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AIM-Harvard 17

6d0e3175-11b9-418d-8e3d-16b63537a0dc

Choose the false statement regarding Hepatitis G virus -a) Also called GB virusb) Blood born RNA virusc) Mostly infected with C virusd) Responds to epivir

ab

bc

bd

cd

3d

multi

Microbiology

7963fb9d-51c3-4c67-8525-7612d0061143

What is the concentration of epipen added to local anesthetic solution-

0.736111111

1:10,000

1 :200000

1.430555556

2c

single

Epinephrine 1:200,000 or 5 microg/ml may be added to local anesthetic solution to produce vasoconstriction. Epinephrine is used along with local anesthetics at a concentration of 5 mg/mL or 1:200,000. At this dose, epinephrine provides adequate vasoconstriction. It is added to local anesthetics to limit systemic absorption and the systemic side effects. It limits the diffusion of the drug away from the site thereby prolongs the duration of block and improves the depth of anesthesia. Epinephrine is also used to detect accidental intraaerial injection of a local anesthetic during the neuraxial block. The classic test dose combines local anesthetic and epinephrine, 3 mL of 1.5% lidocaine with 1:200,000 epinephrine. This epinephrine if injected intraaerially would increase the hea rate by 20% with or without the rise in blood pressure. Use of epinephrine can also enhance analgesia by acting on spinal a2 adrenergic receptors. The extent to which epinephrine prolongs the duration of anesthesia depends on the specific local anesthetic used and the site of injection. It can prolong the block caused by shoer acting agents as compared to longer acting ones. i.e. by adding epinephrine to lidocaine, the duration of the block is prolonged significantly than by the addition of epinephrine to bupivacaine.

Anaesthesia

Cardiopulmonary Cerebral Resuscitation

fbf4bc64-553a-4347-b86d-6668cf81c40c

Which of the following antimicrobial is effective against an organism producing extended spectrum beta lactamase?

Amoxicillin-Clavulinic acid

Cefepime

Piperacillin-Tazobactam

rocephin

2c

single

Ans. (C) Piperacillin-tazobactam(Ref: Harrison 18th/1247)Organisms producing ESBL-like Klebsiella are resistant to most beta-lactams except carbapenems.ESBL can be inhibited by beta lactamase inhibitors.Amoxicillin is not effective against Klebsiella whereas piperacillin has wide spectrum including Klesiella.

Pharmacology

Chemotherapy: General Principles

868279e0-1fad-4961-8e48-c0b0d67d3b44

Drug of choice in intractable hiccups is :

reglan

prozac

emsam

largactil

3d

single

Pharmacology

cbb071cd-818c-4e9e-9385-c5aab9c58b67

Aqueous flow is increased by ?

blocadren

xalatan

atropen

trusopt

1b

single

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

Ophthalmology

a2578af3-ae63-4c1b-b5ec-2784055891c2

All are used for mangement for hypernatremia except

5% dextrose in water

N/2 in 5% dextrose

Nil by mouth

indocin

2c

multi

Ans. is `c' i.e., Nil by mouth T/T of Hypernatremia :? As hypernatremia develops, water moves out from I.C.F. to E.C.F. to maintain equal osmolality inside and outside the cell. So the intracellular fluid decreases. To compensate for this the brain cells generates idiogenic osmoles to increase the intracellular osmolality and prevent the loss of brain water. This mechanism is not instantaneous and is most prominent when hypernatremia has developed gradually. If the hypernatremia is corrected rapidly by administration of fluids, the E.C.F. osmolality lowers rapidly, and now the I. C.F becomes hyperosmotic in comparison to the E.C.F. So, now there is movement of water from serum into the brain cells to equalize the osmolality in the two compament. This results in brain swelling and most commonly it manifests as seizures in infants. (This is clinically similar to hyponatremia) Because of the dangers of ovely rapid correction, hypernatremia should not be corrected rapidly. The goal is to decrease the serum sodium by less than 12-10 mEq/L even, 24 hr, at a rate of 0.5-10 mEq/h. In patients with chronic hypernatremia (hypernatremia that has been present for longer than 48 hours). The treatment regimen is 5 percent dextrose in water, intravenously At a rate of (1.35 mL/hour x patient's weight in kg), or About 70 mL per hour in a 50 kg patient and 100 mL per hour in a 70 kg patient. The goal of this regimen is to lower the serum sodium by a maximum of 10 meq/L in a 24-hour period (0.4 meq/ L/hour). In patients with known acute hypernatremia (hypernatremia that has been present for 48 hours or less). The treatment regimen is (see 'Initial fluid repletion regimen' above) :- 5 percent dextrose in water, intravenously, at a rate of 3 to 6 mL/kg per hour The serum sodium and blood glucose should be monitored every one to two hours until the serum sodium is lowered below 145 meq/L. Once the serum sodium concentration has reached 145 meq/L, the rate of infusion is reduced to 1 mL/kg/hour and continued until normonatremia (140 meq/L) is restored. The goal of this regimen is to lower the serum sodium by 1 to 2 meq/L per hour and to restore normonatremia in less than 24 hours. Patients with diabetes insipidus will also require desmopressin therapy, which is discussed elsewhere. Hyperglycemia may develop with rapid infusions of 5 percent dextrose; to avoid increased water losses from glycosuria, a slower rate of infusion or a change to 2.5 percent dextrose in water may be required after several hours. Risk of correctionof hypernatremia. The treatment goal for chronic hypernatremia is designed to lower the serum sodium by 10 meq/L in 24 hours (12 meq/L in 24 hours is considered the maximum safe limit, 10 meq/L in 24 hours is chosen to increase to safety

Medicine

ae604146-2536-460f-bdf9-574032c32fa3

All about jantoven are true EXCEPT?

Half-life is 36 hours

Crosses placenta

Contraindicated in hepatic failure

Inhibits all vitamin K dependent clotting factors

2c

multi

Ans. is 'c' i.e., Contraindicated in hepatic failure o Liver disease requires dose reduction, but is not a contraindication. Effect of liver disease on warfarin o In liver diseases the dose of oral anticoagulats needs to be decreased because in liver disease the hepatic synthesis of clotting factors is reduced. o Thus there is already a deficiency of clotting factors (i.e. there is preexisting anticoagulant state). o Administration of warfarin is this state increases the risk of bleeding. About other options o Warfarin is an indirectly acting anticoagulant, i.e. it inhibits vitamin K which in turn inhibits coagulation factors. o T1/2 of warfarin is 36 hrs. o Warfarin can cross placenta and cause fetal warfarin syndrome. Therefore it is contraindicated pregnancy. Patient is switched to heparin from warfarin during pregnancy.

Pharmacology

ede3470b-6042-43d2-939a-ebe8add20815

Active substance in Dakins skin dressing agent used in burns is ?

Mafenide acetate

Silver sulfadiazine

Sodium hypochlorite

nilstat

2c

single

Ans. is 'c' i.e., Sodium hypochlorite

Surgery

7e25c218-c643-461a-bc0a-c25e4a253002

Safest transplantation approach in liver disease-

Directly transplanting embryonic stem cell in the liver

Transplanting donor hepatocytes into liver

Transplanting mesenchymal stem cell from adipose tissue to liver

Injecting epogen into body

2c

single

Answer- C. Transplanting mesenchymal stem cell from adipose tissue to liverToday, autologous (from the patient) adipose tissue stem cell are the only stem cells that have been used clinically for treating liver disease.Many trials have shown that patients with liver cirrhosis have benefitted from autologous adipose tissue derived mesenchymal stem cells

Medicine

255b3a76-63e2-46ae-bb15-b72a731f1e47

The fastest acting schizontocidal drug among the following is :

Artemether

lariam

resochin

Proguanil

0a

single

Pharmacology

da5797fd-232d-434e-9979-11cc44d0cdf1

The binding of epipen or glucagen to the corresponding membrane receptor has which of the following effects on glycogen metabolism?

The net synthesis of glycogen is increased.

Glycogen phosphorylase is activated, while glycogen synthase is inactivated.

Glycogen phosphorylase is inactivated, while glycogen synthase is activated.

Both glycogen synthase and phosphorylase are activated.

1b

multi

Both epinephrine and glucagons result in activities which serve to increase (maintain) blood glucose. Activation of glycogen phosphorylase will result in glycogen degradation, ultimately providing a source of glucose. Glycogen synthase inhibition results in decreased synthesis of glycogen.

Biochemistry

fe2c8c20-c89a-4c06-b6f8-6af53c23f2ce

In anterior uveitis with secondary glaucoma, all mydriatics can be given, except

pilagan

Homatropine

epipen

tropicacyl

0a

multi

A i.e. Pilocarpine In inflamatory glaucoma (glaucoma with uveitis) pilocarpine (miotic) & prostaglandin analogue e.g. latanoprost are contraindicated Q because - Pilocarpine 1/t development of posterior synechiae Prostaglandin analogue enhance breakdown of aqueous barrier and exacerbate cystoid macular edema.

Ophthalmology

42a061ca-177b-4b6c-8934-c063f788489d

remicade is :

IgG1 chimeric monoclonal antibody against TNF α

IgG1 fully human monoclonal antibody against TNF α

P75 TNF receptor fusion protein

none

0a

multi

Pharmacology

4759e72c-1e18-4880-b8d2-4405700b0bf6

which of the following antimicrobials should not be given to a 4C asthmatic patient managed on elixophyllin therapy ?

staticin

CEFOTIXIME

COTRIMOXAZOLE

AMOXICILLIN

0a

single

THEOPHYLLIN + ERYTHROMYCIN = QT PROLONGATION REF : KD TRIPATHI 8TH ED

Pharmacology

All India exam

cf90099e-a8fe-458e-a1ab-4b74ced83075

Zero order kinetic is shown by all EXCEPT:

High dose salicylates

dilantin

Ethanol

trexall

3d

multi

Pharmacology

0b54f50e-a750-4d78-a0d6-2cac1368b1ee

If a diabetic patient being treated with an oral hypoglycemic agent, develops dilutional hyponatremia-which one of the following could be responsible for this effect -

diabinese

Tolazamide

Glyburide

Glimepiride

0a

single

Ans. is 'a' i.e., Chlorpropamide o Cholorpropamide causes cholestasis, dilutional hyponatremia, intolerance to alcohol (disulfiram like reaction).

Pharmacology

df2de93d-a380-444f-bebe-2e91a85b82f6

A 35 year old man presents with Acute Pancreatitis. The ideal fluid of choice in the initial management is

Isotonic crystalloid

Hypertonic

Hypotonic

pitressin

0a

multi

(A) Isotonic crystalloid[?]INITIAL MANAGEMENT:oCrystalloids: Ringer's lactate or Normal saline.oWhile crystalloids appear to be the Ideal Choice based on expert opinion & the guidelines/recommendations from America, Italy & Japan.oThese recommendations are not based on high - level evidence in patients with acute pancreatitis.ADVANTAGES & DISADVANTAGES OF DIFFERENT FLUID TYPES IN RESUSCITATIONFluid TypeAdvantagesDisadvantagesIsotonic crystalloids (lactated Ringer's solution, 0.9% sodium chloride, Normosol-R, Plasmalyte A)*. Los cost*. Necessary in dehydration*. Widely available*. Large volumes needed*. Longer time to resuscitate*. Require more technical staff (E.g., Placement of multiple, large-guage IV catheters)*. Risk of hypothermia*. Risk of interstitial edema*. Risk of hemodilution*. Risk of re-bleedingHypertonic saline*. Low cost*. Small volumes needed for rapid resuscitation*. Minimizes risks of interstitial edema*. Beneficial neurological effects; decreases intracranial pressure*. Immunomodulatory effects*. Beneficial cardiac effects*. Short acting when used alone*. Transient hypernatremia*. Hypotension, bronchoconstricction, or arrhythmias with rapid administration*. Risk of volume overload*. Possible phlebitis*. HyperosmolarSynthetic colloids (6% hetastarch, 10% pentastarch, 6% dextran 70)*. Smaller volumes needed for rapid resuscitation compared with crystalloids*. Minimizes risks of interstitial edema*. Longer duration of effect*. Increases COP*. Less hemodilution*. Higher cost*. Risk of volume overload*. Exacerbation of coagulopathies*. Risk of allergic reactions*. Edema with vasculitis*. Interference with cross-matchingHemoglobin-based oxygencarrier (Oxyglobin)*. Increases COP*. Increases oxygen delivery*. Eliminates need to cross-match*. 2 year shelf life*. Higher cost*. Risk of volume overload*. Possible risk of anaphylaxis with multiple uses*. Inability to measure certain blood values after useoAggressive hydration, defined as 250-500 per hour of isotonic crystalloid solution should be provided to all patients, unless cardiovascular, renal or other related co-morbid factors exist.oEarly aggressive intravenous hydration is most beneficial during the first 12-24 hr, and may have little benefit beyond this time period.oIn a patient with severe volume depletion, manifest as hypotension & tachycardia, more rapid repletion (bolus) may be needed.

Medicine

Fluid & Electrolyte

64d6c543-22c3-49c2-9b93-e100259d85ca

b2 agonist with a long duration of action is

ventolin

brethine

serevent

Albuterol

2c

single

A new generation of long-acting b2- selective agonists includes salmeterol (a paial agonist) and formoterol (a full agonist). Both drugs are potent selective b2 agonists that achieve their long duration of action (12 hours or more) as a result of high lipid solubility. These drugs appear to interact with inhaled coicosteroids to improve asthma control. Because they have no anti-inflammatory action, they are not recommended as monotherapy for asthma. An ultra-long-acting b agonist, indacaterol, is currently approved in Europe. It needs to be taken only once a day but is used only for the treatment of chronic obstructive pulmonary disease (COPD). Data on its efficacy and safety in the management of asthma are lacking. Reference: Katzung Pharmacology; 13th edition; Chapter 20; Drugs Used in Asthma

Pharmacology

Cardiovascular system

fc80f152-e452-49e0-a5a2-2d361fda62d2

A 22 yr old female, Neeta presented to you with complaints if headache and vomiting since 2 months b. She is having amenorrhea but urine pregnancy test is negative. She also complained big secretion big milk from the breasts. A provision diagnosis of hyper prolactinemia was made and MRI was suggested. MRI confimed the presence of large Pituatory Adenoma Neeta was advised surgery however she is not willing to undergoe surgery. Which of the following medications is most likely to be prescribed

imitrex.

parlodel

Ergotamine

caplenal

1b

multi

Refer KK Sharma 2/e p 550 Bromocriptine is a D2 agonist and is useful in hyoerprolactinemia by its action to inhibit the release of prolactin.

Pharmacology

Endocrinology

e9afe148-f203-4c4c-b43f-03f7512f1618

Agent of first choice in an acute attack of Prinzmetals angina is -

angiozem

Nitrates

inderal

isoptin

1b

single

Medicine

e9117bb4-1567-4861-9c40-d8aeab82eb45

A 45-year-old Nobel Prize-winner in chemistry has recently been the recipient of a heart transplant. Patient education has included both verbal and written descriptions of the potential cardiovascular effects of pharmacologic agents. Which one of the following drugs is least likely to cause tachycardia in this patient?

Amphetamine

dobutrex

epipen

Isoproterenol

0a

multi

This question is to remind you that indirect-acting sympathomimetics require innervation of the effector organ to exert effects. In this case, amphetamine would not be effective because the transplanted heart lacks sympathetic innervation; thus, there is no "mobile pool" of NE capable of being released by a drug. However, transplanted hearts retain receptors, including those (b1 ) responsive to direct-acting sympathomimetics. Heart transplants are not responsive to AChE inhibitors because they, too, are indirect acting and require vagal innervation to exert effects on the heart.

Pharmacology

C.V.S

a5c3e7e3-7ccf-449e-aa54-197d87234b7f

Anti-hypeensive drug contraindicated in pregnancy is?

vasotec

Cardio selective Beta blockers

Methyl dopa

apresoline

0a

single

Enalapril REF: KDT ed p. 553 Also asked in June 2008 (OBG), December 2008 (pharm) Anti-hypeensive to be avoided in pregnancy Anti-hypeensive to be given in pregnancy * ACE-I , AT-1 blockers ( absolutely c/i) * Hydralazine * Diuretics * Methyl dopa * Non selective beta blockers * Dihydropyridine CCBs * Sodium nitroprusside * Cardioselective beta blockers and those with intrinsic sympathomimetic activities * Prazosine and clonidine

Pharmacology

1bab79a8-4a43-4797-908f-465749dd4891

40 year old male patient presents to the Emergency depament with central chest pain for 2 hours. The ECG shows ST segment depression and cardiac troponins are elevated. Patient has a positive history of previous PCI 3 months back. He is administered Aspirin, plavix, Nitrates and LMWH, in the Emergency Depament and shifted to the coronary are unit. The best recommended course of fuher action should include.

Immediate Revascularization with Thrombolytics

Early Revascularization with PCI

Continue conservative management and monitoring of cardiac enzymes and ECG

Continue conservation management and plan for delayed Revascularization procedure after patient is discharged

1b

single

Answer is B (Early Revascularization with PCI) The patient presenting as a case of NSTE M I to the emergency depament. The presence of elevated cardiac troponins and history of previous PCI place the patient into a high 'risk category'. The Patient in question is th 10 a 'high risk' patient with NSTEMI Such patients are candidates for early invasive management with PCl/CABG.

Medicine

bf295bbe-3223-4366-a8f1-d9c3db1a1986

atropen is useful in organophosphate poisoning because it -

Reactivates acetylcholinesterase

Competes with acetylcholine release

Binds with both nicotinic and muscarinic acetylcholine receptors

Is a competitive antagonist of acetylcholine

3d

multi

Ans. is 'd' i.e., Is a competitive antagonist of acetylcholine o Atropine acts as competitive antagonist at muscarinic receptors. It has no activity on nicotinic receptors and has nothing to do with Ach release.

Pharmacology

2adb2ec5-f423-436a-af8f-8ca28444e90d

Regarding the synthesis of triacylglycerol in adipose tissue, all of the following are true except

Synthesis from vitadye phosphate

Enzyme Glycerol kinase plays an important role

Enzyme Glycerol 3 phosphate dehydrogenase plays an important role

Phosphatidate is hydrolyzed

1b

multi

Biochemistry

26bf22a0-66cb-4046-a082-f04a6d7adcb0

Which of the following drugs used in osteoporosis acts both by decreasing the resorption of bone as well as inducing new bone formation?

forteo

Ibandronate

Strontium ranelate

Calcitonin

2c

multi

Strontium ranelate appears to block differentiation of osteoclasts while promoting their apoptosis, thus inhibiting bone resorption. At the same time, strontium ranelate appears to promote bone formation. Unlike bisphosphonates, denosumab, or teriparatide, this drug increases bone formation markers while inhibiting bone resorption markers. Calcitonin inhibits osteoclastic bone resorption. Although bone formation is not impaired at first after calcitonin administration, with time both formation and resorption of bone are reduced. Ref: Bikle D.D. (2012). Chapter 42. Agents that Affect Bone Mineral Homeostasis. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & Clinical Pharmacology, 12e.

Pharmacology

850002ca-0299-4fe3-9e81-6f25f1bac4bf

Late onset hemorrhagic cystitis after bone marrow transplanatation is caused by:

endoxana

Ifosfamide

Adeno virus

Cytomegalo virus

2c

single

After bone marrow transplantation (BMT), early-onset hemorrhagic cystitis is related to drugs in the treatment regimen (e.g., cyclophosphamide, ifosfamide), and late-onset hemorrhagic cystitis is usually due to the polyoma virus BKV or adenovirus type 11. Ref: Harrisons principles of internal medicine, 18th edition, Page: 2275.

Medicine

1a54ce81-0fbe-4171-a02f-fd9182344736

A child presents with hepatomegaly and hypoglycemia. There is no improvement in blood sugar even after administration of epipen. What is the likely diagnosis –

Von girke's disease

Anderson's disease

Pompe's disease

Mc Ardle's disease

0a

single

Amongst the given options only Von Gierke's disease presents with hepatomegaly and hypoglycemia. "A diagnosis of type I glycogen storage disease (Von Gierke's disease) should be suspected whenever there is hepatomegaly with hypoglycemia that is unresponsive to glucagon or epinephrine".

Pediatrics

7d286fbe-ffae-4413-bfdb-6f4d3e8cf994

The second gas effect is

Displacement of N20 by Oxygen

Displacement of oxygen by N20

Removal of oxygen by N20 from alveoli during recovery from general anaesthesia

Facilitation of inhalation of fluothane by N20

3d

single

Anaesthesia

426cecc5-9086-4d76-86c4-2ab0200c7935

All are true about Hvpothalamus-pituitary-Adnnal axis except

CRH stimulates zona fasiculata leading to increased cortrisol production

CRH & pitressin are released from neurosecretory nerve terminals at the median eminence

Cortisol produced in the adrenal cortex will negatively feedback

epipen and norepinephrine will positively feed- back to the pituitary

0a

multi

(A) CRH stimulates zona fasiculata leading to increased cortisol production.# KEY ELEMENTS OF THE HPA AXIS are:> Paraventricular nucleus of the hypothalamus, contains neuroendocrine neurons that synthesize and secrete vasopressin & corticotropin-releasing hormone (CRH).> These two peptides regulate: Anterior lobe of the pituitary gland. In particular, CRH and vasopressin stimulate the secretion of adrenocorticotropic hormone (ACTH), once known as corticotropin. ACTH in turn acts on: Adrenal cortex, which produces glucocorticoid hormones (mainly cortisol in humans) in response to stimulation by ACTH. Glucocorticoids in turn act back on the hypo- thalamus and pituitary (to suppress CRH and ACTH production) in a negative feedback cycle.> CRH & Vasopressin are released from neurosecretory nerve terminals at the median eminence.> CRH is transported to the anterior pituitary through the portal blood vessel system of the hypophyseal stalk & vasopressin is transported by axonal trans- port to the posterior pituitary gland.> CRH and vasopressin act synergistically to stimulate the secretion of stored ACTH from corticotrope cells.> ACTH is transported by the blood to the adrenal cortex of the adrenal gland, and it rapidly stimulates biosynthesis of corticosteroids such as cortisol from cholesterol.> Cortisol is a major stress hormone and has effects on many tissues in the body, including the brain. In the brain, cortisol acts on two types of receptor - mineralocorticoid receptors and glucocorticoid receptors, and these are expressed by many different types of neurons. One important target of glucocorticoids is the hypothalamus, which is a major controlling centre of the HPA axis.> Vasopressin can be thought of as "water conservation hormone" and is also known as "antidiuretic hormone." It is released when the body is dehydrated and has potent water-conserving effects on the kidney. It is also a potent vasoconstrictor.# Important to the function of the HPA axis are some of the feedback loops: Cortisol produced in the adrenal cortex will negatively feedback to inhibit both the hypothalamus and the pituitary gland. Reduces the secretion of CRH and vasopressin, and also directly reduces the cleavage of propiomelanocortin (POMC) into ACTH and b-endorphins. Epinephrine and norepinephrine (E/NE) are produced by the adrenal medulla through sympathetic stimulation and the local effects of cortisol (upregulation enzymes to make E/NE). E/NE will positively feedback to the pituitary and increase the breakdown of POMCs into ACTH and b-endorphins.

Physiology

Nervous System

f76fc912-e037-445b-a9e4-d6e882d3678a

Which one of the antitubercular drug may precipitate gout :

Pyrazinamide

Rifampicin

Streptomycin

nydrazid

0a

single

Pharmacology

95c0cfd2-8662-4a88-bcb0-9f8b01201ad4

lasix acts by inhibiting -

Na+-K+-2Cl- pump

Na+-Cl- pump

Carbonic anhydrase

Epithelial Na+ channels

0a

single

Ans. is 'a' i.e., Na+-K+-2C1- pump o The major site of action is thick ascending limb of loop of Henle where they inhibit Na+K+2Cl'.o Has been explained in previous sessions

Pharmacology

Diuretic

41da1e95-adc1-47d6-b904-cb8a6548fe04

Anti HER 2/ neu antibody is:

Bevacizumab

Trastuzumab

rituxan

reopro

1b

single

The determination of tumor HER-2/neu expression for all newly diagnosed patients with breast cancer is now recommended. It is used for prognostic purposes in node-negative patients to assist in the selection of adjuvant chemotherapy because response rates appear to be better with doxorubicin-based adjuvant chemotherapy in patients with tumors that overexpress HER-2/neu, and as baseline information in case the patient develops recurrent disease that may benefit from anti-HER-2/neu therapy (trastuzumab). Patients with tumors that overexpress HER-2/neu may benefit if trastuzumab is added to paclitaxel chemotherapy. Cardiotoxicity may develop if trastuzumab is delivered concurrently with doxorubicin-based chemotherapy. Ref: Schwaz's principle of surgery 9th edition, chapter 17.

Surgery

15d8d025-10c9-4932-9c8a-d01c69c721c5

Which of the following drug is commonly responsible for ohostatic hypotension: March 2010

catapres

apresoline

Captoprils

minipress

3d

single

Ans. D: Prazosin Side effects of prazosin include ohostatic hypotension, syncope, and nasal congestion. The ohostatic hypotension and syncope are associated with the body's poor ability to control blood pressure without active alpha-adrenergic receptors. Patients on prazosin should be told not to stand up too quickly, since their poor baroreflex may cause them to faint as all their blood rushes to their feet. The nasal congestion is due to dilation of vessels in the nasal mucosa. One phenomenon associated with prazosin is known as the "first dose response", in which the side effects of the drug, especially ohostatic hypotension and fainting, are especially pronounced after the first dose. Another common side effect of prazosin (and doxazosin) is priapism.

Pharmacology

4b3044f8-cfc9-484f-b83f-78d05c129b63

A person presents with pneumonia. His sputum was sent for culture. The bacterium obtained was gram positive cocci in chains and alpha haemolytic colonies on sheep agar. Which of the following will help in confirming the diagnosis?

albamycin

Optochin

baci-im

Oxacillin

1b

single

Ans. b. Optochin (Ref: Ananthanarayan 8/e p205-206)Gram-positive cocci with alpha hemolytic colonies on sheep agar are Streptococcus viridians and Streptococcus pneumoniae. They can be further differentiated on basis of optochin sensitivity, Streptococcus viridians-optochin resistant or Streptococcus pneumonia-optochin sensitive. Streptococci ViridansStreptococcus pneumoniaeBile solubilityInsolubleQSolubleQFermentation of inulinNot a fermenterQFermenter with acid productionQSensitivity to optochinNot sensitiveQSensitiveQPathogenicity to miceNonpathogenicQPathogenicQQuel lung testNegativeQPositiveQ

Microbiology

Streptococci

cac38c07-5344-4b8c-b986-f7de1f20e64a

zyflo, a 5-lipooxigenase inhibitor, acts by which of the following mechanisms?

LT C4 synthesis inhibitor

D4 synthesis inhibitor

LT B4 synthesis inhibitor

All of the above

3d

multi

Ans. d (All of the above) (Ref. KDT, Pharmacology, 6th ed. 175, 223)ZILEUTON# 5-Lipoxygenase inhibitor and blocks LTC4, LTD4 as well as LTB4 Synthesis# Duration of action - Short 3-4 hrs# Adverse effect - Hepatotoxicity.MONTELEUKAST, ZAFIRLUKAST# Cys LT1 receptor antagonist used in asthma prophylaxis# Side effects:- Eosinophilia, Neuropathy, Churg-Strauss disease

Pharmacology

Asthma

3e7b575d-f30f-481c-975a-0d6b3a40445a

Most common agent associated with agranulocytosis is:

Steroids

Alkylating agents

tylenol

Endotoxemia

1b

single

Ans. b. Alkylating agentsRef: Harrison 19th e/P 417Most common cause of agranulocytosis is iatrogenic, i.e. drug induced.Most common drugs causing agranulocytosis are anticancer drugs which inhibit cell cycle like alkylating agents and antimetabolites like methotrexate, 5-FU and 6-MP.

Pharmacology

Anti-Cancer

224f0abc-fb5d-484d-90a1-9a5570995509

Acute anginal attack can be terminated by: September 2007

glytrin

lanoxin

Lignocaine

isoptin

0a

single

Ans. A: Nitroglycerin Absorption of Nitrates is most rapid and complete through the mucous membrane.For this reason, nitroglycerin is the most commonly administered sublingually. Their mechanism of action is systemic venodilation with concomitant reduction in LV end diastolic volume and pressure, thereby reducing myocardial wall tension and oxygen requirements. Complications are a pulsating feeling in the head, postural dizziness.

Medicine

64c86057-76ce-473e-99dd-b6a071736866

Discolouration of the teeth seen in following intake

Tetracyclines

chloromycetin

minocin

Lymecycline

0a

single

[A) (Tetracycline) (672 - KDT 5th) (714-KDT 6th)* Tetracyclines have chelating property. Calcium- tetracycline chelate gets deposited in developing teeth and bone Given from mid pregnancy to 5 months to extra uterine life the decidous teeth are affected brown discolouration of teeth, more susceptible to carries. Tetracyclines gives between 3 months to 6 years of age affect permanent anterior dentition. Repeated course are more damaging* Prevention of discolouration of permanent front teeth requires that tetracyclines be avoided from the last 2months of pregnancy to 4 years and of other teeth to 8 years of age (or 12 years if the third molar are valued)* Prolonged tetracyclines therapy can also stain the finger nails at all ages.

Pharmacology

Anti Microbial

2e797f75-1b22-4e57-8f5c-3fa2a8fa9370

A child with schizophrenia was on medications. Suddenly he developed neck stiffness and spasm. Best treatment of such a case is?

Benzatropine

ativan

benadryl

inderal

0a

single

Ans. (a) BenzatropineRef. Handbook of psychiatric drug therapy by Lawrence A. Labbate, Maurizio favay Jerrold F. Rosenbaum, George W. Arana 6th ed. /37y Medical toxicology edited by Richard C. Dart 3th ed. /869)

Psychiatry

Schizophreniform Disorder

1359ed08-ab85-4fa8-928b-60d0822747e9

All of the following drugs causes hirsutism except:

dilantin

eulexin

Norethindrone

danocrine

1b

multi

Phenytoin has various adverse effects like hirsutism, hyperglycemia, osteomalacia, gum hyperplasia etc Norethindrone a progestin derivative has various adverse effects like breast enlargement, hirsutism, and hyperglycemia. Danazol is an antiandrogen with side effects like hirsutism, amenorrhea etc Flutamide is androgen receptor antagonist. Hirsutism occurs due to excess testosterone like effects .so this effect is not seen with antiandrogen like flutamide. ESSENTIAL of medical PHARMACOLOGY SEVENTH EDITION-KD TRIPATHI Page:413,414,301,858,318

Pharmacology

Other topics and Adverse effects

c50a55ed-e16d-4962-a3d9-914519eac95f

All of the following drugs are used in alcohol de-addiction except?

revia

Acamprostate

antabuse

Opioids

3d

multi

ALCOHOL DE-ADDICATION Benzodiazepines (chlordiazepoxide and diazepam) are given to prevent withdrawal. These are long acting CNS depressants and can be withdrawn gradually. Naltrexone is an opioid antagonist that can be used to reduce alcohol craving. Acamprosate is an NMDA antagonist that can be used for maintenance therapy of alcohol abstinence. Disulfiram can be used in psychologically dependent persons who are motivated to quit alcohol. It is contraindicated in physically dependent individuals. Disulfiram produces severe distressing symptoms. Topiramate and ondansetron can also decrease alcohol craving.

Pharmacology

CNS

3215a0be-052e-4c6f-aada-78a6979791b9

which of the following antidepressent is used for smoking sessation

wellbutrin

miazapine

trazadone

anafranil

0a

single

NDRI * IMPOANCE Anti-depressant which does not deal with serotonin neurotransmission Also called as Zyban * MECHANISM Prevents reuptake of nor adrenaline and dopamine * DRUGS Bupropion * USE ADHD SMOKING CESSATION HYPOACTIVE SEXUAL DESIRE DISORDER * SIDE EFFECTS seizures ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 954

Psychiatry

Pharmacotherapy in psychiatry

8150c661-3faf-423b-888e-9daa5b7792db

A middle aged man presented with pain in back, lack of interest in recreational activities, low mood, lethargy, decreased sleep and appetite for two months. There was no history suggestive of delusions or hallucinations. He did not suffer from any chronic medical illness. There was no family history of psychiatric illness. Routine investigations including haemogram, renal function tests, liver function tests electrocadiogram did not reveal any abnormality. This patient should be treated with -

Haloperidol

zoloft

xanax

zyprexa

1b

multi

This patient has (for 2 months) i) Lack of interest                   ii) Low mood   iii) Loss of energy / fatigue (lethargy)      iv) Decreased sleep  v) Decreased appetite           Diagnosis is major depression → Antidepressant should be given. Amongst the given options only sertaline is antidepressant.

Psychiatry

7aac9909-c3f8-44b8-b636-4079b8eea6f5

A 50 year old man with a history of smoking, hypeension, and chronic exeional angina develops several daily episodes of chest pain at rest compatible with cardiac ischemia. The patient is hospitalized. All the following would be pa of an appropriate management plan except -

Intravenous heparin

Aspirin

Intravenous glytrin

xylocaine by bolus infusion

3d

multi

Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:188-190 Management 1. Bed-rest 2. Nasal O2 3. Morphine given in an intravenous form (< 1 mg per minute) to a maximum dose of 10-15 mg. It acts as a pulmonary venodilator and also as an analgesic to allete anxiety 4. Nitrates may be given sublingually for rapid action of relief of pain by coronary vasodilation. It also helps to reduce the preload of the hea, being a predominant venodilator. If pain persists after administration of sublingual nitrates, IV infusion of nitroglycerine may be given, provided the systolic BP is maintained above 100 mm Hg 5. Aspirin is given orally in the dose ranging from 100 to 300 mg 6. Thrombolytic therapy (Streptokinase, Urokinase, Tissue plasminogen activator) may be given and is paicularly useful if given within 6 hrs of onset of Comparison of Anterior and Inferior Wall Myocardial Infarction Features Anterior MI Inferior MI 1. Extent of necrosis Large Small 2. Extent of coronary atherosclerosis Small Large 3. Complications a. Ventricular septal rupture Apical, easily repaired Basal, difficult to repair b. Aneurysm Common Uncommon c. Free wall rupture Uncommon Rare d. Mural thrombus Common Uncommon e. Hea blocks Uncommon Common f. Bundle branch blocks Common Uncommon 4. Prognosis Worse than that of inferior MI Better than that of anterior MI 5. Diagnosis a. Symptoms Gastrointestinal symptoms unusual Gastrointestinal symptoms (nausea, vomiting, hiccough) common b. Physical examination Tachycardia; hypotension uncommon. Bradycardia; hypotension common. Jugular venous distention less Jugular venous distention common. common than with inferior MI. 20% have S3 50% have S3 c. ECG Features of anterior wall MI Features of inferior wall MI d. Echocardiogram Abnormal left ventricular wall Abnormal left ventricular wall motion motion is anterior in location. is inferior in location. Right ventricular No abnormal right ventricular abnormal wall motion present in wall motion approximately one-third of patients. symptoms, but may be given upto 12 hrs after onset of symptoms. Ideal--door to needle time 30 min. 7. Heparin may be given in a dose of 5000 U, 12 hourly, subcutaneously, as prophylaxis against development of deep vein thrombosis and 12,500 U, 12 hourly, subcutaneously, as prophylaxis against development of mural thrombus or extension of the coronary thrombus, for a period of 7-10 days 8. b-blockers are staed immediately, or after two weeks and given for a minimum duration of two years, if there is no contraindication for their use, as these agents (atenolol, metoprolol, propranolol) help in reducing morbidity and moality significantly. b-blockers can be given even if the ejection fraction as determined by Echo is < 40%, but calcium channel blockers must be avoided 9. ACE inhibitors help in cardiac remodelling and reduce morbidity and moality 10. Treatment of the associated complications as and when they arise 11. Advice patient to stop smoking 12. Control of associated risk factors (systemic hypeension, diabetes mellitus, hyperlipidaemia) 13. Rehabilitation If the patient is stable and no complications: Sit in a chair - 2nd day Walk to toilet - 3rd day Return home - 7th day Back to work - 6th week Driving (LMV) - 6 weeks Intercourse - 8 weeks Air travel - 8 weeks 14. Surgery (coronary angioplasty, coronary aery bypass grafting) if medical management fails or if there is severe compromise of coronary circulation. 15. Drug eluting stents - Many drugs have been considered for drug eluting stents. The main drugs used are paclitaxel (Taxol), sirolimus and their derivatives (tacrolimus, everolimus). These stents have lower rates of restenosis. They act by inhibiting neointimal hyperplasia (antiproliferative action). 16. Assessment of ischaemic burden: A sub-maximal stress testing is done at the end of first week and a maximal exercise stress test at the end of 6 weeks. Stress testing aids in assessing the patient's ischaemic burden and planning fuher line of management. 17. Alternate therapies: * Transmyocardial laser revascularisation by percutaneous technique * Enhanced external counterpulsation to decrease the frequency of angina * Spinal cord stimulation ( C7-T1 - epidural space electrode) to improve anginal symptoms

Medicine

C.V.S

0e9645f1-2cc2-4a9a-a408-36fabe74e99a

All except one can cross blood brain barrier

prostigmin

atropen

Lignocaine

anticholium

0a

multi

Neostigmine being quaternary amine , is highly ionised and does not cross blood brain barrier.

Anaesthesia

c2c60fd4-2d3d-489d-97ce-0f0246e054f8

lasix causes all except -

Hyperuricemia

Ototoxicity

Hypercalcemia

Hypokalemia

2c

multi

Ans. is `C' i.e., Hypercalcemia Coniolications of high ceiling (furosamidel diuretics o Hypokalemia (M. C) o Hyperuricemia o GI disturbances o Acute saline depletion o Hypocalcemia o Mental disturbances o Dilutional hyponatremia o Hyperglycemia o Allergic manifestations o Alkolosis o Hyperlipidemia o Hearing loss (ototoxicity) o Hypomagnesemia Thiazides also have same complications except o Thiazides cause hypercalcemia o Thiazides may aggravate renal insufficiency. o Thiazides do not cause ototoxicity. Remember o Hypokalemia is less common with loop diuretics than with thiazides. o Hypokalemia is prevented and treated by

Pharmacology

286e13cd-f42b-41c2-a222-590c71212264

Activity of all local anaesthetic solutions is affected by pH of the tissue or infection except:

Propoxycaine

cepacol

xylocaine

None of the above

1b

multi

As benzocaine has no charge

Surgery

fc94b5f1-0d09-469b-97b7-eb196292f2d8

A 60 year old male a sudden fall in toilet. His BP was 90/50 mm Hg and pulse was 100/min. His relatives repoed that his stool was black/dark in colour. Fuher careful history revealed that he is a known case of hypeension and coronary aery disease and was regularly taking aspirin, tenormin and sorbitrate. The most likely diagnosis is-

Gastric ulcer with bleeding

Acute myocardial infarction with cardiogenic shock

Acute cerebrovascular accident

Pulmonary embolism

0a

multi

Peptic ulcers may be in the stomach, the small intestine just below the stomach, or the food pipe above the stomach. Sometimes, peptic ulcers can bleed (known as bleeding ulcers). More severe bleeding, known as hemorrhaging, can be life-threatening. Infections and some medications can cause bleeding ulcers Ref Davidson 23rd edition pg 683

Medicine

C.V.S

c1f612e2-3e6a-4b05-a9a3-c388e6e84fde

An example of covalent drug receptor interaction:

Noradrenaline binding to β1 adrenergic receptor

Acetylcholine binding to muscarinic receptor

minipress binding to α1 adrenergic receptor

dibenyline binding to alpha adrenergic receptor

3d

single

Phenoxybenamine is an irreversible (covalent) antagonist at alpha receptors. All other drugs mentioned are reversibly interacting with their receptors.

Pharmacology

4276f143-e010-4e13-bbcf-1bc9ee184aba

Which of the following anti inflammatory drug is a COX- 2 inhibitor:

Aspirin

orudis

Rofecoxib

Sulidec

2c

single

Pharmacology

690ce7aa-4013-461e-a314-d54bde38a25f

Which of the following drug releases Nitric oxide

apresoline

Aminophylline

Amrinone

Sildenaphil sulphate

0a

multi

Hydralazine is used with or without other medications to treat high blood pressure. Lowering high blood pressure helps prevent strokes, hea attacks, and kidney problems.Hydralazine is called a vasodilator. It works by relaxing blood vessels so blood can flow through the body more easily. Hydralazine may induce aeriolar vasodilation by preventing oxidation of nitric oxide and thereby lowering blood pressure.

Pharmacology

Anesthesia

fe50f378-6a8d-4b6a-8ad2-e11792760d77

A 27 year old man with epilepsy presents with complaints of persistent lethargy and occasional feelings of intoxication, although he does not consume alcohol. The patient is currently taking luminal for the long-term management of tonic-clonic seizures. In addition, he was recently staed on a medication for the treatment of gastroesophageal reflux disease. Which of the following agents was he most likely prescribed?

tagamet

pepcid

prevacid

zantac

0a

single

Cimetidine is an H2-receptor antagonist indicated for the sho-term and maintenance treatment of duodenal and gastric ulceration, as well as gastroesophageal reflux disease. One of the primary disadvantages of using this agent, with respect to other H2-receptor antagonists famotidine and ranitidine, is that it is a relatively potent hepatic enzyme inhibitor. Therefore, this medication is likely to decrease the metabolism of other hepatically metabolized medications, such as phenobarbital. When the metabolism of a medication is decreased, the blood levels will increase, leading to an extension of the therapeutic effect and/or toxicity. Phenobarbital is a barbiturate indicated for the treatment of tonic-clonic seizures and status epilepticus. When the blood concentration of this medication increases, lethargy and feelings of intoxication may occur. Lansoprazole is a gastric acid proton-pump inhibitor indicated for the sho-term and maintenance treatment of duodenal and gastric ulceration, as well as gastroesophageal reflux disease. This agent does not affect hepatic enzymes. Ref: McQuaid K.R. (2012). Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds),Basic & Clinical Pharmacology, 12e.

Pharmacology

e4759190-12aa-4f52-a24c-f9d2232c5314

Which one of the following drugs inhibits bacterial protein synthesis, preventing the translocation step via its interaction with the 50S ribosomal subunit?

cleocin

garamycin

chloromycetin

Imipenem

0a

multi

Clindamycin has a mechanism of action similar to, if not identical with, erythromycin and related macrolides. They bind to rRNA bases on the 50S subunit to prevent translocation of peptidyl-mRNA from the acceptor to the donor site. Chloramphenicol also binds to the 50S subunit but interferes with the activity of peptidyltransferase. Gentamicin and tetracyclines bind to the 30S ribosomal subunit. Imipenem is a cell-wall synthesis inhibitor, acting similarly to beta-lactams.

Pharmacology

Anti Microbial

caa63a04-b88a-4381-ba06-34a103518971

Which of the following drugs is useful in prophylaxis of migraine ?

inderal

imitrex

Domperidone

Ergotamine

0a

single

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

Pharmacology

e7f37c60-8d14-489e-857f-adc9f77c4c4e

Bulls eye retinopathy is seen in toxicity of: (Repeat)

resochin

lariam

Primaquine

qualaquin

0a

single

Ans A (Chloroquine) Ref: CMDT, 2013. pg 197Explanation:Adverse Effects of ChloroquineOcular- Irreversible retinal damage,CNS- Seizures. Tinnitus, Nerve deafnessGIT- Anorexia, nausea, vomitingSkin pigmentation

Medicine

Drugs

0cf0a220-b092-43a9-9991-c6cc08835997

which of the following SSRi is used in the management of pathological emotions

lexapro

brisdelle

anafranil

prozac

0a

single

SSRI * IMPOANCE Most widely prescribed antidepressant * MECHANISM Specifically acts on serotonin transpoers and increases serotonin in synapse. DRUGS FLUOXETINE FLUVOXAMINE DAPOXETINE CITALOPRAM ESCITALOPRAM ESCITALOPRAM SERALINE PAROXETINE USE FLUOXETINE=============CHILDHOOD DEPRESSION FLUVOXAMINE===========OCD DAPOXETINE==============PME ESCITALOPRAM===========HEA SAFE, PATHOLOGICAL EMOTIONS PAROXETINE=========SEDATING, PANIC DISORDER IMPULSE CONTROL DISORDERS PME PARAPHILIA Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 955

Psychiatry

Pharmacotherapy in psychiatry

3a22bb1d-91a8-40a3-976e-7846401e6f4d

A lady presented with creamy white vaginal discharge with fishy odor, drug of choice is:

vibramycin

Ofloxacine

flagyl

cleocin

2c

single

Ans. is c, i.e. MetronidazoleRef: Shaw 15th/ed, p131; CGDT 10th/ed, p670; William's Gynae 1st/ed, p51Creamy white discharge with fishy odor is characteristic of bacterial vaginosis (M/C cause Gardnerella)Drug of choice for management of bacterial vaginosis/Gardnerella vaginitis is --Metronidazole:Dose - 500mg oral metronidazole is given twice daily for 7 daysAlternatively, metronidazole gel (can be applied once daily for 5 days or clindamycin cream (2%) at bedtime for 5 days.Note: Treatment of male sexual partner is not required in bacterial vaginosisQ.In pregnancy:* Bacterial vaginosis is associated with preterm birth and premature rupture of membranes.* Treatment is reserved for symptomatic women who usually complain of fishy odor.* DOC - Metronidazole (oral) in the 2nd and the 3rd trimester.Unfortunately, treatment does not reduce preterm birth and routine screening is not recommended.

Gynaecology & Obstetrics

Sexually Transmitted Disease in the Female

1aedc7eb-6769-4e92-9324-cdc550f32331

A 50 year old man has presented with pain in back, lack of interest in recreational activities, low mood, lethargy, decreased sleep and appetite for two months. There was no history suggestive of delusions or hallucinations. He did not suffer from any chronic medical illness. There was no fami-ly history of psychiatric illness. Routine investigations including haemogram, renal function tests, liver function tests, electroca-rdiogram did not reveal any abnormality. This patient should be treated with:

Haloparidol

Seraline

xanax

zyprexa

1b

multi

B i.e. Seraline

Psychiatry

84c46bf2-bc0a-451c-9b07-200903c9923b

A 20 year old male presents with acute respiratory distress and tachypoea. His B.P. is 90/60. Loud P2 is +nt. True about his condition

D-dimer assay should be done

S wave in lead 1 and Q wave in lead 3 of ECG is seen

kabikinase hold be given

All

3d

multi

The patient is presenting with dyspnea and tachpnea;dyspnoea with hypotension(BP:90/60 mmHg) indicates a massive pulmonary embolism.He is also presenting with a classic sign of PE,i.e.,an accentuated pulmonic component of the second hea sound.The most sensitive test for PE is D-dimer ELISA assay which rises due to the breakdown of fibrin by plasmin.The most frequently cited abnormality in ECG,in addition to sinus tachycardia ,is the S1Q3T3 sign-an S wave in lead I,a Q wave in lead III,and an inveed T wave in lead III.This finding is relatively specific.The gold standard test for PE is CT pulmonary angiography.On confirming the diagnosis ,primary therapy consisting of clot dissolution with thrombolytics like tPA/streptokinase or removal of PE by embolectomy is done.Anticoagulation with heparin and warfarin or placement of an inferior vena caval filter constitutes secondary prevention. Reference:Harrison's medicine-18th edition,page no:2172-2177.

Medicine

Respiratory system

013619b3-4e9a-48da-a26b-df6f6be00947

Carboxylases requires

Vitamin B12

Folic acid

Niacin

appearex

3d

single

Pyruvate in the cytoplasm enters the mitochondria. Then, carboxylation of pyruvate to oxaloacetate is catalyzed by a mitochondrial enzyme, pyruvate carboxylase. It needs the co-enzymes biotin and ATP.Ref: DM Vasudevan, page no: 103

Biochemistry

Enzymes

9b86123c-6636-40ba-a9d9-eb3775ed683b

Eutectic mixture of local anesthetic (EMLA) cream is -

exparel 2.0% + Prilocaine 2.5%

xylocaine 2.5% + Prilocaine 2.5%

xylocaine 2.5% + Prilocaine 5%

exparel 0.5% + xylocaine 2.5%

1b

single

Ans-B

Unknown

3e94e2de-1d3c-4774-a376-abb681db6879

All of the following can cause SLE-like syndrome except

nydrazid

Penicillin

apresoline

Sulphonamide

1b

multi

Hydralazine, procainamide, sulphonamide, isoniazid- causes SLE like syndrome Also, these drugs undergo acetylation Ref: KD Tripathi 8th ed

Pharmacology

General pharmacology

3a41a181-baf8-4d20-8cc1-eb45d7e1911d

Most potent estrogen is -

Estrone (El)

Estradiol (E2)

incurin(E3)

Etisterone enanthate

1b

single

Ans. is 'b' i.e., Estradiol (E2) Estrogeno Natural oestrogens are Cl 8 steroids, the main source of which are the theca and granulosa cells of the Graafian follicles and corpus luteum, while the adrenal cortex is the secondary source of supply.o Oestrogen is secreted as oestradiol. It is bound to albumin (30%) and sex-hormone-binding globulin (SHBG, 69%), and only 1% is biologically active.o It acts by binding to cytoplasmic receptors in the cells.o It is inactivated by the liver and excreted as conjugates of oestrone, oestradiol and oestriol in the urine and bile (85% in urine, 10% in faeces).o Estradiol is ten times more potent than estrone, which is ten times more potent than estriol. Thus potency of estroogens is as follows:Estradiol > estrone > estriol.Major estrogen during:o Reproductive age group - estradiolo Post menopausal period - estroneo Pregnancy - estriol

Gynaecology & Obstetrics

Endocrine Control of the Menstrual Cycle

b2f04f13-0f1c-4b7d-9341-8dd447198242

Which of the following should not be used in the ROSACEA?

Isoetretin

flagyl

Steroids

Benzoyl peroxide

2c

single

ROSACEA is a Vascular disorder predominantly affecting flush areas of face manifesting as erythema and telangiectasia, punctuated with episodes of inflammation during the episodes of inflammation papules, pustules and swelling develop. It has a chronic course. Treatment: a. Oral tetracyclines are drug of choice. b. Topical erythromycin and benzoyl peroxide are also helpful. c. Topical metronidazole is also effective. oral doxycycline and minocycline can also be given. d. The role of topical steroids is limited. e. With halogenated steroids rebound phenomenon and perioral dermatitis is known to occur. Hence their use is not justified. f. Isotretinoin can be used if no response to above drugs. The use of the topical steroid should be limited to the condition. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) does not necessary prevent steroid induced rosacea. Similar conditions have been seen with both Elidel and Protopic, possibly from immunosuppression and Demodex or bacterial growth. Ref Robbins 9 e pg 456

Pathology

All India exam

03731c53-a296-4365-9b9a-a2c7750a7996

Empirical antibiotic treatment in a suspected case of pneumonia who has received no antibiotics in the past three months to be managed on outpatient basis is -

Oral biaxin

Oral fluoroquinolone

Oral beta lactam with injectable aminoglycoside

Oral zyvox

0a

single

Ans. is 'a' i.e., Oral Clarithromycin * As per the recommendations for empirical antibiotic management oral clarithromycin is the Empirical antibiotic treatment in a suspected case of pneumonia who has received no antibiotics in the past three months to be managed on outpatient basis.Empirical Antibotic Treatment of Community-Acquired PneumoniaOutpatientsPreviousuly healthy and no antibiotics in past 3 months* A macrolide (clarithromycin (500 mg PO bid) or azithromycin (500 mg PO once, then 250mg qd) or* Doxycycline (100mg PO bid)Comorbidities or antibiotics in past 3 months: select an alternative from a different class.* A respiratory fluoroquinolone or* A b-lactam .* A b-lactam plus a macrolide Inpatients, ICU* A b-lactam (cefotaxime (1-2 g IV q8h), ceftriaxone (2g IV qd), ampicilin-sulbactam (2g IV 48h)] plus* Azithromycin or a fluoroquinolone (as listed above for inpatients, non-ICU)Special ConcernsIf Pseudomonas is a consideration* An antipneumococal, antipseudomonal b - lactam (piperacilin/tazobactam (4-5 g IV q6h), meropenem (lg IV q8h)] plus either ciprofloxacin (400 mg IV q 12h) or levofloxacin (750mg IV qd)* The above b-lactams plus an aminoglycoside * The above b-lactams plus an aminoglycoside plus an antipneumococcal fluoroquinoloneIf CA-MRSA is a consideration* Add linezolid (600 mg IV q 12h) or vancomycin (lg IV q 12h).

Medicine

Respiratory

6b15963f-56c3-4ba2-9aa7-43182f9e060d

Once weekly administration of which of the following antibiotics has prophylactic activity against bacteremia caused by M. avium complex in AIDS patients?

zithromax

biaxin

nydrazid

Rifabutin

0a

single

The regimen used for the treatment of Mycobacterium avium complex in AIDS patients is REC (Rifabutin, ethambutol and clarithromycin). These drugs are given once daily. Clarithromycin can be replaced with azithromycin which is long acting and can be administered once a week.

Pharmacology

Mycobacterial Diseases (TB, Leprosy and MAC)

c5a4762e-895c-4ec6-8263-3cbc0a5f1784

Which of the following agents is not used in the treatment of Diabetic Macular Edema/Retinopathy?

Ruboxistaurim

Pyridazinoncs

Benfotiamine

nolvadex

3d

single

Delayed side effects of tamoxifen include infrequent pulmonary emboli or thrombosis, depression, retinopathy, corneal opacities and rare endometrial carcinomas. There have been repeated repos of ophthalmic complications from tamoxifen including irreversible retinopathy with seriously reduced visual acuity, refractile opacities, cystoid macular edema, retinal yellow white dots and keratopathy. Ref: Meyler's Side Effects of Endocrine and Metabolic Drugs By J. K. Aronson - Page 304; Medical toxicology By Richard C. Da - Page 524.

Ophthalmology

1a1377b6-a447-48de-8166-998020dd476b

Which is the drug of choice for severe preeclampsia?

trandate

betaloc

A-aldomet

Nifidipine

0a

single

Labetalol is the drug of first choice in severe preeclampsia. The main objective is to reduce the risk of severe hypeension and cerebral haemorrhage. Labetalol is given as 200-400 mg/day in 2 doses

Gynaecology & Obstetrics

Medical, surgical and gynaecological illness complicating pregnancy

01ace0fb-d9ab-477a-8e17-26b5e2fcbede

Which antibiotic decreases absorption of iron ?

Sulfonamide

Tetracyclines

staticin

proquin

1b

single

Ans. is 'b' i.e., Tetracycline Factors facilitating iron absorption - Acid, ascorbic acid (Vit C), amino acids containing SH radical, meat. All these are reducing substances which enhance conversion of Fe" to Fe" and thus improve absorption. Factors impending iron absorption - antacids, alkalies, phosphate (rich in egg yolk), phytates (in maize, wheat), tetracyclines, presence of other food in stomach.

Pharmacology

6a7fda63-01d2-42bd-a4cf-604c06f0236c

Drug of choice for whooping cough

zithromax

staticin

Rifampicin

Tetracyclin

1b

single

Social & Preventive Medicine

008c9036-a64c-4ca1-b7b6-ff285f3bb2e4

Pseudomembranous colitis is associated with:

firvanq

Lincomycin

Rovamycin

cleocin

3d

single

Clindamycin

Pharmacology

7522e5c7-a03d-4daa-bd97-029aa983900a

An enterococcus (E. faecium) was isolated from a urine specimen (100,000 cfu/mL). Treatment of the patient with penbritin and garamycin failed. The most clinically appropriate action is

Do no further clinical workup

Suggest to the laboratory that low colony counts may reflect infection

Determine if fluorescent microscopy is available for the diagnosis of actinomycosis

Consider firvanq as an alternative drug

3d

multi

These questions demonstrate commonly occurring clinical infectious diseases and microbiologic problems. Enterococci may be resistant to ampicillin and gentamicin. Vancomycin would be the drug of choice. However, laboratory results do not always correlate well with clinical response. The National Committee on Clinical Laboratory Standards recommends testing enterococci only for ampicillin and vancomycin.

Microbiology

Bacteria

a83e94cf-e44c-45d3-b326-0ad65ab3597d

Which of the following is most common side effect of retrovir ?

Anemia

Peripheral neuropathy

Lactic acidosis

All

0a

multi

Pharmacology

89f9ece9-ea72-42e8-9ec2-052c5f0d1d4b

Several weeks following a severe streptococcal sore throat, a 7-year-old boy develops acute glomerulonephritis with edema, hypeension, and hematuria. Which of the following best describes the propeies of the most likely causative organism?

Alpha hemolytic, lysed by optochin

Alpha hemolytic, not lysed by optochin

Beta hemolytic, can grow in 40% bile and 6.5% sodium chloride

Beta hemolytic, inhibited by baci-im

3d

single

The most likely cause of glomerulonephritis following streptococcal sore throat is Streptococcus pyogenes. This is the only species in the Group A streptococci, and is characterized by beta hemolysis and inhibition by the antibiotic bacitracin. Streptococcus pyogenes sore throat can also be followed by rheumatic fever. Streptococcus pneumoniae is an example of an alpha hemolytic streptococcus that is lysed by optochin (1st Choice). Streptococcus mutans is an example of an alpha hemolytic streptococcus that is not lysed by optochin (2nd Choice). Enterococcus faecalis is an example of a beta hemolytic streptococcus that can grow in 40% bile and 6.5% sodium chloride (3rd Choice).

Microbiology

a31a9376-3dad-4b02-9e91-4b5c261a2e8d

A 50-year-old male presented to the ER with acute onset of chest pain which was retrosternal and radiated to the back along with dysphagia, regurgitation and heaburn. Patient gave history of similar episodes of chest pain in the past as well. Barium swallow and esophageal manometric studies were performed. ECG of the patient was normal. Manometry study revealed, 1. Aperistalsis in greater than 30% of the wet swallows with 20% of contractions being simultaneous 2. Amplitudes greater than 30 mm Hg in the distal three fifths of the esophagus Which of the following drugs can be used in the above condition to relieve the symptoms: -

viagra

Botulinum

sandostatin

Terlipressin

0a

multi

This is a case of DES (Diffuse esophageal spasm). Normal ECG rules out MI. Diffuse esophageal spasm has a characteristic appearance of multiple simultaneous contractions causing a corkscrew appearance with segmentation. Multiple uncoordinated contractions in the third tracing from the distal esophagus is seen in manometry. Sildenafil, a phosphodiesterase inhibitor, is a smooth muscle relaxant that can lower the LES pressure and spastic contractions of the esophagus. Definitive treatment is myotomy guided by a manometric evidence.n

Unknown

Integrated QBank

7d40677f-9576-4706-873f-4d4ced62b9b7

Adrenal medulla secretes:

Sex hormones

Thyroid stimulating hormones

epipen

Glucocoicoid

2c

single

Tyrosine - L-dopa - Dopamine - Noradrenaline - Adrenaline Coversion of Noradrenaline to Adrenaline requires the following enzyme - PNMT: Phenylethanolamine N- methyltransferase PNMT: Not present in sympathetic post ganglionic nerve fibers Therefore, sympathetic post-ganglionic nerve fibers release norepinephrine

Physiology

Endocrine System

f44e27ff-c5d5-40f5-bacb-82499af7aa5a

Which of the following drugs is not used in Juvenile Myoclonic Epilepsy (JME)?

topamax

zonegran

tegretol

depakene

2c

single

Juvenile myoclonic epilepsy (JME) is a generalized seizure disorder of unknown cause that appears in early adolescence and is usually characterized by bilateral myoclonic jerks that may be single or repetitive.The myoclonic seizures are most frequent in the morning after awakening and can be provoked by sleep deprivation. Consciousness is preserved unless the myoclonus is especially severe.Carbamazepine useful in focal seizures.Ref: Harrison; 19th edition; Page no: 2544

Medicine

All India exam

fdf6044b-94a1-48c6-ab0a-5aa4674687fa

Minimum dose of panmycin which will show tooth discoloration and enamel hypoplasia:

5 mg/kg body weight

15 mg/kg body weight

30 mg/kg body weight

50 mg/kg body weight

3d

single

Dental

bcda69f9-f7c9-4eca-a002-0b1e4b913e7f

First trimester aboion uses all, except: TN 09

mifeprex

Extra-amniotic ethacrydine lactate

Dilatation and evacuation

Suction evacuation

1b

multi

Ans. Extra-amniotic ethacrydine lactate

Forensic Medicine

c5917029-03dd-4d02-aee9-38a899a0c946

Antagonist of benzodiazepine is :

revia

romazicon

narcan

N–Acetyl–cysteine

1b

single

Pharmacology

fa78446a-b54f-4bd7-b9a7-f0bba2ae93c3

Drug which inhibits the reuptake of norepinephrine into presynaptic membrane is

Cocaine

xylocaine

novocaine

Botulinum toxin

0a

single

Cocaine and TCAs inhibit reuptake of neurotransmitters.

Anatomy

General anatomy

42de0bc8-5d8f-42b4-8051-b45b8fb2d81b

Drug of choice for cytomegalovirus retinitis in HIV patients is:-

Acyclovir

cymevene

symmetrel

foscavir

1b

single

Ganciclovir is an analogue of acyclovir which is the most active drugs against CMV. It is activated intracellularly by virus specific thymidine kinase and its triphosphate nucleotide inhibits viral DNA polymerase. CMV retinitis is treated by i.v. infusion of ganciclovir 10 mg/kg/day. This can prevent blindness in AIDS patients. Systemic therapy can be supplemented by intravitreal injection of ganciclovir.

Pharmacology

Anti-Viral Drugs

a3e90be8-15be-4179-a318-8a1d90fbb188

Which muscle relaxant has Maximum duration of action?

tracrium

norcuron

zemuron

Doxacurium

3d

single

Ans. is 'd' i.e., Doxacurium

Anaesthesia

4ace216b-8baa-4c34-92ae-8b379824e907

Altered taste sensation is caused by-

Pefloxacin

Rifampicin

proquin

capoten

3d

single

Ans. is 'd' i.e., Captopril Adverse effects of ACE inhibitor Hypotension Cough Angioedma Teratogenecity Acute renal failure Hyperkalemia Rashes, Uicaria Dysguesia Granulocytopenia o Dysguesia is reversible loss or alteration of taste sensations. Cough and angioedema are due to elevated bradykinin, caused by inhibition of bradykinithubstance P metabolism in lungs.

Pharmacology

dc30030e-99f4-4c00-8102-43aa4aa07faf

Drug of choice in methicillin-resistant Staphylococcus aureus -

rocephin

fortaz

penbritin

firvanq

3d

single

Methicillin resistance in S. aureus is determined by the mecA gene, which encodes for resistance to all b-lactam drugs. If CA-MRSA infection is suspected, either linezolid or vancomycin should be added to the initial empirical regimen. (Harrison's Principles of internal medicine, 20th edition)

Medicine

Infection

dc2f4e23-621e-4172-9c3f-bb7952f86ac5

A 25-year-old man presents with acute, painless loss of vision in the right eye. The appearance of the optic nerve of the right eye is hyperemic. Of the entities listed, the most likely cause may include:

Vitamin BI2 deficiency

myambutol hydrochloride toxicity

Leber hereditary optic neuropathy (LHON)

Dominant optic atrophy

2c

single

Leber hereditary optic neuropathy (LHON) Hereditary, toxic, and nutritional deficiency optic neuropathies commonly present with bilateral, insidious vision loss. In some cases, there can be asymmetry in visual acuity and visual fields. LHON often presents as acute or subacute unilateral vision loss that is followed within several months by vision loss in the fellow eye. The appearance of the optic nerve in LHON is characterized by a triad of circumpapillary telangiectasia, swelling of the nerve fiber layer around the disc, and absence of leakage on fluorescein angiography. LHON should be included in the diagnosis of acute unilateral vision loss from such disorders as optic neuritis and ischemic optic neuropathy.

Surgery

ebba500b-4667-42ee-af82-a31b08ec7e41

A 40 year old man has megaloblastic anemia and early signs of neurological abnormality. The drug most probably required is :

Folic acid

Iron sulphate

epogen

Vitamin B12

3d

single

Deficiency of vitamin B12 results in megaloblastic anemia and demyelination. It can cause subacute combined degeneration of spinal cord and peripheral neuritis.

Pharmacology

d8e35357-c5be-4394-ac9b-c3f217afd2d2

True statement about ultane is

It is nephrotoxic at high doses

It has maximum risk of causing convulsions

It is cardiostable

It can cause fulminatnt hepatitis

0a

multi

Refer Goodman Gilman 11/e p 360 Sevoflurane is a general anesthetic used by inhalation route It is very good agent for children and asthmatic patients It can produce dose dependent hypotension and decrease in cardiac output It high doses it can release fluoride resulting min Nephrotoxicity

Pharmacology

Anesthesia

ea51acab-3541-427f-951d-b75501c76044

Cause of methaemoglobinemia are all except :

Nitrites

Phenacetin

Sulfonamide

dilantin

3d

multi

D i.e. Phenytoin

Physiology

9488617f-4af4-41d2-83c6-5691ac1a531e

Most common drug used in Leprosy is:

aczone

lamprene

trecator

floxin

0a

single

(Dapsone): Ref 709-KDT (752-KDT 6th)Classification of antileprotic drugs1. Sulfone - Dapsone - (DPS)2. Phenazine derivative - clofazimine3. Antitubercular drugs - Rifampin, Ethionamide4. Other antibiotics - Ofloxacin, Minocycline, clarithromycinDAPSONE: - Inhibition of PABA incorporation in to folic acid.* Simplest, oldest, cheapest, most active and most commonly used in leprosy..* RIFAMPIN: - Most important Bactericidial drug in leprosy* Clofazimine: - Dye with leprostatic and anti-inflammatory properties

Pharmacology

Anti Microbial

c3201968-f49c-4db9-aa3c-62ace19d331e

Which of the following is least useful in Rx of "Overactive bladder"?

oxytrol

detrol

cymbalta

Darifenacin

2c

single

Duloxitin is use in the treatment of stress incontinence.

Surgery

All India exam

c2c5b28d-b0f7-40c7-9c82-a8fb3cf56dab

A young lady presents to your office with compalin of copious vagina discharge, but there is no cervical discharge on per speculum examination. which of the following should be given for the management?

flagyl and zithromax

flagyl and vibramycin

Flacon only

flagyl and diflucan

3d

single

Metronidazole 200mg 3 doses /day for 7days  A single dose of fluconazole 150mg is very effective.

Gynaecology & Obstetrics

c3b5f937-92a6-4bca-95ff-f2183394706c

A 65-year-old man presents to your clinic after falling several times in the past few months. On examination, his most notable findings are an unstable, wide-based gait and marked retropulsion. He does have bradykinesia with masked facies and dysahria. You find no evidence of cogwheeling or resting tremor. His symptoms do not respond to dopar/lodosyn. During the next few months, his eye movements are notable for the slowing of veical saccades and fast phases. What is the most likely diagnosis?

L-DOPA resistant PD

Progressive supranuclear gaze palsy

Multiple system atrophy

Foville syndrome

1b

multi

Option A - Ruled out as resting tremors are absent & disease is ruled out as it is a ATYPICAL PARKINSONISM disease. Option B- since in the question its mentioned regarding the veical gaze of the patient, it's the most appropriate option. Option C- Ruled out as autonomic insufficiency isn't mentioned in the question. Option D- Manifestation of STROKE related to Pons with VIth nerve palsy.

Medicine

Raised ICP and Brain death

851071a2-ce97-49dd-a26e-776601566de3

Which of the following drugs can cause torsades'de pointers?

quinora

Lignocaine

brevibloc

tambocor

0a

single

class 1A agents, class 3 antiarrythymic agents commonly produce torsades de pointes class 1 a- quinidine, disopyramide, procainamide class 1b agents doesnt produce torsades pointes-eg lidocaine, phenytoin, mexiletine, tocainide flecainide is class 1c REF.Essentials of Pharmacology KD Tripathi 8th ed.

Pharmacology

Cardiovascular system

e2508ffd-15a6-4f00-a5e7-ae72b3e76c18

In cirrhotic ascites, which diuretic is preferred?

lasix

diamox

carospir

Any of the above

2c

multi

uses of Spironolactone: Cirrhosis edema Aldosterone levels are generally high in cirrhosis. spironolactone is an antagonist for aldosterone. Thus it is paicularly employed in refractory edema caused due to ascites or cirrhoses 2. To counteract K+ loss due to thiazide and loop diuretics. 3. Hypeension: Used only as an adjuvant to thiazide to prevent hypokalaemia; has weak antihypeensive action of its own. 4. CHF: As additional drug to conventional therapy in moderate to severe CHF; can retard disease progression and lower moality ( Essentials of Medical Pharmacology, K.D Tripathi,6 th edition, page 570 )

Pharmacology

Kidney

cde420f3-bed9-43a0-9cc9-0ca287ad119d

Which of the following antimalarial drugs is a slow acting schizonticide?

Artemether

lariam

Pyrimethamine

qualaquin

2c

single

Pharmacology

52a8cf44-d2bb-44b4-a4ea-b6ce626a6383

Indicate the drug which does not improve lower esophageal sphincter tone or prevent gastroesophageal reflux, but is used as the first line treatment of gastroesophageal reflux disease :

Sodium alginate + aluminium hydroxide gel

losec

Mosapride

reglan

1b

single

Increasing GI motility with prokinetic drugs (like metoclopramide and mosapride) or By decreasing gastric acid secretion with PPIs like omeprazole.

Pharmacology

6b881003-232a-436d-aaa8-2d3bec406ae6

A 7 yr old boy underwent neurosurgery for craniopharyngioma following which pituitary functions were lost. Which of the following hormone should be replaced first ?

Hydrocoisone

synthroid

Growth hormone

Prolactin

0a

single

Hydrocoisone is a coicosteroid mainly used for anti inflammatory action. It may have lot of side effects due to a neurosurgery. Hence, it should be first replaced after a surgery Reference: GHAI Essential pediatrics, 8th edition

Pediatrics

Endocrinology

3e2c66e8-3180-4cbe-a219-58e471f4546b

digipepsin is a type of

Oxidoreductase

Ligase

Transferase

Hydrolase

3d

single

(D) Hydrolase# PEPSIN:> Pepsin is produced by the serous cells of the stomach as pepsinogen, the inactive zymogen or proenzyme.> Pepsin A is the most predominant gastric protease which preferentially cleaves peptide bonds formed by amino groups of phenylalanine or tyrosine or leucine.> Protease or Peptidase or Proteinase: is any enzyme that performs proteolysis; protein catabolism by hydrolysis of peptide bonds.> It break down the bonds by a process - hydrolysis and convert proteins into smaller chains - peptides or even smaller units - amino acids.> Pepsinogen is converted to active pepsin either by autocatalysis, brought about by other pepsin molecules or by gastric HCI (pH < 2).HYDROLASESPhospholipids-PhospholipaseLysophospholipidsLecithin - LysolecithinEnzymes Acting on Peptide Bonds:Exopeptidases-CarboxypeptidaseAiminoacidsEndopeptidase-Aminopeptidases(smallerpeptides)E.g.Pepsin > Removal of a fragment of polypeptide chain (44 amino acids in case of pig enzyme) makes the inactive enzyme active after attaining a proper conformation.> Pepsin is an acid-stable endopeptidase optimally active at a very low pH (2.0).> The active site of the enzyme contains two carboxyl groups, which are maintained at low pH.> Pepsin digestion of proteins results in peptides and a few amino acids which act as stimulants for the release of the hormone cholecystokinin from the duodenum.

Biochemistry

Miscellaneous (Bio-Chemistry)