MediCall Book Series FCPS Past Papers PDF

[MediCall Book Series] Click Below to Install Pakistan’s #1 Health App MediCall Application C.E.O & Founder : Dr.Tauseef Afridi  FCPS Past Papers MEDICINE & ALLIED...................................................................................

[MediCall Book Series] Click Below to Install Pakistan’s #1 Health App MediCall Application C.E.O & Founder : Dr.Tauseef Afridi  FCPS Past Papers MEDICINE & ALLIED............................................................................................... 4 01 May2018 Morning (A)..................................................................................................................... 6 01 May2018 Morning (B)................................................................................................................... 30 01 May2018 Noon (A)........................................................................................................................ 52 01 May2018 Noon (B)........................................................................................................................ 75 01 May2018 Evening (A).................................................................................................................... 98 01 May2018 Evening (B).................................................................................................................. 121 02 May2018 Morning (A)................................................................................................................. 143 02 May2018 Morning (B)................................................................................................................. 159 09 March 2018 Evening (A)............................................................................................................. 173 09 March 2018 Evening (B)............................................................................................................. 185 08 March 2018 Evening (A)............................................................................................................. 201 08 March 2018 Evening (B)............................................................................................................. 223 08 March 2018 Morning (A)............................................................................................................. 247 07 March 2018 Morning (A)............................................................................................................. 295 07 March 2018 Morning (B)............................................................................................................. 313 07 March 2018 Evening (A)............................................................................................................. 340 07 Sep 2017 Morning (B)................................................................................................................. 407 1st March 2017 Morning (A)............................................................................................................ 426 1st March 2017 Morning (B)............................................................................................................ 447 09 Nov 2016 Evening (A)................................................................................................................. 466 09 Nov 2016 Evening (B)................................................................................................................. 488 10 Nov 2016 Evening (A)................................................................................................................. 509 10 Nov 2016 Evening (B)................................................................................................................. 526 Parietal layer is sensitive to pain as receptors are present on it and absent on visceral layer.......... 543 SURGERY & ALLIED............................................................................................. 547 02 May 2018 Evening (B)................................................................................................................. 573 01 May 2018 Evening (B)................................................................................................................. 624 www.theMediCall.com Page 1 07 Mar 2018 Evening (A)................................................................................................................. 639 07 Mar 2018 Noon (A)...................................................................................................................... 682 07 Mar 2018 Morning (A)................................................................................................................ 734 07 Mar 2018 Morning (B)................................................................................................................. 748 01 Mar 2017 Morning (A)................................................................................................................ 773 01 Mar 2017 Morning (B)................................................................................................................. 790 GYNAE..................................................................................................................................... 798 01 May 2018 Evening (A)................................................................................................................. 800 01 May 2018 Morning (A)................................................................................................................ 838 01 May 2018 Morning (B)................................................................................................................ 864 08 Mar 2018 Morning (A)................................................................................................................ 887 08 Mar 2018 Morning (B)................................................................................................................. 910 07 Mar 2018 Morning (A)................................................................................................................ 927 07 Mar 2018 Morning (B)................................................................................................................. 952 07 Mar 2018 Evening (A)................................................................................................................. 968 07 Mar 2018 Evening (B)................................................................................................................. 995 EYE............................................................................................................................................... 1020 MARCH 2018 EYE Papers.................................................................................................................. 1021 MD / MS Papers MD-MS FEB 2018.............................................................................................................................. 1076 MD-MS January 2017........................................................................................................................ 1106 MD-MS May 2016............................................................................................................................. 1136 MD MS Nov 2016.............................................................................................................................. 1165 MD-MS October 2017....................................................................................................................... 1194 www.theMediCall.com Page 2 www.theMediCall.com Page 3  MEDICINE & ALLIED ================================================================================= Explanations are written just below the Correct Answer www.Facebook.com/TheMediCall join our Patient Help Group www.Facebook.com/groups/medicallers www.theMediCall.com Page 4 SUBJECT & CHAPTER WISE MCQS AVAILABLE ON APPLICATION Click Below to Install Pakistan’s #1 Health App MediCall Application www.theMediCall.com Page 5  01 May2018 Morning (A) Q: A Shopkeeper suddenly collapsed in his shop. On exam, his pulse was thready BP was 80/60 and Pulse was 120bpm, thready and weak. Most likely he suffered from?  Cardiogenic Shock Sustained hypotension (systolic blood pressure (BP) aortic pressure during systole. Loudest at heart base. radiates to carotids  radiates to LUQ Q: Drug used in diabetic gastropathy  Metoclopramide Metoclopramide:MECHANISM D2 receptor antagonist. Increased resting tone, contractility, LES tone, motility. Does not influence colon tr port time.CLINICAL USE Diabetic and post- surgery gastroparesis, antiemetic.  Omeprazol  MgOH  sucralphate Q: Man had bp 170/110.He did nothing about it.On his next visit it was 170/100.He ignored again.What are the chances of most common complication in future ?  MI  COPD  CLD  Atherosclerosis In the long run, HTN PREDISPOSES to: Atherosclerosis, LVH, stroke, CHF, renal failure, retinopathy, and aortic dissection. Q: Traveler returned from foreign trip.Aftr 6 weeks developed generalyzed lymphadenopathy,hepatospleenomegaly,fever and atypical lymphocytosis. Diagnosis?  malaria  leishmaniasis Leishmania donovani :Tr mitted by Sandfly, causes Visceral leishmaniasis (kala-azar): spiking fevers, hepatosplenomegaly, pancytopenia  typhoid  dengue www.theMediCall.com Page 8 Q: muscle which increase AP diameter of thorax during inspiration  intercostal The anteroposterior diameter is increased by raising the ribs and thrusting the sternum forward through contraction of the intercostal muscles. The tr verse diameter is increased byraising the ribs (like bucket handles) through contraction ofthe intercostal muscles.  tr versus abdominis  scalene posterior  scalne anterior Q: Tr ient adhesion molecules are  integrin  elastin  selectin The weak and tr ient interactions involved in rolling are mediated by the selectin family of adhesion molecules Selectins are receptors expressed on leukocytes and endothelium that contain an extracellular domain that binds sugars (hence the lectin part of the name)  fibrin Q: emphysematous changes are due to deficiency of  α1 anti trypsin Two types of Emphysema are:Centriacinar—associated with smoking.Panacinar—associated with α1-antitrypsin deficiency.  ALP  fibrin  Elastin Q: most comon cause of primary immunodeficiency  SCID Severe combined immunodeficiency (SCID):Several types including defective IL-2R gamma chain (most common, X-linked), adenosine deaminase deficiency (autosomal recessive)  AIDS  lymphoma  leukemia Q: A new born baby boy died after 1 hour.He had microcephaly and extra finger on medial side of both hands.Diagnosis?  Klinefilter syndrome www.theMediCall.com Page 9   Peutz Jeiger syndrome  True hermaphrodite  Patau syndrome Patau syndrome (trisomy 13), 1:15,000 :Findings: severe intellectual disability, rockerbottom feet, microphthalmia, microcephaly, cleft liP/Palate, holoProsencephaly,Polydactyly, congenital heart disease. Death usually occurs within 1 year of birth Q: 3rd heart sound is due to  mitral regurgitation  mitral stenosis  aortic stenosis  CHF S3—in early diastole during rapid ventricular filling phase. Associated with filling pressures (e.g., mitral regurgitation, CHF) and more common in dilated ventricles (but normal in children and pregnant women) Q: premalignant lesion on cheek  actinic kertosis Actinic keratosis: Premalignant lesions caused by sun exposure. Small, rough, erythematous or brownish papules or plaques. Risk of squamous cell carcinoma is proportional to degree of epithelial dysplasia.  leukoplakia  erythroplakia  HPV Q: detoxification of drugs is a function of  RER  golgi complex  nucleolus  SER Smooth endoplasmic reticulum:Site of steroid synthesis and detoxification of drugs and poisons. Lacks surface ribosomes. 19.O2 tension normal but O2 saturation is decreased due to  dec. plasma  inc. plasma www.theMediCall.com Page 10 In case of increased plasma volume but no increase in hemoglobin (relative anemia) leads to decreased O2 saturation.  dec. RBC  dec. surfactant Q: calcitonin is related to which malignancy  Medullary CA thyroid CA-15-3/CA-27-29: Breast cancer.CA-19-9: Pancreatic adenocarcinoma.CA-125: Ovarian cancer.Calcitonin: Medullary thyroid carcinoma  papillary CA  follicular CA  pancreatic cancer Q: post heart lung tr plant.which infection is common?  VZV  HCV  CMV In solid organ tr plant always mark CMV.Its features include Congenital infection, mononucleosis (negative Monospot), pneumonia, retinitis. Infected cells have characteristic “owl eye” inclusions. Latent in mononuclear cells.Tr mitted congenitally and by tr fusion, sexual contact, saliva, urine, tr plant.  HBV Q: hypophyseal part receiving supply from hypophyseal portal system  adenohypophysis Anterior pituitary (adenohypophysis):Secretes FSH, LH, ACTH, TSH, prolactin, GH, melanotropin (MSH). Derived from oral ectoderm (Rathke pouch).  neurohypophysis  Pons  Midbrain Q: true about urine Osmolarity  inc. by ADH Production of concentrated urine: is also called hyperosmotic urine, in which urine osmolarity > blood osmolarity. is produced when circulating ADH levels are high (e.g., water deprivation, volume depletion, SIADH).  dec. by ADH www.theMediCall.com Page 11   dec. by Aldosterone  dec. by Cortisol Q: true about tr versus abdominus  facia tr versalis  oblique fascia  tr versus abdominis  conjoint tendon Near the insertion of anterior abdominal muscles, the lowesttendinous fibers are joined by similar fibers from thetr versus abdominis to form the conjoint tendon, whichstrengthens the medial half of the posterior wall of the inguinal canal. Q: cervical rib compresses which nerve root  upper cord  lower trunk Cervical rib can cause pressure on the lower trunk of the brachial plexus or thesubclavian artery, leading to symptoms and signs thatare referred to as the thoracic outlet syndrome.  lower cord  middle trunk Q: Co-enzyme A requires which component  B1  B2  B5 Vitamin B5 (pantothenate):FUNCTION Essential component of coenzyme A (CoA, a cofactor for acyl tr fers) and fatty acid synthase  B6 Q: which branch of internal iliac supplies the vas deferens  anterior vesical  superior vesical  posterior vesical  inferior vesical Inferior vesical artery: This artery supplies the base ofthe bladder as well as the prostate and the seminal vesiclesin males. It also gives off the artery to the vas deferens. Middle rectal artery: Commonly, this artery arises withthe inferior vesical artery  Pudendal www.theMediCall.com Page 12 Q: Arthus reaction is example of which type of hypersensitivity  1  2  3 Arthus reaction—a local subacute antibodymediated hypersensitivity (type III) reaction. Intradermal injection of antigen induces antibodies, which form antigen-antibody complexes in the skin. Characterized by edema, necrosis, and activation of complement.  4 Q: warty lesions on vulva.cause is viral.what should it be?  CIN2  gonorrhoea  HPV  verrucous Verrucae Warts. caused by HPV. Soft, tan-colored, cauliflower-like papules. Epidermal hyperplasia, hyperkeratosis, koilocytosis. Condyloma acuminatum on genitals Q: sodium is absorbed from collecting tubules by  ADH  Aldosterone Collecting tubule—reabsorbs Na+ in exchange for secreting K+ and H+ (regulated by aldosterone).Aldosterone—acts on mineralocorticoid receptor increased insertion of Na+ channel on luminal side.  Angiotensin-II  H ions Q: child with excesive bleeding epistaxis.same problem in cousins  vWD  Thrombocytopenia  Hemophilia Hemophilia is an X-linked recessive disorder of the defective coagulation, affects males more than females. Presents as increasing bleeding Tedency. Hemophilia A: deficiency of factor VIII.Hemophilia B: deficiency of factor IX.  ITP Q: basement membrane containcollagen type  type 1  type 2 www.theMediCall.com Page 13   type 3  type 4 Type III Reticulin—skin, blood vessels, uterus, fetal tissue, granulation tissue. Type IV Basement membrane, basal lamina, lens Q: Factory worker presented in opd with progressive peripheral motor disfunction and anemia. Cause can be  Folate deficiency  B1 deficiency  Lead poisoning Lead poisoning:Lead inhibits ferrochelatase and ALA dehydratase dec. heme synthesis and inc. RBC protoporphyrin and dec. B6 leading to neurological problems.Also inhibits rRNA degradation, causing RBCs to retain aggregates of rRNA (basophilic spling).High risk in old houses with chipped paint and lead factory worker.  B3 deficiency Q: epithelium of lower respiratory system is derived from  Ectoderm  Endoderm The respiratory epithelium develops from endoderm while the muscles, connective tissues, and cartilages develop from mesoderm.  Mesoderm  Neuroectoderm Q: true about aspirin  inhibits both COX1 and 2 MECHANISM: Irreversibly inhibits cyclooxygenase (both COX-1 and COX-2) enzyme by covalent acetylation. Platelets cannot synthesize new enzyme, so effect lasts until new platelets are produced:  inhibits COX1 only  inhibits COX2 only  inhibit phospholipase Q: Pt with resting tremor, rigidity and expressionless face.Lesion is at  globus pollidus  striatum  substantia nigra www.theMediCall.com Page 14 Parkinson disease Degenerative disorder of CNS associated with Lewy bodies (composed of α-synuclein—intracellular eosinophilic inclusion) and loss of dopaminergic neurons (i.e., depigmentation) of the substantia nigra pars compacta.  cerebellum Q: The organelle that tr fer from mother to child ?  cytoplasm  SER  mitochondrial A double-stranded circular DNA genome-encodes a few of the mitochondrial proteins. Mitochondrial DNA is always inherited from the mother, resulting in the maternal tr mission of diseases of energy metabolism.  RER Q: Diabetes mellitus and diabetes insipidus have which feature opposite to each other?  polyphagia  weight loss  obesity  polydypsia In diabetes mellitus, there is increased plasma Osmolarity that increases thirst level and causes polydypsia. While this is not the case in diabetes inspidus. Q: pregnant female presents with DVT.What is drug of choice?  heparin Correct wer is Heparin which is safe in pregnancy.Warfarin is used in Chronic anticoagulation (after STEMI, venous thromboembolism prophylaxis, and prevention of stroke in atrial fibrillation).But Not used in pregnant women (because warfarin, unlike heparin, can cross the placenta). Follow PT/INR values.  warfarin  aspirin  Clopidogrel Q: The major connection of pontine nuclei in left half of pons are with?  Midbrain  hypothalamus  thalamus  cerebellum www.theMediCall.com Page 15 The pons is located between the medulla (caudally) and the midbrain (rostrally). The cerebellum overlies the pons. It is connected to the brain stem by 3 pairs of cerebellar peduncles. Q: nerve damage in posterior triangle of neck  spinal  spinal acessary The spinal root of CN XI runs downwardand laterally, and it enters the deep surface of the sternocleidomastoid muscle, which it supplies, and then crossesthe posterior triangle of the neck to supply the trapeziusmuscle.  vertebral  hypoglossal Q: Bicarb max absorption from  PCT Early proximal convoluted tubule (PCT)—contains brush border. Reabsorbs all of the glucose and amino acids and most of the HCO3–, Na+, Cl–, PO4–, K+, and H2O.  DCT  loop of Henle  thick limb Q: Person cant feel taste of sugar.which nerve affected  CN XI  CN XII  CN X  CN VII SENSORY INNERVATION Anterior two thirds: The lingual nerve (general sensation) and chorda tympani (taste), anterior of tongue is for sweet taste. Posterior third: The glossopharyngeal nerve (general sensation and taste) Q: schwann cells are present in  tendon  ligaments  Elastin  PNS Myelin results in saltatory conduction of action potential between nodes of Ranvier, where there are high concentrations of Na+channels. CNS—oligodendrocytes, PNS—Schwann cells. www.theMediCall.com Page 16 Q: Increased TPR is due to  parasympathetic activity  sympathetic activity ↑ vasoconstriction of arterioles, resulting from the increased sympathetic outflow. As a result, TPR and arterial pressure will increase  Beta agonist  beta blockers Q: ATT which cause pink urine  rifampin Rifampin undergoes enterohepatic cycling and is partially metabolizedin the liver. Both free drug and metabolites, which are orange-colored, are eliminated mainly in thefeces.  INH  ethambutol  pyrazinamide Q: ant interventricular septum carries vein  great cardiac Great cardiac vein The great cardiac vein lies in the anterior interventricular sulcus with the LAD artery. It is the main tributary of the coronary sinus.  coronary sinus  small cardiac  left cardiac Q: CD4 cells stimulate  IL2 T cells Help maintain specific immune tolerance by suppressing CD4 and CD8 T-cell effector functions.Identified by expression of cell surface markers CD3, CD4, CD25 (α chain of IL-2 receptor), and tr cription factor FOXP3  IL4  IL3  IL1 Q: oligodendrocytes are present in  CNS www.theMediCall.com Page 17 Myelin results in saltatory conduction of action potential between nodes of Ranvier, where there are high concentrations of Na+channels. CNS—oligodendrocytes, PNS—Schwann cells.  PNS  muscles  connective tissue Q: Hyperlipidemics side efect  derranged RFTs  derranged PT  derranged PFTs  derranged LFTs Hepatotoxicity (Increased LFTs), rhabdomyolysis (esp. when used with fibrates and niacin) Q: true about warm receptors  nociceptor Extremes of temperature and painis detected by Nociceptors  tactile receptor  Meissner"s corpuscles  mercle discs Q: TB is a type of hypersensitivity  type 4 Type IV: Mulle sclerosisGuillain-Barré syndromeGraft-versus-host diseasePPD (test for M. tuberculosis)Contact dermatitis (e.g., poison ivy, nickel allergy)  type 1  type 2  type 3 Q: Artery of Adamkiewicz arise from aorta at level of  T7-8  T9-11 The largest anterior medullary feeder, the great anteriorsegmental medullary artery of Adamkiewicz, varies in level, arising from a spinal branch of either one ofthe lower posterior intercostal arteries (T9–11) most commonly , or of the subcostal artery (T12), or less frequently of theupper lumbar arteries (L1 and L2).  T8  T9-10 www.theMediCall.com Page 18 Q: Surfactant starts to be made by which week?  12  14  26 Surfactant synthesis begins around week 26 of gestation, but mature levels are not achieved until around week 35  16 Q: Sensing vibration is the function of  anterolateral  dorsal column Dorsal column system processes sensations of fine touch, pressure, two-point discrimination, vibration, and proprioception. consists primarily of group II fibers  spinothalamic  spinocorticap Q: most common infection to new born child,which causes mental retardation is  AIDS  TORCH Nonspecific signs common to many ToRCHeS infections include hepatosplenomegaly, jaundice, thrombocytopenia, and growth retardation.  RSV  HHV Q: Cerebral cortex is necessary for  Accommodation  light reflex Optic nerve is directly connected to the cerebral cortex in contrast to the other options given in the list.  corneal reflex  pupillary reflex Q: avascular necrosis of head of femur due to fracture neck,which vessel is responsible  anterior  femoral  medial circumflex www.theMediCall.com Page 19 Fractures of the femoralneck interfere with or completely interrupt the mainblood supply from medial circumflex femoral artery to the root of the femoral neck to thefemoral head. Avascular necrosis of the femoral headis a common complication of femoral neck fractures.  anterior circumflex Q: test to detect reinfarct after MI  trop T  trop I  CPK  CKMB CK-MB is predominantly found in myocardium but can also be released from skeletal muscle. Useful in diagnosing reinfarction following acute MI because levels return to normal after 48 hours. Q: Substance which is freely cleared and reabsorbed  PAH Measurement of renal plasma flow (RPF)—clearance of para-aminohippuric acid (PAH) PAH is filtered and secreted by the renal tubules. Clearance of PAH is used to measure RPF  Inulin  PABA  Creatinine Q: trachea bifurcate at level  T1  T2  T4 Trachea: Lies posterior to the aortic arch and bifurcates at the level of T4 vertebra to form the right and left primary bronchi. The carina is an internal projection of cartilage at the bifurcation.  T6 Q: part of long bone formed by secondary centre of ossification  diaphysis  metaphysis  epiphysis Epiphysis :The ends and s of a bone which ossify from secondary centres are called epiphyses  shaft www.theMediCall.com Page 20 Q: A patients labs show urine Osmolarity of 100 and polyuria.ADH analogue is given shows response and increase in urine osmolarity.Diagnosis?  nephrogenic DI  central DI Nephrogenic DI can be caused by mutation in V2-receptor. Desmopressin (ADH analog) = treatment for central DI.  Cushing syndrome  conn syndrome Q: lipids has major component  H ion  O ion  Carbon ion lipids are the organic compounds made up of chemicals of carbon and hydogen along with other atoms related to specific lipids.  Na ion Q: Pulmonary edema without any cardiac cause is  pulmonary edema  asthma  emphysema  ARDS Acute respiratory distress syndrome:May be caused by trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, or amniotic fluid embolism. Diffuse alveolar damage and increased alveolar capillary permeability leading to protein-rich leakage into alveoli and noncardiogenic pulmonary edema (normal PCWP) Q: A burn patient presents with bleeding profusely and shock.Total protiens 4(normal is 5 to 8).labs will have  dec. fibrinogen  clotting factors  dec. plasma  hypoalbuminemia Burn results into endothelial injury and leads to increased vascular permeability that causes loss of plasma proteins especially the albumin being smallest molecular weight protein. Q: ECG shows 2 P wave and 1 QRS complex pattern. Diagnosis is?  Mobitz type2 www.theMediCall.com Page 21 Mobitz type II: Dropped beats that are not preceded by a change in the length of the PR interval (as in type I). It is often found as 2:1 block, where there are 2 or more P waves to 1 QRS response  mobitz type 1  atrial fibrillation  atrial flutter Q: Mets are present in submental and submandibular glands.Where is the primary lesion  Submandibular  Sublingual  tongue LYMPH DRAINAGE : Submental lymph nodes. Sides of anterior two thirds: Submandibular lymphnodes. Posterior third: Deep cervical lymph nodes.  palate Q: Broca plus Wernicke lesion cause  sensory aphasia  motor aphasia  dysarthria  global aphasia Global Nonfluent aphasia with impaired comprehension. Both Broca and Wernicke areas affected. Q: Dorsal column system has arrangement in spinal cord ipsilaterally upper body to lower body as  lateral Legs (Lumbosacral) are Lateral in Lateral corticospinal, spinothalamic tracts.Dorsal column is organized as you are, with hands at sides. Arms outside, legs inside.  medial  anterior  posterior Q: p ystolic murmur in aortic area, Diagnosis?  mitral stenosis  mitral regurgitation  aortic regurgitation  tricuspid stenosis www.theMediCall.com Page 22 P ystolic murmur appears in MR and TR. In aortic area tricuspid regurgitation is the preferred wer. Q: Rbc placed in hyperosmalar solution of urea.What will happen to cells?  swells  no change  inc. O2 content  shrinkage When the RBCs are placed in an hyperosmolar solution, water will move out to the more osmolar compartment leading to cell shrinkage. Q: A man had accident.A metal rod crushed his right cheek, crushing zygomatic bone and orbit floor.Plastic surgery was done and an attempt to salvage eye was made.After few time he had reduced bilateral visual aquity.On examination right eye was enucleated.Choroidal thickening was present.What abnormality at cellular level causing this?  T cell supression  T cell depression  T cell supression failure As the reconstruction was done after the RTA, the T cells should be suppressed in order to maintain and bear the reconstructed tissues.  fibroma Q: Loss of Shoulder abduction above head.Muscle involved is  pec. major  pec. minor  trapezius  deltoid Deltoid causes the abduction above head.  supraspinatus Q: In rods hyperpolarization occurs because of  Cl open  K open  Na closure Decreased levels of cGMP cause closure of Na+ channels, decreased inward Na+current, and, as a result, hyperpolarization of the photoreceptor cell membrane. Increasing light intensity increases the degree of hyperpolarization.  K closure www.theMediCall.com Page 23 Q: maxillary vein starts from  jugular bulb  pterigopalatine fossa  infratemporal fossa The maxillary vein is formed in the infratemporal fossafrom the pterygoid venous plexus. The maxillaryvein joins the superficial temporal vein to form the retromandibular vein.  maxillary fossa Q: synthetic androgen used to treat endometriosis  5HT  anastrozide  anastrazole  danazol Danazol:MECHANISM Synthetic androgen that acts as partial agonist at androgen receptors.CLINICAL USE Endometriosis and hereditary angioedema. Q: in 3rd trimester which vaginal infection is most common  staph aureus  candida Candida albic : alba = white.Systemic or superficial fungal infection. Oral and esophageal thrush in immunocompromised (neonates, steroids, pregnancy, diabetes, AIDS), vulvovaginitis (diabetes, use of antibiotics), diaper rash, endocarditis in IV drug users, disseminated candidiasis (to any organ), chronic mucocutaneous candidiasis.  strep Pneumoniae  Pseudomonas Q: regarding a neat surgical scar after c section after 2 months what cells have predominent role?  macrophages  fibronectin  elastin  fibroblasts PDGF: Secreted by activated platelets and macrophages Induces vascular remodeling and smooth muscle cell migration Stimulates fibroblast growth for collagen synthesis Q: Somatic,lactogenic and interstitial hormones produced by  pituitary www.theMediCall.com Page 24 Anterior pituitary (adenohypophysis): Secretes FSH, LH, ACTH, TSH, prolactin, GH, melanotropin (MSH). Derived from oral ectoderm (Rathke pouch). α subunit—hormone subunit common to TSH, LH, FSH, and hCG. β subunit—determines hormone specificity.  hypothalamus  thalamus  pons Q: Enzyme which adds inorganic phosphate group to substrate  synthatase  hydrolase  phosphorylase Kinase: Uses ATP to add high-energy phosphate group onto substrate (e.g., phosphofructokinase).Phosphorylase: Adds inorganic phosphate onto substrate without using ATP (e.g., glycogen phosphorylase).Phosphatase: Removes phosphate group from substrate (e.g., fructose-1,6-bisphosphatase).  phosphatase Q: muscle of quiet (passive) inspiration  internal oblique  scalenae  intercostal  diaphragm Quiet InspirationThe vertical diameter of the thoracic cavity is increased bythe contraction and descent of the diaphragm. The anteroposterior diameter is increased by raising the ribs and thrusting the sternum forward through contraction of the intercostal muscles. The tr verse diameter is increased byraising the ribs (like bucket handles) through contraction ofthe intercostal muscles. Q: Heinz bodies are seen in  Aplastic anemia  sideroblastic anemia  asplenia  G6PD deficiency Heinz bodies appear in G6PD deficiency and oxidative stress Q: UMNL present on CT scan.There is muscle weakness.what other signs may present?  hypotonia  Hypertonia www.theMediCall.com Page 25 Signs and symptoms of the upper motor neuron lesion are, spasticity, hypertonia, hypereflexia and clonus.  flaccid paralysis  dec. reflexes Q: brachiocephalic trunk divides into  right Subclavian RIGHT SUBCLAVIAN ARTERYThe right subclavian artery arises from the brachiocephalicartery, behind the right sternoclavicular joint  left Subclavian  carotid  internal carotid Q: gastrulation starts with  yolk sac  primitive streak Gastrulation--process that produces the 3 primary germ layers: ectoderm, mesoderm, and endoderm begins with the formation of the primitive streak within the epiblast Ectoderm forms neuroectoderm and neural crest cells.  neuroectoderm  mesenchyme Q: in autoimmune hemolytic anemia most common feature is ?  Coomb"s positive Autoimmune hemolytic anemias are usually Coombs positive.Direct Coombs test—anti-Ig antibody (Coombs reagent) added to patient’s blood. RBCs agglutinate if RBCs are coated with Ig.Indirect Coombs test—normal RBCs added to patient’s serum. If serum has anti-RBC surface Ig, RBCs agglutinate when anti-Ig antibodies (Coombs reagent) added.  dec. Hb  inc. bilurubin  Inc. ALP Q: anterolateral system has  rubrospinal  spinobulbar  Reticular  spinothalamic tracts www.theMediCall.com Page 26 The anterolateral pathway carries pain and temperature sensations. It contains spinothalamic tracts. Q: Ataxia past pointing present.what are other Sign of cerbellar dysfunction  dysphagia  dysphonia  scanning speech Cerebellar lesion: signs and symptoms are nystagmus, scanning speech, intentional tremors, rebound phenomenon, dysdiadokokinesia, pendular knee jerk etc.  dysarthria Q: Example in which Homeostatic function of autonomic nervous system is opposed is  feedback  positive feedback  sympathetic  negative Feedback In a negative feedback system, the outcome or the result of the activity is opposite to previous turn, negative feedback returns the changes towards normal. Q: Example in which Homeostatic function of autonomic nervous system is opposed is  negative Feedback In a negative feedback system, the outcome or the result of the activity is opposite to previous turn, negative feedback returns the changes towards normal.  feedback  positive feedback  sympathetic Q: drug actively secreted by nephron  metronidazole  ciprofloxacin Elimination of most fluoroquinolones is through thekidneys via active tubular secretion, which can be blocked by probenecid. Dosage reductions areusually needed in renal dysfunction except for moxifloxacin which is eliminated partly by hepaticmetabolism and also by biliary excretion.  Ofloxacin  rifampin www.theMediCall.com Page 27 Q: Patient of COPD present with breathlessness. pH shows acidosis. His electrolytes test will show  hypernatremia  hypocalcemia  hypokalemia  hyperkalemia In any case of acidosis, if there is derranged K level than it will be hyperkalemia resulted from outward shift of K. Q: Nerve supply to medial rotator of hip ?  sacral plexus Medial rotation: Anterior fibers of the gluteus mediusand minimus and the tensor fasciae latae muscles. These are supplied by Superior and inferior gluteal nerves, branches of sacral plexus.  Pudendal  femoral  sciatic Q: hormone for primary sexual character of female is  estrogen FUNCTION: Development of genitalia and breast, female fat distributionGrowth of follicle, endometrial proliferation, increases myometrial excitability  LH  FSH  GH Q: ESR increase due to deficiency of  globulin  Albumin Erythrocyte sedimentation rate: Acute-phase reactants in plasma (e.g., fibrinogen) can cause RBC aggregation, thereby inc. RBC sedimentation rate (RBC aggregates have a higher density than plasma).Increased ESR: infections, autoimmune diseases (e.g., SLE, rheumatoid arthritis, temporal arteritis), hypoalbuminemia, malignant neoplasms, GI disease (ulcerative colitis), pregnancy.Decreased ESR: polycythemia, sickle cell anemia, CHF, microcytosis, hypofibrinogenemia.  RBC  WBC www.theMediCall.com Page 28 Q: receptors for temperature regulation are present on  thalamus  pons  hypothalamus Hypothalamic set point for body temperature1. Temperature sensors on the skin and in the hypothalamus “read” the core temperature and relay this information to the anterior hypothalamus.2. The anterior hypothalamus compares the detected core temperature to the set-point temperature  Midbrain Q: true regarding post triangle of neck  contains CNXII  CN X  CN IX  clavicle inferiorly POSTERIOR TRIANGLEThe posterior triangle is bounded posteriorly by the trapezius muscle, anteriorly by the sternocleidomastoid muscle,and inferiorly by the clavicle Q: a butcher develops jaundice for 3 days and has long term history of decreased appetite. His PT & APTT is raised.petechia present on examination,Diagnosis?  HCC  Bud chiari syndrome  Wilson disease  CLD Etiologies—alcohol (60–70%), viral hepatitis, biliary disease, hemochromatosis.Portosystemic shunts partially alleviate portal hypertension:Esophageal varices, spider nevi, decreased production of clotting factors leading to increased bleeding Tedency.Caput medusae. In this case it seems acute on chrnoic hepatits resulting CLD. Q: MOA of propylthiouracil is to inhibit peroxidase and  2"-deodinase  5"-deodinase Propylthiouracil inhibits both peroxidase and 5"-deiodinase. Methimazole inhibits peroxidase only  3"-deodinase  4"-deodinase www.theMediCall.com Page 29  01 May2018 Morning (B) Q: A Pt developed Hoarseness of voice. On indirect Laryngoscopy, sluggish movement of left vocal cord was noticed. Injury to which nerve?  Lt Recurrent L The recurrent laryngeal nerve (RLN) carries signals to different voice box muscles responsible for opening vocal folds (as in breathing, coughing), closing the folds for vibration during voice use, and closing them during swallowing.  Rt Recurrent L  External L  Internal L Q: Which of the following decreases O2 affinity of Hb?  Metabolic Acidosis Metabolism, and Regulation of Organic Phosphates in Erythrocytes. 2,3-DPG, ATP, inositol hexaphosphate (IHP), and other organic phosphates bind to hemoglobin and decrease its affinity for oxygen.  Metabolic Alkalosis  CO Poisoning Q: Highest energy reserve in terms of Kcal/mole in the body is?  Muscle Glycogen  Liver Glycogen  Adipose Tissue Adipose tissue, or fat, is an anatomical term for loose connective tissue composed of adipocytes. Its main role is to store energy in the form of fat, although it also cushions and insulates the body.  Blood Glucose Q: A young Pt reported Greenish, malodorous vaginal discharge. On microscopy, a motile pear shaped organism was identified. Dx?  Candida albic  Neisseria gonorrhea  Trichomonas Trichomonas infection produces a frothy, yellow-green vaginal discharge with a strong odor www.theMediCall.com Page 30 Q: Staging of tumor is by?  Lymphovascular Invasion  Extent of Invasion Cancer staging is the process of determining the extent to which a cancer has developed by growing and spreading. Contemporary practice is to assign a number from I to IV to a cancer. C. a and b Q: Pre-mortem Thrombi characterized by?  Current jelly appearance  Lines of Zahn Lines of Zahn are a characteristic of thrombi that appear particularly when formed in the heart or aorta. They have visible and microscopic alternating layers (laminations) of platelets mixed with fibrin, which appear lighter and darker layers of red blood cells.  All of above Q: 50yr old Female developed Microcytic Hypochromic Anemia. What is most likely cause of her Anemia?  Iron Def Hypochromic me that the red blood cells have less hemoglobin than normal. Low levels of hemoglobin in your red blood cells leads to appear paler in color. Iron deficiency anemia: The most common cause of microcytic anemia is an iron deficiency in the blood.  Sideroblastic Anemia  Anemia of Chronic Disease  Folic acid deficiency Q: Regarding liver of Fetus?  Covers whole of Abdomen???  5% of Body Weight At 8–12 weeks of gestation, liver is a relatively bigger organ which forms 4-5-5.5% of the total body weight and protrudes through the abdominal wall.  Nodular At 8–12 weeks of gestation, liver is a relatively bigger organ which forms 4-5-5.5% of the total body weight and protrudes through the abdominal wall Q: Which Vitamin is responsible for Prothrombin synthesis?  Vit C www.theMediCall.com Page 31   Vit D  Vit K The functions of vitamin K are concerned with blood clotting process. Post-tr lational (after protein biosynthesis in the cell) modification of certain blood clotting factors. The clotting factors II (prothrombin) VII ,IX and X are synthesized as inactive precursors (zymogens) in the liver.  Vit A Q: Conducting System of Heart lies in?  Sub-endocardium The cardiac conduction system is a highly specialized network of cardiomyocytes within the heart that generate and tr mit electrical impulses, The left bundle branch ends up descending as a sheet of cells within the septal subendocardium.  Sub-Epicardium  Endocardium Q: Hyper-vitaminosis-A results in?  Jaundice High intake of beta-carotene (hypercarotenaemia) can colour the skin yellow, sparing the eyes (in contrast to jaundice where the sclera are also yellow). Although hypervitaminosis A can be due to excessive dietary intakes, the condition is usually a result of consuming too much preformed vitamin A  Retinal detachment  Increase mineralocorticoid secretion Q: Thiamine deficiency results in?  Hyperkeratosis  Peripheral neuritis peripheral neuropathy due to vitamin B1 (thiamine) deficiency is a part of beriberi syndrome. Atrophic skin changes are also commonly present. The neuropathic presentation of thiamine deficiency is quite varied and may precede the systemic and cognitive symptoms.  Pellagra Q: On a Radiograph at L-1  SMA arises from aorta www.theMediCall.com Page 32 The abdominal aorta has three ventral branches (Figs. 7-1 and 7-2). The celiac artery arises at the T12-L1 level. It can initially take a forward, upward, or dowward course. The superior mesenteric artery (SMA) takes off at the L1-L2 level about 1 cm below the celiac axis.  IVC joined by portal  Head of Pancreas  Level of Adrenal Glands Q: A female Pt with family hx of fetal abnormalities has been found with decreased Maternal AFP. Dx?  Renal Agenesis  Down syndrome In Down syndrome, the AFP is decreased in the mother's blood, presumably because the yolk sac and fetus are smaller than usual. Estriol is a hormone produced by the placenta, using ingredients made by the fetal liver and adrenal gland. Estriol is decreased in the Down syndrome pregnancy.  Ebstein Anomaly  Neural Tube defects Q: A Pt climbed a peak with a heavy bag on his shoulders. After that he developed loss of adduction of arm with loss of flexion at elbow and loss off extension at wrist. Most likely damage occurs to? a. Radial nerve  Axillary nerve  Musculocutaneous nerve  Upper part of Brachial Plexus A brachial plexus injury (BPI), also known as brachial plexus lesion, is an injury to the brachial plexus, the network of nerves that conducts signals from the spinal cord to the shoulder, arm and hand Q: Slowest conduction occur in which part of Conducting System?  AV node o Speed of conduction—Purkinje > atria > ventricles > AV node  Inter-nodal pathway  Purkinje Fibers  SA Node www.theMediCall.com Page 33 Q: After exercise a person lost fluids by Sweating. He drinks 2 liters of water. What will happen? a. Inc ECF (In sweating more water is lost than solutes so Inc ECF osmolarity as a result water will move from ICF TO ECF- than after drinking pure water also –Inc ECF volume)  Inc ICF  Hyper-osmolality of ECF  Hyper-osmolality of ICF Q: Most important mechanism in formation of Exudate  Increase Vascular permeability the most important and most useful of our host defense mechanisms, and without an adequate inflammatory response. It involves all vessels leading to increase vascular permeability and the formation of inflammatory exudate.  Vasodilation C. Chemotaxis Q: Regarding Internal Jugular Vein:  Starts form ear lobule to sternal Angle  Starts from Angle of Mandible to hyoid bone  Starts from Ear lobule to Sternoclavicular Joint The internal jugular vein is often the access site of choice for central venous cannulation the posterior approach, the needle is placed at the posterior border of the sternocleidomastoid muscle, at a point one-third of the way from the sternoclavicular joint to the mastoid process Q: Urine D/R shows RBC casts. Which part is involved?  Glomeruli Urine casts are cylindrical, cigar-shaped structures produced by the kidney and present in the urine in certain disease conditions.Such casts are indicative of glomerulonephritis, with leakage of RBC's from glomeruli.  Ureters  Bladder Q: Which of the following has an Oro-fecal route?  Hep-E www.theMediCall.com Page 34 Hepatitis E (HEV) is a viral infection causing inflammation of the liver. It is primarily acquired by ingesting water contaminated with fecal matter. The virus is also tr mitted from person to person through the fecal-oral route as a result of poor body hygiene practices.  Typhoid Fever Q: BCG vaccine>>It infers immunity through?  Cytotoxic T cells BCG is primarily believed to mediate immunity through the development of antigen (Ag)- specific memory T cells BCG also induces cytotoxic T cells, whose main function is to lyse infected cells through osmotic disruption.  Antibodies  Helper T Cells Q: PENICILLIN works on bacteria through?  Destruction of Cell Wall  Inhibition of Cell Wall Synthesis Penicillin by inhibiting cell wall synthesis would inhibit both growth and mullication. Since the antibiotic is bactericidal to rapidly mullying cells, its effect on cell wall would interfere with its bactericidal action.  Protein Synthesis Q: Which of the following suggest UTI on Urine D/R?  Proteins  Nitrites The presence of nitrites in urine most commonly me there's a bacterial infection in your urinary tract.  Casts Q: Aortic Pressure highest in which Phase of Cardiac Cycle?  Slow Ejection Phase ejection stage of the cardiac cycle, it is depicted (see circular diagram) as the ventricular systole–first phase followed by the ventricular systole–second phase. After ventricular pressures fall below their peak(s) and below those in the trunks of the aorta and pulmonary arteries  Rapid Ejection Phase  Isovolumetric Contraction  Isovolumetric relaxation www.theMediCall.com Page 35 Q: In which of the following conditions PaO2 is decreased?  Dec Atmospheric O2 concentration  V/Q Mismatch The A-a oxygen difference increases with age. It is primarily due to age-induced decrease in the PaO2 level because of the rise in V/Q mismatch. The drop in PaO2 after 70 years is about 0.43 mmHg per year.  Hyperventilation Q: Which of the following has both Alpha and Beta adrenergic properties? a. Isoproterenol  Albuterol  Epinephrine epinephrine and norepinephrine are called adrenergic receptors. Epinephrine and norepinephrine have equal affinity at both alpha1 and alpha2 receptors.  Metpretrenol Q: Which group of muscles is involved in Eversion of foot?  Peroneus Longus The peroneus muscles are a group of muscles in the leg. While the muscle group exists in many variations, it is normally composed of three muscles: peroneus longus, brevis and tertius.  Tibialis Anterior  Tibialis Posterior Q: Which of the following is involved in eliciting DIC?  Factor 10  Factor 11  Factor 5  Tissue Thromboplastin The role of tissue thromboplastin in the development of DIC accompanying neoplastic diseases Q: A pt developed Microcytic hypochromic anemia. On microscopy of Stools, Eggs were noticed. Which of the following is most likely responsible for this condition?  Ancylostoma duodenale www.theMediCall.com Page 36 The most common intestinal roundworms are those tr mitted through contact with the soil. Ancylostoma duodenale and Necator americanus. They are distinguished by the morphology of the mouth parts and male bursa.  Diphyllobothrium Latum  Ascaris lumbricoides Q: An elderly pt has history of high grade fever of 105F and dark urine, from last 3-4 days, then he suddenly collapsed. On labs, his Hb was 5g/dl. What is the diagnosis? a. Meningitis Severe anaemia, Normocytic anaemia with haemoglobin Lymphocytopenia > Corticosteroids are immunosuppressants)  Anemia  Neutropenia www.theMediCall.com Page 40 89. Anti-D antibody is clinically important because?  Present in all Rh-Neg Individuals  Doesn’t pass Placenta  Causes Hemolytic Disease Maternal anti-D antibodies produced cross placental barrier and destroy fetal RBCs Ref bedside clinics in obstetrics Q: Which drug is used in Pulmonary Edema because it decreases Preload? a. Hydralazine  GTN  Isosorbide Dinitrate isosorbide-dinitrate (ISDN) in the treatment of severe pulmonary edema improves control of respiratory failure, and reduces the need for mechanical ventilation and the rate of myocardial infarction (MI)  Nifedipine Q: A child with recurrent sinusitis, bacterial infections, Otitis media and Chronic Diarrhea. Confirmatory Test?  Chloride Sweat Test sweat chloride tests and genetic testing for diagnosis of CF should be considered in children with nasal polyps, colonization of the nose including chronic otitis media, bronchial asthma, nasal polyps, recurrent pneumonia, immunodeficiencies, aspirin sensitivity, allergic fungal disease,  Sodium Sweat Test Q: Prevention in the disease process before occurrence of disease is?  Primary Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviours that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur  Secondary  Tertiary Q: Solution not Isotonic to Plasma?  5% Dextrose www.theMediCall.com Page 41 Red cells placed in normal saline (ie 0.9% saline) will not swell so normal saline is said to be isotonic.Ganong argues that an infusion of 5% dextrose is initially isotonic but that when the glucose is taken up and metabolised by cells, the overall effect is of infusing a hypotonic solution.  Human Plasma Proteins  0.9% N/S  Ringer Lactate Q: Antibody which easily crosses Placenta?  IgM  IgG Placental tr fer of maternal IgG antibodies to the fetus is an important mechanism that provides protection to the infant while his/her humoral response is inefficient. IgG is the only antibody class that significantly crosses the human placenta Q: Drug of Choice for Trichomonas Vaginalis?  Metronidazole Metronidazole is highly effective in the treatment of many anaerobic bacterial and protozoal infections. Oral metronidazole is the drug of choice for trichomoniasis. Single- dose therapy with 2 g orally is as effective as prolonged therapy with 500 mg twice daily for 7 days.  Tetracycline  Fluconazole Q: Linea Aspera fuses superiorly with?  Inter-trochanteric Line The site of attachment for the muscles.Vastus medialis muscle arises from the distal part of an intertrochanteric line and medial ridge of linea aspera of the femur.  Inter-trochanteric Crest  Gluteal Tuberosity Q: Angiotensin 2 causes salt retention through?  IP3 Ca/IP3 pathway and activates acute responses, such as vascular smooth muscle contraction, MAPK activities, and EGF receptor in the plasma membrane. Thus the retention of salt caused by aldosterone indirectly tends to elevate blood pressure and cardiac output.  C-AMP  C-GMP www.theMediCall.com Page 42   Phospholipase C Q: Virus causes mutations in?  Proto-oncogene A few cancer syndromes are caused by inherited mutations of proto-oncogenes that cause the oncogene to be turned on (activated). But most cancer-causing mutations involving oncogenes are acquired, not inherited.  Oncogene Q: Mechanism of action of Heparin?  Antithrombin 3 Mechanism of action. Heparin binds to the enzyme inhibitor antithrombin III (AT), causing a conformational change that results in its activation through an increase in the flexibility of its reactive site loop. The activated AT then inactivates thrombin, factor Xa and other proteases.  Factor 10 C. Prothrombin 1Q: Bone forming cells are called?  Osteoblasts These old osteoblasts are also called LINING CELLS. They regulate passage of calcium into and out of the bone, and they respond to hormones by making special proteins that activate the osteoclasts. OSTEOCYTES are cells inside the bone. They also come from osteoblasts.  Osteoclasts  Osteocytes Q: Analgesic used in epidural anaesthesia which causes delayed respiratory depression...  halothane  fentanyl Intravenous opioids may cause chest wall rigidity, which can impair ventilation.Respiratory depression with these drugs may be reversed postoperatively with naloxone.  isoflurane  naloxone Q: the nerve which supply the nasopharynx passes through  foramen rotundum www.theMediCall.com Page 43 The maxillary nerve is purely sensory. It leavesthe skull through the foramen rotundum and crosses thepterygopalatine fossa to enter the orbit through the inferiororbital fissure. It then continues as the infraorbital nervein the infraorbital groove, and it emerges on the facethrough the infraorbital foramen. It gives sensory fibers tothe skin of the face, roof of nasopharynx and the side of the nose.  foramen spinosum  foramen ovale  jugular foramen Q: Investiagtion of choice for severity of asthma?  FVC Obstruction of air flow resulting in air trapping in the lungs. Airways close prematurely.Patient have highlung volumes, increased RV and decreased FVC.  FEV  RV  O2 saturation Q: Malignant tumor which is locally infiltrating and does not metastize?  HCC  pancreatic cancer  renal cell CA  BCC Basal cell carcinoma Most common skin cancer. Found in sun-exposed areas of body. Locally invasive, but almost never metastasizes. Pink, pearly nodules, commonly with telangiectasias, rolled borders, and central crusting or ulceration Q: Costodiaphragmatic recess present between?  thoracic cavity  thoracic pleura  layers of pleura The pleural cavity (pleural space) is a slitlike spacethat separates the parietal and the visceral pleurae. It normally contains a small amount of pleural fluid that lubricates the apposing pleural surfaces. The costodiaphragmatic recess is the lowest area of the pleural cavity intowhich the lungs expand during deep inspiration.  pericardium Q: Drug used in pulmonary edema which reduces preload  sotalol  GTN www.theMediCall.com Page 44 Nitroglycerin, isosorbide dinitrate: MECHANISM Vasodilate by increased NO in vascular smooth muscle and increased in cGMP and smooth muscle relaxation. Dilate veins >> arteries. Decreases preload.CLINICAL USE Angina, acute coronary syndrome, pulmonary edema.  morphine  captopril Q: Primordial germ cell derived from?  Endoderm  ectoderm  yolk sac Primordial Germ Cells :Primordial germ cells arise from the lining cells in the wall of the yolk sac. At week 4, primordial germ cells migrate into the indifferent gonad.  Mesoderm Q: Patient under the effect of general anesthesia.What is used to reverse it?  flumezanil Midazolam is widely used adjunctively with inhaled anesthetics and intravenous opioids. Theonset of its CNS effects is slower than that of thiopental, and it has a longer duration of action. Casesof severe postoperative respiratory depression have occurred. The benzodiazepine receptorantagonist, flumazenil, accelerates recovery from midazolam and other benzodiazepines.  atropine  aspirin  naloxone Q: Patient is having left lower limb weakness,atrophy, and hyporeflexia.Lesion is ?  LMNL Characteristic features of the lower motor neuron lesion are decreased reflexes and tone, flaccid paralysis and wasting of muscles with muscle fasciculations.  UMNL  cerebellar lesion  pons lesion Q: what inhibits H/K pump  ranitidine  histamine  Mg(OH)2 www.theMediCall.com Page 45   Omeprazole Proton pump inhibitors: Omeprazole, l oprazole, esomeprazole, pantoprazole, dexl oprazole.MECHANISM: Irreversibly inhibit H+/K+ ATPase in stomach parietal cells Q: Confidence interval mean ?  sensitivity  specificity  standard deviation  specified probablity Confidence interval Range of values in which a specified probability of the me of repeated samples would be expected to fall.CI = range from [mean – Z(SEM)] to [mean + Z(SEM)].The 95% CI (corresponding to p =.05) is often used. For the 95% CI, Z = 1.96.For the 99% CI, Z = 2.58. Q: upper esophagus is supplied by  carotid  jugular  inferior thyroid BLOOD SUPPLYof upper esophagus: The inferior thyroid arteries supply the area.LYMPH DRAINAGEThe lymph drains into the deep cervical lymph nodes.  axillary Q: GFR increase due to to decrease?  effernt constriction  afferent constriction When the sympathetic nervous system is activated, it causes afferant arteriolar constriction that decreases the glomerular capillary pressure and decreases GFR.  Vasodilation  vasoconstriction Q: In essential hypertension, Atherosclerosis is due to which change?  hyperplastic  hyaline Arteriolosclerosis: has Common Two types: hyaline (thickening of small arteries in essential hypertension or diabetes mellitus ) and hyperplastic (“onion skinning” as seen in severe hypertension ).  hypoplastic  Basophilic www.theMediCall.com Page 46 Q: Cardiac output of the right side of the heart is what percentage of the cardiac output of the left side of the heart?  50  75  100 Cardiac output of the left and right sides of the heart is equal. Blood ejected from the left side of the heart to the systemic circulation must be oxygenated by passage through the pulmonary circulation  25 Q: Veins connecting intra cranial sinuses with extra cranial veins...  epidural  subarachnoid  sinuses  emissary veins Emissary veins are valveless channels that course through the bones of the skull and allow dural sinuses to communicate with extracranial veins. Q: Direction of sound waves detected by which structure?  cerebellum  organ of Corti Bending of the cilia in Organ of Corti causes changes in K+ conductance of the hair cell membrane. Bending in one direction causes depolarization, bending in the other direction causes hyperpolarization. The oscillating potential that results is the cochlear microphonic potential.  cerebrum  pons 19. CSF finding: inc. lymphocytes.Microscopy shows halo around nucleus of the organism.Which bug is this?  N. miningitis  tuberculus meningitis  Cryptococcus Cryptococcal meningitis, cryptococcosis. Heavily encapsulated yeast. Not dimorphic. Found in soil, pigeon droppings. Acquired through inhalation with hematogenous dissemination to meninges. Culture on Sabouraud agar. Stains with India ink and mucicarmine. Latex agglutination test detects polysaccharide capsular antigen and is more specific. “Soap bubble” like halos around nucleus lesions in brain. www.theMediCall.com Page 47   H. influenza Q: A person drank 140 meq/l Na in 100ml water. What will be the effect?  inc. ECF volume Given concentration of the solution, 140 meq/L is Isotonic to the ECF, that is why it will increase the ECF volume.  dec. ECF volume  inc. ICF Osmolarity  inc. ICF volume Q: Tractus solitarius carry which sensation?  pain  taste Nerve Supply of Tongue: Taste—CN VII, IX, X (solitary nucleus).Pain—CN V3, IX, X.Motor— CN XII.  touch  osmoreceptors Q: In gene therapy, gene is introduced into another organism using?  RNA  protein  lipids  Plasmid Plasmid Contains a variety of genes for antibiotic resistance, enzymes, and toxins. Used in genetic engineering to insert different genes into the recipient. Q: A man with DM came to you saying he has a problem in bed with his wife.Cause  Sensory Neuropathy  erectile dysfunction Autonomic neuropathy is one of the complications of the DM that can manifest as postural hypotension, dumping syndrome and erectile dysfunction etc.  Nephropathy  sleep apnea Q: Which of the following has end artery..  coronary  hepatic  central retinal www.theMediCall.com Page 48 End Arteries are the one which do not anastomose with their neighbours are called end arteries.Examples: 1. Central artery of retina and labyrinthine artery of internal ear are the best examples of an absolute end arteries. 2. Central branches of cerebral arteries and vasa recta of mesenteric arteries. 3. Arteries of spleen, kidney, lungs and metaphyses of long bones.  scapular Q: Most important buffer of Intracellular fluid?  PO4  proteins  Hb Intracellular buffersa. Organic phosphates (e.g., AMP, ADP, ATP, 2,3-diphosphoglycerate *DPG+)b. Proteins Imidazole and α-amino groups on proteins have pH that are within the physiologic pH range.Hemoglobin is a major intracellular buffer.  HCO3 Q: pregnant women infected with german measles.what will the complication in baby?  typhoid  meningitis  retinal detachment  cataract Rubella virus: A togavirus. Causes rubella, once known as German (3-day) measles. Fever, postauricular and other lymphadenopathy, arthralgias, and fine rash. Causes mild disease in children but serious congenital disease (a ToRCHeS infection). Q: which factor deficient in classic hemophillia  VIII Hereditary deficiencies of each of the coagulation factors have been identified. Hemophilia A, Classic hemophilia (a deficiency of factor VIII) and hemophilia B (Christmas disease, a deficiency of factor IX) are X-linked traits, whereas most deficiencies areautosomal recessive disorders.  VII  IX  X Q: Cell commonly involved in graft rejection?  CD4  CD 8 www.theMediCall.com Page 49 CD8+ T cells kill virus-infected cells directly.Delayed cell-mediated hypersensitivity (type IV).Acute and chronic cellular organ rejection.  CD15  monocytes Q: At the end of marathon, an athlete has more?  gulconeogenesis  glycogenesis  glycogenolysis Skeletal muscle Glycogen undergoes glycogenolysis to produce glucose-1-phosphate and it increases glucose-6-P, which is rapidly metabolized during exercise.  TCA cycle Q: All are true about Hb exept  iron is present in Ferric form Each subunit contains a heme moiety, which is iron-containing porphyrin.The iron is in the ferrous state (Fe2+), which binds O2.Each subunit has a polypeptide chain. Two of the subunits have α chain.  Iron is present in ferrous form  has 2 alpha chains  has 2 beta chains Q: A patient echocardiography shows left atrium mass with ball valve effect. Diagnosis is?  lymphoma  glioma  hemangioma  myxoma Myxomas: Most common 1° cardiac tumor in adults. 90% occur in the atria (mostly left atrium). Myxomas are usually described as a “ball valve” obstruction in the left atrium (associated with mulle syncopal episodes). Q: Most common cause of congenital hypothyroidism?  Iodine deficiency Congenital hypothyroidism (cretinism):Severe fetal hypothyroidism due to maternal hypothyroidism, thyroid agenesis, thyroid dysgenesis (most common cause in U.S.), iodine deficiency (overal most common cause), dyshormonogenic goiter  Hashimoto www.theMediCall.com Page 50   cold nodule  dysgenesis Q: An asthmatic patient had her C section. Drug given for post op analgesia?  paracetamol Here given in the list are drugs that are contraindicated in asthmatics for one or the other. Opioids cause respiratory depression and aspirin causes hypersensitivity in asthmatics.  morphine  aspirin  ibuprofen Q: Sensation of lower teeth is carried by ?  maxillary  ophthalmic  mental nerve  mandibular The inferior alveolar nerve, a branch of Mandibular nerve which enters the mandibular canal to supply the teeth of the lower jaw and emerges through the mental foramen (the mental nerve) to supply the skin of the chin. www.theMediCall.com Page 51  01 May2018 Noon (A) 1Q: A Pt developed moderate pain after limb surgery. The drug of choice for this pt? a. Pethidine  Morphine  Ketorolac Ketorolac is used for the short-term treatment of moderate to severe pain.It is usually used before or after medical procedures or after surgery. Reducing pain helps you recover more comfortably so that you can return to your normal daily activities 1Q: A Pt aspirated on table during surgery. After 10 days a lesion with air fluid levels was noticed. On drain culture, it turned out to be polymicrobial. Dx?  Lung Abscess lung abscess is a subacute infection that destroys lung parenchyma. Further, chest radiographs reveal one or more cavities, often with an air-fluid level 1Q: A Pt suffered anterior wall MI due to embolus in his coronary artery. Which type of necrosis is seen in this pt?  Coagulative necrosis Coagulative necrosis is a type of accidental cell death typically caused by ischemia or infarction. In coagulative necrosis the architecture of dead tissue is preserved for at least a couple of days.  Caseous  Liquificative  Fibrinoid necrosis 1Q: A young child with MCV 51, MCH 17 and low Hb. On exam, hepatosplenomegaly was remarkable. What’s most likely dx? Which test will u do now to confirm diagnosis? a. Ferritin  Bone marrow biopsy  Hb electrophoresis (hepatosplenomegaly is the key word)  Iron and TIBC www.theMediCall.com Page 52 1Q: Which of the following are rapidly adapting receptors?  Pacinian Corpuscles Pacinian corpuscles, are one of the four major types of mechanoreceptor cell in glabrous mammalian skin. They are nerve endings in the skin responsible for sensitivity to vibration and pressure.  Meissner  Baroreceptor  Unencapsulated receptor Q: A patient presented with foul frothy stool, investigation to be done?  USG  PCR  stool culture The features given in scenario are characteristics of protozoa infection of the intestine that can be diagnosed by stool culture and microscopy.  ELISA Q: Man working in construction factory , has pleural plaques on chest X ray due to  silicon  asbestos Asbestosis:Associated with shipbuilding, roofing, and plumbing. “Ivory white,” calcified pleural plaques are pathognomonic of asbestos exposure, but are not precancerous  carbon  tobacco Q: Vertebral vein of brain is located in?  subdural  epidural space The epidural space is located between the inner walls of the vertebral canal and the dura mater. It contains fat and the internal vertebral venous plexus.  sub sinuses  bellow scalp Q: unique movement at a ball and socket joint  eversion  inversion  supination www.theMediCall.com Page 53   circumduction Circumduction is a unique type of joint movement. It is actually combination of all other movements, and is executed at ball and socket joints only Q: man standing for hours, what change will occur in his CVS ?  hypertension  dependant edema When a person stands for a long time, there is pooling of blood in dependant parts leading to dependant edema.  postural hypotension  postural drop Q: how many ATP are formed from 1 NADPH  2  3 One molecule of NADPH produces about 3 ATPs while one molecule of FADH produces about 2 ATPs.  2.5  3.5 Q: Airborn infection is  gonococcal  anthrax Pulmonary anthrax Inhalation of spores leading to flu-like symptoms that rapidly progress to fever, pulmonary hemorrhage, mediastinitis, and shock.  staph aureus  HCV Q: Clouding in front of eye is due to  glaucoma  cataract Cataract:Painless, often bilateral, opacification (causes clouding of vision) of lens leading to blurring and decreased in vision. Risk factors: increasing age, smoking, EtOH, excessive sunlight and prolonged corticosteroid use.  diabetic retinopathy  hypertensive retinopathy www.theMediCall.com Page 54 Q: Gardener has chronic cough, has calcified mass  blastoma  Sarcoidosis  aspergilloma Aspergillomas in lung cavities, especially in chronic exposure in farmer and after TB infection. Some species of Aspergillus produce aflatoxins, which are associated with hepatocellular carcinoma.  TB Q: Patient has developed knife cut wound.Common cause of delay wound healing is  inflamation  vitamin C deficiency  vitamin D deficiency  infection Infection is one of the cause of delayed wound healing, where as fever in this scenario points out to the infection as a cause of delayed wound healing Q: Renin increases in  hypokalemia  hypernatremia  hyperkalemia hyperkalemia is one of the cause to increase the renin secretion, as the serum K increases or the Na decreases, it causes increase in renin secretion to preserve the Na by Aldosterone.  hypercalcemia Q: Blood supply to trachea is by ?  tracheal artery  carotid  hypophyseal BLOOD SUPPLYThe superior and inferior hypophyseal arteries andbranches of the internal carotid artery supply the gland.  Subclavian Q: water percentage in neonates  75 In neonates, water content is more than that of an adult person. Most of this due to edema goes off by the end of 1st week. www.theMediCall.com Page 55   50  40  45 Q: 60yr old patients is diagnosed with meningitis, drug of choice is ?  clindamycin  penicillin  cefuroxime  vancomycin At an age of 60 yrs or more, the causitive agent for meningitis is strep Pneumoniae, and drug of choice is vancomycin Q: Pt with Rt sided ptosis pupil small, Dx..?  facial palsy  Horner syndrome Horner syndrome is characterized by ptosis, miosis, anhydrosis and enophthalmosis.  3rd nerve palsy  cicatricial ptosis 20. Urinary bladdrer cancer can be caused by  S. hematobium Risk factors include Schistosoma haematobium infection (Middle East), chronic cystitis, smoking, and chronic nephrolithiasis. Presents with painless hematuria.  A.lumbricoids  S. m oni  Chlonorchis Q: Pt with rash, joint pain and low complement levels, cause..?  ITP  SLE FINDINGS: Anticardiolipin antibodies—false positive on tests for syphilis, prolonged PTT (paradoxically, increased risk of arteriovenous thromboembolism).Decreased C3, C4, and CH50 due to immune complex formation  TTP  rheumatoid arthritis Q: parotid gland swelling due to obstruction will result into ?  necrosis www.theMediCall.com Page 56   Apoptosis Obstruction to flow of any secretion in body laeds to inflamatory reaction. Here glandular secretion causes self digestion or autophagy of the glandular tissue itself.  hypertrophy  hyperplasia Q: what HIV does after entering into the cell  acts on mitochondira  affects Nuclear membrane  converts RNA to DNA HIV is caused by a retrovirus that contains a characteristic enzyme called the reverse tr criptase that can convert the single stranded RNA into the double stranded DNA.  affects only DNA Q: virus cause carcinogenesis by alterating  proteins  lipids  proto oncogene Viruses incorporate their genetic material into the host DNA and alter the proto oncogenes leading to carcinogenesis.  RNA Q: nerve supply of meninges of Middle cranial fossa  CN IX  CN VII  CN V The trigeminal nerve is the largest cranial nerve.It leaves the anterior aspect of the pons as a small motor rootand a large sensory root, and it passes forward, out of theposterior cranial fossa, to reach the middle cranial fossa, where it supplies the meninges of the fossa.  CN III Q: Testosterone is produced by  zona Fasciculata  sex cord  epidydmis  leydig cells www.theMediCall.com Page 57 Leydig cells (endocrine cells)Secrete testosterone in the presence of LH, testosterone production unaffected by temperature Q: 60 yr male presented with icterus, pruritis and intra hepatic fibrosis  CLD  HCC  chronic pancreatitis  Primary sclerosing cholangitis PRESENTATION: Pruritus, jaundice, dark urine, light stools, hepatosplenomegaly Q: ch alcoholic, centrilobar congestion neck vein distended  CKD  Right heart failure Venous return goes to the Right heart via portal vein to the IVC. In hepatic congestion, the back pressure increases leading to right Heart failure.  COPD  left heart failure Q: Aflatoxin are associated with  SCC  BCC  HCC HCC is the Most common 1° malignant tumor of the liver in adults A. Associated with hepatitis B and C, Wilson disease, hemochromatosis, α1-antitrypsin deficiency, alcoholic cirrhosis, and carcinogens (e.g., aflatoxin from Aspergillus).  pancreatic cancer Q: Scurvy can cause  pleural effusion  hemoperitoneum DEFICIENCY of Vitamin C cuases Scurvy—swollen gums, bruising, hemarthrosis, hemoperitonium, anemia, poor wound healing, perifollicular and subperiosteal hemorrhages, “corkscrew” hair.  pulmonary embolism  pulmonary edema Q: Hall mark of chronic inflammation is  mononuclear cells www.theMediCall.com Page 58 Chronic Inflamation: Mononuclear cell and fibroblast mediated, characterized by persistent destruction and repair. Associated with blood vessel proliferation, fibrosis. Granuloma: nodular collections of epithelioid macrophages and giant cells.  monocytes  eosinophils  macrophages Q: Growth factor act on which receptors  tall like receptor  tyrosine kinase Binding of growth hormone causes dimerization of the receptor and activation of tyrosine kinase in the associated protein (e.g., JAK).Targets of JAK include signal tr ducers and activators of tr cription (STAT), which cause tr cription of new mRNAs and new protein synthesis.  cell membrane  nuclear receptor Q: Patient with twin delivery complicated by post partum haemorrhage.She is unable to breast feed, cause  Prolactinoma  hemangioma  neurofibroma  Sheehan syndrome Sheehan syndrome (ischemic infarct of pituitary following postpartum bleeding,usually presents with failure to lactate) Q: A patient presents with numbness tingling of lower limbs. He is pallor. Provisional diagnosis?  B12 deficiency Neurologic symptoms: subacute combined degeneration (due to involvement of B12 in fatty acid pathways and myelin synthesis):Peripheral neuropathy with sensorimotordysfunctionand tingling sensation.Dorsal columns (vibration/proprioception)  folate deficiency  sickle cell anemia  sideroblastic anemia Q: shortest peptide with 3 aminoacids  LH  GH www.theMediCall.com Page 59   FSH  TRH TRH is one of the smallest peptide (hypothalamus) stimulates TSH (pituitary), which stimulates follicular cells. Q: man working in mine,has hilar lymph nodes on chest X ray, cause  asbestosis  pneumoconiosis  Silicosis Silicosis: Associated with foundries, sandblasting, and mines. Macrophages respond to silica and release fibrogenic factors, leading to fibrosis. It is thought that silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB  beriyllosis Q: Thenar eminance reduced and loss of abduction and opponance, nerve involved is  median Median nerve lesions commonly result from supracondylar fractures of the humerus and from woundsjust proximal to the flexor retinaculum. Among theclinical signs, the muscles of the thenar eminence areparalyzed and wasted so that the eminence is flattened and the thumb is laterally rotated and adducted  ulnar  radial  Musculocutaneous Q: Endo thoracic fascia pierced in gun shot injury, structure at risk  vagus  heart  pericardium  pleura ENDOTHORACIC FASCIAThe endothoracic fascia is a thin layer of loose connectivetissue that separates the parietal pleura from the thoracicwall. Q: small muscles of hand are supplied by  ulnar and median Muscular branches of Ulnar Nerve : Abductor digiti minimi, flexor digitiminimi, opponens digiti minimi, all palmar and all dorsalinterossei, third and fourth lumbricals (1st two are supplied by median) , and adductor pollicis muscles.  median only www.theMediCall.com Page 60   radial  ulnar Q: Depress T wave are in  hypokalemia T wave—ventricular repolarization. T-wave inversion may indicate recent MI. T wave is depressed in hypokalemia and tall in hyperkalemia.  hyperkalemia  hyponatremia  atrial flutter Q: reabsorption of uric acid is inhibited by  penicillinh  feboxustate  probenecid Probenecid: Inhibits reabsorption of uric acid in PCT (also inhibits secretion of penicillin).  allopurinol Q: Soldier went to Siachin started developing dyspnea due to  pulmonary hypertension  cardiogenic shock  high output failure  pulmonary edema Sudden high altitude causes severe hypoxia causes the pulmonary arteriolesto constrict potently, but the constriction is muchgreater in some parts of the lungs than in otherparts, so that more and more of the pulmonaryblood flow is forced through fewer and fewer stillunconstricted pulmonary vessels. The postulatedresult is that the capillary pressure in these areas ofthe lungs becomes especially high and local edemaoccurs Q: rapidly adapting receptors are  Pacinian Rapidly adapting, or phasic, receptors (pacinian corpuscle,light touch) show a decline in action potential frequency with time in response to a constant stimulus. primarily detect onset and offset of a stimulus.  mercle discs  free nerve endings  Meissner"s corpuscles www.theMediCall.com Page 61 Q: Safe NSAID in Peptic ulcer  aspirin  celecoxib Non selective as well as COX-1 inhibitors cause erosion of the gastric mucosal protective mechanisms and exacerbate the gastritis, that is why COX-2 inhibitors are used in gastritis  Ketorolac  morphine Q: Crypt abscess in parotid , agent  staph aureus Causes:Inflammatory disease—skin infections, organ abscesses, pneumonia (often after influenza virus infection), endocarditis, and osteomyelitisToxin-mediated disease—toxic shock syndrome (TSST-1), scalded skin syndrome (exfoliative toxin), rapid-onset food poisoning (enterotoxins)  strep Pneumoniae  staph epidermis  H. influenza Q: In statistics, Positive skewd me deviation of curve to  left  right Positive skew: Typically, mean > median > mode. Asymmetry with longer tail on right. Negative skew: Typically, mean < median < mode. Asymmetry with longer tail on left.  upper  lower Q: During excercise blood supply decreases to  brain  intestine During exercise, most of the blood goes to the skeletal muscles and blood flow to the intestine decreases.  skeletal muscle  kidney Q: Stucture close to crus cerebri  cerebellum  medulla www.theMediCall.com Page 62   substantia nigra For descriptive purposes, the midbrain may be divided into a dorsaltectum and right and left cerebral peduncles, each of which is further divided into a ventral crus cerebriand a dorsal tegmentum by a pigmented lamina, the substantia nigra  spinal cord Q: HIV pt with CD4 count 200 have white cottage lesion, agent  aspergillosis  blastomycosis  C. carinii  C. albican Fluffy white cottage cheese lesions:Pseudohyphae, commonly oral if CD4+ < 400 cells/mm3, esophageal if CD4+ < 100 cells/mm3C. albic (causes oral thrush and esophagitis) Q: Anti cancer cells are  NK Natural killer: cells Use perforin and granzymes to induce apoptosis of virally infected cells and tumor cells.Only lymphocyte member of innate immune system.Activity enhanced by IL- 2, IL-12, IFN-β, and IFN-α  lymphocytes  monocytes  macrophages Q: Newborn with repetive infection, thymic hypoplasia, defect is in?  B cell defect  IgA  IgG  T cell defect Digeorge syndrome:This syndrome leads to a spectrum of clinical abnormalities formerly thought to be at least two separate and distinct disorders. Characteristics include a set of findings whichdenotes Cardiac abnormalities, Abnormal facies, T-cell deficit because of thymic hypoplasia, Cleft palate, Hypocalcemia because of hypoparathyroidism. Q: Toll like receptor are associated with  B cells  MHC II B cell receptor-mediated endocytosis, foreign antigen is presented on MHC II and recognized by TCR on Th cell (signal 1). www.theMediCall.com Page 63   MHC I  surface receptors Q: Type of hypersensitivity in Mulle sclerosis  1  4 Type IV: Mulle sclerosisGuillain-Barré syndromeGraft-versus-host diseasePPD (test for M. tuberculosis)Contact dermatitis (e.g., poison ivy, nickel allergy  2  3 Q: Diff. between CSF and plasma, CSF contains  more cells  more glucose  less glucose CSF as compared to plasma contains more proteins but less cellular components. Moreover, CSF also contains less amount of glucose than that of plasma, about 1/3rd of plasma glucose.  less proteins Q: Pulsatile swelling in the groin  hernia  femoral aneurysm Aneurysm is an abnormal dilatation of the blood vessels and usually is arterial in origin, that can present as pulsating mass at its location.  varicocele  hydrocele Q: Pain in mouth and orbit, sensations are carried by  CN X  CN VII  CN III  CN V In the region of mouth and orbit the sensory supply is by Trigeminal nerve (by its 3 regional Branches), While motor supply is by fascial nerve. Q: inversion and eversion takes place at  axial www.theMediCall.com Page 64   ankle  subtalar The movements of the subtalar, the talocalcaneonavicular,and the calcaneocuboid joints are inversion and eversion.Inversion is more extensive than eversion.  naviculotalar Q: Rheumatic heart disease murmur is  diastolic murmur  early diastolic murmur  machinary murmur  holosystolic Murmur of ARF is of Mitral Regurgitation—loudest at apex and radiates toward axilla. Enhanced by maneuvers that Increased TPR (e.g., squatting, hand grip). MR is often due to ischemic heart disease, MVP, or LV dilation. Q: Pterigopalatine ganglion is related to  Trigeminal  maxillary nerve The pterygopalatine ganglion is a parasympathetic ganglion, which is suspended from the maxillary nerve in thepterygopalatine fossa. It is secretomotor to the lacrimal andthe nasal glands  mandibular  ophthalmic Q: Low Hb, and 2000 ferritin level in blood. Diagnosis?  Aplastic anemia  sickle cell anemia  Sideroblastic anemia Ringed sideroblasts ( with iron-laden mitochondria) seen in bone marrow.increased iron, normal TIBC, increased ferritin. Treatment: pyridoxine (B6, cofactor for δ-ALA synthase).  iron deficiency anemia Q: abdominal angina is due to lesion of  celiac artery  spleenic artery  coronary artery  Superior Mesenteric Artery www.theMediCall.com Page 65 Lesion (occlusion or thrombosis) of the superior mesenteric artery leads to Ischemia of the intestine and causes severe Ischemic pain in abdomen known as abdominal angina. Q: Drug of choice for HTN in pregnancy  atenolol  Methyldopa Treatment of HTN in Pregnancy: antihypertensives (α-methyldopa, labetalol, hydralazine, nifedipine), deliver at 39 weeks.  captopril  furosemide Q: Systolic murmur 4th ICS is due to  aortic regurgitation  mitral stenosis  aortic stenosis Aortic Stenosis: Crescendo-decrescendo systolic ejection murmur. LV >> aortic pressure during systole. Loudest at heart base,radiates to carotids.  mitral regurgitation Q: 25 yr old female, excertional dyspnea, palpitation systolic murmur & fixed splitting  TGA  VSD  PDA  ASD Atrial septal defect Defect in interatrial septum, loud S1,wide, fixed split S2. Usually occurs in septum secundum,septum primum defects usually occur with other anomalies. Symptoms range from none to heart failure. Distinct from patent foramen ovale in that septa are missing tissue rather than unfused Q: organification is function of  Myoglobin  haptoglobin  peroxidase Peroxidase is enzyme responsible for oxidation and organification of iodide as well as coupling of monoiodotyrosine (MIT) and diiodotyrosine (DIT)  5 HT www.theMediCall.com Page 66 Q: At laparotomy, Dark purple small bowel, cause  wet gangrene When complicated by infective heterolysis and consequent liquefactive necrosis, gangrenous necrosis is called wet gangrene (purple in colour).When characterized primarily by coagulative necrosis without liquefaction, gangrenous necrosis is called dry gangrene (white or yellow in colour)  dry gangrene  infection  Granulomatous Q: Drug of choice in diagnosed MI to releive pain ?  aspirin  morphine It is recommended that MI pain is a very severe in intensity and sharp in character muat be managed with a much powerful analgesic that is morphine.  diclophenac  Ketorolac Q: cell membrane contains which type of chemical bonds?  ionic bonds  electrostatic forces  dative bonds  covelent Cell membrane is composed of lipid bilayer and proteins, that are the organic compounds and are composed of covelent bonds along with H-bonds and disulphide bridges. Q: Abducent nerve passes through  foramen ovale  superior orbital fissure It passes forward through the cavernoussinus with the internal carotid artery, enters the orbitthrough the superior orbital fissure, and supplies the lateralrectus muscle  foramen spinosum  inferior orbital fissure Q: blood group antigen is  Ig G  immunogenic www.theMediCall.com Page 67 Incompatible blood tr fusions can cause immunologic response, hemolysis, renal failure, shock, and death  hypersensitive  choriogenic Q: Nephrotoxic drug is  cyclophosphamide Toxicity: Myelosuppression, Nephrotoxic and hemorrhagic cystitis, partially prevented with mesna (thiol group of mesna binds toxic metabolites).  penicillin  allopurinol  Cotraimoxazole Q: ECG changes in pulmonary embolism  tall T wave  depressed T wave  ST depression  Can be normal In pulmonary embolism, the findings on ECG and chest X-ray are normal usually, but perfusion is affected that can be diagnosed by CT angiogram. Q: 57 mg of NaCl dissolved in 1L of solution, Osmolarity is...osmole?  1 Osmolarity is defined as the number of moles of solutes dissolved in 1L of solution. 1 mole of solute dissolved in 1L of solution forms the 1 osmolar solution.  1.5  2  2.5 Q: thyroid is invested by which fascia?  pre-vertebral  deep fascia  endocervical  pretracheal Pretracheal fascia invests the thyroid and the parathyroid glands, forming a sheath for them,