Davidson's principles and practice of medicine 22nd edition. *urea breath test is highly specific and sensitive.in detection of h pylori infection
", "explanation_word_count": 24, "prompt": "A patient with H. pylori infection is treated with drugs. The best method to detect presence of residual H. pylori infection in this person is -\nA. Rapid urease test\nB. Urea breath test\nC. Endoscopy and biopsy\nD. Serum anti H. pylori titre\nReturn the correct option letter.", "reference": "Davidson's principles and practice of medicine 22nd edition. *urea breath test is highly specific and sensitive.in detection of h pylori infection
\nB", "question_key": "a patient with h. pylori infection is treated with drugs. the best method to detect presence of residual h. pylori infection in this person is -", "split": "validation", "is_mia_member": false} {"id": "f72628ec-2156-4c19-a022-a57f5a6d2d18", "question": "Not a constituent of air –", "opa": "H2", "opb": "N2", "opc": "O2", "opd": "CO2", "cop": 0, "answer": "A", "exp": "Air \n\nThe immediate environment of man comprises of air on which depends all forms of life.\nThe requirement for air is about 10-20 M3/day.\nThe constituents of air : -\n\n\nMajor → Nitrogen (N2) - 78.1 %, Oxygen (O2) - 20.93%, Carbon dioxide (CO2) - 0.03%\nMinor → Argon, neon, krypton, xenon, helium, water vapour, traces fo ammonia, suspended matter (dust, bacteria, spores, vegetable debris).", "explanation_word_count": 54, "prompt": "Not a constituent of air –\nA. H2\nB. N2\nC. O2\nD. CO2\nReturn the correct option letter.", "reference": "Air \n\nThe immediate environment of man comprises of air on which depends all forms of life.\nThe requirement for air is about 10-20 M3/day.\nThe constituents of air : -\n\n\nMajor → Nitrogen (N2) - 78.1 %, Oxygen (O2) - 20.93%, Carbon dioxide (CO2) - 0.03%\nMinor → Argon, neon, krypton, xenon, helium, water vapour, traces fo ammonia, suspended matter (dust, bacteria, spores, vegetable debris).\nA", "question_key": "not a constituent of air –", "split": "validation", "is_mia_member": false} {"id": "1dbdb511-4712-464b-a4bb-99884d2c95f8", "question": "Bulge sign in knee joint is seen after how much fluid accumulation ?", "opa": "100m1", "opb": "400m1", "opc": "200m1", "opd": "<30 ml", "cop": 3, "answer": "D", "exp": "Ans. is i.e., < 30 ml The bulge test is used to determine the presence of fluid in the knee joint. It is useful when only a little fluid is present in the joint. The suprapatellar bursa is first emptied of fluid by squeezing distally from about 15 cm above the patella. The medial compament of the knee join is emptied by pressing on the side of the joint with the free hand. The hand is then lifted away and then the lateral side is sharply compressed. If the test is positive, a ripple is seen on the flattened, medial surface. The test is negative if the effusion is tense - up to 120 ml. The bulge test is used to determine minimal fluid in the knee joint. It can detect as little as 4 - 6 ml of fluid in the knee joint.", "explanation_word_count": 137, "prompt": "Bulge sign in knee joint is seen after how much fluid accumulation ?\nA. 100m1\nB. 400m1\nC. 200m1\nD. <30 ml\nReturn the correct option letter.", "reference": "Ans. is i.e., < 30 ml The bulge test is used to determine the presence of fluid in the knee joint. It is useful when only a little fluid is present in the joint. The suprapatellar bursa is first emptied of fluid by squeezing distally from about 15 cm above the patella. The medial compament of the knee join is emptied by pressing on the side of the joint with the free hand. The hand is then lifted away and then the lateral side is sharply compressed. If the test is positive, a ripple is seen on the flattened, medial surface. The test is negative if the effusion is tense - up to 120 ml. The bulge test is used to determine minimal fluid in the knee joint. It can detect as little as 4 - 6 ml of fluid in the knee joint.\nD", "question_key": "bulge sign in knee joint is seen after how much fluid accumulation ?", "split": "validation", "is_mia_member": false} {"id": "82eb55d1-dcf2-472f-9842-f0bf5f9c28d1", "question": "Pain in early labour is limited to dermatomes-", "opa": "T11 T12 L1", "opb": "S1 S3", "opc": "L4 L5", "opd": "L2 L3", "cop": 0, "answer": "A", "exp": "Labor pain caused by uterine contractions and cervical dilation is transmitted through visceral afferent sympathetic nerves entering the spinal cord from T10 - L1. Later in labor, perineal stretching transmits painful stimuli through the pudendal nerve and sacral nerves S2 - S4.", "explanation_word_count": 40, "prompt": "Pain in early labour is limited to dermatomes-\nA. T11 T12 L1\nB. S1 S3\nC. L4 L5\nD. L2 L3\nReturn the correct option letter.", "reference": "Labor pain caused by uterine contractions and cervical dilation is transmitted through visceral afferent sympathetic nerves entering the spinal cord from T10 - L1. Later in labor, perineal stretching transmits painful stimuli through the pudendal nerve and sacral nerves S2 - S4.\nA", "question_key": "pain in early labour is limited to dermatomes-", "split": "validation", "is_mia_member": false} {"id": "03824c49-7586-407e-ba77-b72d12d3ffc4", "question": "Optic vesicle is derived from ?", "opa": "Neuroectoderm", "opb": "Surface ectoderm", "opc": "Endoderm", "opd": "Mesoderum", "cop": 0, "answer": "A", "exp": "Ans. is'a'i.e., Neuroectoderm(Ref Indo Khurana ernbryology p. 268)Formation of optic cupAn outgrowth from prosencephalon forms optic vesicle (neuroectodermal structure).Proximal pa of optic vesicle becomes constricted and elongated to form optic stalk.", "explanation_word_count": 34, "prompt": "Optic vesicle is derived from ?\nA. Neuroectoderm\nB. Surface ectoderm\nC. Endoderm\nD. Mesoderum\nReturn the correct option letter.", "reference": "Ans. is'a'i.e., Neuroectoderm(Ref Indo Khurana ernbryology p. 268)Formation of optic cupAn outgrowth from prosencephalon forms optic vesicle (neuroectodermal structure).Proximal pa of optic vesicle becomes constricted and elongated to form optic stalk.\nA", "question_key": "optic vesicle is derived from ?", "split": "validation", "is_mia_member": false} {"id": "35399572-4e81-45f5-8087-becbe709bd9b", "question": "An African presented with itching with rashes and inguinal lymph nodes. Skin snips shows microfilariae which are non-sheathed. The most probable organism will be:", "opa": "Wuchereria bancrofti", "opb": "Brugia malayi", "opc": "Brugia timori", "opd": "Mansonella streptocerca", "cop": 3, "answer": "D", "exp": "Mansonella streptocerca is transmitted by biting midges. The major clinical manifestations involve the skin and include pruritus, papular rashes, and pigmentation changes. Many infected individuals have inguinal adenopathy, although most are asymptomatic. The diagnosis is made by detection of the characteristic microfilariae in skin snips. Ivermectin is the treatment of choice for streptocerciasis. Non-sheathed microfilariae are: Onchocerca volvulus Mansonella ozzardi M. perstans M. streptocerca Sheathed microfilariae are: Wuchereria bancrofti Brugia malayi B. timori Loa loa Ref: Harrison's Online > Pa 8. Infectious Diseases > Section 19. Helminthic Infections > Chapter 218- Filarial and Related Infections, by Thomas B. Nutman, Peter F. Weller.", "explanation_word_count": 96, "prompt": "An African presented with itching with rashes and inguinal lymph nodes. Skin snips shows microfilariae which are non-sheathed. The most probable organism will be:\nA. Wuchereria bancrofti\nB. Brugia malayi\nC. Brugia timori\nD. Mansonella streptocerca\nReturn the correct option letter.", "reference": "Mansonella streptocerca is transmitted by biting midges. The major clinical manifestations involve the skin and include pruritus, papular rashes, and pigmentation changes. Many infected individuals have inguinal adenopathy, although most are asymptomatic. The diagnosis is made by detection of the characteristic microfilariae in skin snips. Ivermectin is the treatment of choice for streptocerciasis. Non-sheathed microfilariae are: Onchocerca volvulus Mansonella ozzardi M. perstans M. streptocerca Sheathed microfilariae are: Wuchereria bancrofti Brugia malayi B. timori Loa loa Ref: Harrison's Online > Pa 8. Infectious Diseases > Section 19. Helminthic Infections > Chapter 218- Filarial and Related Infections, by Thomas B. Nutman, Peter F. Weller.\nD", "question_key": "an african presented with itching with rashes and inguinal lymph nodes. skin snips shows microfilariae which are non-sheathed. the most probable organism will be:", "split": "validation", "is_mia_member": false} {"id": "101b1441-b74c-4b36-a375-fa14cdf94589", "question": "A 62-year-old farmer presented with a way plaque on the sole of the right foot since a year. Examination revealed a large, way, hyperpigmented plaque on the sole of the involved foot. What is the probable diagnosis?", "opa": "Tuberculosis verrucosa cutis", "opb": "Verruca vulgaris", "opc": "Mycetoma foot", "opd": "Lichen simplex Chronicus", "cop": 0, "answer": "A", "exp": "History suggestive of Tuberculosis verrucosa cutis / Anatomist's wa - Tuberculosis verrucosa cutis - Caused by exogenous inoculation of tubercle bacilli into skin of individuals with good immunity. Affects children/young adults who contract the bacteria by walking barefoot--> way plaque on the sole of the foot Sitting on ground contaminated with TB sputum--> lesion on buttocks. Skin HPE - dermal inflammation, epithelioid cell granuloma with central multinucleated Langhans giant cell. Caseous necrosis absent VIRAL WA ANATOMIST WA Numbers Multiple Single Induration Absent Present Scarring Absent Present(central) Discharge Absent Present( serous) Mycetoma foot- triad of painless subcutaneous mass,multiple sinusesanddischarge containing grains.", "explanation_word_count": 99, "prompt": "A 62-year-old farmer presented with a way plaque on the sole of the right foot since a year. Examination revealed a large, way, hyperpigmented plaque on the sole of the involved foot. What is the probable diagnosis?\nA. Tuberculosis verrucosa cutis\nB. Verruca vulgaris\nC. Mycetoma foot\nD. Lichen simplex Chronicus\nReturn the correct option letter.", "reference": "History suggestive of Tuberculosis verrucosa cutis / Anatomist's wa - Tuberculosis verrucosa cutis - Caused by exogenous inoculation of tubercle bacilli into skin of individuals with good immunity. Affects children/young adults who contract the bacteria by walking barefoot--> way plaque on the sole of the foot Sitting on ground contaminated with TB sputum--> lesion on buttocks. Skin HPE - dermal inflammation, epithelioid cell granuloma with central multinucleated Langhans giant cell. Caseous necrosis absent VIRAL WA ANATOMIST WA Numbers Multiple Single Induration Absent Present Scarring Absent Present(central) Discharge Absent Present( serous) Mycetoma foot- triad of painless subcutaneous mass,multiple sinusesanddischarge containing grains.\nA", "question_key": "a 62-year-old farmer presented with a way plaque on the sole of the right foot since a year. examination revealed a large, way, hyperpigmented plaque on the sole of the involved foot. what is the probable diagnosis?", "split": "validation", "is_mia_member": false} {"id": "e612fd02-144f-4369-b76a-6f915b27a4c6", "question": "Adenosine deaminase deficiency is seen in the following -", "opa": "Common variable immunodeficiency", "opb": "Severe combined immunodeficiency", "opc": "Chronic granulomatous disease", "opd": "Nezelof syndrome", "cop": 1, "answer": "B", "exp": "Severe combined immunodeficiencies include syndrome with severe deficiency of both humoral and cell mediated response. Adenosine deaminase deficiency is a distinct pattern of SCID. - ADA catalyses the conversion of adenosine to inosine in the purine metabolic pathway. This condition is associated with chondrocyte abnormalities. Reference : Anathanarayan & paniker's 9th edition, pg no:174,175 <\\p>", "explanation_word_count": 52, "prompt": "Adenosine deaminase deficiency is seen in the following -\nA. Common variable immunodeficiency\nB. Severe combined immunodeficiency\nC. Chronic granulomatous disease\nD. Nezelof syndrome\nReturn the correct option letter.", "reference": "Severe combined immunodeficiencies include syndrome with severe deficiency of both humoral and cell mediated response. Adenosine deaminase deficiency is a distinct pattern of SCID. - ADA catalyses the conversion of adenosine to inosine in the purine metabolic pathway. This condition is associated with chondrocyte abnormalities. Reference : Anathanarayan & paniker's 9th edition, pg no:174,175 <\\p>\nB", "question_key": "adenosine deaminase deficiency is seen in the following -", "split": "validation", "is_mia_member": false} {"id": "6c367321-76cc-4f83-8d90-4b0e17c16a01", "question": "Beta-Lactamases cause resistance to penicillins and cephalosporins by", "opa": "Breaking one chemical bond", "opb": "Breaking two chemical bonds", "opc": "Adding amino (NH2) groups to a molecule", "opd": "Inhibiting transpeptidase enzymes", "cop": 0, "answer": "A", "exp": "Penicillins and cephalosporins are called beta-Iactam drugs because of the impoance of the intact BETA-lactam ring for antimicrobial activity. -Lactamases inactivate these drugs by breaking the single bond in their BETA-lactam ring. BETA-Lactamases are coded for by either a transferable plasmid or by the genome of the organism. Plasmids are extrachromosomal genetic elements that may be transferred among unrelated bacteria. Ref: katzung 12th ed INtroduction to chemotherapy.", "explanation_word_count": 67, "prompt": "Beta-Lactamases cause resistance to penicillins and cephalosporins by\nA. Breaking one chemical bond\nB. Breaking two chemical bonds\nC. Adding amino (NH2) groups to a molecule\nD. Inhibiting transpeptidase enzymes\nReturn the correct option letter.", "reference": "Penicillins and cephalosporins are called beta-Iactam drugs because of the impoance of the intact BETA-lactam ring for antimicrobial activity. -Lactamases inactivate these drugs by breaking the single bond in their BETA-lactam ring. BETA-Lactamases are coded for by either a transferable plasmid or by the genome of the organism. Plasmids are extrachromosomal genetic elements that may be transferred among unrelated bacteria. Ref: katzung 12th ed INtroduction to chemotherapy.\nA", "question_key": "beta-lactamases cause resistance to penicillins and cephalosporins by", "split": "validation", "is_mia_member": false} {"id": "850d4f2c-54dd-41f7-98b6-2d73cb6806b5", "question": "Uncoupler in ETC -", "opa": "H2S", "opb": "Antimycin a", "opc": "2,4-dinitrophenol", "opd": "Barbiturates", "cop": 2, "answer": "C", "exp": "Ans. C. 2, 4-dinitrophenolUncouplers of oxidative phosphorylation in mitochondria inhibit the coupling between the electron transport and phosphorylation reactions and thus inhibit ATP synthesis without affecting the respiratory chain and ATP synthase (H(+)- ATPase). Physiological uncouplers- long chain fatty acids, thyroxin, calcium ions, brown adipose tissue Pathological uncouplers-2,4 dinitrophenol, 2,4 dinitroocresol, CCCP, FCCP, valinomycin, high dose aspirinClass with examplesAffected complex* or reactionInhibitors of electron transport Rotenone, Piericidin AAmytal, SeconalThenoyltrifluoroacetoneAntimycin A.DimercaprolHCN, H2 SHN3 , COI FMN-Q and or cytb(Fe3+)I FMN-Q and or cytb(Fe3+)II Peptide-FAD-Q and/or cytbIII cytb(Fe2+)-cytcl(Fe3+)(perhaps at NHI)IV cytc(Fe2+)-O2 IV cytc(Fe2+)-O2 Inhibitors of oxidative phosphorylation OiigomycinRutamycinAtractylateBongkrekateInhibit respiration (NADH-O2 or Succinate O2 ) when coupled to phosphorylationUncouplers of oxidative phosphorylation2,4 dinitrophenolDicoumarolValinomycin *Gramicidin A *Stimulate respiration when rate is limited by phosphorylation or blocked by oiigomycin.", "explanation_word_count": 135, "prompt": "Uncoupler in ETC -\nA. H2S\nB. Antimycin a\nC. 2,4-dinitrophenol\nD. Barbiturates\nReturn the correct option letter.", "reference": "Ans. C. 2, 4-dinitrophenolUncouplers of oxidative phosphorylation in mitochondria inhibit the coupling between the electron transport and phosphorylation reactions and thus inhibit ATP synthesis without affecting the respiratory chain and ATP synthase (H(+)- ATPase). Physiological uncouplers- long chain fatty acids, thyroxin, calcium ions, brown adipose tissue Pathological uncouplers-2,4 dinitrophenol, 2,4 dinitroocresol, CCCP, FCCP, valinomycin, high dose aspirinClass with examplesAffected complex* or reactionInhibitors of electron transport Rotenone, Piericidin AAmytal, SeconalThenoyltrifluoroacetoneAntimycin A.DimercaprolHCN, H2 SHN3 , COI FMN-Q and or cytb(Fe3+)I FMN-Q and or cytb(Fe3+)II Peptide-FAD-Q and/or cytbIII cytb(Fe2+)-cytcl(Fe3+)(perhaps at NHI)IV cytc(Fe2+)-O2 IV cytc(Fe2+)-O2 Inhibitors of oxidative phosphorylation OiigomycinRutamycinAtractylateBongkrekateInhibit respiration (NADH-O2 or Succinate O2 ) when coupled to phosphorylationUncouplers of oxidative phosphorylation2,4 dinitrophenolDicoumarolValinomycin *Gramicidin A *Stimulate respiration when rate is limited by phosphorylation or blocked by oiigomycin.\nC", "question_key": "uncoupler in etc -", "split": "validation", "is_mia_member": false} {"id": "ceedcccc-dcc1-4f04-bdcf-e05c7470b40a", "question": "Watershed area between SMA & IMA which commonly result in ischemia is", "opa": "Hepatic flexure", "opb": "Splenic flexure", "opc": "Rectosigmoid Junction", "opd": "Ileocolic Junction", "cop": 1, "answer": "B", "exp": "During times of blockage of one of the aeries that supply the watershed area, such as in atherosclerosis, these regions are spared from ischemia by viue of their dual supply. However, during times of systemic hypoperfusion, such as in disseminated intravesicular coagulation or hea failure, these regions are paicularly vulnerable to ischemia by viue of the fact that they are supplied by the most distal branches of their aeries, and thus the least likely to receive sufficient blood. Watershed areas are found in the brain, where areas are perfused by both the anterior and middle cerebral aeries, and in the intestines, where areas are perfused by both the superior and inferior mesenteric aeries", "explanation_word_count": 113, "prompt": "Watershed area between SMA & IMA which commonly result in ischemia is\nA. Hepatic flexure\nB. Splenic flexure\nC. Rectosigmoid Junction\nD. Ileocolic Junction\nReturn the correct option letter.", "reference": "During times of blockage of one of the aeries that supply the watershed area, such as in atherosclerosis, these regions are spared from ischemia by viue of their dual supply. However, during times of systemic hypoperfusion, such as in disseminated intravesicular coagulation or hea failure, these regions are paicularly vulnerable to ischemia by viue of the fact that they are supplied by the most distal branches of their aeries, and thus the least likely to receive sufficient blood. Watershed areas are found in the brain, where areas are perfused by both the anterior and middle cerebral aeries, and in the intestines, where areas are perfused by both the superior and inferior mesenteric aeries\nB", "question_key": "watershed area between sma & ima which commonly result in ischemia is", "split": "validation", "is_mia_member": false} {"id": "b4816029-73d3-4c73-af3a-df1cddbe4fa5", "question": "An anganwadi worker is trained for -", "opa": "3 months", "opb": "4 months", "opc": "5 months", "opd": "6 months", "cop": 1, "answer": "B", "exp": "-under ICDS Scheme, there is an anganwadi worker for a population of 400-800. - anganwadi worker is selected from the community itself - undergoes a training in various aspects of health, nutrition and child development for 4 months. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:903 <\\p>", "explanation_word_count": 47, "prompt": "An anganwadi worker is trained for -\nA. 3 months\nB. 4 months\nC. 5 months\nD. 6 months\nReturn the correct option letter.", "reference": "-under ICDS Scheme, there is an anganwadi worker for a population of 400-800. - anganwadi worker is selected from the community itself - undergoes a training in various aspects of health, nutrition and child development for 4 months. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:903 <\\p>\nB", "question_key": "an anganwadi worker is trained for -", "split": "validation", "is_mia_member": false} {"id": "8b2e7b95-16b4-4bc8-972b-f2b01090dce9", "question": "Which of the following bariatric procedures is primarily intended to induce weight loss through malabsorption and restriction?", "opa": "Adjustable gastric band", "opb": "Sleeve gastrectomy", "opc": "Roux-en-Y gastric bypass (RYGB)", "opd": "Duodenal switch", "cop": 2, "answer": "C", "exp": "Bariatric procedures are classified as restrictive, malabsorptive, or a combination of restrictive and malabsorptive in the mechanism of weight loss that they induce. Restrictive operations include adjustable gastric band and gastric sleeve, malabsorptive operations include duodenal switch and biliopancreatic diversion, and combined restrictive and malabsorptive procedures include the Roux-en-Y gastric bypass (RYGB).", "explanation_word_count": 52, "prompt": "Which of the following bariatric procedures is primarily intended to induce weight loss through malabsorption and restriction?\nA. Adjustable gastric band\nB. Sleeve gastrectomy\nC. Roux-en-Y gastric bypass (RYGB)\nD. Duodenal switch\nReturn the correct option letter.", "reference": "Bariatric procedures are classified as restrictive, malabsorptive, or a combination of restrictive and malabsorptive in the mechanism of weight loss that they induce. Restrictive operations include adjustable gastric band and gastric sleeve, malabsorptive operations include duodenal switch and biliopancreatic diversion, and combined restrictive and malabsorptive procedures include the Roux-en-Y gastric bypass (RYGB).\nC", "question_key": "which of the following bariatric procedures is primarily intended to induce weight loss through malabsorption and restriction?", "split": "validation", "is_mia_member": false} {"id": "12157c3f-bb08-4e35-bfab-e3c061e7a0ce", "question": "IP3/DAG pathway is activated by which of the following?", "opa": "Protein kinase A", "opb": "Protein kinase C", "opc": "Phospholipase C", "opd": "Phospholipase A", "cop": 2, "answer": "C", "exp": "ANSWER: (C) Phospholipase CREF: Guyton s physiology 12th edition page 890, KDT 6th edition page no 46See APPENDIX- 84 below \"ENDOCRINE GLANDS, HORMONES, AND THEIR FUNCTIONS AND STRUCTURE\"Phospholipase C catalyzes the breakdown of some phospholipids in the cell membrane, especially phosphatidylinositol biphosphate (PIP2), into two different second messenger products: inositol triphosphate (IP3) and diacylglycerol (DAG). The IP3 mobilizes calcium ions from mitochondria and the endoplasmic reticulum, and the calcium ions then have their owm second messenger effects, such as smooth muscle contraction and changes in cell secretion. DAG, the other lipid second messenger, activates the enzyme protein kinase C (PKC), which then phosphorylates a large number of proteins, leading to the cell's responseSummary:IP3/DAG is activated by Phospholipase CIP3/DAG activates protein kinase C (PKC) APPENDIX- 84ENDOCRINE GLANDS, HORMONES, AND THEIR FUNCTIONS AND STRUCTURE:REF: Guyton 11th edition page 907Gland,'TissueHormonesMajor FunctionsChemicalStructureHypothalamusThyrotropin-releasing hormone (TRH)Stimulates secretion of TSH and prolactinPeptideCorticotropin-releasing hormone (CRH)Causes release of ACTHPeptideGrowth hormone-releasing hormone (GHRH)Causes release of growth hormonePeptideGrowth hormoneinhibitory hormone (GHIH) (somatostatin)Inhibits release of growth hormonePeptideGonadotropin-releasing hormone (GnRH)Causes release of LH and FSHPeptideDopamine or prolactin- inhibiting factor (P1F)Inhibits release of prolactinAmineAnterior pituitaryGrowth hormoneStimulates protein synthesis and overall growth of most cells and tissuesPeptideThyroid-stimulating hormone (TSH)Stimulates synthesis and secretion of thyroid hormones (thyroxine and triiodothyronine)PeptideAdrenocorticotropic hormone (ACTH)Stimulates synthesis and secretion of adrenocortical hormones (cortisol, androgens, and aldosterone)PeptideProlactinPromotes development of the female breasts and secretion of milkPeptideFollicle-stimulating hormone (FSH)Causes growth of follicles in the ovaries and sperm maturation in Sertoli cells of testesPeptideLuteinizing hormone (LH)Stimulates testosterone synthesis in Leydig cells of testes; stimulates ovulation, formation of corpus luteum, and estrogen and progesterone synthesis in ovariesPeptidePosterior pituitaryAntidiuretic hormone (ADH) (also called vasopressin)Increases water reabsorption by the kidneys and causes vasoconstriction and increased blood pressurePeptideOxytocinStimulates milk ejection from breasts and uterine contractionsPeptideThyroidThyroxine (T4) and triiodothyronine (T3)Increases the rates of chemical reactions in most cells, thus increasing body metabolic rateAmineCalcitoninPromotes deposition of calcium in the bones and decreases extracellular fluid calcium ion concentrationPeptideAdrenal cortexCortisolHas multiple metabolic functions for controlling metabolism of proteins, carbohydrates, and fats; also has anti-inflammatory effectsSteroidAldosteroneIncreases renal sodium reabsorption, potassium secretion, and hydrogen ion secretionSteroidAdrenal medullaNorepinephrine, epinephrineSame effects as sympathetic stimulationAminePancreasInsulin (b cells)Promotes glucose entry in many cells, and in this way controls carbohydrate metabolismPeptide Glucagon (a cells)Increases synthesis and release of glucose from the liver into the body fluidsPeptideParathyroidParathyroid hormone (PTH)Controls serum calcium ion concentration by increasing calcium absorption by the gut and kidneys and releasing calcium from bonesPeptideTestesTestosteronePromotes development of male reproductive system and male secondary sexual characteristicsSteroidOvariesEstrogensPromotes growth and development of female reproductive system, female breasts, and female secondary sexual characteristicsSteroidProgesteroneStimulates secretion of \"uterine milk1' by the uterine endometrial glands and promotes development of secretory apparatus of breastsSteroidPlacentaHuman chorionic gonadotropin (HCG)Promotes growth of corpus luteum and secretion of estrogens and progesterone by corpus luteumPeptideHuman somatomammotropinProbably helps promote development of some fetal tissues as well as the mothers breastsPeptideEstrogensSee actions of estrogens from ovariesSteroidProgesteroneSee actions of progesterone from ovariesSteroidKidneyReninCatalyzes conversion of angiotensinogen to angiotensin I (acts as an enzyme)Peptide1,25-DihydroxycholecaldferolIncreases intestinal absorption of calcium and bone mineralizationSteroidErythropoietinIncreases erythrocyte productionPeptideHeartAtrial natriuretic peptide (ANP)Increases sodium excretion by kidneys, reduces blood pressurePeptideStomachGastrinStimulates HC1 secretion by parietal cellsPeptideSmall intestineSecretinStimulates pancreatic acinar cells to release bicarbonate and waterPeptideCholecystokinin (CCK)Stimulates gallbladder contraction and release of pancreatic enzymesPeptideAdipocytesLeptinInhibits appetite, stimulates thermogenesisPeptide GENERAL FEATURES OF HORMONE CLASSES. Group IGroup IITypesSteroids, iodothyronines, calcitriol, retinoidsPolypeptides, proteins, glycoproteins, catecholaminesSolubilityLipophilicHydrophilicTransport proteinsYesNoPlasma half-lifeLong (hours to days)Short (minutes)ReceptorIntracellularPlasma membraneMediatorReceptor-hormone complexcAMP, cGMP, Ca2+, metabolites of complex phosphoinositols, kinase cascades CLASSIFICATION OF HORMONES BY MECHANISM OF ACTIONI. HORMONES THAT BIND TO INTRACELLULAR RECEPTORS> Androgens> Estrogen> Calcitriol (l,252-D3)> Glucocorticoids> Mineralocorticoids> Progestins> Retinoic acid> Thyroid hormones (T3 and T4)II. HORMONES THAT BIND TO CELL SURFACE RECEPTORS/ HORMONES USING SECOND MESSENGER SYSTEMSAdenylyl Cyciase-cAMP secondmessenger systemIP3-DAG System or Phospholipase C SecondMessenger SystemCalcium Calmodulin system* Adrenocorticotropic hormone (ACTH)* Angiotensin II (epithelial cells)* Calcitonin* Catecholamines (b receptors)* Corticotropin-releasing hormone (CRH)* Follicle-stimulating hormone (FSH)* Glucagon* Human chorionic gonadotropin (HCG)* Luteinizing hormone (LH)* Parathyroid hormone (PTH)* Secretin* Somatostatin* Thyroid-stimulating hormone (TSH)* Melanocyte-stimulating hormone* Vasopressin (V2 receptor,epithelial cells)* Angiotensin II (vascular smooth muscles)* Catecholamines (a receptors)* Gonadotropin-releasing hormone (GnRH)* Growth hormone-releasing hormone (GHRH)* Oxytocin* Thyroid-releasing hormone (TRH)* Vasopressin (VI receptor, vascular smooth muscle)* Adenylyl cyclase* Phosphodiesterase* Ca2+ /calmodulin dependent protein kinases.* Phosphoprotein phosphatases* Phospholipase A2. and* Troponin C.cGMP second messenger system* Nitric oxide* Atrial natriuretic factor", "explanation_word_count": 733, "prompt": "IP3/DAG pathway is activated by which of the following?\nA. Protein kinase A\nB. Protein kinase C\nC. Phospholipase C\nD. Phospholipase A\nReturn the correct option letter.", "reference": "ANSWER: (C) Phospholipase CREF: Guyton s physiology 12th edition page 890, KDT 6th edition page no 46See APPENDIX- 84 below \"ENDOCRINE GLANDS, HORMONES, AND THEIR FUNCTIONS AND STRUCTURE\"Phospholipase C catalyzes the breakdown of some phospholipids in the cell membrane, especially phosphatidylinositol biphosphate (PIP2), into two different second messenger products: inositol triphosphate (IP3) and diacylglycerol (DAG). The IP3 mobilizes calcium ions from mitochondria and the endoplasmic reticulum, and the calcium ions then have their owm second messenger effects, such as smooth muscle contraction and changes in cell secretion. DAG, the other lipid second messenger, activates the enzyme protein kinase C (PKC), which then phosphorylates a large number of proteins, leading to the cell's responseSummary:IP3/DAG is activated by Phospholipase CIP3/DAG activates protein kinase C (PKC) APPENDIX- 84ENDOCRINE GLANDS, HORMONES, AND THEIR FUNCTIONS AND STRUCTURE:REF: Guyton 11th edition page 907Gland,'TissueHormonesMajor FunctionsChemicalStructureHypothalamusThyrotropin-releasing hormone (TRH)Stimulates secretion of TSH and prolactinPeptideCorticotropin-releasing hormone (CRH)Causes release of ACTHPeptideGrowth hormone-releasing hormone (GHRH)Causes release of growth hormonePeptideGrowth hormoneinhibitory hormone (GHIH) (somatostatin)Inhibits release of growth hormonePeptideGonadotropin-releasing hormone (GnRH)Causes release of LH and FSHPeptideDopamine or prolactin- inhibiting factor (P1F)Inhibits release of prolactinAmineAnterior pituitaryGrowth hormoneStimulates protein synthesis and overall growth of most cells and tissuesPeptideThyroid-stimulating hormone (TSH)Stimulates synthesis and secretion of thyroid hormones (thyroxine and triiodothyronine)PeptideAdrenocorticotropic hormone (ACTH)Stimulates synthesis and secretion of adrenocortical hormones (cortisol, androgens, and aldosterone)PeptideProlactinPromotes development of the female breasts and secretion of milkPeptideFollicle-stimulating hormone (FSH)Causes growth of follicles in the ovaries and sperm maturation in Sertoli cells of testesPeptideLuteinizing hormone (LH)Stimulates testosterone synthesis in Leydig cells of testes; stimulates ovulation, formation of corpus luteum, and estrogen and progesterone synthesis in ovariesPeptidePosterior pituitaryAntidiuretic hormone (ADH) (also called vasopressin)Increases water reabsorption by the kidneys and causes vasoconstriction and increased blood pressurePeptideOxytocinStimulates milk ejection from breasts and uterine contractionsPeptideThyroidThyroxine (T4) and triiodothyronine (T3)Increases the rates of chemical reactions in most cells, thus increasing body metabolic rateAmineCalcitoninPromotes deposition of calcium in the bones and decreases extracellular fluid calcium ion concentrationPeptideAdrenal cortexCortisolHas multiple metabolic functions for controlling metabolism of proteins, carbohydrates, and fats; also has anti-inflammatory effectsSteroidAldosteroneIncreases renal sodium reabsorption, potassium secretion, and hydrogen ion secretionSteroidAdrenal medullaNorepinephrine, epinephrineSame effects as sympathetic stimulationAminePancreasInsulin (b cells)Promotes glucose entry in many cells, and in this way controls carbohydrate metabolismPeptide Glucagon (a cells)Increases synthesis and release of glucose from the liver into the body fluidsPeptideParathyroidParathyroid hormone (PTH)Controls serum calcium ion concentration by increasing calcium absorption by the gut and kidneys and releasing calcium from bonesPeptideTestesTestosteronePromotes development of male reproductive system and male secondary sexual characteristicsSteroidOvariesEstrogensPromotes growth and development of female reproductive system, female breasts, and female secondary sexual characteristicsSteroidProgesteroneStimulates secretion of \"uterine milk1' by the uterine endometrial glands and promotes development of secretory apparatus of breastsSteroidPlacentaHuman chorionic gonadotropin (HCG)Promotes growth of corpus luteum and secretion of estrogens and progesterone by corpus luteumPeptideHuman somatomammotropinProbably helps promote development of some fetal tissues as well as the mothers breastsPeptideEstrogensSee actions of estrogens from ovariesSteroidProgesteroneSee actions of progesterone from ovariesSteroidKidneyReninCatalyzes conversion of angiotensinogen to angiotensin I (acts as an enzyme)Peptide1,25-DihydroxycholecaldferolIncreases intestinal absorption of calcium and bone mineralizationSteroidErythropoietinIncreases erythrocyte productionPeptideHeartAtrial natriuretic peptide (ANP)Increases sodium excretion by kidneys, reduces blood pressurePeptideStomachGastrinStimulates HC1 secretion by parietal cellsPeptideSmall intestineSecretinStimulates pancreatic acinar cells to release bicarbonate and waterPeptideCholecystokinin (CCK)Stimulates gallbladder contraction and release of pancreatic enzymesPeptideAdipocytesLeptinInhibits appetite, stimulates thermogenesisPeptide GENERAL FEATURES OF HORMONE CLASSES. Group IGroup IITypesSteroids, iodothyronines, calcitriol, retinoidsPolypeptides, proteins, glycoproteins, catecholaminesSolubilityLipophilicHydrophilicTransport proteinsYesNoPlasma half-lifeLong (hours to days)Short (minutes)ReceptorIntracellularPlasma membraneMediatorReceptor-hormone complexcAMP, cGMP, Ca2+, metabolites of complex phosphoinositols, kinase cascades CLASSIFICATION OF HORMONES BY MECHANISM OF ACTIONI. HORMONES THAT BIND TO INTRACELLULAR RECEPTORS> Androgens> Estrogen> Calcitriol (l,252-D3)> Glucocorticoids> Mineralocorticoids> Progestins> Retinoic acid> Thyroid hormones (T3 and T4)II. HORMONES THAT BIND TO CELL SURFACE RECEPTORS/ HORMONES USING SECOND MESSENGER SYSTEMSAdenylyl Cyciase-cAMP secondmessenger systemIP3-DAG System or Phospholipase C SecondMessenger SystemCalcium Calmodulin system* Adrenocorticotropic hormone (ACTH)* Angiotensin II (epithelial cells)* Calcitonin* Catecholamines (b receptors)* Corticotropin-releasing hormone (CRH)* Follicle-stimulating hormone (FSH)* Glucagon* Human chorionic gonadotropin (HCG)* Luteinizing hormone (LH)* Parathyroid hormone (PTH)* Secretin* Somatostatin* Thyroid-stimulating hormone (TSH)* Melanocyte-stimulating hormone* Vasopressin (V2 receptor,epithelial cells)* Angiotensin II (vascular smooth muscles)* Catecholamines (a receptors)* Gonadotropin-releasing hormone (GnRH)* Growth hormone-releasing hormone (GHRH)* Oxytocin* Thyroid-releasing hormone (TRH)* Vasopressin (VI receptor, vascular smooth muscle)* Adenylyl cyclase* Phosphodiesterase* Ca2+ /calmodulin dependent protein kinases.* Phosphoprotein phosphatases* Phospholipase A2. and* Troponin C.cGMP second messenger system* Nitric oxide* Atrial natriuretic factor\nC", "question_key": "ip3/dag pathway is activated by which of the following?", "split": "validation", "is_mia_member": false} {"id": "418f69be-e7da-45c0-9937-fc4b92f0741b", "question": "Membranous glomerulonephritis is associated with-", "opa": "Renal Venous thrombosis", "opb": "Hodgkin's disease", "opc": "Subepithelial immune deposits", "opd": "Hematuria", "cop": 0, "answer": "A", "exp": "Membranous nephropathy Membranous nephropathy is the most common cause of nephrotic syndrome in Caucasian adults. It is caused by antibodies (usually autoantibodies) directed at antigen(s) and venous thrombosis Antigens expressed on the surface of the podocytes, including the M-type phospholipase A2 receptor 1. While most cases are idiopathic, a propoion are associated with other causes, such as heavy metal poisoning, drugs, infections, lupus and tumours . Approximately one-third of patients with idiopathic membranous nephropathy undergo spontaneous remission, one-third remain in a nephrotic state, and one-third develop progressive CKD. High doses of glucocoicoids and cyclophosphamide may improve both the nephrotic syndrome and the long-term prognosis. However, because of the toxicity of these regimens, many nephrologists reserve such treatment for those with severe nephrotic syndrome or deteriorating renal function. Treatment of secondary membranous nephropathy is directed at the underlying cause. Ref Harrison20th edition pg 266", "explanation_word_count": 142, "prompt": "Membranous glomerulonephritis is associated with-\nA. Renal Venous thrombosis\nB. Hodgkin's disease\nC. Subepithelial immune deposits\nD. Hematuria\nReturn the correct option letter.", "reference": "Membranous nephropathy Membranous nephropathy is the most common cause of nephrotic syndrome in Caucasian adults. It is caused by antibodies (usually autoantibodies) directed at antigen(s) and venous thrombosis Antigens expressed on the surface of the podocytes, including the M-type phospholipase A2 receptor 1. While most cases are idiopathic, a propoion are associated with other causes, such as heavy metal poisoning, drugs, infections, lupus and tumours . Approximately one-third of patients with idiopathic membranous nephropathy undergo spontaneous remission, one-third remain in a nephrotic state, and one-third develop progressive CKD. High doses of glucocoicoids and cyclophosphamide may improve both the nephrotic syndrome and the long-term prognosis. However, because of the toxicity of these regimens, many nephrologists reserve such treatment for those with severe nephrotic syndrome or deteriorating renal function. Treatment of secondary membranous nephropathy is directed at the underlying cause. Ref Harrison20th edition pg 266\nA", "question_key": "membranous glomerulonephritis is associated with-", "split": "validation", "is_mia_member": false} {"id": "3430f397-1983-4e82-bfeb-2d08d9b013ce", "question": "Chickenpox is caused by", "opa": "Varicella-zoster virus", "opb": "Epstein-barr virus", "opc": "Pox virus", "opd": "Herpes simplex virus", "cop": 0, "answer": "A", "exp": "Ans. A. Varicella-zoster virus. (Ref. Harrison's medicine 17th ed. Chapter 173)Varicella-zoster virus# Varicella-zoster virus (VZV) causes two distinct clinical entities:- varicella (chickenpox) and- herpes zoster (shingles).# Chickenpox, a ubiquitous and extremely contagious infection, is usually a benign illness of childhood characterized by an exanthematous vesicular rash.# With reactivation of latent VZV (which is most common after the sixth decade of life), herpes zoster presents as a dermatomal vesicular rash, usually associated with severe pain.# Children between 5-9 yr age are most commonly affected.# Incubation period 14-17 days.# Secondary attack rate 72-90%.# Patients are infectious prior to onset of rash, during period of vesicle formation (4-5days) & until all vesicles are crusted.# Hallmark of infection is maculopapules, vesicles escabs in various stages.# Most common infectious complication of varicella is superficial bacterial infection of skin by Staph.# Most common extracutaneous site of affection by VZV is CNS.Recommendations for VZIG AdministrationExposure Criteria1. Exposure to person with chickenpox or zostera. Household: residence in the same householdb. Playmate: face-to-face indoor playc. HospitalVaricella: same 2- to 4-bed room or adjacent beds in large ward, face-to-face contact with infectious staff member or patient, visit by a person deemed contagiousZoster: intimate contact (e.g., touching or hugging) with a person deemed contagiousd. Newborn infant: onset of varicella in the mother <5 days before delivery or <48 h after delivery; VZIG not indicated if the mother has zoster2. Patient should receive VZIG as soon as possible but not >96 h after exposureCandidates (Provided They Have Significant Exposure) Include:1. Immunocompromised susceptible children without a history of varicella or varicella immunization2. Susceptible pregnant women3. Newborn infants whose mother had onset of chickenpox within 5 days before or within 48 h after delivery4. Hospitalized premature infant (>28 weeks of gestation) whose mother lacks a reliable history of chickenpox or serologic evidence of protection against varicella5. Hospitalized premature infant (<28 weeks of gestation or <1000-g birth weight), regardless of maternal history of varicella or varicella-zoster virus serologic status.", "explanation_word_count": 314, "prompt": "Chickenpox is caused by\nA. Varicella-zoster virus\nB. Epstein-barr virus\nC. Pox virus\nD. Herpes simplex virus\nReturn the correct option letter.", "reference": "Ans. A. Varicella-zoster virus. (Ref. Harrison's medicine 17th ed. Chapter 173)Varicella-zoster virus# Varicella-zoster virus (VZV) causes two distinct clinical entities:- varicella (chickenpox) and- herpes zoster (shingles).# Chickenpox, a ubiquitous and extremely contagious infection, is usually a benign illness of childhood characterized by an exanthematous vesicular rash.# With reactivation of latent VZV (which is most common after the sixth decade of life), herpes zoster presents as a dermatomal vesicular rash, usually associated with severe pain.# Children between 5-9 yr age are most commonly affected.# Incubation period 14-17 days.# Secondary attack rate 72-90%.# Patients are infectious prior to onset of rash, during period of vesicle formation (4-5days) & until all vesicles are crusted.# Hallmark of infection is maculopapules, vesicles escabs in various stages.# Most common infectious complication of varicella is superficial bacterial infection of skin by Staph.# Most common extracutaneous site of affection by VZV is CNS.Recommendations for VZIG AdministrationExposure Criteria1. Exposure to person with chickenpox or zostera. Household: residence in the same householdb. Playmate: face-to-face indoor playc. HospitalVaricella: same 2- to 4-bed room or adjacent beds in large ward, face-to-face contact with infectious staff member or patient, visit by a person deemed contagiousZoster: intimate contact (e.g., touching or hugging) with a person deemed contagiousd. Newborn infant: onset of varicella in the mother <5 days before delivery or <48 h after delivery; VZIG not indicated if the mother has zoster2. Patient should receive VZIG as soon as possible but not >96 h after exposureCandidates (Provided They Have Significant Exposure) Include:1. Immunocompromised susceptible children without a history of varicella or varicella immunization2. Susceptible pregnant women3. Newborn infants whose mother had onset of chickenpox within 5 days before or within 48 h after delivery4. Hospitalized premature infant (>28 weeks of gestation) whose mother lacks a reliable history of chickenpox or serologic evidence of protection against varicella5. Hospitalized premature infant (<28 weeks of gestation or <1000-g birth weight), regardless of maternal history of varicella or varicella-zoster virus serologic status.\nA", "question_key": "chickenpox is caused by", "split": "validation", "is_mia_member": false} {"id": "9a969791-6e1a-4fc7-90c3-12824f1cb309", "question": "A bactericidal drug would be preferred over a bacteriostatic drug in a patient with:", "opa": "Neutropenia", "opb": "Cirrhosis", "opc": "Pneumonia", "opd": "Hea disease", "cop": 0, "answer": "A", "exp": "Primarily bacteriostatic:Sulfonamides ,Erythromycin Tetracyclines, Ethambutol Chloramphenicol ,Clindamycin Linezolid. Primarily bactericidal Penicillins Cephalosporins Aminoglycosides Vancomycin Polypeptides Nalidixic acid Rifampin Ciprofloxacin Isoniazid Metronidazole Pyrazinamide Cotrimoxazole Many infections in patients with normal host defence respond equally well to bacteriostatic and bactericidal AMAs. But several acute infections resolve faster with a cidal than a static drug, because the cidal drug directly reduces the number of bacteria at the site of infection, while the static drug only prevents increase in their number. Many bactericidal drugs exe prolonged postantibiotic effect so that maintenance of drug level continuously above the MIC is not essential. With bacteriostatic AMAs the bacteria sta multiplying quickly when drug level falls below the MIC, resulting in relapse of infection. A bactericidal antibiotic is clearly superior to bacteriostatic one in treating patients with impaired host defence, life-threatening infections, infections at less accessible sites (SABE) or when carrier state is possible (typhoid) . ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:676", "explanation_word_count": 160, "prompt": "A bactericidal drug would be preferred over a bacteriostatic drug in a patient with:\nA. Neutropenia\nB. Cirrhosis\nC. Pneumonia\nD. Hea disease\nReturn the correct option letter.", "reference": "Primarily bacteriostatic:Sulfonamides ,Erythromycin Tetracyclines, Ethambutol Chloramphenicol ,Clindamycin Linezolid. Primarily bactericidal Penicillins Cephalosporins Aminoglycosides Vancomycin Polypeptides Nalidixic acid Rifampin Ciprofloxacin Isoniazid Metronidazole Pyrazinamide Cotrimoxazole Many infections in patients with normal host defence respond equally well to bacteriostatic and bactericidal AMAs. But several acute infections resolve faster with a cidal than a static drug, because the cidal drug directly reduces the number of bacteria at the site of infection, while the static drug only prevents increase in their number. Many bactericidal drugs exe prolonged postantibiotic effect so that maintenance of drug level continuously above the MIC is not essential. With bacteriostatic AMAs the bacteria sta multiplying quickly when drug level falls below the MIC, resulting in relapse of infection. A bactericidal antibiotic is clearly superior to bacteriostatic one in treating patients with impaired host defence, life-threatening infections, infections at less accessible sites (SABE) or when carrier state is possible (typhoid) . ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:676\nA", "question_key": "a bactericidal drug would be preferred over a bacteriostatic drug in a patient with:", "split": "validation", "is_mia_member": false} {"id": "16d5a54e-fb3a-4453-8caa-f6ec9a909d62", "question": "Treatment of choice for annular pancreas is -", "opa": "Division of pancreas", "opb": "Duodeno-duodenostomy", "opc": "Duodeno-jejunostomy", "opd": "Roux-en-Y loop", "cop": 1, "answer": "B", "exp": "Ans B Reference Sabiston Textbook of Surgery. 20th edition. Annular pancreas results from aberrant migration of the ventral pancreas bud which leads to circumferential or near-circumferential pancreas tissue surrounding the second portion of the duodenum This abnormality may be associated with other congenital defects, including Down syndrome, malrotation, intestinal atresia, and cardiac malformations If symptoms of obstruction occur surgical bypass through duodenojejunostomy is performed Axial image from an abdominal CT scan showing the annulus encircling the duodenum (arrow). Courtesy-", "explanation_word_count": 79, "prompt": "Treatment of choice for annular pancreas is -\nA. Division of pancreas\nB. Duodeno-duodenostomy\nC. Duodeno-jejunostomy\nD. Roux-en-Y loop\nReturn the correct option letter.", "reference": "Ans B Reference Sabiston Textbook of Surgery. 20th edition. Annular pancreas results from aberrant migration of the ventral pancreas bud which leads to circumferential or near-circumferential pancreas tissue surrounding the second portion of the duodenum This abnormality may be associated with other congenital defects, including Down syndrome, malrotation, intestinal atresia, and cardiac malformations If symptoms of obstruction occur surgical bypass through duodenojejunostomy is performed Axial image from an abdominal CT scan showing the annulus encircling the duodenum (arrow). Courtesy-\nB", "question_key": "treatment of choice for annular pancreas is -", "split": "validation", "is_mia_member": false} {"id": "a6633cde-2b8a-4344-a05f-5a8a6ec176ec", "question": "Most common cause of obstructive jaundice in children?", "opa": "Biliary atresia", "opb": "Criggler najjar syndrome", "opc": "Byler disease", "opd": "Caroli cyst", "cop": 0, "answer": "A", "exp": "Biliary atresia: Biliary atresia is characterized by obliteration or discontinuity of the extrahepatic biliary system. The disorder represents the most common surgically treatable cause of cholestasis seen during the newborn period", "explanation_word_count": 31, "prompt": "Most common cause of obstructive jaundice in children?\nA. Biliary atresia\nB. Criggler najjar syndrome\nC. Byler disease\nD. Caroli cyst\nReturn the correct option letter.", "reference": "Biliary atresia: Biliary atresia is characterized by obliteration or discontinuity of the extrahepatic biliary system. The disorder represents the most common surgically treatable cause of cholestasis seen during the newborn period\nA", "question_key": "most common cause of obstructive jaundice in children?", "split": "validation", "is_mia_member": false} {"id": "f6648b1d-d7b0-43de-b8a5-e1685c6e47bc", "question": "Division of zygote took place on 5th day after fertilization. What is the type of twinning:", "opa": "Monochorionic, Monoamniotic", "opb": "Monochorionic, Diamniotic", "opc": "Dichorionic, Diamniotic", "opd": "Dichorionic, Monoamniotic", "cop": 1, "answer": "B", "exp": "Ans. (b) Monochorionic, DiamnioticRef: Dutta 8th ed. 233Division of zygote and types of TwinningDivision of Zygote on/ afterTypes of Twining72 hours/3 daysDichorionic, DiamnioticBetween 4-8 daysMonochorionic, DiamnioticBetween 8-12 daysMonochorionic, Monoamniotic> DaysSiamese, Conjoined TwinsAlso Know* Most common type of twinning is dizygotic twins: 69%* Monozygotic twins in: 31%* MC TYPE OF TWIN GESTATION: Diamniotic Monochorionic (70-75%)* Least common type of twin gestation: Conjoined twins (<1%)* Hellin rule is associated with multiple pregnancyas per which chance of twins is al in 80 pregnancies, triplets 1 in 802 and so on. It can result in complications;* Prematurity is the commonest fetal complication* Post partumhemorrhage is the commonest maternal complication.", "explanation_word_count": 96, "prompt": "Division of zygote took place on 5th day after fertilization. What is the type of twinning:\nA. Monochorionic, Monoamniotic\nB. Monochorionic, Diamniotic\nC. Dichorionic, Diamniotic\nD. Dichorionic, Monoamniotic\nReturn the correct option letter.", "reference": "Ans. (b) Monochorionic, DiamnioticRef: Dutta 8th ed. 233Division of zygote and types of TwinningDivision of Zygote on/ afterTypes of Twining72 hours/3 daysDichorionic, DiamnioticBetween 4-8 daysMonochorionic, DiamnioticBetween 8-12 daysMonochorionic, Monoamniotic> DaysSiamese, Conjoined TwinsAlso Know* Most common type of twinning is dizygotic twins: 69%* Monozygotic twins in: 31%* MC TYPE OF TWIN GESTATION: Diamniotic Monochorionic (70-75%)* Least common type of twin gestation: Conjoined twins (<1%)* Hellin rule is associated with multiple pregnancyas per which chance of twins is al in 80 pregnancies, triplets 1 in 802 and so on. It can result in complications;* Prematurity is the commonest fetal complication* Post partumhemorrhage is the commonest maternal complication.\nB", "question_key": "division of zygote took place on 5th day after fertilization. what is the type of twinning:", "split": "validation", "is_mia_member": false} {"id": "996f63a9-73de-449b-a4d5-21f9e9dc086b", "question": "Most vascular zone of the bone is", "opa": "Metaphysis", "opb": "Diaphysis", "opc": "Epiphysis", "opd": "Medullary Cavity", "cop": 0, "answer": "A", "exp": "Metaphysis is the most vascular zone of the bone especially in children as it has long hairpin loop arranged aerioles and venules running through it.(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 9)", "explanation_word_count": 34, "prompt": "Most vascular zone of the bone is\nA. Metaphysis\nB. Diaphysis\nC. Epiphysis\nD. Medullary Cavity\nReturn the correct option letter.", "reference": "Metaphysis is the most vascular zone of the bone especially in children as it has long hairpin loop arranged aerioles and venules running through it.(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 9)\nA", "question_key": "most vascular zone of the bone is", "split": "validation", "is_mia_member": false} {"id": "05a8b60e-7619-4b98-bbab-9ad7883ab979", "question": "A young male presents with fever, followed by headache, confusion, focal seizures and right hemiparesis. MRI shows bilateral frontotemporal hyperintense lesion. Which of the following is the most likely diagnosis?", "opa": "Acute pyogenic meningitis", "opb": "Herpes simplex encephalitis", "opc": "Neurocysticercosis", "opd": "Carcinomatous meningitis", "cop": 1, "answer": "B", "exp": "Patient is showing features suggestive of herpes simplex encephalitis. Clinical manifestations in viral encephalitis includes altered level of consiousness (confusion, behavioral abnormalities), mild lethargy to coma, evidence of both focal or diffuse neurologic signs and symptoms and focal or generalized seizures. Investigations: CSF shows lymphocytic leukocytosis, red blood cells due to hemorrhagic necrosis and elevated cerebrospinal fluid (CSF) protein levels. In HSV encephalitis80% will have abnormalities in temporal lobe and 10% have extra temporal abnormalities. The lesions are typically hyper intense on T2-weighted images. Brain biopsy has been the gold standard for defining HSV encephalitis, but now PCR for detection of HSV DNA in CSF has largely replaced biopsy for defining CNS infection. Acyclovir is used in the treatment. Ref: Harrison's Internal Medicine, 18th Edition, Pages 3421, 3437, Chapters 179, 379, 381.", "explanation_word_count": 127, "prompt": "A young male presents with fever, followed by headache, confusion, focal seizures and right hemiparesis. MRI shows bilateral frontotemporal hyperintense lesion. Which of the following is the most likely diagnosis?\nA. Acute pyogenic meningitis\nB. Herpes simplex encephalitis\nC. Neurocysticercosis\nD. Carcinomatous meningitis\nReturn the correct option letter.", "reference": "Patient is showing features suggestive of herpes simplex encephalitis. Clinical manifestations in viral encephalitis includes altered level of consiousness (confusion, behavioral abnormalities), mild lethargy to coma, evidence of both focal or diffuse neurologic signs and symptoms and focal or generalized seizures. Investigations: CSF shows lymphocytic leukocytosis, red blood cells due to hemorrhagic necrosis and elevated cerebrospinal fluid (CSF) protein levels. In HSV encephalitis80% will have abnormalities in temporal lobe and 10% have extra temporal abnormalities. The lesions are typically hyper intense on T2-weighted images. Brain biopsy has been the gold standard for defining HSV encephalitis, but now PCR for detection of HSV DNA in CSF has largely replaced biopsy for defining CNS infection. Acyclovir is used in the treatment. Ref: Harrison's Internal Medicine, 18th Edition, Pages 3421, 3437, Chapters 179, 379, 381.\nB", "question_key": "a young male presents with fever, followed by headache, confusion, focal seizures and right hemiparesis. mri shows bilateral frontotemporal hyperintense lesion. which of the following is the most likely diagnosis?", "split": "validation", "is_mia_member": false} {"id": "1e238c55-0e8f-4ec3-b4b8-bf4e6d12b80b", "question": "A pregnant lady complaints of headache, feeling of excessive tiredness and drowsiness whenever she lies down in supine position. Her symptoms are relieved on sitting up and while lying on her side. What is the most likely diagnosis?", "opa": "IVC compression", "opb": "Compression on sympathetic chain", "opc": "Raised intra abdominal pressure", "opd": "Decreased blood supply to placenta", "cop": 0, "answer": "A", "exp": "Patient is showing features of supine hypotensive syndrome caused by the compression of inferior vena cava by the weight of a pregnant female's uterus, fetus, placenta and amniotic fluids while lying in the supine position. This condition can develop as early as the second trimester but is maximal during the third trimester, 36 to 38 weeks. When the pregnant female in these stages lies in the supine position, the added weight of the enlarged uterus and its contents will press down on the inferior vena cava. When the IVC is compressed it reduces the amount of blood that returns to the hea and reduces cardiac output, this can result in a loss of 30% of the effective circulating blood volume. It can take 3-7 minutes for significant hypotension to manifest.", "explanation_word_count": 126, "prompt": "A pregnant lady complaints of headache, feeling of excessive tiredness and drowsiness whenever she lies down in supine position. Her symptoms are relieved on sitting up and while lying on her side. What is the most likely diagnosis?\nA. IVC compression\nB. Compression on sympathetic chain\nC. Raised intra abdominal pressure\nD. Decreased blood supply to placenta\nReturn the correct option letter.", "reference": "Patient is showing features of supine hypotensive syndrome caused by the compression of inferior vena cava by the weight of a pregnant female's uterus, fetus, placenta and amniotic fluids while lying in the supine position. This condition can develop as early as the second trimester but is maximal during the third trimester, 36 to 38 weeks. When the pregnant female in these stages lies in the supine position, the added weight of the enlarged uterus and its contents will press down on the inferior vena cava. When the IVC is compressed it reduces the amount of blood that returns to the hea and reduces cardiac output, this can result in a loss of 30% of the effective circulating blood volume. It can take 3-7 minutes for significant hypotension to manifest.\nA", "question_key": "a pregnant lady complaints of headache, feeling of excessive tiredness and drowsiness whenever she lies down in supine position. her symptoms are relieved on sitting up and while lying on her side. what is the most likely diagnosis?", "split": "validation", "is_mia_member": false} {"id": "e537c061-52ef-4f00-a80e-86ffaee2af86", "question": "A patient with H. Pylori infection is treated with drugs. The best method to detect presence of residual H.Pylori infection in this person is :", "opa": "Rapid unrease test", "opb": "Urea breath test", "opc": "Endoscopy and biopsy", "opd": "Serum anti H.Pylori titre", "cop": 1, "answer": "B", "exp": "Answer is B (Urea breath test) : The test of choice for documenting eradication is urea breath test. Assessing success of Treatment / Eradicatiion of H. Pyrlori : Assessment should be done atleast 4 weeks after completin of anti H. Pylori therapy. In the assessment of treatment success non invasive tests are normally preferred. Assessment of success of treatment Non invasive tests are preferred Inasive tests are not preferred Urea breath test : Test of choice for documenting eradication. Stool antigen test :If UBT is not available a stool antigen test should be considered for documenting eradication Biopsy based tests (Biopsy Urease test, Histology / Culture) are invasive tests based on Endoscopic biopsy. Serological testing :Is not useful for purpose of documentation of eradication as antibody titres fall slowly and often do not become undetectable These may be used to document eradication but are not preferred for this purpose.", "explanation_word_count": 143, "prompt": "A patient with H. Pylori infection is treated with drugs. The best method to detect presence of residual H.Pylori infection in this person is :\nA. Rapid unrease test\nB. Urea breath test\nC. Endoscopy and biopsy\nD. Serum anti H.Pylori titre\nReturn the correct option letter.", "reference": "Answer is B (Urea breath test) : The test of choice for documenting eradication is urea breath test. Assessing success of Treatment / Eradicatiion of H. Pyrlori : Assessment should be done atleast 4 weeks after completin of anti H. Pylori therapy. In the assessment of treatment success non invasive tests are normally preferred. Assessment of success of treatment Non invasive tests are preferred Inasive tests are not preferred Urea breath test : Test of choice for documenting eradication. Stool antigen test :If UBT is not available a stool antigen test should be considered for documenting eradication Biopsy based tests (Biopsy Urease test, Histology / Culture) are invasive tests based on Endoscopic biopsy. Serological testing :Is not useful for purpose of documentation of eradication as antibody titres fall slowly and often do not become undetectable These may be used to document eradication but are not preferred for this purpose.\nB", "question_key": "a patient with h. pylori infection is treated with drugs. the best method to detect presence of residual h.pylori infection in this person is :", "split": "validation", "is_mia_member": false} {"id": "4665c308-c0dd-43da-9ba3-e2e7878e8bdc", "question": "Digoxin increases cardiac contractility by directly engaging in wof", "opa": "Inhibiting myocardial Na + /Ca 2+ -ATPase", "opb": "Activating L-type Ca 2+ channels", "opc": "Inhibiting cardiac phosphodiesterase", "opd": "Inhibiting myocardial Na + /K + -ATPase", "cop": 3, "answer": "D", "exp": "Mechanism of action:- Digoxin increases force of cardiac contraction by a direct action independent of innervation. It selectively binds to extracellular face of the membrane associated Na+K+ ATPase of myocardial fibres and inhibitis this enzyme. Inhibition of this cation pump results in progressive accumulation of Na+ intracellularly. This indirectly results in intracellular Ca2+ accumulation. During depolarization Ca2+ ions enter the cell driven by the steep Ca2+ gradient through voltage sensitive L type Ca2+ channels. This triggers release of larger amount of Ca2+ stored in sarcoplasmic reticulum (SR) through Ryanodine calcium channel 2 (RYR2) - cytosolic Ca2+ increases transiently (calcium transients) - triggers contraction by activating troponin C on myofibrils. Ref:- kd tripathi; pg num:-514", "explanation_word_count": 112, "prompt": "Digoxin increases cardiac contractility by directly engaging in wof\nA. Inhibiting myocardial Na + /Ca 2+ -ATPase\nB. Activating L-type Ca 2+ channels\nC. Inhibiting cardiac phosphodiesterase\nD. Inhibiting myocardial Na + /K + -ATPase\nReturn the correct option letter.", "reference": "Mechanism of action:- Digoxin increases force of cardiac contraction by a direct action independent of innervation. It selectively binds to extracellular face of the membrane associated Na+K+ ATPase of myocardial fibres and inhibitis this enzyme. Inhibition of this cation pump results in progressive accumulation of Na+ intracellularly. This indirectly results in intracellular Ca2+ accumulation. During depolarization Ca2+ ions enter the cell driven by the steep Ca2+ gradient through voltage sensitive L type Ca2+ channels. This triggers release of larger amount of Ca2+ stored in sarcoplasmic reticulum (SR) through Ryanodine calcium channel 2 (RYR2) - cytosolic Ca2+ increases transiently (calcium transients) - triggers contraction by activating troponin C on myofibrils. Ref:- kd tripathi; pg num:-514\nD", "question_key": "digoxin increases cardiac contractility by directly engaging in wof", "split": "validation", "is_mia_member": false} {"id": "9ac791bf-d8b6-4e82-9912-dd5df2d2cad4", "question": "Wof bones is affected more with glucocoicoid induced osteoporosis", "opa": "Humerus", "opb": "Femur", "opc": "Radius", "opd": "veebra", "cop": 3, "answer": "D", "exp": "Adverse effects:- Osteoporosis Especially involving veebrae and other flat spongy bones. Compression fractures of veebrae and spontaneous fracture of long bones can occur, especially in the elderly. Radiological evidence of osteoporosis is an indication for withdrawal of coicoid therapy. Coicosteroid induced osteoporosis can be prevented/arrested by calcium supplements + vit D, and by estrogen/raloxifene or androgen replacement therapy in females and males respectively. However, bisphosphonates are the most effective drugs. Avascular necrosis of head of femur, humerus, or knee joint is an occasional abrupt onset complication of high dose coicosteroid therapy. Ref:- kd tripathi; pg num:-293", "explanation_word_count": 97, "prompt": "Wof bones is affected more with glucocoicoid induced osteoporosis\nA. Humerus\nB. Femur\nC. Radius\nD. veebra\nReturn the correct option letter.", "reference": "Adverse effects:- Osteoporosis Especially involving veebrae and other flat spongy bones. Compression fractures of veebrae and spontaneous fracture of long bones can occur, especially in the elderly. Radiological evidence of osteoporosis is an indication for withdrawal of coicoid therapy. Coicosteroid induced osteoporosis can be prevented/arrested by calcium supplements + vit D, and by estrogen/raloxifene or androgen replacement therapy in females and males respectively. However, bisphosphonates are the most effective drugs. Avascular necrosis of head of femur, humerus, or knee joint is an occasional abrupt onset complication of high dose coicosteroid therapy. Ref:- kd tripathi; pg num:-293\nD", "question_key": "wof bones is affected more with glucocoicoid induced osteoporosis", "split": "validation", "is_mia_member": false} {"id": "5df38361-b59f-41c9-9f8b-649a606b0c50", "question": "Resting membrane potential in ventricular myocardium", "opa": "-50mV", "opb": ">70mV", "opc": "+70mV", "opd": "-90mV", "cop": 3, "answer": "D", "exp": "Ventricular cardiomyocyte membrane potential is about -90 mV at rest, which is close to the potassium reversal potential. When an action potential is generated, the membrane potential rises above this level in four distinct phases.", "explanation_word_count": 34, "prompt": "Resting membrane potential in ventricular myocardium\nA. -50mV\nB. >70mV\nC. +70mV\nD. -90mV\nReturn the correct option letter.", "reference": "Ventricular cardiomyocyte membrane potential is about -90 mV at rest, which is close to the potassium reversal potential. When an action potential is generated, the membrane potential rises above this level in four distinct phases.\nD", "question_key": "resting membrane potential in ventricular myocardium", "split": "validation", "is_mia_member": false} {"id": "b9b7ba1d-e27e-484b-8081-6deb40e2092f", "question": "A middle-aged woman suffers from weakness of her ocular and facial muscles, which worsens with repeated use. She has antibodies to acetylcholine receptors in her serum. The likely diagnosis is:", "opa": "Lymphangioma", "opb": "Parkinson's Disease", "opc": "Osteoid Osteoma", "opd": "Myasthenia gravis", "cop": 3, "answer": "D", "exp": "Myasthenia gravis is an autoimmune disease caused by the product of antibodies against acetylcholine receptors. The ocular and facial muscles are usually weakened. The weakness worsens with repeated contractions of the muscles. Treatment with anticholinesterase agents can improve the weakness and fatigability by increasing the quantity of acetylcholine available at the motor. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 53. Myasthenia Gravis and Related Disorders of the Neuromuscular Junction. In A.H. Ropper, M.A. Samuels (Eds),Adams and Victor's Principles of Neurology, 9e.", "explanation_word_count": 84, "prompt": "A middle-aged woman suffers from weakness of her ocular and facial muscles, which worsens with repeated use. She has antibodies to acetylcholine receptors in her serum. The likely diagnosis is:\nA. Lymphangioma\nB. Parkinson's Disease\nC. Osteoid Osteoma\nD. Myasthenia gravis\nReturn the correct option letter.", "reference": "Myasthenia gravis is an autoimmune disease caused by the product of antibodies against acetylcholine receptors. The ocular and facial muscles are usually weakened. The weakness worsens with repeated contractions of the muscles. Treatment with anticholinesterase agents can improve the weakness and fatigability by increasing the quantity of acetylcholine available at the motor. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 53. Myasthenia Gravis and Related Disorders of the Neuromuscular Junction. In A.H. Ropper, M.A. Samuels (Eds),Adams and Victor's Principles of Neurology, 9e.\nD", "question_key": "a middle-aged woman suffers from weakness of her ocular and facial muscles, which worsens with repeated use. she has antibodies to acetylcholine receptors in her serum. the likely diagnosis is:", "split": "validation", "is_mia_member": false} {"id": "480b3d47-b525-4e7a-ad88-f32ac4659698", "question": "Phrynoderma is NOT due to deficiency of", "opa": "Essential fatty acids", "opb": "Vit A", "opc": "Vit D", "opd": "Vit B", "cop": 2, "answer": "C", "exp": "PHRYNODERMA(toad-skin disease):- May be a manifestation of vitamin A deficiency, though it may also be due to deficiency of essential fatty acids and even vitamin B. Manifests as rough, hyperkeratotic follicular papules around elbows and knees. Ref:- NEENA KHANNA; pg num:- 391", "explanation_word_count": 42, "prompt": "Phrynoderma is NOT due to deficiency of\nA. Essential fatty acids\nB. Vit A\nC. Vit D\nD. Vit B\nReturn the correct option letter.", "reference": "PHRYNODERMA(toad-skin disease):- May be a manifestation of vitamin A deficiency, though it may also be due to deficiency of essential fatty acids and even vitamin B. Manifests as rough, hyperkeratotic follicular papules around elbows and knees. Ref:- NEENA KHANNA; pg num:- 391\nC", "question_key": "phrynoderma is not due to deficiency of", "split": "validation", "is_mia_member": false} {"id": "dfaab0c0-a89f-4502-ab7d-c2f829a85da8", "question": "Which of the following structure forms the medial border of Hesselbach's triangle?", "opa": "Linea alba", "opb": "Linea semilunaris", "opc": "Inferior epigastric aery", "opd": "Conjoint tendon", "cop": 1, "answer": "B", "exp": "Boundaries of Hasselbach's triangle:Medial border: Lateral margin the rectus sheath, also called linea semilunaris.Superolateral border: Inferior epigastric aery.Inferior border: Inguinal ligament, sometimes Referred to as Poupa's ligament.", "explanation_word_count": 30, "prompt": "Which of the following structure forms the medial border of Hesselbach's triangle?\nA. Linea alba\nB. Linea semilunaris\nC. Inferior epigastric aery\nD. Conjoint tendon\nReturn the correct option letter.", "reference": "Boundaries of Hasselbach's triangle:Medial border: Lateral margin the rectus sheath, also called linea semilunaris.Superolateral border: Inferior epigastric aery.Inferior border: Inguinal ligament, sometimes Referred to as Poupa's ligament.\nB", "question_key": "which of the following structure forms the medial border of hesselbach's triangle?", "split": "validation", "is_mia_member": false} {"id": "0268a833-6d2d-45c8-9100-d5a690caf802", "question": "A newborn has multiple congenital defects owing to dysgenesis of the neural crest. Which of the following cells is most likely to be spared?", "opa": "Geniculate ganglion cells", "opb": "Melanocytes", "opc": "Motor neurons", "opd": "Parafollicular cells", "cop": 2, "answer": "C", "exp": "Motor neurons develop from the neural tube, more specifically from the basal plate. Other options (Geniculate ganglion cells,Melanocytes and Parafollicular cells) are derivatives of the neural crest. Derrvatives of the neural crest:", "explanation_word_count": 33, "prompt": "A newborn has multiple congenital defects owing to dysgenesis of the neural crest. Which of the following cells is most likely to be spared?\nA. Geniculate ganglion cells\nB. Melanocytes\nC. Motor neurons\nD. Parafollicular cells\nReturn the correct option letter.", "reference": "Motor neurons develop from the neural tube, more specifically from the basal plate. Other options (Geniculate ganglion cells,Melanocytes and Parafollicular cells) are derivatives of the neural crest. Derrvatives of the neural crest:\nC", "question_key": "a newborn has multiple congenital defects owing to dysgenesis of the neural crest. which of the following cells is most likely to be spared?", "split": "validation", "is_mia_member": false} {"id": "4fb19f04-e93b-4961-9a9c-e20fcbdb194f", "question": "Disulfiram like reaction is commonly caused by which of the following: March 2005", "opa": "Penicillin", "opb": "metronidazole", "opc": "Tetracycline", "opd": "erythromycin", "cop": 1, "answer": "B", "exp": "Ans. B: Metronidazole Drugs causing Disulfiram like reaction Metronidazole Cefamandole Cefoperazone Chlorpropamide Sulfonylureas Quinacrine Griseofuvin Chloramphenicol Tinidazole Procarbazine Ritonavir Nitrofurantoin Chloramphenicol Chloral hydrate", "explanation_word_count": 23, "prompt": "Disulfiram like reaction is commonly caused by which of the following: March 2005\nA. Penicillin\nB. metronidazole\nC. Tetracycline\nD. erythromycin\nReturn the correct option letter.", "reference": "Ans. B: Metronidazole Drugs causing Disulfiram like reaction Metronidazole Cefamandole Cefoperazone Chlorpropamide Sulfonylureas Quinacrine Griseofuvin Chloramphenicol Tinidazole Procarbazine Ritonavir Nitrofurantoin Chloramphenicol Chloral hydrate\nB", "question_key": "disulfiram like reaction is commonly caused by which of the following: march 2005", "split": "validation", "is_mia_member": false} {"id": "3bc545fe-6703-40ad-b463-21bd86431036", "question": "Which of the following among axillary lymphnodes, is a terminal group of lymph nodes", "opa": "Pectoral", "opb": "Central", "opc": "Lateral", "opd": "Apical", "cop": 3, "answer": "D", "exp": "Level III axillary lymph nodes are part of Apical axilla. They include the nodes which lies medial to medial margin of pectoralis minor, namely, subclavicular, infraclavicular or apical. The apical lymph nodes drain lymph from anterior, posterior, central and lateral group of axillary lymph nodes. So they are the terminal group of axillary lymph nodes.", "explanation_word_count": 55, "prompt": "Which of the following among axillary lymphnodes, is a terminal group of lymph nodes\nA. Pectoral\nB. Central\nC. Lateral\nD. Apical\nReturn the correct option letter.", "reference": "Level III axillary lymph nodes are part of Apical axilla. They include the nodes which lies medial to medial margin of pectoralis minor, namely, subclavicular, infraclavicular or apical. The apical lymph nodes drain lymph from anterior, posterior, central and lateral group of axillary lymph nodes. So they are the terminal group of axillary lymph nodes.\nD", "question_key": "which of the following among axillary lymphnodes, is a terminal group of lymph nodes", "split": "validation", "is_mia_member": false} {"id": "eef73746-8a75-4d05-befb-67d65f405a3f", "question": "Which structure(s) passes behind the inguinal ligament -a) Femoral branch of genitofemoral nerveb) Superficial epigastric arteryc) Psoas majord) Femoral veine) Saphenous vein", "opa": "abc", "opb": "ad", "opc": "bc", "opd": "acd", "cop": 3, "answer": "D", "exp": "Structures passing deep to inguinal ligament.\n- Psoas major, Iliacus, pectineus\n- Femoral nerve and vessels\n- Lateral cutaneous nerve of thigh\n- Femoral branch of genitofemoral nerve\n- Lymphatics", "explanation_word_count": 25, "prompt": "Which structure(s) passes behind the inguinal ligament -a) Femoral branch of genitofemoral nerveb) Superficial epigastric arteryc) Psoas majord) Femoral veine) Saphenous vein\nA. abc\nB. ad\nC. bc\nD. acd\nReturn the correct option letter.", "reference": "Structures passing deep to inguinal ligament.\n- Psoas major, Iliacus, pectineus\n- Femoral nerve and vessels\n- Lateral cutaneous nerve of thigh\n- Femoral branch of genitofemoral nerve\n- Lymphatics\nD", "question_key": "which structure(s) passes behind the inguinal ligament -a) femoral branch of genitofemoral nerveb) superficial epigastric arteryc) psoas majord) femoral veine) saphenous vein", "split": "validation", "is_mia_member": false} {"id": "a2f81f12-c510-45b2-b2b2-5de7c4116a99", "question": "After ovulation the discharged oocytes and surrounding layer of granulosa cells are known as", "opa": "Corpus luteum", "opb": "Corona radiata", "opc": "Stigma", "opd": "Zona pellucida", "cop": 1, "answer": "B", "exp": "The corona radiata is the innermost layer of the cells of the cumulus oophorus and is directly adjacent to the zona pellucida, the inner protective glycoprotein layer of the ovum . Its main purpose in many animals is to supply vital proteins to the cell. It is formed by follicle cells adhering to the oocyte before it leaves the ovarian follicle, and originates from the squamous granulosa cells present at the primordial stage of follicular development. The corona radiata is formed when the granulosa cells enlarge and become cuboidal, which occurs during the transition from the primordia to primary stage . These cuboidal granulosa cells, also known as the granulosa radiata, form more layers throughout the maturation process, and remain attached to the zona pellucida after the ovulation of the graafian follicle . For feilization to occur, sperm cells rely on hyaluronidase (an enzyme found in the acrosome of spermatozoa) to disperse the corona radiata from the zona pellucida of the secondary (ovulated) oocyte, thus permitting entry into the perivitelline space and allowing contact between the sperm cell and the nucleus of the oocyte. Ref - Wikipedia.org", "explanation_word_count": 184, "prompt": "After ovulation the discharged oocytes and surrounding layer of granulosa cells are known as\nA. Corpus luteum\nB. Corona radiata\nC. Stigma\nD. Zona pellucida\nReturn the correct option letter.", "reference": "The corona radiata is the innermost layer of the cells of the cumulus oophorus and is directly adjacent to the zona pellucida, the inner protective glycoprotein layer of the ovum . Its main purpose in many animals is to supply vital proteins to the cell. It is formed by follicle cells adhering to the oocyte before it leaves the ovarian follicle, and originates from the squamous granulosa cells present at the primordial stage of follicular development. The corona radiata is formed when the granulosa cells enlarge and become cuboidal, which occurs during the transition from the primordia to primary stage . These cuboidal granulosa cells, also known as the granulosa radiata, form more layers throughout the maturation process, and remain attached to the zona pellucida after the ovulation of the graafian follicle . For feilization to occur, sperm cells rely on hyaluronidase (an enzyme found in the acrosome of spermatozoa) to disperse the corona radiata from the zona pellucida of the secondary (ovulated) oocyte, thus permitting entry into the perivitelline space and allowing contact between the sperm cell and the nucleus of the oocyte. Ref - Wikipedia.org\nB", "question_key": "after ovulation the discharged oocytes and surrounding layer of granulosa cells are known as", "split": "validation", "is_mia_member": false} {"id": "9ab095cb-17cb-4483-91cf-a454db77eee0", "question": "which of the following is a NaSSa", "opa": "miazapine", "opb": "clozapine", "opc": "nefazadone", "opd": "sealine", "cop": 0, "answer": "A", "exp": "NaSSA * IMPOANCE Nor adrenergic and specific serotonergic antidepressant * MECHANISM * Alpha 2 adrenergic receptor antagonism=== increase serotonin and NA * 5HT2,3 antagonist============increase sleep and appetite * DRUGS miazapine * USE Elderly with depression * SIDE EFFECTS hyperlipidemia ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 955", "explanation_word_count": 43, "prompt": "which of the following is a NaSSa\nA. miazapine\nB. clozapine\nC. nefazadone\nD. sealine\nReturn the correct option letter.", "reference": "NaSSA * IMPOANCE Nor adrenergic and specific serotonergic antidepressant * MECHANISM * Alpha 2 adrenergic receptor antagonism=== increase serotonin and NA * 5HT2,3 antagonist============increase sleep and appetite * DRUGS miazapine * USE Elderly with depression * SIDE EFFECTS hyperlipidemia ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 955\nA", "question_key": "which of the following is a nassa", "split": "validation", "is_mia_member": false} {"id": "65f33222-8ead-41f2-8166-26518039e316", "question": "The inheritance pattern of Familial hypercholesterolemia is", "opa": "Autosomal recessive", "opb": "Autosomal dominant", "opc": "X-linked dominant", "opd": "X-linked recessive", "cop": 1, "answer": "B", "exp": "Mutations involving single genes follow one of three patterns of inheritance: autosomal dominant, autosomal recessive, or X-linked. Autosomal Dominant Inheritance Familial hypercholesterolemia Huntington disease Marfan syndrome Ehlers-Danlos syndrome Hereditary spherocytosis Neurofibromatosis, type 1 Adult polycystic kidney disease Familial Hypercholesterolemia Familial hypercholesterolemia is among the most common mendelian disorders; the frequency of the heterozygous condition is 1 in 500 in the general population. It is caused by a mutation in the LDLR gene that encodes the receptor for low-density lipoprotein (LDL), the form in which 70% of total plasma cholesterol is transpoed. A brief review of the synthesis and transpo of cholesterol follows. Normal Cholesterol Metabolism. Cholesterol may be derived from the diet or from endogenous synthesis. Dietary triglycerides and cholesterol are incorporated into chylomicrons in the intestinal mucosa, which drain by way of the gut lymphatics into the blood. These chylomicrons are hydrolyzed by an endothelial lipoprotein lipase in the capillaries of muscle and fat. The chylomicron remnants, rich in cholesterol, are then delivered to the liver. Some of the cholesterol enters the metabolic pool (to be described), and some is excreted as free cholesterol or bile acids into the biliary tract. The endogenous synthesis of cholesterol and LDL begins in the liver (Fig. 6-2). The first step in the synthesis of LDL is the secretion of triglyceride-rich very- low-density lipoprotein (VLDL) by the liver into the blood. In the capillaries of adipose tissue and muscle, the VLDL paicle undergoes lipolysis and is conveed to intermediate- density lipoprotein (IDL). In comparison with VLDL, the content of triglyceride is reduced and that of cholesteryl esters enriched in intermediate-density lipoprotein (IDL), but IDL retains on its surface two of the three VLDL- associated apolipoproteins B-100 and E. Fuher metabo- lism of IDL occurs along two pathways: Most of the IDL paicles are directly taken up by the liver through the LDL receptor described later; others are conveed to cholesterol- rich LDL by a fuher loss of triglycerides and apolipopro- tein E. In the liver cells, IDL is recycled to generate VLDL. Two thirds of the resultant LDL paicles are metabo- lized by the LDL receptor pathway, and the rest is metabo- lized by a receptor for oxidized LDL (scavenger receptor), to be described later. The LDL receptor binds to apolipo- proteins B-100 and E and thus is involved in the transpo of both LDL and IDL. Although the LDL receptors are widely distributed, approximately 75% are located on hepatocytes, so the liver plays an extremely impoant role in LDL metabolism. The first step in the receptor-mediated transpo of LDL involves binding to the cell surface receptor, followed by endocy- totic internalization inside so-called \"clathrin-coated pits\" (Fig. 6-3). Within the cell, the endocytic vesicles fuse with the lysosomes, and the LDL molecule is enzymatically degraded, resulting ultimately in the release of free cholesterol into the cytoplasm. The cholesterol not only is used by the cell for membrane synthesis but also takes pa in intracel- lular cholesterol homeostasis by a sophisticated system of feed- back control: * It suppresses cholesterol synthesis by inhibiting the activity of the enzyme 3-hydroxy-3-methylglutaryl- coenzyme A reductase (HMG-CoA reductase), which is the rate-limiting enzyme in the synthetic pathway. * It stimulates the formation of cholesterol esters for storage of excess cholesterol. * It downregulates the synthesis of cell surface LDL recep- tors, thus protecting cells from excessive accumulation of cholesterol. The transpo of LDL by the scavenger receptors, alluded to earlier, seems to take place in cells of the mononuclear- phagocyte system and possibly in other cells as well. Monocytes and macrophages have receptors for chemically modified (e.g., acetylated or oxidized) LDLs. The amount catabolized by this \"scavenger receptor\" pathway is directly related to the plasma cholesterol level. (Robbins Basic Pathology,9th edition,pg no. 219)", "explanation_word_count": 618, "prompt": "The inheritance pattern of Familial hypercholesterolemia is\nA. Autosomal recessive\nB. Autosomal dominant\nC. X-linked dominant\nD. X-linked recessive\nReturn the correct option letter.", "reference": "Mutations involving single genes follow one of three patterns of inheritance: autosomal dominant, autosomal recessive, or X-linked. Autosomal Dominant Inheritance Familial hypercholesterolemia Huntington disease Marfan syndrome Ehlers-Danlos syndrome Hereditary spherocytosis Neurofibromatosis, type 1 Adult polycystic kidney disease Familial Hypercholesterolemia Familial hypercholesterolemia is among the most common mendelian disorders; the frequency of the heterozygous condition is 1 in 500 in the general population. It is caused by a mutation in the LDLR gene that encodes the receptor for low-density lipoprotein (LDL), the form in which 70% of total plasma cholesterol is transpoed. A brief review of the synthesis and transpo of cholesterol follows. Normal Cholesterol Metabolism. Cholesterol may be derived from the diet or from endogenous synthesis. Dietary triglycerides and cholesterol are incorporated into chylomicrons in the intestinal mucosa, which drain by way of the gut lymphatics into the blood. These chylomicrons are hydrolyzed by an endothelial lipoprotein lipase in the capillaries of muscle and fat. The chylomicron remnants, rich in cholesterol, are then delivered to the liver. Some of the cholesterol enters the metabolic pool (to be described), and some is excreted as free cholesterol or bile acids into the biliary tract. The endogenous synthesis of cholesterol and LDL begins in the liver (Fig. 6-2). The first step in the synthesis of LDL is the secretion of triglyceride-rich very- low-density lipoprotein (VLDL) by the liver into the blood. In the capillaries of adipose tissue and muscle, the VLDL paicle undergoes lipolysis and is conveed to intermediate- density lipoprotein (IDL). In comparison with VLDL, the content of triglyceride is reduced and that of cholesteryl esters enriched in intermediate-density lipoprotein (IDL), but IDL retains on its surface two of the three VLDL- associated apolipoproteins B-100 and E. Fuher metabo- lism of IDL occurs along two pathways: Most of the IDL paicles are directly taken up by the liver through the LDL receptor described later; others are conveed to cholesterol- rich LDL by a fuher loss of triglycerides and apolipopro- tein E. In the liver cells, IDL is recycled to generate VLDL. Two thirds of the resultant LDL paicles are metabo- lized by the LDL receptor pathway, and the rest is metabo- lized by a receptor for oxidized LDL (scavenger receptor), to be described later. The LDL receptor binds to apolipo- proteins B-100 and E and thus is involved in the transpo of both LDL and IDL. Although the LDL receptors are widely distributed, approximately 75% are located on hepatocytes, so the liver plays an extremely impoant role in LDL metabolism. The first step in the receptor-mediated transpo of LDL involves binding to the cell surface receptor, followed by endocy- totic internalization inside so-called \"clathrin-coated pits\" (Fig. 6-3). Within the cell, the endocytic vesicles fuse with the lysosomes, and the LDL molecule is enzymatically degraded, resulting ultimately in the release of free cholesterol into the cytoplasm. The cholesterol not only is used by the cell for membrane synthesis but also takes pa in intracel- lular cholesterol homeostasis by a sophisticated system of feed- back control: * It suppresses cholesterol synthesis by inhibiting the activity of the enzyme 3-hydroxy-3-methylglutaryl- coenzyme A reductase (HMG-CoA reductase), which is the rate-limiting enzyme in the synthetic pathway. * It stimulates the formation of cholesterol esters for storage of excess cholesterol. * It downregulates the synthesis of cell surface LDL recep- tors, thus protecting cells from excessive accumulation of cholesterol. The transpo of LDL by the scavenger receptors, alluded to earlier, seems to take place in cells of the mononuclear- phagocyte system and possibly in other cells as well. Monocytes and macrophages have receptors for chemically modified (e.g., acetylated or oxidized) LDLs. The amount catabolized by this \"scavenger receptor\" pathway is directly related to the plasma cholesterol level. (Robbins Basic Pathology,9th edition,pg no. 219)\nB", "question_key": "the inheritance pattern of familial hypercholesterolemia is", "split": "validation", "is_mia_member": false} {"id": "8667d1a3-bee7-450c-9897-d44d2b2992a9", "question": "Diagnostic power of a test is reflected by", "opa": "image_question", "opb": "image_question", "opc": "image_question", "opd": "image_question", "cop": 2, "answer": "C", "exp": "Diagnostic power of Screening test: Predictive accuracy (it tells the actual no.of people having the disease or not having the disease out of those shown positive or negative by a screening test, respectively) Diagnostic power of a screening test to correctly identify a disease: Positive predictive value(PPV). Diagnostic power of a screening test to correctly exclude a disease: Negative predictive value (NPV) Ref: Parl 25th edition Pgno: 153", "explanation_word_count": 69, "prompt": "Diagnostic power of a test is reflected by\nA. image_question\nB. image_question\nC. image_question\nD. image_question\nReturn the correct option letter.", "reference": "Diagnostic power of Screening test: Predictive accuracy (it tells the actual no.of people having the disease or not having the disease out of those shown positive or negative by a screening test, respectively) Diagnostic power of a screening test to correctly identify a disease: Positive predictive value(PPV). Diagnostic power of a screening test to correctly exclude a disease: Negative predictive value (NPV) Ref: Parl 25th edition Pgno: 153\nC", "question_key": "diagnostic power of a test is reflected by", "split": "validation", "is_mia_member": false} {"id": "e9cc12ec-98f6-4fa0-9cbb-ef636489cd7a", "question": "Which one of the following is not an aetiology of transudative pleural effusion?", "opa": "Mesothelioma", "opb": "Congestive hea failure", "opc": "Cirrhosis", "opd": "Nephrotic syndrome", "cop": 0, "answer": "A", "exp": "Malignant mesothelioma produces exudative pleural effusion.The chest radiograph reveals a pleural effusion,generalized pleural thickening,and a shrunken hemithorax.Mesothelioma arise from the mesothelial cells,and most are related to asbestos exposure. Reference:Harrison's medicine-18th edition,page no:2179.", "explanation_word_count": 40, "prompt": "Which one of the following is not an aetiology of transudative pleural effusion?\nA. Mesothelioma\nB. Congestive hea failure\nC. Cirrhosis\nD. Nephrotic syndrome\nReturn the correct option letter.", "reference": "Malignant mesothelioma produces exudative pleural effusion.The chest radiograph reveals a pleural effusion,generalized pleural thickening,and a shrunken hemithorax.Mesothelioma arise from the mesothelial cells,and most are related to asbestos exposure. Reference:Harrison's medicine-18th edition,page no:2179.\nA", "question_key": "which one of the following is not an aetiology of transudative pleural effusion?", "split": "validation", "is_mia_member": false} {"id": "417e4104-370f-4905-b3f8-ef4fc6fa06c6", "question": "Rupture of the carotid artery in the neck region. Which of the following site pressure is applied", "opa": "C3 vertebra", "opb": "C4vertebr", "opc": "C5 vertebra", "opd": "C6 vertebra", "cop": 3, "answer": "D", "exp": "D. i.e. (C6 - vertebra ) (444 - Grey 14th)The bifurcation of the common carotid artery in to the internal and external carotid arteries can be palpated just beneath the anterior border of sterno cleidomastoid muscle at the level of the superior border of the thyroid cartilage. This is a convenient site to take the carotid pulse (748- Snell 8th) (C3 - C4 junction)The artery may be compressed against the prominent transverse process of the sixth cervical vertebra (chassaignac's tubercle) and above this level it is superficial and its pulsation can be easily fet (444 - Gray - anatomy 14th)* Best radiographic view for fracture of Cl C2 vertebra is odontoid view*** C7 has longest spinous process*** Subclavian Artery in patients with upper limb hemorrhage - compressed against the upper surface of the fist rib (third part of subclavian artery", "explanation_word_count": 133, "prompt": "Rupture of the carotid artery in the neck region. Which of the following site pressure is applied\nA. C3 vertebra\nB. C4vertebr\nC. C5 vertebra\nD. C6 vertebra\nReturn the correct option letter.", "reference": "D. i.e. (C6 - vertebra ) (444 - Grey 14th)The bifurcation of the common carotid artery in to the internal and external carotid arteries can be palpated just beneath the anterior border of sterno cleidomastoid muscle at the level of the superior border of the thyroid cartilage. This is a convenient site to take the carotid pulse (748- Snell 8th) (C3 - C4 junction)The artery may be compressed against the prominent transverse process of the sixth cervical vertebra (chassaignac's tubercle) and above this level it is superficial and its pulsation can be easily fet (444 - Gray - anatomy 14th)* Best radiographic view for fracture of Cl C2 vertebra is odontoid view*** C7 has longest spinous process*** Subclavian Artery in patients with upper limb hemorrhage - compressed against the upper surface of the fist rib (third part of subclavian artery\nD", "question_key": "rupture of the carotid artery in the neck region. which of the following site pressure is applied", "split": "validation", "is_mia_member": false} {"id": "67c333fb-0b37-4a45-8dc7-bf0053de2145", "question": "In a patient with a transplanted heart which of these are the reasons for increased cardiac output during exercise", "opa": "Reinnervation of transplanted heart by vagus", "opb": "Intrinsic mechanism.", "opc": "Epinephrine from medulla", "opd": "Bainbridge reflex", "cop": 2, "answer": "C", "exp": "Cardiac transplantation results in total denervation of the donor's heart, including the donor sinus node, which usually controls heart rate after transplantation.\nDenervation causes an increase in basal heart rate due to parasympathetic sectioning (normally parasympathetic tone is greater than sympathetic tone on the heart).\n\nFurther increase in heart rate during exercise is dependent primarily on increase in plasma catecholamine concentration, e.g. from the adrenal medulla.", "explanation_word_count": 67, "prompt": "In a patient with a transplanted heart which of these are the reasons for increased cardiac output during exercise\nA. Reinnervation of transplanted heart by vagus\nB. Intrinsic mechanism.\nC. Epinephrine from medulla\nD. Bainbridge reflex\nReturn the correct option letter.", "reference": "Cardiac transplantation results in total denervation of the donor's heart, including the donor sinus node, which usually controls heart rate after transplantation.\nDenervation causes an increase in basal heart rate due to parasympathetic sectioning (normally parasympathetic tone is greater than sympathetic tone on the heart).\n\nFurther increase in heart rate during exercise is dependent primarily on increase in plasma catecholamine concentration, e.g. from the adrenal medulla.\nC", "question_key": "in a patient with a transplanted heart which of these are the reasons for increased cardiac output during exercise", "split": "validation", "is_mia_member": false} {"id": "ac0db10d-6cd8-4ef2-9de8-22577d1b8c18", "question": "Agent causing hemorrhagic cystitis", "opa": "Cyclophosphamide", "opb": "Vincristine", "opc": "Cisplatin", "opd": "5 Fluorouracil", "cop": 0, "answer": "A", "exp": "Ans: a (Cyclophosphamide)Ref: KD Tripathi, 6th ed. Pg. 822Haemorrhagic cystitis is caused by a metabolite of cyclophosphamide - acrolein If severe, the cystitis may be effectively treated by mesna.Drugs causing Haemorrhagic cystitisIfosfamide Cyclophosphamide Aniline or toluidine derivatives Penicillins - rare Danazol - rare Ifosfamide is the most common cause of haemorrhagic cystitis.", "explanation_word_count": 51, "prompt": "Agent causing hemorrhagic cystitis\nA. Cyclophosphamide\nB. Vincristine\nC. Cisplatin\nD. 5 Fluorouracil\nReturn the correct option letter.", "reference": "Ans: a (Cyclophosphamide)Ref: KD Tripathi, 6th ed. Pg. 822Haemorrhagic cystitis is caused by a metabolite of cyclophosphamide - acrolein If severe, the cystitis may be effectively treated by mesna.Drugs causing Haemorrhagic cystitisIfosfamide Cyclophosphamide Aniline or toluidine derivatives Penicillins - rare Danazol - rare Ifosfamide is the most common cause of haemorrhagic cystitis.\nA", "question_key": "agent causing hemorrhagic cystitis", "split": "validation", "is_mia_member": false} {"id": "6380a5dd-9aa6-4162-b75d-a1a11364b8a6", "question": "Meig's syndrome is associated with ovarian: September 2006", "opa": "Teratoma", "opb": "Brenner tumour", "opc": "Fibroma", "opd": "Theca cell tumour", "cop": 2, "answer": "C", "exp": "Ans. C: Fibroma Meigs' syndrome, is the triad of ascites, pleural effusiion and benign ovarian fibroma. It resolves after the resection of the tumour. For reasons unknown, the pleural effusion is classically on the right side", "explanation_word_count": 36, "prompt": "Meig's syndrome is associated with ovarian: September 2006\nA. Teratoma\nB. Brenner tumour\nC. Fibroma\nD. Theca cell tumour\nReturn the correct option letter.", "reference": "Ans. C: Fibroma Meigs' syndrome, is the triad of ascites, pleural effusiion and benign ovarian fibroma. It resolves after the resection of the tumour. For reasons unknown, the pleural effusion is classically on the right side\nC", "question_key": "meig's syndrome is associated with ovarian: september 2006", "split": "validation", "is_mia_member": false} {"id": "34524ef4-95a0-49e2-9107-ab204ae1eab5", "question": "Which of the milestones develop first", "opa": "Mirror play", "opb": "Crawling", "opc": "Creeping", "opd": "Pincer grasp", "cop": 0, "answer": "A", "exp": "*Mirror play is attained by 6 months *Crawling by 8 months *Creeps by 10 months and creeps well by 12 months *Immature pincer grasp by 10 months *Mature pincer grasp by 12 months Ref : OP GHAI - ESSENTIAL PEDIATRICS - 8 TH edition page no 4 and 52", "explanation_word_count": 37, "prompt": "Which of the milestones develop first\nA. Mirror play\nB. Crawling\nC. Creeping\nD. Pincer grasp\nReturn the correct option letter.", "reference": "*Mirror play is attained by 6 months *Crawling by 8 months *Creeps by 10 months and creeps well by 12 months *Immature pincer grasp by 10 months *Mature pincer grasp by 12 months Ref : OP GHAI - ESSENTIAL PEDIATRICS - 8 TH edition page no 4 and 52\nA", "question_key": "which of the milestones develop first", "split": "validation", "is_mia_member": false} {"id": "0b7bd8f1-6303-4933-9f6a-657abe3eb0b8", "question": "Which of the following has life span of upto 10 years?", "opa": "Progestasert", "opb": "CuT 380A", "opc": "LNG-IUD", "opd": "CuT 250", "cop": 1, "answer": "B", "exp": "Ans. B. CuT 380A. (Ref. Obstetrics D.C. Dutta 6th Ed. - 483).The TCu380A IUD (ParaGard) is a T-shaped polyethylene rod, wrapped with copper around the arms and stem. It is approved for 10 years of continuous use.Good Candidates for TCu380A# Postpartum women, breastfeeding or not, after 4 weeks.# Women with liver disease, hepatitis.# Women with breast cancer.# Women with hypertension, hyperlipidemia.# Women with current or history of ischemic heart disease, stroke.# Women with multiple risk factors for cardiovascular disease. Women with uncomplicated valvular heart disease.# Women with current deep vein thrombosis/pulmonary embolism.# Women who have had major surgery.# Women with migraines with or without focal neurological symptoms.# Women with gall bladder disease or history of pregnancy-related cholestasis.The LNG-IUS (Mirena). is a T-shaped polydimethylsiloxane rod con- taining 52 mg LNG. The LNG-IUS is approved for 5 years of use. The LNG-IUS adds an important non-contra- ceptive advantage for this age group: it decreases menstrual blood loss and dysmenorrhea and may avoid the need for hysterectomy or endometrial ablation. The copper IUD is generally associated with heavier menses.In addition to decreasing menstrual blood loss, the local administration of LNG to the endometrium protects it from development of estrogen-induced endometrial hyperplasia. This is of benefit for transitional women with irregular bleeding and for women on tamoxifen therapy following breast cancer. Use of the LNG-IUS is reported to reduce the risk of endometrial cancer by 40-60%.GOOD CANDIDATES FOR LNG-IUS# Women with menorrhagia, dysmenorrhea, or endometriosis.# Women with bleeding disorders or on anticoagulation therapy.Women with thalassemia, sickle cell disease, or iron- deficiency anemia.# Breastfeeding women after 4-6 weeks postpartum.Generation of IUCDCoilFailure rateLasts for (years)FirstCuT (200)>2/1003-5 CuT (200)>2/100 SecondMultiload Cu 2501-2 /1003-5 NovaT1-2 /1001-2/100ThirdMultiload Cu 3750.5-111005+ Copper Cu 380A0.3-1/100 Hormone releasingProgestasert (no more manufactured)1lyr LNG-IUCD(52mg Levenorgestrel impregnated; releases at arte of 20?g/day)0.5/100 at 1 yr5 yrs 0.7/100 at 3 yr 1/100 at 5 yr Marina (Latest)Least5 yrsMore Educational points:# Cu T 380A and Levenorgestrel have got lowest rate, whereas progestasert has got highest rate of ectopic pregnancy.# The Mirena IUD works by killing or irreparably damaging sperm and obstructing it's ability to fertilize an egg. It does this by releasing levonorgestrel, also known as progestin.# Progestin is a synthetic substance which imitates the biological activity of the natural hormone progesterone.# Progesterone can inhibit ovulation during pregnancy. Progestin was synthesized for, among reasons, suppresing ovulation for birth control.- Mirena reduces the frequency of ovulation. Ovulation occurs during the menstrual cycle where the ovarian follicle releases an egg. Reduction of the times in which an egg is available to fertilize handicaps the sperm's opportunity for reproduction.- Mirena changes the consistency of cervical mucus. This change thickens the cervical mucus making the passage of sperm through the cervix much more difficult.- Mirena thins the endometrium, the lining of the walls of the uterus. It is thought that this reduces the chances of embryo implantation to the endometrium.LNG-IUCD:# A new device, levonova (LNG IUD) contains 60mg of levonorgestrel and releases the hormone in very low doses i.e. 20 microgram/ day (versus Progestasert which carries 38mg of progesterone and releases 65microgram of the hormone per day).# It is thus longacting (5 years) and has low pregnancy rate of 0-3 per 100 woman years, n However, risk of ectopic pregnancy is higher.# Mechanism of action: - Strong and uniform endometrial suppression - Scanty cervical mucus - Anovulation and insufficient luteal phase and normal progesterone levels, n It can be used as hormone replacing therapy.# It is useful for the treatment of endometrial hyperplasia, n Irregular uterine bleeding can be a problem initially.# MIRENA contains 52mg levonorgestrel, eluting 20 microgram daily. It can be retained for 5 years, with failure rate of 0 to 3 per 100 woman years.EMERGENCY CONTRACEPTION (Postcoital contraception)Mechanism of action1. Delaying /inhibiting ovulation2. Inhibiting fertilization3. Preventing implantation of fertilized eggIndications1. Unprotected intercourse2. Condom rupture3. Missed pills4. Sexual assault or rape5. First time intercourse.Methods1. Morning after pills (Conjugated estrogen and ethnyl estradiol)--use in 72 hr.2. Combined hormonal regimen (YUZPE method)Q3. POP (very successful)4. IUCD (should be inserted within5 days)5. RU486 (Mifepristone)-single dose 600 mg irrespective of day and number of intercourse.", "explanation_word_count": 673, "prompt": "Which of the following has life span of upto 10 years?\nA. Progestasert\nB. CuT 380A\nC. LNG-IUD\nD. CuT 250\nReturn the correct option letter.", "reference": "Ans. B. CuT 380A. (Ref. Obstetrics D.C. Dutta 6th Ed. - 483).The TCu380A IUD (ParaGard) is a T-shaped polyethylene rod, wrapped with copper around the arms and stem. It is approved for 10 years of continuous use.Good Candidates for TCu380A# Postpartum women, breastfeeding or not, after 4 weeks.# Women with liver disease, hepatitis.# Women with breast cancer.# Women with hypertension, hyperlipidemia.# Women with current or history of ischemic heart disease, stroke.# Women with multiple risk factors for cardiovascular disease. Women with uncomplicated valvular heart disease.# Women with current deep vein thrombosis/pulmonary embolism.# Women who have had major surgery.# Women with migraines with or without focal neurological symptoms.# Women with gall bladder disease or history of pregnancy-related cholestasis.The LNG-IUS (Mirena). is a T-shaped polydimethylsiloxane rod con- taining 52 mg LNG. The LNG-IUS is approved for 5 years of use. The LNG-IUS adds an important non-contra- ceptive advantage for this age group: it decreases menstrual blood loss and dysmenorrhea and may avoid the need for hysterectomy or endometrial ablation. The copper IUD is generally associated with heavier menses.In addition to decreasing menstrual blood loss, the local administration of LNG to the endometrium protects it from development of estrogen-induced endometrial hyperplasia. This is of benefit for transitional women with irregular bleeding and for women on tamoxifen therapy following breast cancer. Use of the LNG-IUS is reported to reduce the risk of endometrial cancer by 40-60%.GOOD CANDIDATES FOR LNG-IUS# Women with menorrhagia, dysmenorrhea, or endometriosis.# Women with bleeding disorders or on anticoagulation therapy.Women with thalassemia, sickle cell disease, or iron- deficiency anemia.# Breastfeeding women after 4-6 weeks postpartum.Generation of IUCDCoilFailure rateLasts for (years)FirstCuT (200)>2/1003-5 CuT (200)>2/100 SecondMultiload Cu 2501-2 /1003-5 NovaT1-2 /1001-2/100ThirdMultiload Cu 3750.5-111005+ Copper Cu 380A0.3-1/100 Hormone releasingProgestasert (no more manufactured)1lyr LNG-IUCD(52mg Levenorgestrel impregnated; releases at arte of 20?g/day)0.5/100 at 1 yr5 yrs 0.7/100 at 3 yr 1/100 at 5 yr Marina (Latest)Least5 yrsMore Educational points:# Cu T 380A and Levenorgestrel have got lowest rate, whereas progestasert has got highest rate of ectopic pregnancy.# The Mirena IUD works by killing or irreparably damaging sperm and obstructing it's ability to fertilize an egg. It does this by releasing levonorgestrel, also known as progestin.# Progestin is a synthetic substance which imitates the biological activity of the natural hormone progesterone.# Progesterone can inhibit ovulation during pregnancy. Progestin was synthesized for, among reasons, suppresing ovulation for birth control.- Mirena reduces the frequency of ovulation. Ovulation occurs during the menstrual cycle where the ovarian follicle releases an egg. Reduction of the times in which an egg is available to fertilize handicaps the sperm's opportunity for reproduction.- Mirena changes the consistency of cervical mucus. This change thickens the cervical mucus making the passage of sperm through the cervix much more difficult.- Mirena thins the endometrium, the lining of the walls of the uterus. It is thought that this reduces the chances of embryo implantation to the endometrium.LNG-IUCD:# A new device, levonova (LNG IUD) contains 60mg of levonorgestrel and releases the hormone in very low doses i.e. 20 microgram/ day (versus Progestasert which carries 38mg of progesterone and releases 65microgram of the hormone per day).# It is thus longacting (5 years) and has low pregnancy rate of 0-3 per 100 woman years, n However, risk of ectopic pregnancy is higher.# Mechanism of action: - Strong and uniform endometrial suppression - Scanty cervical mucus - Anovulation and insufficient luteal phase and normal progesterone levels, n It can be used as hormone replacing therapy.# It is useful for the treatment of endometrial hyperplasia, n Irregular uterine bleeding can be a problem initially.# MIRENA contains 52mg levonorgestrel, eluting 20 microgram daily. It can be retained for 5 years, with failure rate of 0 to 3 per 100 woman years.EMERGENCY CONTRACEPTION (Postcoital contraception)Mechanism of action1. Delaying /inhibiting ovulation2. Inhibiting fertilization3. Preventing implantation of fertilized eggIndications1. Unprotected intercourse2. Condom rupture3. Missed pills4. Sexual assault or rape5. First time intercourse.Methods1. Morning after pills (Conjugated estrogen and ethnyl estradiol)--use in 72 hr.2. Combined hormonal regimen (YUZPE method)Q3. POP (very successful)4. IUCD (should be inserted within5 days)5. RU486 (Mifepristone)-single dose 600 mg irrespective of day and number of intercourse.\nB", "question_key": "which of the following has life span of upto 10 years?", "split": "validation", "is_mia_member": false} {"id": "2accf933-b8a2-4d59-a0f4-7f8fce4e1d10", "question": "Which of the following is a long acting bronchodilator?", "opa": "Salbutamol", "opb": "Terbutaline", "opc": "Adrenaline", "opd": "Formoterol", "cop": 3, "answer": "D", "exp": "Beta-2 agonists are well known bronchodilators. This includes:#Salbutamol, Terbutaline, Formoterol, Salmeterol, Indacaterol, Albuterol etc.Among these agents, formoterol, salmeterol, Indacaterol are longer acting analogue and are preferred in prophylactic therapy of bronchial asthma and COPD.", "explanation_word_count": 36, "prompt": "Which of the following is a long acting bronchodilator?\nA. Salbutamol\nB. Terbutaline\nC. Adrenaline\nD. Formoterol\nReturn the correct option letter.", "reference": "Beta-2 agonists are well known bronchodilators. This includes:#Salbutamol, Terbutaline, Formoterol, Salmeterol, Indacaterol, Albuterol etc.Among these agents, formoterol, salmeterol, Indacaterol are longer acting analogue and are preferred in prophylactic therapy of bronchial asthma and COPD.\nD", "question_key": "which of the following is a long acting bronchodilator?", "split": "validation", "is_mia_member": false} {"id": "3a569115-592c-4c84-b164-92ff4c41439f", "question": "Half-life of insulin receptor is", "opa": "3 hr", "opb": "7 hr", "opc": "12 hr", "opd": "24 hr", "cop": 1, "answer": "B", "exp": "The insulin receptor (IR) is a transmembrane receptor that is activated by insulin, IGF-I, IGF-II and belongs to the large class of tyrosine kinase receptors. Metabolically, the insulin receptor plays a key role in the regulation of glucose homeostasis, a functional process that under degenerate conditions may result in a range of clinical manifestations including diabetes and cancer. The half-life of insulin receptor is about 7 hrs.Ref: Ganong&;s review of medical physiology;24th edition; page no-437", "explanation_word_count": 77, "prompt": "Half-life of insulin receptor is\nA. 3 hr\nB. 7 hr\nC. 12 hr\nD. 24 hr\nReturn the correct option letter.", "reference": "The insulin receptor (IR) is a transmembrane receptor that is activated by insulin, IGF-I, IGF-II and belongs to the large class of tyrosine kinase receptors. Metabolically, the insulin receptor plays a key role in the regulation of glucose homeostasis, a functional process that under degenerate conditions may result in a range of clinical manifestations including diabetes and cancer. The half-life of insulin receptor is about 7 hrs.Ref: Ganong&;s review of medical physiology;24th edition; page no-437\nB", "question_key": "half-life of insulin receptor is", "split": "validation", "is_mia_member": false} {"id": "ec127d31-c43f-4034-b0c2-fb8bad817ff7", "question": "Urease test is positive for: March 2013", "opa": "E. coli", "opb": "Klebsiella", "opc": "V. cholerae", "opd": "Filaria", "cop": 1, "answer": "B", "exp": "Ans. B i.e. Klebsiella Urease It catalyzes the hydrolysis of urea to produce ammonia and carbamate, the carbamate produced is subsequently degraded by spontaneous hydrolysis to produce another ammonia and carbonic acid. Urease activity tends to increase the pH of the environment in which it is as it produces ammonia, as it is a basic molecule. Ureases are found in numerous bacteria, fungi, algae, plants and some inveebrates, as well as in soils, as a soil enzyme. They are nickel-containing metalloenzymes of high molecular weight. Mnemonic (PUNCH-K): P-Proteus; U-Ureaplasma; N-Nocardia; C-Cryptococcus; H-Helicobacter; K: Klebsiella", "explanation_word_count": 95, "prompt": "Urease test is positive for: March 2013\nA. E. coli\nB. Klebsiella\nC. V. cholerae\nD. Filaria\nReturn the correct option letter.", "reference": "Ans. B i.e. Klebsiella Urease It catalyzes the hydrolysis of urea to produce ammonia and carbamate, the carbamate produced is subsequently degraded by spontaneous hydrolysis to produce another ammonia and carbonic acid. Urease activity tends to increase the pH of the environment in which it is as it produces ammonia, as it is a basic molecule. Ureases are found in numerous bacteria, fungi, algae, plants and some inveebrates, as well as in soils, as a soil enzyme. They are nickel-containing metalloenzymes of high molecular weight. Mnemonic (PUNCH-K): P-Proteus; U-Ureaplasma; N-Nocardia; C-Cryptococcus; H-Helicobacter; K: Klebsiella\nB", "question_key": "urease test is positive for: march 2013", "split": "validation", "is_mia_member": false} {"id": "2ed70b51-8874-4365-8ab3-9f648e440e6a", "question": "A child comes with a circular 3cm x 3cm scaly patchy hair loss with itching in the lesions. The investigation of choice is", "opa": "Split skin smear", "opb": "KOH mount", "opc": "Gram stain", "opd": "Tzanck smear", "cop": 1, "answer": "B", "exp": "Itchy lesions over head with hair loss likely suggestive of Tinea capitis and KOH mount of hairs is the investigation of choice.", "explanation_word_count": 22, "prompt": "A child comes with a circular 3cm x 3cm scaly patchy hair loss with itching in the lesions. The investigation of choice is\nA. Split skin smear\nB. KOH mount\nC. Gram stain\nD. Tzanck smear\nReturn the correct option letter.", "reference": "Itchy lesions over head with hair loss likely suggestive of Tinea capitis and KOH mount of hairs is the investigation of choice.\nB", "question_key": "a child comes with a circular 3cm x 3cm scaly patchy hair loss with itching in the lesions. the investigation of choice is", "split": "validation", "is_mia_member": false} {"id": "d97e0fca-3912-4e00-96cc-2acf542d2dd8", "question": "Micronutrient associated with rash and diarrhea is:", "opa": "Manganese", "opb": "Copper", "opc": "Zinc", "opd": "Iron", "cop": 2, "answer": "C", "exp": "Acrodermatitis enteropathica is a rare autosomal recessive disorder caused by an inability to absorb sufficient zinc from diet. The cutaneous eruption consists of vesicio-bullous, eczematous, dry scaly or psoriasisiform skin lesions symmetrically distributed in body. Associated manifestations include chronic, stomatitis, glossitis, paronychia and superinfection with candida albicans. Ref: Park 21st edition: page 577.", "explanation_word_count": 52, "prompt": "Micronutrient associated with rash and diarrhea is:\nA. Manganese\nB. Copper\nC. Zinc\nD. Iron\nReturn the correct option letter.", "reference": "Acrodermatitis enteropathica is a rare autosomal recessive disorder caused by an inability to absorb sufficient zinc from diet. The cutaneous eruption consists of vesicio-bullous, eczematous, dry scaly or psoriasisiform skin lesions symmetrically distributed in body. Associated manifestations include chronic, stomatitis, glossitis, paronychia and superinfection with candida albicans. Ref: Park 21st edition: page 577.\nC", "question_key": "micronutrient associated with rash and diarrhea is:", "split": "validation", "is_mia_member": false} {"id": "b9f6c3a3-bc00-4059-b9c6-ff8da9780ac4", "question": "Dakin's solution is", "opa": "0.5% NaOCl", "opb": "2.5% NaOCl", "opc": "1.25% NaOCl", "opd": "5.2% NaOCl", "cop": 0, "answer": "A", "exp": "NaOCl as a buffered 0.5% solution was recommended for irrigation of wound during world war I by Dakin. Coolidge introduced NaoCl to endodontics.", "explanation_word_count": 22, "prompt": "Dakin's solution is\nA. 0.5% NaOCl\nB. 2.5% NaOCl\nC. 1.25% NaOCl\nD. 5.2% NaOCl\nReturn the correct option letter.", "reference": "NaOCl as a buffered 0.5% solution was recommended for irrigation of wound during world war I by Dakin. Coolidge introduced NaoCl to endodontics.\nA", "question_key": "dakin's solution is", "split": "validation", "is_mia_member": false} {"id": "9e756e0b-9bf4-45a1-9bf4-976ba762f958", "question": "Buerger waves (alpha waves) of EEG have the rhythm per sec of", "opa": "0-4", "opb": "7-Apr", "opc": "13-Aug", "opd": "13-30", "cop": 2, "answer": "C", "exp": "Stages of sleep and rhythm\n- Beta rhythm- Alert, awake, maximum concentration- 13-30Hz\n- Alpha rhythm- Eyes closed, mind wandering, less attentiveness- 8-13Hz\n- Theta rhythm- Stage 1 NREM- 4-7 Hz\n- Sleep spindles, K complex- Stage 2 NREM\n- Delta rhythm- Deep sleep (Stage 3 & 4 NREM)- 3-5 Hz\n- Beta Rhythm and occasional alpha rhythm- REM", "explanation_word_count": 46, "prompt": "Buerger waves (alpha waves) of EEG have the rhythm per sec of\nA. 0-4\nB. 7-Apr\nC. 13-Aug\nD. 13-30\nReturn the correct option letter.", "reference": "Stages of sleep and rhythm\n- Beta rhythm- Alert, awake, maximum concentration- 13-30Hz\n- Alpha rhythm- Eyes closed, mind wandering, less attentiveness- 8-13Hz\n- Theta rhythm- Stage 1 NREM- 4-7 Hz\n- Sleep spindles, K complex- Stage 2 NREM\n- Delta rhythm- Deep sleep (Stage 3 & 4 NREM)- 3-5 Hz\n- Beta Rhythm and occasional alpha rhythm- REM\nC", "question_key": "buerger waves (alpha waves) of eeg have the rhythm per sec of", "split": "validation", "is_mia_member": false} {"id": "a83e0975-7442-40dc-ae3e-a36655631a13", "question": "Most prominent spinous process is of which vertebra?", "opa": "C6", "opb": "C7", "opc": "L1", "opd": "T12", "cop": 1, "answer": "B", "exp": "Ans. b (C7). (Ref. BD Chaurasia, Anatomy, Vol 3, 2nd/pg.35)Importance of certain cervical vertebral levelCs-C6Most common disc space reduced in cervical spondylosis.C6has prominent bony tubercle called Chassaignae's tubercle at the level of cricoid cartilage (a level where trachea ends).C7is also known as vertebra prominence as it has most prominent and long spinous process among the all-cervical vertebrae, and the tip of which can be felt on palpation just below the nape of the neck.C7 spinous process tip give attachment to following structures:- Ligamentum nuchae- Rhomboidus minor- Serratus posterior- Semispinalis, and- Trapezius- Interspinalis- Splenius capitis- Spinalis cervicis", "explanation_word_count": 103, "prompt": "Most prominent spinous process is of which vertebra?\nA. C6\nB. C7\nC. L1\nD. T12\nReturn the correct option letter.", "reference": "Ans. b (C7). (Ref. BD Chaurasia, Anatomy, Vol 3, 2nd/pg.35)Importance of certain cervical vertebral levelCs-C6Most common disc space reduced in cervical spondylosis.C6has prominent bony tubercle called Chassaignae's tubercle at the level of cricoid cartilage (a level where trachea ends).C7is also known as vertebra prominence as it has most prominent and long spinous process among the all-cervical vertebrae, and the tip of which can be felt on palpation just below the nape of the neck.C7 spinous process tip give attachment to following structures:- Ligamentum nuchae- Rhomboidus minor- Serratus posterior- Semispinalis, and- Trapezius- Interspinalis- Splenius capitis- Spinalis cervicis\nB", "question_key": "most prominent spinous process is of which vertebra?", "split": "validation", "is_mia_member": false} {"id": "fdd3dd9d-2385-4ab0-82ec-78e9eeef6866", "question": "Polycythemia vera is absolute venous hematocrit of > -", "opa": "45%", "opb": "55%", "opc": "65%", "opd": "70%", "cop": 1, "answer": "B", "exp": "Ans. is 'b' i.e., 55% Diagnosis of polycythemiaHematocrito The hematocrit (HCT) is expressed as the percent of a blood occupied by intact RBC's.o Polycy'themia in the adult patient is suspected when the hematocrit is> 48% in women> 52% in menHemoeiobin concentrationo The hemoglobin concentration (HGB) is its content in grams/100 ml of whole blood. Polycythemia in the adult is suspected when the hemoglobin is>16.5% in women> 18.5% in menRed blood cell counto The red blood cell count is expressed as the number of RBC per microl or L of whole blood,o It is least often used to suggest polycythemia since patients with thalassemia minor may have an elevated RBC count but a normal or reduced hematocrit or hemoglobin due to presence of small (microcytic) poorly hemoglobinized (hypochromid red cells).o Once a high value has been reported it should be confirmed by repeat testing to rule out lab error.o An accurate history and physical examination is critical in order to determine the etiology of polycythemia.o The most common cause of polycythemia is hypoxia secondary to pulmonary disease as a result pertaining eliciting symptoms pertaining to altered lung function.The 2008 WHO diagnostic criteria for polycythemia vera: -MAJOR CRITERIAo Hb > 18.59/dl (men) > 16.5 g/'dl (women)oro Hb or Hct > 99,h percentile of reference for age, sex or altitude of residenceoro Hb> 17g/dl (men)o Hb > 15g;dl (women)If associated with a sustained increase of 129 gdl fronts baseline that cannot be attributed to correction of iron defic iencyoro Elevated red cell mass > 25% above mean normal predicted valueo Presence of JAK 2V617F or similar mutationMINOR CRITERIAo Bone marrow biopsy showing trilineage myeloproliferationo Subnormal serum ervthropoieten level EFC growth", "explanation_word_count": 278, "prompt": "Polycythemia vera is absolute venous hematocrit of > -\nA. 45%\nB. 55%\nC. 65%\nD. 70%\nReturn the correct option letter.", "reference": "Ans. is 'b' i.e., 55% Diagnosis of polycythemiaHematocrito The hematocrit (HCT) is expressed as the percent of a blood occupied by intact RBC's.o Polycy'themia in the adult patient is suspected when the hematocrit is> 48% in women> 52% in menHemoeiobin concentrationo The hemoglobin concentration (HGB) is its content in grams/100 ml of whole blood. Polycythemia in the adult is suspected when the hemoglobin is>16.5% in women> 18.5% in menRed blood cell counto The red blood cell count is expressed as the number of RBC per microl or L of whole blood,o It is least often used to suggest polycythemia since patients with thalassemia minor may have an elevated RBC count but a normal or reduced hematocrit or hemoglobin due to presence of small (microcytic) poorly hemoglobinized (hypochromid red cells).o Once a high value has been reported it should be confirmed by repeat testing to rule out lab error.o An accurate history and physical examination is critical in order to determine the etiology of polycythemia.o The most common cause of polycythemia is hypoxia secondary to pulmonary disease as a result pertaining eliciting symptoms pertaining to altered lung function.The 2008 WHO diagnostic criteria for polycythemia vera: -MAJOR CRITERIAo Hb > 18.59/dl (men) > 16.5 g/'dl (women)oro Hb or Hct > 99,h percentile of reference for age, sex or altitude of residenceoro Hb> 17g/dl (men)o Hb > 15g;dl (women)If associated with a sustained increase of 129 gdl fronts baseline that cannot be attributed to correction of iron defic iencyoro Elevated red cell mass > 25% above mean normal predicted valueo Presence of JAK 2V617F or similar mutationMINOR CRITERIAo Bone marrow biopsy showing trilineage myeloproliferationo Subnormal serum ervthropoieten level EFC growth\nB", "question_key": "polycythemia vera is absolute venous hematocrit of > -", "split": "validation", "is_mia_member": false} {"id": "7658059f-9d3f-4fc0-8f5f-c7c46387d28e", "question": "Which is not transmitted by arthropod :", "opa": "Rickettsia prowazaki", "opb": "Coxiella burneti", "opc": "Rickettsia akasi", "opd": "Rickettsia rickettsi", "cop": 1, "answer": "B", "exp": "Ans. is 'b' i.e. Coxiella Burnetti \"Rickettsia is a small obligate intracellular parasite and except for Q fever (caused by Coxiella burnetti) are transmitted to human by Arthropod\"Human Diseases Caused By RickettsiaOrganism Disease Vector* Rickettsia prowazekii Epidemic Typhus* louse** Rickettsia typhi Endemic Typhus* Flea** Orientia Tsutsugamushi Scrub Typhus* Mite** Rickettsia Ricketsei Rocky mountain* spotted fever* Tick** Rickettsia Akari Rickettsialpox* Mite** Coxiella Burnetti Q fever * Airborne fomites*", "explanation_word_count": 68, "prompt": "Which is not transmitted by arthropod :\nA. Rickettsia prowazaki\nB. Coxiella burneti\nC. Rickettsia akasi\nD. Rickettsia rickettsi\nReturn the correct option letter.", "reference": "Ans. is 'b' i.e. Coxiella Burnetti \"Rickettsia is a small obligate intracellular parasite and except for Q fever (caused by Coxiella burnetti) are transmitted to human by Arthropod\"Human Diseases Caused By RickettsiaOrganism Disease Vector* Rickettsia prowazekii Epidemic Typhus* louse** Rickettsia typhi Endemic Typhus* Flea** Orientia Tsutsugamushi Scrub Typhus* Mite** Rickettsia Ricketsei Rocky mountain* spotted fever* Tick** Rickettsia Akari Rickettsialpox* Mite** Coxiella Burnetti Q fever * Airborne fomites*\nB", "question_key": "which is not transmitted by arthropod :", "split": "validation", "is_mia_member": false} {"id": "bcd242da-73fe-4954-abec-179d85a8af91", "question": "What is the daily requirement of potassium in a healthy adult?", "opa": "2-3 g/day", "opb": "3-4 g/day", "opc": "4-5 g/day", "opd": "5-7 g/day", "cop": 0, "answer": "A", "exp": "Minimum daily requirement for potassium in healthy adults is estimated to be 2g. The average intake of potassium among the adult population of industrialized world is approximately is 2-3 per day. Recommended daily intake of potassium to reduce risk of high blood pressure, stroke, and hea disease is 4-5g/d.", "explanation_word_count": 49, "prompt": "What is the daily requirement of potassium in a healthy adult?\nA. 2-3 g/day\nB. 3-4 g/day\nC. 4-5 g/day\nD. 5-7 g/day\nReturn the correct option letter.", "reference": "Minimum daily requirement for potassium in healthy adults is estimated to be 2g. The average intake of potassium among the adult population of industrialized world is approximately is 2-3 per day. Recommended daily intake of potassium to reduce risk of high blood pressure, stroke, and hea disease is 4-5g/d.\nA", "question_key": "what is the daily requirement of potassium in a healthy adult?", "split": "validation", "is_mia_member": false} {"id": "98962868-b39b-4f72-8a54-79cce3221fba", "question": "The patient with least risk of pulmonary aspiration of gastric contents during induction of anesthesia is:-", "opa": "Markedly obese and NPO for eight hours", "opb": "Fed coffee four hours before elective surgery", "opc": "Scheduled for elective cesarean delivery and NPO for 20 hours", "opd": "NPO for four hours after a full meal", "cop": 0, "answer": "A", "exp": "NPO is same for obese and normal. NPO guidelines - 6hrs for liquid and semisolid, 2 hours NPO for clear fluids. Subset of patients who are at high risk for aspiration - pregnant women, morbidly obese (rapid sequence induction), full fatty meal - 8 hours NPO.", "explanation_word_count": 41, "prompt": "The patient with least risk of pulmonary aspiration of gastric contents during induction of anesthesia is:-\nA. Markedly obese and NPO for eight hours\nB. Fed coffee four hours before elective surgery\nC. Scheduled for elective cesarean delivery and NPO for 20 hours\nD. NPO for four hours after a full meal\nReturn the correct option letter.", "reference": "NPO is same for obese and normal. NPO guidelines - 6hrs for liquid and semisolid, 2 hours NPO for clear fluids. Subset of patients who are at high risk for aspiration - pregnant women, morbidly obese (rapid sequence induction), full fatty meal - 8 hours NPO.\nA", "question_key": "the patient with least risk of pulmonary aspiration of gastric contents during induction of anesthesia is:-", "split": "validation", "is_mia_member": false} {"id": "693f42bd-2c7e-4707-8896-ccb772b7ac3a", "question": "Chemical use in vaginal sponge is -", "opa": "Ethynil estradiol", "opb": "Progesterone", "opc": "Mifepristone", "opd": "Nonoxynol-9", "cop": 3, "answer": "D", "exp": "Ans. is `d' i.e., Non - oxynol - 9 Vaginal sponge It is marketed in USA under the trade name TODAY. o It is small polyurethane foam sponge saturated with spermicide, nanoxynol-9. o The failure rate :- i) Parous women --> 20 to 40 per 100 women years. ii) Nulliparous women --> 9 to 20 per 100 women years.", "explanation_word_count": 48, "prompt": "Chemical use in vaginal sponge is -\nA. Ethynil estradiol\nB. Progesterone\nC. Mifepristone\nD. Nonoxynol-9\nReturn the correct option letter.", "reference": "Ans. is `d' i.e., Non - oxynol - 9 Vaginal sponge It is marketed in USA under the trade name TODAY. o It is small polyurethane foam sponge saturated with spermicide, nanoxynol-9. o The failure rate :- i) Parous women --> 20 to 40 per 100 women years. ii) Nulliparous women --> 9 to 20 per 100 women years.\nD", "question_key": "chemical use in vaginal sponge is -", "split": "validation", "is_mia_member": false} {"id": "bb815f55-5fb4-412b-95a6-8c5a3b8e8747", "question": "Which of the following is a high pitched sound: March 2011", "opa": "1st hea sound", "opb": "Tumour plop", "opc": "Opening Snap", "opd": "4th hea sound", "cop": 2, "answer": "C", "exp": "Ans. C: Opening snap The opening snap (OS) is a brief, high-pitched, early diastolic sound, which is usually due to stenosis of an AV valve, most often the mitral valve First hea sound (S1): Due to closure of AV valves (mitral and tricuspid) Low pitched Duration: 0.14 seconds Soft 51: Mitral stenosis (long standing, calcified), mitral regurgitation Loud Si: Mitral stenosis (prolonged flow through AV valve), anemia, fever, thryotoxicosis Second hea sound (S2): Due to closure of semilunar valves (aoic, pulmonary) High pitched Wide split of S2: Atrial septal defect, mitral regurgitation, pulmonary stenosis Reverse splitting of S2: LBBB, hypeension, aoic stenosis Third hea sound (S3): Due to ventricular filling Low pitched Diastolic, occurring after S2 Best heard at apex with the bell of stethoscope Causes: Children, hyperdynamic states, left ventricular failure, right ventricular failure Fouh hea sounds (S4): Low pitched Pre-systolic, produced during second rapid filling phase (before S1) Best heard with bell of stethoscope Seen in: Hypeension, aoic stenosis, HOCM, acute mitral regurgitation", "explanation_word_count": 163, "prompt": "Which of the following is a high pitched sound: March 2011\nA. 1st hea sound\nB. Tumour plop\nC. Opening Snap\nD. 4th hea sound\nReturn the correct option letter.", "reference": "Ans. C: Opening snap The opening snap (OS) is a brief, high-pitched, early diastolic sound, which is usually due to stenosis of an AV valve, most often the mitral valve First hea sound (S1): Due to closure of AV valves (mitral and tricuspid) Low pitched Duration: 0.14 seconds Soft 51: Mitral stenosis (long standing, calcified), mitral regurgitation Loud Si: Mitral stenosis (prolonged flow through AV valve), anemia, fever, thryotoxicosis Second hea sound (S2): Due to closure of semilunar valves (aoic, pulmonary) High pitched Wide split of S2: Atrial septal defect, mitral regurgitation, pulmonary stenosis Reverse splitting of S2: LBBB, hypeension, aoic stenosis Third hea sound (S3): Due to ventricular filling Low pitched Diastolic, occurring after S2 Best heard at apex with the bell of stethoscope Causes: Children, hyperdynamic states, left ventricular failure, right ventricular failure Fouh hea sounds (S4): Low pitched Pre-systolic, produced during second rapid filling phase (before S1) Best heard with bell of stethoscope Seen in: Hypeension, aoic stenosis, HOCM, acute mitral regurgitation\nC", "question_key": "which of the following is a high pitched sound: march 2011", "split": "validation", "is_mia_member": false} {"id": "a5aefc13-e516-4edb-9531-ae2c91b9f6dc", "question": "Stimulation of which of the following nerves cause improvement in mood?", "opa": "Olfactory Nerve", "opb": "Optic Nerve", "opc": "Trigeminal Nerve", "opd": "Vagus Nerve", "cop": 3, "answer": "D", "exp": "2 Advanced treatment options for depression: Vagus Nerve Stimulation: A number of clinical studies have shown that vagus nerve stimulation (VNS) has antidepressant effects in patients with depression resistant to four or more treatments. Improvement with VNS result in enhanced neurocognitive function in many patients. VNS appears to be most effective in patients with low to moderate antidepressant resistance. Response rates usually range from 30-40%, and long-term VNS treatment appears to be associated with sustained symptomatic improvement. VNS is also known to improve mood in depressed patients with epilepsy. Transcranial Magnetic Stimulation: Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive and easily tolerated method of altering coical physiology. Clinical studies suppo an antidepressant effect of high-frequency rTMS administered to the left PFC; however, antidepressive efficacy is not consistent, and where efficacy is demonstrated, degree of clinical improvement appears to be small. The absence of psychosis, and younger age may be predictors of treatment success. Low frequency TMS to the right PFC also has shown promise. Repetitive TMS may be useful in augmenting or hastening the response of antidepressant drugs in patients with major depressive disorder. Ref: Loosen P.T., Shelton R.C. (2008). Chapter 18. Mood Disorders. In M.H. Ebe, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e.", "explanation_word_count": 211, "prompt": "Stimulation of which of the following nerves cause improvement in mood?\nA. Olfactory Nerve\nB. Optic Nerve\nC. Trigeminal Nerve\nD. Vagus Nerve\nReturn the correct option letter.", "reference": "2 Advanced treatment options for depression: Vagus Nerve Stimulation: A number of clinical studies have shown that vagus nerve stimulation (VNS) has antidepressant effects in patients with depression resistant to four or more treatments. Improvement with VNS result in enhanced neurocognitive function in many patients. VNS appears to be most effective in patients with low to moderate antidepressant resistance. Response rates usually range from 30-40%, and long-term VNS treatment appears to be associated with sustained symptomatic improvement. VNS is also known to improve mood in depressed patients with epilepsy. Transcranial Magnetic Stimulation: Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive and easily tolerated method of altering coical physiology. Clinical studies suppo an antidepressant effect of high-frequency rTMS administered to the left PFC; however, antidepressive efficacy is not consistent, and where efficacy is demonstrated, degree of clinical improvement appears to be small. The absence of psychosis, and younger age may be predictors of treatment success. Low frequency TMS to the right PFC also has shown promise. Repetitive TMS may be useful in augmenting or hastening the response of antidepressant drugs in patients with major depressive disorder. Ref: Loosen P.T., Shelton R.C. (2008). Chapter 18. Mood Disorders. In M.H. Ebe, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e.\nD", "question_key": "stimulation of which of the following nerves cause improvement in mood?", "split": "validation", "is_mia_member": false} {"id": "be53122a-0e83-41b6-95ba-227677365c4b", "question": "Pleural mesothelioma is associated with", "opa": "Asbestosis", "opb": "Berylliosis", "opc": "Silicosis", "opd": "Beryliosis", "cop": 0, "answer": "A", "exp": "Ref:Textbook of pathology (Harsh mohan) 6th edition,page no.493 Asbestos exposure predisposes to a number of cancers, most impoantly bronchogenic carcinoma andmalignant mesothelioma . A few others are: carcinomas of oesophagus, stomach, colon, kidneys and larynx and various lymphoid malignancies. 1. Bronchogenic carcinoma is the most common malignancy in asbestos workers. Its incidence is 5 times higher in non-smoker asbestos workers than the nonsmoker general population and 10 times higher in smoker asbestos workers than the other smokers. 2. pleural mesothelioma is an uncommon tumour but association with asbestos exposure is present in 30 to 80% of cases with mesothelioma. The exposure need not be heavy because mesothelioma is known to develop in people living near asbestos plants or in wives of asbestos workers.", "explanation_word_count": 118, "prompt": "Pleural mesothelioma is associated with\nA. Asbestosis\nB. Berylliosis\nC. Silicosis\nD. Beryliosis\nReturn the correct option letter.", "reference": "Ref:Textbook of pathology (Harsh mohan) 6th edition,page no.493 Asbestos exposure predisposes to a number of cancers, most impoantly bronchogenic carcinoma andmalignant mesothelioma . A few others are: carcinomas of oesophagus, stomach, colon, kidneys and larynx and various lymphoid malignancies. 1. Bronchogenic carcinoma is the most common malignancy in asbestos workers. Its incidence is 5 times higher in non-smoker asbestos workers than the nonsmoker general population and 10 times higher in smoker asbestos workers than the other smokers. 2. pleural mesothelioma is an uncommon tumour but association with asbestos exposure is present in 30 to 80% of cases with mesothelioma. The exposure need not be heavy because mesothelioma is known to develop in people living near asbestos plants or in wives of asbestos workers.\nA", "question_key": "pleural mesothelioma is associated with", "split": "validation", "is_mia_member": false} {"id": "a3f30830-41ca-4308-b6fc-b7e281e02b93", "question": "Hypocalcemia with hypophosphatemia is seen in:September 2006", "opa": "Crush injury", "opb": "Rhabdomyolysis", "opc": "Vitamin D dependent rickets-II", "opd": "Renal failure", "cop": 2, "answer": "C", "exp": "Ans. C: Vitamin D dependent rickets-IIIn rhabdomyolysis due to crush injury, hypocalcemia and hyperphosphatemia may occur. Severe intravascular hemolysis may lead to a similar syndrome.Hyperphosphatemia alters calcium and phosphate ion solubility products, and calcium deposition in soft tissue may occur. The lower circulating concentrations of 1, 25 (OH)2D may fuher aggravate the hypocalcemia by impairing intestinal absorption of calcium.Hyperphosphatemic-induced hypocalcemia inhibits vitamin D synthesis and results in an increase in PTH secretion. Secondary hyperparathyroidism from long-term hyperphosphatemia is usually associated with renal insufficiency. Treatment should be directed towards the hyperphosphatemia in order to correct the hypocalcemia.Hypophosphatemia is more severe than hypocalcemia in vitamin D deficiency states because of the increased secretion of PTH, which is only paly active in elevating blood calcium but is capable of phosphaturia.", "explanation_word_count": 129, "prompt": "Hypocalcemia with hypophosphatemia is seen in:September 2006\nA. Crush injury\nB. Rhabdomyolysis\nC. Vitamin D dependent rickets-II\nD. Renal failure\nReturn the correct option letter.", "reference": "Ans. C: Vitamin D dependent rickets-IIIn rhabdomyolysis due to crush injury, hypocalcemia and hyperphosphatemia may occur. Severe intravascular hemolysis may lead to a similar syndrome.Hyperphosphatemia alters calcium and phosphate ion solubility products, and calcium deposition in soft tissue may occur. The lower circulating concentrations of 1, 25 (OH)2D may fuher aggravate the hypocalcemia by impairing intestinal absorption of calcium.Hyperphosphatemic-induced hypocalcemia inhibits vitamin D synthesis and results in an increase in PTH secretion. Secondary hyperparathyroidism from long-term hyperphosphatemia is usually associated with renal insufficiency. Treatment should be directed towards the hyperphosphatemia in order to correct the hypocalcemia.Hypophosphatemia is more severe than hypocalcemia in vitamin D deficiency states because of the increased secretion of PTH, which is only paly active in elevating blood calcium but is capable of phosphaturia.\nC", "question_key": "hypocalcemia with hypophosphatemia is seen in:september 2006", "split": "validation", "is_mia_member": false} {"id": "88f79590-56c9-41b7-82f2-38a66caecd6b", "question": "A nullipara is on investigations for her infeility. She had a history of pulmonary tuberculosis which was treated effectively. If genital tuberculosis is the reason for her infeility, which organ can be affected the most?", "opa": "Tubes", "opb": "Uterus", "opc": "Cervix", "opd": "Vagina", "cop": 0, "answer": "A", "exp": "Genitourinary TB includes renal, ureteral, bladder, uterine-fallopian, prostatic, and epididymal disease. It is slightly more common in women than men and tends to involve older populations. The commonest site of affection is the Fallopian tubes. Both the tubes are affected simultaneously. The initial site of infection is in the submucosal layer (interstitial salpingitis) of the ampullary pa of the tube. The fimbriae are eveed and the abdominal ostium usually remains patent. The elongated and distended distal tube with the patent abdominal ostium gives the appearance of 'tobacco pouch'. Ref: Textbook of Gynaecology edited by D C Dutta, 4th edition, Page 129-130.", "explanation_word_count": 100, "prompt": "A nullipara is on investigations for her infeility. She had a history of pulmonary tuberculosis which was treated effectively. If genital tuberculosis is the reason for her infeility, which organ can be affected the most?\nA. Tubes\nB. Uterus\nC. Cervix\nD. Vagina\nReturn the correct option letter.", "reference": "Genitourinary TB includes renal, ureteral, bladder, uterine-fallopian, prostatic, and epididymal disease. It is slightly more common in women than men and tends to involve older populations. The commonest site of affection is the Fallopian tubes. Both the tubes are affected simultaneously. The initial site of infection is in the submucosal layer (interstitial salpingitis) of the ampullary pa of the tube. The fimbriae are eveed and the abdominal ostium usually remains patent. The elongated and distended distal tube with the patent abdominal ostium gives the appearance of 'tobacco pouch'. Ref: Textbook of Gynaecology edited by D C Dutta, 4th edition, Page 129-130.\nA", "question_key": "a nullipara is on investigations for her infeility. she had a history of pulmonary tuberculosis which was treated effectively. if genital tuberculosis is the reason for her infeility, which organ can be affected the most?", "split": "validation", "is_mia_member": false} {"id": "ec73670d-f78f-467c-aabb-770f5958c303", "question": "Most dangerous type of diptheria -", "opa": "Facial", "opb": "Laryngeal", "opc": "Nasal", "opd": "Cutaneous", "cop": 1, "answer": "B", "exp": "Ans. is 'b' i.e., Laryngealo Clinically diphtheria is divided into :-1) Facial (tonsillo-pharyngeal) diphtheria# It is the commonest type with incubation period of 2-5 days. There is thick adherent pseudomembrane (grey or white) on one or both tonsils or adjacent pharynx. Dislodging of membrane is likely to cause bleeding. A small perecentage of patient present with massive swelling of tonsils and uvula with cervical lymphadenopathy (bull neck) and severe toxemia, called malignant diphtheria.2) Laryngeal diphtheria# It is the most severe form of diphtheria.3) Nasal diphtheria# It is the mildest form.4) Cutaneous diphtheria# It is caused by nontoxigenic strain and patient presents with \"punched out\" ulcer.5) Other forms# These are conjunctival, otitic, genital (vulval, vaginal or prepucial), and gastrointestinal.", "explanation_word_count": 117, "prompt": "Most dangerous type of diptheria -\nA. Facial\nB. Laryngeal\nC. Nasal\nD. Cutaneous\nReturn the correct option letter.", "reference": "Ans. is 'b' i.e., Laryngealo Clinically diphtheria is divided into :-1) Facial (tonsillo-pharyngeal) diphtheria# It is the commonest type with incubation period of 2-5 days. There is thick adherent pseudomembrane (grey or white) on one or both tonsils or adjacent pharynx. Dislodging of membrane is likely to cause bleeding. A small perecentage of patient present with massive swelling of tonsils and uvula with cervical lymphadenopathy (bull neck) and severe toxemia, called malignant diphtheria.2) Laryngeal diphtheria# It is the most severe form of diphtheria.3) Nasal diphtheria# It is the mildest form.4) Cutaneous diphtheria# It is caused by nontoxigenic strain and patient presents with \"punched out\" ulcer.5) Other forms# These are conjunctival, otitic, genital (vulval, vaginal or prepucial), and gastrointestinal.\nB", "question_key": "most dangerous type of diptheria -", "split": "validation", "is_mia_member": false} {"id": "8992097b-5a22-4124-ba46-46335ba97db5", "question": "Which of the following is not a component of Jones criteria for diagnosing acute rheumatic fever?", "opa": "Pancarditis", "opb": "Migratory polyhritis", "opc": "Erythema nodosum", "opd": "Sydenham chorea", "cop": 2, "answer": "C", "exp": "Major criteria (Jones criteria for Acute Rheumatic fever) Carditis Clinical and/or subclinical Ahritis Polyahritis only Monoahritis or polyahritis or polyahralgia in moderate to high-risk populations Chorea Erythema marginatum Subcutaneous nodules There is a latent period of ~3 weeks (1-5 weeks) between the precipitating group A streptococcal infection and the appearance of the clinical features of ARF. The exceptions are chorea and indolent carditis, which may follow prolonged latent periods lasting up to 6 months. Syndenham's Chorea - commonly occurs in the absence of other manifestations, follows a prolonged latent period after group A streptococcal infection, and is found mainly in females. ARF almost always affects the large joints--most commonly the knees, ankles, hips, and elbows--and is asymmetric Subcutaneous nodules occur as painless, small (0.5-2 cm), mobile lumps beneath the skin overlying bony prominences (extensor surfaces).", "explanation_word_count": 133, "prompt": "Which of the following is not a component of Jones criteria for diagnosing acute rheumatic fever?\nA. Pancarditis\nB. Migratory polyhritis\nC. Erythema nodosum\nD. Sydenham chorea\nReturn the correct option letter.", "reference": "Major criteria (Jones criteria for Acute Rheumatic fever) Carditis Clinical and/or subclinical Ahritis Polyahritis only Monoahritis or polyahritis or polyahralgia in moderate to high-risk populations Chorea Erythema marginatum Subcutaneous nodules There is a latent period of ~3 weeks (1-5 weeks) between the precipitating group A streptococcal infection and the appearance of the clinical features of ARF. The exceptions are chorea and indolent carditis, which may follow prolonged latent periods lasting up to 6 months. Syndenham's Chorea - commonly occurs in the absence of other manifestations, follows a prolonged latent period after group A streptococcal infection, and is found mainly in females. ARF almost always affects the large joints--most commonly the knees, ankles, hips, and elbows--and is asymmetric Subcutaneous nodules occur as painless, small (0.5-2 cm), mobile lumps beneath the skin overlying bony prominences (extensor surfaces).\nC", "question_key": "which of the following is not a component of jones criteria for diagnosing acute rheumatic fever?", "split": "validation", "is_mia_member": false} {"id": "3b2ec133-11fd-474d-8918-61b299823c52", "question": "Which one of the following is not a diagnostic criterion for rheumatoid arthritis according to the American Rheumatism Association?", "opa": "Raised rheumatoid factor.", "opb": "Symmetric swelling (arthritis) for at least 6 weeks.", "opc": "Symmetrical muscle weakness.", "opd": "Rheumatoid nodules.", "cop": 2, "answer": "C", "exp": "Ans. C. Symmetrical muscle weakness.Rheumatoid arthritis is defined by the presence of four or more of the following criteria according to the American Rheumatism Association:a. Morning stiffness in and around joints lasting at least 1 hour before maximal improvement, present for at least 6 weeksb. Soft tissue swelling (arthritis) of three or more joint areas observed by a physician, present for at least 6 weeksc. Swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal or wrist joints for at least 6 weeksd. Symmetric swelling (arthritis) for at least 6 weekse. Rheumatoid nodulesf. The presence of rheumatoid factorg. Radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints", "explanation_word_count": 104, "prompt": "Which one of the following is not a diagnostic criterion for rheumatoid arthritis according to the American Rheumatism Association?\nA. Raised rheumatoid factor.\nB. Symmetric swelling (arthritis) for at least 6 weeks.\nC. Symmetrical muscle weakness.\nD. Rheumatoid nodules.\nReturn the correct option letter.", "reference": "Ans. C. Symmetrical muscle weakness.Rheumatoid arthritis is defined by the presence of four or more of the following criteria according to the American Rheumatism Association:a. Morning stiffness in and around joints lasting at least 1 hour before maximal improvement, present for at least 6 weeksb. Soft tissue swelling (arthritis) of three or more joint areas observed by a physician, present for at least 6 weeksc. Swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal or wrist joints for at least 6 weeksd. Symmetric swelling (arthritis) for at least 6 weekse. Rheumatoid nodulesf. The presence of rheumatoid factorg. Radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints\nC", "question_key": "which one of the following is not a diagnostic criterion for rheumatoid arthritis according to the american rheumatism association?", "split": "validation", "is_mia_member": false} {"id": "09a64b04-343b-4045-aee2-3c4047bbe373", "question": "Unfamiliarity of familiar things is seen in:", "opa": "Deja vu", "opb": "Jamais vu", "opc": "Deja entendu", "opd": "Deja pence", "cop": 1, "answer": "B", "exp": "Jamais vu refers to the feeling of unfamiliarity for familiar things. Deja vu refers to the feeling that an event which is being currently experienced has also happened in the past.", "explanation_word_count": 31, "prompt": "Unfamiliarity of familiar things is seen in:\nA. Deja vu\nB. Jamais vu\nC. Deja entendu\nD. Deja pence\nReturn the correct option letter.", "reference": "Jamais vu refers to the feeling of unfamiliarity for familiar things. Deja vu refers to the feeling that an event which is being currently experienced has also happened in the past.\nB", "question_key": "unfamiliarity of familiar things is seen in:", "split": "validation", "is_mia_member": false} {"id": "d7a74861-ac93-428c-b719-594ef44da167", "question": "Site of lesion in Bitemporal hemianopia is -", "opa": "Optic nerve", "opb": "Optic tract", "opc": "Optic chiasma", "opd": "Optic radiation", "cop": 2, "answer": "C", "exp": "Sagittal (central) lesions of the chiasma. These are characterised by bitemporal hemianopia and bitemporal hemianopic paralysis of pupillary reflexes. These usually lead to paial descending optic atrophy. Common causes of central chiasmal lesion are: suprasellar aneurysms, tumours of pituitary gland, craniopharyngioma, suprasellar meningioma and glioma of third ventricle, third ventricular dilatation due to obstructive hydrocephalus and chronic chiasmal arachnoiditis. Ref:AK Khurana 4thE pg 290", "explanation_word_count": 64, "prompt": "Site of lesion in Bitemporal hemianopia is -\nA. Optic nerve\nB. Optic tract\nC. Optic chiasma\nD. Optic radiation\nReturn the correct option letter.", "reference": "Sagittal (central) lesions of the chiasma. These are characterised by bitemporal hemianopia and bitemporal hemianopic paralysis of pupillary reflexes. These usually lead to paial descending optic atrophy. Common causes of central chiasmal lesion are: suprasellar aneurysms, tumours of pituitary gland, craniopharyngioma, suprasellar meningioma and glioma of third ventricle, third ventricular dilatation due to obstructive hydrocephalus and chronic chiasmal arachnoiditis. Ref:AK Khurana 4thE pg 290\nC", "question_key": "site of lesion in bitemporal hemianopia is -", "split": "validation", "is_mia_member": false} {"id": "6f51b258-3ea2-40a8-a894-11cb5c209170", "question": "A 29-year-old man complains of back pain for several months. It takes him over 2 hours to limber up in the morning. His x-ray is shown in Figure given below. Which of the following is the most likely diagnosis?", "opa": "RA", "opb": "spondylolisthesis", "opc": "osteomalacia", "opd": "ankylosing spondylitis", "cop": 3, "answer": "D", "exp": "The x-ray reveals typical evidence of sacroiliitis, with widening of the joints, sclerosis, and evasions. Similar findings can be seen in psoriatic and enteropathic spondyloarthropathy.", "explanation_word_count": 25, "prompt": "A 29-year-old man complains of back pain for several months. It takes him over 2 hours to limber up in the morning. His x-ray is shown in Figure given below. Which of the following is the most likely diagnosis?\nA. RA\nB. spondylolisthesis\nC. osteomalacia\nD. ankylosing spondylitis\nReturn the correct option letter.", "reference": "The x-ray reveals typical evidence of sacroiliitis, with widening of the joints, sclerosis, and evasions. Similar findings can be seen in psoriatic and enteropathic spondyloarthropathy.\nD", "question_key": "a 29-year-old man complains of back pain for several months. it takes him over 2 hours to limber up in the morning. his x-ray is shown in figure given below. which of the following is the most likely diagnosis?", "split": "validation", "is_mia_member": false} {"id": "4126ebd8-11d1-4cb5-bb67-b7213edf14d0", "question": "Following strain used is ?", "opa": "Methyl violet", "opb": "Brilliant cresyl blue", "opc": "Sudan black", "opd": "Indigo carmine", "cop": 1, "answer": "B", "exp": "This is a form of supravital staining in which cells are stained while living. It takes two days from reticulocytes to become RBC", "explanation_word_count": 23, "prompt": "Following strain used is ?\nA. Methyl violet\nB. Brilliant cresyl blue\nC. Sudan black\nD. Indigo carmine\nReturn the correct option letter.", "reference": "This is a form of supravital staining in which cells are stained while living. It takes two days from reticulocytes to become RBC\nB", "question_key": "following strain used is ?", "split": "validation", "is_mia_member": false} {"id": "bf0d4260-f084-4e46-82ca-ea1c7bdab0a3", "question": "What is the role of Weiger's ligament?", "opa": "Attachment of vitreous to the retina", "opb": "Attachment of vitreous to orra serrata", "opc": "Attachment of vitreous to optic disc", "opd": "Attachment of vitreous to posterior surface of lens", "cop": 3, "answer": "D", "exp": "During childhood, Weiger's ligament (hyaloido capsular ligament) helps in the attachment of vitreous to the posterior surface of the lens. Vitreous is attached to the internal limiting membrane of retina from 2mm anterior to the ora serrata to the edges of the optic disk. The attachment is quite firm at the macula and vitreous base and in peripapillary region. A hyaloid canal (Cloquet's canal) runs down the the centre of the vitreous body from the optic disc to the posterior pole of the lens. Ref: Comprehensive Ophthalmology by AK Khurana, 4th edn, page 243", "explanation_word_count": 93, "prompt": "What is the role of Weiger's ligament?\nA. Attachment of vitreous to the retina\nB. Attachment of vitreous to orra serrata\nC. Attachment of vitreous to optic disc\nD. Attachment of vitreous to posterior surface of lens\nReturn the correct option letter.", "reference": "During childhood, Weiger's ligament (hyaloido capsular ligament) helps in the attachment of vitreous to the posterior surface of the lens. Vitreous is attached to the internal limiting membrane of retina from 2mm anterior to the ora serrata to the edges of the optic disk. The attachment is quite firm at the macula and vitreous base and in peripapillary region. A hyaloid canal (Cloquet's canal) runs down the the centre of the vitreous body from the optic disc to the posterior pole of the lens. Ref: Comprehensive Ophthalmology by AK Khurana, 4th edn, page 243\nD", "question_key": "what is the role of weiger's ligament?", "split": "validation", "is_mia_member": false} {"id": "4caeeb14-fcd2-446e-a0ca-87e57434d1d3", "question": "Best indicator for monitoring of syphilis treatment", "opa": "VDRL", "opb": "FTA-ABS", "opc": "TPI", "opd": "TPHACovered with exudate", "cop": 0, "answer": "A", "exp": "Ans. (a) VDRL Serological test of syphilis Most sensitive test FTA-ABS Most specific test TPI (not used now) Test of choice for rapid diagnosis RPR Test of choice for evaluation of therapy VDRL Test of choice for diagnosis of congenital syphilis IgM FTA-ABS Now, TPPA has supplanted FTA-ABS as definitive diagnosis test for syphilis.", "explanation_word_count": 54, "prompt": "Best indicator for monitoring of syphilis treatment\nA. VDRL\nB. FTA-ABS\nC. TPI\nD. TPHACovered with exudate\nReturn the correct option letter.", "reference": "Ans. (a) VDRL Serological test of syphilis Most sensitive test FTA-ABS Most specific test TPI (not used now) Test of choice for rapid diagnosis RPR Test of choice for evaluation of therapy VDRL Test of choice for diagnosis of congenital syphilis IgM FTA-ABS Now, TPPA has supplanted FTA-ABS as definitive diagnosis test for syphilis.\nA", "question_key": "best indicator for monitoring of syphilis treatment", "split": "validation", "is_mia_member": false} {"id": "0d016065-bf04-4122-8243-6d2be310c274", "question": "Nucleus accumbens is related to which of the following?", "opa": "Basal ganglia", "opb": "Brain stem", "opc": "Thalamus", "opd": "Cerebellum", "cop": 0, "answer": "A", "exp": "Ans. a (Basal ganglia). (Ref. Ganong, Physiology 21st ed., 265)NUCLEUS ACCUMBENS# Nucleus accumbens is located at the base of the striatum, and is a part of basal ganglia.# Addiction is associated with the reward system, particularly with nucleus accumbens.# The medial frontal cortex, the hippocampus, and the amygdala are concerned with memory, and they all project to the nucleus accumbens.# Drugs that block the postsynaptic D3 receptors reduce the rate of self-stimulation and these receptors are mainly located at nucleus accumbens.", "explanation_word_count": 81, "prompt": "Nucleus accumbens is related to which of the following?\nA. Basal ganglia\nB. Brain stem\nC. Thalamus\nD. Cerebellum\nReturn the correct option letter.", "reference": "Ans. a (Basal ganglia). (Ref. Ganong, Physiology 21st ed., 265)NUCLEUS ACCUMBENS# Nucleus accumbens is located at the base of the striatum, and is a part of basal ganglia.# Addiction is associated with the reward system, particularly with nucleus accumbens.# The medial frontal cortex, the hippocampus, and the amygdala are concerned with memory, and they all project to the nucleus accumbens.# Drugs that block the postsynaptic D3 receptors reduce the rate of self-stimulation and these receptors are mainly located at nucleus accumbens.\nA", "question_key": "nucleus accumbens is related to which of the following?", "split": "validation", "is_mia_member": false} {"id": "8c17c2e4-c3a7-44d1-b2c3-5fb37abf0799", "question": "Primary site of involvement in congenital TB:", "opa": "Lungs", "opb": "Liver", "opc": "Lymph nodes", "opd": "Stomach", "cop": 1, "answer": "B", "exp": "Ans. (b) Liver(Ref: Nelson 19 ed Chap 212)In congenital TB, primary organ involved is liver.Congenital tuberculosis is rare because the most common result of female genital tract tuberculosis is infertility.Congenital transmission usually occurs from a lesion in the placenta through the umbilical vein.Primary infection in the mother just before or during pregnancy is more likely to cause congenital infection than is reactivation of a previous infection.The tubercle bacilli first reach the fetal liver, where a primary focus with periportal lymph node involvement may occur.Organisms pass through the liver into the main fetal circulation and infect many organs.", "explanation_word_count": 102, "prompt": "Primary site of involvement in congenital TB:\nA. Lungs\nB. Liver\nC. Lymph nodes\nD. Stomach\nReturn the correct option letter.", "reference": "Ans. (b) Liver(Ref: Nelson 19 ed Chap 212)In congenital TB, primary organ involved is liver.Congenital tuberculosis is rare because the most common result of female genital tract tuberculosis is infertility.Congenital transmission usually occurs from a lesion in the placenta through the umbilical vein.Primary infection in the mother just before or during pregnancy is more likely to cause congenital infection than is reactivation of a previous infection.The tubercle bacilli first reach the fetal liver, where a primary focus with periportal lymph node involvement may occur.Organisms pass through the liver into the main fetal circulation and infect many organs.\nB", "question_key": "primary site of involvement in congenital tb:", "split": "validation", "is_mia_member": false} {"id": "92fe381e-4631-45f9-9235-dd669276b4dd", "question": "Linear lesion is seen in -", "opa": "Sporotrichosis", "opb": "Lichen planus", "opc": "Psoriasis", "opd": "Pemphigus", "cop": 0, "answer": "A", "exp": "Sporotrichosis : Is a subacute or chronic infection caused by sporothrix scheinkii characterised by nodular lesions and ulcers in the skin and subcutaneous tissue and lymph nodes with occasional involvement of internal organs. Etiology : Causative organism:sporothrix scheinkii Dimorphic fungus Mycelia at 26c- bearing flower head endings of mycelia Yeast at 37c Saprophyte in soil and dead plants Route of entry scratches thorn prick Histopathology: Asteroid bodies basphilic yeast like body surrounded by radiating homogeneous eosinophilic material surrounded by granulomatous reaction. Clinical features Lymphocutaneous sporotrichosis =Trauma followed by development of nodules and ulcers along the line of lymphatic stocks Mucocutaneous sporotrichosis Fixed cutaneous sporotrichosis Pulmonary sporotrichosis Disseminated sporotrichosis Laboratory diagnosis. Sabourauds dextrose agar culture Animal inoculation cigar bodies in pus from lesions Sporotrichin skin test Treatment: Treatment of choice for lymphocutaneous lesion: saturated solution of potassium iodide three drops tid Itraconazole Terbinafine Voriconazole Iadvl textbook of dermatology page 306 PSORIASIS:-Inflammatory skin disease.Genetic predisposition. Psoriasis susceptibility 1 (PSORS1) is the most impoant susceptibility locus. 1. Classic lesion-Well defined erythematous plaque with a silvery white scales.2. Size varies from pin point papules to plaques. LICHEN PLANUS:- Inflammatory T cell mediated auto immune disorder affecting skin, hair,nails and mucous membranes. Four Ps- purple , polygonal and pruritic papule. Classic lesion- small polygonal shaped, and red/ violet, flat topped papule. Surface is slightly shiny/ transparent,and a network of fine,white lines called 'Wickhams striae' or small grey white puncta is also seen.", "explanation_word_count": 237, "prompt": "Linear lesion is seen in -\nA. Sporotrichosis\nB. Lichen planus\nC. Psoriasis\nD. Pemphigus\nReturn the correct option letter.", "reference": "Sporotrichosis : Is a subacute or chronic infection caused by sporothrix scheinkii characterised by nodular lesions and ulcers in the skin and subcutaneous tissue and lymph nodes with occasional involvement of internal organs. Etiology : Causative organism:sporothrix scheinkii Dimorphic fungus Mycelia at 26c- bearing flower head endings of mycelia Yeast at 37c Saprophyte in soil and dead plants Route of entry scratches thorn prick Histopathology: Asteroid bodies basphilic yeast like body surrounded by radiating homogeneous eosinophilic material surrounded by granulomatous reaction. Clinical features Lymphocutaneous sporotrichosis =Trauma followed by development of nodules and ulcers along the line of lymphatic stocks Mucocutaneous sporotrichosis Fixed cutaneous sporotrichosis Pulmonary sporotrichosis Disseminated sporotrichosis Laboratory diagnosis. Sabourauds dextrose agar culture Animal inoculation cigar bodies in pus from lesions Sporotrichin skin test Treatment: Treatment of choice for lymphocutaneous lesion: saturated solution of potassium iodide three drops tid Itraconazole Terbinafine Voriconazole Iadvl textbook of dermatology page 306 PSORIASIS:-Inflammatory skin disease.Genetic predisposition. Psoriasis susceptibility 1 (PSORS1) is the most impoant susceptibility locus. 1. Classic lesion-Well defined erythematous plaque with a silvery white scales.2. Size varies from pin point papules to plaques. LICHEN PLANUS:- Inflammatory T cell mediated auto immune disorder affecting skin, hair,nails and mucous membranes. Four Ps- purple , polygonal and pruritic papule. Classic lesion- small polygonal shaped, and red/ violet, flat topped papule. Surface is slightly shiny/ transparent,and a network of fine,white lines called 'Wickhams striae' or small grey white puncta is also seen.\nA", "question_key": "linear lesion is seen in -", "split": "validation", "is_mia_member": false} {"id": "a91f5e09-0811-4845-87cd-d766ab11195f", "question": "In Peripaum cardiomyopathy, cardiac failure occurs at:-", "opa": "Within 7 days after delivery.", "opb": "Within 6 weeks after delivery.", "opc": "Within 24 months after delivery.", "opd": "Within 5 months after delivery.", "cop": 3, "answer": "D", "exp": "Diagnostic criteria for Peripaum cardiomyopathy - A) Development of cardiac failure in the last month of pregnancy or within 5 months after delivery. B) Absence of an identifiable cause for the cardiac failure. C) Absence of recognizable hea disease prior to the last month pf pregnancy D) Left ventricular systolic dysfunction demonstrated by classic echocardiographic criteria, such as depressed ejection fraction along with a dilated left ventricle", "explanation_word_count": 65, "prompt": "In Peripaum cardiomyopathy, cardiac failure occurs at:-\nA. Within 7 days after delivery.\nB. Within 6 weeks after delivery.\nC. Within 24 months after delivery.\nD. Within 5 months after delivery.\nReturn the correct option letter.", "reference": "Diagnostic criteria for Peripaum cardiomyopathy - A) Development of cardiac failure in the last month of pregnancy or within 5 months after delivery. B) Absence of an identifiable cause for the cardiac failure. C) Absence of recognizable hea disease prior to the last month pf pregnancy D) Left ventricular systolic dysfunction demonstrated by classic echocardiographic criteria, such as depressed ejection fraction along with a dilated left ventricle\nD", "question_key": "in peripaum cardiomyopathy, cardiac failure occurs at:-", "split": "validation", "is_mia_member": false} {"id": "cd871163-2422-4a8d-a943-df37925c8378", "question": "Fetal Hb shows high pO2 saturation compared to adult Hb because -", "opa": "Affinity' to binding to DPG is different in fetal Hb", "opb": "Right shift to Oxygen dissociation curve", "opc": "Acidic environment", "opd": "Cooperative binding", "cop": 0, "answer": "A", "exp": "Ans. is 'a' i.e., Affinity to binding to DPG is different in fetal Hb o Make it very clear in mind that higher affinity' of fetal hemoglobin for oxygen is due to low affinity of HbF for 2,3- DPG (not due to decreased 2, 3-DPG concentration). HbF does not combines to 2, 3-DPG as avidly as adult hemoglobin.\"Fetal hemoglobin is left - shifted because it has a low affinity' for DPG\", --Principles of medical physiology'\"It is worth noting that DPG does not combine with fetal hemoglobin. That is perhaps one reason why HbF has greater affin ity for oxygen than adult hemoglobin (HbF) \".-- Understanding of medical physiology\"Fetal hemoglobin binds less 2-3 DPG it has consequently a greater affinity for O2\" -- Pediatric physiologyo All other textbooks have mentioned the same thing.o So, high affinity of HbF to O2 is due to low affinity of HbF for 2,3 DPG (and not due to decreased 2,3-DPG concentration).Effect of 2-3 diphosphoglvcerete (2.3 PPG)o Another important factor which influences oxygen-hemoglobin dissociation curve is 2,3 DPG in RBC. DPG is an optional by-product of the glycolytic pathway. DPG binds with deoxygenated hemoglobin but not with oxygenated hemoglobin. Therefore raised DPG concentration releases oxygen from oxyhemoglobin by shifting the following reversible reaction to the right: -HbO2 + DPG - Hb - DPG + O2o One molecule of DPG binds with one mole of deoxyhemoglobin.o That is why in the presence of raised DPG concentration, less oxygen can combine with hemoglobin at a given PO2. Hence an increase in DPG concentration shifts the oxygen-hemoglobin dissociation curve to the right. Thus 2,3 DPG causes delivery (unloading) of O2 to the tissues.o Factors which increases 2,3 DPG level and therefore lower the oxygen affinity of hemoglobin (right shift of O2 dissociation curve and increased delivery of oxygen to tissues) are : -# Hypoxia# High altitude# Alkalosis# Exercise# Pregnancy# Anemia# Hormones (thyroid, GH, androgen)# Cyanotic congenital heart disease# Chemical agents (Inosine, Pyruvate, PEP, phosphate, dihydroxyacetone)o Factors which decrease 2,3 DPG levels and therefore increase oxygen a ffinity of hemoglobin (left shift of O2 dissociation curve and decreased delivery' of O2 to the tissues) are : - Stored blood, and fetal hemoglobin (HbF).o Fetal hemoglobin has considerably less afinity for 2,3 - DPG than does adult hemoglobin therefore fetal hemoglobin has greater affinity for oxygen than adult hemoglobin. In human blood, the affinity of fetal hemoglobin for 2,3-DPG is only about 40% that of adult hemoglobin. This makes fetal hemoglobin behave as if 2,3-DPG levels are low. Therefore, the oxygen dissociation curve is shifted to the left. Although fetal red cells do contain 2,3 DPG, the poor binding of 2,3-DPG by fetal hemoglobin is an important factor in facilitating transport of oxygen across the placenta from mother to fetus. On the maternal side of the placenta, the reduction of hemoglobin effectively shifts the curve to the right, increasing oxygen release. On the fetal side, 2,3-DPG does not interfere with the affinity' of fetal hemoglobin for oxygen and thus the uptake of oxygen by fetal erythrocytes.", "explanation_word_count": 491, "prompt": "Fetal Hb shows high pO2 saturation compared to adult Hb because -\nA. Affinity' to binding to DPG is different in fetal Hb\nB. Right shift to Oxygen dissociation curve\nC. Acidic environment\nD. Cooperative binding\nReturn the correct option letter.", "reference": "Ans. is 'a' i.e., Affinity to binding to DPG is different in fetal Hb o Make it very clear in mind that higher affinity' of fetal hemoglobin for oxygen is due to low affinity of HbF for 2,3- DPG (not due to decreased 2, 3-DPG concentration). HbF does not combines to 2, 3-DPG as avidly as adult hemoglobin.\"Fetal hemoglobin is left - shifted because it has a low affinity' for DPG\", --Principles of medical physiology'\"It is worth noting that DPG does not combine with fetal hemoglobin. That is perhaps one reason why HbF has greater affin ity for oxygen than adult hemoglobin (HbF) \".-- Understanding of medical physiology\"Fetal hemoglobin binds less 2-3 DPG it has consequently a greater affinity for O2\" -- Pediatric physiologyo All other textbooks have mentioned the same thing.o So, high affinity of HbF to O2 is due to low affinity of HbF for 2,3 DPG (and not due to decreased 2,3-DPG concentration).Effect of 2-3 diphosphoglvcerete (2.3 PPG)o Another important factor which influences oxygen-hemoglobin dissociation curve is 2,3 DPG in RBC. DPG is an optional by-product of the glycolytic pathway. DPG binds with deoxygenated hemoglobin but not with oxygenated hemoglobin. Therefore raised DPG concentration releases oxygen from oxyhemoglobin by shifting the following reversible reaction to the right: -HbO2 + DPG - Hb - DPG + O2o One molecule of DPG binds with one mole of deoxyhemoglobin.o That is why in the presence of raised DPG concentration, less oxygen can combine with hemoglobin at a given PO2. Hence an increase in DPG concentration shifts the oxygen-hemoglobin dissociation curve to the right. Thus 2,3 DPG causes delivery (unloading) of O2 to the tissues.o Factors which increases 2,3 DPG level and therefore lower the oxygen affinity of hemoglobin (right shift of O2 dissociation curve and increased delivery of oxygen to tissues) are : -# Hypoxia# High altitude# Alkalosis# Exercise# Pregnancy# Anemia# Hormones (thyroid, GH, androgen)# Cyanotic congenital heart disease# Chemical agents (Inosine, Pyruvate, PEP, phosphate, dihydroxyacetone)o Factors which decrease 2,3 DPG levels and therefore increase oxygen a ffinity of hemoglobin (left shift of O2 dissociation curve and decreased delivery' of O2 to the tissues) are : - Stored blood, and fetal hemoglobin (HbF).o Fetal hemoglobin has considerably less afinity for 2,3 - DPG than does adult hemoglobin therefore fetal hemoglobin has greater affinity for oxygen than adult hemoglobin. In human blood, the affinity of fetal hemoglobin for 2,3-DPG is only about 40% that of adult hemoglobin. This makes fetal hemoglobin behave as if 2,3-DPG levels are low. Therefore, the oxygen dissociation curve is shifted to the left. Although fetal red cells do contain 2,3 DPG, the poor binding of 2,3-DPG by fetal hemoglobin is an important factor in facilitating transport of oxygen across the placenta from mother to fetus. On the maternal side of the placenta, the reduction of hemoglobin effectively shifts the curve to the right, increasing oxygen release. On the fetal side, 2,3-DPG does not interfere with the affinity' of fetal hemoglobin for oxygen and thus the uptake of oxygen by fetal erythrocytes.\nA", "question_key": "fetal hb shows high po2 saturation compared to adult hb because -", "split": "validation", "is_mia_member": false} {"id": "2ff1cede-b2a0-4b34-b126-37f3c5cbe028", "question": "A 16-year-old boy lost his sight in one eye after a fight. Under which section of IPC is grievous injury included?", "opa": "Section 319", "opb": "Section 320", "opc": "Section 324", "opd": "Section 326", "cop": 1, "answer": "B", "exp": "Grievous injury is included under section 320. The following kinds of hu only are designated as \"grievous\": ? Emasculation ? Permanent privation of the sight of either eye ? Permanent privation of the hearing of either ear ? Privation of any member or joint ? Destruction or permanent impairing of the powers of any member or joint ? Permanent disfiguration of the head or face ? Fracture or dislocation of a bone or tooth ? Any hu which endangers life or which causes the victim to be in severe bodily pain or unable to follow his ordinary pursuits for a period of 20 days.", "explanation_word_count": 94, "prompt": "A 16-year-old boy lost his sight in one eye after a fight. Under which section of IPC is grievous injury included?\nA. Section 319\nB. Section 320\nC. Section 324\nD. Section 326\nReturn the correct option letter.", "reference": "Grievous injury is included under section 320. The following kinds of hu only are designated as \"grievous\": ? Emasculation ? Permanent privation of the sight of either eye ? Permanent privation of the hearing of either ear ? Privation of any member or joint ? Destruction or permanent impairing of the powers of any member or joint ? Permanent disfiguration of the head or face ? Fracture or dislocation of a bone or tooth ? Any hu which endangers life or which causes the victim to be in severe bodily pain or unable to follow his ordinary pursuits for a period of 20 days.\nB", "question_key": "a 16-year-old boy lost his sight in one eye after a fight. under which section of ipc is grievous injury included?", "split": "validation", "is_mia_member": false} {"id": "80b765bf-58b1-467b-8503-18077dfd36cb", "question": "How to differentiate staphylococci and micrococci", "opa": "Catalase test", "opb": "Hugh and Leifson's oxidation-fermentation test", "opc": "Gram staining", "opd": "AFS", "cop": 1, "answer": "B", "exp": "Micrococci are gram-positive cocci which can be mistaken for S.aureus in culture but are larger and mostly in pairs, tetrads or irregular clusters. Micrococci is catalase and modified oxidase positive and oxidative in Hugh and Leifson's oxidation-fermentation test. Ref: Textbook of Ananthanarayan and paniker's; 10th Edition; Pg:209", "explanation_word_count": 48, "prompt": "How to differentiate staphylococci and micrococci\nA. Catalase test\nB. Hugh and Leifson's oxidation-fermentation test\nC. Gram staining\nD. AFS\nReturn the correct option letter.", "reference": "Micrococci are gram-positive cocci which can be mistaken for S.aureus in culture but are larger and mostly in pairs, tetrads or irregular clusters. Micrococci is catalase and modified oxidase positive and oxidative in Hugh and Leifson's oxidation-fermentation test. Ref: Textbook of Ananthanarayan and paniker's; 10th Edition; Pg:209\nB", "question_key": "how to differentiate staphylococci and micrococci", "split": "validation", "is_mia_member": false} {"id": "15ee4034-c6b1-4f2d-93c3-e9fa2d2ef70f", "question": "The longest acting local anesthetics -", "opa": "Bupivacaine", "opb": "Ropivacaine", "opc": "Dibucaine", "opd": "Tetracaine", "cop": 2, "answer": "C", "exp": "long acting ester local anesthetic -Benzocaine . tetracaine long acting amide local anesthetic- bupivacaine, ropivacaine , levobupivacaine , dibucaine overall longest acting local anesthetic- Dibucaine- Tetracaine- Bupivacaine", "explanation_word_count": 24, "prompt": "The longest acting local anesthetics -\nA. Bupivacaine\nB. Ropivacaine\nC. Dibucaine\nD. Tetracaine\nReturn the correct option letter.", "reference": "long acting ester local anesthetic -Benzocaine . tetracaine long acting amide local anesthetic- bupivacaine, ropivacaine , levobupivacaine , dibucaine overall longest acting local anesthetic- Dibucaine- Tetracaine- Bupivacaine\nC", "question_key": "the longest acting local anesthetics -", "split": "validation", "is_mia_member": false} {"id": "228a9c90-d6e9-4c90-ad11-b2c70b74d43b", "question": "Least soluble anaesthetic agent is", "opa": "Desflurane", "opb": "Sevoflurane", "opc": "Halothane", "opd": "Methoxyflurane", "cop": 0, "answer": "A", "exp": "Blood-gas paition coefficient, also known as Ostwald coefficient for blood-gas, is a term used in pharmacology to describe the solubility of inhaled general anesthetics in blood. The coefficient is defined as the ratio of the concentration in blood to the concentration in gas that is in contact with that blood when the paial pressure in both compaments is equal. Newer anesthetics (such as desflurane) typically have smaller blood-gas paition coefficients than older ones (such as ether); these are preferred because they lead to faster onset of anesthesia and faster emergence from anesthesia once application of the anesthetic is stopped. If an anesthetic has a high coefficient, then a large amount of it will have to be taken up in the body's blood before being passed on to the fatty (lipid) tissues of the brain where it can exe its effect. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e", "explanation_word_count": 151, "prompt": "Least soluble anaesthetic agent is\nA. Desflurane\nB. Sevoflurane\nC. Halothane\nD. Methoxyflurane\nReturn the correct option letter.", "reference": "Blood-gas paition coefficient, also known as Ostwald coefficient for blood-gas, is a term used in pharmacology to describe the solubility of inhaled general anesthetics in blood. The coefficient is defined as the ratio of the concentration in blood to the concentration in gas that is in contact with that blood when the paial pressure in both compaments is equal. Newer anesthetics (such as desflurane) typically have smaller blood-gas paition coefficients than older ones (such as ether); these are preferred because they lead to faster onset of anesthesia and faster emergence from anesthesia once application of the anesthetic is stopped. If an anesthetic has a high coefficient, then a large amount of it will have to be taken up in the body's blood before being passed on to the fatty (lipid) tissues of the brain where it can exe its effect. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e\nA", "question_key": "least soluble anaesthetic agent is", "split": "validation", "is_mia_member": false} {"id": "5306e15c-f63f-4363-adc6-09351ca05cd5", "question": "Which of the following aminoacids is a component of Thioredoxin reductase-", "opa": "Selenocysteine", "opb": "Cysteine", "opc": "Methionine", "opd": "Homocysteine", "cop": 0, "answer": "A", "exp": "Ans. is 'a' i.e., Selenocysteine* The 21st proteinogenic aminoacid is selenocysteine (It is represented as sec or as U).* Selenocysteine is a component of:# Thioredoxin reductase# 5' deiodinase# Glutathione peroxidase* Selenocysteine is coded by one of the stop codons UGA, if it is followed by selenocysteine insertion element in the 3' untranslated region of mRNA* tRNAsec (tRNA which is charged with selenocysteine) is first attached to serine by seryl tRNA synthetase or seryl tRNA ligase. But this tRNA is not identified by EF1A (the translation factor which attaches every aminoacyltRNA to A site of ribosome during chain elongation of protein synthesis).* Serine attached tRNAsec is converted into selenocysteine attached tRNAsec by selenocysteine synthetase (Pyridoxal phosphate dependent enzyme) and is guided by EFsec to A site of 60 s ribosome* Please note the 22nd aminoacid is pyrrolysine (represented as pyl or O) is also coded by amber codon UAG. It is not found in human proteins.", "explanation_word_count": 154, "prompt": "Which of the following aminoacids is a component of Thioredoxin reductase-\nA. Selenocysteine\nB. Cysteine\nC. Methionine\nD. Homocysteine\nReturn the correct option letter.", "reference": "Ans. is 'a' i.e., Selenocysteine* The 21st proteinogenic aminoacid is selenocysteine (It is represented as sec or as U).* Selenocysteine is a component of:# Thioredoxin reductase# 5' deiodinase# Glutathione peroxidase* Selenocysteine is coded by one of the stop codons UGA, if it is followed by selenocysteine insertion element in the 3' untranslated region of mRNA* tRNAsec (tRNA which is charged with selenocysteine) is first attached to serine by seryl tRNA synthetase or seryl tRNA ligase. But this tRNA is not identified by EF1A (the translation factor which attaches every aminoacyltRNA to A site of ribosome during chain elongation of protein synthesis).* Serine attached tRNAsec is converted into selenocysteine attached tRNAsec by selenocysteine synthetase (Pyridoxal phosphate dependent enzyme) and is guided by EFsec to A site of 60 s ribosome* Please note the 22nd aminoacid is pyrrolysine (represented as pyl or O) is also coded by amber codon UAG. It is not found in human proteins.\nA", "question_key": "which of the following aminoacids is a component of thioredoxin reductase-", "split": "validation", "is_mia_member": false}