Lyme disease | PGI May 2017 Preparations MCQ

The following are recognized features of Lyme disease:

A. Recurrent headache
B. Seventh nerve facial palsy
C. Behavioural change
D. CSF neutrophil leukocytosis
E. Neutrophil pleocytois on CSF examination.

Ans. A,B,C,D,E

Borrelia Burgdoferi (spirochete).

It is a Zoonosis, with incubation period: 3-32 days.

Clinical features:

Early - Localised: annular rash (erythema migrans), fever,malaise, headache.

Late– Arthritis, waxing and waningover weeks (knee in 90%) worsens over time.

Complications -Dehydration,encephalitis, polyneuritis, impaired memory.

Disseminated: Haemotogenous spread, multiple small skinlesions, conjunctivitis,nodes, aseptic meningitis, seventh nerve palsy. 

Function of Health worker female | PGI May 2017 Preparations MCQ

Function of Health worker female, correct options are:

A. Perform 50% of deliveries
B. Trains dais
C. Enlist dais of the subcentre
D. Chlorination of water
E. Collectors of urine samples.

Ans. A,C

* Under the multipurpose worker system, one health workerfemale and one health worker male are posted at each

subcentre.

* Health worker female conduct about 50% of total deliveries.

* They help the health assistants in training programme of dais.

* List dais in their area and involve them in promoting family welfare work.

* They test the urine for albumin and sugar and do thehaemoglobin typing during their home visit. At the clinic they

conduct urine examination and estimate Hb%.

* Water chlorination is done by health worker male.

CNS involvement in AIDS | PGI May 2017 Preparations MCQ

Concerning CNS involvement in AIDS:

A. Toxoplasma may give rise to a foal lesion with neurological weakness.
B. The HIV virus can be isolated from the brain of anencephalopathic patient.
C. A diagnostic elevation in the CSF IgM occurs in toxoplasmic infection.
D. Cerebral toxoplasmosis can be treated by Pyrimethaminealone.
E. Occular involvement may cause blindness.

Ans.  A,B,E

Cerebral toxoplasmosis presents very variably, from an acuteencephalopathy to subtle neurological syndromes. It should beconsidered in all undiagnosed neurologicaldisease in the under ones, especially if there are retinal lesions.

Characteristic are hydrocephalus, seizures with focal defects,spinal or bulbar palsies, microcephaly, and decreased IQ.

Investigations such as skull x-ray or CT scan show calcificationof the periventricular area, tachyzoites in the CSF and positiveblood titres. Pyrimethamine and Sulphadiazine have asynergistic effect in treating it, and folinic acid may be

necessary to prevent seizures.

Inclubation period | PGI May 2017 Preparations MCQ

Which of the following diseases have inclubation period < 10 days:

A. Cholera 
B. Influenza
C. Plague 
D: Measles
E. Rubella

Ans. A,B,C

Incubation periods :

Cholera : Few hours to 5 days, but commonly 1-2 days

Influenza : 18 to 72 hours

Plague : Bubonic 2-7 days

Septicaemic : 2-7 days

Pneumonic: 1-3 days

Rubella : 2-3 weeks

Measles : 10-14 days

Skeletal metastases | AIIMS Based MCQ

A 40yr old female suffering from breast cancer received Taxane based chemotherapy one week back. She comes to casualty with high fever and on examination she is in shock. Her blood counts show neutrophil count of 100/cu.mm. The treatment of choice 

A. Send immediate blood culture and wait for blood culture report before starting antibiotics. 
B. Filgrastim monotherapy 
C. Emperic Ceftazidime 
D. Emperic polychemotherapy with Carbopenems, Amikacin and Vancomycin

Ans. C. Emperic monotherapy should be initiated and the drug of choice is Ceftazidime. Pseudomonas, Klebsiella and E.coli are the commmest organisms causing febrile neutropenia. If blood culture shows ESBL positive organisms then piperacillin/tazobactam, carbopenems or cefipime monotherapy should be started. Amikacin has a synergistic action against these organisms and can be added to these drugs. Fulgrastim is used as prophylaxis for febrile neutropenia or can be combined with these antibiotics to shorten the course of febrile neutropenia. Filgratim is not used alone in established febrile neutropenia. 

Rapid Acting Insulin | PGI May 2017 Preparations MCQ

Rapid Acting Insulin is/are

A. Insulin Lispro 
B. Insulin Aspart
C. LenteHumulin 
D. Velosulin BR
E. Ultralentehumulin

Ans. A. B

Preparation Preparation	PREPARATION
Rapid acting Insulin	Insulin Lispro, Insulin Aspart
Short acting insulin	Regular, regular Humulin, Velosulin BR
Intermediate acting	LenteHumulin, Lente NPH humulin, NPH
Long acting	Ultralentehumulin, Insulin glargine - Lantus

Auto-antibodies may not have a role in monitoring disease | PGI May 2017 Preparations MCQ

Which of the following auto-antibodies may not have a role in monitoring disease activity.

A. Rheumatoid factor in rheumatoid arthritis
B. Antinuclear antibodies in systemic lupuserythematosus
C. Anti-Sm antibodies in systemic lupuserythematosus
D. Anti-ds DNA antibodies in systemic lupuserythematosus
E. Anti-Ro (SSA) antibodies in Sjogren's syndrome

Ans. A  ,B , C , E

The serum levels of anti-dsDNA antibodies appears to correlate with disease activity in many patients and often levels will rise just before a flare of disease.The relationship is not close enough to be able to alter treatment based on a rising titre of antibodies but patients should be followed more closely in this situation. Anti-Sm antibodies are very specific for SLE but not sensitive and there is no evidence that levels change with disease activity.The only other autoantibody where there may be some correlationbetween levels and disease activity is c-ANCA in Wegener's granulomatosis.

Genodermal disease | PGI May 2017 Preparations MCQ

Genodermal disease that can cause skin malignancy are 

A. Xeroderma pigmentosa 
B. Neurofibromatosis 
C. Actinic keratosis 
D. Porphyria cutanea tarda
E. None of the above

Ans. (A) Xeroderma pigmentosa;
• Xeroederama pigmentosa is a rare autosomal recessive neurocutaneous disorder in addition to
skin lesions, patients may show:-
- Progressive mental deterioration, microcephaly, ataxia, peripheral neuropathy, spasticity,
choreoathetosis, Hypogonadism and nerve deafness.
• Inheritable conditions a/w skin cancer
- Albinism
- Xeroderma pigmentosum
- Congenital nevus.
- BCC nevus syndrome
• Actinic keratosis is a premalignant skin lesion.
• Neurofibromatosis can undergo malignant changes to sarcoma & CNS tumours.

Balanoposthitis | PGI May 2017 Preparations MCQ

Recurrent Balanoposthitis seen in.: 

A. DM 
B. Herpes simplex 
C. Smoking 
D. Alcohol 
E. Bad hygiene

Ans. (A) Diabetes Mellitus.
• Inflammation of the glans penis is called Balanitis and that of mocous surface of prepuce is called prosthitis. Inflammation of both prepuce and blans is called Balanoprosthitis (BP)
• Causes:
TRAUMATIC :

- Zip fasteners,
- Pin pricks excoriations,
- Teeth bite (during sex-play)
- Self infliction (Psychological).
IRRITANT:

-  Retained smegma and urine in the prepuceal sac,

- Contact dermatitis to condom, vaginal spermicidal gelly, various creams used as sexual stimulant, podophylin used for venereal warts.

- Fixed drug cruptions — Tetracycline, sulfonamides phenylbutazone, paracetamol, carbamazepine.
INFECTION :

- M.C. cause of BP is candida albicans (21% cases).

- Others—Bacteroides, Gardnerella vaginalis, Trichomonal, Gonococcal, Mycoplasma fermenters, Grp. B. Hemolytic streptococcus.
MISC

- Syphilis, Chancroid, Donovanasis, LGV, Herpes genitalis.
• DM causes recurrent balanoposthitis

Indications for ECT | PGI May 2017 Preparations MCQ

Indications for ECT are 

A. Paranoid schizophrenia 
B. Depression with suicidal tendency 
C. Catatonic schizophrenia 
D. Neurotic depression 
E. Depression in involutional stage

Ans. (B) Depression with suicidal tendency ;(C) Catatonic schizophrenia
• First and most important indication of ECT is major severe depression with suicidal tendencies.

• Other indications

- Severe catatonia

- Severe psychosis (Schizophrenia or Mania)
• Indication of ECT in depression (Major)
- Suicidal tendencies

- Poor intake of food and fluids

- With psychotic feature
- With melanocholia

- Unsatisfactory response to drugs
- When speedier recovery needed. 

TRUE regarding prions | NEET Based MCQ

Which of the following is TRUE regarding prions? 

A. It contains nuclear material 
B. They are infectitious proteins 
C. Immunogenic 
D. DNA particle

Ans. B. (They are infectitious proteins)

Explanation

• Prions are proteinaceous infectious particles without any detectable nucleic acids, resistant to heat, UV rays and nucleas. and sensitive to proteases. They have the ability to convert the normal non-infectious form of protein in question in::

infectious prion form.

• Prion conversion is accompanied by a change in functional status of protein that allows a cell or organism to be in tso - ferent phenotypic states in which it respectively harbors the normal or the prion form of the particle.

• Prions are responsible for several fatal neurodegenerative disorders known as transmissible spongiform encephalopathies or prion diseases. In these conditions secondary or tertiary structure of a protein is altered.

• They are causative agents of[MCQ]

a. Kuru and Creutzfeldt-Jacob disease

b. Scrapie and Bovine spongiform encephalopathy (mad cow disease)

Apple jelly nodules | NEET Based MCQ

Apple jelly nodules are seen in: 

A. Syphilis 
B. Lupus Vulgaris 
C. CSOM 
D. Menier’s disease

Ans. B. Apple jelly nodules are seen in Lupus Vulgaris.

• Apple jelly nodules are characteristic papular lesions of lupus vulgaris detected on diascopy.
• Apple jelly nodules are small, sharply defined reddish brown papules of gelatinous consistency seen in lupus vulgaris.
Lupus vulgaris:
• It is skin TB with no underlying active focus.
• Form of cutaneous TB common in children and young adults.
• Feature is indurated plaque, annular in shape.
• Heals with scarring, Blanching with glass slide (diascopy) reveals grey or green foci (Apple jelly nodules).
Scrofulodema: is skin TB secondary to involvement of underlying structure e.g. joint, lymph node.
Tuberculosis Verrucosa cutis: TB bacillus here is inoculated into skin and seen in TB patient,
Pathologists, Veterinary surgeons.
Tuberculosis cutis orifacialis: TB of orifices as oral cavity, anal canal, urogenital tract.
**Tuberculids don’t denote true TB but explain hypersensitivity reaction to Mycobacteruim tuberculosis.**

Griesinger’s sign | NEET Based MCQ

Griesinger’s sign is seen in: 

A. Cerebellar abscess 
B. Lateral sinus thrombosis 
C. Otitic hydrocephalus 
D. Meningitits

Ans. B. Griesingers sign is seen in Lateral sinus thrombosis

Tenderness and edema over mastoid (Griesinger’s sign) are pathgnomonic of lateral sinus thrombosis. (LST) 

• Classic symptoms of LST include a “picket fence” fever pattern; chills; progressive anemia (especially with beta-hemolytic strep); and, symptoms of septic emboli, headache and papiledema may indicate extension to involve the cavernous sinus. 

• The Toby-Ayer test is measured by monitoring the CSF pressure during a lumbar puncture. No iriaease in CSF pressure during external compression of the internal jugular vein on the affected side, and an exaggerated response on the patent side, is suggestive of LST. 

• Since the introduction of antibiotics, some authors have noted that a high percentage of cases are due to chronic rather than acute cases of otitis media; however this finding has not been consistent in all reports. Teenagers and young adults are more commonly affected in modern reports whereas younger children were reported in higher numbers in earlier series. In the pre-antibiotic era, 

Most common cause of unilateral offensive nasal discharge | NEET Based MCQ

The most common cause of unilateral offensive nasal discharge in a child is: 

A. Enlarged adenoid 
B. Maxillary sinusitis 
C. Foreign body in the nose 
D. Nasaldiphtheria

Ans. C. The most common cause of unilateral offensive discharge nasal discharge in a child is foreign body in the nose
- Most are self inserted by the child.
- Organic matter presents with early, purulent nasal discharge.
- Inorganic bodies remain inert.
- In case of cooperative child, retrieval by forceps is done.
- In severe cases, extraction under general Anesthesia is done.

Noise induced vertigo | NEET Based MCQ

Noise induced vertigo is seen in: 

A. Tympanosclerosis 
B. Labyrinthine fistula 
C. CSOM 
D. Meniere’s disease

Ans. D. Noise induced vertigo is seen in Menniere’s disease.                  

Mennieres Disease is characterized by:
Deafness, vertigo and tinitus and noise induced vertigo is seen in Meuniere’s disease.
Meniere’s Disease
A disorder characterized by recurrent prostrating vertigo, sensory hearing loss, and tinnitus, associated with generalized dilation of the membranous labyrinth (endolymphatic hydrops). The attacks of vertigo appear suddenly and last from afew to 24 h, and subside gradually. The attacks are associated with nausea and vomiting. The patient may have a recurrent feeling of fullness or pressure in the affected ear, and hearing in that ear tends to fluctuate but progressively worsens over the years. The tinnitus may be constant or intermittent and mau be worse before, after or during an attack of vertigo. Although usually only one ear is affected both ears are involved in 10 to 15% of patients.
In Lermoyez’s variant of Meniere’s disease, hearing loss and tinnitus precede the first attack of vertigo by months or years, and the hearing may improve with the onset of the vertigo.

Inquest Based MCQ | NEET Based MCQ

If death occurs in a jail, the inquest is done by 

A. Police 
B. Magistrate 
C. Medical Officer 
D. Coroner


Ans. B. Magistrate
 Magistrate’s Inquest: This is conducted by a District magistrate, sub-divisional Magistrate, or any other Executive Magistrate, especially empowered by the State Government, such as Collector, Deputy Collector or Tahsildar (Executive Magistrates).
>Magistrate’s Inquest is done in case of
• Death in prison,
• In police custody, and while under police interrogation,
• Death due to police firing,
• Dowry deaths, and
• Exhumation

Conduct money | NEET Based MCQ

Conduct money is given to 

A. money given to doctor for performing autopsy 
B. Witness in civil court 
C. Doctor in criminal court 
D. Reward for good conduct of doctor

Ans. B. Witness in civil court

Conduct money:
> It is the fee offered to paid to the witness in civil cases, at the tie of serving the summons to meet the expenses for attending the court.
>in criminal cases, no fee is paid to the witness. He must attend the court and give evidence because of the interest of the state in securing justice otherwise he will be charged in contempt of court.
How ever in criminal cases, the doctor can claim the conveyance charges and daily allowances.

Drugs used for ovulation induction | PGI May 2017 Preparations

Drugs used for ovulation induction 

A. Clomiphene citrate 
B. Danazol 
C. Cyproterone acetate 
D. Tamoxifen
E. Mefenemic Acid

Ans.  (A) Clomiphene citrate ; (D) Tamoxifen 
• The following drugs are used either single or in combination for induction of ovulation
— Stimulation of ovulation
• Clomiphene citrate (CC)
•FSH
•HCG
•GnRH
• GnRH analogues
— Reduction of level of:
• Androgen = Dexamethasone
• Prolactin = Bromocriptine
— Substitution therapy
•Hypothyroidism — Thyroid extract
•Diabetes mellitus Antidiabetic drugs.
• Tamoxifen is an anti-oestrogen, can be used where the patient is intolerant to clomiphene.
• Cyclofenil is a compound structurally similar to diethyl stilbestrol. It has got anti-oestrogenic property and it produces abundant thin, elastic cervical mucous which facilitate sperm penetration. The indications are same as that of clomiphene.
• Cyproterone acetate is an anti-androgenic progestogen. The compound blocks the hormone action at the receptorlevel. It decreases 5c reductase activity of reduces LH secretion.
It is used in idiopathic hirsutism or hyperandrogenic state.

Cervical CA surgery | PGI May 2017 Preparations MCQ

During cervical CA surgery to prevent the complication asthe vault prolapse, should be treated with 

A. Total Hysterectomy 
B. Vaginal hysterectomy 
C. Subtotal hysterectomy 
D. Abdominal Hysteroctomy
E. Supportive treatment.

Ans. (A) Total Hysterectomy ; (D) Abdominal Hysteroctomy
• Vault prolapse is a special term variously applied to the following several different conditions
— Enterocele
— Prolapse of the vaginal vault (or inversion of vagina) after hysterectomy.
— Collapse of the supports around the upper vagina and uterus which allows these organs to slide: Nulliparous prolapse is commonly of this type.
• Vault prolapse in more likely to occur after subtotal than after total hysterectomy despite the fact that the latter involves division of more elements of the transverse cervical ligaments. But it does leave more fibrosis and the scar tissue might have a supporting role. If cervix.is not removed it may act like the apex of an intussusception and encourage the vault to invert.
• Vaginal hysterectomy is alleged to be more commonly followed by vault prolapse than is abdominal.

Egg shell” calcification | PGI May 2017 Preparations MCQ

Egg shell” calcification is seen in 

A. Bronchiolitis 
B. Silicosis
C. Ca. bronchus 
D. Sarcoidosis 
E. Histoplasmosis

Ans. (B) Silicosis; (D) Sarcoidosis
• Egg cell calcification is peripheral rim calcification of lymphnodes. It is seen in
— Silicosis- Seen approximatly 5% of silicotics. Predominantly hilar lymphnodes may also be observed in anterior or posterior mediastinal lymphnode.
Sarcoidosis-about 5% pt of sarcoidosis present as egg cell calcification.
— Other causes of egg shell calcification
(i) following radiotherapy : appear 1-9 yrs. post radiation.

(ii)Pneumoconiosis- in 1% cases 

Features of cholecystitis on USG | PGI May 2017 Preparations MCQ

True about features of cholecystitis on USG 

A. Thick fibrosed gallbladder wall 
B. Stone impacted at neck of gall bladder 
C. Perigallbladder halo 
D. Increased vascularity
E. None of the above.


Ans. (A) Thick fibrosed gallbladder wall ; (B) Stone impacted at neck of gall bladder
• Ultrasound demonstrate in hepato biliary system
— Gall stones, biliary calculi
—. Size of gal bladder
— Thickness of gall-gladder
— Size CBD
— Stones in billary tree.
• It demonstrate calculi in G.B. in 90 to 95% of cases and specificity — 82%, sensitivity-67%(for USG) 

Prions | NEET Based MCQ

Which of the following is TRUE regarding prions? 

A. It contains nuclear material 

B. They are infectitious proteins 

C. Immunogenic 

D. DNA particle

Ans. B. (They are infectitious proteins) 

Explanation 

• Prions are proteinaceous infectious particles without any detectable nucleic acids, resistant to heat, UV rays and nucleas. and sensitive to proteases. They have the ability to convert the normal non-infectious form of protein in question in::

infectious prion form. 

• Prion conversion is accompanied by a change in functional status of protein that allows a cell or organism to be in tso - ferent phenotypic states in which it respectively harbors the normal or the prion form of the particle.

• Prions are responsible for several fatal neurodegenerative disorders known as transmissible spongiform encephalopathies or prion diseases. In these conditions secondary or tertiary structure of a protein is altered. 

• They are causative agents of^[MCQ]

a. Kuru and Creutzfeldt-Jacob disease

b. Scrapie and Bovine spongiform encephalopathy (mad cow disease)

Pneumocystis jirovecil | AIIMS Based MCQ

Which of the following is TRUE regarding Pneumocystis jirovecil? 

A. Occurs only in immune-compromised individuals.

B. Sputum examination is very helpful in diagnosis 

C. Usually associated with CMV infection 

D. Always associated with pneumatocele

Ans. B. (Sputum examination is very helpful in diagnosis) 

Explanation 

• P. jirovecii is the species found in humans, while P cariniiis the most common species found in rats. How frequently, we read P. carinii as affecting immunocompromised humans in routine microbiology books! Actually, it is P. jirovecii.

• P. jirovecii causes opportunistic pneumonia infection in young immunocompromised adults.

• Pneumocystis may be associated with CMV, but not usually

• A definitive diagnosis requires the demonstration of P cariniiin the lung in addition to clinical signs and symptoms of the infection. Methods for obtaining organisms include bronchoalveolar lavage, tracheal aspirates, transbronchial biopsy, bronchial brushings, percutaneous transthoracic needle aspiration, and open lung biopsy. Induced sputum samples are useful if P. carinii is found, but the absence of the organism does not exclude the infection.

• The epidemic infantile form of P carinii interstitial plasma cell. Pneumonitis is seen predominantly in infants between 3 and 6 mo of age. The onset is subtle with tachypnea and 101° fever, progressing to intercostal suprasternal, and infrasternal real flaring, and cyanosis. In the sporadic form of P carinii,pneumonitis occurring in children and adults with underlying immunodeficiency, the onset is usually abrupt with fever, tachypnea, dyspnea, and cough progressing to nasal flaring and cyanosis.

Note: 

• Pneumatocele are seen in staphylococcal infection, pneumocystic disease, past traumatic (laceration), after treatment of metastasis).

• Risk factors of pneumocystic disease are

— Immunocompromized patients (HIV), primary immunodeficient diseases, patients on immuno-suppressive therapy. Premature malnourished infants (immunodeficient).

Adult hemoglobin appears in fetus at thegestational | PGI May 2017 Preparations MCQ

Adult hemoglobin appears in fetus at thegestational age of (in weeks) 

A. 5th 
B. 10th 
C. 15th 
D. 20th 
E. 25th

 Ans. (E) 25th
• Haematopoiesis is demonstrated in the embryonic phase in the yolk sac by the 14^thday. By 10^thweek, the liver becomes the major site,, and after that gradually bone marrow become the major site of red cell production.
• Between the 5-8weeks, the embryo manufactures some additional haemoglobin : Hb Gower-1, Hb Gower-2 and Hb Portland. At 10-11 wks. HbF (Fetal Hb) predominate.

* From 24 weeks onwards adult type of hemoglobin appears in fetus. But during first half, hemoglobin is fetal type (α₂v₂) and at term about 75-80% of total hemoglobin is fetal type.
• Cord blood level of Iron, ferritin, vit. B₁₂, folic acid are higher than maternal blood.
HbF   : α₂β₂
HbF   : α₂γ₂

HbA₂  :  α₂θ₂

Hydramnios | PGI May 2017 Preparations MCQ

All are associcated with hydramnios except 

A. Premature labour
B. Gestational diabetes
C. Renal agenesis.
D. Increasedamniotic fluid.
E. PROM

Ans.  (C) Renal agenesis
• Renal agenesis is associated with oligohydramnios.
- In Polyhydramnios, amniotic fluid is more than 2 liters.

---- Polyhydramnios is associated with gestational diabetes and premature labour.
The causes of Polyhydramnios divided into :
1. Foetal anomalies :
--- Anencephaly

- Open spina bifida
- Oesophageal or duodenal atresia
-- Facial clefts and neck mass.

- Hydrops fetalis.
II. Placental causes :
- Chorioangioma of placenta.
III. Multiple pregnancy :
Hydramnios is more common in uniovular twins, usually affects the second sac.

IV. Maternal causes :
- Diabetics
- Renal disease.
• Amnion nodosum — is a condition in which there is failure of secretion by the cells of amnion covering the placents  causes oligohydramnios.

CIN-II positive on pap’s smear | PGI May 2017 Preparations MCQ

Patient with CIN-II positive on pap’s smear, next step will be 

A. Repeat pap’s smear 
B. Cone biopsy 
C. Colposcopic directed biopsy 
D. Punch biopsy
E. Start chemotherapy

Ans. (C) Colposcopic directed biopsy :
* Cone biopsy is done when there is discrepancy between cytology and colposcopy

* Hystrectomy is done if there is persistent CIN-II.

* If-CIN-I, then PAP smear is repeated

Note :The sequence of performing tests are
- PAP Smear
- COLPOSCOPY (and biopsy directed by COLPOSCOPY) :any discrepancy or incomplete visualisation of the lesion.
- CONE. BIOPSY
• As pap smear is positive, next step is to visualise the abnormal areas under coploscopy and to take biopsy under guidance of it (abnormality in PAP smear).

Pseudomonas | Crack AIIMS, NEET 2017 with NIME MCQs

Which of the following drug is effective in pseudomonas infection? 

A. Piperacillin 
B. Amoxicillin 
C. Oxacillin 
D. Vancomycin

Ans. A. (Piperacillin)
Explanation:
Antipseudomonal antibiotics
A. Carbenicillin:
The special feature of this penicillin congener is its activity against Pseudomonas aeruginosa and indole-positive proteus which are not inhibited by penicillin G or aminopenicillins. It is less active against Salmonella, E. coli, and Enterobacter, while Klebsiella and Gram-positive cocci are unaffected by it. Pseudomonas strains are less sensitive to carbenicillin in some areas, especially when inadequate doses have been used.
• Carbenicillin is neither penicillinase-resistant nor acid resistant, it is inactive orally and is excreted rapidly in urine (Ph 1 hour). It is used as sodium salt in a dose of l—2 g IM or l—5 g IV every 4—6 hours. At the higher doses, enough sodium may be administered to cause fluid retention and CHF in patients with borderline renal or cardiac function.
High doses have also caused bleeding by interfering with platelet function. This appears to result from perturbation of agonist receptors on platelet surface.
• The indications for carbenicillin are serious infections caused by pseudomonas or proteus, e.g., burns, urinary tract infection, and septicemia; but piperacillin is now preferred. It may be used together with gentamicin, but the two should not be mixed in the same syringe.
B. Ticarcillin
• It is more potent than carbenicillin against pseudomonas, but other properties are similar to it.
C. Piperacillin
• This antipseudomonal penicillin is about 8 times more active than carbenicillin. It has good activity against Kiebsiella and is used mainly in neutropenic immunocompromised patients having serious Gram-negative infections, and in burns. Elimination half life is 1 hour.  Concurrent use of gentamycin or tobramycin is advised.
Antimicrobial agents active against Pseudomonas aeruginosa
• Antipseudomonal penicillins

o Piperacillin
o Piperacillin/tazobactam
o Meziocillin
o Ticarcillin
o Ticarcillin/clavulanatc

• Antipseudomonal cephalosporins

o Ceftazidime
o Cefoperazone
o Cefepime

• Carbapenems

o Imipenem/cilastatin

o Meropenem
• Monobactams

o Aztreonam
• Aminoglvcosides

o Tobramycin

o Gentamicin

o Amikacin
• Fluoroquinolones

o Ciprofloxacin

o Levofloxacin
• Other Agents

oPolymyxin B

o Colistin 

Penicillin | Crack AIIMS, NEET 2017 with NIME MCQs

Which of the following is true about penicillin 

A. Can be given orally 
B. Main mechanism of action is cell wall synthesis 
inhibition 
C. Probenecid given with penicillin G increases its 
duration of action
D. Effective against gram-positive bacteria


Ans. A. (Can be given orally)
Explanation
• Antibacterial spectrum: Penicillin G is a narrow spectrum antibiotic; activity is limited primarily to Gram-positive bacteria and few others.
• Penicillin G is acid labile destroyed by gastric acid. So it is not given orally
• The pharmacokinetics of penicillin G is dominated by very rapid renal excretion; about 10% by glomerular filtration and the rest by tubular secretion.
• Tubular secretion of penicillin G can be blocked by probenecid; higher and longer lasting plasma concentrations are achieved.
• Penicillin act by inhibiting cell wall synthesis.
• They are bactericidal drugs.
• Spectrum of activity of PnG is narrow
• It is primarily active against Gram-positive bacteria
• It is usually inactive against Gram-negative bacteria
• Gram-negative cocci (Gonococci and Meningococci) are sensitive to it
• Bacteroides fragilis, mycobacterium TB are resistant rickettsia, chlamydia, protozoa, fungi, viruses are totally insensitive.

Treatment of choice for neurosyphillis | Crack AIIMS, NEET 2017 with NIME MCQs

Which of the following drug not effective in treatment of typhoid? 

A. Amikacin 
B. Co-trimoxazole 
C. Ciprofloxacin 
D. Ceftriaxone

Ans. A. (Amikacin)
Explanation:
Antibiotic Therapy Options for Typhoid Fever
Antibiotic                                             Dosage
First line
Ciprofloxacin                       500 mg PO bid for 10 days
Ceftriaxone                                          1-2gm IV or IM for 10—14 days

Alternative (NARST)
Azithromycin                       1 g PO days for 5 days
Ciprofloxacin                       10 mg/kg PO bid for 10 days 

T.B. larynx | PGI May 2017 Preparations MCQ

True about T.B. larynx: 

A. Turban’ epiglottis 
B. Odynophagia 
C. Cricoarytenoid fixation 
D. Ulceration of arytenoids 
E. Paralysis of vocal cord

Ans. (A) Turban epiglottis ; (B) Odynophagia; (D) Ulceration of arytenoids:
• Tuberculosis of larynx is always secondary to pulmonary TB, mostly affecting males in middle age gp. Tubercle bacilli reach the larynx by bronchogenic or haematogenous routes.
• It affects — interarytenoid fold, ventricular bands, vocal cords and epiglottis in order (post. part> ant. part)
• C/F:- Weakness and hoarseness of voice, pain, odynophagia, dysphagia.
• Laryngeal examination shows
— Vocal cord Hyperaemia, ulceration giving mouse nibbled appearance. Arytenoids ulceration, granulation tissue.
— Interarytenoid region Granulation tissue, superficial ragged ulceration and swelling that gives rnamillated appearance.
— Epiglottis Pseudoedema — the ‘turban epiglottis’
— Swelling of ventricular bands and aryepiglottic folds.
—Marked pallor of surrounding muscosa.