Category: Quiz

Vegetables, Cantharides and Scorpion Poisons

Vegetable And Cantharides Poisons

Q. 1

Sin needle used to kill animals made of :

 A

Dhatura seeds

 B

Rati seeds

 C

Lead peroxide

 D

Arsenic

Q. 1

Sin needle used to kill animals made of :

 A

Dhatura seeds

 B

Rati seeds

 C

Lead peroxide

 D

Arsenic

Ans. B

Explanation:

B i.e. Rati seeds


Q. 2

Vegetable viper snake poison is

 A

Croton

 B

Madar

 C

Abrus

 D

Semicarpus

Q. 2

Vegetable viper snake poison is

 A

Croton

 B

Madar

 C

Abrus

 D

Semicarpus

Ans. C

Explanation:

C i.e. Abrus


Q. 3

One of the following substance produce injuries which stimulate confusion :

 A

Semicarpus anacardium

 B

Ricinus communis

 C

Abrus percatorius

 D

Capsium annum

Q. 3

One of the following substance produce injuries which stimulate confusion :

 A

Semicarpus anacardium

 B

Ricinus communis

 C

Abrus percatorius

 D

Capsium annum

Ans. A

Explanation:

A i.e. Semicarpus anacardium

Quiz In Between


Q. 4

Average fatal dose of croton oil seed is :

 A

500 drops

 B

Hand ful of seeds

 C

About 4 to 5 drops

 D

20 drops

Q. 4

Average fatal dose of croton oil seed is :

 A

500 drops

 B

Hand ful of seeds

 C

About 4 to 5 drops

 D

20 drops

Ans. D

Explanation:

D i.e. 20 drops


Q. 5

Which of the following protein synthesis inhibitor are non‑plant toxin:

 A

Streptomycin

 B

Abrin

 C

Ricin

 D

Emetine

Q. 5

Which of the following protein synthesis inhibitor are non‑plant toxin:

 A

Streptomycin

 B

Abrin

 C

Ricin

 D

Emetine

Ans. A

Explanation:

A i.e. Streptomycin



Corrosives Poisoning: Magenstrasse

Corrosives Poisoning: Magenstrasse

Q. 1

Magenstrasse refers to:

 A

Signs of magnesium poisoning

 B

Marks of violence in case of poisoning

 C

Route of acidic poisons in stomach

 D

Color change of mucosa seen in corrosives

Q. 1

Magenstrasse refers to:

 A

Signs of magnesium poisoning

 B

Marks of violence in case of poisoning

 C

Route of acidic poisons in stomach

 D

Color change of mucosa seen in corrosives

Ans. C

Explanation:

Ans. Route of acidic poisons in stomach

Quiz In Between



Laws of poisoning

Laws of poisoning

Q. 1

Which of the following statements about the Narcotic Drugs and Psychotropic Substances ACT (NDPS ) is true:

 A

Provides severe punishment for drug users and drug peddlers alike

 B

Recommends treatment / rehabilitation of drug users and punishment for drug peddlers

 C

Recommends treatment / rehabilitation of drug users and punishment for drug peddlers

 D

Farmers growing opium are permitted to grow and consume unlimited amounts of opium

Q. 1

Which of the following statements about the Narcotic Drugs and Psychotropic Substances ACT (NDPS ) is true:

 A

Provides severe punishment for drug users and drug peddlers alike

 B

Recommends treatment / rehabilitation of drug users and punishment for drug peddlers

 C

Recommends treatment / rehabilitation of drug users and punishment for drug peddlers

 D

Farmers growing opium are permitted to grow and consume unlimited amounts of opium

Ans. B

Explanation:

B i.e. Recommends treatment/ rehabilitation of drug users and punishment for drug peddlers

Alcohol is not included in NDPS Act, which regulates and prohibits all activities (from cultivation to consumption) of narcotic drugs & psychotropic substances except for medicinal & scientific purpose. An amendment has diluted & made the punishment less severe for drug offendersQ. It provides identification, treatment & rehabilitation of drug addicts.


Q. 2

Narcotic Drugs and psychotropic substance act was passed in the year:

 A

1981

 B

1983

 C

1985

 D

1986

Q. 2

Narcotic Drugs and psychotropic substance act was passed in the year:

 A

1981

 B

1983

 C

1985

 D

1986

Ans. C

Explanation:

C i.e. 1985


Q. 3

Under the ‘NDPS Act’ following drugs are included, except:       

NIMHANS 08

 A

Opium/heroin

 B

Hashish

 C

Amphetamine

 D

Alcohol

Q. 3

Under the ‘NDPS Act’ following drugs are included, except:       

NIMHANS 08

 A

Opium/heroin

 B

Hashish

 C

Amphetamine

 D

Alcohol

Ans. D

Explanation:

Ans. Alcohol

Quiz In Between



Hair: Examination, Importance, & difference between Human Hair Vs. Animal Hair

Hair: Examination, Importance, & difference between Human Hair Vs. Animal Hair

Q. 1

The hair examination is important for the following cases except :

 A

To find out its origin

 B

To find the accused or victim

 C

In case of sexual assault

 D

In case of lead poisoning

Q. 1

The hair examination is important for the following cases except :

 A

To find out its origin

 B

To find the accused or victim

 C

In case of sexual assault

 D

In case of lead poisoning

Ans. D

Explanation:

D i.e. Pb poisoning


Q. 2

Hairs are preserved in which poisoning:

March 2007

 A

Arsenic

 B

Manganese

 C

Phosphorous

 D

Alcohol

Q. 2

Hairs are preserved in which poisoning:

March 2007

 A

Arsenic

 B

Manganese

 C

Phosphorous

 D

Alcohol

Ans. A

Explanation:

Ans. A: Arsenic

There are tests available to diagnose poisoning by measuring arsenic in blood, urine, hair, and fingernails.

The urine test is the most reliable test for arsenic exposure within the last few days. Urine testing needs to be done within 24-48 hours for an accurate analysis of an acute exposure.

Tests on hair and fingernails can measure exposure to high levels of arsenic over the past 6-12 months. These tests can determine if one has been exposed to above-average levels of arsenic.


Q. 3

Animal hair are/have:     

NEET 14

 A

Fine

 B

Thin

 C

Large scales

 D

Thick cortex

Q. 3

Animal hair are/have:     

NEET 14

 A

Fine

 B

Thin

 C

Large scales

 D

Thick cortex

Ans. C

Explanation:

Ans. Large scales

Quiz In Between


Q. 4

The poison that can be detected in hair/bones long after death is:                            

Gujarat 07; COMEDK 08; FMGE 08

 A

Lead

 B

Mercury

 C

Arsenic

 D

Cannabis

Q. 4

The poison that can be detected in hair/bones long after death is:                            

Gujarat 07; COMEDK 08; FMGE 08

 A

Lead

 B

Mercury

 C

Arsenic

 D

Cannabis

Ans. C

Explanation:

Ans. Arsenic


Q. 5

Animal hair are ‑

 A

Fine

 B

Thin

 C

With large scales

 D

Thick cortex

Q. 5

Animal hair are ‑

 A

Fine

 B

Thin

 C

With large scales

 D

Thick cortex

Ans. C

Explanation:

Ans. is ‘c’ i.e., With large scales

Trait Human hair

Animal hair

General Fine and thin Coarse and thick
Cuticle Scales short, broad, flattened/thin Scales large, wavy projections/step-like projections
Cortex Thick, 4-10 times as broad as medulla Thin, rarely more than twice as broad as medulla
Medulla Varies, narrow, continuous, fragmented or absent, medullary index < 1/3 Continuous, wider medullary index > 1/2
Pigment Evenly distributed Present near the medulla
Precipitin test Specific for human

Specific for animal

Quiz In Between



Seminal stains.

Seminal stains.

Q. 1 Best test for seminal stains is:
 A Barbeiros test
 B Acid Phosphatase test
 C Florence test
 D Alkaline Phosphatase test
Q. 1 Best test for seminal stains is:
 A Barbeiros test
 B Acid Phosphatase test
 C Florence test
 D Alkaline Phosphatase test
Ans. B

Explanation:

The acid phosphatase test- 1. Level > 25 kA Unit is specific for the test or Undiluted semen has an acid phosphatase activity of 340 – 360 Bodansky U/ml, it is higher in humans as compared to animals. 2. It is +ve also by human RBCs, semen of higher apes and juice of cauliflower. 3. The prostatic secretion element of seminal fluid contains  a  very  much  higher  percentage  of  acid  phosphatase.  4.  This  test  is  conclusive  in  the  absence  of demonstrable sperms or in aspermia. 5. Is a quantative test.


Q. 2

Dried semen stain in clothes is identified by

 A

UV light

 B

Spectroscopy

 C

Magnifying lens

 D

Infra red

Q. 2

Dried semen stain in clothes is identified by

 A

UV light

 B

Spectroscopy

 C

Magnifying lens

 D

Infra red

Ans. A

Explanation:

UV light [ Ref: Reddy 29/e, p 377-378; Parikh 6/e, p 7.26-7.271

  • Seminal stains have to be detected in sexual offences. These have to be differentiated from those due to starch, pus, vaginal discharge, urine & egg albumen.
  • Seminal stains may be examined by four methods – (1) Physical (2) chemical (3) Microscopic (4) Electrophoretic

1)   Physical examination – A preliminary examination under filtered ultraviolet light can be made. Stains of urine, vaginal discharge and seminal fluid show a bright fluorescence. The fluorescence of seminal stains is of a bluish white colour & such stains are selected for further examinations.

2)   Chemical examination – Following tests can be done

  • Florence test – It is based o the presence of choline in semen. After adding reagent, dark brown crystals are formed.
  • Barberio’s test – It depends upon the presence of spermine in semen. Yellow, needle shaped, rhombic crystals of spermine pictrate are produced when reagent is added.
  • The acid phosphatase test – A high concentration of acid phosphatase is found only in the semen of human beings & monkeys. This is a quantitative test. The amount of acid phosphatase is estimated. Inhibition of acid phosphatase by 1-tartaric acid, though non specific, is a valuable screening test.
  • Creatine phosphokinase test – Spermatozoa contain a high concentration of cratine phosphokinase. Levels over 400 U/ml is almost diagnostic of semen. The enzyme is stable and can be detected even in old stains of 6 months.
  • Choline and spermine test – Liquid semen and dried seminal stains can be identified by a thin layer chromatographic technique. The test is based on the unique combination of choline & spermine which is present only in semen.
  • Ammonium molybdate test – when reagent is added to stain, a deep yellow colour from the presence of phosphorus is produced.
  • Immunological method – MHS-5 from seminal vesicles and Mab 4 E6 can be detected on the sperm cells & in ejaculated fluid. Prostate specific antigen (PSA, P30) test has replaced the quantitative analysis for acid phosphatase [Fluroscent in situ hybridisation (FISH) has been suggested as a specific & sensitive test for detection of male epithelial cells in the post coital vagina upto one week]

3) Microscopic examination – Involves identification of spermatozoa under the microscope. Fluorescence microscopy is based on the principle that the Y-chromosome is fluorescent to quinacrine.

4) Electrophoretic methods

  • Acid phosphatase isoenzyme test – Polyacrylamide gel electrophoresis followed by staining with methyl umbelliferyl phosphate reagent makes the seminal acid phosphatase to be distinguished from the acid phosphatase present in other substances & in vaginal secretion.

This is superior to LDH isoenzyme method since semen can be identified in the absence of sperms as in azoospermic or vasectomised persons.

  • Lactate dehydrogenase (LDH) isoenzyme Test – Sperm specific LDH isoenzyme can be separated from other LDH isoenzymes of semen by polyacrylamide gel electrophoresis.

Proof of semen: The only absolute proof of semen is the finding of at least one unbroken spermatozoan, or electrophoretic LHD isoenzyme detection of sperms.

  • In case of azoospermia, vasectomy or very old persons a stain will be seminal if it gives

– characteristic fluorescence in UV light

– positive 1-tartarate acid-phosphatase and

– High levels of acid phosphatase & creatine phosphokinase

or electrophoretic seminal acid phosphatase or PSA (P30) positive

  • Species (Human or animal) is confirmed by precipitin test as in blood stains.
  • Source (from which person) is identified by DNA & different grouping systems such as ABO, GM, PGM & GLO-I. New test
  • Commercial ELISA, the SEMA®assay, for a seminal vesicle-specific antigen (SVSA) provides highly sensitive detection of semen but are costly .

Q. 3 Which is a not an essential criteria according to WHO for normal semen analysis
 A Sperm count > 20 million/ml
 B Volume > 1 ml
 C Sperm with normal morphology (strict criteria) > 15%
 D Motility > 25% with rapidly progressive motility
Q. 3 Which is a not an essential criteria according to WHO for normal semen analysis
 A Sperm count > 20 million/ml
 B Volume > 1 ml
 C Sperm with normal morphology (strict criteria) > 15%
 D Motility > 25% with rapidly progressive motility
Ans. B

Explanation:

Volume > 1 ml [Ref William’s Gynaecology p. 449; http//www.gfiner.ch/end%•pgi/network]

THE W.H.O. RECOMMENDS THE FOLLOWING NORMAL VALUES

Volume

Sperm

Total sperm number

Percent mobility

Forward progression

Normal morphology

Round cells

Sperm agglutination

> 2 ml

concentration > 20 million / ml or more

> 40 million/ejaculate

> 50% with forward progression

> 25% with rapid linear progression

> 2 (scale 0-4)

> 30% normal (W.H.O. criteria)

> 14% normal (Kruger and strict criteria)

< 5 million/rnl

< 2 (scale 0-3),w.b.c fewer than I x106 / ml

  • The normal sperm morphology is currently being reassessed by W.H.O
  • In the interim the proportion of normal forms accepted by the laboratories in the U.K is either the earlier W.H.O limits of 30 or 15% based on strict morphological criteria.



Q. 4

Color of dried semen becomes yellow to brown. Dried semen stain in clothes is identified by:

 A

UV light

 B

Spectroscopy

 C

Magnifying lens

 D

Infrared

Q. 4

Color of dried semen becomes yellow to brown. Dried semen stain in clothes is identified by:

 A

UV light

 B

Spectroscopy

 C

Magnifying lens

 D

Infrared

Ans. A

Explanation:

When dried semen is examined under filtered ultraviolet light, they show a fluorescence of a bluish-white colour, which is not specific as other albuminous materials such as nasal, leucorrhoeal discharges and detergents also fluoresce.

Fluorescence depends on choline of semen.

Ref: The Essentials of Forensic Medicine and Toxicology, 27th edition, Page 369.


Q. 5

Which of following tests in used to detect semen?

 A

Phenolphthalein test

 B

Reine’s test

 C

Barberio’s test

 D

Paraffin test

Q. 5

Which of following tests in used to detect semen?

 A

Phenolphthalein test

 B

Reine’s test

 C

Barberio’s test

 D

Paraffin test

Ans. C

Explanation:

C i.e. Barberio’s test :

  • Barberio’s test is used for identification of seminal stains

Few drops of barberio’s reagent (containing pieric acid) are added to the seminal stain.

Positive test is indicated by formation of Yellow and needle shaped crystals of spermine picrate.

(Spermine in seminal stain reacts with picric acid to form these crystals)

  • Phenolphthalein test  (Kastle-Meyer test) is used for identification of haemoglobin in blood stains – Parikh 6th/7.16
  • Paraffin test  (or Dermal nitrate test) is used to detect gun powder on skin i.e. to determine if suspect had discharged a firearm- Parikh 6″/7.39
  • Reine’s test  has not been mentioned in forensic literature

Forensic tests to detect

Seminal Stain

Blood Stains

– Barberio’s testO

– Benzidine testQ

– Fluorence testQ

– Phenophthalein (Kastle‑

– Acid phosphatase

Meyer) testQ

testQ

– Takayama’s

– Creatine phosphatase

Haemochromogen crystal

test

testQ

– Elisa test

– Teichmann’s Haemin crystal

testQ

 

– Spectroscopic test


Q. 6

Spermin is detected in semen by which test‑

 A

Barberio test

 B

Florence

 C

ELISA

 D

Agglutination inhibition

Q. 6

Spermin is detected in semen by which test‑

 A

Barberio test

 B

Florence

 C

ELISA

 D

Agglutination inhibition

Ans. A

Explanation:

A i.e. Barberio test


Q. 7

All are tests for seminal stains except:           

March 2012

 A

Florence test

 B

Creatine phosphate test

 C

Takayama test

 D

Barberio test

Q. 7

All are tests for seminal stains except:           

March 2012

 A

Florence test

 B

Creatine phosphate test

 C

Takayama test

 D

Barberio test

Ans. C

Explanation:

Ans: C i.e. Takayama test

Stains and features

  • If semen is present, florence test will show dark brown crystals of choline iodide.
  • Levels over 400 units of CPK/ ml are almost diagnostic of seminal stains
  • Blood stains with Takayama reagent produces pink, feathery crystals of haemochromogen/ reduced alkaline haematin.
  • If prostatic secretion is present, yellow needle shaped rhombic crystals (spermine picrate) are seen

Q. 8

Florence test is used for: 

Delhi 06

 A

Blood stains

 B

Seminal stains

 C

Salivary stains

 D

Sweat stains

Q. 8

Florence test is used for: 

Delhi 06

 A

Blood stains

 B

Seminal stains

 C

Salivary stains

 D

Sweat stains

Ans. B

Explanation:

Ans. Seminal stains



Thermal injuries: chemical, electric and Lightening burns.

Thermal injuries: chemical and electric burns.

Q. 1 Regarding high-voltage electrical burns to an extremity
 A Injuries are generally more superficial than those of thermal burns
 B Intravenous fluid replacement is based on the percentage of body surface area burned
 C Antibiotic prophylaxis is not required
 D Evaluation for fracture of the other extremities and visceral injury is indicated
Q. 1 Regarding high-voltage electrical burns to an extremity
 A Injuries are generally more superficial than those of thermal burns
 B Intravenous fluid replacement is based on the percentage of body surface area burned
 C Antibiotic prophylaxis is not required
 D Evaluation for fracture of the other extremities and visceral injury is indicated
Ans. D

Explanation:

The treatment of electrical injury should be modified from that of thermal burns because tissue damage is much deeper than is apparent at first inspection. The heat generated is proportional to the resistance to the flow of current. Bone, fat, and tendons offer the greatest resistance. Therefore, the tissue deep within the center of an extremity may be injured while more superficial tissues are spared. For this reason, the quantification of fluid requirements cannot be based on the percentage of body surface area involved, as in the Parkland,Brooke, or Baxter formulas, which are used to calculate fluid replacement after thermal burns. Massive fluid replacement is usually essential. A brisk urine output is desirable because of the likelihood of myonecrosis with consequent myoglobinuria and renal damage. As with deep thermal burns, debridement, skin grafting, and amputation of extremities may be required following electrical injury. However, fasciotomy is more frequently required than escharotomy with electrical injury because deep myonecrosis results in increased intracompartmental pressures and compromised limb perfusion. In addition, distant fractures may result owing to vigorous muscle contraction during the accident or if subsequent falls occur. Cardiac or respiratory arrest may occur if the pathway of the current includes the heart or brain. An electrical current can also damage the pulmonary alveoli and capillaries and lead to respiratory infections, a major cause of death in these victims. Owing to the deep myonecrosis that often accompanies high-voltage injury, prophylaxis for clostridia with high-dose penicillin may be considered.


Q. 2 High tension electrical burns from overhead electric lines can cause-
 A Myoglobinuria and Acute renal failure
 B Severe alkalosis
 C No ECG change will be seen in the first 24 hours
 D Blood vessels are spared
Q. 2 High tension electrical burns from overhead electric lines can cause-
 A Myoglobinuria and Acute renal failure
 B Severe alkalosis
 C No ECG change will be seen in the first 24 hours
 D Blood vessels are spared
Ans. A

Explanation:

• Electricity exerts its tissue damaging effects by conversion to thermal energy.

• Tissue damage following a  high-voltage electrical injury not only occurs at the Cutaneous contact site but may also involve underlying tissues and organs along the route taken by the current between the entrance and exit sites.

• Misleading small cutaneous lesions may overlie extensive areas of devitalized muscle, which may liberate significant quantities of myoglobin and cause acute renal failure if an adequate renal output is not maintained.

• High-voltage electric injury and lightning injury both can cause cardiopulmonary arrest. Cardiopulmonary resuscitation (CPR) must be initiated immediately for the treatment of cardiac arrest.

•Patients may require operative treatment as soon as hemodynamic stability is achieved.

•A number of neurological changes may occur in the patient ranging from immediate peripheral deficits to relatively late- appearing deficits.

•In general motor nerves appear to be more commonly affected than the sensory nerves. [FAQ]

•Liver necrosis, intestinal perforation, focal pancreatic necrosis and focal gall bladder necrosis have been reported.

• Late complications include delayed hemorrhage even from moderate sized blood vessels.


Q. 3

Suspended animation may be seen with :

 A

Electrocution

 B

Strangulation / hanging

 C

Drowning

 D

Burn

Q. 3

Suspended animation may be seen with :

 A

Electrocution

 B

Strangulation / hanging

 C

Drowning

 D

Burn

Ans. A

Explanation:

A i.e. Electrocution

Suspended animation (i.e. apparent death) is seen in electrocution & apparently drowned (not drowning)Q

Quiz In Between


Q. 4

Joule burns is seen in :

 A

Electrocution

 B

Thermal injury

 C

Radiation injury

 D

Lightning

Q. 4

Joule burns is seen in :

 A

Electrocution

 B

Thermal injury

 C

Radiation injury

 D

Lightning

Ans. A

Explanation:

A i.e. Electrocution


Q. 5

Myoglobinuria is seen in which type of burns:

 A

Contact burn

 B

Electric burn

 C

Scald

 D

Flame burn

Q. 5

Myoglobinuria is seen in which type of burns:

 A

Contact burn

 B

Electric burn

 C

Scald

 D

Flame burn

Ans. B

Explanation:

Ans is ‘b’ i.e. Electric burn 

Electrical burns may cause extensive muscle necrosis and consequent myoglobinuria and hemoglobinuria, both of which may lead to renal insufficiency.


Q. 6

The most serious alkali burns of the eye are produced by:

 A

Strong liquid ammonia

 B

Caustic soda

 C

Lime

 D

None of the above

Q. 6

The most serious alkali burns of the eye are produced by:

 A

Strong liquid ammonia

 B

Caustic soda

 C

Lime

 D

None of the above

Ans. A

Explanation:

Ans. Strong liquid ammonia

Quiz In Between


Q. 7

All of the following are true of chemical burns of the eye except:

 A

Acid burns are more serious than the alkali burns

 B

Alkalies combine with lipids of cells to form soluble compounds, which produce a condition of softening and gelatinisation

 C

Acids cause instant coagulation of all the proteins

 D

Symblepharon is a distressing sequelae

Q. 7

All of the following are true of chemical burns of the eye except:

 A

Acid burns are more serious than the alkali burns

 B

Alkalies combine with lipids of cells to form soluble compounds, which produce a condition of softening and gelatinisation

 C

Acids cause instant coagulation of all the proteins

 D

Symblepharon is a distressing sequelae

Ans. A

Explanation:

Ans. Acid burns are more serious than the alkali burns


Q. 8

Electrocution is rare below:          

MP 09

 A

100 volt

 B

150 V

 C

200 V

 D

240 V

Q. 8

Electrocution is rare below:          

MP 09

 A

100 volt

 B

150 V

 C

200 V

 D

240 V

Ans. A

Explanation:

Ans. 100 volt

Quiz In Between



Hanging: Postmortem findings,Strangulation,Medico-legal aspects of hanging.

Hanging: Postmortem findings,Strangulation,Medico-legal aspects of hanging

Q. 1

‘La facies sympathique’ is a condition seen in cases of:

NEET 13; COMEDK 13

 A

Hanging

 B

Strangulation

 C

Throttling

 D

Railway accidents

Q. 1

‘La facies sympathique’ is a condition seen in cases of:

NEET 13; COMEDK 13

 A

Hanging

 B

Strangulation

 C

Throttling

 D

Railway accidents

Ans. A

Explanation:

Ans. Hanging


Q. 2

Following is most suggestive of antemortem hanging:

DNB 09

 A

Salivary dribbling

 B

Congestion of lungs

 C

Ligature marks

 D

Petechial hemorrhages

Q. 2

Following is most suggestive of antemortem hanging:

DNB 09

 A

Salivary dribbling

 B

Congestion of lungs

 C

Ligature marks

 D

Petechial hemorrhages

Ans. A

Explanation:

Ans. Salivary dribbling


Q. 3

Hanging causes injury to:

JIPMER 14

 A

Carotid artery

 B

Esophagus

 C

Trachea

 D

Vertebral artery

Q. 3

Hanging causes injury to:

JIPMER 14

 A

Carotid artery

 B

Esophagus

 C

Trachea

 D

Vertebral artery

Ans. A

Explanation:

Ans. Carotid artery

Quiz In Between


Q. 4

Lynching is a type of:      

AFMC 11; FMGE 13

 A

Homicidal hanging

 B

Suicidal hanging

 C

Judicial hanging

 D

Accidental hanging

Q. 4

Lynching is a type of:      

AFMC 11; FMGE 13

 A

Homicidal hanging

 B

Suicidal hanging

 C

Judicial hanging

 D

Accidental hanging

Ans. A

Explanation:

Ans. Homicidal hanging


Q. 5

Outward displacement of fractured hyoid bone is seen in:        

UP 10

 A

Manual strangulation

 B

Ligature strangulation

 C

Hanging

 D

Bansdola

Q. 5

Outward displacement of fractured hyoid bone is seen in:        

UP 10

 A

Manual strangulation

 B

Ligature strangulation

 C

Hanging

 D

Bansdola

Ans. C

Explanation:

Ans. Hanging


Q. 6

In a case of hanging, ligature mark is an example of:

NEET 13

 A

Contusion

 B

Pressure abrasion

 C

Laceration

 D

Burn

Q. 6

In a case of hanging, ligature mark is an example of:

NEET 13

 A

Contusion

 B

Pressure abrasion

 C

Laceration

 D

Burn

Ans. B

Explanation:

Ans. Pressure abrasion

Quiz In Between


Q. 7

What is the situation of the knot of ligature in cases of typical hanging‑

 A

In front of chin

 B

Angle of mandible

 C

Occiput

 D

Mastoid

Q. 7

What is the situation of the knot of ligature in cases of typical hanging‑

 A

In front of chin

 B

Angle of mandible

 C

Occiput

 D

Mastoid

Ans. C

Explanation:

Ans. is ‘c’ i.e., Occiput

Typical hanging : The ligature runs from the midline above the thyroid cartilage, symmetrically upward on both side of neck to the occipital region, the point of suspension (knot of ligature) being on occiput (at nape of neck).

Atypical hanging : Any variation from typical knot site (i.e. other than occiput/nape of neck) is called atypical hanging. Most common site of knot is near one side of mastoid process or angle of mandible.


Q. 8

Judicial Hanging causes

 A

C2-3 fracture dislocation

 B

C4-5 fracture dislocation

 C

C6-7 Fracture dislocation

 D

None of the above

Q. 8

Judicial Hanging causes

 A

C2-3 fracture dislocation

 B

C4-5 fracture dislocation

 C

C6-7 Fracture dislocation

 D

None of the above

Ans. A

Explanation:

Ans. is ‘a’ i.e., C2-3 fracture dislocation

Judicial hanging

In india, legal death sentence is carried out by hanging the criminal. Placement of knot beneath the chin (submental position) is thought to be most effective, ensuring a quicker death. However some prefer side of neck (left sub aural i.e. below angle of jaw) knot.

The preson is allowed to drop for 5-7 meters according to the weight, age and build of the person. Sudden stop causes fracture dislocation usually at level of C2-C3 or C3-C4 vertebra, and injury to spinal cord and brainstem (pons and medulla).


Q. 9

When a person has suspended himself by applying ligature around neck so that the point of suspension (knot) is situated in the region shown in the picture below.Such a hanging is called as ? 

 A

Typical.

 B

Atypical.

 C

Partial.

 D

Incomplete.

Q. 9

When a person has suspended himself by applying ligature around neck so that the point of suspension (knot) is situated in the region shown in the picture below.Such a hanging is called as ? 

 A

Typical.

 B

Atypical.

 C

Partial.

 D

Incomplete.

Ans. A

Explanation:

Hanging is best defined as the constriction of neck by a ligature tightened by the weight of the body. When the point of suspension is over the center of occiput, there is a maximum possibility of occlusion of the arteries and this is known as typical hanging as shown in the picture above., while all other points of suspension are called atypical hanging.

Quiz In Between



Determination of Age- Introduction and Medico-legal Importance

Determination of Age- Introduction and Medico-legal Importance

Q. 1 ‘Nothing  is an offence  which is done by a child  under  seven  years  of  age’  is  included under which of the following  section:
 A Section 82 IPC
 B Section 83 IPC
 C Section 84 IPC
 D Section 85 IPC
Q. 1 ‘Nothing  is an offence  which is done by a child  under  seven  years  of  age’  is  included under which of the following  section:
 A Section 82 IPC
 B Section 83 IPC
 C Section 84 IPC
 D Section 85 IPC
Ans. A

Explanation:

Age Medicolegal IPC Explanation

<7 year

7-12 

years

<12

years

 

 

Criminal

Responsibility 

Criminal 

Responsibility

Consent

 

 

Sec. 82

IPC 

Sec. 83

IPC

Sec. 89

IPC

 

No criminal

intent guilty 

of offence 

parents give

consent for 

noninvasive 

procedure


Q. 2

What is the minimal cut off age for employment of children under the Factory Act?

 A

12 years

 B

14 years

 C

15 years

 D

18 years

Q. 2

What is the minimal cut off age for employment of children under the Factory Act?

 A

12 years

 B

14 years

 C

15 years

 D

18 years

Ans. B

Explanation:

The Factory Act prohibits the employment of children below 14 years and declares 15 to 18 years as belonging to the adolescent group. Adolescents require fitness certificate prior to employment in a job. 

Ref: Park 21st edition page: 756.

Q. 3

Age at which one becomes major:

PGI 09; MAHE 12

 A

18 years

 B

21 years

 C

25 years

 D

35 years

Q. 3

Age at which one becomes major:

PGI 09; MAHE 12

 A

18 years

 B

21 years

 C

25 years

 D

35 years

Ans. A

Explanation:

Ans. 18 years

Quiz In Between


Q. 4

Age of marriage age for women:    

Gujarat 10

 A

16 years

 B

17 years

 C

18 years

 D

21 years

Q. 4

Age of marriage age for women:    

Gujarat 10

 A

16 years

 B

17 years

 C

18 years

 D

21 years

Ans. C

Explanation:

Ans. 18 years

Prohibition of Child Marriage Act(2006), and it came into effect on 1 November 2007; states that a girl in India can’t marry before the age of 18, and a boy before 21.


Q. 5

Majority is obtained by a person under court guardianship by age of ‑

 A

19 years

 B

20 years

 C

21 years

 D

22 years

Q. 5

Majority is obtained by a person under court guardianship by age of ‑

 A

19 years

 B

20 years

 C

21 years

 D

22 years

Ans. C

Explanation:

Ans. is ‘c’ i.e., 21 years

A person attains majority on completion of 18 years. However if a person is under the guardianship of court, he attains majority after 21 years (Indian Majority Act 1875).


Q. 6

According to juvenile justice act, age of juvenile is ‑

 A

< 14 years

 B
 C

< 18 years

 D

< 20 years

Q. 6

According to juvenile justice act, age of juvenile is ‑

 A

< 14 years

 B
 C

< 18 years

 D

< 20 years

Ans. C

Explanation:

Ans. is ‘c’ i.e., < 18 years

Juvenile Justice Act 2000

  • Juvenile justice (care and protection of children Act, 2000 (now Amendment Act 2006) covers :-
  1. Juveniles in conflict → child who is alleged to have committed an offence.
  2. Children in need of care and protection → children who are neglected, abused, or abandoned.
  • This act defines a juvenile / child as a person who has not completed the age of 18 years.

Quiz In Between


Q. 7

Legal age by which fetus is capable of independent existence is ‑

 A

240 days

 B

230 days

 C

220 days

 D

210 days

Q. 7

Legal age by which fetus is capable of independent existence is ‑

 A

240 days

 B

230 days

 C

220 days

 D

210 days

Ans. D

Explanation:

Ans. is ‘d’ i.e., 210 days

Viability means the physical ability of a foetus to lead a separate existence after birth apart from its mother, by virtue of a certain degree of development. A child is viable after 210 days (7 months) of intrauterine life, and in some cases after 180 days (6 months) but in most of these cases fetus is immature.

Full term mature infant show :-

  • Length (crown-heel length) 48-52 cm, head circumference 30-35 cm.
  • Ossification center at lower end of femur (appears at the end of 9 months or just before birth) and Ossification center of cuboid and upper tibia may also present (Note : some ossification centers are also present, but they appear before the attainment of viability so their presence does not have importance. These are (i) Clavicle, mandible, ribs vertebra → at the end of 2nd month, (ii) Calcaneum(os calcis) and manubrium sterni → at the end of 5th month and (iii) Sternum → at the end of 6 month). Other center which appears at attainment of viability is primary ossificaion center of talus which appears at the end of 7th month.

Q. 8

Age under which child is considered incapable of committing an offence is ‑

 A

3 years

 B

7 years

 C

14 years

 D

18 years

Q. 8

Age under which child is considered incapable of committing an offence is ‑

 A

3 years

 B

7 years

 C

14 years

 D

18 years

Ans. B

Explanation:

Ans. is ‘b’ i.e., 7 years


Q. 9

Legal age of consent is ‑

 A

10 years

 B

12 years

 C

14 years

 D

18 years

Q. 9

Legal age of consent is ‑

 A

10 years

 B

12 years

 C

14 years

 D

18 years

Ans. D

Explanation:

Ans.:D.)18 years.

India’s legal age of consent and marriage is 18 years.

Quiz In Between


Q. 10

Height of child acquire 100 cm in‑

 A

2.5 year

 B

3.5 year

 C

4.5 year

 D

5.5 year

Q. 10

Height of child acquire 100 cm in‑

 A

2.5 year

 B

3.5 year

 C

4.5 year

 D

5.5 year

Ans. C

Explanation:

Ans. is ‘c’ i.e., 4.5 year


Q. 11

Section defining the rape ‑

 A

304 B IPC

 B

302 IPC

 C

375 IPC

 D

376 IPC

Q. 11

Section defining the rape ‑

 A

304 B IPC

 B

302 IPC

 C

375 IPC

 D

376 IPC

Ans. C

Explanation:

Ans. is ‘c’ i.e., 375 IPC

Rape

  • According to Section 375 IPC, a man is said to commit rape, if he has sexual intercourse with a women :‑
  1. Against her will
  2. Without her consent
  3. With her consent if she is
  • Less than 16 years of age.
  • With his own wife less than 15 years of age.
  • Intoxicated or has unsound mind so that she is unable to understand the conseqences.
  • Consent is obtained by unlawful means, i.e. fears of death or hurt to herself or to some one whom she is interested.
  • Impersonation , i.e. when the man knows he is not her husband and her consent is given because she believes that he is another man to whom she is lawfully married.

Q. 12

Juvenile justice act defines a juvenile which is 

 A

Male below 16 years

 B

Female below 16 years

 C

Male below 18 years

 D

None of the above

Q. 12

Juvenile justice act defines a juvenile which is 

 A

Male below 16 years

 B

Female below 16 years

 C

Male below 18 years

 D

None of the above

Ans. C

Explanation:

Ans. is ‘c’ i.e., Male below 18 years

Quiz In Between



Anti-Tubercular Treatment Regime

Anti tubercular treatment regimen

Q. 1

Ramu has been put on DOTS Plus regime recently, which of the following are included in the treatment of this patient?

Note: Km – Kanamycin, Ofx – Ofloxain, Eto – Ethinamide, Cs – Cycloserine, Z – Pyrazinamide, E – Ethambutol. The numbers indicate the number of months of treatment.

 A

2 HR2E + 4 HR

 B

2 HRZES + 6HRZE

 C

6 HRKm OFX + 18 OFXKM

 D

6Km Ofx Eto Cs ZE + 18 Ofx Eto CsE

Q. 1

Ramu has been put on DOTS Plus regime recently, which of the following are included in the treatment of this patient?

Note: Km – Kanamycin, Ofx – Ofloxain, Eto – Ethinamide, Cs – Cycloserine, Z – Pyrazinamide, E – Ethambutol. The numbers indicate the number of months of treatment.

 A

2 HR2E + 4 HR

 B

2 HRZES + 6HRZE

 C

6 HRKm OFX + 18 OFXKM

 D

6Km Ofx Eto Cs ZE + 18 Ofx Eto CsE

Ans. D

Explanation:

In Dots Plus regime the intense phase is for a minimum of 6 months, extended up to 9 months in patients who have +ve culture after 4th month of treatment.

The continuation phase should be a minimum of 18 months.

Following intensive phase culture examination is done at 4, 6, 12, 18 and 24th month of treatment.

If second line drug sensitivity test is available from accredited laboratory individualised treatment may be used in such individuals.

Note:
Km – Kanamycin, Ofx – Ofloxain, Eto – Ethinamide, Cs – Cycloserine, Z – Pyrazinamide, E – Ethambutol.
MDR – TB means resistance at least to Rifampicin and Isoniazid

Q. 2

You are the DOTS provider for a patient. He has completed his 6 months of treatment. He was sputum +ve to begin with, but after the intensive phase of treatment he became sputum –ve. He was again confirmed to be sputum negative 2 months after starting the continuation phase. This patient can be termed as:

 A

Cured

 B

Treatment completed

 C

Transfer out

 D

Defaulted

Q. 2

You are the DOTS provider for a patient. He has completed his 6 months of treatment. He was sputum +ve to begin with, but after the intensive phase of treatment he became sputum –ve. He was again confirmed to be sputum negative 2 months after starting the continuation phase. This patient can be termed as:

 A

Cured

 B

Treatment completed

 C

Transfer out

 D

Defaulted

Ans. B

Explanation:

To be termed as cured a patient who was initially smear positive and completed treatment, should have a negative smear result on at least 2 occasions of which one should be at treatment completion.

A patient is branded as treatment complete if he was either sputum negative to begin with or sputum positive and completed the treatment but with no or only one negative smear during continuation and none at the end of treatment.

Ref: Park, Edition 21, Page 167


Q. 3

You are the medical officer of the PHC in a remote village in a coastal area and a fisherman was diagnosed to have sputum negative pulmonary TB. Because of the nature of his work, he is not able to take the usual DOTS regime and you have no option but to start the non-DOTS regime (ND2). Which of the following is the correct ND2 regime?

 A

12 (HR)

 B

6 (HE)

 C

12 (HRZ)

 D

12 (HE)

Q. 3

You are the medical officer of the PHC in a remote village in a coastal area and a fisherman was diagnosed to have sputum negative pulmonary TB. Because of the nature of his work, he is not able to take the usual DOTS regime and you have no option but to start the non-DOTS regime (ND2). Which of the following is the correct ND2 regime?

 A

12 (HR)

 B

6 (HE)

 C

12 (HRZ)

 D

12 (HE)

Ans. D

Explanation:

Daily self administered non-DOTS regime is followed in extremely rare circumstances where there is an adverse reaction to drugs used in the short – course therapy or when the patient is not able to comply with the regime.

 
The 2 regimes are as given below
1) ND1 regime – For new sputum +ve pulmonary seriously ill patients and extrapulmonary seriously ill patients – 2(SHE) + 10(HE)
2) ND2 regime – For sputum -ve pulmonary not seriously ill patients and extrapulmonary not seriously ill patients – 12(HE)
 
Ref: Park, Edition 21, Page 175

 

Quiz In Between


Q. 4

All are true about DOTS, EXCEPT:

 A

Continuation phase drugs are given in a multi-blister combipack

 B

Medication is to be taken in presence of a health worker

 C

Alternate day treatment

 D

None of the above

Q. 4

All are true about DOTS, EXCEPT:

 A

Continuation phase drugs are given in a multi-blister combipack

 B

Medication is to be taken in presence of a health worker

 C

Alternate day treatment

 D

None of the above

Ans. D

Explanation:

DOTS (Directly Observed Treatment, Short Course Chemotherapy): is a community based tuberculosis treatment and care strategy which combines the benefit of supervised treatment and the benefits of community based care and support.

All the drugs are to be taken on alternate days. Continuation phase drugs are given in a combipack.

Ref: Park’s Textbook of Preventive and Social Medicine By K.Park, 18th Edition, Page 336.


Q. 5

You are the only medical officer of a PHC in a remote tribal area of Rajastan. You had started Category–I DOTS for a 23 year old woman who is the mother of a 2 year old child. What chemoprophylaxis will you recommend for the child in this scenario? Note that the child is asymptomatic and Mantoux test is not available.

 A

INH 3 mg/kg for 6 months

 B

INH 5 mg/kg for 6 months

 C

INH 3 mg/kg for 3 months

 D

INH 5 mg/kg for 3 months

Q. 5

You are the only medical officer of a PHC in a remote tribal area of Rajastan. You had started Category–I DOTS for a 23 year old woman who is the mother of a 2 year old child. What chemoprophylaxis will you recommend for the child in this scenario? Note that the child is asymptomatic and Mantoux test is not available.

 A

INH 3 mg/kg for 6 months

 B

INH 5 mg/kg for 6 months

 C

INH 3 mg/kg for 3 months

 D

INH 5 mg/kg for 3 months

Ans. B

Explanation:

Here since the child is asymptomatic and Mantoux test is not available, INH 5 mg/kg should be given for 6 months.

If Mantoux test was available, the child would have been given chemoprophylaxis for 3 months following which a Mantoux would have been done.If the induration was > or = 6 mm chemoprophylaxis would have been given for another 3 months but if the induration was lesser than 6 mm then the chemoprophylaxis would have been discontinued.

 

Dosages of Anti-tubercular Drugs

Drugs

Daily therapy°

Thrice weekly therapy°

Isoniazid

5 mg/kg

10-15 mg/kg

Rifampicin

10 mg/kg

10 mg/kg

Pyrizinamide

25 mg/kg

35 mg/kg

Streptomycin

15 mg/kg

15 mg/kg

Ethambutol

15 mg/kg

30 mg/kg


Ref: Park, 21st Edition, Page 175.

 


Q. 6

A primigravida in first trimester was observed to be sputum positive for acid fast bacilli. She had no previous history of tuberculosis. Which of the following should be the treatment strategy?

 A

Category I DOTS

 B

Category II DOTS

 C

Category III DOTS

 D

Defer treatment

Q. 6

A primigravida in first trimester was observed to be sputum positive for acid fast bacilli. She had no previous history of tuberculosis. Which of the following should be the treatment strategy?

 A

Category I DOTS

 B

Category II DOTS

 C

Category III DOTS

 D

Defer treatment

Ans. A

Explanation:

The patient in the clinical scenario is a sputum positive newly diagnosed case thus belongs to the category I.

Patients in this category are given Rifampicin / Ethambutol / Isoniazid / Pyrazinamide for 2 months followed by Rifampicin/Isoniazid thrice weekly for 4 months. All the above mentioned drugs can be safely used in pregnancy. While streptomycin, ethionamide and fluroquinolones are teratogenic.
 
Ref:  Emerging Infections in Asia By Yichen Lu, Max Essex, Bryan Roberts, Pages 217-219; Park textbook of preventive and social medicine 21st edition Page 173.

Quiz In Between


Q. 7

DOTS chemotherapy is given for –

 A

TB

 B

Leprosy

 C

AIDS

 D

Tetanus

Q. 7

DOTS chemotherapy is given for –

 A

TB

 B

Leprosy

 C

AIDS

 D

Tetanus

Ans. A

Explanation:

Ans. is ‘a’ i.e., TB 

Directly observed treatment short course (DOTS)

  • In the Revised National Tuberculosis Control Programme (RNTCP), patients are provided short course chemotherapy as DOTS.

o All patients are provided short-course chemotherapy free of charge.

o During the intensive phase of treatment a health worker watches as the patient swallows the drug in his presence. o During continuation phase, the patient is issued medicine for one week in a multiblister combipack of which the first dose is swallowed by the patient in the presence of health worker.

o The consumption of medicine in the continuation phase is also checked by return of empty multiblister combipack when the patient comes to collect medicine for the next week.

  • In this programme, alternate day treatment is given.

o Under RNTCP, active case finding is no longer pursued. Case finding is passive. Patients presenting themselves with symptoms suspicious of tuberculosis are treated with DOTS therapy.

o The colour of boxes (containing the drugs for full course of treatment) is according to the category of regimen : –

i) Category I patients —> Red Category II patients —> Blue iii) Category III patients –> Green


Q. 8

A 25-year-old female has been diagnosed to be suffering from tuberculosis categorized as Category II (Sputum+ve relapse). The treatment regimen recommended under DOTS is – 

 A

2 (HRZE)3 + 5 (HR)3

 B

2 (HRSZE)3 + (HRZE)3 + 5 (HR)3

 C

3 (HRZE)3 + 2 (HRE)3 + 4 (HR)3

 D

3 (HRSZE)3 + 1 (HRZE)3+ 6 

Q. 8

A 25-year-old female has been diagnosed to be suffering from tuberculosis categorized as Category II (Sputum+ve relapse). The treatment regimen recommended under DOTS is – 

 A

2 (HRZE)3 + 5 (HR)3

 B

2 (HRSZE)3 + (HRZE)3 + 5 (HR)3

 C

3 (HRZE)3 + 2 (HRE)3 + 4 (HR)3

 D

3 (HRSZE)3 + 1 (HRZE)3+ 6 

Ans. B

Explanation:

Ans. is ‘b’ i.e., 2 (HRSZE)3 + (HRZE)3 + 5(HR)3


Q. 9

Diagnosis of TB ace to DOTS ? 

 A

1 out of 2 samples positive

 B

2 out of 3 samples positive

 C

3 out of 3 samples positive

 D

None

Q. 9

Diagnosis of TB ace to DOTS ? 

 A

1 out of 2 samples positive

 B

2 out of 3 samples positive

 C

3 out of 3 samples positive

 D

None

Ans. A

Explanation:

Ans. is ‘a’ i.e., 1 out of 2 samples positive

o Two sputum smear samples are examined.

o If any of the two samples or both the samples are positive, the diagnosis of smear-positive TB is confirmed.

Quiz In Between


Q. 10

True about DOTS –

 A

Drugs are given on supervision

 B

Streptomycin always given in first two months

 C

Intermittent regimen are used

 D

a and c

Q. 10

True about DOTS –

 A

Drugs are given on supervision

 B

Streptomycin always given in first two months

 C

Intermittent regimen are used

 D

a and c

Ans. D

Explanation:

Ans. is ‘a’ i.e., Drugs are given on supervision; ‘c’ i.e., Intermittent regimen are used

DOTS

o DOTS is directly observed treatment short course.

o In DOTS during the intensive phase of treatment a health worker or other trained person watches as the patients swallows the drugs in his presence.

o During continuation phase the patient is issued medicine for one week in multiblister combipack of which the first dose is swallowed by the patient in the presence of health worker or trained person.

o The consumption of medicine in the continuation phase is also checked by return of empty multiblister combipack when patient come to collect medicine for the next week.

o In this programme, alternate day treatment is used.

o Patient compliance is critically important throughout the prescribed period of treatment. All other consideration are secondary.

o Drugs are given catagory wise, same regimen is not given to all patient.

o Streptomycin is given in category II only.

o In catagory- I new sputum smear, positive cases sputum examination is done in 2, 4 and 6 months.


Q. 11

After initiation of DOTS therapy for category-I, first sputum examination is done at:      

March 2010

 A

1 month of treatment

 B

2 months of treatment

 C

4 months of treatment

 D

6 months of treatment

Q. 11

After initiation of DOTS therapy for category-I, first sputum examination is done at:      

March 2010

 A

1 month of treatment

 B

2 months of treatment

 C

4 months of treatment

 D

6 months of treatment

Ans. B

Explanation:

Ans. B: 2 months of treatment

The treatment in Category I consists of an intensive phase of H, R, Z and E administered under a direct supervision thrice weekly on alternate days for 2 months, followed by a continuation phase of H and R thrice weekly on alternate days for 4 months

In the Category 1 follow-up, sputum examination is done at 2, 4 and 6 months of treatment.

If smear is positive after 2 months, the intensive phase is extended for one more month and sputum examinations done at 3, 5 and 7 months.


Q. 12

A patient on antitubercular treatment [under DOTS] shows sputum positivity at the end of intensive phase under category I. Next step would be :            

March 2009

 A

Continue treatment of IP for one more month

 B

Switch to category II treatment

 C

Restart category I treatment

 D

Start continuation phase under category I

Q. 12

A patient on antitubercular treatment [under DOTS] shows sputum positivity at the end of intensive phase under category I. Next step would be :            

March 2009

 A

Continue treatment of IP for one more month

 B

Switch to category II treatment

 C

Restart category I treatment

 D

Start continuation phase under category I

Ans. A

Explanation:

Ans. A: Continue treatment of IP for one more month

Quiz In Between


Q. 13

Which of the following is true for DOTS:

March 2012

 A

Treatment under supervision

 B

Every patient is given the same treatment

 C

Streptomycin is given to all the patients

 D

Daily regimen

Q. 13

Which of the following is true for DOTS:

March 2012

 A

Treatment under supervision

 B

Every patient is given the same treatment

 C

Streptomycin is given to all the patients

 D

Daily regimen

Ans. A

Explanation:

Ans: A i.e. Treatment under supervision

DOTS stand for directly observed treatment short course, in which alternate day treatment is used. Drugs is given categorywise.


Q. 14

All are true about DOTS, except ‑

 A

Short course of chemotherapy

 B

Drugs are given free of cost

 C

Supervised drugs intake in intensive phase

 D

Daily treatment is recommended

Q. 14

All are true about DOTS, except ‑

 A

Short course of chemotherapy

 B

Drugs are given free of cost

 C

Supervised drugs intake in intensive phase

 D

Daily treatment is recommended

Ans. D

Explanation:

Ans. is ‘d’ i.e., Daily treatment is recommended

Directly observed treatment short course (DOTS)

  • In the Revised National Tuberculosis Control Programme (RNTCP), patients are provided short course chemotherapy as DOTS.
  • All patients are provided short-course chemotherapy free of charge.
  • During the intensive phase of treatment a health worker watches as the patient swallows the drug in his presence. o During continuation phase, the patient is issued medicine for one week in a multiblister combipack of which the first dose is swallowed by the patient in the presence of health worker.
  • The consumption of medicine in the continuation phase is also checked by return of empty multiblister combipack when the patient comes to collect medicine for the next week.
  • In this programme, alternate day treatment is given.
  • Under RNTCP, active case finding is no longer pursued. Case finding is passive. Patients presenting themselves with symptoms suspicious of tuberculosis are treated with DOTS therapy.
  • The colour of boxes (containing the drugs for full course of treatment) is according to the category of regimen‑
  1. Category I patients → Red
  2. Category II patients → Blue
  3. Category III patients → Green

Q. 15

According to DOTS-PLUS guidelines 2013 treatment of multidrug resistance TB includes all except ‑

 A

Total duration 24-27 months

 B

Intensive phase – 6 drugs

 C

Continutation phase – 2 drugs

 D

Intensive phase 6-9 months

Q. 15

According to DOTS-PLUS guidelines 2013 treatment of multidrug resistance TB includes all except ‑

 A

Total duration 24-27 months

 B

Intensive phase – 6 drugs

 C

Continutation phase – 2 drugs

 D

Intensive phase 6-9 months

Ans. C

Explanation:

Ans. is ‘c i.e., Continutation phase-2 drgus

Treatment of multidrug resistance (MDR) TB

  • MDR-TB is defined as resistance to at least both INH and rifampicin. Previously it was classified as Category IV under DOTS (DOTS-PLUS).
  • The treatment is given in two phases, the intestive phase (IP) and the continuation phase (CP). The total duration of treatment for regimen for MDR-TB is 24-27 months, depending on the IP duration. o Treatment regimen comprises :-
  1. Intensive phase (6-9 months) : Six drugs : Kanamycin (Km), levofloxacin (Lvx), ethionamide (Eto), pyrazinamide (Z), ethambutol (E), and cycloserine (Cs).
  2. Continuation phase (18 months) : Four drugs : Levofloxaxcin, ethionamide, ethambutol and cycloserine.
  3. Total duration of treatment is 24-27 months.

Treatment of extensive drug resistance (XDR) TB

  • XDR-TB is defined as resistance to any fluoroquinolone and at least one of the following three second-line drugs (capreomycin, kanamycin, amikacin), in addition to multidrug resistance.
  • The Regimen for XDR-TB would be of 24-30 months duration, with 6-12 months Intensive Phase (IP) and 18 months Continuation Phase (CP).
  • Regimen is :-
  1. Intensive phase (6-12 months) : Seven drugs : Capreomycin, PAS, moxifloxacin, high dose INH, clofazimine, Linezolid, amoxyclay.
  2. Continuation phase (18 months) : Six drugs : PAS, moxifloxacin, high dose INH, clofazimine, linezolid, amoxyclay.

Quiz In Between


Q. 16

Identify the Symbol shown in the image:

 A

MDT

 B

DOTS

 C

ART

 D

Anti-malaria Therapy

Q. 16

Identify the Symbol shown in the image:

 A

MDT

 B

DOTS

 C

ART

 D

Anti-malaria Therapy

Ans. B

Explanation:

Ans:B.)DOTS

RNTCP and DOTS

  • RNTCP ( Revised National Tuberculosis Control Programme) is an application of WHO recommended strategy of DOTS in India. It was implemented in 1997.
  • The diagnosis is made primarily by sputum microscopy, which is made available free of cost to patients at designated microscopy centers.
  • Treatment is provided under direct observation by a DOT 

Objectives:

1- Detecting at least 70% of sputum positive tuberculosis patients in the community.

2- Curing at least 85% of the newly detected sputum positive cases.

Components of DOTS (Directly observed treatment strategy)

1- Political and administrative commitment at all levels.

2- Diagnosis through sputum microscopy

3- Uninterrupted supply of short course chemotherapy drugs.

4- Direct observation of drug intake ( DOTS)

5- Systematic monitoring, evaluation and supervision at all levels.

Treatment schedule
Category-1:

  • *Newly diagnosed sputum positive pulmonary tuberculosis
  • *Sputum negative pulmonary tuberculosis with extensive parenchymal involvement.
  • *Severe form of extrapulmonary tuberculosis

Category-2

  • *Treatment failure cases
  • * Relapse cases
  • * Return after interruption

Category-3

  • * sputum negative pulmonary tuberculosis with minimal involvement
  • * Less severe form of extrapulmonary tuberculosis

Drug Regimen

  • Category- 1: 2(H3 R3 Z3 E3) 4 ( H3 R3 )
  • Category- 2: 2( S3 H3 R3 Z3 E3)+ 1( H3 R3 Z3 E3 ) 5 ( H3 R3 E3)
  • Category- 3: 2( H3 R3 Z3 ) 4 ( H3 R3 )
  1. H= INH 600mg, R= Rifampicin 450mg, Z= Pyrazinamide 1500mg,
  2. E= Ethambutol 1200mg, S= Streptomycin 750 mg.

Treatment in the RNTCP (Revised National TB Control Programme) consists of 2 phases –

  • An initial intensive phase and a second continuation phase.
  • The total duration of treatment is 6-9 months.

1.The intensive phase lasts for 2-4 months.

  • In this phase, a health worker  watches as the patient swallows the drugs in his presence. Treatment is given thrice a week on alternate days and every dose is directly observed.

2. The continuation phase lasts for 4-5 months depending on the patient’s response to treatment. 

  • In this phase, the first dose of the medicine every week is taken by the patient under direct observation, while the other doses are taken by the patient himself. The patient is requested to bring the previous week’s blister pack when coming to collect the next week’s blister pack.

The colour of boxes (containing the drugs for full course of treatment) is according to the category of regimen : –

  • Category I patients —> Red .
  • Category II patients —> Blue .
  • Category III patients –> Green

Q. 17

Patient diagnosed with HIV and Tuberculosis. How to start ATT and c-A.R.T

 A

Start ATT first

 B

Start cART first

 C

Start both simultaneously

 D

Start cART only

Q. 17

Patient diagnosed with HIV and Tuberculosis. How to start ATT and c-A.R.T

 A

Start ATT first

 B

Start cART first

 C

Start both simultaneously

 D

Start cART only

Ans. A

Explanation:

Ans. is ‘a’ i.e., Start ATT first

  • In a case when HIV and TB are diagnosed together ATT should be started first.
  • ATT started first, because of IRIS (Immune Reconstitution Inflammatory syndrome).
  • If ART started first, it may improve CD4 cells at first, but later a previously acquired infection (TB, Herpes), responds with an overshelming inflammatory response that paradoxically makes the symptom of infection worse.
  • Therefore, starting of ATT-2 weeks before ART, have shown to decrease the incidence of IRIS.

Q. 18

Isoniazid child dose in DOTS regimene (RNTCP)-

 A

10-15 mg/kg/dg

 B

15-20 mg/kg/dg

 C

20-25 mg/kg/dg

 D

5-10 mg/kg/dg

Q. 18

Isoniazid child dose in DOTS regimene (RNTCP)-

 A

10-15 mg/kg/dg

 B

15-20 mg/kg/dg

 C

20-25 mg/kg/dg

 D

5-10 mg/kg/dg

Ans. A

Explanation:

Ans. is ‘a’ i.e., 10 -15 mg/kg/dg

Quiz In Between



Doxycycline

DOXYCYCLINE

Q. 1

A 25 year old patient, Bindu. presents with vagi­nal discharge. Examination of the discharge re­veals the presence of Chlamydial infection. The treatment of choice is :

 A

Azithromycin + contact tracing

 B

Doxycycline + Metronidazole

 C

Fluconazole + Doxycycline

 D

Metronidazole

Q. 1

A 25 year old patient, Bindu. presents with vagi­nal discharge. Examination of the discharge re­veals the presence of Chlamydial infection. The treatment of choice is :

 A

Azithromycin + contact tracing

 B

Doxycycline + Metronidazole

 C

Fluconazole + Doxycycline

 D

Metronidazole

Ans. A

Explanation:

Azithromycin + contact tracing


Q. 2 Which of the following Tetracycline can be used in renal failure wihtout dose adjustment:
 A Oxytetracycline
 B Doxycycline
 C Minocycline
 D Demiclocycline
Q. 2 Which of the following Tetracycline can be used in renal failure wihtout dose adjustment:
 A Oxytetracycline
 B Doxycycline
 C Minocycline
 D Demiclocycline
Ans. B

Explanation:

Doxycycline


Q. 3

Which of the following antibiotics is least Nephrotoxic?

 A

Streptomycin

 B

Gentamycin

 C

Polymixin B

 D

Doxycycline

Q. 3

Which of the following antibiotics is least Nephrotoxic?

 A

Streptomycin

 B

Gentamycin

 C

Polymixin B

 D

Doxycycline

Ans. D

Explanation:

Doxycycline is metabolized in the liver and excreted through the bile and not via kidney and hence it is not nephrotoxic.

Ref: KDT, 6th Edition, Pages 713, 721, 734; Drug Injury: Liability, Analysis and Prevention, 2nd Edition, Page 438

Quiz In Between


Q. 4

Antibiotic treatment of choice for treating cholera in an adult is a single dose of:

 A

Tetracycline

 B

Co-trimoxazole

 C

Doxycycline

 D

Furazolidone

Q. 4

Antibiotic treatment of choice for treating cholera in an adult is a single dose of:

 A

Tetracycline

 B

Co-trimoxazole

 C

Doxycycline

 D

Furazolidone

Ans. C

Explanation:

Doxycycline – antibiotic of choice for adults only single dose suffices.

TMP-SMX – antibiotic of choice for children.
Furazolidone – antibiotic of choice for pregnant women.
 
Ref: Park’s Textbook Of Preventive And Social Medicine By K. Park, 19th Edition, Page 193; Park’s Textbook Of Preventive And Social Medicine By K. Park, 18th Edition, Page 181

Q. 5

Which of the following is the drug of choice for Non-Gonococcal Urethritis?

 A

Ceftriaxone

 B

Ciprofloxacin

 C

Doxycycline

 D

Minocycline

Q. 5

Which of the following is the drug of choice for Non-Gonococcal Urethritis?

 A

Ceftriaxone

 B

Ciprofloxacin

 C

Doxycycline

 D

Minocycline

Ans. C

Explanation:

Non gonococcal urethritis is most commonly caused by Chlamydia trachomatis and ureaplasma urealyticum. Tetracycline is the drug of choice. Doxycycliine can be used as an alternative. Erythromycin can be used in case of tetracycline resistance.

Less common causes include staphylococcus aureus, gam negative rods, candida albicans, trichomonas vaginalis etc.

Ref: Sexually Transmitted Diseases By Sehgal, 4th Edition, Page 25-7


Q. 6

Which among the following is the drug of choice in Mycoplasma infection?

 A

Doxycycline

 B

Penicillin

 C

Ceftriaxone

 D

Cotrimoxazole

Q. 6

Which among the following is the drug of choice in Mycoplasma infection?

 A

Doxycycline

 B

Penicillin

 C

Ceftriaxone

 D

Cotrimoxazole

Ans. A

Explanation:

For mycoplasma tetracyclines are the drugs of choice (doxycycline 100 mg 2 times a day for 10 to 14 days).

Erythromycin, Azithromycin and Fluroquinolones can also be used.

Tetracyclines are contraindicated in pregnancy, therefore erythromycin or spiramycin can be used.

Quiz In Between


Q. 7

42 year old male presented with high grade fever with hepatosplenomegaly. At the time of admission he was very sick. On detailed evaluation doctor noticed a skin lesion on the thigh suggestive of eschar. Patient was diagnosed to have srub typhus. He is BEST treated with:

 A

Oral Doxycycline

 B

Oral Erythromycin

 C

IV ceftriaxone

 D

IV gentamicin

Q. 7

42 year old male presented with high grade fever with hepatosplenomegaly. At the time of admission he was very sick. On detailed evaluation doctor noticed a skin lesion on the thigh suggestive of eschar. Patient was diagnosed to have srub typhus. He is BEST treated with:

 A

Oral Doxycycline

 B

Oral Erythromycin

 C

IV ceftriaxone

 D

IV gentamicin

Ans. A

Explanation:

Srub typhus patients presents with high fever, eschar, regional lymphadenopathy. It is treated with:

  • DOC: Oral doxycycline 100 BD for 7-14 days
  • Alternatives, Azithromycin 500 for 3 days or chloramphenicol

Ref: Harrison, Edition-18, Page.


Q. 8

Treatment of Brucellosis –

 A

Doxycycline

 B

Streptomycin

 C

Erythromycin

 D

a and b

Q. 8

Treatment of Brucellosis –

 A

Doxycycline

 B

Streptomycin

 C

Erythromycin

 D

a and b

Ans. D

Explanation:

Ans. is ‘a’ i.e., Doxycycline; ‘b’ i.e., Streptomycin


Q. 9

Which antibiotic acts by inhibiting protein synthesis

 A

Cefotetan

 B

Doxycycline

 C

Ciprofloxacin

 D

Oxacillin

Q. 9

Which antibiotic acts by inhibiting protein synthesis

 A

Cefotetan

 B

Doxycycline

 C

Ciprofloxacin

 D

Oxacillin

Ans. B

Explanation:

Ans. is ‘b’ i.e., Doxycycline

Quiz In Between


Q. 10

The following has maximum propensity for photodermatitis-

 A

Oxytetracycline

 B

Doxycycline

 C

Minocycline

 D

All

Q. 10

The following has maximum propensity for photodermatitis-

 A

Oxytetracycline

 B

Doxycycline

 C

Minocycline

 D

All

Ans. B

Explanation:

Ans. is ‘b’ i.e., Doxycycline

o Photodermatitis is caused by demeclocycline (max) and doxycycline.


Q. 11

Chemoprophylaxis in an Englishman visiting chloroquine and mefloquine ersistant malaria region is done with –

 A

Primaquine

 B

Doxycycline

 C

Amodiaquine

 D

Hydroxychloroquine

Q. 11

Chemoprophylaxis in an Englishman visiting chloroquine and mefloquine ersistant malaria region is done with –

 A

Primaquine

 B

Doxycycline

 C

Amodiaquine

 D

Hydroxychloroquine

Ans. B

Explanation:

Ans. is ‘b’ i.e., Doxycycline


Q. 12

DOC for LGV

 A

Doxycycline

 B

Ampicillin

 C

Erythromycin

 D

Ceftriaxone

Q. 12

DOC for LGV

 A

Doxycycline

 B

Ampicillin

 C

Erythromycin

 D

Ceftriaxone

Ans. A

Explanation:

A i.e. Doxycycline

Quiz In Between


Q. 13

Antibiotic treatment of choice for treating cholera in an adult is a single dose of – 

 A

Tetracycline 

 B

Cotrimoxazole

 C

Doxycycline 

 D

Furazolidone

Q. 13

Antibiotic treatment of choice for treating cholera in an adult is a single dose of – 

 A

Tetracycline 

 B

Cotrimoxazole

 C

Doxycycline 

 D

Furazolidone

Ans. C

Explanation:

Ans. is ‘c’ i.e., Doxycycline 

o Main treatment of cholera is only rapid and adequate replacement of fluids, electrolytes and base. Although not necessary for cure, the use of an antibiotic to which the organism is susceptible will diminish the duration and volume of fluid loss and will hasten clearance of organism from the stool. Single dose doxycycline is the drug of choice for adults (except pregnant women).


Q. 14

Cholera prophylaxis is by –

 A

Doxycycline 300 mg OD 

 B

Cephalosporin

 C

Streptomycin

 D

Cotrimexazole

Q. 14

Cholera prophylaxis is by –

 A

Doxycycline 300 mg OD 

 B

Cephalosporin

 C

Streptomycin

 D

Cotrimexazole

Ans. A

Explanation:

Ans. is ‘a’ i.e., Doxycyline 300 mg OD 


Q. 15

A 26 year old male in a young adult with a history of extramarital sex,presents with acute onset of tender, enlarged swelling in both groins.Regarding this condition, which of the following statements are true?

 A

May be caused by H.Ducreyi

 B

May be caused by Chlamydia Trachomatis

 C

Doxycycline/Azithromycin given for treatment

 D

All of the above

Q. 15

A 26 year old male in a young adult with a history of extramarital sex,presents with acute onset of tender, enlarged swelling in both groins.Regarding this condition, which of the following statements are true?

 A

May be caused by H.Ducreyi

 B

May be caused by Chlamydia Trachomatis

 C

Doxycycline/Azithromycin given for treatment

 D

All of the above

Ans. D

Explanation:

Ans:D.)All of the above.

Inguinal Bubo.

  • Inguinal and femoral buboes are localised enlargements of the lymph nodes in the groin area, which are painful and may be fluctuant.
  • They are frequently associated with lymphogranuloma venereum and chancroid..

Lymphogranuloma venereum (LGV)

  • It is a sexually transmitted disease caused by the invasive serovars L1, L2, L2a or L3 of Chlamydia trachomatis.
    • Inoculation at the mucous lining of external sex organs (penis and vagina) can lead to the inguinal syndrome named after the formation of buboes or abscesses in the groin (inguinal) region where draining lymph nodes are located.
  • Primary stage:LGV may begin as a self-limited painless genital ulcer that occurs at the contact site 3–12 days after infection.
  • The secondary stage most often occurs 10–30 days later.
    • The infection spreads to the lymph nodes through lymphatic drainage pathways.
    • The most frequent presenting clinical manifestation of LGV among malesis unilateral (in 2/3 of cases) lymphadenitis and lymphangitis, often with tender inguinal and/or femoral lymphadenopathy .
    • Lymphangitis of the dorsal penis may also occur and resembles a string or cord.
    • If the route was anal sex the infected person may experience lymphadenitis and lymphangitis and proctitis.
    • In females, cervicitis, perimetritis, or salpingitis may occur as well as lymphangitis and lymphadenitis in deeper nodes.
  • Treatment involves antibiotics(Tetracycline/Doxycycline,Erythromycin/Azithromycin) and may involve drainage of the buboes or abscesses by needle aspiration or incision.

Chancroid

  • Chancroid is a sexually transmitted disease caused by the fastidious Gram-negative streptobacillus Haemophilus ducreyi.
  • H. ducreyi enters skin through microabrasions incurred during sexual intercourse. A local tissue reaction leads to development of erythomatous papule, which progresses to pustule in 4–7 days. It then undergoes central necrosis to ulcerate.
  • Painful lymphadenopathy occurs in 30 to 60% of patients.
  • Treatment is a single oral dose (1 gram) of azithromycin, or a single IM dose of ceftriaxone, or oral erythromycin for seven days.

Quiz In Between


Q. 16

A 19-year old male presents with several comedones, papules and pustules on face and trunk. The approp-ilte drug ,1choice for the patient would be

 A

Topical retinoic acid

 B

Topical retinoic acid + Oral doxycycline

 C

Topical clindamycin

 D

Topical azithromycin

Q. 16

A 19-year old male presents with several comedones, papules and pustules on face and trunk. The approp-ilte drug ,1choice for the patient would be

 A

Topical retinoic acid

 B

Topical retinoic acid + Oral doxycycline

 C

Topical clindamycin

 D

Topical azithromycin

Ans. B

Explanation:

Ans. b. Topical retinoic acid + Oral doxycycline

A I9-year-old male presents with several comedones, papules and pustules on face and trunk. This is a case of inflammatory acne with comedones and appropriate drug of choice for this patient is topical retinoic acid with oral doxycycline.


Q. 17

Drug of choice for treating chylmydia with gonorrhea is ‑

 A

Ciprofloxacin

 B

Norfloxac in

 C

Nalidixic acid

 D

Doxycycline

Q. 17

Drug of choice for treating chylmydia with gonorrhea is ‑

 A

Ciprofloxacin

 B

Norfloxac in

 C

Nalidixic acid

 D

Doxycycline

Ans. D

Explanation:

Ans. is ‘d’ i.e., Doxycycline

Quiz In Between



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