MDE DMS 2005

Senin, 07 Desember 2009

1. Which cells involved in in the resorption and modeling of bone tissue?
a. Osteoblast
b. Osteocytes
c. Multinucleated giant cells
d. Monocytes
e. Fibrocytes
Bone is a specialized connective tissue composed of intercellular calcified material, the bone matrix, and three cell types:
- osteocytes (osteon, bone, + kytos, cell), which are found in cavities (lacunae) within the matrix;
- osteoblasts (osteon + blastos, germ), which synthesize the organic components of the matrix;
- osteoclasts (osteon + klastos, broken), which are multinucleated giant cells involved in the resorption and remodeling of bone tissue.
Histology, Junqueira 11th, ch.8 bone

2. Which cells synthesizes the organic component of bone matrix?
a. Osteoblast
b. Osteocytes
c. Osteoclast
d. Monocytes
e. Fibrocytes

3. Which cells increased activity results in removal of bone matrix and fibrotic degeneration of fibrosa cystics?
a. Osteoblast
b. Osteocytes
c. Osteoclast
d. Monocytes
e. Fibrocytes
Osteitis fibrosa cystica, in which osteoclast activity results in removal of bone matrix and fibrous degeneration
Histology, Junqueira 11th, ch.8 bone

4. Which cells play prominent role in bone growth and repair?
a. Osteoprogenitor cells in periosteum
b. Osteoblast cells in periosteum
c. Osteoclast cells in periosteum
d. Osteocyte cells in periosteum
e. Fibrocyte cells in periosteum
The inner, more cellular layer of the periosteum is composed of fibroblastlike cells called osteoprogenitor cells, with the potential to divide by mitosis and differentiate into osteoblasts. Osteoprogenitor cells play a prominent role in bone growth and repair
Histology, Junqueira 11th, ch.8 bone

5. The organic matter in bone matrix are?
a. Type I collagen and ground substances
b. Type II collagen and ground substances
c. Type III collagen and ground substances
d. Type IV collagen and ground substances
e. Type V collagen and ground substances
The organic matter in bone matrix is type I collagen and ground substance, which contains proteoglycan aggregates and several specific structural glycoproteins
Histology, Junqueira 11th, ch.8 bone

6. Which one of the following layers in mainly for regeneration of epidermis?
a. Stratum corneum
b. Stratum lucidum
c. Stratum granulosum
d. Stratum spinosum
e. Stratum basale
Stratum Basale (Stratum Germinativum) containing stem cells, is characterized by intense mitotic activity and is responsible, in conjunction with the initial portion of the next layer, for constant renewal of epidermal cells
Stratum spinosum are filled with bundles of keratin filaments, which play an important role in maintaining cohesion among cells and resisting the effects of abrasion
Malpighian layer consists of both the stratum basale and the stratum spinosum, which contains epidermal stem cells
Stratum Granulosum acts as a barrier to penetration by foreign materials and provides a very important sealing effect in the skin
Stratum Lucidum, more apparent in thick skin, is a translucent, thin layer of extremely flattened eosinophilic epidermal cells
Stratum corneum is filled with a birefringent filamentous scleroprotein, keratin, on sole of feet
Histology, Junqueira 11th, ch.18 skin

7. Which one of the following statements is mainly for the fracture repair?
a. Osteoprogenitor cell in outer circumferential lamella
b. Osteoprogenitor cell in inner circumferential lamella
c. Osteoprogenitor cell in interstitial lamella
d. Osteoprogenitor cell in haversian system
e. Osteoprogenitor cell in endosteum
The inner, more cellular layer of the periosteum is composed of fibroblastlike cells called osteoprogenitor cells. The endosteum lines all internal cavities within the bone and is composed of a single layer of flattened osteoprogenitor cells and a very small amount of connective tissue
Periosteum and the endosteum around the fracture respond with intense proliferation producing a tissue that surrounds the fracture and penetrates between the extremities of the fractured bone
Histology, Junqueira 11th, ch.8 bone

8. Which of the following is the almost unique characteristic of biochemistry content of collagen fibers?
a. Glucosamine
b. Galactosamine
c. Glycine
d. Hidroxy proline
e. Apatite crystals
Hydroxyapatite crystals of bone appear as plates that lie alongside the collagen fibrils but are surrounded by ground substance
Histology, Junqueira 11th, ch.8 bone

9. Histology of bone matrix usually refers to the...
a. Organic material minus the collagen fiber
b. Organic material remaining after decalcification
c. Material composing the whole bone
d. Contents of hydration shell crystaline portion of the bone
e. ...
Inorganic matter represents about 50% of the dry weight of bone matrix. The organic matter in bone matrix is type I collagen and ground substance
Histology, Junqueira 11th, ch.8 bone

10. Histology longitudinal growth of long bone is accomplish by...
a. Preosteoblast on periosteum
b. Part of epiphysis
c. Part of metaphysis
d. Osteoblast and osteoclast and the other cells on the epiphyseal plate
e. ...chondrium
Endochondral ossification of a long bone consists of the following sequence of events. This process begins at the central portion of the cartilage model (diaphysis), where blood vessels penetrate through the bone collar previously perforated by osteoclasts, bringing osteoprogenitor cells to this region. Next, osteoblasts adhere to the calcified cartilage matrix and produce continuous layers of primary bone that surround the cartilaginous matrix remnants. In this way the primary ossification center is produced. Then, secondary ossification centers appear at the swellings in the extremities of the cartilage model (epiphyses)
In the secondary ossification centers, cartilage remains in two regions: the articular cartilage, which persists throughout adult life and does not contribute to bone growth in length, and the epiphyseal cartilage, also called the epiphyseal plate, which connects the two epiphyses to the diaphysis. The epiphyseal cartilage is responsible for the growth in length of the bone, and it disappears in adults, which is why bone growth ceases in adulthood
Histology, Junqueira 11th, ch.8 bone

11. In physiologic motor fiber is stimulated, the impluse arriving at the nerve ending
a. Release cholinesterase which by quota reaction cause muscle contraction
b. Creates action potential at motor end plate by formation of postiggmine-like...force
c. Release of electrical impulse to muscle fibers cause contraction
d. Activates release acetilcholyne in turn stimulates motor end plate to form propagated action potential
e. All above are true

13. Histology of bone on haversian canals have been described as containing:
a. A capillary vessel and extracellular fluid
b. A capillary and venule vessels
c. An arteriole, a venule, and a lymphatic
d. An arteriole and a venule vessels
e. An arteiole, a venule, a lymphatic, a nerve fiber, and extracellular fluid
Haversian system showing lamellae, a central blood capillary (there are also small nerves), and many osteocytes with their processes
The whole complex of concentric lamellae of bone surrounding a canal containing blood vessels, nerves, and loose connective tissue is called a haversian system, or osteon
Di gambar tortora ada lymphatic vessel
Histology, Junqueira 11th, ch.8 bone

15. Scoliosis is a condition...
a. Mainly but not always toward the CONVEXITY
b. Always toward the concavity of the curve
c. Mainly, but not always to the CONCAVITY
d. On either direction depending upon muscle imbalance rather than the direction of the curve
e. Indometachine
Scoliosis (crooked or curved back) is characterized by an abnormal lateral curvature that is accompanied by rotation of the vertebrae. The spinous processes turn toward the cavity of the abnormal curvature, and when the individual bends over, the ribs rotate posteriorly (protrude) on the side of the increased convexity.
Anatomy, Moore 5th, ch.4 back

17. Classifying a peripheral nerve injury according to SEDDON, a complete severance is defined:
a. Axonotmesis
b. Neurotmesis
c. Neuropraxia
d. Complete
e. Transverse
Axonotmesis → gangguan axon → wallerian degeneration, konduksi atau transmisi syaraf terganggu, tapi continuity syaraf dan endoneural tube nya masih ada → masih bisa regenerasi
Neurotmesis → paling parah → konduksi syaraf terganggu dan wallerian degeneration → continuity sarafnya sudah tidak ada → endoneural tube hancur → hasil regenerasinya: banyak akson baru yang tdk bisa mencapai segmen distal syaraf → fungsinya tdk akan pernah kembali normal
Neuropraxia → reversible physiological nerve conduction block → spontaneous recovery
Sekarang klasifikasi nerve injury:
- grade 1 → neuropraxia
- grade 2 → axonotmesis
- grade 3 → axonotmesis
- grade 4 → axonotmesis
- grade 5 → neurotmesis
Appley 8th, p231 tabel 11.1

18. You are the first to see the patient in ER following traffic accident. The pateint is obviously onjured with closed fracture of left extremities. The most important first sign of Volkman’s ischemia is...
a. Cold and cyanosis of the fingers
b. Pallor of fingers
c. Obliterations of the radial pulse (pulseness)
d. Paralysis of the flexor and extensor muscle in forearm
e. Pain
Nerve is capable of regeneration but muscle, once infarcted, can never recovered and is replaced by inelastic fibrous tissue (Volkmann’s ischaemic contracture).
Volkman ischemia is final sequale of acute compartment syndrome
Volkmann’s contracture is fibrosis and shortening of muscle due to inadequate blood supply. It is a complication that arise if the blood supply is interrupted by pressure on the blood vessel from a fracture fragment, or from raised pressure due to compartment syndrome, or by pressure fromconstricting bandages and plaster cast
Classic feature of ischaemia are the five Ps: pain (earliest), paraesthesia, pallor, paralysis, pulselessness
Appley 8th, p563-564

19. A greenstick fracture of the midshaft of the radius and ulna in 4 years old child is observed to have 10o of angulations. The best treatment wolud be (under general anasthetic):
a. Without reposition, cast the arm
b. Straighten the extremity to less than 5o and apply cast
c. Anatomical induction, reduce the deformity to 0o and apply cast
d. No plate’s pain is required and simple splinting will surfice
e. Open reduction and internal fixation (ORIF)
Tidak perlu dilakukan tindakan operasi karena bisa menyebabkan komplikasi yang lebih besar, tetapi tulang harus tetap direposisi ke tempat semula (reduce)

20. 5 years old boys has an acute hematogenous ostemyelitis in the distal right femur for 10 days duration. The treatment of choice would be
a. Surgical draining covered by antibiotics
b. Blood culture and sensitivity test and give antibiotic selected from the sensitive group
c. Blood culture, sensitivity test and suregery covered by selected antibiotics
d. Surgical drainage and culture of surgery followed by an antibiotic of proven sensitivity
e. Broad spectrum antibiotic, surgical and culture of surgery followed by an antibiotic of proven sensitivity
Tidak perlu surgical, tetapi dicari bakteri penyebabnya, kemudian diberikan antibiotik yang bekerja spesifik untuk bakteri tersebut

23. Radiation therapy is the LEAST value in
a. Osteosarcoma
b. Ewing’s sarcoma
c. Angiosarcoma
d. Reticulosarcoma
e. Chondrosarcoma
Osteosarcoma → wide resection of tumor and chemoterapy
Ewing’s sarcoma → radotherapy has dramatic effect
Reticulosarcoma → chemotherapy and radial section, radiotherapy is reserved for less accessible lesion
Chondrosarcoma → amputasi, doesn’t respond to either radiotherapy or chemotherapy
Appley 8th, p184-191

26. Bone pain may be presenting complaint in
a. Malignant secondary bone tumor
b. Leukimia
c. MM (multiple myeloma)
d. Osteomalacia
e. All of above

27. Serum alkaline phosphatase level is significantly raised in disease of:
a. Scurfy
b. Arthrogyplasia
c. Sterile osteoporosis
d. Secondary bone tumors
e. Parther disease of hip (avascular...)
Alkaline phosphatase increased in tumor of bone
Henry 25th, p256

28. The deep branch of the ulnar nerve in the hand:
a. Supplies all the lumbrical muscle
b. Profundus muscle
c. The skin of the little finger
d. Adduction pollicis
e. When paralysed produced clawing of all the fingers in that hand
Ulnar nerve
- origin: Larger terminal branch of medial cord, receiving fibers from C8, T1 and often C7
- course: Descends medial arm; passes posterior to medial epicondyle of humerus; then descends ulnar aspect of forearm to hand
- structure innervated: Flexor carpi ulnaris and ulnar half of flexor digitorum profundus (forearm); most intrinsic muscles of hand; skin of hand medial to axial line of digit 4, 5
Anatomy, Moore 5th, ch6 upper limb, tabel 6.5

29. The patient get a lesion of median nerve at the level of the elbow caused by supra...humerus
a. Result in loss of flexion of the thumb
b. Result in loss of flexion of index finger
c. Due to closed fracture is managed by conservative treatment
d. Under general anasthetic, reposition and immobilization
e. All of the above correct
Median nerve innervated muscles of anterior forearm compartment (except for flexor carpi ulnaris and ulnar half of flexor digito-rum profundus), five intrinsic muscles in thenar half of palm and palmar skin
Median Nerve Injury
When the median nerve is severed in the elbow region, flexion of the proximal interphalangeal joints of the 1st and 3rd fingers is lost and flexion of the 4th and 5th fingers is weakened. Flexion of the distal interphalangeal joints of the 2nd and 3rd fingers is also lost. Flexion of the distal interphalangeal joints of the 4th and 5th fingers is not affected because the medial part of the FDP, which produces these movements, is supplied by the ulnar nerve. The ability to flex the metacarpophalangeal joints of the 2nd and 3rd fingers is affected because the digital branches of the median nerve supply the 1st and 2nd lumbricals. Thus, when the person attempts to make a fist, the 2nd and 3rd fingers remain partially extended. Thenar muscle function (function of the muscles at the base of the thumb) is also lost, as in carpal tunnel syndrome
Closed fracture biasanya ditreatment dengan closed reduction (reposition atau immobilization), perlu dilakukan tindakan anasthesia
Anatomy, Moore 5th, ch6 upper limb

30. Acute poliomyelitis in Bogor area is a viral infection that primary affects (damage) what...the nervous system
a. Posterior column of spinal cord
b. White matter of the spinal cord
c. Cerebral motor cortex
d. Frontal lobe
e. Anterior horn cells at the spinal cord
Poliomyelitis: an infectious virus disease affecting CNS. Poliovirus invades the CNS and replicate in motor neuron of the spinal cord (spinal poliomyelitis) or brain stem (bulbar poliomyelitis)
Acute case show mononuclear cell perivascular cuff and neurophagia of the anterior horn motor neuron of the spinal cord
Pathology, Robin Cotran 7th, p364, p1374

31. A 12 years old girl has a 26 idiophatic thoracic scoliosis with the apex at the T9. She is past menarche and is Risser stage I. The management consist of:
a. Use milwakuee brace
b. Conservation and radiographic evaluation in 3-4 months
c. Electrical stimulation
d. Postural exercise
e. Thoracolumbosacral orthosis
Hold reduction dengan mengunakan bracing Milwaukee

32. Secondary bone tumor:
a. Are chiefly found in vertebrae, skull and upper ends of humerus and femur
b. From prostate are usually osteoblastic
c. Cause hypercalcemia
d. From breats cancer are usually osteolytic
e. All of the above correct
Secondary bone tumor (metastatic bone disease):
- skeleton adalah daerah yang paling sering termetastasis oleh kanker dari daerah lain
- sumber kanker yang paling banyak adalah payudara, berikutnya prostat, kidney, lung, thyroid, bladder, dan GI tract
- tempat yang paling terkena kanker sekunder: vertebra, pelvis, proximal half femur dan humerus
- biasanya bersifat osteolitik dan sering terjadi fraktur patologis, kecuali kanker prostat yang bersifat osteoblastik
- CF: pain, fraktur, gejala hiperkalsemi (anorexia, nausea, thirst, polyuria, abdominal pain, weakness, depresi)
Appley 8th, p193-194

33. A plaster of Paris cast:
a. Is usually applied on a padding of cotton
b. The next day patient must be controlled for compartment syndrome
c. If tight be split completely right down to the cotton wool
d. Can be wedge to correct angular deformity in management of closed fracture shaft of tibia
e. All of the above are correct
Plaster of paris cast can be wedge if further correction of angulation is necessary
Appley 8th, p551
A preparation of gypsum (calcium sulphate) that sets hard when water is added. It is used to make plaster cast, untuk memfiksasi bagian tubuh (dorland)

For number 114-118 see clinical scenario below :
An adult male comes to your ER 2 hours after burn injury due to flame. He gets burn in … of his face and neck, the whole right arm, chest, abdomen, groin. After a thorough physical examination, doctor gives him oxygen and infusion.

114. Burn extent examination in this patient is :
A. Burn grade I-II 35%
B. Burn grade II 39%
C. Burn grade II-III 27%
D. Burn grade II-III 36%
E. Burn grade III 29%
Jawaban : (?)
Pembahasan :
Face & neck (%), whole right arm (9%), chest & abdomen (18%), groin (1%). Total 32.5%.

115. According to Baxter-Parkland formula of the fluid resuscitation should be given is :
A. 7800 cc in the first 16 hours
B. 7200 cc in the first 24 hours
C. 3500 cc in the first 8 hours
D. 3600 cc in the first 26 hours
E. 5400 cc in the first 24 hours
Jawaban : (?)
Pembahasan :
Baxter Parkland formula  4cc per weight (kg) per %TBSA in first 24 hours.
Divided to 6 periods (each 4 hours)
Period 1,2  each 25%
Period 3,4,5,6  each 12.5%

116. In his right arm, you could see burn wound that is erythematous, bullae (+), pin prick test (+). It is classified into wound :
A. Grade I
B. Grade II A
C. Grade III B
D. Grade III
E. Grade IV
Jawaban : B.
Pembahasan :
1st degree burn  sampai epidermis (+ erythema, pain, peeling)
2nd degree burn :
 Superficial Partial Thickness  sampai upper dermis / papillary layer (+ blister, pain, moist)
 Deep Partial Thickness  sampai lower dermis / reticular layer (+ mottled, less sensation, hypertrophic scar result)
3rd degree burn  sampai subcutaneous tissue, bahkan sampai bone / muscle (+ painless, white/cherry-red/black, dry, leathery, skin graft is needed)

121. The … for nerve impulses into the muscle occurs at the …
A. Muscle level
B. Fiber level
C. Myofibril level
D. Sarcomer level
E. Fascia level
Jawaban : (?)  B.
Pembahasan :
Proses penghantaran impuls saraf dari sel saraf (neuron) ke sel otot melibatkan peran T-tubule, sarcoplasmic reticulum, myofibril yang ketiganya itu terdapat pada level muscle fiber (= sel otot).

122. In shortening (contraction) of the functional unit of the muscle :
A. The myosin “walks” along the actin filaments
B. The actin “walks” along the myosin filaments
C. The actin and myosin filaments move toward each other
D. The actin and myosin filaments shorten individually
E. The actin filament is shorten
Jawaban : A.
Pembahasan : Tortora hlm 299-300 “The Sliding Filament Mechanism”

123. To produce movement of a limb …
A. One sarcomer acts independently
B. Several sarcomeres, myofibrils, and fibers must be active
C. Only one fiber need to be active
D. Only one myofibril need to be active
E. Several fascicles must be active
Jawaban : E.
Pembahasan :
Untuk pergerakan limb dibutuhkan kontraksi skeletal muscle, yang terdiri dari beberapa fascicles yang terbungkus epimysium.

124. The determinant factor in the action of 2 joint muscles is :
A. The proximity of the muscle belly to each of the joints
B. The length of the movement arm at each joints
C. The shape of bony components of each joints
D. The direction of muscle fibers relative to the joint
E. The strength of the muscles to the joints
Jawaban : (?)
Pembahasan : (?)

125. The shaft of the bone is properly called the …
A. Epiphysis
B. Periosteum
C. Diaphysis
D. Compact bone
E. Metaphysis
Jawaban : C.
Pembahasan : bagian tengah dari bone disebut diaphysis

126. Fracture of the bony callus in fracture repair is followed by :
A. Hematoma formation
B. Fibrocartilaginous callus formation
C. Bone remodelling to convert compact bone
D. Formation of granulation tissue
E. Protein release from the callus
Jawaban : C.
Pembahasan :
Tahapan bone farcture repair :
Hematoma formation  Fibrocartilaginous callus formation  Bony callus formation  Bone remodelling

127. Fracture in which the bone ends are incompletely separated is …
A. Greenstick
B. Compound
C. Simple
D. Comminuted
E. Compression
Jawaban : A.
Pembahasan :
Greenstick fracture  fraktur parsial di mana salah satu sisinya patah, sedangkan sisi lainnya masih tersambung namun menjadi bengkok.

128. Remodelling of the bone is a function of these cells :
A. Chondroblast – osteocyte
B. Osteoblast – osteoclast
C. Chondroblast – osteocyte
D. Osteoblast – osteocyte
E. Osteoblast – osteocyte
Jawaban : B.
Pembahasan :
Osteoblast  bone deposition
Osteoclast  bone absorption

130) jaw : D ;reference : moore,developing human,8th ed;pg 377
132) C ; reference : moore,developing human,8th ed;pg 440
134)B ; reference : moore,developing human,8th ed;pg 339
137)B ; reference : moore,developing human,8th ed ; pg 352-353
138)C ; explaination:the lens develops from the lens vesicle,a derivative of the surface ectoderm (moore,developing human,8th ed ; pg 427)
139)B ; explaination:congenital dislocation of hip : 1)heritage-multifactorial pattern of inheritance ; 2)acetabulum and head of femur (moore,developing human,8th ed ; pg 377)
140)A ; reference : junqueira,basic histology,11th ed
143)A or B ; explaination: radial groove-it is a depression for the radial nerve and deep brachial vessels;fracture of the humerus at mid shaft can injure the radial nerve and deep brachial vessels b`coz they are in contact with bone at this location (medical gross anatomy,university of Mich Medical School)
you can also referred to moore,clinically oriented anatomy pg 793,for more detail,then compare both answers
144)B ; explaination : when it is necessary to ligate the femoral artery,anastomasis of branches of the femoral artery with other arteries that cross the hip joint,may supply blood to lower limb.however,the cruciate anastomosis,consisting of a 4-way common meeting of the medial & lateral circumflex femoral arteries with the inferior gluteal artery superiorly & the 1st perforating artery inferiorly posterior to the femur,occurs less commonly than its frequent description in textbooks & depiction in atlases implies (moore,clinically oriented anat,5th ed ; pg 604)
145)C ; reference : moore,developing human,8th ed ; pg 449
146)B ; cell of the inner ep. Differentiate into ameloblast (moore,developing human,7th ed ; pg 469)
147)A ; the arrector pili muscles are bundles of smooth muscle cells.their contraction results in the erection of the hair shaft to a more upright position (junqueira,basic histology,11th ed ; chapter 18)
148)D ; secrete RAR & RXRboth are members of steroid thyroid hormones superfamily (Fitzpatrick,5th ed ; pg 128-129)
149)A ; can check it in past year compilation
150)E ; after correctly diagnosing a cutaneous disease,the dermatologist must consider a myriad option in formulating an effective treatment plan : selection of an appropriate agent,consideration of the areas of the body affected,the state of the disease skin,concentration of the drug…(Fitzpatrick 6th ed,chapter 242.principle of topical therapy)
153)A ; wet dressing is recommended for use on severely affected or chronically involved areas of dermatitis refractory to therapy.wet dressing has potential to promote drying & fissuring of skin (topical therapy – atopic dermatitis chapter 122)
156)C ; Fitzpatrick 6th ed ;pg 807
158)E ; Fitzpatrick chapter 44
159)C ; hyphema –hemorrhage within the anterior chamber of the eye ;treatment-rest in bed with the head of the bed elevated as much as u can tolerat;steroid dropto fight inflammation & pain (emedicine)
165)A ; treatment of congenital cataract requires surgery,typically at a very early age (younger than 4 months) –moore,developing human,8th ed ; pg 429
166)D ; excessive tearing (epiphora) is occasionally due to canalicular infantile dacryocystitis (inflammation of lacrimal sac),the site of stenosis is usually at the valve of Hasner
167)B ; many cases of infection may still be ‘culture negative’ (Vaughan ophthalmology)
168)B ; hyperacute purulent conjunctivitis caused by M.gonorrhea is transmitted through sex contact.copious green pus is produced and the lid are often extremely edematous.preauricular lymphadenopathy is common.immediate intervention is critical to prevent perforation of corneal ulcers caused by bacterial exotoxins.gram stain and culture of the conjunctiva should be performed.copious irrigation with saline solution is required yo dilute the toxins.systemic antibiotics are required.3rd-generation cephalosporins may be givan intramuscularly/intravenously.adjunctive topical treatment with ciprofloxacin,gentamicin or bacitracin may be helpful. (cecil,textbook of medicine,22nd ed ; pg 2411-2412)
statement of ans E would be correct if the word ‘not’ is deleted,but,if not,the answer would be B and E
169)D ; treatment for corneal ulcer : xboleh dibebat,karena akan menaikkan suhu sehingga akan berfungsi sbg incubator ; diberi antibiotika sesuai dgn kuasa (ilmu penyakit mata UI)
170)C ; can referred to past year questions’ book
171)B ; the fenamates are derivatives of N-phenylanthranilic acid.they include mefenamic,meclofenamic,and flufenamic acid (Pharmacological basis and therapeutics ,goodman & gilman)
172)A ; prolongation bleeding time is common side effect no t specific ; sede effect of mefenamic is hemolytic anemia
173)B ; 1)choice of drug for children :aspirin,naproxen,tolmetin and acetaminophen.aspirin is associated with Reye’s syndrome in children. 2)pregnant women : NSAIDs generally is not recommended.low doses of aspirin propably the safest. 3)piroxicam for treatment dysmenorrheal,acute musculoskeletal disorder,potop pain,and acute gout. 4)acetaminophen for patient in whom aspirin is contraindicated
174)A ; probenecid-uricosuric drugs employed to decrease the body pool of urate in patients with tophaceous gout/in those with increasingly frequent gouty attacks (Katzung 9th ed ; pg 596-598)
175)D ; external application-methyl salicylate ( ‘oil of wintergreen’)is used externally as a cutaneous counterirritant in liniments. (lippincott’s,pharmacology,3rd ed ; pg 500)
176)D ; etodolac is slightly more COX-2-selective than most other NSAIDs (katzung) ; celecoxibcox-2-inhibitor(Lippincott,3rd ed,495)
177)D ; intoxication is not rare.the other statement are correct
178)D ; refer book of past year question
179)E ; piroxicam is a nonselective COX inhibitor but at high concentration also inhibits polymorphomuclear leukocyte migaration,decreases oxygen radical production,and inhibits lymphocyte f(x).its long half-life permits once daily dosing.piroxicam can be used for the usual rheumatic indications (katzung,9th ed ;pg 596-598)
180)B ; mycobacteria are notorious for their ability to develop resistance.combinations of two /more drugs are required to overcome these obstacles and to prevent emergence of resistance during the course of therapy (katzung)
181)D ; mini lecture radiodiagnostic,slide no.58
182)D ; mini lecture radiodiagnostic,slide no.51
185)A ; CT scan is sensitive in demonstrating mucosal thickening and revealing trapped secretions within the sinus cavities.(otorhinolaryngology).b`coz of mucosal thickening,the antrum become thinning
186)B ; skeletal tuberculosis-weght bearing joint (spine-40% cases,hips-13%,knees-10%) are most commonly affected (Harrison,internal medicine,17th ed ; pg 1012)
187)C ; lab man
188)C ; any cancer can spread to bone,but,in adults,>75% of skeletal metastases originate from cancers of prostate,breast,kidney and lung (robbins & cotran,7th ed ; pg 1303)
191)D ; mitochondrial DNA reference from maternal lineage available (minilecture Forensic Identification,slide no.35)

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