NEET PG / FMGE /AIIMS /JIPMER

Answer2089. EXPLANATION ⦁ Spironolactone is a K-sparing diuretic. The drug is well absorbed from the gastrointestinal tract and is bio transformed in the liver to an active metabolite, canrenone. ⦁ Spironolactone is contraindicated in the presence of hyperkalemia, because this aldosterone antagonist may cause further elevation of plasma K concentrations. ⦁ It does not appear to depress adrenal or pituitary function. ⦁ Central nervous system (CNS) side effects of the drug can include lethargy, headache, drowsiness, and mental confusion. ⦁ Spironolactone displaces aldosterone from receptor sites that are responsible for Na resorption in the collecting duct of the nephron; it does not interfere with the synthesis of aldosterone. Ans. B. It binds to a cytoplasmic receptor

Answer2088. EXPLANATION GH is produced by acidophilic cells. Types of cells in anterior pituitary and their secretions- ⦁ Somatotrophs- Growth hormones ⦁ Lactotrophs- Prolactin ⦁ Corticotrophs- ACTH ⦁ Thyrotrophs- TSH ⦁ Gonadotrophs- FSH, LH Answer: (B) Acidophilic

Answer2087. EXPLANATION ⦁ β-adrenergic receptor blockers cause a slowing of heart rate, lower blood pressure, and lessened cardiac contractility without reducing cardiac output. ⦁ There is also a buffering action against adrenergic stimulation of the cardiac autoregulatory mechanism. ⦁ These hemodynamic actions decrease the requirement of the heart for oxygen. Ans. C. Decreased requirement for myocardial oxygen.

Answer2086. EXPLANATION ⦁ The therapeutic index (also known as therapeutic ratio), is a comparison of the amount of a therapeutic agent that causes the therapeutic effect to the amount that causes death. Quantitatively, it is the ratio given by the lethal dose divided by the therapeutic dose. ⦁ A therapeutic index is the lethal dose of a drug for 50% of the population (LD50) divided by the minimum effective dose for 50% of the population (ED50). ⦁ Generally, a drug or other therapeutic agent with a narrow therapeutic range (i.e. with little difference between lethal and therapeutic doses) may have its dosage adjusted according to measurements of the actual blood levels achieved in the person taking it. ⦁ This may be achieved through therapeutic drug monitoring (TDM) protocols. The therapeutic index for diazepam is somewhat forgiving, about = 100. Other drugs, however are much less so, such as Digoxin, which has an index of 2 or 3. ⦁ Other examples of drugs with a narrow therapeutic range, that may require drug monitoring both to achieve therapeutic levels and minimize toxicity, include: dimercaprol, theophylline, warfarin and lithium carbonate. ⦁ Some antibiotics require monitoring to balance efficacy with minimizing adverse effects, including: gentamicin, vancomycin, amphotericin B, and polymyxin B. Ans. B. Digoxin

Answer2085. EXPLANATION ⦁ Pethidine is the drug of choice for treatment of post-anaesthetic chills and shivering associated with Halothane. ⦁ It’s main mechanism here is exerted through subtypes of α2 receptors Ans. C. α2 receptors

Answer2084. EXPLANATION Cutaneous reaction by Allopurinol: ⦁ Predominantly a pruritic, erythematous, or maculopapular eruption ⦁ Sometimes TEN or Stevens-Johnson syndrome may occur within first 2 months of treatment ⦁ Because the rash may precede severe hypersensitivity reactions, patients who develop a rash should discontinue Allopurinol Ans. C. Discontinue Allopurinol

Answer2083. EXPLANATION ⦁ It stimulates chemo-receptors, which activate the sympathetic nervous system to constrict the systemic vasculature and raise arterial pressure. ⦁ Choice "A" is incorrect because increased arterial pulse pressure stimulates arterial baroreceptors, which leads to vagal activation of the heart. ⦁ Choice "C" is incorrect because increased carotid sinus firing (usually caused by elevated arterial pressure) causes a reflex decrease in heart rate brought about by vagal activation and sympathetic withdrawal. ⦁ Choice "D” is incorrect because the vasovagal reflex causes vagal activation and bradycardia. Ans. B. Increased blood PCO2

Answer2082. EXPLANATION Effective Renal plasma flow (ERPF) = 625 mL/min. Renal plasma flow (RPF) = 700 mL/min. eRPF measure by Hippurate. Effective Renal Plasma flow (eRPF) is a measure used in renal physiology to calculate renal plasma flow and hence estimate renal function. It may be estimated by measuring the disappearance of a tracer ( e.g.- Hippurate) from the blood following a single intravenous injection if the tracer used is cleared only by the kidneys. Ans. D. Hippurate I 131

Answer2081. EXPLANATION Misoprostol ⦁ Is contraindicated during pregnancy because it can increase uterine contractility ⦁ Can cause clinical exacerbations of inflammatory bowel disease and should be avoided in patients with this disorder Irritable bowel syndrome is not a contraindication for Misoprostol use. Ans. D. Misoprostol

Answer2080. EXPLANATION ⦁ The answer to this question is (option c) vancomycin CLINICAL SYNDROME SUGGESTED THERAPEUTIC OPTIONS Meningitis • Ampicillin (20–24 g/d IV in divided doses q4h) or penicillin (24 mU/d IV in divided doses q4h) plus an aminoglycoside and consider adding ceftriaxone (2 g IV q12h) • Vancomycin (500–750 mg IV q6h) plus an aminoglycoside or rifampin • Linezolid •High-dose daptomycin (plus intrathecal daptomycin) ± another active agent. ⦁ Vancomycin is recommended only as an alternative to β-lactam agents in cases of allergy or toxicity plus the inability to desensitize. ⦁ Cerebrospinal fluid (CSF) concentrations in meningitis should be determined. ⦁ So as the patient in question has beta lactam hypersensitivity, we will choose vancomycin for him. Ans. C. Vancomycin