helper cells", "opb": "CD8+cells", "opc": "Macrophage", "opd": "Neutrophil", "subject_name": "Medicine", "topic_name": "Virology", "id": "5a6e9bde-818c-4aa9-a9fb-ec9836215b5e", "choice_type": "single"}
+{"question": "Coronary sinus opens into", "exp": null, "cop": 1, "opa": "Right atrium", "opb": "Left atrium", "opc": "Right ventricle", "opd": "Left ventricle", "subject_name": "Medicine", "topic_name": null, "id": "bbe4d478-36e8-4672-9b2b-56b25665ac36", "choice_type": "single"}
+{"question": "Commonest type of seizure in newborn/neonates", "exp": "*Subtle seizures are the commonest type of seizures in newborns especially they can occur within 72 hours of bih .. *They may result from hypoxic-ischemic encephalopathy in preterm infants Ref Harrison20th edition pg 2034", "cop": 3, "opa": "Clonic", "opb": "Tonic", "opc": "Subtle", "opd": "Tonic-clonic", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "635ed4bd-28c3-4589-8c3a-a1a79d72d0b2", "choice_type": "single"}
+{"question": "EEG pattern in REM sleep is", "exp": "(A) High amplitude, slow waves # SLEEP PATTERNS:> There are two different kinds of sleep: rapid eye movement (REM) sleep and non-REM (NREM), or slow wave, sleep.> NREM sleep is divided into four stages. A person falling asleep first enters stage 1, which is characterized by low-amplitude, high-frequency EEG activity> Stage 2 is marked by appearance of sleep spindles.> These are bursts of alpha-like, 10-14-Hz, 50-pV waves.> In stage 3, the pattern is one of lower frequency and increased amplitude of the EEG waves.> Maximum slowing with large waves is seen in stage 4.> Thus, the characteristic of deep sleep is a pattern of rhythmic slow waves, indicating marked synchronization.# REM Sleep:> The high-amplitude slow waves seen in the EEG during sleep are sometimes replaced by rapid, low- voltage EEG activity, which in primates, including humans, resembles that seen in stage 1 sleep.> However, sleep is not interrupted; indeed, the threshold for arousal by sensory stimuli and by stimulation of the reticular formation is elevated.> This condition is sometimes called paradoxical sleep, since the EEG activity is rapid.> Rapid, roving movements of the eyes occur during paradoxical sleep, and it is for this reason that it is also called REM sleep.> No such movements are present in slow-wave sleep, which consequently is often called NREM sleep.> Another characteristic of REM sleep is the occurrence of large phasic potentials, in groups of three to five, that originate in the pons and pass rapidly to the lateral geniculate body and from there to the occipital cortex.> For this reason, they are called pontogeniculo-occipital (PGO) spikes.", "cop": 1, "opa": "High amplitude, slow waves", "opb": "Low amplitude, rapid waves", "opc": "High amplitude, rapid waves", "opd": "Low amplitude, slow waves", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "5fd6c895-6a9a-4d5f-aa1c-706b726c71de", "choice_type": "single"}
+{"question": "Commonest site of involvement of herpes zoster", "exp": "People with herpes zoster most commonly have a rash in one or two adjacent dermatomes (localized zoster). The rash most commonly appears on the trunk along a thoracic dermatome. Less commonly, the rash can be more widespread and affect three or more dermatomes. This condition is called disseminated zoster Ref Harrison20th edition pg 980 Ref Davidson edition23rd pg 240", "cop": 1, "opa": "Thoracic region", "opb": "Cranial nerve", "opc": "Face", "opd": "Lumbar region", "subject_name": "Medicine", "topic_name": "Infection", "id": "26ede5df-0a50-4b12-ad59-269df498a5d7", "choice_type": "single"}
+{"question": "Chronic asbestos exposure causes", "exp": null, "cop": 1, "opa": "Mesothelioma", "opb": "Carcinoma of pharynx", "opc": "Leukoplakia", "opd": "Erythroplakia", "subject_name": "Medicine", "topic_name": null, "id": "be464d96-697a-4a3e-9179-c308bba5f05f", "choice_type": "single"}
+{"question": "The net diffusion of water from one solution of water from one solution through a semipermeable membrane to another solution containing a lower concentration of water is termed", "exp": "Osmosis is defined as the diffusion of water through a semipermeable membrane to a solution with a lower concentration of water. \nFiltration is the process in which fluids are pushed through biologic membranes by unequal processes. \nDiffusion (Brownian motion) is the random kinetic motion causing atoms and molecules to spread out evenly.", "cop": 3, "opa": "filtration", "opb": "diffusion", "opc": "osmosis", "opd": "brownian motion", "subject_name": "Medicine", "topic_name": null, "id": "65e372a9-3940-400d-82df-fb4f008e244a", "choice_type": "single"}
+{"question": "The finding of urine sodium concentration <20 mmol/L in hypovolemic hyponatremia implies", "exp": "Hypovolemic hyponatremia Urine sodium concentration >20 mmol/L Renal losses Diuretic excess Mineral coicoid deficiency Salt-losing deficiency Bicarbonaturia with Renal tubal acidosis and Metabolic alkalosis Ketonuria Osmotic diuresis Cerebral salt wasting syndrome Urine sodium concentration <20 mmol/L Extrarenal losses Vomiting Diarrhea Third spacing of fluids Burns Pancreatitis Trauma Ref: Harrison 19e pg: 299", "cop": 4, "opa": "Salt-wasting nephropathy", "opb": "Diuretic therapy", "opc": "Hypoaldosteronism", "opd": "Trauma", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "73012773-fa04-4119-a99f-d32396a25375", "choice_type": "single"}
+{"question": "&;V&; wave in jugular venous pulse is due to", "exp": "&;V&; wave in jugular venous pressure corresponds to right atrial filling during ventricular systole when the tricuspid valve is closed. The JVP has a biphasic waveform. * The \"a\" wave: First positive presystolic wave. * Right Atrial contraction. * Precedes the upstroke of carotid pulse, syn follows P wave of ECG. J. * * Peak of the &;a&; wave demarcates (\\c the end of atrial systole. * Dominant wave in JVP during inspiration. * Larger than \"v\" wave. s, * The \"x\" descent: (Systolic collapse) * Follows the &;a&; wave * Corresponds to atrial relaXation and rapid atrial filling pressure. * Most prominent motion of normal JVP. * Begins during systole and ends just before S2. * Larger than \"y\" descent. * The \" x&; \" (x prime) descent * Follows the &;c&; wave * Occurs as a result of the right ventricle pulling the tricuspid valve downward during ventricular systole. * As stroke volume is ejected, the ventricle takes up less space in pericardium, allowing relaXed atrium to enlarge. * Can be used as a measure of right ventricle contractility. * The \"c\" wave * and positive venous wave. * Right ventricular (isovolumic) Contraction 4 tricuspid valve to bulge towards the right atrium. The \"v\" wave * 3rd positive wave. * Begins in late systole and ends in early diastole. * Corresponds to Venous filling when the tricuspid valve is closed and venous pressure increases from venous return. * Occurs during and following the carotid pulse and peaks after S2. * The \"y\" descent: * Downslope of v wave. * Decline in RA pressure -rapid emptYing of the RA into the RV following the opening of the tricuspid valve in early diastole. Reference : Harrison 20th edition, pg 1421", "cop": 4, "opa": "Ventricular filling", "opb": "Ventricular contraction", "opc": "Atrial contraction", "opd": "Atrial filling", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "ab09abbd-d026-47a9-b064-725d8e07545d", "choice_type": "single"}
+{"question": "Brain tumor causing hypernatremia in children", "exp": "Ans. is 'c' i.e., Craniophyrangioma", "cop": 3, "opa": "Medulloblastoma", "opb": "Cerebellar astrocytoma", "opc": "Craniophyrangioma", "opd": "Brain stem glioma", "subject_name": "Medicine", "topic_name": null, "id": "66062054-e28e-4ab5-9e48-054e01630861", "choice_type": "single"}
+{"question": "Hyperkalemia is seen in", "exp": "Type - 1,2,3, - Hypokalemia.\nOnly type - 4 Hyperkalemia.", "cop": 4, "opa": "Type 1 RTA", "opb": "Type 2 RTA", "opc": "Type 3 RTA", "opd": "Type 4 RTA", "subject_name": "Medicine", "topic_name": null, "id": "37b2ebb6-9671-40d7-b9ce-7e6b5bb0f3c0", "choice_type": "single"}
+{"question": "The minimum dosage of Candesartan to begin with", "exp": "(A) 2 mg # Candesartan: It has the highest affinity for the AT 1 receptor & produces largely unsurmountable antagonism, probably due to slow dissociation from the receptors or receptor desensitization.> It is indicated i both Hypertension & CHF.> Hypertension: 2-32 mg; CHF: 4-32 mg", "cop": 1, "opa": "2 mg", "opb": "40 mg", "opc": "20 mg", "opd": "30 mg", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "57f9a396-6aca-4eb5-a5b4-b29d5baae575", "choice_type": "single"}
+{"question": "Hyperkalemia is a feature of", "exp": "Answer- C. Pseudohypoaldosteronism type 2Pseudohypoaldosteronism tnre 2 is associated with hyperkalemia.Conns syndrome, Gitelman's syndrome and Liddle syndrome are associated with hypokalemia.", "cop": 3, "opa": "Conns syndrome", "opb": "Gitelman's syndrome", "opc": "Pseudohypoaldosteronism type 2", "opd": "Liddle syndrome", "subject_name": "Medicine", "topic_name": null, "id": "0dd5f78f-09ff-4db1-a7f8-7f608018a5b7", "choice_type": "single"}
+{"question": "Acute and recurrent pancreatitis is repoed to occur in", "exp": "Recurrent acute pancreatic attacks is a rare clinical condition (2-5% of all acute pancreatis) in children and is mainly idiopathic in most cases. Sometimes it may be associated with congenital anomalies, metabolic diseases or hereditary conditions. Isovaleric acidemia (IVA) is a rare autosomal recessive amino acid metabolism disorder associated with isovaleryl coenzyme A dehydrogenase deficiency presenting the clinical findings such metabolic acidosis with increased anion gap, hyperammonemia, ketonemia, hypoglycemia, \"the odor of sweaty feet,\" abdominal pain, vomiting, feeding intolerance, shock and coma. Recurrent acute pancreatitis associated with IVA have been rarely repoed . Ref Davidson 23rd edition pg 1151", "cop": 3, "opa": "Homocystinuria", "opb": "Maple syrup urine disorder", "opc": "Isovaleric acidemia", "opd": "Tyrosinemia", "subject_name": "Medicine", "topic_name": "Immune system", "id": "1bf80d15-6571-47be-b026-adefa9035978", "choice_type": "single"}
+{"question": "Ritcher transformation, CLL transforms to", "exp": "Richter's Syndrome (RS), also known as Richter's Transformation, is a rare complication of Chronic Lymphocytic Leukaemia (CLL) and/or Small Lymphocytic Lymphoma (SLL). It is characterised by the sudden transformation of the CLL/SLL into a significantly more aggressive form of large cell lymphoma. Richter's Syndrome occurs in approximately 2-10% of all CLL/SLL patients during the course of their disease. In the most cases the normally slow growing, or indolent, CLL transforms into a common type of non-Hodgkin lymphoma (NHL) known as Diffuse Large B-Cell Lymphoma (DLBCL). Rarer cases transform into Hodgkin lymphoma(HL)/Hodgkin Disease (HD), and some types of T-cell lymphomas also have been repoed The most common symptoms of Richter's Syndrome arise from a sudden and dramatic increase in the size of lymph nodes (also known as 'lymphadenopathy') characterised by usually painless areas of swelling in the neck, axilla, abdomen (most commonly in the spleen, also known as 'splenomegaly') or groin. Patients also often experience a dramatic increase in unexplained weight loss, fevers and night sweats (often collectively referred to as 'B-symptoms'). Other signs and symptoms may include low haemoglobin (anaemia) characterised by: increasing fatigue shoness of breath dizziness and possible palpitations low platelets (thrombocytopaenia) characterised by excessive bruising or bleeding an increase in serum lactate dehydrogenase (LDH) or elevated serum calcium (hypercalcaemia) on routine blood tests. It is impoant to note that whilst some of these signs and symptoms may already be present to a lesser degree in people with previously diagnosed CLL/SLL, the possibility of Richter's Syndrome needs to be considered if there is a sudden and dramatic increase in these symptoms, which is not generally considered to be a typical feature of normally relatively indolent CLL/SLL disease. Richter's syndrome is a serious complication of CLL/SLL and unfounately is often fatal. If Richter's syndrome is diagnosed, it is advised that the person should seek recommended treatments, but also to get their lives in order to prepare for any outcome. You may wish to discuss an advanced health directive with your treatment team, to let them and your family know how you would like your health to be managed if your treatments are not successful Richter's Syndrome affects approximately 2-10% of patients with a prior diagnosis of CLL/SLL and can occur at any time throughout the course of the disease. Ref Davidson 23rd edition pg 789", "cop": 1, "opa": "Diffuse large B-cell lymphoma", "opb": "Anaplastic Large Cell Lymphoma", "opc": "Burkitt lymphoma", "opd": "Multiple myeloma", "subject_name": "Medicine", "topic_name": "Haematology", "id": "f71d1d66-111f-47cb-95f1-3ca88165cb3b", "choice_type": "single"}
+{"question": "Zellwenger syndrome, defect is in", "exp": "Zellweger syndrome is a rare congenital disorder characterized by the reduction or absence of functional peroxisomes in the cells of an individual. It is one of a family of disorders called Zellweger spectrum disorders which are leukodystrophies . Zellweger spectrum disorder is a group of conditions that have overlapping signs and symptoms and affect many pas of the body. This group of conditions includes Zellweger syndrome, neonatal adrenoleukodystrophy (NALD), and infantile Refsum disease. Ref - =60 years 1B: SBP >140 mmHg or DBP >90 mmHg 1C: Clinical symptomsUnilateral weakness Speech disturbance without weakness 21D: Duration>60 min 10-59 min 21D: Diabetes (oral medications or insulin) 1Score of 0 has 0% increased rate, whereas score of 7 has 22% rate of stroke in 3 months.Ref: Harrison 19e pg: 2569", "cop": 2, "opa": "5-10% in 3 months", "opb": "10-15% in 3 months", "opc": "20-25% in 3 months", "opd": "30-35% in 3 months", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "5621615b-54d2-410c-97a6-3712411de96b", "choice_type": "single"}
+{"question": "Long term glycaemic control in DM with", "exp": "(Glycated haemoglobin) (2296-H17th)Measurement of glycated haemoglobin is the standard method for assessing long term glycaemic controlWhen plasma glucose is consistently elevated there is an increase in non enzymatic glycation of haemoglobin small amount of HbA are non enzymaticaly glycated to form HbAjcThis alteration reflects the glycemic history over previous 2-3 months (since erythrocytes have an average life span of 120 days)* HbAlc assay performed by the high performance liquid chromatography (HPLC)HbAir measurement becomes unreliable in condition like- Haemoglobinopathies- Hemolytic anemia- Uremia* An alternative indicator of glycemic control when HbAjc is inaccurate is glycated albumin*** Nomal values 4-6% of the total hemoglobin* When HPLC the HbAlc approximate the following mean plasma glucose value* HbAlc 6% is 7.5 mmol/L (135mg ldl)7% is 9.5 mmol.L (170 mg/dl)8% is 11.5 mmol/L (205 mg/dL)(al% rise in HbA1c translates into 2.0 mmol/dL (35mg/dL) increase the mean glucose)GLUCOSE TOLERANCE TEST* Most valuable in investigating a case of \"symptomless\" glycosuria such as renal glycosuria and lag type glycosuria* Helpful in recognizing milder case of DM and \"early DM\"Decrease Glucose toleranceIncreased glucose tolerance* DM* In hyper activity of anterior pituitary and adrenal cortex* Hyperthyroidism* Hypopitutarism* Hyperinsulinism* Hypothyroidism* Adrenal cortical hypofunction (such as Addison's disease)* If there is decreased absorption like sprue, celiac disease* Fructosamine assay (albumin) generally reflects the status of glycemic control for only the preceding 2 weeks* Important for - hemoglobinopathies or hemolytic states or when a narrower time frame is required such as for ascertaining glycemic control at the time of conception in a diabetic women who has recently become pregnant (CMDT)", "cop": 2, "opa": "Total protein", "opb": "Glycated haemoglobin", "opc": "Total haemoglobin", "opd": "Glucose tolerance test", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "64f786c8-d8f2-49e2-9c12-5bb2bf3f2ed0", "choice_type": "single"}
+{"question": "Reverse transcriptase of hepatitis B virus is coded on the following gene", "exp": null, "cop": 3, "opa": "C gene", "opb": "S gene", "opc": "P gene", "opd": "X gene", "subject_name": "Medicine", "topic_name": null, "id": "bde21a40-07c1-40f5-9cb3-3b49d85c12e0", "choice_type": "single"}
+{"question": "Vasculitis not commonly seen in adults", "exp": "Kawasaki's disease is an acute, febrile, multisystem disease of children. Some 80% of cases occur prior to the age of 5, with the peak incidence occurring at <=2 years. It is characterized by nonsuppurative cervical adenitis and changes in the skin and mucous membranes such as edema; congested conjunctivae; erythema of the oral cavity, lips, and palms; and desquamation of the skin of the fingeips. Although the disease is generally benign and self-limited, it is associated with coronary aery aneurysms in ~25% of cases, with an overall case fatality rate of 0.5-2.8%. These complications usually occur between the third and fouh weeks of illness during the convalescent stage. Vasculitis of the coronary aeries is seen in almost all the fatal cases that have been autopsied. There is typical intimal proliferation and infiltration of the vessel wall with mononuclear cells. Beadlike aneurysms and thromboses may be seenalong the aery. Other manifestations include pericarditis, myocarditis,myocardial ischemia and infarction, and cardiomegaly . Ref - Harrisons 20e p2588", "cop": 1, "opa": "Kawasaki disease", "opb": "Henoch schonlein purpura", "opc": "Temporal aeritis", "opd": "PAN", "subject_name": "Medicine", "topic_name": "Immune system", "id": "73f55e19-eef0-461e-9a6c-1c260df58680", "choice_type": "single"}
+{"question": "Wide pulse pressure is seen in", "exp": "Wide pulse pressure is when SBP increases by more than 50%. It is seen in:\n\nAortic regurgitation \nPDA\nAnemia\nBeri beri\nHyperthyroidism \nFever\nComplete heart block\nAV shunts", "cop": 1, "opa": "Beri beri", "opb": "Cardiac tamponade", "opc": "Diarrhea", "opd": "Aortic stenosis", "subject_name": "Medicine", "topic_name": null, "id": "fda98ccd-14a1-443b-af07-6b913c213125", "choice_type": "single"}
+{"question": "Torsade de pointes is caused by", "exp": "Electrolyte disturbances including hypomagnesmia predispose patients for marked QT prolongation and Torsade de pointes as a result of reduced repolarization reserve Ref Harrison 20th edition pg 1423", "cop": 3, "opa": "Hypermagnesemia", "opb": "Metabolic acidosis", "opc": "Hypomagnesmia", "opd": "Metabolic alkalosis", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "88ba446c-00d2-4220-a60e-486a957b393c", "choice_type": "single"}
+{"question": "For the following dyslipidemias, select the most characteristic finding.Type III hyperlipoproteinemia.", "exp": "In the rare familial form, raised yellow plaques appear on palms and fingers, and reddish-yellow xanthomas occur on the elbows. This disorder is felt to be secondary to accumulation of abnormal chylomicron and very low-density lipoprotein (VLDL) remnants. It is probably due to inherited homozygous defects in Apo E-II structure.", "cop": 1, "opa": "palmar plane xanthomas", "opb": "triglycerides > 1000", "opc": "subcutaneous extensor tendon xanthomas", "opd": "low serum cholesterol", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "a38b9d29-13c2-40cc-a084-85c058cafdf4", "choice_type": "single"}
+{"question": "Lateral medullary syndrome is associated with", "exp": "Lateral medullary syndrome is a neurological disorder causing a range of symptoms due to ischemia in the lateral pa of the medulla oblongata in the brainstem. The ischemia is a result of a blockage most commonly in the veebral aery or the posterior inferior cerebellar aery Ref Harrison20th edition pg 2334", "cop": 1, "opa": "Dissociative anaesthesia", "opb": "Dense hemianaesthesia", "opc": "Crossed hemianesthesia", "opd": "No sensory defect", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "c3b3831b-dc4e-4c32-bb8c-4060385c7633", "choice_type": "single"}
+{"question": "Devic's disease is associated with", "exp": "(D) Aquaporin 4 # NEUROMYELITIS OPTICA (NMO) or Devic's disease or Devic's syndrome, is a heterogeneous condition consisting of recurrent and simultaneous inflammation and demyelination of the optic nerve (optic neuritis) and the spinal cord (myelitis).> Currently at least two different causes are proposed based on the presence of autoantibodies against AQP4.> Autoimmune reactions against aquaporin 4 produce Devic's disease Mutations in the aquaporin-2 gene cause hereditary nephrogenic diabetes insipidus in humans. Mice homozygous for inactivating mutations in the aquaporin-0 gene develop congenital cataracts.> A small number of people have been identified with severe or total deficiency in aquaporin-1. Interestingly, they are generally healthy, but exhibit a defect in the ability to concentrate solutes in the urine and to conserve water when deprived of drinking water.", "cop": 4, "opa": "Aquaporin 0", "opb": "Aquaporin 1", "opc": "Aquaporin 2", "opd": "Aquaporin 4", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "5333eaa6-744a-45de-a1ff-a03c87ffd2e0", "choice_type": "single"}
+{"question": "A student from Punjab presents for evaluation of anemia. His RDW was observed to be 13.5 while the MCV was 62.5. fl. The likely diagnosis is", "exp": "Ans. is 'd' i.e., Anemia of chronic disease The normal red cell distrubution width (RDW) is less than 14.5 (Ranges from 11.5 to 14.5 but there is no known cause of decreased RDW). Normal MCV varies from 79.93.3 ft. The patient in question therefore has a Reduced MCV and a Normal RDW. Low MCV along with normal RDW suggests a diagnosis of Anemia of chronic disease. Conditions with Reduced MCV and a Normal RDW o Anemia of Chronic disease Beta thalasemia Minor/Trait Alpha Thalassemia Minor/Trait Hemoglobin E Trait Note : Thalassemia Trait - Low MCV: Normal RDW Anemia of chronic disease - Low MCV : Normal RDW or Normal MCV and Normal RDW Iron deficiency Anemia - Low MCV : Increased RDW", "cop": 4, "opa": "Hemoglobin Punjab (HB-D Trait)", "opb": "Thalassemia Major", "opc": "Iron Deficiency Anemia", "opd": "Anemia of chronic disease", "subject_name": "Medicine", "topic_name": null, "id": "7e29a5d6-ff39-4ab0-a817-11713d114bdd", "choice_type": "single"}
+{"question": "De Musset's sign is seen in", "exp": "De Musset's sign - nodding of head with each systole seen in Aortic regurgitation.", "cop": 3, "opa": "Tricuspid regurgitation", "opb": "Mitral stenosis", "opc": "Aortic regurgitation", "opd": "Marfan syndrome", "subject_name": "Medicine", "topic_name": null, "id": "19e73f31-4d88-497c-90e2-582b764b2a8b", "choice_type": "single"}
+{"question": "Floppy iris syndrome is associated with usage of", "exp": "Selective alpha- adrenergic antagonist side effects may include hypotension, dizziness, nasal congestion, headache, and floppy iris syndrome. Ref Harrison 20th edi page no 2833", "cop": 3, "opa": "Anticholinergics", "opb": "PDE- 5 inhibitor", "opc": "Selective alpha- adrenergic antagonist", "opd": "5 alpha reductase inhibitor", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "1b936577-660e-45d6-b5a5-5e997bd72fe0", "choice_type": "single"}
+{"question": "In EEG type of wave seen in metabolic encephalophathy", "exp": "Ans. is 'cl' i.e., Delta E.E.G. changes in metabolic encephalopathy In metabolic encephalopathy changes are typically nonfocal E.E.G. has been widely used to evaluate metabolic encephalopathy. The E.E.G .findings are abnormal in acute encephalopathic stages. It is difficult to establish a diagnosis of metabolic encephalopathy with ceainity through E.E.G. There is generalized slowing of the E.E.G with an excess of the delta and theta waves with suppression of normal alpha and beta wave activity and occasionally bilateral spikes and waves complexes occurring in absence of seizure activity\". In metabolic encephalopathies, the E.E.G evolution correlates well with the severity of encephalopathy. o However EEG has little specificity in differentiating etiologies in metabolic encephalopathy. For example, though triphasic waves are most frequently mentioned in hepatic encephalopathy, they can also be seen in uremic encephalopathy or even in aged psychiatric patients treated with lithium. o Spikes and waves may appear in hypo or hyperglycemia uremic encephalopathy or vitamin deficiencies. Common principles of EEG changes in metabolic encephalopathy are : - Varied degrees of slowing Associated mixtures of epileptic discharge High incidence of triphasic waves Reversibility after treatment of underlying causes Metabolic encephalopathy EEG rythm Grade I (almost normal) Dominant activity is alpha rhythm with minimal teta activity Grade II (mildly abnormal) Dominant teta background with some alpha and delta activities. Grade II (moderately abnormal) Continuous delta activity predominates, little activity of faster frequencies Grade IV (severely abnormal) Low-amplitude delta activity or suppression-burst pattern Grade V (extremely abnormal) Nearly\"flat\" tracing or electrocerebral inactivity.", "cop": 4, "opa": "Alpha", "opb": "Beta", "opc": "Gamma", "opd": "Delta", "subject_name": "Medicine", "topic_name": null, "id": "9fcd3d11-2425-484c-97a3-cf409746efaa", "choice_type": "single"}
+{"question": "Predominantly sensory neuropathy is caused by", "exp": "Pyridoxine is an essential vitamin that serves as a coenzyme for transamination and decarboxylation. However, at high doses (116 mg/d), patients can develop a severe sensory neuropathy with dysesthesias and sensory ataxia. NCS reveal absent or markedly reduced SNAP amplitudes with relatively preserved CMAPs. Nerve biopsy reveals axonal loss of fiber at all diameters. Loss of dorsal root ganglion cells with subsequent degeneration of both the peripheral and central sensory tracts have been repoed in animal models.Ref: Harrison's 18/e p3463", "cop": 2, "opa": "Cisplatin", "opb": "Pyridoxine excess", "opc": "Suramin", "opd": "Diptheria", "subject_name": "Medicine", "topic_name": "All India exam", "id": "3a89f4e3-1865-4150-a4b1-b66a4b3fe110", "choice_type": "single"}
+{"question": "Lactic acidosis is not seen in", "exp": "Answer is D (Tolbutamide) : Oral hypoglycemics of the biguanide group (Metformin & Phettfelrmin) are known to cause Lactic acidosis. It is not a complication of sulfonylureas such as Tolbutamide, Chlorpropamide etc. Lactic acidosis Lactic acid is produced from pyruvate when oxidative metabolism is reduced and glycolysis is increased. Lactic acidosis occurs when the rate of production of lactic acid from pyruvate in muscle, skin brain and erythrocytes exceeds the rate of removal by liver and kidney. The ingestion of methanol (wood alcohol) causes metabolic acidosis and its metabolites formaldehyde and formic acid cause severe optic nerve and central nervous system damage. Lactic acide, Aceto-acids and other unidentified organic acids contribute to the acidosis.", "cop": 4, "opa": "Methanol poisoning", "opb": "Respiratory failure", "opc": "Circulatory failure", "opd": "Tolbutamide", "subject_name": "Medicine", "topic_name": null, "id": "86be3591-f111-4fc1-936c-0a8d574e16ec", "choice_type": "single"}
+{"question": "Most common site of sub ependymal astrocytoma", "exp": "Ans. is 'b' i.e. Foramen of Munro Most common site of subependymal astrocytoma is Foramen of monro.", "cop": 2, "opa": "Trigone of lateral ventricle", "opb": "Foramen of Munro", "opc": "Temporal horn of lateral ventricle", "opd": "4th ventricle", "subject_name": "Medicine", "topic_name": "Tumors of Nervous System", "id": "ee798e4e-8cff-4247-a7df-e8326a6e2d00", "choice_type": "single"}
+{"question": "The Most common lesion in Wernicke's encephalopathy is found in the", "exp": "(D) Mamillary bodies > Lesions in the periventricular regions of the diencephalon, midbrain, and brainstem as well as the superior vermis of the cerebellum consist of symmetric discoloration of structures surrounding the third ventricle, aqueduct, and fourth ventricle, with petechial hemorrhages in occasional acute cases and atrophy of the mamillary bodies in most chronic cases.", "cop": 4, "opa": "Dentate nucleus", "opb": "Substatia nigra", "opc": "Motor cortex", "opd": "Mamillary bodies", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "87b9ae43-c6fc-4080-b2ea-e4b9e0dee1e3", "choice_type": "single"}
+{"question": "Hemorrhagic meningitis is caused by", "exp": "Hemorrhagic Meningitis, also sometimes known as Anthrax Meningitis, occurs when anthrax is inhaled. Bacillus anthracis spreads through the bloodstream from the primary focus of infection causing the Hemorrhagic Meningitis. Ref Harrison20th edition pg 2456", "cop": 3, "opa": "Streptococcus pneumonia", "opb": "Haemophilus influenzae", "opc": "Bacillus anthracis", "opd": "Neisseria meningitidis", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "04ae34f7-63d4-45a8-b1e1-90b4c8d83bd1", "choice_type": "single"}
+{"question": "HIV binds to macrophages having", "exp": null, "cop": 3, "opa": "CD4 molecule", "opb": "CD4 & CXCR molecules", "opc": "CD4 & CCR5 molecule", "opd": "CXCR & CCR5 molecules", "subject_name": "Medicine", "topic_name": null, "id": "fdc885e9-67bb-4629-b9d7-aa55d6386c0e", "choice_type": "single"}
+{"question": "Pseudotumor cerebri is most commonly seen in", "exp": "Ans. a. Obese females in the age group 20-45 years Pseudotumor cerebri is most commonly seen in obese females in the age group 20-45 years. Pseudotumor Cerebri (Idiopathic Intracranial Hypeension) Benign self-limiting disorder with a orable outcome Majority of patients are young, female and obesee It occurs due to decreased CSF absorptione Mostly idiopathic in nature but seen in hypervitaminosis, expired tetracyclines, OCPs and steroid usee Causes of Pseudotumor Cerebri High doses of vitamin AQ Withdrawal of coicosteroid therapyQ Outdated TetracyclineQ Addison's diseaseQ QuinolonesQ SLEQ HypoparathyroidismQ Clinical Features: Manifested by headache, papilledema, normal CSF and normal ventricle size on imaging. No focal neurological signs Characteristic features of Pseudotumor Cerebri Elevated intracranial pressure (intracranial hypeension) with: Normal or Small sized ventricular systemQ No focal neurological signse PapilledemaQ(enlarged blind spot in visual fluid) Normal CSF findingse Normal CT scan, MRI and isotope brain scane Excessive slow-wave activity on ECGe Treatment: Carbonic anhydrase inhibitor (acetazolamide) lowers ICP by reducing the production of CSF. Weight reduction is vital but often unsuccessful. If acetazolamide and weight loss fail and visual field loss is progressive, a shunt should be performed without delay to prevent blindness. Occasionally, emergency surgery is required for sudden blindness caused by fulminant papilledema", "cop": 1, "opa": "Obese females in the age group 20-45 years", "opb": "Obese males in the age group 20-45 years", "opc": "Thin built females in the age group 50-60 years", "opd": "Thin built males in the age group 50-60 years", "subject_name": "Medicine", "topic_name": null, "id": "72c0e427-86e2-4421-88e9-880b34bccc47", "choice_type": "single"}
+{"question": "A 45 year old man had a Subarachnoid hemorrhage from a intracranial aneurysm 6 years ago . He also had progressive renal impairment associated with hematuria diagnosis is", "exp": "ADPCKD is associated with berry aneurysm.", "cop": 1, "opa": "PCKD", "opb": "Medullary Sponge kidney", "opc": "Liddle syndrome", "opd": "Fanconi syndrome", "subject_name": "Medicine", "topic_name": null, "id": "072231c3-5457-4cce-b09c-f19562dfc28e", "choice_type": "single"}
+{"question": "Dicrotic notch is due to closure of", "exp": "Dicrotic notch is due to backflow of blood in the aoa at the beginning of diastole.It marks the end of ventricular systole. Reference:Textbook of medical physiology Geetha,2nd edition,page no:187.", "cop": 1, "opa": "Aoic valve", "opb": "Mitral valve", "opc": "pulmonary", "opd": "Tricuspid valve", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "dfd31e5c-a11e-4664-9f91-c8d98c63b950", "choice_type": "single"}
+{"question": "Zona glomerulosa produces", "exp": "(B) Aldosterone # Synthesis and Secretion of Adrenocortical Hormones> The Adrenal Cortex Has Three Distinct Layers :> The zona glomerulosa, a thin layer of cells that lies just underneath the capsule, constitutes about 15 per cent of the adrenal cortex.> These cells are the only ones in the adrenal gland capable of secreting significant amounts of aldosterone because they contain the enzyme aldosterone synthase, which is necessary for synthesis of aldosterone.> The secretion of these cells is controlled mainly by the extracellular fluid concentrations of angiotensin II and potassium, both of which stimulate aldosterone secretion.> The zona fasciculata, the middle and widest layer, constitutes about 75 per cent of the adrenal cortex and secretes the glucocorticoids cortisol and corticosterone, as well as small amounts of adrenal androgens and estrogens.> The secretion of these cells is controlled in large part by the hypothalamic-pituitary axis via adrenocorticotropic hormone (ACTH).> The zona reticularis, the deep layer of the cortex, secretes the adrenal androgens dehydroepiandrosterone (DHEA) and androstenedione, as well as small amounts of estrogens and some glucocorticoids.", "cop": 2, "opa": "Angiotensin", "opb": "Aldosterone", "opc": "Sensitive changes in the renal blood flow", "opd": "Conversion of angiotensinogen to angiotensin", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "dc27ecf0-ca9d-4dcd-b2c4-3b40d89acd7f", "choice_type": "single"}
+{"question": "The best method of measuring blood glucose level in the long term would be", "exp": null, "cop": 3, "opa": "Glucose tolerance test", "opb": "Benedict's test", "opc": "Glycosylated-Hb method", "opd": "Stressed glucose tolerance test", "subject_name": "Medicine", "topic_name": null, "id": "86796285-77d8-4604-bb64-b3775d689e35", "choice_type": "single"}
+{"question": "A toxin of clostridium tetanus, tetanospasmin causes muscular rigidity by blocking", "exp": null, "cop": 1, "opa": "Gamma amino butyric acid", "opb": "Dopamine", "opc": "Serotonin", "opd": "Glutamine", "subject_name": "Medicine", "topic_name": null, "id": "1bde244c-6a06-4249-8fdc-3365613f85ca", "choice_type": "single"}
+{"question": "In Hemolytic anemias the urobilinogen level in the blood would", "exp": null, "cop": 1, "opa": "Increase", "opb": "Be absent", "opc": "Decrease", "opd": "Mildly decrease", "subject_name": "Medicine", "topic_name": null, "id": "1f50a981-7f50-4ac6-be15-3beea3613501", "choice_type": "single"}
+{"question": "Gait disorder described as 'Slipping Clutch Syndrome' occurs in", "exp": "(D) Frontal gait disorder # FRONTAL GAIT DISORDER (gait apraxia) is common in elderly & has a variety of causes.> Term is used to describe a shuffling freezing gait with imbalance and other signs of higher cerebral dysfunction.> Typical features include a wide base of support a short stride shuffling along the floor & difficulty with starts and turns.> Many patients exhibit a difficulty with gait initiation that is descriptively characterized as the \"slipping clutch\" syndrome or gait ignition failure or lower-body parkinsonism.> Strength is generally preserved & patients are able to make stepping movements when not standing and maintaining their balance at the same time.> Higher-level motor control disorder as opposed to an apraxia.> Most common cause of frontal gait disorder is vascular disease particularly subcortical small-vessel disease.> Lesions are frequently found in the deep frontal white matter and centrum ovale.> Gait disorder may be the salient feature in hypertensive patients with ischemic lesions of the deep-hemisphere white matter (Binswanger's disease).> Clinical syndrome includes mental changes (variable in degree) dysarthria pseudobulbar affect (emotional disinhibition) increased tone and hyperreflexia in the lower limbs.> Communicating hydrocephalus in adults also presents with a gait disorder of this type.> Other features of the diagnostic triad (mental changes incontinence) may be absent in the initial stages.> MRI demonstrates ventricular enlargement an enlarged flow void about the aqueduct and a variable degree of periventricular white-matter change.> Lumbar puncture or Dynamic test is necessary to confirm hydrocephalus.", "cop": 4, "opa": "Cerebellar gait disorder", "opb": "Sensory gait disorder", "opc": "Parkinson gait disorder", "opd": "Frontal gait disorder", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "0278d132-6119-431f-8de1-bc07ddfe2f9d", "choice_type": "single"}
+{"question": "L'Hermittes' sign is characteristic feature of", "exp": "(C) Multiple sclerosis # Lhermitte's Sign, sometimes called the Barber Chair phenomenon, is an electrical sensation that runs down the back and into the limbs, and is produced by bending the neck forward.> Sign suggests a lesion of the dorsal columns of the cervical cord or of the caudal medulla.> Multiple sclerosis: Although often considered a classic finding in multiple sclerosis, it can be caused by a number of conditions, including Behget's disease, trauma, radiation myelopathy, vitamin B12 deficiency (subacute combined degeneration), and compression of the spinal cord in the neck from any cause such as cervical spondylosis, disc herniation, tumor, and Arnold-Chiari malformation.", "cop": 3, "opa": "Syringomyelia", "opb": "Tabes dorsalis", "opc": "Multiple sclerosis", "opd": "Parkinsonism", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "d3d099d3-ed57-4c01-b089-60e37d401106", "choice_type": "single"}
+{"question": "'Square root' sign is characteristic of", "exp": "square root sign is a charecteristic feature of Constrictive pericarditis Dip & plateau pattern' or 'square root sign': Early diastolic filling of the ventricles is unimpeded and abnormally rapid, but late diastolic filling is abbreted and halts abruptly when total cardiac volume expands to the volume limit set by the stiff pericardium Ref Harrison 20th edition pg 1436", "cop": 3, "opa": "Dilated cardiomyopathy", "opb": "Restrictive cardiomyopahty", "opc": "Constrictive pericarditis", "opd": "Contractile dysfuncation seen in which type of cardiomyopathy?", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "bae61c53-47e4-4981-8a73-a0b2a28134d8", "choice_type": "single"}
+{"question": "SSPE is not diagnosed by", "exp": "Ans. is 'a' i.e., Tuberculosis Bronchiectasis Sicca or Dry Bronchiectasis is typically associated with Tuberculosis. Tuberculosis is associted with a type of dry bronchiectasis called Bronchiectasis Sicca, which is predominantly seen in upper lobes. Dry Bronchiectasis (Bronchiectasis Sicca) is typically characterized by absence of copious amount of sputum which is usually a hall mark of bronchiectasis. Dry cough associated with hemoptysis is the typical presentation", "cop": 1, "opa": "EEG", "opb": "Antibodies to measles in CSF", "opc": "Antibodies to measles in blood", "opd": "Antigen in brain biopsy", "subject_name": "Medicine", "topic_name": null, "id": "8db45dc4-3ae3-4bc1-ac84-55f5764ee166", "choice_type": "single"}
+{"question": "Kussmaul's sign is positive in \na. Restrictive cardiomyopathy \nb. Constrictive pericarditis \nc. Cardiac tamponade \nd. Dilated cardiomyopathy \ne. Pneumothorax", "exp": "Kussmaul's sign is rise in JVP with inspiration. It is seen in constrictive pericarditis and Restrictive cardiomyopathy.", "cop": 2, "opa": "a,b,e", "opb": "a,b", "opc": "a,c,d,e", "opd": "a,b,c,d,e", "subject_name": "Medicine", "topic_name": null, "id": "00b53949-9c9a-48f4-8897-df640683fb32", "choice_type": "single"}
+{"question": "Drug of choice for hypeension crises in systemic sclerosis is", "exp": "One of the main causes of death is hypeensive renal crisis, characterised by rapidly developing malignant hypeension and renal failure. Hypeensive renal crisis is much more likely to occur in DCSS than in LCSS, and in patients with topoisomerase 1 antibodies. Hypeension should be treated aggressively with ACE inhibitors, even if renal impairment is present. DAVIDSON&;S 22nd EDITION;PAGE NO 1113", "cop": 3, "opa": "Beta blocker", "opb": "Losaan", "opc": "ACE inhibitor", "opd": "Nitrates", "subject_name": "Medicine", "topic_name": "Immune system", "id": "5d79dffd-dde1-4967-bc9d-0910b7926218", "choice_type": "single"}
+{"question": "Characteristic ECG finding of pulmonary embolism", "exp": "Ans. is `b' i.e., SJQ3T3 E.C.G. changes of pulmonary embolism ? Sinus tachycardia is the most frequent and nonspecific finding on electrocardiography in acute pulmonary embolism. Features suggesting acute right hea strain on the ECG occur relatively infrequently, these include. Acute right axis detion P pulmonale Right bundle branch block Inveed T waves ST segment changes in right sided leads. Earlier the following E.C.G. changes were considered highly predictive of acute pulmonary embolism, but these observations were found in less than 12% of patients with pulmonary emboli in recent studies. These E.C.G. features are - S wave in lead I Q wave in lead III Inveed Tin lead III (\"S1Q31.3\") S waves in lead I, II and III (\"Si,S2 S3\") Also know Areterial blood gas analysis in pulmonary embolism : Arterial blood gas analysis shows Mid to moderate hypoxemia Increased P (A - a) 0, Mildly reduced PaCO2 Almost all patients with pulmonary embolism have PaO, < 80 mm Hg but no absolute level of Pa02 can be used to exclude the diagnosis.", "cop": 2, "opa": "Sinus tachycardia", "opb": "S Q3T3", "opc": "T wave inversion", "opd": "Epsilon waves", "subject_name": "Medicine", "topic_name": null, "id": "fb7cbecd-c2f4-4f0f-a6a6-a8f8595ccb17", "choice_type": "single"}
+{"question": "Red cell cast are more common with", "exp": "Ans. (c) Nephritic syndromeRef: Robbins 8th ed. / Ch. 14The presence of red blood cells within the cast is always pathological, and is strongly indicative of glomerular damage, which can occur in# Glomerulonephritis like P.S.G.N, acute glomerulonephritis, R.P.G.N# Vasculitis, including Wegeners granulomatosis, systemic lupus erythematosus or Goodpasture's syndrome.# Renal infarction# Subacute bacterial endocarditis.* They are a yellowish-brown in color and are generally cylindrical with sometimes ragged edges; their fragility makes inspection of a fresh sample necessary.* RBCs may appear normally shaped, swollen by dilute urine (in fact, only cell ghosts and free hemoglobin may remain), or crenated by concentrated urine.* Both swollen, partly hemolyzed RBCs and crenated RBCs are sometimes difficult to distinguish from WBCs in the urine. In addition, red cell ghosts may simulate yeast.* The presence of dysmorphic RBCs in urine suggests a glomerular disease such as a glomerulonephritis. Dysmorphic RBCs have odd shapes as a consequence of being distorted via passage through the abnormal glomerular structure.", "cop": 3, "opa": "Acute tubular necrosis", "opb": "Nephrotic syndrome", "opc": "Nephritic syndrome", "opd": "Interstitial nephritis", "subject_name": "Medicine", "topic_name": "Glomerular Diseases", "id": "fc3556a3-6c49-4768-ad47-4036ddbb8c63", "choice_type": "single"}
+{"question": "Hypercalcemia is diagnosed by", "exp": "(B) Serum calcium # Approach to medical treatment of hypercalcemia varies with its severity> Mild hypercalcemia,<3.0 mmol/L (12 mg/dL), can be managed by hydration.> More severe hypercalcemia must be managed aggressively;", "cop": 2, "opa": "Ionised calcium level", "opb": "Serum calcium", "opc": "Serum phosphate", "opd": "Urinary calcium concentration", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f71ae904-28ad-49c3-9011-2dd43a4c9d24", "choice_type": "single"}
+{"question": "An elderly man presents with tremors and gives a family history of dementia, The diagnosis is", "exp": "(B) Parkinsonism dementia-ALS complex # Amyotrophic lateral sclerosis (ALS) or Lou Gehrig's Disease or Maladie de Charcot or motor neurone disease) is a progressive, fatal, neurodegenerative disease caused by the degeneration of motor neurons, the nerve cells in the central nervous system that control voluntary muscle movement> The disorder causes muscle weakness and atrophy throughout the body as both the upper & lower motor neurons degenerate and die, ceasing to send messages to muscles> Unable to function, the muscles gradually weaken, atrophy, and develop fasciculations (twitches) because of denervation. Eventually, the brain completely loses its ability to initiate and control voluntary movement.> Frontotemporal dementia with Parkinsonism-17 (FTDP-17) is a type of progressively worsening dementia that affects the frontal (front) and temporal (side) regions of the brain. It includes some instances of what was once called 'Pick's disease'.> Symptoms may include personality changes with loss of social niceties, diminished cognitive capacity and parkinsonism (lack of facial expression, slow movements, rigidity and balance problems).", "cop": 2, "opa": "Alzhiemer's disease", "opb": "Parkinsonism dementia-ALS complex", "opc": "Huntington's chorea", "opd": "Pick's disease", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "eb03d2e3-a264-461b-a3dc-fa87b40c00f0", "choice_type": "single"}
+{"question": "In chronic glomerulonephritis the best urinary finding is", "exp": "In chonic glomerulonephritis the best urinary finding is low Fixed Specific Gravity. \n \nWhile in acute glomerulonephritis, most characteristic is Erythrocyte casts in urine.", "cop": 3, "opa": "Albumin", "opb": "Bacteria", "opc": "Fixed Specific Gravity", "opd": "RBC casts", "subject_name": "Medicine", "topic_name": null, "id": "d56d3fb2-cc57-4f0b-aeea-8341f2eafc72", "choice_type": "single"}
+{"question": "Pulmonary hypeension is caused by", "exp": "Category 1. Pulmonary aerial hypeension (PAH) Key feature: elevation in pulmonary aerial pressure (PAP) with normal pulmonary capillary wedge pressure (pcwp) Includes: Idiopathic (IPAH) * Sporadic * Familial * Exposure to drugs or toxins * Persistent pulmonary hypeension of the newborn * Pulmonary capillary hemangiomatosis (PCH) Associated with other active conditions * Collagen vascular disease * Congenital systemic-to-pulmonary shunts * Poal hypeension * HIV infection Category 2. Pulmonary venous hypeension Key feature: elevation in PAP with elevation in pcwp Includes: * Left-sided atrial or ventricular hea disease * Left-sided valvular hea disease * Pulmonary venous obstruction * Pulmonary venoocclusive disease (PVOD) Category 3. Pulmonary hypeension associated with hypoxemic lung disease Key feature: chronic hypoxia with mild elevation of PAP Includes: * Chronic obstructive lung disease * Interstitial lung disease * Sleep-disordered breathing * Alveolar hypoventilation disorders * Chronic exposure to high altitude * Developmental abnormalities Category 4. Pulmonary hypeension due to chronic thromboembolic disease Key feature: elevation of PA pressure with documentation of pulmonary aerial obstruction for >3 monthsIncludes: * Chronic pulmonary thromboembolism * Nonthrombotic pulmonary embolism (tumor, foreign material) Category 5. Miscellaneous Key feature: elevation in PAP in association with a systemic diseasewhere a causal relationship is not clearly understood. Includes: * Sarcoidosis * Chronic anemias * Histiocytosis X * Lymphangiomatosis * Schistosomiasis ref:Harrison&;s principles of internal medicine,ed 18,pg no 2078", "cop": 1, "opa": "Interstitial lung disease", "opb": "Myocardial infarction", "opc": "Systemic hypeension", "opd": "Thromboembolism", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "d343ef8e-19d0-44eb-9a3b-544077868d72", "choice_type": "single"}
+{"question": "Pink frothy expectoration is seen in", "exp": "A. i.e. (Pulmonary oedema) (1466 - H17th) (26 - 27 - CMDT 09)Pink frothy expectoration is seen in - Pulm. Oedema, Mitral stenosisPULMONARY EDEMA - rapid onset of dyspnea at rest**, tachypnea, tachycardia and severe hypoxemia, Rales and wheezing, Hypertension* Hemoptysis results from rupture ofpulmonary bronchial venous connections secondary to pulmonary venous hypertensionAcute Pulmonary edema - presents with severe dyspnea, production of pink frothy sputum** and diaphoresis and cyanosis (357 - CMDT - 09)* Blood may arise from the airways in COPD, Bronchiectasis and bronchogenic carcinoma; from the pulmonary parenchyma in pneumonia, inhalation of crack cocaine or autoimmune diseases (Such as Good pasture disease or Wegner granulomatosis)", "cop": 1, "opa": "Pulmonary oedema", "opb": "Pulmonary tuberculosis", "opc": "Carcinoma lung", "opd": "Hamartoma", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "8a1bb1a0-5d04-4a36-8bf0-697d2ef11f31", "choice_type": "single"}
+{"question": "Not a feature of triad of hepatopulmonary syndrome", "exp": null, "cop": 4, "opa": "Liver disease", "opb": "Hypoxemia", "opc": "Pulmonary arteriovenous shunting", "opd": "Cardiac dysfunction", "subject_name": "Medicine", "topic_name": null, "id": "aa41eb31-5d12-4a31-ab2c-3ec0fb3ede99", "choice_type": "single"}
+{"question": "Albuminocytological dissociation is associated with", "exp": "(A) Guillain-Barre syndrome# GUILLAIN-BARRE SYNDROME> Diagnosis of GBS usually depends on findings such as rapid development of muscle paralysis, areflexia, absence of fever, and a likely inciting event.> Cerebrospinal fluid analysis (through a lumbar spinal puncture) and electrodiagnostic tests of nerves and muscles (such as nerve conduction studies) are common tests ordered in the diagnosis of GBS.> Typical CSF findings include albumino-cytological dissociation. As opposed to infectious causes, there is an elevated protein level (100-1000 mg/dL), without an accompanying increased cell count pleocytosis. A sustained increased white blood cell count may indicate an alternative diagnosis such as infection.", "cop": 1, "opa": "Guillain-Barre syndrome", "opb": "Subarachnoid haemorrhage", "opc": "Pyogenic meningitis", "opd": "Encephalitis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "654c5327-3f4f-4410-804e-b20288370070", "choice_type": "single"}
+{"question": "Earliest and often the only presentation of TB kidney is", "exp": "Ans. is 'a' i.e., Increased frequency Urinary frequency, dysuria, nocturia, hematuria, and flank or abdominal pain is common presentations. However, patients may be asymptomatic and the disease is discovered only after severe destructive lesions of the kidneys have developed. Urinalysis gives abnormal results in 90% of cases, revealing pyuria and hematuria. The documentation of culture-negative pyuria in acidic urine raises the suspicion of TB. IV pyelography, abdominal CT, or MRI may show deformities and obstruction, and calcifications and ureteral strictures are suggestive findings. Culture of three morning urine specimens yields a definitive diagnosis in nearly 90% of cases.", "cop": 1, "opa": "Increased frequency", "opb": "Colicky pain", "opc": "Hematuria", "opd": "Renal calculi", "subject_name": "Medicine", "topic_name": null, "id": "42e55d5d-5d4b-48ed-9cad-dba534c95a9c", "choice_type": "single"}
+{"question": "The most characteristic manifestation of megaloblastic anaemia", "exp": "The presence of red cells that are macrocytic and oval (macro-ovalocytes) is highly characteristic of megaloblastic anaemia.Other features are: Most macrocytes lack the central pallor of normal red cells and even appear \"hyperchromic,\" but the MCHC is not elevated.The reticulocyte count is low. Nucleated red cell progenitors occasionally appear in the circulating blood when anaemia is severe. Neutrophils are also larger than normal (macro polymorphonuclear) and show nuclear hypersegmentation, having five or more nuclear lobules instead of the normal three to fourThe marrow is usually markedly hypercellular as a result of increased hematopoietic precursors, which often completely replace the fatty marrow. Megaloblastic changes are detected at all stages of erythroid development.Robbins 9e pg: 645", "cop": 1, "opa": "Macrocytosis", "opb": "Hyper segmented neutrophils", "opc": "Basophilic stippling", "opd": "Cabot ring", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "56dad2fb-b853-45b1-a8e7-7f2fb7dc1510", "choice_type": "single"}
+{"question": "High calcium intake leads to", "exp": "Ans. a. Milk-Alkali syndrome The milk-alkali syndrome is due to excessive ingestion of calcium and absorbable antacids such as milk or calcium carbonate. It is much less frequent since proton-pump inhibitors and other treatments became available for peptic ulcer disease. For a time, the increased use of calcium carbonate in the management of secondary hyperparathyroidism led to reappearance of the syndrome. The chronic form of the disease, termed Burnett's syndrome, is associated with irreversible renal damage. The acute syndromes reverse if the excess calcium and absorbable alkali are stopped.' Milk-Alkali Syndrome The milk-alkali syndrome is due to excessive ingestion of calcium and absorbable antacids such as milk or calcium carbonateQ. It is much less frequent since proton-pump inhibitors and other treatments became available for peptic ulcer disease. For a time, the increased use of calcium carbonate in the management of secondary hyperparathyroidism led to reappearance of the syndrome. Several clinical presentations-acute, subacute, and chronic-have been described, all of which feature hypercalcemia, alkalosis, and renal failureQ. The chronic form of the disease, termed Burnett's syndrome, is associated with irreversible renal damageQ. The acute syndromes reverse if the excess calcium and absorbable alkali are stoppedQ. Individual susceptibility is dependent on the fractional calcium absorption as a function of calcium intake. Some individuals absorb a high fraction of calcium, even with intakes >2 g of elemental calcium per day, instead of reducing calcium absorption with high intake, as occurs in most normal individuals. Development of hypercalcemia causes increased sodium excretion and some depletion of total-body water. These phenomena and perhaps some suppression of endogenous PTH secretion due to mild hypercalcemia lead to increased bicarbonate resorption and to alkalosis in the face of continued calcium carbonate ingestion Alkalosis per se selectively enhances calcium resorption in the distal nephron, thus aggravating the hypercalcemia. The cycle of mild hypercalcemia -4 bicarbonate retention alkalosis renal calcium retention -4 severe hypercalcemia perpetuates and aggravates hypercalcemia and alkalosis as long as calcium and absorbable alkali are ingestedQ.", "cop": 1, "opa": "Milk-Alkali syndrome", "opb": "Cardiomyopathy", "opc": "Osteoporosis", "opd": "Osteopetrosis", "subject_name": "Medicine", "topic_name": null, "id": "630c0be0-506e-444c-9cc3-787402a970b5", "choice_type": "single"}
+{"question": "Raised serum amylase levels are used to diagnose", "exp": "Answer is 'D' (Acute pancreatitis) 'The diagnosis of acute pancreatitis is usually established by detection of an increased level of serum amylase Harrison 16th 'Serum amylase level is the standard laboratory test carried out to confirm the diagnosis of acute pancreatitis' Kumar & Clarke 5th Measurement during first 24 hours of onset of pain An elevation of three times the upper limit of normal clinches the diagnosis (provided ove salivary gland disease and gut perforation or infarction are excluded) Measeurement late after presentation After 48-72 hrs even with continuing evidence of pancreatitis, total serum levels tend to return to normal With a late presentation thus, serum amylase levels may give a false negative result. Serum amylase level may be increased in acute cholecystitis, but it does not form a criteria for its diagnosis. There is no definitive correlation between the severity of pancreatitis and the degree of serum amylase elevation. An elevated serum lipase Q. or trypsin value is more specific / diagnostic of acute pancreatitis than serum amylase - (Lipase is the single best enzyme to measure for acute pancreatitis Q).", "cop": 4, "opa": "Autoimmune disease", "opb": "Degenerative diseases", "opc": "Acute cholecystitis", "opd": "Acute pancreatitis", "subject_name": "Medicine", "topic_name": null, "id": "7b9e1586-ae77-471e-be4b-7882c401eae1", "choice_type": "single"}
+{"question": "Non Anionic gap acidosis is seen in", "exp": "(A) Diarrheoa # CAUSES OF NON-ANION GAP METABOLIC ACIDOSIS> Gastrointestinal bicarbonate loss: Diarrhea; External pancreatic or small-bowel drainage; Ureterosigmoidostomy, jejunal loop, ileal loop Drugs: Calcium chloride (acidifying agent); Magnesium sulfate (diarrhoea); Cholestyramine (bile acid diarrhea)> Renal acidosis: Hypokalaemia Proximal RTA (type 2) Distal (classic) RTA (type 1)> Hyperkalemia: Generalized distal nephron dysfunction (type 4 RTA) Mineralocorticoid deficiency Mineralocorticoid resistance inc. Na+ delivery to distal nephron Tubulointerstitial disease Ammonium excretion defect> Drug-induced hyperkalemia (with insufficiency):Potassium-sparing diuretics (amiloride, triamterene, spironolactone) Trimethoprim Pentamidine Angiotensin-converting enzyme inhibitors and AT-II receptor blockers Nonsteroidal anti-inflammatory drugs Cyclosporine> Others: Acid loads (ammonium chloride, hyperalimentation) Loss of potential bicarbonate: ketosis with ketone excretion Expansion acidosis (rapid saline administration) Hippurate, Cation exchange resins In lactic acidosis, DKA and salicylate poisoning high anionic gap metabolic acidosis is seen.", "cop": 1, "opa": "Diarrhoea", "opb": "Lactic acidosis", "opc": "Salicylate poisoning", "opd": "Diabetic ketoacidosis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "0f33e5ef-5ef2-4eeb-822f-7824860275d6", "choice_type": "single"}
+{"question": "In acute renal failure, metabolic acidosis is due to", "exp": null, "cop": 1, "opa": "Loss of HCO3", "opb": "Increased H+ excretion", "opc": "Diuretic therapy", "opd": "Decreased production of bicarbonate", "subject_name": "Medicine", "topic_name": null, "id": "f8441ab7-b86a-4843-8c1b-ebaf136871ac", "choice_type": "single"}
+{"question": "Most common site for berry aneurysm rupture", "exp": "Ans. is 'a' i.e., Anterior circulation of brain The most common sites in descending order of frequency are - Li Proximal poion of anterior communicating aery (at the junction of anterior communicating aery with cerebral aery) At the origin of the posterior communicating aery from the stem of the internal carotid aery. At the first major bifurcation of middle cerebral aery. At the bifurcation of internal carotid into middle and anterior cerebral aeries. Veibrobasilar bifurcation (3%)", "cop": 1, "opa": "Anterior circulation of brai", "opb": "Posterior circulation of brain", "opc": "Ascending aoa", "opd": "Descending aoa", "subject_name": "Medicine", "topic_name": null, "id": "d1c7ae7c-1f43-4ab5-8af6-1619f66b7120", "choice_type": "single"}
+{"question": "Sugarcane induced lung disease", "exp": null, "cop": 1, "opa": "Bagassosis", "opb": "Byssinosis", "opc": "Pneumoconiosis", "opd": "Asbestosis", "subject_name": "Medicine", "topic_name": null, "id": "c3811bbb-8c80-4122-b529-ceb6594fe68e", "choice_type": "single"}
+{"question": "Renal involvement in multiple myeloma is characterized by", "exp": "It is due to the accumulation of light chain immunoglobulins, which here can be referred by nitrogen retention.", "cop": 1, "opa": "Nitrogen retention", "opb": "Hypertension", "opc": "Edema", "opd": "Haematuria", "subject_name": "Medicine", "topic_name": null, "id": "53fbc6a8-d102-4c1d-b2e8-020eb8f2df13", "choice_type": "single"}
+{"question": "Reversed coarctation is seen in", "exp": "Takayasu aeritis affects the aoa, its major branches and occasionally the pulmonary aeries. The typical age at onset is 25-30 years, with an 8 : 1 female-to-male ratio. It has a worldwide distribution but is most common in Asia. Takayasu aeritis is characterised by granulomatous inflammation of the vessel wall, leading to occlusion or weakening of the vessel wall. It presents with claudication, fever, ahralgia and weight loss. Clinical examination may reveal loss of pulses, bruits, hypeension and aoic incompetence. Investigation will identify an acute phase response and normocytic, normochromic anaemia but the diagnosis is based on angiography, which reveals coarctation, occlusion and aneurysmal dilatation. Treatment is with high-dose glucocoicoids and immunosuppressants, as described for ANCA-associated vasculitis. With successful treatment, the 5-year survival is 83%. Ref - Davidsons 23e p 1041", "cop": 3, "opa": "Giant cell aeritis", "opb": "Polyaeritis nodosa", "opc": "Takayasu aeritis", "opd": "Kawasaki disease", "subject_name": "Medicine", "topic_name": "Immune system", "id": "597959ce-fc3b-40b6-99eb-511651ae5c84", "choice_type": "single"}
+{"question": "Diabetes mellitus associated with", "exp": null, "cop": 2, "opa": "↑ HDL", "opb": "↑Triglycerides", "opc": "↓Triglycerides", "opd": "↓ Cholesterol", "subject_name": "Medicine", "topic_name": null, "id": "0d9d664c-78e7-4352-9ebe-1a2742b8c655", "choice_type": "single"}
+{"question": "Number connection test is used in", "exp": "Number connection test or constructional apraxia are a clinical features of hepatic encephalopathy.", "cop": 3, "opa": "Alzheimer's disease", "opb": "Parkinson's disease", "opc": "Hepatic encephalopathy", "opd": "Global aphasia", "subject_name": "Medicine", "topic_name": null, "id": "5e7e887a-b441-4e4b-9684-2c0db964ddb6", "choice_type": "single"}
+{"question": "HAM test is done for", "exp": null, "cop": 1, "opa": "G.P.I. anchor protein", "opb": "Complement defect", "opc": "Spectrin defect", "opd": "Mannose binding protein", "subject_name": "Medicine", "topic_name": null, "id": "31ff159f-37e8-4362-89eb-bc1d5f71ca43", "choice_type": "single"}
+{"question": "Distal renal tubular acidosis is associated with", "exp": null, "cop": 3, "opa": "Oxalate stones", "opb": "Citrate", "opc": "Calcium stones", "opd": "Uric acid", "subject_name": "Medicine", "topic_name": null, "id": "66c3a7ef-0641-48aa-84fe-26ab2a123d63", "choice_type": "single"}
+{"question": "Descending order of types of viruses causing paralytic polio", "exp": "(C) Type 1, type 3, type 2 # POLIOMYELITIS> Definition: Poliomyelitis is an acute infections disease caused by enterovirus.> Poliovirus is an RNA virus with three distinct serotypes v/z.1,2 and 3.> Type 1 is the most frequent and type 2, the least common cause of paralytic poliomyelitis.", "cop": 3, "opa": "Type 1, type 2, type 3", "opb": "Type 2, type 1. type 3", "opc": "Type 1, type 3, type 2", "opd": "Type 2, type 3, type 1", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "af5fafaf-f6c9-4f8c-9746-654d80e71322", "choice_type": "single"}
+{"question": "The most common cause of hyperparathyroidism is", "exp": "Primary hyperparathyroidism is a generalized disorder of calcium, phosphate, and bone metabolism due to an increased secretion of PTH. The elevation of circulating hormone usually leads to hypercalcemia and hypophosphatemia.Solitary adenomas: A single abnormal gland is a cause in ~80% of patients; the abnormality in the gland is usually a benign neoplasmor adenoma and rarely a parathyroid carcinoma.Ref: Harrison; 19th edition; Page no: 2470", "cop": 1, "opa": "Parathyroid adenoma", "opb": "Parathyroid hyperplasia", "opc": "MEN 1", "opd": "Medullary carcinoma of thyroid", "subject_name": "Medicine", "topic_name": "All India exam", "id": "97b9f2d7-af45-4fac-a1c8-b54ef9325438", "choice_type": "single"}
+{"question": "Bronchiectasis with predominantly upper lobe involvement is", "exp": "More pronounced involvement of the upper lung fields is most common in cystic fibrosis(CF) and is also observed in post radiation fibrosis,corresponding to the lung region encompassed by the radiation po.Bronchiectasis with predominant involvement of the lower lung fields is seen in fibrotic lung diseases or hypogammaglobulinemia.Congenital causes of bronchiectasis with predominant midlung field involvement include the dyskinetic/immotile cilia syndrome or Kaagener's syndrome.Finally,predominant involvement of the central airways is repoed in association with allergic bronchopulmonary aspergillosis. Ref:Harrison's medicine-18th edition,page no:2142.", "cop": 3, "opa": "Kaegeners syndrome", "opb": "Hypogammaglobinemia", "opc": "Cystic fibrosis", "opd": "Alpha 1 antitrypsin deficiency", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "088f6404-d968-4b93-9e48-b654e7a2851e", "choice_type": "single"}
+{"question": "In primary pulmonary hypeension, basic abnormality in gene lies in", "exp": "Decreased expression of the voltage-regulated potassium channel, mutations in the bone morphogenetic protein-2 receptor, increased tissue factor expression, overactivation of the serotonin transpoer, transcription factor activation of hypoxia-inducible factor-1 alpha, and activation of nuclear factor of activated T cells. As a result, there appears to be a loss of apoptosis of the smooth muscle cells that allow their proliferation and the emergence of apoptosis-resistant endothelial cells that can obliterate the vascular lumen.Ref: Harrison's 18/e p2077", "cop": 1, "opa": "Bone morphogenic protein receptor II", "opb": "Endothelin", "opc": "Homebox gene", "opd": "PAX - 11", "subject_name": "Medicine", "topic_name": "All India exam", "id": "1c8f0102-823f-469d-9b08-db63c50253b7", "choice_type": "single"}
+{"question": "Woman with myocardial infarction are more likely to present with complications like......than males.", "exp": "Woman with myocardial infarction are more likely to present with cardiac arrest or cardiogenic shock whereas men are more likely to present with ventricular tachycardia. Ref: Harrison, Edition-18, Page-52", "cop": 1, "opa": "Cardiac arrest", "opb": "Ventricular tachycardia", "opc": "Atrial fibrillation", "opd": "Aoic dissection", "subject_name": "Medicine", "topic_name": null, "id": "3387ddf1-d741-471d-ad99-efd3da4caad3", "choice_type": "single"}
+{"question": "Ellis curve is seen in", "exp": "o On chest X-rays, pleural effusion presents as homogenous opacity.\no Typically this opacity has a fairly well defined concave upper edge, is higher laterally than medially and obscures the diaphragmatic shadow", "cop": 4, "opa": "Pheumothorax", "opb": "Pheumonia", "opc": "Asthma", "opd": "Pleural effusion", "subject_name": "Medicine", "topic_name": null, "id": "1fa569d1-49e7-4282-b5b1-49b6ce2ce50f", "choice_type": "single"}
+{"question": "Arsenic causes", "exp": null, "cop": 1, "opa": "Portal hypertension", "opb": "Cirrhosis", "opc": "Extra hepatic portal vein obstruction", "opd": "Hepatic carcinoma", "subject_name": "Medicine", "topic_name": null, "id": "daf5e579-65af-49a2-b65f-6035b2c2edc2", "choice_type": "single"}
+{"question": "Tropical pulmonary eosinophilia is caused because of", "exp": "Ans. is 'a' i.e., Occult filariasis Occult filariasis is a rare condition which is caused by hypersensitivity reaction to filarial antigen. Micro filatia are absent in the blood. Lymphatic filariasis is absent. Indirect evidence of filarial infection is obtained by demonstrating antifilarial antibodies", "cop": 1, "opa": "Occult filariasis", "opb": "Cerebral melaria", "opc": "Penumonic plague", "opd": "Asthmatic bronchitis", "subject_name": "Medicine", "topic_name": null, "id": "68a333e9-bebe-4901-b481-86c571ab3a25", "choice_type": "single"}
+{"question": "A 59 year old man with severe myxomatous mitral regurgitation is asymptomatic, with a left venricular ejection fraction of 45% and an end systobc diameter index of 2.9 cm/m2. The most appropriate treatment is", "exp": "Surgery for chronic, nonischemic, severe MR is indicated once symptoms occur, especially if valve repair is feasible. Other indications for early consideration of mitral valve repair include recent-onset AF and pulmonary hypeension, defined as a PA pressure >=50 mmHg at rest or >=60 mmHg with exercise. Surgical treatment of chronic, nonischemic severe MR is indicated for asymptomatic patients when LV dysfunction is progressive, with LVEF falling below 60% and/or end-systolic dimension increasing beyond 40 mm. ( Harrison&;s principle of internal medicine,18th edition,pg no.1936 )", "cop": 1, "opa": "Mitral valve repair or replacement", "opb": "No treatment", "opc": "ACE inhibitor therapy", "opd": "Digoxin and diuretic therapy", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "ce933437-26ed-4702-99d0-639cbcc3cb85", "choice_type": "single"}
+{"question": "Necrotising lymphadenitis is seen with", "exp": null, "cop": 2, "opa": "Kimura disease", "opb": "Kikuchi disease", "opc": "Castle Man disease", "opd": "Hodgkin's lymphoma", "subject_name": "Medicine", "topic_name": null, "id": "78d08c3f-44b4-4b99-9389-30ebb087b04f", "choice_type": "single"}
+{"question": "Proliferative glomerular deposits are found in", "exp": "IgA nephropathy is an immune complex-mediated glomerulonephritis defined by the presence of diffuse mesangial IgA deposits often associated with mesangial hypercellularity. ref - Harrisons internal medicine 20e pg2135-2140", "cop": 2, "opa": "Amyloidosis", "opb": "IgA nephropathy", "opc": "Diabetes mellitus", "opd": "Membranous glomerulonephritis", "subject_name": "Medicine", "topic_name": "Kidney", "id": "bcece1b7-e496-4c8e-85f7-13dc7923d307", "choice_type": "single"}
+{"question": "Drug used in acute exacerbation of ulcerative colitis is", "exp": "Cyclosporine is used for acute exacerbation of ulcerative colitis, and also as rescue therapy to prevent surgery in ulcerative colitis responding poorly to glucocoicoids. Reference : Davidson, 23rd Edition, page no : 821.", "cop": 4, "opa": "Sulfasalazine", "opb": "Steroids", "opc": "Infliximab", "opd": "Cyclosporine", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "39aff462-1358-49ce-b2f3-032f51a437c0", "choice_type": "single"}
+{"question": "In primary immune deficiency, the fraction of plasma protein reduced is", "exp": null, "cop": 4, "opa": "α-1-globulin", "opb": "α-2-globulin", "opc": "β-globulin", "opd": "γ-globulin", "subject_name": "Medicine", "topic_name": null, "id": "72887b55-2cdf-4c81-b811-a29ef8e69dcc", "choice_type": "single"}
+{"question": "In AIDS patient presenting with fever, cough a diagnosis of pneumocystin pneumonia is best established by", "exp": "Ans. is 'b' i.e., Bronchoalveolar lavage Diagnosis of PCP requires Demonstration of the organism in samples obtained from induced sputum. Bronchoalveolar lavage, transbronchial biopsy, or open-lung biopsy. If the histological examination fails :? u PCR is required to make the diagnosis", "cop": 2, "opa": "CT scan chest", "opb": "Bronchoalveolar lavage", "opc": "Staining of intra-nuclear inclusion with silver staining", "opd": "Aspiration and culture", "subject_name": "Medicine", "topic_name": null, "id": "0c831785-af54-4422-876c-9bde51dd4f9b", "choice_type": "single"}
+{"question": "A middle aged man noticed that he can no longer fit in his shoes and that his jaw was protruding and phalanges were enlarged. These effects are likely to be mediated by.", "exp": "Answer is B (Somatomedins): Many of the physiological affects of Growth Hormone are mediated indirectly through somatomedins like IGF-1 (Insulin like Growth fbactor) which is a potent growth and differentiation factor. Increased shoe size, Prognathism (protruding jaw) and enlarged phalanges in a middle aged man suggest a diagnosis of Growth Hormone oversecretion or Acromegaly. Growth Hormone exes several effects through induction of somatomedins (like IGF), a family of hormones secreted in the blood by the liver and other tissues. What are Somatomedins Somatomedins arc a family of harmones that are potent growth and differentiation factors. The liver is the major source of somatomedins like IGF-1 that mediates many of the physiological effects of Growth Hormone on target tissues. Somatomedins are similar to insulin in molecular structure and are hence also known as 'Insulin like Growth factors' (IGF) and these act on target tissue to increase protein synthesis by increasing the rate of uptake of amino acids. Although GH exes direct effects on target tissues, many of its physiological effects are mediated indirectly through somatomedins like IGF-1", "cop": 2, "opa": "ACTH", "opb": "Somatomedins", "opc": "TRH", "opd": "TGF Beta", "subject_name": "Medicine", "topic_name": null, "id": "421bbad4-fa8e-4884-8e5c-8f47a49fa800", "choice_type": "single"}
+{"question": "The most common cause of fracture in a patient with Hemophilia is", "exp": "Answer is A (Osteoporosis and Restricted Joint Movement) The most common cause of fractures in patients with haemophilia is osteoporosis and restricted joint movements (from haemophilic ahropathj). 'Fractures may occur frequently and after tril trauma because of poor musculature, osteoporosis, limited range of motion in affected joint and haemophilic changes in the bone'.", "cop": 1, "opa": "Osteoporosis and Restricted Joint Movement", "opb": "Osteonecrosis", "opc": "Iron deposition", "opd": "Pseudo-tumors", "subject_name": "Medicine", "topic_name": null, "id": "3fc1d660-b37c-4964-9f76-9adb2283df2d", "choice_type": "single"}
+{"question": "Canon 'a' wave is seen in", "exp": "Ans. is 'a' i.e., Junctional rhythm", "cop": 1, "opa": "Junctional rhythm", "opb": "Atrial fibrillation", "opc": "Atrial flutter", "opd": "Ventricular fibrillation", "subject_name": "Medicine", "topic_name": null, "id": "9dd38f77-1742-4af8-a1aa-3f070e33a814", "choice_type": "single"}
+{"question": "Cardiac biomarker for choice of diagnosis of Reinfraction 8 days after initial ischemia is", "exp": "Ref Harrison 19 th ed pg 1594 CK-MB is the cardiac biomarker of choice for diagnosis of Reinfraction 8 days after initial ischemia event", "cop": 2, "opa": "Troponins", "opb": "CK-MB", "opc": "Myoglobin", "opd": "LDH", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "23a5d7b2-3ddb-4d04-b2ae-24fa13f8b8c0", "choice_type": "single"}
+{"question": "ECG changes that occur after administration of Digoxin includes", "exp": "(D) ST depression# Digoxin effects on ECG: Shows down slope ST depression with a characteristic \"Salvador Dali sagging\" appearance Flattened, inverted, or biphasic T waves. Shortened QT interval. Delay due to development of 1:1 A-V conduction.", "cop": 4, "opa": "ST elevation", "opb": "PR prolongation", "opc": "QT prolongation", "opd": "ST depression", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "aee862df-195b-4efd-b7c9-a7194e0363a1", "choice_type": "single"}
+{"question": "Variceal bleeding is best treated with", "exp": "Bleeding esophageal varices Octreotide is often given as an infusion for management of acute hemorrhage from esophageal varices in liver cirrhosis on the basis that it reduces poal venous pressure, though current evidence suggests that this effect is transient and does not improve survival Ref Davidson edition23rd pg 781", "cop": 3, "opa": "Vasopressin", "opb": "Nitroglycerine", "opc": "Octreotide", "opd": "Desmopressin", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "e2be079e-ed76-4450-b15a-3a9506baeae4", "choice_type": "single"}
+{"question": "A 35 year old female patient presents with proximal weakness of muscles, ptosis and easily fatiguability. September 2011", "exp": "Ans. D: Edrophonium test The intravenous injection of the sho acting anticholinesterase, edrophonium bromide, is a valuable diagnostic aid (the tensilon test) for myasthenia gravis Myasthenia gravis/ MG: A disease characterized by episodic muscle weakness, chiefly in muscle innervated by cranial nerves and characteristically improved by anti-cholinesterase inhibiting drug There is decreased myoneural junction transmission due to auto-immune attack on the acetylcholine receptor of the post-synaptic neuromuscular junction, which results in loss of dysfunction of Ach receptors and jeopardizing normal neuromuscular transmission Dysahria, dysphagia and proximal limb weakness is common Sensory modalities and deep tendon reflexes are normal Pyridostigmine/ Neostigmine are the MC used cholinergic drugs Thymectomy is indicated in all patients with generalized MG Plasmapheresis may be useful for preparing refractory cases fro thymectomy and during respiratory crisis", "cop": 4, "opa": "Muscle biopsy", "opb": "CPK levels", "opc": "EMG", "opd": "Edrophonium test", "subject_name": "Medicine", "topic_name": null, "id": "bcc58b04-ff90-4ae9-9779-a83b009f8f8f", "choice_type": "single"}
+{"question": "First symptom of digoxin overdose is", "exp": null, "cop": 1, "opa": "GIT disturbance", "opb": "U-vave on ECG", "opc": "Ectopic on ECG", "opd": "Fainting spells", "subject_name": "Medicine", "topic_name": null, "id": "88f5d57b-62a1-4b77-9114-3da8d2bd7669", "choice_type": "single"}
+{"question": "The GCS is determined by taking the best response in each category and totaling them; it ranges from", "exp": null, "cop": 1, "opa": "15-Mar", "opb": "0-12", "opc": "18-May", "opd": "10-Jan", "subject_name": "Medicine", "topic_name": null, "id": "32b1721a-94dc-43cd-818a-245ce92d75d9", "choice_type": "single"}
+{"question": "Most common mutated gene in primary hemochromatosis", "exp": "Primary hemochromatosis - HFE gene Chr6P.", "cop": 1, "opa": "HFE gene", "opb": "Transferrin receptor 2", "opc": "Ferroportin 1", "opd": "Hepcidin", "subject_name": "Medicine", "topic_name": null, "id": "396dff2f-20d7-4b0f-8c71-8c1c340c1164", "choice_type": "single"}
+{"question": "In coarctation of aoa, the side of rib notching is", "exp": "Rib notching is unusual in infancy but becomes more frequent with increased age; it is present in 75% of adults with coarctation. Rib notching occurs along the inferior margin of the third to the eighth ribs; it is caused by pulsation of dilated intercostal aeries. Ref Davidson 23rd edition pg 443", "cop": 2, "opa": "Superior to rib", "opb": "Inferior to rib", "opc": "At sternum", "opd": "At veebra", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "fb0b4291-3218-4609-a5f3-8423509cd1ce", "choice_type": "single"}
+{"question": "Lewy bodies contain", "exp": "(A) a-synuclein # Examination of brain in Parkinson's Disease (PD):> Grossly reveals mild frontal atrophy with loss of the normal dark melanin pigment of the midbrain.> Microscopically there is degeneration of the dopaminergic cells with the presence of Lewy bodies (LBs) in the remaining neurons and processes of the substantia nigra pars compacta (SNpc), other brainstem nuclei, and regions such as the medial temporal, limbic, and frontal cortices.> LBs have a high concentration of a-synuclein and are the pathologic hallmark of the disorder.> Mutations in the a-synuclein gene can cause familial PD by promoting the formation of a-synuclein-positive filaments that aggregate into LBs and Lewy neuritis.", "cop": 1, "opa": "a-synuclein", "opb": "Tirofiban", "opc": "Melanin", "opd": "Amyloid", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "e9e4d293-04ea-45a8-a654-63cad69b26d0", "choice_type": "single"}
+{"question": "Chronic hemodialysis in ESRD patient is done", "exp": "Ans. (c) Thrice per weekRef : Harrison 19th ed. /1823For the majority of patients with ESRD, between 9 and 12 h of dialysis are required each week, usually divided into three equal sessions.Current Targets of Hemodialysis* Urea reduction ratio (the fractional reduction in blood urea nitrogen per hemodialysis session) of >65-70%.* Body water-indexed clearance x time product (KT/V) above 1.2 or 1.05.REMEMBERHypotension is the most common acute complication of hemodialysis. Since the introduction of bicarbonate- containing dialysate, dialysis-associated hypotension has become less common. The management of hypotension during dialysis consists of discontinuing ultrafiltration, the administration of 100-250 mL of isotonic saline or 10 mL of 23% saturated hypertonic saline, or administration of salt-poor albumin.", "cop": 3, "opa": "Once per week", "opb": "Twice per week", "opc": "Thrice per week", "opd": "Daily", "subject_name": "Medicine", "topic_name": "Dialysis", "id": "baacd431-3ccb-4c63-a2a6-c869c5bc24cd", "choice_type": "single"}
+{"question": "Diarrhea with acanthocytosis is seen in", "exp": "Diarrhea with acanthocytes Seen in both wolman disease & abetalipoproteinemia * Wolman&;s disease : also called * Acid Cholesterol Ester Hydrolase Deficiency, Type 2 * LIPA Deficiency * LAL Deficiency * Rare autosomal recessive deficiency of lysosomal acid lipase activity causing accumulation of cholesterol and triglycerides throughout body tissues and death within first 6 mos) ref - harrisons internal medicine 20th pg2896,", "cop": 4, "opa": "Whipple", "opb": "Celiac sprue", "opc": "Aggamaglobulinemia", "opd": "Wolmans disease", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "7d4aa44e-8456-463e-a290-7cf00af31bbb", "choice_type": "single"}
+{"question": "Carbmezpine is the drug of choice in", "exp": "K D Tripathy essentials of medical pharmacology 7th edition. *Carbamazepine is the most effective drug for CPS", "cop": 2, "opa": "Absence attacks", "opb": "Paial complex siezures", "opc": "Myoclonus", "opd": "Innantile spams", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "b7d60248-989e-4232-b194-1e745f17f424", "choice_type": "single"}
+{"question": "In Alzheimer's disease, the characteristic lesion is seen in", "exp": "(B) Nucleus of Meynert # Pathology in Alzeihmer's disease:> The most severe pathology is usually found in the hippocampus, temporal cortex, and nucleus basalis of Meynert (lateral septum).> The most important microscopic findings are neuritic \"senile\" plaques and NFTs.> These lesions accumulate in small numbers during normal aging of the brain but occur in excess in AD.> Neuritic plaques contain a central core that includes A p amyloid, proteoglycans, Apo E4, a1 antichymotrypsin, and other proteins.> A amyloid is a protein of 39 to 42 amino acids that is derived proteolytically from a larger transmembrane protein, amyloid precursor protein (APP), which has neurotrophic and neuroprotective activity.> The normal function of A p amyloid is unknown.> Soluble amyloid fibrils may represent the initial pathologic event in AD leading to formation of neuritic plaques.> The plaque core is surrounded by the debris of degenerating neurons, microglia, and macrophages.> The accumulation of amyloid in cerebral arterioles, termed amyloid angiopathy, may lead to cerebral lobar hemorrhages.", "cop": 2, "opa": "Amygdaloid complex", "opb": "Nucleus of Meynert", "opc": "Basal ganglia", "opd": "Periventricle", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f50757d5-ae47-4f4f-91db-56b12dd091aa", "choice_type": "single"}
+{"question": "The treatment most likely to benefit a patient of massive pulmonary embolism in shock", "exp": "For a patient with massive pulmonary embolism in shock,primary therapy consists of clot dissolution with thrombolytics like tPA/streptokinase or removal of PE by embolectomy.The preferred fibrinolytic regimen is 100 mg of recombinant tPA(tissue plasminogen activator) administered as a continuous peripheral iv infusion over 2 hours.Anticoagulation with heparin and warfarin or placement of an inferior vena cava filter constitutes secondary prevention of recurrent PE. Reference:Harrison's Medicine-18th edition, page no:2174-2176.", "cop": 1, "opa": "Thrombolytic therapy", "opb": "Inotropic agent", "opc": "Vasodilator therapy", "opd": "Diuretic therapy", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "91fba7da-3957-4541-bb8d-25a91c3ec50e", "choice_type": "single"}
+{"question": "WPW syndrome is caused by", "exp": "Ans. is 'b' i.e., Right sided accessory pathway Anatomy (Location ofAccessory pathway) in W.R W syndrome Electrophysiological studies and mapping have shown that accessory. Atrioventricular pathways may be located anywhere along the A-V rign or groove in the septum. The most frequent locations are : - Left lateral (50%), posteroseptal (30%) right anteroseptal (10%). Right lateral (10%). Preexcitation resulting from left sided accessory is called type A preexcitation. Preexcitation resulting from right sided accessory pathway is called type B preexcitation.", "cop": 1, "opa": "Bundle Branch Block", "opb": "Right sided accessory pathway", "opc": "Ectopic pacemaker in atrium", "opd": "Left budle Branch block", "subject_name": "Medicine", "topic_name": null, "id": "fe25d0dc-d74f-45d5-8244-6a5c14cf6df6", "choice_type": "single"}
+{"question": "In plasmodium vivax malaria, relapse is caused by", "exp": null, "cop": 3, "opa": "Sporozoite", "opb": "Schizent", "opc": "Hypnozoite", "opd": "Gametocytes", "subject_name": "Medicine", "topic_name": null, "id": "370f3056-c9f0-44c6-b379-2278ebf1a37e", "choice_type": "single"}
+{"question": "Hippocampal sclerosis is seen in", "exp": "Mesial temporal lobe epilepsy (MTLE) is the most common syndrome associated with focal seizures with dyscognitive features and is an example of an epilepsy syndrome with distinctive clinical, electroencephalographic, and pathologic features. Highresolution magnetic resonance imaging (MRI) can detect the characteristic hippocampal sclerosis that appears to be essential in the pathophysiology of MTLE for many patients Ref: Harrison 19e 2544", "cop": 3, "opa": "Juvenile myoclonic epilepsy", "opb": "Lennox-Gastaut syndrome", "opc": "Mesial temporal lobe epilepsy", "opd": "Lafora's disease", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "2e5f29d7-1889-410b-aeea-874cac556c47", "choice_type": "single"}
+{"question": "Dose of streptokinase for fibrinolysis in MI", "exp": "Streptokinase is administered as 1.5 million units (MU) intravenously over 1 h. The current recommended regimen of tPA consists of a 15-mg bolus followed by 50 mg intravenously over the first 30 min, followed by 35 mg over the next 60 min. rPA is administered in a double-bolus regimen consisting of a 10-MU bolus given over 2-3 min, followed by a second 10-MU bolus 30 min later.TNK is given as a single weight-based intravenous bolus of 0.53 mg/kg over 10 s.Ref: Harrison 19e pg: 1605", "cop": 3, "opa": "0.5 million units", "opb": "1.0 million units", "opc": "1.5 million units", "opd": "2.0 million units", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "38e3b071-ce3e-4aae-92f7-a57eb271f8c0", "choice_type": "single"}
+{"question": "High cardiac output & low peripheral resistance shock", "exp": "(C) Septic shock# SEPTIC SHOCK: An inflammatory stimulus (eg, a bacterial toxin) triggers production of proinflammatory mediators, including I NF and IL-1. These cytokines cause neutrophil-endothelial cell adhesion, activate the clotting mechanism, and generate microthrombi> Initially, arteries and arterioles dilate, decreasing peripheral arterial resistance; cardiac output typically increases. This stage has been referred to as warm shock.> Later, cardiac output may decrease, BP falls (with or without an increase in peripheral resistance), and typical features of shock appear.> With sepsis, patients typically have fever, tachycardia, diaphoresis, and tachypnea; BP remains normal. Other signs of the causative infection may be present.", "cop": 3, "opa": "Hypovolemic shock", "opb": "Cardiogenic shock", "opc": "Septic shock", "opd": "Anaphylactic Shock", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "77f04e76-a42f-4997-96b0-1c12a9e58ce4", "choice_type": "single"}
+{"question": "A 17 Year old male complains of recurrent episodes of cough, wheeing and shoness of breath paicularly at night for the last 3 days. His sibling has a history of similar symptoms. A skin test with pollen produces immediate wheal and flare. He should be treated with", "exp": "The patient is having atopic asthma,with sensitization to allergens like pollen,dust mites,etc.The primary modality of treatment for asthma is bronchodilators,which give rapid relief of symptoms mainly through relaxation of airway smooth muscle and relieving bronchoconstriction.Beta agonists(sho acting and long acting),anticholinergics and theophylline are three classes of bronchodilators in current use,of which beta agonists like salbutamol,terbutaline,salmeterol are the most effective. Ref:Harrison's medicine-18th edition,page no: 2109,2110.", "cop": 1, "opa": "Bronchodilators", "opb": "Steroids", "opc": "Antibiotics", "opd": "cough sedative", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "8853e5fe-362a-40d0-8d05-ca49d0226ef0", "choice_type": "single"}
+{"question": "Recommended drug for patients with intrahepatic Wilson's disease i.e. patients with hepatitis, is", "exp": "Answer- A. ZincHepatitis or cirrhosis without decompensation Zinc (first choice) & Trientine (2nd choice).", "cop": 1, "opa": "Zinc", "opb": "Triamterene", "opc": "Trientine", "opd": "Penicillamine", "subject_name": "Medicine", "topic_name": null, "id": "d33e3aa8-168f-40cd-b9cd-5e64cee19c77", "choice_type": "single"}
+{"question": ". In cardiac shock", "exp": "Cardiogenic shock (CS) is characterized by systemic hypoperfusion due to severe depression of the cardiac index and sustained systolic aerial hypotension (<90 mmHg) despite an elevated filling pressure . It is associated with in-hospital moality rates >50%. . Circulatory failure based on cardiac dysfunction may be caused by primary myocardial failure, most commonly secondary to acute myocardial infarction(MI) , and less frequently by cardiomyopathy or myocarditis , cardiac tamponade, or critical valvular hea disease Systolic and diastolic myocardial dysfunction results in a reduction in cardiac output and often pulmonary congestion. Systemic and coronary hypoperfusion occur, resulting in progressive ischemia. Although a number of compensatory mechanisms are activated in an attempt to suppo the circulation, these compensatory mechanisms may become maladaptive and produce a worsening of hemodynamics. *Release of inflammatory cytokines after myocardial infarction may lead to inducible nitric oxide expression, excess nitric oxide, and inappropriate vasodilation. This causes fuher reduction in systemic and coronary perfusion. A vicious spiral of progressive myocardial dysfunction occurs that ultimately results in death if it is not interrupted. LVEDP, left ventricular end-diastolic pressure ref:harrison&;s principles of internal medicine,ed 18,pg no 2232", "cop": 1, "opa": "SBP<90mmof Hg", "opb": "DBP<80mmof Hg", "opc": "Urine output < 20 ml\\/hr", "opd": "Cardiac index < 3.5", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "8d21485c-a7a3-4bce-9c40-e8dd1453cb5d", "choice_type": "single"}
+{"question": "Loud pulmonary component of second hea sound heard in", "exp": "The loudness of each component of the second hea sound is propoional to the respective pressures in the aoa and pulmonary aery at the onset of diastole.P2 is relatively loud in young patients in whom the pulmonary aeries are quite close to the chest wall.The pulmonic component is considered to be abnormally loud in a subject over age 20 if it is greater than the aoic component in the second left inter-costal space (ICS) or if it is audible at the cardiac apex.This may be seen in pulmonary aery hypeension and ASDThe term Eisenmenger's syndrome is applied to patients with a large communication between the two circulations at the aoopulmonary, ventricular, or atrial levels and bidirectional or predominantly right-to-left shunts because of high resistance and obstructive pulmonary hypeension. Hence, the P2 is loud.However, in Eisenmenger&;s syndrome with a large ventricular septal defect (VSD), the pulmonary closure may get completely fused with aoic closure throughout the respiratory cycle. Here, the duration of right and left ventricular systole become viually equal. Hence, a single loud S2 is heard in both phases of respiration.Ref: Harrison's 18/e p1923", "cop": 3, "opa": "MR", "opb": "TOF", "opc": "Eissenmenger's syndrome", "opd": "Pulmonary stenosis", "subject_name": "Medicine", "topic_name": "All India exam", "id": "63cca76b-4769-455f-b2ad-d94b0e186136", "choice_type": "single"}
+{"question": "Most common cause of abdominal aortic aneurysm is", "exp": "(A) Atherosclerosis # ABDOMINAL AORTIC ANEURYSMS:> Abdominal aortic aneurysms occur more frequently in males than in females, and the incidence increases with age.> Abdominal aortic aneurysms may affect 1 to 2% of men older than 50 years.> At least 90% of all abdominal aortic aneurysms > 4.0 cm are affected by atherosclerosis, and most of these aneurysms are below the level of the renal arteries.> Prognosis is related to both the size of the aneurysm and the severity of coexisting coronary artery and cerebrovascular disease.> The risk of rupture increases with the size of the aneurysm.", "cop": 1, "opa": "Atherosclerosis", "opb": "Syphilis", "opc": "Marfan's syndrome", "opd": "Ehlers-Danlos syndrome", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "c9bdb78c-0989-43c6-a5f6-d8f216b0c0b7", "choice_type": "single"}
+{"question": "Pellagra like clinical syndrome is found in", "exp": "Hartnup disease is an autosomal recessive disorder caused by impaired neutral aminoacid transport.\nPresents with pellagra Like skin eruptions , Cerebellar ataxia , and gross aminoaciduria.", "cop": 4, "opa": "Homocystinuria", "opb": "Histidinuria", "opc": "Cystinosis", "opd": "Hartnup disease", "subject_name": "Medicine", "topic_name": null, "id": "cdf1959a-8aa3-434c-91dd-4e09dd10493e", "choice_type": "single"}
+{"question": "A female developed brown macule on the cheek, forehead and nose after exposure to light following delivery of a baby, the diagnosis is", "exp": "Answer is B (Chloasma): Patient has a characteristic 'brown' macule on cheek, with no history suggestive of any systemic involvement, with positive history of delivery of a baby suggesting pregnancy.", "cop": 2, "opa": "SLE", "opb": "Chloasma", "opc": "Photodermatitis", "opd": "Acne rosacea", "subject_name": "Medicine", "topic_name": null, "id": "371f286d-8379-498b-87ea-2ee56f2a3df0", "choice_type": "single"}
+{"question": "In the lower motor neuron lesion diseases, there is", "exp": "(B) There may be wasting of muscles in long standing cases # UMN LESION - Spasticity, Weakness, loss of superficial reflexes, brisk DTR, Clonus present, Babinski sign positive, Hypertonia Clasp Knife spasticity)# LMN lesion - Flaccidity, Decreased tone, loss of superficial & deep reflexes, plantar B/L Flexor, Wasting, Fibrillations.Signs That Distinguish Patterns of WeaknessSIGNS THAT DISTINGUISH PATTERNS OF WEAKNESSSignUpper Motor NeuronLower Motor NeuronMyopathicAtrophyNoneSevereMildFasciculationsNoneCommonNoneToneSpasticDecreasedNormal/decreasedDistribution of weaknessPyramidal/ regionalDistal/segmenta 1ProximalTendon reflexesHyperactive Normal/hypoactiveBabinskils signPresentHypoactive/absent AbsentAbsent", "cop": 2, "opa": "Spastic paralysis", "opb": "There may be wasting of muscles in long standing cases", "opc": "Exaggerated tendon reflexes", "opd": "Absence of fasciculations", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "055f2337-ce6b-4c38-998d-653486367dbe", "choice_type": "single"}
+{"question": "For hiatus hernia, investigation of choice is", "exp": "Barium swallow and meal examination give the best appreciation of gastro-oesophageal anatomy. The patient is in the Trendelenburg position to demonstrate barium in the fundus.Bailey and Love 26th edition Pg: 1015", "cop": 3, "opa": "Barium meal follow through", "opb": "Barium meal upper GI", "opc": "Barium meal upper GI in Trendelenberg position", "opd": "Barium meal double contrast", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "7eeaeca1-1501-41cd-ba54-0a5053f26bf7", "choice_type": "single"}
+{"question": "In ARDS mechanical TV is", "exp": "Low volume ventillation(6 ml/kg predicted body weight)has got lower mortality(31%) as compared to the conventional ventilation (12 mL/kg predicted body weight)-40%.", "cop": 2, "opa": "2-3ml/kg", "opb": "5-7 mI/kg", "opc": "5-lOml/kg", "opd": "12-14ml/kg", "subject_name": "Medicine", "topic_name": null, "id": "1db9edf1-d4fb-4934-b25a-ee694303b622", "choice_type": "single"}
+{"question": "Severity in acute hepatitis is best estimated by", "exp": "Acute Alcoholic Hepatitis The pattern of liver test abnormality is hepatocellular. The AST is typically in the 100 to 200 IU/L range, even in severe disease, and the ALT level may be normal, even in severe cases. The AST level is higher than the ALT level, and the ratio is greater than 2:1 in 70% of patients. Ref Harrison20th edition pg 677", "cop": 4, "opa": "Serum bilirubin", "opb": "PT", "opc": "Alpha glutaryl transferase", "opd": "Alkaline phosphate", "subject_name": "Medicine", "topic_name": "Infection", "id": "3aa5ac44-0b86-4231-9516-b3164a5b2111", "choice_type": "single"}
+{"question": "In the Glasgow Coma Scale, coma score is given by the sum of scores for Eye Opening (E), Best Motor Response (M) and Verbal Response (V). The values assigned to E, M and V in the Glasgow Coma Scale are respectively", "exp": "(C) 4, 6, 5 GLASGOW COMA SCALE (CCS)Eye openingVerbal responseSpontaneous4Orientated5To speech3Confused conversation4To pain2Inappropriate words3Nil1Incomprehensible sounds2Nil1 Best motor responseObeys6Localises5Withdraws4Abnormal flexion3Extension response2Nil1# EMV:# Glasgow Coma Scale (CCS):> The maximum score Is 15, the minimum 3> E + M + V-3 to 15> Less than or equal to 8 are in coma> Greater than or equal to 9 not in coma> 8 is the critical score> Less than or equal to 8 at 6 hours - 50& die> 9-11 = moderate severity> Greater than or equal to 12 = minor injury> Coma is defined as: (1) not opening eyes, (2) not obeying commands, and (3) not uttering understandable words.", "cop": 3, "opa": "5,5,5", "opb": "4,5,6", "opc": "4,6,5", "opd": "5,4,6", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "04cd5376-bc8c-4cc9-895f-6cd9c5c0e456", "choice_type": "single"}
+{"question": "Commonest cause of rupture of spleen is", "exp": "spontaneous splenic rupture, which remain widely accepted to date: Mechanical effect of distention secondary to leukemic infiltration of the spleen, paicularly the capsule; splenic infarct with capsular hemorrhage and subsequent rupture; Ref Davidson edition23rd pg812", "cop": 3, "opa": "Chronic malaria", "opb": "Infectious mononucleosis", "opc": "Leukemia", "opd": "Chronic kala azar", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "8e412bc1-b871-4c09-9a69-407089314770", "choice_type": "single"}
+{"question": "HRT is protective for", "exp": "(A) Hip fracture # BONE DENSITY By reducing bone turnover and resorption rates, estrogen slows the aging-related bone loss experienced by most postmenopausal women. More than 50 randomized trials have demonstrated that postmenopausal estrogen therapy, with or without a progestin, rapidly increases bone mineral density at the spine by 4 to 6% and at the hip by 2 to 3%, and maintains those increases during treatment.> Fractures Data from observational studies indicate a 50 to 80% lower risk of vertebral fracture and a 25 to 30% lower risk of hip, wrist, and other peripheral fractures among current estrogen users; addition of a progestin does not appear to modify this benefit. Discontinuation of estrogen therapy leads to a diminution of protection.> In the WHI, 5 to 6 years of either combined estrogen-progestin or estrogen-only was associated with a 30 to 40% reduction in hip fracture and 20 to 30% fewer total fractures among a population unselected for osteoporosis.BENEFITS & RISKS OF POSTMENOPAUSAL HORMONE THERAPY (HT) IN PRIMARY PREVENTION SETTINGSOutcomeEffectDefinite Benefits Symptoms of menopauseDefinite improvementOsteoporosisDefinite increase in bone mineral density and decrease in fracture riskDefinite Risks Endometrial cancerDefinite increase in risk with estrogen alone; no increase in risk with estrogen- progestinVenous thromboembolismDefinite increase in riskBreast cancerIncrease in risk with long-term use (5 years) of estrogen-progestinGallbladder diseaseDefinite increase in riskProbable or Uncertain Risks and Benefits Coronary heart diseaseProbable increase in risk among older women and women many years past menopause; possible decrease in risk or no effect in younger or recent menopausal womenStrokeProbable increase in riskOvarian cancerProbable increase in risk with long-term use (5 years)Colorectal cancerProbable decrease in risk with estrogen-progestinDiabetes mellitusProbable decrease in riskCognitive dysfunctionUnproven decrease in risk (inconsistent data from observational studies and randomized trials)", "cop": 1, "opa": "Hip fracture", "opb": "Breast cancer", "opc": "DVT", "opd": "MI", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "066a304b-80c1-4864-98cd-75618d41840a", "choice_type": "single"}
+{"question": "ECT is most useful in", "exp": "(Major depression) (98- 213- NA 6th)* Panic disorders (discrete episodes of acute anxiety)* The drug of choice ofgenerilized anxiety disorders are benzodiazepines and for panic disorder (both benzodiazepines and anti depressants* Absolute indication of ECT is (1) major severe depression with suicidal risk (This is the first and most important indication for ECT) with stupur, poor intake of food and fluids, melancholia, psychotic features (2) severe catatonia (functional) (3) severe psychosis (SZP or mania)* The only absolute contraindication is the presence of raised intracranial tension* Bilateral ECT is more effective, but unilateral ECT causes less short term memory impairments", "cop": 2, "opa": "Panic attack", "opb": "Major depression", "opc": "Schizophrenia", "opd": "Manic depressive pyschosis", "subject_name": "Medicine", "topic_name": "Psychiatry", "id": "38bbe0fe-188c-438a-9149-b235a61f4690", "choice_type": "single"}
+{"question": "Rapid X descent unlikely in", "exp": "Answer is C (RVMI) Rapid 'x' descent is rare in RVMI Feature Tamponade Constrictive Pericaditis Restrictive Cardiomyopathy RVMI Prominent x descent Present Usually present Present Rare Prominent y descent Absent Usually present Rare Rare", "cop": 3, "opa": "Constrictive pericarditis", "opb": "Cardiac tamponade", "opc": "RVMI", "opd": "Restrictive cardiomyopathy", "subject_name": "Medicine", "topic_name": null, "id": "579ae78a-c609-4498-9e26-d2e187d2c60c", "choice_type": "single"}
+{"question": "Specific marker for intestinal inflammation", "exp": "Fecal lactoferrin is a highly sensitive and specific marker for detecting intestinal inflammation. Fecal calprotectin levels correlate well with histologic inflammation, predict relapses, and detect pouchitis. Both fecal lactoferrin and calprotectin are becoming an integral pa of IBD management and are used frequently to rule out active inflammationRef: Harrison 19e pg: 1952", "cop": 2, "opa": "C-reactive protein", "opb": "Fecal lactoferrin", "opc": "Erythrocyte sedimentation rate", "opd": "Leukocytosis", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "b536b071-b4b8-4fde-99c0-036eec18b782", "choice_type": "single"}
+{"question": "Artemesinin is best used for", "exp": "Treatment of cerebral malaria:\n\nIV Quinine: Needs continuous cardiac monitoring; can cause QTc prolongation, hypoglycemia\nIV Artesunate has better efficacy and safer than quinine, 2.4 mg/kg IV BD. then OD\nExchange transfusion if parasite index is > 10%\nArtemisinin (qinghaosu) acts rapidly against erythrocytic stages of malarial parasites. It is effective against complicated and multidrug resistant malaria. Due to their short half life, recrudescence is high if used alone, hence not useful for prophylaxis also.\nChloroquine sensitive falci and vivax: Chloroquine l g, 500mg at 6, 24,48 hrs, followed by Primaquine 15mg for 14 days\nChloroquine resistant, uncomplicated falciparum: Oral quinine. Mefloquine, Doxy, Clindamycin, Oral Artesunate", "cop": 3, "opa": "Relapse of malaria", "opb": "Chronic malaria", "opc": "Cerebral malaria", "opd": "Recrudescent malaria", "subject_name": "Medicine", "topic_name": null, "id": "24a4dce6-86b2-4729-8889-9d4764cd1f4e", "choice_type": "single"}
+{"question": "Pneumococcal vaccination is indicated in a) Postsplenectomy b) Sickle cell anemia c) HIV d) After radiotherapy", "exp": null, "cop": 1, "opa": "abc", "opb": "abd", "opc": "ac", "opd": "acd", "subject_name": "Medicine", "topic_name": null, "id": "a2a3b190-0b6c-4230-a148-b679cb874ae0", "choice_type": "single"}
+{"question": "Menkes syndrome is a disorder of", "exp": "Menkes kinky hair syndromeEtiologyFeaturesPrognosisX-linked metabolic disturbance of copper metabolismMutation in copper-transpoing ATP7A geneMental retardationHypocupremiaDecreased circulating ceruloplasminChildren with this disease often die within 5 years because of dissecting aneurysms or cardiac rupture(Ref: Harrison's 18/e p604)", "cop": 1, "opa": "Copper transpo", "opb": "Iron Transpo", "opc": "Sodium transpo", "opd": "Potassium Transpo", "subject_name": "Medicine", "topic_name": "All India exam", "id": "61976f5e-b541-475c-9cca-f9efd808b37e", "choice_type": "single"}
+{"question": "Infectious cause of Erythematous rashes are seen in", "exp": "(A) Measles # Characteristic erythematous, nonpruritic, maculopapular rash of measles begins at the hairline and behind the ears, spreads down the trunk and limbs to include the palms and soles, and often becomes confluent. At this time, the patient is at the most severepoint of the illness. By the fourth day, the rash begins to fade in the order in which it appeared. Early physical findings of enteric fever include rash (\"Rose Spots\"), hepatosplenomegaly, epistaxis, and relative bradycardia. Rose spots make up a faint, salmon-colored, blanching, Maculopapular rash located primarily on the trunk and chest. The rash is evident in 30% of patients at the end of the first week and resolves after 2 to 5 days without leaving a trace. Patients can have two or three crops of lesions, and Salmonella can be cultured from punch biopsies of these lesions. The faintness of the rash makes it difficult to detect in dark-skinned patients. Rashes are not generally a symptom of malaria, but they may appear in some cases, such as in acute falciparum malaria. A classical urticaria (dark red, itchy bumps) or itchy papular rash (round bumps usually 0.5 inches in diameter) may appear.", "cop": 1, "opa": "Measles", "opb": "Typhoid fever", "opc": "Yellow fever", "opd": "Malaria", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "3d213d10-d06f-4ec9-8ccc-986e28bc7fbd", "choice_type": "single"}
+{"question": "Fasting hyperglycemia is almost always seen in", "exp": "fasting glucose levels greater than or equal to 7.0 mmol/l, is frequently present in patients with phaeochromocytoma (24% in the present study) and the diabetes is reversed by removal of the tumour(pheochromocytoma). Ref - Harrison20th edition pg 99", "cop": 2, "opa": "Gastric carcinoma", "opb": "Pheochromocytoma", "opc": "Adrenal tumour", "opd": "Carcinoid tumour", "subject_name": "Medicine", "topic_name": "Nutrition", "id": "c1f0d348-f411-407e-84fc-786e10809637", "choice_type": "single"}
+{"question": "Female patient with bilateral hilar lymphadenopathy and joint pain. ACE levels are elevated. The diagnosis in this patient is", "exp": "Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology characterised by presence of non caseating granulomas. LOFGREN SYNDROME - an acute illness characterised by erythema nodosam, peripheral ahropathy, uveitis, bilateral hilar lymphadenopathy,lethargy and fever often seen in young women. Bilateral hilar lymphadenopathy may be sometimes discovered incidentally on chest x-ray . Ref Davidson edition23rd pg 608", "cop": 3, "opa": "Silicosis", "opb": "Hodgkin lymphoma", "opc": "Sarcoidosis", "opd": "Non Hodgkins lymphoma", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "890ab6d9-73da-41a8-b4c0-565d2ef7985d", "choice_type": "single"}
+{"question": "Most common cause of Seizures in an elderly with Cerebrovascular Stroke is", "exp": "(B) Cerebrovascular stroke # SEIZURE DISORDERS become increasingly common after the age of 60 years.> Seizures are associated with subdural hematoma, stroke, and CNS infection.> They also can occur with systemic metabolic conditions such as uremia, hyperglycemia, hypoglycemia, hyponatremia, and alcohol withdrawal.> Cerebrovascular stroke is the second common disease after heart disease and the most important cause of seizure in elderly.> Of the degenerative disorders, Alzheimer's dementia and amyloid angiopathy are known major causes of seizures> Certain drugs commonly prescribed to elderly people, such as tramadol, also reduce seizure threshold, and are best avoidec> Older people seem to be more susceptible to the epileptogenic effects of some other drugs, such as antipsychotics, antidepressants (particularly tricyclics), antibiotics, theophylline, levodopa, thiazide diuretics and even the herbal remedy, ginkgo biloba> Drugs for first-line monotherapy of seizures in elderly patients include carbamazepine, valproic acid, oxcarbazepine, gabapentin, and lamotrigine.", "cop": 2, "opa": "Alcohol withdrawal", "opb": "Cerebrovascular stroke", "opc": "Uremia", "opd": "Meningitis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "345d9b79-c7d2-4b29-b8b8-81e313ad092f", "choice_type": "single"}
+{"question": "As per etiological classification of diabetes mellitus, Gestational diabetes mellitus is", "exp": "Etiologic Classification of Diabetes MellitusI. Type 1 diabetes (beta cell destruction, usually leading to absolute insulin deficiency)Immune-mediatedIdiopathicII. Type 2 diabetes (may range from predominantly insulin resistance with relative insulin deficiency to a predominantly insulin secretory defect with insulin resistance)III. Other specific types of diabetesGenetic defects of beta cell development or function characterized by mutations in:Genetic defects in insulin actionDiseases of the exocrine pancreas--pancreatitis, pancreatectomy, neoplasia, cystic fibrosis, hemochromatosis, fibrocalculous pancreatopathy, mutations in carboxyl ester lipaseEndocrinopathies--acromegaly, Cushing's syndrome, glucagonoma, pheochromocytoma, hypehyroidism, somatostatinoma, aldosteronomaDrug- or chemical-induced- Glucocoicoids, vacor (a rodenticide), pentamidine, nicotinic acid, diazoxide, b-adrenergic agonists, thiazides, calcineurin and mTOR inhibitors, hydantoins, asparaginase, a-interferon, protease inhibitors, antipsychotics (atypicals and others), epinephrineInfections--ongenital rubella, cytomegalovirus, coxsackievirusUncommon forms of immune-mediated diabetes--\"stiff-person\" syndrome, anti-insulin receptor antibodiesOther genetic syndromes sometimes associated with diabetes--IV. Gestational diabetes mellitus (GDM)Ref: Harrison 19e pg: 2399", "cop": 4, "opa": "Type IA", "opb": "Type IB", "opc": "Type II", "opd": "Type IV", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "3ab4c1c9-6e21-4fc9-9594-2d624a79aff9", "choice_type": "single"}
+{"question": "Parenteral agent used in diabetes", "exp": "Agents Used for Treatment of Type 1 or Type 2 Diabetes Parenteral Amylin agonists Slow gastric emptying, glucagon Pramlintide 0.25-0.5 Reduce postprandial glycemia, weight loss Injection, nausea, risk of hypoglycemia with insulin Agents that also slow GI motility GLP-1 receptor agonists Insulin, glucagon, slow gastric emptying, satiety Exenatide, liraglutide, dulaglutide 0.5-1.0 Weigh loss, do not cause hypoglycemia Injection, nausea, risk of hypoglycemia with insulin secretagogues Renal disease, agents that also slow Gi motility; medullary carcinoma of thyroid Insulin Glucose utilization, hepatic glucose production and other anabolic actions See text and Table 418-4 Not limited Known safety profile Injection, weight gain , hypoglycemia Ref: Harrison 19e pg: 2414", "cop": 2, "opa": "Rosiglitazone", "opb": "Exenatide", "opc": "Repaglinide", "opd": "Canagliflozin", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "4330426b-2976-463a-8acc-6ee9dca02b83", "choice_type": "single"}
+{"question": "Pleural effusion with very low glucose is", "exp": "Rheumatoid ahritis produces an exudative pleural effusion with predominant lymphocytes,positive rheumatoid factor and anti-CCP antibodies,and very low glucose in pleural . Pleural involvement is the most frequent manifestation of rheumatoid ahritis (RA) in the chest. The effusion is an exudate and is characterized by low pH and glucose level, and high lactic dehydrogenase (LDH) and cell count low glucose also seen in malignancy,and tubercular effusion. Ref Davidson edition23rd pg 580", "cop": 4, "opa": "Malignancy", "opb": "Tuberculosis", "opc": "SLE", "opd": "Rheumatoid ahritis", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "deff0a7e-95b5-4cd6-83f7-49236adc3a1d", "choice_type": "single"}
+{"question": "Marker test for vertical transmission of HIV", "exp": "Ans. (a) p24 antigenRef : Harrison 19th ed. /1246-47* Following HIV infection, the sequences of markers to identify infection in their chronologic order of appearance in serum are: viral RNA followed by p24 antigen and lastly anti-HIV antibody.* ELISA is positive in all babies born to HIV positive mother, due to transplacental transferrin of anti - HIV antibody.* About 2 weeks after infection, viremia is thought to increase exponentially and then decline to a steady- state level as the humoral and cell-mediated immune responses control HIV replication. This time interval, the serologic \"window period,\" is characterized by seronegativity, occasionally detectable antigenemia, viremia (as measured by RNA), and variable CD4 lymphocyte levels. Detection of specific antibody to HIV signals the end of the window period and labels the individual as seropositive.* The exact time when HIV RNA, antigen, and antibody can be detected depends on several factors, including the test used, individual host responses, and viral characteristics. Viral RNA can be detected within the first 2 weeks using the highly sensitive RT-PCR method. Antigen, although transient, can appear as early as 2 weeks after infection and lasts 3 to 5 months Newer generation antibody assays, including the HIV third generation antigen-sandwich antibody assays, can detect antibody in most individuals at about 3 to 4 weeks post- infection and Hep D.", "cop": 1, "opa": "p24 antigen", "opb": "Serum ELISA", "opc": "Western blot", "opd": "Immunoblot", "subject_name": "Medicine", "topic_name": "Virology", "id": "9c1a9247-8b42-4a37-bd1c-3d365a32fdaa", "choice_type": "single"}
+{"question": "The common cause of subarachnoid hemorrhage Is", "exp": "*Subarachnoid hemorrhage commonly,but exclusively results from rupture of congenital berry aneurysms in the interpeduncular cistern . Subarachnoid haemorrhage, a medical emergency, is usually from a bulging blood vessel that bursts in the brain (aneurysm). It may lead to permanent brain damage or death if not treated promptly Ref Harrison20th edition pg 2567", "cop": 3, "opa": "Aerio-venous malformation", "opb": "Cavernous angioma", "opc": "Aneurysm", "opd": "Hypeension", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "1096f571-bc78-403c-bf07-054040494600", "choice_type": "single"}
+{"question": "Vanishing tumor is seen in", "exp": "Answer- B. LungAccumulation of fluid in the interlobar spaces of the lung (as a result of CHF) appears as a neoplasm on a radiograph.It is called as Phantom tumor or pseudotumor or vanishing tumor.", "cop": 2, "opa": "Liver", "opb": "Lung", "opc": "Bone", "opd": "Hea", "subject_name": "Medicine", "topic_name": null, "id": "21c248f4-d6a4-423f-8f7f-ac6c0e62cc65", "choice_type": "single"}
+{"question": "Restrictive and constrictive cardiomyopathy occurs together in", "exp": "The etiologies of RCM may be grouped into broad categories as follows: Primary/idiopathic: Endomyocardial fibrosis (EMF), loeffler eosinophilic endomyocardial disease Secondary: Infiltrative, amyloidosis (the most common cause of RCM in the United States), sarcoidosis , progressive systemic sclerosis (scleroderma) , hemochromatosis, , carcinoid hea disease, glycogen storage disease of the hea, radiation/treatment induced, metastatic malignancy, anthracycline toxicity Ref Davidson 23rd edition pg 467", "cop": 4, "opa": "Radiation", "opb": "Adriamycin", "opc": "Post cardiotomy", "opd": "Amyloidosis", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "7b5c8f3a-9423-4a3c-9bcd-41bdf784ab8b", "choice_type": "single"}
+{"question": "DOC for Tourette syndrome", "exp": "Ans. is 'd' i.e., Clonidine Earlier Haloperidol was considered as DOC for Tourette syndrome. Clonidine is considered as DOC for Tourette syndrome", "cop": 4, "opa": "Haloperidol", "opb": "Valproate", "opc": "B complex", "opd": "Clonidine", "subject_name": "Medicine", "topic_name": null, "id": "8750d57d-21f0-4f86-b485-dec7bf7fafa9", "choice_type": "single"}
+{"question": "Duration of apnea in obstructive sleep apnea is", "exp": "Ans. is 'a' i.e., <10 sec Sleep apnea ? o Sleep apnea is defined as intermittent cessation of airflow at the nose and mouth during sleep. o By convention apneas of at least 10 seconds duration have been considered impoant but in most patients the apneas are 20s to 30 seconds in duration and may be as long as 2-3 minutes. o Sleep apnea is of two types - Sleep apnea Obstructive sleep apnea Central sleep apnea Occurs due to occlusion of upperairway at the level of oropharynx Occurs due to transient abolition ofthe central neural drive to the respiratory muscles Conditions associated are adenotonsillarhyperophy, retrognathia, macroglossiaalcohol, obesity Primary and secondary central alveolarhypoventilation syndrome, hypoxia (high altitude) cardiovascular disease, pulmonary congestion, central nervous system disease, prolonged circulation time. Clinical features of sleep apnea - Excessive daytime sleepiness Cardiorespiratory disturbances which include Recurrent respiratory failure Pulmonary hypeension Hea failure Systemic hypeension 7 Chronic hypoventilation Polycythemia o Aerial blood gas analysis reveals hypoxemia and hypercapnia.", "cop": 1, "opa": "<10 sec", "opb": "<20 sec", "opc": "<30 sec", "opd": "<60 sec", "subject_name": "Medicine", "topic_name": null, "id": "d1381609-efaa-460b-be28-b4a42a1b5fdc", "choice_type": "single"}
+{"question": "Direct Coomb's test detects", "exp": "Ans. is 'a' i.e., Antibodies attached to RBC surface", "cop": 1, "opa": "Antibodies attached to RBC surface", "opb": "Antibodies in the serum", "opc": "Antigens attached to RBC surface", "opd": "Antigens in the serum", "subject_name": "Medicine", "topic_name": null, "id": "2334f228-e053-4590-a74f-0c56ee8b6f25", "choice_type": "single"}
+{"question": "The jejunal biopsy is diagnostic in", "exp": "Abetalipoproteinemia is characterized by a normal mucosal appearance except for the presence of mucosal absorptive cellsthat contain lipid postprandially and disappear after a prolonged period of either fat-free intake or fasting.Ref: Harrison; 19th edition; Page no: 1939", "cop": 1, "opa": "Abetalipoproteinemia", "opb": "Giardiasis", "opc": "Tropical sprue", "opd": "Celiac sprue", "subject_name": "Medicine", "topic_name": "All India exam", "id": "35d5cd48-2340-4990-bd0a-9a30ee199012", "choice_type": "single"}
+{"question": "The key factor in the transpo of carbon dioxide as bicarbonate is", "exp": "Since the Pco2 in the tissue is high,CO2 diffuses from tissues into the plasma. From there it enters the RBC which contains plenty of carbonic anhydrase. In blood,70% of CO2 is transpoed as HCO3 by the action of carbonic anhydrase. Reference:Textbook of medical physiology-Geetha N,2nd edition,page no:245.", "cop": 3, "opa": "The high solubility of CO2 in H20", "opb": "The presence of Hb in blood", "opc": "The presence of carbonic anhydrase in the erythrocytes", "opd": "The acid nature of carbon dioxide and the alkaline nature of bicarbonate", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "91c5895a-8f69-4a92-b461-d85b2d71c8d8", "choice_type": "single"}
+{"question": "Characteristic feature of early congenital syphilis is", "exp": null, "cop": 4, "opa": "Microcephaly", "opb": "Saddle nose", "opc": "Interstitial keratitis with sabre skin", "opd": "Vesicular rash with bulla over palms and soles", "subject_name": "Medicine", "topic_name": null, "id": "62650140-3fee-4fca-8842-81ef7a66873a", "choice_type": "single"}
+{"question": "Definition of TIA is, patient signs and symptoms resolve by", "exp": "When blood flow is quickly restored, brain tissue can recover fully and the patient's symptoms are only transient, this is called a transient ischemic attack (TIA). The definition of TIA requires that all neurologic signs and symptoms resolve within 24 h without evidence of brain infarction on brain imaging. Most TIAs last <1 h.Stroke has occurred if the neurologic signs and symptoms last for >24 h or brain infarction is demonstratedRef: Harrison 19e pg: 2559", "cop": 1, "opa": "24 hours", "opb": "36 hours", "opc": "48 hours", "opd": "72 hours", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "24f98377-80d1-4738-98f9-e1bef8552182", "choice_type": "single"}
+{"question": "26 year old man died while playing. His autopsy of the hea revealed myocyte hyperophy. Diagnosis is", "exp": "Ref:Harrison&;s 19th E pg 1568. Most probably it is HOCM. Patients with hyperophic cardiomyopathy have an increased risk of sudden cardiac death from ventricular tachyarrhythmias. Vigorous physical activity and competitive spo are prohibited.", "cop": 1, "opa": "HOCM", "opb": "DCM", "opc": "Arrhythmogenic cardiac problem", "opd": "Restrictive cardiomyopathy", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "4fca192e-c7b2-4651-90e4-55b28ad6126e", "choice_type": "single"}
+{"question": "Features of diabetic nonproliferative retinopathy are a) Hard exudatesb) Soft exudatesc) Microaneurysms d) RD", "exp": null, "cop": 2, "opa": "ab", "opb": "bc", "opc": "ac", "opd": "ad", "subject_name": "Medicine", "topic_name": null, "id": "b0f352d1-abe8-4bab-9283-eeed8e9eff0a", "choice_type": "single"}
+{"question": "In myasthenia gravis antibody are formed against\\", "exp": "(A) ACh receptor > The major problem in myasthenia gravis is a marked reduction of acetylcholine receptors on the motor endplate where cranial nerves form a neuromuscular junction with muscles.> In these patients, autoantibodies against the acetylcholine receptors effectively reduce receptor numbers.> Normally, acetylcholine molecules released by the nerve terminal bind to receptors on the muscle endplate, resulting in a stimulation of contraction by depolarizing the muscle membrane.> The condition is improved with drugs that inhibit acetylcholinesterase. CALCIUM CHANNEL DISORDERS OF MUSCLE: Hypokalemic Periodic Paralysis (HypoKPP). SODIUM CHANNEL DISORDERS OF MUSCLE: Hyperkalemic Periodic Paralysis (HyperKPP). POTASSIUM CHANNEL DISORDERS: Andersen's Syndrome", "cop": 1, "opa": "ACh receptor", "opb": "Ca channel", "opc": "K channel", "opd": "H2 receptor", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "83326594-b153-43bc-809a-202ce3d6fa04", "choice_type": "single"}
+{"question": "Most common cause of death in primary amyloidosis is", "exp": "Primary amyloidosis: (light chain amyloidosis or AL-amyloid disease)Primarily a consequence of plasma cell disordersThe kidney is the most frequently involved organ(80%)Hea is second most frequently involved(40%)Cardiac failure is the most common cause of deathCardiac amyloidosis mostly manifests as restrictive cardiomyopathy(ref: Harrison's 18/e p948)", "cop": 3, "opa": "Respiratory failure", "opb": "Renal failure", "opc": "Cardiac failure", "opd": "Septicemia", "subject_name": "Medicine", "topic_name": "All India exam", "id": "dac57ebd-2e8b-4359-bc25-a5a641957621", "choice_type": "single"}
+{"question": "HLA DQA1 is associated with", "exp": "Molecular analysis of human leukocyte antigen (HLA) class II genes has revealed that Sjogren's syndrome, regardless of the patient's ethnic origin, is highly associated with the HLA DQA1*0501 allele. Reference: Harrison 19th edition PG: 2166", "cop": 2, "opa": "SLE", "opb": "Sjogrens syndrome", "opc": "Scleroderma", "opd": "Ankylosing spondylosis", "subject_name": "Medicine", "topic_name": "Immune system", "id": "8a452974-7a9d-4876-9c02-dc442952ab7f", "choice_type": "single"}
+{"question": "The most common cause of bronchopulmonary aspergillosis is", "exp": "Aspergillus fumigatus is responsible for most cases of invasive aspergillosis including bronchopulmonary aspergillosis,almost all cases of chronic aspergillosis,and most allergic syndromes.A.flavus is more prevalent in some hospitals and causes a higher propoion of cases of sinus and cutaneous infections and keratitis than A.fumigatus.A.Niger can cause invasive infection, but more commonly colonizes the respiratory tract and causes external otitis.A.terreus causes only invasive disease,usually with a poor prognosis.A.nidulans occasionally causes invasive infection,primarily in patients with chronic granulomatous disease. Reference:Harrison's medicine-18th edition,page no:1655.", "cop": 1, "opa": "Aspergillus fumigatus", "opb": "Aspergillus terreus", "opc": "Aspergillus flavus", "opd": "Aspergillus niger", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "28fae6ac-c156-45ed-9c93-bddc2fbd5c5b", "choice_type": "single"}
+{"question": "Acute rheumatic fever occurs most commonly in", "exp": null, "cop": 1, "opa": "5-14 yrs", "opb": "15-20 yrs", "opc": "21-25 yrs", "opd": "26-30 yrs", "subject_name": "Medicine", "topic_name": null, "id": "9ef09d34-0106-427d-b861-b81a87de6e92", "choice_type": "single"}
+{"question": "Broad Granular casts are seen in", "exp": "Broad granular casts - Chronic renal failure.\nRBC casts - Glomerular injury.", "cop": 1, "opa": "Chronic renal failure", "opb": "Glomerular injury", "opc": "Thrombotic Microangiopathy", "opd": "Pyelonephritis", "subject_name": "Medicine", "topic_name": null, "id": "2e7f82c7-75d9-4540-96eb-3860f7fbd9c1", "choice_type": "single"}
+{"question": "Theoretical \"Optimal PEEP\" in ARDS is", "exp": "In most clinical settings, positive end-expiratory pressure (PEEP) is empirically set to minimize Fio2 (inspired O2 percentage) and maximize Pao2 (aerial paial pressure of O2). On most modern mechanical ventilators, it is possible to construct a static pressure-volume curve for the respiratory system. The lower inflection point on the curve represents alveolar opening (or \"recruitment\"). The pressure at this point, usually 12-15 mmHg in ARDS, is a theoretical \"optimal PEEP\" for alveolar recruitment.Ref: Harrison 19e pg: 1738", "cop": 3, "opa": "0 - 5 mm Hg", "opb": "5 - 12 mm Hg", "opc": "12 - 15 mm Hg", "opd": "15 - 18 mm Hg", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "4e507f9e-ba36-4d0f-baa9-dbb6b11da3c6", "choice_type": "single"}
+{"question": "Features not seen in Cushing&;s Syndrome", "exp": "In Cushing&;s syndrome, hyperglycemia usually occur; hyperglycemia may progress to frank diabetes. Page 1940,Nelson textbook of pediatrics 19th edition", "cop": 1, "opa": "Hypoglycemia", "opb": "Hypeension", "opc": "Frank psychosis", "opd": "Hypokalemia", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "fa40f997-9b84-49ee-a355-73b8f061ffc2", "choice_type": "single"}
+{"question": "Paradoxical splitting of S2 is seen in", "exp": "Paradoxical splitting: Reverse of normal physiology, splitting of second hea sounds during expiration, singular during inspiration Seen in conditions that cause delayed conduction down the left bundle (LBBB, pre-excitation of the right ventricle, right ventricular pacing, premature RV beats), aoic stenosis ref - Harrisons internal medicine 20e pg1802-1805", "cop": 3, "opa": "Pulmonary stenosis", "opb": "Pulmonary hypeension", "opc": "Aoic stenosis", "opd": "Congenital absence of pulmonary valve", "subject_name": "Medicine", "topic_name": "All India exam", "id": "c7504d8a-f8cd-401e-8c5a-f8b5b1575c26", "choice_type": "single"}
+{"question": "A negative nitrogen balance is observed", "exp": null, "cop": 3, "opa": "During normal pregnancy", "opb": "during convalescence", "opc": "In malnutrition", "opd": "During normal child growth", "subject_name": "Medicine", "topic_name": null, "id": "67d68f50-02b1-4c75-b50e-740369e9a100", "choice_type": "single"}
+{"question": "Beck's triad is seen in", "exp": "Ref Harrison 19 th ed pg 1573 The three principal features of tamponade (Beck's triad) are hypo- tension, soft or absent hea sounds, and jugular venous distention with a prominent x descent but an absent y descent. The limitations of ventricular filling are responsible for a reduction of cardiac output. The quantity of fluid necessary to produce cardiac tamponade may be as small as 200 mL when the fluid develops rapidly to as much as >2000 mL in slowly developing effusions when the pericardium has had the oppounity to stretch and adapt to an increasing volume.", "cop": 2, "opa": "Constrictive pericarditis", "opb": "Cardiac tamponade", "opc": "Hyperophic obstructive cardiomyopathy", "opd": "Restrictive cardiomyopathy", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "defdafd9-8f9c-4794-9bdd-cc2285c470f6", "choice_type": "single"}
+{"question": "RBBB with left Axis eviation is characteristic of", "exp": null, "cop": 1, "opa": "Ostium Primum ASD", "opb": "Mitral valve prolapse", "opc": "Patent Ductus Arteriosus", "opd": "Ventricular Septal Defect", "subject_name": "Medicine", "topic_name": null, "id": "0baeaab2-e70d-4e4c-b8fa-805e97b5df71", "choice_type": "single"}
+{"question": "Normal CRP with elevated ESR seen in", "exp": "Ans. is 'b' i.e., SLE Both ESR and CRP are markers of inflammation Erythrocyte sedimentation rate or ESR is used to separate inflammation from non-inflammation. Another sign of inflammation is the rise in blood level of number of proteins called as acute phase proteins. One of the proteins is C-reactive protein (CRP). Like ESR and other acute phase proteins, CRP also goes up in inflammation. In systemic lupus however the level does not rise unless there is infection associated. The normal response to active inflammatory disease is an increase in plasma CRP concentration. o For reasons that remain unclear tht response is either significantly lower in magnitude or entirely absent in a few inflammatory conditions. This has proven diagnostically useful because there are very few inflammatory conditions in which ESR is significantly raised (reflecting an inflammatory process) but plasma CRP is only slightly raised or even normal. One ofthese conditions is systemic lupus erythematosus (SLE or lupus), a relatively common chronic autoimmune disease that predominantly affects women of child-bearing age. When this inflammation occurs in the lupus patient it is accompanied as expected by a marked increase in ESR. However in contrst to most other inflammatory condition, the plasma CRP remains resolutely normal. The combination of raised ESR and normal CRP is a useful diagnostic feature of SLE. Other disorders where CRP is not increased Osteoahritis, leukemia, anemia Polycythemia, viral infection Ulcerative colitis, pregnancy, estrogen", "cop": 2, "opa": "RA", "opb": "SLE", "opc": "Scleroderma", "opd": "Polymyalgia rheumatica", "subject_name": "Medicine", "topic_name": null, "id": "87dfebfe-ae29-4d3b-be22-451e45313c96", "choice_type": "single"}
+{"question": "A patient following head injury was admitted in intensive care ward with signs of raised intracranial pressure. He was put on ventilator and ataed on intravenous fluids and diuretics. Twenty four hours later his urine output was 3.5 litres, serum sodium 156 mEq/l and urine osmolality of 316 mOsm/kg. The most likely diagnosis based on these parameters is", "exp": "Answer is A (High output due to diuretics): Presence of high urine osmolality >300 (316 mosmol/Kg) along with increased serum Na suggest a diagnosis of solute diuresis. The patient inquestion has sustained head injury and mannitol is often used insuch cases to reduce the intracranial pressure. Solute diuresis secondary to use of mannitol (diuretic) explains the parameters of the patient in question.", "cop": 1, "opa": "High output due to diuretics", "opb": "Diabetes insipidus", "opc": "Too much infusion of normal saline", "opd": "Cerebral salt retaining syndrome", "subject_name": "Medicine", "topic_name": null, "id": "31916a9b-27b8-44ac-b226-6ac48ad54e6f", "choice_type": "single"}
+{"question": "Most common cause of sudden death", "exp": null, "cop": 1, "opa": "Ventricular fibrilation", "opb": "Atrial fibrilation", "opc": "PSVT", "opd": "A-V block", "subject_name": "Medicine", "topic_name": null, "id": "70f79487-157a-477a-b83c-2ce0e273bbcf", "choice_type": "single"}
+{"question": "ATM mutation is seen in", "exp": "(A) Ataxia telangiectasia # Ataxia telangiectasia mutated (ATM) is a serine/threonine protein kinase that is recruited and activated by DNA double-strand breaks.> ATM phosphorylates several key proteins that initiate activation of the DNA damage checkpoint, leading to cell cycle arrest, DNA repair or apoptosis.> Several of these targets, including p53, CHK2 and H2AX are tumor suppressors.> Ataxia telangiectasia (autosomal recessive): 11 q22-23; ATM gene for regulation of cell cycle; mitogenic signal transduction and meiotic recombination Ataxia-telangiectasia - caused by mutations in the ATM gene Breast cancer - associated with the ATM gene Other cancers - increased risk from variations of the ATM gene Cancers of the stomach, bladder, pancreas, lung, and ovaries occur more frequently in ATM mutation carriers than in people who do not carry these mutations.", "cop": 1, "opa": "Ataxia telangiectasia", "opb": "Fragile X syndrome", "opc": "Joubert syndrome", "opd": "Spinocerebellar ataxia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "2ce04e78-c876-4064-b5b0-686e8cd90970", "choice_type": "single"}
+{"question": "Renal vein thrombosis is most commonly associated with", "exp": "Renal Vein Thrombosis(RVT):The left renal vein is more commonly involved and two-thirds of cases are bilateralEtiology: 1. endothelial damage-Homocystinuria, endovascular intervention, and surgery 2. Venous stasis-Dehydration, retroperitoneal fibrosis and abdominal neoplasms(compression and kinking of the renal veins) 3. hypercoagulable states-proteins C and S, antithrombin deficiency, factor V Leiden, disseminated malignancy, oral contraceptives, APLA, nephrotic syndrome(membranous nephropathy) It can either present with flank pain, tenderness, hematuria, rapid decline in renal function, and proteinuria or it can be silentDiagnostic screening can be performed with Doppler ultrasound; the most sensitive test is CT angiographyTreatment for RVT is anticoagulation and therapy for the underlying cause; Endovascular thrombolysis may be used; Nephrectomy in life-threatening complicationsRef: Harrison's 18/e p2382", "cop": 2, "opa": "Diabetic nephropathy", "opb": "Membranous glomerulopathy", "opc": "Minimal change disease", "opd": "Mesangio-proliferative glomerulonephritis", "subject_name": "Medicine", "topic_name": "All India exam", "id": "84b7415d-ca0e-4681-926f-e7841e971798", "choice_type": "single"}
+{"question": "The Modern Stethoscope was invented by", "exp": "(D) George Phillip Cammann# Stethoscope was invented in France in 1816 by Rene Laennec at the Necker-Enfants Malades Hospital in Paris. It consisted of a wooden tube and was monaural.> In 1840, Golding Bird described a stethoscope he had been using with a flexible tube.> Irish physician Arthur Leared invented a binaural stethoscope.> The modern binaural Stethoscope was invented by the American physician George Philip Cammann in 1852.> George Cammann perfected the design of the instrument for commercial production, which has become the standard ever since.> Cammann also wrote a major treatise on diagnosis by auscultation, which the refined binaural stethoscope made possible.", "cop": 4, "opa": "Rene Laennec", "opb": "Golding Bird", "opc": "Arthur Leared", "opd": "George Phillip Cammann", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "613f5c35-bbf7-43eb-81af-75a87b638b45", "choice_type": "single"}
+{"question": "Frequency of tuning fork used to test vibration sense is", "exp": "(C) 512 hZ # TUNING FORK TESTS: These tests are performed with tuning forks of different frequencies such as 128, 256, 512,1024, 2048 and 4096 Hz, but for routine clinical practice, tuning fork of 512 Hz is ideal.> Forks of lower frequencies produce sense of bone vibration while those of higher frequency have a shorter decay time and are thus not routinely preferred.> Tuning Fork Tests: Rinne test Weber Test Absolute bone conduction test Schwabach's test, Benign test, Gelle's test", "cop": 3, "opa": "128 Hz", "opb": "256 HZ", "opc": "512 hZ", "opd": "1024 Hz", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "b2fd87c0-2572-4cdf-9650-142c79fc3c3c", "choice_type": "single"}
+{"question": "The most impoant area involved in planning and organizing complex sequential skilled movements is", "exp": "Answer is C (Supplementary motor Area): The most impoant area involved in planning and organizing complex sequential skilled movements is the Supplementary Motor Area (SMA). The SMA is impoant for planning and organizing complex sequential movements. For example the sequence of finger movement required to play a muscal instrument such as Clarinet or Piano is planned and organized in the SMA'.", "cop": 3, "opa": "Primary Motor Area", "opb": "Premotor Area", "opc": "Supplementary motor Area", "opd": "Primary sensory Area", "subject_name": "Medicine", "topic_name": null, "id": "7e33ccdb-edab-4b3d-a0ea-a97493799dcc", "choice_type": "single"}
+{"question": "In gram negative septicemia, early findings setting", "exp": "Answer is B (Cardiac output, Total peripheral resistance) septic shock is characterized by normal or. increased cardiac output and decreased systemic vascular resistance. Septic Shock :Usually results from a severe decrease in systemic vascular resistance, besides various other features. Cardiac output is initially normal or even elevated. lnfact, normal or increased cardiac output and decreased systemic vascular resistance characterize septic shock (as in Gram negative septicemia here) and distinguish it from cardiogenic, extra-cardiac, obstructive and hypovolumic shock.", "cop": 2, "opa": "Cardiac output, Total peripheral resistance", "opb": "Cardiac output, Total peripheral resistance", "opc": "Cardiac output, Total peripheral resistance", "opd": "Cardiac output, Total peripheral resistance", "subject_name": "Medicine", "topic_name": null, "id": "a996871d-d184-4a67-9165-23be6645a6e2", "choice_type": "single"}
+{"question": "Features of bronchiolitis are a) Caused by R.S.V. b) Wheeze present c) Pulmonary edema common d) Seen in immunocompromised hosts e) Common age groups is from 5 to 15 years age", "exp": null, "cop": 1, "opa": "ab", "opb": "ac", "opc": "bd", "opd": "de", "subject_name": "Medicine", "topic_name": null, "id": "2db4156d-7cd8-4bfb-b72a-748012e35bf1", "choice_type": "single"}
+{"question": "The most common neurological disorder seen in CRF patients", "exp": "Ans. is 'b' i.e., Peripheral neuropathy", "cop": 2, "opa": "Dementia", "opb": "Peripheral neuropathy", "opc": "Bakes intestinal dilator.", "opd": "Restless leg syndrome", "subject_name": "Medicine", "topic_name": null, "id": "90c5c5bf-57fc-41ff-94f1-bd922bebfaa8", "choice_type": "single"}
+{"question": "The typical movement of mitral valve calcification is", "exp": null, "cop": 1, "opa": "Upwards and downwards", "opb": "Couterclock wise", "opc": "Side to Side", "opd": "Circular", "subject_name": "Medicine", "topic_name": null, "id": "c8aeea85-59fa-4513-bc7d-4e38600945ac", "choice_type": "single"}
+{"question": "Not a feature of chronic liver disease", "exp": "Koilonychia is not a feature of chronic liver disease.", "cop": 4, "opa": "Hepatomegaly", "opb": "Variceal bleeding", "opc": "hepatic encephalopathy", "opd": "Koilonychia", "subject_name": "Medicine", "topic_name": null, "id": "4b0822ee-9350-4478-8f86-5bce965031fe", "choice_type": "single"}
+{"question": "Banding technique used for studying translocations involving centromere is", "exp": "M/c used for cytogenetic analysis - G banding.\nFor studying translocations involving centromere - C banding.", "cop": 4, "opa": "Q banding", "opb": "G banding", "opc": "R banding", "opd": "C banding", "subject_name": "Medicine", "topic_name": null, "id": "83397820-40b3-4d9c-8731-7acddc5c8576", "choice_type": "single"}
+{"question": "Aldose reductase drugs are useful in", "exp": "Aldose reductase (AR) is an enzyme of aldoketo reductase super-family that catalyzes the conversion of glucose to sorbitol in the polyol pathway of glucose metabolism. In this context, aldose reductase inhibitors (ARIs) have received much attention worldwide. Decreased sorbitol flux through polyol pathway by ARIs could be an emerging target for the management of major complications of diabetes. The ARIs developed vary structurally, and representative structural classes of ARIs include i) carboxylic acid derivatives (such as Epalrestat, Alrestatin, Zopalrestat, Zenarestat, Ponalrestat, Lidorestat, and Tolrestat), ii) spirohydantoins and related cyclic amides (such as Sorbinil, Minalrestat, and Fidarestat), and iii) phenolic derivatives (related to Benzopyran-4-one and Chalcone). Among these inhibitors, Epalrestat is the only commercially available inhibitor till date. In addition, some other ARIs such as Sorbinil and Ranirestat had been advanced into late stage of clinical trials and found to be safe for human use. Adapting ARIs could prevent sepsis complications, prevent angiogenesis, ameliorate mild or asymptomatic diabetic cardiovascular autonomic neuropathy and appear to be a promising strategy for the treatment of endotoxemia and other ROS-induced inflammatory diseases . Ref - pubmed.com", "cop": 2, "opa": "Cataract", "opb": "Diabetes mellitus", "opc": "Hereditary fructose intolerance", "opd": "Essential fructosuria", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "6f2b4669-31a6-4d40-b0ea-91b2833c2f98", "choice_type": "single"}
+{"question": "A smoker presented with altered sensorium. His blood osmolality was found to be 240 and urine osmolality 340. His Na+ is 122 meq/L. The diagnosis is", "exp": "(B) SIADH # Psychogenic polydipsia and beer potomania--Marked excess free water intake (generally >10 L/d) may produce hyponatremia.> Euvolemia is maintained through the renal excretion of sodium.> Urine sodium is therefore generally elevated (> 20 mEq/L), but unlike SIADH, levels of ADH are suppressed.> Urine osmolality is appropriately low (< 300 mosm/kg) as the increased free water is excreted.> Hyponatremia from bursts of ADH occurs in manic-depressive patients with excess free water intake.> Psychogenic polydipsia is observed in patients with psychological problems, and these patients frequently take drugs interfering with water excretion.> Similarly, excessive intake of beer, which contains very small amounts of sodium (< 5 mEq/L), can cause severe hyponatremia in cirrhotic patients, who have elevated ADH and often a decreased GFR.", "cop": 2, "opa": "Diabetes insipidus", "opb": "SIADH", "opc": "Renal tubular acidosis", "opd": "Cerebellar degeneration", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "c86571b9-ba8f-45c4-a17a-6fa5310f2a04", "choice_type": "single"}
+{"question": "Prolonged intake of PPI causes", "exp": "Proton Pump (H+, K+-ATPase) Inhibitors Omeprazole, esomeprazole, lansoprazole, rabeprazole, and pantoprazole are substituted benzimidazolederivatives that covalently bind and irreversibly inhibit H+, K+- ATPase.Long-term acid suppression, especially with PPIs, has been associated with a higher incidence of community-acquired pneumonia as well as community and hospital-acquired Clostridium difficile-associated disease.Long-term use of PPIs was associated with the development of hip fractures in older women.Long-term use of PPIs has also been implicated in the development of iron and magnesium deficiency, but here again, the studies are limited and inconclusive. PPIs may exe a negative effect on the antiplatelet effect of clopidogrel.Reference: Harrison; 19th edition; Page no: 1921", "cop": 2, "opa": "Hypothyroidism", "opb": "Pneumonia", "opc": "Hepatitis", "opd": "Pancreatitis", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "9b1f1a28-fb33-4fbd-8300-c530835d0924", "choice_type": "single"}
+{"question": "Dose of rTPA in ischaemic stroke is", "exp": "Ans. is 'b' i.e., 90 mg Recommended dose for thrombolysis with IV TPA is 0.9 mg/kg with the maximum dose being 90 mg. 10% should be given as a bolus over one minute, followed by remaining 90% as a continuous infusion over 60 minutes.", "cop": 2, "opa": "60 mg", "opb": "90 mg", "opc": "100 mg", "opd": "120 mg", "subject_name": "Medicine", "topic_name": null, "id": "983073b0-406e-462b-8e91-ee25f3da128d", "choice_type": "single"}
+{"question": "A common finding in osteomalacia is", "exp": null, "cop": 1, "opa": "Low serum phosphate", "opb": "Normal level of 1, 25 di-hydroxy vit D3", "opc": "Low serum calcium", "opd": "Increased hydroxy proline in urine", "subject_name": "Medicine", "topic_name": null, "id": "c299a73c-f198-4117-a742-9c5989d49b1c", "choice_type": "single"}
+{"question": "Not associated with diabetes mellitus", "exp": "Ans. is 'c' i.e., Hypothyroidism", "cop": 3, "opa": "Cushing syndrome", "opb": "Acromegaly", "opc": "Hypothyroidism", "opd": "Pheochromocytoma", "subject_name": "Medicine", "topic_name": null, "id": "ec8d139b-627a-4003-a24b-fd0ee6eb33f0", "choice_type": "single"}
+{"question": "Highest calcium Concentration is present in", "exp": null, "cop": 1, "opa": "Dates", "opb": "Guava", "opc": "Amla", "opd": "Halibut Liver oil", "subject_name": "Medicine", "topic_name": null, "id": "4a51b95c-fc4e-4210-9dc7-bf5d0973b0b2", "choice_type": "single"}
+{"question": "Anticentromere antibodies are most commonly associated with", "exp": "The constellation of calcinosis cutis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia, was historically termed the CREST syndrome . Anti-centromere antibodies (ACAs; often styled solid, anticentromere) are autoantibodies specific to centromere and kinetochore function. They occur in some autoimmune diseases, frequently in limited systemic scleroderma (formerly called CREST syndrome), and occasionally in the diffuse form of scleroderma. Ref - HArrisons 20e p2546", "cop": 3, "opa": "Diffuse cutaneous systemic sclerosis", "opb": "Mixed connective tissue disease", "opc": "CREST syndrome", "opd": "Polymyositis", "subject_name": "Medicine", "topic_name": "Immune system", "id": "4554e3b0-70c5-485f-ba31-2647016dea40", "choice_type": "single"}
+{"question": "B cell prolymphocytic leukemia patients differ from those with B cell chronic lymphocytic leukemia in", "exp": null, "cop": 4, "opa": "Presenting at a younger age", "opb": "Having a lower total leucocyte count", "opc": "Having prominent lymphadenopathy", "opd": "Having a shorter survival", "subject_name": "Medicine", "topic_name": null, "id": "79cfa9cd-3cb9-4bf5-822a-1b764a773dc2", "choice_type": "single"}
+{"question": "Anti histone antibodies are characteristics of", "exp": "Ref - Harrison's internal medicine 20e p2517", "cop": 1, "opa": "Drug induced lupus", "opb": "Cardiac lupus", "opc": "Lupus nephritis", "opd": "MCTD", "subject_name": "Medicine", "topic_name": "Immune system", "id": "dd2396cb-f86e-45e2-8179-1b7b2ace99d3", "choice_type": "single"}
+{"question": "Pulsus alternans is seen in", "exp": "Pulses alterans is defined by beat-to-beat variability of pulse amplitude.It is seen in patients with severe left ventricular dysfunction and systolic hea failure,and is thought to be due to cyclic changes in intracellular calcium and action potential duration. Hyperophic obstructive cardiomyopathy is characterised by jerky pulse (pulses bisferens). Aoic stenosis is characterised by slow rising carotid pulse.(pulses parvus et tarsus) AS may also have anacrotic pulse Harrison's Medicine-20 the edition.", "cop": 1, "opa": "Severe ventricular dysfunction", "opb": "HOCM", "opc": "AS", "opd": "CP", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "f87299ea-8890-456a-a645-33ea1edf6bdf", "choice_type": "single"}
+{"question": "Right Frontal lobe lesion leads to", "exp": "(A) Impaired left conjugate gaze# Conjugate gaze refers to the eyes working in unison. A disorder of conjugate gaze means that patients are unable to look in certain directions with both eyes, such as upward, downward or laterally.> Centre for lateral conjugate gaze is seen in frontal lobe cortices & in occipital lobe cortices.> Frontal lobe centres for lateral conjugate gaze lie in the posterior aspect of frontal lobes.> They are quite close to the motor cortex and hence conjugate deviation of the eyes is seen in a number of paralytic strokes.> Frontal lobe centre for lateral conjugate gaze control voluntary conjugate eye movements to the opposite side. Teleologically, this makes sense: the left half of the brain \"sees\" space on the right side, therefore the left side of the brain controls movements of the right arm and leg, as well as eye movements to the right side.> In one side of frontal lobe centre destruction, as in a cerebral infarct, the tonic impulses from the opposite frontal lobe cause a deviation of the eyes towards the side of the lesion and patient looks to- wards the lesion and away from the paralyzed side.> Conjugate deviation occurs only in acute phase of an infarct and eventually the patient will recover, but there may be an intermediate stage where they are unable to move the eyes away from the lesion on command, yet able to follow an object to the opposite side.> Occipital lobe centre for lateral gaze control the ability of the eyes to follow an object to the opposite side.> In a patient with destruction of the right frontal centre but with an intact right occipital lobe centre cannot look to the left on command, but may be able to follow an object to the left.> If the patient is unable to follow a moving object, such as a finger, you can assess the occipital lobe centre by having them fixate on an immobile object while you move their head.> Remember! Lesions of occipital centre for lateral conjugate gaze are less common than lesions of frontal centre for lateral conjugate gaze.> Brainstem centre for lateral conjugate gaze are in the pons, very close to the sixth nerve nuclei.> The right frontal centre connects with the left pontine centre, and the left frontal centre with the right pontine centre. The left pontine centre controls lateral conjugate eye movement to the left, and the right pontine centre controls lateral conjugate eye movement to the right.> Thus, a patient who has a destruction of one pontine centre will look away from the lesion and towards the paralyzed side because of the unopposed action of the opposite pontine centre. Recovery of conjugate gaze after a brainstem lesion is unusual.", "cop": 1, "opa": "Impaired left conjugate gaze", "opb": "Impaired right conjugate gaze", "opc": "Impaired upward conjugate gaze", "opd": "Impaired downward conjugate gaze", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "797a9baa-469d-4dcb-b05b-7fa7138f0fdd", "choice_type": "single"}
+{"question": "\"Telescope fingers\" occur in", "exp": "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", "cop": 3, "opa": "Rheumatic ahritis", "opb": "Rheumatoid ahritis", "opc": "Psoriatic ahritis", "opd": "Reiter's ahritis", "subject_name": "Medicine", "topic_name": "Immune system", "id": "fca90256-afc1-4b0c-80a5-b4e063ef41e9", "choice_type": "single"}
+{"question": "The commonest hepatotropic virus causing increased chronic carrier state is", "exp": "Ans. is 'd' i.e.,. HCV Most common hepatitis to progress to chronicity is Hepatitis (G). . HCV =It's major feature, however, is its propensity to cause chronic hepatitis in more than 80% of those infected Clinical and epidemiologic features of viral hepatitis Features HAV HBV HCV HDV HEV * Incubation (days)* 15-45 30-180 15-160 30-180 14-60 * Age* Children, young Adults Young adults Any age but more in adult Any age Young adults * Transmission * Fecal-oral* +++ -- -- -- +++ * Percutaneous* unusual +++ +++ +++ -- * Perinatal* -- +++ + + -- * Sexual * + ++ + ++ -- * Clinical * Severity* Mild Occasionally Severe Moderate Occasionally Severe Mild * Fulminant* l% .1%- 1% .1% 5-20% 1-2% * Progression* to chronicity None Occasional (1-10%) Common (50-70%) Common None * Carrier* None. 1-30% 1.5-3.2% Variable None * Prognosis Excellent Worse with age Moderate Acute, good chronic poor Good", "cop": 4, "opa": "HEV", "opb": "HAV", "opc": "HBV", "opd": "HCV", "subject_name": "Medicine", "topic_name": "Hepatitis", "id": "6cc70afe-700b-4108-a8eb-183c0f2679b3", "choice_type": "single"}
+{"question": "Flourine levels intake required for development of Skeletal Fluorosis", "exp": null, "cop": 3, "opa": "1.0 - 2.0 ppm", "opb": "2.0 - 3.0 ppm", "opc": "3.0 - 6.0 ppm", "opd": "6-9 ppm", "subject_name": "Medicine", "topic_name": null, "id": "cd1dbc7d-c1a0-456c-9e2f-1778f695e1a4", "choice_type": "single"}
+{"question": "Duroziez's sign is seen in", "exp": "Ref Harrison 19 th ed pg 1536 booming \"pistol-shot\" sound can be heard over the femoral aeries (Traube's sign), and a to-and-fro murmur (Duroziez's sign) is audible if the femoral aery is lightly compressed with a stethoscope.", "cop": 1, "opa": "Aoic regurgitation", "opb": "Tricuspid regurgitation", "opc": "Mitral stenosis", "opd": "Carcinoid syndrome", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "4606b481-62b4-4441-bafa-2ba5bac58e5d", "choice_type": "single"}
+{"question": "Not seen with uremic lung", "exp": "Ans. is 'c' i.e., Interstitial fibrosis Uremic lung is referred to abnormalities expressed chest x-ray abnormalities seen in patients with CKD. The pathogenesis was believed to be related to blood urea nitrogen and creatinine retention. There is : Its pathophysiology is based on uremia-induced increased permeability of pulmonary alveolo-capillary interfaces, leading to Interstitial and intra-alveolar edema Atelectasis Alveolar hemorrhage Pulmonary hyaline membrane formation. These changes are compounded by bleeding diathesis secondary to platelet dysfunction in advanced renal disease. The pulmonary symptoms and radiographic findings are reversible with hemodialysis.", "cop": 3, "opa": "alveolar injury", "opb": "Pulmonary edema", "opc": "Interstitial fibrosis", "opd": "Fibrinous exudate in alveoli", "subject_name": "Medicine", "topic_name": null, "id": "43361a35-5ca3-4721-bc1b-ac315f410dbc", "choice_type": "single"}
+{"question": "Ingestion of arsenic causes", "exp": "Ans. is 'c' Non cirrhotic Portal fibrosis. \"Chronic ingestion of Arsenic has been incriminated in causation of NCPF. High Hepatic arsenic levels in patients with NCPF have been reported\" - API", "cop": 3, "opa": "Hepatic carcinoma", "opb": "Hepatic adenoma", "opc": "Noncirrhotic portal fibrosis", "opd": "Hepatic cirrhosis", "subject_name": "Medicine", "topic_name": "Toxicology", "id": "aaa3d000-2b22-4b3d-a17a-37cd9e4af400", "choice_type": "single"}
+{"question": "Arsenic is assocaited with increased risk of a) Mesothelioma b) Melanoma c) Basal cell carcinoma d) Squamous cell carcinoma", "exp": null, "cop": 3, "opa": "ad", "opb": "bd", "opc": "cd", "opd": "ab", "subject_name": "Medicine", "topic_name": null, "id": "4d45b24a-22ad-41a2-929d-1c12f9224d8c", "choice_type": "single"}
+{"question": "S2 is best appreciated in", "exp": "Ans. is 'a' i.e., 3rd left intercostal space", "cop": 1, "opa": "3rd left intercostal space", "opb": "2nd right intercostal space", "opc": "4th left intercostal space", "opd": "5th left intercostal space", "subject_name": "Medicine", "topic_name": null, "id": "285326b8-a9ca-4d17-99d6-3e869497ab7c", "choice_type": "single"}
+{"question": "The recommended target HbA1C to minimise the risk of vascular complications in diabetic individual is", "exp": null, "cop": 3, "opa": "10% or more", "opb": "8%", "opc": "7% or less", "opd": "9%", "subject_name": "Medicine", "topic_name": null, "id": "3f3a0746-67b3-4be9-b894-ad7e5886c2e3", "choice_type": "single"}
+{"question": "Method of choice to confirm H. Pylori eradication is", "exp": null, "cop": 1, "opa": "Urea breath test", "opb": "Culture", "opc": "Serology", "opd": "Microscopy", "subject_name": "Medicine", "topic_name": null, "id": "6135d243-1b46-4d41-902c-4b06165b0717", "choice_type": "single"}
+{"question": "Isosthenuria is seen in", "exp": "Causes :\nChronic renal failure.\nAdministration of furosomide.\nHypercalcemia.", "cop": 1, "opa": "Chronic renal failure", "opb": "Diabetes insipidus", "opc": "Congestive cardiac failure", "opd": "Weil's disease", "subject_name": "Medicine", "topic_name": null, "id": "bd8b8581-ba67-48a3-9c8d-de4245009e49", "choice_type": "single"}
+{"question": "A Parietal lobe lesion presented with Sensory seizures, motor deficits' visual disorders, no touch perception on opposite side and on simultaneous bilateral touch. This is associated with", "exp": "(A) Unilateral parietal lobe dysfunction Unilateral parietal lobe dysfunction (Right or left)Dominant (left) parietal lobe dysfunction (in most right- handed and some left handed patients)Non-dominant (right) parietal lobe dysfunctionBilateral parietal lobe dysfunction* Sensory deficits (asterognosis, agraphesthesia, sensory seizures)* Motor deficits (mild hemiparesis)* Visual disorders (homonymous hemianopia, inferior quadrantanopia, visual inattention)* Contralateral neglect (more obvious for right sided lesions)* Constructional and dressing apraxia* Language disorders (aphasia, alexia)* Gertsmann syndrome (dyscalculia, dysgraphia, finger agnosia, right-left confusion)* Apraxia* Hemispatial neglect* Sensory and visual inattention* Constructional and dressing apraxia (greater severity for right sided lesions)* Visuospatial disorientation* Balint syndrome (optic ataxia, oculomotor apraxia, simultanagnosia)# Symptoms & Signs of Parietal lobe dysfunction: Paroxysmal localized paraesthesia (tingling sensations/'pins and needles'), affecting the contralateral side of the body. Also known as sensory seizures. Sensory deficits to the contralateral side can occur, leading to astereognosis, agraphesthesia, loss of proprioception, vibration and fine touch. Primary sensory modalities may return after a short time, however discrimination between sensations may not. Mild hemiparesis could also occur.", "cop": 1, "opa": "Unilateral parietal lobe dysfunction", "opb": "Dominant parietal lobe dysfunction", "opc": "Non-Dominant parietal lobe dysfunction", "opd": "Bilateral parietal lobe dysfunction", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "085a46cb-aa22-41e0-bfff-259908ba1f2c", "choice_type": "single"}
+{"question": "\"Seal finger\" and \"whale finger\" are associated with infection of", "exp": "(B) Erysipelothrix # Erysipelothrix rhusiopathiae> E. rhusiopathiae is a natural parasite of many animals.> It causes swine erysipelas & human erysipeloid.> Human infection usually occurs on the hand or fingers of persons handling animals fish or animal products> Lesions are painful, edematous and erythematous, usually involving the local lymphnodes and joints.> Occasional cases of endocarditis have been reported.> The bacillus is sensitive to penicillin, erythromycin and broad spectrum antibiotics.", "cop": 2, "opa": "Treponema", "opb": "Erysipelothrix", "opc": "Listeria", "opd": "Corynebacterium", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "b44574dc-10dc-449c-abff-8991e69b7d7c", "choice_type": "single"}
+{"question": "The Investigation of choice for Acute stroke is", "exp": "(A) CT scan # Investigation of Acute Stroke: CT is the most practical and widely available method of imaging the brain. It will usually exclude non-stroke lesions, including subdural haematomas and brain tumours.> It will demonstrate intracerebral haemorrhage within minutes of stroke onset.> However, especially within the first few hours after symptom onset, CT changes in cerebral infarction may be completely absent or very subtle, though changes usually evolve over time.> For most purposes, a CT scan performed within the first day or so is adequate for clinical care but there are certain circumstances in which an immediate CT scan is essential.> Even in the absence of changes suggesting infarction, abnormal perfusion of brain tissue can be imaged with CT after injection of contrast media (i.e. perfusion scanning). This can be useful in guiding hyper-acute treatment of ischaemic stroke.> MRI is not as widely available as CT, scanning times are longer & it cannot be used in some individuals with contraindications", "cop": 1, "opa": "CT scan", "opb": "MRI angiography", "opc": "Functional MRI", "opd": "Contrast CT", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "66b66284-d564-461d-8106-ff8de62c5975", "choice_type": "single"}
+{"question": "Mechanism of action colchicine in acute gout", "exp": "* Gout is a hereditary disorder with increase in serum uric acid due to increased production, or decreased excretion of uric acid and uric salt. * Thought to be caused by lack of an enzyme needed to completely metabolise purines for renal excretion. REF : HARRISONS 21ST ED", "cop": 2, "opa": "Uric acid nephrolithiasis.", "opb": "Deficiency of enzyme Xanthine oxidase", "opc": "Increase in serum urate concentration", "opd": "Renal disease involving interstitial tissues", "subject_name": "Medicine", "topic_name": "All India exam", "id": "baf15d49-1d1c-4bf8-b993-c7dd8e174add", "choice_type": "single"}
+{"question": "Dawson disease is", "exp": "Answer- A. SSPESSPE is ako known as Dawson encephalitis and measles encephalitis.", "cop": 1, "opa": "SSPE", "opb": "Acute disseminated encephalomyelitis", "opc": "Neuromyelitis optica", "opd": "Paralysis agitans", "subject_name": "Medicine", "topic_name": null, "id": "68a793a6-417b-450d-94cc-8deb720b4c4b", "choice_type": "single"}
+{"question": "Gene mutations in Cystic fibrosis occurs at", "exp": null, "cop": 3, "opa": "Short arm of chromosome 7", "opb": "Long arm os chromosome 5", "opc": "Long arm of chromosome 7", "opd": "Short arm of chromosome 3", "subject_name": "Medicine", "topic_name": null, "id": "c756f8b0-4aab-4974-828b-c39338650c59", "choice_type": "single"}
+{"question": "Diabetes control is best monitored by", "exp": null, "cop": 3, "opa": "Serum glucose", "opb": "Post prandial blood glucose", "opc": "HbA1AC", "opd": "HbA2AC", "subject_name": "Medicine", "topic_name": null, "id": "1f64c1df-a757-4176-a9a1-c65642bf17a9", "choice_type": "single"}
+{"question": "ANCA negative vasculitis among the following is", "exp": "c- ANCA predominant vasculitis p- ANCA predominant vasculitis 1. Wegener`s granulomatosis Microscopic polyangiitis Churg-Strauss syndrome Crescentic glomerulonephritis", "cop": 3, "opa": "Wegener's granulomatosis", "opb": "Churg - Strauss syndrome", "opc": "Polyaeritis nodosa", "opd": "Microscopic polyangiitis", "subject_name": "Medicine", "topic_name": "Vasculitis", "id": "00646d5e-1f37-45a7-b40e-f9304f36bce5", "choice_type": "single"}
+{"question": "Prophylactic gonadectomy is done in", "exp": "Gonadectomy is often advised in CAIS due to the risk of gonadal malignancy.\nThe malignancy risk is poorly defined (possibly 5-10% in childhood rising to 30% by the age of 50 years) and is thought to be due to intra abdominal position of the testes.\n\nTiming of gonadectomy is controversial.\n\nSome clinicians advocate early i.e. childhood gonadectomy due to the malignant potential with subsequent HRT to induce puberty.\nOthers prefer to delay gonadectomy until after puberty to allow endogenous gonadal hormones to work throughout puberty.\nHormone replacement therapy is essential after gonadectomy for many aspects of health and well being. One of these is the maintenance of bone mineral density.\n\nMore on management of CAIS\n\nMajority of women with CAIS will have a shortened vagina.\nThe hypoplastic vagina requires treatment.\nThe two main options for vaginal enlargement are vaginoplasty surgery or manual vaginal dilatation.\nVaginal dilatation is usually the first line treatment.", "cop": 1, "opa": "Testicular feminising syndrome", "opb": "Klinefelter's syndrome", "opc": "Kalman's syndrome", "opd": "Down's syndrome", "subject_name": "Medicine", "topic_name": null, "id": "f89cd22f-de15-42ac-813f-ebfd5318d1d4", "choice_type": "single"}
+{"question": "Comment on the diagnosis of the patient.", "exp": "Given X ray shows prominent descending right pulmonary aery- giving \"Jug handle\" appearance Aoic Dissection - seen on CT COA - 3 sign TOF - Boot shaped hea", "cop": 3, "opa": "Aoic dissection", "opb": "Coarctation of aoa", "opc": "Pulmonary aery hypeension", "opd": "Boot shaped hea", "subject_name": "Medicine", "topic_name": "Thromboembolism and Fat Embolism Syndrome", "id": "1d03a955-cc67-4a7f-bd0d-951fb301b237", "choice_type": "single"}
+{"question": "ROSE questionnaire is used for", "exp": "The Rose Angina Questionnaire (RAQ) was developed in 1962 to detect ischemic hea pain (angina pectoris and myocardial infarction) for epidemiological field-surveys.1 Since then, the RAQ has been used in many countries to detect coronary hea disease (CHD) in epidemiological research . Ref Davidson edition23rd pg 460", "cop": 3, "opa": "Alcohol addiction", "opb": "Sex addiction", "opc": "Angina assessment", "opd": "DVT assessment", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "8898c315-f99e-4e0c-bd79-e00e7699e908", "choice_type": "single"}
+{"question": "Of the following vasculitides, coronary artery aneurysms are most often in", "exp": null, "cop": 1, "opa": "Kawasaki disease", "opb": "Giant-cell arteritis", "opc": "Wegener's granulomatosis", "opd": "Leucocytoclastic vasculitis", "subject_name": "Medicine", "topic_name": null, "id": "d06a3793-140f-4843-9af2-9c64361fdecb", "choice_type": "single"}
+{"question": "The most important drug in the treatment of Ischemic Heart Disease", "exp": "Aspirin is the most important drug in the management of Ischemic heart disease", "cop": 2, "opa": "Statins", "opb": "Aspirin", "opc": "Beta blockers", "opd": "Nitrates", "subject_name": "Medicine", "topic_name": null, "id": "fdacd365-5c15-4c2d-bf4f-d27a6fb75f3d", "choice_type": "single"}
+{"question": "A 45year old patient is having FBS 111mg/dl, PPBS 181mg/dl, HbA1C 6.1%. The diagnosis is", "exp": "Ref - DAVIDSOSN 23E P748", "cop": 1, "opa": "Pre diabetes", "opb": "Type 2 DM", "opc": "Type 1 DM", "opd": "Stress hyperglycenia", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "a2e1ece7-3958-44c6-8a9d-b7df9c9d7958", "choice_type": "single"}
+{"question": "A 60 year old man presents with choreoathetosis. O/e KF rings is seen in cornea. Initial treatment of choice is", "exp": "Zinc is the initial treatment of choice.", "cop": 1, "opa": "Zinc", "opb": "Penicillamine", "opc": "Pyridoxine", "opd": "Trientine", "subject_name": "Medicine", "topic_name": null, "id": "fbff2953-db7b-4f69-b23c-2608f2bd7ad5", "choice_type": "single"}
+{"question": "Maximum loss of sodium in a child occurs in", "exp": "Ans. is 'b' i.e., heal fluid Cations and anions in biological fluids in meq/dl Fluid Sodium Potassium Chloride Gastric juice 60 10 85 heal fluid 130 10 115 Diarrhea stool 10-90 10-80 10-110", "cop": 2, "opa": "Gastric juice", "opb": "Ileal fluid", "opc": "Non cholera Diarrhoea", "opd": "Cholera", "subject_name": "Medicine", "topic_name": null, "id": "861327be-6776-4776-a001-3a9bc3f2be7c", "choice_type": "single"}
+{"question": "Most common GI manifestation in HIV infection is", "exp": null, "cop": 2, "opa": "Amebiasis", "opb": "Cryptosoporidiosis", "opc": "Giaridiasis", "opd": "Hook Worm infestation", "subject_name": "Medicine", "topic_name": null, "id": "f30d39af-b295-4680-830f-d96fb8b5b8db", "choice_type": "single"}
+{"question": "A known case of bronchial asthma with eosinophilea. Most common cause of the fungal infection is", "exp": "(Aspergillosis) (1335- CMDT- 08) (234-CMDT-09) (1259-H17th)Allergic bronchopulmonary aspergillosis - occurs in patients with preexisting asthma who develop worsening bronchospasm and fleeting pulmonary infiltrates accompanied by eosinophilia high levels of IgE, IgG, Aspergillus precipitins in the bloodCRYPTOCOCCOSIS - Most common cause of fungal meningitis, Predisposing factors - Hodgkin's disease corticosteroids therapy, HIV infectionsMUCORMYCOSIS (Zygomycosis, phycomycosis) - Predisposing conditions include Diabetic ketoacidosis, CRF, desferoxamine therapy, treatment with corticosteroid or cytotoxic drugsCANDIDIASIS - risk factors - prolonged neutropenia, recent abdominal surgery, broad- spectrum antibiotic therapy, renal failure, presence of intravascular catheters (especially when providing TPN) and Injection drug use* Gastrointestinal mucosal disease, particularly esophagitis most common", "cop": 2, "opa": "Mucormycosis", "opb": "Aspergillosis", "opc": "Candida", "opd": "Cryptococcosis", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "758f5b93-8f3b-4833-bef3-b6e7d0979fbc", "choice_type": "single"}
+{"question": "Thickening of pulmonary memb. is seen in", "exp": null, "cop": 1, "opa": "Asthma", "opb": "Emphysema", "opc": "Bronchitis", "opd": "Skeletal defect", "subject_name": "Medicine", "topic_name": null, "id": "b9a638d8-727b-4f82-8182-9fedc394c1e6", "choice_type": "single"}
+{"question": "Murmur increasing with valsalva maneouvre", "exp": null, "cop": 2, "opa": "Mitral stenosis", "opb": "HOCM", "opc": "M.R.", "opd": "Aortic stenosis", "subject_name": "Medicine", "topic_name": null, "id": "28335aba-9c71-4982-9896-94dd2e773585", "choice_type": "single"}
+{"question": "The annual Conversion rate to dementia in patients with mild congnitive impairment is", "exp": "The term mild cognitive impairment (MCI) has been used to describe the transition between normal cognition and Alzheimer dementia. Mild cognitive impairment is recognized as an impoant public health problem as a dementia risk. Annual conversion rates often range from 10% to 15% in clinic samples. Ref Harrison20th edition pg 2765", "cop": 1, "opa": "10%", "opb": "20%", "opc": "30%", "opd": "40%", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "8d42055b-08a5-4e86-b7a9-fd7f02e9b3a4", "choice_type": "single"}
+{"question": "Viral meningitis with reduced CSF sugar is seen in", "exp": "(D) Coxsackie virus> Chemical meningitis, inflammatory conditions, subarachnoid hemorrhage, and hypoglycemia also cause hypoglycorrhachia (low glucose level in CSF).> Elevated levels of glucose in the blood is the only cause of having an elevated CSF glucose level.> There is no pathologic process that causes CSF glucose levels to be elevated.CNS infections can cause lowered CSF glucose levels, although glucose levels are usually normal in viral infections.", "cop": 4, "opa": "Rubella", "opb": "Mumps", "opc": "AIDS", "opd": "Coxsackie virus", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "85cf8a04-e0cd-42bf-90ac-cfb1baf96415", "choice_type": "single"}
+{"question": "Aldose reductase inhibitor drugs are useful in", "exp": "Ans. is 'b' i.e., Diabetes mellitus Aldose reductase catalyzes the NADPH-dependent conversion of glucose to sorbitol, the first step in polyol pathway of glucose metabolism. Aldose reductase inhibitors are a class of drugs being studied as a way to prevent eye and nerve damage in people with diabetes mellitus. Examples of aldose reductase inhibitors include: Tolrestat (withdrawn from market) Apalrestat Ranirestat Fidarestat", "cop": 2, "opa": "Cataract", "opb": "Diabetes mellitus", "opc": "Hereditary fructose intolerance", "opd": "Essential fructosuria", "subject_name": "Medicine", "topic_name": null, "id": "e4958250-5d35-4cae-8d1e-af35dec6617d", "choice_type": "single"}
+{"question": "Excercise induced asthma is not precipitated by", "exp": null, "cop": 3, "opa": "High altitude climb & excercise", "opb": "Cycling in cold weather", "opc": "Swimming in hot water", "opd": "Swimming in cold water", "subject_name": "Medicine", "topic_name": null, "id": "62cc8998-ae00-4f8b-9bd8-0664f831b6f9", "choice_type": "single"}
+{"question": "Migratory necrolytic erythema is seen in", "exp": "Glucagonoma syndrome is a rare paraneoplastic phenomenon. Necrolytic migratory erythema is often one of the first presenting symptoms. We repo a case of a 55-year-old man with a 2-year history of recalcitrant eruption. Abdominal computer tomography was performed, which revealed a tumor in the tail of the pancreas Ref Harrison 20th edition pg 544", "cop": 1, "opa": "Glucagonoma syndrome", "opb": "Peutz-Jeghers syndrome", "opc": "Sarcoidosis", "opd": "Amyloidosis", "subject_name": "Medicine", "topic_name": "Oncology", "id": "a1c98666-2fc7-4e92-82f7-0232ab32210c", "choice_type": "single"}
+{"question": "Pontine hemorrhage most common cause is", "exp": "Pontine haemorrhage, a form of Ref Harrison20th edition pg 2456", "cop": 1, "opa": "Hypeension", "opb": "Diabetes", "opc": "Trauma", "opd": "Aneurysmal rupture", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "743acf5c-7226-47d4-9cdd-28744fff15dc", "choice_type": "single"}
+{"question": "Richest source of Essential fatty acids", "exp": "Safflower oil contains 73% linoleic acid. \nSunflower oil - 56%.\nCorn oil - 57%.", "cop": 1, "opa": "Safflower oil", "opb": "Corn oil", "opc": "Sunflower oil", "opd": "Soyabean oil", "subject_name": "Medicine", "topic_name": null, "id": "a6d66ac4-4d65-4b67-808a-8290c9ed7513", "choice_type": "single"}
+{"question": "Feature of early dumping syndrome is", "exp": "(A) Occurs immediately after meals FEATURES OF EARLY AND LATE DUMPING EarlyLate* Incidence5-10%5%* Relation to mealsAlmost immediateSecond hour after meal* Durations of attack30-40 minutes30-40 minutes* ReliefLying downFood* Aggravated byMore foodExercise* Precipitating factorFood, especiallyAs early dumping carbohydrate-rich & wet* Major symptomsEpigastric fullness, sweating, light- headedness, tachycardiaTremor, faintness, prostration, colic, sometimes diarrhoea", "cop": 1, "opa": "Occurs immediately after meals", "opb": "Relieved with food", "opc": "Aggravated by exercise", "opd": "Symptoms are tremors, faintness, prostration", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "dd331972-3800-4006-b15d-5512f4b3b8be", "choice_type": "single"}
+{"question": "A blood donor is not considered for safe transfusion, If he has", "exp": null, "cop": 3, "opa": "Anti Hbs Ag +ve", "opb": "Anti HBs Ag and HBc Ag +ve", "opc": "Hbs Ag +ve & IgM anti HBc +ve", "opd": "Anti HBc +ve", "subject_name": "Medicine", "topic_name": null, "id": "f346cb03-9d8b-4e6e-9f8c-b3511e61162c", "choice_type": "single"}
+{"question": "Laron dwarfism is due to", "exp": "Laron syndrome, or Laron-type dwarfism, is an autosomal recessive disorder characterized by an insensitivity to growth hormone (GH), usually caused by a mutant growth hormone receptor . It is caused by changes ( mutations ) in the GHR gene . This gene encodes growth hormone receptor, which is a protein found on the outer membrane of cells throughout the body. ... Mutations in GHR impair the function of growth hormone receptors which interferes with their ability to bind growth hormone . Ref - Harrison's internal medicine 20e p2657, 3417", "cop": 3, "opa": "GH deficiency", "opb": "GHRH deficiency", "opc": "GH receptor resistance", "opd": "IGF-1 deficiency", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "3005bd76-e62b-40e0-ad35-096427d9dc01", "choice_type": "single"}
+{"question": "In facial palsy, food accumulated in the mouth due to paralysis of", "exp": "(D) Buccinator > The facial nerve contributes to the oropharyngeal phase of deglutition via the buccinator, perioral, digastricus posterior, and stylohyoid muscles. The gustatory and salivatory functions of the facial nerve are also known to contribute to swallowing.> The relation between peripheral facial nerve palsy (PFP) and swallowing dysfunction has never been studied systematically", "cop": 4, "opa": "Masseter", "opb": "Temporalis", "opc": "Mentalis", "opd": "Buccinator", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "18843a5c-d0aa-4479-be20-b31105595dc0", "choice_type": "single"}
+{"question": "Broncho penumonia due to measles occurs due to", "exp": "Most complications of measles involve the respiratory tract ,like broncho pneumonia and it result from secondary bacterial infections of the respiratory tract that are attributable to a state of immunosuppression lasting for several weeks to months after acute measles. reference:Harrison' s medicine-18th edition,page no:1603.", "cop": 2, "opa": "Sinusitis", "opb": "Immunomodulation", "opc": "Bronchial obstruction", "opd": "Aspiration", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "435129e5-b7d9-4b0a-8056-17ea78528903", "choice_type": "single"}
+{"question": "Bile salt is mainly absorbed in", "exp": "Ileum - Vit B12 and Bile salts\nDuodenum - Iron.", "cop": 4, "opa": "Stomach", "opb": "Duodenum", "opc": "Jejunum", "opd": "Ileum", "subject_name": "Medicine", "topic_name": null, "id": "5d038455-2290-4f60-ae34-d5e33c11ad0c", "choice_type": "single"}
+{"question": "Investigation of choice in clinical suspicion of stroke", "exp": "After the clinical diagnosis of stroke is made, an orderly process of evaluation and treatment should follow. The first goal is to prevent or reverse brain injury. Attend to the patient's airway, breathing, and circulation (ABCs), and Treat hypoglycemia or hyperglycemia if identified. Perform an emergency noncontrast head CT scan to differentiate between ischemic stroke and hemorrhagic strokeRef: Harrison 19e pg: 2561", "cop": 1, "opa": "Noncontrast head CT", "opb": "Contrast head CT", "opc": "Noncontrast head MRI", "opd": "Contrast head MRI", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "ef7c9158-0e9a-4376-90b5-5ea2a7c5f168", "choice_type": "single"}
+{"question": "Massive bleeding per rectum in a 70 yr old patient is due to", "exp": "Hemorrhage from a colonic diveiculum is the most common cause of hematochezia in patients > 60years old.Most bleeds are self-limited and stop spontaneously with bowel rest. The lifetime risk of rebleeding is 25%.Acute uncomplicated diveiculitis characteristically presents with fever, anorexia, left lower quadrant pain and obstipation.A complicated diveicular disease is defined as a diveicular disease associated with an abscess or perforation and less commonly with a fistula.Barium enema or colonoscopy should not be performed in acute setting because of the higher risk of colonic perforation associated with insufflation or inseion of barium-based contrast material under pressure. (Ref: Harrison's 18/e p2502)", "cop": 1, "opa": "Diveiculosis", "opb": "Carcinoma colon", "opc": "Colitis", "opd": "Polyps", "subject_name": "Medicine", "topic_name": "All India exam", "id": "cb423e78-ede5-4b36-a8c3-847565eae2d6", "choice_type": "single"}
+{"question": "Most common cause of hea block in infants is", "exp": "Ans. is 'b' i.e., Surgery for congentital hea disease In children, the most common cause of permanent acquired complete AV block is surgery for congenital hea disease. Postsurgical completer atrioventricular block (A VB) is the most common cause for acquired AV block in children, resulting from trauma to the AV node at time of surgery (i.e., hemorrhage, ischemia, necrosis, inflammation, traumatic disruption). The second most common cause is congenital herat disease associated with complete AV block. Other etiologies of acquired AV block are often reversible and include : Digitalis and other drug intoxications. Viral myocarditis. Acute rheumatic fever, Lyme disease, and infectious mononucleosis.", "cop": 2, "opa": "SLE", "opb": "Surgery for congentital hea disease", "opc": "Viral myocarditis", "opd": "Rheumatic fever", "subject_name": "Medicine", "topic_name": null, "id": "0400fd22-3799-4d7a-ac9c-4ce045b89b0f", "choice_type": "single"}
+{"question": "Brock's Syndrome is", "exp": "Ans. is 'b' i.e., Middle Lobe Bronchiectasis Brock's Syndrome Right middle lobe bronchiectasis occurring as a late sequel ofprimaiy tuberculosis is known as Brock's syndrome or middle lobe syndrome. Brock's syndrome is believed to be caused by pressure of lymph nodes in primary tuberculosis on the middle lobe bronchus. It has been described as a typical outcome of hilar node involvement by tuberculosis in childhood. This term is also applied to recurrent atelectasis of the right middle lobe in the absence of endobronchial obstruction. Bronchiectasis develops after recurrent episodes of atelectasis and fibrosis", "cop": 2, "opa": "Bronchiectasis Sicca", "opb": "Middle Labe Bronchiectasis", "opc": "Kaagener's Syndrome", "opd": "Sarcoidosis", "subject_name": "Medicine", "topic_name": null, "id": "77e4cf09-95d9-4ea5-b558-9aca2f13c776", "choice_type": "single"}
+{"question": "According to the Glasgow Coma Scale (GCS), a verbal score of 1 indicates", "exp": ". *Glasgow coma score -verbal (nonintubated). 5-oriented and talks 4-disoriented and talks 3-inappropriate words 2-incomprehensible words 1-no response. Ref Harrison20th edition pg 2677", "cop": 1, "opa": "No response", "opb": "Inappropriate words", "opc": "Incomprehensible sounds", "opd": "Disoriented response", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "07c83654-da88-4a8b-9c18-fc2b6883dea1", "choice_type": "single"}
+{"question": "Shelf life of Platelets is", "exp": "Shelf life of Platelets is < 5 days Cryoprecipitate is 2 years.", "cop": 1, "opa": "< 5 days", "opb": "< 3 weeks", "opc": "< 5 weeks", "opd": "< 2 years", "subject_name": "Medicine", "topic_name": null, "id": "f36fe1fd-bdae-4329-9ff2-8b96d7c92949", "choice_type": "single"}
+{"question": "Cause of dysphonia and hoarseness of voice includes", "exp": "(A) Thiamine # WERNICKE-KORSAKOFF SYNDROME, which combines Wernicke encephalopathy and Korsakoff psychosis, occurs in some alcoholics who do not consume foods fortified with thiamin.> Wernicke encephalopathy consists of psychomotor slowing or apathy, nystagmus, ataxia, ophthalmoplegia, impaired consciousness, and, if untreated, coma and death. It probably results from severe acute deficiency superimposed on chronic deficiency.> Korsakoff psychosis consists of mental confusion, dysphonia, and confabulation with impaired memory of recent events. It probably results from chronic deficiency and may develop after repeated episodes of Wernicke encephalopathy.", "cop": 1, "opa": "Thiamine", "opb": "Pyridoxine", "opc": "Vitamin B12", "opd": "Folic Acid", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "41598020-2e06-40e0-80f4-bbf8e5d22edf", "choice_type": "single"}
+{"question": "An elderly man with ataxic hemiparesis, diagnosis is", "exp": "(A) Cerebellar hemorrhage # Ataxic hemiparesis> Fisher initially described and named this syndrome, and it consists of a combination of homolateral ataxia and crural paresis.> The usual clinical features include \"weakness of the lower limb, especially the ankle and toes, and a Babinski sign, associated with striking dysmetria of the arm and leg on the same side\".> Some of the patients also had transient paresthesias, with a stuttering course of symptoms noted. Fisher later renamed the syndrome \"ataxic hemiparesis,\" meaning any combination of weakness and incoordination, out of proportion to weakness, on the same side of the body.> Ataxic hemiparesis occurs in as many as 18% of case series of lacunar infarctions.> Lesions that simultaneously interrupt pyramidal systems (weakness) and adjoining frontopontocerebellar systems (ataxia) produce ataxic hemiparesis. The corona radiata and the anterior limb of the internal capsule are common sites of injury.> Fisher reported 3 autopsied cases that showed contralateral lacunar infarcts in the upper basis pontis.> CT-based series of patients with ataxic hemiparesis have also shown lesions in the internal capsule (posterior limb), corona radiata, lentiform nucleus, and thalamus.> Overall, no distinct clinical features differentiate lacunar infarctions originating in the capsule from those in the pons.> In addition to small deep infarcts, larger anterior cerebral artery infarcts have been recognized as a cause of ataxic hemiparesis with leg-predominant weakness. Ataxic hemiparesis also has been described in several nonischemic lesions, particularly hemorrhages and tumors.> Overall, improvement occurs within days or weeks & occasionally, the hemiparesis improves and the ataxia remains.", "cop": 1, "opa": "Cerebellar hemorrhage", "opb": "Acute ischemic stroke", "opc": "Fredrich's ataxia", "opd": "Spinal hemisection", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "db5c0609-fe45-4d78-a436-5cfe28884bad", "choice_type": "single"}
+{"question": "Most common cause of diffuse bronchiectasis is", "exp": "(C) Cystic Fibrosis # DIFFUSE BRONCHIECTASIS develops most often in patients with genetic, immunologic, or anatomic defects that affect the airways. In developed countries, many cases appear initially to be idiopathic, probably partly because onset is so slow that the triggering problem cannot be identified by the time bronchiectasis is recognized.> With newer, improved genetic and immunologic testing, an increasing number of reports describe finding an etiology in these idiopathic cases after careful, systematic evaluation.> Cystic Fibrosis (CF) is the most common identified cause, and previously undiagnosed CF may account for up to 20% of idiopathic cases. Even heterozygous patients, who typically have no clinical manifestations of CF, may have an increased risk of bronchiectasis.> Immunodeficiencies such as common variable immunodeficiency (CVID) may also lead to diffuse disease, as may rare abnormalities in airway structure. Undernutrition and HIV infection also appear to increase risk.> Congenital defects in mucociliary clearance such as primary ciliary dyskinesia (PCD) syndromes may also be a cause, possibly also explaining some idiopathic cases.> Diffuse bronchiectasis sometimes complicates common autoimmune disorders, such as RAor Sjogren syndrome.> Allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus spp. (Allergic Bronchopulmonary Aspergillosis (ABPA)) that occurs most commonly in people with asthma, but sometimes in patients with CF, can cause or contribute to bronchiectasis.> In developing countries, most cases are probably caused by TB, particularly in patients with impaired immune function due to undernutrition and HIV infection.> Focal bronchiectasis typically develops as a result of untreated pneumonia or obstruction (eg, due to foreign bodies, tumors, postsurgical changes, lymphadenopathy). Mycobacteria (tuberculous or nontuberculous) can both cause focal bronchiectasis and colonize the lungs of patients with bronchiectasis due to other disorders.", "cop": 3, "opa": "Untreated pneumonia", "opb": "Obstruction due to foreign bodies", "opc": "Cystic Fibrosis", "opd": "Tuberculous infection", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "fbabe85b-e0a5-444f-b55f-eba5a982fa1a", "choice_type": "single"}
+{"question": "Gerstmann syndrome occurs due to damage to", "exp": "(A) Left inferior parietal region # Gerstmann's Syndrome is a combination of:1. Acalculia (impairment of simple arithmetic),2. Dysgraphia (impaired writing),3. Finger anomia (an inability to name individual fingers such as the index and thumb), &4. Right-left confusion (an inability to tell whether a hand, foot, or arm of the patient or examiner is on the right or left side of the body).> Diagnosis: it is important to establish that the finger and left-right naming deficits are not part of a more generalized anomia and that the patient is not otherwise aphasic.> Gerstmann's syndrome arises acutely & is commonly associated with damage to the inferior parietal lobule (especially the angular gyrus) in the left hemisphere.", "cop": 1, "opa": "Left inferior parietal region", "opb": "Left temporal region", "opc": "Right Inferior parietal region", "opd": "Right temporal region", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f756dbea-8600-4888-a4b7-c172ef2e46e8", "choice_type": "single"}
+{"question": "Lysosomal Storage disorders are associated with", "exp": "(B) Loss of function # Lysosomal storage disorders (LSDs) are inherited diseases characterized by lysosomal storage and dysfunction.> Loss of lysosomal function is associated with severe neurodegeneration, which is the prominent pathological hallmark of LSDs.> Physical findings are disease-specific, and enzyme assays or genetic testing can be used to make a definitive diagnosis.", "cop": 2, "opa": "Non-disease-specific physical findings", "opb": "Loss of function", "opc": "Enzyme assays not useful", "opd": "Genetic testing is helpless", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "8b4137a2-8215-40bb-bb8d-3e3a42fd6590", "choice_type": "single"}
+{"question": "Laminar necrosis and watershed infarcts are most suggestive of", "exp": "Decreased brain perfusion may be generalized (global) or localized. Global ischemia results from generalized decreased blood flow, such as with shock, cardiac arrest, or hypoxic episodes (e.g., near drowning or carbon monoxide poisoning). Global hypoxia results in watershed (border zone) infarcts, which typically occur at the border of areas supplied by the anterior and middle cerebral aeries, and laminar necrosis, which is related to the sho, penetrating vessels originating from pial aeries. The Purkinje cells of the cerebellum and the pyramidal neurons of Sommer's sector in the hippocampus are paicularly sensitive to hypoxic episodes. Atherosclerosis, which predisposes to vascular thrombi and emboli, is related to regional ischemia. Hypeension damages parenchymal aeries and aerioles, producing small ischemic lesions (lacunar infarcts). Fat emboli, related to trauma of long bones, lodge in small capillaries to form petechiae. Venous sinus thrombosis is related to systemic dehydration, phlebitis, and sickle cell disease. Ref - Harrison's internal medicine 20e pg 1117, 2039-2040", "cop": 1, "opa": "Shock", "opb": "Hypeension", "opc": "Fat emboli", "opd": "Vascular thrombosis", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "83d7a565-3257-4e37-9049-eadfaf8df0d7", "choice_type": "single"}
+{"question": "Lymph node metastasis is common in a) Osteosarcoma b) Fibrous histiocytoma c) Angiosarcoma d) Rhabdomyosarcoma", "exp": null, "cop": 3, "opa": "abc", "opb": "acd", "opc": "cd", "opd": "bd", "subject_name": "Medicine", "topic_name": null, "id": "21653427-85ae-4ffa-9f14-dd8279034f7d", "choice_type": "single"}
+{"question": "Fulminant hepatitis is commonest with", "exp": "In HDV, Fulminant viral hepatitis is 5-20%; HEV: 1-2%; HBV: 0.1-1%; HCV: 0.1%; HAV: 0.1%Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 360; Acute Viral Hepatitis", "cop": 4, "opa": "HAV", "opb": "HBV", "opc": "HCV", "opd": "HDV Superinfection", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "4f57cdca-484a-4626-ac16-0b42ca0a7c85", "choice_type": "single"}
+{"question": "Loud S1 in mitral stenosis is seen in", "exp": null, "cop": 1, "opa": "Prolonged flow through mitral valve", "opb": "1st degree heart block", "opc": "Calcification of the valve", "opd": "Immobilization of the valve", "subject_name": "Medicine", "topic_name": null, "id": "c6bd7b21-7865-46eb-816b-907b07958d56", "choice_type": "single"}
+{"question": "Treatment of choice for chronic ulcerative colitis is", "exp": "In mild to moderate cases of ulcerative colitis, the combination of a once-daily oral and a topical 5-aminosalicylate preparation is effective. MOA of the drug is it modulate cytokine release from mucosa. Reference : Davidson, 23rd Edition, page no : 820.", "cop": 1, "opa": "5 aminosalicylic acid", "opb": "Azathioprine", "opc": "Metronidazole", "opd": "Salicylates", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "5ae315c0-ee5f-411e-b22f-246ae66f6b62", "choice_type": "single"}
+{"question": "Spider neavi is a feature of", "exp": "Spider naevi\n\nOral contraceptive loops\nChronic liver disease\nThyrotoxicosis.", "cop": 4, "opa": "Nephrotic syndrome", "opb": "Hypothyroidism", "opc": "Tuberculosis", "opd": "Chronic liver disease", "subject_name": "Medicine", "topic_name": null, "id": "b14be0b6-04fb-48f5-9a11-a5a02855c172", "choice_type": "single"}
+{"question": "'Shrinking lung' is a feature of", "exp": "Shrinking lung syndrome (SLS) is a rare complication of systemic lupus erythematosus (SLE) characterized by unexplained dyspnea, a restrictive pattern on pulmonary function tests, and an elevated hemidiaphragm.. This disorder is seen primarily during the later stages of SLE Ref Davidson 23rd edition pg 533", "cop": 2, "opa": "Rheumatoid ahritis", "opb": "SLE", "opc": "Systemic scleoris", "opd": "Polymyosities", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "40ea7a51-9d34-42b2-b7f1-acc85adf4164", "choice_type": "single"}
+{"question": "In an obese patient the most likely respiratory change is", "exp": "Obesity hypoventilation syndrome is characterized by :\n\nObesity.\nHypoxemia.\nHyper carbia.\nRespiratory acidosis.\nPulmonary hypertension.\nRight ventricular failure.", "cop": 2, "opa": "FRC is unchanged", "opb": "Alveolar hypo ventilation", "opc": "Residual volume is decreased", "opd": "Normal work of breathing", "subject_name": "Medicine", "topic_name": null, "id": "0e88ee08-615e-4d10-a016-2b91b0ab3a03", "choice_type": "single"}
+{"question": "Most common extra articular manifestation seen in Ankylosing spondylitis", "exp": "M/C extra articular manifestation - Acute anterior uveitis.", "cop": 1, "opa": "Anterior uveitis", "opb": "Keratitis", "opc": "Amyloidosis", "opd": "Upper lobe pulmonary fibrosis", "subject_name": "Medicine", "topic_name": null, "id": "49de0b43-9b9b-4a9c-807e-9efea588b341", "choice_type": "single"}
+{"question": "The drug of choice for the treatment of Pneumocystis jirovei (Pneumocystis carini) pneumonia is", "exp": "Pneumocystis jirovecii pneumonia is characterised by progressive dyspnoea with dry cough and fever.Chest X ray shows bilateral interstitial infiltrate spreading out from hilar regions.High resolution CT scan is more sensitive,showing 'ground-glass' interstitial infiltrates.Diagnosis is made with silver stains,PCR,immunofluorescence of bronchoalveolar lavage(BAL)/induced sputum.Treatment is with high dose co-trimoxazole;together with adjunctive steroids if the patient is hypoxic. Reference: Davidson edition23rd pg 584", "cop": 2, "opa": "Lamivudine", "opb": "Co-trimoxazole", "opc": "Doxycycline", "opd": "Itraconazole", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "8426170a-cc44-429e-8695-2644b4e796e2", "choice_type": "single"}
+{"question": "Most common manifestation of Multiple Sclerosis is", "exp": "(C) Optic neuritis # MANIFESTATIONS OF MULTIPLE SCLEROSIS in the eye include both the afferent and efferent visual pathways. Optic neuritis, the most common ocular manifestation of multiple sclerosis, may be the initial clinical disease manifestation.MANIFESTATION OF MULTIPLE SCLEROSIS* Sensory loss37* Optic neuritis36* Weakness35* Paresthesias24* Diplopia15* Ataxia11", "cop": 3, "opa": "Weakness", "opb": "Ataxia", "opc": "Optic neuritis", "opd": "Inter neuclear ophthalmoplegia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "14b475bb-d54f-4088-a8ed-7fcf503a6ca5", "choice_type": "single"}
+{"question": "Chinese herb nephropathy is caused by", "exp": "Aristolochic acid causes Chinese herb nephropathy and Balkan nephropathy.", "cop": 3, "opa": "Mushroom", "opb": "Lead poisoning", "opc": "Aristolochic acid", "opd": "Tenofovir", "subject_name": "Medicine", "topic_name": null, "id": "f05b96b3-ab46-4c88-b3d2-2b8148f9adc7", "choice_type": "single"}
+{"question": "Continuous murmur is present in", "exp": "A continuous murmur is predicated on a pressure gradient that persists between two cardiac chambers or blood vessels across systole and diastole.The murmurs\ntypically begin in systole, envelop the second heart sound (S 2 ), and continue through some portion of diastole.\nThey can often be difficult to distinguish from individual systolic and diastolic murmurs in patients with mixed valvular heart disease. \nThe classic example of a continuous murmur is that associated with a patent ductus arteriosus, which usually is heard in the second or third interspace at a slight distance from the sternal border. Other causes of a continuous murmur include a ruptured sinus of Valsalva aneurysm with creation of an aortic–right atrial or right ventricular fistula, a coronary or great vessel arteriovenous fistula, and an arteriovenous fistula constructed to provide dialysis access.", "cop": 3, "opa": "cardiomyopathy", "opb": "MS", "opc": "PDA", "opd": "cardiac tamponade", "subject_name": "Medicine", "topic_name": null, "id": "496ee96f-286c-4796-8490-20abc3e6f333", "choice_type": "single"}
+{"question": "Test for confirming H.pylori eradication is", "exp": "The test of choice for documenting of H. pylori eradication is the laboratory-based validated monoclonal stool antigen test or a urea breath test (UBT).The patient must be off antisecretory agents when being tested for the eradication of H. pylori with UBT or stool antigen. Serologic testing is not useful for the purpose of documenting eradication because antibody titers fall slowly and often do not become undetectable.Ref: Harrison; 19th edition; Page no: 1924", "cop": 1, "opa": "Urea breath test", "opb": "Serology", "opc": "Urine antigen test", "opd": "Endoscopy biopsy test", "subject_name": "Medicine", "topic_name": "Nutrition", "id": "10ba9f3f-ed47-4dca-b6f8-d207e14d539b", "choice_type": "single"}
+{"question": "Most commonly associated with Conn&;s syndrome", "exp": "The most common cause of mineralocoicoid excess is primary aldosteronism bilateral micronodular hyperplasia some what more common than unilaterl adrenal adenoma( Ref Harrison 20 th edition)", "cop": 4, "opa": "Coical carcinoma", "opb": "Pheochromocytoma", "opc": "Coical adenoma", "opd": "Bilateral micronodular adrenal hyperplasia", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "62be2008-e479-4845-be7d-44f5413f640e", "choice_type": "single"}
+{"question": "In pseudogout, material deposited is", "exp": "Ans: d (calcium pyrophosphate) Ref: Harrison 17th ed/p.2167.In Pseudogout, calcium pyrophosphate is depositedIn Gout, Monosodium urate crystal is depositedAssociations of CPPD (calcium pyrophosphate dihvdrate) crystal deposition:-* Ageing (most common)* Osteoarthritis* Familial* Metabolic diseases-HaemochromatosisHyperparathyroidismHypophosphatasiaHypomagnesaemiaWilson's diseaseCompensated polarised light microscopy of synovial fluids:-Monosodium urate crystals - Bright birefringence (negative sign) and needle shaped morphologyCalcium pyrophosphate crystals - Weak birefringence (positive sign) and rhomboid morphology.Note:-o Osteoarthritis- involvement of PIP, DIP and 1st carpometacarpal joint (base of thumb). Sparing of MCP and wrist.o Rheumatoid arthritis - involvement of any small joints of the hand i.e PIP, MCP, and wrist. Sparing of DIP.o Psoriatic arthritis - involvement of PIP, DIP, MCP and wrist. Sparing of any joint may or may not be present.", "cop": 4, "opa": "Sodium oxalate", "opb": "Calcium apatite", "opc": "Monosodium urate", "opd": "Calcium pyrophosphate", "subject_name": "Medicine", "topic_name": "Immunology and Rheumatology", "id": "26c9db7a-7aa8-45a9-b7a9-1736df39b836", "choice_type": "single"}
+{"question": "During ventricular pressure pulses square root wave is seen in", "exp": "Ref Harrison 19 th ed pg 1576 constrictive pericarditis, the ventricular pressure pulses in both ventricles exhibit characteristic \"square root\" signs during diastole. These hemodynamic changes, although characteristic, are not pathognomonic of constrictive pericarditis and may also be observed in restrictive cardiomyopathies.", "cop": 4, "opa": "ASD", "opb": "MVPS", "opc": "Dilated cardiomyopathy", "opd": "Constrictive pericarditis", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "547bdb33-59d4-474c-ad2a-1c0a15a003b9", "choice_type": "single"}
+{"question": "Loud pulmonary component of second heart sound heard in a) Pulmonary hypertension b) TOF c) Eissenmenger's syndrome d) Pulmonary stenosis e) AS", "exp": null, "cop": 1, "opa": "ac", "opb": "bc", "opc": "cd", "opd": "bd", "subject_name": "Medicine", "topic_name": null, "id": "19d1833c-ffd1-4898-9b45-b2e6cce1ecda", "choice_type": "single"}
+{"question": "Vegetations on undersurface of A.V. valves are found in", "exp": "Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:163 Endocarditis associated with SLE (Libman-Sachs endocarditis): The vegetations are 3-4 mm in size, composed of degenerating valve tissue; functional disability is minimal; ventricular surface of the mitral valve is commonly involved; aoic valve involvement is rare; entire valve apparatus can be involved.", "cop": 2, "opa": "Acute rheumatic fever", "opb": "Libman Sach's endocarditis", "opc": "Non thrombotic bacterial endocarditis", "opd": "Chronic rheumatic carditis", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "874f9dcb-b3e3-4066-aa4e-b6383b627dc4", "choice_type": "single"}
+{"question": "Earliest clinical indicator of sodium loss is", "exp": "Ans. a (Altered sensorium) (Ref. Harrison's - 18th/pg. Ch. 45).Hyponatremia may be due to water excess, diabetes, lipidemia etc. Drugs known to release ADH will cause dilutional hyponatremia include morphine, tricyclics, nicotine, NSAIDs, etc. The individual present with confusion, anorexia, lethargy and cramps. When sodium drops abruptly, seizures, hemiparesis and coma can develop.CLINICAL FEATURES OF HYPONATREMIA# The clinical manifestations of hyponatremia are related to osmotic water shift leading to increased ICF volume, specifically brain cell swelling or cerebral edema.# The symptoms are primarily neurologic.# Patients may be asymptomatic or complain of nausea and malaise.# As the plasma Na+ concentration falls, the symptoms progress to include headache, lethargy, confusion, and obtundation.# Stupor, seizures, and coma do not usually occur unless the plasma Na+ concentration falls acutely below 120 mmol/L or decreases rapidly.# Loss of Na+ and K+, followed by organic osmolytes, from brain cells decreases brain swelling due to secondary transcellular water shifts (from ICF to ECF).# The net effect is to minimize cerebral edema and its symptoms.Composition of World Health Organization Oral Rehydration Solution (ORS) A,BConstituentConcentration, mmol/LNa+90K+20Cl-80Citrate10Glucose110Also know:*SLADH is characterized by hypotonic hyponatremia with euvolemia. Low plasma osmolality (<280 mOsm/Kg) with high urine osmolality (>100-150 mOsm/Kg) in suspected patients is diagnostic.* Pneumonia, hyponatremia and diarrhea are almost classic for Legionella.* Under most physiologic conditions, sodium, urea, and glucose generate the osmotic pressure of blood. Plasma osmolality is calculated according to the following expression: Posm = 2Na+ + Glu + BUN (all in mmol/L), or, using conventional laboratory values in which glucose and BUN are expressed in milligrams per deciliter: Posm = 2Na+ + Glu/18 + BUN/2.8. The calculated and determined osmolality should agree within 10-15 mmol/kg H20. When the measured osmolality exceeds the calculated osmolality by >15-20 mmol/kg H20, one of two circumstances prevails. Either the serum sodium is spuriously low, as with hyperlipidemia or hyperproteinemia (pseudohyponatremia), or osmolytes other than sodium salts, glucose, or urea have accumulated in plasma.", "cop": 1, "opa": "Altered sensorium", "opb": "Reduced skin turgor", "opc": "Arrhythmia", "opd": "Orthostatic hypertension", "subject_name": "Medicine", "topic_name": "Fluid & Electrolyte", "id": "ea9a7b25-59ee-4f1b-b398-9afb7e6d7373", "choice_type": "single"}
+{"question": "A 25 year male presented with nausea, vomiting, epigastric pain, Na+ level is 125 meq/L. Treatment start with", "exp": "(Give hypotonic saline) (758- 61 - CMDT- 08) (277-79, 2223-2224-Hl7th)* Treatment consist of replacement of lost volume with isotonic or half normal (0.45%) saline or lactated Ringer *s infusion in hypovolemic Hypotonic Hyponatremia* Asymptomatic hyponatremia - water restriction, 0.9% saline Demeclocycline. Fludrocortisone, selective renal vasopressin V2 antagonists (conivaptan. Mozavaptan, tolvaptan)* Hypervolemic hypotonic hyponatremia - water restriction Diuretics and V2 antagonists. Hypertonic (3%) saline", "cop": 1, "opa": "Give hypotonic saline", "opb": "Ultra centrifugation", "opc": "Haemodialysis", "opd": "High protein diet", "subject_name": "Medicine", "topic_name": "Fluid & Electrolyte", "id": "20d215b8-3d20-4860-9c89-2fe06e2c242e", "choice_type": "single"}
+{"question": "Vitamin E toxicity is associated with", "exp": "Severe deficiency, as may occur in persons with abetalipoproteinemia or fat malabsorption, profoundly affects the central nervous system and can cause ataxia and a peripheral neuropathy resembling Friedreich ataxia. Patients receiving large doses of vitamin E may experience a halt in the progression of the disease Reference Harrison20th edition pg 56", "cop": 2, "opa": "Peripheral neuritis", "opb": "Ataxia", "opc": "Loss of vibration sense", "opd": "Exfoliative dermatitis", "subject_name": "Medicine", "topic_name": "Nutrition", "id": "1402eaef-91c5-4ace-a74e-811f9cba6be9", "choice_type": "single"}
+{"question": "Hepatitis C virus is associated with", "exp": "Polyarteritis nodosa - Hepatitis B associated.\nCryoglobulinemic Vasculitis - Hepatitis C associated.", "cop": 3, "opa": "Churg-strauss syndrome", "opb": "Hypersensitivity Vasculitis", "opc": "Cryoglobulinemic Vasculitis", "opd": "Polyarteritis nodosa", "subject_name": "Medicine", "topic_name": null, "id": "0a098715-3377-4224-a8d4-00f0649cda38", "choice_type": "single"}
+{"question": "Venous thrombosis In patients with paroxysmal nocturnal hemoglobinuria is observed in", "exp": "Answer- C. Intrabdominal veinsVenous thrombosis is an inconstant but severe clinical manifestation of P.N.H.Thrombosis occcurs due to absence of CD59 which k a membrane attached proteinThrombosis usually occurs in abdominal veins. Intra-abdominal yeins are the most common site of thromosis in P.N.H.", "cop": 3, "opa": "Cerebral veins", "opb": "Leg veins", "opc": "Intrabdominal veins", "opd": "Axillary vein", "subject_name": "Medicine", "topic_name": null, "id": "c571e0dd-2d39-4762-baa4-34853eaaf4b0", "choice_type": "single"}
+{"question": "Most commonly involved organ in congenital tuberculosis is", "exp": "Ans. Answer is B (Liver): Most common primary site- LIVER (primary complex in liver is suggestive of congenital TB) Most common site is- LUNG The form of disease is usually miliary with multiple organ involvement. Lungs are involved in almost all cases. Other sites frequently involved are liver, spleen, lymph nodes, the gastrointestinal tract and kidney'. -Textbook of Pulmonary Medicine by Behera 2\"a/495", "cop": 2, "opa": "Lungs", "opb": "Liver", "opc": "Lymph nodes", "opd": "Skin", "subject_name": "Medicine", "topic_name": null, "id": "bae335e6-f35e-4635-8d67-c59533717bf3", "choice_type": "single"}
+{"question": "Shelf life of blood in a blood bank in CPDA buffer", "exp": "Answer- C. 35 daysCitrate phosphate dextrose-adenine (CPD-A )- 35 days", "cop": 3, "opa": "21 days", "opb": "30 days", "opc": "35 days", "opd": "42 days", "subject_name": "Medicine", "topic_name": null, "id": "2db02caa-b52d-4c62-afa1-3d7632681f80", "choice_type": "single"}
+{"question": "Rupture of a berry aneurysm of the Circle of Willis would likely produce hemorrhage into the", "exp": "Subarachnoid hemorrhage is much less common than hypeensive intracerebral hemorrhage, and most often it results from rupture of a berry aneurysm. Berry aneurysms are saccular aneurysms that result from congenital defects in the media of aeries. They are typically located at the bifurcations of aeries. They are not the result of atherosclerosis. Instead, berry aneurysms are called congenital, although the aneurysm itself is not present at bih. Berry aneurysms are most commonly found in the circle of Willis, typically either at the junction of the anterior communicating aery with the anterior cerebral aery or at the junction of the middle cerebral aery and the posterior communicating aery. The chance of rupture of berry aneurysms increases with age (rupture is rare in childhood). Rupture causes marked bleeding into the subarachnoid space and produces severe headaches, typically described as the \"worst headache ever.\" Additional symptoms include vomiting, pain and stiffness of the neck (due to meningeal irritation caused by the blood), and papilledema. Death may follow rapidly. Ref - Harrison's internal medicine 20e pg 2073, 2084-2085", "cop": 3, "opa": "Epidural space", "opb": "Cerebellum", "opc": "Subarachnoid space", "opd": "Subdural space", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "0212e46c-de00-42b8-ab62-890b63394e42", "choice_type": "single"}
+{"question": "Drug used in Acute Intermittent Porphyria is", "exp": "(A) Opioids# A high-carbohydrate (10% glucose) infusion is recommended, which may aid in recovery.> If drugs have caused the attack, discontinuing the offending substances is essential.> Infection is one of the top causes of attacks and requires vigorous treatment.> Pain is extremely severe and almost always requires the use of opiates to reduce it to tolerable levels.> Pain should be treated early as medically possible due to its severity.> Nausea can be severe; it may respond to phenothiazine drugs but is sometimes intractable.> Hot water baths or showers may lessen nausea temporarily, but can present a risk of burns or falls.", "cop": 1, "opa": "Opioids", "opb": "Phenobarbitone", "opc": "Primidone", "opd": "Blood tranfusion", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "e5957778-6208-49ea-81e9-48b2d1e60430", "choice_type": "single"}
+{"question": "\"Face of giant panda\" sign on MRI brain is seen in", "exp": "The \"Face of the Giant Panda\" sign, \"Panda Sign of the Midbrain,\" or \"Double-Panda Sign\" refers to a characteristic \"panda's face\" appearance in MRI images of patients suffering from Wilson's disease. Along with Kayser-Fleischer rings, the sign is helpful in diagnosis ref - Researchgate.net", "cop": 1, "opa": "Wilson's disease", "opb": "Japanese encephalitis", "opc": "Rasmussen's encephalitis", "opd": "Wernicke's encephalopathy", "subject_name": "Medicine", "topic_name": "All India exam", "id": "7229feed-a4fb-40c1-a473-a8cc81038300", "choice_type": "single"}
+{"question": "Value of Pa02/ Fi02 chracteristic of ARDS is", "exp": "Answer- A. < 200 mmHgAcute respiratory distress syndrome (ARDS) is a clinical symdrome of severe dyspnea of rapid onset, hypoxemia, and diffirse pulmonary infiltrates leading to respiratory failure.The aerial PaO, (in mmHg)/FiO, (inspiratory O, fraction) <200 mmHg is characteristic of ARDS, while a PaO, /FiO, between 200 and 300 identifies patients with ALI who are likely to benefit from aggressive therapy.", "cop": 1, "opa": "< 200 mmHg", "opb": "200 - 400 mmHg", "opc": "400 - 600 mmHg", "opd": "600 - 800 mmHg", "subject_name": "Medicine", "topic_name": null, "id": "3e9af2d7-735e-405e-a6a9-1c186f40b174", "choice_type": "single"}
+{"question": "An ophthalmoplegic migraine means", "exp": "Ophthalmoplegic migraine is characterized by recurrent attacks of ophthalmoplegia, following severe migrainous headaches. The condition almost always begins in childhood, and is considered to be rare in adults. However, OM may occur for the first time in adult life. The typical clinical picture of OM includes a child with severe migraine that lasts for several days and is followed soon after, by ptosis and diplopia due to isolated oculomotor nerve palsy, as the headache remits. Pupillary involvement with a 'full blown' pupil is the rule in children.However, pupillary sparing is not uncommon, especially in adults. Abducens nerve involvement is uncommon and trochlear nerve palsy is rare. Recovery is the rule. Rarely, deficits persist after multiple attacks. ref - pubmed.com", "cop": 1, "opa": "When headache is followed by complete paralysis of the III rd and VI nerve on the same side as the hemicrania.", "opb": "When the headache is followed by paial paralysis of the IIIrd nerve on the same side as the hemicrania with out any scotoma.", "opc": "Headache associated with IIIrd, IVth and VIth nerve paralysis.", "opd": "Headache associated with optic neuritis", "subject_name": "Medicine", "topic_name": "All India exam", "id": "b8d8db6d-c47f-40d8-b43d-1ad959f039ec", "choice_type": "single"}
+{"question": "ADAM TSB.13 deficiency is seen in", "exp": "Answer- A. TTPTTP is included among group of diseases called thrombotic microangiopathic which are characterised by widespread thrombosis in microcirculation. The other disorder which is included in this group include hemolytic uremic syndrome (HUS)Small vessels like terminal aerioles and capillaries are involved.Pathogenesis of TTPPatients with TTP are deficient in an enzyme called ADAMTSB.T3 also known as vWF metalloprotease that degrades very high molecular weight multitimers of vWF.", "cop": 1, "opa": "TTP", "opb": "HUS", "opc": "Wegner's granulomatosis", "opd": "Membranous nephropathy", "subject_name": "Medicine", "topic_name": null, "id": "674fc963-f4f3-4c48-84ef-7440ccb8f745", "choice_type": "single"}
+{"question": "Followings are the symptoms of carcinoid symptoms a) Wheezing b) Flushing c) Cyanosis d) Clubbing e) Diarrhoea", "exp": null, "cop": 1, "opa": "abe", "opb": "ab", "opc": "ac", "opd": "bc", "subject_name": "Medicine", "topic_name": null, "id": "beda42d3-d09e-4d7e-8649-57bc817845c7", "choice_type": "single"}
+{"question": "Best diagnostic modality for rotavirus diarrhea", "exp": null, "cop": 2, "opa": "Isolation virus from stool culture", "opb": "Detection of antigen in serum", "opc": "Detection of antigen in stool", "opd": "Detection of antibody in serum", "subject_name": "Medicine", "topic_name": null, "id": "d0522b99-ea86-455f-8ba1-188e215de673", "choice_type": "single"}
+{"question": "Type B Lactic acidosis is due to", "exp": "Lactic Acidosis:An increase in plasma l-lactate may be secondary to poor tissue perfusion (type A)--circulatory insufficiency (shock, cardiac failure), severe anemia, mitochondrial enzyme defects, and inhibitors (carbon monoxide, cyanide)--or to aerobic disorders (type B)-- malignancies, nucleoside analogue reverse transcriptase inhibitors in HIV, diabetes mellitus, renal or hepatic failure, thiamine deficiency, severe infections (cholera, malaria), seizures, or drugs/toxins (biguanides, ethanol, methanol, propylene glycol, isoniazid, and fructose).Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 66; Acidosis and Alkalosis", "cop": 2, "opa": "Congestive Hea Failure", "opb": "Diabetes", "opc": "Sho bowel syndrome", "opd": "Cyanide poison", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "fd192bb3-cfa7-4ae2-8eb6-558fc013a89b", "choice_type": "single"}
+{"question": "Most common cause of Cushing syndrome is", "exp": "Steroid supplementation is the most common cause of question syndrome.", "cop": 3, "opa": "Pituitary tumor", "opb": "Ectopic ACTH producing tumor", "opc": "Steroid supplementation", "opd": "Adrenal tumor", "subject_name": "Medicine", "topic_name": null, "id": "3a58b809-d6cf-4109-ac1f-2b4b627c3bba", "choice_type": "single"}
+{"question": "A 35 years old man Ramu has fasting and post prandial blood sugar within normal limit but urine sugar is 3 plus (+++)* The diagnosis is.", "exp": "Ans. is 'a' Renal Glycosuria. /Reference Harrison 15/e p 2315]Patient is excreting Glucose at normal blood glucose concentration. This feature is characteristics of renal glycosuria.\"It is characterized by urinary excretion of Glucose at normal concentrations of blood glucose\"The condition is benign but occasionally glycosuria may be severe enough to cause polyuria and polydipsia.", "cop": 1, "opa": "Renal Glycosuria", "opb": "Pancreatic insufficiency", "opc": "Alimentary glycosuria", "opd": "High carbohydrate diet taken in the morning.", "subject_name": "Medicine", "topic_name": "Diabites & Inappropriate Antidiuretic Hormone", "id": "7102821f-6679-433c-afcb-6c5f4f69ed60", "choice_type": "single"}
+{"question": "One of the following conditions is not associated with clubbing.", "exp": "Ans. is 'b' chronic bronchitis", "cop": 2, "opa": "Primary biliary cirrhosis", "opb": "Chronic bronchitis", "opc": "Cryptogenic fibrosing alveolitis", "opd": "Central bronchiectasis", "subject_name": "Medicine", "topic_name": "General", "id": "3267450e-47e7-4771-99e2-eeefbb13daf9", "choice_type": "single"}
+{"question": "Tumors most amenable (cured with) to chemotherapy.", "exp": "Treatment of low-risk gestational trophoblastic neoplasia (GTN) (invasive mole or choriocarcinoma) may include the following: Chemotherapy with one or more anticancer drugs. Treatment is given until the beta human chorionic gonadotropin (b-hCG) level is normal for at least 3 weeks after treatment ends Ref Harrison 20th edition pg 540", "cop": 1, "opa": "Chorio Ca", "opb": "Embryonal rhabdomyosarcoma", "opc": "Hepatocellular Ca", "opd": "Thyroid Ca", "subject_name": "Medicine", "topic_name": "Oncology", "id": "7eb7d946-6164-4347-9df4-ffa6588f5467", "choice_type": "single"}
+{"question": "Choose the best Lab value for a patient with central diabetes insipidus", "exp": "Diabetes insipidus is the reverse of SIADH, here the ADH level is decreased which leads to excessive water loss from the kidney resulting in hypertonic plasma associated with dilute urine.\nIt can be\n\n- Central → (due to impaired secretion of ADH from the neurohypophysis)\n- Nephrogenic → (due to renal insensitivity or nonresponsiveness to ADH).\n\nIn both circumstances. the serum osnzolality is increased with inappropriately low urine osmolalitv.\nThe two may be distinguished, however, by the response to either exogenous or endogenous vasopressin.\nIn neurogenic (central) DI,\n\n- ADH levels are 100, and the kidney rapidly acts to conserve water once exogenous ADH is administered.\n\nIn contrast, in nephrogenic DI,\n\n- ADH is associated with normal or increased ADHe levels and administration of additional ADH has no significant effect on renal water reabsorption.\nAlso known", "cop": 1, "opa": "Urinary Osmolality - 50, Serum Osmolality - 300", "opb": "Urinary Osmolality - 500, Serum Osmolality - 260", "opc": "Urinary Osmolality - 50, Serum Osmolality - 260", "opd": "Urinary Osmolality - 500, Serum Osmolality - 100", "subject_name": "Medicine", "topic_name": null, "id": "ec3075e1-ae9f-4226-ae41-afdffb9c7f32", "choice_type": "single"}
+{"question": "For the following causes of sexual dysfunction, select the most likely clinical feature.Rarely indicates organic disease.", "exp": "An absent orgasm, when libido and erectile function are normal, invariably indicates that organic disease is absent. Loss of desire can also be caused by psychologic disturbance, but may indicate androgen deficiency or drug effect.", "cop": 4, "opa": "loss of sexual desire", "opb": "failure of erection with absent nocturnal penile tumescence (NPT)", "opc": "absence of emission", "opd": "absence of orgasm with normal libido and erectile function", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "90ca307c-a796-4513-8991-cd5737df83cc", "choice_type": "single"}
+{"question": "Commonest organism causing acute epiglotitis is", "exp": null, "cop": 1, "opa": "H. influenza", "opb": "Clostridium", "opc": "S. pneumonia", "opd": "RSV", "subject_name": "Medicine", "topic_name": null, "id": "001145a9-4f28-423d-8d76-1b6c7ebf03e2", "choice_type": "single"}
+{"question": "Sarcoidosis", "exp": "Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology that is characterised by the presence of non-caseating granulomas . The condition is more frequentlydescribed in colder pas of nohern Europe .The tendency for sarcoid to present in the spring and summer has led to speculation about the role of infective agents, including mycobacteria, propionibacteria and viruses, but the cause remains elusive. Genetic susceptibility is suppoed by familial clustering; a range of class II HLA alleles confer protection from, or susceptibility to, the condition. Sarcoidosis occurs less frequently in smokers. It may be associated with common variable immunodeficiency .Bilateral hilar lymphadenopathy (BHL) is often seen in young women .Alternatively, BHL may be detected in an otherwise asymptomatic individual undergoing a chest X-ray for other purposes. Ref - Davidsons 23e p630", "cop": 4, "opa": "Is associated with HLA B1", "opb": "Is commoner in elderly people", "opc": "Causes caseating granuloma", "opd": "Produces bilateral hilar lymphadenopathies in the absence of pulmonary symptoms", "subject_name": "Medicine", "topic_name": "Immune system", "id": "92503ed2-cd4c-4a5b-bfde-6af6bfd874cb", "choice_type": "single"}
+{"question": "Lung volume reduction surgery is used in the management of", "exp": "Lung volume reduction surgery (LVRS) reduce volume of lung in emphysema. Patients with upper lobe-predominant emphysema and a low post-rehabilitation exercise capacity are most likely to benefit from LVRS. Patients are excluded if they have significant pleural disease, a pulmonary aery systolic pressure >45 mmHg, extreme deconditioning, congestive hea failure, or other severe comorbid conditions. Patients with an FEV1 <20% of predicted and either diffusely distributed emphysema on CT scan or diffusing capacity of lung for carbon monoxide (DlCO) <20% of predicted have an increased moality rate after the procedure and thus are not candidates for LVRS.Ref: Harrison 19e pg: 1706", "cop": 4, "opa": "Bronchial asthma", "opb": "Interstitial lung disease", "opc": "Chronic bronchitis", "opd": "Emphysema", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "185b82ca-0c04-449c-8f0b-7f64a97803e1", "choice_type": "single"}
+{"question": "The minimum concentration of reduced hemoglobin required for cyanosis is", "exp": "Cyanosis refers to a bluish colour of the skin and mucous membranes resulting from an increased quantity of reduced hemoglobin, or of hemoglobin derivatives, in the small blood vessels of those areas. It is usually most marked in the lips, nail beds, ears, and malar eminences.\nThe degree of cyanosis is modified by the colour of the cutaneous pigment and the thickness of the skin, as well as by the state of the cutaneous capillaries.\nIn some instances, central cyanosis can be detected reliably when the SaO2 has fallen to 85%; in others, particularly in dark-skinned persons, it may not be detected until it has declined to 75%.\nThe increase in the quantity of reduced hemoglobin in the mucocutaneous vessels that produces cyanosis may be brought about either by an increase in the quantity of venous blood as a result of dilation of the venules and venous ends of the capillaries or by a reduction in the Sa in the capillary blood. In sulhaemoglobmemia cyanosis occurs when its level exceeds 0.5gm/dl A methemogiobm level of 15% (i.e.,1.5gm/dl) 3 is associated with visible cyanosis-Nelson", "cop": 4, "opa": "1gm/dl.", "opb": "3 gm/d", "opc": "7 gm/d", "opd": "5 gm/d", "subject_name": "Medicine", "topic_name": null, "id": "1d8d7b1f-5de3-43d2-b58a-bc9d12d9cd48", "choice_type": "single"}
+{"question": "Most common cause of decrease in incidence of H.pylori in the western countries is due to", "exp": null, "cop": 1, "opa": "Change in life style", "opb": "Increased use of PPI", "opc": "Chemotherapy", "opd": "Mutation in organism", "subject_name": "Medicine", "topic_name": null, "id": "366c244a-1c55-416d-ab00-04c84a01107d", "choice_type": "single"}
+{"question": "The Most sensitive marker of cardiac injury is", "exp": "(D) Troponin # Plasma biochemical markers: The biochemical markers that are most widely used in the detection of Ml are creatine kinase (CK), a most sensitive and cardiospecific isoform of this enzyme (CK-MB), and the cardiospecific proteins, troponins T and I.> The troponins are also released, to a minor degree, in unstable angina with minimal myocardial damage.", "cop": 4, "opa": "LDH", "opb": "Myoglobin", "opc": "CPK-MB4", "opd": "Troponin", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "05525ef6-884a-41ce-b0a3-69fa62a92882", "choice_type": "single"}
+{"question": "The agent of choice for controlling heparin induced bleeding is", "exp": null, "cop": 1, "opa": "Protamine sulphate", "opb": "Injectable vitamin K", "opc": "Whole blood", "opd": "Fresh frozen plasma", "subject_name": "Medicine", "topic_name": null, "id": "dffcf095-396b-4068-a15f-b652e06c07d4", "choice_type": "single"}
+{"question": "Carney triad consists of.\n(A)Gastric carcinoma\n(B)Paraganglioma\n(C)Pulmonary Chordoma\n(D)Carcinoma bronchus\n(E)Chondromatosis", "exp": "Gastric GIST Paraganglioma Pulmonary chondroma\n\"It describes the coexistence of several neoplasms, mainly in young women, including:\ngastric epithelioid leiomyosarcoma (these are now known to actually be malignant gastrointestinal stromal tumours), pulmonary chondroma, and extra-adrenal paraganglioma\"\nAlso Know: “Carney complex, also known as LAMB syndrome and NAME syndrome is an autosomal dominant condition comprising myxomas of the heart and skin, hyperpigmentation of the skin (lentiginosis), and endocrine overactivity.\nIt is distinct from Carney's triad. Approximately 7% of all cardiac myxomas are associated with Carney complex\"", "cop": 3, "opa": "DAB", "opb": "CAB", "opc": "ABC", "opd": "EBC", "subject_name": "Medicine", "topic_name": null, "id": "477f3f7f-39a6-4c46-8faf-100249054a2d", "choice_type": "single"}
+{"question": "American Heart Association standard pediatric dose of amoxicillin for antibiotic prophylaxis, in cases of endocarditis is", "exp": null, "cop": 2, "opa": "20mg/kg", "opb": "50mg/kg", "opc": "100mg/kg", "opd": "125mg/kg", "subject_name": "Medicine", "topic_name": null, "id": "3c479df2-d6d0-4108-992b-7701a0910f39", "choice_type": "single"}
+{"question": "Reversible myocardial stunning with ecg changes of acute myocardial infarction is seen in", "exp": "Takatsubo cardiomyopathy is stress induced infundibular spasm resulting in LV hypokinesia . ECG shows ST elevation", "cop": 3, "opa": "Restrictive cardiomyopathy", "opb": "Hypertrophic cardiomyopathy", "opc": "Takatsubo cardiomyopathy", "opd": "Dilated cardiomyopathy", "subject_name": "Medicine", "topic_name": null, "id": "7b246fad-ad0d-4703-9efd-510bc8397744", "choice_type": "single"}
+{"question": "V wave in left atrium is higher than in right atrium becasuse", "exp": "Left atrial waveform is very similar to right atrium however a wave and v wave are larger because of lower compliance in left atrium v wave represents the passive filling of atria.", "cop": 1, "opa": "Left side is high pressure system", "opb": "Left atrium good compliance with pulmonary vein", "opc": "Something due to poor transit through lung for atrium", "opd": "Right side is a high pressure system", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "b08a5c63-917d-4ef1-98e2-4c4da47d386e", "choice_type": "single"}
+{"question": "Mast cell stabilizer used in ronchial Asthma is", "exp": null, "cop": 2, "opa": "Raloxifene", "opb": "Ketotifen", "opc": "Azelastin", "opd": "Baclofen", "subject_name": "Medicine", "topic_name": null, "id": "81c1ed41-f800-4596-8a18-84b22054002d", "choice_type": "single"}
+{"question": "Dysmetria is due to lesion of", "exp": "Answer is D (Cerebllum): Dysmetria is a typical feature of cerebellar dysfunction / disease. Dysmetria refers to errors in judging distance and gauging the distance, speed, power and direction of movement. It refers to inaccuracy of movement in which the desired target is either unde- reached (hypometria) or over-reached (hypermetria). Dysmetia is feature of cerebellar disease / dysfunction and is evident on finger chase' or 'toe to finger' tests. Features of Cerebellar Disease / Dysfunction Dysmetria (Inaccuracy of movement, disturbance of rate, range & force of movement) Dysahria (Ataxic dysahria results from disruption of timing, force, range and direction of movement needed to maintain normal aiculation) Ataxia (unsteady to stand or sit without suppo) Incoordination Pastpointing Intention tremor (Inability to coordinate fine motor activity) Dysdiadokinesia (Inability to perform rapid lternating movements) Hypotonia Cerebellar Nystagmus", "cop": 4, "opa": "Midbrain", "opb": "Pons", "opc": "Medulla", "opd": "Cerebllum", "subject_name": "Medicine", "topic_name": null, "id": "7d94a17d-f64b-4c6e-85b4-b3fdd5bdba98", "choice_type": "single"}
+{"question": "Infliximab is contraindicated in", "exp": "(B) Intestinal tuberculosis # Infliximab is a drug used to treat autoimmune disorders.> Infliximab is known as a \"chimeric monoclonal antibody\" (the term \"chimeric\" refers to the use of both mouse (murine) and human components of the drug i.e. murine binding Fab domains and human constant Fc domains).> Case studies have been done into other uses of infliximab, such as to treat skin diseases.> Infliximab has been approved for treating ankylosing spondylitis, Crohn's disease, fistulizing Crohn's disease, pediatric Crohn's disease, psoriatic arthritis, psoriasis, rheumatoid arthritis, and ulcerative colitis.> Infliximab is also prescribed (out of indication) for the treatment of Behcet's disease and infusions of infliximab have been used successfully in the treatment of sciatica due to slipped discs", "cop": 2, "opa": "Crohn's disease", "opb": "Intestinal tuberculosis", "opc": "Ankylosing spondylitis", "opd": "Rheumatoid arthritis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "3ccb3f88-45f7-4c02-a696-e600d9cc4233", "choice_type": "single"}
+{"question": "An 18 year old boy while riding a motorbike without a helmet sustained a road traffic accident. He is brought to casualty and imaging studies done. He is diagnosed with left frontal skull fracture and cortical contusion. He has had no seizures and his GCS is 10. Antiepileptic drug therapy in this patient", "exp": "Prophylactic phenytoin reduces incidence of seizures after head injury, though there is no reduction in long term risk", "cop": 2, "opa": "Is contraindicated due to risk of rash", "opb": "Indicated to reduce incidence of early onset post traumatic seizures", "opc": "Is likely to cause increased cerebral edema", "opd": "Indicated to reduce incidence of late onset post traumatic seizures", "subject_name": "Medicine", "topic_name": null, "id": "899040c0-2426-4d12-9fad-99af7c624223", "choice_type": "single"}
+{"question": "Range of current used by biphasic defibrillator", "exp": "Modern units deliver a biphasic shock, during which shock polarity is reversed mid-shock. This reduces the total energy required to depolarise the hea. The energy of first and second shocks should be 150joules and thereafter up to 200joules. Reference Harrison 20th edition pg 1576", "cop": 2, "opa": "30-100 joules", "opb": "100-300 joules", "opc": "300-1000 joules", "opd": "1000-2000 joules", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "b9256bfb-1fff-482b-89cc-31da38626493", "choice_type": "single"}
+{"question": "A 24 year old male presents with abdominal pain, rashes, palpable purpura and, ahritis. The most probable diagnosis is.", "exp": "Answer is A (Henoch Schonlein Purpura) Palpable Purpura (most commonly distributed over the buttocks and lower extremities), ahralgias, and abdominal pain are all charachteristic features of Henoch-Schonlein purpura. Although H.S purpura is usually seen in a children and most patients range in age from 4-7 years, Harrisons text clearly mentions that this condition may also be seen in infants and adults. The charachteristic clinical manifestation of palpable purpura, ahralgia and abdominal pain in this young adult suggest the diagnosis of H-S purpura. Henoch Schonlein Purpura : Anaphylactoid Purpura : Review What is H. S. Purpura? H. S. Purpura is a vasculitis of small vesselsdeg The pathogenic mechanism for this vasculitis is iminune complex depositiondeg The most common class of antibodies seen in immune complexes of H.S purpura is IgAQ How does H. S. Purpura Present? Vasculitis Vasculitis of Skin Vasculitis of Toints Vasculitis of Gastrointesinal Vasculitis of (cutaneous) (Ahralgias) tract kidney Palpable purpura * Polyahralgiase in absence Colicky Abdominal paine is Mild glomerulonephritis2 Most commonly distributed over the of frank ahritis (Non deforming in nature) the most charachteristic manifestation . leading to proteinuria, microscopic haematuriaQ and buttocks and lower * Mainly involves large joints Other manifestations.. RBC cast in urine are the extremity of the lower extremity * Passage of blood & mucus charachteristic renal * Joint involvement is often migratory per rectum * Nausea/vomiting manifestation * Diarrhea / constipation", "cop": 1, "opa": "Henoch Schonlein Purpura (HSP)", "opb": "Sweet syndrome", "opc": "Meningococcemia", "opd": "HemochromatosisKawasaki Disease", "subject_name": "Medicine", "topic_name": null, "id": "6cb25f41-d090-4aaa-9f1e-18b5c6c7087d", "choice_type": "single"}
+{"question": "A patient presents with Microcytic Hypochromic anemia. Serum iron levels and TIBC are decreased. Likely diagnosis is", "exp": "Answer is B (Anemia of chronic disease) Hypochromic microcytic anemia with decreased serum iron and decreased TIBC is characteristic of anemia of chronic disease. Hypochromic microcytic anemia with 4.serum iron and TTIBC: iron Deficeincy Anemia Hypochromic microcytic anemia with fserum iron and TIBC : Anemia of Chronic disease Condition Iron deficiency Thalassemia Sideroblastic anemia Anemia of chronic disease Test (normal values) Serum iron Low (<30) Normal Normal ,l, (<50) (50-15014/d1) TIBC High (>360) Normal Normal ,l, (<300) (300-600 ug/dl) (Chandrasoma Taylor)", "cop": 2, "opa": "Iron deficiency anemia", "opb": "Anemia of chronic disease", "opc": "Thalassemia", "opd": "Sideroblastic anemia", "subject_name": "Medicine", "topic_name": null, "id": "2bbaaa53-bae2-42b6-9a17-32d623117fe5", "choice_type": "single"}
+{"question": "Adenosine deaminase (enzyme) deficiency is associated with", "exp": "Ten to 20% of SCID patients exhibit a deficiency in adenosine deaminase (ADA), an enzyme of purinemetabolism that deaminates adenosine (ado) and deoxyadenosine(dAdo). An ADA deficiency results in the accumulation of ado and dAdo metabolites that induce premature cell death of lymphocyte progenitors. The condition results in the absence of B and NK lymphocytesas well as T cells. The clinical expression of complete ADA deficiencytypically occurs very early in life. Since ADA is a ubiquitous enzyme,its deficiency can also cause bone dysplasia with abnormal costochondral junctions and metaphyses (found in 50% of cases) and neurologicdefects. The very rare purine nucleoside phosphorylase (PNP) deficiency causes a profound although incomplete T cell deficiency that isoften associated with severe neurologic impairments Ref - Harrison's internal medicine 20e pg 2392-2493", "cop": 1, "opa": "Severe combined immunodeficiency (SCID)", "opb": "X-linked agammaglobulinemia", "opc": "Transient hypogammaglobulinemia of infancy", "opd": "Chronic granulomatous disease", "subject_name": "Medicine", "topic_name": "All India exam", "id": "c4f447df-d313-44a8-94e8-0bf9695cc631", "choice_type": "single"}
+{"question": "Total iron binding capacity is increased in", "exp": "Iron deficiency anaemia.\nSerum ↓.\nSerum ferritin ↓.\nTIBC ↑.", "cop": 1, "opa": "Iron deficiency anaemia", "opb": "Anaemia of chronic disease", "opc": "Sideroblastic anaemia", "opd": "β - thala ssemia", "subject_name": "Medicine", "topic_name": null, "id": "1e784de2-d2c6-4ed7-ae78-92e285b83298", "choice_type": "single"}
+{"question": "Kussumaul's sign is most commonly seen in", "exp": null, "cop": 3, "opa": "Restrictive cardiomyopathy", "opb": "Pericardial tamponade", "opc": "Constrictive pericarditis", "opd": "Right ventricular infarct", "subject_name": "Medicine", "topic_name": null, "id": "ff076586-21d3-4f0a-a27e-8bd1b574a1bc", "choice_type": "single"}
+{"question": "A 40 years old female is came in the depament by describing \"1 have worst headache of my life\". The investigation of choice for this patient", "exp": "Answer- B. Computed tomography (CT)It is a case of \"acute subarachnoid hemorrhage\".The explosive onset of severe, excruciating headache is a common feature of subarachnoid haemonhage (SAH).Diagnosis of Subarachnoid hemorrhageThe hallmark of aneurysmal rupture is blood in the cerebrospinalfluid.More than 95% cases have enough blood to be visualized on a high quality non contract CT scan obtained within 72h.MRI can also be used to diagnose subarachnoid hemorrhage but CT is more sensitive than MRI for acute blood", "cop": 2, "opa": "Four vessels carotid angiography", "opb": "Computed tomography (CT)", "opc": "MRI", "opd": "No scan is required", "subject_name": "Medicine", "topic_name": null, "id": "9f51d2e2-61db-4525-baf6-43ea2575a462", "choice_type": "single"}
+{"question": "Not a cause of hypernatremia", "exp": "Ans. is 'b' i.e., Decreased insensible losses Major causes of hypernatremia Unreplaced water loss (which requires an impairment in either thirst or access to water) Insensible and sweat losses Gastrointestinal losses Central or nephrogenic diabetes insipidus Osmotic diuresis Glucose in uncontrolled diabetes mellitus Urea in high-protein tube feedings Mannitol Hypothalamic lesions impairing thirst or osmoreceptor function Primary hypodipsia Reset osmostat in mineralocoicoid excess Water loss into cells Severe exercise or seizures Sodioum overload Intake or administration of hypeonic sodium solutions", "cop": 2, "opa": "Adipsic diabetes insipidus", "opb": "Decreased insensible losses", "opc": "Nephrogenic diabetes insipidus", "opd": "Carcinoid syndrome", "subject_name": "Medicine", "topic_name": null, "id": "ec358c36-a523-4b7f-9275-c158e706773e", "choice_type": "single"}
+{"question": "Drug of choice for Mycoplasma pneumoniae is", "exp": null, "cop": 4, "opa": "Penicillin", "opb": "Tetracycline", "opc": "Cefuroxirne", "opd": "Erythromycin", "subject_name": "Medicine", "topic_name": null, "id": "e7a3089f-45f4-48e1-9ed3-70f68c6ee497", "choice_type": "single"}
+{"question": "Nicotine dependence", "exp": "(B) Physical dependence < psychic dependence PSYCHOACTIVE SUBSTANCE USE DISORDERSDrugUsual Route of AdministrationPhysical DependencePsychic DependenceTolerance1. AlcoholOral+ ++ ++2. OpioidsOral, Parental, Smoking+ + ++ + ++ + +3. Cannabis (Marihuana)Smoking Oral++ ++4. CocaineInhalation, Oral, Smoking Parental++ +--5. AmphetaminesOral, Parental+ ++ ++ + +6. Lysergic acidOral-++7. BarbituratesOral, Parental+ ++ ++ + +8. BenzodiazepinesOral, Parental+++9. Volatile solventsInhalation++ ++10. Phencyclidine (PCP)Smoking, Inhalation, Parental, Ora!+++11. CaffeineOral++ ++12. NicotineOral, Smoking++ ++-- = None; + = Probable/Little; + = Some / Mild; ++ = Moderate; +++ = Severe.", "cop": 2, "opa": "Physical dependence > psychic dependence", "opb": "Physical dependence < psychic dependence", "opc": "Physical dependence = psychic dependence", "opd": "No tolerance", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f4a677ba-f0b5-4e72-9122-d2b7fe6705ae", "choice_type": "single"}
+{"question": "In leprous neuritis, there is a) Intracutaneous thickening of the nerve b) Facial palsy c) Occurs in warm and moist areas d) Palpable peripheral nerves are present e) > 10 lesions may be found", "exp": null, "cop": 1, "opa": "abde", "opb": "abd", "opc": "abcd", "opd": "acd", "subject_name": "Medicine", "topic_name": null, "id": "ea561b34-510a-455e-bb92-55d76a18dabb", "choice_type": "single"}
+{"question": "Kerley B lines are due to", "exp": "Pulmonary oedema is usually caused by a heart condition. Other causes include pneumonia, exposure to certain toxins and drugs, and being at high elevations.\nDepending on the cause, pulmonary oedema symptoms may appear suddenly or develop over time. Mild to extreme breathing difficulty can occur. Cough, chest pain and fatigue are other symptoms.\nTreatment generally includes supplemental oxygen and medication.", "cop": 2, "opa": "Carcinoma bronchus", "opb": "Pulmonary edema", "opc": "Lung abscess", "opd": "Pulmonary embolism", "subject_name": "Medicine", "topic_name": null, "id": "99da33e9-a9e5-493e-a2e4-6f352e914d56", "choice_type": "single"}
+{"question": "Chances of veical transmission of Hepatitis B may be high as", "exp": "Answer is D (90%) The rate of perinatal transmission of hepatitis B (HBV) essentially depends on the presence or absence of HBe Ag and viral replication. The rate of perinatal transmission of HBV may be as high as 90% in neonates born to mothers who are positive for HBe AG. 'The likelihood of perinatal transmission of HBV correlates with the presence of HBe Ag and high level viral replication. 90% of HBe Ag positive mothers but only 10-15% of Anti-HBe Ag negative mothers transmit HBV to their offspring' - Harrison 18th/2547 `Transmission of infection from an HBV carrier mother to her neonate accounts for the majority of new infections in the world today. Sixty to 90% of Hepatitis B surface antigen (HBs Ag) positive mothers who are Hepatitis B 'e' antigen (HBe Ag) positive transmit the disease to their offspring, whereas mothers who are positive for antibody to HBe Ag (Anti - HBe) do so less frequently (15-20%). -", "cop": 4, "opa": "25%", "opb": "40%", "opc": "60%", "opd": "90%", "subject_name": "Medicine", "topic_name": null, "id": "c83417b5-1187-49a2-a682-fa3d83770aa0", "choice_type": "single"}
+{"question": "Abnormal function of epithelial chloride channel protein is the cause of", "exp": null, "cop": 3, "opa": "Ehlers Danlos syndrome", "opb": "Marfan syndrome", "opc": "Cystic fibrosis", "opd": "Diabetes insipidus", "subject_name": "Medicine", "topic_name": null, "id": "5f4b321f-8d37-411c-b1ab-7262eb4a2a2e", "choice_type": "single"}
+{"question": "Post transfusion hepatitis is common with", "exp": null, "cop": 1, "opa": "Packed cell volume", "opb": "Platelets", "opc": "Whole blood", "opd": "Albumin fraction", "subject_name": "Medicine", "topic_name": null, "id": "92926662-dcbf-48b8-9ceb-aba0743a3a7d", "choice_type": "single"}
+{"question": "Mentzer index more than 13 suggests a diagnosis of", "exp": "Ans. is 'a' i.e., Iron deficiency Anemia Mentzer index more than 13 suggests a diagnosis of Iron-deficiency anemia. Mentzer index The Mentzer index is used to help in differentiating iron deficiency anemia from beta thalassemia. The index is calculated as the quotient of the mean corpuscular volume (MCV, in fL) divided by the red blood cell count (RBC, in millions per microleter). If the Mentzer index is less than 13, thallassemia is said to be more likely. If the Mentzer Index is greater than 13, Then iron-deficiency anemia is said to be more likely. Principle In iron deficiency, the marrow cannot produce as many RBCs and they are small (imcrocytic), so the RBC count and the MCV will both be low, and as a result, the index will be greater than 13. Conversely, in thalassemia, which is a disorder of globin synthesis, the number of RBCs produced is normal, but the cells are smaller and more fragile. Therefore, the RBC count is normal, but the MCV is low, so the index will be less than 13. In practice, the Mentzer index is not a reliable indicator and should not, by itself be used to differentiate the two conditions. Index Formula Value for iron deficiency anemia Value for iron thalassemia Mentzer index MC V/RBC count > 13 < 13 Shine and Lal index MCV2 x MCH x 0.01 > 1530 < 1530 England and Fraser index MCV - RBC - (5 x Hb) 5.19 > 0 < 0 Srivastava index MCH/RBC > 3.8 < 3.8 Green and king index MCV2 x RDW x Hb/100 > 65 < 65 Red cell distribution width index MCV x RDW/RBC > 220 < 220", "cop": 1, "opa": "Iron deficiency anemia", "opb": "Thalassemia", "opc": "Hereditary Spherocytosis", "opd": "Autoimmune Hemolytic Anemia", "subject_name": "Medicine", "topic_name": null, "id": "aa235436-aea1-490f-a636-ad6ddddd477d", "choice_type": "single"}
+{"question": "A person washes hands repeatedly with a fear of getting HIV, he is suffering from", "exp": "(B) Obsessive-compulsive disorder # OBSESSIVE-COMPULSIVE DISORDER:> Washers:* This is commonest type. Here the obsession is of contamination with dirt, germs, body excretions and the like.* The compulsion is washing of hands or the whole body, repeatedly many times a day.* It usually spreads on to washing of clothes, washing of bathroom, bedroom, door knobs and personal articles gradually.", "cop": 2, "opa": "Phobic disorder", "opb": "Obsessive-compulsive disorder", "opc": "Dissriative and conversion disorder", "opd": "Somatoform disorder", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "392afe98-b674-45a9-8eca-946566b1d494", "choice_type": "single"}
+{"question": "Pneumothorax", "exp": "In pneumothorax, the trachea will be deted to the opposite side. Resonant or hyperresonant note on percussion. Breath sounds will be reduced or absent. Tactile vocal fremitus will be decreased. Tactile vocal resonance will also be decreased. Option B: Dull note on percussion is seen in consolidation, collapse, pleural effusion. Reference: Davidson's Medicine-22nd edition, page no:645.", "cop": 1, "opa": "Trachea shifted to opposite side", "opb": "Dull note on percussion", "opc": "Increased Breath Sound", "opd": "Increased Tactile vocal fremitus", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "dae947c5-e449-4dab-888d-c39c15f501db", "choice_type": "single"}
+{"question": "Pulmonary hypertension in COPD is due toa) Constriction of pulm vesselsb) Hypoxiac) Interstitial fibrosisd) Bronchoconstriction", "exp": null, "cop": 1, "opa": "ab", "opb": "a", "opc": "ad", "opd": "bc", "subject_name": "Medicine", "topic_name": null, "id": "7d8c7885-5afd-41dc-8f4a-eb611ac04fc5", "choice_type": "single"}
+{"question": "Reverse Coarctation is seen in", "exp": "Reverse Coarctation ;weak or absent pulse in upper limb + pulse present in lower limb.", "cop": 2, "opa": "Giant cell arteritis", "opb": "Takayasu arteritis", "opc": "Polyarteritis nodosa", "opd": "Microscopic polyangitis", "subject_name": "Medicine", "topic_name": null, "id": "5782c8ae-0a5b-4b61-9c36-9f7cd6db1019", "choice_type": "single"}
+{"question": "In significant bacteriuria, count will be", "exp": "Ans (a) > 105/mlGrowth of >105 indicate infectionmost common organism causing UTI -E coliD O C of uncomplicated UTI- Trimethorprim", "cop": 1, "opa": ">105/ml", "opb": ">103", "opc": ">102", "opd": ">104", "subject_name": "Medicine", "topic_name": "Infection", "id": "ad57bd56-6557-4206-aba1-c8791c6272b7", "choice_type": "single"}
+{"question": "Clinical finding inAV fistula is one of the following", "exp": null, "cop": 2, "opa": "Pericarditis", "opb": "Sinus tachycardia", "opc": "Cardiac arryhthrnia", "opd": "Hypothermia", "subject_name": "Medicine", "topic_name": null, "id": "9723127a-75ca-4abd-96e2-61bddb6b7a2b", "choice_type": "single"}
+{"question": "Investigation of choice to establish the diagnosis in case of nephrotic syndrome in adult is", "exp": "Answer- A. Renal biopsyIn adults since steroid responsive disease is less likely (<30%), and a wide differential diagnosis ofnephrotic syndrome exists, renal biopsy is recommended to establish the diagnosis.", "cop": 1, "opa": "Renal biopsy", "opb": "DMSA", "opc": "CT Scan", "opd": "MRI", "subject_name": "Medicine", "topic_name": null, "id": "9304291e-b48a-4972-8859-2b9e23c436bf", "choice_type": "single"}
+{"question": "In primary immune deficiency, the following plasma protein fraction can be reduced", "exp": "Agammaglobulinemia is a type of primary immunodeficiency of the adaptive immune systemAgammaglobulinemia is characterized by a profound defect in B cell development (<1% of the normal B cell blood count). In most patients, very low residual Ig isotypes can be detected in the serum. In 85% of cases, agammaglobulinemia is caused by a mutation in the BTK gene that is located on the X chromosome.Harrison 19e pg: 2107", "cop": 4, "opa": "Alpha1 globulin", "opb": "Alpha2 globulin", "opc": "Beta globulin", "opd": "Gamma globulin", "subject_name": "Medicine", "topic_name": "All India exam", "id": "f590572b-4ba1-4594-8fa8-b83a6ba3c744", "choice_type": "single"}
+{"question": "An individual is said to be 'overweight' if his BMI is in the range of", "exp": null, "cop": 4, "opa": "24.0 - 26.9", "opb": "24.0 - 27.9", "opc": "25.0 - 28.9", "opd": "25.0 - 29.9", "subject_name": "Medicine", "topic_name": null, "id": "e1530532-f96f-4cfd-ac15-b6c5d275938c", "choice_type": "single"}
+{"question": "Antibiotic associated diarrhea is caused by", "exp": "Inflammation of the colon caused by the bacteria Clostridium difficile. Clostridium difficile colitis results from disruption of normal, healthy bacteria in the colon, often as a result of antibiotics. C. difficile can also be transmitted from person to person by spores. It can cause severe damage to the colon and even be fatal Antibiotic-associated diarrhoea is among the most common adverse events related to antibiotic use. Most cases are mild, but Clostridium difficile infection causes a spectrum of disease, ranging from occasional diarrhoea to colitis, toxic megacolon, and potentially death Ref Harrison20th edition pg 1123", "cop": 1, "opa": "CI. difficile", "opb": "Cholera", "opc": "Salmonella", "opd": "Klebsiella", "subject_name": "Medicine", "topic_name": "Infection", "id": "ad3c59b4-0378-4369-b51a-6617dc216862", "choice_type": "single"}
+{"question": "Renin plays impoant role in", "exp": "Stimulation of the renin-angiotensin-aldosterone system leads to vasoconstriction, salt and water retention, sympathetic nervous system activation. This is mediated by angiotensin II, a potent constrictor of aerioles in both the kidney and the systemic circulation . Activation of the sympathetic nervous system may initially maintain cardiac output through an increase in myocardial contractility, hea rate and peripheral vasoconstriction. However, prolonged sympathetic stimulation leads to cardiac myocyte apoptosis, hyperophy and focal myocardial necrosis.renin also has an essential role in renovascular hypeension.Renovascular hypeension is another renin-mediated form of hypeension. Obstruction of the renal aery leads to decreased renal perfusion pressure, thereby stimulating renin secretion. Over time, as a consequence of secondary renal damage, this form of hypeension may become less renin dependent. ref:Harrison&;s principles of internal medicine,ed 18,pg no 2044", "cop": 1, "opa": "Renovascular hypeension", "opb": "Malignant hypeension", "opc": "Coronary aery disease", "opd": "Essential hypeension'", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "3ba5dd00-fa26-4317-af43-55011b5faa5b", "choice_type": "single"}
+{"question": "Calcium Gluconate is not used in CPR by", "exp": null, "cop": 2, "opa": "Hypocalemia", "opb": "Hypokalemia", "opc": "Hyperkalemia", "opd": "Calcium antagonism", "subject_name": "Medicine", "topic_name": null, "id": "41975ff1-27e6-4a89-8520-4bc117264aec", "choice_type": "single"}
+{"question": "For the following cardiac abnormalities, select the characteristic JVP finding.Complete heart block.", "exp": "Large a waves occur with increased resistance to filling (tricuspid stenosis, pulmonary hypertension) or when the right atrium contracts against a tricuspid valve closed by right ventricular systole (Cannon a waves) in complete heart block or other arrhythmias.", "cop": 1, "opa": "Cannon a wave", "opb": "prominent x descent", "opc": "Kussmaul sign", "opd": "slow y descent", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "d32e8c4a-82ac-4fdc-8d88-eea76a316e13", "choice_type": "single"}
+{"question": "Most common cause of hypernatremia", "exp": "Ans. is `c' i.e., Renal losses Major causes of hypernatremia Unreplaced water loss (which requires an impairment in either thirst or access to water) Insensible and sweat losses Gastrointestinal losses Central or nephrogenic diabetes insipidus o Osmotic diuresis Glucose in uncontrolled diabetes mellitus Urea in high-protein tube feedings Mannitol Hypothalamic lesions impairing thirst or osmoreceptor function Primary hypodipsia Reset osmostat in mineralocoicoid excess Water loss into cells Severe exercise or seizures Sodioutn overload Intake or administration of hypeonic sodium solutions", "cop": 3, "opa": "Adipsic diabetes insipidus", "opb": "Carcinoid syndrome", "opc": "Renal losses", "opd": "Sweating", "subject_name": "Medicine", "topic_name": null, "id": "885618e5-29f8-4a1b-a5c0-3db68c11116c", "choice_type": "single"}
+{"question": "Anakinra, used in the treatment of rheumatoid arthritis is", "exp": "(A) IL-1 # Recombinant IL-1 receptor antagonist (IL-1Ra) (anakinra): Inhibit IL-1 and is FDA approved for rheumatoid arthritis. Recombinant TNF-receptor-Ig fusion protein (etanercept): Inhibit TNF-alfa and is FDA approved for rheumatoid arthritis, juvenile rheumatoid arthritis, psoriasis Anti-TNF-alfa monoclonal antibody: Humanized mouse chimeric MAb, infliximab Fully humanized MAb, adalimumab inhibit TNF- alfa FDA approved for rheumatoid arthritis, Crohn's colitis (infliximab); FDA approved for rheumatoid arthritis (adalimumab). No TNF BETA inhibitors used. No IL-7 inhibitors used Anakinra is also useful in: Neonatal onset inflammatory disease, Muckle-Wells syndrome, and familial cold urticaria, Systemic juvenile onset inflammatory arthritis and adult onset Still's disease. Remember: Anakinra should not be combined with an anti-TNF drug (causes high rate of serious infections).", "cop": 1, "opa": "IL-1", "opb": "TNF ALPHA", "opc": "TNF BETA", "opd": "IL-7", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "e77e9076-4764-40f3-92de-3a5bf02c2221", "choice_type": "single"}
+{"question": "Ectopic ACTH syndrome is seen most commonly with", "exp": "* Ectopic ACTH production is predominantly caused by occult carcinoid tumors, most frequently in the lung, but also in thymus or pancreas. * Advanced small cell lung cancer can cause ectopic ACTH production. In rare cases, ectopic ACTH production has been found to originate from medullary thyroid carcinoma or pheochromocytoma, the latter co-secreting catecholamines and ACTH.", "cop": 3, "opa": "Renal cell carcinoma", "opb": "Lymphoma", "opc": "Bronchogenic carcinoma", "opd": "Pituitary adenoma", "subject_name": "Medicine", "topic_name": "Miscellaneous Questions", "id": "7d3bc306-d0c6-4672-ba77-d0fab320c792", "choice_type": "single"}
+{"question": "The following are preventable risk factors for dementia", "exp": "Many risk factors for dementia have been identified in recent years, most of which are common, and several are associated with both AD and VaD, as well as with atherosclerosis.These include age, hypeension, diabetes mellitus, dyslipidemia, hyperhomocysteinemia, obesity, smoking, coronary aery disease, and low level of education and occupational attainment. It is impoant to note that many of these risk factors seem to exe their critical effects already in midlife In senescence, the changes mayhave disappeared. Most elderly are not overweight any more, have stopped smoking (if they ever did), and even their cholesterol levels are lower than they have ever been. It is impoant to realize that an interaction exists between these factors. Ref Harrison20th edition pg 2297", "cop": 1, "opa": "Hypeension", "opb": "Apo E4", "opc": "Age", "opd": "Lowered Homocysteine", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "565639f7-7fc1-4b47-8ce6-71ba792c05f7", "choice_type": "single"}
+{"question": "Minimal Babinski is", "exp": "(A) Contraction of Hamstring muscles # True BABINSKI SIGN - includes all the components of the fully developed extensor plantar response.> Minimal Babinski sign - is characterised by contraction of the hamstring muscles and the tensor fasciae latae which can be detected by palpation of the thigh.> Spontaneous Babinski sign - is encountered in patients with extensive pyramidal tract lesions. Passive flexion of the hip and knee or passive extension of the knee may produce a positive Babinski sign in adults, as may foot manipulation in infants and children.> Crossed extensor response/bilateral Babinski sign - may be encountered in cases with bilateral cerebral or spinal cord disease. Unilateral foot stimulation elicits a bilateral response in such cases.> Tonic Babinski reflex - is characterised by a slow prolonged contraction of the toe extensors. It is encountered in patients with combined frontal lobe lesions and extrapyramidal involvement.> Exaggerated Babinski sign - may take the form of a flexor or extensor spasm. Flexor spasms can occur in patients with bilateral UMN lesion at the supraspinal or spinal cord level. Extensor spasms can occur in patients with bilateral corticospinal tract lesion but preserved posterior column function.> Babinski mimickers: 1. Pseudo Babinski sign 2.Inversion of plantar reflex 3. Withdrawal response> Pseudo Babinski sign: This sign may be encountered in patients with choreoathetosis where the upgoing toe is a manifestation of hyperkinesia.", "cop": 1, "opa": "Contraction of Hamstring muscles", "opb": "Contraction of Adductor muscles", "opc": "Flexion at hip", "opd": "Flexion at knee", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "6db18a91-3404-4984-b890-6f3ef200e20d", "choice_type": "single"}
+{"question": "The principal impact indicator in Iodine Deficiency disorders", "exp": "Urinary Iodine Levels - principal impact indicator.\nNeonatal TSH levels - screening programme for hypothyroidism.", "cop": 1, "opa": "Urinary Iodine Levels", "opb": "Goitre assessment", "opc": "Neonatal TSH levels", "opd": "Salt Iodine Content", "subject_name": "Medicine", "topic_name": null, "id": "6725e29a-54e8-4b8c-843e-f102a5ad2c83", "choice_type": "single"}
+{"question": "Risk factors for coronary aery disease (CAD)", "exp": "Answer is C Increased homocysteine levels Increased homocysteine levels and increased lipoprotein (a) levels are risk factors for cornonary aery disease Increased risk of coronary aery disease is also associated with: High LDL (not low LDL) Low HDL (not high HDL) Increased Fibrinogen levels (not decreased fibrinogen levels)", "cop": 3, "opa": "High HDL", "opb": "Low LDL", "opc": "Increased homocysteine levels", "opd": "Decreased fibrinogen levels", "subject_name": "Medicine", "topic_name": null, "id": "9eff96b8-5c7e-4fe5-bfe8-eda224dd1949", "choice_type": "single"}
+{"question": "CT scan is complementary to MRI in", "exp": "(C) Posterior fossa tumour# Skull base anatomy is complex. Numerous vital neurovascular structures pass through multiple channels and foramina located in the base skull. With the advent of computerized tomography (CT) and magnetic resonance imaging (MRI), accurate preoperative lesion localization and evaluation of its relationship with adjacent neurovascular structures is possible.> It is imperative that the radiologist and skull base surgeons are familiar with this complex anatomy for localizing the skull base lesion, reaching appropriate differential diagnosis, and deciding the optimal surgical approach.> CT and MRI are complementary to each other and are often used together for the demonstration of the full disease extent> Diagnosis of Posterior Fossa Tumor is based on a thorough medical history and physical examination, followed by imaging tests. The best way to look at the posterior fossa is with an MRI scan. CT scans are usually not helpful to see that area of the brain.> CT scan is very much useful in traumatic lesions.> Hydrocephalus is best diagnosed by MRI scan and even Plain X-ray.", "cop": 3, "opa": "Trauma", "opb": "Hydrocephalus", "opc": "Posterior fossa tumor", "opd": "Vascular lesion", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "7e5d1a75-db4d-4785-9ebb-a95efc40247b", "choice_type": "single"}
+{"question": "HLA* 1502 is a genetic marker of", "exp": "The HLA allele B*1502 as a marker for carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis .This allele is seen in high frequency in many Asian populations other than Han Chinese, but there are few data on whether the allele is a marker for this severe outcome in anyone other than Han Chinese. In fact, the association has not been found in Caucasian patients. Carbamazepine is an impoant treatment for seizure disorders, bipolar disorder, trigeminal neuralgia and chronic pain. However, carbamazepine is also associated with hypersensitivity reactions that range from benign uicaria to life-threatening cutaneous disorders, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) . Ref - harrison's internal medicine 20e p368", "cop": 3, "opa": "SLE", "opb": "Polyaeritis nodosa", "opc": "Steven Johnson syndrome", "opd": "Seronegative spondyloahritis syndrome", "subject_name": "Medicine", "topic_name": "Immune system", "id": "921d64ab-25a8-4ed4-b5d7-53873e409309", "choice_type": "single"}
+{"question": "Increased \"Anion gap' is a characteristic feature", "exp": null, "cop": 3, "opa": "Hyperosmolar non-ketotic diabetic coma", "opb": "Hypoglycaemic coma", "opc": "Phenformin toxicity with coma", "opd": "Renal tubulae acidosis", "subject_name": "Medicine", "topic_name": null, "id": "14174902-92db-47f1-9a5f-db17a024f22a", "choice_type": "single"}
+{"question": "In rheumatoid ahritis pathology stas in", "exp": "Answer- C. SynoviumRA is a chronic multisystem disorder that may affect many tissues and organs, but principally attacks the joint, producing a nonsuppurative proliferative and inflammatory synovitis that often progresses to destruction of the aicular cailage and ankylosis ofthe joint.", "cop": 3, "opa": "Aicular cailage", "opb": "Capsule", "opc": "Synovium", "opd": "Muscle", "subject_name": "Medicine", "topic_name": null, "id": "9e8288f5-da0b-41e5-b21b-966ad75040be", "choice_type": "single"}
+{"question": "GH level increases during", "exp": "(B) Hypoglycaemia # Stimulators of Growth Hormone (GH) secretion include:> Peptide hormones: GHRH (somatocrinin) through binding to the growth hormone-releasing hormone receptor (GHRHR) Ghrelin through binding to growth hormone secretagogue receptors (GHSR)> Sex hormones: Increased androgen secretion during puberty (in males from testis and in females from adrenal cortex)> Estrogen: Clonidine and L-DOPA by stimulating GHRH release a4b2 nicotinic agonists, including nicotine, which also act synergistically with clonidine. Hypoglycemia, arginine and propranolol by inhibiting somatostatin release Deep sleep Niacin as nicotinic acid (Vitamin B3) Fasting Vigorous exercise> Inhibitors of GH secretion include: GHIH (somatostatin) from the periventricular nucleus Circulating concentrations of GH and IGF-1 (negative feedback on the pituitary and hypothalamus) Hyperglycemia Glucocorticoids Dihydrotestosterone> In addition to control by endogenous and stimulus processes, a number of foreign compounds (xenobiotics such as drugs and endocrine disruptors) are known to influence GH secretion and function.", "cop": 2, "opa": "REM sleep", "opb": "Hypoglycaemia", "opc": "Increased cortisol", "opd": "Hyperglycemia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "17912ab1-f97f-48cc-a4e4-809706180afe", "choice_type": "single"}
+{"question": "A 45 year old female is diagnosed as a case of pneumococcal meningitis.Her blood sample were sent for culture sensitivity. In the mean time best drug to sta as an empirical treatment is", "exp": "Harrison's textbook of internal medicine 17th edition . *Treatment of choice for pneumococcal meningitis is cetriaxone (2g q 12h) plus vancomycin (1g q 12h).", "cop": 4, "opa": "Penicillin G", "opb": "Doxycycline", "opc": "Streptomycin", "opd": "Vancomyin + Ceftriaxone", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "82557e10-46c6-4329-b7e1-90178349727f", "choice_type": "single"}
+{"question": "Common presenting symptom of pneumocystis carini pneumonia Is", "exp": "The key presenting symptom of PCP is progressive dyspnoea.Dry cough & fever are common.Physical findings include tachypnoea,tachycardia,and cyanosis.Chest X ray shows typical 'ground-glass' interstitial infiltrates in the perihilar regions.Pneumatoceles may occur and rupture,resulting in a pneumothorax. Reference: Davidson edition23rd pg 585", "cop": 3, "opa": "Cavity on X-ray", "opb": "Haemoptysis", "opc": "Breathlessness", "opd": "Purulent sputum", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "6d608438-2e7b-49e1-b4e0-3ee7b1477bc3", "choice_type": "single"}
+{"question": "Most common cause of acute arterial occlusion", "exp": null, "cop": 3, "opa": "Pulmonary emboli", "opb": "Atherosclerosis plaque", "opc": "Emboli atrial fibrillation", "opd": "Thrombosis of aneurysm", "subject_name": "Medicine", "topic_name": null, "id": "8098bf20-599e-4e3e-944d-ece9aa983a24", "choice_type": "single"}
+{"question": "Increase in blood pressure occurs with", "exp": "Low-potassium diet -- Low dietary potassium intake (below 40 mEq/day ) has been associated with an elevation in blood pressure and an increased risk of stroke , as well as an increase in risk of chronic kidney disease Ref Davidson 23rd edition pg 355", "cop": 1, "opa": "Low potassium intake", "opb": "Low calcium intake", "opc": "Low sodium intake", "opd": "Low choride intake", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "081300ef-01b5-4c80-9c7a-df8943db8c28", "choice_type": "single"}
+{"question": "Contraindication for PA in ischemic stroke is", "exp": "Contraindications for administration of Intravenous Recombinant Tissue Plasminogen Activator (PA ) for Acute Ischemic Stroke (AIS)Sustained BP >185/110 mmHg despite treatmentPlatelets <100,000; HCT <25%; glucose <50 or >400 mg/dLUse of heparin within 48 h and prolonged PTT, or elevated INRRapidly improving symptomsPrior stroke or head injury within3 months; prior intracranial haemorrhageMajor surgery in preceding 14 daysMinor stroke symptomsGastrointestinal bleeding in preceding21 daysRecent myocardial infarctionComa or stuporRef: Harrison 19e pg: 2562", "cop": 3, "opa": "Clinical diagnosis of stroke", "opb": "Systolic BP < 180 mm of Hg", "opc": "Comatose patient", "opd": "Onset of symptoms < 4.5 hours", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "f0fe2f63-664d-459e-ae60-b71381fc76bf", "choice_type": "single"}
+{"question": "Cause of nail bed infarctions a) H.D b) Wegener's granulomatosis c) Infective endocardities d) Surge strauss syndrome e) PAN", "exp": null, "cop": 2, "opa": "abc", "opb": "bc", "opc": "bd", "opd": "cd", "subject_name": "Medicine", "topic_name": null, "id": "7ea04e79-9176-47b2-8a89-bdc039e578a7", "choice_type": "single"}
+{"question": "Clinical finding in AV fistula is one of the following", "exp": "The mechanism behind bradycardia associated with Branham sign is likely similar to the reflex arc that occurs during the Bezold-Jarisch reflex. Presence of an AV fistula results in increased cardiac output because of low resistance across the AV shunt. Ref Davidson 23rd edition pg 467", "cop": 2, "opa": "Pericarditis", "opb": "Sinus tachycardia", "opc": "Cardiac arrhythmia", "opd": "Hypothermia", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "9bd922d6-8bf4-4ea6-9441-171d8d9bf4c8", "choice_type": "single"}
+{"question": "Wing beating tremor is seen in", "exp": null, "cop": 2, "opa": "Huntington disease", "opb": "Wilson disease", "opc": "Parkinsonism", "opd": "Thyrotoxicosis", "subject_name": "Medicine", "topic_name": null, "id": "20ab6e32-a6e4-4be5-9d9c-97aaaf2a7fd5", "choice_type": "single"}
+{"question": "Most common site of thrombosis in paroxysmal nocturnal hemoglobinuria", "exp": "Intra abdominal veins are the most common site of thrombosis in PNH.", "cop": 3, "opa": "Femoral vein", "opb": "Median cubital vein", "opc": "Intra - abdominal veins", "opd": "Saphenous vein", "subject_name": "Medicine", "topic_name": null, "id": "755f2e54-c4cf-49eb-be07-ac81f757992e", "choice_type": "single"}
+{"question": "Retinal output is mainly from", "exp": "(A) Ganglion cell layer # Retina:> Layer of rods & cones: These are the end organs of vision & are also known as photoreceptors> Outer nuclear layer: It consists of nuclei of the rods and cones.> Outer plexiform layer: It consists of connections of rod spherules and cone pedicles with the dendrites of bipolar cells and horizontal cells.> Inner nuclear layer: It mainly consists of cell bodies of bipolar cells.* It also contains cell bodies of horizontal & muller's cells & capillaries of central artery of retina* The bipolar cells constitute the 1 st order neurons> Ganglion cell layer. It mainly contains the cell bodies of ganglion cells (the second order neurons of visual pathway).", "cop": 1, "opa": "Ganglion cell layer", "opb": "Layer of rods & cones", "opc": "Outer nuclear layer", "opd": "Outer plexiform layer", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "c6a5483b-d9e5-4748-96fd-db67312cb3f7", "choice_type": "single"}
+{"question": "In the treatment of megaloblastic anemia, vitamin B12 and folic acid should be given together because", "exp": "Ans. is 'b' i.e., Folic acid alone causes improvement of anemic symptoms but neurological dysfunction continues Percentage absorption of iron falls progressively as iron deficiency is corrected.\" As the hemoglobin levels rise, erythropoietin stimulation decreases and the amount of iron reabsorbed is reduced\" Oral therapy for iron deficiency anemia A dose of 300 mg of elemental iron given per day in divided doses. 300 mg of elemental rion gives about 50 mg of absorbed iron per day (and not 100 mg of absorbed iron). Typically the Hb levels should be fully corrected within I month of initiating therapy in the absence of continuing blood loss (and not after six months). Treatment should not be stopped after normalizing of Hb, but continued for an additional 4 to 6 months to replenish body iron stores.", "cop": 2, "opa": "Vitamin B12 acts as a cofactor for digydrofolate reductase", "opb": "Folic acid alone causes improvement of anemic symptoms but neurological dysfunction continues", "opc": "Vitamin B12 deficiency may result in methylfolate trap", "opd": "Folic acid is required for conversion of methymalonyl-CoA to succinyl Co-A", "subject_name": "Medicine", "topic_name": null, "id": "6303b561-d8c2-42c9-9aba-8d8659ea1f49", "choice_type": "single"}
+{"question": "Acute uraemic syndrome causes disturbance in", "exp": "(B) Consciousness # Clinical Abnormalities in Uremiaa> Neuromuscular disturbances Fatigue Sleep disorders Headache Impaired mentation Lethargy Asterixis Muscular irritability Peripheral neuropathy Restless legs syndrome Paralysis Myoclonus Seizures Coma Muscle cramps Dialysis disequilibrium syndrome Myopathy", "cop": 2, "opa": "Affect", "opb": "Consciousness", "opc": "Thought", "opd": "Memory", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f4ce859c-2d05-4d15-a695-6127f9cd5e1d", "choice_type": "single"}
+{"question": "Normal parent with 2 siblings having osteogenesis imperfecta. Pattern of inheritance is", "exp": "D i.e. Germline mosacism Differential expression of same gene depending on parent of origin is referred to as genomic imprinting. Germline (Gonadal) mosaicism results from a mutation only affecting cells destined to form gonads - postzygotically during early embryonic development. So the individual (parent) is phenotypically normal but can transmit the disease to offsprings through mutant gametesQ. And because the progenitor cells of gametes carry mutation, there is a high possibility that more than 1 child of such parent would be affected.", "cop": 4, "opa": "Mutation", "opb": "Anticipation", "opc": "Genomic imprinting", "opd": "Germline mosacism", "subject_name": "Medicine", "topic_name": null, "id": "28053fab-59dd-4e97-a893-5579a1e5d17c", "choice_type": "single"}
+{"question": "Lupus pernio is seen in", "exp": "Ref Davidsons 23e p609", "cop": 4, "opa": "Tuberculosis", "opb": "SLE", "opc": "PAN", "opd": "Sarcoidosis", "subject_name": "Medicine", "topic_name": "Immune system", "id": "8e12f47b-b70f-4ca7-9179-bd97c78dbf77", "choice_type": "single"}
+{"question": "Decremental response on EMG is seen in", "exp": "Ans. is 'a' i.e., Myasthenia gravisDiagnosis of myaesthenia gravis 1Several special diagnostic Tests for mysthenia gravisElectrophysiological Testing: (Repetitive nerve stimulation test)* Characteristic of myasthenia on electrophysiological testing is rapid reduction in the amplitude of muscle action potentials evoked during a series of repetitive stimulations of a peripheral nerve at a rate of 3 per second (decrementing response)* The traditional and simple method is to stimulate the nerve at 3 Hz and to measure the compound muscle action potential (a decrement of more than 10% when comparing the fifth to the first response is abnormal)Single fibre electromyography:* This is more sensitive but technically more difficult than electrophysiological testing* Confirmatory but not specific.* This technique demonstrates an inconstancy in the firing offibres connected to the same motor unit or a blocking of successive discharges from single muscle fibre belonging to the same motor unit.Edrophonium and Neostigmine test/Tensilon test:* When edrophonium and neostigmine are given intravenously, it produces a transient improvement in strength in patients with myasthenia.* Edrophonium and neostigmine are anticholinesterase so they prolong and exaggerate the effect of acetylcholine in the synapse and therefore provide an increment in muscle power in patient with myasthenia.* It is highly sensitive with 85%Q sensitivity in ocular and 95% sensitivity in systemic myaesthenia.Measurement of receptor antibodies in the blood:* Measurement of antiacetylcholine receptor antibodies provides a sensitive and highly specific test for the diagnosis of myasthenia. Presence ofAch antibodies is virtually diagnostic of Myaesthenia graves.* Sensitivity is limited to about 50% in purely occular myasthenia and about 85% in generalized myasthenia.* Definitive if positive but negative test does not rules out the diagnosis.Also knowMost specific test to diagnose myaesthenia gravis - Anti - AchR antibody test (presence of Anti - AchR antibody is virtuallyDiagnostic of myaesthenia gravis)Most sensitive test to diagnose myaesthenia gravis - Single fibre electromyography", "cop": 1, "opa": "Myansthenia gravis", "opb": "Lambert Eaton syndrome", "opc": "Duschene muscular dystrophy", "opd": "UMN lesion", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "14c5a4dc-20c8-4c7f-b365-e853764e3a53", "choice_type": "single"}
+{"question": "Selenium deficiency causes", "exp": "(A) Cardiomyopathy DEFICIENCIES OF METALSElementDeficiencyBoronNo biologic function determinedCalciumReduced bone mass, osteoporosisCopperAnemia, growth retardation, defective keratinization and pigmentation of hair, hypothermia, degenerative changes in aortic elastin, osteopenia, mental deteriorationChromiumImpaired glucose toleranceFluorideDental cariesIodineThyroid enlargement, T4, cretinismIronMuscle abnormalities, kilonychia, pica, anemia, work performance, impaired cognitive development, premature labor, perinatal maternal mortalityManganeseImpaired growth and skeletal development, reproduction, lipid and carbohydrate metabolism; upper body rashMolybdenumSevere neurologic abnormalitiesSeleniumCardiomyopathy, heart failure, striated muscle degenerationPhosphorousRickets (osteomalacia), proximal muscle weakness, rhabdomyolysis, paresthesia, ataxia, seizure, confusion, heart failure, hemolysis, acidosisZincGrowth retardation, taste and smell, alopecia, dermatitis, diarrhea, immune dysfunction, failure to thrive, gonadal atrophy, congenital malformations", "cop": 1, "opa": "Cardiomyopathy", "opb": "Neuropathy", "opc": "Growth retardation", "opd": "Rhabdomyolysis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "765e2f56-6e13-41e3-a2ab-a2ab7cade593", "choice_type": "single"}
+{"question": "The Prevalence of the following with its degree may correlate with Disease activity in SLE", "exp": "(B) Lymphopenia # Autoimmune Hemolytic Anemia (AIHA) It is characterized by elevated reticulocyte counts, low haptoglobin levels, increased indirect bilirubin concentration and a positive direct Coombs' test. It has been noted in up to 10% of patients with SLE. Presence of hemolytic anemia may associate with manifestations of severe disease such as renal disease, seizures and serositis. Presence of both immunoglobulin and complements on red blood cells is usually associated with some degree of hemolysis, while presence of complements alone (C3 and /or C4) is often not associated with hemolysis AIHA responds to steroids (1 mg/kg per day prednisone or its equivalent in divided doses) in 75 to 96% of patients. Once the hematocrit begins to rise and the reticulocyte count falls, steroids can be rapidly tapered.SLICC CLASSIFICATION CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUSRequirements: > criteria (at least 1 clinical and 1 laboratory criteria. Or Biopsy-proven lupus nephritis with positive ANA or Anti-DNAClinical CriteriaImmunologic Criteria* Acute Cutaneous Lupus* ANA* Chronic cutaneous Lupus* Anti-DNA* Oral or nasal ulcers* Ant-Sm* Non-Scarring alopecia* Antiphospholipid Ab* Arthritis* Low complement (C3, C4, CH50)* Serositis* Direct Coomb's test* Renal * Neurologic* Hemolytic anemia* Leukopenia* Thrombocytopenia (<100,000/mm3)> Leucopenia It is a typical feature of SLE which may occur as a result of lymphopenia, neutropenia or a combination of both. Prevalence of lymphopenia in SLE ranges from 20 to 81% and its degree may correlate with disease activity. Both T and B lymphocytes are reduced, while natural killer cells are typically increased. Reduced surface expression of complement regulatory proteins CD55 and CD59 has been found in leucopenic patients with SLE. Deficiency of these proteins may make these cells susceptible to complement-mediated lysis. There is increasing evidence that endogenous production of type 1 interferons (IFNs) is implicated in the pathogenesis of neutropenia and lymphopenia in SLE. Elevated serum levels of IFN-a in SLE correlate inversely with leucocyte numbers# Neutropenia It is a common feature of SLE, with a prevalence rate of 47%, it may be mediated by anti-neutrophil antibodies. Increased levels of TNF-related apoptosis-inducing ligand (TRAIL) in SLE and may contribute to Neutropenia (through excessive neutrophil apoptosis mediated neutropenia).# Thrombocytopenia It has a reported prevalence ranging from 7 to 30% in large series of patients with SLE. Increased peripheral destruction of platelets and presence of anti-platelet antibodies, is the most likely pathogenic mechanism. Thrombocytopenia is an independent risk factor for increased mortality in SLE.", "cop": 2, "opa": "Autoimmune Hemolytic anemia", "opb": "Lymphopenia", "opc": "Neutropenia", "opd": "Thrombocytopenia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "b0aacc0c-74e0-457d-bbf8-ef03821845d9", "choice_type": "single"}
+{"question": "Chorea is NOT seen in", "exp": "(D) Tourette Syndrome # TOURETTE SYNDROME is a neurological disorder characterised by sudden rapid, involuntary movements called tics, which occur repeatedly. Tourette Syndrome is also linked to other behaviours, most often OCD and Attention Deficit Disorder (ADHD).> Symptoms can include bouts of motor and vocal tics and the focus of these tics tends to wax and wane over time.> Typically tics increase as a result of stress or tension, and may decrease when relaxed or absorbed in a task.> Chorea is seen with: Huntington's disease, a group of neurodegenerative diseases such as Creutzfeldt-Jakob disease and Kuru, children and adolescents with rheumatic fever develop Sydenham's chorea as a complication, drugs like levodopa, anti-convulsants, anti-psychotics, Wilsond disease and Chorea gravidarum is rare type of chorea which is a complication of pregnancy.", "cop": 4, "opa": "Huntington's disease", "opb": "Creutzfeldt-Jakob disease", "opc": "Rheumatic fever", "opd": "Tourette syndrome", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "c67d7e0e-0b1b-44f5-83e6-63e285aa7ed8", "choice_type": "single"}
+{"question": "The most common electrolyte abnormality found in patients with normal anion gap metabolic acidosis is", "exp": "Ans. A. Hyperchloremia.In a normal anion gaps metabolic acidosis there is by definition a rise in the serum chloride equivalent to the fall in the serum bicarbonate such that the anion gap (Na-Cl-HCO3 ) remains unchanged.", "cop": 1, "opa": "Hyperchloremia.", "opb": "Hypochloremia.", "opc": "Hyperkalemia.", "opd": "Hypokalemia.", "subject_name": "Medicine", "topic_name": "Fluid & Electrolyte", "id": "ddf23736-51ba-449a-ab6a-4be90bbd364b", "choice_type": "single"}
+{"question": "Following an attack of myocardial infarction the moality and morbidity of the patient is indicated by", "exp": "Answer is B (Left ventricular ejection fraction) Pump failure is now the primary cause of in hospital death following MI. The degree of pump failure relates well with moality. The most sensitive index of cardiac function amongst the options provided is 'ejection fraction' i.e. the ratio of stroke volume to end diastolic volume. This is thus the best indicator of moality & morbidity following ML", "cop": 2, "opa": "Ventricular extra systole", "opb": "Left ventricular ejection fraction", "opc": "Duration of syncope", "opd": "Percentage of narrowness of coronary aery", "subject_name": "Medicine", "topic_name": null, "id": "ed19916d-718d-42eb-8bc3-fd7b78ac1fbf", "choice_type": "single"}
+{"question": "Thymoma commonly presents with", "exp": "Thymus is abnormal in 75% patients with MG; 65%is hyperplastic and 10 % have thymic rumours or thymomas These patients may present with cough, chest pain, superior vena cava (SVC) syndrome, dysphagia, and hoarseness if the recurrent laryngeal nerve is involved. One third of cases are found incidentally on radiographic examinations during a workup for myasthenia gravis (MG). Ref Harrison20th edition pg 2789", "cop": 1, "opa": "Myasthenia gravis", "opb": "Renal failure", "opc": "Hepatic failure", "opd": "Testicular fiminization", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "854401b0-8079-4793-a19d-12dabf3504b0", "choice_type": "single"}
+{"question": "Graham Steel's murmur is an ausultatory finding of", "exp": "(B) Pulmonary regurgitation > Graham Steell's murmur: a high-pitched diastolic murmur caused by pulmonary regurgitation secondary to severe pulmonary hypertension; it is heard at the left sternal edge, level with the second or third costal cartilage.> Duroziez's murmur: a double murmur over the femoral or other large peripheral artery, due to aortic insufficiency.> Cruveilhier-Baumgarten murmur: a venous murmur heard at the abdominal wall over veins connecting the portal and caval systems.> Carey Coombs murmur: a rumbling apical mid-diastolic cardiac murmur occurring in the acute phase of rheumatic fever and disappearing afterward.> Austin Flint murmur: a presystolic or mid-diastolic murmur heard at the cardiac apex in aortic regurgitation, originating at the mitral valve when blood enters simultaneously from both the aorta and the left atrium.> Gibson murmur or Machinary murmur: a long rumbling sound occupying most of systole and diastole, usually localized in the second left interspace near the sternum, and usually indicative of patent ductus arteriosus> Seagull murmur: a raucous murmur with musical qualities resembling the call of a seagull such as that heard occasionally in aortic insufficiency, and attributed specifically to eversion or retroversion of the right anterior aortic cusp.", "cop": 2, "opa": "Aortic regurgitation", "opb": "Pulmonary regurgitation", "opc": "Tricuspid incompetence", "opd": "Aortic stenosis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "b3fe1ea1-f1c7-4aac-914f-60b7f8dc7bd1", "choice_type": "single"}
+{"question": "Uretheritis is seen in", "exp": "Sexually acquired reactive ahritis (SARA) is predominantly a disease of young men, with a male preponderance of 15 : 1. This may reflect a difficulty in diagnosing the condition in young women, in whom Chlamydia infection is often asymptomatic and is hard to detect in practical terms. Between 1% and 2% of patients with non-specific urethritis seen at genitourinary medicine clinics have SARA . The syndrome of chlamydial urethritis, conjunctivitis and reactive ahritis was formerly known as Reiter's disease . The diagnosis is usually made clinically but joint aspiration may be required to exclude crystal ahritis and aicular infection. ESR and CRP are raised, urethritis may be confirmed in the 'two-glass test' by demonstration of mucoid threads in the first-void specimen that clear in the second. High vaginal swabs may reveal Chlamydia on culture. Except for post-Salmonella ahritis, stool cultures are usually negative by the time the ahritis presents but serology may help confirm previous dysentery. RF, ACPA and ANA are negative Ref - Davidsons 23e p1031", "cop": 1, "opa": "Reiter's disease", "opb": "Gout", "opc": "Rheumatoid ahritis", "opd": "PAN", "subject_name": "Medicine", "topic_name": "Immune system", "id": "d57bba7d-ee1f-4f38-b2c7-31da317eac48", "choice_type": "single"}
+{"question": "Type I Respiratory failure is seen in", "exp": "(B) Emphysema # RESPIRATORY FAILURE may be classified as hypoxic or hypercapnic and may be either acute or chronic.# Hypoxemic respiratory failure (Type I) is characterized by a Pa02of less than 60 mmHg with a normal or low PaCO2.> Most common form of respiratory failure, and it can be associated with virtually all acute diseases of the lung, which generally involve fluid filling or collapse of alveolar units.> Some examples of Type I respiratory failure are cardiogenic or noncardiogenic pulmonary edema, pneumonia, and pulmonary hemorrhage..> Common causes of Type I (hypoxemic) respiratory failure Pneumonia Pulmonary edema Pulmonary fibrosis Asthma Pneumothorax Pulmonary embolism Pulmonary arterial hypertension Pneumoconiosis Granulomatous lung diseases Cyanotic congenital heart disease Bronchiectasis Adult respiratory distress syndrome Fat embolism syndrome Kyphoscoliosis Obesity# Hypercapnic respiratory failure (Type II) is characterized by a PaCO2 of more than 50 mm Hg.> Hypoxemia is common in patients with hypercapnic respiratory failure who are breathing room air.> The pH depends on the level of bicarbonate, which, in turn, is dependent on the duration of hypercapnia.> Common etiologies include drug overdose, neuromuscular disease, chest wall abnormalities, and severe airway disorders < e.g., asthma, chronic obstructive pulmonary disease)# Common causes of Type II (hypercapnic) respiratory failure Chronic bronchitis and emphysema (COPD) Severe asthma Drug overdose Poisonings Myasthenia gravis Polyneuropathy Poliomyelitis Primary muscle disorders Porphyria Cervical cordotomy Head and cervical cord injury Primary alveolar hypoventilation Obesity hypoventilation syndrome Pulmonary edema Adult respiratory distress syndrome Myxedema Tetanus Guillain-Barre syndrome", "cop": 2, "opa": "Anaemia", "opb": "Emphysema", "opc": "Pulmonary oedema", "opd": "Adult respiratory distress syndrome", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "010211cd-af18-469a-8c74-13fdad6fa96b", "choice_type": "single"}
+{"question": "Oral lesions in Immunocompromised state", "exp": null, "cop": 3, "opa": "Lichen planus", "opb": "Lichenoid eruption", "opc": "Oral hairy leukoplakia", "opd": "Erythroplakia", "subject_name": "Medicine", "topic_name": null, "id": "0ca587e9-4d1f-4a2b-b92c-a9b507814dd4", "choice_type": "single"}
+{"question": "For diagnosis of acute rheumatic fever, essential feature is", "exp": "The diagnosis, according to the revised Jones criteria, is based upon two or more major manifestations, or one major and two or more minor manifestations; evidence of preceding streptococcal infection is also required.\nJONES CRITERIA FOR THE DIAGNOSIS OF RHEUMATIC FEVER\nMajor manifestations\n\nCarditis\nPolyathritis\nChorea\nErythema marginatum\nSubcutaneous nodules Minor manifestations\nFever\nArthralgia\nPrevious rheumatic fever\nRaised ESR or CRP\nLeucocytosis\nFirst – degree AV block PLUS\nSupporting evidence of preceding streptococcal infection: recent scarlet fever, raised antistreptolysin 0 or other streptococ-cal antibody titre, positive throat culture\n\nN. B. Evidence of recent streptococcal infection.", "cop": 3, "opa": "Prior history of rheumatic fever", "opb": "Recent sore throat infection", "opc": "1 major and 2 minor criteria", "opd": "Erythema marginatum", "subject_name": "Medicine", "topic_name": null, "id": "3f69c49b-68d4-48fe-ad79-25e43e73519b", "choice_type": "single"}
+{"question": "Comment on the diagnosis based on spirometry repo TLC= 75% FRC= 100% RV = 120 % FEV1 = 60% DLco = 80%", "exp": "Acute asthma and Emphysema- TLC| due to air trapping Pulmonary Fibrosis - TLC| RV| Myasthenia Gravis - TLC| RV| Extraparenchymal Restrictive Lung Disease", "cop": 4, "opa": "Acute asthma", "opb": "Emphysema", "opc": "Pulmonary fibrosis", "opd": "Myasthenia gravis", "subject_name": "Medicine", "topic_name": "COPD and Asthma", "id": "8e72dc94-2fdb-42a7-afd1-fd291c10bf82", "choice_type": "single"}
+{"question": "Alternating RBBB with Left anterior hemiblock is seen in", "exp": "Ans. is 'd' i.e., Bi-fascicular block Bifascicular block - combination of RBBB with either left anterior hemiblock or left posterior hemiblock. Tri fascicular block - RBBB plus either LAHB/LPHB+ first degree AV block. Complete hea block destruction of - AV node leading to AV dissociation", "cop": 4, "opa": "1' degree hea block", "opb": "Complete hea block", "opc": "Mobitz type II block", "opd": "Bi-fascicular block", "subject_name": "Medicine", "topic_name": null, "id": "0a8d5e9a-0c63-4550-adde-ea69ba439d37", "choice_type": "single"}
+{"question": "Dose of MgSO4 in asthma is", "exp": "Bronchodilators Bronchodilator therapy is central to the management of breathlessness. The inhaled route is preferred and a number of different agents delivered by a variety of devices are available. Choice should be informed by patient preference and inhaler assessment. Sho-acting bronchodilators may be used for patients with mild disease but longer-acting bronchodilators are usually more appropriate for those with moderate to severe disease. Significant improvements in breathlessness may be repoed despite minimal changes in FEV1, probably reflecting improvements in lung emptying that reduce dynamic hyperinflation and ease the work of breathing. Oral bronchodilator therapy, such as theophylline preparations, may be contemplated in patients who cannot use inhaled devices efficiently but their use may be limited by side-effects, unpredictable metabolism and drug interactions; hence the requirement to monitor plasma levels. Orally active, highly selective phosphodiesterase inhibitors remain under appraisal. Combined inhaled glucocoicoids and bronchodilators The fixed combination of an inhaled glucocoicoid and a LABA improves lung function, reduces the frequency and severity of exacerbations and improves quality of life. These advantages may be accompanied by an increased risk of pneumonia, paicularly in the elderly. LABA/inhaled glucocoicoid combinations are frequently given with a long-acting muscarinic antagonist (LAMA). LAMAs should be used with caution in patients with significant hea disease or a history of urinary retention. Oral glucocoicoids Oral glucocoicoids are useful during exacerbations but maintenance therapy contributes to osteoporosis and impaired skeletal muscle function, and should be avoided. Oral glucocoicoid trials assist in the diagnosis of asthma but do not predict response to inhaled glucocoicoids in COPD. Pulmonary rehabilitation Exercise should be encouraged at all stages and patients reassured that breathlessness, while distressing, is not dangerous. Multidisciplinary programmes that incorporate physical training, disease education and nutritional counselling reduce symptoms, improve health status and enhance confidence. Most programmes include two to three sessions per week, last between 6 and 12 weeks, and are accompanied by demonstrable and sustained improvements in exercise tolerance and health status. Oxygen therapy Long-term domiciliary oxygen therapy (LTOT) improves survival in selected patients with COPD complicated by severe hypoxaemia (aerial PaO2 < 7.3 kPa (55 mmHg)). It is most conveniently provided by an oxygen concentrator and patients should be instructed to use oxygen for a minimum of 15 hours/ day; greater benefits are seen in those who use it for more than 20 hours/day. The aim of therapy is to increase the PaO2 to at least 8 kPa (60 mmHg) or SaO2 to at least 90%. Ambulatory oxygen therapy should be considered in patients who desaturate on exercise and show objective improvement in exercise capacity and/or dyspnoea with oxygen. Oxygen flow rates should be adjusted to maintain SaO2 above 90%. Surgical intervention Bullectomy may be considered when large bullae compress surrounding normal lung tissue. Patients with predominantly upper lobe emphysema, preserved gas transfer and no evidence of pulmonary hypeension may benefit from lung volume reduction surgery (LVRS), in which peripheral emphysematous lung tissue is resected with the aim of reducing hyperinflation and decreasing the work of breathing. Both bullectomy and LVRS can be performed thorascopically, minimising morbidity. Lung transplantation may benefit carefully selected patients with advanced disease (p. 567). Other measures Patients with COPD should be offered an annual influenza vaccination and, as appropriate, pneumococcal vaccination. Obesity, poor nutrition, depression and social isolation should be identified and, if possible, improved. Mucolytic agents are occasionally used but evidence of benefit is limited. Palliative care Addressing end-of-life needs is an impoant, yet often ignored, aspect of care in advanced disease. Morphine preparations may be used for palliation of breathlessness in advanced disease and benzodiazepines in low dose may reduce anxiety. Decisions regarding resuscitation should be addressed in advance of critical illnes Magnesium sulfate is a bronchodilator. It relaxes the bronchial muscles and expands the airways, allowing more air to flow in and out of the lungs. This can relieve symptoms of asthma, such as shoness of breath. initial loading dose 2 gm over a period of 20 minutes where infused Ref Davidson edition23rd pg 577", "cop": 2, "opa": "8 g i.v. over 20 minutes", "opb": "2g infused over 20 minutes", "opc": "2g i.v. over 40 minute", "opd": "6 g i.V. over 40 minutes", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "cd92d5f0-697a-4575-9627-372c780d3e0d", "choice_type": "single"}
+{"question": "Diagnostic criteria of Metabolic syndrome includea) High serum homocysteineb) High serum triglyceridec) Low HDL cholesterold) High LDL cholesterol", "exp": null, "cop": 3, "opa": "c", "opb": "d", "opc": "bd", "opd": "ac", "subject_name": "Medicine", "topic_name": null, "id": "9d87bb26-233a-449b-a38b-64fe0a3c3f23", "choice_type": "single"}
+{"question": "In Burkitts lymphoma, translocation seen is chromosome", "exp": "Answer is B (8 - 14 translocation) Presence oft (8; 14) or one of its variants t (2; 8) or t (8; 22) can be confirmatory - Harrison 16th/ 652. Impoant translocation to be remembered", "cop": 2, "opa": "12 - 14 translocation", "opb": "8 - 14 translocation", "opc": "4 - 8 translocation", "opd": "12 - 18 translocation", "subject_name": "Medicine", "topic_name": null, "id": "c2f2617c-2ff4-4801-81e6-c58410398769", "choice_type": "single"}
+{"question": "Enzyme raised in myopathies is", "exp": "Ans. a (CPK), (Ref. Harrison, Principles of Medicine, 18th/Chapter 246.)# CPK is raised in many myopathies and in AMI.", "cop": 1, "opa": "CPK", "opb": "SGOT", "opc": "SGPT", "opd": "AST", "subject_name": "Medicine", "topic_name": "Disorder of Metabolism & Connective Tissue", "id": "77c68d11-a3b4-42ee-974e-372f5c1a5e1c", "choice_type": "single"}
+{"question": "Doughy skin and woody induration of tongue is seen in", "exp": "Hypernatremia is defined as a serum sodium concentration of greater The skin can feel doughy or velvety due to intracellular water loss and Woody indurations on tongue are seen Ref Davidson 23rd edition pg 345", "cop": 2, "opa": "Hyponatremia", "opb": "Hypernatremia", "opc": "Hypokalemia", "opd": "Hyperkalemia", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "fd03db3e-9831-4a29-bf29-acb185c80038", "choice_type": "single"}
+{"question": "Strawberry gingivitis seen in", "exp": "Wegener's granulomatosis is a rare multi-system disease characterized by the classic triad of necrotizing granulomas affecting the upper and lower respiratory tracts, disseminated vasculitis and glomerulonephritis. Oral lesions as a presenting feature are only encountered in 2% of these cases. Hyperplastic gingival lesions or strawberry gingivitis, is a characteristic sign of Wegener's granulomatosis. The latter consists of reddish-purple exophytic gingival swellings with petechial haemorrhages thus resembling strawberries. Recognition of this feature is of utmost impoance for timely diagnosis and definitive management of this potentially fatal disease. Ref - pubmed.com", "cop": 3, "opa": "Myelocytic infiltration", "opb": "Phenytoin toxicity", "opc": "Wegner granulomatosis", "opd": "Klipel renaunay syndrome", "subject_name": "Medicine", "topic_name": "Immune system", "id": "ff12cf26-1aec-41ed-967a-f25f6240b766", "choice_type": "single"}
+{"question": "Cause of death in diabetic ketoacidosis in children", "exp": "Ans. is 'a' i.e., Cerebral edema High blood sugar will cross the blood brain barrier and simultaneously will draw water inside leading to cerebral edema. Cerebral edema accounts for 60-90% of all DKA related deaths in children. Infection is a precipitator for development of DKA. Other precipitating factor can be tissue ischemia, inadequate insulin administration, drugs (cocaine) and pregnancy.", "cop": 1, "opa": "Cerebral edema", "opb": "Hypokalemia", "opc": "Infection", "opd": "Acidosis", "subject_name": "Medicine", "topic_name": null, "id": "a86e28a3-072a-484a-ba14-44c938dd4f71", "choice_type": "single"}
+{"question": "Benefits ofEnteric feeding Vs parenteral feeding", "exp": "ENTERAL NUTRITION cheaper. simpler. fewer complications. for efficient use of nutrients. stimulates intestinal blood flow. maintain GI mucosal barrier (prevents bacterial translocation and poal endotoxemia) reduced gut associated lymphoid system (GALT) -> becomes a source of activated cells and proinflammatory stimulants Ref Davidson 23rd edition pg 763", "cop": 1, "opa": "Cost", "opb": "Morbidity", "opc": "Preferred in acute pancreatitis", "opd": "Preserve GIT function", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "da6aaf98-9a75-4b2b-b3e1-e4768c82bd3f", "choice_type": "single"}
+{"question": "Condition associated with prolonged muscle contraction followed by slow muscle relaxation includes", "exp": "(A) Myotonia # Myotonia is a symptom of a small handful of certain neuromuscular disorders characterized by delayed relaxation (prolonged contraction) of the skeletal muscles after voluntary contraction or electrical stimulation.> Myotonia may present in the following diseases with different causes related to the ion channels in the skeletal muscle fiber membrane (Sarcolemma).> Myotonia is present in Myotonia congenita, Paramyotonia Congenita and myotonic dystrophy.", "cop": 1, "opa": "Myotonia", "opb": "Dystonia", "opc": "Mitochondrial Myopathies", "opd": "Hypotonia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f57ea38d-f175-465a-8a37-ee3a6dc93561", "choice_type": "single"}
+{"question": "Testicular descent is controlled in pa by", "exp": "Testicular descent through the inguinal canal is controlled in pa by Leydig cell production of insulin-like factor 3 (INSL3), which acts a receptor termed GREAT ( G protein-coupled receptor affecting testis descent). Ref Harrison 20th edi page no 2769", "cop": 1, "opa": "Insulin like factor 3(INL 3)", "opb": "RANKL", "opc": "FSH", "opd": "LH", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "ccf006f8-add2-48bd-8cfa-c1894d3e46ea", "choice_type": "single"}
+{"question": "Best marker for drug induced lupus is", "exp": "Ref image - Harrison's internal medicine 20e p2517", "cop": 1, "opa": "Anti histone antibodies", "opb": "Anti ds DNA", "opc": "ANA", "opd": "Anti smith Ab", "subject_name": "Medicine", "topic_name": "Immune system", "id": "e417603a-91e5-44f5-87a3-753778b2e087", "choice_type": "single"}
+{"question": "A patient complains of intermittent claudication, dizziness and headache, likely cardiac lesion is", "exp": null, "cop": 4, "opa": "TOF", "opb": "ASD", "opc": "PDA", "opd": "Coarctation of aorta", "subject_name": "Medicine", "topic_name": null, "id": "86f529a7-0d27-4046-9919-822bf90aeddb", "choice_type": "single"}
+{"question": "\"Sleep apnoea\", is defined as a temporary pause in breathing during sleep lasting at least", "exp": null, "cop": 4, "opa": "40 seconds", "opb": "30 seconds", "opc": "20 seconds", "opd": "10 seconds", "subject_name": "Medicine", "topic_name": null, "id": "1779ca32-f3f9-4d33-8e8d-a85ca2014c59", "choice_type": "single"}
+{"question": "Most common anterior mediastinal tumour is", "exp": "(Thymoma): {2181- H 18th edition)MEDIASTINAL MASSESAnterior mediastinumThymoma (Most common)***LymphomaTeratomatous neoplasmsThyroid massesMiddle mediastinum- Vascular masses (Most common)**- Lymph node enlargement from metastasis or granulomatous disease- Pleuropericardial and bronchogenic cystsPosterior mediastinum- Neurogenic tumours (Most common)**- Meningoceles, meningomyelocele- Gastroenteric cysts- Esophageal diverticula* Investigation of choice - CT-scan* Definite diagnosis - Mediastinoscopy or anterior mediastinotomy", "cop": 1, "opa": "Thymoma", "opb": "Neurogenic tumor", "opc": "Lymphoma", "opd": "Teratoma", "subject_name": "Medicine", "topic_name": "Oncology", "id": "bf45216b-20e5-4a64-84d2-a36283428dd0", "choice_type": "single"}
+{"question": "Sudden onset of cough followed by increasing dyspnoea is characteristic of", "exp": "Pneumonia,paicularly lobar pneumonia,usually presents as an acute illness with sudden onset fever,chills,rigor,cough and malaise.Cough is characteristically sho,painful and dry,but later accompanied by the expectoration of mucopurulent sputum(rusty coloured in case of Strep.pneumoniae),with pleuritic chest pain.The patients also presents with increasing dyspnoea with increased respiratory rate(>30/min) and use of accessory muscles of respiration. Pleural effusion has got an insidious onset with breathlessness,with or without cough and pleuritic chest pain.In pneumothorax,the most common symptoms are sudden- onset unilateral pleuritic chest pain or breathlessness.In MI,pain is the cardinal symptom with breathlessness,vomiting & collapse. Reference:Davidson's Medicine-22nd edition,page no:683,661,729,590.", "cop": 2, "opa": "Pleural effusion", "opb": "Lobar pneumonia", "opc": "Myocardial infarct", "opd": "Pneumothorax", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "821ed7f7-a747-4ad8-9945-c0b4e4d9f9c0", "choice_type": "single"}
+{"question": "Multifactorial inheritance Is known in", "exp": "These benign tumors usually develop in or under the skin, but can also grow inside the body. Sometimes, a growth will involve multiple nerves (plexiform neurofibroma). Plexiform neurofibromas, when located on the face, can cause disfigurement. Neurofibromas may increase with age. Bone deformities Neurofibromas arise from nonmyelinating Schwann cells that only express the inactive version of the NF1 gene, which leads to a complete loss of expression of functional neurofibromin. While one defective allele may be inherited, loss of heterozygosity (LOH) must occur before a neurofibroma can form; this is called the 'two-hit hypothesis'. This LOH happens by the same mechanisms, such as oxidative DNA damage, that causes mutations in other cells. Once a nonmyelinating Schwann cell has suffered inactivation of its NF1 genes, it begins to proliferate rapidly. This condition is called hyperplasia, which is cell growth beyond what is normally seen. However, despite increased numbers of nonmyelinating Schwann cells, there is no neurofibroma yet. In order for the neurofibroma to develop, cells that are heterozygous for the NF1 gene must be recruited to the site. It has been hypothesized that the proliferating nonmyelinating Schwann cells secrete chemoattractants such as the KIT ligand, and angiogenic factors such as the heparin-binding growth factor midkine. These chemicals promote the migration of different kinds of cells that are heterozygous for the NF1 gene into the hyperplastic lesions created by the nonmyelinating Schwann cells. These cell types include fibroblasts, perineurial cells, endothelial cells, and mast cells. The mast cells then secrete mitogens or survival factors that alter the developing tumor microenvironment and result in neurofibroma formation.it has multifactorial inheritance Ref Robbins 9/e pg 174", "cop": 1, "opa": "Neurofibroma", "opb": "Hemophilia", "opc": "Cardiac septal defects", "opd": "Hypophospatemic rickets", "subject_name": "Medicine", "topic_name": "Genetics", "id": "4327b766-b53b-4829-a9ca-393878eabf7a", "choice_type": "single"}
+{"question": "Following is indicative of hypercalcemia on ECG", "exp": "(A) Short QT interval ECG OF HYPERCALCEMIAECG OF HYPOCALCEMIA* Marked shortening of Q-T interval* Prolongation of Q-T interval* ST segment is eliminated* Lengthening of ST segment# ECG of HYPERCALCAEMIA:> Short QT interval> Serum calcium > 15 mg% occurs in malignancy.> > 200 mg/day of urinary calcium suggest hypercalcaemia.> < 100 mg/day Hypocalcaemia> ECG shows a shortened QT interval, measurements of PTH and PTH-related protein (PTHrP) help distinguish between maligncmcy- associated by hypercalcaemia (elevated PTHrP) and hypoerparathyroidism (elevated PTH).# Q-T Interval: 'Measurement from the beginning of the Q wave to the end of the T wave.> Normal Q-T interval: is from 0,32 to 0.4 sec.> Shortened Q-T interval: Hyperkalemia; Hypercalcemia; Digitalis and Diphenyhydantoin sodium; Tachycardia.> Prolonged Q-T interval: Bradycardia-complete A-V book Hypokalemia, Hypocalcaemia and hypomagnesemia Drugs--Quinidine, procainamide, phenothiazines, tricyclic antidepressants. IHD, Mitral valve prolapse, CNS disease.", "cop": 1, "opa": "Short QT interval", "opb": "Bundle branch blocks", "opc": "Prolonged PR interval", "opd": "Paroxysmal atrial tachycardia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "69f3ee1b-ffe3-44c5-a20d-a5be9a01529f", "choice_type": "single"}
+{"question": "Murmur increasing with Valsalva manouvre", "exp": "Ref: Harrison's 19th E pg 1568 All murmurs decreases with valsalva maneuver except that of HOCM and MVP. In hocm, blood acts as a physical barrier between hyperophied septum and anterior mitral leaflet. During valsalva, there is decreased venous return and subsequently decreased blood reaching LV. As blood flow reduces, there is more chances of obstruction, it increases the murmur (ejection systolic murmur)", "cop": 2, "opa": "ASD", "opb": "HOCM", "opc": "MS", "opd": "AS", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "97add4d4-5aee-4a79-9218-532d92b07546", "choice_type": "single"}
+{"question": "In benign hypeension commonest vascular pathology is", "exp": "In smaller aeries (< 1 mm), hyaline aeriosclerosis occurs in the wall, the lumen narrows and aneurysms may develop. Widespread atheroma develops and may lead to coronary and cerebrovascular disease, paicularly if other risk factors (e.g. smoking,diabetes, hyperlipidaemia,) are present.These structural changes in the vasculature often perpetuate and aggravate hypeension by increasing peripheral vascular resistance and reducing renal blood flow, thereby activating the renin-angiotensin-aldosterone axis. ref:davidson&;s principles and practices medicine,ed 21,pg no 624", "cop": 4, "opa": "Atherosclerosis", "opb": "Fatty mfilitraion of intima", "opc": "Fibmoid necrosis", "opd": "Hyaline aeriosclerosis", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "e025bee6-cd7d-4ae8-8803-efa9d84bba52", "choice_type": "single"}
+{"question": "In LVH, SV1 +RV6 is more than mm", "exp": "Ans. is 'c' i.e., 35 Arrhythmias by Kathryn Lewis p. 219] o In LVH, SV-1 plus RV-6 is more than 15 mm. To diagnose the left ventricular hyperophy on ECG one of the following criteria should be met :? The sokolow-lyon criteria is most often used - R in V, or V6 + 5 in V > 35 mm in men The cornell-criteria has different values R in aVL and S in V3 > 28 mm in men R in aVL and S in V3 > 20 mm in women As the left ventricular wall becomes thicker QRS complexes are larger in leads V1-V6 S wave is deep in V, R wave is high in V4 ST depression in V,,-V, (strain pattern)", "cop": 3, "opa": "25", "opb": "30", "opc": "35", "opd": "45", "subject_name": "Medicine", "topic_name": null, "id": "dc02803f-537e-49b3-8666-3dd6b043eef5", "choice_type": "single"}
+{"question": "Cryptococcus neoformans has significant predilection for", "exp": null, "cop": 1, "opa": "Central nervous system", "opb": "Respiratory system", "opc": "Gastro intestinal system", "opd": "Cardiovascular system", "subject_name": "Medicine", "topic_name": null, "id": "cd3953c9-4ce0-4956-b8d6-2ba04e2077dc", "choice_type": "single"}
+{"question": "A 32 year old carpenter presented to you with history of recurrent attacks of chest pain . You prescribe him sublingual nitroglycerin and advise him to take it at the time of pain. The patient revisits the hospital again after 2weeks and tells that the intensity of chest pain has increased on taking nitroglycerin. The patient is most likely suffering from", "exp": "Nitrates are vasodilator drugs which aggravate condition of HOCM , so it is generally not used in HOCM", "cop": 2, "opa": "Aortic regurgitation", "opb": "Hypertrophic obstructive cardiomyopathy", "opc": "Aortic dissection", "opd": "Aortic aneurysm", "subject_name": "Medicine", "topic_name": null, "id": "105ca4bd-e16c-4122-8f78-b77e1be7b881", "choice_type": "single"}
+{"question": "In Wilsons disease copper deposition occurs in", "exp": "Wilson's disease (hepatolenticular degeneration) is a rare but impoant autosomal recessive disorder of copper metabolism caused by a variety of mutations in the ATP7B gene on chromosome 13. Total body copper is increased, with excess copper deposited in, and causing damage to, several organs. Normally, dietary copper is absorbed from the stomach and proximal small intestine and is rapidly taken into the liver, where it is stored and incorporated into caeruloplasmin, which is secreted into the blood. The accumulation of excessive copper in the body is ultimately prevented by its excretion, the most impoant route being bile. In Wilson's disease, there is almost always a failure of synthesis of caeruloplasmin; however, some 5% of patients have a normal circulating caeruloplasmin concentration and this is not the primary pathogenic defect. The amount of copper in the body at bih is normal but thereafter it increases steadily; the organs most affected are the liver, basal ganglia of the brain, eyes, kidneys and skeleton . Ref - Davidsns internal medicine 23e p89", "cop": 4, "opa": "Pons", "opb": "Medulla", "opc": "Cerebellum", "opd": "Basal ganglia", "subject_name": "Medicine", "topic_name": "Immune system", "id": "33b3bd9b-1f4a-499e-971c-0b2e92798305", "choice_type": "single"}
+{"question": "Vitamin B level in chronic myeloid leukemia is", "exp": "Ans. is 'a' i.e., Elevated CML there will be rise in B1, level LDH level And decreased levels of ALP.", "cop": 1, "opa": "Elevated'", "opb": "Decreased", "opc": "Normal", "opd": "Markedly", "subject_name": "Medicine", "topic_name": null, "id": "a73ad975-427f-41c9-9166-2e5699e10962", "choice_type": "single"}
+{"question": "If a person has a hea rate of 70 beats/min, a left ventricular end diastolic volume of 100 ml, and an ejectionfraction of 0.50, then the cardiac output is", "exp": "Cardiac output = hea rate x stroke volume. The ejection fraction = stroke volume/left ventricular end- diastolic volume (LVEDV). Therefore, stroke volume ejection fraction x L VEDV, or 0.50 x 100 ml = 50 nit Cardiac output = 50 ml x 70 beats/mm = 3500 mI/minute, or 3.5 liters/mm.", "cop": 2, "opa": "3.0 liters/ min", "opb": "3.5 liters/ min", "opc": "4.0 liters/min", "opd": "4.5 liters/ min", "subject_name": "Medicine", "topic_name": null, "id": "f263ec3f-9124-413c-b285-4c013fb4b8ee", "choice_type": "single"}
+{"question": "'Teichopsia' is seen in", "exp": "Ans. B. Migrane. (Ref Victor Adams Neurology, pg. 182-183.)Classic migraine is usually familial, involves a unilateral, throbbing head pain, and diminishes in fre- quency with age. The blind spot, or scotoma, that may develop as part of the aura of a classic migraine attack will involve the same visual field in both eyes. This defect usually changes over the course of minutes. It typically enlarges and may intrude on the central vision. The margin of the blind spot is often scintillating or dazzling. If this margin has a pattern like the battlement of a castle, it is called a fortification spectrum, or teichopsia. Homonymous hemianoptic defects of the sort that develop during the aura of a classic migraine indicate an irritative lesion that is affecting one part of the occipital cortex in one hemisphere of the brain. The changes in the scotoma over the course of minutes indicate that the irritative phenomenon sets off a cascade of events in the visual cortex that temporarily disturbs vision in a progressively larger area. Other focal neurologic phenomena may precede classic migraine; the most common are tingling of the face or hand, mild confusion, transient hemiparesis, and ataxia. Fatigue, irritability, and easy distractibility often develop before a migraine. Affected persons usually also have hypersensitivity to light and noise during an attack.", "cop": 2, "opa": "Age Related Macular Degeneration (ARMD)", "opb": "Migraine", "opc": "Vitreous hemorrhage", "opd": "Optic atrophy", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "cea63628-dbb0-4628-a980-c10852c81246", "choice_type": "single"}
+{"question": "Most common extra renal manifestation of autosomal dominant polycystic kidney disease .", "exp": "Most common extra renal manifestation of ADPCKD - Cysts in liver (Hepatomegaly).", "cop": 1, "opa": "Cysts in liver", "opb": "Direrticulosis of GUT", "opc": "Berry aneurysms", "opd": "Pancreatic cyst", "subject_name": "Medicine", "topic_name": null, "id": "d4af7278-88b2-4f84-8d8b-6abb20be476e", "choice_type": "single"}
+{"question": "Kussmaul's sign is NOT seen in", "exp": "Answer is C (Cardiac tamponade) most probably Kussmaul's sign is absent in cardiac tamponade. Presence of Kussmaul's sign in cardiac tamponade suggests an organizing process and presence of epicardial constriction (constrictive pericarditis) in addition to effusion. Kussmaul's sign is not a feature of isolated cardiac tamponade. Kussmaul's sign is absent inisolated cardiac tamponade It is frequent with constrictive pericarditis and R.V.MI. Not so frequent in R.C.MP. but definitely present Rare (absent) in Cardiac Tamponade", "cop": 3, "opa": "Restrictive cardiomyopathy", "opb": "Constrictive pericarditis", "opc": "Cardiac tamponade", "opd": "RV infarct", "subject_name": "Medicine", "topic_name": null, "id": "d0b33782-ae47-4cca-9c41-856632f1bde9", "choice_type": "single"}
+{"question": "Purpura fulminans is a feature of", "exp": "Ans. c (Acute Meningococcemia) (Ref. Harrison 18th/ p 114)ACUTE MENINGOCOCCEMIA# Neisseria meningitidis# Petechiae rapidly becoming numerous, sometimes enlarging and becoming vesicular;# Trunk, extremities most commonly involved;# May appear on face, hands, feet;# May include Purpura fulminans reflecting disseminated intravascular coagulation;# Most common in children, individuals with asplenia or terminal complement component deficiency (C5-C8);# Hypotension, meningitis (sometimes preceded by upper respiratory infection) may occur.PURPURA FULMINANS# Feature of severe disseminated intravascular coagulation# Characterized by Large ecchymoses with sharply irregular shapes evolving into hemorrhagic bullae and then into black necrotic lesions# Individuals with sepsis (e.g., involving N. meningitidis), malignancy, or massive trauma; asplenic patients at high risk for sepsis are predisposed.Educational points: Organism (Gram)ToxinMode of actionRole in diseaseProtein synthesis inhibitorsCorynebacterium diphtheria (Th)Diphtheria toxin# ADP ribosyl transferase inactivates EF-2# Targets: heart, nerves, epitheliumInhibits eukaryotic cell protein synthesis Pseudomonas aeruginosa (- )Exotoxin A# ADP ribosyl transferase inactivates EF-2# Target: liverInhibits eukaryotic cell protein synthesis Shigella dysenteriae (-)Shiga toxinInterferes with 60S ribosomal subunit# Inhibits protein synthesis in eukaryotic cells# Enterotoxic, cytotoxic, and neurotoxic Enterohemorrhagic E coli (EHEC) (-)Verotoxin(Shiga-like)Interferes with 60S ribosomal sunbmitInhibits protein synthesis in eurokaryotic cellsNeurotoxinsClostridium tetani (Th)Tetanus toxinBlocks release of glycine and GABAInhibits neurotransmission in inhibitor synapses Clostridium botulinum (Th)Botulinum toxinBlocks release of acetylcholineInhibits cholinergic synapsesEndotoxin enhancersStaphylococcus aureus (Th)TSST-1# Pyrogenic, decreases liver clearance of LPS# SuperantigenFever, increased susceptibility to LPS, rash, shock, capillary leakage Streptococcus pyogenes (Th)Exotoxin A, also called erythrogenic or pyrogenic toxinSimilar to TSST-1Fever, increased susceptibility to LPS, rash, shock, capillary leakage, cardiotoxicityCAMP inducersEnterotoxigenicEscherichia coli (-)Heat labile toxin (LT)LT stimulates an adenylate cyclase by ADP ribosylation of GTP-binding proteinBoth LT and ST promote secretion of fluid and electrolytes from intestinal epithelium Vibrio cholerae (-)Cholera toxinSimilar to E. coli LTProfuse, watery diarrhea Bacillus anthracisAnthrax toxin (3 proteins make 2 toxins)# EF = edema factor= adenylate cyclase# LF - lethal factor# PA = protective antigen (B component for both)# Decreased phagocytosis# Causes edema, kill cells Bordetella pertussis (Th)Pertussis toxinADP ribosylates GI, the negative regulator of adenylate cyclase, leading to increased cAMP# Histamine sensitizing# Lymphocytosis promotion# Islet activationCytolysinsClostridium perfringens (Th)Alpha toxinLecithinase# Damages cell membranes# Myonecrosis Staphylococcus aureus (Th)Alpha toxinPore formerMembrane becomes leaky", "cop": 3, "opa": "Scarlet fever", "opb": "Pseudomonas infection", "opc": "Acute meningococemia", "opd": "Staphylococal disease", "subject_name": "Medicine", "topic_name": "Infection", "id": "6c6f770d-19ec-474a-9c61-b60021da7137", "choice_type": "single"}
+{"question": "Carcinoid tumour is most common in", "exp": "Answer is D (Appendix); Antong, the given option the most common site of carcinoid tumour is appendix. Carcinoid tumor location, Frequency of Metastases, and Association with the Carcinoid Syndrome Site Location (% of Total) Incidence of Metastases Incidence of Carcinoid Syndrome Foregut Esophagus <0.1 - - Stomach 4.6 10 9.5 Duodenum 2.0 - 3.4 Pancreas 0.7 71.9 20 Gallbladder 0.3 17.8 5 Bronchus, lung, trachea 27.9 5.7 13 Midgut Jejunum Ileum 1.8 14.9 158.4 9 9 Meckel's diveiculum 0.5 13 Appendix Colon Liver Ovary Testis Hindgut 4.8 8.6 0.4 1.0 <0.1 38.8 51 32.2 32 - <1 5 - 50 50 Rectum 13.6 3.9 -", "cop": 4, "opa": "Esophagus", "opb": "Stomach", "opc": "Jejunum", "opd": "Appendix", "subject_name": "Medicine", "topic_name": null, "id": "d6efb138-fb61-44fa-bbd9-19add4bc81ae", "choice_type": "single"}
+{"question": "Biot's respiration is seen in", "exp": "(D) Bulbar poliomyelitis # Biot's breathing is caused by brain damage, increased intracranial pressure and drug-induced respiratory depression.> Biot's respiration, sometimes also called ataxic respiration, is an abnormal pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea. It generally indicates a poor prognosis. Biot's respiration is caused by damage to the medulla oblongata due to strokes or trauma or by pressure on the medulla due to uncal or tentorial herniation. It can be caused by opioid use.", "cop": 4, "opa": "Hypnosedative poisoning", "opb": "Appendicitis", "opc": "Cholecystitis", "opd": "Bulbar poliomyelitis", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "fdda2620-c6dd-49c5-bd0f-3244cf0e8b06", "choice_type": "single"}
+{"question": "A 40 year old man was admitted to the hospital emergency with sudden onset of the symptoms and signs of severe left ventricular failure. Calculate the atrial rate of the patient.", "exp": "Ventricular rate : 1500/10 = 150 ECG shows HR of 150/min with normal axis. Saw tooth waves are noted with 2:1 AV block. Ventricular rate is 150/min therefore the atrial rate would be 300/min.", "cop": 4, "opa": "100/min", "opb": "150/min", "opc": "200/min", "opd": "300/min", "subject_name": "Medicine", "topic_name": "ECG and Arrhythmia 2", "id": "e3cfc112-80ba-4d90-80b4-ffd30f8f117c", "choice_type": "single"}
+{"question": "Non modifiable risk factor for hypertension", "exp": null, "cop": 1, "opa": "Gender", "opb": "Obesity", "opc": "Salt intake", "opd": "Cultural characteristic acquired over time", "subject_name": "Medicine", "topic_name": null, "id": "af886d6c-1318-43c1-875b-e42d5860e068", "choice_type": "single"}
+{"question": "A 40 years males presented with painful vesicular lesion in the forehead extending to the eyelids. Diagnosis is", "exp": "(Herpes- Zoster) (52-Roxburg's 17th) (1182- CMDT-08)* Herpes simplex - manifest as acute gingivo-stomalitis, herpes labialis**, balanitis, vulvo-vaginitis, proctitis or kerato conjunctivitis* Intraepidermal vesicles around the mouth and lip (Type I) on the genitalia (Type II)* Herpes Zoster (Shingles) - Involvement of the branches of trigeminal ganglion, with lesions in the distribution of the maxillary, mandibular or ophthalmic sensory nerves as is involvement of dermatomes of the cervical and thoracic regions* H. Zoster affecting the opthalmic branch of the trigeminal nerve involving the right side of the forehead and eye and corneal ulcerations (.Hutchinson's sign)* The eruption consists of grouped tense vesicles or even bullae surrounded by a zone of erythema characteristically limited to a singe neural segment and is strictly unilateralMolluscum Contagiosum - transmitted by skin to skin contact* Typical lesion is a pink - coloured or skin coloured umbilicatedpapule** containing a greyish central plug, face and genital regions are commonly involved* A live attenuated VZV vaccine helps prevent herpes Zoster in persons 60 years and older", "cop": 2, "opa": "Herpes simplex", "opb": "Herpes-Zoster", "opc": "Coxschiae infection", "opd": "Molluscum contagiosum", "subject_name": "Medicine", "topic_name": "Infection", "id": "14757962-c2c8-416e-a97d-bb4cd076044e", "choice_type": "single"}
+{"question": "An elderly male presents with pain in his shoulders and hips. Temporal arteries are tender to palpation. ESR is 105 mm/L.", "exp": "The large vessel vasculitides include temporal (giant cell) arteritis and Takayasu arteritis. Temporal arteritis typically occurs in older patients and is accompanied by aching in the shoulders and hips, jaw claudication, and a markedly elevated ESR. Takayasu arteritis, a granulomatous inflammation of the aorta and its main branches, typically occurs in young women. Symptoms are attributed to local vascular occlusion and may produce arm or leg claudication. Systemic symptoms of arthralgia, fatigue, malaise, anorexia, and weight loss may precede the vascular symptoms. Surgery may be necessary to correct occlusive lesions.", "cop": 3, "opa": "Churg-Strauss syndrome", "opb": "Cryoglobulinemic vasculitis.", "opc": "Temporal arteritis", "opd": "Granulomatosis with polyangiitis (Wegener granulomatosis)", "subject_name": "Medicine", "topic_name": "Immunology and Rheumatology", "id": "d906752a-ca7f-4199-8a52-26e99bf064ec", "choice_type": "single"}
+{"question": "Localisation of parathyroids in hyperparathyroidism is done best with", "exp": null, "cop": 4, "opa": "X ray neck", "opb": "USG neck", "opc": "I131 scan", "opd": "Technetium 99 labelled sestamibi scan", "subject_name": "Medicine", "topic_name": null, "id": "9928a330-aeff-452f-a68b-af7cbdead0bd", "choice_type": "single"}
+{"question": "For the following medical conditions, select the associated acid base disturbances.Sepsis.", "exp": "Sepsis can cause cardiovascular insufficiency with lactic acidosis, whereas fever and endotoxemia stimulate the respiratory center, causing respiratory alkalosis.", "cop": 2, "opa": "metabolic acidosis and respiratory acidosis", "opb": "metabolic acidosis and respiratory alkalosis", "opc": "metabolic alkalosis and respiratory acidosis", "opd": "metabolic alkalosis and respiratory alkalosis", "subject_name": "Medicine", "topic_name": "Oncology", "id": "bdf14420-da97-475d-93e2-49a447dc85b6", "choice_type": "single"}
+{"question": "Philadelphia (Ph) chromosome", "exp": "i.e. (Balanced translocation): (414-H17th) (493-94-CMDT-l1)The Philadelphia chromosome (Ph) is derived from a reciprocal translocation between chromosome 9 and 22 with the break point joining the sequence of ABL oncogene with the BCR gene. The fusion of these DNA sequences allows the generation of an entirely noval fusion protein with modified functionReciprocal translocation generates Ph chromosomes Fusion of BCR and ABL gene sequences Chimeric BCR-ABL *protein-- The first reproducible chromosome abnormality detected in human malignancy was the Philadelphia chromosomes detected in CMLOther example - Translocations of MYC in Burkitt's lymphoma", "cop": 3, "opa": "Deletion", "opb": "Break DNA", "opc": "Balanced translocation", "opd": "Balanced transcription", "subject_name": "Medicine", "topic_name": "Genetics", "id": "6e957c9d-d9dc-449f-b433-f53a00f6e695", "choice_type": "single"}
+{"question": "Suprasellar aneurysms causes", "exp": "(B) Bitemporal hemianopia # Sagittal (central) lesions of the chiasma.These are characterized by bitemporal hemianopia and bitemporal hemianopic paralysis of pupillary reflexes.> Lateral chiasmal lesions: Salient features of such lesions are binasal hemianopia associated with binasal hemianopic paralysis of the pupillary reflexes.> Lesions of optic tract:These are characterized by incongruous homonymous hemianopia associated with contralateral hemianopic pupillary reaction (Wernicke's reaction).", "cop": 2, "opa": "Binasal hemianopia", "opb": "Bitemporal hemianopia", "opc": "Homonymous hemianopia", "opd": "Congruous homonymous hemianopia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "dc9a0ef5-7c1c-4357-a134-969b7efdefbf", "choice_type": "single"}
+{"question": "Wilson's disease is characterized by", "exp": "Wilson's disease (hepatolenticular degeneration) is a rare but impoant autosomal recessive disorder of copper metabolism caused by a variety of mutations in the ATP7B gene on chromosome 13. Total body copper is increased, with excess copper deposited in, and causing damage to, several organs. Normally, dietary copper is absorbed from the stomach and proximal small intestine and is rapidly taken into the liver, where it is stored and incorporated into caeruloplasmin, which is secreted into the blood. The accumulation of excessive copper in the body is ultimately prevented by its excretion, the most impoant route being bile. In Wilson's disease, there is almost always a failure of synthesis of caeruloplasmin; however, some 5% of patients have a normal circulating caeruloplasmin concentration and this is not the primary pathogenic defect. The amount of copper in the body at bih is normal but thereafter it increases steadily; the organs most affected are the liver, basal ganglia of the brain, eyes, kidneys and skeleton . Ref - Davidsons medicine 23e p896", "cop": 2, "opa": "Low serum ceruloplasmin and low urinary copper", "opb": "Low serum ceruloplasmin and high urinary copper", "opc": "High serum ceruloplasmin and low urinary copper", "opd": "High serum ceruloplasmin and high urinary copper", "subject_name": "Medicine", "topic_name": "Immune system", "id": "f5ffeaac-7cb8-40ae-adcc-9155ae4098c8", "choice_type": "single"}
+{"question": "Anaemia due to antibodies against blood group antigens", "exp": "Answer- C. Haemolytic disease of the newbornHemolytic disease of thefetus and newborn (HDFN), also known as alloimmune HDFN or erythroblastosis fetalis, is caused by the destruction of reil blood cells (RBCs) of the neonate or fetus by maternal IgG antibodies.", "cop": 3, "opa": "Hereditary spherocytosis", "opb": "G6PD deficiency", "opc": "Haemolytic disease of the newborn", "opd": "Alpha thalassemia major", "subject_name": "Medicine", "topic_name": null, "id": "857cb53a-51a5-4b1e-8e0b-b6a99708e953", "choice_type": "single"}
+{"question": "Criteria for Brainstem death includes", "exp": "Harrison's principles of internal medicine 17th edition. *Cardinal signs of death are cessation of cardiac function and respiration,pupils become fixed,body becomes cool,muscles and incontinence may occur", "cop": 2, "opa": "Positive Doll's eye Reflex", "opb": "Absent pupillary light reflex and delated pupils", "opc": "Pinpoint pupils", "opd": "Positive vestsibulo-ocular reflex", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "36e030c8-47ef-4f8b-8b00-460344a327d4", "choice_type": "single"}
+{"question": "Most common lung cancer due to tobacco", "exp": null, "cop": 2, "opa": "Adenocarcinoma", "opb": "Squamous cell carcinoma", "opc": "LCC", "opd": "IMAC", "subject_name": "Medicine", "topic_name": null, "id": "e4773538-c71c-4fc5-b428-1aa6fa13145e", "choice_type": "single"}
+{"question": "In Wood's lamp examination, green fluorescence detects", "exp": "(Pseudomonas) (287-88-H 16th) (312, 326-H17th)WOOD'S LIGHT - A wood's lamp generates 360 nm ultraviolet (or black) light that can be used to aid the evaluation of certain skin disorders- Examples.* Erythrasm caused by corynebacterium minutis-simum) to show characteristic coral red color.* Wound colonized by Pseudomonas to appear pale blue.* T.capitis caused by dermatophytes such as Microsporum canis or M. audouini exhibits a yellow fluorescence* Post inflammatory hyperpigmentation fades under Wood's light.* Vitiligo appears totally white under a Wood's lamp.* A Wood lamp may also aid in the demonstration of tinea versicolor and in recognition of ash led spots with tuberous sclerosis.", "cop": 3, "opa": "Corynebacterium diphtheria", "opb": "Pneumococcus", "opc": "Pseudomonas", "opd": "Microsporum-canis", "subject_name": "Medicine", "topic_name": "Skin", "id": "0873a9af-0a3b-41d8-a3bb-196fde307e04", "choice_type": "single"}
+{"question": "Systemic Millary TB spreads", "exp": ". Ans. is 'a' i.e., Aery", "cop": 1, "opa": "Aery", "opb": "Vein", "opc": "Bronchus", "opd": "Lymphatic", "subject_name": "Medicine", "topic_name": null, "id": "5ebb9586-45c5-47f8-833f-4f4edc93c507", "choice_type": "single"}
+{"question": "Marked decreased FEV1 and FEV1/ FVC ratio are seen in", "exp": "In obstructive diseases like asthma,marked fall in FEV1 and FEV1/FVC ratio is present.In restrictive diseases like kyphoscoliosis and fibrosis,lung volumes like TLC,FRC,RV as well as FVC are lowered.Maximal expiratory flows like FEV1 are also reduced compared with normal values,but are relatively elevated when considered in relation to lung volumes.So FEV1/FVC ratio will be normal or slightly increased Ref:Harrison's medicine-18th edition,page no:2093.", "cop": 1, "opa": "Asthma", "opb": "Kyphosis", "opc": "Scoliosis", "opd": "Fibrosis of lung", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "6f662a7c-4e75-4745-a52c-6660c057d1cc", "choice_type": "single"}
+{"question": "Relative risk of developing TB in patients already infected with TB bacilus is highest in", "exp": "Ans. is 'c' i.e., Post transplantation Relative risk of developing T.B. Post transplantation 20-70 HIV 30 Silicosis 30 Recent infection 12 Diabetes 3-4 Malnutrition 2-3", "cop": 3, "opa": "Diabetes", "opb": "Recent infection", "opc": "Post transplantation", "opd": "Malnutrition", "subject_name": "Medicine", "topic_name": null, "id": "485e79f7-47f3-4b45-8a21-7c992c4622e3", "choice_type": "single"}
+{"question": "Most common cause of renal artery stenosis in young females .", "exp": "Elderly - m/c cause - Atherosclerosis.\nYoung females - m/c cause - Fibromuscular dysplasia.", "cop": 2, "opa": "Atherosclerosis", "opb": "Fibromuscular dysplasia", "opc": "Takayasu arteritis", "opd": "Poly cystic kidney disease", "subject_name": "Medicine", "topic_name": null, "id": "7155388a-3bb1-494d-a14e-2c8d719b4aaa", "choice_type": "single"}
+{"question": "The best marker to diagnose thyroid related disorder is", "exp": "Answer is C (TSH) : The enhanced sensitivity and specificity of TSH assays have greatly improved laboratory assessment of thyroid function - Harrison With rare exceptions a normal TSH level excludes a primary abnormality of thyroid function.- Harrison Approach to thyroid testing: Because TSH change dramatically in response to alteration of free T4 and T3, a logical approach to thyroid testing is to determine first whether TSH is suppressed, normal or elevated - Harrison", "cop": 3, "opa": "T3", "opb": "T4", "opc": "TSH", "opd": "Thyroglobulin", "subject_name": "Medicine", "topic_name": null, "id": "c8bcda87-63f5-4e44-8614-fe090f9ecabb", "choice_type": "single"}
+{"question": "Cystatin C is a novel marker of", "exp": null, "cop": 4, "opa": "Vitamin K Status", "opb": "Cholestasis", "opc": "Fatty liver", "opd": "Glomerular filtration", "subject_name": "Medicine", "topic_name": null, "id": "00aa0942-9737-49c0-9946-792a87e2af37", "choice_type": "single"}
+{"question": "Duration of apnea in OSAS is", "exp": null, "cop": 1, "opa": "> 10 seconds", "opb": "> 20 seconds", "opc": "> 30 seconds", "opd": "> 60 seconds", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "f487ff12-d126-45e8-9fd7-df1b23596612", "choice_type": "single"}
+{"question": "Most common cause and the most common valve affected in Infective endocarditis in I.V drug abusers", "exp": "In I.V drug abusers it is staph.aureus to cause Infective endocarditis most commonly and the right sided valves are more commonly affected than the left sided valves", "cop": 3, "opa": "Streptococcus viridans—tricuspid valve", "opb": "Pseudomonas—mitral valve", "opc": "Staphylococcus aureus—tricuspid valve", "opd": "Streptococcus bovis—mitral valve", "subject_name": "Medicine", "topic_name": null, "id": "b2cc7b5d-8112-4cdf-99d8-e7bbdba2c4b0", "choice_type": "single"}
+{"question": "Hepatic secretory function is evaluated using", "exp": "Answer- D. Prothrombin time (PT)The most widely used tests are those measuring the blood concentration of aspaate aminotransferase (AST) and alanine aminotransferase (ALT).Congulation proteins: The easiest way to estimate the concentration of the coagulation factors is by measuring the prothrombin time (PT), which is normally l0 to 13 seconds. Prolonged PT is a sensitive index of liver function loss.", "cop": 4, "opa": "Alkaline phosphatase", "opb": "5' nucleotidase", "opc": "Gamma glutamyl transpeptidase", "opd": "Prothrombin time (PT)", "subject_name": "Medicine", "topic_name": null, "id": "de674ea8-6c8e-4d07-bbaa-cf93f4800b9a", "choice_type": "single"}
+{"question": "Sun damage causes malignant transformation of skin by", "exp": "The most significant cause of BCC and SCC is UV exposure whether through direct exposure to sunlight or by aificial UV light sources (tanning beds). Both UVA and UVB can induce DNA damage through free radical formation (UV A) or induction of pyrimidine dimers (UVB). The sun emits energy across the UV spectrum whereas tanning bed equipment typically emits 97% UV A and 3% UVB Thymine Dimers and Skin Cancercauses of skin cancer : Pathophysiology: UV light causes a crosslink in the DNA The absorption of UV light by a molecule promotes an electron from a filled orbital, to an unfilled orbital such as a non-bonding orbital or antibonding orbital. This makes the molecule potentially very reactive, and in ceain situations can result in new bonds being made between different molecules. This is especially impoant for ceain molecules containing pi bonds such as the DNA bases. In paicular, when thymine absorbs UV light, is becomes reactive with an adjacent thymine molecule in the DNA double helix and can lead to formation of a cyclobutane dimer in which the two thymine residues are covalently linked. This makes it impossible for RNA polymerase to make an accurate mRNA from the DNA, so it effectively prevents the cell from being able to use the DNA to make the correct protein or even replicating. Cytosine residues can also form similar crosslinks. The general term used in the literature to describe these dimers is \"cyclobutane pyrimidine dimers, or CPDs\". Heavy exposure of your skin to UV light causes many such thymine crosslinks to form in the DNA. Founately, we have repair enzymes that can remove the thymine crosslinks and restore the DNA in your skin cells back to the correct sequence. When you get a sunburn, it is because you have caused more thymine crosslinks than can be repaired, so the cells generally just die. This results in the pain and dead skin you get with sunburns. However, in very rare cases, the thymine dimers interupt the funcions of just the right genes so that your skin cells become cancerous. In other words, they sta growing and do not stop like they should. You get tumors, and eventually the cancer cells invade vital organs and prevent an impoant function in your body and you could die. Reference: Harrisons Textbook of Internal Medicine; 19th edition", "cop": 1, "opa": "Free radical formation", "opb": "Induction of purine dimers", "opc": "mutation of p53", "opd": "Direct DNA damage", "subject_name": "Medicine", "topic_name": "Oncology", "id": "408acd87-2271-4ff4-8f96-4ae3462286a0", "choice_type": "single"}
+{"question": "Target BP before thrombolysis in ischemic stroke is below", "exp": "Ans. is 'a' i.e., 185/110 mm Hg", "cop": 1, "opa": "185/110 mmHg", "opb": "165/100 mm Hg", "opc": "145/100 Hg", "opd": "120/80 mm Hg", "subject_name": "Medicine", "topic_name": null, "id": "aef849f3-020a-43c4-a30c-555eb8216961", "choice_type": "single"}
+{"question": "\"Anhedonia\" means", "exp": "Defined as the inability to experience pleasure from activities usually found enjoyableAnhedonia can be characteristic of:Mood disordersSchizoaffective disorderBorderline personality disorderSchizoid personality disorderSchizophreniaRef: Ahuja 5/e p56, 58", "cop": 1, "opa": "Lack of interest", "opb": "Panic attacks", "opc": "Phobic attack", "opd": "Mood swings", "subject_name": "Medicine", "topic_name": "All India exam", "id": "60d6da3e-9a57-4c0f-ace7-25b96d50db98", "choice_type": "single"}
+{"question": "Mast cell stabilizer used in Bronchial Asthma is", "exp": "Mast cells are impoant in initiating the acute bronchoconstrictor responses to allergens & several other indirectly acting stimuli like exercise and hyperventillation.Ketotifen is a mast cell stabilizer which reduces the stimulation of mast cells and mediator release is reduced(histamine,PGD2,leukotrienes). Dose:1-2 mg BD;children 0.5 mg BD Reference:Harrison' s medicine-18th edition,page no:2104;Textbook of pharmacology-K D Tripathi,7th edition,page no:229", "cop": 2, "opa": "Raloxifene", "opb": "Ketotifen", "opc": "Azelastin", "opd": "Baclofen", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "d7da95ec-c0d5-4ca4-95a2-4ec899367efc", "choice_type": "single"}
+{"question": "Brain death is said to occur if there is", "exp": "(C) Absence of brainstem reflexes # BRAIN DEATH is present when there is irreversible loss of all brain function, both brain-stem function & cortical (hemisphere) function.> Brain death criteria - Loss of brainstem function & Absent cranial nerve reflexes - Pupillary light reflex; Corneal reflex; Oculoves-tibular reflex (cold caloric test; No gag reflex).> Absent respiratory brainstem reflexes is done by Apnea test: Loss of cortical function (No spontaneous movement; no response to external stimuli); Irreversibility.> Brain death is present when there is irreversible loss of brain function (criteria-loss of brainstem function) absent cranial nerve reflexes, pupillary light reflex, corneal reflex, oculovestibular reflex.", "cop": 3, "opa": "Absent spinal reflexes", "opb": "Cortical death following widespread brain injury", "opc": "Absence of brainstem reflexes", "opd": "Core temperature of the body is below 35degC", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "d8a62251-35e7-4935-a216-7047306cd163", "choice_type": "single"}
+{"question": "Caplan's syndrome is", "exp": "Rheumatoid Arthritis + Pneumoconiosis nodules = Caplan's syndrome.\nNeutropenia + Splenomegaly + Nodular RA = Felty's syndrome.", "cop": 2, "opa": "Splenomegaly + Neutropenia", "opb": "Rheumatoid Arthritis + Pneumoconiosis", "opc": "Pneumoconiosis + Splenomegaly", "opd": "Pneumoconiosis + Neutropenia", "subject_name": "Medicine", "topic_name": null, "id": "4ae5e8a4-6143-40e7-a113-06ebeea2ec00", "choice_type": "single"}
+{"question": "Most effective medication in GERD", "exp": "(A) PPI > They self-medicate with over the counter medicines such as simple antacids, antacid-alginate preparations and H2recepto' antagonists.> PPis, such as Omeprazole, lansoprazole and pantoprazole, are by far the most effective drug treatment for GERD.", "cop": 1, "opa": "PPI", "opb": "H, blockers", "opc": "Antacids", "opd": "Prokinetic drugs", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "1309a223-8158-48f7-af11-1658ab5ccf2d", "choice_type": "single"}
+{"question": "Punctuate yellow exudates in colon, found on endoscopic examiantion are indicative of", "exp": null, "cop": 3, "opa": "Balantidium coli", "opb": "Ulceratice colitis", "opc": "Antibiotic colitis", "opd": "Gluten induced enteropathy", "subject_name": "Medicine", "topic_name": null, "id": "41de8e3a-84f4-4036-ab44-20dbddf14cc4", "choice_type": "single"}
+{"question": "Gradient in pulmonary aery wedge pressure and left ventricular end diastolic pressure is seen in", "exp": "Answer is C (Left atrial myxoma) An increased gradient during diastole is suggestive of an obstructive lesion between Left atrium and Left ventricle that is not allowing pressures to normalize between the atria and ventricle such as atrial myxoma. Pulmonary aery wedge pressure represents Left atrial pressure. Left ventricular end diastolic pressure represents Left ventricular pressure. Gradient between Left atrial pressure (PCWP) and Left ventricular pressure during diastole: Normally there is no gradient during diastole as both pressures are equal. An increased gradient during diastole is suggestive of an obstructive lesion between Left atrium and Left ventricle that is not allowing pressures to normalize between the atria and ventricle. This may thus be seen in obstructive lesions between Left atria and ventricle such as : Mitral stcnosis Atrial myxomas", "cop": 3, "opa": "Aoic regurgitation", "opb": "Constrictive pericarditis", "opc": "Left atrial myxoma", "opd": "Pulmonary thromboembolism", "subject_name": "Medicine", "topic_name": null, "id": "a3a14fbb-8907-4618-b971-0172c3f5b382", "choice_type": "single"}
+{"question": "Lyme disease is", "exp": null, "cop": 3, "opa": "caused by Borrelia vincentii", "opb": "transmitted by flea bite", "opc": "diagnosed by demonstration of specific IgM antibody", "opd": "the etiological agent can be grown in modified Kelley's medium", "subject_name": "Medicine", "topic_name": null, "id": "ca11af79-4f49-468b-9a01-a11a87f86bf3", "choice_type": "single"}
+{"question": "Factor I and H deficiency causes", "exp": "A typical HUS (Non - epidemic, diarrhea negative) : common cause factor H & I deficiency.", "cop": 2, "opa": "Typical HUS", "opb": "Atypical HUS", "opc": "TTP", "opd": "Acute TTP", "subject_name": "Medicine", "topic_name": null, "id": "860d3e1e-37ff-4b38-b006-e9d2ed855800", "choice_type": "single"}
+{"question": "Treatment therapy for Pneumocystis carinii infection is", "exp": "(Co-trimoxazole) (1362-63-CMDT-09)Infection or MalignancyTreatmentPoenumocystis carinii/ JiroveciTrimethoprim-sulfamethoxazole orally or IV for 14-21 daysPentamidine, Trimethoprim, Primaquine, Atovaquone, TrimetrexateMycobacterium avium complex infectionClarithromycin with ethambutolToxoplasmosisPyrimethamine with sulfadiazine and Folinic acidLymphomaCombination chemotherapy (eg. Modified CHOP, M-BA COD, with or withoutG-CSF or GM-CSF)Central nervous system disease: radiation treatment with dexamethasone for edemaCryptococcal meningitisAmphotericin B, with or without flucytosineFluconazoleCytomegalovirus infectionValganciclovir, Ganciclovir, FoscametEsophageal candidiasis or recurrent vaginal candidiasisFluconazoleHerpes simplexAcyclovir, Famciclovir, Valacyclovir, FoscarnetHerpes zosterAcyclovir, Famciclovir, Valacyclovir, FoscarnetKaposis sarcoma Limited cutaneous diseaseObservation, intralesional VinblastineExtensive or aggressive cutaneous diseaseSystemic chemotherapy (eg. Liposomal Doxorubicin) Alpha interferon (For patients with CD4 > 200 cells/m/L and no constitutional symptoms).Radiation (amelioration of edema)Visceral disease(eg. Pulmonary)Combination chemotherapy (e.g. Daunorubicin, Bleomycin, Vinblastin)", "cop": 1, "opa": "Co-trimoxazole", "opb": "Ceftriaxone", "opc": "Ceftazidime", "opd": "Amicacin", "subject_name": "Medicine", "topic_name": "Infection", "id": "77f4d140-bfa0-421a-9f81-7f1ecbdb234f", "choice_type": "single"}
+{"question": "Cardioselective beta blockers is contraindicated in", "exp": "(B) II & III degree heart block# Except for those drugs specifically approved for use in heart failure, beta blockers are contraindicated in heart failure patients> Side effects of beta-blockers are related to their cardiac mechanisms and include bradycardia, reduced exercise capacity, heart failure, hypotension, and atrioventicular (AV) nodal conduction block.> Beta-blockers are therefore contraindicated in patients with sinus bradycardia and partial AV block.> Non-selective beta-blockers are contraindicated in patients with asthma or chronic obstructive pulmonary disease which is not a contraindication for cardioselective beta blockers.", "cop": 2, "opa": "COPD", "opb": "II & III degree heart block", "opc": "Asthma", "opd": "Tachycardia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "c093c8ce-1696-443f-adb7-e5997a6931da", "choice_type": "single"}
+{"question": "Clubbing is not seen in", "exp": "Clubbing not seen in COPD.", "cop": 4, "opa": "Bronchiectasis", "opb": "Hydropneumothorax", "opc": "ILD", "opd": "COPD", "subject_name": "Medicine", "topic_name": null, "id": "686391a7-5f73-44ff-9ad7-33ab9c0b0a59", "choice_type": "single"}
+{"question": "Pyknolepsy is seen in", "exp": "Pyknolepsy refers to a syndrome of typical absence seizures (both simple and complex) in otherwise normal, prepubeal children older than about 3 to 5 years. There is a strong genetic predisposition, and girls are more frequently affected. The absences are very frequent (occurring at least several times daily), and tend to cluster. The absences may remit during adolescence, but generalized tonic-clonic seizures may develop. The EEG reveals a bilateral, synchronous, symmetric 3-Hz spike-and-wave discharge with normal interictal background activity. No distinct clinical or EEG features completely differentiate childhood absence epilepsy from juvenile absent epilepsy Ref Harrison20th edition pg 2234", "cop": 2, "opa": "Lennox gastout syndrome", "opb": "Absence seizures", "opc": "Marcolepsy", "opd": "Adrenoleukodystrophy", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "a23b7fec-8666-45dd-8888-a9ce2b0e9efe", "choice_type": "single"}
+{"question": "A ventilator pressure relief valve stuck in closed position can result in", "exp": "A ventilator pressure relief valve stuck in closed position can generate excessively high pressure in the patient's lung,resulting in barotrauma.Barotrauma and volutrauma overdistend and distrupt lung tissue;may be clinically manifest by interstitial emphysema,or pneumothorax;and can result in the liberation of cytokines from over distended tissues,fuher promoting tissue injury. Reference:Harrison's Medicine", "cop": 1, "opa": "Barotrauma", "opb": "Hypoventilation", "opc": "Hypoxia", "opd": "Hyperventilation", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "3c8732e0-8801-4176-9574-69a38bcb4e97", "choice_type": "single"}
+{"question": "Treatment of choice for Echinococcus granulosus is.", "exp": "Answer is A (Albendazole): The drug of choice for treatment of Echinococcus granulosus injection (Hydatid cyst) is Albendazole.", "cop": 1, "opa": "Albendazole", "opb": "Mebendazole", "opc": "Thiobendazole", "opd": "Praziquantel", "subject_name": "Medicine", "topic_name": null, "id": "b866d93f-aec0-4401-822d-6f02c6dd4371", "choice_type": "single"}
+{"question": "Kussumauls breathing", "exp": "Rapid,deep(Kussmaul) breathing usually implies metabolic acidosis but may also occur with pontomesencephalic lesions. Ref:Harrison's medicine -18th edition,page no:2251.", "cop": 4, "opa": "Metabolic alkalosis", "opb": "Respiratory alkalosis", "opc": "Respiratory acidosis", "opd": "Metabolic acidosis", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "048023a8-f2c4-43b0-ba35-af0c68424222", "choice_type": "single"}
+{"question": "A patient develops Mitral Regurgitation following myocardial infarction. The likely cause for this complication is", "exp": "(B) Rupture of chorda tendinae # MR is frequently secondary to ischemia.> Thus, it may occur as a consequence of ventricular remodeling or with fibrosis of a papillary muscle in patients with healed myocardial infarction.> It may develop acutely in patients with acute infarction involving the base of a papillary muscle.", "cop": 2, "opa": "Infarction involving the valve", "opb": "Rupture of chorda tendinae", "opc": "Dilatation of the ventricle", "opd": "Atrial fibrillation", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "64fd31dc-ee60-4c02-9c5d-20e2d97cdcca", "choice_type": "single"}
+{"question": "Mental retardation is NOT a feature of one of the mucopolysaccaridos", "exp": "Mucopolysaccharidoses (MPS) The MPSs are a group of closely related syndromes that result from genetically determined deficiencies of enzymes involved in the degradation of mucopolysaccharides (glycosaminoglycans). Chemically, mucopolysaccharides are long-chain complex carbohydrates that are linked with proteins to form proteoglycans. They are abundant in the ground substance of connective tissue. The glycosaminoglycans that accumulate in MPSs are dermatan sulfate, heparan sulfate, keratan sulfate, and chondroitin sulfate. The enzymes involved in the degradation of these molecules cleave terminal sugars from the polysaccharide chains disposed along a polypeptide or core protein. In the absence of enzymes, these chains accumulate within lysosomes in various tissues and organs of the body. Several clinical variants of MPS, classified numerically from MPS I to MPS VII, have been described, each resulting from the deficiency of one specific enzyme. All the MPSs except one are inherited as autosomal recessive traits; the exception, Hunter syndrome, is an X-linked recessive trait. Within a given group (e.g., MPS I, characterized by a deficiency of a-l-iduronidase), subgroups exist that result from different mutant alleles at the same genetic locus. Thus, the severity of enzyme deficiency and the clinical picture even within subgroups are often different. In general, MPSs are progressive disorders, characterized by coarse facial features, clouding of the cornea, joint stiffness, and mental retardation. Urinary excretion of the accumulated mucopolysaccharides is often increased. Ref Robbins 9/e pg 154", "cop": 3, "opa": "Hurler MPS-I", "opb": "Hunter MPS-Il", "opc": "Sanfihippo MPS-III", "opd": "Morquio MPS-IV", "subject_name": "Medicine", "topic_name": "Genetics", "id": "3b2b7508-15f2-428a-a6d2-f71a4ac95635", "choice_type": "single"}
+{"question": "A boy is suffering from acute pyelonephritis. Most specific urinary finding will be", "exp": "Ans. is 'a' i.e. W.B.C. casts RememberThey have specifically asked about pyelonephritis, not urinary tract infection. There are three basic forms of urinary tract infectionPyelonephritisCystitisAsymptomatic bacteriuriapyelonephritisUrinary tract infection involving the renal parenchyma, if there is no parenchymal involvement, the condition may be termed pyelitis.cystitisIt indicates bladder involvement.asymptomatic bacteriuriaIt refers to individuals who have a positive urine culture without any manifestation of infection and occur almost exclusively in girls. Remember that casts can only be formed in the kidney. The presence of cast is specific for kidney. Casts cannot be formed from anywhere else in the urinary tractCasts are the only elements found in urinary sediments which are unique to the kidney.Thus whenever WBC casts are present in a patient suspected of having urinary tract infection it confirms pyelonephritis.According to Harrison \"leucocyte casts can be detected in urine of only selected patients but the detection of these casts is pathognomic\"About \"Bacteria in gram stain\"Bacteria in gram stain can be positive in any type of urinary tract infection whether it is pyelonephritis, cystitis, or urethritis.Presence of bacteria confirms the urinary tract infection but the exact site is detected by W.B.C. casts.Still of am not sure of the answer, because on page 251 Harrison states \"The presence of bacteria suggests infection and white blood cell casts with bacteria are indicative of pyelonephritis. White blood cells and or white blood cell casts may also be seen in tubulointerstitial processes such as interstitial nephritis, S.L.E and transplant rejection\"Nitrite testMore than 90% of common urinary pathogen (gram negative rods) are nitrite producing bacteria.In the presence of infection urinary nitrate is converted to nitrite which can be detected in urine.A positive nitrite test indicates infection with nitrite producing bacteria.Leucocyte esterase testA positive test is seen in presence of WBC's in urine and suggestive of pyuria.A positive leucocyte esterase test results from the presence of WBC. A negative leucocyte esterase test indicates that an infection is unlikely and that without additional evidence of urinary tract infection urine culture need not be.Once again, make it clear\"Although white cell casts may be observed in other conditions they are along with other features of UT1 specific for acute pyelonephritis \"'", "cop": 1, "opa": "W.B.C. casts", "opb": "Leucocyte esterase test", "opc": "Nitrite test", "opd": "Bacteria in gram stain", "subject_name": "Medicine", "topic_name": "Urinary Tract Infections and Interstitial Cystitis", "id": "da104459-b182-4a80-a8c4-19981a4f8e53", "choice_type": "single"}
+{"question": "The number of major hormones produced by the anterior pituitary gland is", "exp": "Six major hormones produced by anterior pituitary gland are Prolactin (PRL), Growth hormone (GH), Adrenocoicotropin hormone (ACTH), Luteinizing hormone (LH), Follicle-stimulating hormone (FSH) & Thyroid-stimulating hormone (TSH).Reference: Harrison 19th edition 401e-1", "cop": 3, "opa": "4", "opb": "5", "opc": "6", "opd": "7", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "1f5ccc91-2a52-4574-943e-a1c01714dcd8", "choice_type": "single"}
+{"question": "Most common cause of death in amyotropic lateral sclerosis is", "exp": "Answer-B. Respiratory failureAmyotrophic lateral sclerosis (ALS) is the most cornmon form of progressive motor neuron disease. It is a prime example of a neurodegenerative disease and is arguably the most devastating ofthe neurodegenerative disorders.Respiratory failure is the leading cause of death in amyotrophic lateral sclerosis, and terminal dysnoea is a major fear in patients with amyotrophic lateral sclerosis.", "cop": 2, "opa": "Cardiac failure", "opb": "Respiratory failure", "opc": "Renal failure", "opd": "Liver failure", "subject_name": "Medicine", "topic_name": null, "id": "141b83d9-eca5-4b10-afcb-2db7b99680b5", "choice_type": "single"}
+{"question": "Bronchial asthma patient on artificial ventilation requires", "exp": null, "cop": 4, "opa": "A low respiratory flow", "opb": "An equal IE ratio of 1:1", "opc": "An inverse ratio ventilation", "opd": "An IE ratio 1:2.5", "subject_name": "Medicine", "topic_name": null, "id": "b56ad393-d045-4024-a3d7-31113989acf1", "choice_type": "single"}
+{"question": "Amaurosis fugax is caused by occlusion of", "exp": "(C) Central retinal artery # Amaurosis fugax> It refers to a sudden, temporary and painless monocular visual loss occurring due to a transient failure of retinal circulation.> Its common causes are: carotid transient ischaemic attacks (TIA), embolization of retinal circulation, papilloedema, giant cell arteritis, Raynaud's disease, migraine, as a prodromal symptom of central retinal artery or carotid artery occlusion, hypertensive retinopathy, and venous stasis retinopathy.> An attack of amaurosis fugax is typically described by the patients as a curtain that descends from above or ascends from below to occupy the upper or lower halves of their visual fields.> The attack lasts for two to five minutes and resolves in the reverse pattern of progression, leaving no residual deficit.> Due to brief duration of the attack, it is rarely possible to observe the fundus.> When observed shortly after an attack, the fundus may either be normal or reveal signs of retinal ischemia such as retinal oedema and small superficial haemorrhages.> In some cases, retinal emboli in the form of white plugs (fibrin-platelet aggregates) may be seen.)", "cop": 3, "opa": "Facial artery", "opb": "Occipital artery", "opc": "Central retinal artery", "opd": "Posterior auricular artery", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "a653f2ba-4344-4f5d-935f-af27f0113cd6", "choice_type": "single"}
+{"question": "Moderate increase in serum aminotransferases with ASTiALT > 3 is suggestive of", "exp": "Ans. c (Alcoholic liver disease) (Ref: Harrison's Internal medicine 18th/Table 307-2)AST, ALTPredictors of alcoholic liver diseaseMild to moderate increaseMarked increaseAST> ALT= 2:1- suggestive.Fatty Liver pregnancyDrug-induced hepatitisAST > ALT = 3:1- Highly suggestive.Alcoholic liver diseaseCCFr GTP- Raised in all alcoholicsChronic hepatitisViral hepatitis (Acute)ALP- Moderate TPOOR PREDICTORS OF ALCOHOLIC HEPATITIS# PMN > 55,00/c mm# Discriminant score > 32# D.S = 4.6 X Prothrombin time control + Serum Bilirubin# Drug used for treatment: Prednisolone (DOC)-preferred choice; others-Pentoxiphylline, TNF a InhibitorsLaboratory Diagnosis of Alcoholic Fatty Liver and Alcoholic HepatitisTestCommentASTIncreased two- to sevenfold, <400 U/L, greater than ALTALTIncreased two- to sevenfold, <400 U/LAST/ALTUsually >1GGTP (maglutamyl transpeptidase)Not specific to alcohol, easily inducible, elevated in all forms of fatty liverBilirubinMay be markedly increased in alcoholic hepatitis despite modest elevation in alkaline phosphatasePolymorphonuclear cellsIf >5500/L, predicts severe alcoholic hepatitis when discriminant function >32", "cop": 3, "opa": "Acute viral hepatitis", "opb": "Prolonged hypotension", "opc": "Alcoholic liver disease", "opd": "Drug hepatotoxicity", "subject_name": "Medicine", "topic_name": "G.I.T.", "id": "29da9acb-c6a1-42cc-ad12-09b41aae9ab4", "choice_type": "single"}
+{"question": "MELD score includes A/E", "exp": "Ans. is 'a' i.e., Sr. creatinine The Model for End-stage Liver Disese (MELD) is a prospectively developed and validated chronic liver disease severity scoring system that uses a patient's laboratory values for - Li Serum bilirubin Serum creatinine The international normalized ratio (INR) for prothrombin time to predict three month survival. Patients with cirrhosis, and increasing MELD score is associated with increasing severity of hepatic dysfunction and increased three-month moality risk. Given its accuracy in predicting sho-term survival among patients with cirrhosis, MELD was adopted by the United network for organ sharing (UNOS) in 2002 for prioritization or patients awaiting liver trasplantation in the United states. Pediatric end stage liver disease (PELD) Serum bilirubin INR Serum albumin Age Nutritional status", "cop": 1, "opa": "Sr. creatinine", "opb": "Transaminase", "opc": "Albumin", "opd": "Alkaline phosphatase", "subject_name": "Medicine", "topic_name": null, "id": "849c3592-fff8-4ea4-b9cf-05560922830c", "choice_type": "single"}
+{"question": "A patient was on antiepileptics. Hirsutism, coarsening of facial features, gingival hyperophy is noted in the patient. The epileptic could be", "exp": "Long-term use of phenytoin is associated with untoward cosmetic effects (e.g., hirsutism, coarsening of facial features, gingival hyperophy) and effects on bone metabolism. Due to these side effects, phenytoin is often avoided in young patients who are likely to require the drug for many years.Ref: Harrison 19e 2552", "cop": 1, "opa": "Phenytoin", "opb": "Valproic acid", "opc": "Ethosuximide", "opd": "Lamotrigine", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "964b8849-aa2d-49cd-8a87-40304a4e4cfa", "choice_type": "single"}
+{"question": "A 25 year old patient complains of Crushing chest discomfort for 45 minutes, no significant medical history. ECG is normal. His chest pain improved with sublingual nitroglycerin diagnosis is", "exp": "DES →\nChest pain simulate that of MI\nPain can be precipitated by drinking cold liquids.", "cop": 1, "opa": "Diffuse esophagial spasm", "opb": "Myocardial infarction", "opc": "Anxiety attack", "opd": "scleroderma", "subject_name": "Medicine", "topic_name": null, "id": "c0979c63-c76b-41d5-a57a-a55896670dc7", "choice_type": "single"}
+{"question": "Indication for prophylaxis in pneumocystis carini pneumonia include", "exp": "Ans. is 'a' i.e., CD4 count < 200 PROPHYLAXIS OF PNEUMOCYSTIC CARINH PNEUMONL4 Primary prophylaxis is indicated for Patients with CD4- cell counts of< 200/4 History of oropharyngeal candidiasis Secondary prophylaxis is indicated for Both HIV infected and non HIV infected patients. Who have recovered from pneumocystosis. Primary and secondary prophylaxis may be discontinued in HIV infected persons once. CD4+ counts have risen to > 200/p1 and remained at that level for 3 months. Also know First choice agent for prophylaxis Trimethoprim, sulphamethoxazole. Other agents used in prophylaxis. Dapsone, pentamidine.", "cop": 1, "opa": "CD4 count < 200", "opb": "Tuberculosis", "opc": "Viral load > 25,000 copies/ml", "opd": "Oral candidiasis", "subject_name": "Medicine", "topic_name": null, "id": "707f4338-6f87-458b-b640-9af310a18e27", "choice_type": "single"}
+{"question": "A patient comes with sudden respiratory distress, on examination, bilateral basal crepts are present over chest suggestive of pulmonary edema with normal alveolar wedge pressure. The likely cause is", "exp": "Answer is A (Narcotic overdose): Pulmonary edema with normal pulmonary capillary wedge pressure suggests a diagnosis of ARDS or non cardiogenic pulmonary edema. Narcotic overdose is the only non cardiogenic cause for pulmonary edema (ARDS) amongst the options provided and hence the answer here.", "cop": 1, "opa": "Narcotic overdose", "opb": "Congestive hea failure", "opc": "Myocardial infarction", "opd": "Cardiogenic shock", "subject_name": "Medicine", "topic_name": null, "id": "89fc1b77-c3b6-40a9-8f8f-5db4ac525b7d", "choice_type": "single"}
+{"question": "The most common causative organism causing lobar pneumonia is", "exp": "Although Streptococcus pneumoniae is most common, other organisms must also be considered in light of the patient&;s risk factors and severity of illness.(Ref: Harrison's 18/e p2131)", "cop": 3, "opa": "Staphylococcus aureus", "opb": "Streptococcus pyogenes", "opc": "Streptococcus pneumonia", "opd": "Hemophilus influenza", "subject_name": "Medicine", "topic_name": "All India exam", "id": "cdc21685-40ec-47eb-a1ee-a71bdf1df620", "choice_type": "single"}
+{"question": "Gamma Glutamyl Transferase is increased in", "exp": "(A) Alcoholic hepatitis # Function of GGT:> It is involved in the transfer of amino acids across the cellular membrane and in glutathione metabolism.> Location> GGT is found in high concentrations in the liver, bile ducts and kidney.> Enzyme is also present in other tissues, such as the epididymis.> Clinical significance Congestive heart failure Cholestasis (congestion of the bile ducts) Cirrhosis of the liver Restricted blood flow to the liver Restricted venous outflow from liver like Budd-Chiari syndrome Necrosis of the liver Liver tumors Hepatitis Hepatotoxic drugs> Its levels are increased in chronic and acute alcohol abuse.", "cop": 1, "opa": "Alcoholic hepatitis", "opb": "Pancreatitis", "opc": "Hepatocellular carcinoma", "opd": "Infective hepatitis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "156f5269-631c-426f-850e-f49f69964d1e", "choice_type": "single"}
+{"question": "AIDS was first diagnosed in patients suffering from", "exp": null, "cop": 2, "opa": "Ciytococcus neoformans meningitis", "opb": "Pneumocystis carini", "opc": "Kaposi sarcoma", "opd": "Tuberculosis", "subject_name": "Medicine", "topic_name": null, "id": "1ffb73cd-b779-46bc-8b61-09612e9172f6", "choice_type": "single"}
+{"question": "CSF glucose level is", "exp": "Answer is B (2/3 of plasma glucose):", "cop": 2, "opa": "Half the plasma glucose", "opb": "2/3 plasma glucose", "opc": "1/3 plasma glucose", "opd": "Same as plasma glucose", "subject_name": "Medicine", "topic_name": null, "id": "700dea0c-8593-43cb-b6a4-0c62bcc2cfc4", "choice_type": "single"}
+{"question": "Positive hepatojugular reflux is found in", "exp": "As is the case for TS, the clinical features of TR result primarily from systemic venous congestion and reduction of CO. With the onset of TR in patients with PA hypeension, symptoms of pulmonary congestion diminish, but the clinical manifestations of right-sided hea failure become intensified. The neck veins are distended with prominent v waves and rapid y descents, marked hepatomegaly, ascites, pleural effusions, edema, systolic pulsations of the liver, and a positive hepatojugular reflex. ref : Harrison&;s principle of internal medicine,20th edition,pg no.1948", "cop": 1, "opa": "Tricuspid regurgitation", "opb": "Left hea failure", "opc": "Decreased after load", "opd": "decreased capillary bed pressure", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "712ca697-9fa1-4cf9-84ae-179ecb2dc16b", "choice_type": "single"}
+{"question": "100% recurrence of disease in Down's syndrome", "exp": "100% recurrence of disease in Down's syndrome is due to balanced translocation (21 : 21).", "cop": 3, "opa": "Translocation of 15 + 21 chromsome", "opb": "Mosaic pattern", "opc": "Trisomy - (21, 21 translocation)", "opd": "Non Dysjunction", "subject_name": "Medicine", "topic_name": null, "id": "bf756858-928b-461e-945c-b1f7a805fce8", "choice_type": "single"}
+{"question": "Celiac sprue is associated with", "exp": "The precise mechanism of mucosal damage is unclear but immunological responses to gluten play a key role . There is a strong genetic component, with around 10% of first-degree relatives of an index case affected, and there is strong (approximately 75%) concordance in monozygotic twins. There is a strong association with human leukocyte antigen (HLA)-DQ2/DQ8. Dysbiosis of the intestinal microbiota has been identified but it is unclear if this is pathological or a response to the underlying mucosal changes Ref Davidson edition23rd pg 805", "cop": 2, "opa": "DR4", "opb": "DQ2", "opc": "DR3", "opd": "B27", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "561de3f1-4d74-4437-bbc9-7845cfa395b7", "choice_type": "single"}
+{"question": "Most common cause of epidural abscess", "exp": "Harrison's principles of internal medicine. * Staphylococci or gram negative organisms are the usual cause of an epidural abscess", "cop": 1, "opa": "Staphylococcus", "opb": "Streptococcus", "opc": "Gram negative bacilli", "opd": "Microanerophilic anaerobic streptococci", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "94334499-a6b2-4393-b3cc-f07406aa6bb9", "choice_type": "single"}
+{"question": "Earliest feature in Multiple sclerosis is", "exp": "* Initial Symptoms and percent of cases Sensory loss -37% Optic neuritis- 36% Weakness -35% Ataxia-11%. Optic nerve Pain and temporary vision loss in one eye are common symptoms of optic neuritis. Optic neuritis is linked to multiple sclerosis (MS), a disease that causes inflammation and damage to nerves in your brain and spinal cord Ref Davidson edition23rd pg1110", "cop": 1, "opa": "Optic neuritis", "opb": "Inter nuclear ophthalmologia", "opc": "Ataxia", "opd": "Weakness", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "955fe790-1a6e-49e1-8860-fc7475a7cdfb", "choice_type": "single"}
+{"question": "Mycosis fungoides is best described as", "exp": "Ans d: (Cutaneous Lymphoma) Ref: Harrison 17th edition pg 697 Mycosis fungoides is a lymphoid neoplasm of mature T cell * Median age of presentation - mid fifties * Males > females * Indolent lymphoma with patient often having several years of eczematous or dermatitic skin lesions before diagnosis is established * Skin lesions progress from patch- plaque & cutaneous tumours * Advanced stage lymphoma spread to lymph node and viscera * Patient with this may develop generalised erythroderma and circulates tumour cells- Sezary syndrome Rx Localised early stage- radiotherapy often total skin electron beam radiation More advanced- Topical gluco- corticoid Topical N2 mustard Phototherapy Psoralen with UV A(PUVA) Interferon, antibodies etc", "cop": 4, "opa": "Cutaneous fungal infection", "opb": "Exematous reaction", "opc": "skin", "opd": "Cutaneous Lymphoma", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "e290751e-244f-4ad0-9793-a0f40e498bfe", "choice_type": "single"}
+{"question": "Bence jones proteinuria is best detected by", "exp": "Ans. is `d' i.e., Electrophoresis Bence Jones proteins are seen in multiple myeloma. Urinary protein electrophoresis will exhibit a discrete protein peak. In myeloma plasma cells produce immuno-globulin of a single heavy and light chain, a monoclonal protein commonly referred to as a paraprotein. Heat test is false negative in 50% of patients with light chain myeloma. Dipstick detects albumin and not paraproteins.", "cop": 4, "opa": "Dipstick method", "opb": "Sulfosalicylic acid", "opc": "Heat test", "opd": "Electrophoresis", "subject_name": "Medicine", "topic_name": null, "id": "95c60fe4-9809-4d32-9194-e3e797fc4a02", "choice_type": "single"}
+{"question": "Best natural source of iodine is", "exp": "Best natural source of iodine is - Sea foods.", "cop": 2, "opa": "Milk", "opb": "Sea foods", "opc": "Salt", "opd": "Green leafy Vegetables", "subject_name": "Medicine", "topic_name": null, "id": "4fd9c7ca-54c0-4195-b8c3-1d23ee89c070", "choice_type": "single"}
+{"question": "Hampton's hump is associated with", "exp": "(D) Pulmonary thromboembolism > Hampton's hump, also called Hampton hump, is a radiologic sign seen on chest radiographs indicating pulmonary infarction and atelectasis classically due to pulmonary embolism. It was first described by Aubrey Otis Hampton.> It consists of a pleura based shallow wedge-shaped consolidation in the lung periphery with the base against the pleural surface.> A normal or near-normal chest x-ray in a dyspneic patient suggests PE. Well-established abnormalities include focal oligemia (Westermark's sign), a peripheral wedged-shaped density above the diaphragm (Hampton's hump), or an enlarged right descending pulmonary artery (Palla's sign).", "cop": 4, "opa": "Aspergellosis", "opb": "Bronchial carcinoma", "opc": "Pulmonary tuberculosis", "opd": "Pulmonary thromboembolism", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "925b2e02-01b4-40d3-a7a4-9651ea0379cd", "choice_type": "single"}
+{"question": "Munchaussen syndrome is a", "exp": "(A) Factitious disorder # FACTITIOUS DISORDERS are conditions in which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms. Factitious disorder by proxy is a condition in which a person deliberately produces, feigns, or exaggerates symptoms in a person who is in their care. Munchausen syndrome is an older term for Factitious disorder. People with this condition may produce symptoms by contaminating urine samples, taking hallucinogens, injecting themselves with bacteria to produce infections, and other such similar behaviour. They might be motivated to perpetrate factitious disorders either as a patient or by proxy as a caregiver to gain any variety of benefits including attention, nurturance, sympathy, and leniency that are unobtainable any other way. Somatoform disorders are characterised by multiple somatic complaints. Conversion disorder is a condition in which you show psychological stress in physical ways. The condition was so named to describe a health problem that starts as a mental or emotional crisis -- a scary or stressful incident of some kind -- and converts to a physical problem. Malingering is a medical term that refers to fabricating or exaggerating the symptoms of mental or physical disorders for a variety of \"secondary gain\" motives, which may include financial compensation (often tied to fraud); avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences; or simply to attract attention or sympathy. Dissociation is an altered state of consciousness characterized by partial or complete disruption of the normal integration of a person's normal conscious or psychological functioning. Dissociation is most commonly experienced as a subjective perception of one's consciousness being detached from one's emotions, body and/or immediate surroundings.", "cop": 1, "opa": "Factitious disorder", "opb": "Conversion disorder", "opc": "Malingering", "opd": "Dissassociation disorder", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "cb9c0a7d-83e0-475d-aedb-62b0601e0ee4", "choice_type": "single"}
+{"question": "HbA1c reduction is maximum with use of", "exp": "Mechanism of ActionExamplesHbA Reduction (%)Agent-Specific AdvantagesAgent-Specific DisadvantagesContraindicationsOralBiguanides|Hepatic glucose productionMetformin1-2Weight neutral, do not cause hypoglycemia, inexpensive, extensive experience, |CV eventsDiarrhea, nausea, lactic acidosisSerum creatinine> 15 mg/dL (men)>1.4 mg/dL (women)(see text), CHF, radio graphic contrast studies,hospitalized patients,acidosisRenal/liver diseasea-Glucosidase inhibitors|GI glucose absorptionAcarbose, miglitol, voglibose0.5-0.8Reduce postprandial glycemiaGI flatulence, liver function testsRenal/liver diseaseDipeptidyl peptidase IV inhibitorsProlong endogenous GLP-1 actionAlogliptin, Linagliptin, Gemigliptin, linagliptin, saxagliptin,sitagliptin, teneligliptin, vildagliptin0.5-0.8Well tolerated, donot cause hypoglycemia Reduced dose with renal disease; one associated with increase hea fail pure risk; possible association with ACE inhibitor-induced angioedemaInsulin secretagogues:Sulfonylureas|Insulin secretionGlibornuride, gliclazide, glimepiride,glipizide, gliquidone,glyburide,glyclopyramide1-2Sho onset of action, lower postprandial glucose, inexpensiveHypoglycemia, weight gainRenal/liver diseaseInsulin secretagogues:Nonsulfonylureas|Insulin secretionNateglinide, repaglinide, mitiglinide0.5-1.0Sho onset of action, lower postprandial glucoseHypoglycemiaRenal/liver diseaseSodium-glucose cotranspoer 2 inhibitors|Urinary glucose excretionCanagliflozin,dapagliflozin,empagliflozin0.5-1.0Insulin secretion and action independentUrinary and vaginal infections, dehydration, exacerbate tendency to hyperkalemiaLimited clinical experience; moderate renal insufficiencyThiazolidinediones|Insulin resistance,|glucose utilizationRosiglitazone, pioglitazone0.5-1.4Lower insulin requirementsPeripheral edema,CHF, weight gain,fractures, macularedemaCHF, liver disease Ref: Harrison 19e pg: 2414", "cop": 1, "opa": "Metformin", "opb": "Anagliptin", "opc": "Voglibose", "opd": "Rosiglitazone", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "35101ac7-b137-4a44-b9f1-df16cdebfba9", "choice_type": "single"}
+{"question": "Sudden death can be due to", "exp": "Ans. a (Ventricular fibrillation). (Ref. Harrison, Principles of Medicine, 18th/Chapter 233.)# Most common electrical mechanism of true cardiac arrest is ventricular fibrillation, responsible for 65-80% of cardiac arrests.# Episodes of cardiac arrest during Holter monitoring reveal that 3/4th of sudden deaths are due to VT/VF.# Treatment: Imparted cardioversion/defibrillator/amiodarone.VPCs in asymptomatic Young individual need no treatment.", "cop": 1, "opa": "Ventricular fibrillation", "opb": "QT prolongation", "opc": "Atrial flutter", "opd": "VPCs", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "6abdbfa4-92c6-4eeb-a3d7-b7330aef7949", "choice_type": "single"}
+{"question": "Condition with characteristic EEG finding", "exp": "(A) SSPE # SSPE- Periodic discharges at 4 sec interval. Maximum at fronto central areas Giant slow waves mixed with several sharp waves.", "cop": 1, "opa": "SSPE", "opb": "REM sleep", "opc": "Partial Seizure", "opd": "Absence Seizure", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f5303248-519a-4881-a240-aee3630d0a30", "choice_type": "single"}
+{"question": "Bechterews disease also known as", "exp": "Ans. is 'b' i.e., Ankylosing spondylitis ANKYLOSING SPONDYLITIS (MARIE - STRUMPELL DISEASE) Ankylosing spondylitis is a chronic progressive inflammatory disease of the sacroiliac joints and the axial skeleton. Prototype of seronegative (absence of rheumatoid factor) spondyloahropathies. Inflammatory disorder of unknown cause. Usually begins in the second or third decade with a median age of 23, in 5% symptoms begin after 40. o Male to female ratio is 2-3 : 1 Strong correlation with HLA-B27 90-95% of cases are positive for HLA B27. Joints involved in ankvlosing spondylitis Ankylosing spondylitis primarily affects axial skeleton. The disease usually begins in the sacro-iliac joints and usually extends upwards to involve the lumbar, thoracic, and often cervical spine. In the worst cases the hips or shoulders are also affected. Hip joint is the most commonly affected peripheral joint. o Rarely knee (Ebenzar 4thie 593) and ankle (Apley's 9th/e 67) are also involved. Clinical features Low back pain of insidious onset Duration usually less than 3 months Significant morning stiffness and improvement with exercise o Limited chest expansion Diffuse tenderness over the spine and sacroiliac joints Loss of lumbar lordosis, increased thoracic kyphosis Decreased spinal movements (especially extension) in all directions. Radiological features of ankvlosing spondvlitis Radiographic evidence of sacroiliac joint is the most consistent finding in ankylosing spondylitis and is crucial for diagnosis. The findings are :? Sclerosis of the aiculating surfaces of SI joints Widening of the sacroiliac joint space Bony ankylosis of the sacroiliac joints Calcification of the sacroiliac ligament and sacro-tuberous ligaments Evidence of enthesopathy - calcification at the attachment of the muscles, tendons and ligaments, paicularly around the pelvis and around the heel. o X-ray of lumbar spine may show :- Squaring of veebrae : The normal anterior concavity of the veebral body is lost because of calcification of the anterior longitudinal ligament. Loss of the lumbar lordosis Bridging `osteophytes' (syndesmophytes) Bamboo spine appearance", "cop": 2, "opa": "Rheumatoid ahritis", "opb": "Ankylosing spondylitis", "opc": "Osteoahritis", "opd": "Syphilitic ahritis", "subject_name": "Medicine", "topic_name": null, "id": "9207d3a9-b1db-44b1-a8b3-8cf4644ac5e3", "choice_type": "single"}
+{"question": "Renal Calculi associated with Proteus infection is", "exp": "Phosphate calculus Phosphate calculus is smooth and diy whiteIt tends to grow in alkaline urine, especially when urea-splitting Proteus organisms are present; As a result, the calculus may enlarge to fill most of the collecting system, forming a staghorn calculusStaghorn calculus may be clinically silent for years and may present with haematuria, urinary infection or renal failure(Ref: Harrison's 18/e p2387; Bailey 26/e p1293)", "cop": 2, "opa": "Uric Acid", "opb": "Triple Phosphate", "opc": "Calcium oxalate", "opd": "Xanthine", "subject_name": "Medicine", "topic_name": "All India exam", "id": "673e5b77-9708-4e98-8705-fbf73393530b", "choice_type": "single"}
+{"question": ". Beevor sign is Seen in", "exp": "*Lesion at T9-T10 paralyse the lower,but not upper-abdominal muscles,resulting in upward movement of the umbilicus when the abdominal wall contracts. Beevor's sign is medical sign seen in the selective weakness of the lower abdominal muscles, involving the movement of the navel towards the head on flexing the neck Beevor's sign is characteristic of spinal cord injury between T9 and T10 levels. This occurs when the upper pa of the Rectus abdominis muscle is intact but the lower pa is weak because of the spinal injury. Thus when the patient is asked to raise his head as he lies supine on bed, only the upper pa of the muscle contracts pulling the umbilicus toward the head. The sign has also been observed in amyotrophic lateral sclerosis, a disease associated with progressive weakening of the muscles of multiple areas of the body, and in facioscapulohumeral muscular dystrophy, a disease of weakness of predominantly the facial, shoulder and upper arm muscles. Ref Harrison20th edition pg 2611", "cop": 1, "opa": "Abdominal muscle", "opb": "Respiratory muscle", "opc": "Facial muscle", "opd": "Hand muscle", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "5bad6fde-dda2-4246-b6d8-9ac98b1a436f", "choice_type": "single"}
+{"question": "Kimmelstiel Wilson disease is", "exp": null, "cop": 3, "opa": "Diffuse glomerulosclerosis", "opb": "Capillary basement membrane thickening", "opc": "Nodular glomerulosclerosis", "opd": "Increase in meningeal matrix", "subject_name": "Medicine", "topic_name": null, "id": "2820f732-df2e-4a9c-a17d-9a9b950ce99d", "choice_type": "single"}
+{"question": "The Antiepileptic drug, Phenytoin therapeutic blood level is", "exp": "(B) 10-19 mcg/ml# SERUM PHENYTOIN LEVELS:> Therapeutic range is 10-20 mcg/mL.# Total phenytoin levels (mcg/mL) - Typical corresponding Signs & Symptoms: Lower than 10- Rare Between 10 and 20 - Occasional mild nystagmus Between 20 and 30 - Nystagmus Between 30 and 40 - Ataxia, slurred speech, nausea, and vomiting Between 40 and 50 - Lethargy and confusion Higher than 50 - Coma and seizures", "cop": 2, "opa": "0-9 mcg/ml", "opb": "10-19 mcg/ml", "opc": "20-29 mcg/ml", "opd": "30-39 mcg/ml", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "00ccbfce-7492-4853-8dba-42b7569f0564", "choice_type": "single"}
+{"question": "A thiy five year old female has proximal weakness of muscles, ptosis and easy fatigability. The most sensitive test to suggest the diagnosis is.", "exp": "Tensilon test (edrophonium test) is a pharmacological test used for the diagnosis of ceain neural diseases, especially myasthenia gravis. It is also used to distinguish a myasthenic crisis from a cholinergic crisis in individuals undergoing treatment for myasthenia gravis 10 mg edrophonium hydrochloride syringe and a 2 mg atropine syringe are prepared. Atropine is prepared for immediate use in case cholinergic crisis occurs. After a neurologic examination and recording of vital signs, first 2 mg edrophonium is injected intravenously. After waiting 30 seconds and ensuring that no adverse reactions occurred, the remaining 8 mg of edrophonium is also injected. A patient suffering from myasthenia gravis experiences improvement in muscle strength and endurance with repetitive movements, while normal persons do not feel any difference. The effects of edrophonium lasts around 10 minutes. The edrophonium allows accumulation of acetylcholine (ACh) in the neuromuscular junctions, and makes more ACh available to the muscle receptors, thereby increasing muscle strength in myasthenia gravis. In newborns, a 0.15 mg/kg edrophonium administered subcutaneously produces a response within 10 minutes. In infants, the drug is administered intravenously at a dose of 0.2 mg/kg. Improvement of diplopia is often used as an evaluation item because in this case, placebo effect can be excluded Ref Harrison20th edition pg 2456", "cop": 3, "opa": "Muscle Biopsy", "opb": "CPK levels", "opc": "Edrophonium test", "opd": "EMG", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "2c4cac73-1967-46ae-a586-185549de5c20", "choice_type": "single"}
+{"question": "Birefringent crystals in urine is seen with", "exp": "Uricosuria refers to uric acid in the urine. Urine levels of uric acid can be described as: Hyperuricosuria, an abnormally high level of uric acid in the urine. Hypouricosuria, an abnormally low level of uric acid in the urine.briskeffervence crystals are seen in urine Ref Harrison20th edition pg 277", "cop": 2, "opa": "Phosphaturia", "opb": "Uricosuria", "opc": "Cystinuria", "opd": "Struvite stones", "subject_name": "Medicine", "topic_name": "Kidney", "id": "ee6e69b8-5a2d-459d-a862-b101839959dd", "choice_type": "single"}
+{"question": "Dialysis disequilibrium is due to", "exp": "Dialysis disequilibrium syndrome due to rapid shifts in urea levels which induce cerebral Odema.", "cop": 3, "opa": "Hypovolemia", "opb": "Bicarbonate Containing dialysate", "opc": "Cerebral Odema", "opd": "Hypokalemia", "subject_name": "Medicine", "topic_name": null, "id": "9478b59b-586c-44be-8b4b-92499637576e", "choice_type": "single"}
+{"question": "Osteitis fibrosa cystica is seen in", "exp": "The clinical presentation of primary hyperparathyroidism is described on page 769. Parathyroid bone disease is now rare due to earlier diagnosis and treatment. Osteitis fibrosa results from increased bone resorption by osteoclasts with fibrous replacement in the lacunae. This may present as bone pain and tenderness, fracture and deformity. Chondrocalcinosis can occur due to deposition of calcium pyrophosphate crystals within aicular cailage. It typically affects the menisci at the knees and can result in secondary degenerative ahritis or predispose to attacks of acute pseudogout Skeletal X-rays are usually normal in mild primary hyperparathyroidism, but in patients with advanced disease characteristic changes are observed. In the early stages there is demineralisation, with subperiosteal erosions and terminal resorption in the phalanges. A 'pepper-pot' appearance may be seen on lateral X-rays of the skull. Reduced bone mineral density, resulting in either osteopenia or osteoporosis, is now the most common skeletal manifestation of hyperparathyroidism. This is usually not evident radiographically and requires assessment by DEXA (p. 1065). Primary hyperparathyroidism Primary hyperparathyroidism is caused by autonomous secretion of PTH, usually by a single parathyroid adenoma, which can vary in diameter from a few millimetres to several centimetres. It should be distinguished from secondary hyperparathyroidism, in which there is a physiological increase in PTH secretion to compensate for prolonged hypocalcaemia (such as in vitamin D deficiency, p. 1126), and from teiary hyperparathyroidism, in which continuous stimulation of the parathyroids over a prolonged period of time results in adenoma formation and autonomous PTH secretion (Box 20.39). This is most commonly seen in individuals with advanced chronic kidney disease (p. 483). The prevalence of primary hyperparathyroidism is about 1 in 800 and it is 2-3 times more common in women than men; 90% of patients are over 50 years of age. It also occurs in the familial MEN syndromes (p. 795), in which case hyperplasia or multiple adenomas of all four parathyroid glands are more likely than a solitary adenoma. Clinical and radiological features The clinical presentation of primary hyperparathyroidism is described on page 769. Parathyroid bone disease is now rare due to earlier diagnosis and treatment. Osteitis fibrosa results from increased bone resorption by osteoclasts with fibrous replacement in the lacunae. This may present as bone pain and tenderness, fracture and deformity. Chondrocalcinosis can occur due to deposition of calcium pyrophosphate crystals within aicular cailage. It typically affects the menisci at the knees and can result in secondary degenerative ahritis or predispose to attacks of acute pseudogout In nephrocalcinosis, scattered opacities may be visible within the renal outline. There may be soft tissue calcif ication in aerial walls and hands and in the cornea. DAVIDSONS PRINCIPLES AND PRACTICE OF MEDICINE 22ND EDITION PAGE NO-769", "cop": 1, "opa": "Hyperparathyroidism", "opb": "Hypoparathyroidism", "opc": "Hypothroidism", "opd": "Hypehyroidism", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "7ff472eb-ccce-4667-a1a0-4e1a209bc1a1", "choice_type": "single"}
+{"question": "Lesion is Alzheimer's disease are commonest at", "exp": "Nucleus basalis of Meyne for Alzheimer's disease and Parkinson's disease dementia. The nucleus basalis of Meyne (NBM) is a large source of cholinergic innervation to widespread coical areas. There have been two repos of DBS of the NBM for either AD or PD. Ref Harrison20th edition pg 2456", "cop": 2, "opa": "Aniygdala", "opb": "Nucleus of Meynes", "opc": "Pineal gland", "opd": "Prefrontal sulcus", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "23b6a6ff-c056-4c39-8f9e-21763c2e6809", "choice_type": "single"}
+{"question": "Tuberculides are seen in", "exp": "(Lichen scrofulosorum) (202-Behl lCfh, 1756-Dorland 28th, 219- Neena khanna)TUBERCULIDES - Group of disease where the evidence for a tuberculous etiology is not definite {May be hypersensitivity reaction) but which show a tuberculous granuloma on histology and respond to ATT)Conditions included in TuberculidsCutaneous Tuberculosis (Non Tuberculides)* Lichen scrofulosorum* Lupus vulgaris* Erythema- induratum* Sacrofuloderma* Papulonecrotc tuberculides (Acne-scrafulosorum)* Tubercularis cutis verrucosus* Lupus miliaris disseminatus faciei* Miliary tuberculosis and metastatic tuberculosis* Rosaceous tuberculide* Miliary tuberculosis and metastatic tuberculosis abscess may also present as cutaneous tuberculosis(According to 'Behl' Erythema - nodosum is also a tuberculide while some texts do not include it as a tuberculide)Features of TB in AIDS patients* |Sputum positivity *** Little or no cavitation*** |ed extra pulmonary tuberculosis *** Negative PPD skin test*** Lack of classic granuloma* Atypical CXR- Diffuse interstitial or military infiltrate* Response to short course chemotherapy is similar*** but adverse effects may be more pronounced including severe or even fatal skin disease* High rate of reactivation Indications of pulmonary resection in tuberculosis / haemoptysis areAbsoluteRelative* Massive haemoptysis (600cc/24 hours)* Destroyed lung, positive sputum* Bronchopleural fistula* Suspicion of carcinoma* Haemoptysis* Bronchial stenosis* Persistent positive sputum* Open negative cavity* T.B. Empyema* Atypical tuberculus infections* Aspergilloma (Fungus balls)Lupus - vulgaris - is a form of cutaneous tuberculosis that is seen in previously infected and sensitized individualsLupus- pernio - is a particular type of sarcoidosis that involves the tip of nose & earlobes with lesions that are violaceous in colourSpino- ventosa - Tuberculosis of bone in which bone is expanded & the cortex thins eg digitsScrofuloderma - Tuberculosis first develops in a lymph node or a bone producing a swelling and subsequently ruptures through the overlying skinFalse negative tuberculin skin test - reactions may result from improper testing technique - concurrent infections, malnutrition advanced age, immunologic disorders, lymphoreticular malignancies, corticosteroid therapy, CRF, HIV infections and fulminant tuberculosis", "cop": 3, "opa": "Lupus vulgaris", "opb": "Scrofuloderma", "opc": "Lichen scrofulosorum", "opd": "Erythema nodosum", "subject_name": "Medicine", "topic_name": "Skin", "id": "e476792d-b36e-42fd-889a-cfad35d4693d", "choice_type": "single"}
+{"question": "Oliguric phase of ARF is characterized by A/E", "exp": "Ans. is 'd' i.e., Hypokalemia", "cop": 4, "opa": "Chest pain", "opb": "Acidosis", "opc": "Hypeension", "opd": "Hypokalemia", "subject_name": "Medicine", "topic_name": null, "id": "695ed886-56c3-4db3-9052-c2f951075512", "choice_type": "single"}
+{"question": "Treatment of choice in neurocysticercoses of T. Solium", "exp": "(B) (Albendazole) (3431-H 18th)* Albendazole 15 mg/kg daily for a minimum of 8 days has become the drug of choice for parenchymal neurocysticercosis (380- Davidson 22nd)* Approximately 85% of parenclymal cysts are destroyed by a single course fo albendazole and 75% are destroyed by a single course of praziquantel for 15 days (3431- H 18th)Drug of choice for CNS toxoplasmosis is combination of sulfadiazine plus pyrimethamine **", "cop": 2, "opa": "Mebendazole", "opb": "Albendazole", "opc": "Praziquentel", "opd": "Metronidazole", "subject_name": "Medicine", "topic_name": "Infection", "id": "0e2befe2-1361-4e77-8c12-777dabc107e3", "choice_type": "single"}
+{"question": "Untoff phenomenon is", "exp": "Harrison's principles of internal medicine 17th edition. *U/l visual blurring may occur following a hot shower or with physical exercise. Uhthoff's phenomenon (also known as Uhthoff's syndrome, Uhthoff's sign, and Uhthoff's symptom) is the worsening of neurologic symptoms in multiple sclerosis (MS) and other neurological, demyelinating conditions when the body gets overheated from hot weather, exercise, fever, or saunas and hot tubs. Ref Harrison20th edition pg 2345", "cop": 3, "opa": "Worsening of symptom with cold", "opb": "Relief of symptom with cold", "opc": "Worsening of symptom with heat and exeion", "opd": "Palsy of symptom with heat and excretion", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "94284280-d6ef-42aa-9454-f6dcca9d4c8c", "choice_type": "single"}
+{"question": "If a patient has to undergo cect chest prerequisite would be", "exp": "Answer: (A) NPO FOR 6HRS &S. CREATININE NORMALIn preparation for a CT scan, patients are often asked to avoid food, especially when contrast material is to be used. Contrast material may be injected intravenously, or administered by mouth or by an enema in order to increase the distinction between various organs or areas of the body. Therefore, fluids and food may be restricted for several hours prior to the examination. If the patient has a history of allergy to contrast material (such as iodine), the requesting physician and radiology staff should be notified. All metallic materials and certain clothing around the body are removed because they can interfere with the clarity of the images.Because Contrast material has to be excreted without any metabolism, kidney functions are required to be normalCT scans have vastly improved the ability of doctors to diagnose many diseases earlier in their course and with much less risk than previous methods. Further refinements in CT scan technology continue to evolve which promise even better picture quality and patient safety. CT scans known as ''spiral\" or \"helical\" CT scans can provide more rapid and accurate visualization of internal organs. For example, many trauma centers are using these scans to more rapidly diagnose internal injuries after serious body trauma. High resolution CT scans (HRCT) are used to accurately assess the lungs for inflammation and scarring. CT angiography is a newer technique that allows noninvasive imaging of the coronary arteries. Note that some CT scanners may not be able to accommodate pat ients that weigh over 400 pounds.", "cop": 1, "opa": "NPO for 6hrs &s. Creatinine normal", "opb": "NPO for 6hrs", "opc": "NPO for 6hrs & LFT normal", "opd": "Blood sugar normal and no dietary restriction", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "19de4002-484d-4743-808f-879146d47382", "choice_type": "single"}
+{"question": "Not seen in hyperparathyroidism", "exp": null, "cop": 2, "opa": "Increase in serum calcium", "opb": "Increase in serum calcitonin", "opc": "Subperiosteol resorption of phalanges", "opd": "Increase in 24 hr urinary calcium excretion > 250", "subject_name": "Medicine", "topic_name": null, "id": "e8daae42-6c94-46bd-82c7-4f3b6e7957ef", "choice_type": "single"}
+{"question": "Best ventilator strategy for ARDS is", "exp": "ARDS can be difficult to distinguish from fluid overload or cardiac failure.Occasionally, conditions may present in a similar way to ARDS but respond to alternative treatments; an example of this might be a glucocoicoid- responsive interstitial pneumonia . Management of ARDS is suppoive, including use of lung-protective mechanical ventilation, inducing a negative fluid balance and treating the underlying cause. Establishing the severity of ARDS is useful, as severe disease will require more proactive management such as prone positioning or extracorporeal membrane oxygenation (ECMO) Berlin definition of ARDS * Onset within 1 week of a known clinical insult, or new or worsening respiratory symptoms * Bilateral opacities on chest X-ray, not fully explained by effusions, lobar/lung collapse or nodules * Respiratory failure not fully explained by cardiac failure or fluid overload. Objective assessment (e.g. by echocardiography) must exclude hydrostatic oedema if no risk factor is present * Impaired oxygenation Ref Davidson edition23rd pg 199_198", "cop": 3, "opa": "CPAP", "opb": "High frequency jet ventilation", "opc": "Assisted control mechanical ventilation", "opd": "Synchronised intermittent mandatory ventilation", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "61ede35e-9a75-4ad4-8d1d-debb2c5e9104", "choice_type": "single"}
+{"question": "In primary pulmonary hypeension basic abnormality in genes lies in", "exp": "Ref Harrison 19 th ed pg 1655 Abnormalities in multiple molecular pathways and genes that regu- late the pulmonary vascular endothelial and smooth muscle cells have been identified ). These abnormalities include decreased expression of the voltage-regulated potassium channel, mutations in the bone morphogenetic protein receptor-2, increased tissue factor expres- sion, overactivation of the serotonin transpoer, hypoxia-induced activation of hypoxia-inducible factor-1a, and activation of nuclear factor of activated T cells.", "cop": 1, "opa": "Bone morphogenetic protein receptor II", "opb": "Endothelin", "opc": "Homebox gene", "opd": "PAX-11", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "fd691805-e689-45bd-9e44-67f42afbd9e0", "choice_type": "single"}
+{"question": "Drug of choice for social phobia is", "exp": "(A) SSRIs # Social Phobia> This is an example of irrational fear of activities or social interaction, characterized by an irrational fear of performing activities in the presence of other people or interacting with others.>The patient is afraid of his own actions being viewed by others critically, resulting in embarrassment or humiliation.> There is marked distress and disturbance in daily functioning.> Examples are fear of blushing (erythrophobia), eating, public speaking, public performance (e.g. on stage), participating in groups, writing in public (e.g. signing a check), speaking to strangers (E.g. for asking for directions), dating, speaking to authority figures, and urinating in a public lavatory (shy bladder).> Sometimes, alcohol (and rarely other drugs is used to overcome the anxiety occurring in social situations.# Drug Treatment of phobia are:> Benzodiazepines are given to reduce the anticipatory anxiety.> Alprazolam is believed to have anti-phobic, anti-panic and anti-anxiety properties.> So, it is the drug of choice when benzodiazepines are used.> Long-term follow-up of double-blind trials are needed before it is firmly established as an anti-phobic.> The other drugs used include Clonazepam, lorazepam and diazepam.> Among the antidepressants, SSRIs are currently drugs of choice, with paroxetine being the most widely used and effective drug.> Other SSRIs, like fluoxetine and sertraline are also very effective.", "cop": 1, "opa": "SSRIs", "opb": "b-blocker", "opc": "Gabapentin", "opd": "Tiagabine", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "c357c3b6-2066-471b-9a94-6728c7046d0c", "choice_type": "single"}
+{"question": "A child presents with massive hemetemesis and systemic hypotension. He has no fever or other significant history. Examination reveal massive splenomegaly but no hepatomegaly. Likely diagnosis is", "exp": "Answer is D (Non cirrhotic poal fibrosis): NCPF is suspected in a patient presenting with symptoms of poal hypeension with: YOUNG AGE Moderate/Large Splenomegaly NO FEATURES SUGGESTIVE OF LIVER CELL FAILURE -No Jaundice (uncommon) - No Ascitis (uncommon) - No Hepatomegaly (uncommon) - No Stigmata of liver cell failure (uncommon) Non cirrhotic poal fibrosis is a condition of liver characterized by widespread fibrosis of the 1 ver (mainly poal, subcapsular and rarely perisinusuoidal) causing wide variation in the normal architecture but there is no true cirrhosis. NCPF is the most impoant causes of intrahepatic non cirrhotic poal hypeension in India", "cop": 4, "opa": "Hepatocellular carcinoma", "opb": "Bleeding duodenal ulcer", "opc": "Oesophageal varices", "opd": "Non-cirrhotic poal fibrosis", "subject_name": "Medicine", "topic_name": null, "id": "cea76f00-c75d-498c-baf5-b24a22f45b6b", "choice_type": "single"}
+{"question": "Leisch nodules are seen in", "exp": "(C) Neurofibromatosis type I # NEUROFIBROMATOSIS TYPES# TYPE 1 (NF-1) Peripheral neurofibromatosis Von Recklinghausen's disease Incidence 1 in 3 000 Gene on long arm of chromosome 17> Diagnostic criteria: Devised by National Institute of Health in 1987 Require 2 or more of the following> Cafe au lait spots 6 or more >5mm (prepubertal) >15mm (postpubertal)> Freckling Axillary or inguinal> Neurofibromas Two or more neurofibromas of any sort OR One plexiform neurofibroma> Optic glioma> Leisch nodules Two or more> Distinctive osseous lesion Sphenoid dysplasia Thinning of long bone cortex with pseudarthrosis> First degree relative with neurofibromatosis Parent, sibling or offspring# NEUROFIBROMATOSIS 2 Central neurofibromatosis Incidence 1 in 50 000 Gene on long arm of chromosome 22> Features Two types> Multiple CNS involvement Neuraxial neoplasia Meningoneuroplasia Cranial schwannoma> Bilateral acoustic neuromas Isolated Dermal lesions unusual", "cop": 3, "opa": "SLE", "opb": "Rheumatoid arthritis", "opc": "Neurofibromatosis type I", "opd": "Ankylosing spondylitis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "417b1d7d-8e6a-460f-8bdb-b5382e3ab6d7", "choice_type": "single"}
+{"question": "Most common cause of unilateral pedal edema", "exp": "Ans. is 'c' i.e., Venous insufficiency The most likely cause of leg edema in patients over age 50 is venous insufficiency. Venous insufficiency affects up to 30% of the population, whereas hea failure affects only approximately 1%. The most impoant cause of unilateral pedal edema is venous insufficiency. Milroys disease : The defect in Milroy's disease is present from bih and symptoms are usually first experienced in childhood. The most common problem is one-sided leg swelling, unilateral edema, which is progressive and can affect both legs. Impaired intestinal lymphatics can cause steatorrhea due to impaired transpo of chylomicrons", "cop": 3, "opa": "Pregnancy", "opb": "Lymphedema", "opc": "Venous insufficiency", "opd": "Milroy disease", "subject_name": "Medicine", "topic_name": null, "id": "17f5fb81-e359-4023-8f30-eac62570cb05", "choice_type": "single"}
+{"question": "Longest acting Insulin among the following", "exp": "insulin degludec which has duration of action upto 42hours Ref Harrison 20th edi page no 2863, tab 397-4", "cop": 3, "opa": "Insulin Glargine", "opb": "Insulin Detemir", "opc": "Insulin Degludec", "opd": "NPH", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "fc098ce8-1d95-4847-ad6d-16e964c18fd6", "choice_type": "single"}
+{"question": "Chronic liver disease is caused by", "exp": null, "cop": 3, "opa": "Hepatitis B", "opb": "Hepatitis A", "opc": "Hepatitis C", "opd": "Hepatitis E", "subject_name": "Medicine", "topic_name": null, "id": "a94c2119-90f3-4607-85c5-285a10f8c897", "choice_type": "single"}
+{"question": "The \"subclan steal syndrome\" occurs due to", "exp": "*Subclan steal:when the arm is used,blood is stolen from the brain the veebral aery .this lead to veebro-basilar ischemia ,which is characterised by dizziness ,coical blindness and/or collapse. Ref Harrison20th edition pg 2456", "cop": 3, "opa": "Occlusion /stenosis of the veebral aery", "opb": "Occlusion/stenosis of the carotid aery", "opc": "Occlusion of the subclan aery proximal to origin of veebral aery", "opd": "Occlusion of the subclan aery distal to origin of veebral aery", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "fe1be890-80bb-4866-8a9d-ec6830fb0429", "choice_type": "single"}
+{"question": "Proptosis is not seen in", "exp": "Ans. is 'd' i.e., Myxoedema Proptosis occurs in thyrotoxicosis not in hypothyroidism Choices Logic Grave's Cytokines appear to play a major role in thyroid-associated ophthalmopathy There is infiltration of the extraocular muscles by activated T cells; the release of cytokines such as IFN-alpha and TNF results in fibroblast activation and increased synthesis of glycosaminoglycans that trap water, thereby leading to characteristic muscle swelling Sarcoidosis Approximately 20%, of patients with ophthalmic findings of sarcoid have soft tissue involvement of the orbit or lacrimal gland and present as a mass lesion with proptosis, ptosis, or ophthalmoplegia. Pituitary adenoma Macro-adenoma associated with pituitary apoplexy can lead to proptosis.", "cop": 4, "opa": "Grave's disease", "opb": "Sarcoidosis", "opc": "Pituitary adenoma", "opd": "Myxoedema", "subject_name": "Medicine", "topic_name": null, "id": "800eb1dc-81e9-47e9-9ae8-541c7a29710d", "choice_type": "single"}
+{"question": "Investigation of choice for leptomeningeal carcinomatosis", "exp": "To detect leptomeningeal metastases, gadolinium-enhanced MRI is more sensitive than CT scanning. The sensitivity of MRI is nearly 70% while that of CT scan is around 30%. The most common MRI findings consist of typical nodules in the subarachnoid and parenchymal regions, parenchymal volume loss and sulcal/dural enhancement CT-myelography is not indicated due to low sensitivity, whereas the value of FDG PET ,SPECT scan is still under investigation Ref Harrison20th edition pg 2234", "cop": 3, "opa": "PET", "opb": "SPECT", "opc": "Gd enhanced MRI", "opd": "CT scan", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "b8c17554-14b2-484b-8fe7-4188d3d008b9", "choice_type": "single"}
+{"question": "Schober's sign is used to evaluate", "exp": "Ans. is 'a' i.e., Flexion of lumbar spine Schober's test is used for the assessment of patients with ankylosing spondylitis. It is performed as follows :? Mark two points 10 cm above and 5 cm below a line joining the dimple of venus on the sacral promontory (the line passing along L5 and dimple indicates the site of posterior superior iliac spine). Ask the patient to bend forward as for as possible. Now measure the distance between upper and lower markings. Normally it in erases by > 5 cm below 50yrs of age If <5cm indicates limitation of the mobility of spine.", "cop": 1, "opa": "Flextion of lumbar spine", "opb": "Chest expansion", "opc": "Pain with motion of hip", "opd": "Neck pain and stiffness", "subject_name": "Medicine", "topic_name": null, "id": "16a51247-1f96-47cb-9f7a-602131341a06", "choice_type": "single"}
+{"question": "Treatment of choice for seasonal influenza is", "exp": "Early treatment of hospitalized adult influenza patients with oseltamivir has been repoed to reduce death in some observational studies. Clinical benefit is greatest when antiviral treatment is administered early, especially within 48 hours of influenza illness onset in clinical trials and observational studies Ref Harrison20th edition pg 980", "cop": 1, "opa": "Oseltamivir", "opb": "Zanamivir", "opc": "Peramavir", "opd": "Amantadine", "subject_name": "Medicine", "topic_name": "Infection", "id": "025dac78-c2d9-4246-a7b1-eb33bce0aa86", "choice_type": "single"}
+{"question": "Criteria of cysts in USG to diagnose ADPKD at 40years of age", "exp": "Diagnosis OF ADPKD: Diagnosis is typically made from a positive family history consistent with autosomal dominant inheritance and multiple kidney cysts bilaterally. Renal ultrasonography is often used for presymptomatic screening of at-risk subjects and for evaluation of potential living related kidney donors from ADPKD families. The presence of at least two renal cysts (unilateral or bilateral) is sufficient for diagnosis among at-risk subjects between 15 and 29 years of age with a sensitivity of 96% and specificity of 100%. The presence of at least two cysts in each kidney and the presence at least four cysts in each kidney are required for the diagnosis of at-risk subjects age 30 to 59 years and age 60 years or older, respectively, with a sensitivity of 100% and specificity of 100%. This is because there is an increased frequency of developing simple renal cysts with age.Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 339; Polycystic Kidney Disease and Other Inherited Disorders of tubule growth and Development", "cop": 2, "opa": "1cyst/kidney", "opb": "2cysts/kidney", "opc": "3cysts/kidney", "opd": "4cysts/kidney", "subject_name": "Medicine", "topic_name": "Kidney", "id": "75226175-0fdb-4948-83dd-f96bb56aa605", "choice_type": "single"}
+{"question": "Most common site of intracranial metastasis is from primary carcinoma of", "exp": "MC brain tumor is metastasis,arising from - (1) Oat cell Ca lung/small cell Ca lung (2) Ca Breast (3) M. Melanoma MC 1deg Brain tumour- Glioma MC benign brain tumour - Meningioma", "cop": 2, "opa": "Breast", "opb": "Lungs", "opc": "Stomach", "opd": "Testes", "subject_name": "Medicine", "topic_name": "FMGE 2018", "id": "d37f7d4a-22fd-4b56-80cd-ef86d68c3b84", "choice_type": "single"}
+{"question": "Features of restrictive lung disease is", "exp": "Answer is D (FEVI/FVC increase and compliance decreases): Restrictive lung diseases are characterized by decreased compliance and increased FEVIFI\"C FENT' & FVC Forced Vital Capacity (FVC) is decreased Forced expiratory flow rates are relatively preserved (FEV1 is preserved) FEV1 / FVC When FEVI is considered as a percentage of FVC, the flow rates tend to become supranormal or dispropoionately high relative to size of lungs. FEV\", is preserved and FVC is decreased so FEV / IFTC is increased The hallmark of restrictive lung diseases is a decrease in lung volumes primarily TLC and V.C.' (FVC is decreased)-Harrison Compliance decreases in restrictive lung disease. Compliance is usually unaffected in obstructive lung diseases except in emphysema where it is increased.", "cop": 4, "opa": "FEV1/FVC decreases and compliance decreases", "opb": "FEV1/FVC increases and compliance increases", "opc": "FEV1/FVC decreases and compliance increases", "opd": "FEV1/FVC increases and compliance decreases", "subject_name": "Medicine", "topic_name": null, "id": "88c17fdc-992f-4593-bac1-45b64cf07c14", "choice_type": "single"}
+{"question": "Phlegmonous gastritis occurs in", "exp": "Phlegmonous gastritis( due to reflux of acid) is an uncommon form of gastritis caused by numerous bacterial agents, including streptococci, staphylococci, Proteus species, Clostridium species, and Escherichia coli. Phlegmonous gastritis usually occurs in individuals who are debilitated. It is associated with a recent large intake of alcohol, a concomitant upper respiratory tract infection, and AIDS. Phlegmonous means a diffuse spreading inflammation of or within the connective tissue. In the stomach, it implies infection of the deeper layers of the stomach (submucosa and muscularis). As a result, purulent bacterial infection may lead to gangrene. Phlegmonous gastritis is rare. The clinical diagnosis is usually established in the operating room, as these patients present with an acute abdominal emergency requiring immediate surgical exploration. Without appropriate therapy, it can progress to peritonitis and death. Ref Davidson edition23rd pg802", "cop": 4, "opa": "H.pylori", "opb": "E.coli", "opc": "Drugs", "opd": "Reflux of acid", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "c428ef9b-d59c-4451-a655-91e94dc774c8", "choice_type": "single"}
+{"question": "A 45 year old man, known case of chronic renal failure develops rugger jersey spine. The probable cause is", "exp": "Answer is B (Secondary Hyperparathyroidism): Rugger .Jersey Spine is characteristically found in secondary hyperparathyroidism (Renal osteodystrophy in CRF).", "cop": 2, "opa": "Aluminium intoxication", "opb": "Secondary hyperparathyroidism", "opc": "Osteoporosis", "opd": "Osteomalacia", "subject_name": "Medicine", "topic_name": null, "id": "fec5388b-b670-43b4-9fef-5c906d203a83", "choice_type": "single"}
+{"question": "Nosocomial pneumonia is most commonly caused by", "exp": null, "cop": 1, "opa": "Gram -ve bacilli", "opb": "Gram + ve bacilli", "opc": "Gram - ve cocci", "opd": "Mycoplasma", "subject_name": "Medicine", "topic_name": null, "id": "ab8d162e-88c0-4649-bf7e-0d1c019a3f27", "choice_type": "single"}
+{"question": "Most well differentiated thyroid tumor is", "exp": "(A) Papillary carcinoma # Follicular cell origin: (A) Differentiated. (B) Undifferentiated.# DIFFERENTIATED:* Papillary carcinoma (60%);* Follicular carcinoma (15%);* Mixed papillary and follicular carcinoma.# UNDIFFERENTIATED:* Anaplastic carcinoma (13%).> Clinical features: It is the most slow growing among the malignant tumours of the thyroid.", "cop": 1, "opa": "Papillary carcinoma", "opb": "Medullary carcinoma", "opc": "Follicular carcinoma", "opd": "Anaplastic carcinoma", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "89c833bd-5a9d-4162-8f31-ecab2d73aae5", "choice_type": "single"}
+{"question": "The drug used in the management of medullary carcinoma thyroid is", "exp": "Ans.is 'a' i.e., Cabozantinib Medullary thyroid cancers (MTCs) are neuroendocrine tumors of thyroid paraf011icular cells that do not concentrate iodine. The primary treatment for MTC is extensive and meticulous surgical resection. There is a limited role for external-beam radiotherapy. For patients with asymptomatic metastatic tumors generally less than 1 to 2 cm in diameter, growing in diameter less than 20 percent per year Systemic therapy is not required Such patients should be monitored for disease progression. Known sites of metastatic disease should be imaged by CT or MRI every 6 to 12 months, and potential new sites of disease should be imaged every 12 to 24 months. For patients with metastatic tumors at least 1 to 2 cm in diameter, growing by at least 20 percent per year, or Or patients with symptoms related to multiple metastatic foci that cannot be alleted with surgery or external beam radiotherapy Administer systemic treatment as pa of a clinical trial. Forpatients with metastatic tumors at least I to 2 cm in diameter, growing by at least 20 percent per year, or for patients with .symptoms related to multiple metastatic foci who cannot paicipate in a clinical trial An oral tyrosine kinase inhibitor (TKI) is suggested, rather than traditional cytotoxic chemotherapy. For initial TKI therapy Cabozantinib or vandetanib rather than sorafenib or sunitinib. Cytotoxic chemotherapy, of which dacarbazine-based regimens such as cyclophosphamide-vincristinedacarbazine are preferable, is an alternative option for patients who cannot tolerate or who fail multiple TKIs Drugs used in medullary carcinoma thyroid Tyrosine kinase inhibitors Cvtotoxic chemotherapy Cabozanitib Cyclophosphamide Vandetanib Vincristine Sorafenib Dacarbazine Sunitinib", "cop": 1, "opa": "Cabozantinib", "opb": "Rituximab", "opc": "Tenofovir", "opd": "Anakinra", "subject_name": "Medicine", "topic_name": null, "id": "ab41d31d-e169-4394-96c9-f8147e5a2e77", "choice_type": "single"}
+{"question": "The commonest of death in ARDS is", "exp": "Moality estimates for ARDS range from 26 to 44%.Moality in ARDS is largely attributable to nonpulmonary causes,with sepsis and nonpulmonary organ failure accounting for >80% of deaths.Increasing age,chronic liver disease,cirrhosis,chronic alcohol abuse,chronic immunosuppression,sepsis,chronic renal disease,any nonpulmonary Organ failure have been linked to increased ARDS moality. Ref:Harrison's disease-18th edition,page no:2209/", "cop": 3, "opa": "Hypoxemia", "opb": "Hypotension", "opc": "Non-pulmonary organ failure", "opd": "Respiratory failure", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "c91f1dc0-3222-474f-a6a7-f1f2e1b453a5", "choice_type": "single"}
+{"question": "Massive hemoptysis seen in", "exp": "Answer- A. Mitral stenosisLarge volume hemoprysis, referred to as massive hemoptysis , is variably defined as hemoptysis of greater than 200-600 cc in 24 h. Massive hemoptysis should be considered a medicai emersency.Hemoptysis does not occur from hea failure itself. Most commonly it is due to mitral valve diseases like or mitral mitral stenosis regurgitation.", "cop": 1, "opa": "Mitral stenosis", "opb": "Aoic stenosis", "opc": "Pulmonary stenosis", "opd": "Aoic regurgitation", "subject_name": "Medicine", "topic_name": null, "id": "e2d45b31-c9b2-4ec5-8af7-17142a9afe1c", "choice_type": "single"}
+{"question": "The pathogenesis of hypochromic anemia in lead poisoning is due to", "exp": "Lead interferes with the synthesis of Heme. Deficiency of heme causes microcytic hypochromic anemia because heme is an integral part of hemoglobin and it is well known that hemoglobin deficiency causes microcytic hypochromic anaemia.", "cop": 1, "opa": "Inhibition of enzymes involved in heme biosynthesis", "opb": "Binding of lead to transferrin, inhibiting the transport of iron", "opc": "Binding of lead to cell membrane of erythroid precursors", "opd": "Binding of lead to ferritin inhibiting their breakdown into hemosiderin", "subject_name": "Medicine", "topic_name": null, "id": "257c17b1-4f63-462b-b8d2-9ae06024c5ea", "choice_type": "single"}
+{"question": "Onion skin spleen is seen in", "exp": "Onion skin patten is due to Concentric Fibrosis seen in SLE.", "cop": 1, "opa": "SLE", "opb": "Sjogren's syndrome", "opc": "Thrombotic thrombocytopenic purpura", "opd": "Henoch shonlein purpura", "subject_name": "Medicine", "topic_name": null, "id": "f1753687-f74a-48b3-a666-94e4c40d2422", "choice_type": "single"}
+{"question": "MIDAS question are is used in assessment of", "exp": "Once a diagnosis of migraine has been established, it is impoant to assess the extent of a patient's disease and disability. The Migraine Disability Assessment Score (MIDAS) is a well-validated, easy-to-use tool . Migraine Disability Assessment Score Five questions related to headache severity are used in assessment Grade I--Minimal or Infrequent Disability: 0-5 Grade II--Mild or Infrequent Disability : 6-10 Grade III--Moderate Disability : 11-20 Grade IV--Severe Disability : > 20 Ref Harrison 20th edition page 3098, 3100(table 422-4)", "cop": 2, "opa": "Severity of weakness in stroke", "opb": "Disability in migraine", "opc": "Memory in alzheimers disease", "opd": "Tremors in parkinsons disease", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "9495e537-ea00-413b-b4d5-157fcbf862b5", "choice_type": "single"}
+{"question": "In a normal electrocardiogram (ECG or EKG),", "exp": "B: The QRS complex consists of three individual waves: the Q, R, and S waves. The QRS complex results from depolarization of the ventricles, and the beginning of the QRS complex precedes ventricular contraction.\nA: The P wave results from depolarization of the atrial myocardium, and the beginning of the P wave precedes the onset of atrial contraction.\nC: The T wave represents the repolarization of the ventricles, and the beginning of the T wave precedes ventricular relaxation.\nD: During the P-R interval, the atria contract and begin to relax.", "cop": 2, "opa": "The P wave results from repolarization of the atria.", "opb": "The QRS complex results from depolarization of the ventricles.", "opc": "The T wave represents repolarization of the auricles.", "opd": "During the P-R interval, the ventricle contract.", "subject_name": "Medicine", "topic_name": null, "id": "9d0fe830-75c2-4917-b5ae-4841e58f4b93", "choice_type": "single"}
+{"question": "Treatment of choice in intractable ulcerative colitis ;", "exp": "Indications for surgery in ulcerative colitis Intractable disease Fulminant disease Toxic megacolon Colonic perforation Massive colonic hemorrhage Extracolonic disease Colonic obstruction Colon cancer prophylaxis Colon dysplasia or cancer", "cop": 1, "opa": "Mucosal proctectomy - Ileoanal pouch anastomosis", "opb": "Proctectomy", "opc": "Colectomy with ileostomy", "opd": "Ileorectal anastomosis", "subject_name": "Medicine", "topic_name": "Inflammatory Bowel Disease", "id": "e459a52a-d9c0-479a-aaf5-e518af647e6a", "choice_type": "single"}
+{"question": "Most common clinical presentation of juvenile myoclonic epilepsy", "exp": "Ans. c. Myoclonus Most common clinical presentation of juvenile myoclonic epilepsy is myoclonus. \"Juvenile myoclonic epilepsy (JME) is a generalized seizure disorder of unknown cause that appears in early adolescence and is usually characterized by bilateral myoclonic jerks that may be single or repetitive. The myoclonic seizures are most frequent in the morning after awakening and can be provoked by sleep deprivation. Consciousness is preserved unless the myoclonus is especially Juvenile Myoclonic Epilepsy Juvenile myoclonic epilepsy (JME) is a generalized seizure disorder of unknown cause that appears in early adolescence Characterized by bilateral myoclonic jerks that may be single or repetitiveQ. Clinical Features: Myoclonic seizures are most frequent in the morning after awakening and can be provoked by sleep deprivationQ. Consciousness is preserved unless the myoclonus is especially severe. Many patients also experience generalized tonic-clonic seizures, and up to one-third have absence seizures. Although complete remission is relatively uncommon, the seizures respond well to appropriate anticonvulsant medication. There is often a family history of epilepsy, and genetic linkage studies suggest a polygenic cause Juvenile Myoclonic Epilepsy Treatment: Valproate is often used to treat juvenile myoclonic epilepsy. Other epilepsy drugs are effective in juvenile myoclonic epilepsy: - LevetiracetamQ - TopiramateQ - LamotrigineQ For most people with JME, treatment is long-term, and often lifelongQ. However, treatment is effective, allowing most people with juvenile myoclonic epilepsy to go five years or more between seizures.", "cop": 3, "opa": "Generalised tonic clonic seizures in sleep", "opb": "Generalised tonic clonic seizures in awake state", "opc": "Myoclonus", "opd": "Absence seizures", "subject_name": "Medicine", "topic_name": null, "id": "4ef4738d-70dd-45df-9a69-c8dfe3309186", "choice_type": "single"}
+{"question": "The most common cause of seizures in a patient of AIDS is", "exp": "Ans. is 'a' i.e., Toxoplasmosis Neurological manifestations of H.I.V. AIDS dementia complex (HIV encephalopathy) is a result of direct effects of HIV on CNS (not an oppounistic disease). It is subcoical dementia. Most common cause of seizures --> Toxoplasma Most common cause of meningitis --> Cryptococcus M.C. cause of focal neurological deficit --> Toxoplasma Toxoplasmosis is the most common CNS infection in AIDS. CNS lymphoma and prograssive multifocal leukoencephalopathy may occur.", "cop": 1, "opa": "Toxoplasmosis", "opb": "Cryptococcal meningitis", "opc": "Progressive multifocal leucoencephalopathy", "opd": "CNS lymphoma", "subject_name": "Medicine", "topic_name": null, "id": "c8d14b52-e2db-4eb4-bc6d-931743702710", "choice_type": "single"}
+{"question": "A ventrolateral cordotomy is performed to produce relief of pain from the right leg. It is effective because effective because it interrupts the", "exp": "The lateral spinothalamic tract conveys pain and temperature. In the spinal cord, the spinothalamic tract has somatotopic organization. The pathway crosses over (decussates) at the level of the spinal cord, rather than in the brainstem like the dorsal column-medial lemniscus pathway and lateral coicospinal tract. Cordotomy (or chordotomy) is a surgical procedure that disables selected pain-conducting tracts in the spinal cord, in order to achieve loss of pain and temperature perception Ref Harrison20th edition pg 2366", "cop": 2, "opa": "Left Dorsal Column", "opb": "Left Lateral Spinothalamic Tract", "opc": "Right Lateral Spinothalamic Tract", "opd": "Right coicospinal Tract", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "1ca6a145-272d-40b6-81e8-c98d073b07de", "choice_type": "single"}
+{"question": "The earliest muscle to be involved in dermatomyositis is", "exp": "Dermatomyositis (DM) is a long-term inflammatory disorder which affects muscles. Its symptoms are generally a skin rash and worsening muscle weakness over time.These may occur suddenly or develop over months.Other symptoms may include weight loss, fever, lung inflammation, or light sensitivity.Complications may include calcium deposits in muscles or skin. People with DM experience progressively worsening muscle weakness in the proximal muscles (for example, the shoulders and thighs).Tasks that use these muscles: standing from sitting, lifting, and climbing stairs, can become increasingly difficult for people with dermatomyositis .(quadriceps are first effected) Ref Robbins 9/e pg 172", "cop": 4, "opa": "Deltoid", "opb": "Gluteal", "opc": "Lumbricals", "opd": "Quadriceps", "subject_name": "Medicine", "topic_name": "Genetics", "id": "a8018455-5cab-4f21-bb6a-167bf790f5b3", "choice_type": "single"}
+{"question": "Disease only transmitted to females", "exp": "Hunter disease (MPS II) is an X-linked disorder due to a deficiency in iduronate sulfate sulfatase and has manifestations similar to those ofMPS I, including neurologic degeneration. There is no corneal clouding or other eye diseases. Hematopoietic stem cell transplantation has not been successful in treating CNS disease associated with MPS II. The FDA and the European Medicines Agency (EMA) have approved enzyme therapy for the visceral manifestations of MPS II. References: Harrison's Principles of Internal Medicine; 19th edition; CHAPTER 432e; Lysosomal Storage Diseases", "cop": 2, "opa": "Hurler's disease", "opb": "Hunter's disease", "opc": "Scheie's disease", "opd": "Fabry's disease", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "fad3d39b-9792-4313-b511-5af1ca924c68", "choice_type": "single"}
+{"question": "Felty syndrome", "exp": "Felty's syndrome is an extra aicular manifestation of rheumatoid ahritis.It is the association of splenomegaly & neutropenia with RA. Common features include spmenomegaly, lymphadenopathy,weight loss,skin pigmentation ,recurrent infections ,nodules,vasculitis,leg ulcers.", "cop": 1, "opa": "Splenomegaly and neutropenia", "opb": "Nodules in upper lobe of lung and difficulty in breathing", "opc": "Digital ulceration and gangrene", "opd": "Multiple finger deformities", "subject_name": "Medicine", "topic_name": "Haematology", "id": "4c3a98e7-48fa-4563-aca7-68149d7d9a38", "choice_type": "single"}
+{"question": "Prolonged intake of PPI does not cause", "exp": "Long-term acid suppression, especially with PPIs, has been associated with A higher incidence of community-acquired pneumonia Community and hospital acquired Clostridium difficile associated disease. Long-term use of PPIs was associated with the development of hip fractures in older women. PPIs may exe a negative effect on the anti-platelet effect of clopidogrel. The mechanism involves the competition of the PPI and clopidogrel with the same cytochrome p450 (CYP2C19).", "cop": 1, "opa": "Hypothyroidism", "opb": "Pelvic fracture", "opc": "Clostridium difficile infection", "opd": "Increased community acquired pneumonia", "subject_name": "Medicine", "topic_name": "Peptic Ulcer Disease", "id": "32c5bed7-141a-421a-8909-b49e9a62a645", "choice_type": "single"}
+{"question": "Proliferative glomerular deposits in the kidney are found in", "exp": "IgA nephropathy or Berger's disease: immune complex-mediated glomerulonephritis defined by the presence of diffuse mesangial IgA deposits often associated with mesangial hypercellularity. Male preponderance, peak incidence in the second and third decades of life.Clinical and laboratory findings: Two most common presentations recurrent episodes of macroscopic hematuria during or immediately following an upper respiratory infection often accompanied by proteinuria or persistent asymptomatic microscopic hematuriaIgA deposited in the mesangium is typically polymeric and of the IgA1 subclass. IgM, IgG, C3, or immunoglobulin light chains may be codistributed with IgAPresence of elevated serum IgA levels in 20-50% of patients, IgA deposition in skin biopsies in 15-55% of patients, elevated levels of secretory IgA and IgA-fibronectin complexesIgA nephropathy is a benign disease mostly, 5-30% of patients go into a complete remission, with others having hematuria but well preserved renal functionAbout 25-30% of patients have progressive disease and developmental failure slowly over 20-25 yearsPersistent proteinuria for 6 months or longer is found to be associated with adverse renal outcomesLight microscopy may reveal lesions such asDPGN; segmental sclerosis; and rarely, segmental necrosis with the cellular crescent formation, which typically presents as RPGNHenoch-Schonlein purpura is distinguished clinically from IgA nephropathy by prominent systemic symptoms, a younger age (<20 years old), preceding infection, and abdominal complaintsRef: Harrison's 18/e p2342", "cop": 3, "opa": "Amyloidosis", "opb": "Diabetes mellitus", "opc": "IgA nephropathy", "opd": "Membranous glomerulonephritis", "subject_name": "Medicine", "topic_name": "All India exam", "id": "e0a730b3-b23d-4712-94da-7857d5c1fdb5", "choice_type": "single"}
+{"question": "Obstructive sleep apnoea syndrome", "exp": "(A) Associated with sudden cardiac death > In severe and prolonged cases there is | in pulmonary prssure that are transmitted to right side of heart - this results in CHF - significantly lower levels of nitrate - CVS complications.", "cop": 1, "opa": "Associated with sudden cardiac death", "opb": "Road traffic accidents", "opc": "Bulimia nervosa", "opd": "Anorexia nervosa", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "e24aa68e-c401-46d6-8cbf-10efbd7d72f9", "choice_type": "single"}
+{"question": "Ahritis is not a pa of", "exp": "Lupus has non-erosive, intermittent polyahritis. Diagnostic criteria for ahritis in SLE includes non-erosive ahritis involving two or more peripheral joints characterised by tenderness, swelling or effusion.Psoriatic ahritis involves PIP, DIP, MCP and wrist. Sparing of any joint may or may not be present.Reiter's syndrome and reactive ahritis are regarded as a spectrum of the same disease. (Triad of ahritis, urethritis, and conjunctivitis - Fiessenger-Leroy-Reiter syndrome)Ref: Harrison's 18/e p2728, 2780, 2790, 2847", "cop": 3, "opa": "Lupus", "opb": "Psoriasis", "opc": "Wegner's granulomatosis", "opd": "Reiter's syndrome", "subject_name": "Medicine", "topic_name": "All India exam", "id": "297965bb-2d36-4d5c-b847-9788e7df8ac6", "choice_type": "single"}
+{"question": "Primary complex in Liver in Congenital tuberculosis occurs through", "exp": "Answer is B (Haematogenous Spread): Primary Complex in Liver in cases of Congenital Tuberculosis occurs when infection enters the fetus through the umbilical veins (Trans-placental; Haematogenous Infection). Liver is the most common Primary site of infection in Congenital Tuberculosis caused by Trans placental or Haematogenous route Lung is the most common Primary site of infection in Congenital Tuberculosis caused by aspiration of infected amniotic fluid Gastrointestinal Tract is the most common Primary site of infection in Congenital Tuberculosis caused by ingestion of infected amniotic fluid Since Lungs are eventually involved in most cases of congenital tuberculosis where Liver is the primary site of infection, Lungs are overall the most commonly involved sites in Congenital Tuberculosis", "cop": 2, "opa": "Lymphatic Spread", "opb": "Haematogenous Spread", "opc": "Aspiration of Infected Amniotic fluid", "opd": "Ingestion of Infected Amniotic Fluid", "subject_name": "Medicine", "topic_name": null, "id": "d4a46845-546b-474e-8ba5-9e470993c9a1", "choice_type": "single"}
+{"question": "The MOST sensitive 24 hour urinary biochemical test to suggest pheochromocytoma among the following is", "exp": "Table 343-2 Biochemical Tests Used for Pheochromocytoma Diagnosis Diagnostic Method Sensitivity Specificity 24-h urinary tests Vanillylmandelic acid ++ ++++ Catecholamines +++ +++ Fractionated metanephrines ++++ ++ Total metanephrines +++ ++++ Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2963", "cop": 2, "opa": "Vanillylmandelic acid", "opb": "Fractionated metanephrines", "opc": "Total metanephrines", "opd": "Catecholamines", "subject_name": "Medicine", "topic_name": null, "id": "e4369500-3981-4ba2-9175-a54712b0bea5", "choice_type": "single"}
+{"question": "Prophylaxis for migraine", "exp": "K.D Tripathy essentials of medical pharmacology 7th edition . *Drugs for prophylaxis of migraine are beta blockers(propranalol ),TCA(amitriptyline ), calciumchannelblockers(flunarizine),anticonvulsants (valproate),5HT antagonist. Ref Harrison20th edition pg 2234", "cop": 2, "opa": "Sumitriptan", "opb": "Amytriptiline", "opc": "Nifidipine", "opd": "Diazepam", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "8e4d1aa5-eb83-4026-b73c-6683ea09530b", "choice_type": "single"}
+{"question": "NARP Syndrome is a", "exp": "NARP SYNDROME NARP syndrome is a mitochondrial function disorder. The main components of NARP syndrome are: Neuropathy (peripheral neuropathy which mostly affects sensory nerves) Ataxia Retinitis pigmentosa Other features include seizures, hearing loss and cardiac conduction defects. It occurs due to a mutation in the MT-ATP6 gene, which results in altered structure or function of mitochondrial ATP synthase leading to decreased ATP production. As it involves a mutation of mitochondrial DNA, it is inherited from mother to child (maternal inheritance). Other maternally inherited mitochondrial DNA disorders include: Leigh syndrome, Leber's hereditary optic neuropathy & Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes ( MELAS ) Ref :Harrison's Principles of Internal Medicine 21st ed .", "cop": 2, "opa": "Lysosomal storage disorder", "opb": "Mitochondrial function disorder", "opc": "Glycogen storage disorder", "opd": "Golgi body transpo disorder", "subject_name": "Medicine", "topic_name": "All India exam", "id": "41a58cf6-ff31-4093-b3cb-27a07bd9b4f0", "choice_type": "single"}
+{"question": "Drug used in irritable bowel syndrome with constipation", "exp": "Lubiprostone (CL- channel activator).", "cop": 1, "opa": "Lubiprostone", "opb": "Fedotozine", "opc": "Loperamide", "opd": "Mebeverine", "subject_name": "Medicine", "topic_name": null, "id": "549e7a73-d601-49bc-b5b3-6a436f0eb2e0", "choice_type": "single"}
+{"question": "Long term control of diabetes is assessed by", "exp": "Ans. D i.e. HbA1c", "cop": 4, "opa": "Random blood sugar", "opb": "Microalbuminuria/ creatinine ratio", "opc": "HbA2", "opd": "HbA1c", "subject_name": "Medicine", "topic_name": null, "id": "5e58e064-06c9-44f7-8a4b-f79b38a6adf0", "choice_type": "single"}
+{"question": "Dissociative sensory loss is not seen in", "exp": "Dissociated sensory loss is a pattern of neurological damage caused by a lesion to a single tract in the spinal cord which involves preservation of fine touch and proprioception with selective loss of pain and temperature. Understanding the mechanisms behind these selective lesions requires a brief discussion of the anatomy involved. Loss of pain and temperature are due to damage to the lateral spinothalamic tracts, which cross the central pa of the cord close to the level where they enter it and travel up the spinal column on the opposite side to the one they innervate (i.e. they ascend contralaterally). Note that a lesion of the lateral spinothalamic tract at a given level will not result in sensory loss for the dermatome of the same level; this is due to the fibers of the tract of Lissauer which transmit the neuron one or two levels above the affected segment (thus bypassing the segmental lesion on the contralateral side). Loss of fine touch and proprioception are due to damage to the dorsal columns, which do not cross the cord until the brainstem, and so travel up the column on the same side to the one they innervate (i.e. they ascend ipsilaterally). This means that a lesion of the dorsal columns will cause loss of touch and proprioception below the lesion and on the same side as it, while a lesion of the spinothalamic tracts will cause loss of pain and temperature below the lesion and on the opposite side to it. Dissociated sensory loss always suggests a focal lesion within the spinal cord or brainstem. The location of cord lesions affects presentation--for instance, a central lesion (such as that of syringomyelia) will knock out second order neurons of the spinothalamic tract as they cross the centre of the cord, and will cause loss of pain and temperature without loss of fine touch or proprioception. Other causes of dissociated sensory loss include: Diabetes mellitus Syringomyelia Brown-Sequard syndrome Lateral medullary syndrome aka Wallenberg's syndrome Anterior spinal aery thrombosis Tangier disease Subacute combined degeneration Multiple sclerosis Tabes dorsalis Friedreich's ataxia (or other spinocerebellar degeneration) Ref Harrison20th edition pg 2756", "cop": 2, "opa": "Syringomelia", "opb": "Cauda equine syndrome", "opc": "Diabetes mellitus", "opd": "Damage to spino-thalamic pathway", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "c6dd7184-c017-4b04-b8bf-543e388b04f3", "choice_type": "single"}
+{"question": "In a patient with myocardial infarction the valvular lesion commonly seen is", "exp": null, "cop": 2, "opa": "Aortic stenosis", "opb": "Mitral regurgitation", "opc": "Aortic regurgitation", "opd": "Septal defect", "subject_name": "Medicine", "topic_name": null, "id": "c7ae36b1-3962-4cfd-8a90-6d8046b75fdf", "choice_type": "single"}
+{"question": "Punched out appearance in skull seen in", "exp": "i.e. (Multiple myeloma): (679-Robbins 7th)MULTIPLE MYELOMA - presents as multifocal destructive bone tumours composed of plasma cells throughout the skeletal system* The bone lesions appears radiographically as punched out defects usually 1 -4 cm in diameter and grossly consists of gelatinous soft red tumour masses* Hyperparathyroidism - \"pepper pot skull\", The mandible a common site for Frown ' tumours* Moth - eaten appearance - syphilis* Rugor Jersy spine - Osteopetrosis* Beheadedscortish terrior sign - Spondylolisthesis", "cop": 1, "opa": "Multiple myeloma", "opb": "Thalassemia", "opc": "Carcinoma lung", "opd": "Hyperparathyroidism", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "752e255e-b15c-40c3-853e-952c1a94974d", "choice_type": "single"}
+{"question": "Treatment for genotype 1a of hepatitis C", "exp": "- Hepatitis C genotypes and their treatment Genotype 1a Ledipasvir + sofosbuvir Genotype 1b Ledipasvir + sofosbuvir Genotype 2 Sofosbuvir + velpatasvir Genotype 3 Sofosbuvir + velpatasvir Genotype 4 Sofosbuvir + velpatasvir Genotype 5,6 Sofosbuvir + velpatasvir", "cop": 1, "opa": "Ledipsavir and Sofosbuvir", "opb": "Sofosbuvir and velpatasvir", "opc": "Pegylated interferon and lamivudine", "opd": "Pegylated interferon and Ribavarin", "subject_name": "Medicine", "topic_name": "Hepatitis", "id": "27eded87-64cb-4fd4-b421-e29fd3321405", "choice_type": "single"}
+{"question": "Most common cause of subarachnoid hemorrhage IS", "exp": "*Commonly result from rupture of congenital berry aneurysms in the interpeduncular cistern Ref Harrison20th edition pg 2344", "cop": 3, "opa": "AV malformation", "opb": "Cavernous angioma", "opc": "Aneurysm", "opd": "Hypeension", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "e15a582d-d402-41ee-bc32-35658212e0dc", "choice_type": "single"}
+{"question": "Single best test for diagnosis of hypothyroidism is estimation of", "exp": "Ans. c (TSH). (Ref. Harrison, Principles of Medicine, 15th ed. 2066)# A normal TSH level excludes primary (but not secondary) hypothyroidsm.# If TSH is elevated, a free T4 level is needed to confirm presen ce of clinical hypothyroidism, but free T4 is inferior to TSH when used as screening test, as it will not detect subclinical or mild hypothyroidsm.# Circulating free T3 levels are normal in about 25% patients, reflecting adaptive response to hypothyroidism. T3 levels are therefore not indicated.# For congenital hypothyroidism even TSH/T4 levels in heel-prick blood specimens are used for neonatal screening.# Note: Iodine deficiency remains the most common cause of hypothyroidsm.", "cop": 3, "opa": "T3", "opb": "T4", "opc": "TSH", "opd": "RAIU", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "5e815ecf-e5f2-495f-b784-334ef0f6ee34", "choice_type": "single"}
+{"question": "Autoimmune hemolytic anemia is seen in", "exp": "Answer is B (Chronic lymphatic leukemia) Leukemias especially of the CLL type are associated with Autoimmune hemolytic anemia - Harrison Hemolvsis due to Antibodies: Warm-Antibody immunohemolytic anemia Cold-Antibody immunohemolytic Anemia 1. 2. 3. 4. 5. 6. Idiopathic Lymphomas: Chronic lymphocytic leukemia, non-Hodgkin's lymphomas, Hodgkin'd disease (infrequent) SLE and other collagen-vascular diseases Drugs (a) a-Methyldopa type (autoantibody to Rh antigens) (b) Penicillin type (stable hapten) (c) Quinidine type (unstable hapten) Postviral infections Other tumors (rare) I. 2. Cold agglutinin disease (a) Acute: Mycoplasma infection, infectious mononucleosis (b) Chronic: Idiopathic, lymphoma Paroxysmal cold hemoglobinuria", "cop": 2, "opa": "Sickle cell anemia", "opb": "Chronic lymphocytic leukemia (CLL)", "opc": "Acute myelocytic leukemia (AML)", "opd": "Multiple myeloma", "subject_name": "Medicine", "topic_name": null, "id": "4113190d-791e-402a-8db7-4532a7058a9f", "choice_type": "single"}
+{"question": "Rome II criteria are used for", "exp": "Rome II criteria for the diagnosis of Irritable Bowel SyndromeRecurrent abdominal pain or discomfo at least 3 days per month in the last 3 months associated with two or more of the following:Improvement with defecationOnset associated with a change in frequency of stoolOnset associated with a change in form (appearance) of stoolRef: Harrison 19e pg: 1965", "cop": 1, "opa": "Irritable bowel syndrome", "opb": "Inflammatory bowel disease", "opc": "Gastrointestinal tumours", "opd": "Neuroendocrine tumours", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "54a0eb08-7d80-4e8c-bd67-cdf11a01940d", "choice_type": "single"}
+{"question": "The Drug of Choice for Sydenham chorea is", "exp": "(D) Sodium Valproate[?]SYDENHAM'S CHOREA:oSydenham's chorea (SC)/Chorea minor/Rheumatic chorea (RC)/St Vitus' s Dance:-Major diagnostic criteria for rheumatic disease-Most common acquired chorea during childhood-Characterized by rapid, uncoordinated jerking movements primarily affecting the face, hands and feet.[?]Treatment of Chorea:oMay be difficult to treat.oTaper or discontinue any medications that can cause or worsen chorea.oIn adults, the mainstay of treatment in adults is Neuroleptics, including Haloperidol & Pimozide.oIn children the incidence of side effects in children is high.oTherefore, treatment is usually:-Benzodiazepine, particularly Clonazepam, Diazepam or Clobazam.-Valproate Is the drug of choiceoSydenham chorea generally responds to dopamine-blocking agents - Valproic acid & carbamazepine.oBenzodiazepines facilitate the action of GABA and valproate enhances the action on GABA, hence these agents are used to treat choreaoBut it is self limited, and treatment generally restricted to those with severe chorea.oSydenham chorea with recurrence in lateral life as pregnancy (Chorea gravidarum) or treatment with sex hormones.[?]Treatment Hyperkinetic Movement Disorders:oDystonia:-Anticholinergic, baclofen, botulinum toxin, globus pallidus internus DBS.oHemifacial spasm:-Botulinum toxinoEssential tremor:-Propranolol, primidone, topiramate, botulinum toxin, ventral intermediate nucleus DBS.oTics (Tourette's syndrome):-Fluphenazine, risperidone, botulinum toxin.oChorea (huntington's Disease):-TetrabenazineoMyoclonus:-Clonazepam, levetiracetam, piracetam, sodium valproate.oTardive dyskinesia:-Withdrawal of the causative treatment, tetrabenazine (for tardive stereotypy, chorea, tremor), botulinum toxin (for tardive dystonia).GENETIC & NON-GENETIC CAUSES OF CHOREAGenetic causesNon-genetic causes* Huntington's Disease* Sydenham's chorea* Neuroacanthocytosis* Metabolic causes* Benign hereditary chorea* Chorea gravidarum* Wilson's disease* Drug induced chorea* Dentatorubropallidolusian atrophy* Senile chorea* Spinocerebellar ataxia type 2* Vascular chorea* McLeod Syndrome* Infective causes[?]CAUSES OF CHOREA:oDrugs:-Levodopa in Parkinson's patients-Oral contraceptive pills-Many psychiatric drugsoVascular disease of the basal ganglia:-Atheroma-Systemic lupus erythematosusoDegeneartive disease:-Huntington's diseaseoPost-infectious:-Sydenham's choreaoOther causes: Thyrotoxicosis", "cop": 4, "opa": "Haloperidol", "opb": "Sodium valproate", "opc": "Diazepam", "opd": "Prednisolone", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "65faa213-b675-4b6e-85de-bfb0c96623d9", "choice_type": "single"}
+{"question": "Treatment of acute cardiac tamponade is", "exp": "Initial management in hospital is by pericardiocentesis. This involves the inseion of a needle through the skin and into the pericardium and aspirating fluid under ultrasound guidance preferably. This can be done laterally through the intercostal spaces, usually the fifth, or as a subxiphoid approach.A left parasternal approach begins 3 to 5 cm left of the sternum to avoid the left internal mammary aery, in the 5th intercostal space. Often, a cannula is left in place during resuscitation following initial drainage so that the procedure can be performed again if the need arises. If facilities are available, an emergency pericardial window may be performed instead] during which the pericardium is cut open to allow fluid to drain. Following stabilization of the person, surgery is provided to seal the source of the bleed and mend the pericardium. In people following hea surgery the nurses monitor the amount of chest tube drainage. If the drainage volume drops off, and the blood pressure goes down, this can suggest tamponade due to chest tube clogging. In that case, the person is taken back to the operating room for an emergency reoperation. If aggressive treatment is offered immediately and no complications arise (shock, AMI or arrhythmia, hea failure, aneurysm, carditis, embolism, or rupture), or they are dealt with quickly and fully contained, then adequate survival is still a distinct possibility. Ref Davidson 23rd edition pg 453", "cop": 1, "opa": "Emergency paracentesis", "opb": "Emergency thoracotomy", "opc": "Pericardiactomy", "opd": "IV fluids", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "563081ee-83b2-4ead-badf-691372608554", "choice_type": "single"}
+{"question": "Bart hemoglobin is a tetramer of", "exp": "Bart Hb is a tetramer of excess γ globin.", "cop": 1, "opa": "γ globin", "opb": "β globin", "opc": "α globin", "opd": "δ globin", "subject_name": "Medicine", "topic_name": null, "id": "2d776f11-383d-4a76-9edc-5f6c7c050a1a", "choice_type": "single"}
+{"question": "Q. Initial Antihypeensive agent of choice in a patient with stable ischemic hea disease is", "exp": "Answer is A (Beta-Blockers) Beta Blockers are recommended as First Line Agents of choice for treatment of hypeension in hypeensive patients with Stable Ischemic Hea Disease.", "cop": 1, "opa": "Beta-Blockers", "opb": "Alpha-Blockers", "opc": "Calcium Channel Blockers", "opd": "Ace Inhibitors", "subject_name": "Medicine", "topic_name": null, "id": "02c3fd63-d433-49f5-b688-ad11479d4474", "choice_type": "single"}
+{"question": "Fever increase water losses by mUday per degree Celsius", "exp": "Ans. is `b' i.e., 200 ml/day per degree Celsius", "cop": 2, "opa": "100", "opb": "200", "opc": "400", "opd": "800", "subject_name": "Medicine", "topic_name": null, "id": "42770ad3-069d-468f-a0a6-b66fc11a4e84", "choice_type": "single"}
+{"question": "Duffy antigen on erythrocytes are receptors for", "exp": null, "cop": 2, "opa": "P. falciparum", "opb": "P. vivax", "opc": "P. ovale", "opd": "P. malariae", "subject_name": "Medicine", "topic_name": null, "id": "90643e0e-0a56-43c7-94d2-8bebb90c8be9", "choice_type": "single"}
+{"question": "NARP syndrome is a type of", "exp": "Harrison's principles of internal medicine 17th edition. * Neurogenic muscular weakness with ataxia and retinitis pigmentosa is a mitochondrial disease", "cop": 1, "opa": "Mitochondrial function disorder", "opb": "Glycogen storage disorder", "opc": "Lysosomal storage disorder", "opd": "Lipid storage disorder", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "c39d408f-9d25-4d43-bf6d-d49aed872e36", "choice_type": "single"}
+{"question": "Fastest tolerance develops in", "exp": "(Opiods): (Neeraj Ahujapsychiatry)DRUGUSUAL ROUTE OF ADMINISTRATIONPHYSICAL DEPENDENCEPSYCHIC DEPENDENCETOLERANCE1. AlcoholOral+ ++ ++2. Alcohol (Morphine Heroin)Oral, Parenteral, Smoking+ + ++ + ++ + +3. Cannabis (Marihuana)Smoking, Oral++ ++4. CocaineInhalation,, Oral, Smoking, Parenterl-+ +-5. AmphetaminesOral, Parenteral++ ++ + +6. Lysergic acid Diethylamide (LSD)Oral-++7. BarbituratesOral, Parenteral+ ++ ++ + +8. Benzodiazepine sOral, Parenteral+++9. Volatile SolventsInhalation++ ++10. Phencyclidine (PCP)Smoking, Inhalation, Parenteral, Oral+++", "cop": 2, "opa": "Cannabis", "opb": "Opiods", "opc": "Alcohol", "opd": "Benzodiazepines", "subject_name": "Medicine", "topic_name": "Drugs", "id": "73bcfd27-c3a9-4d94-b78c-a82aadd5bb4f", "choice_type": "single"}
+{"question": "In vitro DNA amplification is done by", "exp": "(D) Polymerase chain reaction # DNA amplification is done by PCR> Blotting technique Following gel electrophoresis, probes are often used to detect specific molecules from the mixture. However, probes cannot be applied directly to the gel. The problem can be solved by three types of blotting methods: Southern blotting, Northern blotting and Western blotting. Southern blotting is a technique for detecting specific DNA fragments in a complex mixture. Northern blotting is used for detecting RNA fragments, instead of DNA fragments. Western blotting is used to detect a particular protein in a mixture. The probe used is therefore not DNA or RNA, but antibodies. The technique is also called \"immunoblotting\" PCR: In vitro Techniques such as the polymerase chain reaction allow the amplification of specific DNA sequences so that minute quantities of foreign nucleic acids can be recognized in host specimens. Recombinant DNA refers to a collection of techniques for creating (and analyzing) DNA molecules that contain DNA from two unrelated organisms. One of the DNA molecules is typically a bacterial or viral DNA that is capable of accepting another DNA molecule; this is called a vector DNA. The other DNA molecule is from an organism of interest, which could be anything from a bacterium to a whale, or a human. Combining these two DNA molecules allows for the replication of many copies of a specific DNA. These copies of DNA can be studied in detail, used to produce valuable proteins, or used for gene therapy or other applications. Electrophoresis, also called cataphoresis, is the motion of dispersed particles relative to a fluid under the influence of a spatially uniform electric field. This electrokinetic phenomenon was observed for the first time in 1807 by Reuss , who noticed that the application of a constant electric field caused clay particles dispersed in water to migrate. It is ultimately caused by the presence of a charged interface between the particle surface and the surrounding fluid.", "cop": 4, "opa": "Blotting technique", "opb": "Recombinant technique", "opc": "Electrophoresis", "opd": "Polymerase chain reaction", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "1d9e3cf3-13d2-455a-b4be-0ecd106deed2", "choice_type": "single"}
+{"question": "Most important features in cushing syndrome is", "exp": "(Centripetal obesity) (1050- CMDT-10, 2252-2255-H17th)CUSHING SYNDROME (HYPERCORTISOLISM)ESSENTIALS OF DIAGNOSIS* Central obesity, with a plethoric \"moon face\" \"buffalo hump\" supraclavicular fat pad, protuberant abdomen, thin extremities, muscle wasting, thin, skin, purple striae, Hirsutism* Psychological changes - frank psychosis* Olegomenorrhagia or amenorrhea (or impotence in male)* Osteoporosis, hypertension, poor wound healing, polyurea, renal calculi, glaucoma* Hyperglycemia, glycosuria, leukocytosis, lymphocytopenia hypokalemia* Elevated serum cortisol and urinary free cortisol, Lack of normal suppression by dexamethasone*** Hypertension is seen in cushing syndrome because of sodium and water retension so it is sustained hypertension (Not episodic)***Interestingly, hypercortisolism without cushing syndrome can occur in - severe depression, anorexia nervosa, alcoholism and familial cortisol resistance, familial lipodystrophy type I patients receiving anti retroviral therapy for HIV-I infection* Earliest manifestation of cushing's syndrome is - Loss of diurmal variation*** Cushing's disease is associated with increased ACTH and increased cortisol* Conn's syndrome is most commonly associated with cortical adenoma*** NELSON SYNDROME - is a disorder characterized by rapid growth of ACTH secreting pituitary adenoma following bilateral adrenalectomy** (which was performed for cushing disease)* Most common cause of Cushing's syndrome is iatrogenic administration of steroids**Frequency of sign & symptoms of cushing syndrome* Typical habitus (centripetal obesity)97%* Personality changes66%* Increased body weight94%* Ecchymosis65%* Fatigability and weakness87%* Proximal myopathy **62%* Hypertension (BP > 150/90)82%* Edema62%* Hirsutism80%* Polyurea polydipsia23%* Amenorrhea77%* Hypertrophy of clitoris19%* Broad violaceous cutaneous striae67%", "cop": 1, "opa": "Centripetal obesity", "opb": "Hypertension", "opc": "Menorrhagia", "opd": "Polyurea", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "9cfe954b-4276-4e77-851f-3561829269a6", "choice_type": "single"}
+{"question": "Hypogonadism with 47 XXY is a feature of", "exp": "Ans. d (Klinefelter's syndrome) (Ref: Robbins 7th edition, p.179; Harisson's internal medicine 17th edition, p. 2317)Klinefelter syndrome (XXY)# Common cause of hypogonadism seen in infertility work-up# Dysgenesis of seminiferous tubules | inhibin | FSH.# Abnormal Leydig cell function | testosterone | LH | estrogen.# Testicular atrophy, eunuchoid habitus, tall, long extremities, gynecomastia, female hair distribution. May present with developmental delay. Presence of inactivated X chromosome (Barr body).KLINFELTER'S SYNDROME# Most common genetic cause of hypogonadism6# Incidence:- 1 in 500 (Robbin's)- 1 in 1000 (Harrisions's)# C/F: Eunuchoid body habitat, Atropic testis (< 3.5 mL) (r) Gynaecomastia, Small penis ( < 2.5 cm)# Mean I.Q ... Subnormal (mental retardation uncommon)# Semiferous tubules degenerates, Leydig cells are prominent or increased# Diagnosis: FSH--with low testestorone and high estrogen level# Malignancies:| Risk| RiskCa. Breast, Ca. Lung, NHL (mediastinal), Gonadoblastoma# Educational Points:Ca Prostate (Testesterone dependent)SyndromeAssociated Malignancy Down's SyndromeALL (most common)M7 type AMLJuvenile CML Turner's SyndromeGonadoblastoma, | Ca Colon, Cystic hygroma", "cop": 4, "opa": "Down's syndrome", "opb": "Turner's syndrome", "opc": "Edward's syndrome", "opd": "Klinefelter's syndrome", "subject_name": "Medicine", "topic_name": "Genetics", "id": "622e130a-8881-4267-ad34-78cd538b7380", "choice_type": "single"}
+{"question": "Cardiac anomaly seen in Noonan's syndrome is", "exp": "Pulmonary stenosis and hyperophic cardiomyopathy are generally the most common congenital hea defects found in Noonan syndrome. Pulmonary stenosis is often associated with a thickened and dysplastic valve Ref Robbins 9/e pg .532", "cop": 3, "opa": "VSD", "opb": "ASD", "opc": "Pulmonary stenosis", "opd": "Coarctation of aoa", "subject_name": "Medicine", "topic_name": "Genetics", "id": "bc563a8f-b074-4f9d-a54f-1fb059c3631d", "choice_type": "single"}
+{"question": "Hypoxic pulmonary vasoconstriction due to", "exp": "Hypoxic pulmonary vasoconstriction (HPV), also known as the Euler-Liljestrand mechanism, is a physiological phenomenon in which small pulmonary aeries constrict in the presence of alveolar hypoxia (low oxygen levels). Ref Harrison20th edition pg 2334", "cop": 2, "opa": "Irreversible pulmonary vasocontriction hypoxia", "opb": "Reversible pulmonary vasoconstriction due to hypoxia", "opc": "Direct blood to poorly ventilated areas", "opd": "Occurs hours after pulmonary vasoconstriction", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "740725c8-9bee-4ded-aee1-170a163d7818", "choice_type": "single"}
+{"question": "Sumatriptan is", "exp": "Sumatriptan a 5-HT 1D/1B agonist is used for acute migraine attacks. Buspirone, a 5-HT 1A agonist is an effective nonbenzodiazepine anxiolytic. ref - harrisons internal medicine 20e pg3100", "cop": 1, "opa": "5-HT 1D/1B agonists", "opb": "5-HT 1D/1B antagonist", "opc": "5-HT 1A agonist,", "opd": "5-HT 1A antagonist", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "f9b5c9c8-4d50-4638-a4f9-3e8530a3cd9b", "choice_type": "single"}
+{"question": "Tentative marks are indicative of", "exp": "Ans. (c) Suicide.", "cop": 3, "opa": "Homicide", "opb": "Accident", "opc": "Suicide", "opd": "Burking", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "794fd2b7-cb82-4d6e-b7ab-8b01f2e680b3", "choice_type": "single"}
+{"question": "For the following medical conditions, select the associated acid base disturbances.Sepsis", "exp": "Sepsis can cause cardiovascular insufficiency with lactic acidosis, whereas fever and endotoxemia stimulate the respiratory center, causing respiratory alkalosis.", "cop": 2, "opa": "metabolic acidosis and respiratory acidosis", "opb": "metabolic acidosis and respiratory alkalosis", "opc": "metabolic alkalosis and respiratory acidosis", "opd": "metabolic alkalosis and respiratory alkalosis", "subject_name": "Medicine", "topic_name": "Kidney", "id": "0fdf5e74-8e90-4d73-a345-b956ddb6ea3e", "choice_type": "single"}
+{"question": "Dysphagia is the awareness of something", "exp": null, "cop": 3, "opa": "Gurgling in the throat", "opb": "Gushing in the throat", "opc": "Sticking in the throat", "opd": "Slushing in the throat", "subject_name": "Medicine", "topic_name": null, "id": "605caf27-2aac-4233-87bd-84829e227faf", "choice_type": "single"}
+{"question": "Most common cause of Neuropathy is", "exp": "(D) Diabetes mellitus # DIABETIC NEUROPATHY occurs in 50% of individuals with long standing Type I & Type II DM.> It may manifest as poly neuropathy, mono neuropathy, and/or autonomic neuropathy.> As with other complications of DM, the development of neuropathy corrilates with the duration of diabetes and glycemic control.", "cop": 4, "opa": "Leprosy", "opb": "Guillaine-Barre syndrome", "opc": "Amyloidosis", "opd": "Diabetes mellitus", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "dad21dd9-115c-4961-bd73-0e6733f78b69", "choice_type": "single"}
+{"question": "Embolism of posterior cerebral artery leads to memory' impairment because of damage to", "exp": "(A) Hippocampal gyrus # Occlusion of the distal PCA causes> Infarction of the medial temporal and occipital lobes.> Contralateral Homonymous hemianopia with macula sparing is the usual manifestation.> Occasionally, only the upper quadrant of visual field is involved.> If the visual association areas are spared and only the calcarine cortex is involved, the patient may be aware of visual defects.> Medial Temporal lobe and hippocampal involvement maycause an acute disturbance> In memory, particularly if it occurs in the dominant hemisphere.", "cop": 1, "opa": "Hippocampal gyrus", "opb": "Angular gyrus", "opc": "Premarginal area", "opd": "Superior temporal gyrus", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "0f3eaeec-4097-477d-a27d-64c3a2f5d5e0", "choice_type": "single"}
+{"question": "Most common cause of intracranial bleed is", "exp": "(B) Hypertension # INTRAPARENCHYMAL HEMORRHAGE (IPH) is one extension of intracerebral hemorrhage (the other is intraventricular hemorrhage (IVH)) with bleeding within brain parenchyma.> Intraparenchymal hemorrhage accounts for approx. 8-13% of all strokes and results from a wide spectrum of disorders. It is more likely to result in death or major disability than ischemic stroke or subarachnoid hemorrhage, and therefore constitutes an immediate medical emergency.> Intracerebral hemorrhages and accompanying edema may disrupt or compress adjacent brain tissue, leading to neurological dysfunction. Substantial displacement of brain parenchyma may cause elevation of intracranial pressure (ICP) and potentially fatal herniation syndromes.# Pathophysiology: Nontraumatic intraparenchymal hemorrhage most commonly results from Hypertensive damage to blood vessel walls E.g.: - Hypertension - Eclampsia - Drug abuse, but it also may be due to Autoregulatory dysfunction with excessive cerebral blood flow E.g.: Reperfusion injury - Hemorrhagic transformation - Cold exposure - Rupture of an aneurysm or arteriovenous malformation (AVM) Arteriopathy (E.g. cerebral amyloid angiopathy, moyama) - Altered hemostasis (E.g. thrombolysis, anticoagulation, bleeding diathesis) Hemorrhagic necrosis (E.g. Tumor, Infection) Venous outflow obstruction (E.g. Cerebral venous sinus thrombosis). Non penetrating and penetrating cranial trauma can be also common causes of intracerebral hemorrhage.", "cop": 2, "opa": "Berry aneurysm", "opb": "Hypertension", "opc": "Coagulopathy", "opd": "Diabetes mellitus", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "d35e7d25-a1ac-41b7-aad8-6ac6bdfa6a4c", "choice_type": "single"}
+{"question": "Pasteurized milk is most commonly tested by", "exp": "Phosphatase test - widely used test.", "cop": 1, "opa": "Phosphatase test", "opb": "Standard plate count", "opc": "Coliform Count", "opd": "Holder method", "subject_name": "Medicine", "topic_name": null, "id": "d9b7964f-125f-42f6-85ed-fc9f95b6c96e", "choice_type": "single"}
+{"question": "Best Test for intestinal malabsorption", "exp": null, "cop": 1, "opa": "D-xylose test", "opb": "NBT-PABA TEST", "opc": "Fecal fatestimation", "opd": "Schilling test", "subject_name": "Medicine", "topic_name": null, "id": "2ef861f0-78fb-4183-a592-97828eb45457", "choice_type": "single"}
+{"question": "Inability to abduct left eye with LMN fascial palsy on same side. The lesion is in", "exp": "(A) Left pons # Foville's syndrome following dorsal pontine injury includes lateral gaze palsy, ipsilateral facial palsy, and contralateral hemiparesis incurred by damage to descending corticospinal fibers.> Millard-Gubler syndrome from ventral pontine injury is similar, except for the eye findings. There is ipsilateral lateral rectus weakness only, instead of gaze palsy, because the abducens fascicle is injured rather than the nucleus. Infarct, tumor, hemorrhage, vascular malformation, and multiple sclerosis are the most common etiologies of brainstem abducens palsy.", "cop": 1, "opa": "Left pons", "opb": "Right pons", "opc": "CP angle tumor", "opd": "Cerebellar lesions", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "88fae086-b2fb-4b9f-956b-4573470b0a60", "choice_type": "single"}
+{"question": "This ECG is most likely associated with", "exp": "Ans-2.C, If we focus on any one lead like lead 2 ,tall tented t waves are a seen.T wave is said to be tall when its amplitude is more than 50% of R wave.Cause is hyperacute mi or hyperkalemia.out of these options conn's syndrome will cause hypokalemia(t waves short or absent or inverted)multiple myeloma will lead to hypercalcemia(qt interval short in ECG)renal failure is mostly associated with hyperkalemia,while SIADH causes hyponatremia(normal ECG or decreased qrs amplitude but no t wave abnormality)", "cop": 3, "opa": "Conn's syndrome", "opb": "Multiple myeloma", "opc": "Renal failure", "opd": "SIADH", "subject_name": "Medicine", "topic_name": "M.I. & Angina", "id": "93173c67-a75d-479b-bd6d-a44a2272d86a", "choice_type": "single"}
+{"question": "Predisposing factor for pneumococal pneumoniaa) CRFb) Lymphoma c) Thalassemiad) Cystic fibrosis", "exp": null, "cop": 1, "opa": "abc", "opb": "bc", "opc": "acd", "opd": "bcd", "subject_name": "Medicine", "topic_name": null, "id": "eabe080e-8670-4a18-a4c0-a708fec57ec5", "choice_type": "single"}
+{"question": "Severe Obstructive sleep apnea is defined as AHI of greater than", "exp": "Obstructive Sleep Apnea/Hypopnea Syndrome Quantification and Severity scaleApnea-hypopnea index : Number of apnea plus hypopnea per hour of sleepRespiratory disturbance index : Number of apneas plus hypopnea plus RERAs per hour of sleepMild OSAHSAHI of 5-14 events/hourModerate OSAHSAHI of 15-29 events/hourSevere OSAHSAHI of >= 30 events/hourReference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 319; Sleep Apnea", "cop": 4, "opa": "15 events/hour", "opb": "20 events/hour", "opc": "25 events/hour", "opd": "30 events/hour", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "f5f8de47-8033-4a8f-8029-f0161f6c1132", "choice_type": "single"}
+{"question": "Holt Gram syndrome is characterized by", "exp": null, "cop": 1, "opa": "ASD", "opb": "VSD", "opc": "TGA", "opd": "AR", "subject_name": "Medicine", "topic_name": null, "id": "9a22bd5f-d573-45fd-9371-fc71cd5204bd", "choice_type": "single"}
+{"question": "A lady presents with galactorrhea and visual defects. Investigation to be done is", "exp": "MRI is the imaging of choice for pituitary tumour. It is preferred over CT scan.", "cop": 3, "opa": "Serum prolactin", "opb": "CT scan of brain", "opc": "MRI", "opd": "Angiography", "subject_name": "Medicine", "topic_name": "All India exam", "id": "3ad191cd-1c85-45ed-a0f0-0dcef4585aba", "choice_type": "single"}
+{"question": "In renal failure, metabolic acidosis is due to", "exp": "Ans. is 'c' i.e., Decreased ammonia synthesis The predominant reason for metabolic acidosis in C.R.E is decreased ammonia production. Metabolic acidosis is a common disturbance in advanced chronic kidney disease The majority of patients can still acidly the urine but they produce less ammonia and, therefore, cannot excrete the normal quantity of protons in combination with this urinary buffer.", "cop": 3, "opa": "Increased fr production", "opb": "Loss of HCO,", "opc": "Decreased ammonia synthesis", "opd": "Use of diuretics", "subject_name": "Medicine", "topic_name": null, "id": "72760610-25c8-4bde-ba6f-ad222918663a", "choice_type": "single"}
+{"question": "Maralgia paresthetica is not caused by", "exp": "A painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN), meralgia paresthetica is commonly due to focal entrapment of this nerve. Meralgia paraesthetica can occur in pregnancy, in obesity and if there is tense ascites. It may be a result of trauma, surgery (such as pelvic osteotomy, spinal surgeries, laparoscopic hernia repair and bariatric surgery) Ref Harrison20th edition pg 2345", "cop": 2, "opa": "Ascites", "opb": "Alcohol consumption", "opc": "Obesity", "opd": "Pelvic surgery -", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "65277efe-d9b7-46bd-b318-59631c8763cd", "choice_type": "single"}
+{"question": "Elongated filaments in Pick's disease consist of", "exp": "Harrison's principles of internal medicine 17th edition. *In Pick's disease dementia is frontotemporal dementia *Molecular basis - tau *Causal genes and chromosome - tau exon and intron mutation(17) *Susceptibility - H1 tau haplophytes * Pathology - tau inclusions,pick bodies,neurofibrillary tangles", "cop": 1, "opa": "Hyperphosphorylated tau", "opb": "Ubiquitin", "opc": "Alpha-synuclein", "opd": "Beta-synuclein", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "b6a500b8-34fd-422a-8b7c-8c8a514e72d3", "choice_type": "single"}
+{"question": "Hypokalemia is likely to be seen in", "exp": null, "cop": 1, "opa": "Insulin therapy", "opb": "Addison's disease", "opc": "Starvation ketosis", "opd": "Hemolytic anemias", "subject_name": "Medicine", "topic_name": null, "id": "146c543a-43aa-4ffc-bbae-4dad3669d986", "choice_type": "single"}
+{"question": "Bone morphogenic protein receptor 2 gene abnormality seen in", "exp": "primary pulmonary hypeension is idiopathic (BMPR gene abnormality).", "cop": 2, "opa": "Interstitial lung disease", "opb": "Pulmonary aery hypeension", "opc": "cystic fibrosis", "opd": "Diaphragmatic weakness", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "55e7fef2-0b83-4128-99fe-8b5937eac0cd", "choice_type": "single"}
+{"question": "Decreased serum ferritin levels are seen in", "exp": "Ans. a (Iron deficiency anemia). (Ref. Harrison's 17th /Table 98-4; 18th/Ch.103)# Hb contains 70% of iron and 3% myoglobin with remaining being ferritin.# Iron is readily absorbed in ferrous state, but most of the dietary iron is in ferric (Fe+3) state.FACTORS AFFECTING IRON ABSORPTION ARE:# Promoting factors:- Retarding factors:- High pH- Excess mucus- Bile salts- Phosphates- Chlorophyll- Phytates- Vitamin C- Antacids# Mobilferin binds more iron as binding sites increase.# As amount of transferrin in plasma increases, its % of iron saturation decreases.# More iron moves from intercellular iron carrier to transferrin and less binds to apoferritin.# As ferritin stores decreases, less iron is lost in mucosal shedding.# In iron deficiency anaemia ferritin levels decreases.# Normal TIBC is 300.# Low serum iron, decreased MCV with high TIBC is specific for iron deficiency anemia.FERRITIN# Free iron is highly toxic, and the pool of storage iron is tightly bound to either ferritin or hemosiderin.# Ferritin is a protein-iron complex found in all tissues but particularly in liver, spleen, bone marrow, and skeletal muscles.# Intracellular ferritin is located in both the cytosol and lysosomes, in which partially degraded protein shells of ferritin aggregate into hemosiderin granules.# The iron in hemosiderin is chemically reactive and turns blue-black when exposed to potassium ferrocyanide, which is the basis for the Prussian blue stain.# In iron-overloaded cells, most iron is stored in hemosiderin.# Very small amounts of ferritin normally circulate in the plasma.# Since plasma ferritin is derived largely from the storage pool of body iron, its levels correlate well with body iron stores.# In iron deficiency, serum ferritin is always < 12 mg/L, whereas in iron overload, high values approaching 5000 mg/L can be seen.# Iron is transported in plasma by an iron-binding glycoprotein called transferrin, which is synthesized in the liver. In normal individuals, transferrin is about 33% saturated with iron, yielding serum iron levels that average 120 mg/dL in men and 100 mg/dL in women.DIAGNOSIS OF MICROCYTIC ANEMIA TestsIron DeficiencyInflammationThalassemiaSideroblastic Anemia1SmearMicro/ hypoNormal; micro/ hypoMicro/hypo with targetingVariable2SI<30<50Normal to highNormal to high3TIBC>360<300NormalNormal4Percent saturation<1010-2030-8030-805Ferritin (mg/L)<1530-20050-30050-3006Hemoglobin patternNormalNormalAbnormalNormal", "cop": 1, "opa": "Iron deficiency anemia", "opb": "Thalassemia", "opc": "Sideroblastic anaemia", "opd": "Renal failure", "subject_name": "Medicine", "topic_name": "Blood", "id": "81662d1f-b221-4bdd-8794-411a6c3bda64", "choice_type": "single"}
+{"question": "Enzyme defect in acute intermittent porphyria", "exp": "Ref - Davidsons 23e p378", "cop": 1, "opa": "PMB deaminase", "opb": "ALA dehydratase", "opc": "UROI synthase", "opd": "URO II synthase", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "e4de1c6a-86af-46d0-bebd-1d456fff53e2", "choice_type": "single"}
+{"question": "Most common arrhythmia after reperfusion syndrome is", "exp": "AIVR is currently defined as an enhanced ectopic ventricular rhythm with at least 3 consecutive ventricular beats, which is faster than normal intrinsic ventricular escape rhythm (<=40 bpm), but slower than ventricular tachycardia (at least 100-120 bpm) Ref Harrison 20th edition pg 1432", "cop": 1, "opa": "AIVR", "opb": "VT", "opc": "Ventricular fibrillation", "opd": "PSVT", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "002c8df8-c363-42ec-9c7c-5a73cff9f3da", "choice_type": "single"}
+{"question": "A young patient presented with blood pressure of 190/120 mm of Hg without any clinical symptom and fundus examination is normal, treatment of choice", "exp": "Angiotensin-conveing enzyme (ACE) inhibitors block production of the hormone, angiotensin II, a compound in the blood that causes narrowing of blood vessels and increases blood pressure. By reducing production of angiotensin II, ACE inhibitors allow blood vessels to widen, which lowers blood pressure and improves hea output. The available ACE inhibitors include benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril. Side effects -- In some patients, ACE inhibitors cause a persistent dry hacking cough that is reversible when the medication is stopped. Less common side effects include dry mouth, nausea, rash, muscle pain, or occasionally, kidney dysfunction and elevated blood potassium. A potentially serious complication of ACE inhibitors is angioedema, which occurs in 0.1 to 0.7 percent of people. People with angioedema rapidly (minutes to hours after taking the medication) develop swelling of the lips, tongue, and throat, which can interfere with breathing. These symptoms are a medical emergency, and the ACE inhibitor should be discontinued. oral enalapril may also be used in young hypeensives who presents with ususually high levels of blood pressure to overcome the end stage damages that can happen. ref:Harrison&;s principles of internal medicine,ed 18,pg no 2057", "cop": 3, "opa": "Oral Nitroglycerine", "opb": "IV Nitroglycerine", "opc": "Oral Enalapril", "opd": "IV Enalapril", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "3bf58cae-bcf3-45a0-a7b6-90a145478fc9", "choice_type": "single"}
+{"question": "Acute infectious purpura fulminans is caused by", "exp": "Purpura fulminans is an acute, often fatal, thrombotic disorder which manifests as blood spots, bruising and discolouration of the skin resulting from coagulation in small blood vessels within the skin and rapidly leads to skin necrosis and disseminated intravascular coagulation caused by Neisseria meningitidis and varicella Ref Harrison20th edition pg 1078", "cop": 1, "opa": "Neisseria meningitidis and varicella", "opb": "Gonococi", "opc": "E. coli", "opd": "Proteus", "subject_name": "Medicine", "topic_name": "Infection", "id": "d8f139ee-da8c-43c3-9a5b-e7880e448e4c", "choice_type": "single"}
+{"question": "Drug of choice for idiopathic intracranial hypeension", "exp": "Idiopathic intracranial hypeension is treated with acetazolamide. It should not be given in first trimester, in rest of the peroids it is safe. This condition worsens during pregnancy due to weight gain. Reference : Harrison20th edition pg 2334", "cop": 1, "opa": "Acetazolamide", "opb": "Glycerol", "opc": "Mannitol", "opd": "Dexamethasone", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "882dd7e1-e64a-4921-a0ac-ad7402d5cc8e", "choice_type": "single"}
+{"question": "Thymoma associated with", "exp": "* Thymus is abnormal in 75% patients with MG. 65% - hyperplastic, 10%- thymic tumours or thymomas Ref Harrison20th edition pg 2345", "cop": 1, "opa": "Myasthenia gravis", "opb": "Polycythemia", "opc": "Ectopic ACTH", "opd": "Polyaentis nodosa", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "9224ff69-d41e-41cb-96f7-146e5b0c88f6", "choice_type": "single"}
+{"question": "Chronic renal failure is associated with", "exp": null, "cop": 1, "opa": "Metabolic acidosis", "opb": "Respiratory acidosis", "opc": "Respiratory alkalosis", "opd": "Hypoxia", "subject_name": "Medicine", "topic_name": null, "id": "9eb9569c-000a-4d19-abef-3fe8899b1a85", "choice_type": "single"}
+{"question": "Freshwater swimming can lead to", "exp": "Leptospirosis Leptospires excreted in urine and can survive in water for many months, water is an impoant vehicle in their transmissionBabesiosis Veical transmission, blood transfusion, or tick bitebrucellosisOccupational or domestic exposure to infected animals or their products by ingestion, inhalation, or mucosal or percutaneous exposureLassa feverAerosols from infected rodents, capturing or eating these animals, close person to person contact(ref: Harrison's 18/e p1393)", "cop": 2, "opa": "Brucellosis", "opb": "Leptospirosis", "opc": "Babesiosis", "opd": "Lassa fever", "subject_name": "Medicine", "topic_name": "All India exam", "id": "a422db9b-9de3-4053-b842-1217757fe759", "choice_type": "single"}
+{"question": "Marbling is noticed by", "exp": "Ans. (c) 36 hours.", "cop": 3, "opa": "18 hours", "opb": "24 hours", "opc": "36 hours", "opd": "48 hours", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "e3895826-ea20-4345-bbcd-8eeae9b794b5", "choice_type": "single"}
+{"question": "The most common clinical manifestation of Multiple Sclerosis is", "exp": "(C) Optic Neuritis INITIAL SYMPTOMS OF MULTIPLE SCLEROSISSymptomPercent of CasesSymptomPercent of Cases* Sensory loss37* Lhermitte3* Optic neuritis36* Pain3* Weakness35* Dementia2* Paresthesias24* Visual loss2* Diplopia15* Facial palsy1* Ataxia11* Impotence1* Vertigo6* Myokymia1* Paroxysmal attacks4* Epilepsy1* Bladder4* Falling1# Optic neuritis is the commonest presenting feature of multiple sclerosis out of the given choices. It is roughly seen in 36% of cases.> Sensory loss may be the initial symptom in 37% cases.> Optic neuritis generally presents as decreased acuity, dimness or colour desaturation in central field of vision.> Afferent pupillary response may be detected.> Internuclear (not intranuclear) ophthalmoplegia consists of slow adduction of one eye with nystagmus in the abducting eye.> Impaired adduction is due to lesion in medial longitudinal fasciculus.> Bilateral internuclear ophthalmoplegia is highly suggestive of multiple sclerosis. Lhermitte's symptom (sensation of electric shock on flexion of neck) is seen in multiple sclerosis. Seizure and aphasia are uncommon in multiple sclerosis. Afferent pupillary defect is seen in multiple sclerosis. There is abnormality in visual evoked potential. MRI helps in confirming the diagnosis.", "cop": 3, "opa": "Intemuclear Ophthalmoplegia", "opb": "Ataxia", "opc": "Optic Neuritis", "opd": "Diplopia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "a9c267d5-2c67-4d75-853d-c094e0b9784a", "choice_type": "single"}
+{"question": "Immunoglobulins used in Rx of", "exp": "IMMUNOLOGICAL TREATMENT OF MYASTHENIA GRAVIS Ref - Davidsons 23e p1142", "cop": 1, "opa": "Myasthenia gravis", "opb": "Malaria", "opc": "PAN", "opd": "Hemophilia", "subject_name": "Medicine", "topic_name": "Immune system", "id": "f772a81d-0da3-40ae-b5ac-80dc7caa1113", "choice_type": "single"}
+{"question": "Canagliflozin acts by", "exp": "Agents Used for Treat ment of Type 1 or Type 2 Diabetes Mechanism of ActionExamplesHbA Reduction (%)Agent-Specific AdvantagesAgent-Specific DisadvantagesContraindicationsOralBiguanides|Hepatic glucose productionMetformin1-2Weight neutral, do not cause hypoglycemia, inexpensive, extensive experience, |CV eventsDiarrhea, nausea, lactic acidosisSerum creatinine> 15 mg/dL (men)>1.4 mg/dL (women)(see text), CHF, radio graphic contrast studies,hospitalized patients,acidosisRenal/liver diseasea-Glucosidase inhibitors|GI glucose absorptionAcarbose, miglitol, voglibose0.5-0.8Reduce postprandial glycemiaGI flatulence, liver function testsRenal/liver diseaseDipeptidyl peptidase IV inhibitorsProlong endogenous GLP-1 actionAlogliptin, Linagliptin, Gemigliptin, linagliptin, saxagliptin,sitagliptin, teneligliptin, vildagliptin0.5-0.8Well tolerated, donot cause hypoglycemia Reduced dose with renal disease; one associated with increase hea fail pure risk; possible association with ACE inhibitor-induced angioedemaInsulin secretagogues:Sulfonylureas|Insulin secretionGlibornuride, gliclazide, glimepiride,glipizide, gliquidone,glyburide,glyclopyramide1-2Sho onset of action, lower postprandial glucose, inexpensiveHypoglycemia, weight gainRenal/liver diseaseInsulin secretagogues:Nonsulfonylureas|Insulin secretionNateglinide, repaglinide, mitiglinide0.5-1.0Sho onset of action, lower postprandial glucoseHypoglycemiaRenal/liver diseaseSodium-glucose cotranspoer 2 inhibitors|Urinary glucose excretionCanagliflozin,dapagliflozin,empagliflozin0.5-1.0Insulin secretion and action indepentantUrinary and vaginal infections, dehydration, exacerbate tendency to hyperkalemiaLimited clinical experience; moderate renal insufficiencyThiazolidinediones|Insulin resistance,|glucose utilizationRosiglitazone, pioglitazone0.5-1.4Lower insulin requirementsPeripheral edema,CHF, weight gain,fractures, macularedemaCHF, liver disease Ref: Harrison 19e pg: 2414", "cop": 2, "opa": "Decreases hepatic glucose production", "opb": "Increases Urinary glucose excretion", "opc": "Increase insulin secretion", "opd": "Prolong endogenous GLP-1 action", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "cfcaaccc-c95e-4a99-9e0c-d8be8893cc96", "choice_type": "single"}
+{"question": "The drug of choice for the treatment of Thyrotoxicosis during pregnancy is", "exp": "(C) Propyl Thiouracil # All antithyroid drugs can cross placenta so risk of fetal hypothyroidism and goitre is always there.> Both carbimazole and propylthiourcil can be used during pregnancy, but propyl-thiouracil is the drug of choice because its greater protein binding allows low doses of propylthioracil to be transferred across the placenta and therefore less chance of hypothyroidism.> Lowest effective dose of propyl thiouracil should be given and it is often possible to stop treatment in the last trimester since TSH Receptor antibodies tend to decline in pregnancy.> Radioactive iodine is C/l during pregnancy> It can destroy the fetal thyroid tissue resulting in cretinism> Carbimazole and methimazole have been associated with rare cases of foetal aplasia cutis.", "cop": 3, "opa": "Carbimazole", "opb": "Iodine therapy", "opc": "Propyl Thiouracil", "opd": "Metimazole", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "3bcf18e2-7da2-4c1b-80ba-38a17aca8644", "choice_type": "single"}
+{"question": "Gold criteria for very severe airflow obstruction in COPD is", "exp": "(D) FEV1/FVC<0.7 and FEV1<30% predicted [?]Hallmark of COPD is airflow obstruction.oPulmonary function test shows airflow obstruction with a reduction in FEV1 and FEV/FVC.oWith worsening disease severity, lung volumes may increase, resulting in an increase in total lung capacity, functional residual capacity, and residual volume.oIn patients with emphysema, the diffusing capacity may be reduced, reflecting the lung parenchymal destruction characteristic of the disease.oDegree of airflow obstruction is an important prognostic factor in COPDoIt is the basis for the Global Initiative for Lung Disease (GOLD) severity classificationGOLD CRITERIA FOR COPD SEVERITYGold StageSeveritySymptomsSpirometry0At riskChronic cough, sputum, productionNormalIMildWith or without chronic cough or sputum productionFEV1 /FVC<0.7 & FEV1 >80% predictedIIAModerateWith or without chronic cough or sputum productionFEV1 /FVC<0.7 & >=50%FEV1 but <80% predictedIIISevereWith or without chronic cough or sputum productionFEV1 /FVC<0.7SFEV1 >=30% but <50% predictedIVVery SevereWith or without chronic cough or sputum productionFEV1 /FVC<0.7 & FEV1 <30% predicted or FEV1 <50% predicted with respiratory failure or signs of right heart failure[?]Stage IV: Very Severe COPD:oSevere airflow limitation (FEV1/FVC<70%;FEV1<.30% predicted) or FEV1<50% predicted plus chronic respiratory failure.-Quality of life is appreciably impaired.-Exacerbations may be life-threatening.oAvoid risk factorsoOffer influenza vaccinationoAdd short-acting bronchodilators as neededoAdd rehabilitationoAdd inhaled glucocorticoids if repeated exacerbationsoAdd long-term oxygen if chronic respiratory failureoConsider surgical treatments-Arterial blood gases & Oximetry may demonstrate resting or exertional hypoxemia.-Radiographic studies may assist in the classification of the type of COPD.-CT scan is the current definitive test for establishing the presence or absence of emphysema in living subjects.-Recent guidelines have suggested testing for a, AT deficiency in all subjects with COPD or asthma with chronic airflow obstruction.-Only three interventions-smoking cessation, oxygen therapy in chronically hypoxemic patients & lung volume reduction surgery in selected patients with emphysema have been demonstrated to i influence the natural history of patients with COPD.", "cop": 4, "opa": "FEV1/FVC<0.7 & FEV1>=80% predicted", "opb": "FEV1/FVC<0.7 & >=50% FEV1 but <80% predicted", "opc": "FEV1/FVC<0.7 & FEV1>=30% but <50% predicted", "opd": "FEV1/FVC<0.7 and FEV1<30% predicted", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "ee2fb117-be56-45c2-a7fe-6550ae58cd01", "choice_type": "single"}
+{"question": "A patient presented with thunder clap headache. Followed by unconsciousness with progressive 3rd cranial nerve palsy", "exp": "Harrison's textbook of internal medicine 17th edition . *Sudden transient loss of consciousness may be preceded by brief moment of excruciating head ache ,but most patient first complain of head ache on regain the consciousness . *3rd cranial nerve palsy , associate with pupillary dilatation,loss of ipsilateral light reflex,focal pain above and behind the eye . Ref Harrison20th edition pg 2445", "cop": 2, "opa": "Extradual hemorrhage", "opb": "Aneurysmal subarachnoid hemorrhage", "opc": "Basilar migraine", "opd": "Cluster Headache", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "68a6aa19-f2f0-4ea5-ba8a-3c32ce032463", "choice_type": "single"}
+{"question": "Skin lesions of Tuberous sclerosis includes", "exp": "(C) Adenoma sebaceum # Cardinal features of Tuberous sclerosis (Bourneville's disease): are skin lesions, convulsion and mental retardation.> Early skin lesions are hypopigmented, ash-leaf shaped macules, red or pink papules (angiofibromas) called adenoma sebaceum on face. These enlarge with age.> Other lesion are shagreen patches, ungal fibromas and oral fibromas.> Adenoma sebaceum is characteristically seen in tuberous sclerosis.", "cop": 3, "opa": "Haemangioma", "opb": "Periungual fibroma", "opc": "Adenoma sebaceum", "opd": "Hypopigmented macules", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "18382418-d811-4ad4-bff7-ace3f39f7935", "choice_type": "single"}
+{"question": "Blood pressure is defined as the product of.", "exp": "D i.e. Peripheral resistance x cardiac output: Blood pressure is defined as the product of cardiac output and peripheral resistance. Blood pressure = Cardiac output x peripheral resistance or Blood flow (Q) x resistance (R)", "cop": 4, "opa": "Systolic pressure x pulse", "opb": "Diastolic pressure x pulse rate", "opc": "Pulse pressure x pulse rate", "opd": "Cardiac output x peripheral resistance", "subject_name": "Medicine", "topic_name": null, "id": "e24a6e6f-f9b1-4251-8a1c-3410f1fafdd9", "choice_type": "single"}
+{"question": "Homogenous opacification of right hemithorax with right sided shift of mediastinum may be caused by", "exp": "Answer is A (Collapse of Right lung): Collapse of Right lung may present with homogeneous opacification of right hemithorax and ipsilateral mediastinal Shift. Condition Findings Consolidation : Ipsilateral Hamogenous opacification & No mediastinal shift Collapse : Ipsilateral Homogenous opacification & Ipsilateral mediastinal shift Hemothorax : Ipsilateral homogenous opacification & Contralateral shift Hydrothorax : Ipsilateral homogenous opacification & Contralateral shift", "cop": 1, "opa": "Collapse of Right lung", "opb": "Consolidation of Right lung", "opc": "Right sided hemothorax", "opd": "Left sided hydrothorax", "subject_name": "Medicine", "topic_name": null, "id": "31da3658-cc48-40e1-8860-5aeadb845539", "choice_type": "single"}
+{"question": "The treatment of choice for Tension Pneumothorax is", "exp": "Classical management of tension pneumothorax is emergent chest decompression with needle thoracostomy. A 14-16G intravenous cannula is inseed into the second rib space in the mid-clavicular line. The needle is advanced until air can be aspirated into a syringe connected to the needle Ref Davidson edition23rd pg 627", "cop": 1, "opa": "Wide bore needle inseion in 2nd intercostal space", "opb": "Thoracotomy", "opc": "Intubation with IPPV", "opd": "ICD", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "9df8f2a1-eead-4505-ab63-e520b120202b", "choice_type": "single"}
+{"question": "Gold standard for diagnosing pheochromocytoma is", "exp": "Biopsy is avoided in pheochromocytoma.", "cop": 4, "opa": "Urinary metanephrines", "opb": "CT Abdomen", "opc": "MIBG scan", "opd": "Biopsy", "subject_name": "Medicine", "topic_name": null, "id": "e79e936e-2dd6-42cd-90eb-e8d5f4ce218e", "choice_type": "single"}
+{"question": "Most common site of cerebral infarction is in the territory of", "exp": "Ans. is 'b' i.e., Middle cerebral aery", "cop": 2, "opa": "Anterior cerebral aery", "opb": "Middle cerebral aery", "opc": "Posterior cerebral aery", "opd": "Posterior inferior cerebellar aery", "subject_name": "Medicine", "topic_name": null, "id": "b5137fa6-f32e-4024-bdb0-cfa19b3e1346", "choice_type": "single"}
+{"question": "Bundle of Kent is associated with", "exp": "The bundle of Kent is an abnormal extra or accessory conduction pathway between the atria and ventricles that is present in a small percentage (between 0.1 and 0.3%) of the general population. This pathway may communicate between the left atrium and the left ventricle, in which case it is termed a \"type A pre-excitation\", or between the right atrium and the right ventricle, in which case it is termed a \"type B pre-excitation\".Problems arise when this pathway creates an electrical circuit that bypasses the AV node. The AV node is capable of slowing the rate of conduction of electrical impulses to the ventricles, whereas the bundle of Kent lacks this capability. When an aberrant electrical connection is made the bundle of Kent, tachydysrhythmias may therefore result. Ref Harrison 20th edition pg 1532", "cop": 2, "opa": "Sick sinus syndrome", "opb": "WPW syndrome", "opc": "Long-Ganong-Levine syndrome", "opd": "Stokes-Adams syndrome", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "d374730a-0860-4410-885e-9c39f1fb3cda", "choice_type": "single"}
+{"question": "The triad of cirrhosis, hemochromatosis and diabetes are referred to as", "exp": null, "cop": 4, "opa": "Silver diabetes", "opb": "Diabetes mellitus", "opc": "Diabetes insipidus", "opd": "Bronze diabetes", "subject_name": "Medicine", "topic_name": null, "id": "ac215f3c-a456-4a2d-82d0-37bd7b97c313", "choice_type": "single"}
+{"question": "The recent terminlogy for status asthmaticus is", "exp": null, "cop": 4, "opa": "Episodic asthma", "opb": "Chronic asthma", "opc": "Acute asthma", "opd": "Severe actute asthma", "subject_name": "Medicine", "topic_name": null, "id": "78e3111a-bd6a-42fa-a15a-dd827a2f3038", "choice_type": "single"}
+{"question": "Most common complication of Shigellosis", "exp": "(A) HUS # EXTRAINTESTINAL COMPLICATIONS OF SHIGELLOSIS:> Common complications: Bacteremia HUS: occur with S. dysenteriae type 1 infection. Manifestations of HUS usually develop at end of first week of shigellosis. Oliguria, marked drop in hematocrit are the first signs & progress to anuria with renal failure & to severe anemia with congestive heart failure.> Less common complications: Reactive arthritis> Rare complications: Pneumonia; Meningitis; Vaginitis (in prepubertal girls); Keratoconjunctivitis & \"rose spot\" rashes.", "cop": 1, "opa": "HUS", "opb": "Reactive arthritis", "opc": "Pneumonia", "opd": "Meningitis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "4b5b7c5c-9d76-4bef-8940-7d0b96372a31", "choice_type": "single"}
+{"question": "Absence seizures are characterized on EEG by", "exp": "EEG shows generalized, symmetric, 3-Hz spike-and-wave discharge that begins and ends suddenly, superimposed on a normal EEG background. Ref - Harrison's internal medicine 20e pg3051-3052, 3060f", "cop": 1, "opa": "3 Hz spike and wave", "opb": "1-2 Hz spike and wave", "opc": "Generalized poly spikes", "opd": "Hypsarrythmia", "subject_name": "Medicine", "topic_name": "All India exam", "id": "c7e0de4d-3eef-496e-bf11-a8845b305969", "choice_type": "single"}
+{"question": "A 40 year old presenting with dizziness on standing with systolic reduction of BP of 50mm Hg; appropriate treatment", "exp": "Graduated compression stockings (GCS) help prevent the formation of blood clots in the legs by applying varying amounts of pressure to different pas of the leg. Thigh or waist-high stockings help reduce pooling of blood in the legs and help prevent lightheadedness or falling when you stand up (ohostatic hypotension). Stockings that rise to just below the knee help limit lower leg swelling due to fluid buildup Ref Davidson 23rd edition pg 450", "cop": 1, "opa": "Graded compression stockings", "opb": "Salbutamol", "opc": "Fludrocoisone", "opd": "b-blockers", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "dfe3c09d-5b5e-41a9-be50-cb272175c9e6", "choice_type": "single"}
+{"question": "Carpopedal spasm in hyperventilation occurs because", "exp": "Answer- C. Increased calcium binding to plasma proteinCarpopedal spasm and tetany is due to hypocalcemia.\"The alkalosis that result from hyperventilation may worsen the hypocalcemia by increasing the fraction ionized calcium bound to plasma protein.", "cop": 3, "opa": "Increased calcium uptake by sarcoplasmic reticulum of muscles", "opb": "Increased calcium uptake by bones", "opc": "Increased calcium binding to plasma protein", "opd": "Increased urinary excretion of calcium", "subject_name": "Medicine", "topic_name": null, "id": "fd426448-f961-4713-9a30-e986492f3496", "choice_type": "single"}
+{"question": "Cysticercosis present as a) Seizure b) Neuropathy c) Encephalitis d) Muscular hypertrophy", "exp": null, "cop": 1, "opa": "abc", "opb": "abd", "opc": "bcd", "opd": "bd", "subject_name": "Medicine", "topic_name": null, "id": "73b9b76f-3eba-430d-ac93-0b391e269ce3", "choice_type": "single"}
+{"question": "Risk factor for the development of gastric Carcinoma among the following is", "exp": "Risk factors are:Long-term ingestion of high concentration of nitrates.H.pyloriIntestinal metaplasia in patients with atrophic gastritis.Gastric ulcers and adenomatous polyps.Menetrier's disease.Patients with blood group A have a higher incidence of Ca stomach than blood group O.Note: duodenal ulcers are not associated with gastric cancer.Ref: Harrison's 18/e 765.", "cop": 4, "opa": "Blood group O", "opb": "Duodenal ulcer", "opc": "Intestinal hyperplasia", "opd": "Intestinal metaplasia type III", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "c0ed9279-ae53-48cd-82ee-7b167d7f8151", "choice_type": "single"}
+{"question": "Dose of Reteplase for management of acute MI is", "exp": "Ref Harrison 19 th ed pg 758 The recommended dose for Reteplase in acute MI is 10 UNIT bolis given over 2 minutes . It is recommended to repeat the second 10 unit dose after 30 minutes . Two bolus doses given 30 minutes apa are recommended.", "cop": 2, "opa": "5 IU", "opb": "10 IU", "opc": "15 IU", "opd": "50 IU", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "066c718e-0ee9-4623-93c8-4c5e6151aa27", "choice_type": "single"}
+{"question": "In a patient with mild ulcerative colitis, mainstay of treatment is", "exp": "The mainstay of therapy for mild to moderate UC is sulfasalazine and the other 5-ASA agents.The majority of patients with moderate to severe UC benefit from oral or parenteral glucocoicoids.Azathioprine and 6-mercaptopurine (6-MP) are purine analogues commonly employed in the management of glucocoicoid-dependent IBD. Antibiotics have no role in the treatment of active or quiescent UC.Metronidazole is effective in active inflammatory, fistulous, and perianal CD and may prevent recurrence after ileal resection.Ref: Harrison 19e pg: 1960", "cop": 1, "opa": "5-ASA agents", "opb": "Glucocoicoids", "opc": "Azathioprine", "opd": "Antibiotics", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "f5451542-9bb9-491a-b26c-61b9efc57ce8", "choice_type": "single"}
+{"question": "Iodine requirement in pregnancy and lactation is", "exp": "Pre school Children - 90 mcg.\nSchool Children ( 6-12 years ) - 120 mcg.\nAdults ( > 12 years ) - 150 mcg.\nPregnancy and lactation - 250 mcg.", "cop": 4, "opa": "90 mcg", "opb": "120 mcg", "opc": "150 mcg", "opd": "250 mcg", "subject_name": "Medicine", "topic_name": null, "id": "16286c16-95ff-426c-8b1a-4d78dda2b2e2", "choice_type": "single"}
+{"question": "Gene responsible for resistance to rifampicin", "exp": "Ans. is 'a' i.e., Rpo B gene ATT Drug Gene responsible for drug resistance INH inhA and Kat G gene Ethambutol emb B gene Rifampicin rpoB gene Pyrazinamide pncA gene", "cop": 1, "opa": "Rpo B gene", "opb": "Kat G gene", "opc": "Rpm B gene", "opd": "Emb B gene", "subject_name": "Medicine", "topic_name": null, "id": "bd67b726-9ef7-4cd0-aad0-a03a2e9d3eab", "choice_type": "single"}
+{"question": "Minamata disease in Japan is caused by toxicity of", "exp": "(A) Mercury > Minamata disease (Chisso-Minamata disease), is a neurological syndrome caused by severe mercury poisoning. Symptoms include ataxia, numbness in the hands and feet, general muscle weakness, narrowing of the field of vision and damage to hearing and speech. In extreme cases, insanity, paralysis, coma and death follow within weeks of the onset of symptoms. A congenital form of the disease can also affect fetuses in the womb.", "cop": 1, "opa": "Mercury", "opb": "Arsenic", "opc": "Lead", "opd": "Silver", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "c8d393ac-347e-4f5b-b40e-36599a4dd493", "choice_type": "single"}
+{"question": "Recombinant human insulin is made by", "exp": "Answer is C (CDNA of pancreatic cell)", "cop": 3, "opa": "CDNA from any eukaryote cell", "opb": "Genome of any eukaryote", "opc": "CDNA of pancreatic cell", "opd": "Genome of pancreatic cell", "subject_name": "Medicine", "topic_name": null, "id": "36160e04-8156-4415-9a34-062b69e5d415", "choice_type": "single"}
+{"question": "Gestational diabetes develops only during", "exp": null, "cop": 3, "opa": "Old age", "opb": "Younger age", "opc": "Pregnancy", "opd": "Infancy", "subject_name": "Medicine", "topic_name": null, "id": "cd5dcd7a-4e91-40c4-b6c4-2531d63e3da1", "choice_type": "single"}
+{"question": "\"Floating tooth sign\" seen in", "exp": "i.e. (Histiocytosis X): (631-Basis pathology 8th) (2201-H 17th) (595-Ghai 7th)\"Floating tooth sign \" - radiographic examination of the mandible, erosion of the bony alveolus around the teeth, so that they seen to be floating in space. It occurs in some of histiocytosis X** (Internet)HISTIOCYTOSIS - X(Langerhans cell histiocytosis) (LCH)* Malignant proliferations of dendritic cells or macrophages and includes three clinico pathologically related conditions occuring in children - eosinophilic granuloma, Hand-Schiller Christian disease and Letterer - Siwe syndrome* Histiocytosis X comprises a variety of syndrome associated with foci of eosinophilic granuloma, Diabetes insipidus exophthalmos and punched out lytic bone lesions* The hall mark of LCH is the presence of Birbeck granules in the cytoplasm** (rod shaped structure having dilated tennis - racket like terminal end) and positivity for S-100 protein and CD la positivity**** Most common involvement is of the skeleton (80%)Odontogenic Myxoma - locally invasive and recurring tumour characterised by abundant mucoid stroma and loose stellate cellsAmeloblastoma - is the most common benign** but locally invasive epithelial odontogenic tumour* Resemblance to like admantinoma of the tibia**** Follicular pattern is the most common* Commonest site is mandible in the molar ramus areaPindborg tumor - is also known as calcifying epithelial odontogenic tumour. It resembles an ameloblastoma in that it is locally invasive and commonly identified as uni-multilocular swelling in the molar-ramus region* Scattered flecks of calcification throughout the radiolucency give rise to the term Driven SnowAppearance**Eosinophilic granuloma - (108-Dalinert 5th)* Eosinophilic granuloma can cause lytic bevelled lesion or \"hole within hole 9 appearance in skull. This is due to assymetric destruction of inner + outer tables* Other characteristic bony lesions(i) 'Floating teeth' - due to lesion in jaw(ii) Vertebra plana or 'coin on edge' appearance due to collapse of vertebra(iii) \"punched out lesions \"Admantinoma - honey comb appearance, Soap bubble appearance* Radicular cysts (Periapical cysts) - Most common type of jaw cysts**", "cop": 3, "opa": "Odontogenic myxoma", "opb": "Ameloblastoma", "opc": "Histiocytosis-X", "opd": "Odontogenic fibroma", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "e25d4f24-a32c-43a6-8eeb-e3a6984cf2d6", "choice_type": "single"}
+{"question": "Atypical antipsychotic with least extrapyramidal side effects", "exp": "(A) Clozapine # Clozapine:> The risks of extrapyramidal side effects such as Tardive dyskinesia are much less when compared with typical antipsychotics may be due to Clozapine's anticholinergic effects.> Extrapyramidal symptoms subside somewhat after a person switches from another antipsychotic to Clozapine.", "cop": 1, "opa": "Clozapine", "opb": "Risperidone", "opc": "Olanzapine", "opd": "Ziprasdone", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "2e1efc5d-b3bc-4e9e-ac35-e03f40da4e29", "choice_type": "single"}
+{"question": "Bibasilar velcro crackles occur in", "exp": "Idiopathic pulmonary fibrosis is defined as a progressive fibrosing interstitial pneumonia of unknown etiology,occurring in adults.With the advent of widespread CT scanning,it may present as an incidental finding in an otherwise asymptomatic individual, but more typically presents with progressive breathlessness(which may have been insidious) and a non-productive cough.Constitutional symptoms are unusual.Clinical findings include finger clubbing and the presence of bi-basal fine late inspiratory crackles likened to the unfastening of Velcro. Crackles are more commonly a sign of alveolar disease.Processes that fill the alveoli with fluid may result in crackles. Fine localised crackles are a sign of parenchymal infiltration. Fine end inspiratory crackles over both lung bases may be an early sign of LVF. Coarse crackles are seen in gross pulmonary edema. MECHANISM OF CRACKLES: Bubbling or flow of air through secretions in the bronchial level. sudden opening of successive bronchioles and alveoli with rapid equalisation of pressure causing a sequence of explosive sounds. Crackles without sputum production indicates interstitial lung disease. Crackles with sputum production indicate parenchymal lung disease. Early inspiratory crackles - CHRONIC BRONCHITIS Mid inspiratory crackles - BRONCHIECTASIS Late inspiratory crackles - ASBESTOSIS, PULMONARY FIBROSIS, PNEUMONITIS, INTERSTITIAL LUNG DISEASE, PULMONARY EDEMA Expiratory crackles - CHRONIC BRONCHITIS, PULMONARY EDEMA Reference:Davidson's Medicine-22nd edition,page no:708,ALAGAPPAN 4TH EDITION PAGE 216,217", "cop": 3, "opa": "Acute pulmonary edema", "opb": "Acute bronchopneumonia", "opc": "Pulmonary fibrosis", "opd": "Pulmonary embolism", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "22fd9214-72a6-4d67-b7f8-0d4157e7282d", "choice_type": "single"}
+{"question": "Ohodeoxia is a feature of", "exp": "Answer- B. Hepatopulmonary syndromeOhodeoxia refeis to aerial desaturation noted when sitting uP as opposed to lying down.Conditions associated:A) Cardiac (intracardiac shunt)Atrial septal defect (ASD)Patent foramen ovale (PFO)PneumonectomyUsually associated with pulmonary hypeension or raised right atrial (RA) pressure (e.g. constrictive pericarditis, cardiac tamponade).B) Pulmonary (intrapulmonary right-to-left shunts)HepatopulmonarysyndromePulmonary diseaseCOPDPulmonary embolismC) Upper airway tumourAcute respiratory distress syndromeD) MiscellaneouscausesAutonomic neuropathyAcute respiratory distress syndrome (ARDS)", "cop": 2, "opa": "Hepatorenal syndrome", "opb": "Hepatopulmonary syndrome", "opc": "Hepatic encephalopathy", "opd": "Hepatic failure", "subject_name": "Medicine", "topic_name": null, "id": "79f1b641-e0e4-4f37-afd3-697720119640", "choice_type": "single"}
+{"question": "The diagnositc test for cerebral cysticercosis", "exp": null, "cop": 2, "opa": "MRI", "opb": "Non contrast CT scan", "opc": "Contrast CT scan", "opd": "Plain x-ray", "subject_name": "Medicine", "topic_name": null, "id": "f970996f-95ef-49a5-9ffc-b5c2181d93ab", "choice_type": "single"}
+{"question": "Tt/t of choice in status epilepticus", "exp": "K.D Tripathy essentials of medical pharmacology 7th edition . *Diazepam 10mgi.v inj.at 2mg/min ,repeat once after 10min if required.", "cop": 2, "opa": "Im diazepam", "opb": "i.v diazepam", "opc": "Im phenytoin", "opd": "i.v. phenytoin", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "5c1b47fe-72e7-4182-9690-083b98d51e0d", "choice_type": "single"}
+{"question": "Left atrial filling pressure closely approximates", "exp": null, "cop": 1, "opa": "Pulmonary capillary wedge pressure", "opb": "Central venous pressure", "opc": "Intrapleural pressure", "opd": "Intracranial pressure", "subject_name": "Medicine", "topic_name": null, "id": "88341c41-26f2-4a9b-8d6a-c1afcf39da40", "choice_type": "single"}
+{"question": "Multiple cavitatory lesion in lungs, hematuria and renal insufficiency are features in a patient with", "exp": "Granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis) is characterised by granuloma formation, mainly affecting the nasal passages, airways and kidney. A minority of patients present with glomerulonephritis. The most common presentation of granulomatosis with polyangiitis is with epistaxis, nasal crusting and sinusitis, but haemoptysis and mucosal ulceration may also occur. Deafness may be a feature due to inner ear involvement, and proptosis may occur because of inflammation of the retro-orbital tissue. This causes diplopia due to entrapment of the extra-ocular muscles, or loss of vision due to optic nerve compression. Disturbance of colour vision is an early feature of optic nerve compression. Untreated nasal disease ultimately leads to destruction of bone and cailage. Migratory pulmonary infiltrates and nodules occur in 50% of patients (as seen on high-resolution CT of lungs). Patients with granulomatosis with polyangiitis are usually proteinase-3 (PR3) antibody-positive (ELISA).Pulmonary involvement may be manifested as asymptomatic infil\u0002trates or may be clinically expressed as cough, hemoptysis, dyspnea,and chest discomfo. It is present in 85-90% of patients. Endobronchialdisease, either in its active form or as a result of fibrous scarring, maylead to obstruction with atelectasis . Renal disease (77% of patients) generally dominates the clinical pic\u0002ture and, if left untreated, accounts directly or indirectly for most of themoality rate in this disease. Although it may smolder in some casesas a mild glomerulitis with proteinuria, hematuria, and red blood cellcasts, it is clear that once clinically detectable renal functional impair\u0002ment occurs, rapidly progressive renal failure usually ensues unlessappropriate treatment is institutedPatients with active disease usually have a leucocytosis with elevated CRP, ESR and PR3. Complement levels are usually normal or slightly elevated. Imaging of the upper airways or chest . Ref - Davidsons 23e p1041 , harrisons 20e p2578,2579", "cop": 3, "opa": "Polyaeritis nodosa", "opb": "Churg Strauss syndrome", "opc": "Wegener's granulomatosis", "opd": "Temporal aeritis", "subject_name": "Medicine", "topic_name": "Immune system", "id": "b4eafbfd-0ce0-4bef-a78c-026d3c8c537e", "choice_type": "single"}
+{"question": "Ankylosing spondylitis", "exp": "(A) (HLA B27) (1093 - Davidson 21st)ANKYLOSING SPONDYLITIS JOINTS AND SPINE* Predominating effecting the sacroiliac joints and spine* HLA-B27 positive* Increased facel carriage of Klebsiella aerogens occurs in patients with established as and may relate to exacerbation of both joint and eye disease.* Low back pain and marked stiffness* Symptoms are more marked in the early morning and after inactivity, and are relieved by movement.* Although the lumbosacral area is usually the first and worst affected region.* Planter fasciitis, achilis tendinitis and tenderness over bony prominences. Such as the iliac crest and greater trochanter are common reflecting inflammation at the sites of tendon insertion (Enthesitis or Osteitis)*** The modified Schober test is a useful measure of lumber spine flexion.* Most serious complication of the spinal disease is spinal fracture.* Most common extraarticular manifestation is acute anterior uveitis.EXTRA ARTICULAR FEATURES OF AS* Anterior uveitis and conjunctivitis* Prostatitis usually asymptomatic* Cardiovascular disease> Aortic incompetence> Mitral incompetence> Cardiac conduction defects> Pericarditis* Amyloidosis, psoriasis* Atypical upper lobe pulmonary fibrosis* Retroperitoneal fibrosis* Cauda equina syndromeRadiographic features:* Sacroilitis is often first abnormality.* Earliest changes by standard radiography are blurring of the cortical margins of the subchondral bone.* Anterior \"squaring\" of vertebrae due to erosion and sclerosis of the anterior comers and periositis of the waist.* \"Bamboo Spine\" (Bridging the adjacent vertebral bodies).* Osteoporosis and atlanto-axial dislocation can occur as late features.HLA - B 27 is associated with1. Ankylosing spondylitis2. Reiter's syndrome3. Reative arthritis (Yersinia, salmonella, Shigella, Chlamydia)4. Psoriatic spondylitis5. Acute anterior uveitisOther conditions associated with HLA'sHLA B-8 - M. gravisHyperthyroidismDW-4 / DR4- Rheumatoid arthritis P. VulgarisHLA DR 3 - Glutein sensitive enteropathyDiabetes mellitus type IM. gravis chromic active hepatitisHLA - B5 - Bechet's syndromeHLA - DR2 - Narcolepsy, Good pasture's syndrome Multiple selerosis", "cop": 1, "opa": "HLA-B27", "opb": "HLA-DR-4", "opc": "HLA-B-8", "opd": "HLA-DR-3", "subject_name": "Medicine", "topic_name": "Immunology and Rheumatology", "id": "55cee9c3-2f50-414a-8878-f355c6dff07a", "choice_type": "single"}
+{"question": "Pseudochylous pleural effusion is seen in", "exp": "In chronic effusion like tubercular/rheumatoid ahritis fluid rich in cholesterol mimicking chyle accumulates. Chyliform (pseudochylous) pleural effusion. Author information: A chyliform (pseudochylous) effusion is an uncommon disease entity which develops after an exudative effusion is in situ for a long time. It is commonly initiated by a tuberculous pleurisy and it is impoant to exclude the presence of active tuberculosis Ref Davidson edition23rd pg 626", "cop": 1, "opa": "TB", "opb": "Lymphoma", "opc": "Carcinoma lung", "opd": "Filariasis", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "6157478a-ad8b-4376-b2d3-f8ea9ad044f5", "choice_type": "single"}
+{"question": "The commonest histological finding in Hypeensive Nephrosclerosis is", "exp": "\"Hypeensive Nephrosclerosis\"Lesser degrees of hypeension induce less severe, but prevalent changes in kidney vessels and loss of kidney function; a large poion of patients reaching ESRD without a specific etiologic diagnosis are assigned the designation \"hypeensive nephrosclerosis\".Characterised by afferent aeriolar thickening with deposition of homogeneous eosinophilic material (hyaline aeriolosclerosis) associated with narrowing of vascular lumina.Similar vessel changes are associated with aging, dyslipidemia, and glucose intolerance. Antihypeensive therapy slows the progression of proteinuric kidney diseases and reduces the excessive cardiovascular risks associated with CKD, but it does not alter the course of kidney dysfunction identified specifically as hypeensive nephrosclerosis.Ref: Harrison's 18/e p2047", "cop": 3, "opa": "Proliferative endaeritis", "opb": "Necrotizing aeriolitis", "opc": "Hyaline aeriosclerosis", "opd": "Cystic medial necrosis", "subject_name": "Medicine", "topic_name": "All India exam", "id": "7c7f9d55-2ecc-449e-8e46-2e8031c26f95", "choice_type": "single"}
+{"question": "Joint erosions are not a feature of", "exp": "Ref Semantischolar.org", "cop": 4, "opa": "Rheumatoid ahritis", "opb": "Psoriatic ahritis", "opc": "Gout", "opd": "Systemic lupus ehematosus", "subject_name": "Medicine", "topic_name": "Immune system", "id": "c13ceea6-c607-44ef-af6d-f5244dbc4c31", "choice_type": "single"}
+{"question": "Down's syndrome is", "exp": "Ans. c (Trisomy). (Ref Harrison, Medicine, 18th/Ch. 62. Chromosome Disorders)Clinically, the most important of numerical abnormality is trisomy 21, the most frequent cause of Down syndrome.Depending on the maternal age structure of the population and the utilization of prenatal testing, the incidence of trisomy 21 ranges from 1/600 to 1/1000 livebirths, making it the most common chromosome abnormality in live-bom individuals.Like most trisomies, the incidence of trisomy 21 is highly correlated with maternal age, increasing from about 1/1500 livebirths for women 20 years of age to 1/30 for women 45 years.In addition to trisomy 21, only two other autosomal trisomies, 13 and 18, occur with any frequency in livebirths.Incidence rates for trisomies 13 and 18 in livebirths are 1/20,000 and 1/10,000, respectively. Unlike trisomy 21 that is associated with near-normal life expectancy, both trisomies 13 and 18 are associated with death in infancy, typically occurring during the first year of life.Three sex chromosome trisomies the 47,XXX, 47,XXY (Klinefelter's syndrome), and 47,XYY conditions are quite common, with each occurring in about 1/2000 newborns. Of all the trisomic conditions, three have fewest phenotypic complications. In fact, with the exception of infertility in klinefelter's sundrome, it is likely that most individuals with such trisomies may go undetected.TableNumerical chromosomal abnormalities includePolyploidye.g. triploidy = haploid x 3 (69XYY =23x3 common but lethal)AneuploidyAny chromosome number, which is not an exact multiple of haploid number e.g., Down syndrome 47 XY+ 21 or Klinefelter syndrome 47 XXY.TrisomyState of having three representatives of a given chromosome instead of the usual pair, as in trisomy 21 (Down syndrome).", "cop": 3, "opa": "Triploidy", "opb": "Monosomy", "opc": "Trisomy", "opd": "Aneuploidy", "subject_name": "Medicine", "topic_name": "Genetics", "id": "680fb3b1-12e9-4a6c-b3bd-c71bd109cc27", "choice_type": "single"}
+{"question": "Atrial Natriuretic Peptide (ANP) causes", "exp": "(A) | Blood volume# Atrial distention and/or a sodium load cause release into the circulation of atrial natriuretic peptide (ANP), a polypeptide; a high-molecular-weight precursor of ANP is stored in secretory granules within atrial myocytes.> Release of ANP causes:> Excretion of sodium and water by augmenting glomerular filtration rate, inhibiting sodium reabsorption in the proximal tubule, and inhibiting release of renin and aldosterone; and> Arteriolar and venous dilatation by antagonizing the vasoconstrictor actions of All, AVP, and sympathetic stimulation. Thus, ANP has the capacity to oppose sodium retention and arterial pressure elevation in hypervolemic states.# ANP is secreted in response to: Stretching of the atrial wall Reduced Sympathetic stimulation of b-adrenoceptors Raised sodium concentration (hypernatremia), though sodium concentration is not direct stimulus for increased ANP secretion Angiotensin-II Endothelin, a potent vasoconstrictor Exercise", "cop": 1, "opa": "| Blood volume", "opb": "| Cardiac output", "opc": "| Urine output", "opd": "| Renin secretion", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "159b8699-8079-407c-bcfc-7e287fd09558", "choice_type": "single"}
+{"question": "In Asthma patient positive bronchodilator reversibility test is indicated by", "exp": "Answer- B. Increase in FEV1 > 12% after SABA inhalation Bronchial reversibility is defined as SABA induced increase in FEVI > 12% and > 0.20 litres (200 ml)", "cop": 2, "opa": "Increase in FEV1 > 5% after SABA inhalation", "opb": "Increase in FEV1 > 12% after SABA inhalation", "opc": "Increase in FEV1 > 25% after SABA inhalation", "opd": "Increase in FEV1 > 50% after SABA inhalation", "subject_name": "Medicine", "topic_name": null, "id": "7d3c99f3-9e6b-4dfd-838e-bd2265f1bbeb", "choice_type": "single"}
+{"question": "ECG with ST elevation on VI V2, the diagnosis is", "exp": "(A) Hyperkalemia # ST Elevation:> Most important cause of ST segment elevation is acute Ischemia. Other causes are: Early repolarization Acute pericarditis: ST elevation in all leads except aVR Pulmonary embolism: ST elevation in V1 and aVR Hypothermia: ST elevation in V3-V6, II, III and aVF Hypertrophic cardiomyopathy: V3-V5 (sometimes V6) High potassium (hyperkalemia): V1-V2 (V3) During acute neurologic events: all leads, primarily V1-V6 Acute sympathic stress: all leads, especially V1-V6 Brugada syndrome. Cardiac aneurysm. Cardiac contusion Left ventricular hypertrophy Idioventricular rhythm including paced rhythm.", "cop": 1, "opa": "Hyperkalemia", "opb": "Hypokalemia", "opc": "Hyperthermia", "opd": "Hypercalcemia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "10903f0c-2369-4961-947d-29e1bbcd8f5b", "choice_type": "single"}
+{"question": "A patient develops hepatosplenomegaly, lymphadenopathy following sexual contact, 3 weeks back. The best test to rule out HIV infection is", "exp": "the p24 antigen is the earliest marker for HIV infections.\nAcute HIV syndrome develops 3-6 weeks after the infection.\nThe acute HIV syndrome represents the initial or primary response of an immunocompetent adult to the HIV infection.\nIt is characterized by a high level of virus production, viremia and widespread seeding of the lymphoid tissue.\nDuring this phase, the virus can be rapidly isolated from the blood and there are high levels of HIV p.24 Ag in the serum.\nThus, this phase of HIV infection is detected by demonstrating p24 Ag of the HIV virus.\nThe HIV antibody-based test such as ELISA and western blot cannot be used for diagnosing this phase of infection because the immune response has not yet developed.\nSoon, however, a virus-specific immune response develops evidenced by seroconversion (development of antibody).\nThe seroconversion usually occurs within 3-7 weeks of presumed exposure.\n Once the antibody develops, the antibody-based tests ELISA and western blot are used in the diagnosis.", "cop": 3, "opa": "ELISA", "opb": "Western blot", "opc": "p24 Ag", "opd": "Lymph node biopsy", "subject_name": "Medicine", "topic_name": null, "id": "e1370e0c-0662-424d-840f-14902e16b71b", "choice_type": "single"}
+{"question": "Parinaud syndrome is caused by damage to", "exp": "Answer- B. Posterior commisureAlso known as dorsal midbrain syndrome, this is a distinct supranuclear veical gaze disorder caused by damage to the posterior commissure.Pineal region tumors, cysticercosis, and stroke also cause Parinaud's syndrome.", "cop": 2, "opa": "Anterior commisure", "opb": "Posterior commisure", "opc": "Medial commisure", "opd": "Lateral commisure", "subject_name": "Medicine", "topic_name": null, "id": "aed9fa88-bb31-4695-9ef5-3ef87fc70320", "choice_type": "single"}
+{"question": "The Recommended treatment of early diabetic nephropathy manifested by microalbuminuria is", "exp": "Answer is C (Strict glycemic control, Low protein Diet, ACE Inhibitors): Recommended intervention for early diabetic nephropathy manifested by microalbuminuria include glycemic control, strict blood pressure control, ACE Inhibitors/ARB and low protein diet. The Recommendation for treatment of early diabetic nephropathy manifested by microalbuminuria is to delay the progression from microalbuminuria to macroalbuminuria Effective Recommended Interventions i. diabetic patiMilar oalbuminuria Immproved Glycemic control (Normalization of glycemia) Strict Blood Pressure Control (Blood pressure aim < 125/75) ACE Inhibitors and/or Angiotensin Receptor Blockers (Provide drug specific benefit independent of blood pressure control) Modest Reduction in Protein Intake (0.8g/kg /day)", "cop": 3, "opa": "Strict glycemic control", "opb": "Low protein Diet", "opc": "Strict glycemic control and Low Protein Diet", "opd": "Strict glycemic control, Low protein Diet and ACE Inhibitors", "subject_name": "Medicine", "topic_name": null, "id": "096f8b4a-83fe-4c2e-b64e-761c31075867", "choice_type": "single"}
+{"question": "Most appropriate drug used in the management of chelating iron in beta thalassemia major is", "exp": "Deferiprone and Deferasirox are oral chelators used for beta-thalassaemia. Reference : Medicine, Prep Manual for UG, George Mathew, 5th Edition, page no : 33.", "cop": 2, "opa": "Oral desferrioxamine", "opb": "Oral deferiprone", "opc": "Intra muscular EDTA", "opd": "Oral succimer", "subject_name": "Medicine", "topic_name": "Haematology", "id": "2d341b66-3ea1-4dea-8480-93de22f14db2", "choice_type": "single"}
+{"question": "Site specific recombination is", "exp": "C i.e. RE + ligase", "cop": 3, "opa": "Palindromic", "opb": "Ser-form Holliday intermediate", "opc": "RE + ligase", "opd": "Inversion in same orientation / Non precise", "subject_name": "Medicine", "topic_name": null, "id": "0f35fd30-54db-4a93-9e01-3b11c8f0ef4f", "choice_type": "single"}
+{"question": "Drug of choice in sarcoidosis is", "exp": "Management of sarcoidosis Patients who present with acute illness and erythema nodosum should receive NSAIDs and, on occasion, a sho course of glucocoicoids. The majority of patients enjoy spontaneous remission and so, if there is no evidence of organ damage, systemic glucocoicoid therapy can be withheld for 6 months. However, prednisolone (at a staing dose of 20-40 mg/day) should be commenced immediately in the presence of hypercalcaemia, pulmonary impairment, renal impairment and uveitis. Topical glucocoicoids may be useful in cases of mild uveitis, and inhaled glucocoicoids have been used to shoen the duration of systemic glucocoicoid use in asymptomatic parenchymal sarcoid. Patients should be warned that strong sunlight may precipitate hypercalcaemia and endanger renal function. Features suggesting a less ourable outlook include age over 40, Afro-Caribbean ethnicity, persistent symptoms for more than 6 months, the involvement of more than three organs, lupus pernio and a stage III/IV chest X-ray. In patients with severe disease, methotrexate (10-20 mg/week), azathioprine (50-150 mg/day) and specific tumour necrosis factor alpha (TNF-a) inhibitors have been effective. Chloroquine, hydroxychloroquine and low-dose thalidomide may be useful in cutaneous sarcoid with limited pulmonary involvement. Selected patients may be referred for consideration of single lung transplantation. The overall moality is low (1-5%) and usually reflects cardiac involvement or pulmonary fibrosis. ref - Davidsons 23e p608-610", "cop": 3, "opa": "Cyclophosphamide", "opb": "Methotrexate", "opc": "Prednisolone", "opd": "Cyclosporine", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "9c43981c-f26e-447e-8bed-8d1181221ffd", "choice_type": "single"}
+{"question": "Immediate antagonism of the cardiac effects of hyperkalemia is done by", "exp": "Intravenous calcium serves to protect the hea. Calcium raises the action potential threshold and reduces excitability, without changing the resting membrane potential. By restoring the difference between resting and threshold potentials, calcium reverses the depolarization blockade due to hyperkalemia. The recommended dose is 10 mL of 10% calcium gluconate (3-4 mL of calcium chloride), infused intravenously over 2-3 min with cardiac monitoring. Ref: Harrison 19e pg: 312", "cop": 1, "opa": "IV Calcium", "opb": "Dextroversion", "opc": "Dialysis", "opd": "Glucose + Insulin", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "e560f479-c104-4333-8dfa-5ad11eccea22", "choice_type": "single"}
+{"question": "A middle aged female repoed with dull diffuse progressive headache of 2 months duration associated with episodes of vomiting and blurred vision at times. Cough increases the headache.Likely patient has", "exp": "A space-occupying lesion of the brain is usually due to malignancy but it can be caused by other pathology such as an abscess or a haematoma. Almost half of intracerebral tumours are primary but the rest have originated outside the CNS and are metastases Features of a headache indicating a high risk of a space-occupying lesion of the brain or idiopathic intracranial hypeension include: A new headache with features suggestive of raised intracranial pressure, including papilloedema, vomiting, posture-related headache, or headache waking the patient from sleep Ref Harrison20th edition pg 2456", "cop": 2, "opa": "Vascular headache", "opb": "Intracranial space occupying lesion", "opc": "Intracerebral hemorrhage", "opd": "Acute pyogenic meningitis", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "9e3599f3-7dbf-428f-8992-a948c3afe5f8", "choice_type": "single"}
+{"question": "Diagnostic feature of CRF is", "exp": "Ans. is 'a' i.e., Broad casts in urine Casts ? Urinary casts are formed only in the distal convoluted tubulee (DCT) or the collecting dude (distal nephron). The proximal convoluted tubule and loop of henle are not the locations for cast formation. Casts are formed through the solidification of materials in the tubules of nephrons Later the material is flushed out of the kidney upon the production of more urine leaving a small solidified microscopic cylinder that can also contain what ever other materials that might be within the tubules of the kidneys at the time of cast formation. The microscopic detection of various types of casts can often be helpful diagnostic tool in the study of various types of renal diseases", "cop": 1, "opa": "Broad casts in urine", "opb": "Elevated blood urea", "opc": "Proteinuria", "opd": "Bleeding diathesis", "subject_name": "Medicine", "topic_name": null, "id": "079d895c-ca82-47a7-bb5e-d27a5d6773a3", "choice_type": "single"}
+{"question": "Most common cause of death in dialysis patient", "exp": "Cardiovascular disease constitutes the major cause of death in ESRD (rates are higher in patients receiving dialysis than in post transplantation pts) . causes are :associated risk factors (DM, HTN...), changes in extracellular volume, alterations in cardiovascular dynamics during dialysis treatment . Hypotension is the most common acute complication of HEMODIALYSIS paicularly among diabetic pts. Major complications of peritoneal dialysis -peritonitis, weight gain, residual uremia. Ref:Harrison 20th edition pg no.2125,2124", "cop": 1, "opa": "Cardiovascular", "opb": "Infection", "opc": "Malignancy", "opd": "Anemia", "subject_name": "Medicine", "topic_name": "Kidney", "id": "385e2bef-a65c-4369-be31-7a4259e8064b", "choice_type": "single"}
+{"question": "Interstitisl lung disease is seen in", "exp": "Pulmonary involvement in Systemic sclerosis Pulmonary hypeension complicates long-standing disease and is six times more prevalent in lcSScl than in dcSScl. It usually presents with insidiously evolving exeional dyspnoea and signs of right hea failure. Interstitial lung disease is common in patients with dcSScl who have topoisomerase 1 antibodies (Scl70). Dyspnoea can evolve slowly over time or rapidly in occasional cases. Ref - Davidsons 23e p1038", "cop": 3, "opa": "Polymyositis", "opb": "RA", "opc": "Diffuse systemic sclerosis", "opd": "SLE", "subject_name": "Medicine", "topic_name": "Immune system", "id": "1298c145-9545-4bba-b661-83c91e573554", "choice_type": "single"}
+{"question": "Perl's stain is used to demonstrate", "exp": "(B) Haemosiderin > Hemosiderosis: With progressive accumulation of hemosiderin, parenchymal cells throughout the body (principally in the liver, pancreas, heart, & endocrine organs) become pigmented, iron can be visualized in tissues by the Prussian blue histochemical reaction, in which colorless potassium ferrocyanide is converted by iron to blue-black ferric ferrocyanide.> Perl's Prussian Blue Stain for Iron-Positive Cells (e.g., activated macrophages) (a.k.a. Perl's acid ferrocyanide reaction)", "cop": 2, "opa": "Melanin", "opb": "Haemosiderin", "opc": "Bilirubin", "opd": "Lipofuscin", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "e267da4d-f5bd-4823-93e4-d8acac453e68", "choice_type": "single"}
+{"question": "Refractory gastric ulcer is defined as.", "exp": "Refractory gastric ulcer - Fails to heal by 3 month of regular proper dose PPI (Reason could be - Zollinger Ellison syndrome) Refractory Duodenal Ulcer : > 8 weeks with regular PPI Treatment Refractory Gastric Ulcer : > 12 weeks", "cop": 3, "opa": "Ulcer that fails to heal despite 4 weeks of regular proper dose PPI", "opb": "Ulcer that fails to heal despite 8 weeks of regular proper dose PPI", "opc": "Ulcer that fails to heal despite 12 weeks of regular proper dose PPI", "opd": "Ulcer that fails to heal despite 16 weeks of regular proper dose PPI", "subject_name": "Medicine", "topic_name": "Zollinger Ellision Syndrome", "id": "ad4c7c5a-95a5-4822-b080-4b90b4b35d2b", "choice_type": "single"}
+{"question": "The drug of choice in Status epilepticus is", "exp": "(A) # Status epilepticus is a medical emergency.> Initial management includes maintenance of the airway and 50% dextrose (25-50 mL) intravenously in case hypoglycemia is responsible. If seizures continue, 10mg of Diazepam is given intravenously over the course of 2 minutes, and the dose is repeated after 10 minutes if necessary.> Alternatively, a 4 mg intravenous bolus of lorazepam, repeated once after 10 minutes if necessary, is given in place of diazepam.> This is usually effective in halting seizures for a brief period but occasionally causes respiratory depression.", "cop": 1, "opa": "Intravenous diazepam", "opb": "Oral Dilantin", "opc": "Carbamazepine", "opd": "Ethosuximide", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "ec124fc6-100e-4c10-bb07-0108012aeb7f", "choice_type": "single"}
+{"question": "A young lady complains of sudden onset of palpitations, extreme weakness and sweating. On examination, she was found to have B.P. 90/70 with a regular pulse rate of 180/minute. Her symptoms disappeared after vomitting but she complained of polyuria. The most likely diagnosis is", "exp": null, "cop": 3, "opa": "Primary thyrotoxicosis", "opb": "Acute anxiety state", "opc": "Paroxysmal atrial tachycardia", "opd": "Paroxysmal atrial flutter", "subject_name": "Medicine", "topic_name": null, "id": "5348b467-341e-4b52-8e57-bf567c1ba6a5", "choice_type": "single"}
+{"question": "Biomarker not involved in acute kidney injury is", "exp": "Ans. is 'c' i.e., Micro RNA 122", "cop": 3, "opa": "NGAL", "opb": "KIM 1", "opc": "Micro RNA 122", "opd": "Cystatin C", "subject_name": "Medicine", "topic_name": null, "id": "bed08d47-6507-4330-af29-c38593e61f6d", "choice_type": "single"}
+{"question": "Risk factors for coronary aery disease", "exp": "Ref Harrison 19 th ed pg 1579 The major risk factors for atherosclerosis (high levels of plasma low-density lipoprotein , low plasma high-density lipoprotein , cigarette smoking, hypeension, and diabetes mellitus disturb the normal functions of the vascular endothelium.", "cop": 3, "opa": "High HDL", "opb": "Low HDL", "opc": "Increased homocysteine levels", "opd": "Decreased fibrinogen levels", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "322a4a76-4503-4e0a-a582-1149fb9dc031", "choice_type": "single"}
+{"question": "Most common presentation of hepatitis A is", "exp": "Hepatitis A Clinical symptoms then develop, often with a presentation similar to that of gastroenteritis or a viral respiratory infection. The most common signs and symptoms include fatigue, nausea, vomiting, fever, hepatomegaly, jaundice, dark urine, anorexia, and rash Ref Harrison20th edition pg 990", "cop": 4, "opa": "Asymptomatic", "opb": "Fulminant hepatitis", "opc": "Chronic carrier state", "opd": "Transient illness with jaundice", "subject_name": "Medicine", "topic_name": "Infection", "id": "63bc442a-cbd4-46f8-ac8a-13aa93b16101", "choice_type": "single"}
+{"question": "Oxalate crystals in urine is seen in poisoning with", "exp": "Ans: b (Ethylene glycol)Ref: Harrison, 17 ed. pg. 291, Davidson 21 ed. pg.Ethylene glycol poisoning (Antifreeze)Ethylene glycol is metabolized into glycoaldehyde, glycolic acid, glycoxylic acid, oxalic acid causing metabolic acidosis; oxalate causes renal damage due to calcium oxalate crystals in urine.C/F: Ophthalmpoplegia, cranial nerve palsies, myoclonus, hyporeflexia renal failureManagement* Assay not widely available* Diagnosed by the presence of high anion gap, osmolal gap> 10 mOsm and presence of oxalate crystals in urine* Antidote - Oral ethanol, Fomipazole -Inhibit alcohol dehydrogenase* Hemodialysis in severe cases* Hypocalcaemia treated only if severe ECG changes/ seizures present", "cop": 2, "opa": "Methanol", "opb": "Ethylene glycol", "opc": "Potassium dichromate", "opd": "Methylene blue", "subject_name": "Medicine", "topic_name": "Kidney", "id": "29326b17-b6fe-4d86-89d7-c48e1214b465", "choice_type": "single"}
+{"question": "Commonest lesion in middle mediastinum is", "exp": null, "cop": 3, "opa": "Lipoma", "opb": "Aneurysm", "opc": "Congenital cyst", "opd": "Germ cell tumour", "subject_name": "Medicine", "topic_name": null, "id": "440f6ec7-9ba8-4af3-8cb4-04aa95620586", "choice_type": "single"}
+{"question": "Suicide tendency are common in", "exp": "B. (Depression) (236- 37 - Neeraj Ahuja 6th)SUICIDE is a type of deliberate self harm (DSH) and is defined as a human act of self - intentioned and self inflicted cessation (death) It ends with a fatal out comeRISK FACTORS FOR SUICIDE1. Age > 40 years2. Male sex3. Staying single4. Preveious suicidal attempts5. Depression (risk about 25 times more than usual)i. Presence of guilt, self - accusation agitation, nihilistic ideation, worthlessness, hypochondriacal delusions and severe insomniaii. More at the beginning or towards the end of a depressive episodes6. Suicidal preoccupation (eg a \"suicide note\" is written or detailed plans are made for committing suicide)7. Alcohol or drug dependence8. Severe disabling, painful or untreatable physical illness9. Recent serious-loss or major stressful life event10. Social isolation", "cop": 2, "opa": "Mania", "opb": "Depression", "opc": "Schizophrenia", "opd": "Obsessive compulsive disorder", "subject_name": "Medicine", "topic_name": "Psychiatry", "id": "2f79e6c4-8168-47d2-abcb-ed12189f0641", "choice_type": "single"}
+{"question": "Cause of vasodilatation in spider nevi", "exp": "Spider angiomas form due to failure of the sphincteric muscle surrounding a cutaneous aeriole. The central red dot is the dilated aeriole and the red \"spider legs\" are small capillaries carrying away the freely flowing blood. If momentary pressure is applied, it is possible to see the emptied capillaries refilling from the center. No other angiomas show this phenomenon. The dilation, in turn, is caused by increased estrogen levels in the blood. Many pregnant women and women using hormonal contraception have spider angiomas, which is due to high estrogen levels in their blood. Individuals with significant liver disease also show many spider angiomas, as their liver cannot metabolize circulating estrogens, specifically estrone, which derives from the androgen androstenedione Ref - Wikipedia https://en.m.wikipedia.org/wiki/Spider_angioma", "cop": 3, "opa": "Hepatotoxins", "opb": "FSH", "opc": "Estrogen", "opd": "Testosterone", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "431ae430-b2df-4927-8029-643935b316a6", "choice_type": "single"}
+{"question": "Most common cause of death in diphtheria is due to", "exp": "Answer- B. Toxic cardiomyopathyMost common cause of death in diphtheria cardiomyopathy", "cop": 2, "opa": "Airway compromise", "opb": "Toxic cardiomyopathy", "opc": "Sepsis", "opd": "Descending polyneuropathy", "subject_name": "Medicine", "topic_name": null, "id": "9b9c1d96-1995-40d5-a3fa-1761c0b8ad2c", "choice_type": "single"}
+{"question": "In SLE, characteristic kidney lesion is", "exp": "Answer is C (Wire loop lesions): Wire loop lesions are characteristic of SLE Wire loop lesions: Wire loop lesions represent local PAS - Positive thickening of glomerular capillary walls and are characteristically sen in Lupus Nephritis (SLE) These lesions result from subendothelial deposits between endothelium and basement membrane. When extensive and confluent, these subendothelial deposits create a homogenous thickening of the capillary wall which can be seen in light microscopy as 'Wire loop lesion' Wire loop lesions are most characteristic of Lupus Nephritis Class IV or Diffuse Lupus Nephritis These may however also be seen in Class III (Focal Lupus Nephritis) and Class V (membranous) Lupus Nephritis.", "cop": 3, "opa": "Mesangial proliferation", "opb": "Tubular fibrin deposits", "opc": "Wire loop lesions", "opd": "IgG deposits", "subject_name": "Medicine", "topic_name": null, "id": "783b338f-e5bb-4bc2-9269-fbb498bb2d03", "choice_type": "single"}
+{"question": "Hemoglobin Poland is best defined as", "exp": "Answer- C. Zeta 2 : Gamma 2Hb Gower I - Zeta 2 / epsilon 2Hb Poland - Zeta 2 / gamma 2Hb Gower II - Alpha 2 / epsilon 2", "cop": 3, "opa": "Alpha 2 : Delta 2", "opb": "Alpha 2 : Epsilon 2", "opc": "Zeta 2 : Gamma 2", "opd": "Zeta 2 : Epsilon 2", "subject_name": "Medicine", "topic_name": null, "id": "590d3692-2c76-4b6c-a19b-3f501c5e8be0", "choice_type": "single"}
+{"question": "Cause of salt Losing Nephropathy", "exp": "Causes :\nReflux Nephropathy.\nInterstitial nephropathy.\nPost - obstructive uropathy.\nMedullary Cystic disease.\nRecovery phase of ATN.", "cop": 1, "opa": "Interstitial nephropathy", "opb": "Maintenance phase of acute tubular necrosis", "opc": "Post - Streptococcal Glomerulonephritis", "opd": "IgA nephropathy", "subject_name": "Medicine", "topic_name": null, "id": "888a28c7-57de-4ec7-9b96-069a8b6e28ce", "choice_type": "single"}
+{"question": "Most common tumour of the posterior cranial fossa is", "exp": null, "cop": 1, "opa": "Glioma", "opb": "Medulloblastoina", "opc": "Meningioma", "opd": "Oligodendroglioma", "subject_name": "Medicine", "topic_name": null, "id": "69909b00-a538-4485-9385-eab7727356bd", "choice_type": "single"}
+{"question": "Kviem siltzbach test is used in the diagnosis of", "exp": "Ans. is'b'i.e., Sarcoidosis Kveim-Siltzbath skin test It is a useful intradermal diagnostic test The antigen is prepared from involved lymph node or spleen is injected intradermally In a positive test, nodular lesions appears in 3-6 weeks at the inoculation site, which on microscopic examination shows presence of noncaseating granulomas (sarcoidosis like lesions) The kviem siltzbath material is no longer available and with the use of transbronchial biopsy to obtain lung parenchvm for diagnostic purposes, the kviem siltzbath test is only of historic interest. Laboratory anomalies Common abnormalities in the blood include Lymphocytopenia, mild eosinophilia Increased E.S.R., hyperglobulinemia Elevated level of ACE False positive tests for rheumatoid factor or ANA's Hypercalccmia or an elevated 24 hr urine calcium level The lung function abriormalties of sarcoidosis are typical for interstitial Lung diseaseQ and include decreased lung volumes with and diffusing capacity with a normal or supernormal ratio of the forced expiratory volume in is to the forced vital capacity. Also know Sarcoidosis of the lung is primarily an interstitial lung disease in which the inflammatory process involves the alveoli, small bronchi and small blood vessesls. Pleura is involved in 1-5% of cases almost always manifesting as unilateral pleural effitsionso. The effusions usually clear within a few week. Pneumothorax of hydropneumothorax is observed in sarcoidosis but is very rare.", "cop": 2, "opa": "Tuberculosis", "opb": "Sarcoidosis", "opc": "Histoplasmosis", "opd": "Leishmaniasis", "subject_name": "Medicine", "topic_name": null, "id": "f9a9b0bd-1d6b-41bc-8196-51d3eec55c78", "choice_type": "single"}
+{"question": "Mechanism of action of metformin is", "exp": "Agents Used for Treatment of Type 1 or Type 2 Diabetes Mechanism of Action Examples HbA Reduction (%) Agent-Specific Advantages Agent-Specific Disadvantages Contraindications Oral Biguanides |Hepatic glucose production Metformin 1-2 Weight neutral, do not cause hypoglycemia, inexpensive, extensive experience, |CV events Diarrhea, nausea, lactic acidosis Serum creatinine > 15 mg/dL (men) >1.4 mg/dL (women) (see text), CHF, radio graphic contrast studies, hospitalized patients, acidosis Renal/liver disease a-Glucosidase inhibitors |GI glucose absorption Acarbose, miglitol, voglibose 0.5-0.8 Reduce postprandial glycemia GI flatulence, liver function tests Renal/liver disease Dipeptidyl peptidase IV inhibitors Prolong endogenous GLP-1 action Alogliptin, Linagliptin, Gemigliptin, linagliptin, saxagliptin, sitagliptin, teneligliptin, vildagliptin 0.5-0.8 Well tolerated, do not cause hypoglycemia Reduced dose with renal disease; one associated with increase hea fail pure risk; possible association with ACE inhibitor-induced angioedema Insulin secretagogues: Sulfonylureas |Insulin secretion Glibornuride, gliclazide, glimepiride, glipizide, gliquidone, glyburide, glyclopyramide 1-2 Sho onset of action, lower postprandial glucose, inexpensive Hypoglycemia, weight gain Renal/liver disease Insulin secretagogues: Nonsulfonylureas |Insulin secretion Nateglinide, repaglinide, mitiglinide 0.5-1.0 Sho onset of action, lower postprandial glucose Hypoglycemia Renal/liver disease Sodium-glucose cotranspoer 2 inhibitors |Urinary glucose excretion Canagliflozin, dapagliflozin, empagliflozin 0.5-1.0 Insulin secretion and action indepentant Urinary and vaginal infections, dehydration, exacerbate tendency to hyperkalemia Limited clinical experience; moderate renal insufficiency Thiazolidinediones |Insulin resistance, |glucose utilization Rosiglitazone, pioglitazone 0.5-1.4 Lower insulin requirements Peripheral edema, CHF, weight gain, fractures, macular edema CHF, liver disease Ref: Harrison 19e pg: 2414", "cop": 1, "opa": "Decreases hepatic glucose production", "opb": "Increases GI glucose absorption", "opc": "Increase insulin secretion", "opd": "Prolong endogenous GLP-1 action", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "c9c66ea4-9018-43c3-b265-a60e9c849b89", "choice_type": "single"}
+{"question": "An upper motor neuron (UMN) lesion involving cranial nerve VII would most likely produce", "exp": "The physical finding of facial asymmetry is suggestive of an abnormality involving the facial nerve (CN VII). The facial nucleus, which is located within the pons, is divided in half, the upper neurons innervate the upper muscles of the face, while the lower neurons innervate the lower poion of the face. It is impoant to realize that each half receives input from the contralateral motor coex, while only the upper half receives input from the ipsilateral motor coex. Therefore an upper motor neuron (UMN) lesion will produce a defect involving only the contralateral lower half of the face. Causes of UMN lesions involving the facial nerve includes strokes that involve the coex or the internal capsule. In contrast, lesions that affect the facial nerve from the facial nucleus to the remaining length of the nerve result in LMN lesions. Patients present with facial asymmetry involving the ipsilateral upper and lower quadrants. Lesions to the facial nerve within the facial canal (frequently due to cold weather) cause Bell's palsy. Patients present with paralysis of all muscles of facial expression. Bell's phenomenon refers to the finding of the affected eye looking up and out when patients try to close their eyes. Because the lacrimal punctum in the lower eyelid moves away from the surface of the eye, lacrimal fluid does not drain into the nasolacrimal duct. This produces \"crocodile tears.\" ref - pubmed.com", "cop": 1, "opa": "Contralateral weakness of the lower half of the face with sparing of the upper half of the face", "opb": "Decreased gag (pharyngeal) reflex with decreased taste sensation from the posterior one-third of the tongue", "opc": "Hemianesthesia of the face with flaccid paralysis of the muscles of mastication", "opd": "Ipsilateral anosmia with primary amenorrhea in females", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "cfae8a22-731e-46c9-b19c-a61874a8c618", "choice_type": "single"}
+{"question": "Hemiplegia is most commonly caused by thrombosis of", "exp": null, "cop": 2, "opa": "Anterior cerebral artery", "opb": "Middle cerebral artery", "opc": "Posterior cerebral artery", "opd": "Basilar artery", "subject_name": "Medicine", "topic_name": null, "id": "91ce8964-7944-452e-a957-abf67e70f0a9", "choice_type": "single"}
+{"question": "Select the best initial treatment for a patient with Behcet syndrome and ocular involvement", "exp": "Diagnostic Criteria of Behcet's Syndrome Recurrent oral ulceration Plus 2 of the following: Recurrent genital ulceration Ocular lesions Skin lesions Positive Pathergy test Rx: Condition Treatment Lesion in uveal/ oral cavity Topical Steroids CNS/ocular Systemic steroids Serious cases Thalidomide Recent study Apremilast(Phosphodiesterase-4 inhibitor) Mucocutaneous manifestations ,Ahritis Colchicine", "cop": 3, "opa": "Topical glucocoicoids to the oral ulcers and conjunctiva", "opb": "Thalidomide", "opc": "Systemic glucocoicoids and azathioprine", "opd": "Intralesional interferon A", "subject_name": "Medicine", "topic_name": "Emergency Clinical Scenario", "id": "b3d84162-aac4-487a-a109-82466207f647", "choice_type": "single"}
+{"question": "The most common physical sign of cerebral metastasis", "exp": "*in brain metastases,presentation is with headaches(40-50%),focal neurological deficit(20-40%),coognitive dysfunction(35%),seizures(10-20%) and papilledema(<10%). A focal neurologic deficit is a problem with nerve, spinal cord, or brain function. It affects a specific location, such as the left side of the face, right arm, or even a small area such as the tongue. Speech, vision, and hearing problems are also considered focal neurological deficits Ref Harrison20th edition pg 2764", "cop": 2, "opa": "Epilepsy", "opb": "Focal neurological deficit", "opc": "Papilloedema", "opd": "Visual defects", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "0bc9e8d8-db4d-493a-bdf1-83f6fb7a5bc9", "choice_type": "single"}
+{"question": "Electrical alterans in ECG is characteristic of", "exp": null, "cop": 2, "opa": "Severe bronchial asthma", "opb": "Peri cardial effusion", "opc": "Severe LVF", "opd": "–AR", "subject_name": "Medicine", "topic_name": null, "id": "eb6f99c1-92c8-44ad-b741-101c7caa85dc", "choice_type": "single"}
+{"question": "Normal PCWP with pulmonary oedema is seen in", "exp": "Ref Harrison 19 th ed pg 1763 The use of a Swan-Ganz catheter permits measurement of PCWP and helps differentiate high-pressure (cardiogenic) from normal- pressure (noncardiogenic) causes of pulmonary edema. High altitude has been grouped together as one of the miscellaneous causes for ARDS reflecting pulmonary oedema with a normal PCWP", "cop": 2, "opa": "Left atrial myxoma", "opb": "High altitude", "opc": "Pulmonary vein obstruction", "opd": "Pulmonary aery obstruction", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "e85515d6-016b-4cc6-ac0c-5ae778526a92", "choice_type": "single"}
+{"question": "Investigation of choice for detection and characterization of interstitial lung disease is", "exp": "High Resoluon CT (HRCT) is investigation of choice for interstitial lung disease as it can delineate the lung parenchyma upto the level of secondary pulmonary lobule.", "cop": 4, "opa": "MRI", "opb": "Chest x-ray", "opc": "Venlaon perfusion scan", "opd": "High resoluon CT", "subject_name": "Medicine", "topic_name": null, "id": "b6a63ccb-de8b-4d1b-8c95-87cfe02bf801", "choice_type": "single"}
+{"question": "Treatment of choice for hairy cell leukaemia is", "exp": "The first-line therapy for hairy cell leukemia is cladribine, 0.1 mg/kg/d by continuous intravenous infusion for 7 days. The drug can be administered on an outpatient basis with a pump, after placement of a percutaneous intravenous central catheter (PICC). Ref Harrison 20th edition pg 544", "cop": 2, "opa": "Steroids", "opb": "Cladribine", "opc": "Splenectomy", "opd": "Pentostatin", "subject_name": "Medicine", "topic_name": "Oncology", "id": "1a0dc6da-066c-4426-98e7-0c50a28631f8", "choice_type": "single"}
+{"question": "The treatment of choice in acute hyperkalemia of life threatening to cardiac myocytes is", "exp": "Ans. is `a' i.e. Infusion of calcium gluconate", "cop": 1, "opa": "Infusion of calcium gluconate", "opb": "Oral resins", "opc": "Intravenous infusion of insulin", "opd": "b blocker", "subject_name": "Medicine", "topic_name": null, "id": "4fcd7e9a-4e08-4b18-a5e4-5a1c783ecb82", "choice_type": "single"}
+{"question": "Mass Chemoprophylaxis is given for", "exp": null, "cop": 2, "opa": "Plague", "opb": "Filaria", "opc": "Cholera", "opd": "Measles", "subject_name": "Medicine", "topic_name": null, "id": "16f43d89-a827-4752-b603-74809dec7942", "choice_type": "single"}
+{"question": "Most radiosensitive brain tumour is", "exp": "pediatric ependymomas, GTR with adjuvant local radiotherapy has been established as the standard treatment, especially for tumors located in the posterior fossa . Radiotherapy is an impoant treatment modality due to the radiosensitivity of ependymomas. Ref Harrison20th edition pg 1316", "cop": 1, "opa": "Ependymoma", "opb": "Medulloblastoma", "opc": "Glioblastoma multiforme", "opd": "Astrocytoma", "subject_name": "Medicine", "topic_name": "Infection", "id": "c0184ba8-0d2b-407f-82ab-6732cd9eeaaf", "choice_type": "single"}
+{"question": "Brown tumour is found in", "exp": "(Hyper parathyroidism) (990- CMDT-08) (1765-H17th)Hyper parathyroidism causes a loss of cortical bone and again of trabecular bone. Osteitis fibrosa cystica may present as pathologic fracture or as \"brown tumours \" or cysts of Jaw.More commonly, patients have bone pain and arthralgia", "cop": 2, "opa": "Hypoparathyroidism", "opb": "Hyperparathyroidism", "opc": "Hypocalcemia", "opd": "Hypothyroidism", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "4cb40808-e2ce-4175-860f-38076e9a1589", "choice_type": "single"}
+{"question": "Most common cause of embolic stroke is", "exp": "Ans. is 'a' i.e., Intra-Cardiac Thrombi The most common cause of embolic strokes are Intra-cardiac Thrombi. The most common sources of systemic embolism and embolic stroke are Intra-cardiac thrombi formed as a result of atrial fibrillation, ST-elevation MI, left ventricular dysfunction or hea failure.", "cop": 1, "opa": "Intra-Cardiac Thrombi", "opb": "Paiculate matter from IV drug injections", "opc": "Protein C deficiency", "opd": "Antiphospholipid syndrome", "subject_name": "Medicine", "topic_name": null, "id": "e4c197b7-4509-44e4-8ec8-ff3740532c16", "choice_type": "single"}
+{"question": "The most definitive method of diagnosing pulmonary embolism is", "exp": "Pulmonary aeriography is the most definitive method of diagnosing pulmonary embolism.Chest CT with contrast has viually replaced invasive pulmonary angiography as a diagnostic test.A definitive diagnosis of PE depends on visualisation of an intraluminal filling defect in more than one projection.Secondary signs of PE include abrupt occlusion(\"cut-off\") of vessels,segmental oligemia or avascularity,a prolonged aerial phase with slow filling,and touous,tapering peripheral vessels. Reference:Harrison's medicine-18th edition,page no:2174.", "cop": 1, "opa": "Pulmonary ateriography", "opb": "Radioisotope perfusion pulmonary scintigraphy", "opc": "EKG", "opd": "Venography", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "c50c9e1b-2481-4868-80c7-329eca8671fd", "choice_type": "single"}
+{"question": "The most common cause of death in patients in Marfan syndrome patients is", "exp": "Between 75% and 85% of patients with the Marfan syndrome have dilatation of the ascending aoa and annuloaoic ectasia (dilatation of the aoic sinuses and annulus). Such aoic abnormalities are the most common cause of death among patients with Marfan syndrome ref - Harrisons 20edition pg1918,2975,829", "cop": 1, "opa": "Annuloaoic ectasia", "opb": "Mitral valve prolapse", "opc": "Aoic dissection", "opd": "Abdominal aoic aneurysm rupture", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "f5b3050b-4e7f-4891-b45c-5d349f925b13", "choice_type": "single"}
+{"question": "Most common cause of Acute pancreatitis is", "exp": "B. i.e. (Biliary calculus) (2006-HI7th)* Gall stone is the most common cause (30 - 60%)* Alcohol is the second most common cause (15 - 30%)* Pancreatic pseudocysts occurs most commonly after - Pancreatitis*** Gall stone pancreatitis has the best prognosis**Common causes of Acute Pancreatitis* Gall stones (Including microlithiasis) commonest cause* Alcohol (Acute and chronic alcoholism)* Hypertriglyceridemia* ERCP after biliary manometry* Trauma (especially blunt abdominal trauma)* Post operative (Abdominal and non abdominal operations* **Drugs (Azathioprine, 6 mercaptopurine, sulphonamide estrogens, Tetracyclines, valproic acid anti- HIV medications)* Sphincter of oddi- dysfunction", "cop": 2, "opa": "Trauma", "opb": "Biliary calculus", "opc": "Alcoholism", "opd": "Hypertriglyceridemia", "subject_name": "Medicine", "topic_name": "G.I.T.", "id": "5cb3fd86-6319-4645-a9a4-8c753d92d315", "choice_type": "single"}
+{"question": "Pigmented \"muddy brown\" granular cast is characteristic of", "exp": "AKI from ATN due to ischemic injury, sepsis, or ceain nephrotoxins has characteristic urine sediment findings: pigmented \"muddy brown\" granular casts and tubular epithelial cell casts. These findings may be absent in more than 20% of cases Ref: Harrison 19e pg: 1805", "cop": 2, "opa": "Prerenal ARF", "opb": "Ischemic or nephrotoxic ATN", "opc": "Postrenal ARF", "opd": "Chronic renal failure", "subject_name": "Medicine", "topic_name": "Kidney", "id": "3c103424-fa8e-47d0-9533-85a8c9ed4138", "choice_type": "single"}
+{"question": "Aoic dissection is associated with", "exp": "The factors that predispose to aoic dissection include systemic hypeension, a coexisting condition in 70% of patients, and cystic medial necrosis. Aoic dissection is the major cause of morbidity and moality in patients with Marfan syndrome ( Chap. 363 ) and similarly may affect patients with Ehlers-Danlos syndrome. The incidence also is increased in patients with inflammatory aoitis (i.e., Takayasu's aeritis, giant cell aeritis), congenital aoic valve anomalies (e.g., bicuspid valve), coarctation of the aoa, and a history of aoic trauma. In addition, the risk of dissection is increased in otherwise normal women during the third trimester of pregnancy. ref:Harrison&;s principles of internal medicine,ed 18,pg no 2063", "cop": 1, "opa": "Systemic hypeension", "opb": "Coarctation of Aoa", "opc": "In 1\" trimester of pregnancy", "opd": "Takayasu's aeritis", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "112d93d9-b38f-4b4e-9513-aa6214f969f9", "choice_type": "single"}
+{"question": "Kartagener’s syndrome is characterized by A/E", "exp": "Kartagener's syndrome is characterized bv triad of:-\n Situs inversus\n Chronic sinusitis\nBronchiestasis It is a subset of primary ciliary dyskinesia Primary ciliary dyskinesia\nPrimary ciliary dyskinesia (PCD, also called the immotile-cilia syndrome) is characterized by congenital impairment of mucociliary clearance (MCC).\n Clinical manifestations include:-\n Chronic cough\n Chronic rhinitis and\nChronic sinusitis\nOtitis and otosalpingitis (common in childhood)\n Nasal polyposis and agenesis of the frontal sinuses", "cop": 1, "opa": "Situs Solius", "opb": "Dextrocardia", "opc": "Chronic sinusitis", "opd": "Situs inversus", "subject_name": "Medicine", "topic_name": null, "id": "085fa2ee-d518-49f4-8c6c-6ab698c0cdf3", "choice_type": "single"}
+{"question": "A Patient presented with Hypokalemia, Severe Hypertension, and Metabolic Alkalosis. The diagnosis is", "exp": "(A) Liddle syndrome[?]Liddle's Syndrome: Autosomal dominant & is characterized by activating mutation of collecting duct Na+ channel with enhanced sodium reabsorption.oLow renin, low aldosterone levels.oClinical picture mimics Primary Hyperaldosteronism: Hypertension, Hypokalemia & Alkalosis.oIncreased activity of the Epithelial Sodium Channel (E-Na Ch):-Activating kidneys to excrete potassium retaining excessive sodium & water, leading to hypertension.-Classically manifest severe hypertension with hypokalemia, unresponsive to spironolactone yet sensitive to amiloride.oHypertension & hypokalemia are, however, variable aspects of the Liddle's phenotype; more consistent features include a blunted aldosteirone response to ACTH & reduced urinary aldosterone excretion.oIt is a 'gain of function' mutation in the gene encoding ENaC of the collecting tubule resulting in autonomous function of these channel without the influence of aldosterone.oCan be differentiated from Primary Hyperaldosteronism by normal Na+ level and low aldosterone and reninOther OptionsCONGENITAL HYPOKALEMIA ASSOCIATED SYNDROMES[?]Bartter's Syndrome (BS):-Loss of the transport functions of the TALH nephron segments causes hereditary hypokalemic alkalosis.-Typically suffer from polyuria & polydipsia, due to the reduction in renal concentrating ability. May have an increase in urinary calcium excretion & 20% are hypomagnesemia-Marked activation of the renin-angiotensin-aldosterone axis.-Antenatal patients suffer from marked electrolyte wasting, polyhydramnios, and hypercalciuria with nephrocalcinosis; renal prostaglandin synthesis and excretion are significantly increased, accounting for much of the systemic symptoms.-Presence of five disease genes for BS, all of them functioning in some aspect of regulated Na+,K+ & Cl- transport by the TALH.[?]Gitelman's Syndrome (GS):-Loss of the transport functions of the DCT nephron segments causes hereditary hypokalemic alkalosis.-Genetically homogeneous, caused almost exclusively by loss-of-function mutations in thiazide-sensitive Na+-Cl- co transporter of DCT.-Uniformly hypomagnesemic & exhibit marked hypocalciuria, rather than the hypercalciuria typically seen in BS; urinary calcium excretion is thus a critical diagnostic test in GS.-May suffer from chondrocalcinosis, an abnormal deposition of Calcium Pyrophosphate Dihydrate (CPPD) in joint cartilage.[?]Distal Renal Tubular Acidosis:-Defects in multiple renal tubular transport pathways are associated with hypokalemia.-Loss-of-function mutations in subunits of the acidifying-H+-ATPase in alpha-intercalated cells cause hypokalemic distal renal tubular acidosis, as do many acquired disorders of the distal nephron.[?]Cushing's Syndrome:-Hypokalemia may also occur with systemic increasing in glucocorticoids.-Increase in pituitary ACTH incidence of hypokalemia is only 10%, whereas, 60-100% in patients with ectopic secretion of ACTH.", "cop": 1, "opa": "Liddle syndrome", "opb": "Bartter syndrome", "opc": "Gitelman syndrome", "opd": "Renal tubular acidosis", "subject_name": "Medicine", "topic_name": "Fluid & Electrolyte", "id": "6738d961-f289-432a-942e-2c4f832a2348", "choice_type": "single"}
+{"question": "A child has cyanotic disease with left ventricular enlargement wiht left axis deviation. Probable diagnosis is", "exp": null, "cop": 4, "opa": "TOF", "opb": "TA PVC", "opc": "Double outlet right ventricle", "opd": "Tricuspid atresia", "subject_name": "Medicine", "topic_name": null, "id": "d564c339-2fef-4369-86ab-41dd5d70473e", "choice_type": "single"}
+{"question": "Cytotoxic T cells induced by infection with virus A will kill target cells", "exp": "The CD8+ cytotoxic T cells have antigen specific T-cell receptors (TCR) on their membranes that will recognize and bind to self class I antigens. Since the viral peptides are presented as a complex with the self class I antigens, the CD8+ cells can now recognize and react to the virus A peptides. Remember that class I antigens are expressed on all nucleated cells and platelets. Ref: Levinson W. (2012). Chapter 58. Cellular Basis of the Immune Response. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.", "cop": 2, "opa": "From the same host infected with any virus", "opb": "Infected by virus A and identical at class I MHC loci to the cytotoxic T cells", "opc": "Infected by virus A and identical at class II MHC loci to the cytotoxic T cells", "opd": "Infected with any virus and identical at class I MHC loci to the cytotoxic cells", "subject_name": "Medicine", "topic_name": null, "id": "b49cbea5-e131-4bab-b5c5-8af033e5ae3d", "choice_type": "single"}
+{"question": "This sound is produced during the closure of the semilunar valves.", "exp": "B: The second heart sound can be represented by dupp. It occurs at the beginning of ventricular diastole and results from the closure of the semilunar valves.\nA: The first heart sound can be represented by the syllable lubb. It occurs at the beginning of ventricular systole and results from closure of the AV valves.", "cop": 2, "opa": "lubb", "opb": "dupp", "opc": "lubb dupp", "opd": "lubb duppshhh", "subject_name": "Medicine", "topic_name": null, "id": "8bc503e6-56d7-4d0f-9fc1-7668566247dc", "choice_type": "single"}
+{"question": "Moth eaten alopecia is seen", "exp": "The hair loss can be moth-eaten, diffuse or both. The \"moth-eaten\" pattern is the most common type and is considered to be a pathognomonic manifestation of secondary syphilis. The alopecia, which is nonscarring, can occasionally affect hair-bearing areas other than the scalp Ref Davidson 23rd edition pg 238", "cop": 4, "opa": "Black dot tinea", "opb": "Telogen effuvium", "opc": "Alopecia areata", "opd": "Secondary syphilis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "abda1d15-8f55-47d4-9813-d1f95a2db51a", "choice_type": "single"}
+{"question": "Angina pectoris is best diagnosed by", "exp": "Ans. A. HistoryAngina Pectoris is best diagnosed by history.a. This is due to myocardial ischemia and presents as a central chest tightness or heaviness (Levine sign) which is brought on by exertion and relieved by rest.b. It may radiate to one or both arms, the neck, jaw or teeth. Atherosclerosis is the most common cause of CAD.c. ECG and Echo may be normal and cardiac enzyme are usually not raised in angina.", "cop": 1, "opa": "History", "opb": "ECG", "opc": "Cardiac Enzyme", "opd": "Echo", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "1ada7df6-f3a1-46fd-a4f6-c7516c7adb21", "choice_type": "single"}
+{"question": "Most common cause of Auto splenectomy", "exp": "A,b,C are causes of Auto splenectomy m/c cause is sickle cell anemia.", "cop": 1, "opa": "Sickle cell anemia", "opb": "SLE", "opc": "Pneumococcal sepsis", "opd": "Thalassemia", "subject_name": "Medicine", "topic_name": null, "id": "6f4c3722-5be7-4a86-8fdc-37b7afeb5c20", "choice_type": "single"}
+{"question": "Cyanosis cannot occur in severe anaemia because", "exp": "Cyanosis seen when deoxygenated hb >4 gm. so in severe anemia where HB less than 4 gm we cannot see cyanosis.", "cop": 2, "opa": "Anaemic blood has a higher O2 carrying capacity per gram of Hb", "opb": "It requires a critical concentration of reduced Hb in blood", "opc": "Patient improves his alveolar oxygen as a compensation for anaemia", "opd": "There is an increased blood flow through the skin", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "8708bb2f-de3c-4fbe-a5dd-61173751f700", "choice_type": "single"}
+{"question": "Turner syndrome is associated with", "exp": "Turner's syndrome is associated with coarctation of aoa. Reference: Ghai essential pediatrics, 9 th edition, page 638", "cop": 4, "opa": "Aotic regurgitation", "opb": "Aoic dissection", "opc": "Pulmonary stenosis", "opd": "Coarctation of aoa", "subject_name": "Medicine", "topic_name": "Genetics", "id": "9e28c9ce-144d-4ef8-b797-938f0efd1857", "choice_type": "single"}
+{"question": "Percentage of bilirubin production from old RBCs", "exp": "(B) 80% > Bilirubin is the end product of heme degradation.> From 70 to 90% of bilirubin is derived from degradation of the hemoglobin of senescent red blood cells.> Bilirubin produced in the periphery is transported to the liver within the plasma, where, due to its insolubility in aqueous solutions, it is tightly bound to albumin.", "cop": 2, "opa": "20%", "opb": "80%", "opc": "100%", "opd": "40%", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "7dc53c52-1d64-47a3-969e-afc7bb51c90e", "choice_type": "single"}
+{"question": "The operation of choice in ulcerative colitis", "exp": "The operation of choice in ulcerative colitis is proctocolectomy (with preservation of the anal sphincter complex) with ileoanal J pouch anastomosis (IPAA).Total proctocolectomy has the advantage of removing all diseased mucosa, thereby preventing fuher inflammation and the potential for progression to dysplasia or carcinoma. ie; Total colon and rectum are removed, ileal pouch is constructed (to function like rectum) and anastomosed to the anal canalRef: Sabiston 20e pg: 1372, Harrison 19e pg: 1962", "cop": 1, "opa": "Proctocolectomy with ileoanal anastomosis", "opb": "Subtotal colectomy and ileostomy", "opc": "Proctocolectomy and permanent end ileostomy", "opd": "Subtotal colectomy and ileorectal anastomosis", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "d4b726e9-6ee3-48e2-a5b0-0d3be4c7751f", "choice_type": "single"}
+{"question": "Blood transfusion should be completed within hours of initiation", "exp": "Ans. is 'a' i.e., 1-4 hours", "cop": 1, "opa": "1- 4 hours", "opb": "3- 6 hours", "opc": "4- 8 hours", "opd": "8- 12 hours", "subject_name": "Medicine", "topic_name": null, "id": "57ec5aef-7f79-45e7-8685-c0d6ce95171e", "choice_type": "single"}
+{"question": "Resistant schizophrenia is treated with", "exp": "(D) Clozapine # Clozapine can cause agranulocytosis and seizures as side-effects, it should be used with caution.ANTI PSYCHOTIC DRUGSA. Typical Or Traditional Antipsychotics1. Chlorpromazine (CPZ)300-15002. Thioridazine300-8003. Trifluoperazine15-604. Haloperidol5-1005. Pimozide4-126. Triflupromazine100-4007. Prochlorperazine45-1508. Flupenthixol3-109. Loxapine25-15010. Zuclopenthixol50-150B. Atypical Or Newer Antipsychotics11. Clozapine25-45012. Risperidone2-813. Olanzapine5-2014. Ziprasidone40-160", "cop": 4, "opa": "Chlorpromazine", "opb": "Haloperidol", "opc": "Loxapine", "opd": "Clozapine", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "67535dbe-7ed3-4a49-a89e-33fcc99a3ef6", "choice_type": "single"}
+{"question": "In epidural anaesthesia, local drug deposited in", "exp": "(Extradural) (494- Lee's 13th) (361- KDT6th) (128-A. yadav. Anaesthesia 3rd)Epidural Anaesthesia - mainly used for controlling post operative pains** Main site of action is Anterior and posterior nerve root*** Drugs diffuses through dura and arachnoid and inhibits descending pathways in spinal cord* Epidural (extradural) anaesthesia* Spinal (Intradural) anaesthesia* Extradural - The extent to which drugs reach their site of action is termed bioavailability* Intradural - although the dura is a relatively rough, avascular fibrous membrane, the arachnoid with its tight overlapping cells represents 90% of resistance in drug permeability and keeps CSF confined to the subarachnoid space*** Epidural anaesthesia - LA injected in the this space acts primarily on nerve roots (in the epidural as well as subarachnoid spaces to which it diffuses) and small amount permeates through intervertebral foramena to produce multiple paravertebral blocks", "cop": 2, "opa": "Intrathecal space", "opb": "Extradural", "opc": "Paraspinal", "opd": "Intervertebral space", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "1adcb5db-76d8-449b-ac82-500ded04fdd7", "choice_type": "single"}
+{"question": "Adenosine deaminase In CSF Is significantly higher In", "exp": "Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis (TB) and has very high morbidity and moality. TBM is typically a subacute disease with symptoms that may persist for weeks before diagnosis Ref Harrison20th edition pg 2456", "cop": 1, "opa": "Tuberculous meningitis", "opb": "BacteriaI meningitis", "opc": "Viral meningitis", "opd": "Syphilitic meningitis", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "02a81d14-b363-4c9e-801d-64501c5833db", "choice_type": "single"}
+{"question": "C wave in JVP is DUE TO", "exp": "ref : rhagawa rao cardiology", "cop": 1, "opa": "Bulging of tricuspid valve during the isovolumetric contraction phase", "opb": "Atrial systole", "opc": "Passive filling ventricle", "opd": "Atrial relaxation", "subject_name": "Medicine", "topic_name": "All India exam", "id": "ac067301-20b8-445b-8f1f-c1fcd65ad3ee", "choice_type": "single"}
+{"question": "The feature of shock lung is", "exp": "Ref: Harrison's 18/e p2205, 17/e p1680", "cop": 1, "opa": "Diffuse alveolar damage", "opb": "Usual interstitial penumonitis", "opc": "Organizing pneumonia", "opd": "Bronchilolitis", "subject_name": "Medicine", "topic_name": "All India exam", "id": "8bebea0b-a7c3-4608-b61a-38644531acc3", "choice_type": "single"}
+{"question": "Grossly incongruous, incomplete (contralateral) Homonymous Hemianopia causing lesion is", "exp": "(B) Lateral optic chiasma # Visual fields that accompany damage to the visual pathways.1. Optic nerve: unilateral amaurosis.2. Lateral optic chiasm: grossly incongruous, incomplete (contralateral) homonymous hemianopia.3. Central optic chiasm: bitemporal hemianopia.4. Optic tract: incongruous, incomplete homonymous hemianopia.5. Temporal (Meyer's) loop of the optic radiation: congruous partial or complete (contralateral) homonymous superior quadrantanopia.6 Parietal (superior) projection of the optic radiation: congruous partial or complete homonymous inferior quadrantanopia.7. Complete parieto-occipital interruption of the optic radiation: complete congruous homonymous hemianopia with psycho- physical shift of the foveal point, often sparing central vision and resulting in \"macular sparing.\"8. Incomplete damage to the visual cortex: congruous homonymous scotomas, usually encroaching at least acutely on central vision.", "cop": 2, "opa": "Optic nerve", "opb": "Lateral optic chiasma", "opc": "Central optic chiasma", "opd": "Optic tract", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "087e76eb-befe-45b6-8a6b-82fdbe15be95", "choice_type": "single"}
+{"question": "Marker for the renal vasculitis in children is", "exp": "Answer is A (Increased IgA levels): The most common systemic vasculitis in children is Henoch Schonlein Purpura, and the most common primary of glomerular disease is IgA Nephropathy. H.S purpura and IgA nephropathy may actually represent spectra of same disease and both are associated with elevated levels of IgA which is the single best answer of choice.", "cop": 1, "opa": "Increased IgA level", "opb": "Low complement level", "opc": "| Antineutrophilic cytoplasmic antibody titre", "opd": "Increase antinuclear antibody", "subject_name": "Medicine", "topic_name": null, "id": "9dbf8bbd-a92b-45eb-8236-8e5fc1886464", "choice_type": "single"}
+{"question": "Basilar migraine differs from classic migraine in the", "exp": "In both classic migraine and basilar migraine ,women are more susceptible. aura and visual disturbances are seen in both. But it is more severe in basilar migraine that it may lead to complete blindness, frank psychosis, quadriplegia and coma.", "cop": 3, "opa": "Sex of persons affected", "opb": "Duration of aura", "opc": "Severity of symptoms", "opd": "Sequence of neurologic deficits", "subject_name": "Medicine", "topic_name": null, "id": "ba3aaf54-0014-4065-b561-e0d241907b1a", "choice_type": "single"}
+{"question": "Most common site of intracranial bleed on Hypertension is", "exp": "(A) Basal ganglia", "cop": 1, "opa": "Basal ganglia", "opb": "Brain stem", "opc": "Cerebellum", "opd": "Subarachnoid space", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "5a8af261-40e2-4c15-9c2b-535e98d2f873", "choice_type": "single"}
+{"question": "Persistent priapism is rarely seen as a consequence IS", "exp": "Harrison's principles of internal medicine 17th edition. * Priapism refers to a persistent and painful erection and may be associated with hypercoagulable states,spinal cord injury or injection of vasodilator agents in to the penis", "cop": 3, "opa": "Sickle cell disease", "opb": "Leukemia", "opc": "Spinal cord disease", "opd": "Prolonged sexual activity", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "90c67fd3-94c9-4aa6-afa0-e29052ac0d0e", "choice_type": "single"}
+{"question": "Ocular dipping is seen in", "exp": "\"Ocular bobbing\" describes brisk downward and slow upward movements of the eyes associated with loss of horizontal eye movements and is diagnostic of bilateral pontine damage, usually from thrombosis of the basilar aery.\"Ocular dipping\" is a slower, arrhythmic downward movement followed by a faster upward movement in patients with normal reflex horizontal gaze; it usually indicates diffuse coical anoxic damage.Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 328; Coma", "cop": 3, "opa": "Pontine damage", "opb": "Medulla damage", "opc": "Diffuse coical damage", "opd": "Mid brain damage", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "78394c58-10aa-473f-b1d1-99e47f846aa6", "choice_type": "single"}
+{"question": "Ventricular aneurysm has one of the following characteristic features", "exp": "A left ventricular aneurysm can be diagnosed on ECG when there is persistent ST segment elevation occurring 6 weeks after a known transmural myocardial infarction (usually an anterior MI). Without knowing the past medical history, the ECG changes of an aneurysm may mimic an acute anterior MI. With an anterior or apical aneurysm, the persistent ST elevation is in lead V1 and V2 with associated Q waves indicating the old anterior MI. In an inferior aneurysm it would be in lead II, III and aVF, although this is less common. The only way to be sure that the ECG changes present are from an LV aneurysm (not ST elevation from an acute MI) is to have the patient's history of a prior MI and cardiac imaging to document the presence of an aneurysm. The shape of the ST elevation is also relatively unique and has been described as \"coving\" as seen below Ref Harrison 20th edition pg 1435", "cop": 1, "opa": "Persistent ST segment elevation", "opb": "Persistent ST segment depression", "opc": "Left bundle branch block", "opd": "Right bundle branch block", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "2ce44d46-823c-4af4-acd1-f1849fa83e7f", "choice_type": "single"}
+{"question": "Most common cause of Acquired Complete Hea Block in children is", "exp": "Ans. is 'a' i.e., Cardiac Surgery Post surgical third degree A-V block resulting from trauma to the A-V node at operation is the most common cause of acquired A-V block in children", "cop": 1, "opa": "Cardiac Surgery", "opb": "Acute Rheumatic Fever", "opc": "Drug overdose", "opd": "Myocarditis", "subject_name": "Medicine", "topic_name": null, "id": "69858307-fa9c-4843-aede-5b2a7ab37c20", "choice_type": "single"}
+{"question": "Chromosome X is", "exp": "Submetacentric - X-chromosome\nAcrocentric - Y-chromosome", "cop": 2, "opa": "Metacentric", "opb": "Submetacentric", "opc": "Acrocentric", "opd": "Telocentric", "subject_name": "Medicine", "topic_name": null, "id": "3ac5d76d-1788-479a-94c8-cdb27a0831f3", "choice_type": "single"}
+{"question": "The marker for B lymphocyte is", "exp": "CD19 is a marker of B lymphocytesPrimarily B cell-associated antigensCD10 and CD19 to CD23 i.e. CD10, CD19, CD20, CD21, CD22, CD23Primarily T cell-associated antigensCD1 to CD8 with the exception of CD6Primarily monocyte macrophage-associated antigensCD13, CD14, CD15, CD33Primarily NK cells associated antigensCD16 and CD56 (also CD2 which is found expressed in a subset(Ref: Harrison's 18/e p2652)", "cop": 1, "opa": "CD19", "opb": "CD68", "opc": "CD34", "opd": "CD4", "subject_name": "Medicine", "topic_name": "All India exam", "id": "48e4aa71-cf59-446b-88d2-802f5ebf7f49", "choice_type": "single"}
+{"question": "Proved association of Celiac disease is with", "exp": "Celiac disease is associated with dermatitis herpetiformis(DH), but this association has not been explained.Patients with DH have characteristic papulovesicular lesions that respond to dapsone. Almost all patients with DH have histologic changes in the small intestine consistent with celiac disease, although usually much milder and less diffuse in distribution. Celiac disease is also associated with diabetes mellitus type 1, IgA deficiency, Down syndrome, and Turner's syndrome.Ref: Harrison; 19th edition; Page no: 1942", "cop": 4, "opa": "Scleroderma", "opb": "Pemphigus", "opc": "Pomphoid", "opd": "Dermatitis herpetiformis", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "2047ee40-6230-4819-be7f-f4b5211ed12e", "choice_type": "single"}
+{"question": "Rheumatoid factor is", "exp": "(A) IgM Ab against Fc fragment of IgG # Rheumatoid factor is a IgM Ab against Fc fregment of IgG.> Serum IgM RF has been found in 75-80% of patients with RA; therefore, a negative result does not exclude the presence of this disease. It is also found in other connective tissue diseases, such as primary Sjogren's syndrome, systemic lupus erythematosus, and type II mixed essential cryoglobulinemia, as well as chronic infections such as subacute bacterial endocarditis and hepatitis B and C. Serum RF may also be detected in 1-5% of the healthy population.Mnemonic: Man Towards Girl: IgM Ab against Fc fragment of IgG.", "cop": 1, "opa": "IgM Ab against Fc fragment of IgG", "opb": "IgG Ab against Fc fragment of IgG", "opc": "IgM Ab against Fc fragment of IgA", "opd": "IgM Ab against Fc fragment of IgM", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "2827beff-e163-4bd5-900d-b5b63072ba62", "choice_type": "single"}
+{"question": "Most common inherited cause of Aplastic anemia", "exp": "M/C acquired cause - Idiopataic.\nM/C inherited - Fanconi anemia.", "cop": 2, "opa": "Idiopathic", "opb": "Fanconi anemia", "opc": "Scwachman - diamond syndrome", "opd": "Down syndrome", "subject_name": "Medicine", "topic_name": null, "id": "49a21df6-cf26-426c-8efc-c9571574016e", "choice_type": "single"}
+{"question": "The main component of hyperlipidemia constituting a major risk factor for atherosclerosis is", "exp": null, "cop": 3, "opa": "high density lipoprotein (HDL) cholesterol", "opb": "intermediate density lipoprotein (IDL) Cholesterol", "opc": "low density lipoprotein (LDL) cholesterol", "opd": "very low density lipoprotein (VLDL) cholesterol", "subject_name": "Medicine", "topic_name": null, "id": "d1a01001-d053-4788-9c55-027cb7b61a73", "choice_type": "single"}
+{"question": "Not a cause of hemoptysis", "exp": "Empyema is collection of pus in pleural space which is characterised by severe pleuritic pain or persisting or recurrent pyrexia.Other features include rigor,sweating,malaise and weight loss.Usually there is no hemoptysis. Pneumococcal pneumonia often causes rusty coloured sputum.Bronchiectasis and intracavitary mycetoma can cause catastrophic bronchial hemorrhage.Mitral stenosis can also leads to hemoptysis. Ref:Davidson's med:22nd edition, page no:658.", "cop": 3, "opa": "Pneumonia", "opb": "Bronchiectasis", "opc": "Empyema", "opd": "Mitral stenosis", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "9203f807-858c-445c-bac3-0eee7ac16cc8", "choice_type": "single"}
+{"question": "Episodic hypertension is classical feature of", "exp": "Ans. b (Pheochromocytoma) (Ref H-17th12270; Table 337-1)The dominant sign of Pheochromocytoma is hypertension. Classically, patients have episodic hypertension, but sustained hypertension is also frequent. These paroxysms generally last less than an hour and may be precipitated by surgery positional changes,exercise, pregnancy, urination (particularly bladder pheochromocytomas), and various medications (e.g., tricyclic antidepressants, opiates, metoclopramide).PHEOCHROMOCYTOMAClinical FeaturesThe clinical presentation is so variable that pheochromocytoma has been termed \"the great masquerader\". Among the presenting symptoms, episodes of palpitations, headaches, and profuse sweating are typical and constitute a classic triad.To enlist:HeadachesWeight lossSweating attacksParadoxical response to antihypertensive drugsPalpitation and tachycardiaPolyuria and polydipsiaHypertension, sustained or paroxysmalConstipationAnxiety and panic attacksOrthostatic hypotensionPallorDilated cardiomyopathyNauseaErythrocytosisAbdominal painElevated blood sugarWeaknessHypercalcemiaPheochromocytoma, DiagnosisDiagnostic MethodSensitivitySpecificity24-h urinary tests Vanillylmandelic acid++++++Catecholamines++++++Fractionated metanephrines++++++Total metanephrines+++++++Plasma Catecholamines+++++Free metanephrines+++++++Plasma Chromogranin A+++++CT+++++++MRI+++++++MIBG scintigraphy+++++++Somatostatin receptor scintigraphy++++Dopa (dopamine) PET (preliminary data)++++++++", "cop": 2, "opa": "Adrenal carcinoma", "opb": "Pheochromocytoma", "opc": "Conn's syndrome", "opd": "Cushing's disease", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "e73b7529-6e0c-435b-a729-d456f999e50d", "choice_type": "single"}
+{"question": "A double apical impulse is seen in", "exp": "(D) HOCM# Physical findings of HCM are associated with the dynamic outflow obstruction that is often present with this disease.> Upon auscultation, the heart murmur will sound similar to the murmur of aortic stenosis.> However, a murmur due to HCM will increase in intensity with any maneuver that decreases the volume of blood in the left ventricle (such as standing abruptly or the strain phase of a Valsalva maneuver). Administration of amyl nitrite will also accentuate the murmur by decreasing venous return to the heart.> Classically, the murmur is also loudest at the left parasternal edge, 4th intercostal space, rather than in the aortic area.> If dynamic outflow obstruction exists, physical examination findings that can be elicited include the pulsus bisferiens and the double apical impulse with each ventricular contraction.> A double apical impulse may be recognized, particularly with the patient in the left lateral recumbent position.", "cop": 4, "opa": "AS & AR", "opb": "TR&TS", "opc": "MI", "opd": "HOCM", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "61fcf97e-b743-43bf-a4ad-86dcc8985e74", "choice_type": "single"}
+{"question": "MCardle's syndrome is due to", "exp": "McArdle disease (also known as glycogen storage disease type V) is a disorder affecting muscle metabolism. The condition is caused by the lack of an enzyme called muscle phosphorylase. This results in an inability to break down glycogen 'fuel' stores. McArdle disease leads to pain and fatigue with strenuous exercise. Ref Robbins 9/e pg 153", "cop": 1, "opa": "Deficiency of glucose-6-phosphatase", "opb": "Absence of muscle phosphorylase", "opc": "Deficiency of liver phosphorylase", "opd": "Deficiency of liver phosphorylase kinase", "subject_name": "Medicine", "topic_name": "Genetics", "id": "e5eacb0a-0ae8-4d50-8c6a-64638542c62b", "choice_type": "single"}
+{"question": "Hypomagnesemia is associated with", "exp": "(B) Hypokalemia > Other electrolyte abnormalities often seen with Hypomagnesemia, including hypocalcemia (with hypocalciuria) and hypokalemia, may not be easily corrected unless magnesium is administered as well.", "cop": 2, "opa": "Hyercalcemia", "opb": "Hypokalemia", "opc": "Hyperkaemia", "opd": "Hyperphosphatemia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "4acc2cb7-5935-407f-9f38-8a5cfa2e5d75", "choice_type": "single"}
+{"question": "The largest volume of water is reabsorbed in the nephron at the", "exp": null, "cop": 2, "opa": "Collecting duct", "opb": "Proximal convoluted tubule", "opc": "Ascending loop of Henle", "opd": "Descending loop of Henle", "subject_name": "Medicine", "topic_name": null, "id": "16874e09-b4c4-423d-b264-da5e48b04255", "choice_type": "single"}
+{"question": "Most common cause of lobar hemorrhage in the elderly", "exp": "Answer- C. Amyloid angiopathyLobar intracerebral hemorrhage is bleeding in the largest pa of the brain called the cerebrum.Intracerebral hemorrhage are attributed to hypeensive vasculopathy in small penetrating brain aeries and subcoical vessels in patients with amyloid angiopathy.Amyloid angiopathn a chronic deposition of congophilic rnaterial in brain vessels, is the most common cause of lobar hemorrhage in older patients.", "cop": 3, "opa": "Coagulopathy", "opb": "Aneurysm", "opc": "Amyloid angiopathy", "opd": "Trauma", "subject_name": "Medicine", "topic_name": null, "id": "051b8b6f-020c-426b-8a19-623e0ba582a2", "choice_type": "single"}
+{"question": "A Thiy five year old female has proximal weakness of muscles, ptosis and easy fatigability. The most sensitive test to suggest the diagnosis is", "exp": "Single fiber electromyography (SFEMG) was established by Stalberg and Eskedt in the 1960s, and is of proven value in the diagnosis of neuromuscular disorders, especially myasthenia gravis. It has proved to be the most sensitive technique in detecting a neuromuscular transmission defect in comparison with the tensilon test, repetitive stimulation, and acetyl choline receptor antibody estimation. Single fiber electromyography typically requires the use of a specially contracted single fiber EMG needle electrode or facial concentric needle electrode with a small recording surface (25 micrometers), which is exposed at a po on the side of the electrode, 3 mm from the tip. Ref Harrison20th edition pg 2456", "cop": 4, "opa": "Muscle Biopsy", "opb": "CPK levels", "opc": "Edrophonium test", "opd": "Single fiber EMG", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "be069581-8cc6-4296-8b8b-e27e7ffb686b", "choice_type": "single"}
+{"question": "Alzeihmer's disease is associated with", "exp": "Patients with trisomy 21 have 3 copies of the gene for amyloid precursor protein and develop neurological characteristics of Alzheimer's disease by midlife. Alzheimer's Disease in People with Down Syndrome. Many, but not all, people with Down syndrome develop Alzheimer's disease when they get older. People with Down syndrome are born with an extra copy of chromosome 21, which carries the APP gene. This gene produces a specific protein called amyloid precursor protein (APP) .which leads to development of Alzheimer's Ref Harrison20th edition pg 2756", "cop": 1, "opa": "Chr 21", "opb": "Chr 19", "opc": "Chr.21", "opd": "Chr.22", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "92d3f27c-b4e8-48f1-a37f-5e9a7a5f02ac", "choice_type": "single"}
+{"question": "Type I diabetes mellitus is associated with", "exp": null, "cop": 3, "opa": "insulin resistance", "opb": "defect in mitochondrial DNA", "opc": "islet cell autoantibodies", "opd": "beta cell dysfunction", "subject_name": "Medicine", "topic_name": null, "id": "b5a5cb7f-bd4c-4e5d-b4d2-8a58e83bbfea", "choice_type": "single"}
+{"question": "Find the type of inheritence", "exp": "Only females can transmit the disease to offsprings. Males cannot transmit.", "cop": 4, "opa": "Autosomal dominant", "opb": "X-linked dominant", "opc": "Autosomal recessive", "opd": "Mitochondrial", "subject_name": "Medicine", "topic_name": null, "id": "e4db72f1-0f0f-4a76-97cd-227990e50740", "choice_type": "single"}
+{"question": "A patient presented with pulmonary embolism the treatment to be given is", "exp": "(B) i.v. Heparin with continuous infusion followed by coumarin for 4-5 months # Thrombolysis:> Successful thrombolytic therapy rapidly reverses right heart failure and leads to a lower rate of death and recurrent PE.# Thrombolysis usually:> Dissolves much of the anatomically obstructing pulmonary arterial thrombus;> Prevents the continued release of serotonin and other neurohumoral factors that exacerbate pulmonary hypertension; and Dissolves much of the source of the thrombus in the pelvic or deep leg veins, thereby decreasing the likelihood of recurrent PE.> The preferred thrombolytic regimen is 100 mg of recombinant tissue plasminogen activator (tPA) administered as a continuous peripheral intravenous infusion over 2 h.> Patients appear to respond to thrombolysis for up to 14 days after the PE has occurred.> Contraindications to thrombolysis include intracranial disease, recent surgery, or trauma. There is a 1 to 2% risk of intracranial hemorrhage.> Careful screening of patients for contraindications to thrombolysis is the best way to minimize bleeding risk.", "cop": 2, "opa": "Urokinase with fibrinolytics", "opb": "i.v. Heparin with continuous infusion followed by coumarin for 4-5 months", "opc": "Subcutaneous Heparin 5000 units", "opd": "Warfarin with INR 1-1.5", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "18111b17-10e3-445d-9e5a-b8ed5100c223", "choice_type": "single"}
+{"question": "The drug of choice for absence seizure", "exp": "Valproate is the drug of choice for absence seizure.", "cop": 1, "opa": "Valproate", "opb": "Phenytoin", "opc": "Carbamazepine", "opd": "Pregabalin", "subject_name": "Medicine", "topic_name": null, "id": "de3af4f8-6cee-452f-9144-a7914a543de1", "choice_type": "single"}
+{"question": "Gradient in pulmonary artery wedge pressure and left venticular end diastolic pressure is seen in", "exp": null, "cop": 3, "opa": "Aortic regurgitation", "opb": "Constrictive pericarditis", "opc": "Left atrial myxoma", "opd": "Pulmonary thromboembolism", "subject_name": "Medicine", "topic_name": null, "id": "009ad99c-6912-431b-a13e-cc9cdde03953", "choice_type": "single"}
+{"question": "Anuria is defined as urine output less than", "exp": "Anuria is nonpassage of urine, in practice is defined as passage of less than 100milliliters of urine in a day. Anuria is often caused by failure in the function of kidneys. It may also occur because of some severe obstruction like kidney stones or tumours. It may occur with end stage renal disease. It is a more extreme reduction than oliguria (hypouresis), with 100 mL/day being the conventional (albeit slightly arbitrary) cutoff point between the two Ref Harrison20th edition pg 277", "cop": 1, "opa": "4ml/hr", "opb": "8ml/hr", "opc": "12ml/hr", "opd": "16ml/hr", "subject_name": "Medicine", "topic_name": "Kidney", "id": "e90c4404-19c0-4836-8d4c-7e5e9bdb3093", "choice_type": "single"}
+{"question": "Earliest phenotypic manifestation of Idiopathic hereditary hemochromatosis is", "exp": "Investigations in Primary Haemochromatosis Serum iron studies show a greatly increased ferritin, a raised plasma iron and saturated plasma iron-binding capacity. The serum iron level and percent saturation of transferrin are elevated early in the course, but their specificity is reduced by significant false-positive and false-negative rates. For example, serum iron concentration may be increased in patients with alcoholic liver disease without iron overload; in this situation, however, the hepatic iron index is usually not increased as in hemochromatosis (Table 407-1). In otherwise healthy persons, a fasting serum transferrin saturation >45% is abnormal and suggests homozygosity for hemochromatosis. Transferrin saturation of more than 45% is suggestive of iron overload. Significant liver disease is unusual in patients with ferritin lower than 1000 mg/L (100 mg/dL). The differential diagnoses for elevated ferritin are inflammatory disease or excess ethanol consumption for modest elevations (< 1000 mg/L (100 mg/dL). Very significant ferritin elevation can be seen in adult Still's disease. In terms of imaging techniques, MRI has high specificity for iron overload but poor sensitivity. Liver biopsy allows assessment of fibrosis and distribution of iron (hepatocyte iron characteristic of haemochromatosis). The Hepatic Iron Index (HII) provides quantification of liver iron (mmol of iron per g dry weight of liver/age in years). An HII of more than 1.9 suggests genetic haemochromatosis . Both the C282Y and the H63D mutations can be identified by genetic testing, which is now in routine clinical use . Ref Davidsons 23e p895 , Harrison 20e p2980", "cop": 4, "opa": "Post prandial increase in serum iron concentration", "opb": "Elevated serum ferritin level", "opc": "Slate grey pigmentation of skin", "opd": "Increased transferrin saturation", "subject_name": "Medicine", "topic_name": "Immune system", "id": "79f95c02-0ddb-4b7b-9edd-081a46a6d556", "choice_type": "single"}
+{"question": "The first virological marker following acute hepatic infection if he has", "exp": null, "cop": 2, "opa": "IgM Anti Hbc Ag", "opb": "Hbs Ag", "opc": "Anti Hbs Ag", "opd": "Anti Hbe Ag", "subject_name": "Medicine", "topic_name": null, "id": "96abb28f-9417-4a76-a600-e668ed2cf16c", "choice_type": "single"}
+{"question": "Jejunal biopsy is diagnostic in", "exp": "biopsy reveals characteristic findings in the following diseases which may cause steatorrhea: sprue, amyloidosis, Whipple's disease, lymphoma, a-beta-lipoproteinemia, and scleroderma. In nontropical sprue (and to a lesser degree in tropical sprue), microscopic examination of the jejunum reveals blunting or absence of the villi, substitution of cuboidal for columnar surface cells, infiltration of the lamina propria with lymphocytes and plasma cells, and increased mitotic activity in the crypts of the unusually deep intestinal glands. In amyloidosis, which affects the intestinal tract in 50% of cases, there is deposition of amyloid in the lamina propria and around blood vessels. In Whipple's disease, villi of the intestinal mucosa are thickened and have bulbous tips, and the laminae propria contain foamy histiocytes and lipid deposits; also the macrophages contain a carbohydrate-protein complex which is readily demonstrated by the periodic-acid, Schiff staining technic. In lymphoma, mucosal lesions may be identical to those seen in sprue; on the other hand, diagnostic nodules of lymphocytes or unusual cellular infiltrations may be seen in the lamina propria. In a-beta-lipoproteinemia, numerous vacuoles of fat are found in the epithelial cells Ref Davidson edition23rd pg 809", "cop": 1, "opa": "beta lipoproteinemia", "opb": "Giardiasis", "opc": "Tropical sprue", "opd": "Celiac sprue", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "e84cf8bb-c231-4c18-93ca-c96d3816e52a", "choice_type": "single"}
+{"question": "Bilateral facial nerve palsy is seen in", "exp": "(C) Gullian Barre syndrome # BILATERAL FACIAL PALSY occurs in Gullian Barre syndrome, in a form of sarcoidosis called uveoparotid fever (Heerfordt syndrome) & in bilateral acoustic neuroma,> Facial Neuropathy: An isolated facial palsy may occur in patients with HIV seropositivity, sarcoidosis, or Lyme disease. In the Ramsay Hunt syndrome, pain and vesicles appear in the external auditory canal, and patients lose their sense of taste in the anterior two-thirds of the tongue while developing ipsilateral facial palsy. The geniculate ganglion of the sensory branch of the facial nerve is involved. Tumors that invade the temporal bone (carotid body, cholesteatoma, dermoid) may produce a facial palsy, but the onset is insidious and the course progressive. Acoustic neuromas frequently involve the facial nerve by local compression. Infarcts, demyelinating lesions of multiple sclerosis, and tumors are the common pontine lesions that interrupt the facial nerve fibers; other signs of brainstem involvement are usually present. Bilateral facial paralysis (facial diplegia) occurs in Guillain-Barre syndrome and also in a form of sarcoidosis known as uveoparotid fever (Heerfordt syndrome). Lyme disease is a frequent cause of facial palsies in endemic areas. Rare Melkersson-Rosenthal syndrome consists of a triad of recurrent facial paralysis, recurrent--and eventually permanent-- facial (particularly labial) edema, and less constantly, plication of the tongue; its cause is unknown. Leprosy: Frequently involves the facial nerve, and facial neuropathy may also occur in diabetes mellitus.", "cop": 3, "opa": "Herpes zoster", "opb": "Ramsay Hunt syndrome", "opc": "Gullian Barre syndrome", "opd": "Melkersen Rosenthal syndrome", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "a60a5fd2-d92a-47e3-8a2b-3caec390fbdb", "choice_type": "single"}
+{"question": "Radiotherapy is treatment of choice in", "exp": null, "cop": 3, "opa": "Sarcoidosis", "opb": "Tuberculosis", "opc": "Monoclonal hypogammaglobulinemia", "opd": "Sarcomas", "subject_name": "Medicine", "topic_name": null, "id": "0cd1c2f5-7ae4-4fed-9d62-0b63d91a93e4", "choice_type": "single"}
+{"question": "Therapeutic hypothermia is useful in preventing neurological complication in", "exp": "Therapeutic hypothermia (also called targeted temperature management) refers to deliberate reduction of the core body temperature, typically to a range of about 32deg to 34deg C (89.6deg to 93.2deg F) in patients who don't regain consciousness after return of spontaneous circulation following a cardiac arrest. Hypothermia also is used to treat newborns with perinatal asphyxia; however, this aicle focuses on its use in adults. Hypothermia counteracts neuroexcitation in brain cells by stabilizing calcium and glutamate release, reducing the degree of cell death. It also stabilizes the blood-brain barrier and suppresses the inflammatory process, reducing cerebral edema. Cerebral metabolism decreases 6% to 10% for every degree Celsius that body temperature drops. As cerebral metabolism declines, the brain needs less oxygen. In essence, hypothermia counteracts many of the destructive mechanisms of cardiac arrest. Its effects resemble those of cardiac defibrillation, which makes the hea stop and then reset itself to a normal rhythm. Similarly, hypothermia halts destructive brain mechanisms and lets the brain reset itself to normal functioning. Therapeutic hypothermia occurs in three phases--induction, maintenance, and rewarming. Clinicians must control hypothermia and rewarming to prevent potential adverse effects, such as arrhythmias and skin breakdown during the cold phases (induction and maintenance) and rapid electrolyte shifts during the rewarming phase. Temperature should be monitored with a method that measures core temperature, such as use of an esophageal, bladder, or pulmonary aery catheter. REF - pubmed.com , medlineplus.com", "cop": 3, "opa": "Sepsis", "opb": "Poly trauma", "opc": "Cardiac arrest", "opd": "Ischemic stroke", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "a3e4e174-d79b-4273-8ee3-1ab6b9be0c89", "choice_type": "single"}
+{"question": "Diagnostic of acute pulmonary embolism is", "exp": "Ans. d (D-dimer assay). (Ref. Harrison, Medicine, 18th/Chapter 103; fig. 58-2)EVALUATION OF ACUTE PULMONARY EMBOLISM# ECG may show RV hypertrophy with strain, RBBB, increased HR and T-wave inversion in V1 to V4.# CXR is frequently normal. However Palla sign (enlarged right descending pulmonary artery) or Westermark's sign (decreased pulmonary vascular markings peripherally) or Hampton's hump.# If clinical likelihood is low, then d-dimer, ELISA and USG lower extremities are done# D-dimer is elevated in number of conditions other than pulmonary embolism, however, a negative D-dimer assay suggests that likelihood of PE is low. Patients with a low likelihood of DVT or a low-to-moderate likelihood of PE can undergo initial diagnostic evaluation with d-dimer testing alone without obligatory imaging tests. If the d-dimer is abnormally elevated, imaging tests are the next step# VP lung scans are done in any stable patient with suspicion of PE and are investigation of choice.# CT with contrast may be helpful, and may supplement VP Scan in coming days.# Pulmonary arteriography is 'gold-standard' and definitive", "cop": 4, "opa": "Chest radiograph", "opb": "ESR", "opc": "ECG changes", "opd": "D-dimer assay", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "20d2c15c-7941-4b7f-8c07-a08895ffaac0", "choice_type": "single"}
+{"question": "Plantar reflex root value is", "exp": "(B) Afferent S1, Efferent L5, S1 # PATHWAYS FOR PLANTAR REFLEX:> Afferent: Nociception detected in the S1 dermatome and travels up the tibial nerve to the sciatic nerve to roots of L5, S1 and synapse in the anterior horn to elicit the motor response.> Efferent: Motor response back through the L5, S1 roots to the sciatic nerve to its bifurcation. Toe flexors are innervated by tibial nerve. Toe extensors (extensor hallicus longus, extensor digitorum longus) are innervated by the deep peroneal nerve. Loss of normal adult descending pyramidal control of the reflex arc to suppress extensor withdrawl results in the up-going toes in the plantar reflex known as Babinski's sign. There is no such thing as a negative Babinski's sign.> Causes of an extensor plantar response: Pyramidal tract lesions; Normal children up to one year of age; Deep sleep; Coma; General Anaesthesia; Postictal stage of epilepsy; Electroconvulsive therapy (ECT); Hypoglycaemia; Alchol intoxication; Narcosis; Hypnosis; Following severe physical exhaustion; Head trauma with concussion.> Root values of Reflexes: Biceps reflex (C5, C6) Brachioradialis reflex (C5, C6, C7) Extensor digitorum reflex (C6, C7) Triceps reflex (C6, C7, C8) Patellar reflex or knee-jerk reflex L2, L3, L4) Ankle jerk reflex (Achilles reflex) (S1, S2) Plantar reflex or Babinski reflex (L5, S1, S2)", "cop": 2, "opa": "Afferent S1, Efferent L3, S1", "opb": "Afferent S1, Efferent L5, S1", "opc": "Afferent S2, Efferent L3, S1", "opd": "Afferent S2, Efferent L5, S1", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "73e4b868-9eae-497f-a48e-94651546a0c8", "choice_type": "single"}
+{"question": "The most impoant diagnositic feature for beta thalassemia trait", "exp": "Ans. is 'd' i.e., Raised HbA2", "cop": 4, "opa": "Raised HbF", "opb": "Reduced MCH", "opc": "Reduced MCV", "opd": "Raised HbA2", "subject_name": "Medicine", "topic_name": null, "id": "3949be91-7167-4305-9654-869f1577eb44", "choice_type": "single"}
+{"question": "Inclusions in oligodendrogliocytes is a feature of", "exp": "Harrison's principles of internal medicine 17th edition. Pg 1249*Oligodendrocytes have enlarged,densely staining nuclei that contain viral inclusions formed by crystalline arrays of JC virus paicles.", "cop": 4, "opa": "Creutzfeldt-Jakob disease", "opb": "CIDP", "opc": "HSV", "opd": "Progressive multifocal leukoencephalopathy", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "8a059ae6-b4bc-419e-99d5-500624159953", "choice_type": "single"}
+{"question": "Deposition of anti ds DNA Ab in kidney, skin, choroid plexus and joints is seen", "exp": "Ref - Harrison's internal medicine 20e p2517", "cop": 1, "opa": "SLE", "opb": "Good pasture", "opc": "Scleroderma", "opd": "Raynauds disease", "subject_name": "Medicine", "topic_name": "Immune system", "id": "b45ef49a-c1ce-4137-ba70-0f911f298c5f", "choice_type": "single"}
+{"question": "Short acting anticholinesterase is", "exp": "(B) Edrophonium# Pyridostigmine:> Resembles neostigmine in all respects but is dose to dose less potent and longer acting, less frequent dosing is required in myasthenia gravis.# Edrophonium:> Resembles neostigmine in action, has a brief duration (10-30 min), suitable as a diagnostic agent for myasthenia gravis and for postoperative decurarization.# Tacrine:> It is a lipophilic acridine compound which interacts with ChE in a manner analogous to edrophonium.> It crosses blood-brain barrier and has a longer duration of action.# Donepezil:> Another centrally acting anti AChE that has produced cognitive and behavioral improvement in AD.> It is long acting and suitable for once daily administration.", "cop": 2, "opa": "Tacrine", "opb": "Edrophonium", "opc": "Pyridostigmine", "opd": "Donepezil", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f57a5dc8-1629-4c9e-b78f-ab318058285b", "choice_type": "single"}
+{"question": "Hypernatremia is defined as a plasma sodium concentration more than", "exp": "Hypernatremia is defined as a plasma Na+ concentration >145 mmol/L. Hypernatremia can develop following the loss of water both renal and nonrenal routes. Insensible losses of water may increase in the setting of fever, exercise, heat exposure, severe burns, or mechanical ventilation. Diarrhea is, in turn, the most common gastrointestinal cause of hypernatremia. Notably, osmotic diarrhea and viral gastroenteritides typically generate stools with Na+ and K+ <100 mM, thus leading to water loss and hypernatremia; in contrast, secretory diarrhea typically results in isotonic stool and thus hypovolemia with or without hypovolemic hyponatremia. Common causes of renal water loss include osmotic diuresis secondary to hyperglycemia, excess urea, postobstructive diuresis, or mannitol;Hypernatremia due to a water diuresis occurs in central or nephrogenic diabetes insipidus (DI). Ref: Harrison 19e pg: 302", "cop": 3, "opa": "135 mmol/L", "opb": "140 mmol/L", "opc": "145 mmol/L", "opd": "150 mmol/L", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "70bc0517-6560-4161-8fd0-051335dc87fe", "choice_type": "single"}
+{"question": "Commonest presentation of sickle cell anaemia is", "exp": "Sickle cell anemis causes Vaso-occlusive crisis : This means plugging of small vessels in the bone produces severe bone pain. This affects areas of active marrow: the hands and feets in children(dactylitis) or femora, humeri, ribs, pelvis and veebrae in adults. Reference : Davidson, 23rd Edition, page no : 952.", "cop": 2, "opa": "Priapism", "opb": "Bone pain", "opc": "Fever", "opd": "Splenomegaly", "subject_name": "Medicine", "topic_name": "Haematology", "id": "ad804da2-ddca-4a1b-8909-8be4d0728d0c", "choice_type": "single"}
+{"question": "The commonest intrabronchial cause of haemoptysis is", "exp": null, "cop": 4, "opa": "Carcinoma lung", "opb": "Adenoma lug", "opc": "Emphysema", "opd": "Bronchiectasis", "subject_name": "Medicine", "topic_name": null, "id": "8d84a973-1276-4b11-9f65-7c9d92362bc6", "choice_type": "single"}
+{"question": "Maximal deaths in MI occurs within", "exp": "(A) 0-24 hrs > The vast majority of deaths due to ventricular fibrillation occur within the first 24 h of the onset of symptoms, and of these, over half occur in the first hour.> Therefore, the major elements of prehospital care of patients with suspected STEM I include Recognition of symptoms by the patient and prompt seeking of medical attention Rapid deployment of an emergency medical team capable of performing resuscitative maneuvers, including defibrillation Expeditious transportation of the patient to a hospital facility that is continuously staffed by physicians and nurses skilled in managing arrhythmias and providing advanced cardiac life support Expeditious implementation of reperfusion therapy", "cop": 1, "opa": "0-24 hrs", "opb": "24-48 hrs", "opc": "48-72 hrs", "opd": "> 72 hrs", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "510d1522-406d-4716-b9b4-3a5ee1838dc4", "choice_type": "single"}
+{"question": "Most common site of histiocytosis is", "exp": "Ans. is 'a' i.e. bone Histiocytosis is a disorder of the mononuclear phagocytic system.Mononuclear phagocytic system consists of monoblasts, promonocytes, monocytes and tissue macrophages.Macrophages are transformed monocytes i.e. monocytes present in the tissues. Monocytes emigrate continuously from peripheral blood into the tissuesHistiocyteThe term histiocyte is synonymous with macrophage.In diseases of mononuclear phagocytic system the terms histiocyte and histiocytosis are used.Langerhans cellsLangerhans cell is macrophage and plays important role in immunity.It processes antigen and present it to T cells.Langerhans cells histiocytosis (LCH) is a clonal histiocytosis and the lesions are characterized by the presence of Langerhans cells, eosinophils and Lymphocytes in a variable number.The various features of Langerhans cells are:Presence of Birbeck granules (E/M - HX bodies)Presence of enzymes likea Naphthyl acetate esterasea Naphthyl butyrate esteraseAcid phosphataseMarkers likeS-100 positivityCD-I a positivityHCA-DR expressionEarlier the term histiocytosis X was used which includedLetterer-Siwe diseases (generalised disease)Hand schuller-christian diseaseEosinophilic granuloma (localised lesion)However, now the term Langerhans cell histiocytosis is preferred Langerhans cell histiocytosis includes 3 clinicopathologic entitiesAcute disseminated Langerhans cell histiocytosisMultifocal Langerhans cell histiocytosisUnifocal Langerhans cell histiocytosisAcute disseminated LCH (Letterer siewers disease)* This is the most severe form with systemic lesionsUsually affects children < 2 yearsSeborrheic type of skin rash is present over the front and back of the trunk and scalpHepatosplenomegaly is moderateLymphadenopathy is positivePulmonary lesions are not uncommonLytic lesions in bones are seenFever is of moderate degreeOtitis media andMastoiditis may be present Hematological findings of LCH CytopeniasAnemia, neutropenia and thrombocytopenia. These may occur in isolation or in combination.Cytopenias occur because hematopoietic cells in marrow get replaced by histiocytes.Bone marrowBone marrow shows infiltration by histiocytes which are large cells with abundant cytoplasm having a vesicular, oval or indented nucleus. These cells are loaded with cholesterol.E/M reveals Birbeck granulesS100, CD1a positiveMultifocal LCHMultiple lesions involving many systems.Prognosis is better than in the disseminated LCH.Usually affects children who presents with fever and skin eruptions on the scalp.Some of the patients demonstrate involvement of posterior pituitary stalk of hypothalamus resulting in diabetes insipidus.Some manifests proptosis of eye.There is evidence of osteolytic lesions in some of the bones like skull, orbit, jaw, femur, vertebrae and ribsHistomorphology of the lesion demonstrates histiocytes admixed with eosinophils.Unifocal LCHThis is characterized by a focal lesion amenable to treatment and carry a good prognosis.This focal disease affects the skeletal system.Commonly affected bones are calvaria, ribs and femur.The lesions may be asymptomatic or may cause pain, tenderness and pathological fractures.", "cop": 1, "opa": "Bone", "opb": "Skin", "opc": "Lung", "opd": "Liver", "subject_name": "Medicine", "topic_name": "Immunology and Rheumatology", "id": "cca4aa7f-bb2f-4bd9-a3c7-ca0b344f06f2", "choice_type": "single"}
+{"question": "A child is exclusively fed on cow's milk. the deficiency seen in", "exp": "Cow's milk is a poor source of vitamin C and Iron.", "cop": 1, "opa": "Iron", "opb": "Vitamin A", "opc": "Thiamine", "opd": "Riboflavin", "subject_name": "Medicine", "topic_name": null, "id": "5b12cfe6-1e54-43c0-abb5-d4ee774581b9", "choice_type": "single"}
+{"question": "Metabolic alkalosis is seen in", "exp": "Ans. is 'a' i.e., Primary mineralocorticoid excess * Mineralocorticoid excess increases net acid excretion, this leads to metabolic alkalosis.Also knowThe plasma potassium concentration changes with serum pH.If pH decreases the excess H+ tends to enter the body's cells in exchange for K+ and plasma increases.If the pH increases (alkalosis) H+ tends to leave cells and enters bloodstream to partly compensate for the alkalosis.In exchange for H\\ K+ enters the cells and results in decreased plasma hypokalemic alkalosis.Causes of Metabolic AlkalosisExogenous HCO3' loadsAcute alkali administrationMilk-alkali syndromeEffective ECFV contraction, normotension, K+ deficiency, and secondary hyperreninemic hyperaldosteronismGastrointestinal originVomitingGastric aspirationCongenital chloridorrheaVillous adenomaCombined administration of sodium polystyrene sulfonate (Kayexalate) and aluminum hydroxide.Renal originDiureticsEdematous statesPost hypercapnic stateHypercalcemia/hypoparathyroidismRecovery from lactic acidosis or ketoacidosisNonabsorbable anions including penicillin, carbenicillinMg2+deficiencyK+ depletionBartter's syndrome (loss of function mutations in TALH)Gitelman' s syndrome (loss of function mutation in Na+-Cl- cotransporter in DCT)ECFV expansion, hypertension, K+ deficiency, and mineralocorticoid excessHigh reninRenal artery stenosisAccelerated hypertensionRenin-secreting tumorEstrogen therapyLow reninPrimary aldosteronismAdenomaHyperplasiaCarcinomaAdrenal enzyme defectslip - Hydroxylase deficiency17a - Hydroxylase deficiencyCushing's syndrome or diseaseOtherLicoriceCarbenoxoloneChewer's tobaccoLydia Pinkam tabletsGain of function mutation of renal sodium channel with ECFV expansion, hypertension, K+ deficiency, and hyporeninemic- hypoaldosteronismA.Liddle's syndromeThis is the complete list of metabolic alkalosis the list given in answer 32 is not complete.", "cop": 1, "opa": "Primary mineralocorticoid excess", "opb": "Deficiency of mineralocorticoid", "opc": "Decreased acid excretion", "opd": "Increased base excretion", "subject_name": "Medicine", "topic_name": "Fluid & Electrolyte", "id": "506ba226-030b-49f3-b85f-04cd303a80cc", "choice_type": "single"}
+{"question": "Most common symptom of lung carcinoma", "exp": null, "cop": 1, "opa": "Cough", "opb": "Dyspnoea", "opc": "Weight loss", "opd": "Chest pain", "subject_name": "Medicine", "topic_name": null, "id": "aba1b310-3087-4e92-adf3-5e6adc5ed9b3", "choice_type": "single"}
+{"question": "The mortality rate in Acute hemorrhagic pancreatitis is", "exp": "(20%) (1896-H) (628-CMDT-09) (2011-H17th)* The term hemorrhagic pancreatitis is less meaningful in a clinical sense because variable amounts of interstitial hemorrhage can be found in pancreatitis as well as in other disorders such as pancreatic trauma, pancreatic carcinoma, and severe CHF (1896-H)* Prognosis (674-CMDT-05)Mortality rate for acute pancreatitis have declined from at least 10% to around 5% in the past 20 years, but the mortality rate of severe acute pancreatitis (more than three Ranson criteria) remains at least 20%, especially when hepatic cardiovascular or renal impairment is present in association with pancreatic necrosis.* Recurrence are common in alcoholic pancreatitis* Mortality rate for undrained pancreatic abscess approaches 100% (1900-H)", "cop": 1, "opa": "20%", "opb": "40%", "opc": "50%", "opd": "60%", "subject_name": "Medicine", "topic_name": "G.I.T.", "id": "74fec65f-0b0e-4d6a-a249-ef7910925e73", "choice_type": "single"}
+{"question": "Cerebral angiography was performed by", "exp": "Ans. is 'd' i.e., Egas Moniz", "cop": 4, "opa": "Sir Walter Dandy", "opb": "George Moore", "opc": "Seldinger", "opd": "Egas Moniz", "subject_name": "Medicine", "topic_name": null, "id": "be2f6d10-fca3-4dcd-bc90-78659afdc865", "choice_type": "single"}
+{"question": "Residul lung volume increased in", "exp": "(B) Emphysema# FACTORS AFFECTING FRC> FRC Increases with: Increased height Erect position (30% more than in supine) Decreased lung recoil (E.g. emphysema)> FRC Decreases with: Obesity, Muscle Paralysis (especially in supine) Restrictive lung disease (E.g. Fibrosis, Pregnancy) Anaesthesia FRC does not change with age> Emphysema is a condition of the lung characterized by abnormal permanent enlargement of the airspaces distal to the terminal bronchiole, accompanied by destruction of their walls and without obvious fibrosis.> Principal antielastase activity in serum and interstitial tissue is alpha 1 -AT (others are secretory leukoprotease inhibitor in bronchial mucus and serum alphal -macroglobulin), and the principal cellular elastase activity is derived from neutrophils (other elastases are formed by macrophages, mast cells, pancreas, and bacteria). Neutrophil elastase is capable of digesting human lung, and this digestion can be inhibited by alphal-antitrypsin.> The most plausible hypothesis to account for the destruction of alveolar walls is the protease-antiprotease mechanism. This hypothesis is based on two important observations, one clinical and one experimental. The first is that homozygous patients with a genetic deficiency of the protease inhibitor alphal -AT have a markedly enhanced tendency to develop pulmonary emphysema, which is compounded by smoking.# Emphysema is classified into distinct pathologic types:> The most important types being centriacinar and panacinar.# Centriacinar emphysema, the type most frequently associated with cigarette smoking, is characterized by enlarged airspaces found (initially) in association with respiratory bronchioles.> Centriacinar emphysema is most prominent in the upper lobes and superior segments of lower lobes and is often quite focal.# Panacinar emphysema refers to abnormally large airspaces evenly distributed within and across acinar units.> Panacinar emphysema is usually observed in patients with a1 AT deficiency.> Pulmonary function testing shows airflow obstruction with a reduction in FEV1 and FEV1/FVC With worsening disease severity, lung volumes may increase, resulting in an increase in total lung capacity, functional residual capacity, and residual volume.> In patients with emphysema, the diffusing capacity may be reduced, reflecting the parenchymal destruction characteristic of the disease.", "cop": 2, "opa": "Obesity", "opb": "Emphysema", "opc": "Bacterial pneumonia", "opd": "Idiopatic pulmonary fibrosis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "53863cc7-5dfe-4c90-be6a-b0cd962e04da", "choice_type": "single"}
+{"question": "Left Axis Detion is seen as", "exp": "Answer is B (Positive in Lead I and Negative in Lead II) Left axis detion is seen as positive deflexion in Lead I and a Negative deflection in Lead II. Calculating the cardiac axis: Normal Axis Right axis detion Left axis detion Lead I Positive Negative Positive Lead II Positive Positive or negative Negative Lead III Positive or negative Positive Negative Note: Lead I : POSITIVE BETWEEN -90 TO +90 (CLOCKWISE) Lead II : POSITIVE BETWEEN -30 TO +150 (CLOCKWISE) Lead III : POSITIVE BETWEEN +30 TO -150 (CLOCKWISE)", "cop": 2, "opa": "Positive in Lead I and Positive in Lead II", "opb": "Positive in Lead I and Negative in Lead II", "opc": "Negative in Lead I and Negative in Lead II", "opd": "Negative in Lead I and positive in Lead II", "subject_name": "Medicine", "topic_name": null, "id": "bfd58642-521c-40cb-a8e0-cb9616ffa458", "choice_type": "single"}
+{"question": "The following feature is in our of ulcerative colitis over Crohn&;s disease", "exp": "The major symptoms of UC are diarrhea, rectal bleeding, tenesmus, passage of mucus, and crampy abdominal pain.Ulcerative ColitisCrohn's diseaseClinical Gross blood in stoolYes OccasionallyMucusYesOccasionallySystemic symptomsOccasionallyFrequentlyPainOccasionallyFrequentlyAbdominal massRarelyYesSignificant perineal diseaseNoFrequentlyFistulasNoYesSmall intestinal obstructionNoFrequentlyColonic obstructionRarelyFrequentlyResponse to antibioticsNoYesRecurrence after surgeryNoYesEndoscopicRectal sparingRarelyFrequentlyContinuous diseaseYesOccasionally\"Cobblestoning\"NoYesGranuloma on biopsyOccasionallyRadiographicSmall bowel significantly abnormalNoYesAbnormal terminal ileumNoYesSegmental colitisNoYesAsymmetric colitisNoYesStrictureOccasionallyFrequentlyRef: Harrison 19e pg: 1956", "cop": 4, "opa": "Cobblestoning", "opb": "Rectal sparing", "opc": "Fistula", "opd": "Blood and mucus in stool", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "c0de975e-f543-45e7-8142-205b5289e534", "choice_type": "single"}
+{"question": "In a patient with bronchial asthma silent chest signifies", "exp": "Ans. is 'c' i.e., Grave Prognosis Silent chest (Little/no air movement without wheezes in Bronchial Asthma suggests a grave prognosis/impending respiratory failure (Life threatening Asthma). Signs of impending respiratory failure include : Drowsiness or confusion Diaphoresis Bradycardia Paradoxical thoraco abdominal Signs of impending respiratory failure in Asthma Drowsiness or confusion Diaphoresis Bradycardia Paradoxical thracoabdominal movements PEFR < 33% Hypotension Pulsus paradoxus Hypercapnea Silent chest", "cop": 3, "opa": "Good Prognosis", "opb": "Bad Prognosis", "opc": "Grave Prognosis", "opd": "Not a Prognostic sign", "subject_name": "Medicine", "topic_name": null, "id": "8cc24488-c86a-45b2-89b6-30908309e9a2", "choice_type": "single"}
+{"question": "Minimum concentration of reduced hemoglobin required for cyanosis is", "exp": "Cyanosis refers to a bluish discolouration of the skin and mucous membranes resulting from an increased quantity of reduced hemoglobin(I.e.,deoxygenated hemoglobin)or of hemoglobin derivatives(eg.,methemoglobin or sulfhemoglobin)in the small blood vessels of those tissues.Cyanosis becomes apparent when the concentration of reduced hemoglobin in capillary blood exceeds 5gm/dL. Ref:Harrison' s medicine-18th edition page no:288.", "cop": 3, "opa": "1gm/dl", "opb": "3gm/dl", "opc": "5gm/dl", "opd": "7gm/dl", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "ecd446d9-e3ee-4c0e-97c0-0c10cc3938cf", "choice_type": "single"}
+{"question": "The most common presentation of IgA nephropathy", "exp": "The two most common presentations of IgA nephropathy are - Recurrent episodes of macroscopic hematuria during or immediately following an upper respiratory infection often accompanied by proteinuria . Persistent asymptomatic microscopic hematuria. Nephrotic syndrome is uncommon . Ref:Harrison 20 th edition pg no 2140", "cop": 4, "opa": "Nephritic syndrome", "opb": "Nephrotic syndrome", "opc": "Microscopic hematuria", "opd": "Repeated gross hematuria", "subject_name": "Medicine", "topic_name": "Kidney", "id": "36eb7982-f620-48c8-9d37-8d7c9e513a96", "choice_type": "single"}
+{"question": "Single gene autosomal recessive disease is", "exp": "Single gene autosomal recessive disease is Wilson's disease.\nTuberous sclerosis, Huntington's disease are autosomal dominant disorder\nSchizophrenia is a multifactorial disease.", "cop": 1, "opa": "Wilson's disease", "opb": "Tuberous sclerosis", "opc": "Huntington's disease", "opd": "Schizophrenia", "subject_name": "Medicine", "topic_name": null, "id": "b91dadb5-ff18-49a9-893b-33765a5add59", "choice_type": "single"}
+{"question": "Most common cause of pleural effusion in HIV\" patients includes", "exp": "(D) Kaposi's sarcoma # AIDS> Pleural effusions are uncommon in such patients.> The most common cause is Kaposi's sarcoma, followed by parapneumonic effusion.> Other common causes are TB, cryptococcosis, and primary effusion lymphoma.> Pleural effusions are very uncommon with Pneumocystis carinii infection.", "cop": 4, "opa": "Mycobacterium tuberculosis infection", "opb": "P Carinii infection", "opc": "Lymphom", "opd": "Kaposi's sarcoma", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "3da33c57-17bc-4e9d-8136-1e8b0add4265", "choice_type": "single"}
+{"question": "Screening tests for B cell defects", "exp": "T cell markers are unidigits (Eg: CD3) B cell markers are double digits (Eg: CD20)", "cop": 1, "opa": "Isohemagglutinin titers", "opb": "CD 4 levels", "opc": "Nitroblue tetrazolium dye test", "opd": "Candida albicans intradermal skin test", "subject_name": "Medicine", "topic_name": "Immune system", "id": "fa2a619f-4864-4820-99f3-040d154a9836", "choice_type": "single"}
+{"question": "The clinical feature of normal pressure hydrocephalus is", "exp": "(D) Gait disturbance # Causes Of Dementia# Normal-pressure hydrocephalus (NPH) is a relatively uncommon syndrome consisting of an abnormal gait (ataxic or apractic), dementia (usually mild to moderate), and urinary incontinence.> Historically, many individuals who have been treated as having NPH have suffered from other dementias, particularly AD, multi- infarct dementia, and DLB.> Neuroimaging findings in NPH are those of a communicating hydrocephalus with a patent aqueduct of Sylvius.> In many cases periventricular edema is present.> Lumbar puncture findings include an opening pressure in the high-normal range and normal CSF protein, sugar concentrations, and cell count.> NPH is presumed to be caused by obstruction to normal flow of CSF over the cerebral convexity and delayed absorption into the venous system.> Indolent nature of the process results in enlarged lateral ventricles but relatively little increase in CSF pressure.> There is presumably stretching and distortion of white matter tracts in the corona radiata, but the exact physiologic cause of the clinical syndrome is unclear.", "cop": 4, "opa": "Aphasia", "opb": "Ophthalmoplegia", "opc": "Global confusion", "opd": "Gait disturbance", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "291daffe-2364-4f5e-8b3b-46d5faffd2b5", "choice_type": "single"}
+{"question": "Best predictor for coronary artery disease", "exp": "Elevated LDL cholesterol and decreased HDL cholesterol are independent predictors of coronary heart disease.\nAlthough there is consensus regarding the benefits of lowering LDL cholesterol the value of elevating HDL\ncholesterol remains controversial.\nLow HDL and coronary risk\nHigh serum HDL cholesterol is associated with a lower risk of CHD.\nThe incidence of CHD events in a normal population appears to be inversely related to serum HDL cholesterol with\nlow levels being associated with increased coronary risk.\nBased upon data from the Framingham Heart study, the risk for myocardial infarction increases by about 2 5% for\nevery 5mg/dl (.13 mmol/l) decrement in serum HDL cholesterol.\nElevated LDL and coronary risk\nElevation in LDL cholesterol is a well-known risk factor for the development of coronary artery disease.\nAssociation of elevated LDL with coronary artery disease has been established in various trials and studies.\nThere is linear reduction in cardiovascular disease with progressive lowering of the LDL cholesterol.\nTraditionally LDL levels are considered to be the most important factor in the prediction of coronary artery disease.\nThe importance of LDL as a risk factor lies in the fact that effective therapies are available to lower it, while it is not\nso in the case of HDL. So when treating dyslipidemia for reducing cardiovascular events, the first target is LDL and\nnot HDL.\nDoubt and Controversy\nWhat is creating doubts in our mind is a table from Braunwald 8th/e p1008 according to which ‘Low HDL’ appears to\nbe better marker for prediction of future cardiovascular disease than ‘High LDL’\nAccording to this bar diagram in Braunnwald 8th/e pl008 - the adjusted hazard ratio for future cardiovascular events\nfor LDL is 1.62 while that of HDL is 2.32. But the text given in the book does clarify which one is better marker, (we\nhave given this table from Braunwald in our previous discussion on this topic in Nov 2009 Medicine).\nWe have tried to confirm this ‘Low HDL’ fact from various other books. But none of the texts clearly favored any one\nbetween these 2 to be the better marker. Both LDL and HDL are mentioned to be important.\nWe have also consulted several cardiologist on this. All of them say that the answer should be LDL.\nWell, Braunwald is text book of immense reputation, and any information or text given in the book does not need\nconfirmation from any other source. But what has added to the confusion is that the latest edition of Braunwald i.e.,\n9th/e has eliminated that diagram from the book and in the text have not clarified which one is better marker.\nInstead, the text states that Apolipo (a) and B 100 are better marker for predicting future cardiovascular events than\nLDL and HDL.\nWe are not absolutely sure of the answer, but we would for the time being go with LDL.\nAlso Know\nThe following lipid and lipoprotein abnormalities are associated with increased coronary risk.\nElevated total cholesterol\nElevated LDL cholesterol\nLow HDL cholesterol\nIncreased total to HDL cholesterol ratio\nIncreased non HDL cholesterol\nHypertriglyceridemia\nIncreased Lp(a)\nIncreased apolipoprotein B\nSmall dense LDL particles", "cop": 2, "opa": "HDL", "opb": "LDL", "opc": "VLDL", "opd": "Chylomicron", "subject_name": "Medicine", "topic_name": null, "id": "d52b8d56-1ff3-451c-952e-43f34da59143", "choice_type": "single"}
+{"question": "Most common cause of Thrombotic Pulmonary Embolism is", "exp": "(B) Deep vein thrombosis# DEEP VENOUS THROMBOSIS in the leg or in the pelvis is most likely the cause of pulmonary embolism, but in about 80-90%, it occurs without any previous clinical manifestations.> Pulmonary embolism: Following dislodgement of venous thrombi generally from femoral and iliac veins.> Causes: Multiple trauma, tumor embolus, amniotic fluid.> Sign and symptoms: Pleurisy, haemoptysis, crackles, shortness of breath.> Sign and symptoms of right heat failure and raised CVP> Diagnosis: Ventilation perfusion scan (confirm the diagnosis). Contrast enhanced CT scan (most accurate technique).> Treatment: Thrombolytic agents (streptokinase, TP factors).> Pulmonary embolectomy (may be required).> Lung transplantations indicated in: End stage parenchymal or pulmonary vascular disease> Cystic fibrosis and irreversible pulmonary hypertension with right ventricular failure.", "cop": 2, "opa": "progesterone pills", "opb": "Deep vein thrombosis", "opc": "Septicemia", "opd": "Idiopathic", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "ee153c9a-c04b-45fc-8170-0680d47fc751", "choice_type": "single"}
+{"question": "An adult patient weighting 70 kg has fasting blood sugar 180 mg/dl. He is having", "exp": null, "cop": 3, "opa": "Ketoacidosis", "opb": "Hypoglycemia", "opc": "Hyperglycemia", "opd": "Thyroidism", "subject_name": "Medicine", "topic_name": null, "id": "c9a750f1-0c5c-401b-a098-4490282ab61c", "choice_type": "single"}
+{"question": "Chronic Renal Diseases / failure is commonly associated with", "exp": "Answer is A (Metabolic Acidosis): Chronic Renal Disease/Failure is commonly associated with metabolic acidosis. 'Metabolic acidosis is a common disturbance in advanced chronic Renal Disease '-", "cop": 1, "opa": "Metabolic Acidosis", "opb": "Metabolic Alkalosis", "opc": "Respiratory Acidosis", "opd": "Respiratory Acidosis", "subject_name": "Medicine", "topic_name": null, "id": "b56d3d04-2f22-4125-93a8-26c7f7115636", "choice_type": "single"}
+{"question": "Hyperphosphatemia is seen in", "exp": "Hyperphosphatemia in chronic kidney disease (CKD) patients is a potentially life altering condition that can lead to cardiovascular calcification, metabolic bone disease (renal osteodystrophy) and the development of secondary hyperparathyroidism (SHPT). Ref Davidson 23rd edition pg 344", "cop": 1, "opa": "CRF", "opb": "Rickets", "opc": "Prolonged phosphate intake", "opd": "Osteitis fibrosa cystica", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "92c30082-f870-4eb5-82b0-74b38376343f", "choice_type": "single"}
+{"question": "Blink reflex is used for", "exp": "Ans. a. Mid pontine lesions The Blink Reflex Test (B) is a neurophysiological examination used for evaluation of brainstem reflex circuits.: In veebrate anatomy the brainstem (or brain stem) is the posterior pa of the brain, adjoining and structurally continuous with the spinal cord. It is usually described as including the medulla oblongata (myelencephalon), pons (pa of metencephalon), and midbrain (mesencephalon). Pons: The pons contains nuclei that relay signals from the forebrain to the cerebellum, along with nuclei that deal primarily with sleep, respiration, swallowing, bladder control, hearing, equilibrium, taste, eye movement, facial expressions, facial sensation, and posture A number of cranial nerve nuclei are present in the pons Mid-pons: the 'chief' or `pontine' nucleus of the trigeminal nerve sensory nucleus (V) Mid-pons: the motor nucleus for the trigeminal nerve (V) Lower down in the pons: abducens nucleus (VI) Lower down in the pons: facial nerve nucleus (VII) Lower down in the pons: vestibulocochlear nuclei (vestibular nuclei and cochlear nuclei) (VIII) The corneal eye blink reflex neural circuit consists of Trigeminal 1deg afferent (free nerve endings in the cornea, trigeminal nerve, ganglion, root, and spinal trigeminal tract), which end on --> Trigeminal 2deg afferent in the spinal trigeminal nucleus, some of which send their axons to --> Reticular formation interneurons, which send their axons bilaterally to --> Facial motor neurons in the facial nucleus, which send their axons in the facial nerve to --* Orbicularis oculi, which functions to lower the eyelid", "cop": 1, "opa": "Mid pontine lesions", "opb": "Neuromuscular transmission", "opc": "Axonal neuropathy", "opd": "Motor neuron disease", "subject_name": "Medicine", "topic_name": null, "id": "0a677770-1e1b-4046-a0fe-48156ee7fb24", "choice_type": "single"}
+{"question": "Quincke's sign in aortic regurgitation refers to", "exp": "Sign\n Presentation\n\n\n\n\nBecker's sign\nProminent retinal artery pulsation\n\n\nCorrigan's sign\nProminent carotid pulsation\n\n\nDe Musset's sign\nHead nodding in time with the heart beat\n\n\nDuroziez's sign\nSystolic and diastolic murmurs heard over the femoral artery while partially compressing the vessel with the diaphragm of the stethoscope\n\n\nGerhardt's sign\nPulsation of the spleen in time with the heart beat\n\n\nHill's sign\nHigher blood pressure (>20mmHg) in the legs than in the arms.\n\n\nLandolfi's sign\nRhythmic pupillary pulsation in time with the heart beat.\n\n\nLincoln sign\nExcessive pulsation in the popliteal artery.\n\n\nMayne's sign\nA fall in diastolic blood pressure (> 15mm Hg ) on raising the arm above the head\n\n\nMuller's sign\nPulsation of the uvula in time with the heart beat\n\n\nQuincke's sign\nProminent capillary nail bed pulsation\n\n\nRosenbach's sign\nPulsation of the liver in time with the heart beat\n\n\nTraube's sign\nA double sound heard over the femoral artery while compressing it distally\n\n\nAshrafian sign \nPulsatile pseudo proptosis.\n\n\nSherman's sign\nAn easily palpable dorsalis pedis pulse in a patient over the age of 75 years.", "cop": 3, "opa": "Pulsation of uvula in time with heart beat", "opb": "Prominent retinal artery pulsation", "opc": "Capillary nail bed pulsation", "opd": "Pulsating liver in time with heart beat", "subject_name": "Medicine", "topic_name": null, "id": "e9fc4995-12b0-45e8-8341-0142c4f82b42", "choice_type": "single"}
+{"question": "Bipolar II disorder characterized by", "exp": "(B) Hypomania and severe depression # SUBTYPES OF BIPOLAR DISORDER1. Bipolar I: Characterized by episodes of severe mania and severe depression.2. Bipolar II: Characterized by episodes of hypomania (not requiring hospitalization) and severe depression.", "cop": 2, "opa": "Severe mania and severe depression", "opb": "Hypomania and severe depression", "opc": "Only hypomania", "opd": "Only severe depression", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f720443f-b744-4ed8-a457-a0a4e982cd41", "choice_type": "single"}
+{"question": "10% Tumour is", "exp": "Pheochromocytomas normally obey the “rule of 10”. Hence, they are also called the “10% tumor”. i.e. 10% of pheochromocytomas are: \n\nFamilial. \nMalignant. \nBilateral. \nExtra-adrenal. \nSeen in children", "cop": 1, "opa": "Pheochromocytoma", "opb": "Papillary Thyroid Carcinoma", "opc": "Follicular Thyroid Carcinoma", "opd": "Brown’s Tumor", "subject_name": "Medicine", "topic_name": null, "id": "a9544407-6266-41ec-b79f-b02c56e92565", "choice_type": "single"}
+{"question": "Most common cause of chronic kidney disease", "exp": "Most common cause - Diabetes mellitus", "cop": 1, "opa": "Diabetes mellitus", "opb": "Hypertension", "opc": "PCKD", "opd": "Hepatorenal Syndrome", "subject_name": "Medicine", "topic_name": null, "id": "764da52a-c7ab-4311-baab-3c99bd006a71", "choice_type": "single"}
+{"question": "Brugada syndrome is associated with", "exp": "Mutations involving car- diac sodium channels are identified in approximately 25% of cases. Distinction from patients with similar ST elevation owing to LV hyperophy, pericarditis, myocardial ischemia or MI hyperkalemia, hypothermia, right bundle branch block, and ARVC is often difficult Ref Harrison 20th edition pg 1423", "cop": 4, "opa": "Left Bundle Branch Block", "opb": "Left Anterior Fascicular block", "opc": "Left posterior Fascicular block", "opd": "Right bundle Branch block", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "3da64cd1-e10a-4456-b35b-6cbb11df5754", "choice_type": "single"}
+{"question": "Emporiatrics deals with the health of the", "exp": null, "cop": 2, "opa": "Farmers", "opb": "Travellers", "opc": "Industrial workers", "opd": "Mine workers", "subject_name": "Medicine", "topic_name": null, "id": "d7348dd0-1247-485c-b362-d8464aed385a", "choice_type": "single"}
+{"question": "SA node is supplied by", "exp": "Ans. a (Right coronary artery). (Ref. Harrison's Medicine, 18th ed/Chapter 230.)SA NODE# SA node lies at the junction of right atrium and SVC.# It measures 15 mm x 2-3 mm in size.# It is supplied by sinus node artery, which arises from right coronary (60%) or left circumflex coronary artery (40%).AV node# AV node lies at the bases of inter-atrial septum just above the tricuspid annulus and anterior to coronary sinus.# It is supplied by posterior descending coronary artery (90%).Bundle of His# Has dual blood supply (*AV nodal artery + branches of anterior descending coronary artery).", "cop": 1, "opa": "Right coronary artery", "opb": "LAD", "opc": "LCX", "opd": "RAD", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "f2fd4ebb-ddd8-49d1-9d32-e174844534f8", "choice_type": "single"}
+{"question": "A ventricular aneurysm has one of the following characteristic features", "exp": "left ventricular aneurysm can be diagnosed on ECG when there is persistent ST segment elevation occurring 6 weeks after a known transmural myocardial infarction (usually an anterior MI). Without knowing the past medical history, the ECG changes of an aneurysm may mimic an acute anterior MI. Ref Davidson 23rd edition pg 465", "cop": 1, "opa": "Persistent ST elevation", "opb": "Persistent ST depression", "opc": "Left bundle branch block", "opd": "Right bundle branch block", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "fd38c0e5-cf9a-4f5d-92f3-d914156e39c9", "choice_type": "single"}
+{"question": "A patient with burns presents to the emergency room. He was started on intravenous fluids. The best method to assess the adequacy of volume replacement is", "exp": "Answer: b) Urine output (Merck manual & Handbook of Evidence based critical care)Treatment of shock is directed at maintainingCVP of 8-12 mm HgMean arterial pressure of >65 mmHg (systolic pressure >90 mmHg)Cardiac index of 2-4 L/min/m2The urine output rate should be kept at >0.5 mL/kg per hourAdequate end-organ perfusion is best indicated by urine output of > 0.5 to 1 mL/kg/hHeart rate, mental status, and capillary refill may be affected by the underlying disease process and are less reliable markers.Because of compensatory vasoconstriction, mean arterial pressure (MAP) is only a rough guideline; organ hypoperfusion may be present despite apparently normal values.An elevated arterial blood lactate level reflects hypoperfusion; however, levels do not decline for several hours after successful resuscitation.HEMODYNAMIC SUPPORT IN SHOCKNS or RL (crystalloids) is the first choice for acute stage of resuscitationWhen fluid requirements are high, colloids (Dextran, gelatin, 5% albumin) are of usePacked RBC should be given at 10 mL/kg to maintain hematocrit at 30% or Hb 9 g/dLBolus of 20ml/Kg given rapidly over 5-10 mins; if no response - repeat bolusPatients who do not respond to rapid boluses of 40-60ml/Kg in the first hour are labeled as fluid refractory shock and inotrophic support (dopamine or dobutamine) should be givenUse insulin only if it is needed to maintain the blood glucose concentration below 150 mg/dLFirst line Vasopressor inAnaphylactic shock: EpinephrineSeptic shock, Cardiogenic shock, Vasodilatory shock: NorepinephrineRefractory shock: EpinephrineIf shock persists - catecholamine resistant shock - give Hydrocortisone if adrenal insufficiency is suspectedACTH stimulation test is not useful for detecting less profound degrees of corticosteroid deficiency in patients who are critically illVasodilators (nitroprusside, nitroglycerine) in children remaining hypodynamic with high SVR despite fluid and ionotropic supportChildren remaining normotensive with low output state and high SVR despite epinephrine and vasodilator - phosphodiesterase III inhibitors (Amrinone, Milrinone) are givenRecombinant activated protein C (aPC) - for severe sepsis or septic shock", "cop": 2, "opa": "Pulse rate", "opb": "Urine output", "opc": "Systolic blood pressure", "opd": "Central venous pressure", "subject_name": "Medicine", "topic_name": "Fluid & Electrolyte", "id": "42a4f5ab-3ad0-475b-9ca3-fda67c66d3c4", "choice_type": "single"}
+{"question": "Most common site of peptic ulcer is", "exp": "The term 'peptic ulcer' refers to an ulcer in the lower oesophagus, stomach or duodenum, in the jejunum after surgical anastomosis to the stomach or, rarely, in the ileum adjacent to a Meckel's diveiculum. Ulcers in the stomach or duodenum may be acute or chronic; both penetrate the muscularis mucosae but the acute ulcer shows no evidence of fibrosis. Erosions do not penetrate the muscularis mucosae The prevalence of peptic ulcer (0.1-0.2%) is decreasing in many Western communities as a result of widespread use of Helicobacter pylori eradication therapy but it remains high in developing countries. The male-to-female ratio for duodenal ulcer varies from 5:1 to 2:1, while that for gastric ulcer is 2:1 or less. Chronic gastric ulcer is usually single; 90% are situated on the lesser curve within the antrum or at the junction between body and antral mucosa. Chronic duodenal ulcer usually occurs in the first pa of the duodenum and 50% are on the anterior wall. Gastric and duodenal ulcers coexist in 10% of patients and more than one peptic ulcer is found in 10-15% of patients. Ref Davidson edition23rd 798", "cop": 1, "opa": "1st pa of duodenum", "opb": "2nd pa of duodenum", "opc": "Antrum", "opd": "Terminal ileum", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "fa40e170-133c-440d-b4cd-9af4294118eb", "choice_type": "single"}
+{"question": "Xerophthalmia is a public health problem if prevalence of bitot spots is", "exp": "Night blindness : > 1%.\nBitot spots : >0.5%.\nCorneal ulcer : >0.05%.\nCorneal xerosis : >0.01%.", "cop": 2, "opa": "> 1%", "opb": ">0.5%", "opc": "> 0.01%", "opd": "> 0.05%", "subject_name": "Medicine", "topic_name": null, "id": "a96fcd83-9da5-4605-96a3-b3bbd6505e8c", "choice_type": "single"}
+{"question": "Most common Cause of fracture in hemophilic ahropathy", "exp": "Hemophilic ahropathy is a disabling condition characterized by joint impairment, chronic pain, and reduced quality of life . Recent evidence indicates that intra-aicular inflammation and angiogenesis may be pivotal processes in the pathogenic cascade of hemophilic ahropathy . Joint bleeding ors iron release from hemoglobin, thus inducing a chronic inflammatory process mediated by cytokines and pro-angiogenic factors and consequently leading to progressive synol pannus growth and aicular cailage damage . Spontaneous joint bleeding and repeated hemahroses lead to hemophilic ahropathy--a debilitating disease with a significant negative impact on mobility and quality of life. Iron, cytokines, and angiogenic growth factors play a pivotal role in the onset of the inflammatory process that involves the synol tissue, aicular cailage, and subchondral bone, with early damages and molecular changes determining the perpetuation of a chronic inflammatory condition. Synovitis is one of the earliest complications of hemahrosis, and is characterized by synol hyperophy, migration of inflammatory cells, and a high degree of neo-angiogenesis with subsequent bleeding. Ref - pubmed.com Risperidone is not as effective as clozapine in treatment resistant cases but does not carry a risk of blood dyscrasias.> Olanzapine is similar neurochemically to clozapine but has a significant risk of inducing weight gain.> Quetiapine is distinct in having a weak D2 effect but potent a1 and histamine blockade.> Ziprasidone causes minimal weight gain and is unlikely to increase prolactin, but may increase QT prolongation.> Aripiprazole also has little risk of weight gain or prolactin increase but may increase anxiety, nausea, and insomnia as a result of its partial agonist properties.ANTIPSYCHOTIC AGENTSNameUsualPOSide Effects Daily Dose, mgSedationCommentsClozapine(Clozaril)2 0 0 - 600Agranulocytosis (1%); weight gain; seizures; drooling; hyperthermia+ +Requires weekly WBCRisperidone (Risperdal) observed with doses >6 mg qd2-6Orthostasis+Requires slow titration; EPSEsOlanzapine(Zyprexa)10-20Weight gain+ +Mild prolactin elevationQuetiapine(Seroquel)3 5 0 - 700Sedation; weight gain; anxiety+ + +Bid dosingZiprasidone(Geodon)40-60Orthostatic hypotension+/+ +Minimal weight gain; increases QT intervalAripiprazole (Ability)10-30Nausea, anxiety, insomnia0/+Mixed agonist /antagonist", "cop": 2, "opa": "Quetiapine", "opb": "Ziprasidone", "opc": "Olanzapine", "opd": "Risperidone", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "d811341d-3a9c-42e4-91a0-b40a89a3b3d2", "choice_type": "single"}
+{"question": "Helicobacter pylori is not associated with", "exp": null, "cop": 3, "opa": "Gastrointestinal lymphoma", "opb": "Gastric cancer", "opc": "Gastric leiomyoma", "opd": "Peptic ulcer", "subject_name": "Medicine", "topic_name": null, "id": "c158fb5c-1d1f-44ff-9046-506a96900c17", "choice_type": "single"}
+{"question": "Intravenous fluid of choice in management of diabetic ketoacidosis", "exp": "Answer-A. Normal salineTreatment of DKA1. InsulinA bolus of IV IM sho acting insulin (regular insulin) should be given immediately to reduce blood glucose level'Subsequent treatment should piovide continuous and adequate level ofcirculating insulin'2. IV fluidDue to vomiting, osmotic diuresis and hyperventilation, there is dehydration and Na. deficit in DKA which should be treated by iv saline infusion.Normal saline (0.9% saline) k the fluid of choice3. KCI4. Sodium bicarbonate5. Magnesium and phosphate", "cop": 1, "opa": "Normal saline", "opb": "Colloids", "opc": "5% dextrose", "opd": "Dextran - 70", "subject_name": "Medicine", "topic_name": null, "id": "04603b57-2bbf-45b0-890d-d10ee00f6991", "choice_type": "single"}
+{"question": "Suramin is the drug of choice for", "exp": null, "cop": 3, "opa": "Brill Zeinsser disease", "opb": "Rocky mountain spotted fever", "opc": "African trypanosomiasis", "opd": "Q fever", "subject_name": "Medicine", "topic_name": null, "id": "f69e299a-612f-4f07-87eb-08617547a5e2", "choice_type": "single"}
+{"question": "Investigation of choice in bronchiectasis is", "exp": "HRCT chest is more specific for bronchiectasis and is the imaging modality of choice for confirming the diagnosis.CT findings include airway dilation(detected as parallel \"tram tracks\" or as the \"signet-ring sign\"-a cross sectional area of the airway with a diameter at least 1.5 times that of the adjacent vessel),lack of bronchial tapering(including the presence of tubular structures within 1 cm from the pleural surface.),bronchial wall thickening in dilated airways,inspissated secretions (eg.,the \" tree-in-bud\" pattern ),or cysts emanating from the bronchial wall(especially pronounced in cystic bronchiectasis.) Reference:Harrison's medicine-18th edition,page no:2143.", "cop": 3, "opa": "Bronchoscopy", "opb": "MRI thorax", "opc": "HRCT lung", "opd": "Chest X-ray", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "d84bbbff-2835-4d0a-bd1f-2b8ee74e126c", "choice_type": "single"}
+{"question": "The most common cause of malignant adrenal mass is", "exp": "Ans. is 'd' i.e., Metastasis from another solid tissue tumor The most common cause of adrenal tumors is metastasis from another solid tumor like breast cancer and lung cancer. Malignant Percentage Adrenocoical carcinoma 2-5% Malignant pheochromocytoma Mechanism of action: Pyrazinamide is similar to isoniazid in its narrow spectrum of antibacterial activity, which essentially includes only M.tuberculosis. The drug is bactericidal to slowly metabolizing organisms located within the acidic environment of the phagocyte or caseous granuloma; it is active only at a pH of <6.0. Pyrazinamide is considered a prodrug and is converted by the tubercle bacillus to the active form pyrazinoic acid. The target for this compound is thought to be a fatty acid synthase gene. Susceptible strains of M. tuberculosis are inhibited by 20p g/mL.", "cop": 3, "opa": "Interfering folic acid biosynthesis of mycobacteria", "opb": "Bacteriostatic activity on growing organisms", "opc": "Tuberculous bacilli in macrophages", "opd": "Tuberculous bacilli in blood stream", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "7920f24a-edbd-4558-b0f9-18b065dbd78c", "choice_type": "single"}
+{"question": "Type II Respiratory failure is characterised by (Davidson)", "exp": "(Low PaO2/High PaCO2) (1684 -H17th)Respiratory failure - PaO2 <8.0 kPa (60mmHg) and PaCO2 > 6.5 kPa (50 mmHg)Type 1 - PaO2 low, PaCO2 normal or lowType II - PaCO2 raised, PaO2 low - Ventilatory failure* Most important - cause in chronic type II respiratory failure is - chronic bronchitis", "cop": 3, "opa": "Low PaO2 /Low PaCO2", "opb": "Normal PaCO2 / Low PaO2", "opc": "Low PaO2 /High PaCO2", "opd": "High PaO2 / Low PaCO2", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "b83bf1a4-62c4-4558-a167-05b2fdcdb506", "choice_type": "single"}
+{"question": "Most important drug used in the treatment of coronary artery disease is", "exp": null, "cop": 1, "opa": "Aspirin", "opb": "Digoxin", "opc": "Streptokinase", "opd": "Nifedipine", "subject_name": "Medicine", "topic_name": null, "id": "6ecfa5fb-9783-4c46-9c22-4d4767d72444", "choice_type": "single"}
+{"question": "Best treatment for exercise induced asthma is", "exp": "The stepwise approach to the management of asthma Step 1: Occasional use of inhaled sho-acting b2-adrenoreceptor agonist bronchodilators A variety of different inhaled devices are available and the choice of device should be guided by patient preference and competence its use. The metered-dose inhaler remains the most widely prescribed . For patients with mild intermittent asthma (symptoms less than once a week for 3 months and fewer than two nocturnal episodes per month), it is usually sufficient to prescribe an inhaled sho-acting b2-agonist, such as salbutamol or terbutaline, to be used as required. However, many patients (and their physicians) under-estimate the severity of asthma. A history of a severe exacerbation should lead to a step-up in treatment. (BUD), fluticasone, mometasone or ciclesonide) should be staed in addition to inhaled b2-agonists taken on an as-required basis for any patient who: * has experienced an exacerbation of asthma in the last 2 years * uses inhaled b2-agonists three times a week or more * repos symptoms three times a week or more * is awakened by asthma one night per week. For adults, a reasonable staing dose is 400 ug beclometasone dipropionate (BDP) or equivalent per day in adults, although higher doses may be required in smokers. Alternative but much less effective preventive agents include chromones, leukotriene receptor antagonists and theophyllines. The preferred asthma medications are sho-acting beta-2 agonists such asalbuterol. Taken 10 minutes before exercise, thesemedicationscan prevent the airways from contracting and help control exercise-induced asthma. Having good control of asthma in general will also help prevent exercise-induced symptoms Ref Davidson edition23rd pg 571", "cop": 2, "opa": "Montelukast", "opb": "Salbutamol", "opc": "Ipratopium", "opd": "Low dose inhaled steroids", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "4db7b2d5-17be-45fa-aef1-1af0f612682b", "choice_type": "single"}
+{"question": "The treatment of metastatic testicular carcinoma is", "exp": "Standard chemotherapy for Germ Cell tumour is BEP regimen B- Bleomycin (30units) Day 2, 9, 16 E- Etoposide (100mg/m2) Day 15 P- Cisplatin (20mg/m2) Day 15 ref - Harrisons internal medicine 20e pg635-36,633", "cop": 1, "opa": "Bleomycin, Etoposide, Cisplatin", "opb": "Vinblastine, Etoposide, Cisplatin", "opc": "Doxorubicin, 5FU, Mercaptopurine", "opd": "Methotrexate, 5FU, Vincristine", "subject_name": "Medicine", "topic_name": "Oncology", "id": "a99845e0-55d1-4e52-a5b1-22d3a9c88bfe", "choice_type": "single"}
+{"question": "A patient presented with thunder clap headache followed by unconsciousness with pregressive 111 ranial nerve palsy. Likely diagnosis is", "exp": "davidson's principles and practices of medicine 22nd edition. *85% of SAH are caused by saccular or berry aneurysm arise from bifurcation of cerebral aeries *SAH typically presented with a sudden ,severe ,thunderclap headache (often occipital) , which lasts for hours or even days,often accompanied by vomitting , raised blood pressure and neck stiffness or pain. *there may be loos of consciousness at the onset ,so SAHshould be consider if patient is comatose *focal neurological signs like hemiparesis,aphasia may be present at onset if there is an associated intracerebral hematoma *a third nerve palsy present due to local pressure from an aneurysm of posterior communicating aery. Ref Harrison20th edition pg 2456", "cop": 2, "opa": "Extradural hemorrhage", "opb": "Aneurysmal subarachnoid hemorrhage", "opc": "Basilar migraine", "opd": "Cluster headache", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "9aa62d85-d394-4cfc-b208-085c93ef7720", "choice_type": "single"}
+{"question": "A patient presented with high frequency SNHL, Ipsilateral cerebellar ataxia. The site of lesion is", "exp": "(B) Cerebellopontine # Cerebellar limb ataxia results from disorders of the spinocerebellar and corticopontocerebellar inputs, the integrator of these inputs in the intermediate and lateral cerebellum, or the output to the spinal neurons (via the red nucleus and rubrospinal tract) or to the cortex. These pathways ensure adequate speed, fluency, and integration of limb movements. The lateral cerebellar hemisphe es coordinate a polysynaptic feedback circuit that modulates cortically initiated limb movement.", "cop": 2, "opa": "Pons", "opb": "Cerebellopontine", "opc": "Medullary", "opd": "Thalamus", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "923fb131-51f8-4d75-a3f9-0332cda729da", "choice_type": "single"}
+{"question": "The minimum dose of radiation to produce cerebral symptoms", "exp": "(5000 rads) (2588-H 15th)OrganInjuryMinimum tolerance doseMaximum tolerance doseWhole or partial organ(Field size or length)Bone marrowAplasia250450Whole Pancytopenia300004000SegmentalLiverAcute hepatitis25004000*Whole Chronic hepatitis15002000Whole (Strip)StomachPerforation, ulcer, hemorrhage45005500100 cmIntestineUlcer, perforation45005500400 cm Haemorrhage50006500100 cmBrainInfarction necrosis5000*6000WholeSpinal cordInfarction necrosis4500550010 cmHeartPericarditis,4500550060% Pan carditis7000800025%LungAcute and chronic pneumonitis30003500100 cm 15002500WholeKidneyAcute and chronic nephrosclerosis15002000Whole (strip) 20002500WholeFetusDeath200400Whole", "cop": 4, "opa": "500 rads", "opb": "100 rads", "opc": "1000 rads", "opd": "5000 rads", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "436d15fc-17d2-4139-a06e-9a4ee048b8fd", "choice_type": "single"}
+{"question": "SARS causative agent", "exp": "Ans. a. Corona-virus SARS-associated coronavirus (SARS-CoV) caused epidemics of pneumonia from November 2002 to July 2003. Corona Virus SARS virus is corona virus. Corona virus infections in human beings usually remain limited to upper respiratory tract. In contrast, the outbreak of SARS in 2003 was characterized by serious respiratory illness, including pneumonia and progressive respiratory failure. In all likelihood, the SARS virus originated in a non-human host and acquired the ability to infect humans. Chinese horse-shoe bats are natural reservoirs of SARS-like Coronavirus. Incubation period of SARS Coronavirus: 6 days Death from progressive respiratory failure occurs in almost 10% of cases, with highest death rates among elderly.", "cop": 1, "opa": "Corona-virus", "opb": "Picorna-virus", "opc": "Myxovirus", "opd": "Retrovirus", "subject_name": "Medicine", "topic_name": null, "id": "20fc8d82-b9ab-47c2-bc1c-e636008f3666", "choice_type": "single"}
+{"question": "Bilateral facial palsy is not seen in", "exp": "(B) Ramsay Hunt syndrome # Bilateral facial palsy occurs in Gullian Barre syndrome, in a form of sarcoidosis called uveoparotid fever (Heerfordt syndrome) and in bilateral acoustic neuroma.> Facial Neuropathy> An isolated facial palsy may occur in patients with HIV seropositivity, sarcoidosis, or Lyme disease , but most often it is idiopathic (Bell's palsy)> In the Ramsay Hunt syndrome, pain and vesicles appear in the external auditory canal, and patients lose their sense of taste in the anterior two-thirds of the tongue while developing ipsilateral facial palsy. The geniculate ganglion of the sensory branch of the facial nerve is involved.", "cop": 2, "opa": "Sarcoidosis", "opb": "Ramsay Hunt syndrome", "opc": "Gullian Barre syndrome", "opd": "Melkersen Rosenthal syndrome", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "7ac08dd7-7694-4f53-b4fe-796afc04ad4e", "choice_type": "single"}
+{"question": "Hyperpigmentation is seen with", "exp": "Ref image - Davidson's medicine 23e p672", "cop": 3, "opa": "FSH", "opb": "LH", "opc": "ACTH", "opd": "TSH", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "5a16b15f-88c7-44fb-a201-89158b3a2e16", "choice_type": "single"}
+{"question": "A male patient presents with headache, profuse sweating and palpitations with a blood pressure of 180/120 mm Hg. The drug of choice would be", "exp": "Answer is B (Labetalol) Symptomatic Hypeension with diastolic pressure of 120 suggest a diagnosis of Hypeensive Emergency. Labetalol (intravenous) is the drug of choice for management of Hypeensive Emergencies (amongst the options provided).", "cop": 2, "opa": "Nifedipine", "opb": "Labetalol", "opc": "Prazocin", "opd": "Phenoxy benzamine", "subject_name": "Medicine", "topic_name": null, "id": "9510ad68-e1ee-4c2f-84aa-6312df8da029", "choice_type": "single"}
+{"question": "In lobar pneumonia, the presence of fibrinosuppurative exudate with disintegration of red cells is seen in the stage of", "exp": null, "cop": 3, "opa": "congestion", "opb": "red hepatization", "opc": "grey hepatization", "opd": "resolution", "subject_name": "Medicine", "topic_name": null, "id": "ea7e9266-2ec0-4cf0-be34-910969b271a2", "choice_type": "single"}
+{"question": "Beryllium expsore is associated with", "exp": "Beryllium can produce a chronic granulomatous inflammatory disease that is similar to sarcoidosis.It is distinguished from sarcoidosis by evidence of a specific cell-mediated immune response(delayed hypersensitivity) to beryllium.Chest imaging shows nodules along septal lines.Pulmonary function tests show restrictive and /or obstructive ventilatory defects and decreased diffusing capacity. Ref:Harrison's medicine-18th edition,page no:2125.", "cop": 2, "opa": "Pulmonary fibrosis", "opb": "Granulomatous lung disease", "opc": "Lung cancer", "opd": "Mesothelioma", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "9532816c-35d1-485a-8411-1cffb05261e5", "choice_type": "single"}
+{"question": "Features of neurogenic shock are", "exp": null, "cop": 3, "opa": "↑Peripheral resistance ↓ cardiac output", "opb": "↑ Venous return ↑ cardiac output", "opc": "↓Peripheral resistence↓cardiac output", "opd": "Venoconstriction ↓cardiac output", "subject_name": "Medicine", "topic_name": null, "id": "36d1d9e0-62d6-4065-832c-1fedd97d046c", "choice_type": "single"}
+{"question": "Treatment of uncomplicated hydatid cyst in lung is", "exp": null, "cop": 3, "opa": "Marsupialisation", "opb": "Lobectomy", "opc": "Enucleation", "opd": "Extended tube drainage", "subject_name": "Medicine", "topic_name": null, "id": "10032aec-2ba9-400c-8e46-9dae4ffab516", "choice_type": "single"}
+{"question": "Deficiency of Arylsulphatase is seen in", "exp": "(B) Metachromatic leukodystrophy (MLD) # Metachromatic leukodystrophy (MLD) is a lysosomal storage diseases, which are progressive, inherited, and neurodegenerative disorders (MLD included).> 4 types of MLD occur with varying ages of onset and courses (i.e., 1. Late infantile, 2. Early juvenile, 3. Late juvenile, 4. Adu t).> All forms of MLD involve a progressive deterioration of motor & neurocognitive function.> The typing is somewhat arbitrary, as the types overlap, and some cases do not fall neatly within a single type. MLD actuall / describes a continuum of clinical severity. The presence of white matter abnormalities on brain images is characteristic.> Pathophysiology: In patients, the inability to degrade sulfated glycolipids, especially the galactosyl-3-sulfate ceramides, characterizes MLD. A deficiency in the lysosomal enzyme sulfatide sulfatase (arylsulfatase A) is present in MLD.", "cop": 2, "opa": "Gaucher's disease", "opb": "Metachromatic Leuko Dystrophy (MLD)", "opc": "Tay-Sachs's diseas", "opd": "Niemann-Pick disease", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "a0a13d4c-4bc8-42dd-bffd-09c2ed05f38f", "choice_type": "single"}
+{"question": "Broca's aphasia is", "exp": "Ans. is 'b' i.e., Non fluent aphasia", "cop": 2, "opa": "Fluent aphasia", "opb": "Non fluent aphasia", "opc": "Sensory aphasia", "opd": "Conduction aphasia", "subject_name": "Medicine", "topic_name": null, "id": "e57bb02a-165e-4b1e-8f73-fe776c3b7067", "choice_type": "single"}
+{"question": "Nephrocalcinosis is seen in", "exp": "Answer is A (Medullary sponge kidney) Medullary sponge kidney and Hyperparathyroidism are established causes ofNephrocaleinosis.", "cop": 1, "opa": "Medullary sponge disease", "opb": "Acute pyelonephritis", "opc": "Acute glomerulonephritis", "opd": "Chronic pyelonephritis", "subject_name": "Medicine", "topic_name": null, "id": "8afbe42c-3d97-4833-aadf-59dcae9086cf", "choice_type": "single"}
+{"question": "Tadalafil should NOT be used in", "exp": "(B) Patient on Nitrates therapy[?]Sildenafil, Tadalfil, Vardenafil & Avanafil are the only approved & effective oral agents for the treatment of Erectile Dysfunction.oThese 4 drugs markedly improved the management of erectile dysfunction, because they are effective for the treatment of a broad range of causes, including psychogenic, diabetic, vasculogenic, post-radical prostatectomy (nerve-sparing procedures), & spinal cord injury.oThese are Selective & Potent Inhibitors of PDE-5, the predominant phosphodiesterase isoform found in the penis.DrugOnset of ActionHalf-lifeDoseAdverse EffectsContraindicationsTadalafilTmax,30-60 min Duration, 12-36 h Plasma concentration Not affected by food or ETOH17.5 h10 mg, 20 mg; 2.5 or 5 mg or daily doseHeadache,dyspepsia,back pain,nasalcongestion,myalgiaNitratesHypotensionCardiovascular risk factorsRetinitis pigmentosaChange dose with some antiretroviralsShould be on stable dose of alpha blockers[?]Significant Drug Interactions & Contraindications:oPhosphodiesterase 5 (PDE5) inhibitors include Sildenafil (Viagra), Vardenafil (Levitra), & Tadalafil (Cialis).-The administration of any of these drugs with doses of any Nitrate is contraindicated.-The combination can cause dangerously low blood pressure.[?]Contraindications of Tadalafil Black 80 mg:oThe consumption of this drug is chiefly avoided due to some medical issues in men like:-Abnormal conditions or deformity of genitals-Hypersensitivity problem to any ingredient of this drug.-Heart related problems-Severe renal insufficiency-History of stroke & heart attack-Severe pulmonary disorders.-Patients with history of AMI/stroke/fatal arrhythmias <6 month Nitrates - total contraindication/PDEIs in small dose + spacing at least 24 hrs (48 hrs with Tadalafil) for fear of developing IHD/AMI due to severe hypotension.oPrecautions for Tadalafil:-With alpha blockers (except Tamsulosin) - orthostatic hypotension.-With hepato/renal insufficiency.-With Pyronie's disease-With bleeding tendencies (leukemia's, hemophilia, Vitamink K deficiency, Antiphospholipid syndrome... etc).-With quinidine, procainamide, amiodarone (class I & III antiarhtmics) (Vardenafil).-Dose adjustment; when using drugs that have interaction on hepatic livery microsomal enzymes i.e., inhibitors or inducers.-Retinitis pigmentosa.OTHER OPTIONS[?]Nitrates are vasodilators acts by producing vascular smooth muscle relaxation through cGMP pathway.-Cyclic GMP is hydrolyzed to 5 GMP by PDE5-Tadalafil is a Phosphodiesterase 5 (PDE5) inhibitors-Inhibition of PDE5 prolongs and accentuates the cGMP in smooth muscle causes relaxation.-Taking tadalafil with vasodilator drug like nitrate can cause sudden & serious decrease in blood pressure.oTadalafil in treatment of Pulmonary Arterial Hypertension is used to improve haemodynamics & excercise ability oTadalafil in treatment of Sexual dysfunction like Erectile dysfunction is treated by5-20 mg taken 1-2 h before sex, is now the standard treatment for maintaining erections.oRemember1-Combination with vasodilators results in sudden changes of blood pressure values:-Tadalafil relaxes muscles of the blood vessels and increases blood flow to particular areas of the body.-Used to treat erectile dysfunction, and symptoms of benign prostatic hypertrophy-Also in treatment of Pulmonary Arterial Hypertension is used to improve haemodynamics & excercise ability.oWhen given alone to men with severe coronary artery disease, these drugs have modest effects on blood pressure, producing >10% fall in systolic, diastolic & mean systemic pressures & in pulmonary artery systolic & mean pressures.oSildenafil, tadalafil & vardenafil all have a significant & potentially dangerous interaction with organic nitrates, the therapeutic actions of which are mediated via their conversion to NO with resulting increases in cyclic GMP.oIn the presence of a PDE5 inhibitor, nitrates cause profound increases in cyclic GMP and can produce dramatic reductions in blood pressure.", "cop": 2, "opa": "Diabetics", "opb": "Patient on Nitrates therapy", "opc": "Pulmonary arterial hypertension", "opd": "Erectile dysfunction", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "aaa837b6-2042-4da2-8f25-1dedd71440b6", "choice_type": "single"}
+{"question": "Anti fodrin antibodies are positive in", "exp": "Anti fodrin are directed against muscarinic receptors seen in sjogren. Sjogren&;s syndrome is a late onset chronic systemic autoimmune disease characterized by lymphocytic infiltration and destruction of the salivary and lacrimal glands resulting in dry mouth(xerostomia) and dryness and atrophy of conjunctiva and cornea (keratoconjunctivits sicca). This disease is caused by an immune-mediated inflammation of salivary,lacrimal and sweat glands as Sicca Syndrome or with internal organ involvement. Clinical Types PRIMARY SS - Alone. SECONDARY SS - associated underlying connective tissue diseases (RA / SLE / Scleroderma ) SICCA SYNDROME -- Xerophthalmia + Xerostomia --Internal Organ / Bone C/F * Glandular manifestation Dry mouth (Xerostomia) due to decreased production of saliva by salivary glands * Lacrimal Gland Involvement -- Dryness of eyes causes keratoconjuctivitis sicca. * Burning itchy sensation in the eyes. SKIN MANIFESTATIONS (50% Xeroderma, pruritus and scaling Annular erythema, Papular Erythema including Sweet&;s-like lesions. Raynaud&;s syndrome Hyperglobulinemic Purpura Vitiligo Sweating abnormalities Cutaneous Amyloidosis Alopecia diffuse and generalized Diagnosis SS patients of both primary and secondary Sjogren&;s syndrome have marked hypergammaglobulinemia (IgG>IgA>IgM),ANA(>50c)/0) elevated total protein and sedimentation rate. Anti-Ro and Anti-La Antibodies occur in approximately 60% of patients with Sjogren&;s syndrome * Histolgy of skin shows an absence of sebaceous glands and decrease in the sweat glands. Revised classification criteria for Sjogren&;s Syndrome Ocular symptoms : at least one of - * Dry eyes for more than 3 months * Sensation of sand or gravel in the eyes * Need for tear substitutes more than 3 times a day * Oral Symptoms : at least one of -- * Dry mouth for more than 3 months * Recurrently or Persistently swollen salivary glands * Need liquids to swallow dry food * Ocular Signs --at least one the following two tests positive * Schirmer&;s test * Rose Bengal score 4. Histopathology: in minor salivary glands, focal lymphocytic sialoadenitis (focus score ?A). 5. Salivary gland involvement: a positive result for at least one of the following diagnostic tests: 1 Unstimulated whole salivary flow (1.5 ml in 15 min) 2 Parotid sialography showing punctate, cavitary, or destructive pattern, without evidence of obstruction in the major ducts 3 Salivary scintigraphy showing delayed uptake, reduced concentration 6. Autoantibodies -- Anti Ro and Anti La Criteria For primary SS In patients without any potentially associated disease. primary SS may be defined as follows: a. The presence of any four of the six items is indicative of primary SS, as long as either item 4 (Histopathology) or 6 (Serology) is positive. b. The presence of any three of the four objective criteria items (that is, items 3, 4, 5, 6) For secondary SS In patients with a potentially associated disease. the presence of item 1 or item 2 plus any two from among items 3, 4, and 5 may be considered as indicative of secondary SS Treatment Symptomatic treatment for dryness of eyes -- by lubricating agents such as 0.5% methylcellulose eye drops for 4-5 times daily. Cyclosporine ocular drops Bromhexine 16 mg TDS has been found to increase the lacrimal secretion. Aificial saliva and cyclosporin(2.5-5mg/kg), for xerostomia. Routine dental care Steam inhalation may help dryness of the respiratory tract. ref - Harrisons internal medicine 20th ed pg2560", "cop": 2, "opa": "Sarcoidosis", "opb": "Sjogren", "opc": "Systemic sclerosis", "opd": "Dermatomyositis", "subject_name": "Medicine", "topic_name": "Immune system", "id": "6fa0b536-32bc-44fe-8325-5783e227b99e", "choice_type": "single"}
+{"question": "The Hemoglobin A1c level indicates the patient's level of glycemic control during the previous", "exp": "Measurement of glycated haemoglobin (HbA1c) is the standard method for assessing long-term glycemic control. When plasma glucose is consistently elevated, there is an increase in nonenzymatic glycation of haemoglobin; this alteration reflects the glycemic history over the previous 2-3 months because erythrocytes have an average lifespan of 120 days The glycemic level in the preceding month contributes about 50% to the HbA1c value.Harrison 19the pg: 2410", "cop": 2, "opa": "1-2 months", "opb": "2-3 months", "opc": "3-4 months", "opd": "4-5 months", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "ac26ff20-ddb6-4bc6-be08-095c43c329ab", "choice_type": "single"}
+{"question": "A 70 years old male develops pneumonia and septicaemia. Patient goes into renal failure and has a B.P of 70/50 mm of Hg. Drug that should be used to maintain B.P is", "exp": null, "cop": 4, "opa": "Adrenaline", "opb": "Ephedrine", "opc": "Phenylephrine", "opd": "Nor epinephrine", "subject_name": "Medicine", "topic_name": null, "id": "3ef36a99-a305-4eb6-884d-ba434a4a5213", "choice_type": "single"}
+{"question": "Tietze syndrome involves swelling of", "exp": "Painful swelling of second or third Costo chondral joint.", "cop": 2, "opa": "1st Costochondral joint", "opb": "2nd or 3rd Costochondral joint", "opc": "4th & 5th Costochondral joint", "opd": "6th or 7th Costochondral joint", "subject_name": "Medicine", "topic_name": null, "id": "b9299911-2d89-42e4-b0dd-fa2b10e968c2", "choice_type": "single"}
+{"question": "Mutation in alpha 5 chain of collagen 4, the diagnosis", "exp": "Ans. is 'a' i.e. Alport's syndrome Alport's syndrome is a hereditary nephritis, characterized byMicroscopic hematuria (first symptom)QDeafness QPathology of Alport's syndromeAlport's syndrome is characterized by diffuse glomerular basement membrane thickening.The basement membrane of the glomerulus is made up of type IV collagen.Type IV collagen consists of six differenta chains i.e.a1and a2 located on chromosome 13 (col A4A1, col A4A4)a3 and a4 located on chromosome 2 (col A 4A3, col A 4A2)a5 and a6 located on chromosome 6 (col A 4A5 col A 4A6)a3 a4 and a5 form collagen network present inGlomerular basement membraneCochleaLens capsuleIn Alport's syndrome there is defect in the synthesis of type IV collagen Q because there is a mutation in the gene encoding a5 chain of collagen type IV (col 4A5)These mutations are heterogenous and affect all domains of a5 chain.Because of these defects the glomerular membrane is thin and on electron microscopy it demonstrates irregular foci of thickening alternating with thinning with pronounced splitting of the lamina densa often with \"basket weave appearance Q\"Also knowPathogenesis of Good pasture syndromeGood pasture syndrome is an uncommon autoimmune disease, characterized by the presence of circulating autoantibodies targeted against the noncollagenous domain of the a-3 chain of collagen IVQ.These antibodies initiate an inflammatory destruction of the basement membrane in kidney glomeruli and lung alveoli, giving rise to proliferative usually rapidly progressive glomerulonephritis Q and a necrotizing hemorrhagic interstitial pneumonitis Q.Clinical features of Alport's syndromeMicroscopic hematuria QHearing loss Q", "cop": 1, "opa": "Alport's syndrome", "opb": "Thin membrane disease", "opc": "Nodular glomerulosclerosis", "opd": "Good pasture syndrome", "subject_name": "Medicine", "topic_name": "Glomerular Diseases", "id": "d8c4171a-7243-45f9-9233-1f0e3bae52bb", "choice_type": "single"}
+{"question": "The following is a marker of acute hepatitis B infection", "exp": "Ans. is 'a' i.e. DNA polymerase \"DNA polymerase activity, HBVDNA, HBeAg which are representative of the viremic stage of hepatitis B occur early in the incubation period concurrently or shortly after the first appearance of HBsAg\" -Jawetz - 19h/ep. 475.DNA polymerase is a marker for active viral replication.It is not exclusively associated with acute hepatitis B.It is also seen in chronic hepatitis B when there is active viral replication in chronic hepatitis (Chronic active hepatitis).But since active viral replication is usually associated with acute hepatitis, DNA polymerase is usually associated with seen in acute hepatitis B.Serological markers of Acute Hepatitis B infectionHBsAg appears before the onset of symptoms Q, peaks during overt disease and then declines to undetectable levels in 3-6 months.HBeAg, HBV-DNA and DNA polymerase appear in the serum soon after HBsAg and all signify active viral replication.IgM anti-HBc becomes detectable in serum shortly before the onset of symptoms, concurrent with the onset of elevation of serum aminotransferases. Over months the IgM antibody is replaced by IgG Anti HBc (when infection becomes chronic)Anti HBS is detectable shortly after the disappearance of HBeAg implying that the acute infection has peaked and the disease is on the wane.Hepatitis core antigen never appears in the serum.", "cop": 1, "opa": "DNA polymerase", "opb": "Hepatitis core antigen", "opc": "Anti HBs", "opd": "IgG to core antigen", "subject_name": "Medicine", "topic_name": "Hepatitis", "id": "4a34511d-ce9d-447f-acde-252653b84c77", "choice_type": "single"}
+{"question": "In Budd Chiari syndrome, the site of venous thrombosis is", "exp": null, "cop": 3, "opa": "Infrahepatic inferior vena cava", "opb": "Infrarenal inferior vena cava", "opc": "Hepatic veins", "opd": "Portal veins", "subject_name": "Medicine", "topic_name": null, "id": "3c22d179-3339-4aaf-9835-463ba3be0078", "choice_type": "single"}
+{"question": "Rx of latent syphilis a) Penicillin b) Erythromycin c) Tetracycline d) Ciprofloxacin", "exp": null, "cop": 1, "opa": "ac", "opb": "ab", "opc": "bc", "opd": "bd", "subject_name": "Medicine", "topic_name": null, "id": "67d92f70-ba05-4ea5-a063-4ccfe90cf898", "choice_type": "single"}
+{"question": "Drug of choice for maintenance therapy in PSVT is", "exp": "Table 276-3 Verapamil 5-10 mg ,over 3-5 min , maintenance: 2.5-10 mg/h ,SVT, AF rate control Ref Davidson 20th edition pg 1532", "cop": 3, "opa": "Amiodarone", "opb": "Lingnocaine", "opc": "Verapamil", "opd": "Adenosine", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "aebb339c-b6db-4b01-9330-630d760c6b6d", "choice_type": "single"}
+{"question": "Feature of glomerular haematuria", "exp": "Answer is A (Dysmorphic R.BO.) Presence of Dysmorphic RBC and RBC cast suggests hematuria of glomerular origin or a glomerular disease.", "cop": 1, "opa": "Dysmorphic R.B.C.", "opb": "Fragmented R.B.C.", "opc": "Full of R.B.C.", "opd": "Gross haematuria", "subject_name": "Medicine", "topic_name": null, "id": "d00bb988-a01e-49cc-b3ea-9237352842f4", "choice_type": "single"}
+{"question": "The most common cause for chronic cor pulmonale is", "exp": "Answer is B (COPD): The most common cause of chronic cor puhnonale is chronic. obstructive pulmonary disease - Rubin's pathology", "cop": 2, "opa": "Recurrent pulmonary embolization", "opb": "COPD", "opc": "Cystic fibrosis", "opd": "Bronchial Asthma", "subject_name": "Medicine", "topic_name": null, "id": "3b2e0a44-2112-4cef-b514-cb60c30579fe", "choice_type": "single"}
+{"question": "Most common cause of subarachnoid haemorrhage is", "exp": "(C) Trauma # Most common cause of Subarachnoid haemorrhage is Berry aneurysm.> Most common cause of spontaneous subarachnoid haemorrhage is rupture of saccular aneurysm.> Autopsy has revealed 3-4% of population harbour aneurysm. According to Harrison \"... .Excluding head trauma, the most common cause of SAH is rupture of a saccular aneurysm....\" Head trauma is not a spontaneous cause of SAH.> Sudden severe headache is the commonest presentation of subarachnoid haemorrhage.> Mortality rate is about 50% in first month. Arteriovenous malformation presents as stroke in young person. 85% of the aneurysms occur in the anterior circulation of Willis. Prodromal symptoms help to localize unruptured aneurysm.> 3rd nerve palsy with loss of light reflex and pain above or behind eye: Aneurysm at junction of posterior communicating & internal carotid artery. 6th nerve palsy: Aneurysm at cavernous sinus.> Occipital or posterior cervical pain: Aneurysm at posterior inferior cerebellar artery or anterior inferior cerebellar artery. Four major causes of delayed neurological deficit are - rerupture, hydrocephalus, vasospasm and hyponatraemia. Vasospasm is the major cause of delayed neurological deficit.; The incidence of rerupture is maximum at 7th day. The signs of vasospasm are maximum at 7th day.> MC cause of CVA - Thrombosis> MC site of Hypertensive bleeds Putamen> MC site of berry aneurysm-Ant, cerebral- ant, communicating art, junction# This one has been repeated so many times. Excluding trauma, the most common cause of subarachnoid hemorrhag e is rupture of aneurysm# Causes of subarachnoid hemorrhage: Trauma (most common); Rupture of Berry's aneurysm; Rupture of A.V. malformation> Causes of subarachnoid haemorrhage: Aneurysms ... 70% Arteriovenous malformations ... 10% Idiopathic... 5% Other: Spinal AVM, Tumour, Coagulopathy", "cop": 3, "opa": "Aneurysm", "opb": "A-V malformation", "opc": "Trauma", "opd": "Hypertension", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "ce271db1-a463-4931-a0fe-d1694d8e81aa", "choice_type": "single"}
+{"question": "As a result of a unilateral lower motor neuron lesion of the hypoglossal nerve", "exp": "The genioglossus muscle is paralyzed on the side of the lesion in the hypoglossal nerve. When the tongue is protruded, the vector of the fully innervated muscles is unopposed by the muscle on the opposite side, thus producing the obvious detion of the tongue from the midline. Protrusion is still possible due to the normally innervated side. Taste is not related to the muscle innervation of the tongue; it is carried by the trigeminal and glossopharyngeal nerves. Spasticity is a sign of an upper motor neuron lesion. In a lower motor neuron lesion, atrophy of the affected side may be observed by the examiner. Ref - Harrison's internal medicine 20e pg 3028, 3171", "cop": 1, "opa": "The tongue would dete toward the same side as the lesion when protruded", "opb": "The patient would not be able to protrude the tongue", "opc": "Taste would be lost on one side of the tongue", "opd": "The tongue would dete toward the opposit side of the lesion when protruded", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "532f9818-ab06-40d3-a153-4b3c18792f23", "choice_type": "single"}
+{"question": "Chvostek’s sign is elicited by", "exp": "The Clinical manifestations of hypocalcemia are mostly due to neuromuscular irritability.\n The patients complains of paresthesias which are typically perioral or of the hands and feets\n Tetany is the classic manifestation of hypocalcemia, the manifestations are :\n Corpopedal Spasm o Laryngospasm o Seizures Latent tetany occurs which can be manifested by\nChvostek sign and Trousseau sign Electrocardiographic manifestations The classic E.C.G.\nchange with hypocalcemia is prolonged corrected QT interval Other possible E. C. G.\nfindings are o Prolonged ST interval o Peaked T waves o Arryhtmmias Heart block (hypocalcemia may impair cardiac contractility and decrease blood pressure) GI.\nT manifestations o Intestinal cramps and malabsorption NOTE: Corpopedal spasm: o Contraction the muscels of the hand and feet.\nThe wrists are flexed and fingers extended, with the thumbs adducted over the palms. Chvostek sign:\nTapping the facial nerve anterior to the external auditory meatus elicits a twitch of the upper lip or entire mouth.\nThis is not a very specific sign because it is positive in about 10% of patients without hypocalcemia. Trousseau sign:\n A blood pressure cuff is inflated slightly above the systotic blood pressure for more than 3 minutes.\nCorpopedal spasm occurs if hypocalcemia is present as a result of the ischemia of motor nerves.", "cop": 2, "opa": "BP cuff in arm for 5 minutes", "opb": "Facial nerve stimulation by tapping over the parotid", "opc": "Tapping over extensor pollicis brevis", "opd": "Tapping over flexor retinaculum", "subject_name": "Medicine", "topic_name": null, "id": "32c401bd-69c1-4840-99af-b0f4bef76ee4", "choice_type": "single"}
+{"question": "Pulsus Bigeminus is seen in therapy with", "exp": "o Pulsus Bigeminus is recognized as a cause of digitalis toxicity.\no Pulsus Bigeminus is a disorder of rhythm (irregular rhythm; arrhythmia) most commonly caused by Premature Ventricular Contracons that results in a pulse with irregular rhythm that alternates in amplitude (pressure) from beat to beat.\nThe most common cause of Pulsus Bigeminus is Digitalis and Pulsus Bigeminus is recognized as a cause of digitalis toxicity :", "cop": 1, "opa": "Digitalis", "opb": "Beta blockers", "opc": "ACE inhibitors", "opd": "Calcium channel blockers", "subject_name": "Medicine", "topic_name": null, "id": "09933d5c-77af-4f71-a6e3-ba23eb9455b8", "choice_type": "single"}
+{"question": "Feature of Torsade de pointes is", "exp": "Polymorphic VT that occurs in the context of congenital or acquired prolongation of the QT interval often has a waxing and waning QRS amplitude creat- ing a \"twisting about the points\" appearance referred to as Torsade de Pointes Ref Harrison 20th edition pg 1443", "cop": 3, "opa": "Wide QRS complex", "opb": "Sho QRS complex", "opc": "Prolonged QT interval", "opd": "Sho QT interval", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "9844fc05-fbbf-46a1-b5f6-1639812a69ac", "choice_type": "single"}
+{"question": "ST segment elevation on EKG is not seen in", "exp": "Causes of ST-segment elevation are as follows: 1. Ischemia/myocardial infarction a. Noninfarction, transmural ischemia (Prinzmetal's angina, and Takotsubo syndrome) b. Acute MI c. Postmyocardial infarction (ventricular aneurysm) 2. Acute pancarditis 3. Normal variant (early repolarization pattern) 4. Left ventricular hyperophy/left bundle branch block 5. Rare causes a. Brugada pattern b. Class-1c antiarrhythmic drugs c. DC cardioversion d. Hypercalcemia e. Hyperkalemia f. Hypothermia (J wave/Osborne waves) g. Myocardial injury i. Myocarditis J. Tumor invading left ventricle K. Trauma to ventricles Ref - Harrison&;s principles of internal medicine 20th ed pg 1680", "cop": 2, "opa": "Early repolarization variant", "opb": "Constrictive pericarditis", "opc": "Ventricular aneurysm", "opd": "Prinzmetal angina", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "28da19f5-0180-4cfa-8af6-bfb76a9c3e6a", "choice_type": "single"}
+{"question": "Candle wax dripping sign is seen in", "exp": "Answer- A. SarcoidosisCondle wax chipping sign is a feature of occular Sarcoidosis.", "cop": 1, "opa": "Sarcoidosis", "opb": "SLE", "opc": "HIV", "opd": "Rheumatoid ahritis", "subject_name": "Medicine", "topic_name": null, "id": "d67dc20e-215c-4abb-be7e-02d94d9274d6", "choice_type": "single"}
+{"question": "In prolactinoma most common symptom other than galactorrhea is", "exp": "Answer- B. AmennorheaAmenorrhoea and galactorrhoea are the major endocrine manifestation of prolactinoma.", "cop": 2, "opa": "Bitemporal hemianopia", "opb": "Amennorhea", "opc": "Thyroid dysfunction", "opd": "Headache", "subject_name": "Medicine", "topic_name": null, "id": "bf47d5a8-ba42-4929-bb8c-0533361aa2ee", "choice_type": "single"}
+{"question": "A patient underwent adrenalectomy in views of B/L pheochromocytoma , 1 day later developed lethargy ,fatigue, low BP and pulse normal No signs of volume deficit , likely course is", "exp": "ADDISONIAN CRISIS PRESENTATION Sudden penetrating pain in the legs, lower back or abdomen Severe vomiting and diarrhea, resulting in dehydration Low blood pressure, Unexplained shock, usually refractory to fluid and pressor resuscitation Syncope (loss of consciousness) Hypoglycemia Confusion, psychosis, slurred speech Severe lethargy Hypercalcemia Convulsions Fever Rapid withdrawal of long-term steroid therapy \" Hypehermia or hypothermia ref : harrisons 21st ed", "cop": 1, "opa": "Addisonian Crisis", "opb": "SIADH", "opc": "DI", "opd": "Cerebral salt wasting disease", "subject_name": "Medicine", "topic_name": "All India exam", "id": "912a4aa2-6ca9-4750-a3d9-34f09a0a0c5a", "choice_type": "single"}
+{"question": "Cardiac biomarkers of choice for diagnosis of myocardial infraction 10 days after initial event", "exp": "Ref Harrison 19 th ed pg 1594 addition to the clinical examination, three major noninvasive tools are used in the evaluation of NSTEMI-ACS: the electrocardiogram (ECG), cardiac biomarkers, and stress testing. CCTA is an additional emerging option The goals are to: (1) recognize or exclude myocardial infarction (MI) using cardiac biomarkers, preferably cTn;", "cop": 1, "opa": "Troponins", "opb": "CK-MB", "opc": "Myoglobin", "opd": "LDH", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "84799511-83e2-4ef8-a2e7-e9d05045da17", "choice_type": "single"}
+{"question": "Ipsilateral VI & VII nerve palsy with contralateral hemiplegia is known as", "exp": "Site of disease: PonsAery involved is AICAStructure involved are: 6th and 7th cranial nerve and coicospinal tract, so patient presents with ipsilateral 6 & 7 cranial nerve palsy and contralateral hemiparesis.", "cop": 2, "opa": "Weber's syndrome", "opb": "Millard Gubbler syndrome", "opc": "Lateral medullary syndrome", "opd": "Benedict's syndrome", "subject_name": "Medicine", "topic_name": "All India exam", "id": "02ff7837-ff3a-4195-8d3f-1403a2368f2f", "choice_type": "single"}
+{"question": "Antibody in asthma treatment", "exp": "Omalizumab o Omalizumab is an anti IgE agent approved by the (FDA)\nfor use in patients age 12 and above with moderate to severe persistent allergic asthma with\n: - An IgE level of30-700 lu/ml. Positive allergen skin or specific IgE tests to a perenmial allergen and Incomplete symptom control\nwith inhaled glucocorticoid treatment. o Omalizumab is administered by “subcutaneous injecon ” every mo to four weeks in a dose that\nis determined by- body weights and the level of serum IgE.\no Omalizumab produces 25% reduction in rate of asthma exacerbations.\n The response to omalizumab therapy is variable and dif icult to predict with overall response rates in patients with moderate to severe asthma averaging 30-50%.\n A minimum of 12 weeks of treatment is necessary to determine the efficacy 1 ofanti-IgE theraphy", "cop": 3, "opa": "Rituximab", "opb": "Transtusuzumab", "opc": "Omalizumab", "opd": "Daclizumab", "subject_name": "Medicine", "topic_name": null, "id": "10296f16-3600-4fe5-8127-deca32c3bc03", "choice_type": "single"}
+{"question": "The following enzyme is not elevated in polymyositis", "exp": "Polymyositis is a type of inflammatory myopathy, which refers to a group of muscle diseases characterized by chronic muscle inflammation and weakness. elevations of serum activities of the so called \"liver enzymes\", the transaminases and lactate dehydrogenase (LD) in myositis Ref Robbins 9/e pg 226", "cop": 4, "opa": "Creatine kinase", "opb": "Aldolase", "opc": "Lactate dehydrogenase", "opd": "Amylase", "subject_name": "Medicine", "topic_name": "Genetics", "id": "a97ad946-efe3-46a7-b149-486bc482e4cd", "choice_type": "single"}
+{"question": "Alpha,anti trypsin deficiency causes", "exp": "Ans b (panacinar -emphysema) Ref Harrison 17th pg 1638Emphysema is classified into distinct pathologic types, the most important being centriacinar and panacinar.Centriacinar emphysema -cigarette smoking- enlarged airspaces in association with respiratory bronchioles- upper lobes and superior segments of lower lobes and is often quite focal.Panacinar emphysema - large airspaces evenly distributed within and across acinar units-Alpha! AT deficiency- lower lobes.Risk factors for the development of COPDTobacco smokeBiomass solid fuel firesOccupational -Coal miners & cadmiumAir pollutionLow birth weightChildhood infections & maternal smoking", "cop": 2, "opa": "centri acinar emphysema", "opb": "panacinar emphysema", "opc": "centrilobar emphysema", "opd": "irregular emphysema", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "1f9bf11a-a6f5-458c-8260-672c1e297b21", "choice_type": "single"}
+{"question": "Christmas disease is treated by", "exp": "Fresh frozen contains all the coagulation factors except platelets. Also erythrocytes and leukocytes are absent in it. The specific treatment is with factor9 concentrate. The new extended half life recombinant factor 9 products made by Fc fusion, albumin fusion and pegylation offer the possibility of prophylaxis on a once-weekly or even two-weekly schedule. Reference : Davidson, 23rd Edition, page no : 974.", "cop": 1, "opa": "Fresh frozen plasma", "opb": "Fresh frozen blood", "opc": "Cryoprecipitate", "opd": "Steroids", "subject_name": "Medicine", "topic_name": "Haematology", "id": "26077b0e-3735-44e2-a5ac-6eaf6b34cfe4", "choice_type": "single"}
+{"question": "Keshan disease is an endemic cardiomyopathy found in deficiency of", "exp": "(Selenium) (410-H) (449-H17th)Keshan disease - found in children and young women residing in regions of china where dietary intake of selenium is low (< 20 mg/d)* Concomitant deficiencies of iodine and selenium may worsen the clinical manifestations of cretinism.", "cop": 1, "opa": "Selenium", "opb": "Manganese", "opc": "Chromium", "opd": "Copper", "subject_name": "Medicine", "topic_name": "Nutrition", "id": "b576be18-0d42-4fc3-a9b9-e28919117387", "choice_type": "single"}
+{"question": "Faget sign is", "exp": "Answer- B. Bradycardia with hypehermiaThe Faget sign (sphygmotheric dissociation) is the unsual pairing of fever and bradycardia.Often seen in -Yellow feverTyphoid feverTularaemiaBrucellosisColorado tick fever", "cop": 2, "opa": "Tachycardia with hypeension", "opb": "Bradycardia with hypehermia", "opc": "Tachycardia with hypehermia", "opd": "Bradycardia with hypothermia", "subject_name": "Medicine", "topic_name": null, "id": "928586bc-64d4-43ca-abd6-eb740f7dad2e", "choice_type": "single"}
+{"question": "Characteristic feature of korsakoff psychosis is", "exp": null, "cop": 4, "opa": "Disorientation", "opb": "Delirium", "opc": "Coarse tremor", "opd": "Amnesia", "subject_name": "Medicine", "topic_name": null, "id": "addd9f5a-ff2d-4161-a9f7-8409749ff195", "choice_type": "single"}
+{"question": "The most common translocation seen in patients with Multiple Myeloma is", "exp": "Answer is A (t(11;14)) The most common translocation seen in patients with Multiple Myeloma is 01;14). `The most common translocation seen in patients with Multiple Myeloma is t(11;14)(q13;q32) involving the BCL1 locus on chromosome 11g13 and the immunoglobulin heavy (IgH) chain locus on chromosome 14q13 which leads to overexpression of Cyclin D1 '- The Washington Manual of Surgical Pathology `The two most common translocation seen in patients with Multiple Myeloma are t(11;14)and t(4; 14). Both these translocations occur with almost similar frequencies, however the incidence of translocation 1(11; 14) appears to be marginally higher. Patients with t(4; 14) fall within a poor prognosis subgroup, while those with 1(11; 14) have a standard risk' - The Principles of Clinical Cytogenetics The two most common translocation seen in patients with Multiple Myeloma t(11;14)(q13;q32) : Associated with standard prognosis t(4;14) (p16;q32) : Associated with aggressive behaviour and poor prognosis The most common translocation in multiple myeloma associated with a poor prognosis is translocation t(4;14)", "cop": 1, "opa": "t(11;14)", "opb": "t(4;14)", "opc": "t(14;16)", "opd": "t(14;20)", "subject_name": "Medicine", "topic_name": null, "id": "f5a4dbfd-fcff-4518-8c8e-f73618778064", "choice_type": "single"}
+{"question": "Comment on the diagnosis", "exp": "ECG shows hea rate of 70/min with T wave inversion noted in leads V1 to V4. Indicates possible Myocardial ischemia. Choice A and D are ruled out as there is no ST elevation. Pulmonary embolism leads to \"S1Q3T3 pattern\" (McGinn-White Sign)", "cop": 2, "opa": "Prinzmetal angina", "opb": "Myocardial infarction", "opc": "Pulmonary embolism", "opd": "Hyperkalemia", "subject_name": "Medicine", "topic_name": "ECG and Arrhythmias 1", "id": "d45cd1ed-b588-4522-a91c-eb01a16da37e", "choice_type": "single"}
+{"question": "30 year old female patient complains of breath less ness since 5 month, Her pulmonary function tests report is as follows", "exp": "Among the given options pulmonory fibrosis fits into restrictive lung disease.", "cop": 3, "opa": "Asthma", "opb": "Pulmonary Embolism", "opc": "Pulmonary Fibrosis", "opd": "Chronic Bronchitis", "subject_name": "Medicine", "topic_name": null, "id": "8ad91336-5411-4662-b585-1340c2a3c674", "choice_type": "single"}
+{"question": "According to American diabetes association, HbAlc levels in diabetes patients under control are", "exp": null, "cop": 2, "opa": "4-6mg/dl", "opb": "<7mg/dl", "opc": "8mg/dl", "opd": ">8gmd/dl", "subject_name": "Medicine", "topic_name": null, "id": "78c37315-3b9c-4686-8c35-b986c954313c", "choice_type": "single"}
+{"question": "Gegenhalten (paratonia) indicates lesion in", "exp": "Ans. c (Frontal lobe) (Ref. Harrison 18th/Fig 370-9).PARATONIA: | tone that varies irregularly in a manner that may seem related to a degree of relaxation, is present throughout the range of motion, affects flexors and extensors equally, usually results from lesion of bilateral frontal lobes or dominant frontal lobe.RIGIDITY: | Tone, affects flexors and extensors equally; seen in extrapyramidal lesionsSPASTICITY: | tone, affects mainly extensors and seen in pyramidal tract lesions.Signs and symptomsStructures involved# Paralysis of opposite foot and leg# A lesser degree of paresis of opposite arm# Cortical sensory loss over toes, foot, and legMotor leg areaArm area of cortex or fibers descending to corona radiateSensory area for foot and leg# Urinary incontinenceSensorimotor area in paracentral lobule# Contralateral grasp reflex, sucking reflex, gegenhaiten (paratonic rigidity)Medial surface of the posterior frontal lobe; likely supplemental motor area# Abulia (akinetic mutism), slowness, delay, intermittent interruption, lack of spontaneity, whispering, reflex distraction to sights and soundsUncertain localization--probably cingulate gyrus and medial inferior portion of frontal, parietaland temporal lobes# Impairment of gait and stance (gait apraxia)Frontal cortex near leg motor area# Dyspraxia of left limbs, tactile aphasia in left limbsCorpus callosumDeficit/feature of lesion of a particular area of brainLobesImportant regionsDeficit after lesionFrontalPrimary motor and premotorFrontal eye fieldsBroca speech area*Contralatera spastic paresis (region depends on area of homunculusEyes deviate to ipsilateral sideBroca aphasia (expressive, nonfluent aphasia): patient can understand written and spoken language, but speech and writing are slow and effortful; patients are aware of their problem; often associated with contralateral facial and arm weaknessPrefrontal cortexFrontal lobe syndrome: symptoms can include poor judgement, difficulty concentrating and problem solving, apathy, inappropriate social behaviorParietalPrimary somatosensory cortexSuperior parietal lobuleInfrerior parietal lobuleContralateral hemihypesthesia (region depends on area homunculus affected)Contralateral asteroegnosis and sensory neglect, apraxiaGerstmann syndrome (if dominant hemisphere): right/left: confusion, dyscalculia and dysgraphia, finger agnosia, contralateral hemianopia or lower quadrantanopiaTemporalPrimary auditory cortexBilateral damage deafnessUnilateral leads to slight hearing lossWernicke area*Wernicke aphasia (receptive, fluent aphasia); patient cannot understand any form of language; speech is fast and fluent, but not comprehensibleHippocampusAmygdalaOlfactory bulb, tract, primary cortexMeyer loop (visual radiations)Bilateral lesions lead to inability to consolidate short-term to long-termKluver-Bucy syndrome: hyperphagia, hypersexuality, visual agnosia Ipsilateral anosmiaContralateral upper quadrantanopia (\"pie in the sky\")OccipitalPrimary visual cortexBlindnessAlso Remember: Parietal lobe lesions | | | Dominant lobe Non dominant lobe | | Multinodal complex motor activities affected Multinodal complex sensory disabilities | | # Ideational# Ideomotor# Alexia}Apraxia Visuospatial disorders(Hemiattention) AnosognosiaDressing and constructionalApraxia# Gerstamann's syndrome", "cop": 3, "opa": "Parietal lobe (dominant)", "opb": "Temporal lobe (dominant)", "opc": "Frontal lobe (dominant)", "opd": "Parietal lobe (non-dominant)", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "4d547af5-92fa-441a-b406-38db1f1ba519", "choice_type": "single"}
+{"question": "Low haptoglobin in haemorrhage is masked by concurrent presence of", "exp": "D i.e Liver parenchymal disease Haptoglobin (Hp) binds extracorpuscular (i.e. extracellular) hemoglobin (Hb), preventing free Hb from entering the kidney. Hp-Hb complex is removed from plasma by haptocytes. Levels of haptoglobin falls rapidly in situations where hemoglobin is constantly being released from RBC such as occurs in hemolytic anemia (haemorrhage). But in case of parenchymal liver disease, Hp-Hb complex removal is deranged so reduction in haptoglobin level is masked. Haptoglobin It is a plasma glycoprotein that binds extracapsular hemoglobin (Hb) in a tight non-covalent complex. Its amount ranges from 40mg- 180 mg of hemoglobin binding capacity / deciliter. Only 10% of degraded hemoglobin is released in circulation (i.e. extra corpuscular) the remaining 90% is present in old damaged RBCs, which are degraded by histiocytic system. Free Hb (molecular mass 65KDa) passes through glomerulus and precipitate in tubules. However, after binding with haptoglobin (90 KDa) the Hb-Hp complex (155KDa) becomes too large to pass through glomerulus. So the function of haptoglobin is to prevent loss of free hemoglobin into kidney and conserve the valuable iron present in hemoglobin, which would otherwise be lost to the body. Humans have 3 polymorphic forms, k/a Hp 1-1, Hp 2-1, Hp 2-2. Low levels of haptoglobins are found in patients with hemolytic anemia. This is explained by the fact that where the life of Hp is 5 days, the t1/2 of Hb-Hp complex is 90 minutes, the complex being rapidly removed by hepatocytes. So when the hepatoglobin is bound to Hb, it is cleared from plasma about 80 times faster than normally. Hb is an acute phase protein & is elevated in variety of inflammatory states. * Haptoglobin related protein binds hemoglobin; hemopexin binds free heme; and albumin binds metheme (ferric heme)", "cop": 4, "opa": "Malnutrition", "opb": "Pregnancy", "opc": "Obstructive biliary disease", "opd": "Liver parenchymal disease", "subject_name": "Medicine", "topic_name": null, "id": "1165c7cd-c07c-41f0-9b36-83f8f3c0a2da", "choice_type": "single"}
+{"question": "Drug of choice in the treatment of onchocerciasis is", "exp": "(B) Ivermectin # Ivermectin, a semisynthetic macrocyclic lactone active against microfilariae, is the first-line agent for the treatment of onchocerc asis.> It is given orally in a single dose of 150 pg/kg, either yearly or semiannually.", "cop": 2, "opa": "DEC", "opb": "Ivermectin", "opc": "Ketoconazole", "opd": "Cotrimoxazole", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "3d94c4ea-ead6-4489-a46e-00d3eca5173f", "choice_type": "single"}
+{"question": "In essential hypertention changes seen in the heart are", "exp": "Ans. is 'b' i.e., Cardiac cell hypertrophy Hypertrophy - It's increase in size of a tissue d/t increase size of individual cells.Hyperplasia - Increase in size of a tissue as a result of increased no. of component cells . It's the principle mechanism for increased size in tissue composed of labile & stable cells.Hypertrophy is seen in following tissues #Tissue - Cause of increased demandsSkeletal muscle hypertrophy - physical activity, weight lifting*Cardiac muscle hypertrophy - Increased pressure load (Hypertension)*Increased volume load *(\"Valve incompetence causing regurgitation of blood\")Smooth muscle hypertrophy - obstructive lesions (Wall of intestine & urinary bladder)Renal hypertrophy - Unilateral disease of one kidneyRemoval of one kidneyHyperplasia* is seen in - Breast growth* (during pregnancy & lactation)Both hypertrophy and hyperplasia* is seen in - uterine growth during pregnancy*", "cop": 2, "opa": "Cardiac cell hyperplasia", "opb": "Cardiac cell hypertrophy", "opc": "Incresed in the mitochondrial number", "opd": "Increase in size of mitochondria", "subject_name": "Medicine", "topic_name": "Hypertension", "id": "d318d7df-261e-4f4f-ac36-0dedb886caa1", "choice_type": "single"}
+{"question": "Giant V wave on examination of the jugular venous pulse is suggestive of", "exp": "(B) tricuspid incompetence # Tricuspid regurgitation causes the v wave to be more prominent; when tricuspid regurgitation becomes severe, the combination of a prominent v wave and obliteration of the x descent results in a single large positive systolic wave.> After the v wave peaks, the right atrial pressure falls because of the decreased bulging of the tricuspid valve into the right atrium as right ventricular pressure declines and tricuspid valve opens# Jugular venous pulse> Normal: 3 +ve pulse waves -a, c and v 2 -ve pulse waves -x and y> 'a'wave: Due to right atrial contraction Synchronous with carotid artery pulse> Absent'a'wave : Atrial fibrillation> Diminished 'a' wave: Tachycardia Prolonged PR interval> 'a' Wave Fused with (c' Wave: Supra ventricular tachycardia> Large 'a' Waves : Pulmonary hypertension Pulmonary stenosis Tricuspid stenosis Tricuspid atresia AV dissociation> Cannon Waves (Giant 'a' Waves) : Complete heart block when right atrium occasionally contracts against closed tricuspid valve Ventricular tachycardia Ectopic beats> Regular 'a' Waves : AV junctional rhythm 10AV block 2 : 1 AV block Atrial tachycardia> Irregular 'a' Waves: Premature systoles: Atrial Ventricular AV junctional Complete AV dissociation: Complete AV block AV junctional tachycardia Ventricular tachycardia Atrial flutter> Non-conducted 'a' waves: Atrial tachycardia Atrial flutter with block> 'c' Wave : Produced by Impact of carotid artery to jugular vein Retrograde transmission of positive wave in right atrium (by ventricular systole and bulging of tricuspid valve into right atrium). Carotid artefact Systolic bulging of tricuspid valve into RA> V Wave: Absent 'x' wave: Constrictive pericarditis Restrictive cardiomyopathy ASD (sometimes)> v Wave : during ventricle contraction caused by atrial filling and occurs with and just after carotid pulse.# Large V Waves: Tricuspid regurgitation ASD Anomalous pulmonary venous drainage, Right sided heart failure> 'y' Wave: Slow Descent y Wave : Tricuspid stenosis Sharp Descent y Wave : Constrictive pericarditis Rapid Descent y wave : Constrictive pericarditis (Friedreich's sign) Severe heart failure Tricuspid regurgitation", "cop": 2, "opa": "atrial flutter with changing block", "opb": "tricuspid incompetence", "opc": "ventricular septal defect", "opd": "pulmonary stenosis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "9a742b70-29c0-4e47-a294-0f2e483ae822", "choice_type": "single"}
+{"question": "Anti ds DNA antibody is specific for", "exp": "Ref image- Harrison's internal medicine 20e p2517", "cop": 1, "opa": "SLE", "opb": "Systemic sclerosis", "opc": "CREST syndrome", "opd": "Sjogren's syndrome", "subject_name": "Medicine", "topic_name": "Immune system", "id": "9c813cf1-b395-44d0-a709-50a406af648c", "choice_type": "single"}
+{"question": "Electric alternans is seen in", "exp": "Rrf Harrison 19 th ed pg 1573 There may be reduction in ampli- tude of the QRS complexes, and electrical alternans of the P, QRS, or T waves should raise the suspicion of cardiac tamponade . the features that distinguish acute cardiac tampon- ade from constrictive pericarditis.", "cop": 1, "opa": "Cardiac tamponade", "opb": "Restrictive cardiomyopathy", "opc": "Constrictive pericarditis", "opd": "Right ventricular infract", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "333f36cf-93ad-4700-b8b4-ecb5d5622843", "choice_type": "single"}
+{"question": "Late onset of puberty in the male is defined as", "exp": "\"The diagnosis of delayed puberty is made when signs of sexual development, such as an increase in the volume of the testis are not evident even by the age of 14years in boys and breast budding by 13 years in Girls\".\nSome important causes of delayed puberty\n\nHypothyroidism\nHyperprolactinemia\nNoonan syndrome\nKlinefelter syndrome", "cop": 1, "opa": "Puberty onset after 16 years", "opb": "Puberty onset after 17 years", "opc": "Puberty onset after 18 years", "opd": "Puberty onset after 21 years", "subject_name": "Medicine", "topic_name": null, "id": "c1f9efdb-a051-464f-9355-dff0054117e0", "choice_type": "single"}
+{"question": "A common cause of Primary hyperparathyroidism is", "exp": null, "cop": 2, "opa": "Multiple parathyroid adenomas", "opb": "Solitary parathyroid adenoma", "opc": "Adrenal hyperplasia", "opd": "Ectopic PTH production", "subject_name": "Medicine", "topic_name": null, "id": "42c9fdcb-94aa-4074-ab3b-83dfe1589e68", "choice_type": "single"}
+{"question": "A patient with HIV has diarrhoea with AF +ve organism in stool. The most likely organism is", "exp": "Surprised,\n\nUsually, the mycobacterium is associated with respiratory tract infection.\nIn HIV infections mycobacterium is an important cause of diarrhoeas.\nThe incidence of the extrapulmonary disease is increased in patients with HIV.\n\nWork up in an HIV patient with diarrhoea.\n\nThe initial evaluation of a patient with HIV infection and diarrhoea includes:-\nA set of stool examination including culture, examination for ova and parasites. and\nExamination for Clostridium difficile toxin.\nApproximately 50% of the time this workup will demonstrate infection with pathogenic bacteria, mycobacteria or protozoa.\nAFB +ve organism suggests the presence of Mycobacterium.\nWe have two options to choose from either mycobacterium. T.B. or mycobacterium avium intracellulare.\nBoth mycobacterium T.B. and M.A.C. can cause diarrhoea in patients with HIV and obviously, both of them are acid-fast, So, which one to choose from.\nI am in favour of Mycobacterium avium intracellular.\nMAC infections are more likely to cause diarrhoea.\nThe presumed portals of entry in MAC are respiratory and gastrointestinal tract.\nWhile discussing HIV patients with diarrhoea. Harrison Says -\"Abdominal pain and diarrhoea may be seen with MAC infection.\"\nThus it seems MAC infection is more likely to cause diarrhoea.\nBut still, I am not sure of the answer.\nThe incidence of Mycobacterium T.B. is more than the incidence of MAC in HIV, so mycobacterium T.B. should account for the greater number of diarrhoeal cases in H.I.V.", "cop": 1, "opa": "Mycobacterium avium intracellulare", "opb": "Mycobacterium tuberculosis", "opc": "Mycobacterium leprae", "opd": "Mycoplasmas", "subject_name": "Medicine", "topic_name": null, "id": "62a556f3-2e6c-4e3d-8895-73169fcb348a", "choice_type": "single"}
+{"question": "For the following medical conditions, select the associated acid base disturbances.Hepatic cirrhosis complicated by AKI.", "exp": "Hepatic cirrhosis frequently results in chronic respiratory alkalosis. AKI with metabolic acidosis is common in patients with cirrhosis.", "cop": 2, "opa": "metabolic acidosis and respiratory acidosis", "opb": "metabolic acidosis and respiratory alkalosis", "opc": "metabolic alkalosis and respiratory acidosis", "opd": "metabolic alkalosis and respiratory alkalosis", "subject_name": "Medicine", "topic_name": "Oncology", "id": "40b49fc9-9981-470a-8568-03639f213018", "choice_type": "single"}
+{"question": "The following drug is used recently in Alcohol dependence patients", "exp": "(B) Naltrexone # Rehabilitation of Alcoholics> While the mainstay of alcoholic rehabilitation involves counseling, education, and cognitive approaches, several medications might be useful.> The first is the opioid-antagonist drug Naltrexone, 50 to 150 mg/d, which has been reported in several small-scale, short-term studies to decrease the probability of a return to drinking and to shorten periods of relapse.> However, at least one longer-term large-scale trial questioned the superiority of naltrexone to placebo, and more studies are required before the cost-effectiveness of this approach can be established.> A second medication, acamprosate (Campral), 2 g/d, has been tested in >5000 patients in Europe, with results that appear similar to those reported for naltrexone.> Several long-term trials of naltrexone and acamprosate, used individually and in combination, are in progress, and early results are promising.> A third medication, which has historically been used in the treatment of alcoholism, is the ALDH inhibitor disulfiram.> In doses of 250 mg/d this drug produces an unpleasant (and potentially dangerous) reaction in the presence of alcohol, a phenomenon related to rapidly rising blood levels of the first metabolite of alcohol, acetaldehyde.", "cop": 2, "opa": "Tiagabine", "opb": "Naltrexone", "opc": "Gabapentin", "opd": "Lamotrigine", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "3db534c1-d430-45fd-beb5-f4e54682b8c7", "choice_type": "single"}
+{"question": "The test used to diagnose Dubin Johnson syndrome is", "exp": "Answer is B (Bromsulphalein / Sulfobromophthalein) The appearance of late rise in plasma level of Bromsulphalein, BSF / Sulfobromophthalein in the clearance of this dye has been considered as a oathormontie sign of Dubin Johnson syndrome - Metabolism of Bromsulphalein in D-J syndrome; Digestive diseases and Sciences Vol/17 numbers 6. Patients with D - J syndrome exhibit a characteristic rise in plasma concentration of Bromsulphalein at 90 minutes after injection due to reflux of conjugated BSP into circulation from Hepatocyte. - Harrison Bromsulphalein test for Dubin Johnson syndrome : Harrison 16th / 1821 Dubin Johnson syndrome is characterized by a Familial / Autosomal Recessive defect in Hepatic excretory function (fom hepatocyte to biliary canaliculi ) Biliary excretion of a number of anionic compounds is compromised including that of sulfohromphthalein (Bromsulphalein, BSP), a synthetic dye (cholecystographic agent). To test for D -- J syndrome, the role of disappearance of BSP from plasma is determined after its bolus intravenous administration. Patients with D - J syndrome exhibit a characteristic rise in its plasma concentration at 90 minutes after injection due to reflux of conjugated BSP into circulation from Hepatocyte. -- Harrison Dubin Johnson Syndrome : Review During Johnson syndrome is an autosomal recessive() hereditary disorder presenting with conjugated hyperbilirubinemiaQ due to defect in hepatic excretory function across the canalicular membrane of hepatocyte.() Clinical presentation * Most patient are asymptomatic (subclinical chemical hyperbilirubinemia) * Unexplained low grade jaundice during teenage years Often exacerbated by : -- Oral contraceptive use -- Pregnancy -- Intercurrent illness * Physical examination is usually normal (occasional patient may have hepatosplenomegaly) Laboratory studies * Coniuifated Ilvperbilirubinemia :Total bilirubin is typically between 2 -- 5 mg/dl (34 -- 85 ymol/L) May occasionally he Normal or as high as 20-25 mg/dI(340-430 ,umol/L) * Bilirubinitria :Typically present as hyperbilirubinemia is conjugated * Other Routine Liver Function Tests including Serum Transaminases and Alkaline Phosphatase are essentially Normal Diagnosis Bromsulphalein test :Elaborated above Histology : Corporphyrin test Deposition of melanin like pigment occurs in the (Preferential urinary excretion of corporphyrin-l) liver causing liver to appear dark or completely black. Corporphrins are byproducts of heme biosnthesis There are two naturally occurring corporphyrins -- I & III Pigment is thought to be derived from epinephrine Normally approx. 75 % of corporpyrin in urine is isomer III metabolites that are not excreted normally In urine of patients with D-J Syndrome total corporphyrin content in urine is norma but > 80 % is Isomer I", "cop": 2, "opa": "Serum transminases", "opb": "BSP test", "opc": "Hippurate test", "opd": "Gamma glutamyl transferase level", "subject_name": "Medicine", "topic_name": null, "id": "b144e002-a4e9-42bf-89a1-718dc5e48a98", "choice_type": "single"}
+{"question": "Indications for use of cyclophosphamide in SLE is", "exp": "Cytotoxic therapy is a cornerstone for patients with severe systemic lupus erythematosus (SLE). High-dose cyclophosphamide, 200 mg/kg, can induce a complete remission without the need for stem cell rescue in patients with autoimmune illnesses.High dose cyclophosphamide is a therapy capable of decreasing disease severity in poor prognosis SLE patients. Future study is warranted for both refractory patients as well as primary therapy for patients with moderate to severe disease presentations . Ref Davidson 23rd edition pg 941", "cop": 3, "opa": "Ahritis", "opb": "Anti DNA antibody + ive patients", "opc": "Diffuse prolifereative glomerulonephritis", "opd": "Oral ulcers", "subject_name": "Medicine", "topic_name": "Immune system", "id": "c2028e96-61bf-445d-970f-2cec82ecc219", "choice_type": "single"}
+{"question": "In AIDS patients, CD4 count >75 lymphocyte count, cotton wool spots in eye examination reveales infection of", "exp": "(CMV) (1154, 1158- CMDT-08) (1180-CMDT-09)Relationship of CD4 count to development of opportunistic infections || 500 - Bacterial infections TuberculosisH. simplex, Zoster, Hairy leukoplakia Kaposis* sarcoma ||| |||||||||||||||||| 200 -Pneumocytosis Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporidiosis ||| |||||||||| 50 - Disseminated. Mycoavium complex- Histoplasmosis- CMV retinitis- CNS- Lymphoma ||**Cotton wool spots - seen in CMV retinitis** White fluffy exudates is the most common retinal infection in AIDS*Hypogonadism is probably the most common endocrine abnormalities in HIV infected man*Toxoplasmosis is the most common space- occupying lesion in HIV infected patients**Pneumocystis jivoveci pneumonia is the most common opportunistic infection associated with AIDS* Definitive diagnosis can be obtained in 50- 80% of cases by Wright- Giemsa stain or Direct fluorescence antibody (DFA) test of induced sputum* Community acquired pneumonia is the most common cause of pulmonary disease in HIV infected persons", "cop": 1, "opa": "CMV", "opb": "Toxoplasma", "opc": "Cryptococcus", "opd": "Acanthamoeba", "subject_name": "Medicine", "topic_name": "Infection", "id": "0da7a616-2da5-494d-b6d6-692492622f32", "choice_type": "single"}
+{"question": "Rh factor is", "exp": "A i.e. IgM antibody - Rheumatoid (Rh) factor in rheumatoid ahritis is an autoantibody of IgM class directed against Fc fragment of IgGQ. - Antibodies (immunoglobins) are glycoproteins. And Rh factors is an autoantibody of any immunoglobin class directed against Fc fragment of IgG immunoglobin (Davidson).", "cop": 1, "opa": "IgM antibody", "opb": "Mucppolysaccharide", "opc": "IgG antibody", "opd": "Fatty acid", "subject_name": "Medicine", "topic_name": null, "id": "056f5e9d-dff4-47be-b1c4-30e058770cb7", "choice_type": "single"}
+{"question": "Hypersensitivity vasculitis involve", "exp": "Hypersensitivity vasculitis, which is usually represented histopathologically as leukocytoclastic vasculitis (LCV), is a term commonly used to denote a small-vessel vasculitis. There are many potential causes of hypersensitivity vasculitis; however, up to 50% of cases are idiopathic. Hypersensitivity vasculitis may present clinically as cutaneous disease only or it may be a cutaneous manifestation of systemic disease. The internal organs most commonly affected in hypersensitivity vasculitis are the joints, gastrointestinal tract, and kidneys. Hypersensitivity vasculitis may be acute and self-limited, recurrent, or chronic. Overall, hypersensitivity vasculitis has a orable prognosis, paicularly when no internal involvement is present . Hypersensitivity vasculitis tends to affect the skin and occasionally the kidney. The loss of integrity of the capillaries and post capillary venules results in extravasation of red blood cells, usually causing purpura and a burning or minimally pruritic sensation. Hypersensitivity vasculitis is thought to be mediated by immune complex deposition.In this form of vasculitis, circulating antigens in the body (produced by factors such as medications, infections, and neoplasms) induce antibody formation. These antibodies bind to the circulating antigen and create immune complexes, which then deposit within vessels, activating complement and inducing inflammatory mediators. Inflammatory mediators, adhesion molecules, and local factors may affect the endothelial cells and play a role in the manifestations of this disease. Additionally, autoantibodies, such as antineutrophil cytoplasmic antibody (ANCA), may be associated with disease manifestations. In ANCA-mediated vasculitis, intracellular proteins from neutrophils become expressed on the cell surface, leading to formation of antibodies (ANCA). These autoantibodies then bind neutrophils, subsequently leading to neutrophil adhesion to vessel walls and cellular activation. Ref - medscape.com", "cop": 3, "opa": "Capillary", "opb": "Aerioles", "opc": "Postcapillary venules", "opd": "Medium sized aeries", "subject_name": "Medicine", "topic_name": "Immune system", "id": "98c462da-4f5b-464c-b71c-d62415965b81", "choice_type": "single"}
+{"question": "Most common extraintestinal complication of ulcerative colitis is", "exp": "M/c Arthritis\nPeripheral arthritis - responds to treatment\nAxial arthritis -does not responds to treatment.", "cop": 1, "opa": "Arthritis", "opb": "Uveitis", "opc": "Episcleritis", "opd": "Pyoderma gangrenosum", "subject_name": "Medicine", "topic_name": null, "id": "02746b00-0d38-48f8-b677-1a3d2f59870b", "choice_type": "single"}
+{"question": "Persistent priapism in childhood is due to", "exp": "(A) Sickle cell anaemia # Priapism in childhood commonly presents as a common symptom of Sickle Cell Disease especially after puberty, mainly as low flow or as a complication of penile trauma (normally high flow, non-ischemic episodes).> This phenotypic manifestation of SCD can cause persistent impotence, erectile dysfunction and behavioral problems in the sexual realm, as affected individuals fear the induction of an episode of painful erection in the course of normal sexual activity, which is the most common cause of priapism episodes after puberty.> The causative mechanisms are poorly understood but involve complex neurological and vascular factors.>Priapism may be associated with 1. Haematological disorders, especially sickle-cell disease, sickle-cell trait, and 2. Other conditions such as leukemia, thalassemia, and Fabry's disease, and 3. Neurologic disorders such as spinal cord lesions and spinal cord trauma (priapism has been reported in hanging victims; death erection).> Priapism is also found to occur in extreme cases of rabies,>. Priapism can also be caused by reactions to medications.", "cop": 1, "opa": "Sickle cell anaemia", "opb": "Hairy cell leukaemia", "opc": "Paraphimosis", "opd": "Urethral stenosis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "b4c6aa74-23eb-4375-94c0-fce0c1a6c71f", "choice_type": "single"}
+{"question": "The prognosis of rapidly prolifeating glomerulonephritis (Crescentric GN) depends upon", "exp": "Answer is A (Number of crescents) The prognosis of crescentric glonzerulonephritis relates to the number of crescents Prognosis can he roughly related to the number of crescents' - Robbins", "cop": 1, "opa": "Number of crescents", "opb": "Size of crescents", "opc": "Shape of crescents", "opd": "Cellularity of crescents", "subject_name": "Medicine", "topic_name": null, "id": "48bca880-4fba-42a6-8321-d0d5773589a6", "choice_type": "single"}
+{"question": "Age related dementia has been associated with increased levels of", "exp": "Identification of modifiable risk factors provides a crucial approach to the prevention of dementia.. The findings are consistent with moderately raised plasma total homocysteine (>11 mmol/L), which is common in the elderly, being one of the causes of age-related cognitive decline and dementia Ref Harrison20th edition pg 2445", "cop": 1, "opa": "Homocysteine", "opb": "Cysteine", "opc": "Tourine", "opd": "Methionine", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "0623f75b-d859-4c1b-972b-e737be8445ea", "choice_type": "single"}
+{"question": "Dengue shock syndrome occurs due to", "exp": null, "cop": 2, "opa": "Super-imposed Bacterial infection", "opb": "Capillary Leak", "opc": "Addison's Crisis", "opd": "Myocarditis", "subject_name": "Medicine", "topic_name": null, "id": "fff76b99-859a-4531-811b-847eadafffcc", "choice_type": "single"}
+{"question": "Most rapid way of lowering potassium is", "exp": "Insulin. Sta INITIAL INSULIN INFUSION RATE (100 units Regular Insulin/100 mL 0.9% Sodium Chloride): and GlucoseBloodmg/dL) Initial Insulin Infusion Rate. # 75 - 150 = 1 unit IV push then 1 unit per hour.pottasium can be give in a rapid way through insulin drip Ref Davidson 23rd edition pg 234", "cop": 2, "opa": "Albuterol", "opb": "Insulin drip", "opc": "Calcium gluconate", "opd": "Sodium bicarbonate", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "68f03643-3caf-44c3-9c64-4d05aab31bf4", "choice_type": "single"}
+{"question": "Kaposi Sarcoma is commonly seen in", "exp": "Kaposi's sarcoma is a multicentric neoplasm consisting of multiple vascular nodules appearing in the skin, mucous membranes, and viscera. The course ranges from indolent, with only minor skin or lymph node involvement, to fulminant, with extensive cutaneous and visceral involvement. Apa from skin, the lymph nodes, GI tract, and lung are the organ systems most commonly affected by KS. Lesions have been repoed in viuallyevery organ, including the hea and the CNS.Ref: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 226 Human Immunodeficiency Virus Disease: AIDS and Related Disorders; Page no: 1269", "cop": 3, "opa": "Pancreas", "opb": "CNS", "opc": "Skin", "opd": "Hea", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "c4d764a4-9361-4211-b96b-40d58c2901a3", "choice_type": "single"}
+{"question": "Drug not used in treatment of Pituitary Adenoma is", "exp": null, "cop": 3, "opa": "Octreotoid", "opb": "Bromocriptine", "opc": "Orlistat", "opd": "Letrozol", "subject_name": "Medicine", "topic_name": null, "id": "41b34d05-27f0-42e6-94b0-456b0b3af724", "choice_type": "single"}
+{"question": "Liddle syndrome is characterized by", "exp": "Liddle syndrome is an autosomal dominant disorder with genetic defect(gain of function mutation) in collecting tubules sodium channel, resulting in increased tubular sodium reabsorption.", "cop": 2, "opa": "Hypokalemic metabolic alkalosis with hypotension", "opb": "Hypokalemic metabolic alkalosis with hypertension", "opc": "Hyperkalemic metabolic acidosis with hypotension", "opd": "Hyperkalemic metabolic acidosis with hypertension", "subject_name": "Medicine", "topic_name": null, "id": "c71abfd2-8041-40af-add1-5aa59f226032", "choice_type": "single"}
+{"question": "Cotton dust is associated with", "exp": null, "cop": 4, "opa": "Asbestosis", "opb": "Bagassosis", "opc": "Silicosis", "opd": "Byssinosis", "subject_name": "Medicine", "topic_name": null, "id": "499b4c84-eed2-4719-a462-68150d383663", "choice_type": "single"}
+{"question": "Decreased level off serum Vit B6 is seen ina) CRFb) CHF c) INH therapyd) Alcohol", "exp": null, "cop": 3, "opa": "ab", "opb": "bc", "opc": "cd", "opd": "ac", "subject_name": "Medicine", "topic_name": null, "id": "522aca8b-1d5a-492c-8f5b-fa78cb20d61d", "choice_type": "single"}
+{"question": "1st drug to be used in absence seizures", "exp": null, "cop": 3, "opa": "Phenytoin", "opb": "BZD", "opc": "Valproate", "opd": "Carbamazepine", "subject_name": "Medicine", "topic_name": null, "id": "ce4db8ab-8e01-47ab-a672-8def0fac5e6a", "choice_type": "single"}
+{"question": "This clinical sign is seen in ", "exp": "This is a contrast study showing string sign of KantorIn Crohn&;s disease, edema, bowel wall thickening, and fibrosis of the bowel wall within the mass account for the radiographic \"string sign\" of a narrowed intestinal lumen.Ref: Harrison 19e pg: 1953", "cop": 3, "opa": "Carcinoma colon", "opb": "Ulcerative colitis", "opc": "Crohn's disease", "opd": "Tuberculosis", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "b2bc73cd-03cd-4736-979a-abf00d869c40", "choice_type": "single"}
+{"question": "Lung carcinomas most frequently metastasize to", "exp": null, "cop": 1, "opa": "Brain", "opb": "Liver", "opc": "Adrenal", "opd": "Bone", "subject_name": "Medicine", "topic_name": null, "id": "81b7c741-8297-42a7-bee3-78feead68c26", "choice_type": "single"}
+{"question": "Northern blotting is used for analysis of", "exp": null, "cop": 2, "opa": "DNA", "opb": "RNA", "opc": "Proteins", "opd": "Polysaccharides", "subject_name": "Medicine", "topic_name": null, "id": "5eb64642-346e-482c-8b26-65ec19fcbf12", "choice_type": "single"}
+{"question": "The lowest recurrence of peptic ulcer is associated with", "exp": "Answer is C (Vagotomy + Antrectomy) Repeat Vagotomy with Antrectomy is associated with lowest recurrence rates.", "cop": 3, "opa": "Gastric resection", "opb": "Vagotomy + drainage", "opc": "Vagotomy + Antrectomy", "opd": "Highly selective vagotomy", "subject_name": "Medicine", "topic_name": null, "id": "6b41ccd3-4535-4eb7-83e5-532869752e83", "choice_type": "single"}
+{"question": "The commonest site for impaction of foreign body in the Gastro Intestinal Tract is", "exp": null, "cop": 4, "opa": "Ileocaecal junction", "opb": "Pyriform fossa", "opc": "Pyloric sphincter", "opd": "Cricopharynx", "subject_name": "Medicine", "topic_name": null, "id": "8067a822-5a44-40c7-a9ca-c2faa80fd648", "choice_type": "single"}
+{"question": "In Beta thalassemia, there is", "exp": "Ans. is 'b' Decrease in Beta chain and increase in alpha chain The abnormality in Beta thalassemia is a total lack of or a reduction in the synthesis of structurally normal Beta Globin chains with unimpaired synthesis of alpha chains.The hematologic consequence of this is not only low intracellular haemoglobin but also relative excess of alpha chains.The free alpha chains tend to aggregate into insoluble inclusions within erythrocytes and their precursors causing premature destruction of maturing erythroblasts within the marrow ( ineffective erythropoises)* as well as lyses of mature red cells in spleen.", "cop": 2, "opa": "Increase in beta chain,decrease in alpha chain", "opb": "Decrease in beta chain ,increase in alpha chain", "opc": "Decrease in beta chain decrease in alpha chain", "opd": "Increase in beta chain, increase alpha chain", "subject_name": "Medicine", "topic_name": "Blood", "id": "b658dbe9-422a-4e0b-b466-dc7c089681c0", "choice_type": "single"}
+{"question": "Most common ophthalmic complication of diabetes mellitus is", "exp": "(A) Retinopathy # Most common ophthalmic complication of diabetes mellitus is diabetic retinopathy, with diabetic retinopathy being the most common preventable cause of blindness> Ocular features of diabetes mellitus: Blurring of vision Cataract formation Diabetic pupil Diabetic retinopathy Macular edema Retinal neovascularization Vitreous hemorrhage Retinal detachment Neovascularization of the iris (i.e. Rubeosis iridis) Cranial nerveCN III, IV and VI palsy> Blindness is primarily the result of progressive diabetic retinopathy and clinically significant macular edema.> Diabetic retinopathy is classified into two stages: nonproliferative and proliferative. Nonproliferative diabetic retinopathy usually appears late in the first decade or early in the second decade of the disease and is marked by retinal vascular microaneurysms, blot hemorrhages, and cotton wool spots.> Mild nonproliferative retinopathy progresses to more extensive disease, characterized by changes in venous vessel caliber, intraretinal microvascular abnormalities, and more numerous microaneurysms and hemorrhages. The pathophysiologic mechanisms invoked in nonproliferative retinopathy include loss of retinal pericytes, increased retinal vascular permeability, alterations in retinal blood flow, and abnormal retinal microvasculature, all of which lead to retinal ischemia.", "cop": 1, "opa": "Retinopathy", "opb": "Cataract", "opc": "Rubeosis iridis", "opd": "Vitreous hemorrhage", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "1cbc1e30-83a5-441e-88ae-bdbb01c3c049", "choice_type": "single"}
+{"question": "Multiple Sclerosis is", "exp": "(D) Demylinating disorder > Multiple sclerosis (MS) is characterized by a triad of inflammation, demyelination, and gliosis (scarring); the course can be relapsing-remitting or progressive. Lesions of MS are typically disseminated in time and location.", "cop": 4, "opa": "Toxic disorder", "opb": "Infectious disorder", "opc": "Degenerative disorder", "opd": "Demylinating disorder", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "2a7616fa-c573-49f5-9ef7-82e570c41782", "choice_type": "single"}
+{"question": "Opsoclonus as a paraneoplastic manifestation is most commonly seen in", "exp": "Opsoclonus affects children more frequently than adults. Screening for occult neuroblastoma is necessary in all patients with opsoclonus.", "cop": 4, "opa": "Renal cell carcinoma", "opb": "Colon cancer", "opc": "Hepatocellular cancer", "opd": "Neuroblastoma", "subject_name": "Medicine", "topic_name": null, "id": "dd67b805-9e7f-471b-adb2-9c573b33655a", "choice_type": "single"}
+{"question": "Most reliable investigation in the diagnosis of pulmonary embolism is", "exp": "The first line diagnostic test for pulmonary embolism is CT pulmonary angiography(CTPA).It has the advantages of visualising the distribution and extent of the emboli,or highlighting an alternative diagnosis,such as consolidation,pneumothorax or aoic dissection. Chest X-ray is most useful in excluding key differential diagnosis such as pneumonia, pneumothorax etc. ECG changes include sinus tachycardia, anterior T-wave inversion and S1Q3T3 pattern. The most common finding in ECG of pulmonary embolism is sinus tachycardia whereas specific finding is S1Q3T3 pattern. Reference:Davidson's Medicine:22nd edition,page no:722.", "cop": 2, "opa": "Lung scan", "opb": "Angiography", "opc": "Differential gas tension", "opd": "ECG", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "c3a8638b-668a-4a12-8717-916821595390", "choice_type": "single"}
+{"question": "An adult hypeensive male presented with sudden onset severe headache and vomiting. On examination, there is marked neck rigidity and no focal neurological deficit was found. The symptoms are most likely d/t", "exp": "Harrison's principles of internal medicine 17 th edition. *SAH characterised by headache ,which is generalised and sudden onset ,neckstiffness,vomiting is common *Althoughsudden headache without focal neurological deficit may occur as hallmark feature of aneurysmal rupure ,but focal neurological deficit may occur .", "cop": 4, "opa": "Intracerebral parenchymal hemorrhage", "opb": "Ischemic stroke", "opc": "Meningitis", "opd": "Subarachnoid hemorrhage", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "1cce1318-7476-4963-b3ee-76ad75132c1d", "choice_type": "single"}
+{"question": "Fractional excretion of sodium < 1 is seen in", "exp": "Ans. is 'a' i.e., Pre renal azotemia * Urine Diagnostic Indices in differentiation of prerenal Vs Intrinsic Renal FailureDiagnostic IndexPrerenalARFIntrinsic Renal ARF* Fractional Excretion of Na<1> 1* Urine Sodium Concentration (mmol/L)<10>20* Urine Creatinine to Plasma Creatinine ratio>40<20* Urine osmolality (mosmol/kgH20)>500~ 300* Renal failure Index<1>1* Urine urea Nitrogen to plasma urea Nitrogen>8<3* Plasma BUN/Creatinine Ratio>20< 10-15* Urinary SedimentHyalineCastsMuddy Brown Granular Cast* Urine Specific gravity> 1.020-1.010o Acute tubular necrosis is a cause of intrinsic ARF.", "cop": 1, "opa": "Pre renal azotemia", "opb": "Acute tubular necrosis", "opc": "Acute ureteral obstruction", "opd": "Interstitial nephritis", "subject_name": "Medicine", "topic_name": "Chronic Kidney Disease and Uremia", "id": "0cff9f11-f198-4fb3-ad70-626de3916d5b", "choice_type": "single"}
+{"question": "Lucio phenomenon is treated with", "exp": "Answer- D. Exchange transfusionLucion phenomenon is a very rare comcomplication of leprosy.It presents as sudden necrotizing vasculopathy in Patients with longstanding, untreated lepromatous leprosy.TreatmentOptimal wound care and therapy for bacteremia are indicated. Ulcers tend to be chronic and heal poorly.In severe cases exchange transfusion is indicated.", "cop": 4, "opa": "Steroids", "opb": "Lenalidomide", "opc": "Clofazimine", "opd": "Exchange transfusion", "subject_name": "Medicine", "topic_name": null, "id": "fb158faa-588e-4410-a86d-c14a40f0e02d", "choice_type": "single"}
+{"question": "Pure word blindness occurs due to lesion in", "exp": "Answer- B. Posterior cerebral aeryPure alexia almost always involves an infarct to the left posterior cerebral aery which perfuses the splenium of the corpus callosum and left visual coex, among other things)", "cop": 2, "opa": "Anterior cerebral aery", "opb": "Posterior cerebral aery", "opc": "Middle cerebral aery", "opd": "Spinal aery", "subject_name": "Medicine", "topic_name": null, "id": "ccd27dbe-25d3-4acd-89c5-a731b41d6765", "choice_type": "single"}
+{"question": "Drug used in multiple sclerosis", "exp": "*beta interferon have a modest effect on exacerbrations and disease progression in relapsing-remitting MS. Ref Harrison20th edition pg 2456", "cop": 2, "opa": "Inferferon alpha", "opb": "Interferon beta", "opc": "Interferon gamma", "opd": "Infliximab -", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "c481151e-d85f-4e0b-acef-fb4bbd0bf138", "choice_type": "single"}
+{"question": "Waddling gait is seen in", "exp": "*In muscular dystrophies the gait of an individual disclose a lordotic posture caused by combined trunk and hip weakness,frequently exaggerated by toe walking. A waddling gait is caused by the inability of weak hip muscles to prevent hip drop or hip dip . Muscular dystrophy A waddling gait is a symptom of several types of MD, including: Duchenne MD. This disorder occurs almost exclusively in boys and affects the arms, legs, and pelvis. One of the first signs is having difficulty crawling or getting up from the floor Ref Harrison20th edition pg 2456", "cop": 1, "opa": "Muscular dystrophy", "opb": "Traumatic Paraphegia", "opc": "Parkinsonism", "opd": "Cerebellar infarct", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "871cd478-c73c-4e9a-a2f5-b91475707cbe", "choice_type": "single"}
+{"question": "Low serum alkaline phosphatase is seen with", "exp": "SAP| - Hypophosphatasia SAP| - Rickets, increase PTH SAP|||- Paget's SAP Normal - Hypoparathyroidism,Pseudo hypoparathyroidism,Multiple myeloma,Osteoporosis", "cop": 2, "opa": "Hypoparathyroidism", "opb": "Hypophosphatasia", "opc": "Hyperparathyroidism", "opd": "Pseudo-hypoparathyroidism", "subject_name": "Medicine", "topic_name": "Disorders of Parathyroid Gland", "id": "debd7601-6301-4c75-8d49-4820e554eb13", "choice_type": "single"}
+{"question": "Acute Viral hepatitis A & E are diagnosed by", "exp": "(A) IgM A & IgM E CLINICAL AND EPIDEMIOLOGIC FEATURES OF VIRAL HEPATITISFeatureHAVHBVHCVHDVHEV* Incubation (days)15-45, mean 3030-180, mean 60-9015-160, mean 5030-180, mean 60-9014-60, mean 40* OnsetAcuteInsidious or acuteInsidiousInsidious or acuteAcute* Age preferenceChildren, young adultsYoung adults (sexual and percutaneous), babies, toddlersAny age, but more common in adultsAny age (similar to HBV)Young adults (20-10 years)Transmission* Fecal-oral+ + +---+ + +* PercutaneousUnusual+ + ++ + ++ + +-* Perinatal-+ + +++-* Sexual++ +++ +-Clinical* SeverityMildOccasionally severeModerateOccasionally severeMild* Fulminant0.1%0.1-1%0.1%5-20%1-2%", "cop": 1, "opa": "IgM A & IgM E", "opb": "IgG A & IgG E", "opc": "Liver biosy", "opd": "Virus in stool", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "bff7e9c7-e4c5-4c75-84f0-637fd1239938", "choice_type": "single"}
+{"question": "The regional aerial resistance of the mesentery and kidney vessels is reduced by", "exp": "In hyperdynamic sepsis, the peripheral aeriolar tone and BP are low but the cardiac output is often high; therefore the vasoconstrictor noradrenaline (norepinephrine) is appropriate to restore BP, usually at the price of some reduction in cardiac output.In most cases, a vasoconstrictor such as noradrenaline (norepinephrine) is necessary to increase SVR and BP, while an inotrope (dobutamine) may be necessary to maintain cardiac output. In the later stages of severe sepsis, the essential problem is at the microcirculatory level. Oxygen uptake and utilisation are impaired due to failure of the regional distribution of flow and direct cellular toxicity despite adequate global oxygen delivery. Tissue oxygenation may be improved and aerobic metabolism sustained by reducing demand, i.e. metabolic rate. ref:Davidsson&;s principles and practices of medicine,ed 21,pg no 598", "cop": 3, "opa": "Dopamine", "opb": "Dobutamine", "opc": "Nor adrenaline", "opd": "Isoprenaline", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "32dd536f-b070-4428-af6e-b5925aaa9de6", "choice_type": "single"}
+{"question": "Kidney size is normal in", "exp": "Kidney size :\nNormal - Medullary sponge kidney, Simple renal cysts.\nSmall - Medullary Cystic kidney, Nephronophthisis .", "cop": 4, "opa": "Nephronophthisis", "opb": "ADPCKD", "opc": "Acquired renal cysts", "opd": "Medullary sponge kidney", "subject_name": "Medicine", "topic_name": null, "id": "0fc975a9-f7a3-4153-9d50-13cc83ff6c34", "choice_type": "single"}
+{"question": "Non contrast ct is investigation of choice for", "exp": "16 (D) (Interstitial lung disease) (707- Davidson 22nd)High resolution CT is superior to the plain chest x ray for early defection and confirmation of suspected ILD (2163-H 18TH).Clinical assessment including chest x-ray, pulmonary function test, haematology, biochemical andimmunological investigations | High -resolution CT||| |Appearances consistent with usual interstitial pneumonia Inconsistent clinical or CT appearances Appearances consistent with another diffuse parenchymal lung disease e,g, sarcoid| | |Diagnose idiopathic pulmonary fibrosis Further investigations, e,g, bronchoalveolar lavage, transbronchial biopsy, surgical biopsy Diagnose and treat accordinglyAlgorithm for the investigation of patients with interstitial lung disease following initial clinical and chest X-ray examination.", "cop": 4, "opa": "Mediastinal mass", "opb": "Lung mass", "opc": "Nodular thickening of pleura", "opd": "Interstitial lung disease", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "93ba1b85-24b9-4143-a1bb-93f89c1e87e1", "choice_type": "single"}
+{"question": "Gibson’s murmur is a feature of", "exp": "Continuous machinery murmur of PDA is also called Gibson’s murmur.", "cop": 1, "opa": "Patent Ductus arteriosus", "opb": "Mitral Valve prolapse", "opc": "Pulmonary regurgitation", "opd": "Mitral regurgitation", "subject_name": "Medicine", "topic_name": null, "id": "68a94c66-0a23-4014-a30a-0bcd9f2a3f16", "choice_type": "single"}
+{"question": "Most common Posterior fossa Brain tumor in children is", "exp": "(B) Pilocytic astrocytoma# BRAIN TUMOURS IN CHILDREN# Cystic Cerebellar astrocytoma:> These comprises about 33% of all posterior fossa tumors in children.> Represents 25% of all pediatric tumors. Presentation is 9 years in average. Typically, presents as a laterally located cyst with a well-defined solid component. Tumor may be cystic or solid and located medially in Vermis or laterally in Cerebellar hemisphere. PILOCYTIC ASTROCYTOMA IN POSTERIOR FOSSATumorRelative Incidence (%)PresentationDiagnosisPrognosisMedulloblastoma35-402-3 months of headaches, vomiting, tunical ataxiaHeterogeneous or homogeneously enhancing fourth ventricular mass; may be disseminated65-85% survival; dependent on stage/ type; poorer (20-70%) in infantsCerebellar astrocytoma35-403-6 months of limb ataxia; secondary headaches, vomitingCerebellar hemisphere mass, usually with cystic and solid (mural nodule) components90-100% survival in total resected pilocytic typeBrain stem glioma10-151-4 months of double vision, unsteadiness, weakness & other cranial nerve deficits, facial weakness, swallowing deficits, and other deficitsDiffusely expanded, minimally or partially enhancing mass in 80%; 20% more focal cervicomedullary lesion # Medulloblastoma: Initially arises in inferior medullary velum. It grows to fill 4th ventricle by infiltrating the surrounding structures. Earlier, it is thought to be raised from medulloblastoma cells, which do not exist. Better it to be included in the family of PNETs.# Hemangioblastoma accounts about 7-12% of all posterior fossa tumors. Hemangioblastomas occurs 70% in Cerebellum & are cystic in nature, and presenting at the age of 30-40 years, more common in males, and are associated with von Hippel-Lindau disease.", "cop": 2, "opa": "Medulloblastoma", "opb": "Pilocytic astrocytoma", "opc": "Hemangioblastoma", "opd": "Occipital fossa tumor * NIMHANS Pattern Post MBBS 2017; NIMHANS DM Neurology 2012", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "5c5d25e6-3bd5-4a66-a996-0b98824cfe6b", "choice_type": "single"}
+{"question": "A young girl presents with repeated episodes of throbbing occipital headache associated with ataxia and veigo. The family history is positive for similar headaches in her mother. Most likely diagnosis is", "exp": "basilar migraine is a rare type of migraine that begins in the brain stem. A basilar migraine may be caused by a constriction of blood vessels that limit blood flow to the brain. Other conditions that restrict blood flow, such as touous blood vessels, may also cause basilar migraines Ref Harrison20th edition pg 2345", "cop": 2, "opa": "Vestibular Neuronitis", "opb": "Basilar migraine", "opc": "Cluster headache", "opd": "Tension headache", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "90c93524-02b5-4831-bcab-081390ace0fa", "choice_type": "single"}
+{"question": "Total score in Glasgow Coma Scale of a conscious person is", "exp": "(C) 15 GLASGOW COMA SCALE RESPONSESCORE# EYE OPENING Opens eyes spontaneously4 Opens eyes in response to speech3 Open eyes in response to painful stimulation (Eg, endotracheal suctioning)2 Does not open eyes in response to any stimulation1# MOTOR RESPONSE Follows commands6 Makes localized movement in response to painful stimulation5 Makes nonpurposeful movement in response to noxious stimulation4 Flexes upper extremities/extends lower extremities in response to pain3 Extends all extremities in response to pain2 Makes no response to noxious stimuli1# VERBAL RESPONSE Is oriented to person, place, & time5 Converses, may be confused4 Replies with inappropriate words3 Makes incomprehensible sounds2 Makes no response1", "cop": 3, "opa": "8", "opb": "3", "opc": "15", "opd": "10", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "586a749f-3814-4c16-b54f-ec854184edff", "choice_type": "single"}
+{"question": "Most common organic cause of erectile dysfunction", "exp": "M/c organic cause of ED is Atherosclerosis.", "cop": 1, "opa": "Atherosclerosis", "opb": "Multiple sclerosis", "opc": "Penile fibrosis", "opd": "Peyronie's disease", "subject_name": "Medicine", "topic_name": null, "id": "b4faea52-ea78-48d5-81bf-50f06396314b", "choice_type": "single"}
+{"question": "Incubation period of syphilis is", "exp": "Ans. a (9-90 days). (Ref. Harrison, Medicine, 18th/Ch. 169; Table 170-1)SYPHILIS# L Pallidum enters foetal circulation after 20th week of gestation with disappearance of cytotrophoblast in villi (Kerala-2001).# Basic pathology is obliterative endarteritis, in congenital syphilis.# Placenta becomes bulky and spirochaete can hardly be found in placenta.# Spirochaete can however be detected from maculopapular rash in baby.# Irrespective of the serology, treatment should be repeated in subsequent pregnancies.# Incubation period of syphilis is 9-90 days# In blood transfusion and in congenital syphilis, no chancre occurs.# Dark ground microscopic examination is useful but negative results do not exclude diagnosis of syphilis.# Diagnosis by microscopy is applicable in primary and secondary stages and congenital syphilis.# Wet film prepared with exudates is seen under dark ground microscope.# T. pallidum shows slow movement with slender spiral structure# However, serology remains the best diagnostic test for syphilis.# Serological tests for syphilis are:- Tests for antibodies reacting with cardiolipin antigen (Non-specific reagin test, standard tests for syphilis)* VDRL is std test for syphilis- Tests for antibodies reacting with group specific treponemal antigens.- Tests for specific antibodies to pathologic T. pallidum.Comparison of the Treponemes and Associated DiseasesFeatureVenereal SyphilisYawsEndemic SyphilisPintaOrganismT. pallidum subsp. pallidumT. pallidum subsp. pertenueT. pallidum subsp. endemicumT. carateumModes of transmissionSexual, transplacentalSkin-to-skinHousehold contacts: mouth-to-mouth or via shared drinking/ eating utensilsSkin-to-skinUsual age of acquisitionAdulthood or in uteroEarly childhoodEarly childhoodLate childhoodPrimary lesionCutaneous ulcer (chancre)Papilloma, often ulcerativeRarely seenNonulcerating papule with satellites, pruriticLocationGenital, oral, analExtremitiesOralExtremities, faceSecondary lesionsMucocutaneous lesions; condylomata lataCutaneous papul osquamous lesions; osteoperiostitisFlorid mucocutaneous lesions (mucous patch, split papule, condyloma latum); osteoperiostitisPintides, pigmented, pruriticInfectious relapses25%CommonUnknownNoneLate complicationsGummas, cardiovascular and CNS involve- mentaDestructive gummas of skin, bone, cartilageDestructive gummas of skin, bone, cartilageNondestructive, dyschromic, achromic macules", "cop": 1, "opa": "9-90 days", "opb": "2-6 weeks", "opc": "1-3 weeks", "opd": "5-7 days", "subject_name": "Medicine", "topic_name": "Infection", "id": "5df646e0-6e1c-4812-adc5-e8aedbef7d51", "choice_type": "single"}
+{"question": "The plateau (phase 2) of the ventricular myocyte action potential", "exp": "During the plateau phase (phase 2), the membrane&;s conductance to K+ is low. However, the electrochemical gradient for K+ is so strong that some K+ does leak out. The K+ efflux is balanced by the inward movement of Ca2+ and Na + through the slow Ca2+ channels so that the membrane potential plateaus above 0 mV. Sympathetic stimulation and drugs, which increase the concentration of cytosolic Ca2+ (digitalis), shoen the duration of the plateau phase by increasing K+. Ref - Harrison&;s internal medicine 20e pg 1716", "cop": 3, "opa": "Describes when Ca2+ is the only ion moving through the membrane", "opb": "Describes when Ca2+ influx is balanced by Na+ efflux", "opc": "Describes when Ca2+ and Na+ influx is balanced by K+ efflux", "opd": "Can be prolonged by sympathetic nerve stimulation", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "7477446f-2bbb-45fa-a08f-3f2c107d7f60", "choice_type": "single"}
+{"question": "Botulism characterised by a) Seizure b) Fever c) Ascending paralysis d) Descending symmetrical paralysis e) Blurring of vision", "exp": null, "cop": 4, "opa": "abc", "opb": "bd", "opc": "cde", "opd": "de", "subject_name": "Medicine", "topic_name": null, "id": "2d007643-4f63-4fb0-b5b9-baca6096f9fb", "choice_type": "single"}
+{"question": "Mutation in sickle cell disease is a", "exp": "It is a point mutation at the 6th code of β globin chain leading to substitution of glutamine by valine.", "cop": 2, "opa": "Silence mutation", "opb": "Missense mutation", "opc": "Nonsense mutation", "opd": "Frame shift mutation", "subject_name": "Medicine", "topic_name": null, "id": "4646808f-9e6a-439b-9f7f-6c0c8571a677", "choice_type": "single"}
+{"question": "Sinus tachycardia is seen in", "exp": null, "cop": 4, "opa": "Beta blocker therapy", "opb": "Athletes", "opc": "Hypothyroidism", "opd": "Severe anaemia", "subject_name": "Medicine", "topic_name": null, "id": "b6753cfc-22be-4e74-8ed6-d29f4ec3b24d", "choice_type": "single"}
+{"question": "Banana shaped left ventricle is seen in", "exp": "Ans. is 'a' i.e., HOCM Spherical ventricle Dilated cardiomyopathy Apical ballooning Stress cardiomyopathy/Tako-Tsubo Spade-shaped ventricle Apical hyperophic cardiomyopathy Distoion of ventricle Myocardial infarctions/aneurysms/remodeling Banana-shaped ventricle Hyperophic cardiomyopathy", "cop": 1, "opa": "HOCM", "opb": "DCM", "opc": "RCM", "opd": "Takotsubo cardiomyopathy", "subject_name": "Medicine", "topic_name": null, "id": "1736babc-6c4a-4740-9ca1-8251f91206f6", "choice_type": "single"}
+{"question": "Multiple brain abscesses are characteristic of", "exp": "(C) Hematogenous # Metastatic abscesses are commonly located in the parietal, frontal, or temporal lobes, and multiple brain abscesses are usually the result of metastatic spread from remote primary foci, accounting for 6% to 22% of cases.> Most common cause of brain abscesses was haematogenous spread, accounting for 26% of the episodes.", "cop": 3, "opa": "Cyanotic heart disease", "opb": "Otitis media", "opc": "Hematogenous", "opd": "Hemorrhage", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "0807011b-be7d-44b3-92e7-f96913a34d19", "choice_type": "single"}
+{"question": "30 year old female comes with visual defects, breast engorgement and Amenorrhea. Investigation of choice is", "exp": "This is likely to be a case of pituitary adenoma. The most common pituitary adenoma causing the symptoms is prolactinoma.", "cop": 2, "opa": "CT brain", "opb": "Serum prolactin", "opc": "Biopsy", "opd": "Mr angiography", "subject_name": "Medicine", "topic_name": null, "id": "9c0aee66-1cbf-484e-b2b9-333ec407c3c7", "choice_type": "single"}
+{"question": "Acephalgic migraine is", "exp": "Patients with acephalgic migraine (typical aura without headache) experience recurrent neurologic symptoms, often with nausea or vomiting, but with little or no headache. Veigo can be prominent; it has been estimated that one-third of patients referred for veigo or dizziness have a primary diagnosis of migraine. Migraine aura can have prominent brainstem symptoms, and the terms basilar aery and basilar-type migraine have now been replaced by migraine with brainstem aura. Ref Harrison 20th edition page 3096, 3097 ( table 422-1)", "cop": 3, "opa": "Migraine without aura", "opb": "Migraine with typical aura with headache", "opc": "Migraine with typical aura with out headache", "opd": "Migraine with brainstem aura", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "c412a524-0841-4e95-90ae-8482d73c294e", "choice_type": "single"}
+{"question": "The most common cause of sudden death in sarcoidosis is", "exp": "Ans. is 'c' i.e., Arrhythmias", "cop": 3, "opa": "Pneumonia", "opb": "Cor pulmonale", "opc": "Arrythmias", "opd": "Liver failure", "subject_name": "Medicine", "topic_name": null, "id": "e71dcbb5-2fea-4477-b7ec-e6a814431ef5", "choice_type": "single"}
+{"question": "Delusions of persecution, grandiosity and infidelity are features of", "exp": "i.e. (Paranoid schizophrenia): (2721-H 17th)PARANOID SCHIZOPHRENIACharacterized by1. Delusion of persecution2. Delusion of reference3. Delusion of grandeur (or grandiosity)4. Delusion of infidelity (or Jealousy)5. Schneider's first rank symptoms6. The delusions are usually well-systematized7. The personality deterioration is much less than in other types of schizophrenias8. Patients may be apprehensive (due to delusions & hallucination)SCHIZOPHRENIACATATONICClinical presentation is dominated by profound changes in motor activity, negativism and echolalia or echopraxiaPARANOIDProminent preoccupation with a specific delusional systemDISORGANIZEDDisorganized speech and behavior are accompanied by a superficial or silly affectRESIDUALNegative symptomatology exists in the absence of delusions, hallucination or motor disorders", "cop": 3, "opa": "Bipolar disorders", "opb": "Obsessive compulsive disorder", "opc": "Paranoid schizophrenia", "opd": "Borderline personality disorder", "subject_name": "Medicine", "topic_name": "Psychiatry", "id": "6a786bb2-799d-413d-ab36-92550e038f3f", "choice_type": "single"}
+{"question": "The most common location of spider nevi is", "exp": " Ref image - Internet (Researchgate.net)", "cop": 3, "opa": "Abdomen", "opb": "Back", "opc": "Neck and shoulder", "opd": "Upper and lower extremities", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "797daa45-b46b-4901-bb7c-b8121baae1e7", "choice_type": "single"}
+{"question": "Wilson's disease is best diagnosed by", "exp": "Answer is B (Increased urinary copper excretion): Wilson's Disease is charachterized by increased urinary copper excretion. Increased urinary copper excretion over 24 hours is an extremely useful test (+++) for diagnosis of Wilson's disease. Wilson's disease is associated with low levels of serum ceruloplasmin and high urinary copper excretion The basic defect in Wilson's disease is reduced biliary excretion of copper due to a mutation of gene on chromosome 13 which promotes copper excretion. This leads to accumulation of copper initially in the liver and subsequently in plasma and other systems once liver is saturated. Serum ceruloplasmin is the main copper binding protein in the blood and once excess copper spills into the blood, levels of free ceruloplasmin are decreased. Also excess copper is eventually excreted in urine and hence urinary copper levels are increased or high.", "cop": 2, "opa": "Increased serum ceruloplasmin", "opb": "Increased urinary copper excretion", "opc": "Decreased Liver copper", "opd": "Absence of KF rings", "subject_name": "Medicine", "topic_name": null, "id": "8cae7a9f-f2a0-4275-ac89-438f4748bc2b", "choice_type": "single"}
+{"question": "Of the following vasculitides, coronary aery aneurysms are most often seen in", "exp": "Kawasaki disease is a vasculitis that mostly involves the coronary vessels. It presents as an acute systemic disorder, usually affecting children under 5 years. It occurs mainly in Japan and other Asian countries, such as China and Korea, but other ethnic groups may also be affected. Presentation is with fever, generalised rash, including palms and soles, inflamed oral mucosa and conjunctival congestion resembling a viral exanthema. The cause is unknown but it is thought to be an abnormal immune response to an infectious trigger. Cardiovascular complications include coronary aeritis, leading to myocardial infarction , coronary aery aneurysms , transient coronary dilatation, myocarditis, pericarditis, peripheral vascular insufficiency and gangrene. Treatment is with aspirin (5 mg/kg daily for 14 days) and IV Ig (400 mg/kg daily for 4 days) . Ref Davidsons 23e p1041", "cop": 1, "opa": "Kawasaki disease", "opb": "Giant cell aeritis", "opc": "Wegener's granulomatosis", "opd": "Leukocytoclastic vasculitis", "subject_name": "Medicine", "topic_name": "Immune system", "id": "3a2256a5-2d51-4fa8-89cd-5c31fdaaa3d0", "choice_type": "single"}
+{"question": "A middle aged person is rushed to emergency depament with history of loss of motor power on left upper and lower limb since last 30 minutes. Imaging modality of choice to plan appropriate treatment will be", "exp": "Hemiparesis, or unilateral paresis, is weakness of one entire side of the body (hemi- means \"half\"). Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke Depending on the type of hemiparesis diagnosed, different bodily functions can be affected. Some effects are expected (e.g., paial paralysis of a limb on the affected side). Other impairments, though, can at first seem completely non-related to the limb weakness but are, in fact, a direct result of the damage to the affected side of the brain. Loss of motor skills Edit People with hemiparesis often have difficulties maintaining their balance due to limb weaknesses leading to an inability to properly shift body weight. This makes performing everyday activities such as dressing, eating, grabbing objects, or using the bathroom more difficult. Hemiparesis with origin in the lower section of the brain creates a condition known as ataxia, a loss of both gross and fine motor skills, often manifesting as staggering and stumbling. Pure Motor Hemiparesis, a form of hemiparesis characterized by sided weakness in the leg, arm, and face, is the most commonly diagnosed form of hemiparesis Ref Harrison20th edition pg 2234", "cop": 1, "opa": "CT scan of the head", "opb": "MRI of the brain", "opc": "Carotid doppler study", "opd": "EEG", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "015a6f41-e5a6-4c50-b10e-6275cbe630c7", "choice_type": "single"}
+{"question": "Reed sternberg cells are found in", "exp": "* Reed-Sternberg cells * They are usually derived from B lymphocytes, classically considered crippled germinal center B cells. * Seen against a sea of B cells, they give the tissue a moth-eaten appearance. * They are named after Dorothy Reed Mendenhall and Carl Sternberg, who provided the first definitive microscopic descriptions of Hodgkin&;s disease. * Reed-Sternberg cells are large and are either multinucleated or have a bibbed nucleus (thus resembling an \"owl&;s eye\" appearance) with prominent eosinophilic inclusion-like nucleoli. * Reed-Sternberg cells are CD30 and CD15 positive, usually negative for CD20 and CD45. * The presence of these cells is necessary in the diagnosis of Hodgkin&;s lymphoma - the absence of Reed-Sternberg cells has very high negative predictive value. * They can also be found in reactive lymphadenopathy (such as infectious mononucleosis, carbamazepine associated lymphadenopathy) and very often in other types of non-Hodgkin lymphomas. * A special type of Reed-Sternberg cells is the lacunar histiocyte, whose cytoplasm retracts when fixed in formalin, so the nuclei give the appearance of cells that lie with empty spaces (called lacunae) between them. These are characteristic of the nodular sclerosis subtype of Hodgkin&;s lymphoma REF : HARRISONS 21ST ED", "cop": 1, "opa": "Hodgkin's disease", "opb": "Sickle cell anaemia", "opc": "Thalassemia", "opd": "CML", "subject_name": "Medicine", "topic_name": "All India exam", "id": "dd91bade-3833-49b3-8da4-39c9eddcdad5", "choice_type": "single"}
+{"question": "The minimum possible score in “Glasgow coma scale’’ is", "exp": "Explanation: Glasgow Coma Scale for Head Injury", "cop": 1, "opa": "3", "opb": "5", "opc": "1", "opd": "0", "subject_name": "Medicine", "topic_name": null, "id": "fbb92d97-163d-4751-a27c-be05f1fbf301", "choice_type": "single"}
+{"question": "The investigation of choice for diagnosis of Giant cell Aeritis is", "exp": "Answer is A (Temporal Aery Biopsy): Temporal aery biopsy is the gold standard test for diagnosing giant cell Aeritis - Current Rheumatology The diagnosis of giant cell Aeritis is confirmed by Temporal Aery Biopsy-Harrisons Diagnosis of Giant cell Aeritis (GCA) 50 years\" align=\"left\" height=\"28\" width=\"300\">Diagnosis of GCA is suggested clinically by demonstration of complex offever, anemia and high ESR with or without polymyalgia Rheumatica in a patient > 50 years. Diagnosis is confirmed by biopsy of temporal aery (Gold standard). Colour duplex ultrasonographv of affected temporal aery can show a characteristic halo of edema and stenosis but this investigation is no more sensitive for the diagnosis of GCA than careful physical examination (Current Rheumatology). CT Angiographv and MRI may be useful for assessment of Temporal Aery but are not the investigations of choice.", "cop": 1, "opa": "Temporal Aery biopsy", "opb": "Colour Doppler of Temporal Aery", "opc": "CT Angiography", "opd": "MRI", "subject_name": "Medicine", "topic_name": null, "id": "53b464ff-4967-4de0-a849-7be3c61b003a", "choice_type": "single"}
+{"question": "Most common cause of postural hypotension is", "exp": "(C) Peripheral neuropathy # Causes of postural syncope: In patients receiving antihypertensive or vasodilator drugs and those who are hypovolemic because of diuretics, excessive sweating, diarrhea, vomiting, hemorrhage, or adrenal insufficiency.", "cop": 3, "opa": "Progressive cerebellar degeneration", "opb": "Striatonigral degeneration", "opc": "Peripheral neuropathy", "opd": "Adrenal insufficiency", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "a25bdf47-10b5-4eb3-8bfc-b51b91201a5f", "choice_type": "single"}
+{"question": "Brill Zinsser disease is caused by", "exp": "DiseaseEtiologyDescriptionGroup Affected/Epidemiologic FactorsClinical SyndromeEpidemic typhusRickettsia prowazekiiMaculopapular eruption appearing inaxillae, spreading to trunk and later toextremities; usually spares face, palms, soles;evolves from blanchable macules to confluent eruption with petechiae; rash evanescentin recrudescent typhus (Brill-Zinsserdisease)Exposure to body lice;occurrence of recrudescenttyphus as relapseafter 30-50 yearsHeadache, myalgias;moality rates 10-40% ifuntreated; milder clinicalpresentation in recrudescentformRef: Harrison; 19th edition; Page no: 128", "cop": 4, "opa": "C. burnetti", "opb": "R. typhi", "opc": "R. slovaca", "opd": "R. prowazekii", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "ff034053-2ef2-439e-8621-179a5b9903dc", "choice_type": "single"}
+{"question": "Commonest site of the vermiform appendix is", "exp": null, "cop": 1, "opa": "Retrocaecal", "opb": "Subcaecal", "opc": "Pre-ilial", "opd": "Post-ilial", "subject_name": "Medicine", "topic_name": null, "id": "01510ede-ced1-4c50-b109-8bb8f2f8d365", "choice_type": "single"}
+{"question": "Comment on the diagnosis of the patient based on ECG", "exp": "HR of patient is variable. Notice the change in RR interval in lead II. The HR changes from 200 bpm to 150 bpm. Notice the changes in amplitude of P waves which leads to diagnosis as Multifocal atrial tachycardia(MAT). Choice 2 is ruled out as A. fibrillation has an absent P waves Choice 3 is ruled out as Mobitz II hea block has bradycardia Choice 4 is ruled out as Wolf Parkinson white syndrome has Delta waves with broad qRS complex is not seen", "cop": 1, "opa": "Multifocal atrial tachycardia", "opb": "Atrial fibrillation", "opc": "Mobitz II hea block", "opd": "Wolf Parkinson white syndrome", "subject_name": "Medicine", "topic_name": "ECG and Arrhythmias 1", "id": "ea4f073e-d6af-470f-8d2a-dd196cfc2905", "choice_type": "single"}
+{"question": "Erb's point in cardiology refers to", "exp": "Ans. is 'c' i.e., Right 3rd intercostal space Erb's point refers to the third intercostal space on the left sternal border where both components of S2 (A2 and P2) can be well appreciated. Both components of S2 (A21 and P2) are usually well transmitted to the Erb's point. The physiological splitting of S2 into A2 and P2 is believed to be appreciated best at the Erb point or in the pulmonic area. A2 is best heard over -+ the aoic area in the righ second intercostal space. P2 is best heard over -) the pulmonic area in the left second intercostal space. Second hea sound (52) is best heard over -+ the pulmonc area (Since both A2 and P2 can be heard on the 63.pulmonic area) and at the Erbis Point. Note that even at the pulmonic area A2 is louder than P2 Aoic area - Second intercostal space to the right of the sternum (along right upper sternal border). Pulmonic area - Second intercostal space to the left of the sternum (along left upper sternal border) Erb's point - Third intercostal to the left of the sternum (along left sternal border). Tricuspid area - Fouh or Fifth intercostal space to the left of the sternum (along left lower sternal border). Mitral area (Apex) - Fifth intercostal space on the left midclavicular line", "cop": 3, "opa": "Right 2'd intercostal space", "opb": "Left 2\"d intercostal space", "opc": "Right 3rd intercostal space", "opd": "Left 3\" intercostal space", "subject_name": "Medicine", "topic_name": null, "id": "c5d3f9dc-c21a-4998-ade9-9a941c370c57", "choice_type": "single"}
+{"question": "Child criteria include A/E a) Nutritional status b) S.Bilirubin c) S. Creatinine d) Acid phosphate", "exp": null, "cop": 1, "opa": "cd", "opb": "ad", "opc": "ab", "opd": "bd", "subject_name": "Medicine", "topic_name": null, "id": "c2a82326-0c85-460a-8993-73df912e139a", "choice_type": "single"}
+{"question": "NOT a feature of Horner's syndrome", "exp": "(A) Exophthalmos # HORNER'S SYNDROME:> Enophthalmos, Ptosis, Miosis, & Ipsilateral loss of sweating (Anhydrosis)> Malignant pleural effusion often leads to dyspnea.> Pancoast's (or superior sulcus tumor) syndrome results from local extension of a tumor growing in the apex of the lung with involvement of the eighth cervical and first and second thoracic nerves, with shoulder pain that characteristically radiates in the ulnar distribution of the arm, often with radiologic destruction of the first and second ribs.> Often Horner's syndrome & Pancoast's syndrome coexist.", "cop": 1, "opa": "Exophthalmos", "opb": "Ptosis of upper eyelid", "opc": "Miosis", "opd": "Anhydrosis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "d77edfcc-8984-42cc-97f2-682507eeb943", "choice_type": "single"}
+{"question": "The first sign of tetanus is", "exp": null, "cop": 4, "opa": "Dysphagia", "opb": "Neck stiffness", "opc": "Back pain", "opd": "Trismus", "subject_name": "Medicine", "topic_name": null, "id": "f419e5f8-ffaf-496e-b323-4f8de29fa129", "choice_type": "single"}
+{"question": "Treatment of orthostatic hypotension is", "exp": null, "cop": 3, "opa": "Dopamine", "opb": "Diuretics", "opc": "Fludrocortisone", "opd": "Calcium channel blockers", "subject_name": "Medicine", "topic_name": null, "id": "9a22a264-5893-423d-ba03-21b0840c54ec", "choice_type": "single"}
+{"question": "Herpes simplex encephalitis affects lobe", "exp": "(A) Temporal > Approximately 10% of patients with PCR-documented HSV encephalitis will have a normal MRI, although nearly 90% will have abnormalities in the temporal lobe", "cop": 1, "opa": "Temporal", "opb": "Parietal", "opc": "Occipital", "opd": "Frontal+ Parietal", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "b60a19a2-60ee-4685-b949-3954de8e3cde", "choice_type": "single"}
+{"question": "Adenosine is used in", "exp": "Acute management of narrow QRS PSVT is guided by the clinical presentation. Continuous ECG monitoring should be implemented.For stable individuals, initial therapy takes advantage of the fact that most PSVTs are dependent on AV nodal conduction (AV nodal reentry or ohodromic AV reentry) and therefore likely to respond to sympatholytic and vagotonic maneuvers and drugs (IV adenosine)Harrison 19e pg: 1483", "cop": 3, "opa": "Atrial flutter", "opb": "Atrial fibrillation", "opc": "PSVT", "opd": "Ventricular tachycardia", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "07731bd4-275b-47ff-99cf-ad85dfe696c7", "choice_type": "single"}
+{"question": "Ryle's tube is best put in", "exp": null, "cop": 2, "opa": "Left lateral position", "opb": "Sitting position with neck slightly flexed", "opc": "Sitting position with neck slightly extended", "opd": "Supine position", "subject_name": "Medicine", "topic_name": null, "id": "4223ad5b-26c0-458d-8723-af94b4c4278f", "choice_type": "single"}
+{"question": "In acute pulmonary embolism, the most frequent ECG finding is", "exp": "The most frequently cited abnormality in pulmonary embolism is sinus tachycardia.Apa from that,it also shows S1Q3T3 sign-an S wave in lead I,a Q wave in lead III,and an inveed T wave in lead III.This finding is relatively specific. S1Q3T3 pattern in ECG of pulmonary embolism is also termed as Mc Ginn White Sign. Reference:Harrison's medicine-18th edition,page no:2172.", "cop": 3, "opa": "S1Q3T3 pattern", "opb": "P. pulmonale", "opc": "Sinus tachycardia", "opd": "Right axis detion", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "a2e7eaf9-f5ac-45a2-84b8-4862716b8d20", "choice_type": "single"}
+{"question": "Chances of multiple sclerosis are maximum if", "exp": ". *In multiple sclerosis genetic factors are also relevant ,the risk of familial recurrence in MS is 15%,with highest risk in first degree relatives (age adjusted risk:4-5% for siblings and 2-3 % for parents or off spring . Ref Harrison20th edition pg 2456", "cop": 1, "opa": "Mother has the disease", "opb": "Father has the disease", "opc": "Mother is carrier", "opd": "Father is carrier", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "f803c9ba-36f2-4bfe-b9c0-9374b17d9119", "choice_type": "single"}
+{"question": "A female child with virilization, hypeension with low plasma renin diagnosis is", "exp": "Renin is produced from the juxta glomerular cells in the kidney. It acts on the angiotensinogen produced in the liver and conves it to angiotensin I. The latter is conveed to Angiotensin II by the Angiotensin conveing enzyme in the lung. Angiotensin II is a potent vasoconstrictor and acts on the angiotensin receptors. Both high as well as low levels of renin may be associated with hypeension. This aicle deals with hypeensive disorders associated with low renin levels The causes of low renin hypeension are as follows: Low renin essential hypeension (LREH) Primary aldosteronism Conn's syndrome Glucocoicoid-remediable (GRH)/Familial hyperaldosteronism Type I Familial Type II Liddle syndrome Mineralocoicoid receptor mutation Apparent mineralocoicoid excess (AME) Glucocoicoid resistance Gordon syndrome Congenital adrenal hyperplasia (CAH) 11 beta hydroxylase deficiency Ref Robbins 9 /e pg 158", "cop": 2, "opa": "21 alpha hydroxylase deficiency", "opb": "11 beta hydroxylase deficiency", "opc": "3 beta hydroxylase deficiency", "opd": "Conn's syndrome", "subject_name": "Medicine", "topic_name": "Genetics", "id": "18c44ac0-a3e2-431d-8ab0-7f8755e76a6f", "choice_type": "single"}
+{"question": "The diagnosis of a patient presenting with familial Polyostosis, Precocious puberty and Pigmentation is", "exp": "McCune Albright syndrome :\n\nA polyostotic form of fibrous dysplasia\nCutaneous pigmentation\nEndocrine dysfunction, especially Precocious puberty in girls.\nThe triad of symptoms in the question thus characterizes McCune Albright syndrome and hence is the answer.", "cop": 2, "opa": "Tuberous sclerosis", "opb": "McCune Albright syndrome", "opc": "Klinefelter syndrome", "opd": "SLE", "subject_name": "Medicine", "topic_name": null, "id": "aa877102-e58a-49ee-92ba-fe047a794709", "choice_type": "single"}
+{"question": "Austin flint murmur is seen in cases of", "exp": "The Austin Flint murmur of chronic severe AR is a low-pitched mid to late apical diastolic murmur that sometimes can be confused with MS. The Austin Flint murmur typically decreases in intensity after exposure to vasodilators, whereas the murmur of MS may be accompanied by an opening snap and also may increase in intensity after vasodilators because of the associated increase in cardiac output.", "cop": 2, "opa": "Aortic stenosis", "opb": "Aortic regurgitation", "opc": "Hypertrophic obstructive cardiac myopathy", "opd": "Ventricular stenosis", "subject_name": "Medicine", "topic_name": null, "id": "20911c3b-6e7d-415d-822f-7165f1e27074", "choice_type": "single"}
+{"question": "The most common cause of Recurrent syncope includes", "exp": "(D) Neurocardiogenic # CAUSES OF SYNCOPE# Disorders of vascular tone or blood volume> Vasovagal (vasodepressor; neurocardiogenic)> Postural (orthostatic) hypotension1. Drug induced (especially antihypertensive or vasodilator drugs)2. Peripheral neuropathy (diabetic, alcoholic, nutritional, amyloid)3. Idiopathic postural hypotension4. Multisystem atrophies5. Physical deconditioning6. Sympathectomy7. Acute dysautonomia (Guillain-Barre' syndrome variant)8. Decreased blood volume (adrenal insufficiency, acute blood loss, etc.)> Carotid sinus hypersensitivity> Situational1. Cough2. Micturition3. Defecation4. Valsalva5. DeglutitionE. Glossopharyngeal neuralgia# Cardiovascular disorders> Cardiac arrhythmias1, Bradyarrhythmiasa. Sinus bradycardia, sinoatrial block, sinus arrest, sick-sinus syndromeAtrioventricular block> Tachyarrhythmiasa. Supraventricular tachycardia with structural cardiac diseaseb. Atrial fibrillation associated with the Wolff-Parkinson-White syndromec. Atrial flutter with 1:1 atrioventricular conductiond. Ventricular tachycardia> Other cardiopulmonary etiologies1. Pulmonary embolism2. Pulmonary hypertension3. Atrial myxoma4. Myocardial disease (massive myocardial infarction)5. Left ventricular myocardial restriction or constriction6. Pericardial constriction or tamponade7. Aortic outflow tract obstruction8. Aortic valvular stenosis9. Hypertrophic obstructive cardiomyopathy# Cerebrovascular diseaseA. Vertebrobasilar insufficiencyB. Basilar artery migraine# Other disorders that may resemble syncope> Metabolic1. Hypoxia2. Anemia3. Diminished carbon dioxide due to hyperventilation4. Hypoglycemia> Psychogenic1. Anxiety attacks2. Hysterical fainting> Seizures> Neurocardiogenic syncope is frequently recurrent & commonly precipitated by a hot or crowded environment, alcohol, extreme fatigue, severe pain, hunger, prolonged standing, and emotional or stressful situation.", "cop": 4, "opa": "Carotid sinus hypersensitivity", "opb": "Carotid artery stenosis", "opc": "Embolus", "opd": "Neurocardiogenic", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "ad450ce8-92bb-46e6-bfc3-5ba15307ee33", "choice_type": "single"}
+{"question": "Peripheral pulmonic stenosis is associated with", "exp": "Answer is C and E (William syndrome and Rubella) Peripheral pulmonic stenosis is often associated with various congenital and acquired conditions including Rubella and williams syndrome.", "cop": 3, "opa": "Subaoic stenosis", "opb": "Takayasu's aeritis", "opc": "William syndrome", "opd": "Coarctation of syndrome", "subject_name": "Medicine", "topic_name": null, "id": "ec11ccad-6faa-4e2a-82bb-1569a9836dcf", "choice_type": "single"}
+{"question": "In Burkitts lymphoma , translocation seen is chromosome", "exp": "Ans. is 'b' 8-14 translocation Chromosomal translocations Associated Neoplasms8 - 14 -Burkitt's lymphoma*.Acute lymphocytic leukemia (FAB type L3) Immunoblastic B cell lymphoma*15-17 -Promyelocytic leukemia*4-11 -Acute lymphocytic leukemiaH-14 -Chronic lymphocytic leukemia14- 18 -Some B cell lymphomas6 - 14 -Cystadenocarcinoma of ovary3.8 -Renal adenocarcinoma*, mixed parotid tumour.", "cop": 2, "opa": "12 -14 translocation", "opb": "8-14 translocation", "opc": "4-8 translocation", "opd": "12-18 translocation", "subject_name": "Medicine", "topic_name": "Blood", "id": "a37073e4-8ba2-4402-9bdf-bfabf5e4605b", "choice_type": "single"}
+{"question": "Most common site of rupture of aortic aneurysm in Marfan's syndrome is", "exp": null, "cop": 1, "opa": "Ascending aorta", "opb": "Arch of aorta", "opc": "Descending aorta", "opd": "Abdominal aorta", "subject_name": "Medicine", "topic_name": null, "id": "2a514854-7738-4c6a-986d-f8ede8483864", "choice_type": "single"}
+{"question": "Resistance to chloroquine is common among strains of", "exp": "(A) Plasmodium falciparum", "cop": 1, "opa": "Plasmodium falciparum", "opb": "Plasmodium vivax", "opc": "Plasmodium malariae", "opd": "Plasmodium ovale", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "ea49997a-8fab-4f2b-8892-24d9d9493866", "choice_type": "single"}
+{"question": "Cause of large kidney in CRF are a/e", "exp": null, "cop": 3, "opa": "DM", "opb": "Amyloidosis", "opc": "Benign nephrosclerosis", "opd": "Diffuse GN", "subject_name": "Medicine", "topic_name": null, "id": "ff1e5a83-dc51-4745-9982-5a0159015dae", "choice_type": "single"}
+{"question": "Recommended Dextrose fluid conc. in adult patient is", "exp": null, "cop": 4, "opa": "5%", "opb": "10%", "opc": "25%", "opd": "50%", "subject_name": "Medicine", "topic_name": null, "id": "6e88bb69-cf79-4a1a-8df4-b6bf6c57f1ad", "choice_type": "single"}
+{"question": "The following ECG findings are seen in Hypokalemia", "exp": "Effects of hypokalaemia on the ECG Changes appear when K+ < 2.7 mmol/l Increased amplitude and width of the P wave Prolongation of the PR interval T wave flattening and inversion ST depression Prominent (best seen in the precordial leads) Apparent long QT interval due to fusion of the T and U waves Ref Harrison 20th edition pg 1456", "cop": 1, "opa": "Increased PR interval with ST depression", "opb": "Increased PR interval with peaked T wave", "opc": "Prolonged QT interval with T wave inversion", "opd": "Decreased QT interval with ST depression", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "89572cf7-f800-4014-99a4-2ccd1018b09a", "choice_type": "single"}
+{"question": "Bilirubin is absent in urine because it is", "exp": "Bilirubin metabolism and bile The liver plays a central role in the metabolism of bilirubin and is responsible for the production of bile (Fig. 22.6). Between 425 and 510 mmol (250-300 mg) of unconjugated bilirubin is produced from the catabolism of haem daily. Bilirubin in the blood is normally almost all unconjugated and, because it is not water-soluble, is bound to albumin and does not pass into the urine. Unconjugated bilirubin is taken up by hepatocytes at the sinusoidal membrane, where it is conjugated in the endoplasmic reticulum by UDP-glucuronyl transferase, producing bilirubin mono- and diglucuronide. Impaired conjugation by this enzyme is a cause of inherited hyperbilirubinaemias . These bilirubin conjugates are water-soluble and are expoed into the bile canaliculi by specific carriers on the hepatocyte membranes. The conjugated bilirubin is excreted in the bile and passes into the duodenal lumen. Once in the intestine, conjugated bilirubin is metabolised by colonic bacteria to form stercobilinogen, which may be fuher oxidised to stercobilin. Both stercobilinogen and stercobilin are then excreted in the stool, contributing to its brown colour. Biliary obstruction results in reduced stercobilinogen in the stool, and the stools become pale. A small amount of stercobilinogen (4 mg/day) is absorbed from the bowel, passes through the liver and is excreted in the urine, where it is known as urobilinogen or, following fuher oxidisation, urobilin. The liver secretes 1-2 L of bile daily. Bile contains bile acids (formed from cholesterol), phospholipids, bilirubin and cholesterol. Several biliary transpoer proteins have been identified . Mutations in genes encoding these proteins have been identified in inherited intrahepatic biliary diseases presenting in childhood, and in adult-onset disease such as intrahepatic cholestasis of pregnancy and gallstone formation. Urine tests If the blood level of conjugated bilirubin becomes elevated, e.g. due to liver disease, excess conjugated bilirubin is excreted in the urine, indicating a pathological process. Unconjugated bilirubin is not water-soluble and so is not excreted in the urine. Ref Davidson edition23rd pg 851", "cop": 3, "opa": "Distributed in the body fat", "opb": "Conjugated with giucoronide", "opc": "Not filterable", "opd": "Lipophilic", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "9641b6df-90f2-4955-ae32-7c1bd539e57f", "choice_type": "single"}
+{"question": "Inveed T waves are seen in", "exp": "Ans. is 'c' i.e., Wellen syndrome Severe anterior wall Ischemia (with or without infarction) may cause prominent T-wave inversions in the precordial leads. This pattern (sometimes referred to as Wellens T-waves) is usually associated with a high-grade stenosis of the left anterior descending coronary aery. Hyperkalemia has tall Tented T-waves. Coronary syndrome Xis characterised by blockage of perforators while the epicardial coronary aery is normal. In these patients stenting of coronaries is not useful. Nitrates are mainstay of therapy.", "cop": 3, "opa": "Hyperkalemia", "opb": "Hypehermia", "opc": "Wellen syndrome", "opd": "Coronary syndrome", "subject_name": "Medicine", "topic_name": null, "id": "43d2f2c4-de78-4e99-a939-3bdda628326b", "choice_type": "single"}
+{"question": "Lambert Eaton myasthenic syndrome is", "exp": null, "cop": 4, "opa": "A post synaptic disorder", "opb": "Characterized by preserved deep tendon reflexes", "opc": "Characterized by decremental response in ENMG", "opd": "Associated with autonomic dysfunction", "subject_name": "Medicine", "topic_name": null, "id": "281726b1-419a-4ba4-93a9-c9fdac51045d", "choice_type": "single"}
+{"question": "Pout and snout reflex is associated with", "exp": "(B) Frontal lobe# SNOUT REFLEX:> Isa pouting or pursing of the lips that is elicited by light tapping of the closed lips near the midline.> Contraction of the muscles causes the mouth to resemble a snout.> Is tested in a neurological exam and if present, is a sign of brain damage.> Along with the \"suck\" and palmomental reflexes, snout is considered a frontal release sign.> Are normally inhibited by frontal lobe activity in the brain, but can be \"released\" from inhibition if the frontal lobes are damaged.> Are normally present in infancy, however, and up until about one year of age, leading to the hypothesis that they are primitive or archaic reflexes.> Frontal release signs are seen in disorders that affect the frontal lobes, such as dementias, metabolic encephalopathies, closed head injuries, and hydrocephalus.> All of these disorders produce diffuse cerebral damage, usually involving many areas and systems in addition to the frontal lobes and pyramidal system, so the frontal release signs are not sufficient for a diagnosis.> It is suggested that the snout refl ex should really be reserved for the refl ex elicited by a constant pressure on the philtrum, which results in a puckering of the lips and is essentially a variation of the tactile rooting response.> Rooting responses can be diagnostically useful in patients in whom apathy is a feature of a frontal lobe syndrome and who have normal neuroimaging.> Occasionally one is unsure whether such patients suffer primarily from an affective disorder or an underlying frontal degeneration.> Detection of a rooting refl ex will direct one towards the latter.", "cop": 2, "opa": "Occipetal lobe", "opb": "Frontal lobe", "opc": "Temporal lobe", "opd": "Parietal lobe", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "acbfdc75-bf46-40f4-9de0-fb3144a51f34", "choice_type": "single"}
+{"question": "Todd's palsy can occur after episode of", "exp": "Todd's paralysis, or Todd's palsy. Specialty. Neurology. Todd's paresis (or postictal paresis/paralysis, \"after seizure\") is focal weakness in a pa or all of the body after a seizure. This weakness typically affects appendages and is localized to either the left or right side of the body. Ref Harrison20th edition pg 2456", "cop": 2, "opa": "Generalised tonic clonic seizures", "opb": "Paial motor seizures", "opc": "Atonic seizures", "opd": "Myoclonic seizures", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "7e17f476-dc9b-4225-8fec-32ea1546f763", "choice_type": "single"}
+{"question": "Most common sensorineural hearing loss in adults are due to", "exp": null, "cop": 2, "opa": "Meneries disease", "opb": "Presbycusis", "opc": "Meatal osteoarthritis", "opd": "Osteosclerosis", "subject_name": "Medicine", "topic_name": null, "id": "364d3b85-8af2-4444-a26f-2fc3f8a11d37", "choice_type": "single"}
+{"question": "Kespar Hauser syndrome is due to", "exp": null, "cop": 4, "opa": "Constitutional delayed growth", "opb": "Growth hormone deficiency", "opc": "Growth hormone insensitivity", "opd": "Psychosocial causes", "subject_name": "Medicine", "topic_name": null, "id": "f705db8f-33f4-44dc-8df3-d6f0eb9a0b43", "choice_type": "single"}
+{"question": "Amyotrophic Lateral sclerosis is characterized by", "exp": "Harrison's principles of internal medicine 17th edition. *Pathologic hallmark is death of lower motor neurons (consisting of anterior horn cells in the spinal cord and their brainstem homologues innervating bulbar muscles) and upper, or coicospinal, motor neurons (originating in layer five of the motor coex and descending the pyramidal tract to synapse with lower motor neurons). Although at onset ALS may involve selective loss of only upper or lower motor neurons, it ultimately causes progressive loss of both", "cop": 3, "opa": "Spasticity early sing", "opb": "Sensory loss", "opc": "Anterior and Lateral columns affected", "opd": "Incontinence", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "a1206a5e-f5eb-4c65-bd82-56dbb231fea8", "choice_type": "single"}
+{"question": "Nerve involved in Bell's palsy is", "exp": "Ans. a (Facial nerve). (Ref. Harrison-medicine, 18th/Chapter 376.)Bell's palsy# The most common form of facial paralysis is Bells palsy. Bell's palsy is idiopathic palsy of facial nerve.Clinical Manifestations# The onset of Bell's palsy is fairly abrupt, maximal weakness being attained by 48 h as a general rule.# Pain behind the ear may precede the paralysis for a day or two.# Taste sensation may be lost unilaterally, and hyperacusis may be present.# In some cases there is mild cerebrospinal fluid lymphocytosis.# MRI may reveal swelling and uniform enhancement of the geniculate ganglion and facial nerve, and, in some cases, entrapment of the swollen nerve in the temporal bone.# Approximately 80% of patients recover within a few weeks or months.# The presence of incomplete paralysis in the first week is the most favorable prognostic sign.Pathophysiology# Bell's palsy is associated with the presence of herpes simplex virus type 1 DNA in endoneurial fluid and posterior auricular muscle, suggesting that a reactivation of this virus in the geniculate ganglion may be responsible. However, a causal role for herpes simplex virus in Bell's palsy is unproven.Differential Diagnosis# Tumors that invade the temporal bone (carotid body, cholesteatoma, dermoid).# The Ramsay Hunt syndrome, presumably due to herpes zoster of the geniculate ganglion, consists of a severe facial palsy associated with a vesicular eruption in the pharynx, external auditory canal, and other parts of the cranial integument; often the eighth cranial nerve is affected as well.# Acoustic neuromas frequently involve the facial nerve by local compression.# Infarcts, demyelinating lesions of multiple sclerosis, and tumors are the common pontine lesions that interrupt the facial nerve fibers; other signs of brainstem involvement are usually present.# Bilateral facial paralysis (facial diplegia) occurs in Guillain-Barre' syndrome and also in a form of sarcoidosis known as uveoparotid fever (Heerfordt syndrome).# Lyme disease is a frequent cause of facial palsies in endemic areas.# The rare Melkersson-Rosenthal syndrome consists of a triad of recurrent facial paralysis, recurrent--and eventually permanent--facial (particularly labial) edema, and less constantly, plication of the tongue;# Leprosy frequently involves the facial nerve, and facial neuropathy may also occur in diabetes mellitus.# All these forms of nuclear or peripheral facial palsy must be distinguished from the supranuclear type.# In the latter, the frontalis and orbicularis oculi muscles are involved less than those of the lower part of the face, since the upper facial muscles are innervated by corticobulbar pathways from both motor cortices, whereas the lower facial muscles are innervated only by the opposite hemisphere.Treatment# Symptomatic measures include use of paper tape to depress the upper eyelid during sleep and prevent corneal drying, and Massage of the weakened muscles.# A course of glucocorticoids, given as prednisone 60 to 80 mg daily during the first 5 days and then tapered over the next 5 days, appears to shorten the recovery period and modestly improve the functional outcome.# In one double-blind study, patients treated within 3 days of onset with both prednisone and acyclovir (400 mg five times daily for 10 days) had a better outcome than patients treated with prednisone alone.", "cop": 1, "opa": "Facial nerve", "opb": "Oculomotor nerve", "opc": "Trigeminal nerve", "opd": "Trochlear nerve", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "a9ffac81-60a9-4372-90f0-0c630a43f486", "choice_type": "single"}
+{"question": "The most common cause of organic amnestic syndrome is", "exp": "organic amnesia and the amnestic syndrome. .The amnestic syndrome is characterized by disorientation paicularly in time, impairment of immediate recall, loss of recent memory, retroactive loss of remote memory of varying extent and a tendency to confabulation. Ref Harrison20th edition pg 2776", "cop": 4, "opa": "Alzheimer's disease", "opb": "Concussion", "opc": "Hypoxia", "opd": "Vitamin deficiency", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "95eb1749-6e0d-4056-a8b9-8d4c6a5a7c05", "choice_type": "single"}
+{"question": "Alternating hemiplegia is best described as", "exp": "Alternating hemiplegia is a neurological deficit involving limbs on one side and cranial nerves on the opposite side. This is most often related to cranial nerves III, VI, and XII. Although the involvement of the body may be the same, if the lesion is in the midbrain the eye is affected; if it is located in the pons specifically, the lateral rectus muscle is involved; and if the lesion is located in the medulla, the tongue is affected. Ref - Harrison's principles of internal medicine 20e pg 2071", "cop": 2, "opa": "A neurological deficit involving pairs of cranial nerves", "opb": "A neurological deficit involving limbs on one side and cranial nerves on the other side", "opc": "A neurological deficit involving four limbs (quadriplegia)", "opd": "Neurological deficits involving cranial nerves and limbs on the same side", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "ee2d4d2d-c0b5-4a60-a710-763acd4c5664", "choice_type": "single"}
+{"question": "Dissociated sensory loss is seen in", "exp": "Harrison's principles of internal medicine 17th edition. * The classical presentation in syringomyelia is a central cord syndrome consisting of a dissociated sensory loss and areflexic weakness in upper limbs", "cop": 1, "opa": "Syringomyelia", "opb": "Vitamin B12 deficiency", "opc": "Transverse myelitis", "opd": "Pellagra", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "bc9cdf4f-348a-4e10-9fc5-24b1670ac702", "choice_type": "single"}
+{"question": "Drug used in AV Block a) Isoprenaline b) Dopamine c) Astropine d) Disopyramide e) Propranolol", "exp": null, "cop": 1, "opa": "ac", "opb": "ad", "opc": "bd", "opd": "cd", "subject_name": "Medicine", "topic_name": null, "id": "884cf356-54a6-4629-828b-4e386f9a42dc", "choice_type": "single"}
+{"question": "Most common acute complication of dialysis is", "exp": "Ans. is 'a' i.e., Hypotension Hypotension is the most common acute complication of hemodialysis paicularly among patients with diabetes mellitus. Factors involved are :- Excessive ultrafiltration, with inadequate compensatory vascular filling, impaired vasoactive or autonomic response, osmolar shifts, overzealous use of antihypeensives", "cop": 1, "opa": "Hypotension", "opb": "Bleeding", "opc": "Dementia", "opd": "Muscle cramps", "subject_name": "Medicine", "topic_name": null, "id": "0674d347-99de-4d88-b664-7930487773f6", "choice_type": "single"}
+{"question": "AML transformation common in", "exp": "Aplastic anemia to AML Aplastic anemia (AA) is a clinical syndrome of peripheral blood pancytopenia and a hypocellular bone marrow. Immunosuppressive therapy is a key treatment strategy for AA. Genomic instability in AA does not appear to be a rare event. AA evolves into acute myeloid leukemia (AML) in 5-15% of all cases Ref Davidson 23rd edition pg 969", "cop": 1, "opa": "Aplastic anemia", "opb": "MDS", "opc": "Megakaryocytic thrombocytopenia", "opd": "CLL", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "ca75935b-977b-4641-b50f-4d73817e6cd5", "choice_type": "single"}
+{"question": "Syndrome of inappropriate antidiuretic hormone secretion (SIADH) causes", "exp": "The syndrome of inappropriate antidiuresis (SIAD) is the most frequent cause of euvolemic hyponatremia. Glucocoicoid deficiency, Hypothyroidism, Stress, Drugs are other causes of euvolemic hyponatremia. Common causes of SIAD include pulmonary disease (e.g., pneumonia, tuberculosis, pleural effusion) and central nervous system (CNS) diseases (e.g., tumour, subarachnoid haemorrhage, meningitis). SIAD also occurs with malignancies, most commonly with small-cell lung carcinoma (75% of malignancy-associated SIAD) SIAD is also a frequent complication of ceain drugs, most commonly the selective serotonin reuptake inhibitors (SSRIs). Ref: Harrison 19e pg: 300", "cop": 1, "opa": "Euvolemic hyponatremia", "opb": "Hypovolemic hyponatremia", "opc": "Hypervolemic hyponatremia", "opd": "Hypernatremia", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "ff16f2de-f713-4018-845b-5c94e78089a2", "choice_type": "single"}
+{"question": "Hyperprolactinoma causes", "exp": "(Oligomenorhea): (2287-88- H18th edition; 788-Davidson 21st)HYPER PROLACTINEMIA* Hyper prolactinemia is the most common pituitary hormone hyper secretion syndrome in both men and women* PRL- secreting pituitary adenoma (Prolactinomas) are the most common cause of PRL levels > 200 mg/L* Pregnancy and lactation are the important physiologic causes of hyperprolactinemia* Amenorrhea, galactorrhea and infertility are the hall marks of hyperprolactinemia in women* More commonly hyperprolactinemia develops later in life and leads to oligo menorrhea** and ultimately to amenorrhea* Decreased libido, weight gain and mild hirsutism may also complainMen-* Diminished libido , infertility and visual loss, impotence and oligospermia* True galactorrhea is uncommon in men hypogonadism, osteopenia, reduced muscle mass and decreased beard growth", "cop": 3, "opa": "Inter menstrual bleeding", "opb": "Prolonged menstruation", "opc": "Oligomenorrhea", "opd": "Polymenorrhea", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "1f1221f7-7b31-4d65-a8a6-8ab04e99c87a", "choice_type": "single"}
+{"question": "Metabolic encephalopathy presents with", "exp": "Ans. is 'b' anomic aphasia \"Anomic aphasia is the single most common language disturbance seen in head trauma, metabolic encephalopathy and Alzheimer's disease\" - HarrisonAnomic aphasia is dysfunction where a person is unable to name objects.His articulation, comprehension and repetition are intact, but naming, word finding and spellings are impaired.", "cop": 2, "opa": "Broca's aphais", "opb": "Anomic aphasia", "opc": "Transcortical sensory aphasice", "opd": "transcortical motor aphasia.", "subject_name": "Medicine", "topic_name": "Disorder of Metabolism & Connective Tissue", "id": "8cadb326-8244-4b7a-88f0-0033ffd5c54e", "choice_type": "single"}
+{"question": "Vitamin E toxicity causes", "exp": "(A) Reduce platelet aggregation # Vitamin E Toxicity:> It is likely that patients with vitamin E toxicity have been using vitamin E supplements; obtain the dose and duration of vitamin E usage. Assess concurrent use of anticoagulants or aspirin.> A nutritional assessment for vitamin K deficiency is useful in patients who present with bleeding or an elevated PT.> Effects of acute vitamin E toxicity include the following: Nausea; Gastric distress; Abdominal cramps; Diarrhea; Headache; Fatigue.> Easy bruising and bleeding - Prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT).> Inhibition of platelet aggregation: Diplopia - At dosages as low as 300 IU; Muscle weakness; Creatinuria.> Chronic toxicity effects include all of the above, suppression of other antioxidants, and increased risk of hemorrhagic stroke.", "cop": 1, "opa": "Reduce platelet aggregation", "opb": "Polyneuropathy", "opc": "Spinocerebellar ataxia", "opd": "Retrolental fibroplasia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "ce989026-8bf4-4a60-ac7e-7459d4241688", "choice_type": "single"}
+{"question": "Vitamin E deficiency is similar to", "exp": "(A) Spinocerebellar ataxia # Vitamin E deficiency causes Ataxic neuropathy due to loss of proprioception & myopathy with proximal weakness.", "cop": 1, "opa": "Spinocerebellar ataxia", "opb": "Multiple sclerosis", "opc": "Chronic muscle weakness", "opd": "Peripheral neuropathy", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "48974cba-425f-4b68-9de5-ba1ba45dd5f3", "choice_type": "single"}
+{"question": "Indications of dialysis after failure of medical management include", "exp": "Dialysis is indicated when medical management fails to control volume overload, hyperkalemia, or acidosis; in some toxic ingestions; and when there are severe complications of uremia (asterixis, pericardial rub or effusion, encephalopathy, uremic bleeding). One of the major complications of hemodialysis is hypotension, paicularly in the critically ill. Ref: Harrison 19e 1811", "cop": 3, "opa": "Hypervolemia", "opb": "Hyperkalemia", "opc": "Hypotension", "opd": "Uremia", "subject_name": "Medicine", "topic_name": "Kidney", "id": "7d67310a-44e3-480d-9a2f-28634128ab9e", "choice_type": "single"}
+{"question": "Drug of choice for pseudomembranous colitis", "exp": null, "cop": 2, "opa": "Penicillin", "opb": "Metronidazole", "opc": "Ciprofloxacin", "opd": "Vancomycin", "subject_name": "Medicine", "topic_name": null, "id": "a04768ba-80db-4b38-9f7e-5e9c4bd8ec72", "choice_type": "single"}
+{"question": "Smoking predisposes to carcinoma of a) Bladder b) Ovary c) Buccal mucosa d) Breast e) Stomach", "exp": null, "cop": 1, "opa": "ace", "opb": "acd", "opc": "abd", "opd": "ac", "subject_name": "Medicine", "topic_name": null, "id": "1127b843-ffa7-4c91-b8aa-523aadf7b846", "choice_type": "single"}
+{"question": "Gaisbock syndrome is known as", "exp": "Answer is C (Spurious Polycythemia) Gaisbock syndrome refers to Spurious Polycythemia or Relative Erythrocytosis due to decreased plasma volume.", "cop": 3, "opa": "Primary Familial Polycythemia", "opb": "High Altitude Erythrocytosis", "opc": "Spurious Polycythemia", "opd": "Polycythemia Vera", "subject_name": "Medicine", "topic_name": null, "id": "1e1c61d9-023a-485e-8fc7-85d064d28e63", "choice_type": "single"}
+{"question": "The most common cause of pulmonary infection in cystic fibrosis is", "exp": "Answer is A (Pseudomonas Aeroginosa): The most common cause of Pulmonary infections in cystic fibrosis is Pseudomonas aeroginosa The most common pathogen in CF is Pseudomonas Aeroginosa followed by Staphylococcus' - `Pseudomonsa:Getntnu & Molecular Biology' (Harizon Scientific Press)2008/160 Pulmonary Infection in Cystic Fibrosis The most common cause of Pulmonary infection in cystic fibrosis in children is staphylococcus aureusQ The most common cause of Pulmonary infection in cytic fibrosis in adolescents and adults is Pseudomonas Aeroginosa. The two most common cause of pulmonary infection in cystic fibrosis are staphylococcus aureus and Pseudomonas Aeroginosa. Overall (all age groups) Pseudomonas Aeroginosa is marginally more common than staphylococcus aureus as a cause of pulmonary infection in cystic fibrosis. The most common organism causing chronic lung disease in patients with cystic fibrosis is pseudomonas aeroginosa", "cop": 1, "opa": "Pseudomonas Aeroginosa", "opb": "Staphylococcus Aureus", "opc": "Bukholderia cenocapacea", "opd": "Nontuberculous mycobacteria", "subject_name": "Medicine", "topic_name": null, "id": "cc474c6a-8ba2-4f60-8a1b-55e8c33c62e9", "choice_type": "single"}
+{"question": "Pronator drip is a sign of", "exp": "In medicine, pronator drift refers to a pathologic sign seen during a neurological examination. Jean Alexandre Barre is credited with having first described it; thus it is sometimes known as the Barre test or sign. A positive result indicates spasticity seen in UMN lesion of upper limb Ref Harrison20th edition pg 2345", "cop": 1, "opa": "UMN lesion of upper limb", "opb": "LMN lesion", "opc": "Dorsal syringomyelia", "opd": "Carpel tunnel syndrome", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "90a21de7-4d52-4d4f-8d05-49e32681aff5", "choice_type": "single"}
+{"question": "Hepatomegaly with liver pulsations indicates", "exp": "Ref Harrison 19 th ed pg 1548 AyatoSys pulsqtpuls of liver and marked hepatomegaly are characteristic features of tricuspid regurgitation.", "cop": 1, "opa": "TR", "opb": "MR", "opc": "Pulmonary hypeension", "opd": "MS", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "d62fc2c1-44e4-4c05-a182-c6e262450782", "choice_type": "single"}
+{"question": "Drug of choice for MRSA skin infection is", "exp": "(B) Vancomycin # Drugs used in the treatment of MRSA: Vancomycin, Linezolid, Teicoplanin, Cotrimoxazole, Oxacillin, RifampicinTREATMENT OF COMMON INFECTIONS OF THE SKINDiagnosis/ConditionPrimary TreatmentAlternative TreatmentAnimal bite (prophylaxis or early infection)Amoxicillin/clavulanate, 875/125 mg PO bidDoxycycline, 100 mg PO bidAnimal bitea (established infection)Ampicillin/sulbactam, 1.5-3.0 g IV q6hClindamycin, 600-900 mg IV q8h plusCiprofloxacin, 400 mg IV q12horCefoxitin, 2 g IV q6hBacillary angiomatosisErythromycin, 500 mg PO qidDoxycycline, 100 mg PO bidHerpes simplex (primary genital)Acyclovir, 400 mg PO tid for 10 daysFamciclovir, 250 mg PO tid for 5-10 daysorValacyclovir, 1000 mg PO bid for 10 daysHerpes zoster (immunocompetentAcyclovir, 800 mg PO 5 times daily forFamciclovir, 500 mg PO tid for 7-10 dayshost >50 years of age)7-10 daysorValacyclovir, 1000 mg PO tid for 7 daysCellulitis (staphylococcal or streptococcalb.c)Nafcillin or oxacillin, 2 g IV q4-6hCefazolin, 1-2 g q8horAmpicillin/sulbactam, 1.5-3.0 g IV q6horErythromycin, 0.5-1.0 g IV q6horClindamycin, 600-900 mg IV q8hMRSA skin infectionVancomycin, 1 g IV q12hLinezolid, 600 mg IV q12hNecrotizing fasciitis (group A streptococcalb)Clindamycin, 600-900 mg IV q6-8hplusPenicillin G, 4 million units IV q4hClindamycin, 600-900 mg IV q6-8hplusCephalosporin (first- or second-generation)Necrotizing fasciitis (mixed aerobes and anaerobes)Ampicillin, 2 g IV q4hplusClindamycin, 600-900 mg IV q6-8hplusCiprofloxacin, 400 mg IV q6-8hVancomycin, 1 g IV q6hplusMetronidazole, 500 mg IV q6hplusCiprofloxacin, 400 mg IV q6-8hGas gangreneClindamycin, 600-900 mg IV q6-8hplusPenicillin G, 4 million units IV q4-6hClindamycin, 600-900 mg IV q6-8hplusCefoxitin, 2 g IV q6h", "cop": 2, "opa": "Streptogramin", "opb": "Vancomycin", "opc": "Quinupristin", "opd": "Linezolid", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "1075b481-d491-4c4f-94fe-48d97d1a59b0", "choice_type": "single"}
+{"question": "Monday chest tightness is characteristic of", "exp": null, "cop": 3, "opa": "Asbestosis", "opb": "Coal worker's pneumoconiosis", "opc": "Byssinosis", "opd": "Silicosis", "subject_name": "Medicine", "topic_name": null, "id": "522db970-684d-4b9d-bb35-e36c696d29b6", "choice_type": "single"}
+{"question": "A permanent staining of teeth may be produced in infants due to the administration of following in pregnancy", "exp": "(A) Tetracyclines # Tetracyclines are contraindicated in children > 8 years of age because of mottling of the permanent teeth; doxycycline may be less likely than the other tetracyclines to cause this problem.> Worsening of renal function in patients with preexisting renal dysfunction has been reported with use of tetracycline.> Doxycycline & perhaps Minocycline appear to be free from these renal side effects. Alternative effective agents are nearly always available for use in patients with renal dysfunction. Minocycline can cause vertigo in up to 70% of women receiving therapeutic doses and in a lower percentage of men.", "cop": 1, "opa": "Tetracyclines", "opb": "Chloramphenicol", "opc": "Erythromycin", "opd": "Amoxycillin", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f6a934f5-2810-4c6b-807d-1c32c3bb691b", "choice_type": "single"}
+{"question": "pH is 7.2, pO2 is 46, pCO2 of 80 are indicative of", "exp": "Type 2 respiratory failure paco2 increases ,pao2 decrease. An asthma exacerbation is an acute or subacute episode of progressive worsening of symptoms of asthma, including shoness of breath, wheezing, cough, and chest tightness. Exacerbations are marked by decreases from baseline in objective measures of pulmonary function, such as peak expiratory flow rate and FEV1 . Ref Davidson edition23rd pg 573", "cop": 1, "opa": "Acute exacerbation of asthma", "opb": "Idiopathic pulmonary fibrosis", "opc": "Cystic fibrosis", "opd": "ABPA", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "0d204e25-11ac-4d37-ae4e-e5a0ec7ca089", "choice_type": "single"}
+{"question": "Not seen in pre capillary pulm. hypertension", "exp": null, "cop": 4, "opa": "↑ pressure in pulm circulation", "opb": "↑ capillary pressure", "opc": "Rt-vent. hypertrophy", "opd": "↑ Pulm. wedge pressure", "subject_name": "Medicine", "topic_name": null, "id": "6db6a0dc-5b29-490d-8772-4b6e5a3f669c", "choice_type": "single"}
+{"question": "Pathognomonic of miliary TB", "exp": "Ans. is 'b' i.e., Choroid tubercles on fundus examination", "cop": 2, "opa": "Snow storm appearance in CXR", "opb": "Choroid tubercles on fundus examination", "opc": "Pericardial TB", "opd": "Peritoneal TB", "subject_name": "Medicine", "topic_name": null, "id": "434bace2-83b5-47f7-b6af-fcc7ad5de68e", "choice_type": "single"}
+{"question": "The most impoant regulator of serum 1,25 (OH)2 vitamin D concentration is", "exp": "A major function of parathyroid hormone is to act as a trophic hormone to regulate the rate of formation of 1,25(OH)2 vitamin D. The mechanism by which parathyroid hormone exes this effect may be secondary to its effects on phosphorus metabolism. Other hormones, including prolactin and estrogen, also may playa role in stimulating the production of 1,25(OH)2 vitamin D. Ref - Harrison's internal medicine 20e pg bone effects of PTH 2956-2957 PTH in calcium homeostasis, 2095, 2912, 2931f", "cop": 4, "opa": "Serum calcium", "opb": "Serum magnesium", "opc": "Serum 25 (OH) vitamin D", "opd": "Parathyroid hormone", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "429d02ef-d3c1-4b7a-a428-321f0d01e6f2", "choice_type": "single"}
+{"question": "Volcano ulcers in esophagus are seen in", "exp": "Answer- A. Herpetic esophagitisThe ulcers of herpes esophagitis can haye a punctate, linear, stellate, or volcano-like appearance, often with a thin halo fo edemaat the margins.The ulcers may be clustered together or widely separated with normal intemening mucosa.", "cop": 1, "opa": "Herpetic esophagitis", "opb": "Candida esophagitis", "opc": "Apthous ulcer in crohn", "opd": "HIV esophagitis", "subject_name": "Medicine", "topic_name": null, "id": "1f399162-9a73-4dac-9e59-e8dcd9fb2ece", "choice_type": "single"}
+{"question": "Acute onset of blurred vision and absent pupillary response with rapidly progressive descending muscular weakness manifesting as quadriparesis in an afebrile 20 year old male with preserved sensorium is", "exp": "Answer is B (Botulism): Sudden onset of blurred vision, absent pupillary reflexes (fixed /dilated pupil with lack of accomodation), symmetric descending paralysis progressing to qudriparesis and preserved sensorium suggest a diagnosis of Botulism. Cardinal Feature of Botulism Cranial Nerve Palsies with prominent bulbar palsy (4 'D's of Bulbar Palsy) (Diplopia, Dysahria, Dysphonia, Dysphagia, Ptosis, Loss of Accomodation, Fixed / Dilated pupils) Descending motor paralysis (Extent of paralysis from a few cranial nerves only to quadriperesis depends on dose of toxin) Symmetry of symptoms/signs A clear sensorium Absence of fever Lack of sensory findings", "cop": 2, "opa": "Porphyria", "opb": "Botulism", "opc": "Polio", "opd": "Diphtheria", "subject_name": "Medicine", "topic_name": null, "id": "52c70472-d52e-49a0-a4e6-99711caef783", "choice_type": "single"}
+{"question": "Korsakoff's psychosis is caused by deficiency of vitamin", "exp": null, "cop": 1, "opa": "Vitamin B1", "opb": "Vitamin B2", "opc": "Vitamin C", "opd": "Vitamin D", "subject_name": "Medicine", "topic_name": null, "id": "8dd4ece6-2f04-4f37-b307-d3fe0faad471", "choice_type": "single"}
+{"question": "Rasmussen's aneurysm occurs due to", "exp": "Rasmussen's aneurysm is a pulmonary aery aneurysm adjacent or within a tuberculous cavity. It occurs in up to 5% of patients with such lesions. It may lead to rupture and haemorrhage.", "cop": 3, "opa": "Veebral aery", "opb": "Bronchial aery", "opc": "pulmonary aery", "opd": "Posterior intercostal aery", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "175e1f2d-5e1f-4a50-bfd8-3422f3b507e0", "choice_type": "single"}
+{"question": "For the following dyslipidemias, select the most characteristic finding.Hyperchylomicronemia.", "exp": "Very elevated triglycerides are a prominent feature of this disorder. In the familial type 1 form, the defect is believed to be a deficiency of lipoprotein lipase activity. It is a rare autosomal recessive syndrome, and usually presents in childhood with typical eruptive xanthoma and abdominal pain secondary to acute pancreatitis. Secondary hyperchylomicronemia (diabetes, hypothyroidism, uremia) is a much more common syndrome.", "cop": 2, "opa": "palmar plane xanthomas", "opb": "triglycerides > 1000", "opc": "subcutaneous extensor tendon xanthomas", "opd": "low serum cholesterol", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "cede05dc-91b6-437d-aef7-90a15f8b0e3f", "choice_type": "single"}
+{"question": "A 35 years old man Ramu has fasting and post prandial blood sugar within normal limit but urine sugar is 3 plus (+++). The diagnosis is.", "exp": "Answer is A (Renal Glycosuria): 'Renal glycosuria' is characterized by urinary excretion of glucose at normal concentration of glucose in blood: Patient in question is testing positive for urinary glucose despite normal levels of both fasting and postprandial glucose in blood. This thus leads us to the diagnosis of renal glycosuria.", "cop": 1, "opa": "Renal Glycosuria", "opb": "Pancreatic insufficiency", "opc": "Alimentary glycosuria", "opd": "High carbohydrate diet taken in the morning", "subject_name": "Medicine", "topic_name": null, "id": "f43a56a1-c5cb-48ce-9697-a9048bc3efb6", "choice_type": "single"}
+{"question": "Best method to monitor intracranial pressure is", "exp": "The intraventricular catheter is the most accurate monitoring method.of intracranial pressure The catheter is inseed through the brain into the lateral ventricle. This area of the brain contains liquid (cerebrospinal fluid or CSF) that protects the brain and spinal cord. Ref Harrison20th edition pg 2234", "cop": 1, "opa": "Intraventricular catheter", "opb": "Subarachnoid bolt", "opc": "Intraparenchymal catheter", "opd": "Epidural cathetar", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "1891d023-43da-4fa6-85c4-84e1bc5cc273", "choice_type": "single"}
+{"question": "NOT a characteristic feature of Alzheimer's disease", "exp": "(D) Only recent memory loss[?]ALZHEIMER'S DISEASE (Senile Dementia) is a progressive disease that destroys memory and other important mental functions.oMemory loss & confusion are the main symptoms. Aphasia, Amnesia, Agnosia, Acaiculia & Aiexia.Alzheimer's Symptoms10 Warning Signs*. Short term memory loss - forgetting recent events, names and places.1. Memory loss*. Difficulty performing familiar tasks.2. Difficult to performing familiar tasks*. Disorientation especially away from normal surroundings.3. Problems with language*. Increasing problems with planning and managing.4. Disorientation to time & place*. Trouble with language.5. Poor or decreased judgment*. Rapid, unpredictable mood swings.6. Problems with abstract thinking*. Lack of motivation.7. Misplacing things*. Changes in sleep and confusion about the time of day.8. Changes in mood or behavior*. Reduced judgment E.g., being unaware of danger.9. Changes in personality10. Loss of initiative MAKING SENSE OF MEMORY LOSSSymptoms of Alzheimer'sMemory loss from Normal AgingForgetting whole experiencesForgetting part of an experienceRarely able to remember laterOften able to remember laterGradually unable to follow written I spoken directionsUsually able to follow written I spoken directionsGradually unable to use notes as remindersUsually able to use notes as remindersGradually unable to care for oneselfUsually able to care for oneself.oCurrently, there is no cure for Alzheimer's.oDrug & non-drug treatments may help with both cognitive & behavioral symptoms.oTreatments available for Alzheimer's do not slow or stop the progression of the disease, but they may help with the symptoms for a time.oThere are three cholinesterase inhibitors to treat Alzheimer's:-Donepezil; Rivastigmine; Galantamine", "cop": 4, "opa": "Intranuclear neurofibrillary tangles (NFTs)", "opb": "Ab Amyloid extra cellular", "opc": "Decreased ACh in Meynert", "opd": "Only recent memory loss", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "61634f16-9556-4bbc-b158-b1de46979cd5", "choice_type": "single"}
+{"question": "Muehrcke lines in nails are seen in", "exp": "Ans. is 'a' i.e., Nephrotic syndrome", "cop": 1, "opa": "Nephrotic syndrome", "opb": "Barer syndrome", "opc": "Nail patella syndrome", "opd": "Acute tubular necrosis", "subject_name": "Medicine", "topic_name": null, "id": "8464a6fd-1a34-4427-bfbd-9a628078c8bf", "choice_type": "single"}
+{"question": "In the central nervous system (CNS), oligodendrocytes share a similar function with", "exp": "Oligodendrocytes in the central nervous system (CNS) share a similar function with Schwann cells in the peripheral nervous system-synthesis of myelin. Oligodendrocytes are small, round, lymphocyte-size cells that produce and maintain CNS myelin, which is primarily located in the white matter. Ceain diseases, such as progressive multifocal leukoencephalopathy, caused by a papovavirus, specifically attack oligodendrocytes and produce demyelination. Oligodendrogliomas are malignant tumors that are derived from oligodendrocytes. However, unlike Schwann cells, oligodendrocytes contribute segments of myelin sheaths to more than one axon. Gemistocytes are reactive astrocytes that have an eosinophilic cytoplasm. They are commonly seen along the periphery of cerebral infarctions. Some astrocytomas have a gemistocytic appearance. Astrocytes provide the structural framework for the neurons and are analogous to the fibroblasts in connective tissue. However, scarring in the brain is not associated with collagen synthesis but with filling in the defect with the cellular processes of astrocytes. A cerebral abscess is the only example of CNS repair with collagen, which is derived from the blood vessels. Microglial cells are derived from monocytes. They are the phagocytic cell of the CNS. Ependymal cells line the ventricles of the brain and the spinal canal. They do not produce CSF nor are they responsible for reabsorption of CSF, a function relegated to arachnoid cells. Ref - Harrison's principles of internal medicine 20e pg 349 , britannica.com", "cop": 3, "opa": "Gemistocytes", "opb": "Astrocytes", "opc": "Schwann cells", "opd": "Microglial cells", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "e3d69979-1881-4673-a837-f75c2b77959b", "choice_type": "single"}
+{"question": "Most common organ involved in sarcoidosis", "exp": "Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology that is characterised by the presence of non-caseating granulomas . The condition is more frequentlydescribed in colder pas of nohern Europe .The tendency for sarcoid to present in the spring and summer has led to speculation about the role of infective agents, including mycobacteria, propionibacteria and viruses, but the cause remains elusive. Genetic susceptibility is suppoed by familial clustering; a range of class II HLA alleles confer protection from, or susceptibility to, the condition. Sarcoidosis occurs less frequently in smokers. It may be associated with common variable immunodeficiency .Bilateral hilar lymphadenopathy (BHL) is often seen in young women .Alternatively, BHL may be detected in an otherwise asymptomatic individual undergoing a chest X-ray for other purposes. Sarcoidosis is considered with other DPLDs, as over 90% of cases affect the lungs, but the condition can involve almost any organ . Lofgren's syndrome - an acute illness characterised by erythema nodosum, peripheral ahropathy, uveitis, bilateral hilar lymphadenopathy (BHL), lethargy and occasionally fever - is often seen in young women. Alternatively, BHL may be detected in an otherwise asymptomatic individual undergoing a chest X-ray for other purposes. Pulmonary disease may also present in a more insidious manner with cough, exeional breathlessness and radiographic infiltrates; chest auscultation is often surprisingly unremarkable . Ref - Davidsons 23e p630", "cop": 3, "opa": "Skin", "opb": "Eye", "opc": "Lung", "opd": "Lymph node", "subject_name": "Medicine", "topic_name": "Immune system", "id": "6c44fc7d-80ce-4474-a02a-a521937573ac", "choice_type": "single"}
+{"question": "A young girl presents with abdominal pain and a recent change in bowel habit, with passage of mucus in stool. There is no associated blood in stool and symptoms are increased with stress. The most likely diagnosis is.", "exp": "Answer is A (Irritable bowel syndrome) Stress related increase in abdominal pain with change in bowel habit and passage of mucus in stool, together with absence of 'red flag' signs such as blood in stool in a 'young female' suggest a diagnosis of Irritable bowel syndrome. Young age and Female sex are epidemiological risk factors for lBS \"Younger people have a higher prevalence of lBS in the community\" Although IBS may affect all ages most patients have their onset of symptoms before age of 45. Older people have a lower rate repoing frequency and onset in patients > 50 years of age is a 'Red Flag' sign that may suggest the possibility of another disease `Women are diagnosed two or three times as often as men and make up 80% of the population with severe IBS' - Harrison 17th/1899 Onset of symptoms in periods of stress suppo a diagnosis of IBS. Onset of symptoms in periods of stress or emotional upset are suggestive of IBS' - IBS is charachteristically associated with absence of blood in stool Presence of blood in stool is a 'Red Flag 'sign that suggests possibility of another disease.- \"Red flag\" conditions in irritable bowel syndrome that suggest possibility of another disease Presence of any of the following calls lbr fuher investigation to rule out other disease processes: Fever Blood in stools Nocturnal pain Abnormal physical findings Onset in patients> 50 years of age Weight loss or anorexia Anemia Abnormal blood studiesFamily history of inflammatory bowel disease or malignancy Abdominal pain with change in bow el habit together with passage of mucus in stool (in the absence of 'Red Flag' signs) suppos a diagnosis of IBS Symptoms that cumulatively suppo the diagnosis of Irritable Bowel Syndrome: Abnormal stool frequencyQ (for research purposes, \"abnormal- defined as > 3 bowel movements/week) Abnormal stool fOrmationQ (lumpy/hard or loose/watery stool) Abnormal stool habitsQ (straining, urgency, or feeling of incomplete evacuation) Passage of mucusQ Bloating or feeling of abdominal distention", "cop": 1, "opa": "Irritable bowel syndrome", "opb": "Ulcerative Colitis", "opc": "Crohn's disease", "opd": "Amebiasis", "subject_name": "Medicine", "topic_name": null, "id": "4a50d574-a791-46a1-8fd9-d46f22693b50", "choice_type": "single"}
+{"question": "In maturity onset diabetes on the young ( mody) not found is.", "exp": "(D) (Glucokinase deficiency) (2968- H 18Th)Maturity- onset diabetes of the young (MODY)* Single gene defect with autosomal dominant inheritance* Early onset of hypoglycemia (usually <25 years)** Mutations in the insulin receptors cause a group of rare disorders characterized by severe insulin resistance *** MODY - ie noninsulin requiring diabetes presenting before theage of 25 years, very rarely, diabetes can develop at or soon after birth. This neonatal diabetes is usually genetic in origin with 50% due to mutations in the KATP channel of the pancreatic B cell causing insulin deficiency and diabetic ketoacidosis. However sulphonyl urea drugs overcome the defect in potassium channel signaling, so that insulin therapy is not necessary in these patients (807- Dividson 22nd)* The genetic mutation seen in the most common type of MODY is Hepatocyte Nuclear factor 1 (one)", "cop": 4, "opa": "Family history positive", "opb": "Young onset", "opc": "Insulin receptor resistance", "opd": "Glucokinase deficiency", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "c0253fea-8fa4-4bdd-bd7c-9229a23b8cf1", "choice_type": "single"}
+{"question": "Least common finding in lymphoedema", "exp": null, "cop": 1, "opa": "Ulcer", "opb": "Pitting", "opc": "Chronic eczema", "opd": "Swelling", "subject_name": "Medicine", "topic_name": null, "id": "bb8b2319-88a5-48cd-ae44-fc1eaff0aa5d", "choice_type": "single"}
+{"question": "Not a cause of conjugated hyperbilirubinemia", "exp": "Gilbert syndrome - Unconjugated hyperbilirubinemia.", "cop": 3, "opa": "Dubin Johnson syndrome", "opb": "Rotor syndrome", "opc": "Gilbert syndrome", "opd": "Primary biliary Cirrhosis", "subject_name": "Medicine", "topic_name": null, "id": "ecd9ef5c-9e6d-469c-af82-aef5fd8a3b4a", "choice_type": "single"}
+{"question": "Subdural haematoma most commonly results from rupture of", "exp": "Answer is C (Injury to coical bridging veins): Subdural Haemorrhage results from rupture of bridging veins that run from the coex to dural sinuses. The superior cerebral veins that bridge the coex to superior saggital sinus are most commonly involved.", "cop": 3, "opa": "Middle meningeal aery", "opb": "Superior cerebral veins", "opc": "Saccular aneurysms", "opd": "Lenticulostriate branch of middle cerebral aery", "subject_name": "Medicine", "topic_name": null, "id": "bafc9279-8ec8-4fad-81f7-b03e140345fe", "choice_type": "single"}
+{"question": "Most common type of emphysema", "exp": "Ans. (c) Centriacinar emphysemaRef: Harrison 19th ed. /1701Emphysema: The abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of the walls and without obvious fibrosis. It begins in the respiratory bronchioles and spreads peripherally.SMOKING CAUSES intake of TAR which causes | marcrophages in alveolar region. These macrophages secrete enzyme Elastase which causes autodigestion of elastin a leading to | elasticity a EmphysemaCentriacinar emphysema is MOST COMMON FORM.* Associated with smoking* Usually seen in apices* Causes type-I respiratoryfailure: |pO2 |pCO2* MOST RELIABLE radiographic sign: Flattening of the diaphragm* Symptoms:Persistent cough, Dyspnea, Wheezing, Chest pain, Fever.* Upon examination:# Increased RR# BARREL SHAPED CHEST (AP diameter > transverse)# No cyanosis# Pink puffersAlso Know*Panlobular emphysema: involves entire ecinus UNIFORMLY.* Paraseptal emphysema: involves only distal acinus (alveolar ducts and sac). Found near pleura and can result in pneumothorax.* Irregular or cicatricial: can be either of them.", "cop": 3, "opa": "Panacinar emphysema", "opb": "Irregular emphysema", "opc": "Centriacinar emphysema", "opd": "Paraseptal emphysema", "subject_name": "Medicine", "topic_name": "Chronic Obstructive Pulmonary Disease", "id": "213b7437-06bf-4cfe-90d4-9adfb2772d5b", "choice_type": "single"}
+{"question": "The most common source of pulmonary embolism", "exp": null, "cop": 3, "opa": "Amniotic fluid embolism", "opb": "Renal artery embolism", "opc": "Large veins of leg", "opd": "Cardio thoracic surgery", "subject_name": "Medicine", "topic_name": null, "id": "6eb4a656-94f4-4004-8d6c-9c8fa4cfe629", "choice_type": "single"}
+{"question": "Giant cell (Hecht's) pneumonia is due to", "exp": null, "cop": 2, "opa": "CMV", "opb": "Measles", "opc": "Malaria", "opd": "P. carinii", "subject_name": "Medicine", "topic_name": null, "id": "2f0b70ba-c0fd-401a-943b-c73967606454", "choice_type": "single"}
+{"question": "Left vertricular hypertrophy is not a feature of", "exp": null, "cop": 2, "opa": "Mitral regurgitation", "opb": "Isolated mitral stenosis", "opc": "Isolated ventricular septal defect", "opd": "Aortic stenosis", "subject_name": "Medicine", "topic_name": null, "id": "e6e85177-f5f7-44e1-950f-a3e96ccfe060", "choice_type": "single"}
+{"question": "Neurofibromatosis I is most commonly associated with", "exp": "Robbins and cotran Pathologic basis of disease-south asia edition, 9 edition * NF1 is characterised by neurofibromas of peripheral nerve, gliomas of optic nerve,Lisch nodules and cafe au lait spots.", "cop": 2, "opa": "Brain stem gliomas", "opb": "Optic pathway glioma", "opc": "Sub ependymal pilocytic astrocytoma", "opd": "Glioblastoma multiforune", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "1157400e-5500-47b4-86ab-1c304c0729a1", "choice_type": "single"}
+{"question": "Normal value of arterial HC03' in gas exchange is", "exp": "(B) 20-24 meql/L GAS EXCHANGE (SEA LEVEL)Arterial 02 tensionPao212.7 +-0.7 kPa (95+-5mmHg)Arterial C02 tensionPaco25.3 +-0.3 kPa (40 +- 2 mmHg)Arterial 02 saturationSao20.97 +-0.02 (97 +-2%)Arterial blood pHpH7.40 +- 0.02Arterial bicarbonateHCO3-24 + 2meqfLBase excessBE0 +- 2meqfLDiffusing capacity for carbon monoxide (single breath)DLco0.42 mLCO/s per mmHg (25 mL CO/ min per mmHg)Dead space volumeVD2 mUkg body wtPhysiologic dead space: dead space-tidal volume ratioVD/VT Rest <35% VTExercise <20% VTAlveolar-arterial difference for O2P(A-a)o2<2.7 kPa S20 kPa (<20 mmHg)", "cop": 2, "opa": "40-45 meql/L", "opb": "20-24 meql/L", "opc": "10-15 meql/L", "opd": "5-10 meql/L", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "ef59bfc6-1773-44b2-a935-b74b08251b77", "choice_type": "single"}
+{"question": "Ambulance brings a 35 years old woman to the emergency medical services room and the diagnostic tests confirm supraventricular tachycardia as the reason for palpitations. Vagal maneuvers fails to provide adequate response. The best therapy that can be advocated is", "exp": "Answer: d) Adenosine (HARRISON 19TH ED, P-1623)PAROXYSMAL SUPRA VENTRICULAR TACHYCARDIAAV NODAL RE-ENTRANT TACHYCARDIAMost common form of PSVTRegular tachycardia with a rate of 120-240/minIt tends to occur in the absence of structural heart diseaseEpisodes may last from a few seconds to many hoursThe patient is usually aware of a rapid, very forceful, regular heart beat and may experience chest discomfort, lightheadedness or breathlessness.Polyuria, mainly due to the release of atrial natriuretic peptide, is sometimes a feature.ECGTachycardia with normal QRS complexeP wave usually differs in contour from sinus beats and is often buried in the QRS complex ManagementTreatment is not always necessary.An episode may be terminated by carotid sinus massage (increase AV block) or by the Valsalva manoeuvre.Adenosine (3-12 mg rapidly IV in incremental doses until tachycardia stops) or verapamil (5 mg IV over 1 min) will restore sinus rhythm in most cases.In patients with recurrent SVT, catheter ablation is the most effective therapyWOLFF PARKINSON WHITE SYNDROMENormally AV node is the only pathway between atria and ventricles with some conduction delayAccessory bundle between atria and ventricles without conduction delay constitutes WPWA depolarization enters the ventricles early and causes pre-excitationWPW syndrome and AV nodal reentry tachycardia are examples of SVTSymptoms: palpitations, light-headedness, or syncopeECG findingsShort PR interval ( < 120 ms or < 0.12 s)Slurred upstroke of QRS complexes (delta wave)Wide QRS complexesTOC (recurrent symptomatic episodes, incessant SVT, HR > 200)- catheter ablationTreatment in pre-excited atrial fibrillation (life threatening) - DC cardioversionCarotid sinus massage or i.v. adenosine can terminate tachycardiaProphylaxis (amiodarone or propranolol) indicated in symptomatic patients onlyAV nodal reentrant tachycardia: frog sign can be elicited during arrhythmiasResponse to I.V AdenosineSupraventricular tachycardiaTerminationAtrial fibrillation, atrial flutterTransient AV blockVentricular fibrillationNo response", "cop": 4, "opa": "Amiodarone", "opb": "Verapamil", "opc": "Digoxin", "opd": "Adenosine", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "102cf89c-0166-4d7b-95fb-f94d7731824c", "choice_type": "single"}
+{"question": "Autism is", "exp": "(B) Social & language communication problem# Autism (i.e. marked impairment in reciprocal social and interpersonal interaction): Absent social smile, Lack of eye-to-eyecontact, Lack of awareness of others' existence or feelings; treats people as furniture, Lack of attachment to parents and absence of separation anxiety, No or abnormal social play; prefers solitary games, Marked impairment in making friends, Lack of imitative behavior, Absence of fear in presence of danger.", "cop": 2, "opa": "Neurodevelopmental disorder", "opb": "Social and language communication problem", "opc": "Metabolic disease", "opd": "Mainly due to hypothalamus damage", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "01b58d7e-440a-49ca-b799-8ee8cfcd1762", "choice_type": "single"}
+{"question": "In myasthenia gravis the neuromuscular junctions contain deposits of", "exp": "Antibodies to the acetylcholine receptor can be demonstrated in the serum of most patients with myasthenia gravis. This immunoglobulinsare deposited at the neuromuscular junction and can be demonstrated immunohistochemically in muscle biopsies. Ref - Harrison's internal medicine 20e pg 3232", "cop": 4, "opa": "Acetyicholine", "opb": "Acetyicholine Receptor Antigens", "opc": "Acetyicholinesterase", "opd": "Immunoglobulin", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "e47deac8-6fdc-4480-8776-2e70f1de47ac", "choice_type": "single"}
+{"question": "A 23 yr. old female came with arthritis, Malar rash, oral ulcers, serositis (pleuritis or pericarditis). The likely investigation to be positive is", "exp": "(A) Anti nuclear antibody # Antinuclear antibody (ANA) tests are positive in 5 to 10 percent of the general population, a rate that increases with age.> Thus, given a one in 20 frequency for ANAs and a one in 2,000 frequency for systemic lupus erythematosus, only one in 100 persons with a positive ANA test will have the disease.> Consequently, positive ANA test results must be interpreted with caution.> Given the high sensitivity of the currently used substrate for testing, a negative ANA test essentially rules out systemic lupus erythematosus.", "cop": 1, "opa": "Anti nuclear antibody", "opb": "Anti collagen antibody", "opc": "Anti epithelial antibody", "opd": "Antigen antibody complexes", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "53429823-6faf-4881-9039-05c8e917f05f", "choice_type": "single"}
+{"question": "Proximal muscle weakness is not a feature of", "exp": "In Myotonic dystrophy the Muscles affected are Face(including ptosis), sternocleidomastoids, distal limb, generalised later. In all other above mentioned options the proximal muscles are affected. Reference : Harrison20th edition pg 2278", "cop": 2, "opa": "Polymyositis", "opb": "Myotonic dystrophy", "opc": "Becker's muscular dystrophy", "opd": "Duchene's muscular dystrophy", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "e83d752c-b376-40dc-8c75-3e8f44f4544e", "choice_type": "single"}
+{"question": "The best treatment for Hepatorenal syndrome", "exp": "Best treatment - Liver transplantation.", "cop": 4, "opa": "Octreotide", "opb": "Iv albumin", "opc": "Midodrine", "opd": "Liver transplantation", "subject_name": "Medicine", "topic_name": null, "id": "ae3328e7-2cd0-494b-9d2f-1f9bbde495de", "choice_type": "single"}
+{"question": "Veical transmission rate in hepatitis C is", "exp": "Veical transmission refers to viral transmission from the mother to the infant during pregnancy, at the time of delivery, or during the first 28 days after bih. In most infants, HCV RNA levels only become detectable several weeks after bih, suggesting perinatal infection Approximately 5% of pregnant women with chronic HCV infection will transmit the virus to their infants Ref Harrison20th edition pg 980", "cop": 1, "opa": "5%", "opb": "10%", "opc": "25%", "opd": "50%", "subject_name": "Medicine", "topic_name": "Infection", "id": "e9767cbe-026a-4a8d-97da-04a6073162ee", "choice_type": "single"}
+{"question": "A young man back from leisure trip has swollen knee joints & foreign body sensation in eyes. Likely cause is", "exp": "Reactive (spondylo)ahritis (ReA) is a 'reaction' to a number of bacterial triggers with clinical features in keeping with all SpA conditions. The known triggers are Chlamydia, Campylobacter, Salmonella, Shigella and Yersinia. Notably, non-SpA-related reactive ahritis can occur following infection with many viruses, Mycoplasma, Borrelia, streptococci and mycobacteria, including M. leprae, which causes leprosy (Hansen's disease); however, the 'reaction' in these instances consists typically of myoahralgias, is not associated with HLA-B27 and is generally not chronic. The ahritis associated with rheumatic fever is also an example of a reactive ahritis that is not associated with HLA-B27.Sexually acquired reactive ahritis (SARA) is predominantly a disease of young men, with a malepreponderance of 15 : 1. This may reflect a difficulty in diagnosing the condition in young women, in whom Chlamydia infection is often asymptomatic and is hard to detect in practical terms. Between 1% and 2% of patients with non-specific urethritis seen at genitourinary medicine clinics have SARA. The syndrome of chlamydial urethritis, conjunctivitis and reactive ahritis was formerly known as Reiter's disease. Clinical features The onset is typically acute, with an inflammatory enthesitis, oligoahritis and/or spinal inflammation. Lower limb joints and entheses are predominantly affected. In all types of ReA, there may be considerable systemic disturbance, with fever and weight loss. Achilles inseional enthesitis/tendonitis or plantar fasciitis may also be present. The first attack of ahritis is usually self-limiting, but recurrent or chronic ahritis can develop and about 10% still have active disease 20 years after the initial presentation. Low back pain and stiffness due to enthesitis and osteitis are common and 15-20% of patients develop sacroiliitis. Many extra-aicular features in ReA involve the skin, especially in SARA: * circinate balanitis, which stas as vesicles on the coronal margin of the prepuce and glans penis, later rupturing to form superficial erosions with minimal surrounding erythema, some coalescing to give a circular pattern * keratoderma blennorrhagica, which begins as discrete waxy, yellow-brown vesico-papules with desquamating margins, occasionally coalescing to form large crusty plaques on the palms and soles of the feet * pustular psoriasis * nail dystrophy with subungual hyperkeratosis * mouth ulcers * conjunctivitis * uveitis, which is rare with the first attack but arises in 30% of patients with recurring or chronic ahritis. Other complications in ReA are very rare but include aoic incompetence, conduction defects, pleuro-pericarditis, peripheral neuropathy, seizures and meningoencephalitis . Ref - Davidsons 23e p1031", "cop": 1, "opa": "Reiter's syndrome", "opb": "Sarcoidosis", "opc": "Behcet's disease", "opd": "SLE", "subject_name": "Medicine", "topic_name": "Immune system", "id": "ab343574-8149-4f5a-9244-54ded4a3858b", "choice_type": "single"}
+{"question": "SIADH feature", "exp": "(A) Hyponatremia with sodium excretion > 20mEq/l # Syndrome of Inappropriate Antidiuretic Hormone (ADH) secretion (SIADH) is defined by the hyponatremia and hypo-osmolality resulting from inappropriate, continued secretion or action of the hormone despite normal or increased plasma volume, which results in impaired water excretion.> Diagnosis:> In the absence of a single laboratory test to confirm the diagnosis, SIADH is best defined by the classic Bartter-Schwartz criteria, which can be summarized as follows: Hyponatremia with corresponding hypo-osmolality Continued renal excretion of sodium Urine less than maximally dilute Absence of clinical evidence of volume depletion Absence of other causes of hyponatremia Correction of hyponatremia by fluid restriction> Cardinal features of SIADH include: Hyponatermia (dilutional hyponetremia with Na+ < 135 mmol/l) Decreased plasma osmolality (<280 m osm/kg) with inappropriately increased urine osmolality > 150 m osm). Urine sodium over 20 meq/l Low Blood urea Nitrogen < Wmg/L Hypouricemia (<4mg/dL), Absence of cardiac, liver or renal disease, Normal thyroid and adrenal function> A high BUN suggests a volume contracted state and excludes a diagnosis of SIADH.", "cop": 1, "opa": "Hyponatremia with sodium excretion > 20 mEq/L", "opb": "Hypernatremia with hypokalemia", "opc": "Hypernatremia with Na+ excretion < 20 mEq/L", "opd": "Hyponatremia with hyperkalemia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "a3ba4b69-8ca0-44d0-82bb-2ba12a338a7b", "choice_type": "single"}
+{"question": "Mannitol infusion causes increase in", "exp": "Ans. is 'b' i.e., Omolarity", "cop": 2, "opa": "Blood viscosity", "opb": "Osmolarity", "opc": "Intra-ocular tension", "opd": "Intercranial tension", "subject_name": "Medicine", "topic_name": null, "id": "426b7d85-874b-41c2-9583-fc77178061a5", "choice_type": "single"}
+{"question": "Subacture combined degeneration of cord is caused due to deficiency of", "exp": "Ans. is 'd' i.e., Vitamin B12 Subacate combined degeneration of the spinal cord is the term used for the degeneration of the spinal cord due to vitamin B12 deficiency. The spinal cord, brain, optic nerves, peripheral nerves may all be affected in vitamin B12 deficiency but the spinal cord is usually affected first and exclusively. The tracts mainly involved in the spinal cord are: o Posterior column Coicospinal tract Later on peripheral nerves are involved Clinical features of vitamin B deficiency or subacute combined degeneration of the cord : Patient first notices mild general weakenss and paresthesia consisting of tingling 'pins and needle'. As the illness progresses the gait becomes unsteady and stiffness and weakenss of the limbs and legs develop. If the disease remains untreated ataxic paraplegia evolve. Sometimes there may be loss of superficial sensations, such as tactile, pain and thermal sensations, but these signs are rare. Loss of \"vibration sense\" is the most consistent sign and is usually accompanied by loss of position sensee. Motor signs seen are:- Loss of strength in proximal limb muscles Spasticity, changes in tendon reflexes Clonus and extensor plantar responses Sometimes tendon reflexes may be absente (due to involvement of peripheral nerve) o Gait is ataxic Now, The Clinicopathological Correlation Clinical features Tracts involved Paresthesia, inpairment of deep sensation and ataxia Due to lesion in posterior column Weakness, spasticity and increased tendon reflexes Due to coicospinal tract involvement Occasional findings of loss of pain and temperature Due to spinothalamic tract involvement (rarely involved) Distal and symmetrical impairmeat of superficial Involvement of peripheral nerve (occassionally)", "cop": 4, "opa": "Vitamin B1", "opb": "Vitamin B5", "opc": "Vitamin B6", "opd": "Vitamin B12", "subject_name": "Medicine", "topic_name": null, "id": "ad5cea3f-3e0f-4cb8-a052-dfa32ad2bebf", "choice_type": "single"}
+{"question": "For Pure motor hemiparesis involving face, arm, and leg select the site of the lesion of cerebrovascular disease,", "exp": "Sudden, painless monocular blindness is a sign of carotid disease. The symptom is also called amaurosis fugax . The patient may describe a shade dropping in front of the eye or describe vision like looking through ground glass. If a thrombus propagates up the carotid to the middle cerebral aery, then symptoms seen in middle cerebral aery occlusion or embolization (hemiparesis with sensory symptoms, aphasia depending on hemispheric dominance) will also occur. Midbasilar aery disease produces weakness and sensory loss with diplopia, loss of facial sensation or movement, and ataxia. Branches of the basilar aery supply the base of the pons and superior cerebellum. The symptoms described suggest disease in the posterior circulation, whichincludes paired veebral aeries, the basilar aery, and the paired posterior cerebral aeries. The basilar aery divides into two posterior cerebral aeries that provide branches to the cerebellum, medulla, pons, midbrain, thalamus, and temporal and occipital lobes. A midbasilar aery occlusion could cause ataxia of limbs by involving pontine nuclei; paralysis of the face, arm, and leg by involving coicospinal tracts; and impairment of facial sensation by involvement of fifth nerve nucleus. Occlusion of the entire middle cerebral aery results in contralateral hemiplegia, hemianesthesia, and homonymous hemianopsia. When the dominant hemisphere is involved, aphasia is present. When the nondominant hemisphere is involved, apraxia and neglect are produced. When only a penetrating branch of the middle cerebral aery is affected, the syndrome of pure motor hemiplegia is produced, as the infarct involves only the posterior limb of the internal capsule, involving only motor fibers to the face, arm, and leg (lacunar infarct).", "cop": 4, "opa": "Internal carotid aery", "opb": "Middle cerebral aery", "opc": "Midbasilar aery", "opd": "Penetrating branch, middle cerebral aery", "subject_name": "Medicine", "topic_name": null, "id": "fae2f808-f598-4be2-9110-70d9713766fa", "choice_type": "single"}
+{"question": "Critical narrowing of coronary blood vessels is", "exp": null, "cop": 1, "opa": "70%", "opb": "60%", "opc": "80%", "opd": "90%", "subject_name": "Medicine", "topic_name": null, "id": "0b454125-794f-484c-863a-edfb3186c49d", "choice_type": "single"}
+{"question": "Most common cause of cardioembolic stroke is", "exp": "Nonrheumatic atrial fibrillation is the most common cause of cerebral embolism overall. The presumed stroke mechanism is thrombus formation in the fibrillating atrium or atrial appendage, with subsequent embolization. Patients with atrial fibrillation have an average annual risk of stroke of ~5%.MI, prosthetic valves, rheumatic hea disease, and ischemic cardiomyopathy are other causes.Ref: Harrison 19e pg: 2564", "cop": 1, "opa": "Non rheumatic atrial fibrillation", "opb": "Myocardial infarction", "opc": "Ischemic cardiomyopathy", "opd": "Prosthetic valves", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "f43fb838-24a2-4067-b5d7-da7bc3d872b4", "choice_type": "single"}
+{"question": "Screening test for sclerodema", "exp": "Answer- A. Anti-nuclear antibodyANA is the screening method of choice for systemic rheumatic disease such as systemic lupus erythyematous (SLE), mixed connective tissue disease, Sjogren syndrome, scleroderma, CREST syndrome, rheumatoid ahritis, polymyositis, dermatomyositis.", "cop": 1, "opa": "Anti-nuclear antibody", "opb": "Ul-Ribonucleoprotein antibody", "opc": "Anti- L.K.M. antibody", "opd": "Anti- topoisomerase antibody", "subject_name": "Medicine", "topic_name": null, "id": "d6bbfa64-ffe7-4cbe-b56b-0f97dc78cf50", "choice_type": "single"}
+{"question": "Bilateral loss of sensation below a definite level of spinal cord is", "exp": null, "cop": 1, "opa": "Myelopathy", "opb": "Myopathy", "opc": "Neuropathy", "opd": "Nephropathy", "subject_name": "Medicine", "topic_name": null, "id": "9ded32ee-65f6-4d77-81d1-6b5543e2a54f", "choice_type": "single"}
+{"question": "Pseudobulbar palsy is seen with", "exp": "Answer- B. Bilateral coicobulbar lesionsThis pattern of weakness results from disorders that affect the upper motor neurons or their axons in the cerebral coex, subcoical white matter, internal capsule, brainstem, or spinal cord.With coicobulbar involvement, weakness usually is observed only in the lower face and tongue; extraocular, upper facial, pharyngeal, and jaw muscles almost always are spared.With bilateral coicobulbar lesions, pseudobulbar palsy often develops: dysahria, dysphagia, dysphonia, andemotional lability accompany bilateral facial weakness and a brisk jaw jerk.", "cop": 2, "opa": "Unilateral goigandbar lesions", "opb": "Bilateral coicobulbar lesions", "opc": "Cranial nerve IX involvement", "opd": "Cranial nerve N involvement", "subject_name": "Medicine", "topic_name": null, "id": "17ccd155-ddd0-40a3-abe2-401739535359", "choice_type": "single"}
+{"question": "Most common abnormality associated with ARDS", "exp": "The most common feature associated with ARDS is hypoxaemia,i.e.,the aerial Po2(mm Hg)/FIo2 (inspiratory O2 fraction) Reference:Harrison's Medicine- 20edition,page no:2031", "cop": 1, "opa": "Hypoxemia", "opb": "Hypercapnea", "opc": "Diffuse alveolar damage", "opd": "Bilateral alveolar infiltrates", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "4e02072c-c1bf-4918-9c33-0ddb7ea5128a", "choice_type": "single"}
+{"question": "Marcus gunn pupil lesion", "exp": "(A) Cortex# Marcus Gunn pupil is a medical sign observed during the swinging-flashlight test whereupon the patient's pupils constrict less (therefore appearing to dilate) when the light swings from the unaffected eye to the affected eye.> The affected eye still senses light and produces pupillary constriction to some degree, albeit reduced.> The most common cause of Marcus Gunn pupil is a lesion of the optic nerve (before the optic chiasm) or severe retinal disease.> The Marcus Gunn phenomenon is a relative afferent pupillary defect indicating a decreased pupillary response to light in the affected eye.> In the swinging flashlight test, a light source is alternately shone into the left and right eyes.> A normal response would be equal constriction of both pupils, regardless of which eye the light is directed at. This indicates an intact direct and consensual pupillary light reflex.> When the test is performed in an eye with an afferent pupillary defect, light directed in the affected eye will cause only mild constriction of both pupils (due to decreased response to light from the afferent defect), while light in the unaffected eye will cause a normal constriction of both pupils (due to an intact afferent path, and an intact consensual pupillary reflex).", "cop": 1, "opa": "Cortex", "opb": "Cerebellum", "opc": "Midbrain", "opd": "Pons", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f8bad75f-ce59-4b23-a63b-14dbf4d28556", "choice_type": "single"}
+{"question": "Autoimmune destruction of platelets is seen in", "exp": "Immune Thrombocytopenic PurpuraImmune thrombocytopenic purpura (ITP; also termed idiopathic thrombocytopenic purpura) is an acquired disorder in which there is an immune-mediated destruction of platelets and possibly inhibition of platelet release from the megakaryocyte. In children, it is usually an acute disease, most commonly following an infection, and with a self-limited course. In adults, it is a more chronic disease, although, in some adults, spontaneous remission occurs, usually within months of diagnosis.ITP is termed secondary if it is associated with an underlying disorder; autoimmune disorders, paicularly systemic lupus erythematosus (SLE), and infections, such as HIV and hepatitis C, are common causesReference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 140; Disorders of Hemostasis", "cop": 1, "opa": "SLE", "opb": "PAN", "opc": "RA", "opd": "Sarcoidosis", "subject_name": "Medicine", "topic_name": "Haematology", "id": "1e0455e5-4730-4080-9879-d13079885b7e", "choice_type": "single"}
+{"question": "For the following causes of sexual dysfunction, select the most likely clinical feature.Can be caused by vascular disease.", "exp": "Vascular disease, by itself or in conjunction with peripheral neuropathy in DM, is a common cause of erectile dysfunction. The lesions can be in large vessels (aortic occlusion, Leriche syndrome), small arteries, or even in the sinusoidal spaces.", "cop": 2, "opa": "loss of sexual desire", "opb": "failure of erection with absent nocturnal penile tumescence (NPT)", "opc": "absence of emission", "opd": "absence of orgasm with normal libido and erectile function", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "35f972b8-6843-43d4-8ecd-ed23d1dcb59f", "choice_type": "single"}
+{"question": "For Sudden, Unilateral or bilateral weakness, sensory loss, disorder of ocular motility, loss of facial sensation, ataxia select the site of the lesion of cerebrovascular disease,", "exp": "Sudden, painless monocular blindness is a sign of carotid disease. The symptom is also called amaurosis fugax . The patient may describe a shade dropping in front of the eye or describe vision like looking through ground glass. If a thrombus propagates up the carotid to the middle cerebral aery, then symptoms seen in middle cerebral aery occlusion or embolization (hemiparesis with sensory symptoms, aphasia depending on hemispheric dominance) will also occur. Midbasilar aery disease produces weakness and sensory loss with diplopia, loss of facial sensation or movement, and ataxia. Branches of the basilar aery supply the base of the pons and superior cerebellum. The symptoms described suggest disease in the posterior circulation, whichincludes paired veebral aeries, the basilar aery, and the paired posterior cerebral aeries. The basilar aery divides into two posterior cerebral aeries that provide branches to the cerebellum, medulla, pons, midbrain, thalamus, and temporal and occipital lobes. A midbasilar aery occlusion could cause ataxia of limbs by involving pontine nuclei; paralysis of the face, arm, and leg by involving coicospinal tracts; and impairment of facial sensation by involvement of fifth nerve nucleus. Occlusion of the entire middle cerebral aery results in contralateral hemiplegia, hemianesthesia, and homonymous hemianopsia. When the dominant hemisphere is involved, aphasia is present. When the nondominant hemisphere is involved, apraxia and neglect are produced. When only a penetrating branch of the middle cerebral aery is affected, the syndrome of pure motor hemiplegia is produced, as the infarct involves only the posterior limb of the internal capsule, involving only motor fibers to the face, arm, and leg (lacunar infarct).", "cop": 3, "opa": "Internal carotid aery", "opb": "Middle cerebral aery", "opc": "Midbasilar aery", "opd": "Penetrating branch, middle cerebral aery", "subject_name": "Medicine", "topic_name": null, "id": "63c75cb7-1122-49a6-9cb7-d9cb7afedfff", "choice_type": "single"}
+{"question": "Features of secondary syphilis are/is a) Condyloma accuminata b) Condyloma lata c) Mulberry/moon molar d) Lesions over palms/sales", "exp": null, "cop": 2, "opa": "ac", "opb": "bd", "opc": "bc", "opd": "ad", "subject_name": "Medicine", "topic_name": null, "id": "f8e5e359-6131-4cb0-83de-7cdd92e2f8a1", "choice_type": "single"}
+{"question": "Palpable purpura is seen in", "exp": "Answer is C (H. S. Purpura): Henoch Sconlein Purpura is associated with palpable purpura without thrombocytopeniae", "cop": 3, "opa": "Idiopathic thrombocytopenic purpura (ITP)", "opb": "Scurvy", "opc": "Henoch Sconlein Purpura", "opd": "Monoclonal cryoglobulinemia", "subject_name": "Medicine", "topic_name": null, "id": "5e37a48d-5519-4a98-87d9-5af2280ba690", "choice_type": "single"}
+{"question": "The most common cause of dementia is", "exp": "Causes of Dementia: \n\nAlzheimer’s (most common in >65 years old)\nVascular dementia/Multi-infarct dementia\nLewy body dementia\nFronto-Temporal dementia (50-70 years)\nHuntington’s\nTraumatic/Dementia pugilistica\nCreutzfeldt-Jakob disease\n\n \nReversible causes of Dementia\n\nStructural brain lesions:- Normal Pressure Hydrocephalus, SubDural Hematoma, Brain Tumors\nAlcohol dementia/ Wernicke’s encephalopathy\nVitamin B12 deficiency\nEndocrine:- Hypo/Hyper-thyroidism, Hypo-Parathyroidism\nMetabolic disorders:- Dyselectrolytemia (Na, Ca, K), hepatic or renal failure\nAutoimmune:- Hashimoto’s paraneoplastic encephalopathy (anti- Yo, Hu, Ri)\nInfections:- Whipple’s, Lyme disease, Syphilis, HIV dementia.", "cop": 4, "opa": "Fronto-Temporal dementia", "opb": "Senile dementia", "opc": "Multi-infarct dementia", "opd": "Alzheimer’s disease", "subject_name": "Medicine", "topic_name": null, "id": "57491342-73db-49dc-b13c-cabcfd4e580f", "choice_type": "single"}
+{"question": "The commonest type of seizure in a newborn is", "exp": "The most common seizures in late infancy and early childhood are febrile seizures.The overall prevalence is 3-5% and Patients often have a family history of febrile seizures or epilepsy.Febrile seizures usually occur between 3 months and 5 years of age and have a peak incidence between 18 and 24 months.The typical scenario is a child who has a generalized, tonic-clonic seizure during a febrile illness during the rising phase of the temperature curve (i.e., during the first day).A simple febrile seizure is a single, isolated event, brief, and symmetric in appearance.Complex febrile seizures are characterized by repeated seizure activity, duration >15 minutes, or by focal features.Complex febrile seizures have a risk of 2-5% of recurrence.Ref: Harrison; 19th edition", "cop": 3, "opa": "Clonic", "opb": "Tonic", "opc": "Febrile", "opd": "Myoclonic", "subject_name": "Medicine", "topic_name": "All India exam", "id": "c459fc7f-5ee2-4070-b7b6-1979223de8f4", "choice_type": "single"}
+{"question": "Midday meal Contains", "exp": "Midday meal should supply 1/3rd of total energy requirement and 1/2 of total protein requirement.", "cop": 3, "opa": "1/2 proteins and 1/2 calories", "opb": "1/3 proteins and 1/3rd calories", "opc": "1/2 proteins and 1/3rd calories", "opd": "1/3rd proteins and 2/3rd calories", "subject_name": "Medicine", "topic_name": null, "id": "84be9a2f-3a87-4ce1-9adc-84d84b046356", "choice_type": "single"}
+{"question": "Bilateral loss of tendon jerk and extensor plantar response is seen in", "exp": null, "cop": 2, "opa": "Amyotrophic lateral sclerosis", "opb": "Freidrich's ataxia", "opc": "Tabes dorsalis", "opd": "Lead poisoning", "subject_name": "Medicine", "topic_name": null, "id": "b4e37626-7e7a-459b-bfdf-3bc5171b1c50", "choice_type": "single"}
+{"question": "The Most common presentation of multiple sclerosis", "exp": "(A) Sensory loss # Initial symptoms of MSSYMPTOM%SYMPTOM OF CASES%* Sensory loss37* Lhermitte3* Optic neuritis36* Pain3* Weakness35* Dementia2* Paresthesias24* Visual loss2* Diplopia15* Facial palsy1* Ataxia11* Impotence1* Vertigo6* Myokymia1* Paroxysmal attacks4* Epilepsy1* Bladder4* Falling1", "cop": 1, "opa": "Sensory loss", "opb": "Vertigo", "opc": "Pain", "opd": "Epilepsy", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "f87248db-3e1f-47fc-97f5-b07dda117443", "choice_type": "single"}
+{"question": "Shock lung is seen in", "exp": null, "cop": 2, "opa": "Hypovolemic shock", "opb": "Septic shock", "opc": "Anaphylactic shock", "opd": "Neurogenic shock", "subject_name": "Medicine", "topic_name": null, "id": "bc9c428c-5502-4140-a6e4-e4a1aa189356", "choice_type": "single"}
+{"question": "The aery most frequently responsible for bleeding in massive hemoptysis is", "exp": "Answer is A (Bronchial Aery): The most common source of bleeding in massive hemoptysis are the Bronchial aeries which are pa of the high pressure systemic circulation The most common source of bleeding in hemoptysis is the tracheobronchial tree which can be affected by inflammation (bronchitis, bronchiectasis) or neoplasm (bronchiogenic carcinoma, endobronchial metastatic carcinoma or bronchial carcinoid tumor). The bronchial aeries which originate from either the aoa or from intercostal aeries, and are therefore pa of the high pressure systemic circulation are the source of bleeding in bronchitis, bronchiectasis or with endobronchial tumors ' `While alveolar haemorrhages arise from capillaries that are pa of the low pressure pulmonary circulation, bronchial bleeding is generally from bronchial aeries which are under systemic pressure and therefore predisposed to large volume bleeding'", "cop": 1, "opa": "Bronchial Aery", "opb": "Pulmonary Aery", "opc": "Intersegmental Aery", "opd": "Intercostal Aery", "subject_name": "Medicine", "topic_name": null, "id": "27168290-3876-48d6-8fb4-beefeaf586ff", "choice_type": "single"}
+{"question": "A patient comes to hospital with a history of sore throat, diarrhoea and sexual contact 2 weeks before. The best investigation to rule out HIV is", "exp": null, "cop": 1, "opa": "P24 antigen assay", "opb": "ELISA", "opc": "Western blot", "opd": "Lymph node biopsy", "subject_name": "Medicine", "topic_name": null, "id": "7cc39d9a-9d4c-4c8e-9c1e-237b16d2854a", "choice_type": "single"}
+{"question": "Therapeutic hypothermia is of benefit in preventing neurological complications in", "exp": "Ans. is 'c' i.e., Cardiac arrest Inducing mild therapeutic hypothermia in selected patients surviving out-of-hospital sudden cardiac arrest can significantly improve rates of long-term neurologically intact survival and may prove to be one of the impoant clinical advancements in the science of resuscitation. The types of medical events that hypothermic therapies may effectively treat fall into four primary categories: Cardiac arrest Ischemic stroke Trumatic brain or spinal cord injury without fever. Neurogenic fever following brain trauma", "cop": 3, "opa": "Sepsis", "opb": "Poly-trauma", "opc": "Cardiac arrest", "opd": "lschemic stroke", "subject_name": "Medicine", "topic_name": null, "id": "7aa61b21-01ea-4a5e-8fa8-f7c4ee4d5870", "choice_type": "single"}
+{"question": "Poal hypeension is defined as, hepatic venous pressure gradient (HVPG) greater than", "exp": "Poal hypeension is defined as the elevation of the hepatic venous pressure gradient (HVPG) to >5 mmHg. Poal hypeension is caused by a combination of two simultaneously occurring hemodynamic processes: 1) Increased intrahepatic resistance to the passage of blood flow through the liver due to cirrhosis and regenerative nodules, and 2) Increased splanchnic blood flow secondary to vasodilation within the splanchnic vascular bed. Poal hypeension is directly responsible for the two major complications of cirrhosis: variceal haemorrhage and ascites.Ref: Harrison 19e pg: 2063", "cop": 1, "opa": "5 mm of hg", "opb": "10 mm of Hg", "opc": "15 mm of Hg", "opd": "20 mm of Hg", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "5829b69a-6b50-4801-ae72-de0cab511949", "choice_type": "single"}
+{"question": "Eaton Lambe syndrome is associated with", "exp": "Lambe-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disorder characterized by muscle weakness of the limbs. In normal neuromuscular function, a nerve impulse is carried down the axon (the long projection of a nerve cell) from the spinal cord. At the nerve ending in the neuromuscular junction, where the impulse is transferred to the muscle cell, the nerve impulse leads to the opening of voltage-gated calcium channels (VGCC), the influx of calcium ions into the nerve terminal, and the calcium-dependent triggering of synaptic vesicle fusion with plasma membrane. These synaptic vesicles contain acetylcholine, which is released into the synaptic cleft and stimulates the acetylcholine receptors on the muscle. The muscle then contracts. In LEMS, antibodies against VGCC, paicularly the P/Q-type VGCC, decrease the amount of calcium that can enter the nerve ending, hence less acetylcholine can be released from the neuromuscular junction. Apa from skeletal muscle, the autonomic nervous system also requires acetylcholine neurotransmission; this explains the occurrence of autonomic symptoms in LEMSP/Q voltage-gated calcium channels are also found in the cerebellum, explaining why some experience problems with coordination. The antibodies bind paicularly to the pa of the receptor known as the \"domain III S5-S6 linker peptide\".Antibodies may also bind other VGCCs.Some have antibodies that bind synaptotagmin, the protein sensor for calcium-regulated vesicle fusion.Many people with LEMS, both with and without VGCC antibodies, have detectable antibodies against the M1 subtype of the acetylcholine receptor; their presence may paicipate in a lack of compensation for the weak calcium influx anti p/Q antibodies are produced against voltage gated channels mainly P/Q voltage gates Ref Harrison 20th edition pg 567", "cop": 1, "opa": "Anti P/Q antibody", "opb": "Anti HU antibody", "opc": "Anti Jo 1 antibody", "opd": "Large cell carcinoma", "subject_name": "Medicine", "topic_name": "Oncology", "id": "556ec9e0-35f7-45f3-9150-086af9b7663d", "choice_type": "single"}
+{"question": "Foramen spinosum transmits", "exp": "(B) Middle meningeal artery > The foramen spinosum transmits the middle meningeal artery, the meningeal branch of the mandibular nerve (nervus spinesus) & the posterior trunk of the middle meningeal vein.> The foramen spinosum transmits the middle meningeal artery, the meningeal branch of the mandibular nerve (nervus spinesus) & the posterior trunk of the middle meningeal vein.", "cop": 2, "opa": "Lateral petrosal nerve", "opb": "Middle meningeal artery", "opc": "Mandibular nerve", "opd": "Maxillary nerve", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "280deb48-c307-4d6f-a8a0-6f63d6eb3b53", "choice_type": "single"}
+{"question": "Superior colliculus is concerned cells", "exp": "The superior colliculus (SC) is a midbrain area where visual, auditory and somatosensory information are integrated to initiate motor commands. The SC plays a central role in visual information processing in the mouse; it receives projections from 85% to 90% of the retinal ganglion cells (RGCs). Ref Harrison20th edition pg 2345", "cop": 3, "opa": "Olfaction", "opb": "Hearing", "opc": "Vision", "opd": "Pain sensation", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "d245086d-d863-4aa2-ad45-bcd97c7b46a1", "choice_type": "single"}
+{"question": "Basal exudates, infarcts and hydrocephalus are findings observed in Brain imagine studies. The most likely diagnosis is", "exp": "Harrison's textbook of internal medicine 17th edition. *Imaging studies (MRI,CT scan) may show hydrocephalus and abnormal enhancement of basal cisterns or ependyma . *CT and MRI reveals contrast enhanced ring lesions ,but biopsy necessary to establish the diagnosis .", "cop": 1, "opa": "Tubercular Meningitis", "opb": "Viral Meningitis", "opc": "Herpes encephalitis", "opd": "Cerebral Malaria", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "c8068907-8f55-4dd6-89c7-d20e1c9cfcf7", "choice_type": "single"}
+{"question": "Tubular breathing is seen in", "exp": "Tubular or bronchial breath sounds is seen in lobar pneumonia or consolidation. Normally the breath sounds heard over the chest is vesicular. Reference : Davidson, 23rd Edition, page no :547.", "cop": 2, "opa": "Pleural effusion", "opb": "Consolidation", "opc": "Pleurisy", "opd": "TB cavity", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "52828283-e19c-402c-9526-0a4062ebe02c", "choice_type": "single"}
+{"question": "Most common cause of Fulminant hepatitis in pregnancy", "exp": "Ans. (d) Hep ERef: Harrison 19th ed. /152e-2t, 0215* Most common cause of fulminant hepatitis in pregnancy is HEV* Most common cause of viral hepatitis in India overall = Hepatitis A* Most common cause of blood transfusion associated hepatitis =HCV* Most common viral hepatitis in India in children= HAV* Most common viral hepatitis in India in adults= HEV* Most common cause of FULMINANT hepatic failure= toxins> Hepatitis B>superinfection of Hep B", "cop": 4, "opa": "Hep B", "opb": "Hep C", "opc": "Hep D", "opd": "HepE", "subject_name": "Medicine", "topic_name": "Hepatitis", "id": "a4df7c9a-ef55-460c-9d26-c9f6cf502c33", "choice_type": "single"}
+{"question": "Most common pulmonary manifestation in AIDS", "exp": "Ans. is 'b' i.e., Pneumonia Respiratory complications in AIDS Respiratory diseases in AIDS include A) Acute bronchitis and sinusitis They are caused by S. pneumoniae and H influenzae and are very common. B) Pulmonary diseases Pulmonary diseases are :- 1. Pneumonia Most common pulmonary manifestation is pneumonia : Bacterial pneumonia : It is caused most commonly by S pneumoniae and pneumococcal infection is the earliest serious infection in AIDS. H influenzae is also a common cause. P canna pneumonia : It is the most common cause of pneumonia in AIDS. Risk is greater when CD4 count less than 200/ml. 2. Tuberculosis In developing countries like India, most impoant pathogen is M tuberculosis. Other common pathogen causing TB is MAC (atypical mycobacteria). 3. Other pulmonary diseases These are fungal infections (cryptococcus, histoplasma, aspergillus), neopasms (Kaposi sarcoma, lymphoma) and idiopathic interstitial pneumonia.", "cop": 2, "opa": "TB", "opb": "Pneumonia", "opc": "Bronchiectasis", "opd": "Mycobacterial avium intracellular", "subject_name": "Medicine", "topic_name": null, "id": "0d0e67b5-b2de-4f6a-aae5-2014056d58e2", "choice_type": "single"}
+{"question": "For a definitive diagnosis of mental retardation reduced level of intellectual functioning should be seen along with", "exp": "Reduced level of intellectual functioning resulting in diminished ability to adapt to the daily demands of the normal social environment as a diagnostic criteria in ICD, asks for IQ tests to be done with adaptive function assessment .", "cop": 4, "opa": "Impaired motor skills", "opb": "Impaired speech", "opc": "Academic difficulties", "opd": "Impaired adaptive functioning", "subject_name": "Medicine", "topic_name": "All India exam", "id": "2f770dfe-0078-49df-b876-5effca94a7e3", "choice_type": "single"}
+{"question": "Good syndrome is", "exp": "Ans. is 'a' i.e., Thymoma with immunodeficiency Good's syndrome (thymoma with immunodeficiency) is a rare cause of combined B and T cell immunodeficiency in adults. Clinical features of Good's syndrome are :- Increased susceptibility to bacterial infections with encapsulated organisms and oppounistic viral and fungal infection. The most consistent immunological abnormalities are :- Hypogammaglobulinaemia and Reduced or absent B cells Treatment Resection of the thymoma and immunoglobulin replacement to maintain adequate through IgG values", "cop": 1, "opa": "Thymoma with immunodeficiency", "opb": "Thymoma with M. Gravis", "opc": "Thymoma with serum sickness", "opd": "Thymoma with pure red cell aplasia", "subject_name": "Medicine", "topic_name": null, "id": "75669caf-05de-44cf-a439-a700ff70343c", "choice_type": "single"}
+{"question": "Acid secreting cells in stomach known as", "exp": "B. i.e. (Parietal cells) (1857- HI7th)* Acid secreting parietal cell is located in the oxyntic gland, also secretes intrinsic factor* Parietal cell express receptors for several stimulants of acid secretion including histamine (H2), gastrin (cholecystokinin) and acetylcholine (Muscarinic M3)* Chief- cells found primarily in the gastric fundus**, synthesizes and secretes pepsinogen* Gut associated lymphoid tissue (GALT) is located in lamina propria**", "cop": 2, "opa": "Mucus cells", "opb": "Parietal cells", "opc": "Chief cells", "opd": "Endocrine cells", "subject_name": "Medicine", "topic_name": "G.I.T.", "id": "2be07464-662a-4c9c-939e-e016deae2e5b", "choice_type": "single"}
+{"question": "The commonest side effect of cisplatinum in a patient using it for esophageal carcinoma is", "exp": null, "cop": 1, "opa": "Acute tubular necrosis", "opb": "Thrombocytopenia", "opc": "Hepatic failure", "opd": "Cardiomyopathy", "subject_name": "Medicine", "topic_name": null, "id": "b17b14fc-ef9c-412c-a401-76dd7b280203", "choice_type": "single"}
+{"question": "In a person with ventricular tachycardia, extra systoles appear in", "exp": "Extrasystoles are essentially extra beats, or contractions, which occur when there is electrical discharge from somewhere in the hea other than the SA node. Atrial extrasystoles may also be of little consequence but are exacerbated by alcohol and caffeine The P wave indicates atrial depolarizationp. Multiple abnormalities of the P wave are discussed in detail in ECG Reviews and Criteria. Atrial enlargements can widen the P wave or increase the P wave amplitude. Ectopic atrial rhythms( ventricular tachycardia) dampens of the normal morphology of P waves Ref Harrison 20th edition pg 1456", "cop": 1, "opa": "P wave", "opb": "QRS complex", "opc": "T wave", "opd": "R wave", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "51cd4856-9cf7-45f0-9e3d-426a2d8a5820", "choice_type": "single"}
+{"question": "Single most common finding in Aphasic Patients", "exp": "*A deficit of naming (anomia) is the single most common finding in aphasic patients. The persistent inability to find the correct word is known as anomia (literally, 'without names'). Anomia is actually a symptom of all forms of aphasia, but patients whose primary language problem is word retrieval are diagnosed as having anomic aphasia. Ref Harrison20th edition pg 2234", "cop": 1, "opa": "Anomia", "opb": "Apraxia", "opc": "Alexia", "opd": "Agraphia", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "92c94b50-f842-4a70-8634-7a7d3e104a9c", "choice_type": "single"}
+{"question": "The most common causative organism for lobar pneumonia Is", "exp": null, "cop": 3, "opa": "Staphylococcus aureus", "opb": "Streptococcus pyogenes", "opc": "Streptococcus pneumoniae", "opd": "Haemophilus influenzae", "subject_name": "Medicine", "topic_name": null, "id": "795e502c-fd92-4dd0-bba3-2a373092ffca", "choice_type": "single"}
+{"question": "Drug Not used in pulmonary hypertension", "exp": null, "cop": 3, "opa": "Calcium channel blocker", "opb": "Endothelin receptor antagonist", "opc": "Alpha blocker", "opd": "Prostacyclin", "subject_name": "Medicine", "topic_name": null, "id": "8ca6d06f-da40-44ba-8130-d68230413f27", "choice_type": "single"}
+{"question": "Elevated serum ferritin, decreased serum iron and % transferring saturation are most consistent with the diagnosis of", "exp": "Answer is C (Anemia of chronic disease) Decreased Serum Iron Levels, Decreased Transferrin Saturation and Increased Serum Ferritin Levels are typical features of Anemia of Chronic Disease.", "cop": 3, "opa": "Iron deficiency anemia", "opb": "Thalassemia", "opc": "Anemia of chronic disease", "opd": "Sideroblastic anemia", "subject_name": "Medicine", "topic_name": null, "id": "1ab783ee-59ac-45dd-9dd0-8ee8ed22e1db", "choice_type": "single"}
+{"question": "The maximum concentration of potassium delivered central line is", "exp": "In adults, the preferred concentration central line is 20 mEq/100 ml. The maximum concentration for fluid restricted patients is 20 mEq/50 ml. Ref Davidson 23rd edition pg 345", "cop": 1, "opa": "20 mmol/L", "opb": "40 mmol/L", "opc": "60 mmol/L", "opd": "80 mmol/L", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "6f567d4f-2f0d-4963-9068-6b0736ae2ab9", "choice_type": "single"}
+{"question": "RHD diagnostic criteria include", "exp": "Erythema marginatum is a cutaneous finding associated with acute rheumatic fever. The lesions typically develop 7 days to months after the onset of the streptococcal pharyngitis or, rarely, streptococcal skin infections. Erythema marginatum occurs in about 10% cases of acute rheumatic fever. Jones criteria is used for diagnosis of rheumatic fever . Its shown in the following picture Ref Davidson edition23rd pg 532", "cop": 3, "opa": "Oral ulcer", "opb": "Malar rash", "opc": "Erythema marginatum", "opd": "Nail telengectasia", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "4d8d371c-6499-434a-a132-9e4ae8f429fd", "choice_type": "single"}
+{"question": "Commonest site of lytic lesion, in multiple myeloma is", "exp": "Answer is A (Veebral column) The commonest site of involvement in multiple myeloma is veebral column. Although any bone may be involved, the following order of involvement is most often seen. Veebral column (66%) > Ribs (44%) > Skull(41%)> pelvis (28%)>frinur (24%) > clavicle(10%) > scapula(10%)", "cop": 1, "opa": "Veebral column", "opb": "Femur", "opc": "Clavicle", "opd": "Pelvis", "subject_name": "Medicine", "topic_name": null, "id": "5f48c8be-83e1-4ac3-a55f-09c08f92bd66", "choice_type": "single"}
+{"question": "Total lung capacity is not increased in", "exp": "Ans: d (ILD)Ref: Harrison, 17th ed. pg. 1646ILD is a restrictive lung disease characterized by decrease in both total lung capacity as well as residual volume.ParameterObstructive lung diseaseRestrictive lung diseaseTotal lung capacityNormal to IncreaseDecreasesResidual volume VitalIncreasesDecreasescapacity FEV,/FVCDecreasesDecreases(FEV%) FEF 25-75%DecreasesNormal to(Forced expiratory flowDecreases NormalIncreaserate) Diffusion capacity(Decrease in emphysema)Normal DecreasedOut of the four options given, shigellosis is the single best answer of exclusion:Shigellosis clinical manifestations:* Incubation period 1 - 4 days* Diarrhoeal phase - fever, vomiting, tenesmus, watery diarrhoea* Dysenteric phase - small volume bloody mucopurulent stools , acute colitis* Post infectious phaseComplications:* Intestinal - toxic megacolon, intestinal perforation, rectal prolapsed* Metabolic - dehydration, hyponatraemia, hypoglycaemia* HUS - ARF occurs in 55-70 % cases* Ekiri syndrome - toxic encephalopathy associated with abnormal posturing, cerebral oedema, fatty degeneration of viscera, in Japanese children.* Reiter's syndromeBridge:* Shiga toxin by shigella dystentriae type 1 causes HUS* Shigella flexneri causes Reiter's syndromePlease go through Table viral haemorrhagic fevers in Davidson pg. 230 and make your facts clear.Viral fevers with hepatorenal dysfunction:1. Yellow fever2. Dengue fever3. Ebola fever4. Crimean congo haemorrhagic fever5. Hantaan feverPlasmodium falciparum clinical features :Neuro - Coma, seizure, opisthotonus, cranial nerve palsies CVS - Shock , cardiac failure (algid malaria )Renal - ARF, haemoglobinuria Liver - Jaundice, hepatitis Resp - Pulmonary edema", "cop": 4, "opa": "Asthma", "opb": "Acromegaly", "opc": "Emphysema", "opd": "Interstitial lung disease", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "9a048c92-38c7-4cb9-83e3-5038f9ce306b", "choice_type": "single"}
+{"question": "Blood flow in hemodialysis machine", "exp": "Blood flow - 300-500 ml/min.\nDialysate - 500-800 ml/min in opposite direction.", "cop": 2, "opa": "100-200 ml/min", "opb": "300-500 ml/min", "opc": "700-800 ml/min", "opd": ">1000 ml/min", "subject_name": "Medicine", "topic_name": null, "id": "1972350a-ecb9-46d8-9176-ffc6bb2c1e8f", "choice_type": "single"}
+{"question": "A female has episodic, recurrent headache in left hemicranium with nausea and parasthesia on right upper and lower limbs is most probably suffering from", "exp": "Ans. is 'a' i.e Migraine A female giving above mentioned symptoms is most probably suffering from migraine (classical migraine with Aura)migraine headache has the following characteristicsUnilateral locationPulsating qualitiesModerate or severe intensityFrontotemporal in locationAggravation by walking, climbing stairs or similar routine physical activityDuring headache at least one of the followingNausea or VomitingPhotophobia and phonophobiaIf the headache occurs in association with Aura then it is a classical migraine with Aura.Aura usually consists of Homonymous visual disturbance, hemiparesis, Hemisensory symptoms, Dysphasias or any combination of these symptoms.visual aura is most common and usually consists of photopsia & scintillation.sometimes basilar migraine in which headache is accompanied by brainstem symptoms.Glossopharyngeal neuralgiaThe patient gets brief attack of lancinating pain in the side of the throat radiating down the side of the neck, the back of the lower jaw and deep towards the inner ear. The attacks are precipitated by protruding or swallowing the tongue.Post herpetic trigeminal pain - Usually distinguished by h/o of zoster & residual scars, constant quality of pain over the distribution of the trigeminal nerve and sometimes sensory impairment over involved area.Brain tumour - May present with prostrating pounding headache that is associated with nausea & Vomiting. It is usually difficult to distinguish headache of migraine from brain tumour.", "cop": 1, "opa": "Migraine", "opb": "Glossopharyngeal neuralgia", "opc": "Herpes zoster infection of trigeminal Nerve", "opd": "Brain tumour", "subject_name": "Medicine", "topic_name": "C.N.S.", "id": "dffc5533-7599-4a59-bc4f-1117097ec841", "choice_type": "single"}
+{"question": "Complications of lobar pneumonia do not include", "exp": "Common complications of severe CAP include respiratory failure,shock and multiorgan failure,coagulopathy,and exacerbation of comorbid illnesses.Three paicularly notewohy conditions are metastatic infection,lung abscess,and complicated pleural effusion.Metastatic infection can lead to brain abscess,suppurative ahritis, or infective endocarditis. Reference:Harrison' s Medicine-18th edition,page no:2136 .", "cop": 2, "opa": "Lung abscess", "opb": "Amyloidosis", "opc": "Suppurative ahritis", "opd": "Infective endocarditis", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "f4f59b64-9b18-423c-96ed-9614aead3423", "choice_type": "single"}
+{"question": "A man presented with right sided moderate size pneumothorax without tension, Physical finding present as", "exp": "Ans A (Ipsilateral chest with bulge)Patients with small pneumothorax findings are:Decreased breath soundsDecreased vocal fremitusResonant percussion noteLarger pneumothrax:Tachypnea and distressBulge of affected hemithoraxImmobile during respirationVery large pneumothorax under tension:Severe respiratory distress DiaphoresisCyanosis HypotensionTraumatic pneumothorax:Subcutaneous emphysema", "cop": 1, "opa": "Ipsilateral chest with bulge", "opb": "Bronchial breathing", "opc": "Mediastinal crunch", "opd": "Subcutaneous crepitus", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "7b6eca79-3faf-4a7a-afa3-807a83296c25", "choice_type": "single"}
+{"question": "Intra aerial thrombolysis is indicated in", "exp": "Answer- A. Suspected occlusion of larger aeryAcute ischemic stroke < 6 hours in durationStroke is significant, (i.e., disabling or life threatening)Suspected occlusion of a large aery (i.e., non-lacunar stroke syndrome)No hemorrhage on screening computed tomography scan", "cop": 1, "opa": "Suspected occlusion of larger aery", "opb": "History of subarachnoid hemorrhage", "opc": "History of dementia", "opd": "Stroke of > 6 hours duration", "subject_name": "Medicine", "topic_name": null, "id": "cd4de170-c118-4614-8ed6-3cfd02253bb8", "choice_type": "single"}
+{"question": "Modified wells criteria is used for initial assessment of patients with suspected", "exp": "Answer- A. Pulmonary embolism", "cop": 1, "opa": "Pulmonary embolism", "opb": "Pleural Effusion", "opc": "Cardiac tamponade", "opd": "Myocardial infarction", "subject_name": "Medicine", "topic_name": null, "id": "0e68b1ce-c5a8-42ee-85da-257e2ec1447b", "choice_type": "single"}
+{"question": "The most common toxin causing dilated cardiomyopathy is", "exp": "Ref Harrison 19 th ed pg 1558 Toxic 1.Alcohol 2.Catecholamin: amphetamines, cocaine 3.3.Chemotherapeut agents (anthracyclines, trastuzumab) 4.Interferon 5.Other therapeutic agents (hydroxychloroquine, chloroquine)6.Dru of misuse (emetine, anabolic steroids) 7. metals: lead, mercury Occupational exposure: hydrocarbons, arsenicals.", "cop": 1, "opa": "Alcohol", "opb": "Chemotherapeutic agents", "opc": "Heavy metal", "opd": "Occupational exposure", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "efed0816-93fe-4736-9d6a-8775cfed5d6a", "choice_type": "single"}
+{"question": "Cause of metabolic alkalosis includes", "exp": "Causes of Metabolic Alkalosis I. Exogenous HCO3-loads A. Acute alkali administration B. Milk-alkali syndrome II. Effective ECFV contraction, normotension, K+ deficiency, and secondary hyperreninemic hyperaldosteronism A. Gastrointestinal origin 1. Vomiting 2. Gastric aspiration 3. Congenital chloridorrhea 4. Villous adenoma B. Renal origin 1. Diuretics 2. Posthypercapnic state 3. Hypercalcemia/hypoparathyroidism 4. Recovery from lactic acidosis or ketoacidosis 5. Nonreabsorbable anions including penicillin, carbenicillin 6. Mg2+ deficiency 7. K+ depletion 8. Bater's syndrome (loss of function mutations of transpoers and ion channels in TALH) 9. Gitelman's syndrome (loss of function mutation in Na+-Cl-cotranspoer in DCT) III. ECFV expansion, hypeension, K+ deficiency, and mineralocoicoid excess A. High renin 1. Renal aery stenosis 2. Accelerated hypeension 3. Renin-secreting tumor 4. Estrogen therapy B. Low renin 1. Primary aldosteronism a. Adenoma b. Hyperplasia c. Carcinoma 2. Adrenal enzyme defects a. 11b-Hydroxylase deficiency b. 17a-Hydroxylase deficiency 3. Cushing's syndrome or disease 4. Other a. Licorice b. Carbenoxolone c. Chewer's tobacco IV. Gain-of-function mutation of renal sodium channel with ECFV expansion, hypeension, K+ deficiency, and hyporeninemic-hypoaldosteronism A. Liddle's syndrome", "cop": 1, "opa": "Furosemide", "opb": "Addision disease", "opc": "Hyperkalemia", "opd": "Hyponatremia", "subject_name": "Medicine", "topic_name": "Fluid and electrolytes", "id": "9e9f8511-c62c-447f-8175-6a6b4b062b8c", "choice_type": "single"}
+{"question": "Cranial nerve most commonly involved in posterior communicating aery aneurysm is", "exp": ". *a third nerve palsy may be present due to local pressure from an aneurysm of the posterior communicating aery. Ref Harrison20th edition pg 2456", "cop": 1, "opa": "Oculomotor", "opb": "Facial", "opc": "Optic", "opd": "Trigeminal", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "61b42508-728a-4c96-beda-80976bb60d37", "choice_type": "single"}
+{"question": "Spontaneous pneumothorax is seen ina) Smokersb) Male sexc) Exercised) Short stature", "exp": null, "cop": 4, "opa": "ac", "opb": "a", "opc": "ad", "opd": "ab", "subject_name": "Medicine", "topic_name": null, "id": "b3515116-9c0a-4df0-bd88-a0acb445f0b8", "choice_type": "single"}
+{"question": "Herpes zoster infection can lead to", "exp": "Ans. is 'd' i.e., Occipital neuralgia Herpes simplex infection has a prediliction for the involvement of Temporal lobe. The lesions in HSV encephalitis are intense hemorrhagic necrosis of the inferior and medial temporal lobe and the mediorbital pa of frontal lobes. The temporal lobe lesions are usually b/L but not symmetrical. The distribution of the lesion is so characteristic that the diagnosis can be made by gross inspection or by their location and appearance on imaging studies. In the acute stages of the disease, intranuclear eosinophilic inclusions are found in neurons and glial cells in addition to the usual microscopic abnormalities of acute encephalitis and hemorrhagic necrosis C.S.F examination. Increased C.S.F pressure. Pleocytosis, cells are mostly lymphocytes. Red cells sometimes numbering in thousands and xantho chromia are found reflecting the hemorrhagic nature of the brain lesions. Protein content is increased in most cases. Slight reduction", "cop": 4, "opa": "Frontal lobe infarction", "opb": "Parietal lobe infarction", "opc": "Temporal lobe infarction", "opd": "Occipital neuralgia", "subject_name": "Medicine", "topic_name": null, "id": "d3c6a862-7bf1-44ac-b5ae-9ee7bc6c4da5", "choice_type": "single"}
+{"question": "Most common cause of aplastic anemia is", "exp": "Aplastic anemia is pancytopenia with bone marrow hypocellularity. Acquired aplastic anemia is distinguished from iatrogenic aplasia, marrow hypocellularity after intensive cytotoxic chemotherapy for cancer, and from usually accidental physical and chemical injury, as in radiation poisoning. Most cases of aplastic anemia are idiopathic, little other than history separates these cases from those with a presumed etiology such as a drug exposure. ref - Harrisons internal medicine 20e pg 724", "cop": 1, "opa": "Exposure to drugs", "opb": "Viral hepatitis", "opc": "Fanconi anemia", "opd": "Fungal infection", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "17476c1f-4449-42f2-a61b-42b68466c98d", "choice_type": "single"}
+{"question": "Most common cause of Papillary necrosis is", "exp": "Major causes of Papillary Necrosis1. Analgesic nephropathy2. Sickle cell nephropathy3. Diabetes with UTI4. Prolonged NSAID use Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 340; Tubulointerstitial Diseases of the Kidney", "cop": 3, "opa": "Diabetes Mellitus", "opb": "Sickle cell anaemia", "opc": "Analgesics", "opd": "Pyelonephritis", "subject_name": "Medicine", "topic_name": "Kidney", "id": "67ceb846-ab6f-411b-8c28-d9e47f0fe14d", "choice_type": "single"}
+{"question": "Cyclosporine inducced HTN is treated by a) Clonidine b) Enalapril c) Nifedipine d) Methyl dopa", "exp": null, "cop": 2, "opa": "ad", "opb": "bc", "opc": "ac", "opd": "bd", "subject_name": "Medicine", "topic_name": null, "id": "67b2b70d-85b9-45e0-95cb-4814959240ee", "choice_type": "single"}
+{"question": "A CKD patient is having protracted vomiting episodes. pH=7.42, pC02= 40, HCO3= 25, Na= 140mEq, Chloride= 95mEq and HCO3= 25mEq. Comment on the diagnosis.", "exp": "CKD - M. acidosis Vomiting - M. alkalosis (| Aldosterone) Anion gap = Na+ - (Cl-+ HCO3-) = 140 - (95 + 25) = 140 - 120 High anion gap = 20 meq", "cop": 1, "opa": "Metabolic acidosis and metabolic alkalosis", "opb": "Metabolic acidosis and compensated respiratory alkalosis", "opc": "Metabolic acidosis and respiratory acidosis", "opd": "Normal ABG repo with normal electrolytes", "subject_name": "Medicine", "topic_name": "Electrolyte Imbalance", "id": "f2b36175-dd02-49b7-be12-fe83c5725c41", "choice_type": "single"}
+{"question": "Calculate water deficit for 50 kg male with Na=160 meg", "exp": "Ans. is 'b' i.e., 2.9L half normal saline", "cop": 2, "opa": "2.9 L hypeonic saline", "opb": "2.9 L half normal saline", "opc": "1.5 L 5% dextrose in water", "opd": "1.5 L 10% dextrose in water", "subject_name": "Medicine", "topic_name": null, "id": "11985383-5f0a-4f6f-b392-777699ee463a", "choice_type": "single"}
+{"question": "Most common cause of precipitation of renal failure in multiple myeloma is", "exp": "(C) Hypercalcaemia # Renal failure is seen in 25% patients and hypercalcaemia is the most common cause of renal failure.> Quite often renal failure develops rapidly even at an unchanged ratio of production and serum concentration of light chains. Various factors can favour renal cast formation in myeloma patients. Dehydration, sometimes due to diuretics, reduces the glomerular filtaration rate (GFR) and causes an increase in the plasma concentration of light chains which then exceeds the capacity for reabsorption and catabolism of light chains in the proximal tubuli.> Hypercalcaemia may induce vasoconstriction followed by a decrease in GFR. Several drugs, in particular non- steroidal anti-inflammatory agents (NSAIDs), reduce renal blood flow. Radiographic contrast agents may induce acute renal failure in myeloma patients, particularly if patients are dehydrated and ionic contrast media are used.> The osteoclasts respond to osteoclast activating factors (OAF) made by the myeloma cells . leading to hypercaicaemia. Renal failure occurs in nearly 25% of myeloma patients, and some renal pathology is noted in over half. Hypercalcemia is the most common cause of renal failure. Glomerular deposits of amyloid, hyperuricemia, recurrent infections, and occasional infiltration of the kidney by myeloma cells all may contribute to renal dysfunction. However, tubular damage associated with the excretion of light chains is almost always present. Normally, light chains are filtered, reabsorbed in the tubules, and catabolized. With the increase in the amount of light chains presented to the tubule, the tubular cells become overloaded with these proteins, and tubular damage results either directly from light chain toxic effects or indirectly from the release of intracellular lysosomal enzymes. The earliest manifestation of this tubular damage is the adult Fanconi syndrome (a type 2 proximal renal tubular acidosis), with loss of glucose and amino acids, as well as defects in the ability of the kidney to acidify and concentrate the urine. The proteinuria is not accompanied by hypertension, and the protein is nearly all light chains. Generally, very little albumin is in the urine because glomerular function is usually normal.", "cop": 3, "opa": "Hyperurecemia", "opb": "Infection", "opc": "Hypercalcaemia", "opd": "Amyloidosis", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "75fc64f0-d253-4ae4-aec7-2c4d2f70a444", "choice_type": "single"}
+{"question": "Colour coding for Nitrous oxide cylinder is", "exp": "(C) French blue IDENTIFICATION OF MEDICAL GAS CYLINDERSGasColor of cylinderPressure at 15degC when full British standard (Body/Shoulder)United StatesLbf/in2Bar1. Oxygen (O2)Black / WhiteGreen19871372. Nitrous oxide (N2O)French blueBlue638443. CyclopropaneOrangeOrange7354. Carbondioxide (CO2)GreyGrey725505. Helium (He)BrownBrown19871376. AirGreyYellow19871377. O^HeliumBlackGreen/Brown19871378. OJC02BlackGreen/Grey19871379. EntonoxBlueBlue/Green1987137", "cop": 3, "opa": "Black", "opb": "Black with white shoulders", "opc": "French blue", "opd": "Gray", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "ff31e723-1491-430d-a182-a21e6a2e9675", "choice_type": "single"}
+{"question": "Van den Berg test for", "exp": "ref : harissons 21st ed", "cop": 1, "opa": "Direct bilirubin", "opb": "indirect bilirubin", "opc": "copropoolphyrin", "opd": "Total bilirubin", "subject_name": "Medicine", "topic_name": "All India exam", "id": "1b425e34-2739-40fd-aaef-fc125ee38ec1", "choice_type": "single"}
+{"question": "Treatment for multiple sclerosis", "exp": "Beta interferons. These medications are among the most commonly prescribed medications to treat MS. They are injected under the skin or into muscle and can reduce the frequency and severity of relapses Interferon alpha is used to treat various cancers (e.g., leukemia, melanoma, AIDS-related Kaposi's sarcoma). It is also used to treat virus infections Interferon-g 1b is approved by the U.S. Food and Drug Administration to treat chronic granulomatous disease and osteoporosis This medication is used to treat ceain types of ahritis (rheumatoid ahritis, ahritis of the spine, psoriatic ahritis), ceain bowel diseases (Crohn's disease, ulcerative colitis), and a ceain severe skin disease (chronic plaque psoriasis). Ref Harrison20th edition pg 2345", "cop": 2, "opa": "Interferon alpha", "opb": "Interferon beta", "opc": "Infliximab", "opd": "Interferon gamma", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "753f7e8b-b92b-462c-8134-d4eab3a3e55d", "choice_type": "single"}
+{"question": "Association of deafness & nephritis is seen in", "exp": "Answer is B (Alpo's syndrome): Alpo's syndrome is an inherited disorder characterized by hereditary nephritis, sensorineural deafness and ocular abnormalities paicularly lenticonus.", "cop": 2, "opa": "Pickwickian syndrome", "opb": "Alpo's syndrome", "opc": "Fabry's disease", "opd": "Lawrence Moon Biedl syndrome", "subject_name": "Medicine", "topic_name": null, "id": "5a3034f3-12b7-489a-9779-bdf86dd3483b", "choice_type": "single"}
+{"question": "Hyaline casts are seen in", "exp": "Hyaline casts\nNormal urine , Febrile disease, diuretics thereapy, prerenal azotemia.", "cop": 3, "opa": "Acute tubular necrosis", "opb": "Thrombotic microangiopathy", "opc": "Normal urine", "opd": "Pyelonephritis", "subject_name": "Medicine", "topic_name": null, "id": "4a216eaf-1ff0-495f-8f85-6277019ddcfd", "choice_type": "single"}
+{"question": "Hemangioblastoma associated with VHL are most commonly seen in", "exp": "Answer is A (Cerebellum) Hemangioblastomas associated with Von-Hippel-Lindau Disease are most commonly seen in the cerebellum. The hallmark lesion of Von-Hippel-Lindau (VHL) disease is the hemangioblastoma. These are most commonly seen in the cerebellum but occasionally seen in the medulla oblongata (most common brainstem site), spinal cord and supratentorially in the optic nerves and cerebral hemispheres' - MR1 of the Brain and spine (Lippincott). 'The most common CNS manifestation of VHL is the charachteristic cerebellar hemangioblastoma. Approximately 6080% of VHL patients ultimately develop a CNS Hemangioblastoma. Three quaers of these are cerebellar in location with the majority of the remaining hemangioblastomas located in the spinal cord. Hemangioblastomas of the cerebral hemisphere account for only a small minority of lesions '", "cop": 1, "opa": "Cerebellum", "opb": "Liver", "opc": "Kidney", "opd": "Pancreas", "subject_name": "Medicine", "topic_name": null, "id": "5e0b6237-5bec-41a0-aaa9-379883b199cb", "choice_type": "single"}
+{"question": "Most common cause of acute polyneuropathy is", "exp": "(B) Guillian Barre syndrome # Myocarditis & Polyneuropathy are the prominent toxic manifestations of diphtheria. The risk of each is proportional to the severity of local disease.> Polyneuropathy typically begins 3 to 5 weeks after onset of diphtheria and has a slow course. It appears earliest in patients who experience the most severe and prolonged neurologic abnormalities. Guillain-Barre syndrome (GBS) sometimes called Landry's paralysis, is an acute inflammatory demyelinating polyneuropathy (AIDP), a disorder affecting the peripheral nervous system. Ascending paralysis, weakness beginning in the feet and hands and migrating towards the trunk, is the most typical symptom. It can cause life-threatening complications, particularly if the breathing muscles are affected or if there is dysfunction of the autonomic nervous system. The disease is usually triggered by an acute infection. Guillain-Barre syndrome is a form of peripheral neuropathy. Rarely in Sarcoidosis, multiple lesions occur that mimic multiple sclerosis, spinal cord abnormalities, and peripheral neuropathy. Charcot-Marie-Tooth disease type 1, also known as hereditary motor sensory neuropathy type 1, is an uncommon autosomal dominant disease that causes destruction of peripheral nerves with a varied clinical course, but often leads to muscle weakness. If the peroneal muscle is involved, the patient may develop a characteristic slapping gait.", "cop": 2, "opa": "Diphteria", "opb": "Guillian Barre syndrome", "opc": "Sarcoidosis", "opd": "Charcot-Marie-Tooth disease", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "ea08faf4-00a0-4249-a553-ae465a5a9a0a", "choice_type": "single"}
+{"question": "'a' wave is absent in", "exp": "(A) # 'a' wave of JVP: Due to right atrial contraction Synchronous with carotid artery pulse> Absent 'a' wave: Atrial fibrillation> Diminished 'a' wave: Tachycardia; Prolonged PR interval> 'a' Wave Fused with 'c' Wave: Supra ventricular tachycardia> Large 'a' Waves: Pulmonary hypertension Pulmonary stenosis; Tricuspid stenosis Tricuspid atresia; AV dissociation> Cannon Waves (Giant 'a' Waves): Complete heart block when right atrium occasionally contracts against closed tricuspid valve Ventricular tachycardia; Ectopic beats", "cop": 1, "opa": "Atrial fibrillation", "opb": "Heart block", "opc": "Tricuspid regurgitation", "opd": "Pericardial effusion", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "10585724-67a9-405e-a3ee-278f6367c41c", "choice_type": "single"}
+{"question": "Appendicectomy is protective in", "exp": "There is a protective effect of the previous appendectomy with confirmed appendicitis (reduction of 13-26%), paicularly at a young age, on the development of UCRef: Harrison 19e pg: 1947", "cop": 2, "opa": "Irritable bowel syndrome", "opb": "Ulcerative colitis", "opc": "Crohn's disease", "opd": "Caeliac sprue", "subject_name": "Medicine", "topic_name": "G.I.T", "id": "66b39249-36f8-4670-936a-bb358c6c998f", "choice_type": "single"}
+{"question": "Treatment of tetanus is", "exp": "If possible, the entry wound should be identified, cleaned, and debrided of necrotic material in order to remove anaerobic foci of infection and prevent fuher toxin production. Metronidazole (400 mg rectally or 500 mg IV every 6 h for 7 days) is the preferred antibiotic. An alternative is penicillin (100,000-200,000 IU/kg per day), although this drug theoretically may exacerbate spasms. (Harrison's Principles of internal medicine,20th edition, page 1199)", "cop": 3, "opa": "Clindamycin", "opb": "Doxycycline", "opc": "Metronidazole", "opd": "Penicillin", "subject_name": "Medicine", "topic_name": "Infection", "id": "0392a703-56b2-45a8-bc09-86029b4a6c00", "choice_type": "single"}
+{"question": "Skip granulomatous lesions are seen in", "exp": "Ans. is 'b' i.e., Crohn's disease Skip lesions are characteristic of Crohn's disease. This pt. is suffering with Crohn's ds. The characterstics of Crohn's ds and their comparison with Ulcerative colitis are given --> Once you know them the answer becomes obvious", "cop": 2, "opa": "Ulcerative colitis", "opb": "Crohn's disease", "opc": "Whipple's disease", "opd": "Reiter's disease", "subject_name": "Medicine", "topic_name": null, "id": "a5da48c0-c75c-4957-adbd-16f4dd9ee041", "choice_type": "single"}
+{"question": "A patient presents with B/L proptosis, heat intolerance and palpitations; most unlikely diagnosis here would be", "exp": "Answer is D (Reidel's thyroiditis) : Reidel's thyroiditis is usually a consistently hypothyroid condition. The patient in the given question is presenting with symptoms of Hypehyroidism. The condition, most unlikely to produce the picture is the one where hypehyroidism is not a feature, not even transient. Reidel's thyroiditis is one such consistently hypothyroid condition. Thyrotoxicosis is usual with thyroid adenoma and diffuse thyroid goitre and Hashimoto's thyroiditis can present with transient hypehyroidism. Hashimoto's Thyroiditis (Auto immune): In this variant, mild hypehyroidism may be present initially, although hypothyroidism is inevitable. Hypothyroidism may develop rapidly or extremely slowly. The initial phase of hypehyroidism may account for the symptoms in the given patient. Thyroid adenoma, diffuse toxic goitre or Grave's disease, toxic nodular goitre, toxic nodule: All are causes of thyrotoxicosis & explain the symptoms of thyrotoxicosis in the above patient. 733/L&B Riedle's thyroiditis is a very rare disease wherein , the thyroid tissue is replaced by cellular fibrous tissue. The goitre may be unilateral or bilateral & is very hard and fixed. This condition presents with features of hypothyroidism. Hypehyroidism is not manifested, not even transiently. The differential diagnosis is from an anaplastic carcinoma & can be made with ceainity only by biopsy. Diffuse thyroid goitre :Most commonly presents with a euthyroid status however patients may present with hypehyroidism.", "cop": 4, "opa": "Hoshimoto's thyroiditis", "opb": "Thyroid adenoma", "opc": "Diffuse thyroid goitre", "opd": "Reidel's thyroiditis", "subject_name": "Medicine", "topic_name": null, "id": "cfba4c31-ce27-4d39-82c6-f87153bc3efb", "choice_type": "single"}
+{"question": "Conn's syndrome is characterized by diastolic hypeension without edema.", "exp": "Answer is A Excess Aldosterone is associated with Hypokalemia and not Hyperkalemia.", "cop": 1, "opa": "Hypokalemia", "opb": "Hyperkalemia", "opc": "Sodium retention", "opd": "Hypeension", "subject_name": "Medicine", "topic_name": null, "id": "1cfc2a19-72f6-47a1-b14e-1e83bdc938ce", "choice_type": "single"}
+{"question": "The single most common feature in Aphasic patients is", "exp": "(C) Anomia # Clinical Examination of Language should include the assessment of naming, spontaneous speech, comprehension, repetition, reading, and writing.> A deficit of naming (anomia) is the single most common finding in aphasic patients.# Anomic Aphasia:> Anomic aphasia is the single most common language disturbance seen in head trauma, metabolic encephalopathy; and Alzheimer's disease.# Pure Alexia without Agraphia:> This is the visual equivalent of pure word deafness.> The lesions (usually a combination of damage to the left occipital cortex and to a posterior sector of the corpus callosum- -the splenium) interrupt the flow of visual input into the language network.", "cop": 3, "opa": "Agraphia", "opb": "Alexia", "opc": "Anomia", "opd": "Apraxia", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "28be531e-1e72-4b13-86f5-d873ce1dabdf", "choice_type": "single"}
+{"question": "Nail and half nail sign, seen in uremia is", "exp": "Ans. is 'b' i.e. Increased capillary density at the distal half of nails Half and Half nail are characterized by a band in the midportion of the nail separating the darker distal portion from the proximal white portion. They are a common occurrence in renal failure and are seen in l/3rd patients of renal failure.Pathophysiology of Half and half nailThey are also called Lindsay's nailTheir pathogenesis is not clearly understood.Two mechanisms have been proposed.increased melanin depositionthe proximal half of the nail appears white because of the edema associated with dilated capillary network According to Oxford text book of clinical nephrology 2nd/e chapter 11.3.11. \"The so called \"half-and half nail\" in typical of uremia the distal portion of each nail bed is red, pink or brown, occupies 20-60 percent of the total nail length, and always sharply demarcated, the proximal portion has dull whitish ground glass appearance.When pressure is applied, the discoloration does not fade completely. This change can affect single nails, or all the nails, or all the nails of the hand or feet or both. Half and half nail often begins before dialysis. It occurs in 15-50% of patients on regular dialysis.The histology of the nail plate itself shows no change and it contains no melanin, the number of capillaries under the nail plate is increased, with remarkable thickening of the capillary walls.The increase in capillary density of the nail bed might account for the band.The disorder in probably partially reversible. In some patients a lightening of the colour and a decrease in the width of the brown are have been seen after months of observation", "cop": 2, "opa": "Due to melanin deposition", "opb": "Increased capillary density at the distal half of nails", "opc": "Hypoproteinemia", "opd": "Circulating toxin", "subject_name": "Medicine", "topic_name": "Chronic Kidney Disease and Uremia", "id": "6e64073c-e9fb-4325-8a18-49dc502722e0", "choice_type": "single"}
+{"question": "Amongst various current criteria for FUO (Fever of Unknown origin), one relates to body temperature =", "exp": "Ans. d (101deg F). (Ref: Harrison's 17th edition, P. 130).PUO/FUO# Petersdorf and Beeson (1961)# Temperature > 101deg F (38.3degF) on several occasions# Duration of fever > 3 weeks# Failure to reach diagnosis despite inpatient investigations for 1 week.Also Remember:Neutropenic FUO# Neutrophil count < 500/cmmHIV Associated FUO# Duration of fever >4 weeks# And inpatient investigation with failure to reach diagnosis is > 3 daysMost common cause of PUO# Infection (26%) -m/c extrapulmonary TBMost common cause of PUO in elderly# Multisystem disease (Giant cell artheritis)Undiagnosed Cause for FUO# 25-30Malignancies associated with FUO# Ca colon (most common cause)# Hepatoma# Gall bladder Ca# Lymphoma, leukemia# Pancreatic cancer# Renal cell cancer# Sarcoma# Atrial myxoma# Renal angiomyoliposa", "cop": 4, "opa": "98.4deg F", "opb": "99.4deg F", "opc": "100deg F", "opd": "101deg F", "subject_name": "Medicine", "topic_name": "Alteration of Body Temperature", "id": "23d33eba-fc8f-4e43-adda-f5e83abd2dd8", "choice_type": "single"}
+{"question": "Adenoma sebaceum is seen in", "exp": "i.e. (Tuberous sclerosis): (96Q-CMDT-11) (1798 -1000-H17th)* Adenoma sebaceum subungual fibromas, shagreen patches (leathery plaques of subepidermal fibrosis) and leaf shaped hypopigmented spots - cutaneous abnormalities seen in TUBEROUS - SCLEROSIS* Renal abnormalities includes - Renal cysts, Angiolipomas, Renal cell carcinoma***TUBEROUS - SCLEROSIS* TS - is an Autosomal dominant inheritance* *** Mutations that inactivating in either the TSCJ gene encoding tuberin or the TSC2 gene encoding hamartin* CNS hamartomas can cause seizures, mental retardation and autism* Associated abnormalities includes - retinal lesions, benign rhabdomyomas of the heart, lung cysts, benign tumours in the viscera and bone cysts* Classical Triad -(i) Seizures(ii) Mental retardation(iii) Adenoma sebacium* The characteristic brain lesion is a \"Cortical Tuber\" The most common neurological manifestations include seizures, cognitive impairment and behavioral abnormalities including autism", "cop": 2, "opa": "Scleroderma", "opb": "Tuberous sclerosis", "opc": "SLE", "opd": "Systemic sclerosis", "subject_name": "Medicine", "topic_name": "Skin", "id": "a75fe2a4-c4a8-4fc3-a989-4fef0ab97005", "choice_type": "single"}
+{"question": "The commonest cause of chronic renal failure is", "exp": "Commonest cause of chronic renal failure is pyelonephritis.", "cop": 2, "opa": "Chronic glomerulonephritis", "opb": "Chronic pyelonephritis", "opc": "Multiple myeloma", "opd": "Subacute bacterial endocarditis", "subject_name": "Medicine", "topic_name": null, "id": "b5218719-2e82-484c-8fe6-1167a6a9c3bd", "choice_type": "single"}
+{"question": "Pariaeriole space is formed in spleen by", "exp": "Lymphocytes that aggregate around the central aery (mostly T-lymphocytes) create the periaerial lymphatic sheath(ref:Gray's Anatomy 40/e p1194)", "cop": 1, "opa": "T lymphocyte", "opb": "B lymphocyte", "opc": "Rete", "opd": "Macrophage", "subject_name": "Medicine", "topic_name": "All India exam", "id": "d0ea08e1-8f5f-4456-8f7d-c282ca1e2f8d", "choice_type": "single"}
+{"question": "Water brash is a classic symptom of", "exp": "Water brash is excessive salivation resulting from a vagal reflex triggered by acidification of the esophageal mucosa. This is not a common symptom. Afflicted individuals will describe the unpleasant sensation of the mouth rapidly filling with salty thin fluid, often in the setting of concomitant heaburn.When classic symptoms of gastroesophageal reflux are present, such as water brash and substernal heaburn, presumptive diagnosis andempirical treatment is often sufficient.Ref: Harrison; 19th edition; Page no: 1901", "cop": 3, "opa": "Dyspepsia", "opb": "Indigestion", "opc": "GERD", "opd": "Duodenal ulcer", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "72c4cb55-180a-4935-8f37-e7a26e362695", "choice_type": "single"}
+{"question": "Most accurate, inexpensive, noninvasive, simpler test of Helicobacter pylori", "exp": "(C) Urea breath test TESTS COMMONLY USED TO DETECT H. PYLORI:NoninvasiveSerologyInexpensive & convenientCannot be used for early follow-up; some commercial kits inaccurate13C or14C urea breath testInexpensive and simpler than endoscopy; useful for follow-up after treatmentLow-dose irradiation in 14C testStool antigen testInexpensive and convenient; useful for follow-up after treatment; may be useful in childrenNew test; role not fully established; appears less accurate than urea breath test", "cop": 3, "opa": "Stool antigen test", "opb": "Serology", "opc": "Urea breath test", "opd": "Biopsy wrease test", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "31b7c642-95ca-407e-8697-15414a1021dd", "choice_type": "single"}
+{"question": "impaired function of aquorporin results in", "exp": "ref : harrisons 21st ed", "cop": 1, "opa": "Nephrogenic DI", "opb": "Liddle syndrome", "opc": "Cystic fibrosis", "opd": "Baer Syndrome", "subject_name": "Medicine", "topic_name": "All India exam", "id": "d400c01c-9ac7-4c2e-8cc4-063c33539369", "choice_type": "single"}
+{"question": "Elevated JVP is seen in", "exp": "Ans. (a) Corpulmonale", "cop": 1, "opa": "Corpulmonale", "opb": "Pneumonia", "opc": "ARDS", "opd": "Pleural effusion", "subject_name": "Medicine", "topic_name": "C.V.S.", "id": "22ad1e6a-52c5-49f0-afa6-c2cbbe9cace9", "choice_type": "single"}
+{"question": "Gelastic seizure is a", "exp": "(A) Laughing epilepsy # Gelastic seizure or \"Gelastic epilepsy\" is a rare type of seizure that involves a sudden burst of energy, usually in the form of laughing or crying. This syndrome usually occurs for no obvious reason and is uncontrollable. It is slightly more common in males than females.> Term Gelastic originates from the Greek word \"Gelos\" which means laughter. The main sign of a gelastic seizure is a sudden outhurst of laughter or crying with no apparent cause. The laughter may sound unpleasant and sardonic rather than joyful. The outburst usually lasts for less than a minute.> During or shortly after a seizure, an individual might display some twitching, strange eye movements, lip smacking, fidgeting or mumbling. If a person of who suffers from the seizures is hooked up to an electroencephalogram it will reveal interictal epileptic discharges.> A gelastic seizure is typically caused by a hypothalamic hamartomas, or a brain tumor.> Gelastic seizures are not responsive to therapy. They can produce secondary seizure characteristics which may respond to medications or surgery.", "cop": 1, "opa": "Laughing epilepsy", "opb": "Febrile epilepsy", "opc": "Postpartum epilepsy", "opd": "Clonic-tonic type epilepsy", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "cb5936a6-9b45-4ed4-918b-8dc27d7080c8", "choice_type": "single"}
+{"question": "Gestational hypehyroidism occurs due to", "exp": "A common cause of overactive thyroid in pregnant women is Graves' disease. This disease occurs when your immune system becomes overactive and forms antibodies (immune proteins) that attack the thyroid. This causes the gland to enlarge and make too much thyroid hormone. Most women with Graves' disease find out they have it and get treatment before they become pregnant. Women with severe nausea and vomiting or those expecting twins may develop temporary hypehyroidism. Called transient gestational thyrotoxicosis, this hypehyroidism is due to high levels of a pregnancy hormone called human chorionic gonadotropin or hCG. Because it resolves by week 14 to 18 of pregnancy, women do not need antithyroid drugs to treat this condition. Ref - pubmed.com", "cop": 1, "opa": "Beta HCG from placenta", "opb": "Trans-placental transfer of TSH", "opc": "TPO antibodies", "opd": "Anti thyroglobulin antibody", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "1245bce9-91db-4311-913b-42f82d062b50", "choice_type": "single"}
+{"question": "Stroke prevention", "exp": "(C) Warfarin# MEDICATIONS for TIA/STROKE PREVENTION> Anti-platelet medications:> Anti-platelet medications used to prevent and reduce the risk of stroke include: Aspirin; Aspirin/extended-release dipyridamole; Clopidogrel; Ticlopidine> Aspirin is the most commonly used preventive therapy for patients at risk for stroke. However, at least 10 percent of patients are unable to take aspirin long-term, usually due to stomach problems.> Anticoagulant medication: that is usually prescribed to reduce the risk of stroke is warfarin. Warfarin usually is prescribed in patients with atrial fibrillation and other cardiovascular disorders to reduce the risk of stroke. If you are in the hospital, heparin is an anticoagulant that may be given intravenously. Anticoagulants can also be injected into the skin to prevent clots in the legs. Such clots can form when patients are on bed rest.> Anticoagulants decrease the blood's ability to clot and prevent the formation of additional clots. If you are prescribed an anticoagulant, your follow-up will include frequent blood tests so your response to the medication can be monitored.> Treatment for acute (sudden onset) stroke is the administration of a thrombolytic agent, or \"clot buster,\" including streptokinase or streptase and tissue plasminogen activator (TPA).> These medications can dissolve the blockage within the artery to restore blood flow to the brain. They must be given within the first three hours of the onset of stroke symptoms and are usually given in a hospital where the patient can be closely monitored. The risk, however, is bleeding into the brain, which can worsen the disability. Patients need to be carefully screened and evaluated before and after thrombolytic treatment.", "cop": 3, "opa": "Streptokinase", "opb": "Streptase", "opc": "Warfarin", "opd": "Tissue plasminogen activator", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "0d37dcd5-3067-4c88-a9f0-a9f862a9f319", "choice_type": "single"}
+{"question": "Pleural effusion, in standing position gravitates n the region of", "exp": "i.e. (Costodiaphragmatic recess: (1658-66 - H17th) (306-8-CMDT-l1)* Most dependent recess of the pleura is the posterior costophrenic angle**. So in pleural effusion this recess would be filled earliest. But at least 100-200 ml of fluid. Would be required to fill this recess before it can be defected on a PA view* The lung is less dense than water and floates on pleural fluid that accumulates in dependent regions* Sub pulmonary fluid may appear as lateral displacement of the apex of the diaphragm with an abrupt slop to the costophrenic sulcus or a greater than 2 cm seperation between the gastric air bubble and the lung.* On a standard upright chest radiograph approximately 75-100 ml of pleural fluid must accumulate in the posterior costophrenic sulcus to the visible on the lateral view and 175-200 ml must be present in the lateral costophrenic sulcus to be visible on he frontal view (307-CMDT-l 1)* Best method to defect minimal pleural effusion decubitus view with a horizontal beam*** Most common cause of pleural effusion is LVF* Most common cause of an exudative pleural effusion developing countries TuberculosisCriteria of Exudative pleural effusion1. Pleural fluid protein / serum protein > 0.52. Pleural fluid LDH / serum LDH >0.63. Pleural fluid more than two thirds normal upper limit for serumCauses of Transudative Pleural Effusion 1. CHF (>90% of cases)2. Cirrhosis with ascitis3. Pulmonary embolization4. Nephrotic syndrome5. Peritoneal dialysis6. SVC obstruction7. Myxedema8. Urinothorax9. Constrictive pericarditis10. Atelectasis (Acute)Chest CT scan may identify as little as 10 ml of fluid", "cop": 3, "opa": "Oblique fissure", "opb": "Costomediastinum recess", "opc": "Costodiaphragmatic recess", "opd": "Cardiac knoch", "subject_name": "Medicine", "topic_name": "Respiratory", "id": "853e41dc-17a9-42f4-974b-88e5ba10f65b", "choice_type": "single"}
+{"question": "According to CDC, past smoker is", "exp": null, "cop": 1, "opa": "Person who had smoked >100 cigarettes previously and is not smoking currently", "opb": "Person who has smoked >10 cigarettes previously and is not smoking currently", "opc": "Person who has smoked >100 cigarettes previously and reduces to 10 cigarettes per day", "opd": "Person who has smoked > 100 cigarettes in his or her lifetime, who smokes now, but does not smoke every day", "subject_name": "Medicine", "topic_name": null, "id": "78819aed-74f7-4ba3-825b-5f4e80c77f8b", "choice_type": "single"}
+{"question": "Low serum iron and low serum ferritin is seen in", "exp": "Low serum iron is seen in iron deficiency anemia. Serum iron will be also low in case of anemia of chronic diseases and also in case of malabsorption, pregnancy and in pubey where the demand increases. Serum ferritin is a measure of iron stores and is the best single test to confirm iron deficiency. Reference : Davidson, 23rd Edition, page no : 941.", "cop": 1, "opa": "Iron deficiency anaemia", "opb": "Chronic kidney disease", "opc": "Sideroblastic anaemia", "opd": "Fanconi anaemia", "subject_name": "Medicine", "topic_name": "Haematology", "id": "8e616c6d-43a9-4fc3-bf28-d7acc9ce106d", "choice_type": "single"}
+{"question": "Hyperventilation can provoke the following", "exp": "The electrophysiologic hallmark of typical absence seizures is a generalized, symmetric, 3-Hz spike-and-wave discharge that begins and ends suddenly, superimposed on a normal EEG background.In tonic-clonic seizures, The EEG during the tonic phase of the seizure shows a progressive increase in generalized low-voltage fast activity, followed by generalized high-amplitude, polyspike discharges. In the clonic phase, the high-amplitude activity is typically interrupted by slow waves to create a spike-and-wave pattern. The postictal EEG shows diffuse slowing that gradually recovers as the patient awakens.Hyperventilation tends to provoke these electrographic discharges and even the seizures themselves and is routinely used when recording the EEG.Ref: Harrison 19e 2543", "cop": 4, "opa": "Tonic-clonic seizures", "opb": "Simple paial seizures", "opc": "Complex paial seizures", "opd": "Absence seizures", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "b16beaa8-e5cb-4cf8-bab1-b4bf86db3315", "choice_type": "single"}
+{"question": "A patient on amphotericin emia of", "exp": "Ans. d. 120-160 mEq over 24 hours Except in unusual circumstances, the total amount of potassium administered daily should not exceed 200 mEq. Potassium Supplementation A prudent protocol to follow is to add potassium chloride to IV solutions at a final concentration of 40-60 mEq/L and to administer no more than 10-20 mEq/L of potassium per hour Except in unusual circumstances, the total amount of potassium administered daily should not exceed 200 mEq. IV potassium replacement is indicated for patients with severe hypokalemia and for those who can not take oral supplementation. For severe deficiency, potassium may be given through a peripheral IV line in a concentration that should exceed 40 mEq/L, at the rates upto 40 mEq/L/Hour. Continuous ECG monitoring is indicated and the serum potassium levels should be checked every 3-6 hours. For the initial administration, avoid glucose containing fluid to prevent fuher shift of potassium intothe cells. . Magnesium deficiency also needs to be corrected at the same time, paicularly in refractory hypokalemia", "cop": 4, "opa": "40 mEq over 24 hours", "opb": "60 mEq over 24 hours", "opc": "80 mEq over 24 hours", "opd": "120-160 mEq over 24 hours", "subject_name": "Medicine", "topic_name": null, "id": "30ed74ee-a7b9-4374-8560-ac74f6a1c5d6", "choice_type": "single"}
+{"question": "Calcium homeostasis disturbance is seen in", "exp": null, "cop": 1, "opa": "Malignant hyperthermia", "opb": "DMD", "opc": "Tibial muscular dystrophy", "opd": "Limb girdle muscle dystrophy", "subject_name": "Medicine", "topic_name": null, "id": "6463048d-0fbd-431d-bc20-28eabe3e6e6d", "choice_type": "single"}
+{"question": "Lisch Nodules are seen", "exp": "Harrison's principles of internal medicine 17 th edition. *Multiple neurofibromas usually in combination with 6 or more CALM measuring>1.5 cm, axillary freckling and multiple Lisch nodules are seen in NF type 1.", "cop": 1, "opa": "Neurofibromatosis I", "opb": "Sturge weber's syndrome", "opc": "Tuberous sclerosis", "opd": "Von hippel lindau syndrome", "subject_name": "Medicine", "topic_name": "C.N.S", "id": "a1646598-191c-4f7d-84c5-f4eccdcd3241", "choice_type": "single"}
+{"question": "In Budd chiary syndrome , the site of venous thrombosis is", "exp": "i.e. (Hepatic veins): (673-CMDT-ll) (661, 733, 1945, 1950 H17th)Budd chiary syndrome is characterized by post sinusoidal obstruction outside the liver at the level of hepatic veinsFactors that predispose to hepatic vein thrombosis (Budd chiary syndrome)* Polycythemia vera** or other myeloproliferative disease* Activated protein C resistance (factor V Leiden mutation)* Protein C or S or antithrombin deficiency*** Hyper prothrombinemia (factor 11 G 20210 A mutation)* Methylenetetra hydrofolate reductase TT 677 mutation,* Antiphospholipid antibodies* Caval webs, right sided heart failure or constrictive pericarditis, neoplasm.* Paroxysmal nocturnal hemoglobinuria, Behcet's syndrome, blunt abdominal trauma, use of oral contraceptives** and pregnancy* Some cytotoxic agents (cyclophosphamide, azathioprine, carmustine, busulfan or etoposide) and pyrrolizidine alkaloids (\"bush & eas\")The screening test of choice is contrast - enhanced, color or pulsed doppler ultrasonography* Classical Triad of Budd Chiary Syndrome - Abdominal pain, ascites and hepatomegaly", "cop": 3, "opa": "Infra venal IVC", "opb": "Infra hepatic IVC", "opc": "Hepatic veins", "opd": "Portal veins", "subject_name": "Medicine", "topic_name": "G.I.T.", "id": "fbd462df-b68c-49ae-b1ab-1d52a00690e8", "choice_type": "single"}
+{"question": "Disecting hematoma is a clinical complication occurring in", "exp": "Marfan Syndrome Marfan syndrome is a disorder of connective tissues, manifested principally by changes in the skeleton, eyes, and cardiovascular system. Its prevalence is estimated to be 1 in 5000. Approximately 70% to 85% of cases are familial and transmitted by autosomal dominant inheritance. The remainder are sporadic and arise from new mutations. Pathogenesis. Marfan syndrome results from an inherited defect in an extracellular glycoprotein called fibrillin- 1. There are two fundamental mechanisms by which loss of fibrillin leads to the clinical manifestations of Marfan syndrome: loss of structural suppo in microfibril rich connective tissue and excessive activation of TGF-b signaling. Each of these is discussed below. * Fibrillin is the major component of microfibrils found in the extracellular matrix. These fibrils provide a scaffolding on which tropoelastin is deposited to form elastic fibers. Although microfibrils are widely distributed in the body, they are paicularly abundant in the aoa, ligaments, and the ciliary zonules that suppo the lens; these tissues are prominently affected in Marfan syndrome. Fibrillin occurs in two homologous forms, fibrillin-1 and fibrillin-2, encoded by two separate genes, FBN1 and FBN2, mapped on chromosomes 15q21.1 and 5q23.31, respectively. Mutations of FBN1 underlie Marfan syndrome; mutations of the related FBN2 gene are less common, and they give rise to congenital contractural arachnodactyly, an autosomal dominant disorder characterized by skeletal abnormalities. Mutational analysis has revealed more than 600 distinct mutations of the FBN1 gene in individuals with Marfan syndrome. Most of these are missense mutations that give rise to abnormal fibrillin-1. These can inhibit polymerization of fibrillin fibers (dominant negative effect). Alternatively, the reduction of fibrillin content below a ceain threshold weakens the connective tissue (haploinsufficiency). * While many clinical manifestations of Marfan syndrome can be explained by changes in the mechanical propeies of the extracellular matrix resulting from abnormalities of fibrillin, several others such as bone overgrowth and myxoid changes in mitral valves cannot be attributed to changes in tissue elasticity. Recent studies indicate that loss of microfibrils gives rise to abnormal and excessive activation of transforming growth factor-b (TGF-b), since normal microfibrils sequester TGF-b and thus control the bioavailability of this cytokine. Excessive TGF-b signaling has deleterious effects on vascular smooth muscle development and it also increases the activity of metalloproteases, causing loss of extracellular matrix. This schema is suppoed by two sets of observations. First, in a small number of individuals with clinical features of Marfan syndrome (MFS2), there are no mutations in FBN1 but instead gain-of-function mutations in genes that encode TGF-b receptors. Second, in mouse models of Marfan syndrome generated by mutations in Fbn1, administration of antibodies to TGF-b prevents alterations in the aoa and mitral valves. Ref Robbins 9/e pg 144", "cop": 4, "opa": "Turner's syndrome", "opb": "Klinefelter's syndrome", "opc": "Down syndrome", "opd": "Marfan syndrome", "subject_name": "Medicine", "topic_name": "Genetics", "id": "73c9e1d1-7158-4f5e-9f08-48904d42ab38", "choice_type": "single"}
+{"question": "The Most common cause of embolism causing cerebro vascular disease is", "exp": "(B) Non rheumatic atrial fibrillation # Sources of cardioembolic embolism include the following:> Valvular diseases Rheumatic mitral stenosis Prosthetic valves Calcific aortic stenosis Bicuspid aortic valves Mitral annulus calcification Nonbacterial thrombotic (marantic) endocarditis associated with malignancies and prothrombic states Myxomatous mitral valvulopathy with prolapse> Infective endocarditis Inflammatory valvulitis (ie, Libman-Sacks endocarditis, Behget disease, syphilis) Lambl excrescences and/or strands> Left ventricular thrombi Ischemic heart disease Acute myocardial infarction Left ventricular akinesis or aneurysm Idiopathic hypertrophic subaortic stenosis Trauma (myocardial contusion) Ventricular noncompaction Nonischemic cardiomyopathies (E.g., idiopathic dilating, viral myocarditis-associated, echinococcal, peripartum, amyloid- associated, hypereosinophilia syndrome-associated, rheumatic myocarditis-associated, sarcoidosis-related, neuromuscular disorder-associated, alcoholism-related, catecholamine-induced, Chagas disease-associated, doxorubicin-induced, mitoxantrone-related, crack cocaine-related, cardiac oxalosis-associated) Left ventricular thrombi associated with prothrombotic states Antiphospholipid antibodies Diffuse intravascular coagulation Essential thrombocythemia & myeloproliferative diseases> Left atrial thrombi Arrhythmias A trial fibril la tion (Mos t common) Sick sinus syndrome/atrial asystole Atrial flutter Atrial septal aneurysms Chiari network > Cardiac tumors Atrial myxoma> Cardiac sarcoma Endocardial fibroelastoma Metastatic disease> Paradoxical emboli (major risk) Atrial septal defects> PFO Ventricular septal defects Pulmonary arteriovenous fistulas> Miscellaneous Postcardiac catheterization> Postvalvuloplasty> Esophageal-atrial fistula", "cop": 2, "opa": "Prosthetic valves", "opb": "Non rheumatic atrial fibrillation", "opc": "Paradoxical embolus", "opd": "PSVT", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "053e21ab-7267-46d4-bdf9-55601188bb1b", "choice_type": "single"}
+{"question": "The severity of mitral stenosis is assessed by", "exp": "Mitral stenosis. A normal mitral valve will have an area of >4 cm2, but symptoms are usually only present once the stenosis is moderate-severe. Grading into mild, moderate, or severe disease is based on both the pressure needed to drive blood across the valve (mean pressure gradient) and the valve area. Ref Davidson 23rd edition pg 435", "cop": 4, "opa": "Character of murmur", "opb": "Splitting of S", "opc": "Loudness of S,", "opd": "S2-OS interval", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "63329b01-dc68-4a5d-83b5-2bf04de06cbb", "choice_type": "single"}
+{"question": "Sustained Response to antiviral therapy (IFN + Ribavarin) in hepatitis C is indicated by", "exp": "Answer is D (Female sex): Female sex is a ourable feature, associated with sustained responsiveness to antiviral therapy Male sex is associated with reduced responsiveness. Reduced Responsiveness Genotype 1 High levels of HCV RNA Adranced fibrosis (ciorrhosis, bridging fibrosis) Long duration disease Age > 40 years I mmunosupression African American Obesity Hepatic steatosis Reduced adherence Male sex (Handbook of Gastroenterology) Sustained Responsiveness Genotype 2 and 3 Low levels of HCV RNA Minimal fibrosis Sho duration disease Age < 40 years Immunocompetance Others Absence of obesity Absence of Hepatic steatosis Increased Adherence Female sex (Handbook of Gastroenterology)", "cop": 4, "opa": "High HCV-RNA", "opb": "Cirrhosis", "opc": "Age > 40 years", "opd": "Female sex", "subject_name": "Medicine", "topic_name": null, "id": "0aee4675-5a6d-4851-9f59-dad5f175dee8", "choice_type": "single"}
+{"question": "Rytand's murmur is seen in", "exp": "Ans. is 'a' i. e.,A-V Block Rytand Murmur Rytan 's murmur is mid-diastolic (or late-diastolic) murmur that is heard in patients with complete aioventricular hea block. Rytand's murmur is best heard at the apex and may be confused with mitral stenosis. The slow hea rate, variable duration of the murmur changing intensity of the S I and lack of opening snap are helpful Also know Carey Coombs murmur - Rheumatic fever Austin Flint murmur - Aoic regurgitation Graham-Steel murmur - Pulmonary regurgitation Rytands murmur - Complete hea block Docks murmur - Left Anterior Descending (LAD) aery stenosis Mill wheel murmur - Due to air emboli (air in PV cavity)", "cop": 1, "opa": "A-V Block", "opb": "Mitral stenosis", "opc": "Aoic stenosis", "opd": "Aoic regurgitation", "subject_name": "Medicine", "topic_name": null, "id": "a27bce5d-a84d-48b7-a85a-c0573b8389c5", "choice_type": "single"}
+{"question": "Most common presentation of Neurocysticercosis is", "exp": "(A) Seizures # Neurocysticercosis:> Symptoms of cysticercosis may include seizures, elevated intracranial pressure (ICR), meningoencephalitis, psychiatric disorder, stroke, and/or radiculopathy or myelopathy, if the spinal cord is involved.> Symptoms are mainly due to mass effect, an inflammatory response, or obstruction of the foramina and ventricular system of the brain.> Most common symptoms include seizures, focal neurologic signs, and intracranial hypertension.> Generally, the patient's history includes exposure to an area where the parasite is endemic and an adolescent- or adult-onset seizure disorder.> Symptoms of hydrocephalus should raise concerns about extraparenchymal disease.> Parenchymal CNS disease Seizures may be focal, focal with secondary generalization, or generalized. Headaches are common and may be migrainelike or tension-type. Neurocognitive deficits, while rare, may include learning disabilities, depression, or even psychosis.> Extraparenchymal disease Most patients present with headaches or symptoms of hydrocephalus. Symptoms of increased ICP may include headache, nausea or vomiting, altered mental status, dizziness, and decreased visual acuity due to papilledema. Patients with numerous cysticerci in the basilar cisterns may present with communicating hydrocephalus, meningismus (without fever), symptoms of lacunar infarcts due to small-vessel vasculitis, or symptoms of large-vessel infarcts due to cysticercal erosion into major arteries or severe inflammation of those arteries. Patients with spinal cysticerci typically present with radicular symptoms, but rarely with motor or sensory deficits traceable to a spinal level. Patients with ocular cysticerci report visual changes.> Spinal cord involvement Radiculopathy Myelopathy> Other Meningoencephalitis Stroke (in young adults) Subcutaneous nodules Ocular cysts> \"These is wide variety of presentation of Neurocysticercosis depending on the intensity of the infestation, the localization o: cystecerci and the degree of inflammatory reaction.> Epilepsy (seizure activity) is the most common manifestation occuring in up to 50% cases.> Cysticercosis is infection with the larval stage (cysticercus) of T. solium.> These cysts are located in order of frequency in : CNS (Neurological manifestations are the most common) Subcutaneous tissue Striated muscle Globe of the eye> Most common cause of sporadic viral encephalitis HSV-I> Most common cause of epidemic viral encephalitis Arbovirus> Most common cause of viral meningitis is Enterovirus.", "cop": 1, "opa": "Seizures", "opb": "Focal neurological deficits", "opc": "Dementia", "opd": "Radiculopathy", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "9b9b2bdc-8c52-4801-aa10-6fa731c913d2", "choice_type": "single"}
+{"question": "Auenbrugger's sign is seen in", "exp": "Bulging of the epigastrium (Auenbrugger's sign) seen in cases of large pericardial effusion.", "cop": 1, "opa": "Pericardial effusion", "opb": "Mitral regurgitation", "opc": "Cardiac tamponade", "opd": "HOCM", "subject_name": "Medicine", "topic_name": null, "id": "fd80c2a6-1829-4072-9d31-8e4dd31f7f9b", "choice_type": "single"}
+{"question": "Treatment of choice of severe ITP is", "exp": "Ans. b (IV gamma globulin). (Ref. Harrison, Principles of Medicine, 18th/Chapter 115.)IDIOPATHIC THROMBOCYTOPENIC PURPURA# Explosive onset of severe thrombocytopenia following recovery of viral exanthema or URI is common in children and accounts for 90% of paediatric immunologic thrombocytopenia.# 90% recover in 3-6 months.# Chronic ITP is common in females, 20-40 years of age.# Treatment include- glucocorticoids- danazol,- IV Ig or anti-RhD.- Emergency splenectomy depending on response to medical line of treatment is recommended.- Anti CD 20 abs (Rituximab) is also being tried in treatment of ITP.Initial treatment in patients without significant bleeding symptoms, severe thrombocytopenia (<5000/L), or signs of impending bleeding (such as retinal hemorrhage or large oral mucosal hemorrhages) can be instituted as an outpatient using single agents. Traditionally, this has been prednisone at 1 mg/kg, although Rh (D) immune globulin therapy (WinRho SDF), at 50-75 g/kg, is also being used in this setting.IVIgG has more efficacy than anti-Rh0(D) in postsplenectomized patients. IVIgG is dosed at 2 g/kg total, given in divided doses over 2-5 days.For patients with severe ITP and/or symptoms of bleeding, hospital admission and combined-modality therapy is given using high-dose glucocorticoids with IVIgG or anti-Rh D therapy, and, as needed, additional immunosuppressive agents. Rituximab, an anti-CD20 (B cell) antibody, has shown efficacy in the treatment of refractory ITP.Splenectomy has been used for treatment of patients who relapse after glucocorticoids are tapered.Thrombopoietin receptor agonists are now available for the treatment of ITP. Two agents, one administered subcutaneously (romiplostim) and another orally (eltrombopag), have shown response in many patients with refractory ITP.", "cop": 2, "opa": "BMT", "opb": "IV gammaglobulins", "opc": "Plasmapheresis", "opd": "Steroids", "subject_name": "Medicine", "topic_name": "Blood", "id": "c000a951-d99e-4415-9c5c-b9be6b87e965", "choice_type": "single"}
+{"question": "For the following causes of sexual dysfunction, select the most likely clinical feature.Can be caused by high prolactin level.", "exp": "High prolactin level suppresses luteinizing hormone-releasing hormone (LH-RH), and can result in low plasma gonadotropin and testosterone levels. It may not be obvious on physical examination. Therapy with a dopamine agonist may lower prolactin levels and reverse impotence.", "cop": 2, "opa": "loss of sexual desire", "opb": "failure of erection with absent nocturnal penile tumescence (NPT)", "opc": "absence of emission", "opd": "absence of orgasm with normal libido and erectile function", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "841b749d-cf69-4ce8-bb0f-101569ecb9a0", "choice_type": "single"}
+{"question": "A post operative cardiac surgery patient developed sudden hypotension, raised Central venous pressure, pulsus paradoxus at the 4th post operative hour .The most probable diagnosis is", "exp": "Ref Harrison 19 th ed pg 1573-1574 Features of rising pressure , falling aerial pressure and pulsus paradoxus following surgery on the hea leads us to the diagnosis of cardiac tamponade.", "cop": 4, "opa": "Excessive mediastinal bleeding", "opb": "Ventricular dysfunction", "opc": "Congestive cardiac failure", "opd": "Cardiac tamponade", "subject_name": "Medicine", "topic_name": "C.V.S", "id": "f6a77fa6-8b2e-40c1-80b3-ad1b9077117f", "choice_type": "single"}
+{"question": "Complication of streptokinase a) Myocardial rupture b) Joint pain c) Intracranial bleed d) Anaphylaxis e) Parkinsonism", "exp": null, "cop": 3, "opa": "abc", "opb": "bd", "opc": "cd", "opd": "ad", "subject_name": "Medicine", "topic_name": null, "id": "8c82499c-4f6b-43a9-a7cc-358332384fff", "choice_type": "single"}
+{"question": "Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the", "exp": "The trachea will shift according to the pressure gradients within the thoracic cavity. \nIn tension pneumothorax and hemothorax, accumulation of air or fluid causes a shift away from the injured side. \nIf there is no significant air or fluid accumulation, the trachea will not shift.\nTracheal deviation toward the contralateral side in simple pneumothorax is seen when the thoracic contents shift in response to the \nrelease of normal thoracic pressure gradients on the injured side.", "cop": 4, "opa": "Contralateral side in a simple pneumothorax", "opb": "Affected side in a hemothorax", "opc": "Affected side in a tension pneumothorax", "opd": "Contralateral side in hemothorax", "subject_name": "Medicine", "topic_name": null, "id": "c9d9c714-6f17-4456-b4b4-2f496c59194a", "choice_type": "single"}
+{"question": "A 25 year old female with 16 weeks of gestation presents with excess vomiting, apathy, ataxia, nystagmus and ophthalmoplegia. The diagnosis is", "exp": "(A) Wernicke's encephalopathy# Features of WERNICKE'S DISEASE:> Wernicke's disease is a common and preventable disorder due to a deficiency of thiamine> Characteristic clinical Triad is that of Ophthalmoplegia, Ataxia, & Global confusion. Only 1/3rd of patients with acute Wernicke's disease present with the classic clinical triad.> Most patients are profoundly disoriented, indifferent, and inattentive, although rarely they have an agitated delirium related to ethanol withdrawal.> If the disease is not treated, stupor, coma, and death may ensue.> Ocular motor abnormalities include horizontal nystagmus on lateral gaze, lateral rectus palsy (usually bilateral), conjugate gaze palsies, and rarely ptosis.> Gait ataxia probably results from a combination of polyneuropathy, cerebellar involvement, and vestibular paresis.> Pupils are usually spared, but they may become miotic with advanced disease.> Tachycardia & postural hypotension may be related to impaired function of the autonomic nervous system or to the coexisterce of cardiovascular beriberi.> Most common cause of Wernike's disease is noise-induced hearing loss.> Other causes include: Neurological damage - Multiple sclerosis, Ear infections, Oxidative stress, Emotional stress.", "cop": 1, "opa": "Wernicke's encephalopathy", "opb": "Hyperemesis gravidarum", "opc": "Chorea gravidarum", "opd": "Korsakoff's encephalopathy", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "025eeae4-18c1-4e1c-abb4-b5e7f6ecd91f", "choice_type": "single"}
+{"question": "The abnormal preoperative pulmonary function test in a patient with severe kyphoscoliosis includes", "exp": "In severe kyphoscoliosis RV is normal TLC decreased FRC decreased/normal FVC decreases", "cop": 1, "opa": "Normal RV and decreasd TLC", "opb": "Reduced FEV1/ FVC", "opc": "Reduced FEV 25-75", "opd": "Increased FRC", "subject_name": "Medicine", "topic_name": "Respiratory system", "id": "30330faa-6558-4900-9f18-cf14fafe3f28", "choice_type": "single"}
+{"question": "Helmet cells are a feature of", "exp": "Bite cells / Blister cells / Helmet cells - G6PD deficency.", "cop": 1, "opa": "G6PD deficiency", "opb": "pyruvate kinase deficiency", "opc": "Pyrimidine 5 - nucleotidase", "opd": "Adenylate kinase deficiency", "subject_name": "Medicine", "topic_name": null, "id": "e4b2be74-72bc-4c20-af92-8e70b3cbfd99", "choice_type": "single"}
+{"question": "Angina & sycope in same patient is seen in", "exp": null, "cop": 1, "opa": "Aortic stenosis", "opb": "MVP", "opc": "MS", "opd": "AR", "subject_name": "Medicine", "topic_name": null, "id": "3cdcc514-42a5-4c7d-b3cf-b88146d97223", "choice_type": "single"}
+{"question": "Insulin preperation with longest action", "exp": "Propeies of Insulin PreparationsPreparationTime of Action (Hr)Onset PeakEffective durationSho actingAspa<0.250.5-1.52-4Glusiline<0.250.5-1.52-4Lispro<0.250.5-1.52-4Regular0.5-1.02-33-6Long actingDetemir1-4---12-24Glargine2-4---12-24NPH2-44-1010-16Ref: Harrison 19e pg: 2411", "cop": 3, "opa": "Aspa", "opb": "Lispro", "opc": "Glargine", "opd": "NPH", "subject_name": "Medicine", "topic_name": "Endocrinology", "id": "e4e45f25-e2f1-435d-a085-7d99f457f84a", "choice_type": "single"}
+{"question": "Person having cerebellar signs on the same side with hearing loss. Site of damage is", "exp": "(A) Left cerebellopontine angle # CEREBELLOPONTINE ANGLE TUMORS:> Tumors within the nerve canaliculi initially present with unilateral sensorineural hearing loss, unilateral tinnitus, or disequilibrium (vertigo is rare, on account of the slow growth of neuromas).> Speech discrimination out of proportion to hearing loss, difficulty talking on the telephone are frequent accompaniments.> Tumors extending into the CPA will likely present with disequilibrium or ataxia depending on the amount of extension on the brainstem.> With brainstem extension, midfacial and corneal hypesthesia, hydrocephalus, and other cranial neuropathies become more prevalent.> Cerebellopontine angle (CPA) tumors are the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumors.> Most CPA tumors are benign, with over 85% being vestibular Schwannomas (acoustic neuromas), lipomas, vascular malformations, & hemangiomas.> Most frequent non acoustic CPA tumors are meningiomas, epidermoids (primary cholesteatomas), and facial or lower cranial nerve Schwannomas.> Primary malignancies or metastatic lesions account for less than 2% of neoplasms in the CPA.> Presenting symptoms of CPA tumors (including acoustic neuromas) include the following: Hearing loss - 95% Tinnitus - 80% Vertigo/unsteadiness - 50-75% Headache - 25% Facial hypesthesia - 35-50% Diplopia-10%> Presenting symptoms can vary according to the size and location of the lesion.", "cop": 1, "opa": "Left cerebellopontine angle", "opb": "Left pons", "opc": "Left medulla", "opd": "Middle ear", "subject_name": "Medicine", "topic_name": "Miscellaneous", "id": "4adcc710-1a2f-4ec0-bcd5-15b5cce9da04", "choice_type": "single"}
+{"question": "A patient on amphotericin B has weakness and cramps. Serum potassium = 2.3 mEq/dl. Calculate the total parenteral potassium supplementation to be given to the patient over the next 24 hours", "exp": "For causing a rise of potassium in blood by 1 mEq/dl, 200 mEq of potassium supplementation is required. Since symptoms develops with serum potassium less than 3 mEq/dl, the clinician should give sufficient potassium to rise upto 3 mEq/dl intravenous route. Following this oral potassium supplement will suffice Hence mathematically speaking this patient requires approximately 0.7 mEq/dl of potassium to rise in the blood leading to a requirement of 0.7x 200 = 140 mEq over 24 hours", "cop": 4, "opa": "40 mEq", "opb": "80 mEq", "opc": "100 mEq", "opd": "140 mEq", "subject_name": "Medicine", "topic_name": "Fluids and Electrolyte Imbalance", "id": "a8a9444d-d9dc-4300-b8cb-6d43d850d08a", "choice_type": "single"}
+{"question": "Microalbuminuria is defined as albumin", "exp": null, "cop": 2, "opa": "<30 microgms/24 hrs. urine collection", "opb": "30-300 microgms/24 hrs. urine collection", "opc": "300-550 microgms/24 hrs. urine collection", "opd": ">550 microgms/24 hrs. urine collection", "subject_name": "Medicine", "topic_name": null, "id": "da0881b1-066b-4d1f-804f-ee6cc396aebd", "choice_type": "single"}
+{"question": "NESTROFT test is used for screening of", "exp": "NESTROFT (Naked eye single tube red cell osmotic fragility test) is used for screening of thalassema.", "cop": 1, "opa": "Thalassemia", "opb": "Sickle cell anemia", "opc": "PNH", "opd": "PCH", "subject_name": "Medicine", "topic_name": null, "id": "89e68afa-9446-4146-984b-548b13dbea03", "choice_type": "single"}
+{"question": "A 28 years old man has anterior lenticonus and ESRD now. His maternal uncle also died of similar illness. Diagnosis is", "exp": "Ans. d. Alpo's syndrome The given clinical picture is typical of Alpo's syndrome, which is characterized by triad of hereditary nephritis (ESRD), sensorineural deafness and ocular abnormalities (anterior lenticonus). Alpo's Syndrome (Characterized by triad of) Hereditary Nephritis Hematuria (earliest feature)Q Mild ProteinuriaQ Chronic glomerulosclerosis Progressive renal insufficiency Nephrotic syndrome (rare) Sensorineural Deafness MC extra-renal abnormalityQ AsymmetricQ Ocular Abnormalities Anterior lenticonusQ Dot and Fleck retinopathy Recurrent corneal erosionsQ and opacitiesQ CataractQ Retinal detachment Nystagmus Leiomyomatosis Treatment of Alpo's Syndrome Primary treatment is control of systemic hypeension and use of ACE inhibitors to slow renal disease progression", "cop": 4, "opa": "ARPKD", "opb": "ADPKD", "opc": "Oxalosis", "opd": "Alpo's syndrome", "subject_name": "Medicine", "topic_name": null, "id": "67867bb1-0a63-4653-8d5e-533476eafbea", "choice_type": "single"}
+{"question": "Retinopathy is most likely to be seen with", "exp": "Complication of Retinopathy/nephropathy takes 5 years to develop in type 1 diabetes. Complication of Retinopathy/nephropathy takes 15-20 years to develop in type 2 diabetes.", "cop": 1, "opa": "IDDM of 5 years duration", "opb": "NIDDM of 8 years duration", "opc": "Gestational diabetes", "opd": "Juvenile diabetes staed before pubey", "subject_name": "Medicine", "topic_name": "Diabetes Mellitus", "id": "ca7ff2d7-c3fc-476e-b361-13ff9fa7eae1", "choice_type": "single"}
+{"question": "Patient had loss of temporal field of vision in right eye and nasal field of vision in the left eye. The possible site of lesion is", "exp": null, "cop": 2, "opa": "Optic chiasma", "opb": "Left optic tract", "opc": "Right optic radiation", "opd": "Left optic nerve", "subject_name": "Medicine", "topic_name": null, "id": "11c072f0-d1e9-42f9-b755-ecf0848a1873", "choice_type": "single"}