Datasets:

ridhomhd

/

MedMCQA-filtered

like 0

94dc8abd-ff8c-40d1-a032-3d2acd0bb952

True about Dextrain -

Cause Rouleaux formation

Impair factor VIIIO function

Sugar level

) Improve microcirculation

multi

The reversible aggregation of human red blood cells (RBC) continues to be of interest in the field of hemorheology because RBC aggregation is a major determinant of the in vitro rheological propeies of blood. Enhanced aggregation increases low shear blood viscosity and the degree of non-Newtonian behavior (1,2). In addition, the in vivo flow dynamics and flow resistance of blood are influenced by RBC aggregation (3), and marked increases of RBC aggregation have been observed in several diseases associated with vascular disorders (e.g., diabetes mellitus, hypeension). Measures of RBC aggregation, such as the erythrocyte sedimentation rate (ESR), are commonly used as diagnostic tests and as one index to the efficacy of therapy. For example, ESR is measured during drug therapy for rheumatoid ahritis, and has been shown to be normalized by improved glycemic control in diabetes (4). There is now general agreement regarding the correlations between elevated levels of fibrinogen or other large plasma proteins and enhanced RBC aggregation, and the effects of molecular mass and concentration for neutral polymers have been repoed (5). However, the specific mechanisms involved in RBC aggregation have not been fully elucidated, and thus it is not yet possible to fully understand the relations between pathology and altered RBC aggregation. RBC form multicell linear or branched aggregates in vitro when they are suspended in either plasma or solutions containing large polymers (e.g., dextran >=40 kDa); RBC aggregates also form in vivo in regions of low flow or stasis and, hence, in regions of low shear. These linear forms are often termed rouleaux because they resemble a stack of coins. It is impoant to note that RBC aggregation is a reversible process, with aggregates dispersed by mechanical or fluid flow forces and then reforming when the forces are removed. Conversely, RBC agglutination and blood coagulation are irreversible processes due to either protein polymerization or strong antigen-antibody attractive forces. RBC aggregation is primarily determined by the type and concentration of polymers in solution or the plasma level of large proteins and by RBC aggregability (i.e., the intrinsic cell characteristics affecting RBC aggregation) In blood, the protein fibrinogen is a primary determinant of blood viscosity due to its strong tendency to increase both plasma viscosity and RBC aggregation In the past, most repos have primarily examined the ability of plasma proteins to promote aggregation; for example, higher fibrinogen levels have been linked to elevated blood viscosities in hypeensive patients Ref Harrison20th edition pg 1079

Medicine

Infection

0395f9f9-7f9c-442b-82a4-ffc33eb9bdf8

Peripheral neuritis induced by isoniazid is prevented by giving which vitamin along with it?

Vitamin B1

Vitamin B6

Vitamin B3

Vitamin B12

single

Ans. is 'b' i.e., Vitamin B6 Isoniazid induced peripheral neuritis/ neuropathy* Peripheral neuritis is a well documented adverse effect of INH, which is also the most important dose dependant toxic effect.* Peripheral neuropathy is observed in 10 to 20% of patients given dosages greater than 5 mg/kg/d, but it is infrequently seen with the standard 300-mg adult dose.* Peripheral neuropathy is more likely to occur in slow acetylators and patients with predisposing conditions such as malnutrition, alcoholism, diabetes, AIDS, and uremia.* Neuropathy is due to a relative pyridoxine deficiency. It is due to interference with production of active co - enzyme PLP (Pyridoxal phosphate) from pyridoxine.* It is readily reversed by administration of pyridoxine in a dosage as low as 10 mg/d.

Pharmacology

Anti Microbial

e8fb054c-3690-427b-b0f4-60a2e007ab01

Proved association of celiac sprue is with:

Dermatitis herpetiformis

Scleroderma

Pemphigus

Pemphoid

single

Answer is A (Dermatitis Herpetiformis) Celiac disease is associated with Dermatitis Herpetiformis Dermatitis Herpetiformis is regarded as cutaneous variant of celiac disease. Almost all patients with dermatitis N as Herpetiformis have evidence of celiac disease on intestinal biopsy' - CMD Associations of Celiac Disease (CMDT & Harrisons) Dermatitis Herpetiformis Other autoimmune disease including: (CMDT) - Addison's disease - Grave's disease Diabetes mellitus- Type I (Harrisons) - Myaesthenia Gravis - Slogren syndrome - Atrophic Gastritis - Pancreatic insufficiency IgA deficiency (Harrisons) Lymphomas (Harrisons) Note Celiac disease is associated with an increased risk of cancer including Lymphomas (NHL, Intestinal T cell Lymphoma) The possibility of Lymphoma must be considered whenever a patient with celiac sprue previously doing well on a gluten free diet is no longer responsive to gluten free diet' - Harrisons

Medicine

8070fb18-eea7-4a40-b3db-37d724e4ae00

Atheromatous changes of blood vessels affects early in

Kidney

Hea

Liver

Spleen

single

repeated question The risk factors are Constitutional- genetic abnormalities,family history , increasing age, male gender, hyperlipidemia,hypeension,cigaratte smoking, diabetes, inflammation Myocardial infarction is the main condition

Pathology

Cardiovascular system

ec5f5cd8-5b53-4f94-808b-cfd991a60152

All are risk factors for vaginal candidiasis except:

HIV

Hypertension

Pregnancy

Diabetes mellitus

multi

Ans. is b, i.e. HypertensionRef: Shaw 15th/ed, p146Risk factors for Candidal (Monilla) Vaginitis* Promiscuity* Immunosuppression (like HIV)* Pregnancy* Steroid therapy* Following long-term broad spectrum antibiotic therapy* Oral contraception pills* Diabetes mellitus* Poor personal hygiene* Obesity

Gynaecology & Obstetrics

Sexually Transmitted Disease in the Female

52278a30-23fe-41d6-9fc9-b7a19c6a2304

Snowflake cataract is associated with: September 2008

Hypeension

Adult diabetes

Trauma

Juvenile diabetes

single

Ans. D: Juvenile diabetes Snowflake Cataracts: This type of cataract represents dots of various sizes (and sometimes various colours) distributed throughout the coex surrounding the nucleus for 360deg. This is the most common cataract seen in Down Syndrome (extra copy of chromosome 21 also called trisomy 21) and juvenile diabetes mellitus. These usually have very little effect on vision. Adult diabetic cataract shows coical and/or nuclear and/or subcapsular (same as age related)

Ophthalmology

577f2265-89c6-4ac1-b475-f158a54027d4

Ketone body formation without glycosuria seen in -

DM

DI

Prolonged starvation

Obesity'

single

Ans. is 'c' i.e., Prolonged starvation o Amongst the given options, DM and starvation are the causes of ketosisDiabetes :- Ketosis with hyperglycemia and glycosuria Prolonged starvation :- Ketosis with low or normal glucose and without glycosuria.o In diabetic Ketoacidosis:- (i) Positive Rothera's test (due to ketone bodies) (ii) Positive Benedict's test (due to presence of reducing sugar in urine)o In Starvation ketosis:- (i) Postive Rothera's test (due to ketone bodies), (ii) Negative Benedict's test (no sugar in urine)

Biochemistry

Oxidation of Fatty acids: Ketogenesis

c5f160d7-ad62-4769-8001-073410928e83

If prevalence of diabetes is 10%, the probability that three people selected at random from the population will have diabetes is -

0.01

0.03

0.001

0.003

single

Ref :Parks 23rd edition Prevalence = 10% So probability of selecting a person having DM = 10/100= 0.1 So probability of selecting 3 persons with diabetes = 0.1*0.1*0.1= 0.001

Social & Preventive Medicine

Biostatistics

8409ee38-1922-4ac9-9178-ba699e33e643

Long term use of lithium causes -

Hypopituitarism

Diabetes mellitus

Hypothyroidism

Hyperthyroidism

single

Ans. is 'c' i.e., Hypothyroidism o Lithium can cause hypokalemia.Side effects of lithium1) Neurological: - Tremor is the commonest side effect of lithium. Other CNS side effects are giddiness, ataxia, motor incordination, hyperreflexia, mental confusion, nystagmus.2) Renal: - Nephrogenic diabetes insipidus with polyuria & polydipsia. Amiloride is the DOC for Lithium induced nephrogenic DI.3) Cardiovascular: - Effects are similar to hypokalemia which causes arrhythmia. Most common ECG change is T wave depression.4) Endocrine: - Goitre, hypothyroidism.5) GIT: - Nausea, vomiting, diarrhoea, metallic test, abdominal pain.6) Dermatological: - Acneiform eruptions, papular eruption, exacerbation of psoriasis.7) Teratogenicity: - Ebstein's anomaly in fetus.

Pharmacology

C.N.S

1653b946-25af-4c0b-9408-f6a7ad21d1a2

A 45-year-old woman presents with a 6-month history of fatigue and swelling in her neck. Physical examination shows a goiter. A CBC discloses megaloblastic anemia and a normal reticulocyte count. Additionally, there is an elevated serum level of TSH and antithyroid antibodies. Needle aspiration of the left lobe of the thyroid reveals benign follicular cells and numerous lymphocytes. Anemia in this patient is most likely caused by antibodies directed to which of the following targets?

Chief cells

Intrinsic factor

Paneth cells

TSH receptor

multi

This patient has chronic lymphocytic thyroiditis (Hashimoto thyroiditis) and pernicious anemia. Pernicious anemia is a megaloblastic anemia that is caused by malabsorption of vitamin B12 due to a deficiency of the intrinsic factor. In many cases, pernicious anemia is associated with other autoimmune diseases (e.g., Hashimoto thyroiditis, Graves disease, Addison disease, or diabetes mellitus type 1). Circulating antibodies to parietal cells, some of which are cytotoxic in the presence of complement, occur in 90% of patients with pernicious anemia. Two thirds of patients display an antibody to the intrinsic factor that prevents its combination with vitamin B12 thereby preventing formation of the complex that is later absorbed in the ileum. Half of all patients with pernicious anemia have circulating antibodies to thyroid tissue.Diagnosis: Pernicious anemia, Hashimoto thyroiditis

Pathology

G.I.T.

1fcfafc5-d7c1-41fa-bd76-03c209e8ad6e

A 45 year old male known case of diabetes presents with nausea , multiple episodes of vomiting and abdominal pain.He is stuporous , having blood glucoselevel of 402 mg% and on urine examination Ketone bodies are detected.He is having tachycardina along with ohostatic hypotension. On lab investigation,his potassium levels are 3 meq/L.The next best step in the management will be:

Manage hypokalemia-Repeat serum K+ levels- IV fluids and sta IV regular insulin

IV fluids-give IV regular insulin and lastly manage hypokalemia

Give IV regular insulin along with K+ - IV fluids after the K+ level is normal

IV fluids - give Lente insulin and side by side manage hypokalemia

multi

This is a case of diabetic ketoacidosis (DKA)- Patient's serum K+ level is< 3.3 meq/L,In such cases K+ Level need to be corrected first, even before administering insulin. So next best steps in the management of this patient include: Correct hypokalemia-Repeat K+levels in serum-Give IV regular insulin after K+ level is> 3.3 meq/L Even during the treatment with insulin and fluids, Hypokalemia worsens because of: Insulin mediated potassium entry into cells Settlement of acidosis K+ loss in urine Therefore if we won't correct hypokalemia (<3.3 meq/L) in case of DKA, it will aggravate with the insulin and fluids if given initially. Note-Nausea and severe vomiting are due to the ketonemia which trigger vomiting center- CTZ

Medicine

Diabetes Mellitus

64528e1e-fc04-495d-b051-509ff608d34b

Which one of the following gross appearances of a kidney is most characteristic of malignant nephrosclerosis?

Broad U-shaped coical scars overlying dilated calyces in renal poles

Depressed coical areas overlying necrotic papillae of varying stages

Multiple small petechial hemorrhages on the surface

Multiple small white areas on the surface

multi

Renal aeriolar changes in malignant nephrosclerosis (malignant hypeension) include fibrinoid necrosis of aerioles (necrotizing aeriolitis), hyperplastic aeriolosclerosis (onion-skinning), necrotizing glomerulitis, and often a thrombotic microangiopathy. Grossly, multiple small petechial hemorrhages are found on the surface of the kidneys. The clinical course is often downhill, with only 50% of patients surviving 5 years; marked proteinuria, hematuria, cardiovascular problems, and finally renal failure contribute to death. The disease is often associated with accelerated preexisting benign essential hypeension, chronic renal disease (glomerulonephritis), or scleroderma In contrast, benign nephrosclerosis (renal disease occurring in benign hypeension) is characterized by hyaline aeriolosclerosis with thickened, hyalinized aeriolar walls and narrowed lumina. Fibroelastic hyperplasia occurs in the larger muscular aeries. Small kidneys with a finely granular surface often result because of ischemic atrophy of nephrons. Broad Ushaped coical scars overlying dilated calyces in the renal poles are seen with chronic pyelonephritis (reflux causes scars involving poles only, while obstruction produces scars all over the kidney), depressed coical areas overlying necrotic papillae of varying stages are seen with analgesic nephropathy and diabetes mellitus, multiple small white areas on the surface are seen with acute pyelonephritis, and wedge-shaped (i.e., V-shaped) pale coical scars are seen with renal infarcts. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition

Pathology

miscellaneous

69a1c96a-bfaa-4c78-aaed-65b684a22dc4

A study of patients more than 25 years of age with body mass index above 30, dyslipidemia, hypertension, and fasting glucose averaging 115 mg/ dL is performed. They have adipose tissue abnormalities including increased non-esterified fatty acid release, altered adipokines with decreased adiponectin, greater proinflammatory cytokine release, and diminished peroxisome proliferator-activated receptor gamma (PPARg) function. Which of the following is the best initial therapeutic intervention for these patients?

Adrenalectomy

Caloric restriction

Insulin injection

L-Thyroxine

multi

The findings are those of insulin resistance from obesity with metabolic syndrome. Insulin resistance drives beta-cell dysfunction, but other factors such as the TCF7L2 gene play a role in the eventual development of overt type 2 diabetes mellitus. Excess free fatty acids may stimulate cytokine release from beta cells to promote inflammation and islet cell dysfunction. Lifestyle modification with dietary modification for weight reduction coupled with increased exercise will aid in reversing the insulin resistance so that no drug therapy is needed to control hyperglycemia. Cushing syndrome may occur from ACTH-independent adrenal cortical lesions, such as primary hyperplasia, adenoma, or carcinoma, and lead to secondary diabetes from glucocorticoid-induced insulin resistance, but primary adrenal lesions are less common than metabolic syndrome from obesity alone, and the study patients lack additional features of Cushing syndrome such as hirsuitism, osteoporosis, and easy bruisability. The absolute decrease of insulin with type 1 diabetes mellitus must be treated with insulin injections. There is modest weight gain with hypothyroidism, but without abnormalities of adipocytes leading to insulin resistance. Liposuction is a plastic surgery technique used for body contouring, not weight reduction.

Pathology

Endocrine

5dd7fc2d-eeee-4ab2-9a72-3ac6fd02b366

All of the following are associated with increased risk of atherosclerotic plaque formation except

Apo E mutation

Oxidized LDL

Increased homocysteine

Increased Alpha 2 macroglobulin

multi

Risk Factors for Cardiovascular Disease Class 1: Modifiable risk factors, Interventions have been proved to lower CAD risk. 1. Cigarette smoking 2. High total cholesterol 3. High LDL cholesterol 4. Low HDL cholesterol 5. High fat/cholesterol diet 6. Left ventricular hyperophy (LVH) 7. Thrombogenic factors Class 2: Modifiable risk factors, Interventions are likely to lower CAD risk. 8. Lipoprotein (a) or Lp(a) 9. Diabetes mellitus 10. Hypeension 11. Physical inactivity 12. Obesity 13. High triglycerides 14. High homocysteine 15. Increased high-sensitivity-CRP (hs-CRP) 16. Stress Class 3: Nonmodifiable risk factors. 17. Age 18. Male gender 19. Family history of CAD Alpha-2-Macroglobulin (AMG) AMG is a tetrameric protein with a molecular weight of 725 kD. It is the major component of alpha-2 globulins. It is synthesized by hepatocytes and macrophages. AMG inactivates all proteases and is impoant in vivo anti-coagulant. AMG is the carrier of many growth factors such as platelet-derived growth factor (PDGF). Normal serum level is 130-300 mg/dl. Its concentration is markedly increased (up to 2-3 g/dl) in Nephrotic syndrome, where other proteins are lost through urine.Ref: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 294, 335

Biochemistry

Metabolism of lipid

68b351a9-c7f7-4307-9d1c-07a7eb2bab53

WHO Global Target for Prevention and Control of Non-communicable Disease by 2025 is to decrease Hypeension by:-

25%

35%

55%

75%

single

THE WHO NCD TARGETS (to be achieved by 2025) : Target 1: 25% relative reduction in the overall moality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases. Target 2: At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context. Target 3: 10% relative reduction in prevalence of insufficient physical activity. Target 4: 30% relative reduction in mean population intake of salt/sodium. Target 5: 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years. Target 6: 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances. Target 7: Halt the rise in diabetes and obesity. Target 8: At least 50% of eligible people receive drug therapy and counseling (including glycemic control) to prevent hea attacks and strokes. Target 9: An 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities.

Social & Preventive Medicine

NEET 2018

5e807044-50e7-46f3-9092-256f3f1e70a5

Epiretinal membrane is seen in -

Posterior vitreous detachment

Optic neuritis

Papilloedema

Glaucomatous optic atrophy

single

Ans. is 'a' i.e. Posterior vitreous detachment o Epiretinal membrane is a disease of the eye in response to changes in the vitreous humor or more rarely, diabetes. It is also called macular pucker.o Sometimes, as a result of immune system response to protect the retina, cells converge in the macular area as the vitreous ages and pulls away in posterior vitreous detachment (PVD).o PVD can create minor damage to the retina, stimulating exudate, inflammation, and leucocyte response. These cells can form a transparent layer gradually and, like all scar tissue, tighten to create tension on the retina which may bulge and pucker (e.g., macular pucker), or even cause swelling or macular edema.

Ophthalmology

Retinal Detachment

871b8abf-c3be-45d7-82e5-ed4dda8d41a8

Roth spots are seen in:

Infective endocarditis

Central retinal vein occlusion

Retintits pigmentosa

Diabetic retinopathy

single

Ans: A (Infective endocarditis) Ref; Harrisons Principles of Internal Medicine 18th edition ROTH SPOTS in Infective Endocarditis They are retinal hemorrhages with pale centres. They represent capillary hemorrhages and not bacterial infection. Apart from IE, they can also be seen in vasculitis, anemia, leukemia, diabetes and carbon monoxide poisoning. Explanation: Roth's spots are retinal hemorrhages with w hite or pale centers composed of coagulated fibrin. They are typically seen using an ophthalmoscope or slit lamp exam. They are usually caused by immune complex mediated vasculitis often resulting from bacterial endocarditis. Roth's spots may also be seen in Leukemia Diabetes Subacute bacterial endocarditis Pernicious anemia Ischemic events HIV retinopathy Manifestations of Infective Endocarditis HISTORY Prior congenital or rheumatic heart disease Preceding dental, urinary tract, or intestinal procedure Intravenous drug use Central venous catheter Prosthetic heart valve SYMPTOMS Fever Chills Chest and abdominal pain Arthralgia, myalgia Dyspnea Malaise, weakness Night sweats Weight loss CNS manifestations (stroke, seizures, headache) SIGNS Elevated temperature Tachycardia Embolic phenomena (Roth spots, petechiae, splinter nail bed hemorrhages, Osier nodes, CNS or ocular lesions) Janeway lesions (painless small erythematous or hemorrhagic lesions on the palms and soles) New or changing murmur Splenomegaly Arthritis Heart failure Arrhythmias Metastatic infection (arthritis, meningitis, mycotic arterial aneurysm, pericarditis, abscesses, septic pulmonary emboli) Clubbing LABORATORY Positive blood culture Elevated erythrocyte sedimentation rate Elevated C-reactive protein Anemia Leukocytosis Hypergammaglobulinemia Hypocomplementemia Cryoglobulinemia Rheumatoid factor Hematuria Renal failure: azotemia, high creatinine (glomerulonephritis) Chest radiograph: bilateral infiltrates, nodules, pleural effusions Echocardiographic evidence of valve vegetations, prosthetic valve dysfunction or leak, myocardial abscess, new-onset valve insufficiency

Unknown

e46e807c-6f19-4803-81fa-9650de289294

Diabetic patient with liver cirrhosis and hyperpigmentation, diagnosis is ?

Wilson's disease

Hemochromatosis

Primary sclerosing cholangitis

Hepatitis B

single

Ans. is 'b' i.e., Hemochromatosiso Information in the question :?i) Diabetesii) Hyperpigmentationiii) Cirrhosiso Among the given options, only hemochromatosis can cause all three.

Pathology

16d158a4-01c1-4dc4-a937-052d7504cf42

Lacunar infarcts may manifest all of the following except:

Pure sensory weakness

Pure motor weakness

Ataxia paresis

Quadriparesis

multi

Answer is D (Quadriparesis): Quadriparesis or Quadriplegia are not associated with lacunar infarcts. Lacunar Infarcts Lacunar infarcts are small vessel strokes caused by occlusion of a single penetrating aery that supplies one of the deep structures in brain such as the internal capsule, corona radiate, basal ganglia, thalamus and brainstem. These are usually caused by Lipohyalinosis of penetrating aeries from longstanding hypeension, atherosclerosis or diabetes Several distinct syndromes are associated with lacunar infarcts. Distinct clinical syndromes associated with lacunar infarcts. Pure motor Hemiparesis Most common lacunar syndrome Results from infarction of contralateral internal capsule (may also be seen with infarcts in corona radiate and pons) The face, arm and leg are equally affected There is no sensory loss, homonymous hemianopia, Aphasia or hemineglect Pure sensory stroke Infarction almost always involves the thalamus Sensory loss is present throughout the contralateral side, but various paial hemisensory syndrome can occur. Sensation is usually decreased for all sensory modalities, and no other neurologic deficits are present. Patient often complains of abnormal spontaneous sensation, such as "pins-and?needles" or skin tightness. Sensorimotor stroke Infarcts involve both internal capsule and thalamus Ataxic Hemiparesis Contralateral weakness and limb ataxia Weakness and ataxia present on the same side with the ataxia usually more severe than the weakness. Most commonly occurs in the pons, the internal capsule or the corona radiata Dysahria Clumsiness Syndrome Prominent dysahria and ataxia of the upper limb Facial weakness, dysphagia and varying degrees of weakness in the arm and leg Associated with infarction in the internal capsule or the pons.

Medicine

a2e9a0d5-8983-470a-b01d-0f24fdf723c3

Lallo, aged 54 years, who is a known diabetic patient develops cirrhosis. There is associated skin hyperpigmentation and restrictive cardiomyopathy which of the following is the best initial test to diagnose this case.

Iron binding capacity

Serum ferritin

Serum copper

Serum ceruloplasmin

multi

Answer is A (Iron binding capacity): The presence of hyperpigmentation and diabetes (bronze diabetes) together with restrictive cardiomyopathy and cirrhosis.suggests a diagnosis of hereditary hematochromatosis. The best initial test to diagnose hereditary hematochromatosis are Transferrin saturation and unsaturated Iron binding capacity As transferrin saturation is not provided amongst the options, Iron binding capacity is the single best answer of choice. Note Serum ferritin levels are a good index of body iron stores and are raised early during the cause of disease. Yet serum ferritin levels should not he used as initial screening test to detect hereditary hematochromatosis. This is because serum ferritin also acts as an acute phase reactant and its levels are increased in variable infections and inflammatory conditions without iron overload. Also the serum concentration of ferritin may be increased in patients with hepatocelltdar injury as in viral hepatitis, alcoholic fatty liver disease or alcoholic liver diseases due to increased release from tissue cells.

Medicine

1af1e0a3-da55-4f83-a775-af9475a66356

The most common lesion of a mature placenta with no much clinical significance is:

Infarct

Hyperophic villous lesions

Marginal hematoma

Breus mole

single

Chorionic villi receive oxygen solely from maternal circulation through the uteroplacental vessels, which jet blood into the intervillous space. Uteroplacental diseases that diminish or obstruct this connection can lead to villous infarction. Although these are common lesions in mature placentas, if they are numerous, placental insufficiency may develop. When they are thick, centrally located, and randomly distributed, they may be associated with preeclampsia or lupus anticoagulant. Striking enlargement of the chorionic villi is commonly seen in association with severe erythroblastosis and fetal hydrops. It also has been described in maternal diabetes, fetal congestive hea failure, and maternal-fetal syphilis. Large retroplacental, marginal, and subchorial hematoma (also known as Breus mole) have been associated with higher rates of miscarriage, abruption, fetal-growth restriction, preterm delivery, and adherent placenta. Ref: Leveno K.J., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 27. Abnormalities of the Placenta, Umbilical Cord, and Membranes. In K.J. Leveno, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

Gynaecology & Obstetrics

f869f102-353e-43e2-8ab2-35fa0907bbca

Most common cause of first trimester aboion:

Genetic factors

Endocrine disorders

Immunological disorders

Infection

single

Common Causes of aboion First trimester: 1. Genetic factors (50%) 2. Endocrine disorders (luteal phase defect, thyroid abnormalities, and diabetes) 3. Immunological disorders (autoimmune and alloimmune) 4. Infection 5. Unexplained

Gynaecology & Obstetrics

Aboions, Spontaneous & Induced Emergency Contraception (Hey,whats the hurry !)

82352a14-9de3-43fe-8cb7-aa252705b3e7

Causes of Acalculous cholecystitis are the following except

Bile duct stricture

Schistosomiasis

Prolonged TNP

Major operations

multi

Ans. (b) SchistosomiasisRef: Sabiston Page 1508, 20th editionRisk factors of Acalculous cholecystitis:* Old age* Critical illness* Burns* Prolonged TPN* Major operations* Diabetes* Immunosuppression

Surgery

Gall Bladder & Bile Ducts

53f325ec-6755-4e39-8a24-4966bd0c7504

Type 1 diabetes mellitus is associated with-

Male gender

Old age

Gestational diabetes

HLADR3

single

Type 1 DM is the result of interactions of genetic, environmental, and immunologic factors that ultimately lead to T-cell mediated autoimmune destruction of the pancreatic beta cells and insulin deficiency. Type 1 DM, which can develop at any age, develops most commonly before 20 years of age. Most individuals with type 1 DM have the HLA DR3 and/or DR4 haplotype. There is little or no sex bias within either Type I (insulin-dependent)(although most autoimmune diseases dispropoionately affect females) or Type II (non-insulin-dependent) diabetes mellitus. Reference : page 2403 Harrison's Principles of Internal Medicine 19th edition

Medicine

Endocrinology

131f6764-5942-4cc5-b8c3-655d1873a34c

A rapidly destructive infection of nose and paranasal sinuses in diabetics is:

Histoplasmosis

Sporotrichosis

Mucormycosis

Sarcoidosis

single

Mucormycosis It is a fungal infection of nose and paranasal sinuses which may prove rapidly fatal. It is seen in uncontrolled diabetes or in those taking immunosuppressive drugs Ref Dhingra 6/e,p 159

ENT

Nose and paranasal sinuses

82ca1438-8fda-4318-9cd3-ca03bbc10080

All of the following are true regarding vancomycin except: September 2009

Excreted unchanged mainly by glomerular filtration

Poorly distributed in the body fluids

May cause red man syndrome

Not absorbed orally

multi

Ans. B: Poorly distributed in the body fluids Vancomycin undergoes limited absorption when administered orally and is therefore restricted to parenteral administration for the treatment of systemic infections. It is distributed widely to various tissues and body fluids. Penetration of vancomycin may vary by site and concomitant disease states. For example, limited CSF penetration may be enhanced by the presence of inflamed meninges. The orable penetration of vancomycin into skin tissues may be significantly impaired in patients with diabetes. Vancomycin penetration into lung epithelial lining fluid is limited relative to that of simultaneous serum concentration (the ratio of lung tissue to serum concentration is about 0.25). Vancomycin's primary route of elimination is renal excretion of unchanged drug. The rate of elimination is directly related to creatinine clearance. Rapid intravenous injection may cause chills, fever, uicaria and intense flushing-called 'red man syndome'.

Pharmacology

b547491d-045c-4020-8f3d-bc5fd4aec625

Earliest ophthalmic finding in Diabetes mellitus retinopathy

Cotton wool spots

Micro-aneurysm

Flame shaped haemorrhage

Hard exudate

single

(Microaneurysm) (260- Khurana 4th) (295-P)Microaneurysms in the macular area (The earliest detectable lesions)Ophthalmic features of Non proliferative diabetic retinopathy* Micro aneurysm (Earliest detactable lesions)* Retinal haemorrhages both deep {dot and blot haemorrhages) and superficial haemorrhages {flame-shaped)* Hard exudates - yellowish- white waxy looking patches* Retinal oedema* Cotton - wool spots (If >8, there is high risk of developing PDR)* Venous abnormalities - beading, looping and dilatation* Intraretinal microvascular abnormalities (IRMA)**Hall mark of proliferative diabetic retinopathy (PDR) is the occurrence of neovascularization** Moderate loss of vision in DM is due - Macular oedema* Earliest changes of background DR-characteristically effect the small blood vessels. Small dot and blot haemorrhages are common and degeneration of the vessel walls leads to the development of micro aneurysm

Ophthalmology

Retina

8341bc92-48c7-4165-b847-45777cc90579

Which of the following is X linked disease?

Thalassemia

Galactosemia

Color blindness

Sickle cell disease

single

Autosomal recessive conditions System Disorder Metabolic Cystic fibrosis Galactosemia Homocystinuria a1 antitrypsin deficiency Wilson disease Hemochromatosis Glycogen storage disease Lysosomal storage disease Hematopoietic Thalassemias Sickle cell anemia Endocrine CAH(congenital adrenal hyperplasia) Skeletal Ehlers danlo's (some variants) Alkaptonuria Nervous Friedreich ataxia Spinal muscular atrophy Neurogenic muscular atrophies X linked recessive disorders System Disease Musculoskeletal Duchenne muscular dystrophy Blood Hemophilia A&B, G6PD deficiency, Chr. granulomatous disease Immune Agammaglobulinemia, Wiskott Aldrich syndrome Metabolic Lesch nyhan syndrome, Diabetes insipidus Nervous Fragile X syndrome

Pathology

Specific Cytogenetic Disorders

dd0311fe-6496-4be0-a497-074b115c0c5d

A 60 year old man with history of long standing diabetes mellitus presents with painless, swollen right ankle joint. X-rays of the ankle show destroyed joint with large number of loose bodies. The most probable diagnosis is:

Charcot's joint

Clutton's joint

Osteoarthritis

Rheumatoid arthritis

single

Ans. A. Charcot's jointa. It is progressive destructive arthritis arising from loss of pain sensation and proprioceptionb. Joints lack normal reflex safeguard against abnormal stress injury.c. Causes- DM, Tabes dorsalis, Leprosy, syringomyelia, Myelomeningocele, Chronic alcoholism

Orthopaedics

Arthritis

0852953c-aa60-4ce0-989e-db70693de472

A mother arrives to your office in a panic. She had just returned home from the delivery of her third child, who was born by cesarean section because he was large for gestation age. Upon changing his first diaper at home she noticed gross blood in his diaper. On examination, you find a left-sided abdominal mass that was not present in the normal newborn nursery. Which of the following is the most appropriate next step in the diagnosis and management of this child?

Urine catheterization and initiation of intravenous antibiotics

Measurement of urine catecholamines to include vanillylmandelic and homovanillic acid levels

CT scan of the chest and abdomen

Renal ultrasound with renal vein Doppler studies

multi

The child in the question likely has renal vein thrombosis, a condition more commonly seen in infants who are dehydrated, had birth depression, have polycythemia or were born to diabetic mothers. The child in the case was large for gestational age, a hint that gestational diabetes might have been present and which also can result in polycythemia. Children with renal vein thrombosis can present with history of oliguria and hematuria, and on examination enlarged kidneys may be palpable. Confirmation of the diagnosis is by renal ultrasound with renal vein Doppler studies. UTI in a 3-day- old infant is unusual, and the presentation with abdominal mass without temperature instability is unlikely making a urine catheterization and intravenous antibiotics a lower priority. Abdominal tumors such as Wilms or neuroblastoma are less likely in such a young infant making CT scans or urine catecholamine measurements a lesser priority.

Pediatrics

Urinary Tract

c4481d2a-cf26-424a-b240-b9ad6c9c8923

Pinna calcification is seen in all except

Gout

Ochronosis

Frost bite

Addison's disease

multi

Ans. a. Gout Pinna Calcification is seen in Addison's diseaseQ Diabetes mellitus OchronosisQ HypehyroidismQ AcromegalyQ von Meyenburg's disease (systemicchondromalacia) Hypeension Late calcification of the auricular cailage following frostbite. ( of Chapter/1550092413 .pdf) Delayed dystrophic calcification of the underlying auricular cailage may develop years after the initial frostbite. When this occurs, the pinna is bony and hard to palpation. A radiograph of the pinna will reveal radiodense areas of calcification in the auricular cailage.

Medicine

970a171d-1204-4d71-811c-fbc4f46c9a81

Glucose tolerance test is indicated in pregnancy becasue of:a) Big babyb) Eclampsiac) Previous GDMd) H/O diabetes in maternal uncle

abc

ad

acd

bde

single

Gynaecology & Obstetrics

a1740657-0641-4cf6-abe2-5637962c2dcf

WHO global target for prevention and control of non communicable diseases by 2025 is to decrease hypeension by

25%

55%

75%

90%

single

WHO Global action plan for the prevention and Control of Non-communicable Diseases 2013-2020 VISION : A world free of the avoidable burden of non-communicable disease GOAL: To reduce the preventive and avoidable burden of Morbidity, Moality and disability due to NCD's Voluntary Global Targets 25% relative reduction in the overall Moality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases >= 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context 10% relative reduction in prevalence of insufficient physical activity 30% relative reduction on prevalence of current tobacco use in persons aged 15+ years 25% relative reduction in the prevalence if raised blood pressure or contain the prevelance if raised blood pressure, according to national circumstances Halt the rise in diabetes and obesity >=50% of eligible people receive drug therapy and counselling (including glycemic control) to prevent hea attacks and strokes 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major NCD's disease in both public and private facilities Ref: Park 25th edition Pgno : 383

Social & Preventive Medicine

Non communicable diseases

30de7635-1cd5-48f4-a1fc-2819a1ab19d7

All of the following conditions are known to cause diabetes insipidus, except :

Multiple sclerosis

Head injury

Histiocytosis

Viral encephalitis

multi

Answer is A (Multiple sclerosis) : Multiple sclerosis has not been mentioned as a cause for diabetes insipidus. Diabetes insipidus is a syndrome caused by either deficiency of vasopressin or resistance to action of vasopressin in passage of abnormally large volume of urine of low specific gravity. Causes of diabetes insipidus Pituitary form of DI (Neurohypophysial or central) Deficient secretion of vasopressin from pituitary Nephrogenic DI (Renal D.I.) Resistance to action of vasopressin on kidney Primary polydispisa Congenital malformations Genetic Acquired Genetic Acquired Psychogenic Acquired Drugs Schizophrenia Head trauma (closed and penetrating) Lithium Obsesive-compulsive Neoplasms Demeclocyline disorder Primary Methoxyflurane Dipsogenic (abnormal thirst) Craniopharyngioma Amphotericin B Granulomas: Pituitary adenoma (suprasellar) Aminoglycosides Neurosarcoid Dysgerminoma Cisplatin Infectious: Tuberculous Meningioma Rifampin meningitis Metastatic (lung, breast) Foscarnet Head trauma (closed and Hematologic (lymphoma, leukemia) Metabolic penetrating) Granulomas: Neurosarcoid Hypercalcemia, hypercalcinuria Demyelimation: Multiple Histiocytosis Hypokalemia sclerosis Xanthoma disseminatum Obstruction (ureter or urethra) Drugs: Infectious: Chronic meningitis Vascular Lithium Viral encephalitis Sickle cell disease and trait Carbamazepine Toxoplasmosis lschemia (acute tubular necrosis) Idiopathic Inflammatory:Lymphocytic Granulomas Iatrogenic Infundibuloneurohypophysitis Neurosarcoid Wegener's granulomatosis Neoplasms Lupus erythematous Sarcoma Scleroderma Infiltration Chemical toxins: Tetrodotoxin, Snake venom Amyloidosis Vascular:Sheehan's syndrome Pregnancy Aneurysm (internal carotid) Idiopathic Aoocoronary bypass Hypoxic encephalopathy Pregnancy (vasopressinase) Idiopathic

Medicine

373916eb-7cb9-43bb-a560-7a8455c5621d

A child with a small head, minor anomalies of the face including a thin upper lip, growth delay, and developmental disability can have all of the following,except

A chromosomal syndrome

A teratogenic syndrome

A mendelian syndrome

A polygenic syndrome

multi

The features given can occur as a pa of a chromosomal / teratogenic / mendelian syndrome. Polygenic inheritance is the answer of exclusion. In a polygenic inheritance, multiple genes are involved in the phenotypic expression. Some examples of polygenic inheritance are hypeension and diabetes. Reference: GHAI Essential pediatrics, 8th edition

Pediatrics

Genetic and genetic disorders

78d84e8a-356a-4e72-b06f-443d8b0a0819

Search for gestational diabetes is carried out at what gestational age?

16 weeks

20 weeks

28 weeks

32 weeks

single

Ans, c (28 weeks). (Ref. Textbook of Obstetrics by Dutta, 3rd ed., 292)Note: The actual answer is 24 to 28 weeks.GTT IN PREGNANCY# Screening for gestational diabetes should be done between 24-28 weeks of gestation by using glucose tolerance.# Test - 50 gm oral glucose without regard to time of day and last meal.# Plasma glucose of 140 mg% or 130 mg% of whole blood at 1 hour is considered cut-off point for consideration of 100 gm (WHO 75 gm GTT). TimeWhole blood (mg%)Plasma1Fasting19010521 hr16519032 hr14516543 hr125145

Gynaecology & Obstetrics

Miscellaneous (Gynae)

177d2d4c-8688-4383-8a6c-45e08ff5a4af

Hand-knee gait is seen in patients of: March 2013 (b, e)

Leprosy

TB

Polio

Common peroneal nerve palsy

single

Ans. C i.e. Polio Hand knee gait Extend of the paralysis in the lower limbs determines the walking ability of the patient with poliomyelitis. When one leg has a normal or nearly normal muscles power, and some residual power in the antigravity muscles (gluteus maximus, quadriceps, and triceps surae) of the other limb, the patient can walk without external suppo. If the flexion contracture develops in the knee joint of the effected limb, they often assume a hand-knee gait. Normally, the knee joint extends at heel strike, if it is unable to extend because of a weak quadriceps (unstable knee gait) or if the knee is fused in flexion, the patient will try to push it into extension with his hand. The hand-knee gait causes lurch in the limbs, which is tiring and painful. Many Patients fall down frequently and suffer injuries and fractures. Some abnormal gait patterns & causes Cerebellar - think drunk people. - Wide base/reeling on a narrow base; - Patient falls to side of lesion; - Feet raised excessively and placed down carefully. - The cerebellum deals with fine control. - Seen in any lesion of the cerebellum. - There are a whole heap of causes but these are the most impoant: CVA, alcohol, tumour, MS (multiple sclerosis) High-stepping - this is foot-drop. - Remember the "heel-on, toe-off" from above? - It's the opposite. - Foot doesn't dorsiflex before touching the ground. - In order to not trip over, patient need to lift it really high. - It dangles (hence "foot-drop") and lands toes-first. Causes include ? Local: common peroneal nerve palsy, sciatic nerve palsy, distal myopathy; spine: L4,5 root lesion; Generalised: peripheral neuropathy (alcohol, diabetes), motor neurone disease. Parkinsonian - this type of gait has a lot of specific features but the mains ones are: TRAPS- Resting tremor, Rigidity, Akinesia, Stooping posture, Shuffling gait - Mainly seen in idiopathic parkinson's disease. Sensory ataxia - broad base, bangs feet down clumsily (may have foot-drop), looks at feet throughout gait cycle. - Positive Romberg's sign.; - Generalised: peripheral neuropathy; - Spinal cord: cervical spondylosis, MS, B12/folate deficiency and bizarrely syphillis. Scissor - typical of cerebral palsy. - Walking on tip-toes (plantar flexed feet), flexed kneed, adducted and internally rotated hip, ridigity, excessive adduction in leg swing and contractures in all spastic muscles. Waddling - broad-base; duck-like waddle; - Pelvis tilts away from lifted leg; - Forward curvature of lumbar spine; and - Marked body swing. - CDH, proximal myopathy, being overweight and being pregnant Antalgic - patient leans on affected side taking rapid, heavy step. - The step on the unaffected side is slower. Usually caused by hip osteoahritis.

Surgery

0fc3fb4e-5f77-4733-a8dc-750732f2bd47

A person with type 1 diabetes ran out of her prescription insulin and has not been able to inject insulin for the past 3 days. The patient is hyperventilating to compensate for her metabolic acidosis. Which of the following reactions explains this partially compensating respiratory alkalosis?

H+NH3=NH4+

CH3CHOHCH2COOH=CH3CHOHCH2COO-+H+

CO2+H2O=H2CO3=H++HCO3-

H2O=H++HO-

multi

The patient is "blowing off CO2 " to reduce acid. The equation described in answer C is the conversion of carbon dioxide into a soluble form, then into bicarbonate. During an acidosis, the high levels of protons push the reaction described in answer C to the left, to the formation of water and carbon dioxide. As the carbon dioxide is exhaled, and the concentration of carbon dioxide decreases, more carbon dioxide is formed, thereby reducing the pool of free protons and raising the pH. The protonation of ammonia to form ammonium ion takes place in the kidney and not the lungs. Its primary purpose is to alkalinize the urine if it is too acidic. The reaction described in answer B is the dissociation of a proton from b-hydroxybutyrate (a ketone body) to form the anion of b-hydroxybutyrate and a proton. This is the reaction that is occurring to bring about the ketoacidosis and is not the compensatory respiratory alkalosis. Reaction D is the dissociation of water, which cannot buffer the acidosis.

Biochemistry

Miscellaneous (Bio-Chemistry)

d1574b02-d106-4539-8fc1-96a0a3cb349a

Not true obstructive sleep appoea

Nocturnal asphyxia

Alcoholism is a cofactor

Prone to hypeension

Overnight oximetry is diagnostic to replace polysomnography

multi

Ans. is 'd' i.e., Overnight oximetry is diagnostic to replace polysomnography Cardinal features in adults include: Obstructive apneas, hypopneas, or respiratory effo related arousals Daytime symptoms attributable to disrupted sleep, such as sleepiness, fatigue, or poor concentration Signs of disturbed sleep, such as snoring, restlessness, or resuscitative snos Clinical presentation Most patients with OSA first come to the attention of a clinician because the patient complains of daytime sleepiness, or the bed paner repos loud snoring, gasping, snoing, or interruptions in breathing while sleeping. Daytime sleepiness, distinct from fatigue, is a common feature of OSA Sleepiness is the inability to remain fully awake or ale during the wakefulness poion of the sleep-wake cycle. Snoring is the other common feature of OSA. While snoring is associated with a sensitivity of 80 to 90 percent for the diagnosis of OSA, its specificity is below 50 percent. Clinical features of obstructive sleep apnea (OSA) Daytime sleepiness Obesity Nonrestorative sleep Large neck circumference Loud snoring Systemic hypeension Witnessed apneas by bed paner Hypercapnia Awakening with choking Cardiovascular disease Nocturnal restlessness Cerebrovascular disease Insomnia with frequent awakenings Cardiac dysrhythmias Lack of concentration Narrow or "crowded" airway Cognitive deficits Pulmonary hypeension Changes in mood Cor pulmonale Morning headaches Polycythemia Vivid, strange, or threatening dreams Floppy eyelid syndrome Gastroesophageal reflux Nocturia Polysomnography Full-night, attended, in-laboratory polysomnography is considered the "gold-standard diagnostic" test for OSA. It involves monitoring the patient during a full night's sleep. Unattended, out of centre sleep "(OCST) may be used as an alternative to polysomnography for the diagnosis of OSA in patients with a high pre-test probability of moderate to severe OSA, provided there are no medical comorbidities such as hea failure that predispose to alternative or additional sleep related breathing disorders. The diagnosis of OSA is based upon the presence or absence of related symptoms, as well as the frequency of respiratory events during sleep (ie, apneas, hypopneas, and respiratory effo related arousals IRERAsJ as measured by polysomnography or out-of-center sleep testing (OCST). In adults, the diagnosis of OSA is confirmed if either of the two conditions exists: There are "fil_y" or more predominantly obstructive respiratory events (obstructive and mixed apneas, hypopneas, or RERAs) per hour of sleep (for polysomnography) or recording time (for OCST) in a patient with one or more of the following: Sleepiness, nonrestorative sleep, fatigue, or insomnia symptoms. Waking up with breath holding, gasping, or choking. Habitual snoring, breathing interruptions, or both noted by a bed paner or other observer Hypeension, mood disorder, cognitive dysfunction, coronary aery disease, stroke, congestive hea failure, atrial fibrillation, or type 2 diabetes mellitus There are 15 or more predominantly obstructive respiratory events (apneas, hypopneas, or RERAs) per hour of sleep (for polysomnography) or recording time (for OCST), regardless of the presence of associated symptoms or comorbidities

Medicine

f96a54e6-ffa2-40e6-b2c9-84ec6a532037

An elderly female presents with the nasal blockade and nasal discharge with black debris. Blood sugar was raised and urine is positive for ketones. Best treatment for the patient would be:(AIIMS May 2013, Nov 2012)

Amphotericin B

Itraconazole

Ketoconazole

Broad spectrum antibiotics

single

Ans. a. Amphotericin B (Ref: Harrison 19/e p1350, 18/e p1661)This diabetic patient is most likely suffering from mucormycosis, in which there is involvement of peri-orbital region and visual impairment. I.V. Amphotericin BQ is the treatment most commonly used in all forms of Mucormycosis.Amphotericin B deoxycholate remains the only licensed antifungal agent for the treatment of mucormycosis.'- Harrison 18/e p1664Infections in Diabetes MellitusHyperglycemia aids the colonization and growth of a variety of organisms (Candida and other fungal species).Many common infections are more frequent and severe in diabetic population, whereas several rare infections are seen almost exclusively in the diabetic populationQ.Example in this latter category includes Rhinocerebral Mucormycosis, emphysematous infections of the gall bladder and urinary tract, and malignant or invasive otitis externaQ.MucormycosisSpecies of Rhizopus, Rhizomucor, and CunninhamellaQ are the most common causes of mucormycosis.Mucormycosis originating in the Paranasal sinuses and noseQ predominantly affects patients with poorly controlled diabetes mellitusQ.In all forms of Mucormycosis, vascular invasion by hyphaeQ is a prominent feature.Ischemic or hemorrhagic necrosisQ is the foremost histologic finding.Predisposing Factors* Diabetes mellitus* Organ transplantation recipients* Long-term desferoxamine therapy* Prolonged cytotoxic or steroid treatment* Hematologic malignancies* Chronic renal failureClinical manifestationsCharacteristic picture in nose and paranasal sinus involvementLow grade fever, dull sinus pain, nasal congestion or thin bloody discharge followed in few days by double vision,increasing fever, and obtundation.Examination reveals a unilateral generalized reduction of ocular motion, chemosis, ProptosisQ.The nasal turbinates on the affected site may be dusky red or necrotic.A sharply delineated area of necrosis, strictly respecting the midline, may appear in hard palateQ.Pulmonary Mucormycosis: Manifests as severe pneumoniaCutaneous MucormycosisGI invasion presents as one or more ulcers and then perforatesDiagnosis:Microscopic examination and culture of biopsy:Appear as rod-ribbon like, usually with non-septate hyphae with branch at right angleTreatment:Successful treatment requires early diagnosis, reversal of underlying predisposing factors, if possible, surgical debridement and prompt antifungal treatment.Regulation of diabetes mellitus and a decrease in the dose of immunosuppressive drugs facilitate the treatment.Extensive debridementQ of craniofacial lesions and orbital exenteration if required.I.V. Amphotericin BQ is TOC in all forms of Mucormycosis.

Medicine

Drugs

5b82c5ff-2d6b-4711-9be6-2928767a8be1

All of the following are true about acarbose, EXCEPT:

Controls both pre and post-prandial hyperglycemia

When it is given alone, there is no risk of hypoglycemia

It is an alpha glucosidase inhibitor

It delays progression of diabetes

multi

Acarbose is an alpha-glucosidase inhibitor which reduce intestinal absorption of starch, dextrin, and disaccharides by inhibiting the action of alpha-glucosidase in the intestinal brush border. Inhibition of this enzyme slows the absorption of carbohydrates from the GI tract and blunts the rate of rise of postprandial plasma glucose. It has been demonstrated to reduce the progression from impaired glucose tolerance to type 2 diabetes. When acarbose is given alone, there is no risk of hypoglycemia. Ref: Powers A.C., D'Alessio D. (2011). Chapter 43. Endocrine Pancreas and Pharmacotherapy of Diabetes Mellitus and Hypoglycemia. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.

Pharmacology

aff9a799-c259-47b1-b0a2-5183996116d3

Microalbuminuria is dened as protein levels os -

10-150 mg/dL

30-300 mg/dL

15-200 mg/dL

30-100 mg/dL

single

Albuminuria in the range of 30-300 mg/24 hrs is called microalbuminuria , In patients with type 1 & 2 diabetes microalbuminuria appears 5-10 years after the onset of diabetes.

Medicine

0396e4ba-6be2-4d01-9b6c-52b21e06f269

Diabetes mellitus is present in all except

Fanconi syndrome

Noonan syndrome

Ataxia telengiectasia

Myotonic dystrophy

multi

The disorder is characterized by progressively impaired coordination of voluntary movements (ataxia), the development of reddish lesions of the skin and mucous membranes due to permanent widening of groups of blood vessels (telangiectasia), and impaired functioning of the immune system (i.e., cellular and humoral) Ref Robbins 9/e pg 243

Medicine

Genetics

52443341-f114-4f83-97b7-80043d636ad3

Drug of choice for central diabetes insipidus is :

Desmopressin

Leuprolide

Thiazide diuretics

Insulin

single

Pharmacology

cb290a08-834e-47d5-82a2-ad81046bc57f

Oral hypoglycemics are useful in which of the types of diabetes mellitus

Mild stable maturity onset type

Juvenile type

Diabetes in obese

Diabetic ketoacidosis type

single

Medicine

386c83b7-9c20-46e4-b269-7fbc698bbf11

Which of the following drugs is to be discontinued on the day of surgery

Atenolol

Amlodipine

Metformin

Statins

single

Metformin If the patient is taking an oral hypoglycemic agent preoperatively the drug can be continued until the day of surgery, but sulfonylureas and nzetfornzin should not be used 24-48 h before surgery beause of their long half-lives. Patients with type 11 diabetes mellitus should be stopped oral hypoglycemics several days prior to surgery (especially metformin which is known to contribute to postoperative lactic acidosis) About other options Antihypeensive agents With rare exceptions antihypeensive drug therapy should be continued upto the time of surgery. Some clinicians withhold ACE inhibitors on the morning of surgery because of their association with an increased incidence of intraoperative hypotension. However withholding these agents increases the risk of marked perioperative hypeension and the need for parenteral antihypeensive agents. Surgical procedures on patients with sustained preoperative diastolic blood pressure higher than 110 mmHg-paicularly those with evidence of endorgan damage should be delayed until blood pressure is better controlled over the course of several days. Beta blockers A sudden stop can result in rebound hypeension, tachycardia and recurrent myocardial ischemia. They are continued up to and including morning of surgery and restaed immediately afterwards. Antianginal drugs Antianginal drugs such as calcium channel blockers or nitrates (GTN) should not be stopped before surgery without a very specific reason or angina may recur. Calcium channel blockers They have antiischaemic propey despite a theoretical risk of increased bleeding. They should be continued upto including the day of surgery. Nitrates To be continued up to and including day of surgery. About other classes of drugs Statins They should have a beneficial effect on outcome especially after coronary aery bypass grafting thus they are continued up to the day of surgery. Alpha 2 agonists Abrupt withdrawl an result in extreme hypeension and myocardial ischemia. So it should be continued upto and including the day of surgery. Diuretics There is risk of hypovolemia and hypotension but still should be continued up to the day of surgery. Digoxin and antiarryhthmics Should be continued upto the day of surgery. ACE inhibitors Continued use can result in perioperative hemodynamic instability For hypeension: continued to the day of surgery For hea failure: discontinue on the day of surgery especially if baseline blood pressure is low. Drugs that should be stopped before surgery Lithium It should be stopped 2 days before major surgery as it potentiates the non depolarizing group of relaxants and in emergency cases suxamethonium and regional blocks should be considered as alternative. Oestrogen containing oral contraceptive pills They are stopped before surgery beause they increase the risk of deep venous thrombosis. Surgery and the combined pill both reduce the activity of antithrombin Combined pills, should if possible be discontinued 4 weeks before major elective surgery or leg surgery such as varicose veins and staed again at the first period following an interval of 2 weeks after the operation. Aspirin Use may be associated with increased bleeding due to platelet dysfunction. They should be stopped 5-7 days before surgery if possible. Oral anticoagulants (warfarin) Should be stopped 4 days prior to surgery and substituted by iv heparin. Oral hypoglycemics Patients with type II diabetes mellitus should stop oral hypoglycemics several days prior to surgery (especially metformin which is known to contribute to postoperative lactic (acidosis) Patients on insulin (SC or iv) should omit their morning dose. Also know about these Monoamine oxidase inhibitors These drugs irreversibly inhibit monoamine oxidase. Stopping these drugs three weeks prior to anaesthesia to allow resynthesis of the enzyme is no longer considered necessary. Tricyclic antidepressants It competitively blocks norepinephrine reuptake by postganglionis sympathetic nerve endings. Patients taking these drugs are therefore more sensitive to catecholamines so any sympathominetic given simultaneously may cause hypeension and arryhthmia. These drugs were discontinued earlier but nowdays they are used.

Pharmacology

e23bf88f-c1c0-4d32-b8e1-bc0105bfb269

Vanillylmandelic acid (VMA) is excreted in urine in which of the following condition?

Alkaptonuria

Phenylketonuria

Pheochromocytoma

Diabetic ketoacidosis

single

(C) Pheochromocytoma[?]ODOUR:oMisty/Mousy Odour of urine - PhenylketonuriaoFruity/Sweet odour - Presence of ketones.oPungent smell - Presence of bacterial / specimen contaminated with bacteria.oOdour of sweaty feet - Isovaleric acidemiaoMaple syrup - Maple syrup urine diseaseoFishy odour / Rancid butter - HypermethioninemiaMETABOLIC DISORDERS WITH ABNORMAL URINE ODORInborn errors of metabolismUrine odorGlutaric acidemia 2Sweaty feet, acridHawkinsinuriaSwimming PoolIsovaleric acidemiaSweaty feet, acridMSUDMaple syrupHypermethioninemiaBoiled cabbageMultiple carboxylase deficiencyTomcat urineOasthouse urine diseaseBuilding for drying hopsPKUMousy or mustyTrimethylaminuriaRotting fishTyrosinemiaBoiled cabbage, rancid butter INBORN ERRORS OF AMINO ACID METABOLISM ASSOCIATED WITH ABNORMAL ODORInborn error of metabolismUrine odorGultaric AcidemiaSweaty feetMaple syrup urine diseaseMaple syrupHypermethioninemiaBoiled cabbagePhenylketonuriaMousy or mustyTrimethylaminuriaRotten fish OdorObserved InFruity smellDiabetes mellitus Type 1Mousy odorPhenylketonuriaFishyUTIAmmonical odorUTI caused by pseudomonas & proteusBurnt SugarMaple syrup urine disease[?]BIOCHEMICAL TESTING:oPheochromocytomas & paragangliomas synthesize and store catecholamines, which include norepinephrine (noradrenaline), epinephrine (adrenaline), and dopamine.oElevated plasma and urinary levels of catecholamines and the methylated metabolites, metanephrines, are the cornerstone for the diagnosis.oCatecholamines and metanephrines can be measured by using different methodsoIn a clinical context suspicious for pheochromocytoma, when values are increased three times the upper limit of normal, a pheochromocytoma is highly likely regardless of the assay used.[?]VMA is the end product of catabolism of catecholamines.oIn pheochromocytoma and neuroblastoma there is excessive synthesis of catecholamines which causes enhanced synthesis of VMA and its excretion in the urine.oVMA is the urinary product of both epinephrine and nor-epinephrine.oIt is a good screening test for pheochromocytoma, and is also used to diagnose and follow up neuroblastoma and ganglioneuroma.oPheochromocytoma (PCC) is a neuroendocrine tumor of the medulla of the adrenal glands (originating in the chromaffin cells), or extra-adrenal chromaffin tissue that failed to involute after birth, that secretes high amounts of catecholamines,omostly nor-epinephrine, plus epinephrine to a lesser extent.Other Options[?]Alkaptonuria is a rare inherited genetic disorder in which the body cannot process the amino acids phenylalanine and tyrosine, which occur in protein.[?]Phenylketonuria (PKU) is an inherited disorder that increases the levels of a substance called phenylalanine in the blood. Phenylalanine is a building block of proteins (an amino acid) that is obtained through the diet.[?]Diabetic ketoacidosis (DKA) is a life-threatening condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy because there is not enough insulin. When the sugar cannot get into the cells, it stays in the blood.

Biochemistry

Proteins and Amino Acids

7f60dcd8-cc6a-4347-9196-74c4537711c7

Most common gynaecological malignancy in affluent obese women is -

Endometrial

Cervical

Vaginal

Ovarian

single

Ans. is 'a' i.e., Endometrial o Most common gynaecological cancer in developed countries is endometrial cancer# Most common gynaecological cancer in developing countries like india is cervical cancer.Risk Factorso Estrogen replacement without concomitant progesterone carries a relative risl of 4.5 to 8 & persists for 10 years after treatment is stopped.o BMI >30 kg/m2 will triple the risk of 2 in 1000 of developing endometrial cancer ans 40% of women will develop cancer more than 12 months after stopping therapy.o Women with HNPCC syndrome have 39% risk of developing endometrial cancer by the age of 70 years.o OCP s decrease endometrial cancer risk by 40%, even uptil 15 years after discontinuation and the protection increases with the lenth of use.Epidemoiogyo Most common gynecological malignancy in developed countries and the the 4th most common cancer in women.o 20% of women develop endometrial carcinoma in lifetime.o Mean age ofpresentation is 60 years : peak incidence occurs from 55 to 70 years.o Majority are diagnosed early,o 5 year survival for state 1 disease is more than 90%.o Overall 5 year survival for all stages is 60-70%.Risk factorso Family history'o Hypertensiono Obesityo Late menopause/Early menarcheo Diabeteso A typical endometrial hyperplasiao Unopposed estrogen or increased estrogen in body as in : HRT, fibroid, PCOD and Feminizing ovarian tumours.o Nulliparityo Therapy : Tamoxifen Therapy and Radiation Therapyo H/O infertility/menstrual irregularity.

Gynaecology & Obstetrics

Aetiological factors

198c11da-cee0-40e8-af41-1551730d2507

NARY is a -

Lipid storage disorder

Glycogen storage disorder

Mitochondrial disorder

Lysosomal storage disorder

single

Ans is 'c' i.e., Mitochondria! disorder Clinical Syndromes of Mitochondrial Diseases Primary Features Chronic progressive external o External ophthalmoplegia ophthalmoplegia (CPEO) o Bilateral ptosis o PEO onset before age 20 years o Pigmentary retinopathy o One of the following CSF protein greater than I g/L, cerebellar ataxia, hea block o Sideroblastic anemia of childhood o Panytopenia o Exocrine pancreatic failure o Hypotonia in the first year of life o Feeding and respiratory difficulties o Subacute relapsing encephalopathy o Cerebellar and brain-stem signs o Infantile onset o Late-childhood or adult-onset peripheral neuropathy o Ataxia o Pigmentary retinopathy o Stroke-like episodes before age 40 years o Seizures and/or dementia o Ragged-red fibers and/or lactic acidosis o Myoclonus o Seizures o Cerebellar ataxia o Myopathy o Subacute painless bilateral visual failure o Males: females-- 4:1 o Median age of onset 24 years Bilateral deafness Myopathy Dysphagia Diabetes mellitus Hypoparathyroidism Dementia Renal tubular defects Fatal form may be associated with a cardiomyopathy and/or the Toni-Fanconi-Debre syndrome Basal ganglia lucencies Maternal history of neurologic disease of Leigh syndroms Basal ganglia lucencies Abnormal electroretinogram Sensorimotor neuropathy 0 Diabetes mellitus 0 Cardiomyopathy (initially hyperophic; later dilated) 0 Bilateral deafness 0 Pigmentary retinopathy 0 Cerebellar ataxia Dementia Optic atrophy Bilateral deafness Peripheral neuropathy Spasticity Multiple lipomata Dystonia Cardiac pre-excitation syndromes

Pathology

c8efce29-f950-4ceb-a08e-70e3a543e08c

Macrosomia is associated with :

Gestational diabetes mellitus

Hypeension

Hypothyroidism

Hyperbilirubinemia

single

Macrosomia is the term used to describe a large fetus. A bih weight at term 4000g or more is also considered as macrosomia in the Indian context. RISK FACTORS: Maternal diabetes is the most impoant risk factor. Maternal obesity Previous large baby Post-term pregnancy Multiparity In Maternal Diabetes, Fetal macrosomia with bih weight of >4kgs results from Maternal Hyperglycemia-->hyperophy and hyperplasia of the fetal islets of langerhans-->increases secretion of fetal insulin-->stimulates carbohydrates,utilization and accumulation of fat. Insulin like growth factors are also involved in fetal growth and adiposity. Elevated maternal free fatty acid in DM leads to increased transfer to the fetus-->accelaration of triglyceride synthesis-->adiposity. Reference: DC DUTTA'S TEXTBOOK OF OBS,9th edition,page no.265

Gynaecology & Obstetrics

Fetus

fbf73371-d52a-4260-8a63-ba1a053264b4

Radiograph of the ankle of a diabetic patient with painless, swollen joint shows destroyed joint with large number of loose bodies. The most probable diagnosis is:

Charcot's joint

Clutton's joint

Osteoahritis

Rheumatoid ahritis

single

Neuropathic ahritis (Charcot's joint) is encountered most often in patients with diabetes mellitus. It is a progressive destructive ahritis associated with loss of pain sensation, proprioception, or both. Without these protective mechanisms, joints are subjected to repeated trauma, resulting in progressive cailage and bone damage. There is fragmentation and eventual loss of aicular cailage with eburnation of the underlying bone resulting in the formation of loose bodies. Clutton's joints is a term describing the finding of symmetrical joint swelling seen in patients with congenital syphilis. It is most commonly affects the knees presenting with synovitis and joint effusions. Ref: Harrisons principles of internal medicine, 18th edition, chapter: 336

Radiology

cf5fdc5d-e730-4647-a1c9-e538c6257e06

Carpal tunnel syndrome is caused by all EXCEPT:

Hypothyroidism

Tuberculosis

Pregnancy

Acromegaly

multi

ANSWER: (B) TuberculosisREF: Apley's system of orthopedics & fracture 8th edition page 247-248Carpal tunnel syndrome is produced by entrapment of median nerve beneath the flexor retinaculum. Associated conditions that can leads to carpal tunnel syndrome are:Idiopathic (most common)PregnancyEndocrine disordersHypothyroidismDiabetes mellitusMyxedemaAcromegalyHyperparathyroidismDeposition disordersRheumatoid disorderGoutRheumatic disorderAmyloidosisSarcoidosisLeukemiaChronic renal failure

Orthopaedics

Peripheral Nerve Injuries

b39778c7-9d90-4f24-a825-732ffff6dbe5

Glycemic control in diabetes is best assessed by-

HbA1c

Urinary glucose

Fasting glucose

Post prandial glucose

single

Glycated hemoglobin provides an accurate and objective measure of glycemic control integrated over a period of 2-3 months (life span of RBCs is 120 days). HbA1c is most sensitive to changes in glycemic control occuring in the month before measurement. The rate of formation of HbA1c is directly propoional to the ambient blood glucose concentration; a rise of 1 % in HbA1c corresponds to an approx. average increase of 2 mmol/L (36 mg/dL) in blood glucose. In most individuals, the target HbA1c should be <7%. A value of 10 % indicates very poor control. In patients achieving their glycemic goal, the ADA recommends measurement of the HbA1c at least twice per year; more frequently (every 3 months) when glycemic control is inadequate or when therapy has changed. Reference : page 2410 Harrison's Principles of Internal Medicine 19th edition and page 808 Davidson's Principles and practice of Medicine 22nd edition

Medicine

Endocrinology

9d0968c7-0bfa-42c5-9e1f-1cf35c40b36e

Dupuytren's contracture mvolves-

Dorsal fascia

Palmar fascia

Ulnar bursa

Radial bursa

single

Ans. is 'b' i.e., Palmar fascia o Dupuytren's contracture is characterized in the established phase by flexion contracture of one or more fingers from thickening and shortening of palmar aponeurosis.o The exact etiology is unknow; However, the condition is more commonly associated with following conditionsi) Epileptics taking phenytoiniv) Alcoholic cirrhosisii) Diabetesv) AIDSiii) Smokingvi) Pulmonary TB o Often both hands are affected (Bilateral disease), one more than the other,o The earliest sign is a small thickened nodule in the mid-palm opposite the base of ring finger,o Gradually this extends distally to involve the ring or little finger.o There is a rare, curious association with fibrosis of the corpus Cavemosum.

Orthopaedics

Tendon and Crush Injuries

ce69c832-d6cb-4007-b4b6-cc78301c3343

Drug-induced diabetes is seen with all the following except

Diazoxide

Hydrochlohiazide

Alloxan

multi

Diabetes is induced by alloxan and streptozotocin in animals for expirimental purposes. Thiazides also cause hyperglycemia Ref: HL sharma 3rd ed.Pg: 234-235

Pharmacology

Kidney

eef4765a-d087-4d1f-96bb-1faa7cdbe32f

Dyslipidemia associated with alcohol consumption-

Decreased HDL

Increased HDL

Decreased triglycerase

Decreased lipoprotein

single

Dyslipidemia is an abnormal amount of lipids (e.g. triglycerides, cholesterol and/or fat phospholipids) in the blood. In developed countries, most dyslipidemias are hyperlipidemias; that is, an elevation of lipids in the blood. This is often due to diet and lifestyle. Prolonged elevation of insulin levels can also lead to dyslipidemia. Likewise, increased levels of O-GlcNAc transferase (OGT) may cause dyslipidemia. The most common conditions that were felt to be contributing to dyslipidemia were excessive alcohol intake (10 percent) and uncontrolled diabetes mellitus (8 percent). Hyperlipidemia in association with insulin resistance is common in patients with type 2 diabetes mellitus Dyslipidemia is a high level of lipids (cholesterol, triglycerides, or both) or a low high-density lipoprotein (HDL) cholesterol level. Lifestyle, genetics, disorders (such as low thyroid hormone levels or kidney disease), drugs, or a combination can contribute. Ref Davidson 23rd edition pg 838

Medicine

Miscellaneous

0d4b737f-74b9-49ee-925f-5ecef09b7875

Which is not a component of metabolic syndrome?

Central obesity

Hyperiglyceridemia

Increased Insulin sensitivity

Hypeension

single

NCEP: ATPIII Definition Criteria for the Metabolic Syndrome: Three or more of the following: Central obesity: waist circumference >102 cm (M), >88 cm (F) Hyperiglyceridemia: triglyceride level >=150 mg/dL or specificmedication Low HDL cholesterol: <40 mg/dL and <50 mg/dL for men andwomen, respectively, or specific medication Hypeension: blood pressure >=130 mmHg systolic or >=85 mmHg diastolic or specific medication Fasting plasma glucose level >=100 mg/dL or specific medicationor previously diagnosed type 2 diabetes In metabolic syndrome or syndrome X, there is hyperinsulinemia due to insulin resistance Ref: Harrison; 20th edition , pg2903

Medicine

C.V.S

480f6ca3-591e-4b4e-94dc-93a595b90533

The major limitation in the use of clozapine for treatment of schizophrenia is

Its potential to cause agranulocytosis

High incidence of extrapyramidal side effects

Production of hyperprolactinemia

Its inability to benefit negative symptoms of schizophrenia

single

Clozapine:- It is the first atypical anti- psychotic. It has only weak D2 blocking action, produces few/no extrapyramidal symptoms; tardive dyskinesia is rare and prolactin level does not rise. Both positive and negative symptoms of schizophrenia are improved and clozapine is the most effective drug in refractory schizophrenia, i.e. patients not responding to typical neuroleptics may respond to it. Pharmacokinetics:- Clozapine is metabolized by CYP1A2, CYP2C19 & CYP3A4 into active and inactive metabolites with an average t 1/2 of 12 hours. Adverse effects:- It's major limitation is higher incidence of agranulocytosis (0.8%) and other blood dyscrasias: weekly monitoring of leucocyte count is required. Metabolic complication like weight gain, hyperlipidemia and precipitation of diabetes is another major limilation. Ref:- kd tripathi; pg num:-441

Pharmacology

Central Nervous system

349fa480-b37a-4aa9-8da5-c25414c3b4c6

Which of the following is a mood stabilizer?

Lithium

Haloperidol

Amitriptyline

Diazepam

single

Ans: a (Lithium) Ref:Katzung, 10th ed, p 455Lithium carbonate is often referred to as an "antimanic" drug, and is considered a "mood-stabilizing" agent because of its primary action of preventing mood swings in patients with bipolar affective (manic-depressive) disorder. Concentrations considered to be effective and acceptably safe are between 0.6 and 1.25 mEq/L. The range of 0.9-1.1 mEq/L isfavoured for treatment of acutely manic or hypomanic patients. Somewhat lower values (0.6-0.75 mEq/L) are considered adequate and are safer for long-term use for prevention of recurrent manic-depressive illness.Adverse Effects & ComplicationsMany adverse effects associated with lithium treatment occur at varying times after treatment is started.Some are harmless, but it is important to be alert to adverse effects that may signify impending serious toxic reactions.A. NEUROLOGIC AND PSYCHIATRIC ADVERSE EFFECTSTremor is one of the most common adverse effects of lithium treatment, and it occurs with therapeutic doses. Propranolol and atenolol, which have been reported to be effective in essential tremor, also alleviate lithium-induced tremor. Other reported neurologic abnormalities include choreoathetosis, motor hyperactivity, ataxia, dysarthria, and aphasia. Psychiatric disturbances at toxic concentrations are generally marked by mental confusion and withdrawal. Appearance of any new neurologic or psychiatric symptoms or signs is a clear indication for temporarily stopping treatment with lithium and close monitoring of serum levels.B. DECREASED THYROID FUNCTIONLithium probably decreases thyroid function in most patients exposed to the drug, but the effect is reversible or nonprogressive. Few patients develop frank thyroid enlar gement, and fewer still show symptoms of hypothyroidism. Although initial thyroid testing followed by regular- monitoring of thyroid function has been proposed, such procedures are not cost-effective. Obtaining a serum TSH concentration every 6-12 months, however, is prudent.C. NEPHROGENIC DIABETES INSIPIDUS AND OTHER RENAL ADVERSE EFFECTSPolydipsia and polyuria are common but reversible concomitants of lithium treatment, occurring at therapeutic serum concentrations. The principal physiologic lesion involved is loss of responsiveness to antidiuretic hormone (nephrogenic diabetes insipidus). Lithium-induced diabetes insipidus is resistant to vasopressin but responds to amiloride.An extensive literature has accumulated concerning other forms of renal dysfunction during long-term lithium therapy, including chronic interstitial nephritis and minimal-change glomerulopathy with nephritic syndrome. Some instances of decreased glomerular filtration rate have been encountered but no instances of marked azotemia or renal failure.Patients receiving lithium should avoid dehydration and the associated increased concentration of lithium in urine. Periodic tests of renal concentrating ability should be performed to detect changes.D. OEDEMAOedema is a common adverse effect of lithium treatment and may be related to some effect of lithium on sodium retention. Although weight gain may be expected in patients who become edematous, water retention does not account for the weight gain observed in up to 30% of patients taking lithium.E. CARDIAC ADVERSE EFFECTSThe bradycardia-tachycardia ("sick sinus") syndrome is a definite contraindication to the use of lithium because the ion further depresses the sinus node. T-wave flattening is often observed on ECG but is of questionable significance.F. USE DURING PREGNANCYRenal clearance of lithium increases during pregnancy and reverts to lower levels immediately after delivery. A patient whose serum lithium concentration is in a good therapeutic range during pregnancy may develop toxic levels following delivery. Special care in monitoring lithium levels is needed at these times. Lithium is transferred to nursing infants through breast milk, in which it has a concentration about one-third to one-half that of serum. Lithium toxicity in newborns is manifested by lethargy, cyanosis, poor suck and Moro reflexes, and perhaps hepatomegaly.An earlier report suggested an increase in the frequency of cardiac anomalies, especially Ebstein anomaly, in lithium babies. However, more recent data suggest that lithium carries a relatively low risk of teratogenic effects.G MISCELLANEOUS ADVERSE EFFECTSTransient acneiform eruptions have been noted early in lithium treatment. Some of them subside with temporary discontinuance of treatment and do not recur with its resumption. Folliculitis is less dramatic and probably occurs more frequently. Leukocytosis is always present during lithium treatment, probably reflecting a direct effect on leukopoiesis rather than mobilization from the marginal pool. This adverse effect has now become a therapeutic effect in patients with low leukocyte counts.Haloperidol is an antipsychotic and is butyrophenone derivativeThe butyrophenones and congeners tend to be more potent and to have fewer autonomic effects but greater extrapyramidal effects.

Pharmacology

C.N.S

a5e010ff-cb12-4d53-beb4-ee5ac5b1bcac

Chediak Higashi disease is characterized by the following except?

Neutrophilia

Defective degranulation

Delayed microbial killing

Giant granules

multi

Ans. A. Neutrophilia. (Ref, Robbing pathology 8th/pg. 154)Befects, Phauocytzc,CellsDiseaseMolecular Defect(s)SymptomsChronic granulomatous disease (C6D)Deficiency of NADPH oxidase (any one of four component proteins), failure to generate superoxide anion, other O2 radicalsRecurrent infections with catalase-positive bacteria and fungiChediak-Higashi syndromeGranule structural defectRecurrent infection with bacteria; chemotactic and degranulation defects; absent NK activity, partial albinismLeukocyte adhesion deficiencyAbsence of CD 18--common b chain of the leukocyte integrinsRecurrent and chronic infections, failure to form pus, does not reject umbiliicai cord slumpCHEDIAK-HIGASHI SYNDROME (CHS)INTRODUCTION# autosomal recessive disease.0# affects lysosomes in leukocytes, Schwann cells, melanocytes, renal tubular cells, and thyroid cells.# Associated with partial oculocutaneous albinism, neuropathy, and recurrent infections.Q# Neutrophils from these patients respond poorly to chemotactic stimuli and exhibit impaired intracellular killing (and degranulation) and depressed T-cell and NK cell killing of microbes.# Antimicrobial prophylaxis with Trimethoprim-Sulfamethoxazole is recommended. QPATHOGENESIS# CHS is caused by mutations in LYST (lysosomal trafficking regulator) gene, located on chromosome lq42-q44.Q# Ocular albinism.# Oversized and dysmorphic lysosomes, storage granules, or related vesicular structures.# Increased susceptibility to infection: due to giant neutrophil granules.C/F:# Decreased pigmentation of hair and eyes resulting in partial albinism, photophobia, and nystagmus.# The phenotype includes neutropenia, abnormal susceptibility to infection, and malignant lymphoma.# From 85 to 90% of CHS patients develop a lymphoproliferative syndrome, the "accelerated phase" of the disorder, characterized by generalized lymphohistiocytic infiltrates, fever, jaundice, hepatosplenomegaly, lymphadenopathy, pancytopenia, and bleeding.RX:# Management of the early stage include management of infectious complications.- Prophylactic antibiotics (trimethoprim-sulfamethoxazole) should be given, and infections should be treated vigorously with appropriate antibiotic therapy.# Ascorbic acid (20 mg/kg/day) has corrected the microbicidal defect in some patients.# Bone marrow transplantation is the Rx of choice during progression to the accelerated phase.- Bone marrow transplantation is curative.Q(but has no effect on the neurologic ones).INHERITED DISORDERS OF PHAGOCYTE FUNCTION:CLINICAL MANIFESTATIONSDEFECTSDIAGNOSISChronic Granulomatous Diseases (70% X-linked, 30% Autosomal Recessive)Severe infections with catalase-positive microorganisms such as S. aureus, Burkholderia cepacia , Aspergillus spp.,Chromobacterium violaceum; often hard to culture organism; excessive inflammation with granulomas, frequent lymph node suppuration; granulomas can obstruct GI or GU tracts; gingivitis, aphthous ulcers, seborrheic dermatitis.No respiratory burst due to the lack of one of four NADPH oxidase subunits in neutrophils, monocytes, and eosinophils.QNBT or DHR test; no superoxide and H2O2 production by neutrophils;Q immunoblot for NADPH oxidase components; genetic detectionChediak-Higashi Syndrome (Autosomal Recessive)Recurrent pyogenic infections, especially with S. aureus;QReduced chemotaxis andGiant primary granules inmany patients get lymphoma-like illness; periodontalphagolysosome fusion,neutrophils and otherdisease; partial oculocutaneous albinism, nystagmus, progressive peripheral neuropathy, mental retardation in some patientsincreased respiratory burst activity, defective egress from marrow, abnormal skin window; defect in LYST.Qgranule-bearing cells (Wright's stain); genetic detectionMyeloperoxidase Deficiency (Autosomal Recessive)Clinically normal except in patients with underlying disease (eg. diabetes mellitus); then candidiasis or other fungal infections.No myeloperoxidase due to pre-and posttranslational defectsNo peroxidase in neutrophils; genetic detection.Leukocyte Adhesion DeficiencyType 1: Delayed separation of umbilical cord, sustained neutrophilia, recurrent infections of skin and mucosa, gingivitis, periodontal diseaseImpaired phagocyte adherence, aggregation, spreading, chemotaxis, phagocytosis of C3bi-coated particles; defective production of CD18 common to leukocyte integrinsReduced phagocyte surface expression of the CD18- containing integrins with monoclonal ab againstLFA-1 (CD18/CD11a), Mac-1 or CR3 (CD18/CD11b), p150,95 (CD18/CD11c); genetic detectionType 2: Mental retardation, short stature, Bombay (hh) blood phenotype, recurrent infections, neutrophilia.Impaired phagocyte rolling along endothelium.QReduced phagocyte surface expression of Sialyl-Lewisx, with monoclonal antibodies against CD15s; genetic detection.QHyper IgE-Recurrent Infection Syndrome (Autosomal Dominant) (Job's Syndrome)Eczematoid or pruritic dermatitis, "cold" skin abscesses, recurrent pneumonias with S. aureus with bronchopleural fistulae and cyst formation, mild eosinophilia, mucocutaneous candidiasis, characteristic facies, restrictive lung disease, scoliosis, delayed primary dental deciduationReduced chemotaxis in some patients, reduced suppressor T cell activity.Clinical features, involving lungs, skeleton, and immune system; serum IgE > 2000 IU/ mL

Pathology

Immunity

2e09fc7b-62d5-42c4-b734-27f4770c8f6d

Best method of estimation of amount of proteinuria in a child with nephrotic syndrome is -

Dipstick testing

24 hr urine for protein and creatinine

Spot urine sample for protein/ creatinine ratio

Microalbuminuria

single

Ans. is 'b' i.e., 24 hr urine for protein and creatinine Methods Available to Test for ProteinuriaMethodIndicationsNormal RangeCommentsDipstick testingRoutine screening for proteinuria performed in the officeNegative of trace in a concentrated urine specimen (specific gravity: > 1.020)False-positive test can occur if urine is very alkaline (pH > 8.0) or very concentrated (specific gravity: > 1.025)24hr urine for protein and creatinine* excretionQuantitation of proteinuria (as well as creatinine clearances)<100 mg/m2/24hr or < 150 mg/24 hr in a documented 24 hr collectionMore accurate than spot urine analysis: inconvenient for patient; limited use in pediatric practice.Spot urine for protein/ creatinine ratio-preferably on first morning urine specimen.Semiquantitative assessment of proteinuria.< 0.2 mg protein/mg creatinine in children > 2yr old.< 0.5 mg protein/mg creatinine in those 6-24 mo old.Simplest method to quantitate proteinuria: less accurate than measuring 24hr proteinuria.MicroalbuminuriaAssess risk of progressive glomerulopathy in patients with diabetes mellitus.< 30mg urine albumin per gram of creatinine on first morning urine.Therapy should be intensified in diabetics with microablbuminuria.

Pediatrics

Kidney

ba8308f7-e773-4396-912b-4bf9c37c7aac

True about insulin is

Anabolic steroid

Induce lipolysis

Produced by a-cells

multi

Insulin is a polypeptide hormone, secreted by b cells in the islets of Langerhans, which promotes glucose use, protein synthesis, and the formation and storage of neutral lipids; available in various preparations including genetically engineered human insulin, which is currently ored. Insulin is used parenterally in the treatment of diabetes mellitus.Ref: Ganong&;s review of medical physiology;24th edition; page no-432

Physiology

Endocrinology

a5526967-130a-4bd4-a6cc-3663aa0b37c3

A 60-year-old man is brought to the emergency department because of new symptoms of double vision and discomfort in his left eye. He reports no other neurologic symptoms. On physical examination, there is ptosis of the left eyelid, the eye is rotated down and out, and the pupil is 3 mm and reactive to light. The right eye is normal, and there are no other focal neurological deficits. Which of the following is the most likely diagnosis?

fourth nerve palsy

diabetic autonomic neuropathy

third nerve palsy

sixth nerve palsy

single

Third nerve palsy can result in ptosis of the eyelid. There is also loss of the ability to open the eye, and the eyeball is deviated outward and slightly downward. With complete lesions, the pupil is dilated, does not react to light, and loses the power of accommodation. In diabetes, the pupil is often spared. The sixth cranial nerve can also be affected by diabetes, but this is much less common.

Medicine

C.N.S.

e02481c2-5d25-4bea-ab09-ecb34acc9375

Trial of labour is contraindicated in all of the following conditions, except :

Rachitic pelvis

Maipresentation

Previous LSCS

Multigravida

multi

Ans. is d i.e. Multigravida Trial of labour is conduction of spontaneous labour in a moderate degree of cephalopelvic dispropoion, under supervision with watchful expectancy, hoping for a vaginal delivery. The phrase 'trial' which was originally used to test for pelvic adequacy is now being used to test numerous factors other than only pelvic capacity . Contraindications of Trial of Labour Midpelvis and outlet contraction (here, Rachitic Pelvis) Associated risk factors like : - Elderly primigravida Previous cesarean pregnancy Malpresentation - Preeclampsia - Post maturity. Associated medical disorders like : - Hea disease - Diabetes. In a setup where facility for cesarean section is not available round the clock. Also Know Trial of labour is indicated in : * Mild CPDdeg

Gynaecology & Obstetrics

1636111e-8fee-429e-8893-793d5f676d3f

A 48-year-old right-handed man was admitted with a 3-day history of brief generalised tonic-clonic seizures,muscle weakness, a 3-month history of weight loss with increasing difficulty in eating and a 1-week history of word finding difficulties and speech apraxia with reduced fine motor skills.He had a diagnosis of type 2 diabetes mellitus, epilepsy and a history of a left temporal lobe infarct 3 years ago. MRI of the brain showing bilateral coical-based signal abnormality with associated oedema, with corresponding diffusion hyperintensity. MR spectroscopy showing a lactate doublet peak. HPE of muscle biopsy was shown below.What is the most probable diagnosis?

Duchenne muscular dystrophy

Beckers muscular dystrophy

Myotonic dystrophy

MELA's disease

single

The clinical scenario shows a child who had normal development previously and then presenting with symptoms of lactic acidosis and stroke(seizures with focal neurological deficits). The microscopy of muscle biopsy with modified Gomori trichrome staining shows ragged red fibers (arrowhead). Based on these features, the child is probably suffering from mitochondrial encephalopathy, lactic acidosis, and stroke (MELAS), which is a mitochondrial inherited condition due to complex I or complex IV deficiency. Treatment options for MELAS are limited and largely focus on suppoive therapy. Reference: Harpers illustrated biochemistry 30th edition

Biochemistry

Respiratory chain

45f943e0-5c97-43e2-bd28-6e2fe7000b23

All of the following skin lesions are associated with Diabetes mellitus except

Necrobiosis Lipoidica

Granuloma annulare

Acanthosis nigricans

Pyogenic granuloma

multi

Pyogenic granuloma is associated with IBD. (Ulcerative colitis > Crohn's disease).

Dental

4dc6995c-18e8-4abe-b37c-a00bb2d5d2a2

Baby is not at risk for hypoglycemia

Post dated pregnancy

Mother on beta blocker

Mother with diabetes mellitus

IUGR

single

newborns are at risk for hypoglycemia : Babies born to mothers with diabetes. Babies who are small for gestational age or growth-restricted. Preterm babies, especially those with low bih weights. Babies born under significant stress. Babies with mothers treated with ceain medicines such as terbutaline. Reference: GHAI Essential pediatrics, 8th edition

Pediatrics

New born infants

d68e5fbb-d38d-416c-b902-08c2be896ca5

Charcot's joint is another name for joint affected by ?

Neuropathy

Osteoahritis

Rheumatoid ahritis

Ankylosing spondylitis

single

Ans. is 'a' i.e., Neuropathy Another name given to joint affected by neuropathic ahropathy is charcot's joint. Neuropathic joint (Charcoat's joint) It is a progressive destructive ahritis associated with loss of pain sensation, proprioception or both, in addition normal muscular reflexes that modulate joint movements are decreased. Without these protective mechanisms, joints are subjected to repeated trauma, resulting in progressive cailage and bone damage. It is most commonly caused by diabetes mellitus. Pathophysiology At least two underlying mechanisms are believed to be involved in the pathogenesis of neuropathic ahritis. i) An abnormal autonomic nervous system is thought to be responsible for the increased blood flow to the joint and subsequent resorption of bone. ii) With the loss of deep pain, proprioception and protective neuromuscular reflexes, the joint is subjected to repeated injuries including ligamental tears and bone fractures. Pathology The pathological changes seen in charcoat's joints are similar to those found in severe osteoahritic joint. There is fragmentation and eventual loss of aicular cailage with eburnation of the underlying bone. Osteophytes are found at the joint margins. With more advanced diseases, erosions are present on the joint surface. Fractures, devitalized bone, and intraaicular loose bodies may be present. Joint effusions are prominent. Clinical manifestations Usually begins in a single joint and then progresses to involve other joints. The involved joints progressively becomes enlarged from bony overgrowth and synol effusion. o Loose bodies may be palpated in the joint cavity.

Surgery

2739b82c-7a24-4440-b58a-35f970fb801a

Nephrotic syndrome is the hall mark of the following primary kidney diseases except

Membranous Glomerulopathy

IgA nephropathy

Minimal change disease

Focal segmental Glomerulosclerosis

multi

Ans. is 'b' i.e., IgA nephropathy Most common presentation of IgA nephropathy is grass hematuria. It is the most common form of glomerulonephritis worldwide Causes of Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis o Membranous glomerulonephritis o Diabetes nephropathy AL and AA amyloidosis Light chain deposition disease Fibrillary immunotactoid disease

Medicine

83bea5f6-cfe6-48e8-a2ea-0c3062bf70f9

The following skin lesion can be seen in all except?

Normo lipidemia

Hypertension

Diabetes mellitus

Secondary biliary cirrhosis

multi

Ans. B. Hypertensiona. The image shows xanthelasma involving both upper and lower eye lids on both sides.b. Xanthelasma palpebrarum is the most common type of xanthoma.c. Causes of Xanthelasma palpebrarum:i. Normo lipidemiaii. Type III hyperlipidemiaiii. Diabetes mellitusiv. Secondary biliary cirrhosis

Skin

Miscellaneous

48490a94-01e2-4b89-9949-af0236a39998

Which of the following surgery is contraindicated below 12 years of age?

Rhinoplasty

Antral puncture

SMR

Septoplasty

single

Contraindications of SMR Patients below 17 years of age. In such cases, a conservative surgery (septoplasty) should be done. An acute episode of respiratory infection. Bleeding diathesis. Untreated diabetes or hypertension.

ENT

f983f68b-145c-4a55-8ee8-d62edf1c0e3c

Dose of insulin in stable diabetics is reduced in-

Thyrotoxicosis

Propanolol therapy

III trimester of pregnancy

CRF

single

Insulin in CRF The kidneys carry out one third of exogenous insulin degradation. It is filtered at the glomerulus and is absorbed by the proximal tubule. Sixty percent of the renal clearance is due to glomerular filtration and 40% in the secretion by uptake from peritubular vessels. Reduction in renal filtration is paially counterbalanced by secretion. The dose of exogenous insulin is reduced 25% when eGFR is 10-50 mL/min and 50% when eGFR is < 10 mL/min . Metformin is the preffered choice of treatment of diabetes in CRF REfF - pubmed.com<a href="

Medicine

Endocrinology

9dab3242-318e-44b4-bbc6-54ec02fd84df

Statement true about ketone bodies is

Major source of energy supply to liver

They are derived from cholesterol

Their levels increase in starvation

Levels are raised in fed state

multi

KETOSISUnder ceain metabolic conditions associated with a high rate of fatty acid oxidation, liver produces considerable quantities of compounds like acetoacetate and b-OH butyric acid, which pass by diffusion into the blood. Acetoacetate continually undergoes spontaneous decarboxylation to produce acetone. These three substances are collectively known as "ketone bodies" (or "acetone bodies"). Sometimes also called as "ketones", which is rather a misnomer.Concentration of Ketone BodiesConcentration of total ketone bodies in the blood of well fed individuals does not normally exceed 1 mg/100 ml (as acetone equivalents).Urine: Loss urine is usually less than 1 mg/ 24 hrs in humans.Ketoacidosis: Acetoacetic acid and b-OH-butyric acid are moderately strong acids. They are buffered when present in blood and tissues, entailing some loss of buffer cations, which progressively depletes the alkali reserve| causing ketoacidosis.Note: This may be fatal in uncontrolled diabetes mellitusCauses1. Starvation: Simplest form of ketosis occurs in starvation.Mechanism: Involves depletion of available carbohydrate reserve, coupled with mobilisation of FFA and oxidation to produce energy.2. In Pathologic States* In Diabetes mellitus: Clinical and experimental.* In some types of alkalosis: Ketosis may develop.* Pregnancy toxaemia in sheep and in lactating cattle.3. In prolonged ether anaesthesia.4. Other non-pathologic forms of ketosis are found under conditions of:* High fat feeding.* After severe exercise in the postabsorptive state.5. Injection of anterior pituitary extracts. Site of Formation and Fate Liver appears to be the only organ which produces ketone bodies and add to the blood. Extrahepatic tissues can pick up ketone bodies from the circulating blood and utilise them as respiratory substrates. Net flow of ketone bodies from the liver to extrahepatic tissues results from an active enzymatic mechanism in the liver which exists, for the production of ketone bodies, coupled with very low activity of the enzymes rather than their absence, responsible for their degradation or utilisation. The reverse situation exists in extrahepatic tissuesRef: M.N.Chatterjee Textbook of Biochemistry 8th edition pg no: 425

Biochemistry

Metabolism of lipid

cf1ed13f-6c27-4dfa-b783-df26f3785de2

Which of the following doesnot predispose to cholangiocarcinoma

Ulcerative colitis

Clonorchis sinensis

Choledochal cyst

Chronic pancreatitis

single

Risk factors for cholangiocarcinoma Choledochal cyst Primary sclerosing cholangitis Ulcerative colitis. RPC or hepatolithiasis. Biliary enteric anastomosis HBV, HIV, HCV Choledocholithiasis Clonorchis sinensis and opisthorchis viverrini Cirrhosis Radon Asbestos, Nitrosamines, Dioxib(AND). Diabetes, Obesity, OCP's, smoking, Thorotrast, Isoniazid(DOSTI) Ref: Sabiston 20th edition Pgno :1514

Anatomy

G.I.T

95922f1a-c60e-4e7a-bb45-ff64b93ca616

If the grading of diabetes is classified as mild, moderate and severe the scale of measurement used is:

Interval

Nominal

Ordinal

Ratio

single

Ordinal

Social & Preventive Medicine

c093b440-477b-4cdd-97f2-11d0937e2fd4

A 82-year-old female presented with history of loss of vision in right eye for about 15 minutes and it cleared up. She has a history of diabetes and hypertension. She had which showed old infarct on right side. Carotid duplex showed that patient had 99% carotid artery stenosis. Which one of the following statements is TRUE?

60%chance that extra cranial carotid artery stenosis is the cause of transient ischemic attack (TIA)

It is always due to platelet emboli.

25% may be intracranial bleed.

0.5 to 10% may have cardiac and other causes of TIA.

multi

Neurological events are associated with extracranial carotid artery in about 60%. Forty percent may have extracranial/intracranial cause for neurological events, which includes cardiac emboli, arch of aorta as source of emboli; intracranial bleed may be more than just a TIA. It is not always that platelet emboli are the cause of TIA, it could be due to atheroma. It is not always attributed to thrombus.

Surgery

Arterial Disorders

90f956a7-4869-4c34-b1fe-222bbb7a347f

Cotton wool spots are commonly seen in: March 2007

HIV

Diabetes Mellitus

Hypeension

All of the above

multi

Ans. D: All of the above Cotton wool spots are an abnormal finding on fundoscopic exam of the retina. They appear as puffy white patches on the retina. They are caused by damage to nerve fibers. The nerve fibers are damaged by swelling in the surface layer of the retina. The cause of this swelling is due to the reduced axonal transpo (and hence backlog of intracellular products) within the nerves because of the ischaemia. Diabetes and hypeension are the two most common diseases that cause these spots, and the best treatment would be to treat the underlying disease. In diabetes they are one of the hallmarks of pre-proliferative retinopathy. More rarely, HIV and pancreatitis (Puscher) retinopathy can also lead to the appearance of cotton wool spots.

Ophthalmology

314a8830-616b-4e05-bf21-923e5775c925

Most common oral infection in diabetes mellitus?

Candida

Aspergillus

Streptococcus

Stphylococcus

single

Ans. is 'a' i.e., Candida o Individuals with DM have a greater frequency and severity of infection. The reasons for this include incompletely defined abnormalities in cell-mediated immunity and phagocyte function associated with hyperglycemia, as well as diminished vascularization. Hyperglycemia aids the colonization and growth of a variety of organisms (candida and other fungal species).

Medicine

Diabites & Inappropriate Antidiuretic Hormone

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Calculous cholecystitis is associated with all of the following except: March 2005

Oral contraceptives

Oestrogen

Obesity

Diabetes

multi

Ans. D: Diabetes Risk factors for calculous cholecystitis mirror those for cholelithiasis and include the following: Female sex Ceain ethnic groups Obesity or rapid weight loss Drugs (especially hormonal therapy in women) Pregnancy Increasing age

Surgery

2337f0bf-2f4a-414e-bea2-a677d4e648f7

All are used in the diagnosis of diabetes mellitus except:

FBS

HbAlc

D-xylose absorption test

OGTT

multi

C i.e. D-xylose absorption testGlycosylated hemoglobin (HbAic, an index of average glucose level in preceding 12 weeks), Fasting blood sugar (FBS 126 mg/dl), oral glucose tolerance test (OGTT) i.e. 2 hour post prandial glucose levels (> 200 mg/dl) and random blood sugar (RBS > 200 mg(dl) are used to diagnose diabetes mellitus whereas D-xylose absorption test is used to determine absorption of D-xylose in proximal small intestine (duodenum & jejunum) to detect intestinal malabsorption syndrome.

Biochemistry

524d1f3d-97d0-42d7-95d2-66a3a12b7df8

Antral puncture is done through-

Superior meatus

Inferior meatus

Middle meatus

All

multi

Proof puncture (Antral puncture) This procedure involves puncturing the medial wall of the maxillary sinus in the region of the inferior meatus and irrigating the sinus. Indications 1)   Chronic and subacute maxillary sinusitis with the dual purpose of : Confirming the diagnosis and Washing out the pus 2)   To collect the specimen of the antral contents for culture and sensitivity, or cytological examination to exclude early malignancy. Contraindications Children less than 12 years of age. Acute maxillary sinusitis as it may lead to osteomyelitis Fracture of maxilla as fluid may pass through fracture line. Diabetes

ENT

0b36b0e7-191d-4270-98e3-a7e0b77c505e

Characteristics of an ideal candidate for Copper - T inseion include all of the following except :

Has born at least one child

Is willing to check IUD tail

Has a history of ectopic pregnancy

Has normal menstrual periods

multi

Ans. is c i.e. Has history of ectopic pregnancy The planned parenthood federation of America has described Ideal IUCD candidate as a woman. Who has no history of pelvic disease. Who has born at least one child Has normal menstrual periods Is willing to check IUCD tail Has access to follow up and t/t of potential problems Is in a monogamous relationship. Also know : Absolute contraindication of lUCD : Please Don't Ever Put Condom Pregnancy - Suspected / confirmed. DUB H/O ectopic pregnancy (Friends here I want you to know that according to Newer criteria a woman with a previous ectopic pregnancy can use IUCD.' PID (untreated acute cervicitis, vaginitis including bacterial vaginosis until infection is controlled) Cancer cervix. Mnemonic - Please Don't ever put condom. Relative contra indication are : Anaemiadeg Menorrhagiadeg Purulent cervical dischargedeg Distoions of the uterine cavity due to congenital malformations, fibroidsdeg Unmotivated persondeg Postpaum endometritis or infective aboion in the past 3 months. Multiple sex paners of woman or her husband. Genital actinomycosis. Extra Edge : Some impoant points from 'Leon Speroff' on patient selection for IUD. Age and parity are not critical factors in selection, the risk factors for STI's are the most impoant considerations Contraception of choice in patients with current recent or recurrent PID is Hormonal or Barrier method: Patients with heavy menstrual periods should be cautioned regarding the increase in menstrual bleeding associated with copper IUD. Women who are anticoagulated or have bleeding disorder are obviously not good candidates for copper IUCD, but might benefit from progestin IUCD. - Women who have abnormalities of uterus like bicornuate uterus are not good candidates for IUD inseion.deg - Patients with Wilson disease are not recommended copper containing IUCD as contraceptive - Immunosuppressed individuals should not use IUCD. Patients at risk for endocarditis should be treated with prophylactic antibiotics at the inseion and removal of IUCD. According to Speroff : cervical dysplasias are not contraindication for use of IUCD'sdeg but in patients with cervical stenosis it may be difficult to inse IUCD. No increase in adverse events has been observed with copper containing IUCD in women with either insulin dependent or non insulin dependent diabetes. Intact Cu containing IUCD's can be the ideal choice for a woman with diabetes especially if vascular disease is present.

Gynaecology & Obstetrics

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NOT a side effect of Lithium

Leucopenia

Hypothyroidism

Polyuria

Hypercalcaemia

single

(A) Leucopenia # RENAL: The renal side-effects occur in 10-50% of all patients on maintenance lithium therapy. Polyuria, polydipsia. Tubular changes. Nephrogenic diabetes insipidus. Nephrotic syndrome.> Gastrointestinal: These side-effects are nausea, vomiting, diarrhea, metallic taste and abdominal pain.> Dermatological: These include acneiform eruptions, papular eruptions and exacerbation of psoriasis.

Psychiatry

Miscellaneous

6b23ce2b-90da-42a2-bb89-5ded2eeb45fb

All are factors of poor wound healing except -

Young age

Infection

Zinc deficiency

Vitamin D deficiency

multi

Answer- A. Young ageSystemic factorsPoor nutrition (protein deficiency, vitamin C deficiency)Metabolic abnormalities (Diabetes mellitus).Poor circulatory status (Inadequate blood supply)Hormones, e.g. glucocoicoidsB. Local factorsInfection is the single most impoant factor.Mechanical factors, e.g. early mobilization.Foreign bodies (unnecessary sutures, fragments of steel or glass).Wound in poorly vaculatized area, e.g. foot.

Pathology

0119fec0-c567-4783-b5e6-a8e693b28399

A 90-year-old woman with mild diabetes and Alzheimer disease dies in her sleep. At autopsy, hepatocytes are noted to contain golden cytoplasmic granules that do not stain with Prussian blue. Which of the following best accounts for pigment accumulation in the liver of this patient?

Advanced age

Alzheimer disease

Congestive heart failure

Diabetic ketoacidosis

single

Advanced age. Substances that cannot be metabolized accumulate in cells. Examples include (1) endogenous substrates that are not processed because a key enzyme is missing (lysosomal storage diseases), (2) insoluble endogenous pigments (lipofuscin and melanin), and (3) exogenous particulates (silica and carbon). Lipofuscin is a "wear and tear" pigment of aging that accumulates in organs such as the brain, heart, and liver. None of the other choices are associated with lipofuscin accumulation.Diagnosis: Aging, lipofuscin

Pathology

Cellular Pathology

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An unconscious 50 year old known case of diabetes mellitus is brought to the ER. His medical records show he is on warfarin for atrial fibrillation. Which of the following investigations will not be done in this patient for work up?

Lumbar puncture

Random blood sugar

NCCT

ECG monitoring

single

Option A- Always C/I in bleeding diathesis & in |ICT Option B- Known case of D.M so RBS should be done. Option C- Since he is unconscious may be d/t warfarin toxicity so CT scan is a probable investigation. Option D- patient on warfarin for atrial fibrillation so ECG monitoring is mandatory.

Medicine

Diabetes Mellitus

cbed74ec-4099-4d59-a022-ddbf4be7d0d1

Rubeosis iridis is not seen in: September 2008

CRVO

Diabetic retinopathy

Hypeensive retinopathy

Ocular ischemic syndrome

single

Ans. C: Hypeensive retinopathy Neovascularization of the iris (NVI) or rubeosis iridis is a condition characterized by the development of new, branching and enlarged vessels in the iris. Rubeosis iridis is often associated with diabetes in advanced proliferative diabetic retinopathy. Other conditions causing rubeosis iridis include central retinal vein occlusion, ocular ischemic syndrome, and chronic retinal detachment The visual prognosis is poor

Ophthalmology

4647f80b-541f-4c5f-beaf-61fdb6ef9f05

A 35 year old obese female with hirsutism, diabetes, and hypeension. True is

She is at risk of ovarian cancer

She is at risk of endometrial cancer

She is at risk of cervical cancer

She is at risk of vulval cancer

multi

Consequences of Polycystic Ovarian SyndromeSho-Term ConsequencesLong-Term ConsequencesuMenstrual dysfunction (Irregular menses)o Amenorrheao Oligomenorrheao Episodic menometrorrhagiauHyperandrogenismo HirsutismoAcneo Androgenic alopeciauInfeilityuObesityuInsulin resistance (Acanthosis nigricans)Dyslipidemia (Androgenic lipoprotein profile)o|LDLo|TGo|Total cholesterol: HDL ratioo|HDLuMetabolic syndrome - Characterized by insulin resistance, obesity, androgenic dyslipidemia and hypeensionuObstructive sleep apnea (Related to central obesity and dyslipidemia)uDiabetes mellitus uIncreased risk of impaired glucose tolerance and type 2 DM in PCOS patientsuCardiovascular diseases: Greater prevalence of atherosclerosis and cardiovascular disease with an increased risk of myocardial infarctionuCancero Endometrial carcinoma (3 fold increase risk)o Ovarian canceruWomen with PCOS are associated with a definite increased risk of endometrial cancer. An increased risk of ovarian cancer and breast cancer has also been suggested.

Anatomy

All India exam

76e93c4e-f180-45a3-8c6e-f35032f13a32

Dying back neuropathy is seen in all except :

Diabetic Neutropathy

Arsenic neuropathy

Porphyria

Gullian Bare syndrome (GBS)

multi

Answer is D (CBS) The two basic pathological processes of pathogenesis in neuropathy include Axonal degenetration and Demyelination. Neuropathy associated with Axonal degeneration is often called 'dying back neuropathy' as degeneration usually proceeds from distal to proximal. Neuropathy associated with Diabetes mellitus, Porphyria and Arsenic are primarily caused by axonal degeneration and represent examples of dying back neuropathy. GBS is primarily a demyelinating neuropathy and is the single best answer of choice. Pathology of Ncuropathy Axonal Degeneration (Retrograde) (Dying Back Neuropathy) Retrograde Axonal Degeneration is one type of classical response of nerve to an insult and consists of degeneration of axon from distal to proximal (Referred to as 'Dying back neuropathy) This type of degeneration is most commonly seen after toxic and metabolic injuries (Since the distal axon is the poion fahest from the cell body it is most vulnerable to toxic and metabolic derangements) Neuropathies resulting from Toxins (eg Arsenic) and.Metabolic derrangements (Diabetes, Porphyria) are pathologically caused by axonal degeneration (Refer Harrison 16th/2504, 2505) and may hence be grouped as dying back neuropathies. Demyelination Demyelination is another type of response of nerve to an insult Such demyelination is associated with a' ' conduction block' which results from failure of nerve conduction across the demyelinated segment and results in a rapid onset type neuropathy (weakness) Neuropathies resulting from demyelination do not have a distal to proximal progression and may occur either distally The primary pathological process in GBS is demyelination (although associated axonal degeneration may he present) and hence it represents an example of Demyelinating neuropathies and not a type of dying back neuropathy

Medicine

32e71d58-67df-427b-ad36-950bf6850b8b

Prader - Willi syndrome is associated with following EXCEPT

Hypogonadotropic hypogonadism

Hyperphagia - obesity

Chronic muscle hypeonia

Adult - onset diabetes mellitus

multi

PWS has many signs and symptoms. The symptoms cann range from poor muscle tone during infancy to behavioral problems in early childhood. Some symptoms that are usually found in infants, besides poor muscle tone, are a lack of eye coordination, some are born with almond-shaped eyes, and due to poor muscle tone, some may not have a strong sucking reflex. Their cries are weak, and they have difficulty waking up. Another sign of this condition is a thin upper lip. More aspects seen in a clinical overview include hypotonia and abnormal neurologic function, hypogonadism, adult onset diabetes mellitus,developmental and cognitive delays, hyperphagia and obesity, sho stature, and behavioral and psychiatric disturbances. Reference: GHAI Essential pediatrics, 8th edition

Pediatrics

Genetic and genetic disorders

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A diabetic mother gives bih to a baby who dies in the first week of life. Autopsy reveals a severe cardiac malformation. Which of the following is the most likely diagnosis?

Atrial septal defect

Coarctation of the aoa

Eisenmenger's syndrome

Transposition of the great aeries

single

Maternal diabetes is best known for causing large but immature-for-age babies. There is also a specific association between maternal diabetes and transposition of the great vessels. In transposition of the great vessels, the aoa takes off from the anterior pa of the right ventricle and the pulmonary trunk takes off from the posterior pa of the left ventricle. This produces a complete separation of the systemic and pulmonary circulations. Without surgical correction, most affected infants die within the first months of life, although a patent ductus aeriosus, patent foramen ovale, or ventricular septal defect may allow enough mixing of blood to temporarily sustain life. In atrial septal defect blood can pass from one atrium to the other. Associate coarctation of the aoa with Turner syndrome. Eisenmenger's syndrome is a shift from a left-to-right shunt to a right-to-left shunt secondary to developing pulmonary hypeension. Ref: McAnulty J.H., Broberg C.S., Metcalfe J. (2011). Chapter 97. Hea Disease and Pregnancy. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e.

Gynaecology & Obstetrics

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60 year old diabetic female presented with burning sensation to spicy food. Intraoral examination revealed multiple periodontal abscess and keratotic area in a lace pattern with occasional erosive areas inside the lace pattern. Syndrome associated with this disease is

Down's syndrome

Grinspan syndrome

Peutzjeghers syndrome

Sjogren's syndrome

single

Grinspan's syndrome is an interesting association of lichen planus, diabetes mellitus and vascular hypertension.

Pathology

12588b6b-2da3-490c-a0bd-36d3ac354637

Insulin of choice for the treatment of diabetes mellitus is:

Regular Insulin

NPH insulin

Insulin glargine

Insulin lispro

single

(Ref: Katzung 14th ed. P 753)Regular insulin is a short-acting, soluble crystalline zinc insulinHypoglycemic effect appears within 30 minutes after subcutaneous injection, peaks at about 2 hours, and lasts for 5-7 hours.For very insulin-resistant subjects who would otherwise require large volumes of insulin solution, a U500 preparation of human regular insulin is available both in a vial form and a disposable penIV infusion: used in treatment of diabetic ketoacidosis

Pharmacology

Endocrinology

47228fb1-7cd2-437c-8065-36a520a05640

Contraindication of OC Pills

Liver disease

PID

Renal disease

Epilepsy

single

Contraindications of OCP's Absolute contraindications Relative contraindications: (Require medical surveillance) Breast cancer Genital cancer Liver disease H/o thromboembolism Cardiac abnormalities Congenital hyperlipidemia. Undiagnosed abnormal uterine bleeding Pregnancy Age >40 years Smoking and age >35 years Mild hypeension Chronic renal disease Epilepsy Migraine Nursing mothers (0-6 months) Diabetes mellitus Gall bladder disease History of infrequent bleeding Amenorrhoea Ref: Park 25th edition Pgno : 537

Social & Preventive Medicine

Demography and family planning

74bbacc8-9784-4c09-bbd0-f6587abadad3

Kaposi sarcoma is characterized by all of the following except: March 2008

Usually of the four types

Skin lesion are sparse in African type

Lymphadenopathy is an essential feature in the classical type

AIDS-associated is commoner in homosexual

multi

Ans. C: Lymphadenopathy is an essential feature in the classical type Kaposi sarcoma is common in patients with AIDS; indeed, its presence is used as a criterion for diagnosing AIDS. There are four types of Kaposi sarcoma: The classic type/chronic KS/ European KS affects elderly men of Mediterranean and Middle European descent and in men in Sub-Saharan Africa. It presents with multiple red to purple skin plaques or nodules, usually in the distal lower extremities; these slowly increase in size and number and spread more proximally. Classic Kaposi sarcoma is rare and unassociated with HIV infection. It most often arises in middle-aged to elderly men of Mediterranean or Jewis descent (less than 10% are women), paicularly if they come from a rural environment. They have a higher than expected rate of diabetes mellitus HIV-associated/epidemic Kaposi sarcoma mainly affects men who have sex with men. Endemic/ African/ Lymphadenopathic Kaposi sarcoma arises in some pas of Africa in children and young adults. It is not associated with HIV. Skin lesion are sparse. Iatrogenic/transplant associated Kaposi sarcoma is due to drug treatment causing immune suppression in the setting of solid organ transplantation.

Pathology

488a8483-d7c3-4926-9a19-1987a94a62ff

True for lithium:-

Delayed absorption

Narrow therapeutic index

Protein bound

Can be given safely in renal dysfunction

multi

LITIHIUM* Well absorbed orally(peal level in 2- 3 hours)* Not protein bounded * Handled by kidney * Very narrow therapeutic index * Lithium concentration for optimizing therapy - 0.5 -0.8meq/l - bipolar disorder - 0.8 -1.2meq/l - acute mania - >1.5meq/dl -toxicity * S/E - fine tremors - CNS toxicity - coarse tremors ,ataxia , hyperflexion, mental confusion - >2meq/l -muscle twitching , drowsiness ,convulsions ,coma* Diabetes insipidus * Weight gain * C/I - pregnancy - congenital defect (Ebstein anomaly is associated with lithium exposure)* USE - bipolar disorders - Acute mania

Psychiatry

FMGE 2018

3370ec34-7e0c-4aa7-a846-4616ff634364

A boy has shortness of breath, presents in OPD; is injected with penicillin. He has never shown any history of allergy. On examination, after 48 hours, his RBC's are getting destroyed. He has been diagnosed with AIHA (Autoimmune hemolytic anaemia). Type of hypersensitivity is:

Type I

Type II

Type III

Type IV

multi

Type II or cytotoxic reaction is defined as reaction by humoral antibodies that attack cell surface antigens on the specific cells and tissues and cause lysis of target cells.  Type II reaction too appears generally within 15-30 minutes after exposure to antigen.   EXAMPLES OF TYPE II REACTION   1. Cytotoxic antibodies to blood cells:  i) Autoimmune haemolytic anaemia in which the red cell injury is brought about by auto-antibodies reacting with antigens present on red cell membrane. Antiglobulin test (direct Coombs’ test) is employed to detect the antibody on red cell surface. ii) Transfusion reactions  iii) Haemolytic disease of the newborn (erythroblastosis foetalis)  iv) Idiopathic thrombocytopenic purpura (ITP) v) Leucopenia with agranulocytosis vi) Drug-induced cytotoxic antibodies   2. Cytotoxic antibodies to tissue components: i) In Graves’ disease (primary hyperthyroidism)  ii) In myasthenia gravis iii) In male sterility iv) In type 1 diabetes mellitus v) In hyperacute rejection reaction   Mohan H. Textbook of pathology. Jaypee Brothers Medical Publishers; 2015. Edition 7. Page 60

Pathology

6afcf29a-3400-42d7-863a-50989c5d4c5e

All of the following conditions are associated with Hypehyroidism, EXCEPT:

Hoshimoto's Thyroiditis

Grave's Disease

Toxic Multinodular Goiter

Struma ovary

multi

Chronic thyroiditis or Hashimoto's disease is a common hypothyroid disorder. It can occur at any age, but is most often seen in middle-aged women. It is caused by a reaction of the immune system against the thyroid gland.The disease begins slowly. It may take months or even years for the condition to be detected. Chronic thyroiditis is most common in women and people with a family history of thyroid disease. It affects between 0.1% and 5% of all adults in Western countries.Hashimoto's disease may, in rare cases, be associated with other endocrine disorders caused by the immune system. Hashimoto's disease can occur with adrenal insufficiency and type 1 diabetes. In these cases, the condition is called type 2 polyglandular autoimmune syndrome (PGA II). Ref: Harrison's 16th Edition, Page 2113 (table); CMDT 2008 Edition, Page 965.

Medicine

aab06caf-c5b8-4b93-9487-0cce45041c44

Candidiasis is associated with all except

OCP user

IUCD user

Diabetes

Pregnancy

multi

The predisposing factors for candidiasis are diabetes, immunodeficiency, malignancy, prolonged administration of antibiotics and patients on immunosuppressive drugs and intravenous catheters. OCP causes elevation of blood glucose levels by causing carbohydrate intolerance which in turn causes diabetes. IUCD causes PID mainly bacterial. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition

Microbiology

mycology

85b10f2f-35dc-47ef-8490-ecae314aafb9

All of the following may result in polyuria except?

Chronic renal failure

Hypoadrenalism

Hypercalcemia

Lithium carbonate therapy

multi

Hypoadrenalism Aldosterone deficiency leads to salt wasting and polyuria Hypercalcemia Hypercalcemia can lead to reversible renal tubular defects, increased urination Lithium carbonate Lithium accumulates in principal cells of the collecting duct by entering through the epithelial sodium channel (ENaC) and leads to nephrogenic diabetes insipidus manifesting as polyuria and polydipsia.

Medicine

Chronic Kidney Disease & Diabetic Nephropathy