diff --git "a/Unknown.jsonl" "b/Unknown.jsonl"
new file mode 100644--- /dev/null
+++ "b/Unknown.jsonl"
@@ -0,0 +1,184 @@
+{"question": "This graft is", "exp": null, "cop": 2, "opa": "Nontextile synthetic", "opb": "Textile synthetic", "opc": "Nontextile biologic", "opd": "Textile biologic", "subject_name": "Unknown", "topic_name": null, "id": "18924ae1-c293-4f1a-b8e5-f73955a14724", "choice_type": "single"}
+{"question": "Not a tumor marker", "exp": "Ans. d (Alpha-1 antitrypsin). (Ref. Robbins, Pathologic Basis of Disease, 6th/pg.325) Alpha-1 Antitrypsin Blood Levels as Indicator for the Efficacy of Cancer Treatment Ref- Our data came to confirm this suggestion and to strongly conclude that the measurement of a1-AT blood levels during the course of cancer treatment has a valuable clinical significance as an indicator for the efficacy of treatment. Tumor markers Malignancy 1 AFP (5-fetoprotein) - Normally made by fetus. - Hepatocellular carcinomas. - Nonseminomatous germ cell tumors of the testis (e.g., yolk sac tumor). 2 b-hCG - Hydatidiform moles, - Choriocarcinomas, and - Gestational trophoblastic tumors. 3 Inhibin - Granulosa cell tumor 4 CEA - Nonspecific but produced by 70% of colorectal and pancreatic cancers; - Also produced by gastric and breast carcinomas. 5 Ca 125 - Malignant Epithelial ovarian tumors 6 PSA - Ca prostate 7 TRAP (Tartrate-resistant acid phosphatase) - Hairy cell leukemia (a B-cell neoplasm) 8 b2-Macroglobulin - Multiple myeloma 9 VMA - Pheochromocytoma 10 5-HT - Carcinoid tumor 11 5-HIAA - Carcinoid tumor 12 LDH - GCT, seminoma 13 CA-19-9 - Pancreatic adenocarcinoma. 14 Bombesin - Neuroblastoma, lung and gastric cancer. 15 Alkaline phosphatase - Metastases to bone, - Obstructive biliary disease, - Paget's disease of bone. 16 S-100 - Melanoma, neural tumors, astrocytomas.", "cop": 4, "opa": "Tartarate resistant alkaline phosphatase", "opb": "CEA", "opc": "AFP", "opd": "Alpha-1 antitrypsin", "subject_name": "Unknown", "topic_name": null, "id": "c34ffe33-7feb-42de-a781-639642d8ab59", "choice_type": "single"}
+{"question": "The most likely diagnosis is", "exp": "This is a typical presentation of stage IV neuroblastoma, with the primary tumor arising from orie of the paravertebral sympathetic ganglia and metastasizing to bone marrow, cortical bone, and the retro orbital tissues. Histiocytosis X may have a somewhat similar presentation and involve multiple bones, but it usually involves one rather than both orbits; the right flank mass and tumor clumps in the marrow of this patient also are not characteristic\" of histiocytosis X. Rhabdomyosarcoma may arise in the orbit but usually is unilateral; the tumor also rarely is associated with systemic metastases at initial diagnosis. Wilms tumor would produce a right renal rather than suprarenal mass and would metastasize to the lungs rather than to bone and bone marrow. Lymphoblastic lymphoma usually arises in the anterior mediastinum or peripheral node's. Even if it were to present with widespread dissemination, abdominal rather than thoracic disease would be unusual and Lymphoblasts rather than tumor clumps would be seen in the marrow.", "cop": 3, "opa": "Histiocytosis X", "opb": "Rhabdomyosarcoma", "opc": "Neuroblastoma", "opd": "Wilms tumor", "subject_name": "Unknown", "topic_name": null, "id": "5663a055-bef3-463a-82d5-6237c8874a59", "choice_type": "single"}
+{"question": "Hypersensitivity vasculitisis seen most commonly in", "exp": "HYPERSENSITIVITY VASCULITIS\nIn hypersensitivity vasuculitis, postcapillaryvenules are the most commonly involved vessels, capillaries and arterioles are involved less frequently.\nIt is primarily a disease of small vessels.\nIt is characterized by leukocytoclasis, a term that refers to the nuclear debris remaining from the neutrophils that have infiltrated in and around the vessels during the acute stages.", "cop": 1, "opa": "Post capillary venules", "opb": "Arterioles", "opc": "Veins", "opd": "Capillaries", "subject_name": "Unknown", "topic_name": null, "id": "f32952db-07e6-4160-91e2-cc86b3147f3b", "choice_type": "single"}
+{"question": "Age of eruption of Permanent 1st molar", "exp": "Ans. is 'a- i.e., 6 years Eruption of temporary teeth (Primary' dentition) Tooth Age in range (months) Average age (months) Lower Cl Upper Cl UpplerLI Lower LI I molar Canine II molar 6-8 7-9 7-9 10-12 12-14 17-18 20-30 7 8 8 11 13 17[?]5 25 Eruption of permanent teeth (Secondary dentition) Age in range (years) Average age (years) First Molar Central incisor Lateral incisor First PM Second PM Canine Second Molar Third molar 6-7 7-8 8-9 9-11 10-12 11-12 12-14 17-25 6[?]5 7 8 10 11 11 5 13 17", "cop": 1, "opa": "6 years", "opb": "8 years", "opc": "10 years", "opd": "12 years", "subject_name": "Unknown", "topic_name": null, "id": "4175ae32-f5e4-4fb1-8f75-51eafb135e11", "choice_type": "single"}
+{"question": "In the central nervous system (CNS), oligoden¬drocytes share a similar function with", "exp": "Oligodendrocytes in the central nervous system (CNS) share a similar function with Schwann cells in the peripheral nervous system-synthesis of myelin. Oli­godendrocytes are small, round, lymphocyte-size cells that produce and maintain CNS myelin, which is primarily located in the white matter. Certain diseases, such as progressive multifocal leukoencephalopathy, caused by a papovavirus, specifically attack oligoden­drocytes and produce demyelination. Oligodendrogli­omas are malignant tumors that are derived from oligo­dendrocytes. However, unlike Schwann cells, oligodendrocytes contribute segments of myelin sheaths to more than one axon.\nGemistocytes are reactive astrocytes that have an eosinophilic cytoplasm. They are commonly seen along the periphery of cerebral infarctions. Some astro­cytomas have a gemistocytic appearance.\nAstrocytes provide the structural framework for the neurons and are analogous to the fibroblasts in connec­tive tissue. However, scarring in the brain is not associ­ated with collagen synthesis but with filling in the defect with the cellular processes of astrocytes. A cere­bral abscess is the only example of CNS repair with collagen, which is derived from the blood vessels.\nMicroglial cells are derived from monocytes. They are the phagocytic cell of the CNS.\nEpendymal cells line the ventricles of the brain and the spinal canal. They do not produce CSF nor are they responsible for reabsorption of CSF, a function relegated to arachnoid cells.", "cop": 3, "opa": "Gemistocytes", "opb": "Astrocytes", "opc": "Schwann cells", "opd": "Microglial cells", "subject_name": "Unknown", "topic_name": null, "id": "ee0ce131-2ec3-4ae4-92a8-193be0f3ca9d", "choice_type": "single"}
+{"question": "A patient with diarrhea has a fecal smear that is negative for leukocytes. The patient's diarrhea is most likely caused by", "exp": "The enterotoxigenic strain of Escherichia coli secretes a heat-labile toxin that stimulates adenylate cyclase, producing a cholera-like syndrome that is responsible for the majority of cases of traveler's diarrhea. Because the bowel mucosa is not invaded and there is no toxin-induced damage, the fecal smear is negative for leukocytes. Campylobacter enteritis, shigellosis, ty­phoid fever, and amebiasis are all invasive, and infected individuals have stools with inflammatory cells. Ty­phoid fever is unique because the inflammatory cells are not neutrophils, but mononuclear cells.", "cop": 4, "opa": "Campylobacter enteritis", "opb": "Shigellosis", "opc": "Typhoid fever", "opd": "Enterotoxigenic Escherichia coli", "subject_name": "Unknown", "topic_name": null, "id": "e371d146-de5d-45c9-9044-d4207bba4b7f", "choice_type": "single"}
+{"question": "Folic acid is absorbed from", "exp": "Ans- D Proximal Jejunum", "cop": 4, "opa": "Duodenum", "opb": "Stomach", "opc": "Ileum", "opd": "Proximal Jejunum", "subject_name": "Unknown", "topic_name": null, "id": "48be3d83-52e7-4f55-ad1e-67ea1cf13a8d", "choice_type": "single"}
+{"question": "A child has no criminal responsibility if the age is less than", "exp": "Ans. is 'b' i.e., 7 years", "cop": 2, "opa": "5 years", "opb": "7 years", "opc": "12 years", "opd": "18 years", "subject_name": "Unknown", "topic_name": null, "id": "c93fcefb-37f2-4f8c-96fd-feeab9ac0d87", "choice_type": "single"}
+{"question": "A child with a constellation of finding including fever, disabling arthritis, rash, and blindness is MOST likely suffering form", "exp": "A child with a constellation of findings including fever, disabling arthritis, rash, and blindness is most likely suffering from juvenile rheumatoid arthritis (JRA). JRA is characterized by a chronic synovial inflamma­tion of unknown origin; it most commonly affects the knees, but can also manifest in wrists, ankles, and the atlanto-axial joint in the neck. In general, JRA is more common in girls than boys, but this varies with the type of JRA, which can be divided into the following variant subsets: Still disease (20%), polyarticular (40%), and pauciarticular (40%). Still disease most closely resembles an infectious disease, with spiking fever, a centripetal rash, generalized lymphadenopathy, hepatosplenomegaly, transient arthralgias and ar­thritis, and effusions (pericardial and pleural). The polyarticular variant is associated with destructive ar­thritis, particularly if the patient tests positive for the rheumatoid factor. The pauciarticular variant features polyarthritis and inflammation of the anterior uveal tract 10%-50%), which predisposes the patient to visual loss and blindness. In most cases of JRA, with the exception of the polyarticular variant, the rheumatoid factor is negative. Anemia and leukocytosis are noted in acute attacks. Aspirin is the major anti-inflamma­tory agent that is used for treatment. Regarding the other choices in the question:\n\nrheumatic fever features polyarthritis, but it is not destructive\nLyme disease displays many of these findings, but blindness is not a key feature\nHenoch-Schoenlein vasculitis has palpable purpura, non-disabling arthritis, but is not associated with blindness\ndermatomyositis does not usually involve the joints", "cop": 3, "opa": "Rheumatic fever", "opb": "Lyme disease", "opc": "Juvenile rheumatoid arthritis", "opd": "Henoch-Schoenlein vasculitis", "subject_name": "Unknown", "topic_name": null, "id": "cb0d65e3-9f0b-41df-b2b0-822272e9c8d5", "choice_type": "single"}
+{"question": "The line joining ant. sup iliac spine to ischial tuberosity and passes a greater trochanter", "exp": "Ans. is 'a' i.e Nelaton's line Maheshwari 3/e p 310(2/e, p299)] Nelaton's line : With the hip in 90 degrees of flexion, a line joining the ASIS and ischial tuberosity passes through the tip of the greater trochanter on that side. In cases of subtrochanteric shortening, the trochanter will be proximal to this line. Shoemaker's line: With the patient lying supine, the line joining AS1S and tip of the greater trochanter is extended on the side of the abdomen on both sides. Normally these lines meet in the middle above the umbilicus. In case one of the greater trochanters has migrated proximally the lines will meet in the opposite side of the abdomen and below the umbilicus. Chiene's line : With the patient lying supine, lines are drawn joining the two AS1S and the two greater trochanters. Normally these make two parallel lines. In case one of the trochanters has moved proximally the lines will converge on that side. Perkin's line : When the cong. Dislocation of the hip is mild in nature, the Perkins lines are drawn to detect it. A horizontal line is drawn through the triradiate cartilage and a vertical line is drawn down from the outer edge of the acetabulum on both sides. The upper femoral epiphyses normally lies medial to the vertical line and below the horizontal line. But in cong. dislocation of hip the epiphyses will lie on the outer aspect of the vertical line and above the horizontal line. Bryant's triangle : The patient lies supine. The tips of the greater trochanter and ASIS on both sides are marked. A perpendicular is dropped from each ASIS on to the bed. From the tip of the greater trochanter, another perpendicular is dropped on to the first one. The tips of the greater trochanter are joined to the ASIS on the respective side. This forms a triangle ABC. The side BC of the triangle measures supra trochanteric shortening of hip.", "cop": 1, "opa": "Nelaton's line", "opb": "Showmakers line", "opc": "Chiene's line", "opd": "Perkins line", "subject_name": "Unknown", "topic_name": null, "id": "0edbc4a9-c403-4ede-bfb5-4c0ea67b4a2a", "choice_type": "single"}
+{"question": "Maximum refractive index is in ......... component of eye", "exp": "Ans- C Refractive index of various eye partsa. Cornea-1.376b. Aqueous humor-1.335c. Lenscortex 1.39d. Lens nucleus : 1.41e. Vitreous humor-1.336", "cop": 3, "opa": "Anterior surface of lens", "opb": "Posterior surface of lens", "opc": "Centre of lens", "opd": "Cornea", "subject_name": "Unknown", "topic_name": null, "id": "245bbbd3-8f83-4983-98fe-f35eadbc486f", "choice_type": "single"}
+{"question": "Cytosolic cytochrome C plays an important function in", "exp": "Ans. is 'a' i.e. Apoptosis Apoptosis is a programmed cell death.Mechanism of ApoptosisApoptosis is induced by a cascade of molecular events that may be initiated in distinct ways but culminate in the activation of caspases.Caspases are central to the pathogenesis of apoptosisThe process of apoptosis is divided into two phasesInitiation phase - During this phase caspases become catalytically activeExecution phase - During this phase caspases act to cause cell death.Initiation phase of apoptosisInitiation of apoptosis occurs principally by signals from two distinct but convergent pathwaysExtrinsic or receptor-initiated pathwayIntrinsic or mitochondrial pathwayExtrinsic or death receptor-initiated pathwayThis pathway is initiated by expression of cell surface death receptors on a variety of cells.Death receptors are members of tumor necrosis factor receptor family that contain a cytoplasmic domain involved in protein-protein interactions that are called death domain because it is essential for delivering apoptotic signals (or death signals)The best-known death receptors are the type 1 TNF receptor (TNFRI) and a related protein called Fas (CD95).When the Fas receptors are cross-linked by its ligand it triggers a sequence of events which eventually leads to activation of caspases.This pathway of apoptosis can be inhibited by a protein called FLIP, which can bind to inactive or procaspases but cannot cleave and activate these enzymes.The intrinsic mitochondrial pathwayThis pathway has no role for death receptors.This pathway is the result of increased mitochondrial permeability and the release of proapoptotic molecules in the cytoplasm.Note that antiapoptotic proteins reside in the mitochondrial membrane (Bcl-2 and Bcl-X).When cells are deprived of survival signals or subjected to stress Bcl-2 and Bcl-X are lost from the mitochondrial membrane and are replaced by proapoptotic members of the family such as Bak, Bax, and Bim.This leads to increase in the permeability of the mitochondrial membrane.Due to increased permeability of the mitochondrial membrane, several proteins that can activate the caspase leak out.One of these proteins is cytochrome C, well known for its role in mitochondrial respiration.In the cytoplasm, cytochrome binds to a protein called Apaf-1 (apoptosis-activating factor-1) and the complex activates caspase.* So, the final result of both the pathways that are extrinsic receptor mediated pathway and the intrinsic mitochondrial pathway is the same i.e. activation of the caspase.The execution phase of apoptosisAfter being activated the caspases act on many cellular components.They cleave cytoskeletal and nuclear matrix proteins and thus disrupts the cytoskeleton.They also lead to the breakdown of the nucleus.In the nucleus, the' target of caspase activation includes proteins involved in transcription, DNA replication andDNA repair.", "cop": 1, "opa": "Apoptosis", "opb": "Cell necrosis", "opc": "Electron transport chain", "opd": "Cell division", "subject_name": "Unknown", "topic_name": null, "id": "7ab7800a-a73f-4602-863b-69f4a0251dfb", "choice_type": "single"}
+{"question": "Pollicization is best described as", "exp": "• Reconstruction of thumb is called pollicization. Typically this Consists of surgically migrating the index finger to\nthe position of the thumb\n• During pollicization the index finger metacarpal bone is cut and the finger is rotated approximately 120—160 degrees and replaced at the base of the hand at the usual position of the thumb\n• The arteries and veins are left attached.\nAmputated digits should be well washed with saline and wrapped in STERILE GAUZE soaked in STERILE SALINE or RL and put in STERILE plastic bag & put in an CONTAINER with ICE(digits should not be in direct contact with ICE).\nTRANSPORT :   room temperature 6 hrs and at 4 deg C for 12 hrs\nThe vessels SHOULD NOT be clamped but SECURED with pressure DRESSING only.", "cop": 4, "opa": "Amputation of thumb", "opb": "Equalization of fingers", "opc": "Toe to thumb transplantation", "opd": "Reconstruction of thumb", "subject_name": "Unknown", "topic_name": null, "id": "a560751d-21d9-45ec-bd0c-e3d7186398a4", "choice_type": "single"}
+{"question": "Lamina cribrosa is not present in", "exp": "Morning glory syndrome is a mesodermal defect in which there is peripapillary defect along with absence of lamina cribrosa.", "cop": 1, "opa": "Morning glory syndrome", "opb": "Nanophthalmia", "opc": "Coloboma of retina", "opd": "Optic nerve agenesis", "subject_name": "Unknown", "topic_name": null, "id": "45e2355c-34f7-4b52-8a50-1570b25e7b80", "choice_type": "single"}
+{"question": "Lymphnodes not involved in CA endometrium is", "exp": "Ans-C Inferior mesenteric Lymphatics from the uterus do not drain inferior mesenteric nodesLymphatic drainage of uterus -Upper lymphatics - Aortic & superficial inguinal nodes* (from fundus)Middle lymphatics - Ext. iliac nodes* (from body)Lower lymphatics - Ext. iliac nodes, internal iliac nodes* (from cervix)", "cop": 3, "opa": "Paraaortic", "opb": "Presacral", "opc": "Inferior mesentric", "opd": "Inguinal", "subject_name": "Unknown", "topic_name": null, "id": "e82d0cfa-702c-4a9c-936f-b9106550da10", "choice_type": "single"}
+{"question": "Hormone Therapy indicated in menopausal women", "exp": "Ref. DC Dutta's Textbook of Obstetrics. Pg 890\n \nINDICATIONS OF HORMONAL THERAPY\n\nRelief of menopausal symptoms like hot flushes, senile vaginitis, mood swings, decreased libido, memory loss, irritability, increased risk of CAD\nPrevention of osteoporosis\nTo maintain the quality of life in menopausal years", "cop": 1, "opa": "Hot flash", "opb": "Ca breast", "opc": "Endometriosis", "opd": "Uterine bleeding", "subject_name": "Unknown", "topic_name": null, "id": "b91aca44-de3b-480b-85f4-fdef10cc52f5", "choice_type": "single"}
+{"question": "This scalpel works on the principle of", "exp": "Harmonic scalpel works on the principle of high energy ultrasonic waves (megahertz). Harmonic scalpel is used in liver resections and laparoscopic surgery.", "cop": 4, "opa": "Electricity", "opb": "Laser", "opc": "Radiofrequency", "opd": "Ultrasonic waves", "subject_name": "Unknown", "topic_name": null, "id": "979d0fac-3eae-4b5a-9991-c37f4b8a4b88", "choice_type": "single"}
+{"question": "As per MCI regulations, a medical practitioner should maintain the records of in patients for a minimum period of", "exp": "(Refer: Rajesh Bardale - Principles of Forensic medicine & Toxicology, 1st edition, pg no: 32)\nEvery physician shall maintain the medical records pertaining to his / her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India", "cop": 2, "opa": "2 years", "opb": "3 years", "opc": "4 years", "opd": "5 years", "subject_name": "Unknown", "topic_name": null, "id": "f6efb07c-78b3-4b4b-b6f3-5cec518a6675", "choice_type": "single"}
+{"question": "C/F of complicated cataract A/E", "exp": "Ans: (B) Opacity along sutures Ref.: A.K. Khurana 6th ed. /194-95 * Complicated cataract : Cataract secondary to some intraocular disease which may be: # Anterior cortical in anterior segmental lesion as glaucoma, acute iritis, or, # Posterior cortical in posterior segmental lesion as uveitis, RD, pigmentary retinal dystrophy. * The second type of complicated cataract presents with posterior cortical bread crumb appearance/ polychromatic lusture or rainbow cataract. * Bread crumbs appearance is Pathognomonic of posterior cataract. * Opacity usually commence in posterior cortex and spread axially and NOT along sutures. * Vision is much impaired even in early stage, owing to the position of the opacity near the nodal point of the eye.", "cop": 2, "opa": "Polychromic lusture", "opb": "Opacity along sutures", "opc": "Axial spread of opacity", "opd": "Post. Subcapsular opacity", "subject_name": "Unknown", "topic_name": null, "id": "3f1ed725-a99a-494d-910b-67e964d4525e", "choice_type": "single"}
+{"question": "In full term neonates, the ductus arteriosus closure is mainly due to", "exp": "(Low pressure O2): Ref 45-Dutta 6th (394-Ghai 7th) Changes of the fetal circulation at birth 1. Closure of the umbilical arteries: Functional closure is almost instaneous preventing even slight amount of the fetal blood to drain out. Actual obliteration takes about 2-3 months. The distal parts from the lateral umbilical ligaments and the proximal parts remain open as superior vesical arteries. 2. Closure of umbilical vein: - The obliteration occurs a little latter than the arteries, After obliteration, the umbilical vein forms the ligamentum teres and the ductus venosus becomes ligamentum venosum 3. Closure of the ductus arteriosus - Within few hours of respiration, the muscle wall of the ductus arteriosus contracts probably in response to rising oxygen tension of the blood flowing through the duct. The effects of the variation of the O2 tension on the ductus arteriosus are thought to be mediated through the action of prostaglandins. Prostaglandin antagonists given to the mother may lead to the premature closure of the ductus arteriosus. Whereas functional closure of the ductus may occur soon after the establishment of pulmonary circulation, the anatomical obliteration takes about 1-3 months and becomes ligamentum arteriosum 4. Closure of the foramen ovale: - This is caused by an increased pressure of the left atrium combined with a decreased pressure on the right atrium. Functional closure occurs soon after birth but anatomical closure occurs in about 1 year time. Within one or two hours following birth ,the cardiac output is estimated to be a bout 500 ml per minute, and the heart rate varies from 120 -140 per minute * During foetal life, patency of the ductus arteriosus appears to be maintained by the combined relaxant effects of low oxygen tension and endogenously produced prostaglandins (PGE2), In full term neonates the oxygen is the most important factor controlling ductual closure (1480- Nelson 17th) Ref 2 - PATHOPHYSIOLOGY The DA is derived from the distal dorsal sixth aortic arch and is completely formed by the eighth week of gestation.6 Its role is to shunt the blood from the nonfunctional fetal lung through its connection between the main pulmonary artery and the proximal descending aorta. This right-to-left shunt allows the blood with a relatively low oxygen concentration to be carried from the right ventricle through the descending aorta and eventually to the placenta, where gas exchange will occur. Before birth, approximately 90% of right ventricular output flows through the DA. Figure 1 illustrates the role of the DA in redirecting fetal circulation in comparison to neonatal circulation.15 Premature closure in the fetus is associated with significant morbidities, including right-sided heart failure, which may result in fetal hydrops.6 Normally, the DA closes within 24-72 hours after a full-term birth; if after 72 hours the ductus fails to close, a diagnosis of persistent PDA may be made.1,16 Figure 1. Left-The ductus arteriosus is an essential component of fetal circulation. It functions by shunting blood away from the nonfunctional fetal lung and into the systemic circulation through the aorta. Right-After birth, decreases in PGE2 and oxygen tension contribute to the closure of the ductus Arteriosus, allowing gas exchange to occur in the newly functioning lungs rather than the now absent placenta. Blue = oxygen-poor blood; Red = oxygen-rich blood; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle. The paradoxical patent ductus arteriosus. J Clin Invest 166:2863-2866 by Ivey KN, and Srivastava D. Copyright 2006 by J Clin Invest. Reproduced with permission of J Clin Invest via Copyright Clearance Center. The patency of the DA is primarily controlled by low fetal oxygen tension and the circulation of prostanoids produced from the metabolism of arachidonic acid by COX, with PGE2 producing the most profound ductal relaxation among the prostanoids.16,17 Smooth muscle relaxation of the DA results from the activation of the G-coupled prostaglandin receptor EP4 by PGE2. Following the activation of prostaglandin receptor EP4, a cascade of events ensues, which includes the accumulation of cyclic adenosine monophosphate, increased protein kinase A, and finally, decreased myosin light chain kinase, leading to vasodilation and ultimately DA patency.15 The preterm ductus is especially sensitive to the vasodilatory effects of prostaglandins, contributing to the failure of ductal closure.18 In term infants, as birth approaches, decreased sensitivity of the DA to prostaglandins and decreased circulating levels of PGE2 contribute to DA closure.19 Within 24-72 hours after a full-term birth, the DA closes as a result of increased oxygen tension and decreased circulating PGE2 and prostacyclins (PGI2). As oxygen tension increases, smooth muscle voltage-dependent potassium channels are inhibited. Through this inhibition, an influx of calcium contributes to ductal constriction. This oxygen-induced constriction fails in preterm infants potentially due to immaturity of oxygen-sensing receptors.20 Levels of circulating PGE2 and PGI2 are decreased as a result of increased metabolism in the newly functioning lung, as well as the removal of the placental source. The decreased circulating levels of these potent vasodilators allow the DA to constrict. These factors collectively contribute to smooth muscle constriction, leading to ischemic hypoxia of the inner muscle wall of the DA. As the ductus constricts, the luminal area is diminished, resulting in a thickened vessel wall and obstructed flow through the vasa vasorum, the essential capillary network nourishing the outer cells of the vessel. This causes an increased distance of diffusion for oxygen and nutrients, including glucose, glycogen, and adenosine triphosphate (ATP), which results in nutritional deficit and oxygen starvation, leading to cell death.21 Ductal constriction in preterm infants is not sufficiently profound. Consequently, preterm infants are resistant to smooth muscle hypoxia, which is paramount in triggering the cell death and remodeling required for permanent closure of the DA.22 Inhibition of prostaglandin and nitric oxide resulting from tissue hypoxia is not as extensive in the preterm neonate in comparison to the term infant, further contributing to resistance to DA closure in the preterm infant.23 The main provider of nutrients to the DA is the lumen; however, the vasa vasorum is also a substantial provider to the outer wall of the ductus. The vasa vasorum grows toward the lumen and extends 400-500 mm from the outer wall of the ductus. The distance between the lumen and the vasa vasorum (40-500 mm) is referred to as the avascular zone and represents the maximum distance allowable for effective nutrient diffusion. In full-term infants, this avascular zone is expanded beyond the effective diffusion distance, therefore contributing to cell death. In preterm infants, the avascular zone does not sufficiently expand, resulting in cell survival and maintenance of ductal patency.24 If the levels of circulating PGE2 and other prostaglandins are decreased through COX inhibition, closure is facilitated. The abovementioned differences between ductal vessel wall thickness of the fetus, term neonate, and preterm neonate are illustrated in Figure 2.16 In response to the nutritional deficit and ischemic hypoxia, vascular endothelial growth factor and transforming growth factor beta (both of which contribute to endothelial proliferation), in combination with other inflammatory mediators, contribute to the remodeling of the DA into the non-contractile ligament commonly referred to as the ligamentum arteriosum.16,24 Figure 2. Comparison of fetal and both the premature and full-term newborn ductus arteriosus. The avascular zone in the preterm ductus (bottom row) does not sufficiently expand beyond the effective diffusion distance after birth (bottom right). Hermes-deSantis et al.16 Reprinted by permission from Macmillan Publishers Ltd: J Perinatol 26: s14-s18, copyright 2006.", "cop": 4, "opa": "Cardiac output", "opb": "Prostaglandins", "opc": "Low pressure CO2", "opd": "Low pressure O2", "subject_name": "Unknown", "topic_name": null, "id": "b7b524d6-fb9c-4af7-b601-e353bb14e97b", "choice_type": "single"}
+{"question": "Median weight of 100 children was 16 kgs. The standard deviation was 8.calculate the percentage coefficient of variance.", "exp": "Coefficient of Variation (COV)\n\n\nCOV = SD × 100\n\nMean or Median\nIs SD expressed as percentage of mean OR median.\n\nCV = SD / MEAN × 100 = 8/16 × 100 = 50%", "cop": 1, "opa": "50%", "opb": "35%", "opc": "45%", "opd": "55%", "subject_name": "Unknown", "topic_name": null, "id": "d8ac9fe3-8e2a-4bc6-9a88-595baee99645", "choice_type": "single"}
+{"question": "The action potential of the the sinoatrial node", "exp": "The action potential of the sinoatrial node and atrio­ventricular node results from the opening of the slow Ca2+ channels and the influx of Ca2+(some Na+ may also enter through these slow Ca2+channels). An action potential is elicited when the membrane potential reaches threshold. Spontaneous depolarization is an intrinsic property of nodal tissue and can occur in the absence of nerves. The low resting potential results in a small action potential that propagates slowly. The rapid Na+ channels are inactivated in nodal tissue. An increase in the conductance to K+ would hyperpolarize the membrane.", "cop": 2, "opa": "Reuslts from the activation of rapid Na+ channels", "opb": "Results from opening of the slow Ca2+ channels", "opc": "Is equivalent in height and conduction velocity to that of the atrial muscle", "opd": "Results from an increase in conductance to K+", "subject_name": "Unknown", "topic_name": null, "id": "18a3073e-8c3d-41bc-af08-c38e554fb7fa", "choice_type": "single"}
+{"question": "Incidence of mucocele is lowest in", "exp": "Paranasal sinus mucocelesmost commonly occur in the third or fourth decades of life with a slight male predilection.\nThe frontal sinus is most commonly affected followed by the ethmoid sinuses, with reports suggesting 70–90 % of mucoceles occur in these locations.\nTen percent of mucoceles occur in the maxillary sinus and the sphenoid sinus is involved rarely", "cop": 2, "opa": "Frontal sinus", "opb": "Sphenoid sinus", "opc": "Maxillary sinus", "opd": "Ethmoid sinus", "subject_name": "Unknown", "topic_name": null, "id": "d45342c7-c893-499b-8ef3-609d17800405", "choice_type": "single"}
+{"question": "The permissible concentration of fluorides in drinking water is", "exp": "Ans. C 0.5 - 0.8 (Ref. Park's textbook of PSM - 22nd/pg. 467, 597) ENDEMIC FLUOROSIS # The permissible concentration of fluorides in drinking water is 0.5 to 0.8 mg/L. # Where drinking water contains excessive amounts of fluorine (3-5 mg/L), endemic fluorosis has been observed. # Certain parts of the country, e.g., Andhra Pradesh, Punjab, Haryana, Karnataka, Kerala, and TN are known for it. # Dental Fluorosis: Ingested during the years of tooth calcification essentially during the first 7 years of life by \"mottling of dental enamel\", which has been reported at levels above 1.5 mg/L intake. Mottling is best seen on the incisors of the upper jaw. # Skeletal Fluorosis/ Genu valgum: Lifetime daily intake of 3.0-6.0 mg/L or more. # Prevention: Changing the water source. # Nalgonda technique for defluoridation of water. The presence of following chemicals in excess of prescribed limits may constitute ground for rejection of the water as a source of public water supply: # Inorganic constituents: - Arsenic: recommended maximum limit of the concentration is 0.01 mg/L. - Cadmium 0.003 mg/L maximum limit. - Chromium - Cyanide: maximum limit 0.07 mg/L. - Fluoride should not be more than 1.5 mg/L - Lead - Mercury: 0.001 mg/L minimum upper limit. Bacterial plate count on yeast extract agar after incubation at 22degC for 7 days might serve as the best general-purpose indicator of microbiological quality. - Selenium - Nitrite and Nitrate: When nitrate level in drinking water exceeds 50 mg/L, methemoglobinemia may occur; most susceptible are bottle-fed infants of less than 3 months. Nitrate is a good indicator of past contamination. # Organic constituents - Polynuclear aromatic hydrocarbons - Pesticides", "cop": 3, "opa": "1.5 - 2.5", "opb": "2-Jan", "opc": "0.5 - 0.8", "opd": "0.1 - 0.2", "subject_name": "Unknown", "topic_name": null, "id": "8f7c6ad5-88c8-405a-a298-9aaeabe45ca1", "choice_type": "single"}
+{"question": "Dequervain's tenosynovitis is a stenosing tenosynovitis of the", "exp": "Dequervain's tenosynovitis is a stenosing tenosynovitis of the first exten­sor compartment at the wrist comprising the tendons of extensor pollicis brevis and Abductor pollicis longus.", "cop": 3, "opa": "Tendo Achilles", "opb": "Iliolumbar ligament", "opc": "First extensor compartment of the wrist", "opd": "Median nerve", "subject_name": "Unknown", "topic_name": null, "id": "a53e7715-6d3d-4442-b9a5-c0ffc5097875", "choice_type": "single"}
+{"question": "The superior vesical arteries are direct branches of the", "exp": "The umbilical artery is a branch of the internal iliac artery. In the fetus, the umbilical artery passes over the bladder and continues up the anterior body wall to the umbilical cord and out to the placenta. As it passes the bladder, it gives rise to the superior vesical arteries. After birth, the part of the artery distal to the bladder becomes fibrous, but the proximal part remains patent and continues to supply the bladder.", "cop": 2, "opa": "Internal iliac artery", "opb": "Umbilical artery", "opc": "Internal pudendal artery", "opd": "External pudendal artery", "subject_name": "Unknown", "topic_name": null, "id": "b19a6f05-e018-4c05-8766-4f7cca585125", "choice_type": "single"}
+{"question": "Alopecia, Hyper pigmentation, Hypogonadism characteristic for deficiency of", "exp": "The essential feature of Zinc deficiency.\n \nA distinctive rash most often around the eyes, nose, mouth, anus and distal parts called\n \nAcrodermatitis Enteropathica.\n \nGrowth retardation in children.\n \nImpaired wound healing\n \nHypogonadism with diminished reproductive capacity.\n \nAnorexia often accompanied by diarrhoea\n \nDepressed mental function.\n \nOther important disease\n \nSelenium deficiency causes Keshan disease. Copper deficiency causes Menke's disease.", "cop": 1, "opa": "Zinc", "opb": "Magnesium", "opc": "Selenium", "opd": "Copper", "subject_name": "Unknown", "topic_name": null, "id": "334821bd-e764-459d-bb86-9e56bda249ac", "choice_type": "single"}
+{"question": "A patient sustains a knife wound through the right fourth intercostals space, 2 cm to the right of the sternum. The area most likely penetrated by the knife is the", "exp": "The right border of the heart is approximately 1 to 2 cm to the right of the right border of the sternum; therefore, the knife probably did not hit the heart. The middle lobe of the right lung extends from the level of the fourth costochondral junction to the level of the fifth intercostal space. The middle lobe is most likely at the level of the fourth intercostal space.", "cop": 2, "opa": "Right upper lobe of the lung", "opb": "Right middle lobe of the lung", "opc": "Right lower lobe of the lung", "opd": "Right atrium of the heart", "subject_name": "Unknown", "topic_name": null, "id": "90e558f4-a467-4287-bec6-31dbcf861e43", "choice_type": "single"}
+{"question": "Electrolyte abnormalties are caused by (PGI June 2009)", "exp": "Ans : D (Al (OH) E (Hydrochlor-thiazide) 0.9% Nad. KCI & j\\aHC03 are used in the treatment of electrolyte disturbances.\"Hypokalemia is the most significant problem with use of thiazides(e.g., hydrochlorothiazide) & high ceiling diuretics therapy.lt can be prevented & treated by High dietary K+ intake, supplements of KCI (24-72mEq/day)or by concurrent use of K+ sparing diuretics\"- KDT 6th 7566NaCI: Hypertonic saline & normal saline is used in the treatment of hyponatremia'' (H17th/279)NaHC03: It is used in the treatment of metabolic acidosis (HI 7th/290)Al(OH)3: Aluminium hydroxide gel is used as an antacid to neutralize gastric acid. It binds with phosphate in the intestine & prevents its absorption - hypophosphatemia occurs on regular use (KDT 6th/635)", "cop": 4, "opa": "KC1", "opb": "0.9 NaCl", "opc": "NaHCO3", "opd": "A1 (OH)3", "subject_name": "Unknown", "topic_name": null, "id": "53a8fcfb-5c6f-4ef1-bc74-4b6e59e8975e", "choice_type": "single"}
+{"question": "Condyloma accuminatum caused most commonly by human papilloma virus (HPV) types of", "exp": "Ans- C 6,11", "cop": 3, "opa": "18,31", "opb": "17, 12", "opc": "6,11", "opd": "16,18", "subject_name": "Unknown", "topic_name": null, "id": "b38664b9-2f72-4243-bcc3-45fcfe6c9d2c", "choice_type": "single"}
+{"question": "This disease is", "exp": "Osteochondrosis of the tarsal navicular (Kohler's disease) is characterised by aseptic necrosis of the Navicular bone causing a painful limp in a child usually 4-10 years of age.", "cop": 2, "opa": "Osteochondrosis of the lunate", "opb": "Osteochondrosis of the navicularq", "opc": "Tuberculosis of the scaphoid", "opd": "Syphilitic dactylitis", "subject_name": "Unknown", "topic_name": null, "id": "7a0a3d59-64c7-4ff9-bb1e-cf7fabcd8896", "choice_type": "single"}
+{"question": "Best treatment of old fracture is", "exp": "Nonunion fracture shaft femur requires open reduction and rigid internal fixation with either intramedullary nail or DC plating and bone grafting.", "cop": 2, "opa": "Manipulation and POP cast application.", "opb": "Open reduction and internal fixation and bone grafting.", "opc": "K Wire fixation", "opd": "External fixation", "subject_name": "Unknown", "topic_name": null, "id": "a14b3941-8e39-4751-a11d-bd6902347986", "choice_type": "single"}
+{"question": "The classical flexion and rotation deformities at hip and knee joints, as a sequela of poliomyelitis, are due to the contracture of.", "exp": "Ans. is 'a' i.e., Tension fascia lata The flexion and rotation deformities at the hip and knee joint in poliomyelitis are due to iliotibial band contracture.As the iliotibial band is a direct extension of tensor facial lata muscle its pull on the hip and knee joint are actually due to contracture of the tensor facialata muscle.The common deformities seen in polio are-At hip - Flexion abduction and external rotationAt knee - Flexion, genu valgum and triple deformity At foot - Talipes equinovarusAlso, rememberThe test required for iliotibial band contracture - Ober's test *", "cop": 1, "opa": "Tensor fascia lata", "opb": "Gastrocnemius", "opc": "Tendo Achilles", "opd": "Hamstrings", "subject_name": "Unknown", "topic_name": null, "id": "c58134f8-c711-42d6-8a51-cfdc9efdd3d4", "choice_type": "single"}
+{"question": "In myocardial infarction the infarct acquires hyperemic rim with an yellow centre at", "exp": "3 – 7 days Findings\nGross examination at border\nSoftening yellow-tan center Histopathology\n(light microscopy)\nBeginning of disintegration of dead muscle fibers\nNecrosis of neutrophils\nBeginning of macrophageremoval of dead cells at border", "cop": 1, "opa": "3-7 days", "opb": "10-20 days", "opc": "7-14 days", "opd": "1-2 hours", "subject_name": "Unknown", "topic_name": null, "id": "a550df94-cd27-4745-b699-dcf1669ed036", "choice_type": "single"}
+{"question": "Fluidity buffer present in cell membrane is", "exp": "Membrane fluidity\nMembrane fluidity changes with temperature Transition temperature (Tm)\n“More is the Tm,less is the fluidity”\nCholesterol-Fluidity buffer\nSaturated FAs\nincrease Tm and decrease fluidity Unsaturated FAs\ndecrease Tm and increase fluidity", "cop": 3, "opa": "Stearic acid", "opb": "Palmitic acid", "opc": "Cholesterol", "opd": "Linoleic acid", "subject_name": "Unknown", "topic_name": null, "id": "5f2f013d-9d51-4a8b-a7f5-943a51efafb8", "choice_type": "single"}
+{"question": "Serum ca& fetoprotein level is elevated in", "exp": null, "cop": 2, "opa": "Dysgerminoma", "opb": "Endodermal cell tumour", "opc": "Immature teratoma", "opd": "Choriocarcinoma", "subject_name": "Unknown", "topic_name": null, "id": "05ae4841-f88d-4a8b-9ec1-e4a1bed1d99b", "choice_type": "single"}
+{"question": "Extramammary paget’s is seen in", "exp": "Ref. Robbins Pathology. 9th edition. Page. 999\nExtramammary Paget's disease (EMPD), also extramammary Paget disease, is a rare, slow-growing,  usually noninvasive intraepithelial (in the skin) adenocarcinoma outside the mammary gland and  includes Paget's disease of the vulva and the extremely rare Paget's disease of the penis.", "cop": 2, "opa": "Uterus", "opb": "Vulva", "opc": "Vagina", "opd": "Ovary", "subject_name": "Unknown", "topic_name": null, "id": "b2439308-f92a-41cc-ba3c-0751e5f48ed6", "choice_type": "single"}
+{"question": "The immunoglobulin mediates ADCC", "exp": "IgG Antibody\no     Half life(23d),\no     High Serum concerntration (GAMDE) ,\nResponsible for-\no     Precipitation,\no     neutralization,\no     NK cell (ADCC)\no  Classical complement\nAppear late, indicates past / chronic infection", "cop": 3, "opa": "IgM", "opb": "IgA", "opc": "IgG", "opd": "IgE", "subject_name": "Unknown", "topic_name": null, "id": "098b5bfa-8894-46e2-a40c-7e948a78a491", "choice_type": "single"}
+{"question": "In Corynebacterium diphtheria", "exp": "• Diphtheria acts by its toxin and invasion is not seen.\n• Elekc gel precipitation test is done for determination of pathogenicity of diphtheria.\n• Metachromatic granules are seen also called as Babes earnest granules. Bacteriophages (extra-chromosomal) are responsible for toxigenicity by phage conversion.", "cop": 4, "opa": "Deep invasion is not seen", "opb": "Elek’s test is done for toxigenicity", "opc": "Metachromatic granules are seen", "opd": "Toxigenicity is mediated by chromosomal change", "subject_name": "Unknown", "topic_name": null, "id": "48d2f703-c32c-46e9-b8cf-4e63a91630b7", "choice_type": "single"}
+{"question": "Percentage of Blasts in AML", "exp": "Ans.(c) 20%Ref: Nelson 18th ed. ch. 495* The characteristic feature of AML is that >20% of bone marrow cells on bone marrow aspiration or biopsy touch preparations constitute a fairly homogeneous population of blast cells, with features similar to those that characterize early differentiation states of the myeloid-monocyte-megakaryocyte series of blood cells. The most common classification of the subtypes of AML is the FAB system.French-American-British (FAB) Classification of Acute Myelogenous LeukemiaSUBTYPECOMMON NAMEMlAcute myeloblastic leukemia without maturationM2Acute myeloblastic leukemia with maturationM3Acute promyeloblastic leukemiaM4Acute myelomonocytic leukemiaM5Acute monocytic leukemiaM6ErythroleukemiaM7Acute megakaryocytic leukemia", "cop": 3, "opa": "8%", "opb": "15%", "opc": "20%", "opd": "25%", "subject_name": "Unknown", "topic_name": null, "id": "1716fa60-524f-4472-8481-c93afff1ea78", "choice_type": "single"}
+{"question": "A 5 year old male child has multiple hyper pigmented macules over the trunk, on rubbing the lesion with the rounded end of a pen. He developed urticarial wheal, confined to the border of the lesion. The most likely diagnosis is", "exp": "Urticaria is characterized by large, irregularly shaped pruritic, erythematous wheels\n\nSpecial forms of urticaria have special features (Dermographism, cholinergic urticaria, solar urticaria, or cold uritcaria)\nMost incidents are acute and self-limited over a period of 1-2 weeks\nChronic urticaria (episodes lasting> 6 weeks) may have an autoimmune basis\nThe most common immunologic mechanism is hypersensitivity mediated by IgE, seen for most patients with acute urticaria\nThe morphology of the lesions may vary over a period of minutes to hours, resulting in geographic or bizarre, pattern, true urticaria last less than 24 hours and often only 2-4 hours.\nThe most common cause of acute urticaria are foods, viral infections and medications Diagnosis - In vivo allergy skin testing and in vitro RAST testing\nDetermination of serum tryptase (Increased in anaphylaxis, systemic mastocytosis, non IgE mediated disease (\"anaphylactoid reaction\")\nACE inhibitors and Angiotensin II receptors antagonist therapy is contraindicated.\n\nUrticaria pigmentosa (mastocytosis) - consists of multiple irregularly shaped hyperpigmented macule which may present on the trunk and extremities.\n\nStroking the skin through the lesion with a blunt instrument elicits the classical \"triple response of Lewis\" called Darier's sign\n\nTreatment - Avoides taking drugs of Aspirin, NSAID', drugs, morphine, codeine, procaine, thiamine, polymyxin B and alcohol.                .\n\nThe main stay of treatment is initially includes HI antihistamines (Hydroxyzine, cyproheptadine, Loratadine\nDoxepin (TCA) - very effective in chronic urticaria.\n\nUrticarial vasculitis may be seen as part of serum sickness, associated with fever and arthralgia.", "cop": 3, "opa": "Fixed drug eruption", "opb": "Licken planus", "opc": "Urticaria pigmentosa", "opd": "Urticarial vasculitis", "subject_name": "Unknown", "topic_name": null, "id": "46889b8d-539a-449b-97d9-b5024456364d", "choice_type": "single"}
+{"question": "Osgood schlatters disease is associated with osteochondritis of", "exp": "Types of Osteobchondritis and Nomenclature", "cop": 3, "opa": "Patella", "opb": "Femur medial condyle", "opc": "Tibial tubercle", "opd": "Femur lateral condyle", "subject_name": "Unknown", "topic_name": null, "id": "02bfab7c-082e-48d8-a0a1-60a75dd0678d", "choice_type": "single"}
+{"question": "The following structure is transmitted via foramen ovale", "exp": null, "cop": 2, "opa": "Greater petrosal nerve", "opb": "Mandibular nerve", "opc": "Oculomotor nerve", "opd": "Sympathetic nerve fibres", "subject_name": "Unknown", "topic_name": null, "id": "ea0a9b35-85f6-4d77-8f04-cb1ef49d110c", "choice_type": "single"}
+{"question": "In Bartters syndrome there is defect in", "exp": "Ref. Guyton. 13th edition. Page. 1103\nNa+--K+--2Cl- transporter \nThis is an electro neutral transport resulting in the reabsorption of about 25% of the filtered sodium, chloride, and potassium.\n\nThe luminal membrane contains a K+ channel (Figure VIII-4-4), allowing diffusion of this ion back into lumen (recall that the concentration of K+ inside cells is very high compared to the extracellular concentration). 
\nThis back diffusion of K+ into the lumen creates a positive luminal potential, which in turn, promotes calcium and magnesium reabsorption (about 25% of FL) via a paracellular pathway (primarily). This positive luminal potential also causes sodium reabsorption via a paracellular pathway. 
\n\nBartter’s syndrome\n\nIt is a genetic mutation resulting in diminished function of the Na+--K+--2Cl- transporter in Ascending loop of Henle\nThis leads to a low volume state, which causes an increase in renin and aldosterone (know as a secondary hyperaldosteronism).\nPatients exhibit hypokalemia, alkalosis, and elevated urine calcium.", "cop": 2, "opa": "DCT", "opb": "Thick ascending limb of LOH", "opc": "PCT", "opd": "Descending limb of LOH", "subject_name": "Unknown", "topic_name": null, "id": "3822ba84-97b0-4d01-a5e9-21fdfeccf1f6", "choice_type": "single"}
+{"question": "20 year old patient presents with hypokalemia, alkalosis with normal blood pressure and no edema. the diagnosis is", "exp": "It is characterized by hypokalemia , alkalosis, high rennin level and hypercalciuria , but with normal blood pressure and no edema.\nThis is due to mutation Na-k-cl co transporter gene , usually begins in childhood.", "cop": 1, "opa": "Bartter syndrome", "opb": "Liddle syndrome", "opc": "Glucocorticoids remediable aldosteronism", "opd": "Apparent mineral ocorticoid excess syndrome", "subject_name": "Unknown", "topic_name": null, "id": "fb1109b3-6119-4c6f-b479-4a5be4408e0b", "choice_type": "single"}
+{"question": "In ca ovary inguinal lymph nodes are involved in stage", "exp": "FIGO revised the staging of carcinoma ovary in January 2014 and according to the new staging inguinal LN involvement is stage IV b.", "cop": 4, "opa": "Stage II", "opb": "Stage III a", "opc": "Stage IIIc", "opd": "Stage IVb", "subject_name": "Unknown", "topic_name": null, "id": "aa26906f-4243-46fa-b7f4-1d6c9b6dc2a9", "choice_type": "single"}
+{"question": "In a study in the UK, an association was found between the sale of antiarrhythmic drug and an increase in deaths due to asthma. This is an example of", "exp": "Ans. is 'a' i.e. Ecological study Repeat May 08 www. ucel ac. uk. rlos/specs/rlo_observational_study. doc; http.//cancersupportivecare. com/epidemiology.html] For explanation see May 08", "cop": 1, "opa": "Ecological study", "opb": "Cohort study", "opc": "Case reference study", "opd": "Experimental study", "subject_name": "Unknown", "topic_name": null, "id": "920ca602-208e-4267-b6aa-cb11e6662eb7", "choice_type": "single"}
+{"question": "Cell organelle affected in Wolman’s Disease is", "exp": "Characteristics of Lysosomes\n\nDiscovered by Christian de Duve\nContains acid hydrolases,acid lipases,collagenase\nATP-dependent proton pumps in the membrane maintain an acidic environment (pH 4.0–5.0)\n\nLysosomal Diseases\nTay-Sachs disease\nHexosamidase A\nGaucher’s disease\nBeta galactocerebrosidase\nI-cell disease\nAbsent mannose-6-phosphate tag", "cop": 2, "opa": "Peroxisome", "opb": "Lysosome", "opc": "Liposome", "opd": "Dyctyosome", "subject_name": "Unknown", "topic_name": null, "id": "959589b2-71aa-47b5-b6ee-8b28052e82e6", "choice_type": "single"}
+{"question": "Anemia of chronic disease is characterised by", "exp": "(Ref: Robbins 8/e p662)\n\nAnemia of chronic disease- Impaired red cell production associated with any chronic diseases that would be infectious/inflammatory/neoplastic.\nChronic diseases produce a cytokine “IL-6” that increases the production of hepcidin from liver.  Hepcidin inhibits ferroportin function in macrophages and reduces the transfer of iron from storage pool to developing erythroid precursors in bone marrow.\nSo the patient develop anemia irrespective of increased amount of iron in macrophages.\nLaboratory findings- Increased ferritin (storage iron), Low serum iron  and reduced total iron binding capacity.\nWhereas in iron deficiency anemia, the patient will have decreased ferritin, lowserum iron and high iron binding capacity.", "cop": 3, "opa": "Increased sideroblast", "opb": "Increased TIBC", "opc": "Increased bone marrow iron", "opd": "Increased protoporphyrin", "subject_name": "Unknown", "topic_name": null, "id": "b8930b48-32e6-4700-9951-bd12426ad066", "choice_type": "single"}
+{"question": "The operative procedure is known as \"microfracture\" is done for the", "exp": "Ans. is 'd' i.e. Osteochondral defect of the femurRef. Various internet sites (www.orthopedics.hss.edu, www.kneeguru.co.uk)Microfracture is an arthroscopic procedure used to treat osteochondral defects (damaged areas of articular cartilage of the knee)", "cop": 4, "opa": "Delayed union of femur.", "opb": "Non union of tibia", "opc": "Loose bodies of ankle joint", "opd": "Osteochondral defect of femur", "subject_name": "Unknown", "topic_name": null, "id": "0ad66707-63e9-43d7-8426-048859ca33e5", "choice_type": "single"}
+{"question": "Indicator for outbreak of Plague epidemic is", "exp": "“Cheopis index : It is an average no of X.cheopis per rat. It is a specific flea index. If this index is more than 1, it is regarded as indicative of potential explosiveness of the situation, should a plague outbreak occur”", "cop": 4, "opa": "Rat burrow index", "opb": "Total flea", "opc": "Specific flea index", "opd": "Cheopis index", "subject_name": "Unknown", "topic_name": null, "id": "21e6edb8-0ec0-4707-a6f3-6dee8ec51ddc", "choice_type": "single"}
+{"question": "A patient presented with a 1 x 1.5 cms growth on the lateral border of the tongue. The treatment indicated would be.", "exp": "Ans- B Interstitial brachytherapy Ref- Although this study is retrospective, the results are noteworthy, considering its long follow up and the description of results in terms of LCR, toxicities, and functional outcome. Our study recommends treating patients with brachytherapy alone in T1 stage and demonstrates the need for addressing nodal region either by neck dissection or nodal irradiation in T2 stage patients. The highlight of the study is that it establishes the need for dose escalation (from the doses used in the study) in both T1 and T2 stage tumors when using interstitial brachytherapy either as sole modality or as a boost.", "cop": 2, "opa": "Laser ablation", "opb": "Interstitial brachytherapy", "opc": "External beam radiotherapy", "opd": "Chemotherapy", "subject_name": "Unknown", "topic_name": null, "id": "41256fd7-a11f-4523-8d4f-e3433d2d11b8", "choice_type": "single"}
+{"question": "Number of permanent teeth in a 8 year old child", "exp": null, "cop": 3, "opa": "4", "opb": "8", "opc": "12", "opd": "20", "subject_name": "Unknown", "topic_name": null, "id": "d99c710b-f775-4150-9472-85d5d7a0b6d8", "choice_type": "single"}
+{"question": "Optic tract fibers project to thesuperior colliculi for", "exp": "Optic tract fibers project to the\n\nSuperior colliculifor reflex gazes\nPretectal areafor the light reflex\nSuprachiasmatic nucleusof theanterior hypothalamus for generation of circadian rhythms.", "cop": 1, "opa": "Reflex gazes", "opb": "Light reflex", "opc": "Generation of circadian rhythms.", "opd": "Vertical nystagmus", "subject_name": "Unknown", "topic_name": null, "id": "7a44b356-7c94-4a4e-8076-841c864288b7", "choice_type": "single"}
+{"question": "Autoimmune thyroiditis can be confirmed in a patient by", "exp": "Once hypothyroidism is diagnosed by clinical features, TSH and free T4 measurements, etiology can be confirmed by measuring the presence of autoantibody—particularly thyroid peroxidase (TPO), which is present in 90 to 95% of patients with autoimmune hypothyroidism. Biopsy by fine needle aspirate can confirm the diagnosis but is not necessary in most cases.", "cop": 1, "opa": "Thyroid peroxidase antibody (TPO)", "opb": "Antinuclear antibody", "opc": "Thyroid uptake resin", "opd": "Thyroid aspiration", "subject_name": "Unknown", "topic_name": null, "id": "fd7bc512-9f93-4fd4-82a0-79e88aa3d6b6", "choice_type": "single"}
+{"question": "A 10 years child has unilateral nasal obstruction epistaxis, swelling over the cheek, the diagnosis is", "exp": "Ans. is 'c' i.e.Angiofibroma Angiofibroma ( Nasopharyngeal fibroma)Age group: the 2nd decade of life.Sex: Predominantly males ( almost exclusively males)*The site of origin*: posterior part of the nasal cavity close to the margin of sphenopalatine foramen.*Growth: From its site of origin the tumor grows into the nasal cavity, nasopharynx - pterygopalatine fossa - pterygomaxillary fossa - infratemporal fossa & checkClinical features :Profuse and recurrent epistasis ( MC presentation)*Progressive nasal obstruction*Conductive hearing loss and serous otitis media d/t obstruction of auditory tubeBroadening of nasal bridge*Proptosis*Swelling of cheek, * infratemporal fossaInvolvement of 2nd, 3rd, 4th, 6th C.N", "cop": 3, "opa": "Nasal polyp", "opb": "Nasopharyngeal carcinoma", "opc": "Angiofibroma", "opd": "Foreign bodies", "subject_name": "Unknown", "topic_name": null, "id": "e5dc32ac-3c05-4e65-853e-781467d318f4", "choice_type": "single"}
+{"question": "The investigative method of choice for confirmation of H.pylori eradication is", "exp": "In summary, it is not necessary to perform endoscopy to diagnose H. pylori. Serology is the test of choice for initial diagnosis when endoscopy is not required. If, however, endoscopy is to be performed, the rapid urease assay and histology are both excellent options, but the cost advantage lies with the rapid urease assay. After treatment, the urea breath test is the method of choice but again should not be performed until 4 weeks after therapy ends. If the breath test is unavailable, endoscopy may be performed in selected patients such as those with bleeding ulcers or other complications of their PUD.", "cop": 1, "opa": "Urea breath test", "opb": "Rapid urease assay", "opc": "Culture from gastric mucosa", "opd": "Serology", "subject_name": "Unknown", "topic_name": null, "id": "d519f463-f810-4e10-a230-ac6df1a0c883", "choice_type": "single"}
+{"question": "Gleason's classification used for", "exp": "(Carcinoma Prostate) (699- Basic robbins 8th)GLEASON - SYSTEM - Gleason grade has proved to correlate reasonably well with both the anatomic stage of prostatic carcinoma and the prognosis* Pancreatic cancer probably arise from precursor lesion (Pan INs) developing by a progressive accumulation of characteristic mutations of oncogenes (eg K-RAS) and tumor suppressor genes (eg P16, P53 and SMA D4)* Breast cancer - the majority are in the BRCA-1 and BRCA2 genes, less commonly in P53, PTEN or ATM genes", "cop": 2, "opa": "Carcinoma breast", "opb": "Carcinoma prostate", "opc": "Carcinoma pancreas", "opd": "Carcinoma rectum", "subject_name": "Unknown", "topic_name": null, "id": "9733a43c-7224-4e7c-9e0f-cb9fcf7d7880", "choice_type": "single"}
+{"question": "The lineage specific marker for B cells is", "exp": "Lineage specific B cell marker is CD 19. However on IHC the best marker is CD 20. CD 21 is the receptor for EBV", "cop": 1, "opa": "CD 19", "opb": "CD 20", "opc": "CD 21", "opd": "CD 22", "subject_name": "Unknown", "topic_name": null, "id": "ac5e62fd-723e-465b-ba02-cc84adfa210a", "choice_type": "single"}
+{"question": "In postpartum patients, the blood volumes become normal after nonpregnant state is", "exp": "Ans-C", "cop": 3, "opa": "2 weeks", "opb": "4 weeks", "opc": "6 weeks", "opd": "10 weeks", "subject_name": "Unknown", "topic_name": null, "id": "7171ad2a-3656-4cce-aa20-7b4fc0f8d0db", "choice_type": "single"}
+{"question": "The effect of progesterone on lipids", "exp": "While part of the administered progestogen is metabolized to oestrogen, it is also partly metabolized to testosterone. If administered to a patient during pregnancy, some progestogens have virilizing effect upon a female fetus. Lipid metabolism decreases HDL but increases low-density lipoprotein. Thus, it is harmful to the heart.\nIt improves the immune response", "cop": 3, "opa": "Lowers LDL, increases HDL", "opb": "Lowers LDL and HDL", "opc": "Lowers HDL and increases LDL", "opd": "Increases LDL and HDL", "subject_name": "Unknown", "topic_name": null, "id": "1d3a4629-5a84-48ea-b119-827d08ce2066", "choice_type": "single"}
+{"question": "Fistula formation due to the below etiology  occurs within", "exp": "Vesicovaginal fistula: In obstructed labor, the bladder becomes an abdominal organ and due to compression of urethra between presenting part and pubic symphysis, patient fails to empty bladder. The bladder wall gets traumatized which may lead to bloodstained urine, a common finding in obstructed labor. The bases of the bladder and urethra which are nipped in between presenting part and pubic symphysis may undergo pressure necrosis. The devitalized tissue becomes infected and later on may slough off around the 3rd to 5th day of puerperium resulting in genitourinary fistula which is a remote complication (does not present on the day of injury as in perineal tear).\nCauses:\n\nObstetric cause—97% obstructed labor is the prime cause, and bladder neck is the most common site;\nGynecological operations—anterior colporrhaphy, total hysterectomy, or Wertheim’s operation, sling operation.", "cop": 3, "opa": "24 hours", "opb": "48 hours", "opc": "5 days", "opd": "2 weeks", "subject_name": "Unknown", "topic_name": null, "id": "96d2ec41-b4bd-478f-80d8-b80c8c0fd9f0", "choice_type": "single"}
+{"question": "Florence test for seminal stains tests for the presence of", "exp": "(Refer: Rajesh Bardale - Principles of Forensic medicine & Toxicology, 1st edition, pg no: 401)", "cop": 1, "opa": "Spermine", "opb": "Choline", "opc": "Inositol", "opd": "Aluminium molybdate", "subject_name": "Unknown", "topic_name": null, "id": "64a6d67d-a246-434a-b68e-d62f5bbab6df", "choice_type": "single"}
+{"question": "The drug of choice of hypertensive uveitis is", "exp": "Latanoprost is a PG F2 analogue and should not be given in patents of uveitis\nCholinergic drugs like Pilocarpine are also contraindicated in Ocular inflammation\nDipivefrin- (diphenylephrine) - sympathomimetic drugs (Adrenergic drugs)\nMechanism of action ­\n1. Increase aqueous out flow results by virtue of both alpha and beta receptor stimulation\n2. Decreased aqueous humour production occurs due to stimulation of alpha - receptors in the ciliary body", "cop": 3, "opa": "Phosphatidyl choline", "opb": "Latanoprost", "opc": "Diphenylephrine", "opd": "Pilocarpine", "subject_name": "Unknown", "topic_name": null, "id": "10f9922b-f9d8-47f7-9259-2f42469c2f8b", "choice_type": "single"}
+{"question": "Less sedating anti emetic used in motion sickness and vertigo", "exp": "Meclizine and cyclizine are often used in preventing motion sickness and for short-term treatment of vertigo because they are less sedating than diphenhydra­mine and promethazine.\nPromethazine also causes antiemetic activity and is available as a suppository or for injection. Chlorphen­iramine and brompheniramine, which are less sedating than diphenhydramine and promethazine, are often used alone or in combination with decongestants for allergies and colds. Cyproheptadine has antiserotonin activiry and may be useful in treating patients with carcinoid tUmor, where it blocks the effects of seroto­nin and histamine on smooth muscle. Aztemizole, loratadine, and terfenadine are nonsedating antihista­mines that do not cross the blood-brain barrier.", "cop": 4, "opa": "Cyproheptadine", "opb": "Chlorpheniramine", "opc": "Promethazine", "opd": "Meclizine", "subject_name": "Unknown", "topic_name": null, "id": "9ddaa708-0867-468f-8cfd-7ef79e6e99b6", "choice_type": "single"}
+{"question": "Most common malignant brain tumor", "exp": "Ans. B Glioblastoma multiforme Ref: Sabiston.Page 1371 The following data should be remembered for brain tumors- Most common malignant Brain tumor: Secondaries > Gliomas > Meningiomas > Astrocytomas.", "cop": 2, "opa": "Astrocytoma", "opb": "Glioblastoma multiforme", "opc": "Oligodendroglioma", "opd": "Ependymoma", "subject_name": "Unknown", "topic_name": null, "id": "dfa832fb-9953-4898-8114-02bfb159b6d1", "choice_type": "single"}
+{"question": "Hatter's shake is seen in", "exp": "Ans. is 'b' i.e., Mercury poisoning * Metallic mercury (para or quick silver) is not poisonous on ingestion, as it is not absorbed. But its vapours are poisonous. Mercuric compounds being soluble are more poisonous than mercurous compounds. Mercuric chloride (HgCl2), also called corrosive sublimate or perchloride of mercury, is most poisons salt of mercury.* Acute poisoning presents with syncope, convulsions general instability and nephrotoxicity (proximal tubular). The mouth, tongue and fauces become corroded and appears grayish white.* Signs and symptoms of chronic mercury poisoning are :1) Excessive salivation, metallic taste, loosening of teeth, and blue black lining on gums (similar to lead poisoning).2) Diphtheria like membranous colitis and dysentery.3) Anorexia, insomnia, sweating, nausea, irritability and photophobia.4) Special features are : i) Mercuria lentis: Brownish deposition of mercury on anterior lens capsule.ii) Tremors : There are moderately coarse, intentional tremors starting in fingers and hands, and legs. They are also called Danbury tremors or hatter's shake or glass blower's shake. In severe form, patient becomes unable to dress, write or walk, i.e. concussion mercurialis (shaking palsy).iii) Erethism (neuropsychiatric changes): The personality disturbance is characterized by shyness, irritability, tremors, loss of memory and insomnia. There may be depression, delusion, hallucination and MDP (mad hatter).iv) Acrodynia (Pink disease): This is idiosyncratic hypersensitivity reaction with a generalized pinkish rash described as 5P : pinkish, puffy, painful, paraesthesia hands and peeling of skin.v) Minimata disease: It is due to organic mercury poisoning due to eating fish poisoned by mercury.vi) Membranous glomerulopathy.", "cop": 2, "opa": "Phosphorus poisoning", "opb": "Mercury poisoning", "opc": "Arsenic poisoning", "opd": "Lead poisoning", "subject_name": "Unknown", "topic_name": null, "id": "0c87ae18-5c61-4fb2-8257-4b9d354e30aa", "choice_type": "single"}
+{"question": "Transport medium for Streptococcus will be", "exp": "Transport media: used to transport the specimen from collection place to laboratory. Transport media mainly used to avoid multiplication of commensals in the particular sample.\n\nStuart (charcoal swab), Amies medium -Gonococcus o Pikes - Streptococcus\nVenkatraman Ramakrishnan medium, autoclaved sea water, Alkaline salt water- Vibrio\nBuffered glycerol saline–Typhoid bacilli o Carry Blair medium–Enteric pathogen", "cop": 1, "opa": "Pikes medium", "opb": "Stuarts medium", "opc": "VR medium", "opd": "Selenite F medium", "subject_name": "Unknown", "topic_name": null, "id": "7ec977cb-4153-42f1-8062-8d6f2dd6e456", "choice_type": "single"}
+{"question": "Usual presentation of cauda equina syndrome is", "exp": "Conus medullaris syndrome is usually sudden and bilateral whereas cauda equina is grdual and unilateral.", "cop": 4, "opa": "Sudden and unilateral", "opb": "Gradual and bilateral", "opc": "Sudden and bilateral", "opd": "Gradual and unilateral", "subject_name": "Unknown", "topic_name": null, "id": "ea7d3626-a290-419c-bbdf-049cab463c40", "choice_type": "single"}
+{"question": "Best monitoring of progress of labor is done by", "exp": "Ans-A", "cop": 1, "opa": "Partogram", "opb": "Bishops score", "opc": "Manning score", "opd": "Regular vaginal examination", "subject_name": "Unknown", "topic_name": null, "id": "557214a7-48d8-447f-a439-447e22a1c5d3", "choice_type": "single"}
+{"question": "Adenocarcinoma of ethmoid sinus associated with", "exp": "Ans. is 'a' i.e Woodworkers Workers of wood industry develop - Adenocarcinomas of ethmoid & other nasal sinusesWorkers of Nickle refining industry - Sq. cell Ca & anaplastic Ca of nasal sinuses.", "cop": 1, "opa": "Woodworkers", "opb": "Nickel workers", "opc": "Coal workers", "opd": "Chimney workers", "subject_name": "Unknown", "topic_name": null, "id": "c2d720f9-1fcc-4d3c-b428-31aad52a7e1a", "choice_type": "single"}
+{"question": "The most common metabolic abnormality pre¬disposing patients to renal stone formation is", "exp": "The most common metabolic abnormality predispos­ing patients to renal stone formation is hypercalciuria. Calcium oxalate and calcium phosphate stones are the two most common stones. Hypercalciuria combined with decreased fluid intake is frequently associated with stone formation; thus, adequate hydration is im­portant in the treatment of stones.\nHyperuricemia can contribute to stone formation, but uric acid stones are not as common as calcium stones and most people with hyperuricemia do not have stones. Distal renal tubular acidosis can lead to calcium phosphate stones, but this disorder is not as common as stone formation in hypercalciuria. In­creased urine volume and increased urine citrate con­centration would both decrease the incidence of stones. In adequate concentrations, citrate binds to calcium and renders it unavailable for stone formation.", "cop": 2, "opa": "Hyperuricemia", "opb": "Hypercalciuria", "opc": "Distal renal tubular acidosis", "opd": "Increased urine volume", "subject_name": "Unknown", "topic_name": null, "id": "41cf56c1-fe40-49a8-b543-dcf6caa6e6a9", "choice_type": "single"}
+{"question": "Sarcomeresare the fundamental contractile unit of skeletal muscle and are characterized by their highly ordered appearance under a polarizing light microscope\nThick filaments in the A bandare composed primarily of the protein myosin.\n\nEach myosin moleculeis composed of", "exp": "Sarcomeresare the fundamental contractile unit of skeletal muscle and are characterized by their highly ordered appearance under a polarizing light microscope\nThick filaments\nThick filaments in the A band are composed primarily of the protein myosin. Each myosin molecule is composed of six monomers: two protein strands intertwined in a helical arrangement (termed heavy chains) and four smaller, globular proteins (termed myosin light chains).\nThin filaments\nThin filaments are composed of three primary proteins: actin, tropomyosin, and troponin", "cop": 3, "opa": "Two monomers", "opb": "Four monomers", "opc": "Six monomers", "opd": "Seven monomers", "subject_name": "Unknown", "topic_name": null, "id": "e8b94537-9a26-47b4-8f74-01f6052b1611", "choice_type": "single"}
+{"question": "Endodermal sinus tumor is associated with", "exp": "Ans-A i.e. Schiller Duval body Endodermal sinus tumor (yolk sac tumor)This tumor is rare but it is the second most common malignant tumor of germ cell origin.It is thought to be derived from differentiation of malignant germ cells towards extraembryonic yolk sac structure.Similar to the yolk sac the tumor is rich is a fetoprotein and antitrypsin.9 The characteristic histological feature of yolk sal tumor is Schuller Duval body.Schiller Duval body is a glomerulus like structure composed of central blood vessel enveloped by germ cells within a space lined by germ cells. Also, know Call Exner bodyReinke's crystalSignet ring cellsHobnail cellsPsammoma bodies-----Granulosa cell tumorHills a cell tumorKrukenberg tumorClear cell carcinomaPapillary serous cystadenoma of the ovary.", "cop": 1, "opa": "Schiller dual body", "opb": "Multinucleate giant cells", "opc": "R-S cells", "opd": "Plasma cells", "subject_name": "Unknown", "topic_name": null, "id": "403a4f2a-4424-4156-ba67-1e40b92bbe05", "choice_type": "single"}
+{"question": "Bloody discharge from the nipple is most commonly due to", "exp": "Ans C Duct papilloma Ref: Bailey & Love's short practice of surgery 25th ed Causes of nipple discharge Blood Green Single duct Duct papilloma Ductal carcinoma Duct ectasia Duct ectasia Serous Fibrocystic disease Duct ectasia Multiple ducts Ductal carcinoma Duct ectasia Fibrocystic disease", "cop": 3, "opa": "Mammary duct ectasia", "opb": "Carcinoma", "opc": "Duct papilloma", "opd": "Fibrocystic disease", "subject_name": "Unknown", "topic_name": null, "id": "43e23212-eb0d-4788-8aa5-5fd85a2046ef", "choice_type": "single"}
+{"question": "Test discovered by this scientist is a type of", "exp": "WIDAL Fernand Isidore discovered widal test.", "cop": 2, "opa": "Slide agglutination test", "opb": "Tube agglutination test", "opc": "CFT", "opd": "Ring precipitation test", "subject_name": "Unknown", "topic_name": null, "id": "9d9a401b-9f13-41ac-a16a-e2809fca8e07", "choice_type": "single"}
+{"question": "A neonate with Down syndrome is having bilious vomiting", "exp": "Ans. (a) Duodenal atresia Ref - The image shows the presence of double bubble appearance suggestive of diagnosis of duodenal atresia. About 8% of children with Down syndrome are born with duodenal atresia which presents with bilious vomiting.", "cop": 1, "opa": "Duodenal atresia", "opb": "Congenital hypertrophic pyloric stenosis", "opc": "Ileal atresia", "opd": "Anorectal malformation", "subject_name": "Unknown", "topic_name": null, "id": "8fad4303-be72-4862-be96-64c16f46c1eb", "choice_type": "single"}
+{"question": "Two live vaccines the minimum duration between injections should be", "exp": "Directly from CDC guidelines\n \nThe timing and spacing of vaccine doses are two of the most important issues in the appropriate use of vaccines.\n\nIf the live vaccine is given first, it is necessary to wait at least 2 weeks (i.e., an incubation period) before giving the antibody. If the interval between the vaccine and antibody is less than 2 weeks, the recipient should be tested for immunity or the vaccine dose should be repeated.\nIf live parenteral (injected) vaccines (MMR, MMRV, varicella, zoster, and yellow fever) and live intranasal influenza vaccine (LAIV) are not administered at the same visit, they should be separated by at least 4 weeks.\nAn exception to this recommendation is yellow fever vaccine administered less than 4 weeks after single-antigen measles vaccine.", "cop": 2, "opa": "2 Weeks", "opb": "4 Weeks", "opc": "4 Months", "opd": "6 Months", "subject_name": "Unknown", "topic_name": null, "id": "71ad768d-da38-414b-af09-3bdc49690801", "choice_type": "single"}
+{"question": "Rain drop skull appearance is seen", "exp": "Ref. Grainger and Allison's Diagnostic Radiology. Page. 409\n \nMULTIPLE MYELOMA –RAIN DROP APPERANCE /PUNCHED OUT LESIONS IN THE SKULL\nImp radiological features –\n\nExpansile osteolytic lesions associated with soft tissue masses\nDiffuse osteolysis or generalised osteoporosis\nPeriosteal new bone formation is characteristically absent\nSpine –diffuse lytic lesions", "cop": 1, "opa": "Multiple myeloma", "opb": "Eosinophilic granuloma", "opc": "Pagets disease", "opd": "Sickle cell anemia", "subject_name": "Unknown", "topic_name": null, "id": "1c4b8722-8d86-43bb-86b6-c7a33c7bdc95", "choice_type": "single"}
+{"question": "A chronic alcoholic patient on high carbohydrate diet develops a deficiency of", "exp": "(Manganese) (410-H) (449-H17th) Deficiencies of manganese have been reported to result in bone demineralization, poor growth, ataxia, disturbances in carbohydrate and lipid metabolism and convulsion Deficiency and Toxicities of Metals Element Deficiency Toxicity Boron No-biologic function determined Developmental defects, male sterility, testicular atrophy Copper Anemia, growth retardation, defective keratinization and pigmentation of hair, hypothermia, degenerative changes in aortic elastin, osteopenia, mental deterioration. Hepatic failure, tremor, mental deterioration, hemolytic anemia, renal dysfunction Chromium Impaired glucose tolerance* Occupational renal failure dermatitis, pulmonary cancers. Manganese Impaired growth and skeletal development, reproduction, lipid and carbohydrate metabolism: upper body rash General:- Neurotoxicity, Parkinson like symptoms. Occupational:- Encephalitis like syndrome, Parkinson like syndrome, psychosis pneumoconiosis. Molybdenum Severe Neurologic abnormalities Reproductive and fetal abnormalities Selenium Cardiomyopathy, heart failure, striated muscle degeneration General:- Alopecia, abnormal nails, emotional lability, peripheral neuropathy, lassitude, garlic odor to breath, dermatitis. Occupational:- Lung and nasal carcinoma, liver necrosis, pulmonary inflammation.", "cop": 3, "opa": "Selenium", "opb": "Cadmium", "opc": "Manganese", "opd": "Iodine", "subject_name": "Unknown", "topic_name": null, "id": "9ca124bb-ab99-448b-9bec-2946932eb10f", "choice_type": "single"}
+{"question": "Peripheral nerve regenerates at a rate of", "exp": "The axonal regeneration proceeds slowly at rate of 1-2 mm/day in human.", "cop": 2, "opa": "0.2 mm/day", "opb": "1 mm/day", "opc": "2 mm/day", "opd": "0.5 nun/day", "subject_name": "Unknown", "topic_name": null, "id": "e6442e08-ef90-41f9-8038-0b14599212ba", "choice_type": "single"}
+{"question": "Establishment of fetoplacental circulation seen at", "exp": "Ref. DC Dutta's Textbook of Obstetrics. Pg 36\n \nImplantation of 12-16 cell stage occurs in the endometrium on the anterior and posterior wall of the body near the fundus on the 6th day following fertilization.\n\nThen the deeper penetration of the human blastocyst is called interstitial implantation, which happens by approx. 13th day after fertilization\nThe fetal circulation is established by 21st days after fertilization", "cop": 2, "opa": "11 to 13 days", "opb": "20 to 22 days", "opc": "7 days", "opd": "25 to 26 days", "subject_name": "Unknown", "topic_name": null, "id": "489cff3d-b4c9-4e02-9206-c84133427fa7", "choice_type": "single"}
+{"question": "The most common type of Rhabdomyosarcoma is", "exp": "Rhabdomyosarcoma, the most common soft-tissue sarcoma of childhood and adolescence, usually appears before age 20. It may arise in any anatomic location, but most occur in the head and neck or genitourinary tract, where there is little if any skeletal muscle as a normal constituent. Rhabdomyosarcoma is histologically sub classified into embryonal, alveolar, and pleomorphic variants. The rhabdomyoblast—the diagnostic cell in all types—contains eccentric eosinophilic granular cytoplasm rich in thick and thin filaments. Rhabdomyoblasts may be round or elongate; the latter are known as tadpole or strap cells, and may contain cross-striations visible by light microscopy.\nEmbryonal rhabdomyosarcoma is the most common type, accounting for 60% of rhabdomyosarcomas. It includes the sarcoma botryoides as well as spindle cell and anaplasticvariants. The tumor occurs in children younger than 10 years of age and typically arises in the nasal cavity, orbit, middle ear, prostate, and paratesticular region. This variant of rhabdomyosarcoma commonly has parental isodisomy of chromosome 11p15.5, which leads to overexpression of the imprinted IGFII gene. The sarcoma botryoides subtype develops in the walls of hollow, mucosal-lined structures, such as the nasopharynx, common bile duct, bladder, and vagina. Where the tumors abut the mucosa of an organ, they form a submucosal zone of hypercellularity called the cambium layer.", "cop": 1, "opa": "Embryonal", "opb": "Alveolar", "opc": "Pleomorphic", "opd": "Inflammatory", "subject_name": "Unknown", "topic_name": null, "id": "96469236-5a03-4a29-9308-c8741561444e", "choice_type": "single"}
+{"question": "Serum amyloid associated protein, found in", "exp": "(Chronic inflammatory states) (84 - HM) (159 - R) (168- Basic pathology 8th)* AA amyloid fibril proteins are typically deposited in the setting of chronic inflammary states & traumatic conditions they derive from a larger serum precursor synthesized in the liver called SAA {Serum amyloid associated) protein* b- amyloid protein found in Alzheimer's disease", "cop": 2, "opa": "Alzheimer's disease", "opb": "Chronic inflammatory states", "opc": "Chronic renal failure", "opd": "Malignant hypertension", "subject_name": "Unknown", "topic_name": null, "id": "de6d4671-c202-4aa3-b86b-e8100038138d", "choice_type": "single"}
+{"question": "Bullous pemphigoidis characterized by", "exp": "Bullous pemphigoid ischaracterized by non acantholytic blisters on trunk and limbs. .\nIt is characterized by a negative Nikolsky’s sign, so B is incorrect.\nBlisters of bullous pemphigoid are tense and not at all easily ruptured, so C is incorrect.\nTypical tense blisters of BP come on red/ urticarial base in elderly population", "cop": 1, "opa": "Blisters coming on urticarial skin", "opb": "A positive Nikolsky sign", "opc": "Easily rupturing blisters", "opd": "Acantholysis", "subject_name": "Unknown", "topic_name": null, "id": "7329768b-0685-4ff1-ad4f-c091cbb55b4d", "choice_type": "single"}
+{"question": "Earliest manifestation of megaloblastic anemia is", "exp": "(Ref: Harrison 18/e p866, 17/e p645-646, Tejinder Singh 2/e p54-61)\n \n\n\n\n\nPeripheral blood picture\n\n\nBone marrow picture\n\n\n\n\n\nMacrocytosis (↑ MCV, MCH. Normal MCHC)\nPeripheral smear\n\n           Macroovalocytes\n           Few nucleated RBCs\n           Evidence of dyserythropoiesis like-\n\nBasophilic stippling\nCabot ring\nHowell- Jolly bodies\n\n\n↓ Hb\n↓ Hematocrit\nReticulocyte count – Normal or mild decrease\nWhite cells- Leucopenia\nHypersegmented neutrophils/ Macropolycytes- First manifestation \n↓ Platelets\nPancytopenia (10-20%)\n\n   Lab investigations:\n\nSerum iron, ferritin - ↑ in pure VitB12/ Folate defect\nSerum bilirubin & LDH ↑- due to hemolytic component\nSchillings test: Used to assess status of intrinsic factor (IF) & Vit B12 to distinguish pernicious anemia from other causes of Vit.B12  deficiency.\n\n\n\n\nModerate- marked hypercellularity\nErythroid hyperplasia\nM:E ratio reversal\nErthropoiesis- Megaloblastic\nGiant metamyelocytes\nMildly reduced megakaryocytes\nBM iron moderately increased in pure Vit B12/ Folate defects.", "cop": 2, "opa": "Macrocytosis", "opb": "Hypersegmented neutrophils", "opc": "Basophilic stippling", "opd": "Cabot ring", "subject_name": "Unknown", "topic_name": null, "id": "c970b6a7-50ec-477a-bc93-2b31d6b0f385", "choice_type": "single"}
+{"question": "Neurotransmitter employed by rods and cones is", "exp": null, "cop": 3, "opa": "Dopamine", "opb": "Serotonin", "opc": "Glutamate", "opd": "Nitric oxide", "subject_name": "Unknown", "topic_name": null, "id": "ba953b17-103e-468d-8642-832cdbec1e78", "choice_type": "single"}
+{"question": "A 40 year old patient has a dry eye and reduced nasal secretions. On routine examination CNS system was normal. The location of a lesion might be in the", "exp": "The sphenopalatine ganglion (or pterygopalatine ganglion) is a parasympathetic ganglion found in the pterygopalatine fossa.\nIt takes care of several glands like LNP – lacrimal, nasal & palatine glands\nThe pterygopalatine ganglion (ganglion of Meckel), the largest of the parasympathetic ganglia associated with the branches of the trigeminal (maxillary branch) nerve, is deeply placed in the pterygopalatine fossa, close to the sphenopalatine foramen.", "cop": 2, "opa": "Otic ganglion", "opb": "Sphenopalatine ganglion", "opc": "Ciliary ganglion", "opd": "Superior cervical ganglion", "subject_name": "Unknown", "topic_name": null, "id": "c77e3350-e0a5-48a6-a192-eb784d569014", "choice_type": "single"}
+{"question": "Mc benign epithelial ovarian tumor is", "exp": "Serous cystadenoma and cystadenocarcinoma\nSerous cystadenoma and cystadenocarcinoma are amongst the most common of cystic ovarian neoplasms, accounting about 50% of all ovarian tumours; of these, 60-70% are benign, 15% borderline and 20-25% are malignant.", "cop": 1, "opa": "Serous cystadenoma", "opb": "Mucinous cystadenoma", "opc": "Brenner tumor", "opd": "Ovarian fibroma", "subject_name": "Unknown", "topic_name": null, "id": "f968aea4-be9b-4740-b6a2-f04da6de5d38", "choice_type": "single"}
+{"question": "The membrane attack complex formed by the complement cascade is", "exp": "Activation of the complement cascade by the classical or alternative pathway leads to the cleavage of complement fragments and the formation of active enzymatic complexes. The C5b fragment aggregates with complement proteins C6, C7, CS, and C9, resulting in the polymerization of the final product, known as the “membrane-attack complex” (MAC). MAC lyses cells by inserting into the plasma membrane and destroying the permeability barrier.", "cop": 2, "opa": "Lipid insoluble.", "opb": "Capable of lysing cells.", "opc": "A complement fragment.", "opd": "Formed only in the classical complement pathway.", "subject_name": "Unknown", "topic_name": null, "id": "7bb61beb-3893-4fa1-8298-0e94594bfb88", "choice_type": "single"}
+{"question": "The appearance of the colon on a barium enema is seen in", "exp": null, "cop": 1, "opa": "Amoebiasis", "opb": "Ulcerative colitis", "opc": "Tuberculosis of the colon", "opd": "Crohn’s involvement of the colon", "subject_name": "Unknown", "topic_name": null, "id": "7d3fae56-6462-4252-a670-f0e9cc1173f6", "choice_type": "single"}
+{"question": "Following features seen are characteristic  of", "exp": null, "cop": 2, "opa": "Aplastic anemia", "opb": "Megaloblastic anemia", "opc": "Iron deficiency anemia", "opd": "Leukemia", "subject_name": "Unknown", "topic_name": null, "id": "22f1b335-2c8a-440a-8bf2-0b3362da1994", "choice_type": "single"}
+{"question": "Nerve element of brachial arch are developed from", "exp": "Ref. Gray’s anatomy.  41st edition. Page. 449.\nTopic, Subtopic – Brachial arch, embryology\nBranchial or pharyngeal arches are masses of mesoderm covered by ectoderm and lined by endoderm. Within these masses, muscular and skeletal components develop, as well as aortic arches and nerve networks. The arches are separated by grooves, visible on the surface of the embryo as pharyngeal clefts and in the interior as the pharyngeal pouches\n\nIn the human embryo, the arches are first seen during the 4th week of development.\nThey appear as a series of outpouchings of mesoderm on both sides of developing pharynx.\n\nThe neural crest are bilaterally paired strips of cells arising in the ectoderm at the margins of the neural tube. These cells migrate to many different locations and differentiate into many cell types within the embryo.", "cop": 2, "opa": "Ectoderm", "opb": "Neural crest cells", "opc": "Endoderm", "opd": "Mesoderm", "subject_name": "Unknown", "topic_name": null, "id": "331f6668-8689-4e91-8224-bec94fc380d4", "choice_type": "single"}
+{"question": "Specific cell surface proteins, such as alkaline phosphatase, and lipoprotein lipase, are anchored to the cell membrane. This anchoring is accomplished by covalent binding through an oligosaccharide bridge to component of the cell membrane. This component is", "exp": "Phosphatidylinositol derivatives play several distinct roles in the cell membrane, one of which is that they anchor several cell surface proteins. Cell surface pro­teins bound to phosphatidylinositol are also found in several parasitic protozoa. By altering these proteins, these protozoa can change their antigenic properties and avoid immunosurveillance. Being attached via a telatively long chain to the membrane via phosphatidylinositol, rather than being a part of the membrane itself, allows these proteins lateral movement on the cell surface. The proteins can be cleaved from the membrane by the action of phospholipase C. The other compounds listed are also phospholipids, but they do not anchor proteins in the membrane.", "cop": 4, "opa": "Sphingomyelin", "opb": "Phospphatidic acid", "opc": "Phosphatidylserine", "opd": "Phosphatidylinositol", "subject_name": "Unknown", "topic_name": null, "id": "380fe628-43c3-42d9-8c15-3f03afd88f11", "choice_type": "single"}
+{"question": "Bacillary angiomatosis is caused by", "exp": "Henselae causes bacillary angiomatosis, a condition resembling Kaposi’s sarcoma in patients with AIDS. The skin, lymph nodes or liver and spleen are primarily involved in this condition. The bacteria also cause sub acute bacterial endocarditis.", "cop": 1, "opa": "Bartonella henselae", "opb": "Hansen’s bacillus", "opc": "Koch’s bacillus", "opd": "H. ducreyi", "subject_name": "Unknown", "topic_name": null, "id": "b90afa31-0e4e-4024-a881-571979c1217c", "choice_type": "single"}
+{"question": "Vomiting on the first day of birth is caused by", "exp": "Infant may vomit mucus, occasionally blood streaked in the first few hour after birth, if may be due to irritation of the gastric mucosa by material swallowed during delivery.\n• A large number of normal babies vomit on first day due to irritation of stomach by swallowed amniotic fluid\n• Vomiting from esophageal obstruction occurs with the first feeding\n• Vomiting due to obstruction of the small intestine usually begins on the 1st day of life and is frequent persistent, usual, non projectile, copious, and unless the obstruction is above the ampulla of vater, bile- stained.\n• Vomiting of pyloric stenosis may begin any time after birth but does not assume its characteristic pattern before the 2nd, 3rd week", "cop": 4, "opa": "Pyloric stenosis", "opb": "Oesophageal atresia", "opc": "Aerophagy", "opd": "Amniotic gastritis", "subject_name": "Unknown", "topic_name": null, "id": "755dfe55-b9e7-425b-bcd1-0dce1fa5e837", "choice_type": "single"}
+{"question": "The local anesthetic with the longest duration of action is", "exp": "Longest acting, most potent and most toxic local anesthetic is dibucaine.\nChlorprocaine is the shortest acting local anesthetic.", "cop": 4, "opa": "Procaine", "opb": "Chlorprocaine", "opc": "Lignocaine", "opd": "Dibucaine", "subject_name": "Unknown", "topic_name": null, "id": "1a1d791f-01af-4866-9a13-7ab09ce5746b", "choice_type": "single"}
+{"question": "Ocular symptom of Von Recklinghausen disease is", "exp": "• NF-1 is the most common phakomatosis, affecting 1:4000 individuals, and presents in childhood.\n• The gene locus is on 17q11.", "cop": 2, "opa": "Deformed anterior chamber with reduced angle of AC", "opb": "Glaucoma", "opc": "Choroidal hemangioma", "opd": "Subretinal neovascularization", "subject_name": "Unknown", "topic_name": null, "id": "cb4a8cd0-b22a-483f-ab16-f837234c1816", "choice_type": "single"}
+{"question": "Commonest site of the foreign body lies in", "exp": "(Subtarsal sulcus): Ref: 370-73-P, 402-408-KH Intra ocular foreign bodies Chip of iron and steel (90%) are commonest foreign body Mechanical effects - In general these include comeal or/and scleral perforation, hyphaema, iris hole, rupture of the lens and traumatic cataract, vitreous haemorrhage and/or degeneration, choroidal perforation, haemorrhage and inflammation, retinal hole haemorrhage, oedeama and detachment. Extraocular foreign bodies: Small foreign body impact on the comeal or conjuctival surface (674-K) * Adhere to the superior palpebral conunctiva in the subtarsal sulcus and abrade the cornea with every blink. A pathognomic pattern of linear comeal abrasion may be seen. A subtarsal foreign body is easily missed unless the upper lid is everted. * Ascend and lodge in the superior conjucntival fornix and produce chronic conjunctivitis * Impact in the bulbar conjunctiva * Impact in the comeal epithelium or stroma to a depth proportional to the velocity of the foreign body * A very high velocity foreign body may penetrate the cornea or sclera and lodge intraocularly.", "cop": 3, "opa": "Bulbar conjunctiva", "opb": "Limbus", "opc": "Subtarsal sulcus", "opd": "Cornea", "subject_name": "Unknown", "topic_name": null, "id": "44e06101-b58a-4cca-80e3-212290cb2b49", "choice_type": "single"}
+{"question": "Minimum effective dose of oestrogen in OCP’s is", "exp": "Combined oral pills\nCombined oral pills contain a mixture of ethinyloestradiol (EE2) in a dose of 20 to 30 μg and an orally active progestogen which is a 19-norsteroid. Mala-D contains 0.5 mg of d-norgestrel and Mala-N contains 1 mg norethisterone; these are available free of cost in India. The tablets are taken starting on the second day of the cycle for 21 days. A new course of tablets should be commenced 7 days after the cessation of the previous course. They should be taken at a fixed time of the day, preferably after a meal.", "cop": 1, "opa": "20 mcg", "opb": "30 mcg", "opc": "40 mcg", "opd": "50 mcg", "subject_name": "Unknown", "topic_name": null, "id": "3ebc310d-8a4a-4f58-9fbb-f785adfd31e4", "choice_type": "single"}
+{"question": "Loss of insight is seen in", "exp": "Ans. is 'D' SchizophreniaLoss of insight is seen in Psychotic disorders which includeSchizophrenia*Mood disorders (Mania, Depression, MDP) *Delusional disorder*", "cop": 4, "opa": "Hysteria", "opb": "Anxiety", "opc": "OC neurosis", "opd": "Schizophrenia", "subject_name": "Unknown", "topic_name": null, "id": "53665b60-bbfa-4ad5-85b7-bbef864a96b3", "choice_type": "single"}
+{"question": "The following feature is most commonly seen in", "exp": "Parakeratasis is appearance of nuclei in the stratum corneum, which is normally nonnucleated cell layer. It can be a result of incomplete differentiation in keratinocytes or of reduced transit time. Clinically parakeratosis manifests as scaling, which is typical of papulosquamous disorders. \nActinic keratosis shows atypical pleomorphic keratinocytes in the basal layer, over which acanthosis, hyperkeratosis, and parakeratosis are also found. \nSeborrheic keratosis is characterized by uniform basaloid cells, keratin cysts, and a large number of melanocytes.", "cop": 1, "opa": "Actinic keratoses", "opb": "Seborrheic keratoses", "opc": "Molluscum contagiosum", "opd": "Basal cell carcinoma", "subject_name": "Unknown", "topic_name": null, "id": "a8034990-fc79-4ccd-8603-ada27991fbe5", "choice_type": "single"}
+{"question": "Diagnostic test for group A streptococcal \nerythroderma is", "exp": null, "cop": 4, "opa": "Bile solubility test", "opb": "Catalase test", "opc": "Optochin sensitivity", "opd": "Bacitracin sensitivity", "subject_name": "Unknown", "topic_name": null, "id": "5498b8aa-bc70-47eb-9004-e4b104acc857", "choice_type": "single"}
+{"question": "Steroids hormones exert their effects\nby binding to", "exp": "Steroid hormones cross the cell membrane and bind to specific receptors within the cell. These receptors are transcription factors that are active only in the presence of particular hormones. The hormone-tran­scription factor complex binds to steroid hormone responsive elements in DNA to influence transcription from steroid-sensitive genes. Thyroid hormone, reti­noic acid, and 1,25-dihydroxycholecalciferol exert their effects in a similar way.", "cop": 3, "opa": "Cell surface receptors", "opb": "G proteins", "opc": "Transcription factors", "opd": "Cyclic adenosine monophophate (AMP)", "subject_name": "Unknown", "topic_name": null, "id": "4cff88f7-0ae0-4adc-91bb-cee19ef74783", "choice_type": "single"}
+{"question": "The daily extra calories in the second and third trimester of pregnancy is", "exp": "Ans- C Extra calories required in pregnancy during 1st trimester is 150 kcals and 2nd trimester and 3rd trimester is 350 kcals", "cop": 3, "opa": "150 kCals", "opb": "200 kCals", "opc": "350 kCals", "opd": "250 kCals", "subject_name": "Unknown", "topic_name": null, "id": "55ad8221-2958-4e23-8515-3ac1e7792db0", "choice_type": "single"}
+{"question": "Ganciclovir is used in the treatment of", "exp": "Ans. is 'b' i.e., Cytomegalovirus Ganciclovir is an antiherpetic antiviral drug. It is active against all Herpetic viruses such as - H. simplex H. Zoster E.B. virus Cytomega lo virus However it is more active against CMV. Because: - Concentration of active inhibitor ganciclovir triphosphate is much higher inside CMV infected cells. Plasma t1/2 of ganciclovir is 2-4 hrs but that inside CMV is > 24 hrs. Because systemic toxicity of Ganciclovir is very high, its use is restricted to CMV infections in immunocompromised patient.", "cop": 2, "opa": "Adenovirus", "opb": "Cytomegalovirus", "opc": "EB virus", "opd": "Arenavirus", "subject_name": "Unknown", "topic_name": null, "id": "5ceea4ab-013f-4906-8642-77d3e963df03", "choice_type": "single"}
+{"question": "Ochronosis is due to chronic exposure to", "exp": "(Refer: Rajesh Bardale - Principles of Forensic medicine & Toxicology, 1st edition, pg no: 440)\nCarbolic aci", "cop": 1, "opa": "Carbolic acid", "opb": "Phosphorus", "opc": "Mercury salts", "opd": "Iodine fumes", "subject_name": "Unknown", "topic_name": null, "id": "22a56d9e-d5c3-43a3-9cba-1c078abdfe8b", "choice_type": "single"}
+{"question": "Investigation of choice to assess cardiotoxicity of anthracycline drugs is", "exp": "The best noninvasive method to study the LVEF (left ventricular ejection fraction) is Multiple Gated (MUGA or gated blood pool imaging) radioneuclide scan using Stannous pyrophosphate to label RBC’s and 9mTC pertechnetate for imaging. Altered Ejection Fraction is a contraindication for anthracycline drugs. However Echocardiogram is the investigation of choice because of its wider availability, simpler and reasonable accuracy in determining LVEF. The best investigation is myocardial biopsy.", "cop": 1, "opa": "Echocardiogram", "opb": "Myocardial biopsy", "opc": "ECG", "opd": "CT angiography", "subject_name": "Unknown", "topic_name": null, "id": "d2f045d1-2e42-4739-b4d4-4a8d9127822f", "choice_type": "single"}
+{"question": "Noninvasive prenatal testing (NIPT)", "exp": "Ref. The Short Textbook of Obstetrics. Page. 778\n \nNON INVASIVE PRENATAL TESTING\n\nTargeted ultrasonography\nFetal blood cells in maternal blood\nDouble marker and triple screening\nMaternal serum estriol\n\nINVASIVE PRENATAL TESTING\n\nAmniocentesis\nChronic villus sampling\nCordocentesis", "cop": 3, "opa": "Preconceptional gene testing on ova", "opb": "Testing on maternal tissue", "opc": "Maternal serum for evaluation of Down’s syndrome", "opd": "Amniocentesis for evaluation of fetal chromosomal anomalies", "subject_name": "Unknown", "topic_name": null, "id": "36a705d5-abd8-4634-b391-afeb0ac83cb6", "choice_type": "single"}
+{"question": "Special visceral efferent doesn’t involve", "exp": "Ref. Gray’s anatomy.  41st edition. Page.  982\nAll of the spinal nerves contain both sensory and motor functions and can be organized on the basis of the functional components of each nerve.\n\nGeneral Somatic Afferent (GSA) fibers are related to receptors for pain temperture and mechanical receptors in the skin, muscles and joints\nGeneral Visceral Afferent (GVA) fibers are related to receptors in visceral structures\nGeneral Visceral Efferent (GVE) fibers are preganglionic autonomic fibers\nGeneral Somatic Efferent (GSE) fibers innervate skeletal muscle (these are axons of alpha and gamma motor neurons)", "cop": 3, "opa": "Nucleus ambiguous", "opb": "Motor nucleus of fifth cranial nerve", "opc": "Dorsal nucleus of tenth cranial nerve", "opd": "Motor nucleus of seventh cranial nerve", "subject_name": "Unknown", "topic_name": null, "id": "1994d3ee-02ff-4c90-8851-96cf7a553f7e", "choice_type": "single"}
+{"question": "Hypokalemic paralysis is side effect of", "exp": "Its use as a male contraceptive was discovered in China. Gossypol is a yellow pigment isolated from cottonseed oil. It is administered orally 10 to 20 mg daily for 3 months and thereafter 20 mg twice weekly. The action is directly on the seminiferous tubules inhibiting spermatogenesis without altering FSH and LH levels. The side effects such as weakness, hypokalaemia and permanent sterility in 20% cases limit its use.", "cop": 1, "opa": "Gossypol", "opb": "DMPA", "opc": "Testosterone enanthate", "opd": "Cyproterone acetate", "subject_name": "Unknown", "topic_name": null, "id": "64752e10-cb36-4881-8bcf-7d0d666d9639", "choice_type": "single"}
+{"question": "Test done for Mycobacterium tuberculosis based on CMI is", "exp": "Ref. Textbook of Microbiology and Immunology BY Parija. Page. 350\n \nIGRA\nIGRAs measure a person’s immune reactivity to M. tuberculosis. White blood cells from most persons that have been infected with M. tuberculosis will release interferon-gamma (IFN-g) when mixed with antigens (substances that can produce an immune response) derived from M. tuberculosis.\nTypes of IGRA\n\nQuantiFERON TB Gold In-Tube test (QFT-GIT);\nT-SPOT.TB test (T-Spot)", "cop": 1, "opa": "IGRA", "opb": "BACTEC", "opc": "Culture", "opd": "GenXpert", "subject_name": "Unknown", "topic_name": null, "id": "b8dff8b7-49a2-4042-a5f2-1972f6c63604", "choice_type": "single"}
+{"question": "Traveller’s diarrhea is caused due to", "exp": "Persons from developed countries visiting endemic areas often suffer from ETEC diarrhea—a condition known as Traveler’s diarrhea.", "cop": 1, "opa": "Enterotoxigenic E. coil", "opb": "Enterohemorrhagic E. coli", "opc": "Enteropathogenic E. coli", "opd": "Enteroinvasive E. coli", "subject_name": "Unknown", "topic_name": null, "id": "5f407565-7044-4479-9673-cc279d0b6842", "choice_type": "single"}
+{"question": "The most common sequelae of tuberculous spondylitis in an adolescent is", "exp": "Fibrous ankylosis is seen in healed tubercular joints. Bony ankylosis is seen in healed tubercular spine.", "cop": 2, "opa": "Fibrous ankylosis", "opb": "Bony ankylosis", "opc": "Pathological dislocation", "opd": "Chronic osteomyelitis", "subject_name": "Unknown", "topic_name": null, "id": "16ebc4cd-a0a1-486b-a521-373364b525c0", "choice_type": "single"}
+{"question": "Number of Milk teeth are", "exp": "20 (Deciduous teeth)", "cop": 3, "opa": "8", "opb": "16", "opc": "20", "opd": "32", "subject_name": "Unknown", "topic_name": null, "id": "a2519a94-b043-4310-aefb-e1f01fcc275f", "choice_type": "single"}
+{"question": "A factory worker presents with excessive salivation, blue line on gums, tremors, disturbed personality, insomnia and loss of appetite. Diagnosis", "exp": "(Refer: Rajesh Bardale - Principles of Forensic medicine & Toxicology, 1st edition, pg no: 458)\nMercury poisoning:\n\nChronic Poisoning:  Otherwise called as ‘Hydrargyrism’.\nMC poisonous salt of mercury is Chloride\nClassic Triad:Gingivitis, Salivation and Tremors.\nSigns & Symptoms:\n\n\nBlue lines on gums\nTremors (Danbury tremors) which starts in hands and then progresses to other parts of the body. When generalized, it is called as ‘Hatter’s Shake’, glassblowers shakes\nMost severe form called as ‘Concussio mercurialis’ where no activity is possible.\n‘Mercurial Erethism’ which occurs in worker of mirror industry where there is development of psychological symptoms\n‘Mercuria lentis’ is a peculiar eye change where brownish deposit of mercury seen on anterior lens capsule and this is due to exposure to mercury vapor. It has no effects on visual acuity\nAcrodynia ( Pink disease)\nIdiosyncratic hypersensitivity reaction, seen in children\nGeneralized erythematous, eczematous papular type of lesions mostly in hands & feet, accompanied by thickening & peeling of the skin.\n\n\nDimercaprol (BAL) is used in treatment of mercury poisoning.", "cop": 3, "opa": "Arsenic poisoning", "opb": "Lead poisoning", "opc": "Mercury poisoning", "opd": "Phosphorus poisoning", "subject_name": "Unknown", "topic_name": null, "id": "50176cbe-bcfc-4078-838f-9e87a5afd743", "choice_type": "single"}
+{"question": "The operative procedure known as “micro fracture” is done for the", "exp": "Microfracture is an orthopedic procedure used to treat osteochondral defects (damaged areas of articular cartilage of\nthe knee).", "cop": 4, "opa": "Delayed union of femur", "opb": "Nonunion of tibia", "opc": "Loose bodies of ankle joint", "opd": "Osteochondral defect of femur", "subject_name": "Unknown", "topic_name": null, "id": "e42a42e6-bb5f-48bc-bc1e-4551ce3ddbd4", "choice_type": "single"}
+{"question": "Painful ulcers over genitalia are caused by", "exp": "Ans. c (Chancroid). (Ref. Ananthnarayan, 6th /326, Harrison, Medicine, 15th/1004)Painful ulcer on the penis is due to Haemophilus ducreyi or chancroid or soft chancre.Differential diagnosis of ulcers on genitalia is.Herpes simplex Organisms causing an ulcer on genitaliaCommentsChancroid# It is acute onset, painful ulcer, preceded by vesiculopustule, causes multiple ulcers, with a soft base, tender, bleeding ulcer, the floor of ulcer is formed by the slough, with undermined edges, purulent & profuse discharge surr by the inflammatory skin, & progresses fast.# Caused by Haemophilus ducreyii. Smear shows Gram-negative bacilli in chains.Granuloma inguinale# Caused by Calymmatobacterium granulomatis,Primary syphilis (Condyloma lata)# Treponema pallidum. (Hard chancre)Herpes simplex", "cop": 3, "opa": "Primary syphilis", "opb": "Granuloma inguinale", "opc": "Chanchroid", "opd": "Lymphogranuloma venerum", "subject_name": "Unknown", "topic_name": null, "id": "018c3eb4-bc42-4e94-8fda-203343c77797", "choice_type": "single"}
+{"question": "Japanese encephalitis vaccine in the routine schedule is as follows", "exp": "Ans- A", "cop": 1, "opa": "First dose at 9-12 months followed by booster at 16-24 months", "opb": "Single dose vaccine", "opc": "Three doses 1 month apart followed by a booster if needed", "opd": "Three doses with the second dose 1 month and 3rd dose 6 months after the first dose", "subject_name": "Unknown", "topic_name": null, "id": "eb30f1ba-28f6-4bfb-9cba-12d0a1a71738", "choice_type": "single"}
+{"question": "Combination chemotherapy ( ABV )with daunorubicin , bleomycin , vincristine is used in", "exp": "It is used in Kaposi’s sarcoma. Intraleisional danorubicin and vinblastine, radiation treatment, placitaxel, interferon alpha are also used.", "cop": 1, "opa": "Kaposi sarcoma", "opb": "Rhabdomyosarcoma", "opc": "Wilms tumour", "opd": "Seminoma", "subject_name": "Unknown", "topic_name": null, "id": "bcdcb959-d364-4cda-be21-60b25bfecdde", "choice_type": "single"}
+{"question": "Mediator of acute inflammation not derived from cell is (D. REPEAT Feb 2014)", "exp": "Ans: C (Kinins) Ref: Harsh Mohan, Textbook of Pathology, 6th edition, pg 136-37Explanation:Chemical Mediators of InflammationAka permeability factors or endogenous mediators of increased vascular permeability.They are broadly classified into 2 groups:Mediators released by ceils.Mediators originating from plasma.Chemical Mediators of Acute InflammationA. Cell-Derived MediatorsVasoactive aminesHistamine5-hydroxytryptamineNeuropeptidesArachidonic acid metabolites (Eicosanoids)Metabolites via cyclo-oxygenase pathwayProstaglandinsThromboxane A2ProstacyclinResolvinsMetabolites via lipo-oxygenase pathway5-HETELeukotrienesLipoxinsLysosomal components (from PM Ns, macrophages)Platelet activating factor (PAF)CytokinesIL-1TNF-aTNF-bIFN-gChemokinesFree radicalsOxygen metabolitesNitric oxideB. Plasma-Derived Mediators (Plasma Proteases) Products of:The Kin in the system.The Clotting system.The Fibrinolytic system.The Complement system.", "cop": 3, "opa": "Histamine", "opb": "Leukotrienes", "opc": "Kinins", "opd": "Cytokines", "subject_name": "Unknown", "topic_name": null, "id": "07877a41-a920-4f46-aa62-cab288a6f6a5", "choice_type": "single"}
+{"question": "Mapleson’s classification of anesthetic breathing system", "exp": "The Mapleson D may be described as a co-axial modification of the basic T-piece system, developed to facilitate scavenging of waste anaesthetic gases.\nCircuit", "cop": 2, "opa": "Describes four systems A, B, C, D", "opb": "Classifies the Bain system as Mapleson", "opc": "Describes the T-piece as M", "opd": "Describes the T-piece system as requiring a fresh gas flow rate of 1.5 – 2 times the minute volume", "subject_name": "Unknown", "topic_name": null, "id": "52dec404-7e46-46ca-b9d3-482d5954b372", "choice_type": "single"}
+{"question": "A large volume of gas is seen at sub diaphragm level in x ray presentation diagnosis is", "exp": "A. i.e. (Peritoneal perforation) (994-B & L 25th) Radiological Findings * Peritoneal perforation (Peritonitis) - Erect chest x-ray shows free air under the diaphragm (perforated viscus * Presence of dilated gas-filled loops of bowel or show free gas. * Intestinal obstruction - multiple gas-fluid levels** are most important criteria, ladder-like pattern * Paralytic ileus - shows gas -filled loop of intestine with multiple fluid levels * Intussusception - shows an absence of caecal gas shadow and increased gas shadows in the small intestine", "cop": 1, "opa": "Peritoneal perforation", "opb": "Intestinal obstruction", "opc": "Paralytic ileus", "opd": "Intussusception", "subject_name": "Unknown", "topic_name": null, "id": "bd5045a9-5765-496c-9aa2-e7cb4bf6340a", "choice_type": "single"}
+{"question": "HIV treatment in pregnancy", "exp": "Ref. DC Dutta's Textbook of Obstetrics. Pg 352\n \nRegardless of HIV viral load and CD4 count, all HIV infected pregnant women should be offered antiretroviral therapy (ART) after diagnosis till lifelong to reduce perinatal transmission\n\nART should focus on reduction of perinatal transmission and treatment of maternal HIV disease.\nIt reduces perinatal transmission by several mechanisms , including lowering maternal antepartum viral load and pre exposure and post exposure prophylaxis of the infant.\nTherefore, for prevention of perinatal transmission of HIV ,combined antepartum, intrapartum, and infant antiretroviral prophylaxis is recommended .", "cop": 1, "opa": "After diagnosis till lifelong", "opb": "After 1st trimester till lifelong", "opc": "After diagnosis till puerperium", "opd": "After pregnancy till lifelong", "subject_name": "Unknown", "topic_name": null, "id": "e9464fab-d638-43a3-ac47-3258e059faa6", "choice_type": "single"}
+{"question": "Colchicine mechanism of action in acute gout", "exp": "Ref. KDT. Page. 214\nIt does not inhibit the synthesis or promote the excretion of uric acid. – Direct lines from Tripathi, guides may lead you wrong. But they don’t have an effect \n \nColchicine MOA\nThe first two points is how it acts in acute Gout\n\nColchicine does not affect phagocytosis of urate crystals but inhibits release of the glycoprotein and the subsequent events.\nBy binding to fibrillar protein tubulin, it inhibits granulocyte migration into the inflamed joint and thus interrupts the vicious cycle.\nAntimitotic: causes metaphase arrest by binding to microtubules of mitotic spindle.\nIncreases gut motility through neural mechanisms", "cop": 2, "opa": "Inhibition of release of chemotactic factors", "opb": "Binding to tubulin and inhibition of leucocyte migration", "opc": "Promotes metabolism of urate crystals", "opd": "Inhibition of leukotriene B4", "subject_name": "Unknown", "topic_name": null, "id": "fb72cbb0-dd22-4ee4-bbc8-f17850e2d090", "choice_type": "single"}
+{"question": "Flame cells are seen in", "exp": "Multiple myeloma usually presents as destructive plasma cell tumors (plasmacytomas) involving the axial skeleton. Relatively normal-appearing plasma cells, plasma blasts with vesicular nuclear chromatin and a prominent single nucleolus, or bizarre, multinucleated cells may predominate. Other cytologic variants stem from the dysregulated synthesis and secretion of Ig, which often leads to intracellular accumulation of intact or partially degraded protein. Such variants include flame cells with fiery red cytoplasm, Mott cells with multiple grapelike cytoplasmic droplets, and cells containing a variety of other inclusions, including fibrils, crystalline rods, and globules. The globular inclusions are referred to as Russell bodies (if cytoplasmic) or Dutcher bodies (if nuclear). In advanced disease, plasma cell infiltrates may be present in the spleen, liver, kidneys, lungs, lymph nodes, and other soft tissues.", "cop": 1, "opa": "Multiple myeloma", "opb": "Malignant melanoma", "opc": "Nodular colloid goiter", "opd": "Hashimoto thyroiditis", "subject_name": "Unknown", "topic_name": null, "id": "f0290286-3d86-4841-a0b2-d94976e02c16", "choice_type": "single"}
+{"question": "Mucopolysaccharides are", "exp": "Mucopolysaccharides (commonly known as glycosaminoglycans) are heteropolysaccharides composed of sugar derivatives (mainly amino sugars and uronic acids). The important mucopolysaccharides include hyaluronic acid, heparin, chondroitin sulfate, dermatan sulfate and keratan sulfate.\nHyaluronic acid is the ground substance of synovial fluid of joints. It serves as lubricants and shock absorbent in joints.", "cop": 1, "opa": "Homopolysaccharides", "opb": "Heteropolysaccharides", "opc": "Proteins", "opd": "Amino acids.", "subject_name": "Unknown", "topic_name": null, "id": "f2da2def-fc5f-4d4c-a45f-5fec86b39078", "choice_type": "single"}
+{"question": "The only reliable means of diagnosing acute cardiac rejection before substantial myocardial damage has occurred is", "exp": "Of the major complications, allograft rejection is the primary problem requiring surveillance; scheduled endomyocardial biopsy is the only reliable means of diagnosing acute cardiac rejection before substantial myocardial damage has occurred and at a stage that is reversible in the majority of instances. Rejection is characterized by interstitial lymphocytic inflammation that, in its more advanced stages, damages adjacent myocytes; the histology resembles myocarditis. When myocardial injury is not extensive, the “rejection episode” is usually either self-limited or successfully reversed by increased immunosuppressive therapy. Advanced rejection may be irreversible and fatal if it is not promptly treated.", "cop": 3, "opa": "Echocardiography", "opb": "ECG", "opc": "Endomyocardial biopsy", "opd": "Ultrasound", "subject_name": "Unknown", "topic_name": null, "id": "29d5a964-358b-4dcb-ba33-749c7984a533", "choice_type": "single"}
+{"question": "Carotid body containsislands of two types of cells, type I and type II cells, surrounded by fenestrated sinusoidal capillaries. Type I cells are excited byhypoxia, and the principal transmitter appears to be", "exp": "Carotid & Aortic Bodies\nThere is a carotid body near the carotid bifurcation on each side, and there are usually two or more aortic bodies near the arch of the aorta .\nEach carotid and aortic body (glomus) contains islands of two types of cells, type I and type II cells, surrounded by fenestrated sinusoidal capillaries.\nType I cells\nThe type I or glomus cells are closely associated with cup-like endings of the afferent nerves.\nThe glomus cells resemble adrenal chromaffin cells and have dense-core granules containing catecholamines that are released upon exposure to hypoxia and cyanide .\nThe cells are excited byhypoxia, and the principal transmitter appears to be dopamine, which excites the nerve endings by way of D2 receptors.\nType II cells\nThe type II cells are glia-like, and each surrounds four to six type I cells. Their function is probably sustentacular.", "cop": 3, "opa": "Serotonin", "opb": "Adrenaline", "opc": "Dopamine", "opd": "Potassium", "subject_name": "Unknown", "topic_name": null, "id": "d2f9e570-64c4-4cf6-988d-60a557ee8075", "choice_type": "single"}
+{"question": "The primary pathophysiologic problem in in idiopathic pulmonary fibrosis is believed to be", "exp": "Bronchoalveolar lavage in patients with idiopathic pulmonary fibrosis, a chronic inflammatory disorder of the lower respiratory tract characterized by dyspnea and reticulonodular infiltrates on chest radiography, discloses an abundance of alveolar macrophages. Probably related to locally generated immune complexes, alveolar macro phages become activated and then produce several mediators that recruit and induce fibroblast proliferation, which causes secondary damage. Macrophage-derived mediators believed to be important in this process include fibronectin, a 200-kDa dimeric glycoprotein that interacts with connective tissue matrix as well as specific receptors on fibroblasts, and platelet-derived growth factor, whose chain is encoded by the c-sis protooncogene. Platelet-derived growth factor is believed to play an important role in recruiting fibroblasts to the site of inflammation. Macrophages also producechemotaxins such, as leukotriene 84 and interleukin 8, which attract neutrophils and eosinophils into the region.", "cop": 2, "opa": "Microorganism mediated activation of pulmonary neutrophils", "opb": "Immune complex mediated activation of alveolar macrophages", "opc": "Direct immune complex mediated pulmonary interstitial damage", "opd": "Primary fibroblast", "subject_name": "Unknown", "topic_name": null, "id": "8a0caf55-1800-4322-91a2-463236023059", "choice_type": "single"}
+{"question": "Excitatory post synaptic potential is due to", "exp": "EPSP (Excitatory post synaptic potential) -\n1. Definition: the increase in voltage above the normal resting potential — that is to a less negative value — is called\nEPSP because if this potential rises high enough, it will elicit on action potential in the neuron, thus exciting it.\n    EPSP is due to depolarization.\n2. Production à rapid influx of Na+ to the interior neutralised part of the negativity of RMP à RMP ­ed from - 65 to      - 45 my à EPSP à excite the neuron.", "cop": 3, "opa": "K+ influx", "opb": "Na+ efflux", "opc": "Na+ influx", "opd": "Ca++ influx", "subject_name": "Unknown", "topic_name": null, "id": "9c3faa6a-fa42-4aa3-beae-56202061ed57", "choice_type": "single"}
+{"question": "For spinal anesthesia lignocaine is used as", "exp": "Lignocaine is used as 5% (heavy) for spinal anesthesia.", "cop": 4, "opa": "0.5 % solution", "opb": "1 % solution", "opc": "2 % solution", "opd": "5% solution", "subject_name": "Unknown", "topic_name": null, "id": "91e1f0ae-4ce7-4100-8d0e-7d9c50562040", "choice_type": "single"}
+{"question": "In a population of 5000, on 1st January, total cases of myopia were 500. Till 31st December, 90 new cases were found. Calculate the incidence of myopia PER 100.", "exp": null, "cop": 2, "opa": "1.8", "opb": "2", "opc": "5", "opd": "18", "subject_name": "Unknown", "topic_name": null, "id": "1316cc15-af56-4bf1-84ca-e2203a0965d0", "choice_type": "single"}
+{"question": "The test having the fastest lab processing time for karyo type assessment is", "exp": "Amniocentesis, cordocentesis, cystic hygroma aspiration, and chorionic villus samplingare techniques of obtaining fetal tissues that are amenable to cytogenetic analysis.\nAmniotic fluid cellsrequire tissue culture to obtain adequate cell numbers for analysis.\nChorionic villi can be harvested directlyfor extremely rapid diagnosis or can be cultured for higher banding (increased detail).", "cop": 3, "opa": "Amniocentesis", "opb": "Cordocentesis", "opc": "Chorionic villus sampling (CVS)", "opd": "Doppler flow ultrasound", "subject_name": "Unknown", "topic_name": null, "id": "ac7038f4-eeb4-4cfc-bd9b-8719630a4db4", "choice_type": "single"}
+{"question": "Speech discrimination score, lowest in", "exp": "D. i.e. (Acoustic neuroma) (137 - Maqbool)SPEECH DISCRIMINATION SCORE (speech recognition or word recognition score) - tested at 30 to 40 dB, SLUSES1. It determines the extent of discrimination difficulty2. It aids in the diagnosis of the site of pathology in the auditory system eg poor in acoustic neuroma. The normal in conductive deafness3. It assists in rehabilitative measures like the fitting of a hearing aid***Hitzelberg sign seen in Acoustic neuromaVOCAL INDEX - is the relationship between hearing loss for speech and whispered voice* Small in conductive deafness and high in perceptive deafness* Laryngeal pseudosulcus is seen in - Laryngophrayngeal reflux**", "cop": 4, "opa": "Conductive deafness", "opb": "Sensori neural deafness", "opc": "Cortical deafness", "opd": "Acoustic neuroma", "subject_name": "Unknown", "topic_name": null, "id": "0e8d8ff3-1b9b-44dc-a4ec-4400a196c062", "choice_type": "single"}
+{"question": "Riehl’s melanosis involves", "exp": "Riehl’s melanosis (pigmented contact dermatitis) involves face and neck", "cop": 1, "opa": "Face and neck", "opb": "Trunk", "opc": "Extremities", "opd": "Palms only", "subject_name": "Unknown", "topic_name": null, "id": "1f60d6e9-00f5-4be4-923e-0437908c07b7", "choice_type": "single"}
+{"question": "Lymphatic Drainage of the Maxillary Sinus goes first to", "exp": "Through the posterior pathway, the lymphatics from the maxillary and ethmoid sinuses drain into the retropharyngeal lymph nodes", "cop": 4, "opa": "Upper Deep Cervical Lymph Nodes", "opb": "Submental Nodes", "opc": "Submandibular Nodes", "opd": "Retropharyngeal Nodes", "subject_name": "Unknown", "topic_name": null, "id": "95c606fc-6d30-4e4a-bff0-22b02c4a8173", "choice_type": "single"}
+{"question": "Steroids hormones exert their effects by binding to", "exp": "Steroid hormones cross the cell membrane and bind to specific receptors within the cell. These receptors are transcription factors that are active only in the presence of particular hormones. The hormone-tran­scription factor complex binds to steroid hormone responsive elements in DNA to influence transcription from steroid-sensitive genes. Thyroid hormone, reti­noic acid, and 1,25-dihydroxycholecalciferol exert their effects in a similar way.", "cop": 3, "opa": "Cell surface receptors", "opb": "G proteins", "opc": "Transcription factors", "opd": "Cyclic adenosine monophophate (AMP)", "subject_name": "Unknown", "topic_name": null, "id": "9be8289d-c49b-4c8c-a965-509afbcccf3e", "choice_type": "single"}
+{"question": "Umbilical artery is a branch of", "exp": "Anterior division of internal iliac artery\n\nA part of Umbilical artery persists as superior vesical artery and remaining artery becomes obliterated forming medial umbilical ligament.", "cop": 3, "opa": "Coeliac artery", "opb": "Superior mesenteric artery", "opc": "Anterior division of internal iliac artery", "opd": "Posterior division of internal iliac artery", "subject_name": "Unknown", "topic_name": null, "id": "1741a21e-08a7-4969-8b7d-7318f799ea68", "choice_type": "single"}
+{"question": "A 6 years child has foreign body in trachea .Best initial management is", "exp": "Ans. is 'a' i.e.Heimlich's maneuver The best option here is Heimlich's maneuver.\"Heimlich man oeuvre: stand behind the person and place your arms around his lower chest and give four abdominal thrusts. The residual air in the lungs may dislodge the foreign body providing some airway. \"Heimlich's maneuveris actually performed for laryngeal foreign bodies and not for tracheal or bronchial foreign bodies.Heimlich's is performed for completed obstruction and should not be tried in partial obstructions (for fear of causing total obstruction )If Hemlocks m fails then cricothyrotomy or emergency tracheostomy is done.Once the emergency is over, foreign body can be removed by direct laryngoscopy or by laryngofissure (if body is impacted )Tracheal & Bronchial foreign bodiesEmergency removal is not indicated in these ( unless there is airway obstruction or they are of vegetable matter eg seeds likely to swell up)Removed by bronchoscopy with full preparation and under GA.Rigid bronchoscope is used.", "cop": 1, "opa": "Heimlich's maneuver", "opb": "Cardiac massage", "opc": "Intubation", "opd": "Oxygen mask with IPPV", "subject_name": "Unknown", "topic_name": null, "id": "413efacc-9e54-44e4-b93f-f089da1be4f7", "choice_type": "single"}
+{"question": "Type of reaction in Type I Lepra reaction is", "exp": "Type IV delayed Hypersensitivity reaction\nLepra reactions\nType 1 reaction is also called as “Downgrading” or “reversal” reaction\n• It occurs in Borderline Leprosy\n• It is type “IV delayed Hypersensitivity reaction”.", "cop": 4, "opa": "Type I", "opb": "Type II", "opc": "Type III", "opd": "TypeIV", "subject_name": "Unknown", "topic_name": null, "id": "b5e0f414-5081-4f8f-b0c2-86a1c4925b8a", "choice_type": "single"}
+{"question": "Sensation of proprioception is transmitted by;", "exp": "(Refer: Ganong’s Review of Medical Physiology, 24th edition, pg no: 92-94)\nNumerical Classification of Sensory Fibres", "cop": 1, "opa": "A alpha", "opb": "A beta", "opc": "A gamma", "opd": "A delta", "subject_name": "Unknown", "topic_name": null, "id": "076eaea8-f54c-409a-8f5b-536541dc93a3", "choice_type": "single"}
+{"question": "Poiseuille’s hagen lawis", "exp": "Poiseuille-Hagen Formula\nThe relation between the flow in a long narrow tube, the viscosity of the fluid, and the radius of the tube is expressed mathematically in the Poiseuille-Hagen formula:", "cop": 1, "opa": "F = (PA–PB) × 3.14 × r4/8nl", "opb": "F = (PA+PB) × 3.14 × r4/8nl", "opc": "F = (PA/PB) × 3.14 × r4/8nl", "opd": "F = (PA × PB) × 3.14 × r4/8nl", "subject_name": "Unknown", "topic_name": null, "id": "6336772f-0a4c-44d3-96d5-ecabbdac91f2", "choice_type": "single"}
+{"question": "Perjury under section IPC", "exp": "C 191. Sec 191 IPC - Perjury (definition of giving false evidence) Sec 193 IPC - Perjury (punishment for giving false evidence) - Upto 7 years (offense is triable by a first class magistrate) Sec 195 CrPC - Prosecution for contempt of lawful authority of public servants, for offenses against public justice and for offenses relating to documents given for evidence For a person to be punished for perjury, a complaint has to be made in writing as per the above section (195 crpc) Sec 340 CrPC - Procedure in cases mentioned in Sec 195 CrPC - When a complaint is received in writing, the procedure of further inquiry and punishment of accused is as per this section. Sec 154 IEA - Hostile witness", "cop": 3, "opa": "192", "opb": "193", "opc": "191", "opd": "197", "subject_name": "Unknown", "topic_name": null, "id": "5477084a-cef8-4e8e-a2fa-e4f1c57147e8", "choice_type": "single"}
+{"question": "Typical appearance of Tumour cells and Macrophages on Histological section indicate", "exp": "Burkitt lymphoma (Appearance: Starry-sky pattern)", "cop": 4, "opa": "ALCL", "opb": "CLL", "opc": "Diffuse large B cell lymphoma", "opd": "Burkitt's lymphoma", "subject_name": "Unknown", "topic_name": null, "id": "e9df6ea6-8070-4c58-b754-f09c854bdf45", "choice_type": "single"}
+{"question": "In carcinoma base of tongue pain is referred to ear through", "exp": "Ans. is 'c' i.e., Glossopharyngeal Referred otalgiao As ear receives nerve supply from Vth (auriculotemporal branch), IXth (tympanic branch) and IXth (auricular branch) cranial nerves; and from C2 (lesser occipital) and C2 and C3 (greater auricular), pain may be referred from these remote areas.Via IXth cranial nerveDental: - Caries tooth, apical abscess, impacted molar, malocclusion.Oral cavity: - Benign or malignant ulcerative lesions of oral cavity or tongue.Temporomandibular joint disorders: - Bruxism, osteoarthritis, recurrent dislocation, ill-fitting denture.Sphenopalatine neuralgiaVia IXth cranial nerveOropharynx : - Acute tonsillitis, peritonsillar abscess, tonsillectomy. Benign or malignant ulcers of soft palate, tonsil and its pillars.Base of tongue: - Tuberculosis or malignancyElongated styloid process.Via Xth cranial cerve : Malignancy or ulcerative lesion of vallecula, epiglottis, larynx or laryngopharynx, oesophagus.Via C2 and C3 spinal nerves : Cervical spondylosis, injuries of cervical spine, caries spine.", "cop": 3, "opa": "Trochlea", "opb": "Olfactory", "opc": "Glossopharyngeal", "opd": "Abducent", "subject_name": "Unknown", "topic_name": null, "id": "49f1fecd-7312-4130-b863-bc903b143a14", "choice_type": "single"}
+{"question": "Red degeneration of uterine fibroid is mc in", "exp": "Red degeneration\nThis complication of uterine myomas develops most frequently during pregnancy, although it is not rare in cases of painful myomas in women over the age of 40. The myoma becomes tense and tender and causes severe abdominal pain with constitutional upset and fever. The tumour itself assumes a peculiar purple red colour and develops a fishy odour. If the tumour is carefully examined, some of the large veins in the capsule and the small vessels in the substance of the tumour will be found thrombosed", "cop": 2, "opa": "First trimester", "opb": "Second trimester", "opc": "Third trimester", "opd": "Peurperium", "subject_name": "Unknown", "topic_name": null, "id": "fb502572-ce2c-4b81-b41e-49414f7bb5a7", "choice_type": "single"}
+{"question": "CLO test is used for", "exp": "Ans. is 'a' i.e., H. pylori CLO test is another name for campvlobacter-like organism test :-o Rapid urease test, also known as the CLO test (Campylobacter-like organism test), is a rapid diagnostic test for diagnosis of Helicobacter pylori.o The basis of the test is the ability ofH. pylori to secrete the urease enzyme, which catalyzes the conversion of urea to ammonia and carbon dioxide.o The urease produced by H. pylori hydrolyzes urea to ammonia, which raises the pH of the medium, and changes the color of the specimen from yellow (Negative) to red (Positive).", "cop": 1, "opa": "H. pylori", "opb": "Brucella", "opc": "Gonorrhoea", "opd": "EBOLA", "subject_name": "Unknown", "topic_name": null, "id": "f29c99c2-69a7-4db3-865c-59881dcaa56f", "choice_type": "single"}
+{"question": "In combination birth control pills, the contraceptive effect of the estrogenic component is primarily related to", "exp": "The two estrogenic compounds used in oral contraceptives are ethinyl estradiol and its 3-methyl ether, mestranol.\nTo become biologically effective, mestranol must be demethylated to ethinyl estradiol, because mestranol does not bind to the estrogenic cytosol receptor.\nThe degree of conversion of mestranol to ethinyl estradiol varies among individuals; however, it is estimated that ethinyl estradiol is about 1.7 times as potent as the same weight of mestranol.\nThe estrogenic component of birth control pills was originally added to control irregular endometrial desquamation resulting in undesirable vaginal bleeding.", "cop": 4, "opa": "Conversion of ethinyl estradiol to mestranol", "opb": "Suppression of cervical mucus secretion", "opc": "Suppression of luteinizing hormone (LH) secretion", "opd": "Suppression of follicle-stimulating hormone (FSH) secretion", "subject_name": "Unknown", "topic_name": null, "id": "53316c73-34c7-4d60-8e6b-2378013f95c3", "choice_type": "single"}
+{"question": "Trisodium phosphonoformate (foscarnet) is a po¬tent antiviral agent for treating herpes simplex infec¬tions. It works by affecting", "exp": "Trisodium phosphonoformate (foscarnet) inhibits herpes simplex virus (HSV) replication. Foscarnet is a potent inhibitor of HSV-induced DNA polymerase, and has little effect on known cellular DNA polymer­ases. Herpesvirus mutants resistant to the drug arise easily.\nTo a lesser extent, foscarnet also appears to inhibit the polymerase of hepatitis B virus and retroviruses.\nCombinations of antivirals, including foscarnet, are currently prescribed to increase the clinical usefulness of the drugs.", "cop": 2, "opa": "The viral RNA polymerase", "opb": "The viral DNA polymerase", "opc": "The viral reverse transcriptase", "opd": "The host-cellular DNA polymerase", "subject_name": "Unknown", "topic_name": null, "id": "7537be44-5ec0-470e-b9fc-c047298b91e9", "choice_type": "single"}
+{"question": "Young lady presents with acute abdominal pain and history of 1 1/2 months amenorrhoea on USG examination there is a collection of fluid in the pouch of Douglas and empty uterine cavity. Diagnosis is", "exp": "Ans-A ectopic pregnancy (Ref Dutta, 6/e, p 186 (5/e, p. 198, 4/e, pl98)).History of amenorrhoea and absence of gestational sac and collection of fluid in the pouch of Douglas leaves no doubt about the diagnosis of ectopic pregnancy.", "cop": 1, "opa": "Ectopic pregnancy", "opb": "Pelvic hematocele", "opc": "Threatened abortion", "opd": "Twisted ovarian cyst", "subject_name": "Unknown", "topic_name": null, "id": "ebdd7d46-7e54-4471-887f-d70dc225bf3c", "choice_type": "single"}
+{"question": "Uterine bleeding at 12 weeks gestation without any cervical dilationis an indicative of", "exp": "Bleeding occurs in about 30 to 40%of human gestations before 20 weeks of pregnancy, with about half of these pregnancies ending in spontaneous abortion.\nA threatened abortion takes place when this uterine bleeding occurs without any cervical dilation or effacement", "cop": 2, "opa": "Incomplete abortion", "opb": "Threatened abortion", "opc": "Missed abortion", "opd": "Inevitable abortion", "subject_name": "Unknown", "topic_name": null, "id": "40036cf5-8bc5-4e9f-a0d6-221853f15a93", "choice_type": "single"}
+{"question": "Mechanism that does not contribute to counter current multiplier in nephron", "exp": "Ref. Guyton. 13th edition. Page. 435\nCountercurrent multiplication in the kidneys is the process of using energy to generate an osmotic gradient that enables you to reabsorb water from the tubular fluid and produce concentrated urine.\n \nThe three segments of the loops of Henle have different characteristics that enable countercurrent multiplication.\n\nThe thin descending limb is passively permeable to both water and small solutes such as sodium chloride and urea. The tubular fluid becomes steadily more concentrated or hyperosmotic (compared to blood) as it travels down the thin descending limb of the tubule.\nThe thin ascending limb is passively permeable to small solutes, but impermeable to water, which means water cannot escape from this part of the loop. The tubular fluid becomes steadily more dilute or hyposmotic as it moves up the ascending limb of the tubule.\nThe thick ascending limb actively reabsorbs sodium, potassium and chloride. this segment is also impermeable to water, which again means that water cannot escape from this part of the loop. This segment is sometimes called the “diluting segment”", "cop": 3, "opa": "Active transport of sodium and chloride out of thick ascending limb of LOH", "opb": "Water reabsorption in thin descending limb of LOH", "opc": "Sodium reabsorption out of thin descending limb of LOH", "opd": "Urea concentration in collecting duct", "subject_name": "Unknown", "topic_name": null, "id": "aa37274b-7e52-4e39-be2b-729beab86aed", "choice_type": "single"}
+{"question": "Wound contraction is primarily mediated by", "exp": "Myofibroblasts, cells with features intermediate between fibroblasts and smooth muscle cells, appear in the wound 2 to 3 days after injury. Their active contraction decreases the size of the defect.", "cop": 4, "opa": "Smooth muscle cells.", "opb": "Macrophages.", "opc": "Fibroblasts.", "opd": "Myofibroblasts.", "subject_name": "Unknown", "topic_name": null, "id": "fd1e3f3a-c229-42cc-afba-53f01826f9df", "choice_type": "single"}
+{"question": "The definite diagnosis of malignancy in pheochromocytoma is based on", "exp": "Pheochromocytoma are neoplasms composed of chromaffin cells, which synthesize and release catecholamines and in some instances peptide hormones. It is important to recognize these tumors because they are a rare cause of surgically correctable hypertension. Pheochromocytoma range from small, circumscribed lesions confined to the adrenal to large hemorrhagic masses weighing kilograms. The tumors are composed of polygonal to spindle-shaped chromaffin cells or chief cells, clustered with the sustentacular cells into small nests or alveoli (zellballen) by a rich vascular network. The cytoplasm has a finely granular appearance, best demonstrated with silver stains, due to the presence of granules containing catecholamines. The nuclei are usually round to ovoid, with a stippled “salt and pepper” chromatin that is characteristic of neuroendocrine tumors.\nThere is no histologic feature that reliably predicts clinical behavior. Several histologic features, such as numbers of mitoses, confluent tumor necrosis, and spindle cell morphology, have been associated with an aggressive behavior and increased risk of metastasis, but these are not entirely reliable. Tumors with “benign” histologic features may metastasize, while bizarrely pleomorphic tumors may remain confined to the adrenal gland. In fact, cellular and nuclear pleomorphism, including the presence of giant cells, and mitotic figures are often seen in benign pheochromocytomas, while cellular monotony is paradoxically associated with an aggressive behavior. Even capsular and vascular invasion may be encountered in benign lesions. Therefore, the definitive diagnosis of malignancy in pheochromocytomas is based exclusively on the presence of metastases. These may involve regional lymph nodes as well as more distant sites, including liver, lung, and bone.", "cop": 1, "opa": "Presence of metastasis", "opb": "Cellular pleomorphism", "opc": "Nuclear pleomorphism", "opd": "Mitotic figures", "subject_name": "Unknown", "topic_name": null, "id": "5807634d-107d-4488-b7fa-5635b7005953", "choice_type": "single"}
+{"question": "A crisis in a patient with sickle cell disease is most likely to be cause by", "exp": "A crisis in sickle cell disease occurs when deoxygenated HbS precipitates, deforming (sickling) red blood cells and .blocking capillaries. Variables that increase the proportion ofHbS in the \"deoxy\" state tend to increase the probability of a crisis by increasing the extent of sickling. The \"deoxy\" form of hemoglobin is favored by a decrease in pH (acidosis). An increase in pH (alkalosis), increased oxygen concentration, decreased CO2 concentration, and decreased 2,3-bisphospho­glycerate concentration would all favor the\" oxy\" form of hemoglobin.", "cop": 2, "opa": "Alkalosis", "opb": "Acidosis", "opc": "Increased oxygen concentration", "opd": "Decreased CO2 concentration", "subject_name": "Unknown", "topic_name": null, "id": "47f18d93-14b8-443d-91c8-43a5b5764b85", "choice_type": "single"}
+{"question": "\"Golden S\" sign is seen in", "exp": "i.e. (Bronchogenic carcinoma with upper lobe collapse): (Internet) Golden S sign is a sign seen on imaging of the chest that suggests a central lung mass or lung collapse. It was first described by Golden in 1925 in association with bronchial carcinoma, but it is also seen in metastatic cancer, enlarged lymph nodes, and collapse of the right upper lobe of the lung. The Golden S sign can be seen on plain radiographs as well as on computed tomography (CT) scans of the chest. The sign is seen in the right lung as a distorted minor fissure, whose lateral aspect is concave inferiorly and whose medial aspect is convex inferiorly. This produces a \"reverse S\" appearance, responsible for the sign being occasionally called the reverse S sign of Golden Right upper lope collapse around a large central mass. Discussion: The mass prevents the central part of the lobe from losing volume. Because the peripheral lobe collapses and the central portion doen't. It appears convex centrally and concave peripherally. The shape therefore resembles an S or reverse S, and is called the Golden S sign after Golden's description of cases of lobar collapse caused by carcinoma of the lung. Golden S sign - The sign is seen in the right lung as a distorted minor fissure * Floating membrane sign\" in liver found in Hydatid disease * Floating water lily sign is seen in Hydatid cysts** Egg Shell Calcifications * Silicosis * Sarcoidosis * Scleroderma * Histoplasmosis * Amyloidosis * Lymphoma following radiotherapy \" Popcorn calcification\" is pathognomic for Hemartoma on chest X-ray (562-H17th) Pulmonary embolism - X-ray chest findings Hampton's hump As peripheral wedge shaped opacity due to pulmonary infarct Wester mark's sign It is a focal area of oligemia due to vasoconstriction distal to embolus Palla's sign Enlarged right descending pulmonary artery", "cop": 1, "opa": "Bronchogenic carcinoma with upper lobe collapse", "opb": "Bronchogenic carcinoma with lower lobe collapse", "opc": "Bronchogenic carcinoma in interlobular fissure", "opd": "Hydatid cyst", "subject_name": "Unknown", "topic_name": null, "id": "1968f024-30f9-4d13-8d26-a5a415890d79", "choice_type": "single"}
+{"question": "Generation time for E.coli is", "exp": "Ans: b) 20mts Generation time of E COLI 20 MIN M TB 16-18 HOURS M LEPRAE 14 DAYS", "cop": 2, "opa": "2 MIN", "opb": "20 MIN", "opc": "2 hrs", "opd": "20 days", "subject_name": "Unknown", "topic_name": null, "id": "64760da8-7637-4d28-b8af-e5aa8596a733", "choice_type": "single"}
+{"question": "The immunity responsible for to control epidemic spread of a pathogen", "exp": "Herd immunity-\nOverall immunity of a community to a pathogen\nIf Herd immunity is good- chance of epidemic is less\nEradication of a communicable disease- depends on good Herd immunity\nProvided by mass vaccination by live vaccination to all individual at same time.", "cop": 3, "opa": "Innate immunity", "opb": "Active acquired immunity", "opc": "Herd immunity", "opd": "Passive natural immunity", "subject_name": "Unknown", "topic_name": null, "id": "3f07d2b2-990f-4d28-86e8-745f7bba2ccc", "choice_type": "single"}
+{"question": "Comment on this CTG", "exp": null, "cop": 4, "opa": "Normal", "opb": "Early deceleration", "opc": "Late deceleration", "opd": "Variable deceleration", "subject_name": "Unknown", "topic_name": null, "id": "3ebddd3c-11ae-4378-a409-89340eb0c063", "choice_type": "single"}
+{"question": "Splenic auto infarction is seen in", "exp": "Sickle cell disease\nAs the largest unit of the mononuclear phagocyte system, the spleen is involved in all systemic inflammations, generalized hematopoietic disorders, and many metabolic disturbances. In each, the spleen undergoes enlargement (splenomegaly), which is the major manifestation of disorders of this organ. It is rarely the primary site of disease. Splenic insufficiency due to splenectomy or autoinfarction (as in sickle-cell disease) has one major clinical manifestation, an increased susceptibility to sepsis cause by encapsulated bacteria such as pneumococcus, meningococcus, and Haemophilus influenzae. The loss of filtering and antibody production functions both contribute to the increased risk of sepsis, which may be fatal. All asplenic individuals should be vaccinated against these agents to reduce the risk of this tragic complication.", "cop": 3, "opa": "Splenic amyloidosis", "opb": "Thalassemia", "opc": "Sickle cell disease", "opd": "Gauchers disease", "subject_name": "Unknown", "topic_name": null, "id": "04a76a2b-4e4a-4134-86a2-e2599b986989", "choice_type": "single"}
+{"question": "Halban disease is due to", "exp": "Irregular shedding (Halban's disease)\nIt is rare and self-limited. It is due to persistent corpusluteum. The menstruation comes on time, is prolonged but not heavy. Progestogen can suppress the bleeding, but needs to be taken on tapering dose for 20 days to complete the cycle.", "cop": 1, "opa": "Persistent corpus luteum", "opb": "Deficient corpus luteum", "opc": "Persistent trophoblast", "opd": "Deficient trophoblast", "subject_name": "Unknown", "topic_name": null, "id": "87106559-d5dc-4712-adf1-aeda95628cae", "choice_type": "single"}
+{"question": "The gold standard for diagnosing the Cystic fibrosis is", "exp": "In most cases, the diagnosis of cystic fibrosis is based on persistently elevated sweat electrolyte concentrations (often the mother makes the diagnosis by recognizing her infant's abnormally salty sweat), characteristic clinical findings (sinopulmonary disease and gastrointestinal manifestations), an abnormal newborn screening test, or a family history. A minority of patients with cystic fibrosis, especially those with at least one “mild” CFTR mutation, may have a normal or near-normal sweat test (<60 mM/L). Measurement of nasal transepithelial potential difference in vivo can be a useful adjunct test under these circumstances; individuals with cystic fibrosis demonstrate a significantly more negative baseline nasal potential difference than controls. Sequencing the CFTR gene is, of course, the “gold standard” for diagnosis of cystic fibrosis. Therefore, in patients with suggestive clinical findings or family history (or both), genetic analysis may be warranted.", "cop": 1, "opa": "Sequencing the CFTR gene", "opb": "Sweat chloride test", "opc": "Positive newborn screening test result", "opd": "Nasal transepithelial potential difference", "subject_name": "Unknown", "topic_name": null, "id": "58e7a5ba-b3a7-4a3e-8e63-984a319e3086", "choice_type": "single"}
+{"question": "During Acute tonsillitis Pain in the ear is due to Involvement of", "exp": "Ref. Diseases of Ear, Nose and Throat. Pg 258\nBelow is a compiled pic of referred pain to ear", "cop": 3, "opa": "Trigeminal nerve", "opb": "Facial nerve", "opc": "Glossopharyngeal nerve", "opd": "Vagus nerve", "subject_name": "Unknown", "topic_name": null, "id": "ac9bf7a5-dd51-4fd1-9011-e4f7d89b968e", "choice_type": "single"}
+{"question": "Commonest site of Morgagni hernia", "exp": "Morgagni hernias are related to maldevelopment of the embryologic septum transversum and to failed fusion of the sternal and costal fibrotendinous elements of the diaphragm. These hernias are generally asymptomatic and usually detected as incidental findings on radiographs.", "cop": 1, "opa": "Right anterior", "opb": "Right posterior", "opc": "Right anterior", "opd": "Left posterior", "subject_name": "Unknown", "topic_name": null, "id": "76ffa75a-a1bf-4a09-8159-4457387e4a3b", "choice_type": "single"}
+{"question": "On accident there is damage of cervical spine, first line of management is", "exp": "Ans. is 'd' i.e stablise the cervical spine According to ATLS in case of spinal injuries spinal stabilization done at 1st...after dt maintain airway...", "cop": 4, "opa": "x-ray", "opb": "turn head to side", "opc": "maintain airway", "opd": "stabilize the cervical spine", "subject_name": "Unknown", "topic_name": null, "id": "3a2a3010-1ea8-44c1-914f-bfc8e87323e3", "choice_type": "single"}
+{"question": "Anemia of advanced renal insufficiency is best treated by", "exp": "• A normocytic, normochromic anemia attributable to CRD is observed beginning at stage 3 CRD and is almost\nuniversal at stage 4.\n• The primary cause of anemia in patients with CRD is insufficient production of EPO by the diseased kidney.\n• Management guidelines for correction of anemia of chronic renal disease—\n1.Recombinant human EPO, epoetinalfa.\n2. Darbepoetinalfa is a hyperglycosylated analog of recombinant human EPO that possesses greater biologic\nactivity and prolonged half-life.\nIron supplementation is usually essential to ensure an adequate response to EPO in patients with CRD because the\ndemands for iron by the erythroid marrow frequently exceed the amount of iron that is immediately available for erythropoiesis as well as iron stores.", "cop": 2, "opa": "Blood transfusions", "opb": "Recombinant human erythropoietin", "opc": "Parenteral iron therapy", "opd": "Folic acid", "subject_name": "Unknown", "topic_name": null, "id": "99690e81-8d11-4c79-941e-5484b8082bb2", "choice_type": "single"}
+{"question": "A 7years old boy has progressive difficulty in climbing the stairs and walks with waddling gait also has calf muscle hypertrophy diagnosis is", "exp": "(D) (Becker's muscular dystrophy) (3492-95 H 18th)* Becker muscular dystrophy differ from Duchene muscular dystrophy by its (595- Ghai 8th)* Later age of onset (usually >6 years of age)* Later age of wheelchair confinement (>15 years)* More incidence of myalgias* Occasional rhabdomyolysis following exercise and early cardiomyopathyPresence of muscular weakness in association with positive Gower's sign, hypertrophy of calves (pseudohypertrophy) and elevated CPK values in a young male suggests a diagnosis of Duchenne's muscular dystrophy.Essentials of Diagnosis; Duchenne Muscular Dystrophy; Current Diagnosis & Treatment Neurology * Typically affects males* Positive family History (X-linked recessive inheritance)* Onset before 5 years of age with delayed motor milestones* Proximal muscle weakness, positive Gower's sign and calf muscle pseudohypertrophy (common)* Elevated CK levels (>10 fold increase)* Severely reduced or absent dystrophin in muscle biopsy or genetic testing provides definitive diagnosisDuchenne Muscular Dystrophy (pseudohypertrophic Muscular Dystrophy; ReviewDuchenne's muscular dystrophy is the most common hereditary neuromuscular disease affecting all races and ethnic groupInheritance and pathology* Duchenne's muscular dystrophy is inherited as an x-Linked Recessive disorder9* It is caused by a multation in the gene responsible for producing dystrophin9* Dystrophin is a subsarcolemmal protein9 localized to the inner surface of the sarcolemma9 of the muscle fibre* Lack of dystrophin protein results in weakness of sarcolemma, causing membrane tears and muscle fibre necrosis, therepy resuiting in muscle weaknessPresentation & clinical Manifestations* Typically affects males & family histoy is positive (X Linked recessive inheritance)* Typically present between ages 3 and 5 (Disorder docs not present at birth9 or infancy) (Delayed motor milestones may be apparent after the first year of life)* Gower's sign is positive9* Pseudohypertrophy of calf is seen9 (muscle is replaced by fat & connective tissue)* Loss of muscle strength is progressive9* Proximal muscle and neck flexors are involved more9* Leg involvement is more severe than arm involvement* Contractures of heel cords and iliotibial band occurs (by age of 6 years)* Progressive scoliosis developsComplicationsChest deformity9 (Scoliosis)9;Impairs pulmonary function9By age of 16 and 18 years patients are predisposed to serious pulmonary fatal infectionsCardiacCardiomyopathy9 and CHF may be seenCardiac cause of death is uncommonIntelectual impairment;is common9 (IQ is one SD below the mean)Remember: Onset9Before age of 59 Confined to wheel chairInability to walkAfter age of 129 Respiratory failureIn second or third decade (after 16-18years)9 Progressive Musclear DystrophiesTypeInheritanceDefective Gene/proteinOnset AgeClinical featuresOther organ system involvedDuchenne'sXRDystrophinBefore 5 yearsProgressive weakness of girdle muscles unable to walk after age 12 progressive kyphoscoliosis Respiratory failure in 2nd or 3rd decadeCardiomyopathy Mental impairmentBecker'sXRDystrophinEarly childhood to adultProgressive weakness of girdle muscle Able to walk after age 15 Respiratory failure may develop by 4th decadeCardiomyopathyLimb-girdleAD/ARSeveralEarly childhood to early adultSlow progressive weakness of shoulder and hip girdle muscles+- CardiomyopathyEmery-DreifussXR/ADEmerin/Lamins A/C Nesprin-1, Nesprin 2, TMEM43Childhood to adultElbow contractures, umeral and peroneal weaknessCardiomyopathyCongenitalARSeveralAt birth or within first few monthsHypotonia, contractures, delayed milestones progression to respiratory failure in some; static course in othersCNS abnormalities (hypomyelination,malform ation) Eye abnormalitiesMyotonic (DMI,DM2)ADDM1; Expansion CTG repeat DM2; Expansion CCTG repeatChildhood to adult Maybe infancy if mother affected (DMI Only)Slowly progressive weakness of face, shoulder girdle, and foot dorsiflexion preferential proximal weakness in DM2Cardiac conduction defectsMental impairment cataracts frontal baldness Gonadal atrophyFacioscapulohumeralADDUX44qChildhood to adultSlowly progressive weakness fo face, shoulder girdle, and foot dorsiflexionDeafness coats (eye)diseaseOculopharyngealADExpansion, poly- A RNA binding protein5th to 6th decadeSlowly progressive weakness of extraocular, pharyngeal, and limb muscles", "cop": 4, "opa": "DMD", "opb": "Myositis", "opc": "Dermatomyositis", "opd": "Becker's muscular dystrophy", "subject_name": "Unknown", "topic_name": null, "id": "21429ec0-2b74-496f-9d69-c1c1007b84cf", "choice_type": "single"}
+{"question": "The operation of choice for the below condition", "exp": "The treatment of annular pancreas is duodenojejunostomy or gastrojejunostomy either of which bypasses the obstruction.\nAccording to Bailey and Love duodenoduodenostomy or duodenojejunostomy are usual operation. Obstructing pancreatic ring must not be simply divided. Since this may not relieve the obstruction and pancreatic fistula may result.\nAnnular pancreas is formed by a thin band of normal pancreas tissue that completely encircles the second portion of duodenum and is continuous with head of pancreas anteriorly and posteriorly. 40% patients have associated duodenal stenosis or atresia.\nSymptoms of duodenal obstruction (gastric distention and vomiting) occur in about one third of cases in the first week of life and about one half of cases in the first year. Rests are asymptomatic until adulthood, when abdominal pain, nausea and vomiting may occur.", "cop": 3, "opa": "Division of annular ring", "opb": "Gastrojejunostomy", "opc": "Duodenojejunostomy", "opd": "Pancreaticoduodenal tom", "subject_name": "Unknown", "topic_name": null, "id": "dbeb173e-3b55-4aab-b790-37781327b168", "choice_type": "single"}
+{"question": "The pH of vagina in adults is", "exp": "The vaginal secretion is small in amount in healthy women and consists of white coagulated material. When it is examined under the microscope, squamous cells which have been shed from the vaginal epithelium and Doderlein's bacilli alone are found. Doderlein's bacillus is a large gram-positive rod-shaped organism, which grows anaerobically on acid media. The vaginal secretion is acidic due to the presence of lactic acid, and this acidity inhibits the growth of pathogenic organisms. The pH of the vagina averages about 4.5 during reproductive life. The acidity, which is undoubtedly oestrogen-dependent, falls after menopause to neutral or even alkaline. Before puberty, the pH is about 7. This high pH before puberty and after menopause explains the tendency for the development of mixed organism infections in these age groups.", "cop": 2, "opa": "3.5- 4.5", "opb": "4.5-5.5", "opc": "5.5- 6.5", "opd": "6.5- 7.5", "subject_name": "Unknown", "topic_name": null, "id": "a161eb75-a4b2-4dc0-a46f-36f4d0b3ed88", "choice_type": "single"}
+{"question": "Retention of urine in a pregnant women, retroverted uterus is seen at", "exp": "Retroverted gravid uterus - As a result of retention, the bladder gets distended and becomes an abdominal organ reaching' even up to umbilicus.\nAs pressure from the full bladder increases, small amounts of urine are passed involuntarily, but the bladder never empties entirely - paradoxical incontinence", "cop": 2, "opa": "8-10 weeks", "opb": "12-16 weeks", "opc": "20-24 weeks", "opd": "28-32 weeks", "subject_name": "Unknown", "topic_name": null, "id": "68229151-0523-40e4-8f04-1f3f18533f4d", "choice_type": "single"}
+{"question": "Carcinoma endometrium involving uterine cavity more than 10 cms long with early myometrial involvement is", "exp": "Ans- The International Federation of Gynecology and Obstetrics(FIGO) staging system for carcinoma of corpus uteri is as follows:Stage IA-Tumor limited to endometrium <8 cm)Stage IB-Invasion to less than one half the myometrium (>8 cm)Stage IC-Invasion to more than one half the myometriumStage IIA-Endocervical glandular involvement onlyStage lIB-Cervical stromal invasionStage IlIA-Tumor invades serosa and/or adnexa and/or positive peritoneal cytologyStage IIIB-Vaginal metastasisStage IUC-Metastases to pelvic and/or para-aortic lymph nodesStage IVA-Tumor invasion of bladder and/or bowel mucosaStage IVB-Distant metastases including intra-abdominal and/or inguinal lymph nodesCases of carcinoma of the corpus should be classified (or graded) according to the degree of histologic differentiation. The histopathology and degree of differentiation is as follows:i. Class G1-Non squamous or non morular solid growth pattern of 5% or lessii. Class G2-Non squamous or non morular solid growth pattern of 6-50%iii. Class G3-Non squamous or non morular solid growth pattern of more than 50%Please note the new staging and use this for answering mcqsCARCINOMA OF THE ENDOMETRIUMIA Tumor confined to the uterus, no or < 1/2 myometrial invasionIB Tumor confined to the uterus, > 1/2 myometrial invasionII Cervical stromal invasion, but not beyond uterusIIIA Tumor invades serosa or adnexaIIIB Vaginal and/or parametrial involvementIIIC1 Pelvic node involvementIIIC2 Para-aortic involvementIVA Tumor invasion bladder and/or bowel mucosaIVB Distant metastases including abdominal metastases and/or inguinal lymph nodes", "cop": 2, "opa": "Stage Ia", "opb": "Stage Ib", "opc": "Stage IIa", "opd": "Stage IIb", "subject_name": "Unknown", "topic_name": null, "id": "6cf35ab9-10b2-462e-8f6c-f61fe297b4e2", "choice_type": "single"}
+{"question": "Placenta previa should be suspected in 3rd trimester in case of", "exp": "Ans-A (Painless vaginal bleeding)Ref: William's Obstetrics, 23rd ed. chapter 35Placenta previa is used to describe a placenta that is implanted over or very near the internal cervical os.There are several possibilities: total placenta previa, marginal placenta previa, partial placenta previa.The most characteristic event in placenta previa is painless hemorrhage, which usually does not appear until near the end of the second trimester or after. However, bleeding may begin earlier, and some abortions may result from such an abnormal location of the developing placenta.Digital cervical examination is never permissible unless the woman is in an operating room with all the preparations for immediate cesarean delivery--even the gentlest digital examination can cause torrential haemorrhage.The simplest, safest, and most accurate method of placental localization is provided by transabdominal sonography. Accordingly, the average accuracy is 96 percent, and rates as high as 98 percent have been obtained. False-positive results are often a result of bladder distension. Therefore, scans in apparently positive cases should be repeated after emptying the bladder.Cesarean delivery is necessary in practically all women with placenta previa. Most often, a transverse uterine incision is possible. However, because foetal bleeding may result from a transverse incision into an anterior placenta, a vertical incision is sometimes employed. But, even when the incision extends through the placenta, maternal or fetal outcomes are rarely compromised.", "cop": 1, "opa": "Painless vaginal bleeding", "opb": "Unengaged Head", "opc": "Painful uterine bleeding", "opd": "Painful vaginal bleeding", "subject_name": "Unknown", "topic_name": null, "id": "735808d1-53e6-419f-977c-4354484fa8c4", "choice_type": "single"}
+{"question": "Proper management of a child with an absolute neutrophil count (ANC) of 100/mm3 would be", "exp": "A child with an absolute neutrophil count (ANC) of 100/mm3 is severely neutropenic and is at risk of death from overwhelming septicemia. Because most signs of infection (e.g., pneumonitis, pyuria) depend on the presence of neutrophils, serious infection may be present in such a patient without producing characteristic physical, radiologic, or laboratory findings. Thus, broad spectrum antibiotics (to treat a variety of possible infections) must be initiated promptly after cultures are obtained. Deferring treatment until culture results are available may result in overwhelming septicemia and death. Granulocyte transfusions usually are not beneficial in these patients because of the short survival time of the cells in the bloodstream (plasma half-life is approximately 7 hours). Iron and vitamin B12 are treatments for nutritional anemias and are of no therapeutic' value in neutropenia.", "cop": 1, "opa": "The start of broad-spectrum intravenous antibiotics", "opb": "Careful physical examination and chest radiograph; close observation pending result of blood cultures", "opc": "Granulocyte transfusion", "opd": "Nutritional support with oral iron and intramuscular injection or vitamin B12", "subject_name": "Unknown", "topic_name": null, "id": "65fb3525-fdee-4d33-aff8-ed71b6b5da1b", "choice_type": "single"}
+{"question": "Following blunt abdominal trauma, A 2 year old girl develops upper abdominal pain and vomiting. An upper gastrointestinal series reveals a total obstruction of the duodenum with a coiled spring appearance in the second and third portions. Appropriate management is", "exp": "Duodenal hematomas result from blunt abdominal trauma. They present as a high bowel obstruction with abdominal pain and occasionally a palpable right upper quadrant mass An upper gastrointestinal series is almost always diagnostic with the classic coiled. spring appearance of the second and third portions of the duodenum secondary to the crowding of the valvulae conniventes (circular folds) by the hematoma. Nonsurgical management is the mainstay of therapy because the vast majority of duodenal hematomas resolve spontaneously Simple evacuation of the hematoma is the operative procedure of choice. However, bypass procedures and duodenal resection have been performed for this problem. In patients with duodenal obstruction from the superior mesenteric artery syndrome, the obstruction is usually the result of a marked weight loss and, in conjunction with this, loss of the retropentoneal fat pad that elevates the superior mesenteric artery from the third and fourth portions of the duodenum. Nutritional repletion and replenishment of this fat pad will elevate the artery off the duodenum and relieve the obstruction.", "cop": 2, "opa": "Gastrojejunostomy", "opb": "Nasogastric suction and observation", "opc": "Duodenal resection", "opd": "Duodenojejunostomy", "subject_name": "Unknown", "topic_name": null, "id": "c86f479f-b897-4aa9-8eb2-5cd3dd9d0187", "choice_type": "single"}
+{"question": "In autonomic nervous system, parasympathetic outflow is mainly by", "exp": null, "cop": 1, "opa": "Cholinergic", "opb": "Adrenergic", "opc": "Noradrenergic", "opd": "Histaminergic", "subject_name": "Unknown", "topic_name": null, "id": "24a23e89-e531-4119-ad19-b90031d527fa", "choice_type": "single"}
+{"question": "Typical bodies in Bronchial mucosa from Sputum of Patient is seen in", "exp": "Bronchial asthma (Body shown: Creola body)", "cop": 1, "opa": "Bronchial asthma", "opb": "Emphysema", "opc": "Chronic bronchitis", "opd": "Bronchiectasis", "subject_name": "Unknown", "topic_name": null, "id": "67513140-fce4-47ad-88e4-ec6d035aaeda", "choice_type": "single"}
+{"question": "Kuttner Tumour is a lesion of following gland", "exp": "• Kuttner tumor is also called as Chronic sclerosing sialadenitis\n• Benign inflammatory lesion (fibro inflammatory)\n• Associated with submandibular glands in most of the cases.\n• Is basically a chronic inflammatory disease of salivary glands.\n• Positive for cytokeratin CK 7, 8, 13, 19.", "cop": 2, "opa": "Lymph gland", "opb": "Salivary gland", "opc": "Sebaceous gland", "opd": "Thymus gland", "subject_name": "Unknown", "topic_name": null, "id": "e0ece168-56b8-4ba6-8fab-c9b0a69eb104", "choice_type": "single"}
+{"question": "Streptolysin O is inactivated by", "exp": "Streptococci produce 2 types of Streptolysin ( O&S) based on oxygen dependency. Streptolysin O is oxygen labile. It is inactive in the presence of Oxygen. Streptolysin O is antigenic and ASO titre is a standard serological diagnosis of Acute Rheumatic fever. Streptolysin O & S both can cause hemolysis.", "cop": 3, "opa": "CO2", "opb": "Nitrogen", "opc": "Oxygen", "opd": "Serum", "subject_name": "Unknown", "topic_name": null, "id": "f256ead6-8476-48f1-8492-c114feead752", "choice_type": "single"}
+{"question": "Absorption of glucose is intestine is by", "exp": "Ref. Guyton. 13th edition. Page. 840\nPrimary and secondary transport \n\nIn primary active transport, ATP is consumed directly by the transporting protein, (e.g., the Na/K-ATPase pump, or the calcium-dependent ATPase of the sarcoplasmic reticulum). 
\nSecondary active transport depends indirectly on ATP as a source of energy, as in the co-transport of Na-glucose in the proximal tubule. This process depends on ATP utilized by the Na/K-ATPase pump. 
\nGlucose moves up a concentration gradient via secondary active transport.", "cop": 1, "opa": "Secondary active transport", "opb": "Facilitated diffusion", "opc": "Primary active transport", "opd": "Osmosis", "subject_name": "Unknown", "topic_name": null, "id": "2675bc11-6e5e-477d-861d-3b4ccac823d7", "choice_type": "single"}
+{"question": "In comparing laparoscopic salpingostomy vs. laparotomy with salpingectomy for the treatment of ectopic pregnancy, laparoscopic therapy results in", "exp": "Conservative laparoscopictreatment of ectopic pregnancy is now commonplace, although not yet universal.\nWith increasing sophistication of techniques and fiberoptics, many microsurgical procedures can be done through the laparoscope.\nRecent studies suggestthat the fertility rates for laparoscopy and laparotomy are comparable, as are the implications of repeat ectopic pregnancies.\nCertainly laparoscopy, because of its small incision, results in fewer breakdowns and shorter hospital stays, but the incidence of complications due to retained ectopic tissue is higher.", "cop": 1, "opa": "Higher fertility rate", "opb": "Lower repeat ectopic pregnancy rate", "opc": "Comparable persistent ectopic tissue rate", "opd": "Greater scar formation", "subject_name": "Unknown", "topic_name": null, "id": "61e34a43-390d-4886-85e4-369317cc1d69", "choice_type": "single"}
+{"question": "The first gene to be knocked out in the carcinogenesis of endometrium is", "exp": "The primary gene involved in transformation of a normal or a hyperplastic endometrium to a neoplastic endometrium is loss of PTEN gene function.", "cop": 2, "opa": "PI3KCA", "opb": "PTEN", "opc": "KRAS", "opd": "p53", "subject_name": "Unknown", "topic_name": null, "id": "70fcfd10-eaa7-4268-b998-944cf7067619", "choice_type": "single"}
+{"question": "In Glanzmann thrombasthenia, the defect is", "exp": "It is due to defective aggregation because of surface deficiency of GP II b- IIIa.", "cop": 3, "opa": "Decreased platelets", "opb": "Defective adhesion", "opc": "Defective aggregation", "opd": "Defective secretion of granules", "subject_name": "Unknown", "topic_name": null, "id": "1ad59d14-37d3-400e-9b69-87ff957dbb41", "choice_type": "single"}