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AIM-Harvard 17

28730a8c-1e31-45a4-ac50-3f7fa3d7b6b1

Which drug can be given in G-6-P-D deficiency ?

Cloroquine

benemid

Amidopyrine

Primaquin

1b

single

Ans. is 'b' i.e., Probenecid

Pharmacology

2c5d3b88-aeb0-4def-961d-ad8057e317ef

atropen when used as a pre–medication causes all of the following symptoms except:

Skin flush

Bronchoconstriction

Prevents bradycardia

Dryness of mouth

1b

multi

Pharmacology

b3568b92-fa5b-494e-b7be-9025ad7e693f

Antipsychotic drug with prolonged action

Trifluperazine

Thioridazine

Penfluridol

prolixin

3d

single

D i.e. Fluphenazine

Psychiatry

40d4a2bf-0dd6-4978-85ec-81bcafa94b0f

During induction of general anesthesia, administration of oxygen with high concentration of nitrous oxide and fluothane hastens the uptake of fluothane, this is known as

Fink effect

Concentration effect

Second gas effect

Third gas effect

2c

single

During induction ofgeneral anesthesia, when a large volume of a gas (nitrous oxide) is taken up from alveoli into pulmonary capillary blood, the concentration of gases remaining in the alveoli is increased. This results in effects known as the second gas effect. These effects occur because of the contraction of alveolar volume associated with the uptake of the nitrous oxide. this effect makes speed of induction fast

Anaesthesia

Inhalational Anesthetic Agents

3f09d790-900d-491f-bebb-f403e3ac600a

Vitamin D analogue calcijex is useful in the treatment of –

Lichen planus

Psoriasis

Phemphigus

Leprosy

1b

single

Drugs for psoriasis Topical medications Vitamin D (calcipotriene) Cool tar Corticosteroids Tree bark extract (dithranol) Topical retinoids Systemic   Psoralens (Methoxsalen, trioxsalen)                      Methotrexate                                                       Acitretin                                                              Etanercept                                                           Cyclosporine                                                        Alefacept Tacrolimus 6-Thioguanine Hydroxyurea Tacrolimus Adalimumab Photo therapy PUVA (oral psoralen plus UV-A) Narrow - band UV-B (NB-UVB)

Dental

2d38eca6-e444-4900-9900-067fe8ca1bf3

A patient on lithium therapy was found to be hypertensive also. Which of the following antihypertensive drugs is contraindicated in a patient on lithium therapy in order to prevent toxicity ?

catapres

Beta blockers

Calcium channel blockers

Diuretics

3d

single

Pharmacology

cac7472d-7b8a-40b6-b5f9-29e4b7586103

ketalar produces-

Analgesia

Allodynia

Hyperpathia

Dystonia

0a

multi

Ans. is 'a' i.e., Analgesia Ketamineo The primary' site of action is in the cortex and subcortical areas; not in the reticular activating system (site of action of barbiturates),o It acts on NMD A receptors.o Short duration of action (10-15 minutes) is due to redistribution from brain and blood to other tissues of the body,o Ketamine is different from most other anaesthetic induction agents in that it has significant analgesic action.o Ketamine increases 10T and cerebral metabolism - contraindicated in head injury.o It causes sympathetic stimulation with elevation of HR, CO & BP -contraindicated in hypertension and ischemic heart disease.o It also raises IOT - contraindicated in glaucoma.o It relieves bronchospasm - intravenous anaesthetic of choice in asthmatics (inhalation anaesthetic of choice in asthmatic is halothane).o Injection is not painful (All other inducing agents cause pain on injection),o It is i.v. anaesthetic of choice in children (Sevoflurane is inhalation agent of choice).o Because it causes sympathetic stimulation it is intravenous anaesthetic of choice in patients with shock and hypovolumia.o It has no muscle relaxant property rather muscle tone is increased.o Airway reflexes (pharyngeal and laryngeal) are not depressed - intravenous anaesthetic of choice for emergency- anaesthesia (no starvation is required).o Ketamine produces emergence reaction during awakening from anaesthesia - vivid dreaming, illusions, extracorporeal experiences, excitment, confusion, fear and euphoria - contraindicated in psychiatric illness like schizophrenia.

Pharmacology

Anaesthesia

c9f082bb-3358-4d0f-b92b-04336aa69bc4

The following are related to the treatment of thalassaemia except:

Fresh (relatively) blood transfusion

Folic acid

Routine iron therapy

desferal improves pregnancy outcome

2c

multi

As discussed in detail in preceeding text– on thalassemia, routine iron therapy should not be given in patients of thalassemia as it leads to hemochromatosis. Only if there is documented iron deficiency then given iron. Rest all options are correct

Gynaecology & Obstetrics

485339f2-8407-4d4f-bb14-8372fbc0d09c

Which one of the following antibiotics binds sterols and alters membrane permeability?

Penicillin

Amdinocillin

Amphotericin

chloromycetin

2c

single

Because amphotericin binds to sterols (such as cholesterol) in the cell membrane, its range of activity is predictable; that is, it is effective against microorganisms that contain sterol in the cell membrane (such as molds, yeasts, and certain amebae). These polyene antibiotics cause reorientation of sterols in the membrane, and membrane structure is altered to the extent that permeability is affected. If sterol synthesis is blocked in fungi, then amphotericin is not effective. This occurs when fungi are exposed to miconazole, another antifungal antibiotic.

Microbiology

General

78fb2bf8-3ce3-4f0f-bff7-9f455f8a7d89

Anaesthetic gas with maximum respiratory irritation

suprane

ultane

ethrane

fluothane

0a

single

* Desflurane, unlike halothane or sevoflurane has a pungent smell which makes it unpleasant for inhalational induction. * When more than 6% desflurane is used, the pungency produces salivation, airway irritation, breath holding and coughing. Ref:- Stoelting's Pharmacology and Physiology in Anesthetic Practice 5th edition; pg num:- 101

Anaesthesia

General anaesthesia

5c5b9f66-e705-4bda-965e-3e79a0d0b7fe

A 70 kg young athlete was planned for surgery. During anesthesia,norcuron was not available so repeated doses of succinylcholine was given intermittently up to 640mg. During recovery ,patient was not able to spontaneously respire and more limbs. What is the cause

Pseudocholinestrease deficiency

Phase 2 blockade

Muscle weakness due to repeated fasiculations

Undiagnosed muscular dystrophy

1b

single

Refer Wiley 7/584 Succinylcholine produces a characteristic depolarising block that is associated with absence of fade in response to train-of -four and titanic stimulation, the absence of post tetanic facilitation and increased block in the presence of anticholinesterase drugs. The type of block may change into a non depolarising type following prolonged admistration of drug

Pharmacology

Anesthesia

3f0d927a-460a-41be-874b-ba58aaa3fdf5

A patient presents with malignant hypehermia and metabolic acidosis. Immediate treatment should be staed with

Intravenous dantrium

Sodium bicarbonate

Intravenous fluids

tylenol

0a

single

IV dantrolene (1mg/kg repeated if required) is the life saving drug in malignant hypehermia. Oxygen inhalation, treatment of acidosis and immediate cooling of body may also help. Ref: KD Tripathi 8th ed.

Pharmacology

Central Nervous system

c0a51dca-3483-4ac4-9ed1-83cb5219a4ad

Which one of the following drugs is antipseudomonal penicillin?

keflex

Cloxacillin

Piperacillin

dynapen

2c

single

Microbiology

fe236f55-39a6-4155-8eea-0b6a8c6a4717

Which of the following used as skin antiseptic?

Cidex

Cresol

chloraprep

Lysol

2c

single

Option 1 Glutaraldehyde is less toxic, less irritant and less corrosive, hence is best used to sterilize endoscopes and cystoscopes: It is used as 2% concentration (2% cidex) for 20 min. Option 2, 4 Phenolics as disinfectants: Cresol, xylenol, Lysol and oho-phenylphenol are used as disinfectants in laboratories and hospitals. All have the ability to retain activity in presence of organic matter. They are toxic and irritant to skin, hence used as disinfectants but not as antiseptics. Option 3 Skin antiseptics are Halogens: Povidone iodine-Betadine (best) and Tincture iodine. Phenol as antiseptics: Chlorhexidine (Savlon), Chloroxylenol (Dettol). Alcohol: Isopropyl alcohol, Ethanol. Heavy Metal salts: Silver sulfadiazine (burns surfaces), 1% Silver nitrate (Ophthalmia neonatorum) Surface active agents: Cationic detergents, Anionic surfactant (common soaps).u Dyes: Aniline and Acridine.

Microbiology

General Microbiology Pa-2 and Pa-3 (Sterilization and Bacterial Genetics)

59dccdb8-03f7-42b3-8903-d958f1ed7ef8

Decrease in gastric acid secretion by all except -

zantac

losec

Sucalfate

Perenzepine

2c

multi

Ans. is 'c' i.e., SucralfateDrugs for peptic ulcer1. Reduce gastric acid secretiunH, antihistaminic - Cimetidine, Ranitidine, Famotidine, Roxatidine.Proton pump inhibitors - Omeprazole; Lansoprazole. Pantoprazole, Rabeprazole, Esomeprazole.Anticholinergics - Pirenzepine, propantheline, oxyphenonium.Prostaglandin analogue - Misoprostol, enprostil, rioprostih2. Neutralization of gastric acid (antacids)Systemic - Sodium bicarbonate, sodium citrate.Non systemic - Magnesium hydroxide, Mag. trisilicate. aluminium hydroxide, Magaldrate. calcium carbonate.3. Ulcer protectivesSucralfate, colloidal bismuth subcitrate, Prostaglandin analogue.4. Anti H. pylori durgsAmoxicillin, clarithromycin, metronidazole, Tinidazole. tetracycline.

Pharmacology

G.I.T

00bc964e-7e44-4108-a824-ab89d1c47c1e

A 25 year old man with a psychotic illness, was treated with haloperido130mg/day. On the third day, he developed pacing, and inability to sit still in one place. The medication likely to be helpful is -

dilantin

inderal

ritalin

Trihexyphenedyl

1b

single

Restlessness (inability to sit still) and pacing suggests the diagnosis of Akathesia. The drug of choice for Akathesia is one of the β-blocker.

Psychiatry

4fb049af-6dc2-460d-83ab-9a86f15d6068

In recommending treatment for your carcinoid patient, you will consider all of the following except

periactin

Ketanserin

sansert

imitrex

3d

multi

All of the drugs listed have significant blocking effects on 5HT receptors except sumatriptan, which is an agonist at 5HT1 receptors.

Physiology

All India exam

a64304b6-3e9f-4733-804f-a121d5671ec0

Which of the following drugs does not act by blocking Gp IIb/IIIa receptors ?

reopro

integrilin

aggrastat

plavix

3d

single

Pharmacology

6f00df03-97f5-4248-a992-b8bf1c1fe723

A 6 yr old child presents with malignant hypeension. The Drug of choice is -

Na nitropress

Sublingual adalat

Furoscmide

vasotec

0a

single

Ans. is 'a' i.e., Sodium Nitroprusside "The drug most commonly used to treat hypeensive emergencies is the vasodilator sodium nitroprusside" "Because of predictable, instantaneous, titratable and balanced aerio-venous vasodilator)/ action which persists without tolerance till infused, nitroprusside is the drug of choice for most hypeensive emergencies". DOC for hypeensive emergencies is calcium channel blockers (nicardipine or clevidipine). Nitroprusside is no longer preferred now.

Pharmacology

bd469dc3-dfef-4241-87af-c8c2717a5b73

DPP-IV inhibitor used in renal failure:

Linagliptin

januvia

Vildagliptin

Saxagliptin

0a

single

A i.e. LinagliptinRef: HohIA, Ronsoni MF, Guedes EP, de Melo TG, Lauand F (2014), Linagliptin: DPP-4 Inhibition in the Treatment of Type 2, Diabetes Mellitus, J Diabetes Metab Disord Control 1(1): 00005, DOI: 10.15406/jdmdc,2014.01.00005Explanation:Patients with T2DM have dysfunction in incretin hormones (such as glucagon-like peptide-1 or GLP-1 and glucose-dependent insulinotropic polypeptide or GIP).By inhibiting the dipeptidyl peptidase-4 (DPP-4) enzyme, it is possible to slow the inactivation of GLP-1 and GIP, promoting blood glucose level decrease in a glucose-dependent manner.Linagliptin is a dipeptidyl peptidase-4 inhibitor DPP IV inhibitor.Linagliptin is approved by FDA and EMA for the T2DM treatment as an anti-hyperglycemic agent that can be used as monotherapy or in combination with other medications (metformin, sulphonylurea, pioglitazone, metformin plus sulphonylurea or insulin).NOTE:Linagliptin is safe in renal failure, as it is eliminated majorly by biliary excretion and it also undergoes enterohepatic recycling.Chemical and metabolic characteristics of DPP-4 inhibitorsInhibitorChemical StructureMetabolitesRoute of EliminationLinagliptinBased on XanthineNegligibleBiliary(> 70% unchanged); <6% via kidneySaxagliptinCyanopyrrolidineMetabolized in the liver to active metabolite (via P450 3A4/5)Renal (12-29% unchanged and 21-52% as metabolite)SitagliptinBased on p-amino acidNegligibleRenal (80% unchanged)VildagliptinCyanopyrrolidineHydrolyzed to inactive metabolite (P450 enzyme-independent)Renal (22% unchanged and 55% as primary metabolite)AlogliptinPyrimidineDemethylated, acetylatedRenal

Pharmacology

Endocrinology

701ef3cc-56f9-478b-95ac-bb7d421d406f

Which drug should be avoided in the management of traumatic hyphema in a dark race individual?

blocadren

diamox

atropen

Steroids

1b

single

Traumatic hyphema presents with raised intraocular pressure.Timolol will help to control raised IOP. Atropine will provide cycloplegic action and will provide relief from pain. Steroids will help to prevent rebleed. Acetazolamide is not given in dark race patients due to risk of sickling as a result of metabolic acidosis caused by acetazolamide.

Ophthalmology

Investigation in ophthalmology and miscellaneous topics

63897228-78fb-45c9-bce6-92c2248554a1

Patient on att is having problem in distinguishingred-green lights. The agent responsible is

Capreomycin

myambutol

trecator

Some 2nd line agents

1b

single

(B) (Ethambutol) (269-KDT 7th)* Loss of visual acquity/ colour vision, field defects due to optic neuritis is the most important dose and duration of therapy dependent toxicity seen in ETHAMBUTOL* Other side effects are - Nausea, rashes fever rarely peripheral neuritis, Hyperuricemia * *** Contraindicated in optic neuritisDrugSide effectsETHIONAMIDE* Salivation, metallic taste, epigastric discomfort, sulfiirous belching and hepatitis, rash peripheral neuritis, behavioueral changes, impotence, menstrual disturbance and goiter on prolonged useCapreomycin* Ototoxicity and nephrotoxicity eosinophelia, rashes, fever injection site painCycloserine* Primarily neurological sleepness, tremor, slurring of speech altered behavior, depression or frank psychosis **RifabutinGi intolerance, granulocytopenia myalgia, and UveitisPara-amino salicylic acid (PAS)Rashes, fever, malaise, hypokalaemia, goiter, liver disfunction and rarely blood dyscrasias* MDR gene acts by - causes efflux of drug* Peripheral Neuropathy in 1NH therapy is more common in following groupsSlow Acetylators* Diabetes patients* AnemiaHypoprotenemia (Protein Energy Malnutrition)* Urine and secretions in patients receiving Rifampicin may become orange- red **.* Rifampicin is primarily metabolized in the liver and excreted in bile, so Rifampicin does not require dosage adjustment in renal failure**

Pharmacology

Anti Microbial

9a51a879-6462-4ae5-bed2-6fd343c817fe

True about sulfonylureas is -

diabinese is 2nd generation agent

Most common side effect is hypoglycemia

Effective even after pancreactomy

Safe in pregnancy

1b

multi

Ans. is 'b' i.e., Most common side effect is hypoglycemiao Sulfonylureas are -1. First generation Tolbutamide, chlorpropamide.2. Second generation Glibenclamide (Glyburide), glipizide, gliclazide, glimpride.Sulfonylureas act byo Sulfonylurease provoke a brisk release of insulin from pancreas. They act on the so called "Sulfonylurea receptors" (SUR1) on pancreatic b-cell membrane - cause depolarization by reducing conductance of ATP sensitive K+ channels. This enhances influx of Ca+2 - degranulation. They do not cause hypoglycemia in pancreatectomized animals and type 1 diabetes (Presence of at least 30% of functional b-cells in essential for their action). A minor action reducing glucagon secretion by increasing insulin and somatostatin release has been demonstratedo Extrahepatic action# On chronic administration they sensitize the target cells (especially the liver) to the action of insulin.# On chronic administration their action on pancrease (to release insuline) declines due to down regulation of sulfonylurea receptors.# But glycemic control is maintained due to extrahepatic action.# Glimepiride exerts beneficial effects with regard to ischemic preconditioning.Sulfonyloreas cause following adverse effectso Hypoglycemia# This is commonest side effect.# More common in elderly, liver and kidney disease.# Chlorpropamide is a frequent culprit due to its long action due to its long action.# Tolbutamide carries lowest risk due to its low potency and short duration of action.# Lower incidence is also reported with glipizide, glibenclamide, glimepiride.o Hypersensitivity# Rashes, photosensitivity, purpura, transient leukopenia, rarely agranulocytosiso Adverse effects specific to particular drug# Cholorpropamide causes cholestasis, dilutional hyponatremia, intolerance to alcohol (disulfiram like reaction). Chlorpropamide causes dilutional hyponatremia by sensitising the kidney to ADH action.# Tolbutamide reduces iodine uptake by thyroid.o Sulfonylureas are not safe during pregnancy - change over to insulin. Sulfonylureas are secreted in milk - should not be given to nursing mothers. Gliclazide has an antiplatelet effect.

Pharmacology

Anti Diabetes

638b6f8a-aabe-4032-b46f-e183023e2181

All are ototoxic drugs except

Diuretics

Streptomycin

qualaquin

Propanolol

3d

multi

OTOTOXIC DRUGS Ref:- Dhingra; pg num:-33,34

ENT

Ear

d9882e46-0c53-4b1f-8cea-37c72a00026d

A person consumes large quantities of alcohol daily since 20 years.He is physically dependent on alcohol. Drug should be given to this person is:

antabuse

Acamprosate

revia

librium

0a

multi

Disulfiram is the main drug tahtbsi used to make alcohol consumption an unpleasant experience. Disulfiram inhibit aldehyde dehydrogenase , alcohol is not metabolized and acetaldehyde accumulates which produces unpleasant symptoms and patient develops an aversion.All the other given drugs can be used but primarily displaces is tried. Ref: KD Tripathi 8th ed.

Pharmacology

Central Nervous system

d88b9608-9ff4-4def-bcab-6e9a852f7b75

Z track technique is used for

Monitoring of lithium therapy

Monitoring of tegretol therapy

Administration of long acting depot antipsychotics

Administration of nicotine patches

2c

single

Ans. (C) Administration of long acting depot antipsychotics(Ref: Kaplan and Sadock's Concise Text book of Clinical Psychiatry 11th Ed; Page No- 873)Guidelines for Administration of Long Acting Antipsychotic Depot Injections (LAAI)LAAIs are given to patient with psychosis or mania who have poor compliance to oral treatment.A test dose is given for all drugs except olanzapine, risperidone, paliperidone and aripiprazole.Route of administration is by intramuscular route with maximum permissible volume as given below.Deltoid2 mlDorsogluteal4 mlVentrogluteal (Safest site)4 mlRectus femoris5 mlVastus lateralis5 mlZ track technique is used for injection into all sites, except deltoid. The skin is stretched laterally from the intended site of injection and then insert the needle at 90deg angle. After 10 seconds of injecting the drug, skin is released to allow the displaced tissue to cover the needle track. It is done to maximize absorption in to muscles by preventing the drug from moving back to subcutaneous tissue.Z track technique is also used to inject iron.

Psychiatry

Pharmacotherapy In Psychiatry

8427aa4c-9cf2-4d4e-bbe9-1d61871301a1

ketalar should be avoided in -

The presence of increased aerial pressure

Pregnancy

Hypovolemic shock

Asthmatic

0a

single

Ans. is 'a' i.e., The presence of increased aerial pressure `Ketamine increases BP and intracranial tension, it therefore should be avoided in hypeension and in the presence of raised ICT.'

Pharmacology

dbac705d-60c8-4b93-913c-dd6afb03dcee

What is the treatment for sudden worsening of TOF?

PGE 1 infusion

O2 therapy

inderal

All of the above

3d

multi

Ans. is 'd' i.e., All of the above * Sudden worsening ofTOF - known as 'Cyanotic spelV* Therapy is aimed at providing an immediate increase in pulmonary blood flow to prevent the sequelae of severe hypoxia.* Management consists of:i) Knee chest positionii) Humidified oxygeniii) Hydration - Prevention or prompt treatment of dehydration is important to avoid hemoconcentration and possible thrombotic episodes.iv) Prostaglandin El - Dilatation of ductus arteriosus and provides adequate pulmonary blood flow. This agent should be administered intravenously as soon as cyanotic congenital heart disease is clinically suspected and continued through the preoperative period and during cardiac catheterization.v) Morphine 0.1 to 0.2 mg/kg subcutaneous inj.vi) Correction of acidosis with sodium bicarbonate IV.vii) Propranolol: 0.5 - 1 mg/kg/IV - to decrease the frequency and severity of hypercyanotic spells, but with the excellent surgical results available today, surgical treatment is now indicated as soon as spells begin.viii) Vasopressors: Methoxamine or phenylephrine.ix) Correction of Anaemia.

Pediatrics

C.V.S.

68287103-4dac-464b-a451-f7881a2a5538

Least mineralocoicoid activity is seen in

Aldosterone

Aldosterone

decadron

Flurotisol

2c

single

C i.e. Dexamethasone

Physiology

1c284a28-f01e-4297-bb8d-13d4bd318f9d

In elixophyllin metabolism, drug interactions occurs with all Except :

tagamet

Phenobarbitone

Rifamipicin

Tetracyclines

3d

multi

Pharmacology

8e34980c-b750-4a70-98a1-ecb9e84706fd

A depressed patient does not want to take medication on a daily basis. The selective serotonin reuptake inhibitor (SSRI) most suitable for this patient is?

Escitalporam

prozac

Fluvoxamine

brisdelle

1b

single

The half life of fluoxetine is longer than 72 hour so patient can take the medication every other day and thus it is most suitable for him.

Psychiatry

Mood Disorders

efba4db3-e3a9-4608-b8d3-0880a626ee96

Calcium channel blockers used in HTN are all except:

norvasc

Clevidipine

capoten

adalat

2c

multi

Captopril is an ACE inhibitor- prototype ACE inhibitor all others mentioned in options are calcium channel blockers- all are dihydropyridines (Ref- Essentials of medical pharmacology K D TRIPATHI 8th Edition)

Pharmacology

Cardiovascular system

92fa0020-199d-41f3-bac4-f9fe80109c17

The behaviour therapeutic falls in management of enuresis, The pharmacological drug of choice for this case is -

dilantin

Diazepalm

tofranil

Alprax

2c

multi

Ans. is 'c' i.e., Imipramine o Desmopressin is best answer. o But it is not given in options. o Amongst the given options only imipramine is used in enuresis.

Pediatrics

a2e6ccb7-b16b-479f-b33e-8376909e9093

Which of the follwoing is TRUE about free water clearance?

Regulated by ADH

Regulated by aldosterone

Increased by lasix

None of the above

0a

multi

"Free water clearance" (CH2O) is the difference between the urine volume and the clearance of osmoles (COsm). The excretion or retention of electrolyte-free water by the kidney is modulated by circulating vasopressin (ADH). ADH acts on renal V2-type receptors in the thick ascending limb of Henle and principal cells of the collecting duct (CD), increasing cyclic adenosine monophosphate (AMP) and activating protein kinase A (PKA)-dependent phosphorylation of multiple transpo proteins. Ref: Mount D.B. (2012). Chapter 45. Fluid and Electrolyte Disturbances. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.

Physiology

ff228354-2bba-4624-97e2-d25d829ddc76

Which teratogen causes deafness ?

Isotretnoin

resochin

Alcohol

jantoven

0a

single

Ans. is 'a' i.e., Isotretnoid o Isotretinoin can cause microtia or anotia. o These defects are frequently associated with agenesis or stenosis of external ear canal and may lead to deafness.

Pharmacology

d69ba902-aff4-4e59-a78b-acfc03e7b121

A 44 year old man sustains a myocardial infarction, and is admitted to the hospital from the emergency room. Serum chemistries reveal two-fold elevation of his LDL cholesterol. He is prescribed mevacor, which acts by inhibiting which of the following enzymes?

Acetyl-CoA carboxylase

Carbamoyl phosphate synthetase I

Hydroxymethylglutaryl-CoA reductase

Pyruvate dehydrogenase

2c

single

Hydroxymethylglutaryl-CoA reductase (HMG-CoA reductase) catalyzes the rate-limiting step in cholesterol synthesis, in which HMG-CoA (formed from 3 acetyl-CoA molecules) is reduced to mevalonic acid, using 2 NADPH. Lovastatin and pravastatin reduce cholesterol synthesis and lower serum cholesterol levels by inhibiting this enzyme. Lovastatin is metabolized by the CYP3A isoform of cytochrome P450. In contrast, gemfibrozil and clofibrate lower cholesterol by increasing the activity of lipoprotein lipase, which is produced by the endothelial cells of the vasculature of adipose and muscle tissue. Acetyl-CoA carboxylase catalyzes the first step in fatty acid synthesis. Carbamoyl phosphate synthetase catalyzes the rate-limiting step in urea synthesis. Pyruvate dehydrogenase catalyzes the transition step between glycolysis and the TCA (Krebs) cycle. Ref: Botham K.M., Mayes P.A. (2011). Chapter 26. Cholesterol Synthesis, Transpo, & Excretion. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.

Pharmacology

9e773122-037d-4b79-88cf-544eae7d468e

DOC for the treatment of Tularemia is:

Kanamycin

Neomycin

Streptomycin

chloromycetin

2c

single

TULAREMIA: (aka) Rabbit Fever or Deer Fly Fever Is a rare infectious disease that typically attacks the skin, eyes, lymph nodes and lungs. Caused by bacterium Francisella tularensis. STREPTOMYCIN(or gentamicin) is considered as DOC for Tularemia. Most cases respond to the administration of 1-2 g (15-25 mg/kg) streptomycin per day (in divided doses) for 10-14 days.

Pharmacology

Protein Synthesis Inhibitors

e83c2ed9-46c4-466f-b56a-6a9f817470d0

Diurnal variation in Eosinophil count is related to:

Coisol

synthroid

Growth hormone

Testesterone

0a

single

A i.e. CoisolDiurnal variation in eosinophilic count is reciprocally (invrsely) related to circadian levels of coisolQ.- Suprachiasmatic nuclei (SCN) of hypothalamus is the biological clock responsible for diurnal (circadian) rhythm of ACTH, which intum leads to diurnal rhythm of coisol (glucocoicoid) secretion. In humans, ACTH irregular bursts (episodes of high secretion) are most frequent in early morning and least frequent in the evening. Increased ACTH secretion is not d/t stress of getting up in the morning as these bursts occur before waking up. Even if the length of day is experimentally lengthened to >24 hrs ie if the person is isolated and day's activities are spread over more than 24h, the adrenal cycle also lengthens, but the ACTH burst still occurs during period of sleep. The circadian rhythm of ACTH secretion is present in patients Eosinophil with adrenal insufficiency receiving constant dose of glucocoicoids.- Coisol decrease the number of circulating eosinophils by increasing their sequestration in the spleen & lung. So the diurnal variations in blood eosinophilic counts is inversely related to the circadian coisol levelsQ. The eosinophilic concentration in blood is < 450 / mL usually. A reciprocal relationship to plasma coisol, causes the diurnal eosinophilic concentrations to vary -- 2 fold (40%) with eosinophilic count lowest in morning and peaking in evening.

Physiology

d1124333-1133-4e38-b780-4b246a38e78d

The combination of proloprim and sulfamethoxazole is effective against which of the following oppounistic infections in the AIDS patient?

Disseminated Herpes simplex

Cryptococcal meningitis

Pneumocystis jiroveci

Tuberculosis

2c

single

Cotrimoxazole is drug of choice for : - Pneumocystis- Nocardia- Burkholderia Cepacia Both sulfonamide and trimethoprime are bacteriostatic when used alone, it becomes bacteriocidal in combine state. Cotrimoxazole is used as a prophylaxis for Pneumocystis Jirovecii pneumonia in immunocompromised individuals like HIV. Aerolized pentamidine, Dapsone, Dapsone plus pyrimethamine, Atovoquone are other drugs which can be used for the same also. Herpes Simplex: DOC is Acyclovir Cryptococcal meningitis: Acute phase: amphotericin BMaintenance phase: Fluconazole Suldoxime + Pyrimethamine is used for parasite(malaria and toxoplasmosis)

Pharmacology

Antimicrobial Drugs

41f4849f-0f2a-4f36-a3cb-8b972ef65184

The most important mechanism by which gram negative bacilli acquire chloromycetin resistance is:

Decreased permeability into the bacterial cell.

Acquisition of a plasmid encoded for chloromycetin acetyl transferase.

Lowered affinity of the bacterial ribosome for chloromycetin.

Switching over from ribosomal to mitochondrial protein synthesis.

1b

single

Pharmacology

634dc187-97a8-4ea3-8c0f-cc6bec376e93

glucagen stimulates -

Gluconeogenesis

Glycogenesis

Fatty acid synthesis

Glycolysis

0a

single

Ans. is 'a' i.e.. Gluconeogenesiso Glucagon is a polypeptide hormone which is secreted by the A cells of the islets of Langerhans of pancreas. Glucagon is a group IIA hormone, i.e., acts by increasing cAMP. The actions of glucagon are somewhat opposite those of insulin.Glucagon stimulates glycogenolysis in the liver but not in muscle. Breakdown of glycogen yields glucose.Glucagon stimulates production of glucose from amino acids (gluconeogenesis). Both glycogenolysis and gluconeogenesis tend to raise plasma glucose level.Glucagon stimulates lipolysis. Breakdown of lipids yields free fatty acids, which may be oxidized completely to carbon dioxide, or incompletely to form ketone bodies.

Biochemistry

Gluconeogenesis

2c4cac73-1967-46ae-a586-185549de5c20

A thiy five year old female has proximal weakness of muscles, ptosis and easy fatigability. The most sensitive test to suggest the diagnosis is.

Muscle Biopsy

CPK levels

tensilon test

EMG

2c

single

Tensilon test (edrophonium test) is a pharmacological test used for the diagnosis of ceain neural diseases, especially myasthenia gravis. It is also used to distinguish a myasthenic crisis from a cholinergic crisis in individuals undergoing treatment for myasthenia gravis 10 mg edrophonium hydrochloride syringe and a 2 mg atropine syringe are prepared. Atropine is prepared for immediate use in case cholinergic crisis occurs. After a neurologic examination and recording of vital signs, first 2 mg edrophonium is injected intravenously. After waiting 30 seconds and ensuring that no adverse reactions occurred, the remaining 8 mg of edrophonium is also injected. A patient suffering from myasthenia gravis experiences improvement in muscle strength and endurance with repetitive movements, while normal persons do not feel any difference. The effects of edrophonium lasts around 10 minutes. The edrophonium allows accumulation of acetylcholine (ACh) in the neuromuscular junctions, and makes more ACh available to the muscle receptors, thereby increasing muscle strength in myasthenia gravis. In newborns, a 0.15 mg/kg edrophonium administered subcutaneously produces a response within 10 minutes. In infants, the drug is administered intravenously at a dose of 0.2 mg/kg. Improvement of diplopia is often used as an evaluation item because in this case, placebo effect can be excluded Ref Harrison20th edition pg 2456

Medicine

C.N.S

4ff9a053-3fd2-49e4-a074-1e40f8b69d30

Conversion of T4 to T3 inhibition is associated with:

Propylthiouracil

penbritin

Lithium

Carbimazole

0a

single

Pharmacology

0509c262-7ed2-4223-89ef-adca1e7eb11f

Long term steroid therapy can lead to suppression of hypothalamic-pituitary-adrenal axis. lt can be overcome by using alternate day therapy with coicosteroids. Which of the following steroids are unsuitable for alternate day therapy for such purpose?

Coisol

orapred

Betamethasone

Hydrocoisone

2c

single

(Ref: KDT 6/e p282, 287) Steroids with long half life like betamethasone and dexamethasone cannot be used for alternate day therapy because even in alternate day therapy there will be sufficient blood levels of these steroids to cause suppression of HPA axis.

Anatomy

Other topics and Adverse effects

14ad74a2-ffe5-4ada-984c-a9a04a48344d

All of the following are cycloplegics except :

vazculep

atropen

Homatropine

Cocaine

0a

multi

A i.e. Phenylephrine

Ophthalmology

66833a4b-5449-4e63-a225-149169a0c253

Intrauterine seizure in foetus is seen due to deficiency of

appearex

Riboflavin

Thiamine

Glutamic acid

3d

single

(D) Glutamic acid

Gynaecology & Obstetrics

Miscellaneous (Obs)

4fb87cb9-e163-4dda-a42a-205df8ad21c0

A previously well 1-year-old infant has had a runny nose and has been sneezing and coughing for 2 days. Two other members of the family had similar symptoms. Four hours ago, his cough became much worse. On physical examination in the ED, he is in moderate respiratory distress with tachypnea and nasal flaring. Upon auscultation, he has easily audible wheezing with scattered crackles bilaterally. His arterial blood gas on room air revealed a pH of 7.46, a PaCO2 of 34 mm Hg, and a PaO2 of 75 mm Hg. His chest radiographs are shown. Which of the following is the appropriate next course of action?

Monitoring oxygenation and fluid status

Inhaled epipen and a single dose of steroids

Acute-acting bronchodilators and a short course of oral steroids

Emergent intubation, mechanical ventilation, and antibiotics

0a

multi

(a) Source: (Hay et al, pp 512-513. Kliegman et al, pp 1456-1459. McMillan et al, pp 699-700, 1391-1394. Rudolph et al, pp 962, 963, 966.) Of the choices given and with the findings on the radiograph (patchy infiltrates with flat diaphragms), monitoring oxygenation and hydration status is the most appropriate course of action as bronchiolitis is the most likely diagnosis. Bronchodilators and a short course of steroids are treatments for asthma, a less likely diagnosis in this patient without previous wheezing episodes and without a family history of atopy. A single dose of short-acting b-agonist might be tried in this patient but would be expected to be of limited benefit. A single dose of steroids would be an appropriate treatment for viral croup; intubation and antibiotics would be the approach to a patient with epiglottitis. Chest tube placement for a pneumothorax may be required if unilateral breath sounds were absent or if the radiograph demonstrated collapse; neither is noted in this case. The most likely cause of the illness is infection by respiratory syncytial virus, which causes outbreaks of bronchiolitis of varying severity, usually in the winter and spring. Other viruses, such as parainfluenza and the adeno-viruses, have also been implicated in producing bronchiolitis. Treatment is generally supportive in this usually self-limited condition.

Pediatrics

Respiratory System

876ea082-20c5-4c4a-a55b-6d4e7e937a6c

A 6 year old boy taken for ophthalmic examination under anaesthesia. His father told that he has lower limb weakness & his elder brother died at 14 years of age. Which anaesthetic drug has to be avoided.

Succinylcholine

pavulon

tracrium

Dexacurium

0a

single

ROLE OF SUCCINYLCHOLINE ON MUSCLES * Succinylcholine, commonly used in anesthesia, paralyzes normal skeletal muscles by blocking transmission at the myoneural junction

Anaesthesia

Muscle relaxants

fc9701b5-edfa-43ea-a9ee-67d4ec582723

Hepatotoxic drug used in tuberculosis is ?

nydrazid

Streptomycin

Kanamycin

myambutol

0a

single

Ans. is 'a' i.e., Isoniazid

Pharmacology

0c495cec-4b48-43d4-82e3-a3b9b750cdb1

Juxta glamerular cells secretes

Angiotensin

Renin

Atrial natriuretic peptide

epogen

1b

single

i.e. (Renin): (670-Ganong 23rd)RENIN - is a glycoprotein hormone secreted by the granular cells (Juxtaglomerular cells) of the Juxta glomerular apparatus.* Juxtaglomerular apparatus (JGA) lies at hilum of glomerulus** (Juxta means near)Secretion of renin is stimulated by four factors1. Fall in arterial blood pressure2. Reduction in the volume of extracellular fluid3. Increased sympathetic activity4. Decreased load of sodium and chloride in macula densaATRIAL - NATRIURETIC PEPTIDE : secreted by atrial musculature of the heart*** ANP increases excretion of sodium ions through urine (natriuresis)* ANP causes dilatation of vessels (vasodilation) and lowering blood pressure* ANP is responsible for escape phenomenon and prevention of edema in primary hyperaldosteronism in spite of increased volume of ECFERYTHROPOIETIN is secreted by interstitial cells in the peritubular capillary bed of kidney (85%) and by perivenous hepatocytes in the liver (15%)The principal site of inactivation of erythropoietin is the liverANGIOTENSINOGEN - synthesized in the liver*Its circulating level is increased by glucocorticoids thyroid hormones, estrogen, several cytokines and angiotensin II

Physiology

Kidneys and Body Fluids

d45e81ad-fb19-46a7-bc31-1c17ff9e7df9

A 14 year old boy presents with chronic diarrhea. Duodenal biopsy shows villous atrophy. Anti endomysial antibodies and IgA TTG antibodies are positive. What is the treatment of choice?

Gluten free diet

Antibiotics

imodium

5-ASA

0a

single

Chronic diarrhea, villous atrophy of duodenal biopsy, anti-endomysial antibodies and IgA TTG antibodies are features of coeliac sprue. Management of coeliac sprue includes life long gluten free diet and correcting deficiencies of iron, folate and calcium. Ref: Davidson's principles and practice of Medicine, 20th Edition, Chapter 22, Page 894-896; Harrison's Principles of Internal Medicine, 16th Edition, Page 1772

Medicine

29705e2a-d5c0-4057-ab54-5bb5ebdc6b9e

Which of the following is not used as an emergency contraceptive?

Oral LNG

LNG- Intrauterine device

CuT-Intrauterine device

Oral mifeprex

1b

single

Social & Preventive Medicine

e58c4709-69e9-4dc4-afea-72b4921df0ae

All of the following drug is CYP3A inhibitor except:

staticin

sporanox

norvir

invirase

3d

multi

Ans. D. SaquinavirOut of all protease inhibitors, Saquinavir has least effect on hepatic microsomal enzymes. Rest of the protease inhibitors inhibit microsomal enzymesImportant enzymes inhibitors:a. Acute alcohol intakeb. Sodium valproatec. Cimetidine, Ketoconazole, Erythromycind. Grape fruit juicee. Protease inhibitors (Pls)f. Fluoroquinolonesg. Omeprazole

Pharmacology

Anti Microbial

c0f69e40-9b3e-4d55-9cf3-3bdb6614343e

Drug of choice in Belladonna poisoning is -

prostigmin

anticholium

Methacholine

atropen

1b

single

Signs of symptoms, treatment, and postmortem appearances in Atropa belladonna (deadly nightshade) and Hyoscyamus niger are same as datura. Specific antidote is physostigmine.

Forensic Medicine

e33b8ae1-03ea-4269-9965-f3705bbcea53

Tolerance develops to following actions of oramorph except

Euphoria

Miosis

Nausea and vomiting

Analgesia

1b

multi

"Tolerance develops to almost all actions of morphine except the constipation and miotic action".

Pharmacology

All India exam

3b2f768b-6af1-44c0-b4cd-057dd34cedeb

nymalize is given in:

Extradural hemorrhage

Subdural hemorrhage

Intracerebral

Subarachnoid hemorrhage

3d

single

Ans. (D) Subarachnoid hemorrhage(Ref: Katzung 13th/e p202)Nimodipine is a cerebroselective calcium channel blocker indicated in subarachnoid hemorrhage.

Pharmacology

C.V.S

b7e3e8c9-a426-4170-a436-a430cc771888

lanoxin toxicity is aggravated by: a) Hypokalemia b) Hyperkalernia c) Hypercalcemia d) Hypermagnesemia e) Hypocalcemia

ad

bc

cd

ac

3d

single

Pharmacology

8130fa36-4eab-4679-bb02-bb148c3d7f3a

Which of the following local anaesthetic agent is a vasoconstrictor

Lignocaine

Cocaine

exparel

Tetracaine

1b

single

Cocaine is sympathomimetic agent.

Anaesthesia

7d8876aa-da72-4dda-8dcb-98265a57bb9d

This drug depolarizer cell membranes of aerobic Gram Positive Bacteria. It is effective against firvanq resistance entercoccal infection. It may cause myopathy especially in patients taking stating .it is

Teicoplann

cubicin

zyvox

Streptogramin

1b

multi

(Ref: KDT 6/e p741, Daptomvcin is a newer antibiotic that acts by causing depolarization.of bacterial cell membranes. It is effective in MRSA, VRSA and even streptogramin resistant SA infections as well as VRE infections. It can cause myopathy in patients taking statins.

Anatomy

Other topics and Adverse effects

68b5ffd7-98ce-4e67-a2b0-ccc67f53a001

A patient on antidepressant therapy developed sudden hypeension on consuming cheese. The antidepressant is possibly :

Amitryptiline

Tranylcypromine

prozac

Seraline

1b

single

B i.e. Tranylcypromine

Psychiatry

37e12b3d-8acc-4f11-823e-02397b6ea3e0

Which of the following is not a side effect of dilantin?

Hypoglycemia

Osteomalacia

Gum hyperophy

Lymphadenopathy

0a

single

Side Effects. Headache, nausea, vomiting, constipation, dizziness, feeling of spinning, drowsiness, trouble sleeping, or nervousness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. Phenytoin may cause swelling and bleeding of the gums Ref: KD Tripathi 8th ed.

Pharmacology

Central Nervous system

7d29cf86-9fad-4c70-8236-79da70c4b410

Malignant neurolept hyperthermia (NMS) seen in all except -

Haloperidol

reglan

Domperidone

symmetrel

3d

multi

Amantidine is used for the treatment of the neuroleptic malignant syndrome. Drugs causing neuroleptic malignant syndrome:- Antipsychotics Phenothiazines (chlorpromazine), butyrophenones (Haloperidol, penfluridol), thioxanthenes (thiothixene, molindone). Antiemitics Metoclopramide, domperidone.

Psychiatry

fa7c69f4-eda7-4536-8f78-005a9f4e8d69

All of the following statements about trientine use in Wilson's disease are true except :

It is more potent than cuprimine.

It is used as an alternative to cuprimine in non- tolerant patients

It should not be administered within 2 hours of iron supplementation.

It can cause iron def anemia which is reversible by oral iron supplements

0a

multi

Penicillamine is the most potent chelating agent useful in Wilson's disease. Trientine is not as potent as penicillamine and was used in patients unable to tolerate penicillamine. However, nowadays, trientine is preferred because of the severe adverse effects of penicillamine. Trientine causes fewer adverse effects other than mild anemia due to iron deficiency in few patients. Concomitant administration with iron reduces absorption of both. Thus a minimum gap of two hours should be given between the administration of trientine and iron salts.

Pharmacology

0fc0caee-7c8b-4ba0-8676-651a9b8578f3

The first step in the management of hirsutism due to Stein-Leventhal syndrome is:

OCP

HMG

carospir

parlodel

0a

multi

Gynaecology & Obstetrics

5cd0fb73-9be7-4c1e-b165-0be05411f779

All of the following antihypertensive drugs increase plasma renin activity except:

catapres

apresoline

adalat

capoten

0a

multi

Pharmacology

6e222ead-6f0c-41d7-be16-fb4d6a96b988

Which of the following patients is most likely to be treated with intravenous glucagen?

A young man who took cocaine and has a blood pressure of 190/110 mm Hg

A middle aged man with type II diabetes who has not taken his regular dose of glibenese for last 4 days

An old man with severe bradycardia and hypotension resulting from ingestion of overdose of tenormin

An old woman with lactic acidosis as a complication of severe infection and shock

2c

single

Glucagon : Use in hypoglycemia DOC for beta blocker poisoning A life-threatening adverse cardiac effect of a b antagonist may be overcome directly with isoproterenol or with glucagon (glucagon stimulates the hea glucagon receptors, which are not blocked by b antagonists), but neither of these methods is without hazard.

Pharmacology

Pancreas

5a24eb91-6365-482c-a7a0-eac45bd99ee8

Sympathetic stimulation of nerves innervating the islets of the pancreas will:

Have no effect

Increase secretion of insulin from B cells

Decrease secretion of insulin from B cells

Increase secretion of glucagen from A cells

3d

single

The pancreatic islets receive innervation from both the sympathetic and parasympathetic nervous system. Stimulation of the parasympathetic system increases secretion of insulin from the B cells. Stimulation of the sympathetic system increases glucagon secretion from the A cells. Insulin is inhibited by sympathetic stimulation. Ref: Molina P.E. (2013). Chapter 7. Endocrine Pancreas. In P.E. Molina (Ed),Endocrine Physiology, 4e.

Physiology

94efad1a-4648-4755-ae8b-969239e32dd7

All of the following statements regarding sandostatin is TRUE, EXCEPT:

It is a somatostatin analogue

Used in secretory diarrhea in AIDS

Used in carcinoid

An absorbent

3d

multi

Octreotide is an octapeptide analog of somatostatin. It acts by inhibiting hormone secretion such as 5HT and other GI peptides. Indications: It is effectively used in treating severe secretory diarrhea brought about by hormone-secreting tumors of the pancreas and the GI tract. It is also used off label in the treatment of secretory diarrhea such as chemotherapy-induced diarrhea, diarrhea associated with HIV and diabetes-associated diarrhea. It is also used in dumping syndrome seen in some patients after gastric surgery and pyloroplasty. In this condition, octreotide inhibits the release of hormones that are responsible for distressing local and systemic effects. Ref: Sharkey K.A., Wallace J.L. (2011). Chapter 46. Treatment of Disorders of Bowel Motility and Water Flux; Anti-Emetics; Agents Used in Biliary and Pancreatic Disease. In B.C. Knollmann (Ed), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.

Pharmacology

14b06d7f-2076-4373-a7e3-a436e3b19be8

Multidrug (MDT) regimen under the National Leprosy Eradication Program for treatment of all Multibacillary Leprosy would include:-

lamprene, Thiacetazone and aczone

lamprene, Rifampicin and aczone

trecator, Rifampicin and aczone

Propionamide, Rifampicin and aczone

1b

multi

Paucibacillary Multibacillary Lesions <=5 >5 RX 6 months 12 months Follow-up 2 years 5 years Drugs Dapsone, Rifampicin Dapsone, Rifampicin, Clofazimine Now, India may soon adopt "Uniform MDT" regimen in which drugs used will be D + R + CF to all leprosy Patients.

Social & Preventive Medicine

Leprosy, HIV & STDs

760abe95-2c7b-4235-b12e-0bbe791a220d

A 19-year old male presents with several comedones, papules and pustules on face and trunk. The approp-ilte drug ,*1choice for the patient would be

Topical retinoic acid

Topical retinoic acid + Oral vibramycin

Topical cleocin

Topical zithromax

1b

single

Ans. b. Topical retinoic acid + Oral doxycycline A I9-year-old male presents with several comedones, papules and pustules on face and trunk. This is a case of inflammatory acne with comedones and appropriate drug of choice for this patient is topical retinoic acid with oral doxycycline.

ENT

91c4fab4-2e06-4cc8-b371-0aef322052bc

Which of the following anti - glaucoma drug can likely cause black pigmentation on conjunctiva

Adrenaline

xalatan

Beta blockers

pilagan

0a

single

Adrenaline used in glaucoma can lead to conjunctival pigmentation because of adrenochrome.

Pharmacology

5a87e448-552f-4f1a-a8a7-4f94bbcf79ef

tracleer is a/an :

Serotonin uptake inhibitor

Endothelin receptor antagonist

Leukotriene modifier

Phosphodiestease inhibitor

1b

single

Pharmacology

39bfc1b4-0b3c-4171-888d-41e933ca5c86

Anticancer drug causing SIADH as an adverse effect is:

vincasar

taxol

Dacarbazine

endoxana

1b

single

TAXANES Paclitaxel It is a complex diterpin taxane obtained from bark of the Western yew tree, which exes cytotoxic action by a novel mechanism. It enhances polymerization of tubulin: a mechanism opposite to that of vinca alkaloids. The microtubules are stabilized and their depolymerization is prevented. This stability results in inhibition of normal dynamic reorganization of the microtubule network that is essential for vital interphase and mitotic functions. Abnormal arrays or &;bundles&; of microtubules are produced throughout the cell cycle. Cytotoxic action of paclitaxel emphasizes the impoance of tubulin-microtubule dynamic equilibrium. The approved indications of paclitaxel are metastatic ovarian and breast carcinoma after failure of first line chemotherapy and relapse cases. It has also shown efficacy in advanced cases of head and neck cancer, small cell lung cancer, esophageal adenocarcinoma and hormone refractory prostate cancer. The major toxicity is reversible myelosuppression and &;stocking and glove&; neuropathy. Chest pain, ahralgia, myalgia, mucositis and edema can be troublesome.The syndrome of inappropriate ADH secretion is attributed to excessive ADH release. It is defined as less than maximally dilute urine in the presence of plasma hypoosmolality (hyponatremia), without volume depletion or overload, emotional stress, pain, diuretics or other drugs that stimulate ADH secretion. Paclitaxel regimen, cause severe hyponatremia (grade 4) due to documented syndrome of inappropriate antidiuretic hormone secretion (SIADH). ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:826

Pharmacology

Chemotherapy

a429b25b-2e24-457d-a12c-9440f4e0b62e

Inhibition of protein synthesis in translocation steps occurs by

panmycin

staticin

Aminoglycosides

Penicillin

1b

multi

Reversible Inhibitors in bacteria : These antibiotics are bacteriostatic . Tetracycline bind to the 30S subunit of bacterial ribosome and so inhibit attachment of aminoacyl tRNA to the A site of ribosomes. Chloramphenicol inhibits the peptidyl transeferase acitivity of bacterial ribosomes. Erythromycin (macrolides) and clindamycin prevent the translocation process. REFERENCE : DM.VASUDEVAN.TEXTBOOK ; SEVENTH EDITION ; PAGE NO : 605.

Biochemistry

Metabolism of nucleic acids

1a9070a0-49b6-4717-bc04-0ee66d8fb3dd

Antilipidemic drugs that prevent hypercho- lesterolemia by inhibiting absorption :

zetia

Statins

xenical

Cholestyramine

0a

single

Ezetimibe inhibits absorption of cholesterol by binding to transpoer located in intestinal brush border, so decreases delivery of intestinal cholesterol to liver. Orlistat is antiobesity drug, acts as inhibitor of gastric and pancreatic lipase, interfere with digestion and absorption of dietary TG's. Statins act by inhibiting HMG CoA reductase. Cholestyramine acts as a bile acid sequestrant.

Surgery

65c2c1a1-2172-4a0b-b746-5856b8283be0

Antimetabolite drug used for the treatment of gout?

caplenal

retrovir

imuran

None of the above

0a

multi

Synthetic nucleotide used in the treatment of Gout-Alloourinol.

Biochemistry

12fed86a-3db5-423c-a469-596925d1afa9

An obese NIDDM patient present with FBS=180 mg% and PPBS=260 mg% Management include-a) Glibenclamideb) Diet therapy+exercisec) Diet therapy+exercise + glucophage d) diabinese

ab

bc

bd

cd

1b

single

Medicine

459f6c5c-71a3-487d-8095-25a314394f67

Which among the following is not an antipsychotic?

Risperidone

Haloperidol

librium

clozaril

2c

single

Chlordiazepoxide is a BZD that can be used also an anti anxiety agent. Rest all three given drugs are anti psychotic. Ref: KD Tripathi 8th ed.

Pharmacology

Central Nervous system

8c005186-aeab-4c1f-b112-396013f12742

For glucose estimation in blood, the mode of transport from a PHC to lab:

Sodium fluoride

disotate

Citrate

0.9% saline

0a

single

Ans. A. Sodium fluorideIn glycolysis, (i.e. the pathway in which, glucose is utilized to form energy), 'Enolase' is an enzyme which converts 2- phosphoglycerate to a high energy compound phosphoenolpyruvate.a. This enzyme requires Mg++&Mn++ & is inhibited by fluoride.b. For blood glucose estimation, fluoride is added to the blood to prevent glycolysis by cells, so that the blood glucose is correctly estimated.

Biochemistry

Carbohydrates

048f642a-e0af-4690-817f-0bf435da755e

The specific antidote for benzodiazepine poisoning is:

narcan

romazicon

antizol

protopam

1b

single

Pharmacology

8145aae9-e0e0-4bdd-9a92-cdba8c4a0dd3

"Monday disease" is seen with

Calcium channel blockers

Benzodiazepines

monoket Mono nitrate

Chlorpromozine

2c

single

Isosorbide Mononitrate is a venodilator, which is associated with Monday disease, where nitrate industry workers gets dizziness & hypotension on Monday, but symptoms disappear by the weekend because of down regulation of enzymes.

Pharmacology

cb4109c5-a1c8-41b7-9dbe-b46010a1f4e1

Which of the following antifungal drug is developing drug resistance and has not been prescribed for tinea cruris and tinea corporis for the last 2 years?

griseofulvic

lamisil

sporanox

vfend

0a

single

(a) Griseofulvin,Ref: Katzung, 13th ed., pg. 832 and class="katex">PMC4804599/* Among various options, topical terbinafine for 4 weeks appears to be the treatment of choice for limited disease (tinea corporis/cruris/pedis). For more extensive disease, the choice is less clear. It is also effective orally. Both terbinafine (250-500 mg/day for 2-6 weeks) and itraconazole (100--200 mg/day for 2-4 weeks) appear to be effective. Voriconazole is also an effective drug for these conditions.* Griseofulvin is an oral drug used for tinea infections. It is not effective topically. Because of emergence of resistance over the past few years, griseofulvin has been largely replaced by other antifungal agents like terbinafine and itraconazole.* Luliconazole is an imidazole topical cream recently approved by the FDA and the CDSCO for treatment of interdigital tinea pedis, tinea cruris, and tinea corporis.

Pharmacology

Anti Microbial

8aa568aa-a041-4a10-a8f8-a688d73c4fa0

Most important side effect of myambutol is :

Hepatotoxicity

Renal toxicity

Peripheral neuropathy

Retrobulbar neuritis

3d

single

Pharmacology

d9b7327b-503a-48fe-a73a-fa1ca1375010

Which one of the following insecticides is commonly used for ultra low volume fogging -

Abate

DDT

Paris green

ovide

3d

single

Ans. is 'd' i.e., Malathion o New equipment has been developed to use residual insecticide as space spray by ultra low volume (ULV technique. o Malathions and fenthion are most commonly used.

Social & Preventive Medicine

e5a79401-abe3-4c8a-8c4f-b74cadf01444

Which of the following drugs has been found to be useful in acute severe asthma?

Magnesium Sulphate

Anti-leukotrine

intal Sodium

restasis

0a

single

Ans. (A) Magnesium sulphate(Ref: Harrison 17th/e p1605)Magnesium sulphate by i.v. or inhalational route has been used for the treatment of acute severe asthma. All other drugs mentioned in the options are used for prophylaxis of asthma.

Pharmacology

Asthma

a22ba2d1-ceb3-4742-a67f-4d8d0e4e2c3e

Drug that is safe in G6PD deficiency:

Primaquine

Acetanilide

quinora

aczone

2c

single

c. Quinidine(Ref: Nelson's 20/e p 2335, Ghai 8/e p 339)Quinidine does not carry risk of hemolysis in persons with G-6-PD deficiency.

Pediatrics

C.V.S.

ec46b793-2ec3-4fbd-84dd-656c26939749

Rk39 dip stick kit was found to be positive, the treatment of choice is:

Amphotericin B

albenza

vibramycin

Praziquantel

0a

single

Ans. (a) Amphotericin B Ref Paniker 7/e, p 58 RK 39, is a rapid dip stick method for detecting antileishmanial antibodies has been developed using a recombinant leishmanial antigen rk 39 consisting of 39 amino acids conserved in kinesin region of L. infantum. The sensitivity of test is 98% and specificity is 90%. Thus, a positive rk39 test indicates Lishmenial infection Treatment of Leishmaniasis Kala-azar responds better to treatment than visceral leishmaniasis Pentavalent antimonial compound is the drug of choice in most of the endemic region except Bihar, where there is resistance to pentavalent compound Amphotericin B is the first line drug to be used in Bihar Liposomal Amphotericin B: It is the only drug approved by FDA for treatment if visceral leishmaniasis Note: Other impoant Rapid dipstick test: RDT dipsticks for HRP-2 and pLDH: Plasmodium Optimal rapid dipstick test: Plasmodium falciparum > Plasmodium vivax RDT for Fl antigen: Yersinia pestis RDT for 01 and 0139: Rapid detection of Vibrio cholerae serotypes Strep A Rapid Test Dipstick (GIMA): Streptococcus pyogenes is throat swab

Microbiology

bdf28029-b1a3-4059-974d-dd8f512bc64d

The short acting anticholinesterase drug is:

tensilon

Demecarium

Dyflos

Ectothiophate

0a

single

Pharmacology

de1c9e1b-650c-484f-8cc9-1c3587b05bdc

Treatment of choice in acute congestive glaucoma –

pilagan

Laser iridotomy

blocadren

Trabeculoplasty

1b

single

Treatment of choice for PACG is peripheral laser iridotomy.

Ophthalmology

87cf8a4f-b647-486c-9435-d66201c192aa

Drug that inhibits cell wall synthesis is ?

Tetracyclines

Penicillins

Aminoglycosides

chloromycetin

1b

multi

Pharmacology

fa29bd47-6a0f-495b-9887-8c6c716252e4

singulair is ?

Leukotriene antagonist

Potassium channel opener

Smooth muscle relaxant

Anti - inflammatory

0a

single

Ans. is 'a' i.e., Leukotriene antagonist Leukotriene antagonists Monteleukast and zafirleucast are cystenyl LT, (cys LT1) receptor antagonists. They are indicated for prophylactic therapy of mild to moderate asthma as alternatives to inhaled glucocoicoids. They are more acceptable in children. They are not used for terminating asthma episodes. They are effective in aspirin induced asthma. They are very safe drugs, produce few side effects like headache and rashes. Eosinophilia, neuropathy and churg-strauss syndrome are other rare side effects.

Pharmacology

04022e53-d467-4ded-b6b0-46e81f520a4e

Drug causing malignant hyperthermia:

nimbex

quelicin

diprivan

Thiopentone

1b

single

Ans. b. Suxamethonium (Ref: Milier's 7/e p1180-1189, Lee 13/e p352-354, Morgan 4/e p945-950)Suxamethonium is the drug most commonly responsible for causing malignant hyperthermia.

Anaesthesia

Complications Of Anaesthesia

55f88cdf-9502-47e6-8505-6009e66c0d0e

All of the following agents are used for emergency contraception, EXCEPT

Combined Pill

Levonorgestrel

cytotec

mifeprex

2c

multi

Emergency contraceptive is means of contraception used after act of unprotected intercourse. Misoprostol is a prostaglandin which is an excellent agent for causing early and mid trimester aboions but as an emergency contraceptive it has no role as there is no pregnancy to abo in the first three days of intercourse. Emergency contraceptives IUCD: Can prevent implantation up till 5th day of unprotected inter-course Progesterone only pill: LNG 1.5 mg :can reduce tubal motility , make endometrium 'Out of Phase" for implantation of embryo Combined Pill: the Yuzpe regimen can prevent embryo implantation since the estrogen component makes the endometrium unreceptive. Mifepristone, Antiprogestin, RU 486, prevents implantation Ulipristal acetate: SPRM: Selective progesterone receptor modulator

Gynaecology & Obstetrics

Contraceptives

803de733-55f1-4996-af8e-efcbc9cbd085

A patient presents with lower gastrointestinal bleed. Sigmoidoscopy shows ulcers in the sigmoid. Biopsy from this area shows flask-shaped ulcers. Which of the following is the most appropriate treatment ?

Intravenous rocephin

Intravenous flagyl

Intravenous steroids and sulphasalazine

Hydrocoisone enemas

1b

single

Ans. is `b' i.e., Intravenous metronidazole Lower gastrointestinal bleeding along with the presence of flask shaped ulcers on sigmoidoscopy confirms the diagnosis of intestinal amoebiasis (Amoebic colitis). Drug therapy for Amoebiasis Asymptomatic carrier (Luminal agents) * lodoquinol * Paromomycin 650 mg t.i.d. for 20 days 500 , '0 day.s. Acute colitis * Metronidazole * plus Luminal agents as above 750 mg PO or IV tid for 5-10 days Amoebic liver abscess * Metronidazole or * Tinidazole or * Ornidazole * plus Luminal agent as above 750 mg PO or IV tid for 5-10 days 2gPO 2 g PO once

Surgery

eb71b850-01c3-4af8-aade-384a022a7f1f

Group A streptococci is best diagnosed by -

Optochin sensitivity

baci-im sensitivity

Catalase negative

Bile solubility

1b

single

Ans. is 'b' i.e., Bacitracin sensitivity Streptococci are classified according to the type of hemolysis on when cultured on blood Agar namely a, b or v hemolysis. b HemolysisThese streptococci undergo complete hemolysis of sheep red blood cells in agar and therefore shows a clear zone around colonies. Hemolysis is caused by the enzyme hemolysins. a HemolysisIncomplete hemolysis producing greenish discolouration around colonies. g HemolvsisNon hemolysis b hemolytic streptococcibHemolytic streptococci are further classified into lancefied groups (A-H K-V) based on the antigenic carbohydrate in the cell wallGroup A, B, C, D and G are the groups most commonly associated with human infections.Group A streptococci (streptococcus pyogenic) is responsible for a wide range of superficial and deep infections and are further classified according to M protein an antiphagocytic fibrillar molecule that interferes with deposition of complement C3b.Group A streptococci is also classified using bacitracin sensitivity test: - BACITRACIN SENSITIVITY TESTThe bacitracin sensitivity test is useful for the differentiation of B hemolytic Group A streptococci from b hemolytic non Group A streptococciThis is important because most streptococcal diseases are caused by Group A streptococci."Streptococcus A (pyogenes) is bacitracin sensitive while streptococcus agalactiae is bacitracin resistantCAMP TESTThis test is used for the presumptive identification of Group B streptococcus (streptococcus agalactiae) and to differentiate it from streptococcus pyogenes group A.Group B is the only B hemolytic streptococcus which yields a positive CAMP testThis test detects a diffusible heat stable extracellular protein produced by Group B streptococcus that enhances the hemolysis of sheep erythrocytes by staphylococcus aureus.The CAMP factor acts synergistically with the beta hemolysin produced by staphylococcus aureus to induce enhanced hemolysis of sheep or bovine RBL.A known hemolytic strain of S. aureus is streaked in a straight line across the centre of the sheep blood agar plate.The test material is streaked in a straight line perpendicular to staphylococcus aureus streak but without touching it.The plate is incubated at 37deg C for 18-24 hours.A positive test for CAMP factor appears as arrowhead hemolysis between the junction of growth of staphylococcus aureus and Group B streptococcus.There is no enhanced or arrowhead hemolysis if the test isolate is not Group B streptococcus. OPTOCHINTESTOptochin sensitivity test is used to differentiate pneumococcus from other a hemolytic streptococci.a hemolytic streptococci may be pathogens such as streptococcus pneumonia or they may be a part of the flora of the upper respiratory tract i.e. viridans streptococci.Streptococcus pneumonia is sensitive to optochin therefore it does not grow around the optochin disc while bacterias that are optochin resistant will be unaffected.Bile solubility test * Bile solubility test is used to distinguish streptococcus pneumoniae from other d hemolytic streptococci.Bile will selectively lyse colonies of streptococcus pneumoniae while other streptococci are immune to bile's activity.When a bile salt such as deoxycholate is added directly to streptococcus pneumoniae growing on an agar plate or in a broth culture the bacteria will lyse and the area becomes clear. Other 5 hemolytic streptococci are resistant to (not lysed by bile) and will stay viable or turbidClassification of Streptococci

Microbiology

Bacteria

7d24b4e5-3a3a-4587-b2f1-afe3a9fc4e83

A person has headache & profuse sweating. On examination his B.P is 200/120 mm Hg. Which of the following shoud not be used -a) Nifedipineb) Phenoxybenozamine c) Methyldopad) trandate

ab

abc

bc

bd

1b

single

Medicine

9e621b2e-b9b0-4972-b81c-0603618d405d

A patient with ruptured spleen is taken for laparotomy. His blood pressure is 80/50 and heart rate is 125/min. Induction agent of choice for this patient is:

Sodium Thiopentone

sublimaze

ketalar

fluothane

2c

single

Ans. (C) Ketamine(Ref: Goodman and Gilman 12th/e p538-539)Ketamine increases all pressures (blood pressure, intracranial tension, intraocular pressure) in the body. It is therefore intravenous anesthetic of choice for shock (increases blood pressure).

Pharmacology

Anaesthesia

9ab6c518-d764-4a06-987f-2d540ebbdfc9

A known alcoholic is brought to the emergency depament by his wife. The person has not consumed alcohol for the past two days due to religious reasons. The person complained of nausea, vomiting and dizziness. On the second day, he developed seizures, that progressed to generalized tonic clonic seizures (GTCs). Which of the following would be the best medication to manage the seizures of the patients?

Sodium depakene

dilantin

valium

catapres

2c

single

Ans. c. DiazepamThe seizures in this patient, is due to alcohol withdrawal. Diazepam would be best medication to manage the seizure ofthe patient.'Long acting benzodiazepines such as chlordiazepoxide and diazepam or sho acting such as lorazepam can be used totreat mild-moderate uncomplicated alcohol withdrawal.'Chlordiazepoxide is preferred over diazepamfor treatment of alcohol withdrawal syndrome.

Psychiatry

e8ec18f8-528f-4fe0-a216-caa416cdec02

Drug of choice for reversal of muscle relaxant after anaerthesia -

Pralidoxine

prostigmin

atropen

None

1b

multi

Ans. is 'b' i.e., Neostigmine Reversal of neuromuscular blocko Nondepolarising muscle relaxants have antagonistic action on acetylcholineo They act by blocking the action of acetylcholine released at the neuromuscular junction which are then not able to combine with its receptors to generate endplate potential,o The antagonistic action of nondepolarizing muscle relaxant can be overcome by increasing the concentration of acetylcholine at the neuromuscular junction,o This is achieved by administering anticholinesterases to the patiento Anticholinestrases act by inhibiting the action of acetylcholinesterase (an enzyme that degrades acetylcholine by causing its hydrolysis).o Anticholinesterases thus increase the level of acetylcholine at the neuromuscular junction,o Neostigmine also has some additional direct action on cholinergic receptors i.e., it depolarizes motor end plate,o It does not increase the release of ACH. Accumulated ACH acts on prejunctional muscarinic autoreceptors and inhibits the release of ACH.

Pharmacology

D.O.C

d9ddc65f-f19b-4c79-ae3c-a25942b105b5

Emergency contraceptive of choice is :

OCP

danocrine

Levonorgestrel

mifeprex

2c

single

Levonorgestrol can be used as a single dose, can be given upto 120hrs following unprotected intercourse and no estrogenic side effects

Gynaecology & Obstetrics

Contraception