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AIM-Harvard 19

5974fb01-abf1-47f5-b19d-ac6705dcc527

Drug used for sympathectomy in experimental animals is ?

Guanethidine

atropen

Diazoxide

Thebaine

0a

single

Ans. is 'a' i.e., Guanethidine Guanethidine is used for experimental sympthectomy. Guanethidine a polar guanidine compound which is taken up into adrenergic nerve endings by active amine transpo and has three impoant facets of action : Displaces NA from storage granules stochiometrically. Inhibits nerve impulse coupled release of NA Engages and blocks NA uptake mechanism at the axonal membrane. It was used for sympathectomy in experimental animal.

Pharmacology

75b9c9d5-7e91-44b6-afc9-6ae20d2fcccd

Treatment for streptococcal necrotizing fascitis -a) Surgical debridement b) Penicillinc) Clindamycind) Metronidazolee) firvanq

ab

bc

acd

abc

3d

single

Microbiology

a67e6a63-ba49-45fd-bf67-4990cf4dcf9d

Which of the following is not a cardioselective beta blocker:

Acebutol

tenormin

visken

betaloc

2c

single

Pindolol

Pharmacology

45f784d8-1068-4f75-b41a-1daa3b5cdd7d

Drug causing peptic ulcer are all except: (PGI Nov 2009)

KC1

zorvolex

restasis

Clopidegrel

2c

multi

Ans: C (Cyclosporine) Drug Causing Peptic UlcerIngestion of NSAIDs (including aspirin) is the main cause' of gastric and duodenal ulcers that are not associated with H. pylori infection."Diclofenac :Gastric ulceration & bleeding are less common"- K.D.T. 6th/193The isoenzymes cyclo-oxygenase-1 and cyclo-oxygenase-2 are largely responsible for the mucosal protective and antiinflammatory effects respectively of NSAIDs. Therefore newer NSAIDs, such as celecoxih and rofecoxih. that are highly selective for cyclo-oxygenase-2, control inflammation with 'ess risk*--' of causing ulcers.The use of alternative medications such as paracetamol is the best way to prevent NSAID-associated ulcers'1. NSAIDs are now generally avoided in non-inflammatory conditions such as osteoarthritis. When NSAIDs are required a cyclo- oxygenase-2-selective drug is preferred.If an ulcerogenic NSAID has to be continued in a patient at risk then ulcer prophylaxis is indicated. Proton pump inhibitors and misoprostol are both effective in healing and preventing NSAID-associated ulcers. The former are generally preferred because they have fewer side-effects: misoprostol in particular tends to cause diarrhoeaTable (Harrison): Causes of Ulcers Not Caused by HelicobacterPylori and NSAIDsPathogenesis of Non-Hp and Non-NSAIDInfection Cytomegalovirus Herpes simplex virus Hel i cobacter heil manniDrug/Toxin Bisphosphonates Chemotherapy Clopidogrel Q Crack cocaine GlucocorticoidsQ (when combined with NSAIDs) Mycophenolate mofetilQ Potassium chloride0 Miscellaneous Basophilia in myeloproliferative disease Duodenal obstruction (e.g., annular pancreas) Infiltrating disease Ischemia Radiation therapy Sarcoidosis Crohn's disease Idiopathic hypersecretory state

Pharmacology

Adverse Drug Effect

00287ac9-894b-4040-82b0-3d3cf00461b2

Periportal fatty infiltration of the liver is seen with-

Alcoholism

Viral hepatitis

Malnutrition

panmycin

2c

single

Causes of periportal fatty infiltration Low protein diet Total parenteral nutrition Langerhans cell histiocytosis.

Pathology

d435d0ca-d9e2-48c0-a4ee-a6135502ad85

Which drug has least extrapyramidal symptoms?

abilify

Loxapine

prolixin

largactil

0a

single

(Ref: KDT 8th ed. pg. 467)* Among given choice, least risk of EPS among atypicals is: ARIPIPRAZOLE.* Typicals always has high EPS.

Pharmacology

C.N.S

027fa9d0-0e6a-4519-9854-d61b3b3f49a1

Gynaecomastia may be associated with administration of-

zantac

tagamet

Terfenadine

losec

1b

single

Ans. is 'b' i.e., Cimetidine Cimetidine (but not other H2blockers) o Has anti-androgenic action (by displacing DHT from receptor) o Increases plasma prolactin levels --> Galactorrhea in female o Inhibits degradation of Estradiol by liver. Therefore it cause gyaenecomastia, loss of libido, impotence & temporary decrease in sperm count. Other adverse effects of cimetidine o CNS effects --> confusional state (Delirium), restlessness, convulsions, coma, headache, dizziness, hallucination. o Bowel upset, rashes, dry mouth. o Bolus i.v. injection can cause histamine release --> arrhythmias and cardiac arrest. o Transient elevation of plasma aminotransferases. o Cimetidine inhibits several cytochrome P-450 isoenzymes --> inhibits metabolism of many drugs.

Pharmacology

71472b0a-ada2-4336-8f84-7452f7a846ba

Least diffusion coefficient is for :

isoflo

ethrane

fluothane

N20

3d

single

D i.e N20

Anaesthesia

a2ac093e-9b81-4c13-9c20-9948ffa93b60

Which of the following is not a pharmacological propey of prandin?

Insulin Secretagogues

Reduces insulin resistance

Causes less hypoglycemia than sulfonylureas

Effectively reduced postprandial hyperglycemia

1b

single

Repaglinide: the first member of the group, was approved for clinical use in 1998. These drugs modulate B cell insulin release by regula ng potassium efflux through the potassium channels. It should be taken just before each meal in doses of 0.25-4 mg; hypoglycemia is a risk if the meal is delayed or skipped or contains inadequate carbohydrate.

Pathology

All India exam

12ccf10c-6594-4fb4-8422-27ba831fc4ca

Which of the following drugs is a direct inhibitor of clotting factor Xa?

eliquis

Argatroban

arixtra

Aspirin

0a

single

All the drugs ending with XA BAN are direct Xa inhibitor XaBlocker Impoant ones are :- (1) Rivaroxaban (2) Apixaban (3) Edoxaban (4) Betrixaban (b) Argatroban - Direct thrombin inhibitors. (synthetic non-peptide compound which binds reversibly to the catalytic site of thrombin but not to the substrate recognition site)Argatroban uses ---- Tx of Thrombosis and for PCI(PCI = Per cutaneous Intervention) in HIT patients (HIT= Heparin induced thrombocytopenia ) (c) Fondaparinux - Indirect thrombin inhitor. (Penta-saccharidewith specitic sequence that binds to AT -III with high affinity inducing an irreversible conformational change to selectively in actively factor Xawithout binding thrombin) Fondaparinux use - prophylaxis and Tx of DVT &PE(Pulmonary Embolism) as well as ACS (Acute coronary syndrome) (d)Aspirin - Thromboxane synthesis inhibitor Aspirin use - CAD (Coronary Aery Disease), Stroke.

Pharmacology

FMGE 2018

49cc3f73-df06-46ff-b008-f891b4e05b61

Bone marrow depression is seen with chronic administration of -

isoflo

N2O

Ether

fluothane

1b

single

Ans. is 'b' i.e., N2O Nitrous oxide N2Oo It is colourless, odourless, heavier than air, nonirritating and noninflammable gas.o It is also called laughing gas.o MAC is 105% (least potent) - even pure N2O at 1 atmospheric pressure can not produce adequate anaesthesia.o It has good analgesic but poor muscle relaxant activity.o It is supplied under pressure in blue coloured steel cyclinders.o It has very low blood solubility - induction is quick and smooth with rapid recovery.o Second gas effect and diffusion hypoxia occur with N2O only.o N2O is generally used as a carrier and adjuvant to other anaesthetics - A mixture of 70% N2O + 25 - 30% O2 + 0[?]2 - 2% another potent anaesthetic is employed for most of the surgical procedures.o Entonox is a mixture of 50% N2O and 50% O2.o It has little effect on respiration, heart and BP.o It can cause bone marrow depression and vit B12 deficiency.o N2O is the only anaesthetic reported to produce hematologic toxicity and neurotoxicity with long term administration.o Both toxicides are the result of the interaction of N2O with vit B12.o Complete bone marrow failure can be expected after several days of continuous exposure.o Bone marrow changes are preventable by pretreating patients with large doses of folinic acid.o Other manifestations of vit B12 deficiency eg. megaloblastic anemia, subacute combined degeneration of cord may also occur.o Methemoglobinemia and laryngospasm may occur.o It is contraindicated in patients with air cavities like pneumothorax, pneumoperitoneum and volvulus - expansion and increase in pressure occur.

Anaesthesia

Complications Of Anaesthesia

7c2d6218-1915-45af-890f-c270d2f8f894

All are used to shrink fibroids EXCEPT:

Estrogen

danocrine

mifeprex

GnRH analogue

0a

multi

(Estrogen) (345-46-Shaw's 13th) (323-S14th)* Estrogen are used to control the bleeding not the shrinkage tumours:Medical treatment of Fibroids* Iron therapy for anaemia* Drugs used to control menorrhagia* RU 486 (Mifepristone) Dannazol, Gn Rh analogues (depot leuprolide or nafarelin) used to reduce the size of the tumour upto 50 - 80%

Gynaecology & Obstetrics

Miscellaneous (Gynae)

9de7b613-5c19-4846-878e-d7dd15f6e94b

Indicate the drug which does not improve lower esophageal sphincter tone or prevent gastroesophageal reflux, but is used as the first line treatment of gastroesophageal reflux disease:

Sodium alginate+aluminium hydroxide gel

losec

Mosapride

Metoclopramid

1b

single

(Ref: KDT 6/e p648) Treatment of GERD can be acomplished by Increasing GI motility with prokinetic drugs (like metoclopramide and mosapride) or By decreasing gastric acid secretion with PPIs like omeprazole.

Pharmacology

Other topics and Adverse effects

3f034882-6b9b-4ecd-855e-8dee610936c7

Emergence Delirium is characteristic of ?

seizalam

ketalar

Thiopentone

Opioids

1b

single

Ans. is 'b' i.e., Ketamine o Ketamine produces emergence reaction during awakening from anaesthesia --> vivid dreaming, illusions, extracorporeal experiences, excitment, confusion, fear and euphoria --> contraindicated in psychiatric illness like schizophrenia.

Pharmacology

49885cd2-df24-4697-a610-a2d677cd77b8

Which of the following increases during surgical stress?

Coisol

glucagen

Insulin

Gastrin

0a

single

Stress hormones such as coisol and norepinephrine are released by the body in situations that are interpreted as being potentially dangerous. The hormone regulating system is known as the endocrine system. Coisol is believed to affect the metabolic system and norepinephrine is believed to play a role in ADHD as well as depression and hypeension.Glucagon, a peptide hormone secreted by the pancreas, raises blood glucose levels. Its effect is opposite that of insulin, which lowers blood glucose levels.Insulin is a peptide hormone, produced by beta cells of the pancreas, and is central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, skeletal muscles, and fat tissue to absorb glucose from the blood. In the liver and skeletal muscles, glucose is stored as glycogen, and in fat cells (adipocytes) it is stored as triglycerides.In humans, gastrin is a peptide hormone that stimulates secretion of gastric acid (HCl) by the parietal cells of the stomach and aids in gastric motility. It is released by G cells in the antrum of the stomach (the poion of the stomach adjacent the pyloric valve), duodenum, and the pancreas.Ref: Ganong&;s review of medical physiology;24th edition; page no-362

Physiology

Endocrinology

b6f6344c-eb41-47c5-9589-d1d7d2b75a64

cytotec is an analogue of:

PGE1

PGE2

PGF2

PGI2

0a

single

Pharmacology

efa912fc-d135-4e06-83a0-719b5480b863

Which anaesthetic gas is contraindicated in the presence of pneumothorax ?

fluothane

isoflo

Nitrous oxide

Chloroform

2c

single

Anaesthesia

6ff422a1-73c9-4453-b82e-33451639c0f4

All of the following can cause SLE–like syndrome except:

nydrazid

Penicillin

apresoline

Sulphonamide

1b

multi

Pharmacology

7db17906-e8f4-462b-81a1-5e3fdc422c1f

A child was diagnosed as a case of pauci–immune crescentic glomerulonephritis. The treatment to be given in this child is –

orapred + endoxana

medrol

endoxana

Immumoglobins

0a

single

Panel-immune glomerulonephritis Pauci-immune glomerulonephritis is defined as the lack of anti-GBM antibodies or immune complex. It is a type of rapidly progressive glomerulonephritis. Causes are :- Idiopathic renal-limited crescentic glomerulonephritis (ANCA associated).  Microscopic PAN         Microscopic polyangitis             Wegner's gramdomatosis                                                                                         It is treated aggressively with glucocorticoids with or without cyclophosphamide or azathioprine

Pediatrics

60a90f4e-fb83-4c32-ae2b-497ee4b58ad6

Antimitotic drugs of plant source is/are?

vincasar

amnesteem

Bleomycine

Methotraxate

0a

single

Ans. is 'a' i.e., Vincristine

Pharmacology

2380afde-689e-49bf-9141-7f2e35b157d6

In the treatment of severe bradycardia, all of the following can be the best modality of treatment except-

atropen

Pacing

Isoproterenol

angiozem

3d

multi

atropine,pacing,isoproterenol can be used to increase hea rate in bradycardia diltiazem is a calcium channel blocker used to reduce hea rate Ref Harrison 20th edition pg 1456

Medicine

C.V.S

300b7c29-d46b-4746-a108-b022a3feefe8

Induction agent of choice in day care surgery is :

ketalar

diprivan

Methohexitone

Thiopentone sodium

1b

single

Pharmacology

7353f819-6bb7-42d7-b04c-8c47947c2c8d

Which of the following is a monoclonal antibody against IL-5

xolair

nucala

actemra

Alemtuzumab

1b

single

Mepolizumab & Reslizumab are monoclonal antibodies against IL-5 used in bronchial asthma, which act by inhibiting recruitment of esinophils.

Pharmacology

4bf5e2a4-b20f-4004-85d0-c96b4fcc3189

Which one of the following drugs should be avoided in Wolff-Parkinson-White (WPW) Syndrome ?

lanoxin

Adenosine

pronestyl

cordarone

0a

single

Medicine

8691a81f-70ec-4627-bed5-60bc642571cd

A 37-year-old woman presents with complaints of severe heartburn with or without meals. She has a history of hypertension, which has been treated with capoten. She also has a history of Raynaud disease, multiple facial telangiectasias, and very taut skin on the dorsum of both hands. She has failed to obtain relief for her heartburn with large doses of antacids, or losec. Esophageal manometry is ordered. Most likely results of this test is ?

Decreased esophageal peristalsis and decreased LES pressure

Decreased esophageal peristalsis and increased LES pressure

Increased esophageal peristalsis and decreased LES pressure

Increased esophageal peristalsis and increased LES pressure

0a

multi

This patient has the classic presentation of gastroesophageal reflux disease (GERD) in association with scleroderma. These patients have the deposition of collagen in the body of the esophagus, as well as the lower esophageal sphincter (LES). This results in the typical pattern of decreased esophageal peristalsis and the reduced ability of the LES to maintain its high pressures between swallowing. These patients are therefore at risk for severe GERD and subsequent complications of peptic stricture and Barrett's esophagus. Although there is no corrective therapy to improve esophageal motility or increase LES pressure, aggressive treatment is generally aimed at reducing acid production with the use of high doses of proton pump inhibitors. Nevertheless, many of these patients develop the long-term consequences of GERD.  Achalasia, in which impaired esophageal peristalsis is often accompanied by a lack of lower esophageal sphincter relaxation.

Unknown

ca08ee13-d968-48f4-89da-16781b58edfb

Treatment of choice for prophylaxis in patients with repeated episodes of bipolar illness: March 2004

Lithium

depakene

A + B

None of the above

2c

multi

Ans. C i.e. A + B Ref: Kumar and Clark's

Psychiatry

1294ba95-dae2-466b-96d1-c3ea02941fd6

Drug of choice for a child with first episode nephrotic syndrome is?

endoxana

orapred

Mycophenolate

restasis

1b

single

Drug of choice for a child with first episode nephrotic syndrome is oral prednisolone. Drug of choice for steroid dependent nephrotic syndrome is Levamisole, Steroid resistant Nephrotic syndrome are calcineurin inhibitors like Cyclosporine and Tacrolimus.

Pediatrics

Nephritic & Nephrotic Syndrome

6f17b679-e7d1-4c35-b3a9-66f71e3ab255

Drug of choice for attention deficit disorder with hyperactivity is: September 2009

largactil

catapres

tofranil

ritalin

3d

single

Ans. D: Methylphenidate Attention-Deficit Hyperactivity Disorder/ ADHD/ AD/ HD is a neurobehavioral developmental disorder. It is primarily characterized by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone" and symptoms staing before seven years of age. ADHD is the most commonly studied and diagnosed psychiatric disorder in children, affecting about 3% to 5% of children globally. Stimulant medication are the most commonly prescribed medications for ADHD. The most common stimulant medications are the chain subsitituted amphetamine methylphenidate (currently, the drug of choice), dextroamphetamine and dexamohetamine. Atomoxetine, a norepinephrine reuptake inhibitor, may be an alternative for children who do not respond to stimulants.

Psychiatry

9265bbfb-9616-4de2-b2b0-2c43ef45387a

A 30 weeks pregnant multigravida was found to have high BP, proteinuria and pedal edema. The antihypeensive can be used to control BP in this patient is:

Guanethidine

trandate

tenormin

capoten

1b

single

Labetalol is an alpha1-adrenergic blocker and a nonselective beta-adrenergic blocker and it is safe during pregnancy. The beta-blockade/alpha-blockade ratio is 7:1. It appears to lack teratogenicity and crosses the placenta in small amounts. Methyldopa, labetalol, or nifedipine are first-line antihypeensive agents in pregnancy. Among them, methyldopa is the first-line antihypeensive agent in pregnancy. Other antihypeensive medications used in pregnancy include metoprolol, prazosin, minoxidil, hydralazine, thiazide diuretics, and clonidine. Ref: Miller D.A. (2013). Chapter 26. Hypeension in Pregnancy. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.

Gynaecology & Obstetrics

0d33134b-6d10-4e95-b9eb-130be1d39da5

Strongest stimulus of lactation is by :

reglan

Post paum hemorrhage

Bromocripti ne

Suckling

3d

single

Suckling

Gynaecology & Obstetrics

3d974e42-d610-4a9b-8f70-edf5c1c4cd65

Features of liver damage are all except

Decreased factor VII levels

Raised prothrombin time

Conjugated as well as unconjugated hyperbilirubinemia

Decreased epogen production

3d

multi

Ans. d (Decreased erythropoietin production). (Ref. Harrison's 18,h/Ch. 301., Robbins 6th/846, 1667)SIGNS OF LIVER FAILURE:# Intermediate metabolism of amino acids and carbohydrates# Synthesis and degradation of proteins and glycoproteins# Metabolism and degradation of drugs and hormones# Restriction of lipid and cholesterol metabolism# Coagulation factor# Bile, bile salts and impaired metabolism.

Medicine

G.I.T.

b92c2758-e30f-484f-b7f2-f086afa7533b

Following are features of oramorph withdrawl, except:

Piloerection

Insomnia

Discharge from nose

Constipation

3d

multi

Constipation

Psychiatry

68163ab9-795b-403d-aed3-c89e3b82cbd6

Most potent analgesic:

COX-2 inhibitor

ultiva

oramorph

sufenta

3d

single

Ref: Goodman & Gillman 13th ed. P 376* Fentanyl citrate and sufentanil citrate are congeners of fentanyl and are considered as potent analgesics* After systemic delivery:# Fentanyl is about 100 times more potent than morphine# Sufentanil is about 1000 times more potent than morphine* Time to peak analgesic effect after IV administration: 5 minutes* These drugs are well known to be used as epidural analgesic.

Pharmacology

Endocrinology

abda6ac9-fa74-4a35-b75e-dedeb0c56673

A female patient with a mechanical heart valve who is taking jantoven informs you that she hopes to get pregnant in the near future. What advice do you give her regarding her antithrombotic medication during the anticipated pregnancy?

Continue with jantoven until the third trimester.

She should replace jantoven with aspirin at analgesic doses.

Discontinue all medications that affect the blood.

Replace jantoven with heparin.

3d

multi

Discontinuance of warfarin is appropriate during pregnancy because it is a known teratogen that causes bone dysmorphogenesis. The patient will need continued protection against thrombus formation, and heparin (or a related low molecular weight compound) is usually advised, despite the fact that the drug will require parenteral administration and can cause thrombocytopenia.

Pharmacology

Anti-Cancer

5d739a5a-3864-4e86-b99b-d1d9f687f1a1

mood stabilzer used in the management of trigeminal neuralgia is

carbamezepine

depakene

lamictal

lithium

0a

single

Carbamazepine - USES - TRIGEMINAL NEURALGIA - TEMPORAL LOBE EPILEPSY - SECOND LINE MOOD STABILIZER Ref.Kaplon and Sadock, synopsis of psychitry, 11 th edition, pg no.935

Anatomy

Pharmacotherapy in psychiatry

c653ec61-c176-4b1c-952a-142d9ec20846

Alpha 1 blocker used for BHP is:

Tamsolusin

minipress

Oxazosin

Dolazoline

0a

single

Tamsolusin

Pharmacology

c8b63608-1954-4ae1-8ab6-5ebedbb95f3c

Bronze baby syndrome is caused by:

Phototherapy

Phenobarbitone

Hemosiderosis

chloromycetin

0a

single

Bronze baby syndrome: is a dark, grayish brown skin discoloration mainly seen in infants with elevated conjugated bilirubin, as an adverse effect of phototherapy

Pediatrics

Neonatal Jaundice

644a2452-0ffb-456c-843d-1e0f210183b6

Oxalate crystals in urine is seen in: (PGI Dec 2006)

Ethylene glycol poison

Di glycol poison

Alcohol

crixivan

0a

single

Ans: A (Ethylene glycol poisoning) Ethylene Glycol Poisoning# Ingestion of ethylene glycol (commonly used in antifreeze) leads to a metabolic acidosis and severe damage to the central nervous system, heart, lungs, and kidneys. The increased AG and osmolar gap are attributable to ethylene glycol and its metabolites, oxalic acid, glycolic acid, and other organic acids. Lactic acid production increases secondary to inhibition of the tricarboxylic add cycle and altered intracellular redox state.# Diagnosis is facilitated by recognizing oxalate crystals in the urine(r) the presence of an osmolar gap in serum, and a high-AG acidosis. If anti freeze containing a fluorescent dye is ingested, a Wood's lamp applied to the urine may be revealing. Treatment should not be delayed while awaiting measurement of ethylene glycol le%rels in this setting

Medicine

Toxicology

92b573b9-f22d-45ff-8bc7-8fdd4e124978

A 48-year-old male presented to OPD with complaints of generalized swelling over face and legs. Lab repos show moderately increased albuminuria. He gives history of HTN and T2DM for 15 years which is improperly controlled. He is staed on cA preparations,which of following drug should not be prescribed to this patient?

tivicay

epivir

emtriva

Tenofovir

3d

single

Albuminuria in presence of T2DM And HTN is pointing towards renal dysfunction Tenofovir disoproxil fumarate (TDF, commonly termed 'tenofovir') is the antiretroviral most commonly implicated in antiretroviral-induced nephrotoxicity. It is mainly metabolized and excreted by kidneys, therefore avoided in patients with renal dysfunction

Medicine

viral infection

449d128b-e935-4c62-a958-45501729944c

A 28 year old Raji was HbsAg positive during her first pregnancy 8 years ago. She was asymptomatic and had regular check ups with a Hepatologist. Rani is now 32 weeks pregnant with the following lab parameters : LFT Normal, HbsAg Positive, HbeAg Negative, HBV DNA 90,000 copies/ml. Her first child was given hepatitis B immunoglobulin and Vaccination soon after bih and the child is HBsAg negative. Which of the following statement is true about the current scenario?

Very high risk of hepatitis B transmission to the baby

baraclude is safe in pregnancy and should be staed as early as possible to mother

Antiviral therapy against hepatitis B is contraindicated in pregnancy

The patient can be monitored without antivirals and the baby should be given immunoglobulin and active immunisation soon after delivery

3d

multi

The patient can be monitored without antivirals and the baby should be given immunoglobulin and active immunisation soon after delivery

Medicine

5bf3aa0c-328c-4450-b0df-c6910e3798c1

Regarding sulpha group of drugs all the below statements are true, except:

Sulfonamide may cause Kernicterus in newborn

Sulfonamides are used in Norcardia infections

Crystalluria can occur with sulfonamide

azulfidine is absorbed well from GIT

3d

multi

Sulfasalazine is usaually absorbed from the small intestines. Only 10% of drug is absorbed remaining excreted unaltered in bowel. Hence, this drug acts locally in the intestine of patient with inflammatory bowel disease. Ref: Paul Beringer (2006), Chapter 90, "Antiinfectives", In the book, "Remington: The Science and Practice of Pharmacy", Lippincott Williams and Wilkins, USA, Page 1631 ; KD Tripathi, 5th Edition, Pages 186, 643 ; Katzung 9th Edition, Page 591

Pharmacology

fd9b2009-a6e4-4479-b9c0-7e0fc3530ae3

Which of the following local anesthetic is a vasoconstrictor

xylocaine

novocaine

exparel

naropin

3d

single

Surgery

dfdb9eca-d73d-4d45-a382-fb677cdee025

A 53-year-old man presents to Casualty with severe chest pain. He has a history of angina. ECG shows ST elevation of 4 mm in leads V1 and V4 Thrombolysis has been done but pain and ECG findings are persisting 90 minutes after start of thrombolysis. What is the best management of this patient?

Rescue PCI

Primary PCI

Delayed PCI

IV reopro

0a

single

Ans. A Rescue PCIRef: CMDT 2019 pg. 386The patient is having failure of thrombolysis. In case of failure of thrombolysis, rescue PCI is performed. Primary PCI is done for STEMI. Delayed PCI is done for NSTEMI and hence are ruled out.

Physiology

Nervous System

4d08b1ed-f5c3-4d60-8c24-d363697d7d66

Which amide local anaesthetic causes allergy

Lignocaine

Articane

cepacol

Prilocaine

1b

multi

Articane is the only amide local anaesthetic agent metabolised by pseudocholinesterase, produces PABA thus causing allergy.

Anaesthesia

df0a364e-028c-440e-b61c-b8fb79d37919

firazyr IS A ?

bradykinin B 1 antagonist

bradykinin B 2 antagonist

bradykinin B 3 antagonist

histamine receptor H3 antagonist

1b

single

Icatibant, New Bradykinin-Receptor Antagonist, in HAE Icatibant (Firazyr, Shire) synthetic selective decapeptide bradykinin B2 receptor competitive antagonist contains 5 non-natural amino acids to enhance resistance to peptidases Icatibant administered sc injection as single 30 mg peak concentration within 30 minutes, ref : kd tripathi 8th ed

Pharmacology

All India exam

2bdf52c0-327e-4e2f-acea-73648a2a8c1d

A 55-year-old woman was admitted to the intensive care unit with severe lobar pneumonia and septic shock. She remained hypoxemic despite intubation, a high fraction of inspired oxygen, and positive end-expiratory pressure (PEEP). When PEEP was increased further, she paradoxically became more hypoxemic and her blood pressure and central venous hemoglobin saturation fell. What would be your approach

Keep PEEP at the highest and give adrenaline

Initiate dobutrex and reduce PEEP to 5cm H2O

Increase PEEP further

Increase FiO2

1b

multi

High levels of PEEP can decrease cardiac output and tissue oxygen delivery with subsequent decreases in mixed and central venous oxygen content that contribute to impaired arterial oxygenation in patients with increased shunt fractions. So in this patient give dobutamine to correct hypotension and reduce PEEP so as to increase oxygenation.

Anaesthesia

31065b71-cacd-4766-ab02-9f93e0807b23

Which of the following drugs is contra-indicated in acute intermittent porphyria?

Thiopentone

seizalam

diprivan

amidate

0a

single

Barbiturates are contra-indicated in acute intermittent porphyria. Ref: KD Tripathi 8th ed.

Pharmacology

Central Nervous system

0c2166d9-c644-4cf9-a1c5-6e1e653af19b

A 32-year old male with no past medical history is brought to the emergency department after being injured in a bomb blast. On examination he is suspected to have a splenic injury and is supposed to undergo an emergency laparotomy. Which of the following is the ideal anaesthetic agent of choice ?

ultiva

oramorph

amidate

fluothane

2c

single

Inducing agents of choice patients with hypotension are Ketamine and Etomidate :- (1) If the patient is hypertensive at the time of induction → Etomidate is preferable. (2) If the patient is normotensive or mild hypotensive → Either of two can be used. (3) If the patient is severely hypotensive → Ketamine is preferred.

Anaesthesia

8c4c66f9-8ca5-4af1-bf76-162954c50674

Delta cells of pancreas secretes

glucagen

Insulin

Somatostatin

Pancreatic polypeptide

2c

single

Ans. (c) Somatostatin

Physiology

Pancreas

687f89a2-ab71-4b49-a2bc-99ac61e19de5

Which of the following pair of drugs are metabolized by same Cytochrome enzyme

losec and plavix

dilantin and prograf

tylenol and jantoven

losec and jantoven

0a

single

Both are metabolized by CYP2C19.

Pharmacology

0092c918-83ea-4e0d-acf1-64bbcfc74021

Which of the following medications should be used for pheochromocytoma associated hypeension after dibenyline is staed?

norvasc

inderal

adalat

angiozem

1b

single

Option B- in order to control tremors and palpitation complaints in the patient For Pheochromocytoma : (a+b) =Ideal management recommended protocol (b+a) = C/I

Medicine

Disorders of Adrenal Gland

7d1f1e2f-423f-4aab-be37-c69f837211cc

Amphotericin B (Fungizone) IV is given to a client with aspergillosis, a fungal infection. In order to prevent its side effects, the nurse anticipate administering which of the following prior, except?

Hydrocortisone.

extina.

benadryl.

Meperidine.

1b

multi

Azole antifungals (eg, ketoconazole) decreases the effectiveness of amphotericin b. Options A and C: Fever, shaking, chills, flushing, loss of appetite, dizziness, nausea, vomiting, headache, shortness of breath, or fast breathing may occur 1 to 3 hours after the infusion is started. Medications such as acetaminophen, diphenhydramine, corticosteroids such as hydrocortisone) may be necessary to prevent these side effects. Option D: Meperidine (25 to 50 mg IV) has been shown in some patients to decrease the duration of shaking chills and fever that may accompany the infusion of amphotericin B.

Medicine

a04d5ed2-9c9b-47bb-9e2e-ee7d95c3f1e8

All of the following are true about "aldara" EXCEPT:

Direct antiviral activity

Indirect antiviral activity

Antitumor activity

It release cytokines

0a

multi

IMIQUIMOD: Mechanism of Action An unknown mechanism in treating actinic keratosis and external genital was; immune response modifier, stimulates the release of inflammatory cytokines and proliferation/migration of immune cells No direct antiviral activity Absorption Appears to be dependent on the area of application rather than the amount applied Peak plasma concentration (Aldara): 0.1-3.5 ng/mL Peak plasma concentration (Zyclara): 0.323 ng/mL Elimination Excretion: Urine USES: Actinic Keratosis Indicated for topical treatment of clinically typical, nonhyperkeratotic, nonhyperophic actinic keratoses on the face or scalp in immunocompetent adults Zyclara 2.5% or 3.75%: Apply qDay to the skin of affected area (either entire face or balding scalp) for two 2-week treatment cycles separated by 2-week no-treatment period Aldara 5%: Apply 2 times a week for 16 weeks to one defined treatment area (contiguous area <25 cm2); examples of dosing schedules include Monday and Thursday or Tuesday and Friday Superficial Basal Cell Carcinoma Target tumor should have maximum <2 cm diameter and be located on trunk (excluding anogenital skin), neck, or extremities (excluding hands and feet); treatment area should include 1 cm margin of skin around tumor Aldara 5%: Apply 5 times a week for 6 weeks to biopsy-confirmed superficial basal cell carcinoma and include 1 cm margin of skin around tumor External Genital Was Indicated for the treatment of external genital and perianal was/condyloma acuminata Zyclara 3.75%: Apply a thin film to the entire treatment area and rub in until the cream is no longer visible; may wash with mild soap and water after 8 hours of application; use 1 packet or 1 full actuation of the pump Aldara 5%: Apply 3 times a week until total clearance of was or for a maximum of 16 weeks; examples of application schedules are Monday, Wednesday, Friday or Tuesday, Thursday, Saturday; use 1 packet only for each application Bladder Cancer (Orphan) Orphan designation for the treatment of carcinoma in situ of the urinary bladder. Adverse Effects >10% Application site reaction (33%) UI (15%) Erythema (54-61%) Erosion (29-31%) Excoriation/flaking (18-25%) Edema (12-17%) Itching (20%) 1-10% Sinusitis (7%) Burning (6%) Headache (5%) Carcinoma squamous (4%) Diarrhea (3%) Bleeding (3%) Stinging (3%) Pain (3%) Eczema (2%) Induration (2%) Tenderness (2%) Irritation (2%) Back pain (1%) Fatigue (1%) Atrial fibrillation (1%) REF KD Tripathi 8th ed

Pharmacology

Immunomodulators

1b81e59f-0bb4-412e-9b1e-b6267bfd6bf2

Best uterine relaxation is seen with –

Chloroform

Nitrous oxide

Ether

fluothane

3d

single

All fluorinated inhalational agents (including halothane) can cause uterine relaxation. Traditionally, Halothane is considered as to posseses maximum uterine relaxant property.

Anaesthesia

175791c5-c987-45dd-838e-d01765b25045

Cholinergic drugs such as pilagan are routinely used to treat glaucoma. What is their mechanism of action in the eye that accounts for this ophthalmologic use?

Reduction in the formation of aqueous humor

Blockade of adrenergic receptors to potentiate cholinergic effects

Alkalinization of aqueous humor

Improved drainage of aqueous humor

3d

single

Like other cholinergics with muscarinic action, pilocarpine improves the drainage of aqueous humor from the anterior chamber angle of the eye. The cholinomimetic effect results in contraction of the ciliary body and causes a change in its position. This altered position increases flow of aqueous humor through the trabecular network and into the canal of Schlemm, thus decreasing the intraocular pressure of glaucoma. Ref: Brown J.H., Laiken N. (2011). Chapter 9. Muscarinic Receptor Agonists and Antagonists. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.

Ophthalmology

99c767c2-bde7-4e08-9e54-ec93630332d8

Drug of choice in delirium tremens is -

Diazepalm

dilantin

librium

oramorph

2c

single

Chlordiazepoxide is preferred over diazepam.

Psychiatry

4a892906-a105-424d-b963-549152241d63

Which one of the following drugs can reduce the efficacy of low dose oral contraceptive pill :

Penicillin

panmycin

penbritin

Rifampicin

3d

single

Rifampicin

Gynaecology & Obstetrics

e29c2837-ae3d-4e9b-ab1e-d1e1462f5358

Drug of choice for generalized anxiety ?

3-blocker

xanax

Buspirone

dilantin

1b

single

Ans. is 'b' i.e., Alprazolam Treatment of generalized anxiety Benzodiazepines are the drug of choice. Drugs in this group are diazepam, Lorazepam, Alprazolam, Oxazepam, chlordiazepoxide. Other drugs used are buspirone; TCA (amptriptyline, imipramine, clomipramine, desipramine); SSRIs (Fluoxetine, Sealine, Paroxetine, Citalopram); SNRIs (Venalafaxine), 13-blockers. Anticonvulsants with GABAergic propeies may also be effective against anxiety, e.g., Gabapentin, Oxcarbazepine, Tiagabine, pregabalin, and Valproate (divalporex).

Psychiatry

e14f1a88-4afe-4ebd-ac48-02d55dc3b087

Drug not having any role in Acute Asthma is:

atrovent

Steroid

ventolin

Sodium Chromoglycate

3d

single

Sodium Chromoglycate Sodium Chromoglycate

Pharmacology

718cc486-4e8a-4400-92f1-c479a4be7c1b

Drug of choice for cystitis ?

Amoxicillin

chloromycetin

Cotrimoxazole

proquin

3d

single

Ans. is 'd' i.e., Ciprofloxacin Fluroquinolones form the first line of drugs to be used against cystits. Ciprofloxacin is a fluoroquinolone and so the most appropriate answer.

Pharmacology

753f7e8b-b92b-462c-8134-d4eab3a3e55d

Treatment for multiple sclerosis

Interferon alpha

Interferon beta

remicade

Interferon gamma

1b

single

Beta interferons. These medications are among the most commonly prescribed medications to treat MS. They are injected under the skin or into muscle and can reduce the frequency and severity of relapses Interferon alpha is used to treat various cancers (e.g., leukemia, melanoma, AIDS-related Kaposi's sarcoma). It is also used to treat virus infections Interferon-g 1b is approved by the U.S. Food and Drug Administration to treat chronic granulomatous disease and osteoporosis This medication is used to treat ceain types of ahritis (rheumatoid ahritis, ahritis of the spine, psoriatic ahritis), ceain bowel diseases (Crohn's disease, ulcerative colitis), and a ceain severe skin disease (chronic plaque psoriasis). Ref Harrison20th edition pg 2345

Medicine

C.N.S

d5e36578-bfe7-4155-a7d7-1ab91a0244a7

Coronary steal phenomenon is seen with:

Dipyridamole

angiozem

inderal

isoptin

0a

single

There are two types of vessels in coronary circulaton – 1. Larger conducting arteries which run epicardially and send perforating branches. 2. Smaller resistance arterioles - These are perforating branches of conducting arteries. These arterioles supply blood to the endocardium.   During ischemia, adenosine (a local mediator) causes dilatation of resistance arterioles in the ischemic area only, the tone of resistance vessels of the nonischemic area does not change → the increased flow to the ischemic area.  Dipyridamole is a powerful coronary dilator; increases total coronary flow by preventing uptake and degradation of adenosine.  It dilates resistance vessels in the nonischemic zone as well → Diverts the already reduced blood flow away from ischemic zone - Coronary steal phenomenon.  It has no effect on larger conducting vessels (contrast nitrates which dilate larger conducting vessels and cause redistribution of blood towards ischemic zone).  Dipyridamole inhibits platelet aggregation by increasing cAMP (by inhibiting phosphodiesterase) which potentiates PGI and interferes with aggregation.  It is not useful as an antianginal drug (due to coronary steal phenomenon), but can be used for prophylaxis of coronary and cerebral thrombosis in post-MI and post-stroke patients as well as to prevent thrombosis in patients with a prosthetic heart valve.

Pharmacology

e4db8a6b-f808-46f8-8507-5d0b31789591

Patient was given resochin & vibramycin for 7 days. Patient&;s fever decreases in 4 days but , peripheral smear showed occasional gametocytes of plasmodium falciparum. This type of drug resistance is -

R1 type

R2 type

R3 type

R4 type

1b

single

Types of Drug Resistance In defining criteria for resistance to the aminoquinolineantimalarial drugs, the WHO has described three grades of resistance following treatment (Low grade) R1 : Recrudescence of infection between 7 and 28 days of completing treatment following initial resolution of symptoms and parasite clearance. (High grade) R2 : Reduction of parasitaemia by > 75% at 48 hours but failure to clear parasites<br />within 7 days. R3 : Parasitaemia does not fall by >75% within 48 hours. (www.slideshare.net)

Social & Preventive Medicine

Communicable diseases

f470bc50-f939-4f1b-8a5e-22457c0639e8

Granulomatous hepatitis may be seen with :

tegretol

caplenal

Phenylbutazone

All of the above

3d

multi

Answer is D (All of the above) Granulomatous Hepatitis has been implicated with the following drugs: PhenyIbutazoneQ Sulfimamides.Q INHQ AllopurinolQ QuinidineQ CarbamazepineQ

Medicine

468888e8-7c81-48b1-8753-1e1447a73081

A patient with HIV infection complains of rapidly progressive painless visual loss.Fundus shows exudates and haemorrhage especially along blood vessels. In this case, the treatment of choice would be-

Amphotericin B

nebupent

Acyclovir

cymevene

3d

multi

Medicine

df4037c5-e602-4360-828a-bc1124733dc4

G.P. is plasticized (softened) by

Alcohol

Chloroform

Eugenol

disotate

1b

single

Dental

f342478a-6e8a-495e-a318-80b2247f6122

Peripheral aerial disease can be treated by all, EXCEPT:

Pentoxifylline

pletal

viagra

Percutaneous angioplasty

2c

multi

Pentoxifylline, a xanthine derivative, is thought to act by reducing the viscosity of blood, allowing it to flow more easily through paially obstructed areas. Cilostazol, a phosphodiesterase type 3 (PDE3) inhibitor, is poorly understood, but may have selective antiplatelet and vasodilating effects. Both drugs have been shown to increase exercise tolerance in patients with severe claudication. Percutaneous angioplasty with stenting is often effective in patients with medically intractable signs and symptoms of ischemia. Ref: Katzung, 11th edition, Chapter 12.

Pharmacology

10ad4257-6232-418e-a4f9-a38ef90941e4

Aryan, a 14-year–old boy presented with chronic diarrhea and weight loss. History reveals that he has repeated attacks of respiratory tract infections with Pseudomonas aeruginosa. His younger brother died from a severe respiratory infection at the age of 7. Which of the following agents is most likely to improve this patient's condition

sandostatin

Pancreatic lipase

flagyl

imodium

1b

single

In a young male, a history of recurrent respiratory infections with P. aeruginosa, chronic diarrhea, weight loss, and death of a sibling due to respiratory infection suggests a diagnosis of cystic fibrosis (CF). Chronic diarrhea and weight loss in patients with CF are typically caused by malabsorption secondary to pancreatic insufficiency and can be corrected by pancreatic enzyme supplementation.

Pharmacology

b806dad8-1798-4bbc-a447-e077c1815996

A patient Amit Kumar is suffering from atherosclerosis. Which of the following is the most beneficial drug for prevention of stroke in this patient ?

Aspirin

jantoven

Low dose subcutaneous heparin

lanoxin

0a

single

Pharmacology

a1d788bf-ec6d-4347-a7c5-28c3da42ee92

What is the alternative drug for epipen in ACLS?

cordarone infusion

atropen

High dose pitressin

Adenosine

2c

single

Ans. c. High dose vasopressinADVANCED CARDIAC LIFE SUPPORT ALGORITHMS

Medicine

C.V.S.

29986844-1c38-47d7-8084-0092f8072914

A patient after valve replacement will require follow up treatment with

jantoven

ACE inhibitors

Beta blockers

Thiazide

0a

single

Warfarin-Warfarin being oral anticoagulant is used as prophylaxis after valve replacement because of propensity of these pts. developing thromboembolism is higher. Rx- warfarin + Inj heparin -life time use Heparin is discontinued after five days where as warfarin is taken lifelong. As warfarin takes at least 5 days to show its effect. Note-with warfarin therapy INR monitoring should be done.

Pharmacology

FMGE 2019

8b7a8f39-9807-4b50-ae66-80369a9e7cef

What is proposed mechanism of dissociative anesthesia effect of ketalar:-

Inhibition of thalmocoical pathway

Stimulation of limbic system

Both

None

2c

multi

Ketamine produces dissociative anesthesia which is characterized by a state wherein the patient is conscious (eg., eye opening, swallowing, muscle contracture) but unable to process or respond to sensory input. It acts as an antagonist at the phencyclidine site of the NMDA receptor. Ketamine functionally "dissociates" the thalamus (which relays sensory impulses from the reticular activating system to the cerebral coex) from the limbic coex (which is involved with the awareness of sensation). Though the patient may have intact corneal, cough, and swallow reflexes, they need not be protective.

Anaesthesia

Intravenous Anesthetic Agents

b397c823-d371-481c-b221-b3b3b5a4ce08

Which antihypeensive is a prodrug and is coveed to its active form in brain?

catapres

aldomet

Minoxidil

nitropress

1b

single

(Ref: KDT 6/e p547) Although both methyldopa and minoxidil are produrgs, conversion of methyldopa to a-methylnorepinephrine takes place in the brain whereas minoxidil is activated to minoxidil sulphate (by phase II reaction) in the periphery.

Anatomy

Other topics and Adverse effects

83e5d0b5-e019-46b0-a218-7cca98fb56ba

False statement regarding dilantin is:-

It is highly protein bound

Its half-life increases with increase in dose

It is a microsomal enzyme inducer

It follows zero order kinetics at lower doses

3d

multi

Most of the drugs which follow zero order kinetics, do so at higher plasma concentration including phenytoin PHENYTOIN It is a non sedating oral antiepileptic drug. Fosphenytoin is a water soluble prodrug of phenytoin that can be administered parenterally (i.v. or i.m.) for acute attack of seizures (status epilepticus). Fosphenytoincauses hyperphosphatemia in renal failure . ECG monitoring is must while administering fosphenytoin intravenously due to cardiotoxic effect . These drugs act by blocking the use dependent Na+ channels. Phenytoin is useful in GTCS and paial seizures. It can also be used as an anti-arrhythmic drug (class Ib) for the treatment of digitalis induced arrhythmia. This drug follows saturation kinetics (kinetics changes from first order to zero order at high doses, within therapeutic concentrations). Phenytoin from different manufacturers (different brands) have different bioavailability and therefore brand change can lead to toxicity or suboptimal levels. It is also a potent enzyme inducer and can increase the metabolism of various drugs.

Pharmacology

Epilepsy

a6b54aff-5961-4f54-ba58-7d7985a910b4

Antitubercular drug which is least hepatotoxic: September 2010

Rifampicin

Pyrazinamide

myambutol

INH

2c

single

Ans. C: Ethambutol The single biggest problem with TB treatment is drug-induced hepatitis, which has a moality rate of around 5%. Three drugs can induce hepatitis: PZA, INH and RMP (in decreasing order of frequency). It is not possible to distinguish between these three causes based purely on signs and symptoms.

Pharmacology

358cc29b-cc5c-45b0-92a1-21255eb707bf

Orange urine and tears are adverse effect of

Rifampicin

nydrazid

myambutol

Pyrazinamide

0a

single

A. i.e. (Rifampicin) (742- KDT6th) (398- Lipincott's 3rd* Urine of patients taking Nitrofurantoin becomes dark brown due to its metabolites* Systemic administration of phenol gives - green colour to urineDrugAdverse- effectsCommentsEthambutolOptic neuritis** with blurred vision, red- green color blindnessEstablish baseline visual acuity and color vision test monthlyIsoniazidHepatic enzyme elevation, hepatitis, peripheral neuropathy*** Take base line LFT measurement* Clinically significant interaction with phenytoin* and anifungal agents (azols)PyrazinamideNausea, hepatitis, hyperuricemia**, rash joint ache, gout (rare)Take base line LFT and uric acid measurementRifampinHepatitis, GI upset, flue- like syndrome,**Take baseline LFT and CBC count, Warn patients that urine and tears may turn red- orange in color**StreptomycinOtotoxicity, nephrotoxicity**Do base line audiography and renal function tests* Red Man's Syndrome is caused by vancomycin (Fever, Urticaria and Intense flushing)

Pharmacology

Anti Microbial

a33b81ad-234a-44fb-bffe-e183528c805b

First step in management of raised intracranial pressure

Airway maintainance

Breathing

iv osmitrol

Loading dose of epsolin

0a

multi

Answer- A. Airway maintainanceABC is followed i.e. Airway Breathing then Circulation is evaluated in order.

Surgery

0e3181d6-b911-4985-9c48-5a20b89e2c6c

Which of the following is LEAST useful in treatment of OCD?

anafranil

SSRIs

Cognitive behavioral therapy

Systematic desensitization

3d

single

SSRIs, Clomipramine and CBT are all first line treatment. Systematic desensitization is least effective of all.

Psychiatry

Neurotic, Stress Related and Somatoform Disorders

560898ea-4bec-4998-b4e0-c8d7eb99084f

All of the following cause macrocytic anaemia,except -

Primaquine

trexall

Trimethoprin

imuran

0a

multi

Pathology

adea7e09-5a75-454d-91df-88d3835167f7

A 55-year-old female developed ESRD due to poorly controlled diabetes. She underwent dialysis 2-3 times a week. She was advised for kidney transplant which she received from cadaveric donor. She was put on immunosuppressive therapy with imuran, restasis, medrol and anti-thymocyte globulin. Two weeks following the surgery, the patient was discharged on medications. 2 weeks later she presented to emergency with complaints of decreased urine output. On examination, her BP was noted to be 160/95 mm hg. The region of the graft is enlarged and is tender to touch. Lab investigations revealed serum creatinine of 4 mg/dl. Her differential diagnosis includes transplant rejection and drug toxicity. Which drug could be held responsible for the above clinical scenario?

imuran

restasis

medrol

ATG

1b

multi

Cyclosporine: Immunosuppressive agent with efficacy in human organ transplantation treatment of graft-versus-host (GVH) disease after hematopoietic stem cell transplantation treatment of selected autoimmune disorders. Cyclosporine act at an early stage in the antigen receptor-induced differentiation of T cells and blocks their activation. Cyclosporine binds to cyclophilin (immunophilins). Toxicities are numerous and include Nephrotoxicity hypeension, hyperglycemia liver dysfunction hyperkalemia Altered mental status Seizures hirsutism. Cyclosporine uses: Cadaveric transplantation of the kidney, pancreas, and liver, and useful in cardiac transplantation. With methotrexate: Prophylactic regimen to prevent GVH disease after allogeneic stem cell transplantation. Autoimmune disorders Uveitis rheumatoid ahritis psoriasis asthma.

Unknown

Integrated QBank

c28d5ab1-bd66-4974-a8be-6c4edc3e444f

Oral hypoglycemic which should be stopped prior to surgery under GA:

actos

glucophage

Gliclazide

Glibenclamide

1b

single

Medicine

9da0b14a-e192-4e2f-aebb-f7766bfad918

In a patient with chronic congestive cardiac-failure, all of the following drugs prolong survival except :

betaloc

coreg

vasotec

lanoxin

3d

multi

Answer is D (Digoxin) `Digitalis does not improve survival in patients with hea failure and sinus rhythm.' It reduces symptoms of hea failure and need for hospitalization. ACE inhibitors (Corvedilol and enalapril) and Betablockers (Metaprolol) prolong life. `ACE inhibitors improve symptoms and prolong life' -- Oxford handbook 5th/122 ACE inhibitors.

Medicine

cd5c22b4-a3f2-418d-9205-5dac08509931

imitrex is used in :

Mania

Depression

Schizophrenia

Migraine

3d

single

Pharmacology

fb9bef3a-e21c-4528-a621-16ea352072db

A 25-year-old male presents to the emergency depament with occasional severe headaches, nausea, and vomiting. Blood pressure while sitting is 230/130 mmHg with a hea rate of 90 beats/min but on standing the blood pressure drops to 200/100 mmHg and the hea rate increases to 140 beats/min. A cardiovascular examination depicted tachycardia with normal S1, S2 sounds . The patient's lungs are clear. The optic discs are blurred, but there are no exudates or hemorrhages. Select appropriate treatment for such condition .

trandate

nitropress

oraverse

apresoline

2c

single

If SBP gets reduced by >20mmHg & DBP get reduced by >10mmHg On change of posture=Postural or Ohostatic Hypotension * |HR * Headache+ HTN * In early phase, the BP will be elevated for few min-hours i.e. Episodic HTN * In late phase, the BP will show postural hypotension. All are Features of Pheochromocytoma [?] Phentolamine Option A & B- used in HTN encephalopathy (Unconsciousness, brisk reflexes) Option D- can l/t reflex tachycardia which ||HR

Medicine

Raised ICP and Brain death

ae9be457-aa63-4fc6-a618-d569ddf8d81e

Which of the following drugs is not used topically for treatment of open angle glaucoma?

Lanatoprost

alphagan

diamox

Dorazolamide

2c

multi

Ans. is 'c' i.e., Acetazolamide

Pharmacology

31b94a39-0b25-4b5d-b16d-4c4bcaf57734

All of the following drugs are useful for long-term treatment of congestive hea failure except:

lanoxin

altace

dobutrex

carospir

2c

multi

Dobutamine is indicated only for the acute t/t of decompensated CHF. Cardiac glycosides (digoxin) can be used for acute treatment as well as maintenance therapy of CHF. ACE inhibitors and spironolactone are indicated only for chronic CHF.

Pharmacology

CHF, Angina Pectoris and Myocardial Infarction

b82a0c78-76ef-4a95-8a2b-1cd2fd8fb267

The drug that should be used for prophylaxis of close contacts of a patient suffering from meningococcal meningitis is:

Rifampicin

aczone

staticin

amikin

0a

single

- Rifampicin, ceftriaxone and ciprofloxacin are used for the prophylaxis of meningococcal meningitis. - Ceftriaxone is most effective drug for prophylaxis of meningococcal meningitis, however it is injectable drug. - Resistance to rifampicin has been repoed in many meningococci, so it is not preferred these days. - The drug of choice for prophylaxis of meningococcal meningitis should be chosen as Ciprofloxacin > Rifampicin > Ceftriaxone

Pharmacology

Cell Wall Synthesis Inhibitors

6bfa3814-6c14-42da-8b6a-096db4b5f607

Treatment for acute attack of Hereditary angioneurotic edema

Ecallantide

firazyr

danocrine

C1 INH Concentrate

3d

multi

C1 INH Concentrate - Treatment of choice.

Microbiology

94d4337a-499f-4163-a4b7-513e6de5b8e2

Which acts on nuclear receptors

Glucocorticoids

synthroid

Progesterone

Insulin

1b

single

Ans. is 'b' i.e., Thyroxine Hormones with intracellular receptors (Group I hormones)* Cytoplasmic :- Glucocorticoids (cortisol/cortisone), mineralocorticoids, androgens, progestins.* Nucleus :- Estrogen, Thyroid hormones (T3, T4), retinoic acid, Vitamin D (Calcitriol or 1,25 (OH)2 D3).

Physiology

Endocrinology and Reproduction

919b0298-132f-4aaa-a3e6-c5582e48577a

Moraxella catarrhalis is resistant to which antibiotic?

Amoxicillin

biaxin

zithromax

Amoxicillin and clavulanic acid combination

0a

single

Ans. is 'a' i.e., Amoxicillin Treatment of M. caterrahlis infection: M. catarrhalisrapidly acquired -lactamases during the 1970s and 1980s; antimicrobial susceptibility patterns have remained relatively stable since that time, with >90% of strains now producing -lactamase and thus resistant to amoxicillin. Most strains of M. catarrhalisare susceptible to amoxicillin and clavulanic acid combination, extended-spectrum cephalosporins, newer macrolides (azithromycin, clarithromycin), trimethoprim- sulfamethoxazole, and fluoroquinolones.

Pharmacology

48293923-35a9-41ba-af99-ef72d021a590

Which of the following anesthetic agents is contraindicated in patients with hypeension?

ketalar

diprivan

amidate

valium

0a

single

Ketamine produces a increase in both systolic and diastolic blood pressure in a dose dependent manner and thus it is mostly avoided in patients with a history of hypeension. Ref: Irwin and Rippe's Intensive Care Medicine 6th edition, Page 215 - 216; Goldfrank's Toxicologic Emergencies 8th edition, Page 1235 - 1236.

Anaesthesia

d377036b-c6b2-44a6-8399-39b051e03d86

In a school, a child had abscess on lower leg. Swab taken revealed gram positive beta-hemolytic streptococci, and these were baci-im sensitive. School physician observed that similar organism was isolated from throats of many other children. Which of the following is true statement with regards to this patient -

Difference in surface protein can differentiate the pathogenic bacteria from the pharyngeal culture bacteria.

Component C carbohydrate can differentiate the pathogenic bacteria from the throat culture bacteria.

MEG 3 positive are throat culture streptococci.

Depending on M protein, the cutaneous pathogenic bacteria can be differentiated from the pharyngeal culture bacteria

3d

multi

Microbiology

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A primigravida at term pregnancy is in labor and on escalating doses of inj oxoject. CTG shows persistent declarations after each contraction. On pelvic examination, patient is fully dilated, veex is positioned at station above 0 with caput. What is the best management?

Increase oxoject drop rate

Ventouse delivery

Outlet Forceps delivery

Caesarean delivery

3d

multi

The patient is showing persistent late type of decelerations suggestive of non-reassuring Fetal Hea status, therefore delivery must be expedited with either instrumental delivery or caesarean section Since an impoant prerequisite for outlet forceps or ventouse application is that the fetal skull should have reached the pelvic floor, and the station in question is above 0,so ideal management is emergency LSCS.

Gynaecology & Obstetrics

Caesarean section

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Which of the following is not used in acute attack of severe pain due to gout ?

Indomethacine

colcrys

uloric

Coicosteroids

2c

single

Ans. is 'c' i.e., Febuxostat

Pharmacology

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aczone is NOT used in: March 2013

Alopecia areata

Leprosy

Dermatitis herpetiformis

Malarial prophylaxis

0a

single

Ans. A i.e. Alopecia areata Alopecia areata (AA) Non-cicatricial/ non scaring alopecia Exclamation mark sign is characteristic Clinical presentation: Single or multiple circumscribed smooth patchy hair loss, most obviously on scalp but frequently involving any hair bearing skin like beard, eyebrows, eyelashes, with pathognomic "exclamation marks" and "going gray overnight" phenomenon AA is treated by: Minoxidil

Skin

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Neurotransmitter present in nigro-striatal pathway is:March 2012

Acetylcholine

Dopamine

epipen

GABA

1b

single

Ans: B i.e. DopamineNeurotransmittersCholinergic i.e.acetylcholine secreting neurons, are present in the pathway that emerges from cerebral coex to end in neostriatumDopaminergic neurons,are present in the nigro-striatal pathwayGABAergic fibres are present in pathway that connect cerebral coex to substantia nigra

Physiology

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A Patient presents with macroglossia and loss of tongue papilla. His hemoglobin (Hb) is 11.5 and mean corpuscular volume (MCV) is 100. What should be the next step in investigating this patient?

B12 estimation

Brush biopsy of the lesion

diflucan treatment

Incision biopsy

0a

multi

Increased MCV (normal MCV = 79- 93.3), anemia (normal Hb = 12--16.2) and characteristic oral manifestation (macroglossia and Atrophy of Papillae) suggest the diagnosis of megaloblastic anemia. The next best step is to confirm the diagnosis by estimating vitamin B12 levels and folate levels. So B12 estimation is the single best answer of choice. Ref: Harrison's Principles of Internal Medicine, 16th Edition, Pages 602-03; Davidson's Principles and Practice of Medicine, 19th Edition, Pages 918-20; Manual of Practical Medicine By R Alagappan, 3rd Edition, Pages 327-29

Medicine

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Which of the following does not have analgesic propey

Ether

ketalar

fluothane

oramorph

2c

single

Refer KDT 6 /e p 372 Halothane and newer flourinated inhalation anesthestic agent are devoid of analgesic propey

Pharmacology

Anesthesia

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A patient lalita present with dry mouth, pupillary dilation and warm skin, the likely drug toxicity is:

Organo-phosphorus

tegretol

Lithium

Amytriptyline 1:1

3d

single

D i.e. Amitryptiline Most tricyclic anti depressants eg. imipramine, amitryptiline have potent anticholinergic side effects. So atropine is not used in treatment of amitryptiline poisoningQ

Forensic Medicine

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Urinary bladder spasmolytic having localanaesthetic propey?

flomax

hytrin

oxytrol

yohimex

2c

single

Ans. is 'c' i.e., Oxybutynin Oxybutynin this newer antimuscarinic has high affinity for receptors in urinary bladder and salivary glands alongwith additional smooth muscle relaxant and local anaesthetic propeies.

Pharmacology