Instruction:
High dose of morphine is used without much danger in -
A. Gall bladdersurgery
B. Labour
C. Myocardial infarction
D. Head injury

Response:
Ans. is 'c' i.e., Myocardial infarction o Morphine should be given promptly in myocardial infarction to allay apprehension and reflex sympathetic stimulation.About other optionso Morphine should be used cautiously in gall bladder and biliary tract dysfunction as it causes spasm of sphincter of oddi and can cause acute rise of intrabiliary pressure,o Used during labour, morphine can cause neonatal respiratory distress,o Head injury is a contraindication for morphine use.Precautions and contraindications of Morphine:Head injury: morphine is contraindicated in patients with head injury (KDT). Reasons are -By retaining C02 it increases intracranial tension which will add to that caused by head injury itself.Even therapeutic doses can cause marked respiratory depression in these patients.Vomiting, miosis, and altered mentation produce by morphine interfere with assessment of progress in head injury cases.Branchial asthma: Morphine can precipitate an attack by its histamine releasing action.Hypothyroidism, liver and kidney disease patients are more sensitive to morphineInfants and elderly are more susceptible to the respiratory depressant action of morphine.It is dangerous in patients with respiratory insufficiency (Emphysema, pulmonary fibrosis, corpulmonale), sudden deaths have occurred.Hypotensive states and hypovolemia exagerate fall in BP due to morphine.Undiagnosed acute abdominal pain - morphine can aggravate certain conditions e.g., diverticulitis, biliary colic, pancreatitis.Elderly male - chances of urinary retention are high.Unstable personalities - are liable to continue its use and become addicted.

So the answer to this question is C


Instruction:
Pleomorphic adenoma has?
A. Columnar cells enclosing lymphoid stroma
B. Exclusively myoepithelial cells
C. Epithelial cells in chondroid matrix
D. Nests of squamous cells & vacuolated cells containing mucin

Response:
Mixed tumour of salivary gland (pleomorphic adenoma) is derived from a single clone (either myoepithelial or ductal reserve cell) and giving rise to two components, namely epithelial and myoepithelial (stromal elements) cells Pleomorphic adenoma: Encapsulated but pseudopodia (fingerlike projections) into the surrounding gland.

So the answer to this question is C


Instruction:
Primigravida with full term, complains of faintness on lying down and she feels well when turns to side or sitting position. This is due to
A. Increased intraabdominal pressure
B. IVC compression
C. Increased intracranial pressure
D. After heavy lunch

Response:
Supine hypotension syndrome : During late pregnancy,the gravid uterus produces a compression effect on the IVC when patient is in supine position . In 90% cases, this results in opening up of the collateral circulation by means of paraveebral and azygos veins. In 10 % cases, when collaterals fails to open up, the venous rReturn Ofthe hea may be seriously cuailed. This results in production of hypotension, tachycardia and syncope -Supine Hypotension Syndrome. The normal blood pressure is quickly restored by turning the patient to lateral position. Ref:Datta Obs 9e pg 49.

So the answer to this question is B


Instruction:
A 24 year old female presents with abdominal pain, hermaturia and arhthralgia. On examination, palpable purpuric rash was seen on trunk, limbs and buttocks. Coagulation tests were normal. What is the most probable diagnosis
A. Hemolytic uremic syndrome
B. Henoch-Schonlein purpura
C. Meningococcemia
D. Thrombotic thrombocytopenic purpura

Response:
Henoch-Schonlein purpura is a small-vessel vasculitis caused by immune complex deposition following an infectious trigger. It is predominantly a disease of children and young adults. The usual presentation is with purpura over the buttocks and lower legs, accompanied by abdominal pain, gastrointestinal bleeding and ahralgia. Nephritis can also occur and may present up to 4 weeks after the onset of other symptoms. Biopsy of affected tissue shows a vasculitis with IgA deposits in the vessel wall. Henoch-Schonlein purpura is usually a self-limiting disorder that settles spontaneously without specific treatment. Glucocoicoids and immunosuppressive therapy may be required in patients with more severe disease, paicularly in the presence of nephritis. Ref - davidsons 23e p1043

So the answer to this question is B


Instruction:
Soap Bubble appearance in X-ray is seen in
A. Multiple cystic Kidney
B. Neuroblastoma
C. Cystic lymphagiectasis
D. Meconium ileus

Response:
D i.e. Meconium ileus

So the answer to this question is D


Instruction:
Which of the following drugs used to treat MDR TB can cause hypothyroidism:
A. Kanamycin
B. Pyrazinamide
C. Ethionamide
D. None of the above

Response:
Adverse effects of Ethionamide Gastro-intestinal: epigastric discomfo, anorexia, nausea, metallic taste, vomiting, excessive salivation, and sulfurous belching Psychiatric: hallucination and depression Hepatitis Hypothyroidism and goitre with prolonged administration Gynaecomastia, menstrual disturbances, impotence, acne, headache, and peripheral neuropathy Ref:

So the answer to this question is C


Instruction:
Laser used in the treatment of ureteric calculi is
A. Holmium
B. Nd-Yag
C. Argon
D. CO2

Response:
The Ho:YAG laser is a 2140-nm pulsed laser that is used for soft-tissue and lithotripsy applications in urology. The 2140-nm wavelength is strongly absorbed in water, traveling only about 0.5 mm in the fluid medium, making it ideal for the urologicenvironment. In the prostate, the absorption depth is about 0.4 mm resulting in a high-energy density that leads to the rapid vaporization of tissue. In the 1980s, lasers first became of interest to researchers and clinicians in urology, and at the present time a wide range of lasers are employed to treat various soft-tissue and stone conditions. Although the holmium:yttrium-aluminum-garnet (Ho:YAG) laser has become the accepted gold standard for the treatment of urinary calculi at this time, various wavelengths of lasers are employed to treat soft-tissue conditions such as stricture disease, benign prostatic hyperplasia (BPH), urothelial cell cancer, and genital skin lesions ref : Campbell - Walsh urology 11th edition , chapter 11 , pg no :- 228

So the answer to this question is A


Instruction:
Tube testing is done under :
A. Ketamine
B. General anesthesia
C. No anesthesia
D. Local anesthesia

Response:
No anesthesia

So the answer to this question is C


Instruction:
BNP is regarded by
A. Neutral endopeptidases
B. Elastase
C. Omapatrilat
D. ACE

Response:
Inhibition of the neutral endopeptidase (NEPinh) had been investigated as a potential novel therapeutic approach because of its ability to increase the plasma concentrations of the natriuretic peptides (NPs). Indeed, the NPs have potent natriuretic and vasodilator propeies, inhibit the activity of the renin-angiotensin-aldosterone system, lower sympathetic drive, and have antiproliferative and antihyperophic effects Refer katzung 11e p303

So the answer to this question is A


Instruction:
A young patient presents with a massive injury to proximal duodenum, head of pancreas and distal common bile duct. The procedure of choice in this patient should be
A. Roux-en-Y anastonmosis
B. Pancreaticoduodenectomy (Whipple's operation)
C. Lateral tube jejunostomy
D. Retrograde jejunostomy

Response:
.whipple&;s operation is done by removing (tumor with) head and neck of pancreas , c loop of duodenum, 40% distal stomach, 10cm proximal jejenum, lower end of common bile duct,gall bladder, peripancreatic,pericholedochal, paraduodenal and perihepatic nodes. continuity is maintained by choledochojejunostomy, pancreaticojejunostomy, and gastrojejunostomy. few advocate pancreaticogastrostomy into posterior wall of stomach. moality in whipple&;s operation is 2-8% (Ref: SRB&;s Manual of Surgery, 5th edition, pg no. 706)

So the answer to this question is B


Instruction:
Fine needle aspiration cytology is used as a diagnostic modality in all the following thyroid malignancies except:
A. Papillary Ca
B. FollicularCa
C. Anaplastic Ca
D. Medullary Ca

Response:
Ans: B (FollicularCa) Ref: Bailey B Love's Short Practice of Surgery, 25th Edition 792 Sabiston Textbook of Surgery, 19th Edition 909Explanation:The distinction between a follicular carcinoma and an adenoma can only be made by histological examinationInvasion of the capsule or of pericapsular blood vessels is necessary to diagnose Carcinoma which can be demonstrated only by histopathology.Intraoperative frozen section is not usefulFOLLICULAR CANCERSecond most common thyroid malignancy (most common-Papillary)Cinical Features40-60 yearsFemale:Male=3:lMost commonly presents as asymptomatic thyroid noduleCan be associated with Multinodular Goitre in 10%Diagnosis: Only on Histopathological examinationManagementBased on size of the lesion*<2cm - Hemithyroidectomy followed by Histopathological examination.If HPE showsAdenoma - No further treatment Carcinoma - proceed with Total Thyroidectomy>2cm- Total thyroidectomyThyroid OperationsAll thyroid operations can be assembled from three basic elements:Total lobectomyIsthmusectomySubtotal lobectomyTotal thyroidectomy = 2xtotal lobectomy + isthmusectomySubtotal thyroidectomy = 2xsubtotal lobectomy + isthmusectomyNear-total thryroidectomv = total lobectomy +isthmusectomy + subtotalLobectomyLobectomy = total lobectomy + isthmusectomy

So the answer to this question is B


Instruction:
What is the root value of the posterior cutaneous nerve of the thigh?
A. S1, S2
B. S1, S2, S3
C. S2, S3
D. S2, S3, S4

Response:
Posterior cutaneous nerve of thigh- S1,2,3

So the answer to this question is B


Instruction:
An elderly male presents with history of dysphagia, regurgitation, foul breath, hoarseness and cough. Right sided lung crepts are noted on examination. The most likely diagnosis is:
A. Schatzki ring
B. Zenker's diverticulum
C. Corkscrew esophagus
D. Plummer-Vinson syndrome

Response:
(b) Zenker's diverticulum(Ref. Scott Brown, 8th ed., Vol 3; 812)The given clinical presentation, where dysphagia is mentioned along with regurgitation (hoarseness, cough, lung crepts) is consistent with an oropharyngeal cause, i.e. Zenker's diverticulum. Here the collected food in the diverticulum leads to foul breath.Schatzki ring and Corkscrew oesophagus can also lead to dysphagia but they being distal oesophageal conditions are characterised by associated symptoms like retrosternal chest pain and heart burn. In these oesophageal pathologies the chances of regurgitation are far less.Schatzki ring is a narrowing of the lower part of the esophagus that can cause intermittent dysphagia especially during hurried ingestion of solid food.Corkscrew esophagus also known as nutcracker esophagus, is a spastic motility disorder in which uncoordinated contractions of the esophagus occur because of which food cannot be effectively propelled to the stomach.Plummer-Vinson syndrome (PVS), also called Paterson-Brown-Kelly syndrome, however is a proximal oesophageal condition and presents as a triad of postcricoid dysphagia, upper esophageal web and iron deficiency anemia. Regurgitation can occur due to the proximal location of oesophageal web. However, it usually occurs in postmenopausal women.

So the answer to this question is B


Instruction:
Hemolytic anemia may be characterized by all of the following except -
A. Hyperbilirubinemia
B. Reticulocytosis
C. Hemoglobinuria
D. Increased plasma haptoglobin level

Response:
None

So the answer to this question is D


Instruction:
What is the IOC for bronchiectasis?
A. HRCT scan
B. Spiral CT
C. Bronchoscopy
D. Pulmonary angiography

Response:
The best test to evaluate the destruction and dilatation of large airways which are filled with pus in bronchiectasis is HRCT. Spiral CT is preferred for pulmonary embolism. Pulmonary angiography is done for lung sequestration and is the gold standard for pulmonary embolism.

So the answer to this question is A


Instruction:
Drugs used in the treatment of schizophrenia have in common their ability to?
A. Block a-adrenergic receptors in the locus ceruleus
B. Block dopamine receptors in the brain
C. Sensitize the dopamine receptors in the locus ceruleus
D. Increase functional levels of norepinephrine in the synapses

Response:
All antipsychotic agents except rauwolfia alkaloids block dopamine receptors in the brain. Locus coeruleus is the site of most noradrenergic neurons in the brain. The dopaminergic neurons in the brain are primarily found in three areas ;the basal ganglia (nigrostriatal tract), the midbrain (mesolimbic tract), and the hypothalamus. Ref: Nurnberger, Jr. J.I. (2008). Chapter 3. Psychiatric Genetics. In M.H. Ebe, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e.

So the answer to this question is B


Instruction:
A 7 year old boy with abrupt onset of pain in hip with hip held in abduction. Hemogram is normal. ESR is raised. What is the next line of management?
A. Hospitalize and observe
B. Ambulatory observation
C. Intravenous antibiotics
D. USG guided aspiration of hip

Response:
Synol fluid analysis allows most effusions to be classified as normal, inflammatory, non- inflammatory, infectious, or hemorrhagic. Each type of effusion suggests ceain joint diseases. So-called non-inflammatory effusions are actually mildly inflammatory but tend to suggest diseases with less inflammatory mechanisms. If infection is suspected, a poion of the synol fluid sample should be sent to the laboratory for Gram stain and culture. Synol fluid analysis provides a definitive diagnosis for infections and crystal ahropathies that rarely affect hip joints. Ref: Gurkan I., Mears S. (2007). Chapter 11. The Patient with Hip Pain. In J.B. Imboden, D.B. Hellmann, J.H. Stone (Eds), CURRENT Rheumatology Diagnosis & Treatment, 2e.

So the answer to this question is D


Instruction:
Pro inflammatory Cytokines include all of the following except -
A. Interleukin 1
B. Interleukin-10
C. Interleukin6
D. TNF-Alpha

Response:
Ans. is 'b' i.e., Interleukin-10 o Cytokines are involved in immunological reaction, but some cytokines may also take part in inflammation.o They may be: -1. Proinflammatorv cytokineso Involved in amplification of inflammation and tissue destruction.o IL-1 & TNF-a are the two most important proinflammatorv cytokines. IL-6 may also act as proinflammatorv cytokine.o Other proinflammatory cytokines are IL-2, IL-4, IL-5, IL-6, IL-8, IL-I1, IL-12, IL-15, IL-21, IL-23, IFN- gamma and granulocyte- macrophage- colony stimulatinhg factor (GM-CSF). ( Source Fundamental immunology by William E. Paul).2 Antinflammatory cytokineso Reduce inflammation and produce healing,o Example are IL-4, IL-13, IL-1L-10

So the answer to this question is B


Instruction:
A diabetic patient 2 days after post cataract surgery develops develops hypopyon. What will be the management?
A. Intravitreal antibiotics
B. Eye drops
C. Surgery
D. No treatment required

Response:
REF : AK KHURANA 7TH ED

So the answer to this question is A


Instruction:
Ortolani's test is done in:
A. CDH
B. Perthes disease
C. Posterior dislocation of hip
D. Septic arthritis

Response:
Ans: a (CDH) Ref: Maheswari, 3rd ed, p. 201Special tests designed for early detection of CDH are1) Barlow test2) Ortolani testBarlow test: Consists of 2 parts1st part: Hip & knee flexed & thighs gently adducted.Feel for abnormal posterior movement & sometimes dislocation with a distinct 'clink' of femoral head.2nd part: Thighs are gently abducted. If the hip was dislocated earlier, a distinct clink will be heard & felt indicating reduction of dislocated hip.Ortolani's test:Similar to 2nd part of Barlow's test.Hip & knee flexed and thighs gently abducted.A click of entrance will be felt as the femoral head slips back into the acetabulum from the position of dislocation.Few commonly asked named tests & signs: Alli'stest-CDH Barlow's test-CDH Ortolani's test-CDH Gallezi'ssign-CDH Hamilton ruler test-Anterior dislocation of shoulder Bryant's test-Anterior dislocation of shoulder Callaway's test-Anterior dislocation of shoulder Duga'stest-Anterior dislocation of shoulder Apprehension test-For recurrent dislocation of shoulder Sulcus sign-For inferior dislocation of shoulder Cozen'ssign-Tennis elbow Miller's sign-Tennis elbow Finkelstein'stest-For Dequervains tenosynovitis Kanavel'ssign-Ulnar bursa infection.(AIIMS 2007) Knee: Pivot shift test-Anterior cruciate ligament (ACL) injuryAnterior drawer's test-ACL injuryLachmann's test-ACL injuryPosterior drawer's test-PCL injuryMe Murray's test-Meniscal injuryApley's grinding test-Meniscal injuryAdduction & abduction tests- Medial & lateral collateral ligaments.

So the answer to this question is A


Instruction:
What is the use of Asche's forceps?
A. Used for reduction of the nasal complex fractures
B. To reduce the tooth-bearing portion of the upper jaw
C. To elevate fractured zygomatic bone
D. All of the above

Response:
Walsham or Asche's forcep is used for the reduction of the nasal complex fractures.

So the answer to this question is A


Instruction:
Van herick&;s angle grade 3 of anterior chamber denotes
A. Wide open glaucoma
B. Moderately open glaucoma
C. Moderately narrow glaucoma
D. Closed angle

Response:
Van herick&;s method:*To evaluate the chamber depth of the right eye, turn the lamp so that the light is coming at the temporal limbus at an angle of 60 degrees. Change the slit to its most narrow setting, and direct the beam onto the cornea, just barely to the right of the limbus. *You should see three things: the beam of light sharply focused on the cornea in a thin slit, the light falling on the iris(unfocused), and a dark interval in between.* The dark interval is the area of interest, as it represents the chamber's depth. *If this shadow is one-quaer to one-half the width of the illuminated corneal section, the angle is open. If the dark section is less than one-quaer the width of the corneal beam, the chamber is narrow. If there is no dark interval (ie, the corneal and iris beams meet), the angle is extremely narrow or closed. The chamber is graded from 1 to 4 or labeled as closed, open, shallow, or moderate.FeaturesGradeClosed angle0Angle extremely narrow, probable closure1+Angle moderately narrow, possible closure2+Angle moderately open, closure not possible3+Angle wide open, closure not possible4+Ref: The slit lamp primer; 2nd edition; Pg. 41

So the answer to this question is B


Instruction:
In sickle cell anaemia, there is
A. 75 to 100% haemoglobin
B. 10 to 20% haemoglobin
C. 20 to 30% haemoglobin
D. 50 to 60% haemoglobin

Response:
None

So the answer to this question is A


Instruction:
Other name for transvestism is -
A. Onanism
B. Eonism
C. Scoptophilia
D. Satyriasis

Response:
Ans. is 'b' i.e., Eonism Necrophilia:* In this condition, there is a desire for sexual intercourse with dead bodies.* It is said to have sadomasochistic foundation and that decomposition, foul smell, and coldness act as stimulants.* Sexual perversions -These are persistently indulged sexual acts in which complete satisfaction is sought and obtained without sexual intercourse. These includea) Sadism: Sexual gratification is obtained or increased from acts of physical cruelty or infliction of pain on ones partner. It is seen more commonly in men. To obtain sexual gratification, the sadist may bite, beat, whip, produce cuts on the victim, etc.b) Lust murder: In extremes of sadism, murder serves as a stimulus for the sexual act and becomes the equivalent of coitus, the act being accompanied by erection, ejaculation, and orgasm.c) Necrophagia: (Necros =corpse; phagia = to eat): This is extreme degree of sadism in which the person after mutilating the body, sucks or licks the wounds, bites the skin, drinks blood, and eats the flesh of his victim to derive sexual pleasure.d) Masochism: Sexual gratification is obtained or increased by the suffering of pain. Masochists get pleasure from being beaten, abused, tortured, humiliated, enslaved, degraded, or dominated by their sexual partner.e) Necrophilia: In this condition, there is a desire for sexual intercourse with dead bodies. It is said to have sadomasochistic foundation and that decomposition, foul smell and coldness act as stimulants.f) Fetishism: A fetish is an abnormal stimulus or object of sexual desire. Fetishism means the use of such objects of sexual gratification leading to orgasm, eg underclothing, brassiere, petticoat, stocking, shoes, etc.g) Transvestism = Eonism: A transvestite (trans = opposite, vista = clothing) is a person whose whole personality is dominated by the desire of being identified with the opposite sex. His dress, manner, occupational interest, and associations are all designed to increase his feeling of being a woman. There is no hormonal disturbance or genital abnormality.h) Masturbation = Onanism = Ipsation is the deliberate self-stimulation that effects sexual arousal. In males, it is done by moving the penis against a bed or other object. In females, finges are gently and rhythmically moved over clitoris or labia minora or steady pressure is applied over these parts with several fingers or whole hands (it is an offence when done in public).i) Exhibitionism (Sec 294IPC): It is a willful and intentional exposure of the genitalia in a public place while in the presence of others to obtain sexual pleasure. May or may not be associated with masturbation (punishment = 3 months + fine).j) Voyeurism = Scoptophilia = Peeping tom: Sexual gratification is obtained by looking at the sexual organs of other persons, watching the act of sexual intercourse, or witnessing undressing by a woman.k) Frotteurism: Sexual satisfaction is obtained by rubbing against persons in crowd. If they attempt intercourse, they have a premature ejaculation or they are impotent. It is an uncommon perversion and rarely occurs alone.l) Undinism: In this, the sexual pleasure is often obtained by witnessing the act of urination by someone of the same or opposite sex.m) Indecent assault (Sec 354 IPC) is any offence committed on a female with the intention or knowledge to outrage her modesty. Usually, the act involves the sexual part of either or is sexually favored. In such assaults, a man may try to kiss a woman, press or fondle with her breasts, touch or expose the genitalia or thighs, try to put a finger in her vagina, play with vulva.# A medical practitioner can be accused of indecent assault if he examines a female patient by stripping her clothes without her consent or even with her consent in the absence of a female attendant.# Such assaults are punishable under Sec 354 IPC, upto 2 years imprisonment and/or fine.n) Uranism: General term for perversion of the sexual instinct.o) Satyriasis: Incessant sexual desire.p) Priapism: Painful penile erection in absence of sexual desire.

So the answer to this question is B


Instruction:
Duret's haemorrhage is seen in:
A. Retina
B. Ventricles
C. Midbrain and pons
D. None of the above

Response:
Duret hemorrhages are secondary herniation hemorrhages in the midbrain and pons ranging from small streaks to confluent hemorrhages. Ref: Reddy 23rd ed, page 208.

So the answer to this question is C


Instruction:
Poisoning which is illuminous, translucent and waxy?
A. Iodine
B. Ammonium bromide
C. Cobra venom
D. Yellow phosphorus

Response:
Features Yellow/white phosphorus Red phosphorus Colour and appearance White, waxy, crystalline translucent soft cylinders. On exposure to air becomes yellow Violet-red, amorphous mass Taste and odour Garlicky odour and taste Odourless and tasteless Luminosity in dark Luminous Not luminous Exposure to air Phosphorescence Not Phosphorescence Toxicity Highly toxic Non-toxic REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO312

So the answer to this question is D


Instruction:
Which one of the following cooking oils contains highest percentage of linoleic acid ?
A. Safflower oil
B. Sunflower oil
C. Corn oil
D. Groundnut oil

Response:
None

So the answer to this question is A


Instruction:
The commonest benign intramural tumor of the esophagus is -
A. Fibroma
B. Leiomyoma
C. Angioma
D. Lipoma

Response:
Leiomyoma is the most common benign neoplasma of esophagus and accounts for two-third of all the benign neoplasms.
They usually arise as intramural growth, most commonly along the distal two-third of the esophagus.

So the answer to this question is B


Instruction:
Two important byproducts of HMP shunt are
A. NADH and pentose sugars
B. NADPH and pentose sugars
C. Pentose sugars and 4 membered sugars
D. Pentose sugars and sedoheptulose

Response:
The HMP shunt pathway has oxidative and non-oxidative phases. During the oxidative phase, glucose-6-phosphate is oxidized with the generation of 2 molecules of NADPH, and one molecule of pentose phosphate, with the liberation of one molecule of CO2. During the non-oxidative phase, the pentose phosphates are converted to intermediates of glycolysis.

So the answer to this question is B


Instruction:
Which of the following is associated with PAS positive Macrophages
A. Whipple's disease
B. Tropical sprue
C. Celiac disease
D. Crohn's Disease

Response:
The hallmark of Whipple&;s disease is the histopathological finding of macrophages that are positive on periodic acid-Schiff (PAS) staining. The main histological features are extensive PAS-positive material in the lamina propria, and villous atrophy. Characteristic Histopathological finding in Whipple&;s DIsease Infiltration of Lamina Propria with PAS-positive macrophages that are resistant to Diastase (Granular foamy macrophages stained purple with PAS) Inclusions of T.whipplei bacilli or its paly digested remnants may be observed. T.whipplei is a gram-positive, non-acid-fast periodic acid-Schiff (PAS)-positive bacillus with a characteristic trilamellar plasma membrane surrounded by a cell wall. Bacilli with a characteristic trilamellar membrane/wall is specific for Whipple&;s disease The disease of the T.whipplei bacillus outside of macrophages is a more impoant indicator of active disease than is their presence within the macrophages. Whipple&;s Disease Tropical Sprue Coeliac Disease Malasorption syndrome with systemic features with infections etiology Malabsorption syndrome of infection etiology without systemic features Malabsorption syndrome of non-infectious etiology without systemic features Etiology Etiology Etiology Tropheryma whippelii is a small gram-positive bacillus in the group Actinobacteria Caused by some strains of E.coli Caused by intolerance to &;gliadin&; gluten a protein found in wheat rye, barley Biopsy Biopsy Biopsy Biopsy is Abnormal and specific/diagnostic Lamina Propria is infiltrated with macrophages containing PAS positive glycoproteins and rod shaped bacilli Villous Atrophy Biopsy is abnormal but not specific/diagnostic Shoened, thickened villi increased crypt depth infiltration by mononuclear cells Biopsy is abnormal but not specific/diagnostic Blunting and flattening surface with villi either absent or broad and sho crypts are elongated. Dense infiltration of inflammatory cells in lamina propria Clinical features Clinical features Clinical features Features of malabsorption + Array of systemic features Features of malabsorption Features of malabsorption Management Management Management Etiology is infectious so treatment is with Antibiotics Trimethoprim + Sulfamethoxazole Etiology is infectious so treatment is with antibiotics (Sulphonamide/Tetracycline) Etiology is not infectious but immune Gluten free diet (no antibiotics) + Glucocoicoids or immunosuppressive agents Ref: Harsh Mohan 7th edition Pgno: 559

So the answer to this question is A


Instruction:
Dose and duration of benzathine penicillin G for prophylaxis of rheumatic fever is:-
A. 1.2 MU every 2 weeks
B. 1.2 MU every 4 weeks
C. 2.4 MU every 2 weeks
D. 2.4 MU every 4 weeks

Response:
Drug of choice for secondary prophylaxis of rheumatic fever (RF) is Benzathine penicillin G. It is given intramuscular every 4 weeks. Duration of prophylaxis Category Duration of prophylaxis RF without carditis For 5 years after the last episode or till 21 years of age (whichever is longer) RF with carditis but without valvular disease For 10 years after the last episode or till 21 years of age (whichever is longer) RF with valvular disease For 10 years after the last episode or till 40 years of age (whichever is longer); sometimes life-long

So the answer to this question is B


Instruction:
All of the following are true for metoclopramide except?
A. Chemically related to procainamide
B. Speeds gastric emptying
C. Stimulates chemoreceptor trigger zone
D. Blocks D2 receptors

Response:
Ans. is 'c' i.e., Stimulates chemoreceptor trigger zone Metoclopromide suppresses chemoreceptor trigger zone (CTZ) --> has antiemetic action.

So the answer to this question is C


Instruction:
A newborn girl presents with severe Purpura Fulminans. Family has history of 1 year old male died of severe purpura fulminans. Other 2 siblings are normal. What is the diagnosis?
A. Hemophilia A
B. Protein C deficiency
C. ITP
D. vWD

Response:
Purpura fulminans: Coagulation of the microvasculature, which leads to purpuric lesions and skin necrosis. =3 types: NEONATAL: Hereditary deficiency of protein C, protein S and antithrombin III IDIOPATHIC: Post infectious autoimmune disorder ACUTE INFECTIOUS: most common type- manifests as a skin finding in the most severe septic patients as well as in necrotizing fascitis SINCE the neonate has severe purpura fulminans and family history- answer is protein C deficiency.

So the answer to this question is B


Instruction:
On endoscopy there is Serpiginous Ulcers in Distal Esophagus with otherwise normal mucosa seen- Diagnosis is
A. Herpes Simplex
B. Candidiasis
C. Pill induced
D. CMV

Response:
CMV Esophagitis: - * Seen in Graft versus host disease following BM transplantation. * Endosocopy shows characteristic - Geographical or Serpentine border. Ref:- Bailey and Love 27th Edition; Pg num:- 1104

So the answer to this question is D


Instruction:
Ehlers-Danlos syndrome can be caused by a problem with the metabolism of which particular compound.
A. Glycogen
B. Collagen
C. Dopamine
D. Valine

Response:
Synthesis of collagena. The polypeptide chains of preprocollagen are synthesized on the rough endoplasmic reticulum, and the signal (pre) sequence is cleaved.b. Proline and lysine residues are hydroxylated by a reaction that requires O2 and vitamin C.c. Galactose and glucose are added to hydroxylysine residues.d. The triple helix forms, and procollagen is secreted from the cell and cleaved to form collagen.e. Cross-links are produced. The side chains of lysine and hydroxylysine residues are oxidized to form aldehydes, which can undergo aldol condensation or form Schiff bases with the amino groups of lysine residues.A defect in the synthesis or processing of collagen will lead to a variety of diseases, of which Ehlers-Danlos syndrome is one (osteogenesis imperfecta is another). Parkinson disease is caused by low levels of dopamine in the nervous system. In the initial stages of Parkinson disease, giving dihydroxyphenylalanine (DOPA) can reduce the severity of the symptoms because DOPA can be decarboxylated to form dopamine. DOPA can easily enter the brain, whereas dopamine cannot. Tay-Sachs disease results from an inability to degrade GM2, a ganglioside (it is also a sphingolipid). The enzyme missing is b-hexosaminidase. McArdle disease is caused by a defective muscle glycogen phosphorylase, such that the muscle cannot generate glucose from glycogen, leading to exercise intolerance. Maple syrup urine disease is caused by the lack of branched-chain a-keto acid dehydrogenase activity, a necessary step in the metabolism of the branched-chain amino acids (leucine, isoleucine, and valine).

So the answer to this question is B


Instruction:
True regarding secondary prophylaxis of a 6 year old child with carditis is: March 2005
A. Duration of prophylaxis is life long
B. Duration of prophylaxis is till 18 years
C. Duration of prophylaxis is at least 5 years after onset
D. Duration of prophylaxis is till 25 years of age

Response:
Ans. D: Duration of prophylaxis is till 25 years of age The duration of prophylaxis differs from case to case. In patient without proven carditis: This drug prophylaxis may be given till the child reaches 18 years of age, or for five years after the last attack of RF /RHD (whichever is longer). In patient with proven carditis: This drug prophylaxis may be given till the child reaches 25 years of age, or for ten years after the last attack of RF /RHD (whichever is longer). Drug prophylaxis may be required almost forever/lifelong, especially in cases which exhibit permanent signs of valvular /rheumatic hea disease or after valvular surgery. These damaged valves need foolproof protection against infection, and due to this reason, drug prophylaxis is given continuously.

So the answer to this question is D


Instruction:
NMR is based on the principle of
A. Electron beam
B. Proton beam
C. Neutron beam
D. Magnetic field

Response:
The phenomenon of 'nuclear induction', later to be termed 'nuclear magnetic resonance' (NMR), was described by Bloch and Purcell and their colleagues in 1946. NMR has been used extensively for studying the propeies of matter at the molecular level (NMR spectroscopy). In applications to medicine, the term 'nuclear' has been dropped, leaving it as magnetic resonance or MR(Ref: Grainger&;s diagnostic radiology, 6th ed; page 90)

So the answer to this question is D


Instruction:
On biopsy, a characteristic finding of malignant mesothelioma is -
A. Myelin
B. Desmosine
C. Weibel-palade bodies
D. Branching microvilli

Response:
Most malignant mesothelioma (50% to 60%) are of the epithelial type, approximately 10% are sarcomatoid and the rest are biphasic malignant mesotheliomas.
The diagnosis of malignant mesothelioma should be confirmed by immunohistochemistry, which shows that the tumor cells are diffusely positive for pankeratin, keratin 5/6, calretinin and WT1, and negative for the epithelial markers CEA, CD15, Ber-EP4, Moc-31, TTF- 1, B72.3 and so forth.
For epithelial mesotheliomas, positive staining for pankeratin and calretinin and negative staining for three epithelial markers are considered sufficient for diagnosis. Occasionally, however, more stainings are required, because some carcinomas are positive for calretinin or are negative for some of the epithelial markers.
In these difficult cases, electron microscopy showing the classic long-branching microvilli of human mesothelial cells compared to the short nonbranching microvilli of carcinomas can still be considered the gold standard for correct diagnosis.

So the answer to this question is D


Instruction:
A dense renogram is obtained by:
A. Dehydrating the patient
B. Increasing the dose of contrast media
C. Rapid (Bolus) injection of dye
D. Using non ionic media

Response:
In a normally functioning kidney, rapid injection of the dye gives an uniform dense nephrogram because of appearance of contrast material in the proximal tubule and peritubular capillaries within 30seconds of injection and approximately 2 minutes later contrast agent begin to appear in the calyces. Ref: Diseases of The Kidney and Urinary Tract By Robe W. Schrier, Page 338, 706

So the answer to this question is C


Instruction:
Alkalinization of urine ameliorates the toxicity of which of the following drugs
A. Arabinoside -cytosine
B. Ifosfamide
C. Cisplatin
D. Methotrexate

Response:
refer Goodman Gilman 12/e p85 Alkalinization of urine speeds the clearance of weakly acidic drugs like. Aspirin Phenobarbitone Chlotpropapamide Methotrexate

So the answer to this question is D


Instruction:
Principal cell of epidermis:
A. Melanocytes
B. Langerhan cell
C. Keratinocytes
D. Merkel cell

Response:
Ans. (c) KeratinocytesRef : Fitzpatrick 7th ed. /100CELLS OF EPIDERMIS* Keratinocytes: These are considered as the principal cells of epidermis. They proliferate in basal layer and differentiation occurs in spinosum and granulosum layer which further matures fully and dies in corneum. (keratinocytes are present in all 4 layers of epidermis)* Melanocytes and Merkel cell: Present in stratum basale.# Melanocytes synthesize melanin pigment and transfer to keratinocytes# Merkel cells for touch sensation. Aka touch cells* Langerhan cell found in stratum spinosum and act as antigen presenting cells (macrophages).# They contain tennis racquet shaped granules aka Bierbeck granules

So the answer to this question is C


Instruction:
In vitamin A deficiency all are seen except:
A. Nyctalopia
B. Follicular hyperkeratosis
C. Osteomalacia
D. Growth retardation

Response:
Ans: c (Osteomalacia) Ref: Park, 19th ed,p. 485-486Signs of vit Adeficiencies are predominantly ocular.They include night blindness (nyctalopia), conjunctival xerosis, Bitot's spots, comeal xerosis and keratomalacia.Extraocular manifestations comprises of follicular hyperkeratosis, anorexia and growth retardation.Osteomalacia is due to defecincy of vit D.

So the answer to this question is C


Instruction:
In the development of balanced occlusion of a complete denture, during tooth arrangement, a steep condylar path is associated with a low degree of incisel guidance, this requires that the compensating curve should be;
A. Flat
B. Shallow
C. Prominent
D. Reverse

Response:
None

So the answer to this question is C


Instruction:
Sympathetic stimulation has following effect on insulin release
A. Stimulation
B. Inhibition
C. Inhibition followed by stimulation
D. No effect

Response:
Sympathetic stimulation decreases the release of insulin Ref: guyton and hall textbook of medical physiology 12 edition page number:610,611,612

So the answer to this question is B


Instruction:
Prophylactic chemotherapy in hydatidiform mole should preferably be given:
A. Prior to evacuation as a routine
B. Following evacuation as a routine
C. Selected cases following evacuation
D. As a routine 6 weeks postevacuation

Response:
ptophylatic chemotherapy is not reconmended .Hence,it is advisable to follow uo the cases of molar pregnancy with serum beta hcg and institute chdmothetapy only in selected cases. Refer page no 171 of Text book of obstetrics,sheila balakrishnan,2 nd edition.

So the answer to this question is C


Instruction:
Which one of the following sensation appears first on recovery for local anesthesia?
A. Temperature
B. Muscle tone
C. Proprioception
D. Pain

Response:
Answer: c) ProprioceptionProprioception is the first sensation to recover from anesthesia.It is followed by muscle tone, pain, touch, and temperature.The order of sensitivity is of nerve fibers to anesthetic is:Type B and C > type A d > type Ab and Ag > type AaThinner and myelinated fibers have greater firing range and are the first nerve fibers to be affected during anesthesia.

So the answer to this question is C


Instruction:
Pleural effusion in rheumatoid ahritis is typically associated with the following features except
A. Glucose > 60 mg/dl
B. Protein > 3 gm/di
C. Pleural fluid protien to serum protein ratio of >0 .5
D. Pleural fluid LDH to serum LDH ratio of >0.6

Response:
Ans. is 'a' i.e., Glucose > 60 mg/dl Causes of low glucose pleural fluid Malignancy Rheumatoid ahritis Empyema Hemothorax Paragonimiasis Churg strauss syndrome Lupus pleuritis (occasionally)

So the answer to this question is A


Instruction:
Which is not true about PBC
A. No increase in risk of HCC
B. Often asymptomatic
C. Elevated IgM
D. Positive anti-mitochondrial antibody

Response:
Patients with PBC have an increased risk of hepatocellular carcinoma compared to the general population, as is found in other cirrhotic patients. In patients with advanced disease, one series found an incidence of 20 percent in men and 4 percent in women Complications of PBC can be related to chronic cholestasis or cirrhosis of the liver. Chronic cholestasis leads to osteopenic bone disease and osteoporosis, alongside hyperlipidaemia and vitamin deficiencies. Ref : Internet sources (wiki)

So the answer to this question is A


Instruction:
True about lymphangiomaa) It is a malignant tumourb) It is a congenital sequestration of lymphaticc) Cystic hygroma is a lymphangiomad) Laser excision is donee) Sclerotherapy is commonly done
A. bcd
B. bc
C. abc
D. ab

Response:
. Lymphangioma are localized cluster of dilated lymphatic channels similar to hemangiomas of blood vessels. They are of 2 types Simple or capillary lymphangioma Cavernous lymphangioma or cystic hygroma They are thought to represent isolated and sequestered segments of the lymphatic system that retain the ability to produce lymph. As the volume of lymph inside the cystic tumor increases, they grow larger within the surrounding tissues. The majority of these benign tumors are present at bih, and 90% of them can be identified by the end of the first year of life. The cavernous lymphangiomas (or cystic hygromas almost invariably occur in the neck or the axilla and very rarely in the retroperitoneum. The simple capillary lymphangiomas also tend to occur subcutaneously in the head and neck region as well as the axilla. Rarely, however, they can be found in the trunk within the internal organs or the connective tissue in and about the abdominal or thoracic cavities. The treatment of lymphangiomas should be surgical excision, taking care to preserve all normal surrounding infiltrated structures.

So the answer to this question is B


Instruction:
Commonest tumour among children 1-5 years inSouth Africa is -
A. Neuroblastoma
B. Wilm's tumour
C. Neurofibroma
D. Burkitts lymphoma

Response:
Ans. is 'd' i.e., Burkitts lymphoma

So the answer to this question is D


Instruction:
Fatal period in sulphuric acid poisoning is -
A. 2-4 hours
B. 6-10 hours
C. 12-16 hours
D. 8-14 hours

Response:
For H2SO4, fatal period is 12-24 hours and fatal dose is 10-15 ml.

So the answer to this question is C


Instruction:
A pediatrician discovers a large mass in the abdomen of a 3 year old child. Ultrasound examination demonstrates that the mass appears to arise from the right kidney. Which of the following tumours is most likely present?
A. Coical adenoma
B. Hemangioma
C. Nephroblastoma
D. Oncocytoma

Response:
Nephroblastoma (Wilms tumor) characteristically affects children between 2 and 4 years of age and can form large spherical masses composed of variegated tissues including primitive renal epithelial elements, a sarcomatous-appearing stroma, aboive glomeruli and tubules, and heterologous tissues such as muscle, cailage, fat, and bone. Coical adenoma is a small (under 2 cm) benign tumor that is usually found incidentally at autopsy. Hemangiomas can occur in the kidney, but would not usually produce a large mass. Oncocytomas are benign tumors that can be large but do not usually affect young children. Ref: Graham D.K., Quinones R.R., Keating A.K., Maloney K., Foreman N.K., Giller R.H., Greffe B.S. (2012). Chapter 31. Neoplastic Disease. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.

So the answer to this question is C


Instruction:
All of the following are features of Argyll Robeson pupil, EXCEPT:
A. There is no reaction to light
B. Accommodation reflex is intact
C. Pupils dilate very poorly to mydriatics
D. Vision of the affected eye is diminished

Response:
Argyll Robeson pupil occur in neurosyphilis and is characterised by a lesion in the tectum. The lesion is in the region of the syln aqueduct when the fibers from the pretectal nucleus go to the Edinger Westphal nucleus. In this condition the vision of the affected eye is normal. Features: Vision of the affected eye is normal There is no reaction to light Accommodation reflex is intact because the fibers that mediate the pupillary near response lie ventral to the internuncial neurons that enter the Edinger Westphal nucleus. The pupils are miotic and irregular The pupils dilate very poorly with mydriatics Ref: Textbook of Ophthalmology edited by Sunita Agarwal PAGE 305.

So the answer to this question is D


Instruction:
Which of the following metabolic abnormality is seen in multiple myeloma -
A. Hyponatremia
B. Hypokalemia
C. Hypercalcemia
D. Hyperphosphatemia

Response:
Ans: C

So the answer to this question is C


Instruction:
A 60 year old male gives history of cataract surgery 1 year back. He now complaints of diminished vision and on slitlamp examination the following finding are seen. What is the most likely cause of his loss of vision?
A. Irvin gass syndrome
B. After cataract
C. UGH syndrome
D. Endophthalmitis

Response:
Ans. (b) After cataractRef: Kanski 7/e, p. 295-296In the image a PCIOL (behind the iris margin) can be seen and posterior to the PCIOL a fibrous opacification is seen, which can be inferred to be opacification of the posterior capsule of lens.Option a - Irvin Gass syndrome usually occurs 6-10 weeks after surgeryOption b - After cataract (posterior capsule opacification) is the most common late complication of uncomplicated cataract surgery. Presents with reducing visual acuity, contrast sensitivity impairment, glare and mono-ocular diplopia Option c - UGH syndrome occurs due to ACIOL (commonly)Option d - Endophthalmitis presents with Hypopyon, Vitreous inflammation, Circumcorneal congestion etc.

So the answer to this question is B


Instruction:
What is the use of the instrument shown here?
A. To catch bleeding artery
B. Occlude bowel
C. Vascular clamp
D. Clip the towel

Response:
Ans. (d) Clip the towel* Towel clips are used to hold the sterile dressing after drape in position* Some surgeons use this to hold and retract the tongue outside for intra oral surgeries.

So the answer to this question is D


Instruction:
Compound nevi with dysplasia is:
A. Clarks nevi.
B. Spitz nevi.
C. Blue nevi.
D. None.

Response:
None

So the answer to this question is A


Instruction:
Which of the following does not suggest postoperative infection?
A. Increase in temperature
B. Swelling
C. Pain
D. Pitting edema

Response:
None

So the answer to this question is D


Instruction:
True about nucleosome: (PGI Nov 2009)
A. Use only one type of histone protein
B. Each complex is separated from each other by non histone proteins
C. Regular repeating structure of DNA & histone proteins
D. Reflect small nucleus

Response:
Ans: C (Regular repeating structure of DNA & histone proteins) Chromatin is the chromosomal material in the nuclei of cells of eukaryotic organisms:ChromatinQ consists of very long double-stranded DNAQ molecules and a nearly equal mass of rather small basic proteins termed histonesQ as well as a smaller amount of nonhistone proteins (most of which are acidic and larger than histones and a small quantity of RNA.The non histone proteins include enzymes involved in DNA replication and repair, and the proteins involved in RNA synthesis, processing, and transport to the cytoplasm. Histones, is to condense the DNA; however it is important to note that the histones also integrally participate in gene regulation.NucleosomeThe core is composed of two molecules each of histonesQ (H2A, H2B, H3, and H4).Each core with two turns of DNA double helix wrapped around it (approx 150 bp) is termed as nucleosomeQ, the basic unit of chromatin.Electron microscopic studies of chromatin have demonstrated dense spherical particles called nudeosomes, the basic unit of chromatinNucleosomes are separated by linker DNA7 to which h istone; HI is attachedThe continuous string of nucleosome represent beads-on-a - string form of chromatin* "Histones are highly conserved and can he grouped into five major classes: H1/H5. H2A. H2B. H3, and H4". These are organized into two super-classes as follows:core histones - H2A, H2B, H3 and H4linker histones HI and H5# The linker histone H1 binds the nucleosome and the entry 1 and exit sites of the DNA, thus locking the DNA into place I and allowing the formation of higher order structure.Function of histone: to condense DNA7 & to participate in gene regulationQ (Harper 28th/312)

So the answer to this question is C


Instruction:
Mangled Extremity Severity Score (MESS) includes all of the following except?
A. Shock
B. Ischemia
C. Neurogenic injury
D. Energy of injury

Response:
The Mangled Extremity Severity score(MESS) is useful in deciding about limb salvage. It includes Skeletal and soft tissue injuries categorised as :high energy, moderate energy and low energy. Shock Ischemia Age Mnemonic SASI Reference: Bailey and love, 27th edition page 416

So the answer to this question is C


Instruction:
A 30-year-old female presented with stridor following upper respiratory infection. I/L shows glottic gap is 3 mm. It can be managed by the following except:
A. Tracheostomy
B. Type II thyroplasty
C. Type I thyroplasty
D. Cordectomy

Response:
(c) Type I thyroplasty(Ref. Current Diagnosis & Treatment Otolaryngology, Lalwani, 3rd ed., 478)Stridor means B/L RLN palsy. Glottic gap being 3mm so VC are in paramedian position. So the management is tracheostomy followed by lateralisation of the VC by type II thyroplasty or Cordectomy. Type I thyroplasty means doing medialisation of VC which will aggravate the condition.

So the answer to this question is C


Instruction:
Battle's sign is
A. Periorbital ecchymosis
B. Ecchymosis around mastoid area
C. Facial congestion and cyanosis
D. Pulsatile ear discharge

Response:
(B) Ecchymosis around mastoid area # Battle's sign, or mastoid ecchymosis, is an indication of fracture of posterior cranial fossa of the skull, and may suggest underlying brain trauma.> Battle's sign (named after William Henry Battle) consists of bruising over the mastoid process, as a result of extravasation of blood along the path of the posterior auricular artery.> Note well that this sign will take at least one day to appear after the initial traumatic basilar skull fracture, similar to Raccoon eyes.> It is usually seen after head injuries resulting in injury to mastoid process leading to bruising.> Battle's sign may be confused with a spreading hematoma from a fracture of the mandibular condyle (less serious injury).

So the answer to this question is B


Instruction:
Which of the following statement about VHL syndrome is true?
A. Multiple tumors are rarely seen
B. Craniospinal hemangioblastoma are common
C. Supratentorial tumors are common
D. Tumors of Schwann cells are common

Response:
Ans. (b) Craniospinal hemangioblastoma are commonRef: Sabiston 19th edition page 708Von Hippel Lindau Syndrome:* Autosomal dominant* Multiple vascular tumors in many organs* Hemangioblastomas of Retina and CNS* Renal cysts, Cysts in Epididymis, Liver and Pancreas* Clear cell RCC* Pheochromocytoma* Pancreatic endocrine tumors* Adrenal cancers* Polycythemia is a characteristic feature of VHL due to erythropoietin production by hemangioblastoma

So the answer to this question is B


Instruction:
Function of inhibin:
A. Inhibin A/B is useful tumor marker for Sertoli-Leydig tumors.
B. Inhibin-B Produces positive feedback for FSH
C. Inhibin-A decreases in trisomy 21 (Down syndrome)
D. Inhibin-A decreases in trisomy 18 (Edwards syndrome)

Response:
Ans. d. Inhibin-A decreases in trisomy 18 (Edwards syndrome)Inhibin A/B is useful tumor marker for Granulosa cell tumors.FSH binds to Sertoli cells and activates a Gs --cAMPpathway. Sertoli cellsRelease inhibin B, which has negative feedback on FSH secretion.Trisomy 21 with down syndrome, levels for MS-AFP and estriol are decreased, but hCG and inhibin-A are, increased. Perform an amniocentesis for karyotype.Trisomy 18 With Edward syndrome, levels for all 4 markers (MS-AFP, estriol, inhibin-A, and hCG) are decreased. Perform an amniocentesis for karyotype.

So the answer to this question is D


Instruction:
Which of the following features suggesting malignant lesion on mammography?
A. Round well defined borders
B. Macrocalcifications
C. Microcalcifications
D. Fat content

Response:
Microcalcifications are suggestive of a malignant lesion. Macrocalcification/ Popcorn calcifications are fibroadenomas which are benign lesions The pattern and shape of microcalcifications can also give radiologists clues about whether cancer may be present. Linear, rod-like calcifications raise suspicion of underlying breast cancer, whereas popcorn, eggshell, and rim-like calcifications are usually benign.

So the answer to this question is C


Instruction:
Gingival enlargement is a side effect of
A. Phenytoin
B. Calcium channel blockers
C. Acute myelocytic leukemia
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
Obesity is associated with decreased risk of
A. Hypeension
B. Hyperuricemia
C. Osteoporosis
D. Hea disease

Response:
Answer- C. Osteoporosis

So the answer to this question is C


Instruction:
Arrange Mapelson circuit for spontaneous ventilation in an adult from best to worst
A. D>B>C>A
B. A>C>B>D
C. A>D>C>B
D. B>C>D>A

Response:
During spontaneous ventilation, alveolar gas containing Co2 will be exhaled into the breathing tube or directly vented through an open APL valve. Before inhalation occurs, if the fresh gas flow exceeds alveolar minute ventilation, the in flow of fresh gas will force the alveolar gas remaining in the breathing tube to exit from the APL valve. Because a fresh gas flow equal to minute ventilation is sufficient to prevent rebreathing, the Mapelson a design is the most efficient for spontaneous ventilation

So the answer to this question is C


Instruction:
Antithrombin is protein produced by
A. Liver
B. Spleen
C. Kidney
D. Lung

Response:
(Liver): (459- 992 H 18th edition)ANTI THROMBIN (or anti thrombin III) is the major plasma protease inhibitor of thrombin and the other clotting factors in coagulation. Synthesized in the liver and circulating in plasma at a concentration of 2.6 + 0.4mm antithrombin acts as suicide substrate for its target enzymes.

So the answer to this question is A


Instruction:
Dentist prescribed home applied bleaching technique uses:
A. 35% Hydrogen Peroxide
B. 10% Carbamide peroxide
C. 18% Hydrochloric acid
D. Sodium perborate

Response:
HOME BLEACHING TECHNIQUE/NIGHT GUARD BLEACHING
Commonly used solution for night guard bleaching

10% carbamide peroxide with or without carbopol.
15% carbamide peroxide.
Hydrogen peroxide (1-10%).

So the answer to this question is B


Instruction:
True about DNA reconstruction technology
A. Restriction endonucleases are involved
B. DNA ligase is used
C. Acid phosphatase is used
D. Reverse transcriptase needed

Response:
DNA phenotyping (fee-no-type-ing) is the process of predicting an organism's phenotype using only genetic information collected from genotyping or DNA sequencing. This term, also known as molecular photofitting, is primarily used to refer to the prediction of a person's physical appearance and/or biogeographic ancestry for forensic purposes.DNA phenotyping uses many of the same scientific methods as those being used for genetically-informed personalized medicine, in which drug responsiveness (pharmacogenomics) and medical outcomes are predicted from a patient's genetic information. Significant genetic variants associated with a paicular trait are discovered using a genome-wide association study (GWAS) approach, in which hundreds of thousands or millions of single-nucleotide polymorphisms (SNPs) are tested for their association with each trait of interest. Predictive modeling is then used to build a mathematical model for making trait predictions about new subjectsRef: https://en.wikipedia.org/wiki/DNA_phenotyping

So the answer to this question is A


Instruction:
Pre Botzinger complex is a part of :
A. VRG
B. DRG
C. Both
D. None

Response:
Dorsal and ventral groups of respiratory neurons (DRG and VRG) are present in the medulla. However,  lesions of these neurons do not abolish respiratory activity, and they apparently project to the pre- Botzinger pacemaker neurons.
DRG contains mainly I (inspiratory neurons) neurons and is part of the nucleus of the solitary tract  (or nucleus tractus solitarius, NTS).
The aﬀerent input from arterial chemoreceptors and lung mechanoreceptor synapses on neurons  in the NTS near the DRG. So, major function of DRG is integration of sensory information from respiratory system.
VRG is a column of neurons that ﬁre action potentials in phase with respiration. It includes neurons depolarizing during inspiration (I neurons) and expiration (E neurons). All of these respiratory centers are bilaterally symmetrical on the right and left sides of the  brainstem.
VRG contains three regions that performs speciﬁc functions:

Rostral VRG: Known as Botzinger complex: Expiratory neurons.
Intermediate VRG: Pre-Botzinger complex: Inspiratory neurons generate respiratory rhythm.
Caudal VRG: Expiratory neurons.

So, pre-Botzinger complex is a part of VRG.
Reference: Ganong’s Review of Medical Physiology 25 Ed page no 656

So the answer to this question is A


Instruction:
Lesion in Wernicke's encephalopathy occurs in -
A. Mamillary body
B. Cerebellum
C. Motor cortex
D. Substantia nigra

Response:
In thiamine deficiency, hemorrhages into the mamillary bodies cause Wernicke-korsakof syndrome.
Other regions of CNS involved in thiamine deficiency are periventricular regions of the thalamus, the floor of the fourth ventricle and the anterior region of the cerebellum.

So the answer to this question is A


Instruction:
Length of lower esophageal sphincter -
A. 1-2 cm
B. 3-4cm
C. 1-2 mm
D. 3-4 mm

Response:
Ans. is 'b' i.e., 3-4 cm "The cricopharyngeal sphincter is 2-3 cm, and the lower esophageal sphincter (LES) is 3-4 cm long". - Textbook of GI Surgeryo Approximately 2 cm of the esophagus lie below the diaphragm in the abdomen (abdominal part of esophagus)o Within this portion of esophagus the abdominal part of LES is locatedo Another 1-2 cm of LES lie above the diaphragm in mediastinum, i.e. thoracic part of LES.o Thus total length of LES is 3-4 cm.

So the answer to this question is B


Instruction:
Newborn eye is ?
A. Myopic
B. Hypermetropic
C. Presbyopic
D. None of the above

Response:
Ans. is 'b' i.e., Hypermetropic Eye at bih Anteroposterior diameter of eye ball is about 16.5 mm (70% of adult size). Adult size is attained by 7-8 years. Corneal diameter is about 10 mm. Adult size (11.7 mm) is attained by 2 years of age. Anterior chamber is shallow and angle is narrow. Lens is spherical at bih. Retina :- Apa from macular area, the retina is fully differentiated. Macula differentiates 4-6 months after bih. Myelination of optic nerve fibres has reached the lamina cribrosa. New born is usually hypermetropic by +2 to +3D. Orbit is more divergent (50deg) as compared to adult (45deg). Lacrimal gland is still underdeveloped and tears are not secreted.

So the answer to this question is B


Instruction:
Which of the following drug should be given in sustained release oral dosage form
A. An anti-arrhythmic drug with a plasma half life of 10 seconds used for acute treatment of PSVT
B. Anti inflammatory drugs with the plasma half life of 24 hours
C. Hypnotic drugs with a plasma half life of 2 hours
D. An anti hypeensive with a plasma half life of 3 hours

Response:
Ref-KDT 6/e p78 Sustained release formulations of a drug are used for the drugs having sho duration of action requiring prolonged administration. PSVT is an acute condition and requires a sho and fast acting drug. Adenosine is theretore, the drug ot choice for this condition. Option (b) describes a drug having long half life (24 hours). This drug need not be administered as sustained release preparation. For a hypnotic drug, action required is brief i.e. to induce sleep.Therefore, it should not be given as a sustained release preparation. Treatment of hypeension is life long, Drug with half life of 3hours, needs to be administered several times a day, therefore sustained release oral dosage form is best utilized for this drug.

So the answer to this question is D


Instruction:
Management of 5 cm size renal struvite calculus
A. ESWL
B. PCNL
C. Retrograde intrarenal surgery
D. Open Pyelolithotomy

Response:
For stones which are

>2cm size
Hydronephrosis
Obstructed

PCNL is performed

So the answer to this question is B


Instruction:
In a child with hyperophied adenoids, the voice abnormality that is seen is
A. Hot potato voice
B. Staccato voice
C. Rhinolalia apea
D. Rhinolalia clausa

Response:
HYPONASALITY (RHINOLALIA CLAUSA) It is lack of nasal resonance for words which are resonated in the nasal cavity, e.g. m, n, ng. It is due to blockage of the nose or nasopharynx. Ref:- Dhingra; pg num:-315

So the answer to this question is D


Instruction:
Non stess test (NST) done on a 36 week pregnant diabetic female is found to be non reactive. What should be done next?
A. Induction of labour
B. LSCS
C. Do NST after 1hr
D. Proceed to biophysical profile

Response:
Nonreactive NST refers to absence of any fetal activity. Since the NST of this patient is non reactive, the most appropriate next step would be to do a Biophysical profile (BPP). Common indications for BPP are during conditions with significant risk of fetal hypoxia, or as a followup testing for a nonreactive NST. The most common indications for BPP are: Suspected IUGR Preganancy more than 40 weeks Insulin dependent diabetes Hypeension Oligohydramnios Multiple gestation Preterm rupture of membranes Non stress test is based on the principle that well oxygenated fetus responds to spontaneous or induced movement with fetal hea accelerations. NST is considered to be reactive when there are two or more accelerations of more than 15 beats per minute above the baseline and longer than 15 seconds in duration are present in a 20minutes observation.

So the answer to this question is D


Instruction:
Which of the following drugs are indicated for management of severe malaria?
A. Quinine
B. Artemether
C. Artesunate
D. All of the above

Response:
Ans. D. All of the aboveMalaria is a potentially life-threatening disease caused by infection with Plasmodium protozoa transmitted by an infective female Anopheles mosquito. Plasmodium falciparum infection carries a poor prognosis with a high mortality if untreated, but it has an excellent prognosis if diagnosed early and treated appropriately. Severe malaria may present with cerebral malaria, convulsions, hypoglycemia, and metabolic acidosis with respiratory distress, acute pulmonary edema, circulatory collapse, jaundice, hemoglobinuria, and hyperpyrexia. Drugs used for management of severe malaria include Quinine, artemether and artesunate.

So the answer to this question is D


Instruction:
In the treatment of congenital adrenal hyperplasia due to lack of 21 b-hydroxylase, the purpose of administration of a synthetic glucocoocoid is:
A. Inhibition of aldosterone synthesis
B. Prevention of hypoglycemia
C. Recovery of normal immune function
D. Suppression of ACTH secretion

Response:
In congenital adrenal hyperplasia, Due to decreased formation of steroids--> decreased feedback inhibition of ACTH. Thus more ACTH is formed which leads to adrenal hyperplasia-->exogenous steroids are given to suppress ACTH secretion.

So the answer to this question is D


Instruction:
A VDRL reactive mother gave bih to an infant. All of the following would help in determining the risk of transmission to the infant, EXCEPT:
A. TPHA test on the serum sample of the mother
B. TPHA test on the serum sample of the infant
C. VDRL on the paired serum sample of the infant and mother
D. Time interval between the treatment of the mother and her delivery

Response:
The likely diagnosis of congenital syphilis is made on the basis of maternal serology and whether or not the mother has been adequately treated during pregnancy. Serological diagnosis of syphilis in neonates is not reliable. Ref: Infectious Diseases By Cohen, Powderly, 3rd Edition, Pages 7I8, 814, 815

So the answer to this question is B


Instruction:
Clavipectoral fascia is derived from which ligament ?
A. Coracoacromial
B. Coracoclavicular
C. Costoclavicular
D. Costocoracoid

Response:
Ans. is 'd' i.e., Costocoracoid

So the answer to this question is D


Instruction:
False about CURB-65 criteria to assess pneumonia severity is:
A. Urea >7 mmol/L
B. Respiratory rate >=30/min
C. Systolic blood pressure <=100 mmHg
D. Diastolic blood pressure <=60 mmHg

Response:
Ans. C. Systolic blood pressure <=100mmHgCURB-65 includes systolic blood pressure <=90mmHg as criteria, not <=100mmHg.The CURB-65 is used to assess the severity of pneumonia.It includes five variables:* Confusion* Urea >7mmol/L* Respiratory rate >=30/min* Blood pressure, systolic <=90mmHgor diastolic<=60mmHg* Age >= 65 years

So the answer to this question is C


Instruction:
Number of variable regions on each light and heavy chain of an antibody -
A. 1
B. 2
C. 3
D. 4

Response:
A light chain has two successive domains: one constant domain and one variable domain. Heavy chain with one variable (VH) domain followed by a constant domain (CH) Ref: Ananthanarayan & Panikers textbook of microbiology 9th edition pg:94

So the answer to this question is A


Instruction:
A child is below the third percentile for height. Growth velocity is normal, but chronologic age is more than skeletal age. The most likely diagnosis is:
A. Constitutional delay in growth
B. Genetic short stature
C. Primordial dwarfism
D. Hypopituitarism

Response:
None

So the answer to this question is A


Instruction:
A lady with a long-standing thyroid nodule is planned for a subtotal thyroidectomy. Before the surgery, the surgeon must check/ do -
A. Serum Calcium levels
B. Serum PTH assay
C. Indirect Laryngoscopy
D. Iodine 131 scan

Response:
Ans. is 'c' i.e., Indirect Laryngoscopy o Nerve Damage to recurrent/superior laryngeal nerve is a known complication of thyroidectomy. Hence it is important to document the state of the vocal cords before surgery to prevent litigation liability

So the answer to this question is C


Instruction:
Which among the following is the ideal contraception for lactating mothers?
A. Barrier method
B. Combined OCP
C. Lactational amenorrhoea
D. Progesterone only pill

Response:
The lactational amenorrhea method can be a highly efficient method for breastfeeding women to use physiology to space bihs. Suckling results in a reduction in the release of gonadotropin-releasing hormone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Beta endorphins induced by suckling also induce a decline in the secretion of dopamine, which normally suppresses the release of prolactin. This results in a condition of amenorrhea and anovulation. Ref: Burkman R.T., Brzezinski A. (2013). Chapter 58. Contraception & Family Planning. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.

So the answer to this question is C


Instruction:
Epley's test is used for?
A. Benign paroxysmal vertigo
B. Basilar migraine
C. Orthostatic hypotension
D. Thoracic outlet syndrome

Response:
ANSWER: (A) Benign paroxysmal vertigoREF: Dhingra 4th edition page 45Benign paroxysmal positional vertigo (BPPV):It is characterised by vertigo when the head is placed in a certain critical position. There is no hearing loss or other neurologic symptoms.Disease is caused by a disorder of posterior semicircular canal though many patients have history of head trauma and ear infectionIt has been demonstrated that otoconial debris, consisting of crystals of calcium carbonate, is released from the degenerating macula of the utricle and floats freely in the endolymphThe condition can be treated by performing Epley's manoeuvre. The principle of this manoeuvre is to reposition the otoconial debris from the posterior semicircular canal back into the utricle.The manoeuvre consists of five positions.Position 1; With the head turned 45deg, the patient is made to lie down in head-hanging position (DixHallpike manoeuvre). It will cause vertigo and nystagmus. Wait till vertigo and nystagmus subside.Position 2. Head is now turned so that affected ear is up.Position 3. The whole body and head are now rorated away from the affected ear to a la teral recumbent position in a face-down position.Position 4. Patient is now brought to a Sitting posiition with head st ill turned to the unaffected side by 45degPosition 5. The head is now turned forward and chin brought down 20deg.

So the answer to this question is A


Instruction:
All of the following are absoulate indications for intubation except -
A. Depressed level of consciousness
B. Bleeding into the airway
C. Falling O2 Saturation
D. Maxillofacial fractures

Response:
Ans. is 'd' i.e., Maxillofacial fractures o Basic indications for emergency endotracheal intubation1. Airway blockage# Life-threatening airway obstruction may occur when a foreign bodybecomes lodged in the airway; this is especially common in infants and toddlers.# Severe blunt or penetrating injury to the face or neck may be accompanied by swellingand an expanding hematoma, or injury to the larynx, trachea or bronchi. Airway obstruction is also common in people who have suffered smoke inhalation or bums within or near the airway or epiglottitis.2. Hypoxemia# Intubation may be necessary for a patient with decreased oxygen content and oxygen saturation of the blood caused when their breathing is inadequate (hypoventilation), suspended (apnea), or when the lungs are unable to sufficiently transfer gasses to the blood. Such patients, who may be awake and alert, are typically critically ill with a multisystem disease or multiple severe injuries. Examples of such conditions include cervical spine injury, multiple rib fractures, severepneumonia, acute respiratory distress syndrome (ARDS), or near-drowning3. Depressed level of consciousness# Perhaps the most common indication for tracheal intubation is for the placement of a conduit through which nitrous oxide or volatile anesthetics may be administered. General anesthetic agents, opioids, and neuromuscular- blocking drugs may diminish or even abolish the respiratory drive. Although it is not the only means to maintain a patent airway during general anesthesia, intubation of the trachea provides the most reliable means of oxygenation and ventilation and the greatest degree of protection against regurgitation and pulmonary aspiration.# Damage to the brain (such as from a massive stroke, non-penetrating head injury, intoxication orpoisoning) may result in a depressed level of consciousness. When this becomes severe to the point of stupor or coma (defined as a score on the Glasgow Coma Scale of less than 8.

So the answer to this question is D


Instruction:
Cherry red postmortem staining is seen in
A. Cyanide
B. Carbon monoxide
C. Nitrites
D. Phosphorus

Response:
Ans. is 'b' i.e., Carbon monoxide * Color of post-mortem staining in various poisoning:POISONCOLORCarbon mono-oxide and hypothermiaCherry redHCN, burnsBright redNitrites, potassium chlorate, potassium bicarbonateNitrobenzene, acetanilide, bromates, aniline (causing methaemoglobinuria)Chocolate or Copper brownPhosphorousDark brown or yellowHydrogen sulphideBluish green

So the answer to this question is B


Instruction:
Commonest cause of skeletal metastasis is
A. Kidney
B. Prostate
C. Breast
D. Thyroid

Response:
C. i.e. (Breast) (1202 - CSDT 12th) (450 - S. Das 5th)METASTATIC BONE TUMORS80% of these metastatic lesions are from primary carcinomas - particularly of the Breast, Prostate, lung kidney, thyroid' pancreas or stomach in that order of frequency* Breast or prostate metastasis either partly or solely osteoblastic** OSSOPHILE TUMOURS shows predilection for metastasis in the bone eg Breast, Prostate, Kidney, Bronchus, and Thyroid OSSOPHOBE TUMOURS Do not show predilection for metastasis in the bone eg GIT, urinary bladder, genitalia etc* Most common primary source of solitary skeletal metastasis at the time of first diagnosis is carcinoma of the kidney (1202 - CSDT 12th)

So the answer to this question is C


Instruction:
Which one is not poor prognostic factor for acute pancreatitis:
A. Hyperglycemia
B. Hypocalcemia
C. Raised LDH level in blood
D. Hyperamylasemia

Response:
Answer is D (Hyperamylasemia) Serum amylase levels do not form any criteria for prognosis in acute pancreatitis. Hyperglycemia, Hypocalcemia and raised LDH levels are poor prognostic factors according to Ranson's criteria.

So the answer to this question is D


Instruction:
A 1-week-old black infant presents to you for the first time with a large, fairly well-defined, grey-blue lesion over the buttocks bilaterally. The lesion is not palpable, and it is not warm or tender. The mother denies trauma and reports that the lesion has been present since birth. This otherwise well-appearing infant is growing and developing normally and appears normal upon physical examination. Which of the following is the most appropriate course of action in this infant?
A. Report the family to child protective services
B. Reassurance of the normalcy of the condition
C. Soft tissue films of the buttocks to identify calcifications
D. Administration of vitamin K

Response:
(b) Source: (Hay et al, p 384. Kliegman et al, p 2219. McMillan et al, p 828. Rudolph et al, p 1275.) The lesion is a Mongolian spot, a bluish-gray lesion located over the buttocks, lower back, and occasionally, the extensor surfaces of the extremities. These are common in blacks, Asians, and Latin Americans. They tend to disappear by 1 to 2 years of age, although those on the extremities may not fully resolve. Child abuse is unlikely to present with bruises alone; children frequently present with more extensive injuries. Subcutaneous fat necrosis, which may ultimately result in subcutaneous calcifications in the affected area, is usually found as a sharply demarcated, hard lesion on the cheeks, buttocks, and limbs but it usually is red. Hemophilia and vitamin K deficiency rarely present with subcutaneous lesions as described and are more likely to present as a bleeding episode.

So the answer to this question is B


Instruction:
Following are the features of chronic arsenic poisoning except ?
A. Emaciation
B. Conjunctivitis running nose
C. Black pigmentation of skin
D. Sensory motor polyneuropathy

Response:
Ans. is 'c' i.e., Black pigmentation of skin There is patchy brown (not black) pigmentation of skin. Chronic arsenic poisoning has four stages : First stage (nutritional and gastrointestinal disturbances) : The earliest sign is gradual emaciation. There is loss of appetite, nausea and intermittent vomiting and diarrhea. Second stage (catarrhal changes) : It resembles common cold, i.e. conjunctivitis, running nose and eyes, coughing etc. Third stage (skin rash) : There is classical 'rain drop pigmentation', i.e. patchy brown pigmentation of skin. At initial stages, there is a vesicular eruption which may resemble nettle rash. Hyperkeratosis of palms and soles occur. There are white transverse bands crossing the nails, known as Mee's line, and indicate periods of arrested growth due to interference with normal metabolism. There is alopecia and exfoliative dermatitis. Fouh stage (nervous disturbances) : There is sensory and motor (i.e. mixed) polyneuropathy, with painful paresthesia of hands and feet and muscle tenderness.

So the answer to this question is C


Instruction:
Cells involved in active protein synthesis have-
A. Increased mitochondria
B. Increased Rough Endoplasmic reticulum
C. Increased golgi apparatus
D. Increased lysosomes

Response:
In Rough endoplasmic reticulum, ribosomes are attached. Protein synthesis can occur in ribosomes and mitochondria. So the answer to this question would be rough endoplasmic reticulum.

So the answer to this question is B


Instruction:
The additional amount of oxygen transpoed in 100 ml of blood in a subject breathing 100% oxygen under hyperbaric conditions of 4 ATA compared to normobaric conditions (lATA) will be:
A. 9 ml
B. 6 ml
C. 3 ml
D. 0.3 nil

Response:
B i.e. 6 ml

So the answer to this question is B


Instruction:
Artery that does not supply Tonsil is
A. Lingual artery
B. Facial artery
C. Maxillary artery
D. Temporal artery

Response:
None

So the answer to this question is D


Instruction:
In acute pulmonary embolism, the most frequent ECG finding is :
A. S1Q3T3 pattern
B. P. pulmonale
C. Sinus tachycardia
D. Right axis detion

Response:
Answer is C (Sinus Tachycardia ) Sinus tachycardia is the commonest ECG abnormality in pulmonary embolism- OHCM 5th / 88 Classic Abnormalities on ECG in pulmonary Embolism Sinus Tachycardia (Commonest : OHCM) Right ventricular strain pattern (T wave inversion in leads VI to V4 perhaps most frequent - Harrison) SI QIII TIII Pattern :(Classic pattern but rare (OHCM)) Deeps S waves in lead I Q wave Inveed T wave in lead Ill New onset Atrial Fibrillation / Atrial Flutter. Right Axis Detion / RBBB.

So the answer to this question is C


Instruction:
Which of the following is not a myeloproliferative neoplasm?
A. Polycythemia vera
B. Juvenile myelomonocytic leukemia
C. Chronic myeloid leukemia
D. Essential thrombocythemia

Response:
Juvenile myelomonocytic leukemia is not included in the category of MPNs (myeloproliferative neoplasms) in WHO classification Examples of myeloproliferative neoplasms: Chronic myeloid leukemia Polycythemia vera Primary myelofibrosis Essential thrombocythemia Chronic eosinophilic leukemia Activating JAK2 mutations are seen in: Nearly all cases of polycythemia vera Approx. 50% of cases of primary myelofibrosis and essential thrombocythemia BCR-ABL1 translocation seen in CML

So the answer to this question is B


Instruction:
The foetal blood is separated from the syncytiotrophoblast with all EXCEPT:
A. Foetal blood capillary membrane
B. Mesenchyme inter villous blood space
C. Cytotrophoblast
D. Decidua - parietalis

Response:
(Decidua-parietalis) (25, 36-Duta 6th)Decidua-vera or parietalis - the rest of the deciduas lining the uterine cavity outside the site of implantation.* Foetal blood now circulate through the villi, while maternal blood circulate through intervillous space (69-IBS- Embryology 7th)* Synocytiotrophoblast grows into the endometrium. As endometrium is eroded, some of its blood vessels are opened up, and blood from them fills the lacunar spaces {intervillous space)* Each trabeculus is initially made up entirely by syncytiotrophoblast. Now the cells of the cytotrophoblast begin to multiply and grow into each trabeculus. The trabeculus thus comes to have a central core of cytotrophoblast covered by an outer layer of syncytium. It is surrounded by maternal blood filling the lacunar space. The trabeculus is now called is primary villous.

So the answer to this question is D


Instruction:
Site of action of ADH is: March 2008
A. PCT
B. Vasa recta
C. Loop of henle
D. Collecting ducts

Response:
Ans. D: Collecting ducts Because one of its principal physiologic effects is the retention of water by the kidney, vasopressin is often called the antidiuretic hormone (ADH). It increases the permeability of the collecting ducts of the kidney, so that water enters the hypeonic interstitium of the renal pyramids. The urine becomes concentrated, and its volume decreases. The overall effect is therefore retention of water in excess of solute; consequently, the effective osmotic pressure of the body fluids is decreased. In the absence of vasopressin, the urine is hypotonic to plasma, urine volume is increased, and there is a net water loss. Consequently, the osmolality of the body fluid rises.

So the answer to this question is D


Instruction:
Person after seeing clouds says "God has sent me this as signal to save the world"
This is an example for:
A. Delusion
B. Visual Hallucination
C. Delusional perception
D. Somatic passivity

Response:
Delusional perception is one of the 11 first rank symptoms where patient attaches a delusional component to normally perceived thing.

So the answer to this question is C


Instruction:
How many incisions are used in the divided system approach of pars planavitrectomy?
A. 1
B. 2
C. 3
D. 4

Response:
It has the advantage of smaller instruments,easy handling,improved visualisation REF:khurana,pg no 261

So the answer to this question is C


Instruction:
A most common cause of amoebic lung abscess is -
A. Direct extension from liver
B. Hematogenous spread
C. Lymphatic spread
D. By inhalation

Response:
Amoebic lung abscess is a result of direct spread of infection from liver to lung.
	The infection spreads directly through the diaphragm.
The most common area of the lung involved is right lower lobe.
The amoebic liver abscess ruptures and then it can involve any of the following structures.

Right lung (Most commonly)
Right pleural cavity
Left Lung
Pericardium
Peritoneal cavity

Also know
"Pleuropulmonary involvement is seen in 20-30 % of cases and is the most frequent complication of Amoebic liver abscess"- Harrison

So the answer to this question is A


Instruction:
The afferent fibers which are most sensitive to local anesthetic belong to group
A. A
B. B
C. C
D. D

Response:
None

So the answer to this question is C


Instruction:
Entonox is combination of
A. 25% oxygen 25%N2O
B. 50% oxygen 50%N2O
C. 75% oxygen 25% N2O
D. 100% oxygen 0%N2O

Response:
B. i.e. (50% oxygen : 50% N2O) (132 - Lee s synopsis of anaesthesia 13th )ENTONOX - is the trade name for a 50 - 50 mixture of gaseous N2O and O2* The cylinder shoulder is painted white and blue in quarters and body is blueUses include - obstetric analgesia, and analgesia for dressed wounds, coronary infarction and dental surgery**PIN number for oxygen - 2, 5 for Entonox- 7. Nitrous oxide 3, 5, air 1, 5

So the answer to this question is B


Instruction:
Which of the following is TRUE? 1. Square (Reef) Knot 2. Surgeons Knot 3. Granny (Pseudo-square) Knot 4. Reverse cutting needle 5. Veical Mattress 6. Purse String Suture A B C D E F
A. 1-D; 2-F; 3-A; 4-E; 5-B; 6-C
B. 1-F; 2-D; 3-A; 4-E; 5-B; 6-C
C. 1-A; 2-D; 3-F; 4-E; 5-B; 6-C
D. 1-F; 2-A; 3-D; 4-E; 5-B; 6-C

Response:
Square (Reef) Knot Surgeons knot Granny (Pseudo-square) knot - Consist of two throws - Crossing is done in each throw - Secured knot - Consist of two throws - Two wraps in first throw - Crossing occurs in each throw - Consists of two throws - Crossing does not occur in any throw - Not a secured knot Horizontal Mattress Veical Mattress - Initial suture is inseed as for a interrupted suture but then needle moves horizontally & traverses both edges of the wound once again. - Initial suture is inseed as for an interrupted suture but then needle moves veically & transverses both edges of wound once again. Horizontal Mattress: Suture parallel to line of incision. Veical Mattress: Suture perpendicular to line of incision. Purse string suture - Continuous stitch parallel to a circular wound is applied. - Used for hernia sac & appendectomy

So the answer to this question is B


Instruction:
Urogenital diaphragm is pierced by all except -
A. Intemalpudendal aery
B. Dorsalaery of penis
C. Dorsal nerve of penis
D. Urethra

Response:
Male:Urethra, 2-3 cm behind the inferior border of the symphysis pubis.Vessels and neryes to the bulb of the penis.Ductus of the bulbourethral glands, posterolateral to the urethral orifice.Deep dorsal vessels and dorsal nerves of the penis, behind the pubic arch in the midline.Posterior scrotal vessels and nerves, anterior to the transverse perinei.Female:Urethra, 2-3 cm behind the inferior border of the symphysis pubis. Vagina, centrallyDucts of Baholin's glands, posterolateral to tbe urethral orificeDeep dorsal vessels and dorsal nerves of the clitoris, behind the pubic arch io the midline.Posterior labial vessels and nerves, anterior to the transverse perinei.

So the answer to this question is A


Instruction:
Common salt can be used as a chemical antidote for washing the stomach in case of oral poisoning by
A. Mercuric sulphide
B. Silver nitrate
C. Copper sulphate
D. Lead bicarbonate

Response:
.

So the answer to this question is B


Instruction:
All of the following statements about Botulism are true except
A. Botulism is caused by endotoxin
B. Honey ingestion causes infant botulism
C. Constpation is seen
D. Detection of antitoxin in the serum can aid in diagnosis

Response:
Clostridium botulinum produces a powerful exotoxin that is responsible for its pathogenicity. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 269

So the answer to this question is A


Instruction:
Which of the following is caused by arsenic poisoning
A. Extra hepatic poal vein obstruction
B. Hepatic carcinoma
C. Poal hypeension
D. Cirrhosis

Response:
Extrahepatic poal vein obstruction is a vascular disorder of liver, which results in obstruction and cavernomatous transformation of poal vein with or without the involvement of intrahepatic poal vein, splenic vein, or superior mesenteric vein. of 10 mg daily for up to 60 days, followed by different dosing in consolidation and maintenance regimens. Hepatotoxicity Acute poisoning with arsenic is marked by severe abdominal pain, nausea and vomiting, diarrhea, muscle cramps, metallic taste and extreme thirst, followed by stupor, coma, cardiovascular collapse and death. Death can occur within 24 hours of exposure, but with sublethal doses, survival is possible and liver injury may arise 24 to 48 hours after the acute ingestion. Other symptoms include conjunctival and respiratory tract inflammation, epistaxis, rash, renal insufficiency and painful neuropathy. The characteristics of the liver injury have not been well defined, but are likely similar to those with acute iron poisoning, with a clinical phenotype of acute hepatic necrosis, marked elevations in serum aminotransferase levels, early onset of hepatic failure and rapid recovery in cases without early fatality. Chronic, lower dose exposure to arsenic can be toxic and result in arsenosis, a syndrome marked by fatigue, nausea and vomiting, abdominal crampy pain, weakness, stupor, seizures and neuropathy. Skin manifestations are frequent and characteristic with chronic excessive exposure marked by hyper- and hypo-pigmentation, a "rain-drop" pattern of skin discoloration, skin dryness and exfoliation, keratosis of the palms and soles, and skin cancers. Arsenic is also deposited in the hair and nails, where it can be detected even after it is no longer measureable in urine. Liver injury can also occur with chronic arsenic exposure, typically with appearance of signs and symptoms of poal hypeension, without obvious cirrhosis (idiopathic or noncirrhotic poal hypeension). The clinical onset of noncirrhotic poal hypeension is often insidious with weight loss, fatigue and abdominal swelling and minor, nonspecific elevations in serum enzymes, followed by appearance of variceal hemorrhage or ascites. Features of poal hypeension (ascites, variceal hemorrhage) rather than hepatic failure (jaundice, encephalopathy or coagulopathy) predominate. Ref Harrison 20th edition pg 789

So the answer to this question is A


Instruction:
The feature of hemorrhagic disease of the new born is -
A. Prolonged prothrombin time
B. Defective platelet count
C. Decreased bleeding time
D. Prolonged thrombin time

Response:
Ans. is 'a' Prolonged prothrombin time Hemorrhagic disease of the newborn. It is caused by a deficiency of vitamin K dependent factors (II, VII, IX, X)*. Bleeding occurs in 0.25-1.7% of newborns who do not receive vitamin K prophylaxis after birth. Symptoms - Sites of ecchymoses and surface bleeding include - Gastrointestinal tract Umbilical cord Circumcision site Nose Sometimes intracranial hemorrhage can occur. Laboratory features of hemorrhagic disease of new bom : Platelet count -Normal Prothrombin time -Prolonged* Thrombin time -Normal until very late in the disease* Fibrinogen -Normal Factor V -Normal

So the answer to this question is A


Instruction:
Myelination of optic nerve begins at what gestational age-
A. 2 month
B. 4 month
C. 5 month
D. 7 month

Response:
Ans. is 'd' i.e., 7 months o Myelination of optic nerves starts between 6 and 8 months of gestational age.o Myelination of the optic nerves begins at the lateral geniculate nucleus, reaching the orbital part of the optic nerve at term, and continues over the following 2 years postnatally.o Myelination of geniculostriate pathway begins in the 10th fetal month and is fully mature about 4 months postnatally.o The rate of myelination appears to be hastened by light exposure. Thus, preterm infant, on reaching chronological term, has more advanced myelination than a full-term newborn.

So the answer to this question is D


Instruction:
A 20 year old man from hilly areas presented with epistaxis. His DSA showing sphenopalatine branch of maxillary artery is shown below. The arrow most likely points to which pathology?
A. Rhinosporidiosis
B. AVM
C. Angiofibroma
D. Pseudoaneurysm

Response:
Ans. B. AVM* The arrow points to the blush due to AVM supplied by the ethmoidal branch of ophthalmic artery (from ICA) and the sphenopalatine branch of internal maxillary artery (from ECA).* This is typical of AV malformation. Note the communication between these arteries.* Normally, the nasal fossa is supplied by both the ICA and ECA.* The blush in angiofibroma won't be so anterior and there won't be communication between arteries.

So the answer to this question is B


Instruction:
Which of the following disease has incubation period< 1week?
A. Cholera
B. Kala-azar
C. Filariasis
D. Measles

Response:
Incubation period of cholera: 1-2 days. Incubation period of kala azar: 1-4 months. Incubation period of filariasis: 8-16 months. Incubation period of measles: 10-14 days.

So the answer to this question is A


Instruction:
The commonest cause of congenital hypothyroidism: September 2012
A. Thyroid dysgenesis
B. Pendred syndrome
C. Defective iodine release
D. Deficiency of de-iodinase

Response:
Ans. A i.e. Thyroid dysgenesis Congenital hypothyroidism Large & open posterior fontanelle, Absent social smile & eyebrows, Growth retardation, Delayed pubey, Cold extremities, Large tongue, Prolongation of physiological jaundice & Epiphyseal dysgenesis

So the answer to this question is A


Instruction:
In which leukemia, autoimmune hemolytic anemia is most common: -
A. ALL
B. AML
C. CML
D. CLL

Response:
CLL is the most common of the known cause of AIHA

So the answer to this question is D


Instruction:
Kashima operation is done for:
A. Recurrent cholesteatoma
B. Bilateral vocal cord palsy
C. Atrophic rhinitis
D. Choanal atresia

Response:
Ans. b. Bilateral vocal cord palsy (Ref: Dhingra 6/e p300)Transverse cordotomy or Kashima operation is done for bilateral vocal cord palsy.Bilateral Recurrent Laryngeal Nerve Paralysis (Bilateral Abductor Paralysis)Neuritis or surgical trauma (thyroidectomy) are the most important causes.Position of cords: As all the intrinsic muscles of larynx are paralyzed, the vocal cords lie in median or paramedianQ position due to unopposed action of cricothyroid musclesClinical Features:As both the cords lie in median or paramedian position, so there is dyspnea and stridor but voice is goodQTreatment:Emergency tracheostomy or widening the respiratory airway without a permanent tracheostomy by arytenoidectomy with suture, arytenoidopexy (fixing the arytenoid in lateral position), lateralization of vocal cord and laser cordectomy (replaced by less invasive techniques)Less Invasive Techniques for Bilateral RLN Paralysis1. Transverse cordotomy (Kashima operation)* Soft tissue at the junction of membranous cord and vocal process of arytenoid is excised laterally with laser.* This provides good airway. In case airway is still insufficient more tissue can be removed at subsequent operation.2. Partial arytenoidectomy* Medial part of arytenoid is excised with laser.* Sometimes only the vocal process of arytenoids is ablated.3. Reinnervation procedures* These have been used to innervate paralyzed posterior cricoarytenoid muscle by implanting a nerve-muscle pedicle of sternohyoid or omohyoid muscle with its nerve supply from ansa hypoglossi.* These procedures have not been very successful.4. Thyroplasty type II* It creates lateral expansion of larynx and is similar to vocal cord lateralization. Quality of voice may not be good.

So the answer to this question is B


Instruction:
The ability of an alloy to withstand mechanical stresses without permanent  deformation is reﬂected by its:
A. Resilience
B. Elastic limit/Elastic strain
C. Hardness
D. Fatigue resistance

Response:
Elastic strain—Amount of deformation that is recovered instantaneously when an externally applied force or pressure is reduced or eliminated.
Strain may be either elastic, plastic, elastic and plastic, or viscoelastic.
Elastic strain is reversible. The object fully recovers its original shape when the force is removed. Plastic strain represents a permanent deformation of the material; it does not decrease when the force is removed. When a prosthetic component such as a clasp arm on a partial denture is deformed past the elastic limit into the plastic deformation region, elastic plus plastic deformation has occurred, but only the elastic strain is recovered when the force is released. Thus, when an adjustment is made by bending an orthodontic wire, a margin of a metal crown, or a denture clasp, the plastic strain is permanent but the wire, margin, or clasp springs back a certain amount as elastic strain recovery occurs.
Reference: PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 48,51

So the answer to this question is B


Instruction:
Most common serotype of listeria causing infections:
A. 1/2a
B. 1/3a
C. 1/3b
D. 1/2c

Response:
Ans. is. 'a' i. e., 1/2a

So the answer to this question is A


Instruction:
Anatomical feratures of prostatic Urethra are following except?
A. Trapezoidal shape on cross- section
B. Trapezoidal shape on cross- section
C. Trapezoidal shape on cross- section
D. Urethral Crest on posterior wall

Response:
A i.e. Trapezoidal shape on cross- section

So the answer to this question is A


Instruction:
In selecting a screening test for a disease which of the following should not be considered
A. Cost of the test
B. Efficiency of the treatment
C. Knowledge of the physician about the disease
D. Sufferings from disease to the people

Response:
.screening differs from periodic health examinations in such wat that, 1.capable of wide application 2.relatively inexpensive requires little physician&;s time,they are required only to interpret the results. ref:park&;s textbook,ed 22,pg no 127

So the answer to this question is A


Instruction:
A 45-year-old intoxicated male was struck by a tour bus while walking in the middle of the street. The man was admitted to the emergency department and during physical examination was diagnosed with "scissor gait," in which an individual crosses one limb in front of the other, due to powerful hip adduction. Which of the following nerves was most likely involved in this condition?
A. Tibial
B. Obturator
C. Inferior gluteal
D. Superior gluteal

Response:
The obturator nerve innervates the adductor muscles, including the gracilis, pectineus, and obturator externus. The tibial nerve supplies the calf muscles and intrinsic muscles in the plantar portion of the foot. The inferior gluteal nerve innervates the gluteus maximus; the superior gluteal nerve supplies the gluteus medius and minimus and tensor fasciae latae. The femoral nerve provides motor supply to the quadriceps femoris, sartorius, and, in some cases, the pectineus.

So the answer to this question is B


Instruction:
In a child of IQ 50, which of the following is true -a) Can look after himself independentlyb) Can study upto 8th standardc) Can follow simple verbal commandsd) Can handle moneye) Recognize family members
A. bce
B. bde
C. abcd
D. acde

Response:
IQ – 50 indicates mild mental retardation. A person with mild mental retardation can lead to a successful and independent life. They are able to achieve academic skills up to 6" grade. They can easily handle money and recognize family members very well. They are educable (can follow simple verbal commands).

So the answer to this question is D


Instruction:
Commonest uterine anomaly is: March 2007
A. Uterus unicornis
B. Uterus bicornis
C. Uterus didelphys
D. Subseptate uterus

Response:
Ans. B: Uterus Bicornis Uterine malformation is the result of an abnormal development of the Mullerian duct. Class I: Mullerian agenesis (absent uterus). - Uterus is not present, vagina only rudimentary or absent. - The condition is also called Mayer-Rokitansky-Kuster-Hauser syndrome. - The patient with MRKH syndrome will have primary amenorrhoea. Class II: unicornuate uterus (a one-sided uterus). - Only one side of the Mullerian duct forms. - The uterus has a typical "penis shape" on imaging systems. Class III: Uterus didelphys (double uterus). - Both Mullerian ducts develop but fail to fuse, thus the patient has a "double uterus". - This may be a condition with a double cervix and a vaginal paition (v.i.), or the lower Mullerian system fused into its unpaired condition. Class IV: Bicornuate uterus (uterus with two horns). - Only the upper pa of that pa of the Mullerian system that forms the uterus fails to fuse, thus the caudal pa of the uterus is normal, the cranial pa is bifurcated. - The uterus is "hea-shaped". Uterus bicornis unicolis is the most common. Class V: septated uterus (uterine septum or paition). The two Mullerian ducts have fused, but the paition between them is still present, splitting the system into two pas. - With a complete septum the vagina, cervix and the uterus can be paitioned. Usually the septum affects only the cranial pa of the uterus. - MRI is considered the preferred modality due to its multiplanar capabilities as well as its ability to evaluate the uterine contour, junctional zone, and other pelvic anatomy. - A hysterosalpingogram is not considered as useful due to the inability of the technique to evaluate the exterior contour of the uterus and distinguish between a bicornuate and septate uterus. - Class VI: DES uterus. The uterine cavity has a "T-shape" as a result of fetal exposure to Diethylstilbestrol. Arcuate uterus where there is a concave dimple in the uterine fundus within the cavity. A rudimentary uterus is a uterine remnant not connected to cervix and vagina and may be found on the other side of an unicornuate uterus. Patients with uterine abnormalities may have associated renal abnormalities including unilateral renal agenesis.

So the answer to this question is B


Instruction:
Which carries more weight in a court of law -
A. Dying declaration
B. Dying deposition
C. Both carry the same weight
D. Both are not significant

Response:
None

So the answer to this question is B


Instruction:
Commonest type of lung carcinoma in non-smokers is
A. Squamous cell carcinoma
B. Small cell carcinoma
C. Adenocarcinoma
D. Alveolar cell carcinoma

Response:
The most common lung carcinoma arising in life time non smokers is adenocarcinoma Commonest lung carcinoma in wolrd Common in females Ref Harrison 19th edition pg 515

So the answer to this question is C