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AIM-Harvard 17

a644b2dc-1a9a-495d-9a7a-83f23eb31d93

serophene citrate is :

Anti-androgen

Synthetic steroid

Anti estrogen

GnRH analogue

2c

single

Ans. is c i.e. Antiestrogen Clomiphene is an antiestrogen. Category Drug Antiestrogen Clomiphene, Tamoxifen Antiprogesterone Mifepristone Testosterone (Androgen derivative) Danazol, Gestrinone Antiandrogen Cyproterone acetate, Spironolactone, Flutamide,Finasteride

Gynaecology & Obstetrics

b8f8a2fa-bfd2-4cc4-b8eb-f3806f0a61ac

TRUE statement about penicillin G is:

It is administered orally

It has a wide spectrum

It can be used for rat bite fever

Co-administration of benemid decreases its duration of action

2c

multi

Ans. (C) It can be used for rat bite fever(Ref: KDT 8th/e p768-770)Penicillin GIt is acid labile, thus not effective orally.Penicillin G has short duration of action. Probenecid inhibits tubular secretion and prolongs its duration of action.It has narrow antibacterial spectrum, mainly for gram positive bacteria.Penicillin G is drug of choice for infections caused by Treponema like syphilis (T. pallidum) and Rat bite fever (Spirillum minus).

Pharmacology

Chemotherapy: General Principles

35e91c51-f93f-4512-9543-eda7d81f93d9

Uricase used in the treatment of chronic gout is

caplenal

Benzbromarone

krystexxa

trexall

2c

multi

Ans. is 'c' i.e., Pegloticase Pegloticase is a recombinant mammalian Uricase linked to polyethylene glycol (PEG) approved for the treatment of Hyperuricemia in patients with treatment refractory gout. Pegloticase facilitates the conversion of Uric acid into allantoin, which is far more soluble. Pegloticase is approved for intravenous administration and its use is associated with rapid and marked decline in serum uric acid levels. Agents inhibiting IL-1 action are used for the treatment of refractory Gout Anakinra Canakinumab

Medicine

c945a535-720b-49e5-9272-351189e70d28

A patient of glaucoma with bronchial asthma presents to the emergency with status asthamaticus, causative agent might have. been

pilagan eye drop

blocadren eye drop

Betaxolol eye drop

Levobunolol eye drop

1b

single

B i.e. Timolol eye drop B2 receptors are responsible for bronchodialation, therefore blocking B2 would aggravate asthma and Timolol is nonselective beta blocker (i.e. blocks B1 & B2 both) Topical nonselective 0 blockers (e.g. timolol) are contraindicated in asthma Q, COPD, CHF, sinus bradycardia & AV blocks where as selective pi blockers (e.g. betaxolol) are C/I in sinus bradycardia & atrioventricular blocks only.

Ophthalmology

24a9e835-5b14-414f-b80a-a795c01f7a1f

A female patient has primary adrenal insufficiency. She is on hydrocoisone 15 mg a day and fludrocoisone 0.1 mg daily. She becomes acutely ill after eating raw oysters. She has severe, "cramping" abdominal pain and profuse watery diarrhea. Vital signs show a hea rate of 135 bpm, respiration rate of 28 bpm, blood pressure of 72/25 mm Hg, and temperature of 38.1degC. The exam shows tachycardia, dry oral mucosa, clear lungs, and diffuse abdominal tenderness. A rectal exam is heme negative. There are no skin rashes. Which of the following is most appropriate for the initial management of this patient?

Saline bolus

dobutrex

D5 half-normal saline at 100 cc/hour

CT of abdomen and pelvis

0a

single

Anytime the BP is <80 need to give Saline bolus and correct the dehydration component. /F of the patient is Dehydration with known case of Addison's disease.(primary adrenal insufficiency)

Medicine

Disorders of Adrenal Gland

6f0bc724-f4aa-47c4-a28e-64eba2a7ce01

A commonest side effect of aczone is :

Hemolytic anemia

Thrombocytopenia

Cyanosis

Bone marrow depression

0a

single

Hemolysis develops in almost every individual treated with 200-300 mg dapsone per day. Doses of less than 100 mg in healthy persons and less than 50 mg per day in persons with G-6PD deficiency do not cause hemolysis. Methemoglobinemia is also very common.

Pharmacology

360fa208-7c9e-4c22-8c8d-d91cd61b50da

All of the following are true for reglan except?

Chemically related to pronestyl

Speeds gastric emptying

Stimulates chemoreceptor trigger zone

Blocks D2 receptors

2c

multi

Ans. is 'c' i.e., Stimulates chemoreceptor trigger zone Metoclopromide suppresses chemoreceptor trigger zone (CTZ) --> has antiemetic action.

Pharmacology

0b45127d-1ec3-4a5d-b867-2e83d38a43b3

A lady gets pregnant even if she was on contraceptive pills, she is suspected to consume

Rifampicin

proquin

Streptomycin

None of the above

0a

multi

This table summarises important points for neet 5. Essential medicines are the drugs that cater to priority health-cam needs of a population. Most of these are formulated as single compounds. 6. Important drugs causing hemolysis in a patient with G-6-PD deficiency are primaquine, sulfonamides, dapsone and methylene blue. 7.

Pharmacology

d2fc93c6-66bd-44a9-9489-a325b4001d4e

A farmer was brought to the casualty with restlessness & agitation. Examination shows temp. 103° F, flushed face, pupils dilated and fixed. The diagnosis is -

Datura poisoning

Organophosphorus poisoning

valium poisoning

Opium poisoning

0a

single

Among the given options, only datura causes dilatation of pupil. All the other features given in question are also seen in datura poisoning.

Forensic Medicine

e7abf668-1cfd-40ec-bbbe-11bee127d7d2

Pulmonary fibrosis is associated with the use of

Bleomycin

platinol

trexall

Actinomycin D

0a

single

question repeated

Medicine

Respiratory system

f138b61c-6b7f-4735-b355-d59a974b07cc

Drug useful in malignant hyperthermia is:

fluothane

Succinyl choline

dantrium

Haloperidol

2c

single

Pharmacology

a56e0bee-289d-4012-a7c7-8a2bce5fe451

Treatment for the child with frequent tapeworm infestation -

albenza

niclocide

Praziquantel

All

3d

multi

Ans. is 'a' i.e., Albendazole; 'b' i.e., Niclosamide; 'c' i.e., Praziquantel

Pediatrics

9ff7d8c9-549f-4921-9c9c-585b87ddb3dd

requip is most useful for the treatment of :

Parkinson's disease

Wilson's disease

Hoffmann syndrome

Carpal tunnel syndrome

0a

single

Ropinirole is a non-ergot dopamine agonist useful for Parkinsonism. It is also used these days for restless leg syndrome.

Pharmacology

ee7b75d5-cd1b-4a9e-b291-e0e45d2e126d

Most common mode of treatment of a 1 year old child with asthma is

Inhaled sho acting beta 2 agonist

Oral sho acting elixophyllin

Oral zaditor

Leukotriene agonist

0a

single

The pharmacological therapy of bronchial asthma involves use of drugs that relax smooth muscle and dilates the airways and drugs that decrease inflammation and there by prevent exacerbations. The commonly used bronchodilators are adrenaline,terbutaline and salbutamol.Terbutaline and salbutamol are specific beta 2 agonists and therefore less cardiac side effects. Ref : Essential paediatrics,O.P.Ghai,7 th edition ,pg no:361

Pediatrics

Respiratory system

ef238ec0-c2ad-4a84-9ef3-65be3b2eace6

All of the following drugs are useful in detrussor instability except aEUR'

Solefenacin

detrol

Flavoxate

cymbalta

3d

multi

Duloxetine Detrusor instability Detrusor is a smooth muscle which forms the body of the bladder. Its contraction causes micturition. The other smooth muscle that plays an impoant role in micturition is the internal sphincter. Internal sphincter is a concentraction of smooth muscle at the bladder neck. It is well developed only in males and its principal function is to prevent retrograde.flow of semen during ejaculation. When detrusor relaxes and the sphincters close urine is stored. Whereas voiding requires contraction of destrusor accompanied by relaxation of sphincters. Detrusor is innervated mainly by parasympathetic nerves which are excitatory and cause the muscle to contract where as internal sphincter is rich in al adrenoreceptor (sympathetic nerves). Thus the mechanisms of urine voiding involves :? - Increased parasympathetic drive Contracts the detrusor - Decreased sympathetic drive ---> Relax the sphincter Detrusor instability or unstable bladder is characterized by uninhibited, unstable contractions of the detrusor which may be of unknown etiology or secondary to an upper motor neuron lesion or bladder neck obstruction. Since detrusor contracts under parasympathetic influence, Anticholinergic (specifically antimuscarinic) drugs are used to treat overactive bladder disease or detrusor instability. These agents lower intravesical pressure, increase capacity and reduce the .frequency of contractions by antagonizing parasympathetic control of bladder. These agents include : -Darifenacin -Solefenacin - Tolterodine -Trospium chloride -Oxybutynin - -Solifenacin - Flavoxate Duloxetine is used in stress incontinence. It is a dual norepinephrine and serotonin reuptake inhibitor. Its mechanism of action is thought to be centrally, by increasing urethral sphincter tone and contractility. It can be used in mixed incontinence. Comparison of different drugs used for treatment of Detrusor instability Drug Benefits Weaknesses * Generic - Cheap Poorly tolerated oxybutynin - Recommended by NICE well established * Slow release - Improved side-effect profile More expensive than oxybutynin - Escalating does regimen possible immediate release * Oxybutynin - Reduced side - effect profile Patches may cause skin patches Irritation limiting use * Flavo xate - Less side effects than Less offecting Oxybutinin * Tolterodine - First of newer anticholinergics Trial suggests not as - Robust trial evidence effective as solifenacin * Trosplum - Does not cross blood- brain harrier Broad spectrum - May have benefits in the elderly or anticholinergic side patients with polypharrnacy effects * Propiverine - Calcium antagonist action Recommended for frequency but not urge incontinence * Solifenacin - STAR study suggests some benefits Commonest side effect over tolterodine at normal does - dry mouth * Darifenacin - M3 selective Limited direct clinical experience outside of trials

Pharmacology

a9ae556d-78fe-4d9d-bf66-bb96411abd0d

Which one of the following inhaiational agent is contraindicated in a patient witj history of epilepsy?

isoflo

ethrane

fluothane

ultane

1b

single

(B) Enflurane # Brief clonic seizures occur with the use of enflurane. Therefore enflurane is contraindicated.# Enflurane> Though it can give rise to fluoride as a metabolite, the quantity is insufficient to cause renal toxicity.> Bronchodilation and uterine relaxation is similar to halothane but it is better skeletal muscle relaxant> It stimulates salivary and respiratory secretions slightly, but they generally do not pose any problem.> It does not sensitize the heart to adrenaline (Arrhythmias are rare)> Fall in B.P. is similar to that caused by halothane as it also decreases peripheral resistance to some extent.

Anaesthesia

Miscellaneous

2b523b65-91cd-4e21-9e91-ebfc05fce3a1

Drug of choice for Prophylaxis of Bronchialitis in a child with heart disease

rebetol

vibramycin

Palivizumab

Penicillin V

2c

single

Treatment for Bronchiolitis in a child with co-morbidities is inhaled Ribavirin. Drug of choice for prophylaxis of Bronchialitis in a child with co-morbidities is Palivizumab.

Pediatrics

cf3220b8-4a97-48c0-8345-d0666984d8e9

The following drug inhibits histamine release

D tubocurare

oramorph

quelicin

Ketotifin

3d

single

Ketotifen, nedocromil are mast cell stabilizers inhibiting the release of histamine.remaining all options given are histamine releasersRef: KD Tripathi 7th ed pg 229

Pharmacology

All India exam

9da93df6-c72c-4a51-abac-f426e911cc7c

Anaphylaxis is caused by -

N2O

Althesin

fluothane

diprivan

1b

single

Ans. is 'b' i.e., Aithesin Althesino Althesis is a neurosteriodo It was used as a parenteral anaesthetico It was withdrawn from the market because of several severe anaphylactic reactions

Anaesthesia

Complications Of Anaesthesia

e7963222-0927-4785-80c6-0a5fb40f64db

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

topamax

zonegran

Carbamezapine

depakene

2c

single

Answer is C (Carbamezapine): Carbamezapine is not indicated in the treatment of Juvenile Myoclonic Epilepsy. Carbamezapine (and phenytoin) may aggravate myoclonus in juvenile myoclonic epilepsy. Antiepileptic Drugs in the treatment sequence of Juvenile Myoclonic Epilepsy (JME) First choice Valproate, Lamotrigine Second choice Levetivacetam, Clonazepam Consider Topiramate, Zonisamide, Pnenobarbitol, Primidone (Felbamate may also be effective againts JME) Taken jrom 'Current Management in Child Neurology' by Maria 4th/127, 163 Note Carbamezapine and Phenytoindeg may aggravate myoclonus in juvenile myoclonic epilepsy.

Medicine

d0eed121-846d-44f0-98e5-4eaddf1857ac

Slow acetylators of nydrazid are more prone to develop :

Failure of therapy

Peripheral neuropathy

Hepatotoxicity

Allergic reactions

1b

multi

Acetylator status of a person determines the response of drugs metabolized by acetylation (e.g. isoniazid, sulfonamides, procainamide and hydralazine). Isoniazid is metabolized to acetyl-isoniazid and then to acetyl hydrazine. Accumulation of isoniazid is responsible for peripheral neuropathy whereas acetylhydrazine accumulation may cause hepatotoxicity. Thus, slow acetylators will not be able to metabolize the drug quickly and there can be an accumulation of parent drug (isoniazid in this case), leading to peripheral neuropathy. On the other hand, fast acetylators are more prone to develop hepatotoxicity.

Pharmacology

3fb385c8-70bb-4776-a4f4-c98ae921b436

The selective MAO-B inhibitor among the following is

emsam

Clorgyline

Moclobemide

Tranylcypromine

0a

single

MAO is mono amine oxidase exists in two isoforms MAO A and MAO B. MAO A inhibitors are used in treatment of depression where as MAO B in treatment of parkinsons MAO B inhibitors include selegeline and rasagiline. Ref: KD Tripathi 8th ed.

Pharmacology

All India exam

f30acd23-48d2-460d-bf90-dec87f898dc8

Treatment of choice in Gardenella vaginitis in pregnancy :

cleocin

flagyl

Ehromycin

panmycin

1b

single

Metronidazole

Gynaecology & Obstetrics

c727751e-5858-48fc-bf1c-fc662658d195

Drug of choice for chemoprophrlaxis in meningococcal meningitis is -

panmycin

Rifampicin

Streptomycin

staticin

1b

single

Ans. is 'b' i.e., Rifampicin Chemoprophvlaxis o Meningococcal meningitis is the only type of bacterial meningitis that occurs in epidemic form. o Close contacts of index case (such as other household member, infants in day-care centers, or military recrutis) are at increased risk for developing meningococcal disease. casual contacts such as schoolmates do not appear to be at increased risk. Chemoprophylaxis is indicated only for close contacts. Sulfonamides, once widely employed in chemoprophylaxis, should no longer be used for that purpose because approximately 25% of meningococcal isolates are now resistant to sulfonamide. o Rifampicin is the drug of choice to accomplish prophylaxis in close contacts. The recommended dose in adults is either 600 mg orally every 12 hours for 2 days or 600 mg orally once daily for 4 days (total 4 doses). o Other drugs for chemoprophylaxis are ceftriaxone, ciprofloxacin, Azithromycin, minocycline.

Social & Preventive Medicine

bede5553-ce33-4c9e-a6c8-ee0d3f8c9714

Which one of the following oral hypoglycemic agents is not an insulin secretogogue ?

Gliclazide

Glimiperide

prandin

Rosiglitazone

3d

single

Rosiglitazone is a thiazolidinedione which reduce insulin resistance by binding to the PPAR-g (peroxisome proliferator-activated receptor g) nuclear receptor (which forms a heterodimer with the retinoid X receptor). The PPAR-g receptor is found at highest levels in adipocytes. Agonists of this receptor regulate a large number of genes, promote adipocyte differentiation, reduce hepatic fat accumulation, and promote fatty acid storage. Thiazolidinediones promote a redistribution of fat from central to peripheral locations. Thus it enhances the actions of endogenous insulin. Reference : page 2415 Harrison's Principles of Internal Medicine 19th edition

Medicine

Endocrinology

41994a34-fc23-4ce5-ad4c-a0193b06f961

Aplastic anemia is a side effect of which antiepileptic medication?

Valproic acid

tegretol

neurontin

lamictal

1b

single

Carbamazepine may lead to aplastic anemia. Ref: Harrisons principles of internal medicine, 18 th edition, Page: 3263, Table: 369/9

Medicine

958b7a95-6fc0-41e2-8067-f4570bde9fe4

A 26-year-old male, Vikas presents to OPD complaining of hair lose and itching on scalp. Physical examination reveals moderate patchy hair loss fron the central poion of scalp and the lesions have ring like configuration with central clearing. Which of the following drugs can be used to treat this patient s condition?

Local glucocoicoid

Progesterone

Finasteride

lamisil

3d

single

Ref-Katzung 11/842 The diagnosis of tinea capitis and terbinafine is used for the treatment of male pattern baldness stas from anterior poion and scalp and are non pruritic will family history.the treatment of latter is finasteride

Anatomy

Other topics and Adverse effects

b1a73776-2ccd-4f72-9ce5-3fd8c1f7f7df

A 5 year old boy suffering from Duchenne muscular dystrophy has to undergo tendon lengthening procedure. The most approp-riate anaesthetic would be:

Induction with intravenous thiopentone and N20; and fluothane for maintenance

Induction with intravenous suxamethonim and N20; and oxygen for maintenance

Induction with intravenous quelicin and N20; and fluothane for maintenance

Inhalation induction with inhalation fluothane and N20; oxygen for maintenance

0a

single

A i.e. Induction with intravenous thiopentone and N20; and halothane for maintenance In this boy with duchene muscular dystrophy, there is high risk of malignant hypehermia. The earliest signs of malignant hypehermia are masseter muscle rigidity (MMR), tachycardia, and hypercarbia due to increased CO2 production.

Anaesthesia

3beb2157-da6f-4f8d-824c-a42653b3bf0b

Oxime is not useful in case of which poisoning

Parathion

Carbaryl

ovide

Phosmet

1b

single

Ref:HL Sharma 3rd ed pg no: 147 oximes are cholinesterase reactivators- not used in carbamate poisoning like carbaryl, propoxur as anionic site of ACHE is not free they can be used for OP poisoning

Pharmacology

Autonomic nervous system

d7c0ea2c-c6a8-4272-88e4-47d957299d38

Us(NNIs) include all of the following except:

viramune

Delavirdine

Etavirine

epivir

3d

multi

Ans. d. Lamivudine

Pharmacology

c45db9d5-014d-4f75-9dde-f0246fe791fc

A 50-year-old woman is 5 ft 7 in tall and weighs 185 lb. There is a family history of diabetes mellitus. Fasting blood glucose (FBG) is 160 mg/dL and 155 mg/dL on two occasions. HgA1c is 7.9%. You educate the patient on medical nutrition therapy. She returns for reevaluation in 8 weeks. She states she has followed diet and exercise recommendations, but her FBG remains between 140 and 150 and HgA1C is 7.7%. She is asymptomatic, and physical examination shows no abnormalities. Which of the following is the treatment of choice?

A thiazolidinedione such as actos

A dipeptidyl peptidase-4 (DPP-4) inhibitor such as januvia.

Insulin glargine at bedtime

glucophage

3d

multi

The classification of diabetes mellitus has changed to emphasize the process that leads to hyperglycemia. Type 2 DM is a group of heterogeneous disorders characterized by insulin resistance, impaired secretion of insulin, and increased glucose production. In this type 2 patient, the first intervention, medical nutrition therapy, failed to achieve the goal HgA1c of less than 7.0%. Medical nutrition therapy (MNT) is a term now used to describe the best possible coordination of calorie intake, weight loss, and exercise. It emphasizes modification of risk factors for hypertension and hyperlipidemia, not just weight loss and calorie restriction. This was appropriately instituted in the question. Blood glucose control should be evaluated after 4 to 6 weeks and additional therapy should be added if the goal has not been reached. Metformin is considered first-line therapy in that it promotes mild weight loss, has known efficacy and side-effect profile, and is available as a generic with very low cost. Thiazolidinediones ("glitazones"), DPP-4 inhibitors, GLP-1 agonists, sulfonylureas, and insulin are all considered second-line or add-on therapy for most patients with type 2 DM.

Medicine

Endocrinology

95914f56-0526-4bad-969b-fb1f8f8120b2

Which of the following drug causes acute pancreatitis

L-Asperaginase

flagyl

proquin

Penicillin

1b

single

Drugs associated with pancreatitis Definitive cause (MAD CAT PET TV FM) 6-Mercaptopurine Azathioprine Dideoxyinosine Cytosine arabinoside 5-Aminosalicylate Tetracycline Pentamidine Estrogens Trimethoprim - Sulfamethoxazole Thiazide Valproic acid Furosemide Metronidazole Probable cause (PILAAS) Phenformin Procainamide Isoniazid L-Asperaginase Acetaminophen Alpha-Methyl-dopa Sulindac Ref: Sabiston 20th edition Pgno : 1526

Anatomy

G.I.T

48a31379-cac6-4a72-aeb1-57f9c42cbe7a

Ultra short acting beta blocker most commonly used in anaesthesia is –

brevibloc

Nadalol

Propanalol

tenormin

0a

single

Esmolol is ultrashort acting β-blocker and is used for arrhythmias during anaesthesia.

Anaesthesia

d5aee823-0a98-4912-80bc-03200b46a564

A 63 year old male presented with chronic watery diarrhea associated with flushing charecterised by sudden onset deep red or violaceous erythema of the upper body often with pruritus, lacrimation and facial edema. The flushing was noticed to be precipitated by exercise, alcohol, stress and cheese intake. He has a history of wheezing and clinical examination revealed pellagra like skin lesion. All are useful steps in the treatment of this clinical condition, EXCEPT:

Lanreotide can be used to control the symptoms

Hepatic aery chemoembolization using adriamycin is effective

Interferon Alpha can be effective in controlling the symptoms

Rapamycin is useful to control symptoms

3d

multi

The clinical features in this case is suggestive of carcinoid syndrome. Serotonin receptor antagonists or somatostatin analogues are the drugs of choice to control diarrhea. Synthetic analogues of somatostatin (octreotide, lanreotide) are now the most widely used agents to control the symptoms of patients with carcinoid syndrome. Interferon alpha is repoed to be effective either alone or combined with hepatic aery embolization. Hepatic aery chemoembolization using (5-fluorouracil, doxorubicin, cisplatin, mitomycin) is effective in 60-75% of patients. Mammalian target of rapamycin (mTor) inhibitors (everolimus, rapamycin) are repoed to control the hypoglycemia in insulinoma. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 3062-65

Medicine

69c9bf99-0ec8-4dea-9f42-56bc83365ef5

In case of spasticity, the drug not used is:

valium

lioresal

zanaflex

Amitryptiline

3d

single

Spasticity is a condition in which ceain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and can interfere with normal movement, speech and gait.Spasticity is usually caused by damage to the poion of the brain or spinal cord that controls voluntary movement. Amitriptyline, sold under the brand name Elavil among others, is a medicine primarily used to treat a number of mental illnesses. These include major depressive disorder and anxiety disorders, and less commonly attention deficit hyperactivity disorder and bipolar disorder.

Pharmacology

Anesthesia

cd28460c-43bb-4bda-8e36-4fba19074536

Which of the following drug is used for long term maintenance in opioid addiction?

narcan

narcan

Butylphenol

dolophine

3d

single

Methadone has a long half life of 15-40 hours. Because of the extended duration of action it suppresses the withdrawal symptoms in dependent patients and is therefore used for long term maintenance in opioid addiction. Methadone is a slow-acting agonist of -opioid receptor. It is absorbed well from the GI tract and can be detected in plasma within 30 minutes of oral ingestion. Peak concentrations occur in brain within 1-2 hours of subcutaneous or intramuscular administration. It is primarily used for the relief of chronic pain, in the treatment of opioid abstinence syndromes, and for treating heroin users. Methadone causes prolongation of QT interval. It causes serious cardiac arrhythmias including torsade de pointes. Ref: Yaksh T.L., Wallace M.S. (2011). Chapter 18. Opioids, Analgesia, and Pain Management.

Psychiatry

37a45ec9-1b9e-4b50-b22a-e320f29e4caf

WHO recommended dose of cytotec I'm the treatment of post paum hemorrhage

400 mcg oral

600 mcg sublingual

800 mcg sublingual

1000 mcg oral

2c

single

Refer WHO recommendations for prevention and treatment of PPH 2012 Oxytocin is drug of choice for treatment and we'll as prevention of post paum hemorrhage Alternative are ergometrine, fixed dose combination of Oxytocin and ergometrine and misopristol Misopristol is recommended as 600 mg orally for prevention of PPH and 800 mg sublingually for treatment of PPH

Pharmacology

Endocrinology

3f792c42-3125-4091-b196-bb126606251a

Chemoprophy laxis with panmycin is useful in which of the following ?

Cholera

Brucellosis

Meningitis

Leptospirosis

0a

single

Ans. is 'a' i.e., Cholera o Tetracycline is the drug of choice for chemoprophylaxis in cholera and plague.

Social & Preventive Medicine

356bf4ca-968c-4e18-b583-1d9ce5b3531c

Which of the following is directly acting skeletal muscle relaxant -

dantrium

quelicin

pavulon

tracrium

0a

single

Ans. is 'a' i.e., Dantrolene Dantrolene is a directly acting skeletal muscle relaxant.

Pharmacology

33337a0e-ac92-4421-b656-10e039a3f68d

Antipyschotic drug-induced Parkinsonism is treated by -

Anticholinergics

dopar

emsam

symmetrel

0a

single

Ans. is 'a' i.e., Anticholinergics Parkisonism o Rigidity, tremor, hypokinesia, mask like facies, shuffling gate. o Between 1-4 weeks of therapy. o Treatment --> central anticholinergic (levodopa is ineffective).

Pharmacology

9731bf6e-93d6-4836-9db2-9fa41dc5054b

Antidotes for acute iron poisoning -

Desferrioxamine

Na disotate

BAL

cuprimine

0a

single

​​Desferioxamine is the antidote of choice in acute iron poisoning.

Forensic Medicine

0973a113-6ce8-4125-af0f-a998c949569c

All are true about Typhoid except -

Incubation period 10-14 years

Most common among males

Carrier are treated by penbritin

Highest incidence occur in 30-40 years age group

3d

multi

<p> Typhoid fever:- Typical continuous fever for 3-4 weeks,relative bradycardia with involvement of lymphoid tissue. Without effective treatment, typhoid kills over 10% of those infected. Causative agent- Salmonella typhi. S.paraA and S.paraB are infrequent. Reservoir- man Case - a case is infectious as long as bacilli appear in stools /urine. Carriers:- 1. Convalescent carriers-excrete bacilli for 6-8 weeks,after which their number dimnishes rapidly. 2. Chronic carriers- persons who excrete bacilli for more than a year after a clinical attack. In most chronic carriers,the organism persists in gall bladder and in biliary tract. Source of infection- faeces and urine of cases/carriers. Age group involved mostly is 5-19 yrs old. Males affected more than females. Incubation period- 10-14 days. Mode of transmission: faecal oral route/ urine oral routes. Treatment of carriers:- Intensive course of ampicillin/ amoxycillin (4-6g/day) together with probenecid for 6 weeks. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.235}</p>

Social & Preventive Medicine

Communicable diseases

d389b022-71aa-4f0b-8725-0457c31b1045

The following should be avoided in asthma patient

NSAID

brethine

elixophyllin

Steroids

0a

single

Aspirin and other painkillers. Approximately 10% to 20% of adults with asthma have sensitivity to aspirin or a group of painkillers called non-steroidal anti-inflammatory drugs -- or NSAIDS -- such as ibuprofen ( Motrin , Advil) and naproxen ( Aleve , Naprosyn ). Ref Davidson edition23rd pg 576

Medicine

Respiratory system

f4b8522b-53ed-4a81-b762-629eec40766f

Reaction occuring in conversion of norepinephrine to epipen-

Hydroxylation

Oxidation

Glucuronidation

Methylation

3d

single

Ans. is 'd' i.e., MethylationDopaTyrosine hydroxylase--------- Tyrosinase ..-------- DopaTyrosine|Dopa decarboxylase| | TyrosinaseDopamine Throxine (T4)Dopaquinone|b-oxidaseTriiodothyronine|(b-bydroxylase) NorepinephrineMelanin|N -methyl transferase (N-methylation)Epinephrine

Biochemistry

Amino Acid Metabolism

32b9f1fd-c646-46b0-b5b7-7d7b289c37ce

Not used for treatment of heroin detoxification: AIIMS 09, 10; AP 11

antabuse

Buprenorphine

catapres

Lofexidine

0a

single

Ans. Disulfiram

Forensic Medicine

7b9f525c-6bab-4201-a81b-362cfcc89c68

All of the following are Anticholinesteroses used in Alzheimer's disease except

Rivastimine

reminyl

namenda

aricept

2c

multi

Memantine is used to treat Alzeihmer's disease but it is not an anticholinesterase.It acts by blocking NMDA receptors.

Psychiatry

c43944ca-7007-47ed-8431-e0f25cbc2ee5

L.A. causing Meth Haemoglobinemia

novocaine

Prilocaine

Both

None

1b

multi

B i.e. Prilocaine

Anaesthesia

049afc6b-223f-47f3-b65f-f1a7c38f8628

All arc atypical antipsychotic drugs except

clozaril

Risperidone

zyprexa

Loxapine

3d

multi

Atypical antipsychotic Clozapine Risperidone Olanzapine Quetiapine Aripiprazole Ziprasidone Other hetrocyclics Pimozide, Loxapine Ref: K D Tripathi 8th edition

Pharmacology

Central Nervous system

2eaa1026-52f1-4cf2-80e4-7e27033594a4

Which of the following statements is true regarding enzyme inhibition?

Sulfonamides inhibit folate reductase irreversibily

Ethanol inhibits aldehyde dehydrogenase when used in methanol poisoning

Acetylcholinesterase inhibition by ovide can be reversed by increasing the levels of Acetylcholine

Fluoroacetate competitively inhibits Aconitase

3d

multi

Sodium flouroacetate compete with acetic acid and form flouroacetic acid .This inhibit TCAcycle by poisoning aconitase enzyme activity. Ref: Perspective in mycological research by Perspective in mycological research, The encyclopedia of nutrition and good health By Robe A. Ronzio page 436; Medical toxicology By Richard C. Da page 65.

Biochemistry

34eedcdd-49ad-4608-9e21-a8e156e5c66c

Which of the following drug is NOT used in the treatment of type II lepra reaction?

restasis

['thalomid']

lamprene

Coicosteroids

0a

single

Cyclosporine is not indicated in the treatment of type II lepra reaction. Patients with type II lepra reactions are given glucocoicoids. If ENL recurs or persists even after use of steroids, thalidomide is initiated with the dose depending on the severity of the reaction. Clofazimine in high doses has some efficacy against ENL. Patients with type I leprae reactions are best treated with glucocoicoids. Thalidomide is ineffective in its treatment. Clofazimine is of questionable benefit in type I leprae reactions, but in any event it is less efficacious than glucocoicoids. Ref: Gelber R.H. (2012). Chapter 166. Leprosy. 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.

Skin

17e283be-6891-4805-966a-eb41fcd84c7a

A 72-year-old man is prescribed esidrix for hypertension. Which of the following is the most likely symptomatic side effect?

increased serum potassium

metabolic acidosis

sexual impotence

respiratory alkalosis

2c

single

The most common symptomatic side effect in men is impotence, and it should be specifically looked for. The most serious complications relate to fluid and electrolyte imbalance and include hyponatremia, hypokalemia, and volume contraction.

Medicine

Endocrinology

4be1a00e-d743-41fd-a429-2c7fe04634dd

Following are hepatotoxic anesthetic agents except?

fluothane

Chloroform

Ether

diprivan

3d

multi

Ans. is `d' i.e., Propofol Zimmermann p. 458] Following are the groups of hepatotoxic anesthetic agents: Group I : Drugs with well known hepatotoxic potential and containing Chlorine or bromine. Eg: chloroform. Group II : Drugs which contain fluorine Eg: halothane, methoxyflurane. Desflurane, enflurane, sevoflurane, isoflurane, nitrous oxide and carbon tetrachloride are also linked with hepatotoxicity.

Anaesthesia

757a2626-1f43-4c39-83a8-3a6cae4768a5

Which of the following is not a front line antihypeensives -

vasotec

Hydrochlohiazide

norvasc

tenormin

3d

single

Ans. is 'd' i.e., Atenolol Firstlinean-Wnsivechli drugs o First line antihypeensive agents are the drugs, which are choosen for initiation of therapy. 1. Thiazide diuretics (e.g., Hydrochlohiazide) 2.ACE inhibitors (e.g., Enalapril) 3. Angiotensin H receptor antagonists 4. Calcium channel blocker (e.g., amlodipine) Beta blockers are not considered first line antihypeensives by JNC-VIII guidelines.

Pharmacology

f0fcbee1-39f5-40f3-ade5-af5f671cf454

,70yr old male with history of HTN and DM developed the following rhythm with Bp 90/ 40 mm Hg and feeble pulse what is the next step of management

IV adenosine

IV angiozem

DC cardioversion

Ibuteilide

2c

multi

ECG : SVT REF : HARISSONS 21ST ED

Medicine

All India exam

83339ca9-c3b7-470d-8846-b49acacfb311

The antibiotic panmycin:

Is bactericidal drug.

Is a safe drug for administration irrespective of age and sex of the patients.

Is also administered along with penicillin.

Is a broad-spectrum antibiotic.

3d

single

Tetracycline is bacteriostatic and has a broad spectrum of action.

Pharmacology

35306629-d356-46ff-9121-a9efd3d1f4ef

A diabetic patient developed cellulitis due to S.aureus, which was found to be methicillin re- sistant on the antibiotic sensitivity testing. All the following antibiotics will be appropriate except:

firvanq

Imipenem

Teichoplanin

zyvox

1b

multi

“Imipenam is not effective against Enterococcus faecium, MRSA, Clostridium difficle, Burkholderia cepacia as they produce metallobetalactmases" TREATMENT OF MRSA

Microbiology

90e79771-232d-4f0e-9d28-eecf0400a250

Anesthetic having epileptogenic potential?

ethrane

Nitrous oxide

suprane

isoflo

0a

single

Sevoflurane and enflurane may be associated with epileptiform activity on the EEG, especially at higher concentrations or when controlled hyperventilation is instituted. Seizure-like activity has been repoed in children during sevoflurane induction, but the clinical implications of these observations are not clear Basics of Anaesthesia 7e pg: 110

Anaesthesia

General anaesthesia

496465f1-88dd-45fc-aae3-7299017face6

Based on the given mechanism of action as shown in the Figure, Drug A is likely to be:

byetta

Vildagliptin

Canagliflozin

symlin

1b

single

Parasympathetic nerve supply is richly suuplied to Gastrointenstinal tract(GIT). It helps in peristalsis, digestion,motility and absorption of nutrients.

Pharmacology

Endocrine

0e3ddcd8-27f6-4c60-98e0-ec343bfaeb4e

A 17 year old girl had been taking a drug for the treatment of acne for the last 2 years, which has lead to pigmentation. Which drug could it be?

vibramycin

minocin

zithromax

largactil

1b

single

Both minocycline as well as chlorpromazine can cause pigmentation on long-term use. However, as the patient in question is being treated for acne, the answer should be minocycline. Antibiotics used in acne are erythromycin, clindamycin, tetracycline, doxycycline and minocycline.

Pharmacology

81609dcf-0288-4983-92d7-5dca8f5d2f73

danocrine is used in all of the following except :

Fibroadenosis of breast

Dysfunctional uterine bleeding

Pituitary adenoma

Endometriosis

2c

multi

Pituitary adenoma

Gynaecology & Obstetrics

d2176fdc-8141-482a-881a-fb792b531595

Acute attck of gout patient came with non tolerance to NSAIDS, which drug to be given

caplenal

Steroid

benemid

uloric

1b

multi

In Acute gout oral prednisolone(15-20mg daily) or intramuscular methylprednisolone(80-120mg daily) for 2-3 days are highly effective and are a good choice in elderly patients where there is an increased risk of toxicity with colchine and NSAID. Reference : Harrison20th edition pg 2567

Medicine

C.N.S

a4f34a13-973c-4cd4-91e1-b709eed154c5

Magnesium and neuromuscular - blockade: True statement

Reduction neuromuscular - blockade when magnesium is administered to patients

Interaction probably more pronounced with magnesium and norcuron

Accentuates blockades by nondepolorizing agents, not by depolarizing drugs

All of the above

1b

multi

Magnesium accentuates both depolarizing & non depolarizing Neuromuscular blocker. More so of non depolarizing neuromuscular blocker. Magnesium has a membrane stabilising effect at neuromuscular junction thus potentiation of effects of neuromuscular blocker.

Anaesthesia

Neuromuscular Blocker

0e644b63-d4d1-42be-a236-de495b1c9229

A young female, Rama with amenorrhea, infeility and galactorrhoea was treated with a drug that successfully restored ovulation and menstruation. Before being given the drug, the woman was carefully questioned about previous mental health problems, which she did not have. She was advised to take the drug orally. The drug used to treat this patient was probably:

parlodel

stimate

Human gonadotropin hormone

Leuprolide

0a

multi

Symptoms of the patient (amenorrhea, galactorrhea and infeility) points towards the diagnosis of Hyperprolactinemia. Bromocriptine--> D2 receptor agonist --> used in Rx(dopamine acts as prolactin release inhibiting hormone in the hypothalamus). Psychosis occurs due to excessive stimulation of D2 receptors (D2 blockers are used as typical antipsychotic drugs) and Bromocriptine can precipitate the symptoms in predisposed patients.

Pharmacology

Endocrine

936156ad-2af2-4e27-8567-593934c00eae

Which of the following is used as epidural anaesthetic agent commonly?

nesacaine

xylocaine

carbocaine

All of the above

3d

multi

Commonly used sho- to intermediate-acting agents for epidural anesthesia include, Chloroprocaine Lidocaine Mepivacaine Longer acting agents include, Bupivacaine Levobupivacaine Ropivacaine Ref: Butterwoh IV J.F., Butterwoh IV J.F., Mackey D.C., Wasnick J.D., Mackey D.C., Wasnick J.D. (2013). Chapter 45. Spinal, Epidural, & Caudal Blocks. In J.F. Butterwoh IV, J.F. Butterwoh IV, D.C. Mackey, J.D. Wasnick, D.C. Mackey, J.D. Wasnick (Eds), Morgan & Mikhail's Clinical Anesthesiology, 5e.

Anaesthesia

546370dc-b753-4dc2-bea4-8369a70b73a2

In pulpotomy, medicament used for preservation of pulp:

Calcium hydroxide

glutarol

Ferric sulphate

All of the above

3d

multi

Devitalisation Formocresol Mummifying paste Electrocautery Preservation Ca(OH)2, Fe2(SO4)3 Glutaraldehyde Regeneration Bone morphogenic protein Tricalcium phosphate

Dental

425c7e06-d807-4232-adae-247d80c325be

Hypercalcemia is caused by which drug :

Bumetanide

carospir

Thiazide

lasix

2c

single

Pharmacology

b6bf6641-1261-4000-946e-a21d6436f867

A 45-year-old woman underwent a modified radical mastectomy 4 years ago. She was treated for multiple bone metastases with endoxana, adriamycin, and adrucil for 6 months. She is complaining of exertion on exercise, swelling of the legs, and swelling around eyes in the morning. On examination, she has bilateral rales in the lungs, S1, S2 audible, S3, S4 gallop present. Her BP is 149/117 mm Hg, PR is 80/min, and RR is 18/min. What is the most likely cause for her cardiac condition?

Systolic dysfunction CHF

Drug induced cardiac toxicity

Metastatic cardiac disease

Pneumonia

1b

multi

Ans. is 'b' i.e. Drug-induced cardiac toxicity A woman with H/O doxorubicin intake and presenting with complaints of congestive cardiac failure suggests cardiac toxicity due to doxorubicin.Doxorubicin causes cardiac toxicity which can manifest either acutely with ECG changes, arrhythmias, and hypotension or be delayed, and present with congestive heart failure.Congestive cardiac failure occurs due to cardiomyopathy.About 5% of the patients who receive > 550 mg/m2 of doxorubicin will develop congestive cardiac failure.

Unknown

60b7eade-8aa8-44d7-a5a4-f53b7b5bc69b

Pancreatitis may be produced by following drug :

Colchcine

L-Asparaginase

proquin

Nalidixic acid

1b

single

Ans. is 'b' i.e. L-asparaginase

Surgery

b7ff30b1-7abf-4477-a142-c7834ffb1c10

Which of the following intravenous induction agent is the most suitable for day care surgery –

oramorph

ketalar

diprivan

valium

2c

single

Induction anaesthetic of choice → Propofol. Inhalation agent of choice (for maintenance) → Desflurane (1st choice), sevoflurane (2nd choice).

Anaesthesia

4255d8d0-8d16-4439-97b7-014178d36fdf

Regarding lasix, true is

Given by parental route only

Used in pulmonary edema

Acts at PCT

Causes hypercalcemia

1b

multi

Pharmacology

258c61d7-f9f3-4a5f-ac6a-151aa3aac628

38 year old hypothyroid female patient presents for uterine fibroid excision. She is 5’5” and weighs 60 kg. She ate at 8 PM the previous night and took synthroid tablet with sip of water in the morning. If the case is supposed to start at 8 AM, what is fluid deficit

1.5L

1.2L

1.4L

1.6L

1b

single

Remember 4:2:1 rule = for maintenance fluid, the first 10 kg should receive 4ml/hr, the second 10 kg of the patient should receive 2ml/hr and rest after that should receive 1ml/hr 40+20+40=100 Since patient was nil per orally for 12 hours = 12 * 100 = 1200ml is the fluid deficit.

Anaesthesia

3456bd4a-56cb-4199-bfd5-737316ee5670

Active form of Vitamin D is: March 2011, March 2013 (a, e, g)

Cholecalciferol

24, 25 hydroxy Vitamin D

1, 25 hydroxy Vitamin D (calcijex)

25, hydroxyl Vitamin D

2c

single

Ans. C: 1, 25 hydroxy Vitamin D (Calcitriol) Calcitriol (1, 25-DHCC) is the biologically active form of vitamin D Calcitriol/ 1, 25-dihydroxycholecalciferol/ 1,25-dihydroxyvitamin D3 It is the hormonally active form of vitamin D with three hydroxyl groups (abbreted 1,25-(OH)2D3 or simply 1, 25 (OH)2D). It increases the level of calcium (Ca2+) in the blood by (1) increasing the uptake of calcium from the gut into the blood, (2) decreasing the transfer of calcium from blood to the urine by the kidney, and (3) increasing the release of calcium into the blood from bone Calcitriol increases blood calcium levels () by promoting absorption of dietary calcium from the gastrointestinal tract and increasing renal tubular reabsorption of calcium thus reducing the loss of calcium in the urine. Calcitriol also stimulates release of calcium from bone by its action on the osteoblasts, causing them to release RANKL, which in turn activates osteoclasts. Calcitriol acts in conce with parathyroid hormone (PTH) in all three of these roles. For instance, PTH also stimulates osteoclasts. However, the main effect of PTH is to increase the rate at which the kidneys excrete inorganic phosphate (Pi), the counterion of Ca2+. The resulting decrease in serum phosphate causes Ca5 (PO4)30H to dissolve out of bone thus increasing serum calcium. PTH also stimulates the production of calcitriol. Many of the effects of calcitriol are mediated by its interaction with the calcitriol receptor, also called the vitamin D receptor or VDR.The maintenance of electroneutrality requires that the transpo of Ca2+ ions catalyzed by the intestinal epithelial cells be accompanied by counterions, primarily inorganic phosphate. Thus calcitriol also stimulates the intestinal absorption of phosphate.Calcitriol also inhibits the release of calcitonin, a hormone which reduces blood calcium primarily by inhibiting calcium release from bone. Calcitriol is produced in the cells of the proximal tubule of the nephron in the kidneys by the action of 25-hydroxyvitamin D3 1-alpha-hydroxylase, a mitochondrial oxygenase and an enzyme which catalyzes the hydroxylation of 25-hydroxycholecalciferol (calcifediol). The activity of the enzyme is stimulated by PTH. The reaction is an impoant control point in Ca2+ homeostasis. The production of calcitriol is also increased by prolactin, a hormone which stimulates lactogenesis, a process which requires large amounts of calcium.

Anatomy

6f95b352-df62-4d70-b9e4-8d1ade7c023d

Which of the following antibiotics is least Nephrotoxic?

Streptomycin

Gentamycin

Polymixin B

vibramycin

3d

single

Doxycycline is metabolized in the liver and excreted through the bile and not kidney and hence it is not nephrotoxic. Ref: KDT, 6th Edition, Pages 713, 721, 734; Drug Injury: Liability, Analysis and Prevention, 2nd Edition, Page 438

Pharmacology

b50e82a6-a4cf-4258-a78e-ce3280a30018

A dead body in casuality showed fine leathery froth coming out of the month and nostrils; and it comes out profusely on pressing the chest wall; cause is -

Drowning

oramorph poisoning

Strangulation

Dhatura poisoning

0a

multi

Fine lathery froth in mouth and nose which increases on chest compression → specific finding of drowning.

Forensic Medicine

744495ef-ee7e-47f8-ba02-550430cbda9f

Action of progesterone is

Increased sensitivity of uterus to oxoject

Inhibits LH secretion

Decreases basal body temperature

Causes proliferative changes in uterus

1b

single

Progesterone, hormone secreted by the female reproductive system that functions mainly to regulate the condition of the inner lining (endometrium) of the uterus. Progesterone is produced by the ovaries, placenta, and adrenal glands. Ref: guyton and hall textbook of medical physiology 12 edition page number:644,645,646

Physiology

Endocrinology

19c05a86-a0be-40df-bbe9-bbcfab348ca1

King&;s college criteria for ohotopic liver transplanation in acute liver failure (tylenol Induced) include all of the following except -

pH<7-30

PT>100s

Grade three encephalopathy

Serum bilimbin> 300 micromol\/L

0a

multi

<p>Davidson&;s principles and practice of medicine 22nd edition. *pH is <7.3 at or beyond 24 hours following the over dose. </p>

Medicine

G.I.T

55e6cf5c-fcf7-4ec2-b325-d8c5b0e9203a

Appetite is decreased by following, except:

ritalin

zyprexa

prozac

Seraline

1b

multi

Olanzapine

Pharmacology

c68e283c-c72f-41b1-8a1d-78ef772aab3c

All of the following drugs cause osteoporosis except: September 2011

Steroid

fosamax

synthroid

Heparin

1b

multi

Ans. B: Alendronate Biphosphonates are the first drug of choice for treating post-menopausal osteoporosis PLEASE NOTE: A biphosphonate (pamidronate or zolendronic acid) inhibits osteoclastic bone resorption and is paicularly useful in hypercalcemia of malignancy as well Osteoporosis In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered. Osteoporosis is defined by the World Health Organization (WHO) as a bone mineral density that is 2.5 standard detions or more below the mean peak bone mass (average of young, healthy adults) as measured by DXA; the term "established osteoporosis" includes the presence of a fragility fracture. The disease may be classified as primary type 1, primary type 2, or secondary. The form of osteoporosis most common in women after menopause is referred to as primary type 1 or postmenopausal osteoporosis. Primary type 2 osteoporosis or senile osteoporosis occurs after age 75 and is seen in both females and males at a ratio of 2:1. Finally, secondary osteoporosis may arise at any age and affects men and women equally. This form of osteoporosis results from chronic predisposing medical problems or disease, or prolonged use of medications such as glucocoicoids, when the disease is called steroid- or glucocoicoid-induced osteoporosis (SIOP or GIOP). Ceain medications have been associated with an increase in osteoporosis risk; only steroids and anticonvulsants are classically associated Steroid-induced osteoporosis (SIOP) arises due to use of glucocoicoids - analogous to Cushing's syndrome and involving mainly the axial skeleton. The synthetic glucocoicoid prescription drug prednisone is a main candidate after prolonged intake. Barbiturates, phenytoin and some other enzyme-inducing antiepileptics - These probably accelerate the metabolism of vitamin D. L-Thyroxine over-replacement may contribute to osteoporosis, in a similar fashion as thyrotoxicosis does. Anticoagulants - Long-term use of heparin is associated with a decrease in bone density, and warfarin (and related coumarins) have been linked with an increased risk in osteoporotic fracture in long-term use. Proton pump inhibitors - These drugs inhibit the production of stomach acid; it is thought that this interferes with calcium absorption. Chronic phosphate binding may also occur with aluminium-containing antacids. Thiazolidinediones (used for diabetes) - Rosiglitazone and possibly pioglitazone, inhibitors of PPAR-gamma, have been linked with an increased risk of osteoporosis and fracture. Chronic lithium therapy has been associated with osteoporosis The diagnosis of osteoporosis can be made using conventional radiography and by measuring the bone mineral density (BMD). The most popular method of measuring BMD is dual energy x-ray absorptiometry (DXA or DEXA). There are several medications used to treat osteoporosis, depending on gender. Medications themselves can be classified as antiresorptive or bone anabolic agents. Antiresorptive agents work primarily by reducing bone resorption, while bone anabolic agents build bone rather than inhibit resorption. Bisphosphonates are the main pharmacological measures for treatment. However, newer drugs have appeared in the 1990s, such as teriparatide and strontium ranelate. In confirmed osteoporosis, bisphosphonate drugs are the first-line treatment in women. The most often prescribed bisphosphonates are presently sodium alendronate, risedronate or ibandronate. Oral bisphosphonates are relatively poorly absorbed, and must therefore be taken on an empty stomach, with no food or drink to follow for the next 30 minutes. They are associated with inflammation of the esophagus (esophagitis) Estrogen replacement therapy remains a good treatment for prevention of osteoporosis. Selective Estrogen Receptor Modulators (SERMs) are a class of medications that act on the estrogen receptors throughout the body in a selective manner. Normally, bone mineral density (BMD) is tightly regulated by a balance between osteoblast and osteoclast activity in the trabecular bone. Estrogen has a major role in regulation of the bone formation-resorption equilibrium, as it stimulates osteoblast activity. Some SERMs such as raloxifene, act on the bone by slowing bone resorption by the osteoclasts. Raloxifene has the added advantage of reducing the risk of invasive breast cancer. Calcitonin works by directly inhibiting osteoclast activity the calcitonin receptor. Teriparatide (recombinant parathyroid hormone residues 1-34) has been shown to be effective in osteoporosis. It acts like parathyroid hormone and stimulates osteoblasts, thus increasing their activity. It is used mostly for patients with established osteoporosis (who have already fractured), have paicularly low BMD or several risk factors for fracture or cannot tolerate the oral bisphosphonates. Calcium salts come as water insoluble and soluble formulations. Calcium carbonate is the primary water insoluble drug, while calcium citrate, lactate, and gluconate are water soluble. Sodium fluoride treatment in patients with osteoporosis has been shown to cause skeletal changes such as pronounced bone density with increased number and thickness of trabeculae, coical thickening, and paial obliteration of the medullary space. Denosumab is a fully human monoclonal antibody that mimics the activity of osteoprotegerin. It binds to RANKL, thereby preventing RANKL from interacting with RANK and reducing its bone resorption. Oral strontium ranelate is an alternative oral treatment, belonging to a class of drugs called "dual action bone agents" (DABAs). Strontium ranelate has side effect benefits over the bisphosphonates, as it does not cause any form of upper GI side effect, which is the most common cause for medication withdrawal in osteoporosis. Calcium is required to suppo bone growth, bone healing and maintain bone strength and is one aspect of treatment for osteoporosis. A high intake of vitamin D reduces fractures in the elderly It did increase formation of kidney stones by 17%. Calcium and vitamin D are currently recommended for the primary prevention of osteoporosis and the primary and secondary prevention of osteoporotic fractures.

Pharmacology

bbe0bc36-a308-4aba-8e76-da8b618b8bfc

Regarding Giardiasis, all of the following options are true except

Diarrhea with steatosis

Bloody diarrhea

flagyl is the drug of choice

Absence of fever

1b

multi

Ans. is 'b' i.e., Bloody diarrhea Giardiasis o Most of the infected patients are asymptomatic. o Giardia causes diarrhea arid malabsorption. Malabsorption is due to loss of brush border enzyme activities, which cause fat malabsorption (steatorrhea) and vitamin deficiency, o There may be abdominal pain, bloating, nausea & vomiting, flatulence and flatus. o The mechanisms by which Giardia causes an alteration in small bowel function are largely unknown. Although trophozoites adhere to the epithelium, they do not cause invasive or locally destructive alterations. o Fever; the presence of blood or mucus in the stools suggest a different diagnosis as all these are absent in giardiasis. o Giardia may also cause traveler's diarrhea. o Predisposing conditions to giardiasis are agammaglobulinemia, common variable immunodeficiency, and selective IgA-deficiency. Diagnosis and treatment o The gold - standard for diagnosis of giardiasis is the microscopic demonstration of the trophozoite, cyst or both in feces. o Duodenal aspirate or jejunal biopsy may be required for diagnosis. o In acute giardiasis trophozoites show the typical ''falling-leaf' motility in wet mount examination of feces, o Metronidazole and tinidazole are the drug of choice for Giardia lamblia.

Unknown

658bc4c5-2497-4841-b27d-034913175a9e

The drug that should be used for prophylaxis of close contacts of a patient suffering from meningococcal meningitis is

Rifampicin

aczone

staticin

amikin

0a

single

Ref-KDT 6/e p729 Rifampicin and ciprofloxacin are used for the prophylaxis of meningococcal meningitis

Anatomy

Other topics and Adverse effects

55a690cf-e420-4a5b-8ba5-e9cd0d2d229f

Which of the following anti-tubercular drug can cause hypothyroidism?

seromycin

trecator

INH

Rifampicin

1b

single

Ethionamide and PAS are associated with hypothyroidism ADVERSE EFFECTS OF SECOND LINE ATD: Thioacetazone (tuberculostatic drug): Hepatitis, bone marrow suppression and Steven Johnson syndrome. Para amino salicylic acid (PAS) can cause kidney, liver and thyroid dysfunction. Ethionamide can cause hepatitis, optic neuritis and hypothyroidism. Cycloserine can cause neuropsychiatric adverse effects. Kanamycin, Amikacin and Capreomycin can cause ototoxicity, nephrotoxicity, hypokalemia and hypomagnesemia. Rifabutin commonly causes gastrointestinal adverse effects. Rarely, it can cause anterior uveitis, clostridium difficile-associated diarrhea, diffuse polymyalgia syndrome, yellow skin discoloration (Pseudo-jaundice) and pancytopenia.

Pharmacology

Mycobacterial Diseases (TB, Leprosy and MAC)

404be195-b477-46fa-83b4-63d059d7f9bc

xenazine acts by inhibiting

MAO-B

Vesicular monoamine transpoer

Dopamine D2 receptors

COMT

1b

single

Tetrabenazine: Inhibit VMAT 2(vesicular monoamine transpoer), which transpo dopamine and norepinephrine into adrenergic vesicle in nerve ending. Use for treatment of chorea in Huntington and tardive dyskinesia. In above figure: Pharmacologic strategies for dopaminergic therapy of Parkinson's disease. Drugs and their effects are indicated (see text). MAO, monoamine oxidase; COMT, catechol-O-methyltransferase; DOPAC, dihydroxyphenylacetic acid; L-DOPA, levodopa; 3-OMD, 3-O-methydopa; 3-MT, 3-methoxytramine.

Pharmacology

JIPMER 2017

ca44e858-7f2d-4e4e-bf55-d0f56080385b

Which among the following is a Transcription inhibitor?

chloromycetin

Streptomycin

Puromycin

Amanitin

3d

single

The inhibitors of transcription and its action is very impoant in the entrance exams. Rifampicin: bind beta subunit of polymerase Actinomycin D: inhibit elongation of RNA strands by inhibiting RNA polymerase Streptoglydin Heparin Alpha-Amanitin blocks the translocation of RNA polymerase during transcription Ref: Harper, 27th Edition, Page 351

Biochemistry

5282149b-8194-485e-ac2f-990ef7b51f67

Which does not act by blocking NMDA receptors?

Methoxetamine

dolophine

ketalar

angiozem

3d

single

Ans. is 'd' i.e., Diltiazem Drugs acting by blocking NMDA receptors are: Methoxetamine Phencyclidine Methadone Dizocilpine Felbamate Dextropropoxyphene Acamprost Tramadol Ketamine Pethidine Atomoxetine Nitrous oxide

Pharmacology

43fa63c1-2364-45a0-8f27-ebc16b0b8c97

Heart rate is decreased by:

inderal

Isoprenaline

Dopamine

dobutrex

0a

single

Pharmacology

1d6363d1-73f0-4c57-a1bf-ba911adb6ab9

A 57-year-old woman is complaining of frequent headaches and scalp tenderness. She also has arthralgias, fatigue, and discomfort in her jaw when she chews. On examination, her head and neck is normal, but the right temporal artery is tender on palpation. Her erythrocyte sedimentation rate (ESR) is 50 mm/h and hemoglobin 10.5 g/dL. A temporal artery biopsy is obtained for diagnostic confirmation. Which of the following is the most appropriate next step in management?

intravenous high-dose steroids

acetylsalicylic acid

indocin

low-dose (deltasone 40 mg/day) steroids by mouth

3d

multi

The response of pain, stiffness, and headaches to 40-60 mg of prednisone is dramatic in giant cell arteritis. The duration of treatment is not known but most patients require treatment for more than 2 years. ESR is used to monitor response to therapy. Patients need treatment and evaluation for the complications of long-term steroid use such as osteoporosis and diabetes.

Medicine

Miscellaneous

29d30426-b7b5-4c3b-812f-9051f43e06c7

Rain drop pigmentation is caused by -

lamprene

aczone

minocin

Arsenic

3d

single

Ans. is 'd' i.e., ArsenicDrugs causing hyperpigmentationDrugsType of pigmentationo Clofazimineo Psoralenso Minocyclineo Bleomycino Busulfano Cyclophosphamideo Dapsoneo ArsenicOrange pigmentationBrown pigmentationBlue black discoloration in healing acnelesions, shins & mucosaGeneralized hyperpigmentationGeneralized hyperpigmentationGeneralized hyperpigmentationRain drop pigmentation

Skin

Disorders of Hyperpigmentation

a985717c-801a-4e5a-a379-8f9aa0aa1c59

Which of the following antihypeensive drug is not given in pregnancy

vasotec

Alpha methyl dopa

LabetoLol

adalat

0a

single

ACE inhibitor like Enalapril is contraindicated in pregnancy. These are teratogenic drugs. Other drugs given in the option are safe in pregnancy Refer Goodman and Gilman p736

Pharmacology

Cardiovascular system

78e844a6-50d4-4466-a2a4-eb8ec270df93

Which one of the following drugs is not a reversible anticholinesterase drug?

tensilon

Demecarium

Carbaryl

Twine

2c

single

Pharmacology

5703b2bc-7e4c-4271-98ea-5d307cc8beb6

Only nitrate not undergoing first pass metabolism is

glytrin

monoket dinitrate

monoket mononitrate

None of the above

2c

multi

Isosorbide mononitrate does not undergo first pass metabolism.

Pharmacology

5b6eae06-5136-41d8-8bfd-d44c572c6390

The drug used for first-trimester abortion is:

Oral mifeprex

Intra–amniotic saline

Extra–amniotic ethacridine lactate

oxoject infusion

0a

single

Pharmacology

58e369ed-0ef3-4e9f-97cd-ad3db4cb8fe5

A 31 year old HIV-positive man develops a severe pneumonia. Lower respiratory tract secretions obtained by fiberoptic bronchoscopy with bronchoalveolar lavage and stained with hiprex silver stain demonstrate cup-shaped cysts with sharply outlined walls. Which of the following organisms is the most likely pathogen in this case?

Candida albicans

Giardia lamblia

Haemophilus influenzae

Pneumocystis carinii

3d

multi

The organism described is Pneumocystis carinii, which is an oppounistic parasite that appears to be more closely related to fungi than to protozoa. Its cyst form, when stained with silver stains, has the distinctive appearance described in the question stem, and is typically found in frothy material that occupies the lumen of alveoli. The trophozoites are smaller and much harder to recognize. Bronchoalveolar lavage is considered much more reliable than induced sputum as a diagnostic specimen. Pneumocystis pneumonia is a common infection among AIDS patients, and is very uncommon in other clinical settings. Formerly, many AIDS patients died with Pneumocystis pneumonia, but the combination of early drug treatment (with trimethoprim/sulfamethoxazole or pentamidine) and prophylaxis (usually with trimethoprim/sulfamethoxazole) has decreased the number of fatal infections. In severe cases, Pneumocystis infection can sometimes be demonstrated in extrapulmonary sites. Candida albicans(choice A) can infect the lung and stain with methenamine silver, but the description of the lavage material would probably include the terms fungal hyphae and yeast forms. Giardia lamblia (choice B) causes diarrhea, rather than pneumonia. Haemophilus influenzae(choice C) and Streptococcus pneumoniae(choice E) are bacteria and would not stain with silver stains. Ref: Levinson W. (2012). Chapter 52. Blood & Tissue Protozoa. In W. Levinson (Ed),Review of Medical Microbiology & Immunology, 12e.

Microbiology

4938f254-fc3a-423f-9ad5-28ad31e724f9

exelon and aricept are drugs used predominantly in the management of

Depression

Dissociation

Delusion

Dementia

3d

single

In dementia, specific drug treatment such as cholinesterase inhibitors (e.g. donepezil, rivastigmine, galantamine) in moderate Alzheimer&;s disease, or memantine (NMDA antagonist) in moderate to severe Alzheimer's disease, can be helpful. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 26

Psychiatry

Organic mental disorders

901c10b9-11b9-4252-b634-6e42d8e1fe59

nydrazid child dose in DOTS regimene (RNTCP)-

10-15 mg/kg/dg

15-20mg'kg'dg

20-25 mg/kg/dg

5-10mg'kg'dg

0a

single

Ans. is 'a' i.e., 10 -15 mg/kg/dgTreatment scheduleCategory-1:Newly diagnosed sputum positive pulmonary tuberculosisSputum negative pulmonary tuberculosis with extensive parenchymal involvement,Severe form of extrapulmonary tuberculosisCategory-2 :#Treatment failure casesRelapse casesReturn after interruptionCategory-3# sputum negative pulmonary tuberculosis with minimal involvementLess severe form of extrapulmonary tuberculosisDrug Regimen# Category- 1: 2 (H3 R3 Z3 E3) 4 (H3 R3)# Category- 2: 2 (S3 H3 R3 Z3 E3) + 1 (H3 R3 Z3 E3) 5 (H3 R3 E3) # Category- 3: 2 (H3 R3 Z3) 4 (H3 R3)DrugDose in mg thrice a week) in adultsDose in mg per kg bodyweight (thrice a week) in childrenIsoniazid60010-15Rifampiein45010Pyrazinamide150035Ethambutol120030Streptomycin75015

Pediatrics

Mycobacterial Infections

e5fe13ff-a63d-4d55-bf95-ff33551ac440

Drug used for midtrimester abortion is -

mifeprex

Atosiban

Valethamate

trexall

0a

single

Ans. is 'a' i.e., Mifepristone Mid trimester Termination of Pregnancy:A) Medical Methods: o Prostaglandins:a) Misoprostol (PGE1 analogue) with or without Mifepristone.b) Gemeprost(PGEl analogue)c) Dinoprostone (PGE2 analogue)d) Carboprost (PGF2 alpha)o Oxytocin : High dose oxytocin is used as a single agent for second trimester abortion.B) Surgical methods:i) Between 13 -15 weeks :# Dilatation and Evacuation :o Intracervical tent (laminaria osmotic dilator), mifepristone or misoprostol are used as cervical priming agents.ii) Between 16-20 weeks :# Intra - amniotic instillation of hypertonic saline : Amount of saline = weeks of gestation x 10 ml.# Intra - amniotic instillation of hyperosmotic urea: intra - amniotic instillation of 40% urea solution (80 gm of urea in 200 ml of distilled water).# Extra - amniotic instillation of 01% ethacrydine lactate - done trancervically through No. 16 Foley's catheter.

Gynaecology & Obstetrics

Midtrimester Abortion

d4168c37-1084-4724-ac5d-ec5c76978dad

Coenzyme for phenylalanine hydroxylase is -

Tetrahydrofolate

Pyridoxal phosphate

S-adenosyl methionine

kuvan

3d

single

Ans. is 'd' i.e., Tetrahydrobiopterino Phenylalanine metabolism is initiated by its oxidation to tyrosine which then undergoes oxidative degradation.

Biochemistry

Amino Acid Metabolism

8e1b6ec6-0e8b-4749-8f9f-3996b6308c0a

Ototoxicity and nephrotoxicity are characteristic adverse effects of wof

chloromycetin

Fluoroquinolones

b-Lactam antibiotics

Aminoglycosides

3d

single

Aminoglycoside Antibiotics SHARED TOXICITIES The aminoglycosides produce toxic effects which are common to all members( include ototoxicity, nephrotoxicity), but the relative propensity differs Ref:- kd tripathi; pg num:-744

Pharmacology

Antibiotics

b4a337d5-118e-4e19-a0b9-c1afd27987c7

Which of the following antihelmintic acts by producing flaccid paralysis of the worm?

Quinacrine

Diethylcarbamazine

vermox

Piperazine

3d

single

Anti-helminthic drugsAnti-helminthicMechanism of actionParasites susceptibleMebendazole Inhibits polymerization of b-tubulin of susceptible worms - live worms expelled Roundworm, Hookworm, Whipworm, Pinworm, Trichinella spiralis Pyrantel palmate Inhibits cholinesterase in worms - persistent depolarization - spastic paralysis - live worms expelledAscaris, Enterobius, Ancylostoma, Strongyloides Piperazine Hyperpolarization of muscle by GABA agonistic action - flaccid paralysis - live worms expelledAscaris, Enterobius Ivermectin Potentiates glutamate-gated Cl- channel & increases GABA transmission in worms - hyperpolarization and paralysis of worms - dead worms expelledPediculosis, Scabies, Onchocerca, Strongyloides, Ascaris, Cutaneous larva migrans Praziquantel Increased muscular contraction & spastic paralysis of worms - dead worms expelledTrematode, Cestodes Levamisole &Tetramisole Ganglionic stimulation - tonic paralysis - live worms expelledAscaris, Ancylostoma, Strongyloides Diethyl carbamazepine Hyperpolarization of muscles - live worms expelledMicrofilaria of bancrofti, malayi, Loa loa, Onchocerca Niclosamide Inhibits oxidative Phosphorylation in mitochondria Cestodes (Refer: Rang and Dale's Clinical Pharmacology, 7th edition, pg no: 670)

Anatomy

All India exam

3d290869-74da-4a43-addd-d0826cfaadfa

IV dose of 1:10000 concentration of epipen in the preterm baby is

0.1 ml

0.2 ml

0.3 ml

0.4 ml

1b

single

EpinephrineThe IV dose of 1:10000 concentration is 0.1 ml/kg. thus it is about 0.5 ml for term baby and 0.2 ml for the preterm babyEndotracheal tube dosing is 1ml/kg thus it is about 3ml for term baby and 1 ml for preterm(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 246)

Anaesthesia

All India exam

f82a3492-0c8b-4fc5-9893-e356992cc985

Which of the following drug do not have anti-inflammatory effect?

advil

tylenol

zorvolex

Aspirin

1b

single

Ans. B. ParacetamolIbuprofen is propionic acid derivative which are used in pediatric patients for PDA. Paracetamol do not possess anti-inflammatory properties as they are not active in presence of peroxides which are produced at site of inflammation. Both aspirin and diclofenac have anti-inflammatory properties.

Pharmacology

Adverse Drug Effect