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All of the poisons caused uterine contractions EXCEPT:
ANSWER: (B) ArsenicREF: Forensic medicine and Toxicology by R N Karmakar 3rd edition page 230, Parikh 6th edition various pageABORTIFACI ENT DRUGS:EcbolicsIncreases uterine contractionErgot, Quinine, Pituitary extract, LeadEmmenagoguesIncreases menstrual flow (abortifacient in large repeated doses)Cantharides, Aloes, EstrogenGI irritantsIrritation of colon and congestion of pelvic organsArsenic, Mercury
2
Lead
Arsenic
Ergot
Quinine
Forensic Medicine
Forensic Toxicology - Concepts, Statutes, Evidence, and Techniques
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Treatment of thyroglossal cyst
Ans. (a) Sistrunk operation* Sistrunk operation: Excision of cyst and also full tract up to the foramen caecum is done along with removal of central part of the hyoid bone, as the tract passes through it.* Sistrunk operation is also named for Filarial leg surgery
1
Sistrunk Operation
Cyst operation
Antibiotics
All the above
Surgery
Thyroid Gland
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Metabolic abnormality seen in congenital hypertrophic pyloric stenosis is
Ans. is 'a' i.e. Hypochloremic hypokalemic metabolic alkalosis * Repeated vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic {paradoxical aciduria)Cause of paradoxical aciduria - Initially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions, thus the urine becomes acidic and metabolic alkaline state is further aggravated
1
Hypochloremic hypokalemic metabolic alkalosis
Hyperchlonemic hypokalemic metabolic alkalosis
Hypochloremic hypokalemic metabolic acidosis
Hyperchloremic hypokalemic metabolic acidosis
Surgery
Benign Gastric Disease
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Clinical manifestations of bronchogenic carcinoma include the following except-
null
4
Hoarseness of voice due to involvement of left recurrent laryngeal nerve
Homer's syndrome
Diaphragmatic palsy due to infiltration of phrenic nerve
Gastroparesis due to vagal involvement
Surgery
null
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Spoke wheel calcification in an osteolytic lesion is seen in
Radiological findings in intraosseous hemangioma are : Prominent trabecular pattern Better visualization of thickened veical trabeculation: polka-dot appearance on axial images and corduroy sign on coronal and sagittal images. Lytic calvarial lesions with spoke-wheel appearance Irregular and lytic in long bones, with a honeycomb appearance
1
Hemangioma
Secondaries
Plasmacytosis
Hydatid disease
Radiology
Skeletal system
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All of the following statements is/are true about post streptococcal glomerulonephritis except -a) Early treatment of streptococcal pharyngitis prevents glomerulonephritisb) All cases of streptococcal infection lead to glomerulonephritisc) Hump sign may be presentd) Immune complex deposits are seene) Commonly presents with crescent formation
There is no evidence to date that the early treatment of streptococcal disease, either pharyngitic or cellulitic, will alter the risk of PSGN. Not all cases of streptococcal infection lead to glomerulonephritis. PSGN usually develops 1-3 weeks following acute infection with specific nephritogenic strains of group A beta-hemolytic streptococcus. The incidence of GN is approximately 5-10% in persons with pharyngitis and 25% in those with skin infection. The characteristic ultrastructural feature of PSGN is subepithelial like dense deposits. By immunofluorescence microscopy, there are granular deposits of IgG, IgM and C3 in the mesangium and along GBM. Focal and sparse immune complex deposits are almost universally present. PSGN does not commonly present with crescent formation. Only in its severe form PSGN may show rapid deterioration of renal function with formation of crescent in the glomeruli It is referred to as rapidly progressive glomerulonephritis.
3
abc
bcd
abe
acd
Pathology
null
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All of the following are risk factors for postoperative infection after hysterectomy except :
Ans. is b i.e. Use of blood transfusion Friends, let's discuss each option one by one. Urinary catheterization (Option 'a) It is very obvious that urinary catheterization for > 7 days will increase the chances of post operative infection. "Almost all nosocomial UT/ are associated with preceeding instrumentation and indwelling catheter, which create a 3-10% risk of infection each day." Surgery for malignancy (Option 'c) Telinde's Operative Gynaecology 9/e, p 197 and William Gynae, l/e p 77 gives a list of risk factors for Post Operative Infection. Risk factors for Postoperative Infection : Altered immunocompetence Obesity Bacterial vaginosis Excessive intraoperative blood loss Telinde's Operative Gynaecology Radical surgery - a/w prolonged surgical procedure (>3-5 hrs) Prolonged preoperative hospitalization Operative inexperience * Lower socioeconomic status * Poor nutrition * Excessive devitalized tissue * Diabetes mellitus * Failure to use prophylactic anitbiotics * Surgery in an infected operative site. Young age/old age (Williams Gynae 1/e, p 77) From the table it is clear : Radical surgery which is carried out for carcinoma endometrium and carcinoma cervix carries risk for postoperative infection. (Option "c") As far as age is concerned : Telinde operative gynaecology 9/e. p 196 says: "Young age has been considered a risk factor for vaginal posthysterectomy infection, although the exact reason is unclear." And table in Williams Gynae lie. p 77 gives old age as a risk factors for abdominal hysterectomy and young age as a risk factor for vaginal hysterectomy. This leaves us with option 'b' i.e. use of blood transfusion. Though theoretically by blood transfusion risk of infection with - HIV. hepatitis B/C, G etc is high but practically the technique by which blood is prepared there is minimal risk .
2
Urinary catheterization > 7 days
Use of blood transfusion
Surgery for malignancy
Age > 50 years
Gynaecology & Obstetrics
null
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Best time for diagnosing fetal abnormalities by USG: September 2009
Ans. B: 13-19 weeks of pregnancy
2
6-12 weeks of pregnancy
13-19 weeks of pregnancy
20-26 weeks of pregnancy
27-32 weeks of pregnancy
Gynaecology & Obstetrics
null
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Collagen accumulated in space of Disse in case of liver cirrhosis are
In the normal liver, ECM consisting of interstitial collagens(fibril forming collagen types I, II, V and XI) is present only in the liver capsule, in poal tracts and around central veins. In cirrhosis, types I and III collagen and other ECM components are deposited in the space of disse. ROBBINS BASIC PATHOLOGY NINTH EDITION PAGE 607
3
1 and 4
2 and 4
1 and 3
2 and 3
Pathology
G.I.T
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Which among the following decreases absorption of Iron from the intestine?
Coffee and tea consumption at the time of a meal can significantly decrease iron absorption (the polyphenols bind the iron). Excess consumption of high fiber foods or bran supplements (the phytates in such foods inhibit absorption) and high intake of calcium also decrease the iron absorption. Tetracyclines also decrease Fe absorption. Vit-C and acids increase Fe absorption.
4
Phosphates
Phytales
Alkalies
All the above
Biochemistry
null
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True about obsession - compulsive disorder are A/E
C i.e. Egosyntonic- In OCD, the thought is egodystonic or egoalien (ie foreign to one's personality)(2; not ego syntonic - OCD is a neurosis, so insight is presentQ
3
Ego-alien
Patient tries to resist against
Ego syntonic
Insight is present
Psychiatry
null
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Moeller's glossitis is due to a
Atrophic glossitis. Atrophic glossitis, also known as bald tongue, smooth tongue, Hunter glossitis, Moeller glossitis, or Moller-Hunter glossitis, is a condition characterized by a smooth glossy tongue that is often tender/painful, caused by complete atrophy of the lingual papillae Ref Davidson 23rd edition pg 1036
1
pernicious anemia
Riboflavin deficiency
Acute monocytic leukemia
Late acquired syphilis
Medicine
Miscellaneous
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This virus causes a mononucleosis-like syndrome caused by a latent herpesvirus; it is often a congenital infection. Large amounts of the virus are excreted in the urine; thus, urine becomes the fluid of choice for diagnosis of this disease.
Epstein-Barr virus (EBV) is a herpesvirus that causes a number of syndromes; the most common is infectious mononucleosis. It is a ubiquitous enveloped DNA virus. Only one serotype of EBV has been recognized, although molecular methods have reorganized a number of genotypes of EBV.Infectious mononucleosis is an acute disease most commonly seen in younger people. It is characterized by a proliferation of lymphocytes, lymph node enlargement, pharyngitis, fatigue, and fever. Infection in young children is usually either asymptomatic or characteristic of an acute upper respiratory infection. Diagnosis is usually made by a positive heterophil test. Heterophil antibodies are those that occur in one species (human) and react with antigens of a different species. The heterophil test may be insensitive (30 to 60%) in children. Definitive diagnosis is made by detection of antibodies to EBV components.EBV causes a variety of other syndromes including Burkitt's lymphoma, the most common childhood cancer in Africa, and nasopharyngeal carcinoma, commonly seen in China.Similar mononucleosis-like diseases are caused by cytomegalovirus (CMV) and Toxoplasma gondii, a parasite. CMV causes fewer than 10% of infectious mononucleosis-like diseases. CMV "mono" is primarily characterized by fatigue. Congenital infection with CMV almost always causes serious sequelae, such as retardation and hearing loss. T. gondii also causes a variety of clinical problems, among them encephalitis in AIDS patients and food poisoning from the ingestion of raw meat. Although CMV and T. gondii are relatively rare causes of infectious mononucleosis, they must be ruled out, particularly when EBV tests are nonreactive.
2
Epstein-Barr virus
Cytomegalovirus
HHV-6
Parvovirus
Microbiology
Virology
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In a patient presenting with abdominal trauma,fracture rib and bruise over left hypochondrium probable diagnosis is -
Ans. is 'c' i.e., Splenic rupture
3
Rupture left lobe of liver
Rupture right lobe of liver
Splenic rupture
Rupture stomach
Surgery
null
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Most common cause of death in the age group of 1-4 years children is -
Most common cause of death of children in age group of 1-4yrs is infectionsREF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 527
1
Infections
Respiratory disease
Diarrhea
Malnutrition
Social & Preventive Medicine
obstetrics,pediatrics and geriatrics
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A previously healthy 6 weeks old female infant is found unresponsive in her crib. In the emergency department, she is notedto be well developed and well nourished with normal blood pressure and appearance of the genitalia but with increased pigmentation other skin. Blood glucose level is 30 mg/dl.. The most likely diagnosis is:
Ans. b. Familial glucocorticoid deficiency Hypoglycemia, hyperpigmentation with normal BP and normal genitalia in a child points towards Familial glucocorticoid deficiency.Familial Glucocorticoid Deficiency* Familial glucocorticoid deficiency is a rare autosomal recessive condition.* It is characterized by adrenal insufficiency.Pathology:Pathological Examination of the Adrenal GlandZona glomerulosaWell preservedZona fasciculataAtrophiedZona reticularisAtrophiedThis causes low cortisol concentration because the zona fasciculata is primarily responsible for glucocorticoid production.* Zona glomerulosa is well preserved, mineralocorticoid action is usually unaffected.* Low circulating serum cortisol results in lack of feedback inhibition to the hypothalamus, which results in increased ACTH secretion from pituitary.Clinical features* Patients with familial glucocorticoid deficiency generally presents with signs and symptoms of''adrenal insufficiency" with the important distinction that mineralocorticoid production is always normal.* .VIC initial presenting sign is deep hyperpigmentation of the skin, mucous membrane or both as a result of the action of ACTH on cutaneous MSH receptors^.* The symptoms are compatible with glucocorticoid deficiency. May patients presents with recurrent hypoglycemia or severe infections.* In the neonatal period, frequent presenting signs include feeding problems, failure to thrive, regurgitation and hypoglycemia manifesting as seizures.
2
CAH due to 21-alpha hydroxylase deficiency
Familial glucocorticoid deficiency
Cushing syndrome
Insulinoma
Pediatrics
Adrenal Gland
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Drug of choice for treatment of intrahepatic cholestasis in pregnancy is ?
Ursodeoxycholic acid decreases bile salt levels and relieves pruritus. It can also decrease the chance for fetal complications Ref : Dutta book of obstetrics 8th Ed
1
Ursodeoxycholic acid
Dexamethasone
Antihistamines
Cholestyramine
Gynaecology & Obstetrics
All India exam
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Stellate Granuloma are seen in
Ans. (a) Cat scratch disease(Ref: Robbins 9th/98)Cat-scratch disease causes rounded or stellate granuloma containing central granular debris and recognizable neutrophils; giant cells
1
Cat scratch disease
Sarcoidosis
LGV
Histoplasmosis
Pathology
Immunity
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All of the following are true about lymphoma of the thyroid except
Primary thyroid lymphoma diagnosis is considered in patients with a goiter, especially one that has apparently grown significantly in a sho period. Other initial symptoms include hoarseness, dysphagia, and fever. Rapid growth, nerve involvement may raise suspicion of anaplastic carcinoma Thyroid lymphoma occurs four times more frequently in women than in men Approximately half of primary thyroid lymphomas occur in the setting of pre existing Hashimoto thyroiditis. Source : Sabiston 20 th edition Pg : 911
2
More common in females
Slow growing
Clinically confused with undifferentiated tumours
May present with respiratory distress and dysphagia
Surgery
Endocrinology and breast
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DOC in esophageal candidiasis in HIV-
Drug of choice for esophageal candidiasis is - Fluconazole oral or itraconazole solution.
1
Fluconazole
Miconazole
Amphotericin-B
Griseofulvin
Medicine
null
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Supination in flexed elbow is produced by -
Ans. is 'b' i.e., Biceps MovementMuscles causing movementPronationPronator quadratus (strong pronator), Pronator teres (Rapid pronator).SupinationSupinator (when elbow is extended). Biceps (when elbow is flexed).
2
Supinator
Biceps
Coracobrachialis
Brachialis
Anatomy
Forearm
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Investigation of choice for solitary pulmonary nodule -
Ans. is 'b' i.e., CT ScanInvestigations of choice in respiratory systemDiseaseInvestigationo Intersitiai lung diseaseo BronchiectasisHRCTHRCT (1st choice)Bronchography (2nd choice)o Pulmonary embolismCT with i.v. Contrast (1st choice)V/Q scan (2nd choice)o Solitary' pulmonary noduleo Calcificationo Pulmonary malignancyo Superior sulcus or pancoast tumorCT scanCT scanCT scan (except in superior sulcus or pancoast tumor)MRI
2
USG
CT Scan
MRI
X-ray
Radiology
Imaging of Lung Nodules and Masses
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All of the following statements regarding Dracunculiasis are true except -
null
2
India has eradicated this disease
Niridazole prevents transmission of the disease
The disease is limited to tropical and subtropical regions
No animal reservoir has been proved
Social & Preventive Medicine
null
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Bilateral proptosis and bilateral 6th nerve palsy in seen is:
In cavernous sinus thrombosis, there is bilateral orbital involvement whereas in orbital cellulitis, it is unilateral.
1
Cavernous sinus thrombosis
Meningitis
Hydrocephalus
Orbital Cellulitis
ENT
null
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If an anaesthetist at high altitude uses plenum vaporizers. It will deliver the vapour concentration –
Plenum vaporizer is typically set to deliver a 1-2 kPa partial pressure of anaesthetic agent. At sea level, where atmospheric pressure is around 100 kPa, this equates conveniently to a concentration of 1-2% of anaesthetic agent (1-2kPa out of 100 kPa). At higher altitude, the atmospheric pressure is low (e.g. 75 kPa). The plenum vaporizer deliver 1-2 kPa partial pressure of anaesthetic agent. So, the concentration of anaesthetic vapours will 1.25 - 2.5% → Greater than the concentration of anaesthetic agent at same partial pressure at sea level.
3
Higher than the original concentration at high partial pressure
Lower than the concentration at lower partial pressure
Higher than the concentration at same partial pressure
Lower than concentration at same partial pressure
Anaesthesia
null
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Aificial bruises are produced by ?
Ans. is 'b' i.e., Marking nut Semicarpus anacardium (marking nut or bhilawanl Its seed are hea shaped, conical and black with acrid oily juice which is brownish but turns black on exposure to air. Active principles are semecarpol and bhilawanol. Juice applied to skin produces irritation, painful blisters followed by itching and eczema. Therefore it is used to produce aificial bruises. It is also used by washerman to mark clothes
2
Capcicum
Marking nut
Croton
Abrus precatorius
Forensic Medicine
null
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Which of the following does not cross the cell membrane :
A i.e. Glucose-6-phosphate Glucose-6-phosphate cannot cross the cell membrane unless it in conveed into Glucose by the enzyme - Glucose-6-phosphatase.QVon Gerkes disease in deficiency of Glucose-6-phosphatase leads to accumulation of glucose-6-phosphate (and hence glycogen in the liver). In the absence of this enzyme, glucose-6-phosphate is not conveed into glucose and thus cannot enter the blood leading to hypoglycemia.
1
Glucose-6-phosphate
Glucose
Nitrous oxide
Carbon monoxide
Biochemistry
null
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To visualize vascular sling causing tracheal/external airway compression which of the following would you best prefer?
B i.e. MRI Vascular Rings Vascular rings is a condition in which an anomalous configuration of the arch and /or its associated vessels completely or incompletely surrounds the trachea & oesophagus causing compression of these structures. Neonates present with respiratory distress and older children present with stridor or dysphagia. Fouh developmental arch is most impoant. The two most common types of complete vascular rings, which account for 85-95% of cases are double aoic arch and right aoic arch with left ligamentum aeriosum Chest x-ray is the first & most commonly performed investigation. The identification of right aoic arch or ill defined arch location and compression of trachea in symptomatic child indicate the diagnosis. Many authorities consider barium oesophagoscopy to be the most impoant study in patients with suspected vascular ring and it is diagnostic in vast majority of cases. - A double aoic arch produce bilateral & posterior compression of oesophagus, which remain constant regardless of peristalsis. The right indentation is usually slightly higher than left and posterior one is usually wide & course in a downward direction from right to left. Right subclan aery takes a retrooesophageal course, there is a posterior defect slanting upward from left to right. The posterior defect is less broad than in double aoic arch. Echocardiography can be used but structures without lumen such as ligamentum aeriosum or an atretic arch are difficult to be identified. Plain x-ray & barium swallow can not reliably distinguish among the types of vascular rings. Cross section images by CT, MRI and digital substraction angiography (DSA) can be useful diagnostic tool in delineating the anatomy and aiding in presurgical planning & post surgical assessment. MR angiography (MRA) is an excellent substitute for DSA but young patients may require general anesthesia & where there is already airway compromise, this should be avoided. MRI is preferred as it is non invasive and avoids radiation riskQ. Multidetector CT is rarely used b/o radiation implication. Angiography (an invasive method) is rarely required unless cardiac catheterization is necessary for investigation of associated cardiac anomalies and if MRI is equivocal (same protocol applies for coarctation of aoa i.e. MRI > CT > Angiography).
2
Catheter angiography of aoa and pulmonary aery
MRI
CT
PET-CT
Radiology
null
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According to WHO, MMR is
(B) Death after 42 days > Late maternal death: A late maternal death is the death of a woman from direct or indirect obstetric causes more than 42 days but less than one year after termination of pregnancy.
2
Death immediately after the delivery
Death after 42 days
Death after 30 days
Death after 7 days
Social & Preventive Medicine
Miscellaneous
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Which of the following side effect is associated with Spironolactone
Spironolactone is an aldosterone antagonist that inhibits sodium resorption in the distal convoluted tubule of the kidney. Use of spironolactone may be limited by hyponatremia, hyperkalemia, and painful gynecomastia.If the gynecomastia is distressing, amiloride (5-40 mg/d) may be substituted for spironolactone.Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 60e; Dysuria, Bladder Pain, and the Interstitial Cystitis/Bladder Pain Syndrome
3
Alkalosis
Hirsutism
Hyperkalemia
Hyperglycemia
Pharmacology
Kidney
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Medical sociology deals with -
Medical sociology is a specialization within the field of sociology its main interest is in the study of health , health behaviour, and medical institutions ref ;(page no;670)23rd edition of PARK&;s textbook of Preventive and Social medicine
4
Health
Health behaviour
Medical Institution
all of the above
Social & Preventive Medicine
Social science, Mental health & Genetics
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Dosage of drug in child is calculated based on March 2013
Ans. B i.e. Weight Drug dosage for children is calculated based on age and weight of the child.
2
Race
Weight
Sex
Height
Pediatrics
null
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A 6 week old boy is brought to the Paediatrician in Kanpur. His parents repo that he has not had significant use of his right arm since bih. Bih history is significant for a prolonged labor with difficult breech delivery. On physical examination, his arm hangs at his side and is in a medially rotated position with the forearm in pronation. He will actively use his left arm, but does not move his affected right arm or hand. Injury to which of the following cervical nerve roots account for this patient's posture?
This patient has an Erb-Duchenne palsy, which is the result of an injury to the superior trunks of the C5 and C6 nerve roots.The C8 and T1 nerve roots are injured in a Klumpke's paralysis.The other combinations all may be injured as a result of bih palsy, but do not have distinct syndromes associated with them.
2
C4 and C5
C5 and C6
C6 and C7
C7 and C8
Anatomy
null
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Gamma motor neurons are mainly influenced by
Gamma motor neurones are mainly influenced by rubrospinal tract Ref: guyton and hall textbook of medical physiology 12 edition page number:765,766,767
2
Vestibulospinal tract
Rubrospinal tract
Anterior coicospinal tract
Tectospinal tract
Physiology
Nervous system
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Pointing index in supracondylar fracture is due to which nerve injury? (D. REPEAT Feb 2014)
Ans: B (Anterior interosseous nerve) Ref: Apley's System of Orthopaedics and Fractures. 9th ed.Explanation:Complications of Supracondylar FracturesNerve injury - 7%.Vascular injury -1%.Most common nerve injured in extension type - Median, nerve especially anterior interosseous branch.Most common nerve injured in flexion type supracondylar fracture - Ulnar nerve.Most common nerve injured iatrogenicaliy {during Kirschner wire application) - Ulnar nerve.Anterior interosseous nerve supplies deep muscles of forearm except medial half of flexor digitorum profundus.Anterior interosseous nerve supplieso Pronator quadratuso Flexor pollicis longuso Lateral half of flexor digitorum longusThe main portion of the median nerve supplies: o Superficial group:>> Pronator teresFlexor carpi radialisPaSmaris longuso Intermediate group:# Flexor digitorum superficialis muscle.Note:Anterior interosseous nerve palsy causes weakness of lateral half of flexor digitorum longus, hence the index finger does not flex at the DIP joint, causing Pointing finger.
2
Radial nerve
Anterior interosseous nerve
Ulnar nerve
Musculocutaneous nerve
Orthopaedics
Peripheral Nerve Injuries
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Mycosis fungoides is? -
Mycosis fungoides is a slowly evolving cutaneous T cell lymphoma occuring in middle aged adult males. The condition is often preceded by eczema or dermatitis for several years. This is followed by infilteration by CD4+T cells in the epidermis and dermis as a plaque. Reference ; HARSH MOHAN TEXTBOOK OF PATHOLOGY, 7TH EDITION.PG NO. 359
1
T cell lymphoma
B cell lymphoma
Mixed
Plasma cell tumour
Pathology
Haematology
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Which of the following prevents hyperextension of thigh
B. i.e. Iliofemoral ligament
2
Ischiofemoral ligament
Iliofemoral ligament
Pectofemoral ligament
Puboischial ligament
Anatomy
null
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Which of the following statements about confidence limits/ interval is true-
.
4
Smaller the confidence level larger will be the confidence interval
Less variable the data, wider will be the confidence interval
Sample size does not affect the confidence interval
95% confidence interval will cover 2 standard errors around the mean
Social & Preventive Medicine
Biostatistics
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multi
Avascular necrosis of femur head is due to which of the following aery?
Reticular aery branch of medial circumflex femoral aery supplies the head of femur. In case of femur neck fracture, this aery may be occluded leading to avascular necrosis of femur head.
1
Medial circumflex femoral aery
Lateral circumflex femoral aery
Obturator aery
Profunda femoris aery
Orthopaedics
FMGE 2019
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Following gene when mutated, protects tumor cells from Apoptosis
Ans. (a) BCL-2(Ref: Robbins 9th/pg 594-595)BCL2 antagonizes apoptosis and promotes survival of follicular lymphoma cells.BCL stands for 'B Cell Lymphoma'
1
BCL-2
BRCA
RB
TGF-b
Pathology
Misc. (W.B.C)
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All of the following statements are true regarding the pudendal nerve, except:
Pudendal nerve leaves the pelvis, to enter the gluteal region, by passing through the lower pa of the greater sciatic foramen. Pudendal nerve leaves the gluteal region by passing through the lesser sciatic foramen and enters the pudendal canal, and by means of its branches supplies the external anal sphincter and muscles and skin of the perineum. Ref: Clinical anatomy for Medical Students By Richard S Snell, 6th Edition, Pages 362-3 ; B.D.Chaurasia's Human Anatomy, 5th Edition, Volume 2, Page 365
3
It is both sensory and motor
It is derived from S2,3,4
It leaves the pelvis through the lesser sciatic foramen
It leaves through lesser sciatic foramen and enter pudendal canal
Anatomy
null
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multi
Which of the following is the first fetal bone to ossify under normal circumstances?
Ans:B.)Clavicle.Assessment of Bone Age: BoneOssification CentresClavicle,Mandible and Membranous Bones of the Skull50 days to 5 months of GestationOs Calcis(Calcaneum) and Talus22-26 weeks of gestationDistal Epiphysis of Femur31-39 weeks of gestationProximal Epiphysis of Tibia34 weeks of gestation to 5th week post-natallyCuboid36 weeks of gestation to 8th week post-natallyProximal end of Humerus37 weeks of gestation to 16 weeks post-natally
2
Lower end of femur
Clavicle
Upper end of humerus
Upper end of tibia
Anatomy
null
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single
Best approach for surgical repair of the injury to abdominal aoa above the level of renal aery involving superior aery, celiac trunk, and the suprarenal branch:
Left medial visceral rotation exposes entire length of abdominal aoa, celiac axis, proximal pa of mesenteric aeries and proximal left renal aery. Maneuvers for Retroperitoneal Exposure Kocher&;s Maneuvre Extended Kocher&;s Maneuver Mattox Maneuver Cattel-Braasch Maneuver Surgical maneuver to expose structures in the retroperitoneum behind the duodenum and pancreas Used for mobilization of duodenum Right sided medial visceral rotation Right colon and duodenum is reflected medially Exposes IVC, Infrarenal aoa, right renal aery and iliac vessels Recommended for drainage of Inframesocolic hematoma Left sided medial visceral rotation. Left sided viscera(Left Kidney, left colon, Spleen and Pancreas) are brought to midline Exposes entire length of abdominal aoa, celiac axis, proximal pa of mesenteric aeries and proximal left renal aery. Recommended for drainage of Central supra-mesocolic hematoma For extensive retroperitoneal exposure Right colon is fully mobilized and reflected medially Good option for exposure of the infrapancreatic segment Ref: Sabiston 20th edition Pgno: 1546
2
Right medial visceral rotation
Left medial visceral rotation
Right lateral visceral rotation
Left lateral visceral rotation
Surgery
Vascular surgery
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In which one of the following conditions is sling operation done :
Nulliparous prolapse
2
Multiple prolapse
Nulliparous prolapse
Cystocoele
Rectocoele
Gynaecology & Obstetrics
null
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single
A 45 yr old lady presented with recurrent uterine bleeding. On transvaginal USG thickness of endometrium was found to be 8 mm. What should be the next step in the management of this patient ?
Ans. is 'a' i.e., Histopathology Uterine bleeding in a 45 year old may also occur due to endometrial carcinoma.Transvaginal ultrasound is used to assess the endometrial thickness.Endometrial thickness depends upon the stage of the menstrual cycle.Immediately after menstruation the endometrium is homogenous, 1-4 mm thick.As the oestrogen concentration increases, endometrium proliferates and its thickness increases to 7-10 mm.After ovulation the echogenicity of endometrium increases and it becomes hyper echogenic throughout with a thickness of 8-16 mm.Transvaginal ultrasound is usually the first investigation in case of dysfunctional uterine bleeding.TVS measures endometrial thickness. The exact cut off values for endometrial thickness measurement in premenopausal women to predict endometrial neoplasia are subject to continuing debate.The British "RCOG" Guideline development group analyzed a number of studies and concluded that 10-12 mm was a reasonable cut off when using TVS preferably undertaken in follicular phase, as a method prior to more invasive procedures of endometrial assessment.In the question, the endometrial thickness is 8mm but the stage of the cycle is not mentioned.The endometrial thickness of the patient does not fulfill the criteria meted out by RCOG but still she should undergo further endometrial evaluation as her age is 45 years.Women aged 40 years or more with vaginal bleeding should have an endometrial biopsy to exclude endometrial carcinoma.According to Shaw's "It is essential to rule out endometrial carcinoma in premenopausal women with menorrhagia ",Also know
1
Histopathology
Hysterectomy
Progesterone
OCP
Gynaecology & Obstetrics
Heavy menstrual bleeding
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Following drugs have abuse liability except -
SSRIs have no addictive property - do not produce dependence. Opioids (Dihydroxy propoxyphene & buprenorphine) are highly addictive. BZDs (Alprazolam) have some addictive property, but less than barbiturates
3
Buprenorphine
Alprazolam
Fluoxetine
Dextropropoxyphene
Psychiatry
null
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multi
In a pregnant woman with raised phenylalanine in blood, offspring is most likely to have:
Ans: a (Mental retardation) Ref: Nelson, 17th ed, 400; 18th ed, p. 531Question is about pregnancy with hyperphenylalaninimea.Pregnant women with hyperphenylalaninimea who are not receiving phenylalanine restricted diet cany a very high risk of having an offspring with mental retardation, microcephaly and congenital heart disease.These complications are related to high levels of maternal plasma phenylalanine during pregnancy.Prospective mothers who have been treated for hyperphenylalaninimea should be maintained on a phenylalanine restricted diet before and during pregnancy, and should be made to keep blood phenylalanine level below 6 mg/dl throughout pregnancy.PHENYLKETONURIA~ Deficiency of phenylalanine hydroxylase~Normal at birth~ Progressive MR- loses 4 points in IQ/month in 1 st year~Purposeless movements- rocking / athetosis~ Fair skin and blue eyes~ Rash eczematoid / seborrheic~ Mousy/ musty odour~ Hypertonia with hyper rellexia~ 25% shows seizures 50% will have EEG abnormalities~ Microcephaly~Enamel hypoplasia~ FIT -growth retardationDiagnosis:At birth urine test is negative, blood phenylalanine may be increased.Estimation is better done after protein challenge (breast feed).Guthrie test (Bacterial inhibition test) is used to detect level of phenylalanine in blood.Ideally done 48-72 hours after protein feed.Treatment:Low phenylalanine diet (level 3-15 ng/dl)FeCk testPhenylketonuriaGreen colourMaple syrup urine diseaseNavy blue colour
1
Mental retardation
Lighter complexion
Microcephaly
Reduction of limb growth
Pediatrics
Inborn Errors of Metabolism
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Superior quadrantic hemianopia is caused by:
SUPERIOR QUADRANTANOPIA / PIE IN THE SKY - Inferior fibres are damaged - Inferior fibres pass through temporal lobe - ALL PIE IN THE SKY ARE SEEN IN OPPOSITE TEMPORAL LOBE LESIONS LESIONS Disc/optic nerve lesions Same sided monocular blindness Chiasmal lesions Bitemporal Hemianopia Optic tract lesions (mc) Incongruous Homonymous hemianopia Lt. Geniculate body lesions Incongruous Homonymous hemianopia Meyer's loop (Temporal lobe) Pie in the sky Baum's loop (parietal lobe) Pie on the Floor Occipital lobe lesion Congruous Homonymous hemianopia with macular sparing Both pituitary adenoma and a craniopharyngioma can also cause chiasmal compression and produce visual field defects. However, they both end up producing typical type of junctional scotomas rather than quadrantic defects and are hence not considered to be causes for the later. Extra benefit - Junctional scotomas are visual field defects due to anterior or posterior chiasmal lesions and not typical central or temporal lesions.
4
Craniopharyngioma
Meningioma
Pituitary adenoma
Temporal lobe lesion
Ophthalmology
Neuro Ophthalmology
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A 17 year old girl presents with history of generalised abdominal pain, fever, recurrent vomiting. On examination, she has a temperature of 103degF, Right Iliac fossa tenderness, and WBC are 19600/mm' ?
Ans. is 'a' i.e., Ruptured appendicular abscess Abdominal pain and vomiting suggest the most likely diagnosis of appendicitis. High temp (103degF) and high WBC count suggest appendiceal rupture. Schwaz writes - "Rupture should be suspected in the presence of fever greater than 39degC (102degF) and a WBC count greater than 18,000/mm3." Other options are less likely, as fever and vomiting is uncommon in them. Intussusception Is usually seen in children younger than 2 yrs of age Fever, leucocytosis is not seen. Ruptured ectopic pregnancy Schwaz writes - "Rupture of . tubal or ovarian pregnancies can mimic appendicitis. Patients usually give a history of abnormal menses; either missing one or two periods or noting only slight vaginal bleeding. The diagnosis of ruptured ectopic pregnancy should be relatively easy. The presence of a pelvic mass and elevated levels of chorionic gonadotropin are characteristic While the leukocyte count rises slightly (to approx. 14,000), the hematocrit level falls as a consequence of the intraabdominal haemorrhage. Vaginal examination reveals cervical motion and adenexal tenderness." Twisted ovarian cyst Shaw's writes - "A twisted ovarian cyst causes sudden pain in abdomen with occasional vomiting, but pyrexia is usually absent or very low. An abdominal lump is felt distinctly.
1
Ruptured Appendicular Abscess
Twisted Ovarian cyst
Ruptured Ectopic Pregnancy
Intussusception
Surgery
null
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Drug not given with ketoconazole:
(Ref: Goodman & Gillman s 13th ed. P 90)The common antifungal agent ketoconazole is a potent inhibitor of CYP3A4Therefore coadministration of ketoconazole with other CYP3A4 inhibitors like anti-HIV drug viral protease inhibitors (ritonavir, indinavir), clarithromycin, itraconazole, nefazodone, and grapefruit juice reduces the clearance of these drugs and increases its plasma concentration and the risk of toxicity. Hence these drugs are not given together.
4
Aminoglycoside
Macrolide
Indinavir
All of the above
Pharmacology
General Pharmacology
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Which of the following immunoglobulin is a pentamer?
IgM Both secretory IgA (dimeric) and IgM (pentameric) have J chains IgM is the main immunoglobulin produced early in the primary immune response. IgM is present on the surface of viually all uncommitted B cells. It is a pentamer composed of five H,L, units (each similar to one IgG unit) and one molecule of J (joining) chain.
3
IgG
IgA
IgM
IgD
Microbiology
null
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single
Which of the following is false about scapula?
The medial border is thin.it extends from the superior angle to the inferior angle. Reference BD chaurasia pageno : 9 , 6th edition.
3
Root of spine is at T3
Inferior angle is at T7
Medial border indicates horizontal fissure
Lateral angle bears glenoid cavity
Anatomy
Upper limb
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Recently approved drug for psychosis associated with Parkinsonism is?
Pimavanserin An inverse agonist at 5HT2A receptor Approved for psychosis associated parkinsonism
2
Lorcaserin
Pimavanserin
Cycloserine
Mianserin
Pharmacology
Sedative-Hypnotics and Parkinsonism
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All of the following bacteria protein is secreted from the primary granules of neutrophil except:
null
4
Bacterial cell permeability protein
Defensins
Lysosome
Lactoferine
Medicine
null
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multi
______________ is not a property of X-rays
null
4
Ionization
Action on photographic film
Excitation
Collimation
Radiology
null
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single
In bacterial mRNA, Shane-Dalganro sequence is situated near which of the following codon?
Shine-Dalgarno sequence is apparently the eukaryotic small ribosomal subunit binds to the 5'end of a eukaryotic mRNA and scans along it until it encounters an AUG codon.They assist in aligning mRNA on the ribosomes. Ref: Biochemistry By Reginald Garrett, Charles M. Grisham, 2005 Page A 38 ; Biochemistry By J. Stenesh, Volume 1, Page 487
3
CAG codon
UAG codon
AUG codon
UGA codon
Biochemistry
null
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single
A 30-year-old male had severely itchy papulo–vesicular lesions on extremities, knees, elbows and buttocks for one year. Immunofluorescence staining of the lesions showed IgA deposition at dermo-epidermal junction. The most probable diagnosis is –
Itchy papulovesicular lesions on extensor surfaces and deposition of IgA at DEJ suggests the diagnosis of dermatitis herpatiformis, which is associated with Coeliac disease
3
Pemphigus vulgaris
Bullous pemphigoid
Dermatitis herpetiforms
Nummular eczema
Dental
null
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At PHC level vaccine storage is by?
.ice lined refrigerators(ILR)are mkept at the PHC level.the cabinet temperature is maintained at 2 to 8 degree celsius.at the PHC level,ILR s are used to store all UIP vaccines.they are lined with tubes or ice packs filled with water which freezes and keeps the internal temperature at a safe level.</p><p>ref:park&;s textbook of preventive and social medicine,22 nd edition ,pg no 104</p>
1
IRL
Walk in cold rooms
Cold boxes
vaccine carriers
Social & Preventive Medicine
Epidemiology
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single
Gunstock deformity is seen in
A most common complication of supracondylar fracture is malunion, which further can lead to cubitus varus deformity. This is because of the reason that fracture unites with the distal fragment tilted medially and in internal rotation. This cubitus varus is usually termed as gunstock deformity. Most common nerve damaged in supracondylar fracture: Anterior Interosseous Nerve.
4
Lateral condyle fracture
Radial head fracture
Ulnar head fracture
Supracondylar fracture of humerus
Orthopaedics
null
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single
Which of the following is mature defence mechanism?
Ans. b (Humor.) (Ref. Kaplan & Sadock's Synopsis of Psychiatry, 10th ed., p. 203. Table 6.1-3)COMMON FREUDIAN DEFENSE MECHANISMSDefence mechanismShort DefinitionImportant AssociationsProjectionAttibuting inner feelings to othersParanoid behaviorsDenialSaying it is not soSubstance abuse, reaction to deathSplittingThe world composed of polar oppositesBorderline personality, good versus evilBlockingTransient inability to rememberMomentary lapseRegressionReturning to an earlier stage of developmentEnuresis, primitive behaviorsSomatizationPhysical symptoms for psychological reasonsSomatoform disordersIntrojectionThe outside becomes insideSupergo, being like parentsDisplacementSource stays the same, but target changesRedirected emotion, phobias, scapegoatRepressionForgetting, so it is nonretrievableForget and forgetisolation of affectFacies without feelingBlunted affect, la belle indifferenceIntellectualizationAffect repalced by academic contentAcademic, not emotional reactionActing outAffect covered up by excessive action or sensationSubstance abuse, fighting, gamblingRationalizationWhy the unacceptable is okay in this instanceJustification, string of reasonsReaction formationThe unacceptable transformed into its oppositeManifesting the opposite; fee love but show hate: "Girls have cooties."UndoingAction to symbolically reverse the accaptableFixing or repairing, obsessive-compulsive behaviorsPassive-aggressivePassive nonperformance after promiseUnconscious, indirect hostilityDissociationSeperating self from one's own experienceFugue, depersonalization, amnesia, multiple personalityHumorA pleasant release from anxietyLaughter hides the painSublimationMoving an unacceptable impulse into an acceptable channelArt, literature, mentoringSuppressionForgetting, but is retrievableForget and rememberPsychodynamic PsychotherapyDEFENSE MECHANISMS# The way & means that the Ego wards off anxiety & controls instinctive, urges & unpleasant affects (Emotions)# All Defense Mechanisms are Unconscious (except Suppression), Discrete, Dynamic & Irreversible, Adaptive & Maladaptive# Highly adaptive (mature)- Altruism, Humor, Sublimation & Suppression# Less adaptive- Displacement, Intellectualization, Isolation of Affect, Rationalization, Reaction Formation & Repression# Primitive (immature)- Acting out, Denial (deletion from consciousness), Projection & Splitting# Transference & Countertransference- Brings unconscious topics into consciousness# Transference# Feelings of patient toward therapist# Occurs in all patient/physician relationships- Countertransference# Feelings of therapist toward patient# Occurs in all patient/physician relationships# Interpretation- Therapist identifies feelings, drives, and defenses in action
2
Rationalization
Humor
Denial
Displacement
Psychiatry
Miscellaneous
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single
A counsellor should not show to the patient
null
1
Sensitive
Understanding
Patience
Sympathy
Social & Preventive Medicine
null
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single
At what angle hallpike thermal calorie test is done
Dix Hillpike manoeuvre: Patient sits on a couch. Examiner holds the patient's head, turns it 45deg to the right and then places the patient in a supine position so that his head hangs 30deg below the horizontal. Patient's eyes are observed for nystagmus. The test is repeated with head turned to left and then again in straight head-hanging position. Four parameters of nystagmus are observed: latency, duration, direction and fatiguability Ref: Dhingra 7e pg 44.
2
15
30
45
60
ENT
Ear
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All are true about rectal cancer except:
Ans. (c) Dissection lateral to endopelvic fascia investing the mesorectum causes local recurrence* Total mesorectal Excision (TME) provides least recurrence* Most common symptom is bleeding PR* Sigmoidoscopy is used to localize the tumor* RT given for ca rectum is 60 Gy.
3
Most common symptom is hematochezia
Precise location of tumor is done with rigid proctosigmoidoscopy
Dissection lateral to endopelvic fascia investing the mesorectum causes local recurrence
Radiation dose is 60 Gray
Surgery
Rectum
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Hepatic secretory function is evaluated using
Answer- D. Prothrombin time (PT)The most widely used tests are those measuring the blood concentration of aspaate aminotransferase (AST) and alanine aminotransferase (ALT).Congulation proteins: The easiest way to estimate the concentration of the coagulation factors is by measuring the prothrombin time (PT), which is normally l0 to 13 seconds. Prolonged PT is a sensitive index of liver function loss.
4
Alkaline phosphatase
5' nucleotidase
Gamma glutamyl transpeptidase
Prothrombin time (PT)
Medicine
null
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A person with AIDS related complex is most likely suffering from:
Ans. (a) Oppounistic infection Natural course of HIV infection can be divided into following stages: HIV infectioh. Seen in 30% of individuals within 3-6 weeks of infection. They present with low grade fever, headache, malaise some time with rash and ahropathy resembling glandular fever. Spontaneous rresolution occurs within weeks. Tests for HIV antibodies are usually negative at the onset of illness but become positive during its course. So this stage is also called as seroconversion illness. `,symptomatic or Latent Infectio. Seen in all patients. This phase which lasts upto several years, patient remain asymptomatic. HIV antibody test is positive in this phase and patients are infectious. This period of clinical latency does not mean viral latency as virus multiplication goes on throughout. "ercictant generalized lvninhadenonathy This stage is defined as presence of enlarged lymphnodes at least 1 cm in diameter in two or more non-contagious extrainguinal sites, that persist for at least three months, in absence of any current illness or medication that may cause lymphadenopathy. AIDS related corn /Ilex. This group include patients with considerable immunodeficiency suffering from various constitutional symptoms or minor oppoinistic infections like oral candidiasis herps zoster, hairy cell leukoplakia. AIDS: This is the endstage representing the irreversible breakdown of immunodefence mechanisms leading to progressive oppounistic infection and malignancies. merr"- During the period of clinical latency 10 billion HIV paicles are produced and destroyed every day. Half life of virus in plasma is about 6 hours. Virus life cycle (from the time of infection of a cell to the production of new progeny that infect the next cell) averages 2.6 days
1
Oppuinistic infection
Cancer related to AIDS
Generalized lymphadenopathy
Herpes zoster
Microbiology
null
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single
Not a muscle of Ist layer of foot
Flexor digitorum accessorius is a muscle of 2nd layer of foot
4
Flexor digitorum brevis
Abductor Hallucis
Abductor digiti minimi
Flexor digitorum accessorius
Anatomy
null
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multi
Lesh Nyhan syndrome is associated with deficiency of
REF :DM VASUDEVAN TEXTBOOK :7th EDITION ;Page no :403 Disease deficient enzyme GPD Deficiency G6PD Gaucher's disease beta glucosidase Lesch-Nyhan syndrome HGPase
2
HGP (paial)
HGP (total)
PRPP (paial)
PRPP (total)
Biochemistry
Metabolism of nucleic acids
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Acantholysis is seen in all except ?
Ans. is 'D'.e., Bullous pemphigoid Acantholysis Separation of epidermal keratinocytes due to loss of intercellular bridge is referred to as acantholysis . Diseases causing acantholysis are : ? Pemphigus (Pemphigus vulgaris, P. vegetans, P.foilaceous, P. erythematosus) Eosinophilic spongiosis Darrier's disease Grover's disease (Transient acantholytic dermatosis) Hailey-Hailey disease (Familial benign chronic pemphigus) Infections with HSV-1 & 2. Staphylococcus scalded skin syndrome.
4
Pemphigus vulgaris
Darrier's disease
SSSS
Bullous pemphigoid
Skin
null
82b430be-98e4-40ac-8d1a-9dcc047b18f1
multi
Cellular oxidation is inhibited by
null
1
Cyanide
Carbon dioxide
Chocolate
Carbonated beverages
Biochemistry
null
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single
Aldosterone synthesis is stimulated by which of the following?
Mineralocoicoid secretion is stimulated by hyperkalemia, angiotensin-H, ACTH and hyponatremia, in reducing order of efficacy. 1. Aldosterone secretion in response to hyperkalemia is the most impoant and forms the basis for renal regulation of body potassium balance. 2. Stimulation of aldosterone by angiotensin II (through renin-angioensin system) is impoant for the correction of hypovolemia and hypotension in conditions like salt depletion or renal ischemia. 3. Stimulation of aldosterone secretion by ACTH results in diurnal variation of aldosterone secretion. 4. However, ACTH is not an impoant physiological regulator for aldosterone secretion. Hyponatremia is a weak stimulator of aldosterone secretion REF : HARRISONS 21ST ED
2
ACTH
Hyperkalemia
Hypernatremia
Exogenous steroids
Medicine
All India exam
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single
Bejel is caused by -
null
2
T. pallidum
T. endemicum
T. pertenue
T. carateum
Microbiology
null
2167727b-9788-40fd-b326-f59fc06559ae
multi
Which antihypertensive is a prodrug and is converted to its active form in the brain?
null
2
Clonidine
Methyldopa
Minoxidil
Nitroprusside
Pharmacology
null
20892d62-46ce-4830-a805-84433a6df3b7
single
A patient with an abdominal malignancy underwent procedure for celiac plexus block. Which of the following can be the most common complication in this patient?
The most common complication of celiac plexus block is postural hypotension, from block of the visceral sympathetic innervation and resultant vasodilation. For this reason, patients should be adequately hydrated intravenously prior to this block. Other complications include, Accidental intravascular injection into the vena cava Accidental intra aoic injection Pneumothorax Retroperitoneal hemorrhage Injury to the kidneys or pancreas Sexual dysfunction Paraplegia (due to injury to the lumbar aery of Adamkiewicz) Increased gastrointestinal motility and diarrhea Back pain Ref: Butterwoh IV J.F., Mackey D.C., Wasnick J.D. (2013). Chapter 47. Chronic Pain Management. In J.F. Butterwoh IV, D.C. Mackey, J.D. Wasnick (Eds), Morgan & Mikhail's Clinical Anesthesiology, 5e.
1
Hypotension
Retroperitoneal hemorrhage
Pneumothorax
Intravascular injection
Anaesthesia
null
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single
Small bones are supplied by
Periosteal arteries  These are especially numerous beneath the muscular and ligamentous attachments.  They ramify beneath the periosteum and enter the Volkmann's canals to supply the outer 1/3 of the cortex.  In miniature long bones, the infection begins in the middle of the shaft rather than at the metaphysis because, the nutrient artery  breaks up into a plexus immediately upon reaching the medullary  cavity. In the adults, however, the chances of infection are minimized because the nutrient artery is mostly replaced by the periosteal vessels. KEY CONCEPT: Short bones are supplied by numerous periosteal vessels which enter their nonarticular surfaces.
2
Nutrient artery
Periosteal vessels
Subperiosteal
Epiphyseal
Anatomy
null
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multi
The PEFR of a group of 11 year old girls follow a normal distrubution with mean 300 1/min and standard deviation 20 1/min -
1 SD includes → 68% of values 2 SD includes → 95% of values 3 SD includes → 99.7% of values In this question Mean PEFR = 300 L/min SD = 2 L/min Area around 1SD on either side of mean (x ± 1SD) will include 68% of values, i.e. x± 1SD=300±20 So, 68% of girls have PEFR between 280 & 320 L/min. Area around 2SD on either side of mean (x ± 2SD) will include 95% of values, i.e. x±2SD=300±40 So, 95% of girls have PEFR between 260 & 340 L/min. Area around 3SD on either side of mean (x ± 3SD) will include 99.7% of values, i.e. - x ±3SD = 300 ± 60 So, 99.7% of girls will have PEFR between 240 & 360 L/min.
1
About 95% of the girls have PEFR between 260 and 340 1/min.
The girls have healthy lungs
About 5% of girls have PEFR below 260 1/min.
All the PEFR must be less than 340 1/min.
Social & Preventive Medicine
null
d04257ef-50d8-4a97-b354-780f16c969bf
multi
Which is predominant in normal healthyhuman ?
Ans. is 'b' i.e., LDH2 IsoenzymeSubmit compositionIssuePercentage in serrumLDH IHHHHMyocardium, RBC30LDH2HHHMMyocardium, RBC35LDH3HHMMBrain, Kidney20LDH4HMMMSkeletal muscle, Liver10LDH 5MMMMSkeletal muscle, Liver5
2
LDH 1
LDH2
LDH 3
LDH4
Biochemistry
null
4867e0a3-fa5f-4aee-8158-9edc9c8b4d5e
single
Which one of the following is the level of residual free chlorine recommended for swimming pool water disinfection?
Chlorination is the most widely used method of pool disinfection. Various workers have stated that continuous maintenance of 1mg/litre(1ppm) of free residual chlorine provides adequate protection against bacterial and viral agents. Park's Textbook of Preventive and Social Medicine, 25th edition, Page No. 788
3
0.5 mg/litre
0.8 mg/litre
1 mg/litre
5 mg/litre
Social & Preventive Medicine
Environment and health
8497c754-89fe-4044-9721-13f289c02304
single
Which of the following is not a source of Indoor air pollution?
Sources of Indoor air pollution: Indoor air pollutants Sources Respirable paicles Tobacco, smoke, stove, aerosols Carbon monoxide Combustion equipments, stove, gas, heaters Nitrogen dioxide Gas cookers, cigarettes Sulphur dioxide Coal combustion Carbon dioxide Combustion, respiration Formaldehyde Paicle board, carpet adhesives, insulation Organic vapours (benzene, toulidine) Solvents, adhesives, resins, aerosols Ozone Electric aecing, UV light Radon Building materials Asbestos Insulation, fire-proofing Mineral fibers Appliances
4
Carbon monoxide
Nitrogen dioxide
Radon
Mercury vapour
Social & Preventive Medicine
Air, Light, Sound, Housing, Radiation, Waste Disposal
b969f07a-a463-41df-ad75-9843e7f2b477
single
Which is the best fluid for resuscitation during shock state?
ANSWER: (A) CrystalloidsREF: Schwartz's Principles of Surgery 9th ed chapter 5"Fluid resuscitation is a major adjunct to physically controlling hemorrhage in patients with shock. The ideal type of fluid to be used continues to be debated; however, crystalloids continue to be the mainstay of fluid choice"Several studies have demonstrated increased risk of death in bleeding trauma patients treated with colloid compared to patients treated with crystalloid. In patients with severe hemorrhage, restoration of intravascular volume should be achieved ivith blood products.Ongoing studies continue to evaluate the use of hypertonic saline as a resuscitative adjunct in bleeding patients. The benefit of hypertonic saline solutions may be immunomodulatory. Specifically, these effects have been attributed to pharmacologic effects resulting in decreased reperfusion-mediated injury with decreased O2 radical formation, less impairment of immune function compared to standard crystalloid solution, and less brain swelling in the multi- injured patient. The reduction of total volume used for resuscitation makes this approach appealing as a resuscitation agent for combat injuries and may contribute to a decrease in the incidence of ARDS and multiple organ failure.
1
Crystalloids
Colloids
Plasma substitutes
5% dextrose
Surgery
Shock
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multi
Commonest cause of hematogenous osteomyelitis: March 2011
Ans. B: Staph. aureus Staphylococcus aureus is the commonest causative organism causing acute osteomyelitis Osteomyelitis: Earliest site of involvement in bone: Metaphysis Brodie's abscess: A static cavity remains in bone, without fuher enlargement. Blood culture are positive in 65% of cases Periosteal reaction may be the radiological sign visible (after 10 days) MC cause of acute osteomyelitis: Staph. Aureus
2
Streptococcus
Staph. aureus
Salmonella
H. influenza
Surgery
null
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Cardiac arrest developed due to local anaesthetic systemic absorption. All are management except-
Vasopressin not used Advanced Cardiac Life Suppo algorithms for cardiopulmonary resuscitation must be followed should cardiac arrest occur. Chest compressions should be initiated immediately and continued until return of spontaneous circulation. If epinephrine is used, small initial doses of <=1 ug[?]kg-1 are preferred to avoid impaired pulmonary gas exchange and increased afterload. Vasopressin is not recommended for use as it has been associated with adverse outcomes in animal models. In the absence of rapid recovery following advanced life suppo measures and intravenous lipid emulsion therapy, early consideration should be given to cardiopulmonary bypass for circulatory suppo. The inotropic effect of lipid emulsion therapy only occurs once the myocardial LA levels are below a threshold that corresponds to ion channel blocking concentrations. This emphasizes the impoance of effective chest compressions to ensure coronary perfusion is sufficient to reduce LA tissue levels in order to obtain the benefit of lipid emulsion therapy. If cardiac output is maintained but there are deleterious CVS effects - such as arrhythmias, conduction block, progressive hypotension, and bradycardia - standard Advanced Cardiac Life Suppo algorithms should be followed with the omission of LA, such as lidocaine, for the treatment of arrhythmia. Amiodarone is the first-line antiarrhythmic in the event of ventricular dysrhythmia.
4
Cardiac compression
Adrenaline
20 % intralipid emulsion
Vasopressin
Anaesthesia
Cardiopulmonary Cerebral Resuscitation
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Pasteurised milk is tested by:
Ans: a (Phosphatase test) Ref; Park, 19 ed, p. 522Tests for pasteurised milk:Phosphatase testStandard plate countColiform countOTA test--for detection and estimation of free and combined chlorine in chlorinated water.Benzidine test--chemical test for the detection of blood stainParaffin test--detection of gun powder residuesMethylene blue reduction test--It is an indirect method for detection of micro-organisms in milk.This test is carried out on milk accepted for pasteurizationMethods of pasteurization:Holder or Vat method:In this the milk is kept at 63- 66oC for atleast 30 min and then cooled to 5degCHigh temperature short time method: (HTST)Milk is rapidly heated to temperature of nearly 72degC and held at that temperature for not less than 15 sec and is then cooled to 4degC.Most widely used method now.UHT method / Ultra high temperature method:Milk is rapidly heated usually in 2 stages to 125degC (second stage under pressure.)Thermodynamic bacteria and bacterial spores are resistant towards pasteurization.
1
Phosphatase test
OTA test
Benzidine test
Paraffin test
Social & Preventive Medicine
Nutrition and Health
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single
Serotonin is synthesized from-
Ans. is 'c' i.e., Tryptophan o Hvdroxytryptamine (serotonin) is synthesized from tryptophan.
3
Tiyrosine
Alanine
Tryptophan
Glycine
Biochemistry
Amino Acid Metabolism
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Hypoxic pulmonary vasoconstriction:
The great reduction in pulmonary vascular resistance during the transition from placental to normal respiration is largely brought about by the process of hypoxic pulmonary vasoconstriction. The other choices are incorrect because the PO2 of alveolar gas is much more impoant than the PO2 of mixed venous blood, CO2 uptake is irrelevant, the constriction paly dives blood flow from poorly ventilated, not well-ventilated regions of diseased lungs, and the inhalation of nitric oxide paly reverses hypoxic pulmonary vasoconstriction.
2
Depends more on the PO2 of mixed venous blood than alveolar gas
Is released in the transition from placental to air respiration
Involves CO2 uptake in vascular smooth muscle
Paly dives blood flow from well-ventilated regions of diseased lungs
Physiology
Respiratory System Pa 3
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Alternative parenteral drug for multi drug resistant malaria is
Multidrug-resistant P. falciparum malaria : Either aemether-lumefantrinec (1.5/9 mg/kg bid for 3 days with food) or Aesunatec (4 mg/kg qd for 3 days) plus Mefloquine (25 mg of base/kg--either 8 mg/kg qd for 3 days or 15 mg/kg on day 2 and then 10 mg/kg on day 3) Aemisinin and derivatives (aemether, aesunate) : Good oral absorption, slow and variable absorption of IM aemether; aesunate and aemether biotransformed to active metabolite dihydroaemisinin; all drugs eliminated very rapidly; t1/2: <1 h (Harrison's Principles of internal medicine, 20th edition, page 1699)
3
Mefloquine
Sulfamethoxazole
Aemisinin
Dihydroaemesin
Medicine
Infection
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An enzyme produced by Staphylococcus aureus that dissolves fibrin clots is:
Pathogenic bacteria release exoenzymes that increase their ability to invade body tissue. These include coagulase, kinases, lipase, hyaluronidase, and collagenase. All Staphylococci produce catalase, an enzyme responsible for conversion of toxic hydrogen peroxide to water and oxygen which accumulates during bacterial metabolism or is released following phagocytosis. Kinases dissolve fibrin clots thus enabling the organism to invade and spread throughout the body. Staphylococcus aureus produces staphylokinase which is fibrinolytic. Coagulase is the exoenzyme produced by Staphylococcus aureus and it clots the plasma. Lipase hydrolyzes lipids, and aids in the survival of staphylococci in the sebaceous glands. Hyaluronidase enables pathogen to spread through connective tissue by breaking down hyaluronic acid, the "cement" that holds tissue cells together. Ref: Francis C.W., Crowther M. (2010). Chapter 23. Principles of Antithrombotic Therapy. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds), Williams Hematology, 8e.
3
Hyaluronidase
Catalase
Staphylokinase
Lipase
Microbiology
null
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single
Curie is a unit of-
Ans. is 'a' i.e. Radioactivity * Old unit of radioactivity is Curie and new unit (SI) is Becquerel.* Old unit of radiation exposure is Roentegn and new unit (SI) is Columb/cmQuantity measuredOld unitNew (SI)unit RadioactivityCurieBecquerel1 curie = 3.7 x 101 becquerel -2.7 x 10Radiation exposureRoentgenColumb/cm Absorbed doseRadGray100 rad = 1 gray1 rad = 0.01 grayDose equivalentRemSievert (Sv)100 rem = 1 SvIrem = 0.01 Sv
1
Radioactivity
Radiation exposure
Absorbed dose
Dose equivalent
Radiology
Fundamentals In Radiology
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The agent used to stain soft tissues is called
null
2
Staining agent
Disclosing agent
Mordent
All
Dental
null
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multi
The % of coincidence between sore throat and acute rheumatic fever is -
Ans. is 'a' i.e., 3% Only a small propoion of patients with streptococcal pharyngeal infection develops Rheumatic fever. Attack rate is less than 3%
1
3%
5%
7%
9%
Pathology
null
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single
Major Disadvantage of peripheral line is
Ref: Bailey and love 27th edition Pg no :287
4
Catheter related sepsis
Damage to adjacent aery
Refeeding syndrome
Thrombophlebitis
Anatomy
General anatomy
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Not true about angioneurotic edema -
Angioedema is an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes.The swelling may occur in the face, tongue, larynx, abdomen, or arms and legs.Often it is associated with hives, which are swelling within the upper skin.Onset is typically over minutes to hours The underlying mechanism typically involves histamine or bradykinin. The version related to histamine is due to an allergic reaction to agents such as insect bites, foods, or medications. The version related to bradykinin may occur due to an inherited problem known as C1 esterase inhibitor deficiency, medications known as angiotensin-conveing enzyme inhibitors, or a lymphoproliferative disorder. Effos to protect the airway may include intubation or cricothyroidotomy. Histamine-related angioedema can be treated with antihistamines, coicosteroids, and epinephrine.In those with bradykinin-related disease a C1 esterase inhibitor, ecallantide, or icatibant may be used.Fresh frozen plasma may be used insteadIn the United States the disease affects about 100,000 people a year. The skin of the face, normally around the mouth, and the mucosa of the mouth and/or throat, as well as the tongue, swell over the period of minutes to hours. The swelling can also occur elsewhere, typically in the hands. The swelling can be itchy or painful. There may also be slightly decreased sensation in the affected areas due to compression of the nerves. Uicaria (hives) may develop simultaneously. In severe cases, stridor of the airway occurs, with gasping or wheezy inspiratory breath sounds and decreasing oxygen levels. Tracheal intubation is required in these situations to prevent respiratory arrest and risk of death. Sometimes, the cause is recent exposure to an allergen (e.g. peanuts), but more often it is either idiopathic (unknown) or only weakly correlated to allergen exposure Ref Davidson 23rd edition pg 461
1
Pitting edema of face, lips and mucous membrane
CI esterase inhibitor deficiency can cause it
Extreme temperature exposure can provoke it
Known with ACE inhibitors
Medicine
Miscellaneous
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An 10 month-old baby is brought to the pediatric clinic with symptoms of diarrhea, hair loss and failure to thrive. On clinical examination, there is inflammation of the skin around the mouth and the perianal region. The mineral deficiency responsible for this disease is a cofactor for all of the following enzymes except?
The above features, strongly suggest a diagnosis of Acrodermatitis enteropathica which is due the deficiency is of zinc and it is a cofactor for Lactate dehydrogenase. It is an autosomal recessive disease due to a defect in zinc absorbing transmembrane protein. Symptoms: Growth retardation Diarrhea Alopecia Dermatitis around the orifices Gonadal atrophy Impaired wound healing Zinc acts as a cofactor for: Carbonic anhydrase Carboxypeptidase Lactate dehydrogenase Alcohol dehydrogenase Alkaline phosphatase Reference: Harpers illustrated biochemistry 30th edition
3
Lactate dehydrogenase
Alcohol dehydrogenase
Glutathione peroxidase
Alkaline phosphatase
Biochemistry
vitamins
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Paralysis of 3rd, 4th, 6th, nerves with involvement of ophthalmic division of 5th nerve, localizes the lesion to -
Cavernous sinus lesions may be associated with paralysis of 3rd, 4th, 5th (ophthalmic and maxillary divisions) and 6th nerve on account of its characteristic relations.
1
Cavernous sinus
Apex of orbit
Brainstem
Base of skull
Anatomy
null
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single
A 14 year old female patient presents with a habit of lower lip sucking. Lip bumper was cemented onto the mandibular first molars. What is the anchorage value of this tooth?
null
3
533
450
475
500
Dental
null
88ae784c-5824-465e-96b3-ac1842667489
single
Locally invasive gastric carcinoma. Investigation of choice to know depth of cancer invasion:
The best way to stage the tumor locally is EUS, which gives fairly accurate (80%) information about the depth of tumor penetration into the gastric wall, and can show enlarged (>5mm) perigastric and celiac lymph nodes
4
CECT
MRI
Barium
EUS
Surgery
Stomach & Duodenum
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In presence of unusually high outliers, preferred measure of central tendency is:
The mean is vitiated due to presence of outliers. Outliers are unusually high or unusually low values that do not go with other values. Whenever such values are present, mean is not a good choice. In such cases, the median is used as it is not really affected by unusually high or low values. Ref: Medical biostatistics, 1st edition pg: 115
3
Mean
Mode
Median
Range
Social & Preventive Medicine
null
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multi
Lady with central obesity & abd. Skin showing purple striae-
centripetal obesity, and broad violaceous cutaneous striae in abdomen classical presentation of Cushing's syndrome ( Harrison 17 pg 2255)
2
Conn's syndrome
Cushing's syndrome
Addison's disease
Hypothyroidism
Medicine
Endocrinology
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single
Which of the following is used for staging of CKD?
e-GFR and albuminuria- used for staging of CKD
4
e-GFR and serum creatinine
e-GFR and serum albumin
e-GFR and urine output/d
e-GFR and albuminuria
Medicine
Chronic Kidney Disease & Diabetic Nephropathy
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Long acting barbiturate is ?
Ans. is 'c' i.e., Phenobarbitone Long acting barbiturates -4 Phenobarbitone, Mephobarbitone. Sho acting barbiturates-4 Butobarbitone, secobarbitone, Pentobarbitone. Ultrasho acting -4 Thiopentone, Methohexitone, Hexobarbitone.
3
Thiopentone
Secobarbitone
Phenobarbitone
Pentobarbitone
Pharmacology
null
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single
Which of the following enzymes is stable at acidic pH
Optimum pH for Pepsin- 1.6-3.2
1
Pepsin
Trypsin
Chymotrypsin
Carboxypeptidase
Physiology
null
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single