PGMEE Android and get solved paper of AIIMS NOV 2016

Q-1. If a drug is given through skin, maximum percutaneous absorption of given drug
a) Posterior auricular
b) Scalp
c) Scrotum
d) Plantar surface

Answer: Posterior auricular
Order of percutaneous absorption of drug applied topically:
Posterior auricular > Scrotum > Scalp > Fore arm > Plantar surface

Q-2. Pigmentation of nail caused by all except
a) Cyclophosphamide
b) Chlorpropamazine
C) Chloroquine
d) Amiodarone

Answer: Chlorpropamazine
Drugs causing nail pigmentation:
Anti-malarial therapy

Q-3. Thrombocytopenia causing drugs A/E
a) Cephalosporin
b) Vitamin K analogue
c) Cephalosporins
d) Anti-depressant

Answer: Vitamin K analogue
Medications causing drug associated thrombocytopenia:
Immuno-modulator agents, Immuno-suppressant and chemotherapy agents
Anticoagulant agents: Heparin and LMW Heparin
Neuro-psychotic drugs
Analgesic agent
Gastro-intestinal agents- Cimetidine, ranitidine and famotidine
Cardiovascular agents- Digoxin, amiodarone, captopril, Hydrochlorothiazide, Atorvastatin and Simvastatin
Anti-platelet agents- Abciximab, Tirofiban
Antimicrobial agents:
Penicillins and cephalosporins
Isoniazid and rifampicin
Sulfa drugs
Adefovir, Ritonavir and Indinavir

Q-4. Drug of choice for precocious puberty in girls
a) GnRH
b) Danazole
c) Cyproterone acetate
d) Medroxy progesterone

Answer: GnRH
Long-acting gonado-trophin releasing hormone (GnRH) agonists are the current therapy of choice for central precocious puberty.
GnRH agonists are not effective as therapy for peripheral precocious puberty. Androgen antagonists, spironolactone, aromatase inhibitors (Anastrozole and Letrozole), testolactone, ketoconazole, and medroxy-progesterone acetate are used to treat peripheral precocious puberty.

Q-5. Insulin not preferred by which site?
a) Anterior thigh
b) Lateral thigh
c) Dorsum of forearm
d) Around umbilicus

Answer: Around umbilicus
Any part of the body covered by loose skin can be used, such as the abdomen, thighs, upper arms, flanks and upper buttock.
Usually, the abdomen is the preferred site (except for a 2-inch circle around the umbilicus).

Q-6. Weight of rabbit in pharmacological studies
a) 1-1.5 kg
b) 1.5-2 kg
c) 4-5 kg
d) 10-12 kg

Answer: 1.5-2 kg
Weight and age of rabbit in pharmacological studies:
Adult weight: 1.5-3.0 Kg
Age suitable for experiment: 5-6 months

Q-7. All present on drug advertisement except
a) Expiry date
b) Reference of the information
c) Rare dangerous side effect
d) Common side effect

Answer: Expiry date (?)
WHO criteria for drug advertisements includes information related to generic name of the drug, indication, dosage, precaution, contraindication, adverse effect, price, postal address of pharmaceutical company, and reference to scientific literature.

Q-8. Palivizumab is used for prophylaxis for
a) Metapneumovirus
b) Para-influenza virus
c) Influenza virus
d) RSV

Answer: RSV
Palivizumab is a monoclonal antibody produced by recombinant DNA technology.
It is used in the prevention of respiratory syncytial virus (RSV) infections.

Q-9. Teratogenic drug with cleft lip
a) Niacin
b) Retinoic acid
c) Thiamine
d) Folic acid

Answer: Retinoic acid
Retinoic acid and isotretinoin:
Terato-genicity is well recognized and regarded as one of the most serious potential adverse effects.
Half of pregnancies spontaneously abort, and of the remainder about half of the infants are born with cardiovascular or skeletal deformities.

Q-10. All of side effect of thionamide group of anti-thyroid except
a) Agranulocytosis
b) Aplasia anemia
c) Liver toxicity
d) Lung fibrosis

Answer: Lung fibrosis
Thionamides or thioamides: Anti-thyroid agents
Methimazole, Carbimazole, and Propylthiouracil
They are actively transported into the thyroid gland where they inhibit both the organification of iodine to tyrosine residues in thyro-globulin and the coupling of iodotyrosines.
Side effect of thionamide:
Maculo-papular pruritic rashes, exfoliative dermatitis and fever
Vasculitis, poly-serositis, poly-arthralgia
Hepatotoxicity and Cholestatic jaundice
Aplastic anemia (A rare life threatening complication)

Q-11. Drug used in osteoporosis all except
a) PTH
b) Calcitonin
c) Strontium ranelate
d) Denosumab

Answer: PTH
Drug used in osteoporosis:
Vitamin D and calcium
Bis-phosphonates- Alendronate, Risedronate, Zoledronic acid (Third generation Bis-phosphonate)
Sex hormones- Post-menopausal estrogen replacement therapy
Selective estrogen receptor modulators- Raloxifene
Analog of PTH- Teriparatide
Calcitonin nasal spray
Denosumab-Monoclonal antibody inhibiting proliferation of pre-osteoclast into mature osteoclast
Important point:
Strontium ranelate is used to treat severe osteoporosis in women who have gone through the menopause and who are at high risk of fracture. It is also used to treat severe osteoporosis in men who are at increased risk of fracture.

Q-12. All are risk factors for increased lactic acidosis in patient on metformin except
a) Advanced age
b) Liver dysfunction
c) Renal dysfunction
d) Smoking

Answer: Smoking
Risk factors for increased lactic acidosis in patient on metformin:
Advanced age
Kidney, Liver or Cardio-respiratory insufficiency (Tissue hypoxia)
Important point:
Metformin therapy should be temporally halted on the day of radio-contrast administration and restarted a day or two later after confirmation that renal function has not deteriorate.

Q-13. Which of the anti-diabetic drug does not need drug dose reduction in patient with renal disease?
a) Sitagliptin
b) Linagliptin
c) Vildagliptin
d) Saxagliptin

Answer: Linagliptin
DPP-4 inhibitors: Sitagliptin, Vildagliptin, Saxagliptin and Linagliptin
Di-peptidyl-peptidase-IV (DPP-4) inhibitors have become an important orally active drug class for the treatment of type 2 diabetes as second-line therapy.
DPP-4 inhibitors act mainly by increasing endogenous incretin hormone concentrations. They stimulate insulin secretion and inhibit glucagon secretion in a glucose-dependent manner with a significantly lower risk for hypoglycemia than sulfonylureas.
Linagliptin is eliminated by a hepato-biliary route, whereas the other DPP-4 inhibitors show a renal elimination.
Therefore, it can be used in all stages of chronic kidney disease without dose adjustments.

Q-14. Hyper-calcemia with serum calcium 16 mg/dl, immediate treatment
a) Subcutaneous calcitonin
b) IV fluids and diuretics
c) Bis-phosphate injection
d) Glucocorticoids

Answer: Subcutaneous calcitonin (?)
Mild hyper-calcemia (> 10.5 mg/dl) - Due to primary hyperthyroidism
Severe hyper-calcemia (> 14 mg/dl) – Due to hyper-calcemia of malignancy
Treatment of hyper-calcemia:
Aggressive hydration until the primary cause can be identified and treated
Bis-phosphonates are the treatment of choice for hyper-calcemia of malignancy.
Calcitonin may be helpful in the short term until bis-phosphonate reach therapeutic levels.
Calcimimetic agent cinacalcet hydrochloride suppresses PTH secretion and decreases serum calcium concentration
In emergency cases, dialysis with low calcium dialysate may be needed.
Important points:
Thiazides can worsen hyper-calcemia.
Bis-phosphonate may require up-to 48-72 hours before reaching full therapeutic effect.

Q-15. A 80 kg patient is brought in causality. Patient is in shock. Vaso-pressure is to be started @10 micro/kg/min. Vial has 200 mg in 5 ml, 2 vials diluted in 250 ml NS. 16 drops is equal to 1 ml. Calculate drops per minute required
a) 8
b) 16
c) 24
d) 32

Answer: 8
250 ml of NS contains 200 mg x 2 = 400 mg vaso-pressure
1 ml NS contains = 1.6 mg vaso-pressure
Vaso-pressure started @ 10 micro/kg/min or 80 x 10 micro g/min = 800 micro g/min or 0.8 mg /min
Vaso-pressure started @ 0.8 mg/ min 0r 0.5 ml/ min (1 ml NS contains = 1.6 mg vaso-pressure) or 8 drops/ min (1 ml = 16 drops)

Q-16. Dose response curve shows
dose-response-curve image
a) A and B are fully agonist
b) C is a non-competitive antagonist
c) B is more potent
d) A more efficacious than B

Answer: C is a non-competitive antagonist
dose-response-curve image
A -> Agonist
B-> Competitive antagonist being less potent but equally efficacious as A
C-> Non-competitive antagonist being less potent and less efficacious than A and B