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b5dfa3c3-c841-4c76-a771-87ba597a77a6 | All are adulterants of heroin, except: | Chalk powder | Quinine | Charcoal | Fructose | 2c
| multi | C i.e Charcoal Morphine depress respiratory centre, so rate & tidal volume both are decreasedQ & death is due to respiratory failure. YawningQ, dysphoric mood & insomnia with water loss from different orifices (i.e. lacrymation, sweating, diarrhoea, vomiting, rhinorrhea) are characteristic symptoms of opioid withdrawl Opium (Morphine) poisoning has 3 stages Stage of Excitement - HallucinationQ, Euphoria, Maniacal features Stage of Stupor - Headache, nausea, vomiting, incapacity for exeion, a sense of weight in limbs, giddiness, drowsiness, stupor Stage of Coma - Abolished reflex, Pin point non reacting pupilQ, All secretions are suspended except sweat, respiratory depressionQ & paralysis -Charas or Hashish is resinous exudates from the leaves & stems of plant cannabis indica or Cannabis sativa.Q - The activa principle of cannabis is a fat soluble oleoresin, cannabinol (tetra h dro-cannabinol- THC). Cannabis is used in four forms Bhang Dried leaves & fruit shoots Majun Sweet meat made with bhang. It produces grandiose delusions in addition to effects of bhang Ganja Dried flowering tops of female plant.Q Charas or Hashish Resinous exudates from leaves & stem of plantQ | Forensic Medicine | null | [
"quinine"
] | 51,140 |
a089b3a5-70d5-4257-9f69-d31f916ca709 | True about tamoxifen is- | Selective estrogen receptor downregulator | Selective estrogen receptor modulator | Selective tissue estrogen activator regulator | Estrogen antagonist | 1b
| multi | Ans. is 'b' i.e., SERM * Has been explained in previous sessions | Pharmacology | Endocrinology | [
"tamoxifen"
] | 51,141 |
1d69169b-38f9-49eb-b237-f7ffa6f9dabb | Transaerial chemoembolization (TACE) is used in the treatment of unresectable hepatocellular carcinoma without poal vein thrombosis. The drug commonly used for TACE is: | Doxorubicin | Sorafenib | Tamoxifen | Carboplatin | 0a
| single | There are different treatment modalities for HCC. Curative treatments are resection, liver transplantation, Radiofrequency ablation (RFA), Percutaneous ethanol injection etc. Palliative treatments are TACE, Sorafenib etc. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Cha in Page 781. | Medicine | null | [
"tamoxifen",
"carboplatin",
"doxorubicin"
] | 51,146 |
52411363-8333-4571-8ab2-4872d5fbd235 | Resuscitation of a child with HR<60/min includes all of the following, except | Chest compression | Adrenaline | Endrotracheal tube intubation | Never give atropine | 3d
| multi | Ref. The Short Textbook of Pediatrics. Pg 271
Atropine is considered when there is a AV block | Unknown | null | [
"atropine"
] | 51,147 |
540b6a57-ac39-4d03-b2ed-12c7bc3d4d61 | Presence of trifluroacetic acid (TFA) in urine indicates that volatile anaesthetic agent used was | Halothane | Methoxyflurane | Trichloroethylene | None of the above | 0a
| multi | Ans. is 'a' i.e., Halothane | Surgery | null | [
"methoxyflurane",
"halothane"
] | 51,155 |
230158d2-3358-44dd-84b9-522a4e5b2323 | Site of action of vecuronium is? | Cerebrum | Reticular formation | Motor neuron | Neuro-muscular junction | 3d
| single | Ans. is 'd' i.e., Neuro-muscular junction* Vecuronium, a non-depolarizing blocker, acts on nicotinic receptors at myoneural junction.* Neuro-muscular blocker act at myoneural junction1. Competitive (Non-depolarizing) blocker: -# They compete with Achfor Nm receptors - called competitive blockers. They prevent binding of Ach to Nm receptors - No opening of Na+ channels - No depolarization, so these are called non-depolarizing blockers. Competitive blockers reduce the frequency of channel opening but not its duration or the conductance of a channel once it has opened. When the magnitude of end plate potential falls below a critical level, it is unable to trigger propagated muscle action potential - muscle fails to contract. Neostigmine (anticholinesterases) antagonises competitive blockers as it increases the concentration of Ach by inhibiting its degradation by cholinesterase. Therefore, Neostigmine is used for the reversal of competitive (nondepolarizing) blockers.2. Depolarizing blockers (Succinylcholine, Decamethonium)# Depolarizing blockers have affinity as well as submaximal intrinsic activity on NM receptors. They depolarize muscle end plates by opening of Na+ channels and initially produce twitching and fasciculations (not full contraction as these drugs have submaximal activity) - So, they are called depolarizing blocker. These drugs do not dissociate rapidly from the receptor (NM) - Persistant partial depolarization - Na+ channels get inactivated - flaccid paralysis. Neostigmine does not antagonize depolarising blockers (Therefore neostigmine cannot be used for reversal).Inf act neostigmine can potentiate the block as neostigmine and other anti-cholinesterase also inhibits pseudocholinesterase which metabolizes Sch.Under certain conditions depolarizing agents produce dual mechanism of neuromuscular blockade which can be divided into two phases :a) Phase I block* Rapid in onset* Result from persistant depolarization of muscle end plate - Typical mechanism of action of depolarizing blocker.* Has classical features of depolarization block.* Block is not antagonized by anticholinesterases (neostigmine).b) Phase II block (Dual block)* Slow in onset* Results from desensitization of receptor to ACh - Ach can not act on Nm receptors (similar to competitive blocker).* Resembles block produced by competitive blockers - Therefore, has characteristics similar to non-depolarizing (competitive) block.* Block is partially reversed by anticholinesterases (Neostigmine).# In man, normally, only phase I block is seen - typical depolarizing block.# Phase II block is seen when fluorinated anaesthetics have been given or when SCh is injected in high dose.# SCh also produces phase II block in patients with atypical or deficient pseudocholinesterase. | Anaesthesia | Muscle Relaxant | [
"vecuronium"
] | 51,171 |
572a90dd-f1bc-45d9-a2bf-53d8dd7f58a8 | In treatment of Osteosarcoma all of the following are used except (REPEAT) | High dose Methotrexate | Cycloohosphamide | Vincristine | Doxorubicin | 2c
| multi | Though surgery is the form of primary treatment in Osteosarcoma but etoposide cycloohosphamide, Cisplatin, Doxorubicin have been used High dose Methotrexate has been the drug of choice and is the only FDA approved agent for this condition Ref Katzung 10th/891 | Pharmacology | Chemotherapy | [
"methotrexate",
"vincristine",
"doxorubicin"
] | 51,179 |
dce86bb6-0ff4-45b0-8d61-e30f2b17cb44 | Which of the following is not conveed into active metabolite | Lisinopril | Fluxotine | Cyclophosphamide | Diazepam | 0a
| single | all ACE inhibitor are prodrug except captopril and lisinopril drug -active metabolite fluxotine-non fluxotine Cyclophosphamide- adenophosphamide Diazepam-oxazepam Refer KDT 7/e p22 -23 | Anatomy | General anatomy | [
"lisinopril",
"cyclophosphamide",
"diazepam"
] | 51,184 |
407b777e-b8f5-4c3c-b7e3-a95896225948 | Drug of choice for ventricular arrhythmia due to myocardial infarction is | Quinidine | Amiodarone | Xylocaine | Diphenylhydantoin | 2c
| single | Refer kDT 6/e p 519 Drug of choice for ventricular arrhythmias with myocardial infarction is lignocaine Drug of choice for supraventricular arrhythmia after myocardial infection is beta blockers cardiac function is adequate | Pharmacology | Cardiovascular system | [
"amiodarone",
"xylocaine",
"quinidine"
] | 51,203 |
e225e13d-0396-47db-958e-43a5ad7c3c75 | The production of cervical mucus is stimulated by : | Progesterone | Estradiol | Estriol | Pregnenolone | 1b
| single | Cervical mucus is a glycoprotein gel that expand and contract in response to cyclic changes in the steroid hormone environment across the menstrual cycle to facilitate or inhibit the passage of sperms. Estrogen stimulates cervical mucus production, and as levels rise during the follicular phase, mucus becomes more abundant and watery, less cellular, and more easily penetrated by sperm. Progesterone inhibits cervical mucus production and renders it opaque, viscid, and impenetrable. Ref: Clinical Gynaecologic Endocrinology and Infeility; 8th Edition, Chapter 27 | Gynaecology & Obstetrics | Reproductive physiology and hormones in females | [
"estriol"
] | 51,215 |
81bce5ef-7c7a-4307-ac5b-1b1a65201a47 | Which of the following antibiotic does not act by inhibiting protein synthesis ? | Vancomycin | Tetracycline | Streptomycin | Azithromycin | 0a
| single | null | Pharmacology | null | [
"azithromycin",
"tetracycline",
"vancomycin"
] | 51,249 |
613b20fa-4770-4b74-8147-1486c0eabd60 | Which of the following drugs can cause galactorrhea? | Omeprazole | Metoclopramide | Bromocriptine | Ranitidine | 1b
| single | Galactorrhea is caused by prolactin secretion. Dopamine normally inhibits the secretion of prolactin. Thus dopamine antagonists can cause hyperprolactinemia leading to galactorrhea. The drugs include: Typical Antipsychotics like Haloperidol Antiemetics like Metoclopramide Dopamine depleter like Reserpine. Drugs stimulating dopamine receptors like Bromocriptine and Cabergoline are used for treatment of Hyperprolactinemia. | Pharmacology | Pituitary-Hypothalmic System and Thyroid | [
"metoclopramide",
"bromocriptine",
"ranitidine",
"omeprazole"
] | 51,259 |
ffe1a875-2f3a-4280-9b43-5e5fc9927ec3 | Preferred fluid in a poly-traumatic patient with shock? | Ringer lactate | Normal saline | Dextran | Dextrose-normal saline | 1b
| single | Ans. (b) Normal salineRef.-.Harrison 18th ed. / 270Normal saline is the preferred fluid for volume expansion in a crashing patient with un-recordable BP. The main point to be noted is that if ringer lactate is infused in these patients, then lactate in the solution will never reach the liver where it is normally converted into bicarbonate. Hence the accumulated lactate will get broken into lactic acid that will worsen the status of patient of poly-trauma who is already acidotic. Dextran would not be indicated as it exhibits anti-thrombotic tendency. | Surgery | Miscellaneous (Fluid & Electrolyte) | [
"dextran"
] | 51,271 |
80d90d08-f819-4195-90f0-05a3d0545643 | Catalase positive novobiocin resistant bacteria is: | Staphylococcus aureus | Staphylococcus epidermidis | Staphylococcus saprophyticus | None of the above | 2c
| multi | Ans. is 'c' i.e., Staphylococcus saprophyticus(Ref: Ananthanarayan, 9th/e, p. 202)* All staphylococcus are catalase positive.* Staphylococcus saprophyticus is resistant to novobiocin. | Microbiology | Bacteria | [
"novobiocin"
] | 51,283 |
a9e4d73d-869e-47df-8039-19f88b29cdfa | All of the following agents are used in the treatment of hot flashes, EXCEPT: | Tamoxifen | Venlafaxine | Gabapentin | Paroxetine | 0a
| multi | Tamoxifen is a selective estrogen receptor modulator (SERM) which exhibits anti-estrogenic activity on tissues like breast and central nervous system and estrogenic activity on tissues like bone. Tamoxifen produces hot flashes and other adverse effects, including cataracts and nausea . The other three options - Venlafaxine, Gabapentin and Paroxetine are included in the non-hormonal treatment of hot flashes. Ref: Levin E.R., Hammes S.R. (2011). Chapter 40. Estrogens and Progestins. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e ; Treatment of the postmenopausal woman: By Rogerio A. Lobo, Pages 3-6. | Gynaecology & Obstetrics | null | [
"gabapentin",
"tamoxifen",
"paroxetine"
] | 51,330 |
4ad0838e-4aec-4723-9c44-a152a743ab92 | Which of the following barbiturate is used for induction? | Thiopentone | Naloxone | Naltrexone | Phenobarbitone | 0a
| single | Ans: a (Thiopentone) Ref: KDT, 6th ed,p. 374* Thiopentone sodium is an ultrashortacting thiobarbiturate highly soluble in water, yielding a very alkaline solution (pH 10.4)* On IV injection it produces loss of consciousness in one arm- brain circulation time * Ultrashort duration of thiopentone is because of methyl group added to it. At induction it causes mild hypokalaemia* Elimination half life of thiopentone is 10.4 hours but consciousness is regained after 15-20 min because of redistribution (drug redistributed from brain to tissues with less vascularity like muscle or fat)* 80-90% is bound to plasma proteins (mainly albumin)* Metabolized in liver and metabolic products are eliminated through kidney* MOA - inhibits function of synapse. Transmission of excitatory neurotransmitters like Ach is inhibited and that of inhibitory neurotransmitters like GABA is enhanced* Cerebral protection - cerebral oxygen consumption, cerebral metabolic rate and intra cranial tension are decreased (therefore agent of choice)* Causes hypotension and decreases intra ocular pressure* Pregnancy - crosses placental barrier and achieves high concentration in brain of fetus* Stimulates ADH action and has got antithyroid activity* * poor analgesic and muscle relaxant action* Intra arterial injection - very dreadful complication which may lead to gangrene and loss of limb if not diagnosed early* Absolute contraindication - acute intermittent porphyria and variegate porphyriaThiopentone induces enzyme aminolevulenic acid synthetase which stimulates formation of porphyrin in susceptible individuals Barbiturates Long acting- PhenobarbitoneShort acting- Butobarbitone- PentobarbitoneUltra short acting- Thiopentone- Methohexitone | Anaesthesia | General Anesthesia | [
"naloxone",
"naltrexone"
] | 51,332 |
e5e7854d-3d62-4512-be2e-1a7e559f1c01 | Pilocarpine is not used in young adults as it causes: | Retinal detachment | Myopia | Iris cysts | Shallow anterior chamber | 1b
| multi | Ans. (b) MyopiaRef: Khurana 6/e, p. 449; Kanski 7/e; p. 386Contraction of ciliary muscle results in accommodation and thus also cause transient, fluctuating myopia. | Ophthalmology | Glaucoma | [
"pilocarpine"
] | 51,353 |
a3ec7e91-5048-4de9-8b06-d6e9ca551fe1 | Maximum analgesic action found in – | Catecholamine | Propofol | Ketamine | Thiopentone | 2c
| single | Ketamine is different from most other anaesthetic induction agents in that it has significant analgesic action. | Anaesthesia | null | [
"ketamine",
"propofol"
] | 51,357 |
df6b1d88-d71d-410d-a38f-7e1934629338 | Malignant hypehermia is a rare complication of the use of the following anaesthetic: | Ketamine | Thiopentone sodium | Halothane | Ether | 2c
| single | Rarely, Halothane can cause Malignant hypehermia, which is treated with dantrolene Inhalational anesthetic agents and Depolarising NM blockers like succinylcholine can precipitate malignant hypehermia. | Pharmacology | Anaesthesia | [
"ketamine",
"halothane"
] | 51,360 |
0ba3932a-a8be-484c-809f-7e72fa31b880 | A 30-year old female complains of lower abdominal pain and purulent vaginal discharge. Her pulse rate is 98/min, temperature is 101oF, WBC and ESR are raised. Per vaginal examination reveals lower abdominal tenderness and cervical motion tenderness. What is the best treatment option for her? | Single IM injection of Ceftriaxone with oral doxycycline and oral metronidazole for 14 days | Single dose of Ceftriaxone injection with oral Azithromycin for 14 days | Oral Metranidazole for 14 days | Oral Oflaxacin and oral Metronidazole for 14 days | 0a
| multi | The best treatment is single IM injection of Ceftrixone with oral Doxycycline and oral metronidazole for 14 days. The diagnosis is pelvic inflammatory disease. Sexually transmitted organisms especially N.gonorrhoeae and C.trachomatis are implicated in many cases. The best treatment for OPD management of PID is: Inj. Ceftrixone 250mg IM single dose + Doxycycline 100 mg BD * 14 days +/- Metronidazole 500 mg BD * 14 days Best parenteral treatment for PID is : Inj. Cefotetan 2g IV BD + Doxycycline 100 mg BD or Inj. Cefoxitin 2g QID+ Doxycycline 100 mg BD To minimize disease transmission, women should be instructed to abstain from sexual intercourse until therapy is completed, symptoms have resolved, and sex paners have been adequately treated. Ref: Online resources | Gynaecology & Obstetrics | Infections of the genital tract | [
"metronidazole",
"azithromycin",
"doxycycline",
"ceftriaxone"
] | 51,362 |
1c2213b8-bcd6-4a50-9afd-c95e1d5c74de | Best anaesthetic drug to be given in day care surgery: | Ketamine | Sevoflurane | Desflurane | Propofol | 3d
| single | Ans. (d) PropofolRef: KDT 6th ed./373-374PROPOFOL* Anesthesia of choice for day care surgery.* Short acting, action diminishes the same day.* Advantage: has anti emetic property. It is safe in porphyria.* Disadv: Causes myocardial depression and hypotension. | Anaesthesia | Miscellaneous General Anesthesia | [
"ketamine",
"sevoflurane",
"desflurane",
"propofol"
] | 51,366 |
42fcf2f0-f933-49fd-8d67-602b988d3b2e | Main MOA brimonidine in glaucoma - | Decreased aqueous secretion | Increased trabecular outflow | Increased uveoscleral outflow | Reduce vitreous volume | 0a
| single | Brimonidine (0.2% : 2 times/day). It is a selective alpha-2-adrenergic agonist and lowers IOP by decreasing aqueous production. Because of increased allergic reactions and tachyphylaxis rates it is not considered the drug of first choice in POAG. It is used as second drug of choice and also for combination therapy with other drugs. Ref.AK Khurana 4th edition page no 223 | Ophthalmology | Glaucoma | [
"brimonidine"
] | 51,381 |
83e5e391-180a-425f-8b7a-3b864b2b5ca0 | Mucormycosis -a) Angio-invasionb) Lymph invasionc) Septate hyphaed) Long term deferoxamine therapy is predisposing factore) It may lead to blindness | acd | ade | abd | ad | 1b
| single | null | Microbiology | null | [
"deferoxamine"
] | 51,383 |
8a77376c-51e4-4c2e-946f-720572390f1f | Drug of choice as antidiabetic in obese patient: | Glipizide | Insulin | Tolbutamide | Metformin | 3d
| single | Ans. D. MetforminMetformin is the first line treatment in case obese diabetic patient as it is known to cause weight loss. It doesn't cause the release of insulin and thus less chances of hypoglycemia. | Pharmacology | Endocrinology | [
"glipizide",
"metformin",
"tolbutamide"
] | 51,389 |
70aa145c-cb91-40ed-b04b-73ffda9b3785 | Mitosis is arrested in ________ phase by using colchicine in cytogenetic analysis. | Prophase | Metaphase | Anaphase | Telophase | 1b
| single | null | Medicine | null | [
"colchicine"
] | 51,390 |
27cf10ee-16ce-4c86-b739-15f380471e95 | All of the following causes increase in heart rate except: | Halothane | Isoflurane | Sevoflurane | Desflurane | 0a
| multi | null | Pharmacology | null | [
"sevoflurane",
"desflurane",
"isoflurane",
"halothane"
] | 51,402 |
b950ee35-8a68-4f91-b2d1-a803352fcc4f | Side effects of Pilocarpine are A/E – | Shallow anterior chamber | Punctate stenosis | Follicular conjunctivitis | Posterior synechia | 1b
| multi | Most guides have given option a as the answer.
I have done extensive search on this. First you see the topical adverse effects of parasympathomimetic antiglaucoma drugs (from yanoff & Duker) :-
Directly acting (cholinergic agonists like pilocarpine, carbachol) → Miosis, uveitis, browache, cataracts, myopia, retinal detachment, colour vision changes, angle closure, ocular cicatracial pemphigoid.
Indirectly acting (anticholineesterases like demecarium) :- Intense miosis, iris pigment cysts, punctal stenosis, myopia, cataract, retinal detachment, angle closure.
Now see each option sequentially :-
Option '1'
Pilocarpine can cause shallow anterior chamber :-
"The use of pilocarpine is somewhat paradoxical since it is known to cause further shallowing of anterior chamber".
— Evidence - based ophthalmology.
Now you must be thinking then why pilocarpine is the drug of choice for angle closure glaucoma. Pilocarpine works by helping to open the angle by tensing the iris-diaphragm and pulling on the scleral spur. It may also help to resolve relative pupil block.
Option '2'
Punctal stenosis is caused by indirect cholinomimetic (cholinesterase) not by direct cholinomimetic (pilocarpine).
Option '3'
Rarely, pilocarpine can cause follicular conjunctivitis :-
"Pilocarpine and carbachol may both cause conjunctival follicle".
— Clinical ophthalmology.
Option '4'
Miotics (pilocarpine) makes the iris thin and pulls it away from lens removing the pupillary block, increasing the chances of posterior synechiae (due to stretching & increased surface of iris) and restoring aqueous flow by opening irido-corneal angle. | Ophthalmology | null | [
"pilocarpine"
] | 51,405 |
aa69e4c6-2f9c-45dd-b7d1-5ff7cdd2dee0 | Select the antibiotic most frequently associated with the Hypoplasia and staining of fetal teeth (SELECT 1 ANTIBIOTIC) | Tetracycline | Streptomycin | Nitrofurantoin | Chloramphenicol | 0a
| single | Fetal exposure to an antibiotic depends on many factors such as gestational age, protein binding, lipid solubility, pH, molecular weight, degree of ionization, and concentration gradient. Some antibiotics are even concentrated in the fetal compartment. Tetracycline is contraindicated in all three trimesters. It has been associated with skeletal abnormalities, staining and hypoplasia of budding fetal teeth, bone hypoplasia, and fatal maternal liver decompensation. Sulfonamides are associated with kernicterus in the newborn. They compete with bilirubin for binding sites on albumin, thereby leaving more bilirubin free for diffusion into tissues. Sulfonamides should be withheld during the last 2 to 6 weeks of pregnancy. With prolonged treatment of tuberculosis (TB) in pregnancy, streptomycin has been associated with fetal hearing loss. Its use is restricted to complicated cases of TB. Nitrofurantoin can cause maternal and fetal hemolytic anemia if glucose- 6-phosphate dehydrogenase deficiency is present. Chloramphenicol is noted for causing the gray baby syndrome. Infants are unable to properly metabolize the drug, which reaches toxic levels in about 4 days and can lead to neonatal death within 1 to 2 days. | Gynaecology & Obstetrics | Fetus & New Born and their Diseases | [
"tetracycline",
"chloramphenicol",
"nitrofurantoin"
] | 51,412 |
1075b481-d491-4c4f-94fe-48d97d1a59b0 | Drug of choice for MRSA skin infection is | Streptogramin | Vancomycin | Quinupristin | Linezolid | 1b
| single | (B) Vancomycin # Drugs used in the treatment of MRSA: Vancomycin, Linezolid, Teicoplanin, Cotrimoxazole, Oxacillin, RifampicinTREATMENT OF COMMON INFECTIONS OF THE SKINDiagnosis/ConditionPrimary TreatmentAlternative TreatmentAnimal bite (prophylaxis or early infection)Amoxicillin/clavulanate, 875/125 mg PO bidDoxycycline, 100 mg PO bidAnimal bitea (established infection)Ampicillin/sulbactam, 1.5-3.0 g IV q6hClindamycin, 600-900 mg IV q8h plusCiprofloxacin, 400 mg IV q12horCefoxitin, 2 g IV q6hBacillary angiomatosisErythromycin, 500 mg PO qidDoxycycline, 100 mg PO bidHerpes simplex (primary genital)Acyclovir, 400 mg PO tid for 10 daysFamciclovir, 250 mg PO tid for 5-10 daysorValacyclovir, 1000 mg PO bid for 10 daysHerpes zoster (immunocompetentAcyclovir, 800 mg PO 5 times daily forFamciclovir, 500 mg PO tid for 7-10 dayshost >50 years of age)7-10 daysorValacyclovir, 1000 mg PO tid for 7 daysCellulitis (staphylococcal or streptococcalb.c)Nafcillin or oxacillin, 2 g IV q4-6hCefazolin, 1-2 g q8horAmpicillin/sulbactam, 1.5-3.0 g IV q6horErythromycin, 0.5-1.0 g IV q6horClindamycin, 600-900 mg IV q8hMRSA skin infectionVancomycin, 1 g IV q12hLinezolid, 600 mg IV q12hNecrotizing fasciitis (group A streptococcalb)Clindamycin, 600-900 mg IV q6-8hplusPenicillin G, 4 million units IV q4hClindamycin, 600-900 mg IV q6-8hplusCephalosporin (first- or second-generation)Necrotizing fasciitis (mixed aerobes and anaerobes)Ampicillin, 2 g IV q4hplusClindamycin, 600-900 mg IV q6-8hplusCiprofloxacin, 400 mg IV q6-8hVancomycin, 1 g IV q6hplusMetronidazole, 500 mg IV q6hplusCiprofloxacin, 400 mg IV q6-8hGas gangreneClindamycin, 600-900 mg IV q6-8hplusPenicillin G, 4 million units IV q4-6hClindamycin, 600-900 mg IV q6-8hplusCefoxitin, 2 g IV q6h | Medicine | Miscellaneous | [
"linezolid",
"vancomycin"
] | 51,416 |
74b64e24-b9b1-4796-b918-d9ff2d840fff | Treatment for Pityriasis versicolor includes? | Griesofiilvin | Terbinafine | Itraconazole | All of the above | 2c
| multi | Ans. is 'c' i.e., Itraconazole 'Adequate treatment with itraconazole can be achieved with a total dose of as little as 1000mg, given as 200mg per day for 5-7 days." - IADVL 3rd/e p. 288* Selenium sulphide (2.5%) in detergent base is applied all over body below neck (sparing the genitalia), left overnight and washed of next morning. Two to three applications applied once or twice a week usually clears the infection.Treatment of P. versicolor1) Systemic agents:- azoles such as ketoconazole, fluconazole or itraconazole.2) Topical agents:-a) Azoles - clotrimazole, econazole, miconazole, ketoconazole.b) Others - selenium sulfide (2.5%), sodium thiosulphate (20%), whitfield's ointment (3% Salicylic acid + 6% Benzoic acid), zinc pyrithione(l%), tolnaftate, ciclopirox olamine. | Skin | Fungal Infection | [
"itraconazole",
"terbinafine"
] | 51,431 |
fc36d1d4-b62d-46f2-b1be-f7f4f2e6adfd | Which antibiotic acts by inhibiting protein synthesis - | Cefotetan | Doxycycline | Ciprofloxacin | Oxacillin | 1b
| single | Ans. is 'b' i.e., Doxycycline | Pharmacology | null | [
"cefotetan",
"ciprofloxacin",
"doxycycline"
] | 51,441 |
da5a4975-1338-4395-a177-b880fcfd103a | A 28 year old male presented with rash on his arms, legs and face, and painful ulceration of his lips and mouth along with fever. He developed an acute sore throat and conjunctivitis, following which a diagnosis of acute pharyngitis was made, presumed streptococcal, and oral penicillin was prescribed. All of the following can be used in the treatment of the above disease except: - | Cyclophosphamide | IVIg | Cyclosporine | Etanercept | 0a
| multi | This is a case of Steven Johnson syndrome with the classical targetoid lesions. In Stevens- Johnson syndrome, lesions involve not only the skin but also the lips and oral mucosa, conjunctiva, urethra, and genital and perianal areas. On histologic examination, the "targetoid" lesions show a superficial perivascular, lymphocytic infiltrate associated with dermal edema and accumulation of lymphocytes. These are along the dermo-epidermal junction, where they are intimately associated with degenerating and necrotic keratinocytes, a pattern termed interface dermatitis. Treatment approved are: - Steroids IVIg Cyclosporine Etanercept | Unknown | Integrated QBank | [
"etanercept",
"cyclophosphamide",
"cyclosporine"
] | 51,450 |
20725f98-fab9-4671-8bf2-37e6116b039b | All of the following agents are used in the treatment of alcohol dependence except: | Flumazenil | Acamprosate | Naltrexone | Disulfiram | 0a
| multi | Flumazenil (Benzodiazepine receptor antagonist) --> It is used in benzodiazepine overdose. Disulfiram- Aversive agents Acamprosate- Anticraving agent Naltrexone- Anticraving agent | Psychiatry | Substance Related and Addictive Disorders | [
"disulfiram",
"flumazenil",
"naltrexone"
] | 51,452 |
8f47cd58-8656-4b51-82df-4cdf28a33d03 | A 10 years boy presented with Cola coloured urine, oliguria for 3 days, facial puffiness, edema and hypeension. Urine albumin is positive and C3 levels are reduced. BP is 130/80. He had skin infection two weeks back. Which of the following is true about this condition? | Renal biopsy is required in all cases | C3 levels return to normal in 6-8 weeks | Cyclosporine is the treatment of choice | Most common age group involved is 1-4 years | 1b
| multi | The given clinical picture suggests a diagnosis of nephritic syndrome, most probably post-streptococcal glomerulonephritis (PSGN). Poststreptococcal glomerulonephritis (PSGN) is a classic example of the acute nephritic syndrome characterized by the sudden onset of gross hematuria, edema, hypeension, and renal insufficiency. PSGN follows infection of the throat or skin by ceain "nephritogenic" strains of group A b-hemolytic streptococci.( Throat serotypes - M1, M4, M25, and some strains of M12 and skin serotype - M49) Poststreptococcal GN usually affects school-age children (5-12 years of age) and is uncommon below 3 years of age. Lab Diagnosis of PSGN: Antistreptolysin O titer is commonly elevated after a pharyngeal infection but rarely increases after streptococcal skin infections. Best single antibody to document cutaneous streptococcal infection is anti deoxyribonuclease (DNase) B level The serum C3 level is significantly reduced in >90% of patients, and returns to normal 6-8 wk after onset. C4 is most often normal. Serum CH50 is commonly depressed A biopsy is rarely indicated when: renal function is severely impaired beyond 7-10 days serum C3 remains depressed beyond 12 weeks Patient with features of a systemic illness Management of PSGN involves: Symptomatic & suppoive therapy (treating the acute effects of renal insufficiency and hypeension) | Pediatrics | Nephritic & Nephrotic Syndrome | [
"cyclosporine"
] | 51,458 |
8ea0b3d1-8a63-4b1a-b91e-109daf355576 | Depression in elderly is treated with? | Imipramine | Dothiepin | Fluoxetine | Mianserine | 2c
| single | Ans. c. Fluoxetine. (Ref. Psychiatry by Niraj Ahuja, 5th ed., 78)Newer anti-depressants like SSRI (fluxetine, sertraline, citalopram, mitrazepam, and venlafexine) have very little cholinergic effects, side effects and hence safer drugs to use in elderly, especially with heart diseases and BMP. Educational points: Grief "Bereavement"Depression "Pathological Grief"Definition- Sadness & Tearfullness- |sleep, Appetite & Interest- Sadness& Tearfulness- |sleep, Appetite & InterestSymptoms- Wax & Wane- Shame & guilt less common- Threaten suicide less often- Symptoms can last < one year- Usually return to baseline level of Functioning within 2 months- Pervasive & Unremitting- Shame & guilt are common- Threaten suicide more often- Symptoms continue > one year- Patients do not return to baseline level of functioningTreatmentSupportive PsychotherapyAntidepressant (5SRI) Post partum Blues"Baby Blues"Post partumDepressionPostpartumPsychosisOccur afterAny babyThe 2nd babyThe 1st babyBegins after birthUp to 2 weeksWithin 1 monthWilthin 1 monthThoughts of hurting the babyNo. Mother cares about the babyYesYesSymptomsMild depressionSevere DepressionSevere Depression & Psychotic symptomsTreatmentNo Treatment necessaryAntidepressantsAntidepressants & Mood Stabilizers or Antipsychotics | Psychiatry | Mood Disorders | [
"fluoxetine",
"imipramine"
] | 51,480 |
237f8403-4861-4b0c-bb4e-fcaab70bf3b2 | Which of these drugs DO NOT decrease angiotensin Il activity | Enalapril | Valsaan | Nesiritide | Omapatrilat | 2c
| single | (Ref: Katzung 10/e p205, 286) ACE inhibitors and AT1, antagonists decrease angiotensin Il activity. Omapatrilat is a vasopeptidase inhibitor that acts by inhibiting two enzymes, ACE and NEP. As it inhibits ACE, it may also decrease angitotensin II activity. Nesiritide is a recombinant BNP and has no effect on angiotensin II activity. | Anatomy | Other topics and Adverse effects | [
"nesiritide",
"enalapril"
] | 51,490 |
9e9f8511-c62c-447f-8175-6a6b4b062b8c | Cause of metabolic alkalosis includes | Furosemide | Addision disease | Hyperkalemia | Hyponatremia | 0a
| single | Causes of Metabolic Alkalosis I. Exogenous HCO3-loads A. Acute alkali administration B. Milk-alkali syndrome II. Effective ECFV contraction, normotension, K+ deficiency, and secondary hyperreninemic hyperaldosteronism A. Gastrointestinal origin 1. Vomiting 2. Gastric aspiration 3. Congenital chloridorrhea 4. Villous adenoma B. Renal origin 1. Diuretics 2. Posthypercapnic state 3. Hypercalcemia/hypoparathyroidism 4. Recovery from lactic acidosis or ketoacidosis 5. Nonreabsorbable anions including penicillin, carbenicillin 6. Mg2+ deficiency 7. K+ depletion 8. Bater's syndrome (loss of function mutations of transpoers and ion channels in TALH) 9. Gitelman's syndrome (loss of function mutation in Na+-Cl-cotranspoer in DCT) III. ECFV expansion, hypeension, K+ deficiency, and mineralocoicoid excess A. High renin 1. Renal aery stenosis 2. Accelerated hypeension 3. Renin-secreting tumor 4. Estrogen therapy B. Low renin 1. Primary aldosteronism a. Adenoma b. Hyperplasia c. Carcinoma 2. Adrenal enzyme defects a. 11b-Hydroxylase deficiency b. 17a-Hydroxylase deficiency 3. Cushing's syndrome or disease 4. Other a. Licorice b. Carbenoxolone c. Chewer's tobacco IV. Gain-of-function mutation of renal sodium channel with ECFV expansion, hypeension, K+ deficiency, and hyporeninemic-hypoaldosteronism A. Liddle's syndrome | Medicine | Fluid and electrolytes | [
"furosemide"
] | 51,492 |
f5c1edcd-44e5-43ae-b578-4e7571c6c83c | Which of the following drugs cannot be used in patient with Multi drug resistant Tuberculosis? | Ciprofloxacin | Tobramycin | Clarithromycin | Amikacin | 1b
| single | It is aminoglycoside group of drug used in various bacterial infection, paiculary gram negative. It extes its action by inhibiting on the bacterial 30S and 50S ribosome, preventing formation of the 70S complex. It is not used as antimycobacterial. Other aminoglycosides such as streptomycin and amikacin are used as antimycobacteriasl. Ref: Richard Finkel, Michelle Alexia Clark, Pamela C. Champe, Luigi X. Cubeddu (2009), Chapter 34, "Antimycrobials", In the book, "Pharmacology", 4th Edition, Lippincott Williams and Wilkins Publications, United States, Pages 399-406 ; KD Tripathy, 5th Edition, Pages 684, 699 | Pharmacology | null | [
"amikacin",
"clarithromycin",
"ciprofloxacin"
] | 51,501 |
78677219-0a75-4535-920c-52a9ca05e4de | Veical transmission of resistance to ciprofloxacin occurs :- | Transduction | Transformation | Conjugation | Mutation | 3d
| single | Ciprofloxacin: Veical transmission -from parents to progeny (daughter cells) among bacterial cells Horizontal transmission - from one bacteria to another bacteria simultaneously Veical transmission is mainly by mutation Horizontal transmission is mainly by various methods Transduction Transformation Conjugation | Pharmacology | FMGE 2017 | [
"ciprofloxacin"
] | 51,508 |
a349488b-a294-430c-932e-2f43f89b03ca | The following antibiotic accentuates the neuromuscular blockade produced by pancuronium : | Streptomycin | Erythromycin | Penicillin G | Chloramphenicol | 0a
| single | null | Pharmacology | null | [
"erythromycin",
"chloramphenicol",
"pancuronium"
] | 51,511 |
61953b92-4696-4cad-80a0-c135d25d97f6 | Nitroglycerin cause all except | Hypotention and bradycardia | Methamoglobinemia | Hypotention and tachycardia | Vasodilatation | 0a
| multi | Refer katzung 11e p 265 KDT 6/e p524 Nitrates most commonly used antianginal drugs. These act by decreasing delivery of nitric oxide in the blood vessels leading to vasodilatation. | Pharmacology | Cardiovascular system | [
"nitroglycerin"
] | 51,520 |
38baef17-ee53-4ac3-bf8b-486713961ff9 | A patient admitted to an ICU is on a central venous line for the last one week. He is on ceftazidime and amikacin. After 7 days of antibiotics, he develops a spike of fever, and his blood culture is positive for gram-positive cocci in chains, which are catalase negative. Following this, vancomycin was staed, but the culture remained positive for the same organism even after 2 weeks of therapy. The most likely organism causing infection is | Coagulase- negative staphylococcus | Staphylococcus aureus | Enterococcus faecalis | Viridans streptococci | 2c
| single | From the case scenario, the most likely organism involved is Enterococcus faecalis. The organism is described as gram positive cocci in chains, which are catalase negative. This helps rule out Staphylocococcus aureus and coagulase-negative Staphylococcus. Streptococcus viridians is usually sensitive to penicillin and vancomycin hence it is ruled out. Here, even after treatment with aminoglycosides, cephalosporin, and vancomycin, the culture remains positive. So, this is a case of vancomycin-resistant enterococci. The mechanism is the alteration of the D-alanyl-D-alanine chain in cell wall. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition | Microbiology | miscellaneous | [
"amikacin",
"ceftazidime",
"vancomycin"
] | 51,525 |
8c3401a0-3ac8-4cb4-b570-5f731bf6e040 | Oligospermia caused by- | Methotrexate | Hydroxychloroq uine | Leflunomide | D-penicillamine | 0a
| single | Ans. is 'a' i.e., Methotrexate"Transient but reversible oligospermia has been repoed in males receiving high dose methotrexate for cancer chemotherapy".Defective oogenesis or spermatogenesis "Occurs in methotrexate therapy" | Pharmacology | null | [
"methotrexate",
"penicillamine"
] | 51,535 |
27d104d7-9c07-4a04-8980-bf7da5694f06 | A 43-year-old woman develops acute renal failure following an emergency resection of a leaking abdominal aortic aneurysm.Three days after surgery, the following laboratory values are obtained:* Serum electrolytes (mEq/L): Na+:127;K+:5.9;Cl-:92;HCO3-:15* Blood urea nitrogen: 82 mg/dL* Serum creatinine: 6.7 mg/dLThe patient has gained 4 kg since surgery and is mildly dyspneic at rest. Eight hours after these values are reported, the electrocardiogram shown below is obtained. The initial treatment for this patient should be | 10% calcium gluconate, 10 mL | Digoxin, 0.25 mg every 3 h for three doses | Oral Kayexalate | Lidocaine, 100 mg | 0a
| single | The electrocardiogram exhibited in the question demonstrates changes that are essentially diagnostic of severe hyperkalemia. Correct treatment for the affected patient includes administration of a source of calcium ions (which will immediately oppose the neuromuscular effect of potassium) and administration of sodium ions (which, by producing a mild alkalosis, will shift potassium into cells); each will temporarily reduce serum potassium concentration. Infusion of glucose and insulin would also effect a temporary transcellular shift of potassium. However, these maneuvers are only temporarily effective; definitive treatment calls for removal of potassium from the body. The sodium- potassium exchange resin sodium polystyrene sulfonate (Kayexalate) would accomplish this removal, but over a period of hours and at the price of adding a sodium ion for each potassium ion that is removed. Hemodialysis or peritoneal dialysis is probably required for this patient, since these procedures also rectify the other consequences of acute renal failure, but they would not be the first line of therapy given the acute need to reduce the potassium level. Both lidocaine and digoxin would not only be ineffective but contraindicated since they would further depress the myocardial conduction system. | Surgery | Wounds, Tissue Repair & Scars | [
"digoxin",
"lidocaine"
] | 51,550 |
782e618e-e369-4e1d-962d-ee4e8f8bc595 | A 72 year old woman presents with complaints of persistent urinary urgency, and incontinence. Her past medical history is significant for type 2 diabetes, for which she is currently taking glyburide, 5 mg twice daily. Which of the following is the most appropriate treatment for this patient? | Bumetanide | Metoprolol | Neostigmine | Oxybutynin | 3d
| single | The patient is presenting with signs and symptoms of bladder instability. Oxybutynin both exes a direct antispasmodic effect and inhibits the muscarinic action of acetylcholine on smooth muscle. Although this agent exes approximately one fifth the anticholinergic activity of atropine, it has 4-10 times the antispasmodic activity of this agent. In addition, oxybutynin will not interact with her current medication regimen. Bumetanide is a "loop" diuretic used in the treatment of edematous states secondary to a wide variety of pathologic conditions. Since this agent promotes diuresis, it would most likely worsen the signs and symptoms of persistent urinary urgency, and urge incontinence. Metoprolol is a beta-1 selective receptor blocking agent indicated for the treatment of hypeension and tachyarrhythmias. The use of this agent would not have an effect on this patient's persistent urinary problems. Fuhermore, this agent is generally not used in diabetic patients, since it can block the normal premonitory signs of hypoglycemia. Neostigmine inhibits acetylcholine hydrolysis in the synaptic cleft acetylcholinesterase inhibition. The net effect is an increase in cholinergic activity, leading to detrusor muscle contraction. This agent is indicated for the treatment of urinary retention, and it would most likely worsen this patient's incontinence. | Pharmacology | null | [
"oxybutynin",
"metoprolol",
"neostigmine"
] | 51,561 |
b316bc28-f75e-41db-9f24-ea31da08017d | A patient presents with nephrotic syndrome and hypoalbuminemia. Protein binding of which drug is not affected - | Tolbutamide | Morphine | Diazepam | Valproate | 1b
| single | Ans. is 'b' i.e., Morphine in nephrotic syndrome there is no effect on protein binding. o Other three drugs are plasma protein bound drugs. | Pharmacology | null | [
"morphine",
"valproate",
"diazepam",
"tolbutamide"
] | 51,564 |
ba361f07-b0a5-4a3f-951e-1e9e3ba0d5ee | Propranolol is C/I in a patient of angina who is already receiving | Nifedipine | Aspirin | Verapamil | Isosorbide mononitrate | 2c
| single | propranolol is a beta blocker and verapamil is a calcium channel blocker both given in combination can cause decrease in hea rate drastically hence contraindicated. Ref: KD Tripathi 8th ed. | Pharmacology | All India exam | [
"propranolol",
"nifedipine",
"verapamil",
"isosorbide"
] | 51,575 |
c9351352-d944-444b-9c7b-adea5c20d921 | Diplopia with ataxia are the adverse effects of which of the following drugs? | Phenytoin and carbamazepine | Gabapentin and carbamazepine | Gabapentin with phenytoin | Valproate and topiramate | 0a
| single | Phenytoin ,Valproate and Carbamazepine causes ataxia with diplopia Topiramate mainly causes renal stones. So first option is better one. | Pharmacology | Epilepsy | [
"carbamazepine",
"valproate",
"gabapentin",
"phenytoin",
"topiramate"
] | 51,600 |
d74072b5-9c6d-4479-ac56-51443252f730 | At the end of a balanced anaesthesia technique with non-depolarizing muscle relaxant, a patient recovered spontaneously from the effect of muscle relaxant without any reversal. Which is the most probable relaxant the patient had received? | Pancuronium | Gallamine | Atracurium | Vecuronium | 2c
| multi | This patient has received a non depolarizing muscle relaxant and has recovered spontaneously from its effect without any reversal, so he would have received atracurium. Atracurium is a sho acting muscle relaxant. It is inactivated spontaneously by nonenzymatic degradation (Hofmann elimination) in addition to that by cholinesterase. So reversal is mostly not required when it is used. Hofmann elimination is the spontaneous fragmentation of atracurium at the bond between the quaternary nitrogen and the central chain. Ref: Essentials of Medical Pharmacology By K D Tripathi, 5th Edition, Page 314 ; Fundamentals of Anaesthesia By Tim Smith, Colin Pinnock, Ted Lin, 3rd Edition, Pages 617-18 | Anaesthesia | null | [
"atracurium",
"vecuronium",
"pancuronium",
"gallamine"
] | 51,606 |
0552ea96-94c2-4a60-8dd8-2ccdbc030053 | Malignant hypehermia is most common with | Succinyl Choline | Gallamine | Dantrolene | Ketamine | 0a
| multi | A i.e. Succinyl choline | Anaesthesia | null | [
"ketamine",
"dantrolene",
"gallamine"
] | 51,612 |
965d678a-e4bf-48b9-ac11-17cf72cb42bb | Treatment of acute phase of Kawasaki Disease is - | Aspirin | IV steroids | IV immunoglobins | Cyclophosphamide | 2c
| single | Ans. is 'c' i.e., IV immunoglobins Kawasaki diseaseo Kawasaki disease, also known as lymph node syndrome, mucocutaneous-lymph node syndrome, and infant polyarteritis, is a poorly understood self-limited vasculitis that affects many organs, including the skin mucous membrane, lymph nodes, heart and blood vessel wallso It is usually seen in children younger than 5 years.# Kawasaki disease predominantly affect medium sized vessels, but may also affect small or large vessels.# Presentation may be -1) Mucocutaneous, lymph node involvement: Conjunctival injection, erythema, strawberry tongue, rash with perineal desquamation, Beau's line (transverse grooves on nails), cervical lymphadenopathy.2) Heart: Coronary vasculitis, coronary artery aneurysm (in 25% patients), coronary ectasia, MI, valvular regurgitation.# Treatment of choice for acute phase is intravenous immunoglobulin along with high dose of aspirin. For subacute phase low dose aspirin is given. | Pediatrics | Musculo Skeletal Disorders | [
"cyclophosphamide"
] | 51,619 |
d20291b2-55d8-4156-bcd8-af95761db95b | During rapid induction of anesthesia ? | Sellick's maneuver is not required | Pre-oxygenation is mandatory | Suxamethonium is contraindicated | Patient is mechanically ventilated before endotracheal intubation | 1b
| multi | Ans. is 'b' i.e., Pre-oxygenation is mandatory During rapid sequence induction preoxygenation is done for full 3 minutes. Sch is the muscle relaxant of choice for intubation. Sallieck's maneuver is done to prevent aspiration. Manual ventilation before intubation is avoided as this inflates the stomach and encourages regurgitation & aspiration. Rapid sequence anaesthesia When anaesthesia is given for emergency surgery, it is called a "rapid sequence anaesthesia". The patients have full stomach because there is no starvation for anaesthesia (it is an emergency surgery) and gastric emptying is delayed due to trauma, acute abdomen. Therefore, the objective of rapid sequence anaesthesia is to secure the airway rapidly and prevent aspiration of gastric contents. Procedure of rapid sequence has following steps : - Li The patient is preoxygenatedfor full 3 minutes. Intravenous induction agent (thiopentone or propofol) is given. Sellick's maneuver (cricoid/pressure) is done to prevent aspiration. After ensuring the correct position of tube cricoid pressure is released and maintenance anaesthesia (NCO 66%, 02% 33%, & inhalational agent) is given. A non-depolarizing blocker is now added. Suxamethenium (succinylcholine) is given as it quickly relaxes the laryngeal muscles so that rapid intubation can be done. Not done during rapid sequence anaesthesia : ? Manual ventilation before intubation is avoided as this inflates the stomach and encourages regurgitation & aspiration. Premedications are not given. | Anaesthesia | null | [
"suxamethonium"
] | 51,621 |
c2db1050-f62f-4b22-a11b-78f8bcbea0b6 | A 33-year-old man is diagnosed with essential hypeension. He is staed on a blood pressure medication, and after 6 weeks, he notes fatigue, rash over his face, joint aches, and effusions. A serum antinuclear antibody (ANA) test is positive. Wof is the most likely agent | Propranolol | Nifedipine | Thiazide diuretic | Hydralazine | 3d
| single | VASODILATORS Hydralazine/Dihydralazine Adverse effects:- are frequent and mainly due to vasodilatation. * Facial flushing, conjunctival injection, throbbing headache, dizziness, palpitation, nasal stuffiness, fluid retention, edema, CHF. * Angina and MI may be precipitated in patients with coronary aery disease. * Postural hypotension is not prominent because of little action on veins: venous return and c.o. are not reduced. * Paresthesias, tremor, muscle cramps, rarely peripheral neuritis. * Lupus erythematosus or rheumatoid ahritis like symptoms develop on prolonged use of doses above 100 mg/day. This is more common in women and in slow acetylators. Ref:- kd tripathi; pg num:-567 | Pharmacology | Cardiovascular system | [
"propranolol",
"hydralazine",
"nifedipine"
] | 51,622 |
03675637-6c06-49c2-9def-fafcec6b3b51 | Kamla Rani, a 20 yrs old female having mitral stenosis class II and Rheumatic hea disease becomes pregnant. Which is not indicated in her management during labor: | Give Prophylactic antibiotics | Apply Outlet forceps in 2nd stage of labor | Give iv furosemide at delivery of placenta | Give Methergin at delivery of anterior shoulder | 3d
| single | Use of ergometrine/methergin, with or following delivery, is contraindicated in patients with cardiac disease. Ref: Dewhurst's Textbook of Obstetrics and Gynaecology, 5th edition, Page 224 ; Textbook of Obstetrics By Dutta, 4th Edition, Page 541 and 6th Edition, Page 280 | Gynaecology & Obstetrics | null | [
"furosemide"
] | 51,650 |
c5a13143-3f1d-4272-a1c4-6b2da99ea737 | Which among the following does not cause hyperpyrexia? | MAO Inhibitors | Alcohol | Atropine | Amphetamine | 1b
| single | Ans. (B) Alcohol(Ref: Modi's Medical Jurisprudence and Toxicology, 23th/e p313)Ethyl alcohol causes vasodilatation and peripheral circulation increases, resulting in a feeling of warmth, but at the same time there will be loss of body heat from the skin.In atropine poisoning, Pyrexia (hot as a hare) is a common event and the temperature may be raised by 1 to 6degF.When taken in excess, Amphetamine produces a dry mouth, loss of appetite, irritability, dizziness, loss of sleep, dilated pupils, severe chest pain, restlessness, tachycardia, hypertension, rise of temperature and death.MAOI toxicity may present as opisthotonus, muscle rigidity, diaphoresis, hypertension, chest pain, diarrhea, hallucinations, combativeness, confusion, marked hyperthermia and trismus. | Pharmacology | Miscellaneous | [
"atropine"
] | 51,666 |
809ae052-97d7-49b6-a13a-ea72df8ac9b9 | Highly vestibulotoxic drug is : | Cisplatin | Streptomycin | Dihydrostreptomycin | Quinine | 1b
| single | null | Pharmacology | null | [
"quinine",
"cisplatin"
] | 51,683 |
e92804ac-8dd9-48c5-9bc6-7a5d16e6eaeb | In LVF, the drug which can be administered is: | Propanlol | Morphine | Amlodipine | Epinephrine | 1b
| single | Morphine is given in left ventricular failure as it decreases peripheral pooling of blood, decreases preload, shifts blood from pulmonary to systemic circuit, relives pulmonary edema and congestion It depresses resp. center and decreases air hunger Ref: KD Tripathi 8th ed | Pharmacology | Cardiovascular system | [
"morphine",
"epinephrine",
"amlodipine"
] | 51,735 |
dbf70338-5bd9-49ca-aa01-21760322d3c1 | An old patient Ram Kishore having asthma and glaucoma is to receive a β blocker. Regarding β blocking drugs: | Metoprolol blocks β2 receptors selectively | Esmolol's pharmacokinetics are compatible with chronic topical use | Nadolol lacks β2 blocking action | Timolol lacks the local anaesthetic effects of propranolol | 3d
| single | null | Pharmacology | null | [
"propranolol",
"nadolol",
"metoprolol",
"esmolol",
"timolol"
] | 51,738 |
1dbbf8f7-604f-4b45-bad8-a5cf8f4a5a50 | Which of the following can cause hypoglycemia in a patient of severe cerebral malaria on treatment ? | Quinine | Chloroquine | Halofantrine | Mefloquine | 0a
| single | null | Pharmacology | null | [
"quinine",
"mefloquine",
"chloroquine"
] | 51,742 |
90997355-a3f5-4a62-8f41-e50c30daa7e8 | All of the following pharmaceutical agents cause gynaecomastia, EXCEPT: | INH | Cimetidine | Digitalis | Pyrazinamide | 3d
| multi | Pyrazinamide will cause gynaecomastia. List of drugs which cause gynaecomastia are: Hormones Androgens and anabolic steroids Chorionic gonadotropin Estrogens and estrogen agonists Growth hormone Environmental estrogens Antiandrogens or inhibitors of androgen synthesis Cyproterone Flutamide Bicalutamide Antibiotics Isoniazid Ketoconazole Metronidazole Anti-ulcer medications Cimetidine Omeprazole Ranitidine Cancer chemotherapeutic agents (especially alkylating agents) Cardiovascular drugs Amiodarone Captopril Enalapril Nifedipine Spironolactone Verapamil Psychoactive agents Diazepam Haloperidol Phenothiazines Tricyclic antidepressants Drugs of abuse Alcohol Amphetamines Heroin Marijuana Other Highly active antiretroviral therapy (HAA) Phenytoin Penicillamine Ref: Braunstein G.D. (2011). Chapter 12. Testes. In D.G. Gardner, D. Shoback (Eds), Greenspan's Basic & Clinical Endocrinology, 9e. | Pharmacology | null | [
"cimetidine"
] | 51,762 |
9c4013bb-d194-4f88-bb2d-31c3f448aeea | Ejection of milk is caused by | Oxytocin | ADH | Progesterone | Thyroxine | 0a
| single | Oxytocin plays roles in sexual reproduction, in paicular during and after childbih. It is released in large amounts after distension of the cervix and uterus during labor, facilitating bih, maternal bonding, and, after stimulation of the nipples, breastfeeding. Both childbih and milk ejection result from positive feedback mechanisms.ADH (antidiuretic hormone) a hormone secreted by neurosecretory cells of the HYPOTHALAMUS and released by the posterior lobe of the PITUITARY GLAND. ADH stimulates the reabsorption of water through the distal convoluted tubule of the KIDNEY nephron in mammals and thus limits the water content and the overall volume of urine.Progesterone also known as P4 is a C-21steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species. Progesterone belongs to a class of hormones called progestogens and is the major naturally occurring human progestogen.thyroxine a thyroid hormone that contains iodine and is a derivative of the amino acid tyrosine, occurring naturally as l-thyroxine; its chemical name is tetraiodothyronine. It is formed and stored in the thyroid follicles as thyroglobulin and released from the gland by the action of a proteolytic enzyme. It is deiodinated in peripheral tissues to form triiodothyronine (T3), which has a greater biological activity.Ref: Ganong&;s review of medical physiology;24th edition; page no-151 | Physiology | Endocrinology | [
"oxytocin",
"thyroxine"
] | 51,783 |
224758e1-c712-4e5d-8ec7-4ad8e00af404 | Drug used for treatment of influenza is - | Ritonavir | Idoxuridine | Lumefantrine | Oseltamivir | 3d
| single | Ans. is 'd' i.e., Oseltamivir o Anti-influenza drugs are:-i) Amantidineii) Rimantidineiii) Oseltamiviriv) Zanamavir | Pharmacology | Anti-Viral | [
"ritonavir",
"oseltamivir"
] | 51,796 |
e3c94852-de8f-4d6d-b4d8-e850179b05a8 | All are true regarding antiarrhythmic, EXCEPT : | Verapamil belongs to second group drugs | Contraindicated in Sick sinus syndrome | It is contraindicated in complete heart block. | It depresses heart rate | 0a
| multi | Ans. is 'a' i.e. Verapamil belongs to second group drugs Verapamil is a calcium channel blocker. It belongs to class IV anti-arrhythmic drugs. Electrophysiological properties of verapamil. Among the Ca2+ channel blockers, verapamil has the most prominent cardiac electrophysiological action. It is a cardio depressant drug. Specific effects of verapamil. 1. S.A. nodal atomicity - decrease 2. Ventricular atomicity - decrease 3. A-V nodal ERP - increase 4. PR interval - increase Verapamil A. Uses as Antiarrhythmic PSVT - Preferred for PSVT. The drug of choice for PSVT is Adenosine* Control ventricular rate in AF or AFI. B. Contraindications 1) Partial heart block* 2) Sick sinus* 3) Ventricular arrhythmia (ppt-VF)* 4) Digitalis toxicity (Additive A-V block)* | Unknown | null | [
"verapamil"
] | 51,799 |
e9be813e-4c2c-44bf-9b66-884c20cc71e2 | All the following drugs act on the Microtubular Protein Tubulin EXCEPT: | Colchicine | Vincristin | Bleomycin | Paclitaxel | 2c
| multi | Bleomycin | Pharmacology | null | [
"paclitaxel",
"colchicine"
] | 51,800 |
1c245d0e-1ab7-4828-a65c-2d473ec787a2 | Smooth induction is seen by - | Ether | Halothane | Isoflurane | Enflurane | 2c
| single | Ans. is 'c' i.e., Isoflurane Induction by inhalation agents Unpleasant Intermediate Smooth Ether Halothane Isoflurane En flurane Desflurane Sevoflurane Nitrous oxide | Anaesthesia | null | [
"enflurane",
"isoflurane",
"halothane"
] | 51,812 |
80d7cc70-4f4a-4ea3-beed-835681009b02 | Warfarin embryopathy is due to action of: | Osteophysin | Osteotensin | Osteocalcin | Osteogenin | 2c
| single | Ans: (c) OsteocalcinRef: style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif; margin: 0 0 0 4px">Warfarin embryopathyThe process of osteocalcin carboxylation in human bone formation is a vitamin K-dependent process and that circulating osteocalcin will be altered structurally by warfarin administrationThis finding has pathophysiological implications for: o Fetal warfarin embryopathy syndromeBone disease associated with chronic liver diseasesOsteoporosisIn all the above conditions vitamin K deficiency has been implicated Note:The similarity between fetal warfarin syndrome and X-linked recessive chondroplasia puntata has suggested a common pathogenesis for these two disorders. Warfarin appears to inhibit arylsulfatase, a genetically determined deficiency which is responsible for chondroplasia puntata. | Pharmacology | Hematology | [
"warfarin"
] | 51,835 |
1518c60a-317d-4fe5-8387-842386ad4173 | Which of the following is called hunger hormone | Epinephrine | Glucagon | Pituitary | Thyroxine | 1b
| multi | null | Physiology | null | [
"epinephrine",
"thyroxine",
"glucagon"
] | 51,838 |
5aee8115-72a7-41c7-8433-b58dbdff38a6 | A 59 year old man with severe myxomatous mitral regurgitation is asymptomatic. His echo shows a left ventricular ejection fraction of 45% and an end-systolic diameter index of 2.9 cm/m2. Which of the following represents the most appropriate mode of treatment ? | No treatment | ACE inhibitor therapy | Mitral valve repair or replacement | Digoxin and diuretic therapy | 2c
| single | This man is asymptomatic, but his left ventricular ejection fraction is 45%, so the most appropriate treatment is mitral valve repair or replacement. Indications of surgical repair of mitral valve are patients who are symptomatic, asymptomatic patients with left ventricular ejection fraction less than 60% and/or end-systolic dimension increasing beyond 40 mmHg, recent onset atrial fibrillation and pulmonary hypeension (Pulmonary aery pressure 50 mmHg at rest or 60 mmHg with exercise). Ref: Harrison's Internal Medicine, 18th Edition, Chapter 237 | Medicine | null | [
"digoxin"
] | 51,845 |
73f56eb3-2cc3-4b3a-bf29-6da71a5ca3d0 | The renal biopsy of a 6-year-old boy with recurrent gross hematuria shows IgA nephropathy. The urinary protein excretion is 130 mg/day. Which of the following is the most appropriate next step in the management - | Administer coicosteroids | Give Azathioprine | Sta Cyclosporine | Urinary bag sample | 0a
| multi | Ans. is 'a' i.e., Administer coicosteroids T/T of IgA nephropathy ? o There is no proven t/t for IgA nephropathy. o The primary t/t is proper blood pressure control. The drugs which have been proved useful are :? i) Fish oil (It contains omega - 3 fatty acids). It is an antiinflammatory agent and it prevents the rate of renal progression. ii) Immunosuppressive therapy - It is done with coicosteroids with or without cytotoxic therapy. iii) ACE inhibitors and Angiotensin II receptor antagonists - Their role in reducing proteinuria and retarding the rate of renal progression is still to be determined. iv) Prophylactic antibiotics and tonsillectomy - It may reduce frequency of gross hematuria but they have no effect on progression of renal disease. | Pediatrics | null | [
"azathioprine",
"cyclosporine"
] | 51,852 |
f1faa205-d55e-446b-a348-b58da8f652a4 | Which of the following topical steroids is the most potent? | Halobetasol propionate | Fluticasone | Hydrocortisone | Triamcinolone acetonide | 0a
| single | Ans. is 'a' i.e., Halobetasol propionate Classification of topical steroids based on potencyClass 1(Super potent)Clobetasol propionate ointment and cream 0.5%Betamethasone dipropionate ointment 0.05%Halobetasol propionate ointment and cream 0.05%Class 2(Highly potent)Mometasone furoate ointment 0.1%Class 3(Potent)Betamethasone dipropionate cream 0.05%Fluticasone propionate ointment 0.05%Class 4(Moderately potent)Fluocinolone acetonide ointment 0.025%Fluticasone propionate cream 0.05%Mometasone furoate cream 0.1%Class 5(Moderately potent)Betamethasone valerate cream 0.1%Hydrocortisone butyrate cream 0.1%Class 6(Mildly potent)Desonide cream 0.05%Fluocinolone acetonide solution 0.05%Class 7(Least potent)Dexamethasone cream 0.1%Hydrocortisone 1% | Pharmacology | Endocrinology | [
"triamcinolone"
] | 51,861 |
9db0b36f-da7a-4436-8583-268f6e709197 | Which of the following is most uroselective anticholinergic drug? | Darifenacin | Tolbutamide | Duloxetine | Tamsulosin | 0a
| single | Muscarinic anatagonists acting on bladder : SOFT BLADDER S - solifenacin O - Oxybutynin F - Flavoxate T - Tolterodine , Trospium chloride Bladder- Darifenacin Side effects - Urinary Retention Tolbutamide is sulfonylureas , used as a hypoglycemic agent,stimulates the secretion of insulin by the pancreas Duloxetine is used AS SNRI in depression,neuropathic pain ,fibromyalgia etc Tamsulosin is uroselective alpha blocker, used in BPH | Pharmacology | ANS | [
"tamsulosin",
"duloxetine",
"tolbutamide"
] | 51,867 |
8d184219-0ad4-4a7e-a005-8ae2064b8658 | Pseudolymphoma is a manifestation of ? | Phenytoin | Carbamazepine | Sodium valproate | Phenobarbital | 0a
| single | Ans. is 'a' i.e., Phenytoin Phenytoin on long term administration can lead to lymphadenopathy which is sometimes difficult to distinguish from malignant lymphoma. It is known as pseudolymphoma. | Pharmacology | null | [
"valproate",
"carbamazepine",
"phenytoin",
"phenobarbital"
] | 51,880 |
94c13eea-0868-474f-b0d7-769b129a53f5 | A Schizophrenic patient is responding well to haloperidol. But, now he has developed symptoms of parkinsonism. What is the drug of choice to treat this condition - | Levodopa | Bromocriptine | Tolcapene | Anticholinergic | 3d
| single | Ans: D AnticholinergicExtrapyramidal side effects of antipsvchotics.Major dose limiting side effects.Maximum with halopridol.Parkinsonism:Appears between 1-4 weeks of therapy.Central anticholinergics like benzhexol are durg of choice for drug induced Parkinsonism. | Pharmacology | null | [
"bromocriptine",
"levodopa"
] | 51,899 |
f8450403-f378-48bd-8438-8e9024a32ce1 | Which of these is an FDA approved indication for use of modafinil as an adjunct ? | Major depression and associated lethargy | Narcolepsy | Obstructive sleep apnea | Shift work disorder | 2c
| single | null | Pharmacology | null | [
"modafinil"
] | 51,900 |
59b28f30-f3a1-41ce-b1c6-b42f518ad1be | Which of the following drugs is most effective in the management of malignant hyperthermia ? | Baclofen | Dantrolene | Succinylcholine | Vecuronium | 1b
| single | null | Pharmacology | null | [
"dantrolene",
"vecuronium",
"baclofen"
] | 51,907 |
e201dd2d-4689-4d25-9608-522194e06aae | All the following features are associated with Chancroid except- | Painful ulcer | Painless lymphadenopathy | School of fish appearance on staining | Azithromycin is useful in treatment | 1b
| multi | Ans is 'b' i.e. Painless lymphadenopathy* Chancroid is associated with painful suppurative inguinal lymphadenopathy.Chancroid (soft chancre/soft sore)* Chancroid is an STD caused by H.ducreyi, a gram negative cocobacilli. Incubation period of chancroid is 1-7 days. Clinically it is characterized by: -i) Multiple ulcersii) Non-indurated or soft indurationiii) Painful (Tender)iv) Bleed easilyv) Undermined, sloughed erythematous edgesvi) Painful suppurative inguinal lymphadenopathyDiagnosis & Treatment* Gram's staining of swab from the lesion may reveal a predominance of characteristic gramnegative coccobacilli, arranged in parallel chains giving a "School offish" or "rail road track" appearance. An accurate diagnosis relies on cultures of H.ducreyi from the lesion.* Azithromycin is the DOC for treatment. Ceftriaxoney Ciprofloxacin & erythromycin are alternatives. | Skin | S.T.D. | [
"azithromycin"
] | 51,911 |
950862f7-a707-4458-be3f-bdcbe30695b7 | Ulipristal acetate is used for | Breast cancer | Endometriosis | Emergency contraception | AUB | 2c
| single | This drug is a SPRM (selective progesterone receptor modulator). It is used for emergency contraception and is the only hormonal contraception that is effective for 120 hrs. It is contraindicated in hepatic disorder and in lactational mothers. For emergency contraception. a 30 mg tablet is used within 120 hours (5 days) after an unprotected intercourse or contraceptive failure. It has been shown to prevent about 60% of expected pregnancies, and prevents more pregnancies than emergency contraception with levonorgestrel. Ulipristal acetate is used for pre-operative treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age in a daily dose of a 5 mg tablet. | Anatomy | All India exam | [
"ulipristal"
] | 51,934 |
cdd9fab3-00ba-4a22-b913-8cd833e94c96 | Which of the following is given to a patient who is planned for ECT: September 2003 | Diazepam | Phenytoin | Muscle relaxant | Barbiturate | 2c
| single | Ans. C i.e. Muscle relaxant | Psychiatry | null | [
"phenytoin",
"diazepam"
] | 51,944 |
78dc20f9-3ef1-4b6c-b3d4-81bf65148cf5 | All the following drugs are used for thrombo prophylaxis except | Heparin | Warfarin | Aspirin | Anti thrombin | 3d
| multi | Ans is 'd' i.e. Anti thrombin | Pharmacology | Anticoagulants and Coagulants | [
"warfarin"
] | 51,969 |
22ce9958-b969-4dda-9022-b446b3983a53 | In a patient with chronic congestive cardiac failure, all of the following drugs prolong survival, except? | Metoprolol | Carvedilol | Enalapri I | Digoxin | 3d
| multi | Ans. is 'd' i.e., Digoxin Arrest of disease progression and reduced moility in CHFo The major humoral abnormalities in hea failure, which are responsible for disease progression, cardiac remodelling and moility, are excessive activation of the RAA system and adrenergic system.o The drugs which block the effect of RAA system and adrenergic system will arrest/reverse the disease progression and reduce the moality.o Drugs are1. On RAA system ACE inhibitors --> Inhibit (conversion of A-I to A-ID. AT 1 antagonists --> Block ATI receptors Spironolactone Blocks mineralocoicoid (aldosterone) receptors. 2. Adrenergic systema) b-blockers Interfere with harmful effects of sustained activation of the adrenargic system.Note : Studies have also shown that combination of hydralazine and isosarbide dinitrate also arrest the progression and reduce the moality. | Pharmacology | null | [
"carvedilol",
"metoprolol",
"digoxin"
] | 51,972 |
49cbe634-1394-469c-a3ce-926db17f0f74 | Which of the following anti TB drug is NOT bactericidal | Rifampicin | Isoniazid | Pyrazinamide | Ethambutol | 3d
| single | Ans. (d) EthambutolRef. KDT/742* Ethalmbutol is selectively tuberculostatic and clinically as active as Streptomycin.1st Line ATT Drugs action on bacteria and hepatoxictyDrugBactericidal/ BacteristaticHepatotoxicityIsoniazidCidal+RifampicinCidal+PyrazinamideCidal++++EthambutolSTATIC-NoStreptomycinCidal-No | Pharmacology | Anti Microbial | [
"ethambutol",
"isoniazid"
] | 51,981 |
87f6356e-82bd-491c-94a2-14ab0deab9aa | A highway truck driver has profuse rhinorrhea and sneezing. Which of the following drugs would you prescribe him? | Cetrizine | Pheniramine | Promethazine | Dimenhydrinate | 0a
| single | As the patient in the question is a truck driver, antihistamine which is best suitable for him is cetrizine. Cetirizine is a second generation antihistamine with least sedation. Promethazine and Dimenhydrinate are highly sedative and Pheniramine is moderately sedative preparations of H1 antihistamine which is not preferred for a truck driver as it causes sedation while driving. Ref: Essentials of Medical Pharmacology By K D Tripathi, 5th Edition, Pages 141-2 | Pharmacology | null | [
"promethazine"
] | 51,985 |
d993bb8f-846b-48e0-8af4-a2899b432648 | All of the following statements about Digoxin induced arrhythmia's are true, except: | Bi ventricular Tachycardia | Paroxysmal Atrial Tachycardia with variable AV block | Ventricular Bigeminy | May be used to treat Atrial Fibrillation | 0a
| multi | The most frequent disturbances of cardiac rhythm associated with digitalis intoxication are ventricular premature beats, bigeminy, ventricular tachycardia and rarely ventricular fibrillation. AV block and nonparoxysmal atrial tachycardia with variable AV block are characteristic of intoxication. Ref: Harrison's 16th Edition, Page 1375 | Medicine | null | [
"digoxin"
] | 51,986 |
9d2c0fd0-096d-4494-9118-05851254db1a | The following antibiotic accentuates the neuromuscular blockade produced by pancuronium | Streptomycin | Penicillin | Chloramphenicol | Erythromycin | 0a
| single | DRUG INTERACTIONS Antibiotics:- Aminoglycoside antibiotics (streptomycin) reduce Ach release from prejunctional nerve endings by competing with Ca2+. They interfere with mobilization of ACh containing vesicles from a central location to near the terminal membrane, and have a weak stabilizing action on the postjunctional membrane. In clinically used doses, they do not by themselves produce muscle relaxation, but potentiate competitive blockers. Tetracyclines (by chelating Ca2+), polypeptide antibiotics, clindamycin and lincomycin also synergise with competitive blockers. Ref:- kd tripathi; pg num:-354 | Pharmacology | Anesthesia | [
"erythromycin",
"chloramphenicol",
"pancuronium"
] | 51,993 |
231731aa-d3f8-4115-bff1-3aa5e7527eee | The drug used in coronary aery stenosis during Angio procedure? | Pindolol | Octreotide | Desmopressin | Tolazoline | 3d
| single | Talazoline is used as a vasodilator for angio proccedures. Non-selective alpha blockers like phentolamine and tolazoline are used for this purpose. Ref: CMDT-2010/Pg 1434. | Pharmacology | Cardiovascular system | [
"desmopressin",
"pindolol",
"octreotide"
] | 52,000 |
975cd87c-32b5-4d37-bec1-0c56fe973c2d | Which of the following is a long-acting beta 2 against - | Orciprenaline | Penoterol | Pexbaterol | Salmeterol | 3d
| single | β2,-agonists used in Asthma 1. Short acng → Salbutamol, terbutaline
2. Long acng → Salmeterol, formoterol Bambuterol is a prodrug of terbutaline. It is slowly hydrolysed by pseudocholineterase.
Short-acting β2-agonists produce bronchodilation within 5 min and action lasts for 2-6 hrs →
are used to abort and terminate acute asthma, but are not suitable for prophylaxis,
Salmeterol is delayed acting, can be used for prophylaxis only, while formoterol is fast acng and long acng can be used for both prophylaxis and acute aack.
Salbutamole & Terbutaline →
Only for acute attack Salmeterol →
Only for prophylaxis Formoterol → Both for prophylaxis and acute attack
Long acting β2-agonists (salmeterol & formoterol) are superior to short acting β2-agonists (salbutamol & terbutaline),
and equivalent to inhaled anticholinergics in COPD. NoteFor one opon go ahead with opon ‘d’, i.e. adrenaline because amongst the given opons,
adrenaline is shortest acng (60 - 90 minutes).
Salmeterol and formoterol are long-acting β2,-agonists.
Their lipophilic action is responsible for longer action → Lipophilic side chain anchors the drug in membrane adjacent to the receptor, slowing | Pharmacology | null | [
"salmeterol"
] | 52,007 |
ec6af887-0794-4731-b0c1-313f3836086d | Initial drug of choice in a child with status epilepticus – | Lorazepam | Phenobarbitone | Valproate | Phenytoin | 0a
| single | Drug used are → Lorazepam, Clonazepam, Diazepam, Phenytoin, Phenobarbitone, Thiopentol, Propofol, Midazolam.
Lorazepann i.v. is now the preferred initial choice. | Pediatrics | null | [
"valproate",
"lorazepam",
"phenytoin"
] | 52,010 |
55c4ebde-f087-4826-882f-bfbf02d48e76 | A previously healthy and active 72-year-old woman presents to your office with a complaint of stiffness and pain in her neck and shoulders. The symptoms are much worse in the morning and improve throughout the day. The pain affects the soft tissues and does not appear localized to the shoulder or hip joints. She denies headache or jaw claudication. Physical examination is unrevealing; there is no inflammatory synovitis, muscle tenderness, or skin rash. Muscle strength is normal in the deltoid and iliopsoas muscle groups. She has normal range of motion of the shoulder and hip joints. Laboratory studies reveal an elevated ESR of 92 mm/h and a mild normocytic anemia. Which of the following is the best next step in management of this patient? | Empiric trial of prednisone 15 mg daily | Graded exercise regimen | MRI of bilateral shoulders | Trapezius muscle biopsy | 0a
| multi | The patient has PMR. A relatively common disease of the elderly, PMR presents as morning stiffness and pain in the shoulders, neck, and hip girdle. Diagnosis is mainly clinical; improvement of symptoms throughout the day and an absence of joint findings on physical examination provide clues to the diagnosis. Most patients have a markedly elevated ESR. PMR overlaps with giant cell (temporal) arteritis, so it is worthwhile to ask about symptoms of headache or jaw claudication. In the absence of symptoms or signs of temporal arteritis, no additional testing is indicated, and the diagnosis is presumptively confirmed by prompt response to moderate dose steroids (10-20 mg prednisone per day). Patients with occult temporal arteritis will not usually respond to modest doses of prednisone. Caution must be taken in tapering the steroids as patients with PMR frequently relapse upon discontinuation of treatment. A graded exercise regimen (answer b) would be an appropriate treatment option for fibromyalgia, but fibromyalgia rarely begins at age 72 and does not cause elevation of the ESR. MRI of the upper torso may show inflammation of the bursa and shoulder joint synovium, but this patient does not have localized tenderness in these structures. Muscle biopsy (answer d) is indicated in polymyositis or inclusion body myositis, but this patient does not have muscle weakness. Temporal artery biopsy (answer e) should be performed in patients suspected of having giant cell arteritis. Our patient, however, denies symptoms consistent with arterial involvement. If the patient does not respond to treatment with modest dose steroids, stronger consideration should be given to "blind" temporal artery biopsy. | Medicine | Immunology and Rheumatology | [
"prednisone"
] | 52,014 |
d097868d-da81-45ed-b306-8448fb104636 | A 70 year old man presents with complaints of chest pain, fever, cough with sputum. On examination of sputum pus cells with gram positive cocci are present. Blood agar showed positive result. How will you differentiate this from other gram positive cocci? | Bacitracin sensitivity | Optochin sensitivity | Bile solubility | Positive coagulase | 2c
| single | Pneumococci are bile soluble. If a few drops of 10% sodium deoxycholate solution are added to 1 ml of an overnight broth culture, the culture clears due to the lysis of cocci. Alternatively, if a loopful of 10% deoxycholate solution is placed on a pneumococcus colony on blood agar the colony lysis within a few minutes. Bile solubility is a constant propey of pneumococci and hence is of diagnostic impoance. The bile solubility test is based on the presence in the pneumococci of an autolytic amidase that cleaves the bond between alanine and muramic acid in the peptidoglycan. The amidase is activated by surface active agents such as bile / bile salts, resulting in lysis of the organisms. Ref: Ananthanarayanan & Paniker's textbook of microbiology Ed 8 Pg - 219. | Microbiology | null | [
"bacitracin"
] | 52,020 |
e2f3c992-3816-47a8-8039-0a30eb35d602 | which of the following drugs should be removed by dialysis? | digoxin | salicylates | benzodiazepines | organophosphates | 1b
| single | Salicylates stay in blood whereas digoxin,diazepam and organophosphates are distributed widely | Anatomy | General anatomy | [
"digoxin"
] | 52,055 |
095e14fc-b95d-4d6d-9837-6c8fb56c573d | OCP fails when used with the following drugs, EXCEPT: | Aspirin | Phenytoin | Rifampin | Tetracycline | 0a
| multi | Larger doses of aspirin may be required when given with oral contraceptive pills. Drugs that May Reduce Combined Hormonal Contraceptive Efficacy: Antituberculous Rifampin Antifungals Griseofulvin Anticonvulsants and Sedatives Phenytoin Mephenytoin Phenobarbital Primidone Carbamazepine Ethosuximide Antibiotics Tetracycline Doxycycline Penicillins Ciprofloxacin Ofloxacin Antiretrovirals Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 32. Contraception. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e. | Pharmacology | null | [
"rifampin",
"tetracycline",
"phenytoin"
] | 52,080 |
51b7e05c-bfd4-4107-9f30-40a4b21925bd | A 60-year-old male complains of pain in both knees coming on gradually over the past 2 years. The pain is relieved by rest and worsened by the movement. There is bony enlargement of the knees with mild inflammation. Crepitation is noted on motion of the knee joint. There are no other findings except for bony enlargement at the distal interphalangeal joint. The patient is 5 feet 9 in. tall and weighs 88 kgs. The best way to prevent disease progression is | Weight reduction | NSAID's and Calcium supplementation | Total knee replacement | Oral prednisone | 0a
| multi | (Braunwald, 15/e, pp 1987-1993.) The clinical picture of a noninflammatory ahritis of weight-bearing joints is suggestive of degenerative joint disease, also called osteoahritis. Crepitation over the involved joints is characteristic, as are bony enlargements of the DIP joints. In this overweight patient, weight reduction is the best method to decrease the risk of fuher degenerative changes. Aspirin or acetominophen can be used as symptomatic treatment, but do not affect the course of the disease. Calcium supplementation may be relevant to associated osteoporosis, but not to the osteoahritis. Oral prednisone would be contraindicated; intraaicular coicosteroid injections may be given two to three times peryear for symptom reduction. Knee replacement is the treatment of last reso, usually when pain occurs around the clock and symptoms are not controlled by medical regimens. | Surgery | null | [
"prednisone"
] | 52,094 |
2b0eec7d-f0fb-4802-9809-34891dee6781 | Which of the following statements are true regarding benzodiazepines? | It acts as GABA agonist | Diazepam is a sho acting benzodiazepines | Diazepam causes lesser respiratory depression than midazolam | Nitrazepam is metabolized in liver | 2c
| multi | Benzodiazepines act on BZD receptors of GABAA-BZD receptor-chloride channel complex and increase the frequency of CI -channel opening GABA facilitatory action. Thus these are not GABA agonists. Coma, respiratory depression though rare,can occur with ultra sho acting agents like midazolam,thriazolam. Diazolam has rapid onset of action but prolonged action due to formation of active metabolized. Ref: KD Tripathi 8th ed. | Pharmacology | Central Nervous system | [
"midazolam",
"diazepam"
] | 52,105 |
71abb2f3-32bd-4ccd-bb0d-ec2ece093727 | Drug of choice for treatment of infestation due to Onchocerca volvolus is : | Albendazole | Ivermectin | Praziquantel | Suramin | 1b
| single | null | Pharmacology | null | [
"albendazole",
"ivermectin"
] | 52,106 |
8e02b885-9dcd-4fff-97e5-7991bd9f5f9a | Drugs used for anaesthesia in a hypotensive is? | Propofol | Ketamine | Thiopentone | None | 3d
| multi | Ans. is 'b' i.e., Ketamine Ketamine raises the BP, therefore is the induction agent of choice in hypotensive states and shock | Anaesthesia | null | [
"ketamine",
"propofol"
] | 52,107 |
cb5667f9-70a3-4b7b-b5c3-e0b17efb9dff | Best forensic sample for DNA analysis is: TN 09 | Blood in EDTA | Hair | Vitreous humor | Femur bone | 0a
| single | Ans. Blood in EDTA | Forensic Medicine | null | [
"edta"
] | 52,109 |
dc9bf7df-55e5-4f26-bdc2-a60c0eb95292 | A young man presents with asymptomatic macules and erythematous painless lesion over glans with generalized lymphadenopathy. Treatment of choice in this condition: | Ceftriaxone | Benzathine penicillin | Acyclovir | Fluconazole | 1b
| single | Ans. b. Benzathine penicillin (Ref: Fitzpatrick's 6/e p2164-2212; Rooks Textbook of Dermatology 7/e p30.1-35, 25.20-39)Asymptomatic macules and papule over the trunk and reddish patch over the palate with a flat, moist lesion on glans penis in a young man with generalized lymphadenopathy is suggestive of syphilis.Benzathine penicillin first line of treatment for syphilis.Clinical Presentation of SyphilisEarly Congenital Syphilis:Snuffles (rhinitis)Q is the earliest feature.Lesions are vesiculobullous and snail track ulcers on the mucosaLate Congenital Syphilis:Characterized by Hutchinson's triad (interstitial keratitis + 8th nerve deafness + Hutchinson's teeth i.e. pegged central upper incisors)QSaddle nose, saber tibia, mulberry molarsBull dog's jaw (protrusion of jaw)RhagadesQ (linear fissure at the mouth, nares)Frontal bossing, hot cross bun deformity of the skullClutton's joints (painless swelling of joints, most commonly both knee)Palatal perforationsHigaumenakis sign (periostitis leads to unilateral enlargement of sternal end of clavicle)Primary Syphilis:Painless, indurated, non-bleeding, usually single punched out ulcer (hard chancre)QPainless, rubbery shotty lymphadenopathySecondary Syphilis:Bilateral symmetrical asymptomatic localized or diffuse mucocutaneous lesions (macule, papule, papulosquamous and rarely pustule)Non-tender generalized lymphadenopathyHighly infectious condylomata IataQ, in warm moist intertriginous areasMoth ate alopecia, arthritis, proteinuriaQTertiary Syphilis:Gumma, neurosyphilis/tabes dorsalisQOstitis, periostitisAortitis, aortic insufficiencyQ coronary stenosis and nocturnal anginaQSyphilisCaused by Treponema pallidumQDiagnosed by dark field microscopyFTA-ABS (most sensitive test, earliest test to become positive)QVDRL or RPR titer (determine response to treatment as they become negative)QTPI (most specific test)QTPH (2nd most sensitive test)Treatment of Sexually transmitted DiseasesDiseaseDrug of choice* Gonorrhea- Non-penicillinase producing- Penicillinase-producing or disseminated gonorrhea- Amoxy/ampicillin, Procaine penicillin G - Ceftriaxone, cefuroximeQ* Syphilis- Early (Primary, secondary and latent) and Late- Neurosyphilis- Benzathine Penicillin GQ/Procaine penicillin G- Aqueous penicillin G/Aqueous Pen. G procaineQ* LGV (Chlamydia trachomatis)- AzithromycinQ- DoxycyclineQ* Donovanosis/Granuloma inguinale (Calymmobacterium granulomatis)- Doxycycline/tetracyclineQ* Chancroid (H. ducreyi)- CeftriaxoneQ- Azithro/ErytrhromycinQ- CotrimoxazoleQ | Unknown | null | [
"fluconazole",
"ceftriaxone"
] | 52,114 |
c4a81534-7243-40bd-a8a1-895f81db3330 | Drugs acting on dopamine receptors are all except | Dopamine | Fenoldopam | Dobutamine | Haloperidol | 2c
| multi | -Dopamine It stimulates 3 receptors Receptors Dose of Dopamine for stimulation D1 <2 mg/Kg/min b1 2-10 mg/Kg/min a1 >10 mg/Kg/min -Fenoldopam is dopamine agonist -D1 Used in hypeensive emergency -Dobutamine Does not act on dopamine receptors Mainly act on beta 1 Used in CHF -Haloperidol - typical antipsychotic with D2 blocking action | Pharmacology | Sympathetic System | [
"fenoldopam",
"dobutamine"
] | 52,119 |
78e9e758-8ea1-402c-b8d7-619155a5dfe8 | Scabies oral drug of choice: | Permethrin | Benzyl Benzoate | Ivermectin | Lindane | 2c
| single | Ref: Katzung, 14th ed. pg. 939, 1075; KDT, 6th ed. pg. 864* Scabies is caused by an ectoparasite sarcoptes scabei. It is highly contagious. The mite burrows through the epidermis, laying eggs which form papules that itch intensely.* Most common site of entry- finger webs.* Drugs used are:# Permethrin 5%: broad spectrum and potent insecticide, currently most efficacious.* It is DOC for scabies.* MOA: It causes neurological paralysis in insects by delaying depolarization.* Single application needed in most cases.* Very less toxicity; 100% cure rate.# Lindane: another broad spectrum insecticide.Efficacy lower than permethrin.MOA: kills lice and mites by penetrating through their chitinous cover and affecting the nervous system.# Benzyl benzoate: Oily liquid with a faint aromatic smell.It is applied over face and neck after a bath. A second coat is applied next day which is washed after 24 hours.# Crotamiton# Sulfur# Ivermectin: Highly effective in scabies and pediculosis as well. Oral DOC in scabies.* It is the only ORALLY administered drug which is used for scabies (ectoparasitosis)* A single dose of 0.2mg/kg has cured almost 90-100% of population.* It is contraindicated in children <5 yrs, pregnant and lactating women. | Pharmacology | Anti Microbial | [
"ivermectin"
] | 52,154 |
3c9b142e-ea01-4676-a8bf-06923b8732ef | Which of the following is a GLP-1 agonist? | Pramlintide | Exenatide | Sitagliptin | None of the above | 1b
| multi | Alpha-Glucosidase inhibitors |Glucose absorption Acarbose, Miglitol Dipeptidyl peptidase IV inhibitors Prolong endogenous GLP-1 action Sitagliptin GLP-1 agonist |Insulin, |Glucagon, slow gastric emptying Exenatide Amylin agonist Slow gastric emptying, |Glucagon Pramlintide Ref: KD TRIPATHI 8TH ED. | Pharmacology | Endocrinology | [
"sitagliptin",
"exenatide",
"pramlintide"
] | 52,157 |
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