Instruction:
The age by which most of the normal babies know their gender is
A. 1 year
B. 2 years
C. 3 years
D. 4 years

Response:
<p>. Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand). 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. {Reference: GHAI Essential pediatrics, eighth edition}

So the answer to this question is C


Instruction:
At which location along the basilar membrane are the highest frequency sounds detected?
A. Near oval window
B. Fahest from the oval window, near the helicotrema
C. Uniformly along the basilar membrane
D. At the midpoint of the membrane

Response:
Each wave is relatively weak at the outset but becomes strong when it reaches the poion of the basilar membrane that has a natural resonant frequency equal to the respective sound frequency. At this point, the basilar membrane can vibrate back and foh with such ease that the energy in the wave is dissipated. Consequently, the wave dies at this point and fails to travel the remaining distance along the basilar membrane.Thus, a high-frequency sound wave travels only a sho distance along the basilar membrane before it reaches its resonant point and dies, a medium-frequency sound wave travels about halfway and then dies, and a very low-frequency sound wave travels the entire distance along the membrane.Ref: Guyton; 13th edition; Chapter 53 The Sense of Hearing; Page no: 675

So the answer to this question is A


Instruction:
The most potent stimulator of naive T cells is -
A. B cell
B. Mature dendritic cells
C. Epithelial cells
D. Macrophages

Response:
Ans. is 'b' i.e., Mature dendritic cells Naive T cellThese are newly produced T cells.This is a T cell arising from immune system production of fresh cells in bone marrow.These cells respond to the newly encountered pathogens containing antigens which the immune system has not processed before.The naive T cell activation and proliferation create an acquired immunity to the newly encountered pathogen.After the disease is eradicated a small portion of T cell population engendered by activated Naive T cell constitute a reservoir of Memory T cell which proliferate and respond very quickly to the recurrence of disease.Proliferation of Naive T cells.Dendritic cells and dendritic cell derived cytokines are the most potent stimulator for proliferation of Naive T cells.

So the answer to this question is B


Instruction:
Confirmation of the diagnosis of vesicular mole is by :
A. Vaginal examination
B. X-rays
C. Abdominal examination
D. Ultrasonogram

Response:
Ultrasonogram

So the answer to this question is D


Instruction:
Chemotherapeutic drugs can cause:
A. Only necrosis
B. Only apoptosis
C. Both necrosis and apoptosis
D. Anoikis

Response:
Ans. is 'c' i.e., Both necrosis and apoptosis Chemotherapeutic drugs can cause both necrosis and apoptosis, but it is apoptosis which is the basis of action of chemotherapeutic drugs.Apoptosis is a process by which single cell are removed from the midst of living tissue by fragmentation into membrane bound particles and phagocytosed by other cells without disturbing its architecture or function or eliciting an inflammatory response (therefore known as programmed cell death).Though it is clearly written in Harrison that chemotherapeutic drugs can cause apoptosis and necrosis but its not clear whether necrosis has any role to play in therapeutic action.Also knowNecrosis - refers to cell death induced for example, by physical damage with the hallmark of cell swelling and membrane disruptionAnakusis - refers to death of epithelial cells after removal from the normal milieu of substrate, particularly from cell to cell contact.

So the answer to this question is C


Instruction:
Increased risk of Myocardial infarction is associated with which amino acid?
A. Valine
B. Ornithine
C. Methionine
D. Homocystine

Response:
Homocysteine is a metabolite of the methionine cycle, is a strong independant risk factor for cardiovascular disease. Homocysteine is said to have a role in both atherogenesis and thrombogenesis. Risk factors for Atheresclerosis: Hypercholesterolemia Low HDL level Hypeension Male gender Diabetes mellitus Family with premature coronary aery disease High lipoprotein level Cigarette smoking Post menopausal state Hyper fibrinogenemia Hyperhomoeysteinemia Physical inactivity Obesity Angiotensin conveing enzyme polymorphism Homocysteine (Hcy) is a sulfydryl aminoacid that lies at an impoant metabolic branch point of methionine metabolism, between remethylation and transulfuration pathways. This lead to the formation of methionine and cystathionine respectively. Several enzymes regulate these pathways under normal condition in the presence of Vit. B12, B6 and Folic acid. Abnormality in any of the enzymes or vitamin deficiency may give rise to hyperhomocysteinemia. Hyperhomocysteinemia has been classified as: Moderate (Hcy >15 to 30 mmol/L), Intermediate (Hcy >30 to 100 .mmol/L) and Severe (Hcy >100 mmol/L) Hyperhomocysteinemia and CVD Hyperhomocysteinemia induce smooth muscle proliferation, accelerate oxidation of LDL cholesterol, impair endothelial derived nitric oxide, decrease synthesis of heparan sulphate proteoglycan and also induce proinflammatory changes in the vessel wall. The exact mechanism of atherothrombosis associated with yperhomocysteinemia is not clear. Several studies have pointed to an association with inhibition of thrombomodulin activity, reduction of protein c activation, increased platelet aggregation, and predisposition to endothelial injury. Ref: Harrison's, Principles of internal medicine,16th Edition, Page 1432

So the answer to this question is D


Instruction:
An 81-year-old female presents to ER. Her son gives a collateral history, as the patient is very difficult to understand. He repos that the patient has had difficulty walking and could not lift her left arm for the past hour. He has also noticed the patient's speech doesn't make sense. O/E-The patient is right-handed. There is reduced power (MRC 2/5) and flaccidity in the left arm and leg. Light touch sensation is also decreased on the left arm and leg. The right arm and leg appear normal. Visual fields are normal, but there is a detion of both eyes to right. According to the Oxford Classification of Stroke, what type of stroke is this ?
A. Total Anterior Circulation Infarction
B. Paial Anterior Circulation Infarction
C. Superior Cerebellar Aery Infarction
D. Lacunar Infarction

Response:
-Difficulty walking, difficulty in movements- DYSAHRIA (unclear speech). -Visual field are N but optic detion in both eyes i.e optic radiation to the contralateral side at the site of lesion as in coical stroke can be seen. Therefore, here problem in LEFT side, patient's eyes is deted to contra lateral side/towards the side of stroke. Since the question mentions weakness in the arms & legs we can diagnose it as Ant. CIRCULATION. Option C- gait ataxia and cerebellar damage features not mentioned & cannot be the answer. Option D- Causes either pure motor or pure sensory but here there is motor+ sensory involvement affected. Oxford Stroke Classification Type of infarct Criteria and features Total anterior circulation infarct (TACI) Combination of all 3: 1. Unilateral hemiparesis and/or hemisensory loss of face, arm and legs-(motor and sensory coex affected) 2. Homonymous hemianopia (involvement of the optic radiation) 3. Higher cognitive dysfunction: - Expressive or receptive Dysphasia (Dominant hemisphere involved) - Visual and sensory inattention - Neglect(Non dominant hemisphere involved) Paial anterior circulation infarcts (PACI) 2/3 of the criteria for TACI Lacunar Infarction (LACI) Coex is spared(No higher coical function defect) One of the following is needed for diagnosis: - Pure motor hemiparesis - Pure hemi sensory loss - Sensorimotor stroke - Ataxic hemiparesis - Dysahria Posterior Circulation Infarction (POCI) "Crossed" syndromes, with I/L cranial nerve palsy C/L motor and/or sensory deficit Features include: - Ataxia - Cerebellar syndrome - Horner's Syndrome - Isolated homonymous hemianopia (occipital lobe supplied by posterior cerebral aery) - Coical blindness (basilar aery occlusion affecting both occipital coices)

So the answer to this question is B


Instruction:
Drug of choice for myoclonic seizures is:
A. Valproic acid
B. Phenytoin
C. Ethosuximide
D. Carbamazepine

Response:
None

So the answer to this question is A


Instruction:
A Schizophrenic patient is responding well to haloperidol. But, now he has developed symptoms of parkinsonism. What is the drug of choice to treat this condition -
A. Levodopa
B. Bromocriptine
C. Tolcapene
D. Anticholinergic

Response:
Ans: D AnticholinergicExtrapyramidal side effects of antipsvchotics.Major dose limiting side effects.Maximum with halopridol.Parkinsonism:Appears between 1-4 weeks of therapy.Central anticholinergics like benzhexol are durg of choice for drug induced Parkinsonism.

So the answer to this question is D


Instruction:
Duochrome test is for -
A. Subjective verification of refraction
B. Subjective refinement of refraction
C. Subjective binocular balancing
D. Subjective monocular balancing

Response:
Duochrome test is based on the principle of chromatic aberrations. It helps in verifying the spherical correction subjectively. In it, the patient is asked to tell the clarity of the letters with red background visa- vis green background. To an emmetropic patient letters of both the colours look equally sharp; while to a slightly myopic patient the red letters appear sharper and to a slightly hypermetropic patient the green letters look sharper. Reference : A K KHURANA OPHTALMOLOGY,Edition 4, Page-563

So the answer to this question is B


Instruction:
Harmonic imaging is used in?
A. USG
B. CT
C. MRI
D. MRCP

Response:
Harmonic imaging is a technique in ultrasonography that provides images of better quality as compared with conventional ultrasound technique. Advantages over conventional ultrasound Decreased reverberation and side lobe aifacts. Increased axial and lateral resolution. Cyst clearing. Increased signal to noise ratio. Improved resolution in patients with large body habitus.

So the answer to this question is A


Instruction:
Which of the following is polar?
A. Isoleucine
B. Methionine
C. Glutamic acid
D. Tryptophan

Response:
Classification of aminoacids based on side chain and charges. Acidic amino acids (with negative charge) Basic amino acids (with positive charge) Neutal aminoacids (having non-polar side chains )(hydrophobic) Neutral amino acids (having polar side chains )(hydropilic) Tyrosine Lysine Alanine Aspaic acid Arginine Valine Serine Glutamic acid Histidine Leucine Threonine Isoleucine Cysteine Methionine Glutamine Phenylalanine Asparagine Tryptophan Proline REFERENCE: DM VASUDEVAN TEXTBOOK EIGHTH EDITION ;Page no:27 t

So the answer to this question is C


Instruction:
All of the following statements are true about congenital rubella except
A. It is diagnosed when the infant has IgM antibodies at bih
B. It is diagnosed when Ig G antibodies persist for more than 6 months
C. M.C. congenital defects are deafness, congenital hea disease and cataract
D. Infection after 16 weeks of gestation result in major congenital defects

Response:
The risk of congenital defects has been estimated at 90% for maternal infection before 11 wks of gestation,33% at 11-12 wks ,11% at 13-14 wks, and 24% at 15-16 wks Defects occuring after 16 wks of gestation are uncommon ,even if fetal infection occurs. The fetus is completely spared if infection occurs beyond 16 weeks. Reference: Nelson textbook of pediatrics 19th edition Page 1075

So the answer to this question is D


Instruction:
Which of the following burs is used for developing
chamfer margins?
A. Flat ended, tapered diamond cylinder
B. Round ended, tapered diamond cylinder
C. Twelve fluted carbide burs
D. End cutting burs

Response:
None

So the answer to this question is B


Instruction:
Social Mobility is -
A. From rural to urban areas for work
B. Industrialization
C. Interaction between cultures
D. Movement in socio-economic stratas

Response:
Ans. is 'd' i.e., Movement in socio-economic status Social mobilityo Social mobility is the degree to which an individual's is family or group's social status can change throughout the course of their life through a system of social hierarchy or stratification.o The individual or family can move up or down the social classes based on achievements or factors beyond their control.o If such mobility involves a change in position, especially in occupation, but no change in social class, it is called "horizontal mobility ". Example - a person who moves from a managerial position in one company to a similar position in another.o If the move involves a change in social class it is called "vertical mobilityExample - An industrial worker who becomes a wealthy businessman moves upward in the class system.

So the answer to this question is D


Instruction:
The mechanism of action of topically applied sodium fluoride includes all of the following EXCEPT-
A. When sodium fluoride solution is applied on the tooth surface as a topical agent, it reacts with the hydroxy apatite crystals in enamel to  form calcium fluoride which is the main end product of the reaction.
B. As a thick layer of calcium fluoride gets formed, it interferes with the further diffusion of fluoride from the topical fluoride  solution  to  react with hydroxyapatite and blocks further entry of fluoride ions.
C. Calcium fluoride acts as a reservoir for fluoride release
D. The stoppage of release of fluoride is termed as chocking off effect.

Response:
Mechanism of action of sodium fluoride –
When sodium fluoride solution is applied on the tooth surface as a topical agent, it reacts with the hydroxy apatite crystals in enamel to form calcium fluoride which is the main end  product of the reaction. As a thick layer of calcium fluoride gets formed, it interferes with the further diffusion of fluoride from the topical fluoride  solution  to  react with hydroxyapatite and blocks further entry of fluoride ions. This sudden stop of the entry of fluoride is termed as "Choking off effect". Fluoride then slowly leaches from the calcium fluoride. Thus calcium fluoride acts as a reservoir for fluoride release (It is for this reason that after each application of sodium fluoride on to the tooth surface, it is left to dry for 4 minutes). The calcium fluoride formed reacts with the hydroxyapatite crystals to form fluoridated hydroxyapatite. The  hydroxyapatite  thus formed  increases  the  concentration  of fluoride on enamel surface, which in turn makes the tooth surface resistant against caries attack through the action of fluoride.

So the answer to this question is D


Instruction:
Fox Fordyce's disease is a disease of -
A. Eccrine sweat glands
B. Apocrine sweat glands
C. Sebaceous glands
D. Pilosebaceous glands

Response:
Ans. is 'b' i.e., Apocrine sweat glands Diseases of Sweat glands 1) Eccrine glands - Hyperhydrosis, Anhydrosis, 2) Apocrine glands - Chromhidrosis (colored sweet), Osmidrosis (offensive sweat odor), Bromhidrosis (hyperhidrosis + offensive odor), Fox - Fordyce's disease (apocrine miliaria), hidradenitis suppurativa. Diseases of sebaceous glands 1) Pilosebaceous glands - Acne vulgaris. Epidermoid (sebaceous) cyst. 2) Ectopic sebaceous glands - Fordyce's spot, Montgomery's tubercle Note: Fordyce's spot represents ectopic sebaceous glands on lips (most common site) and oral mucosa. They may also appear on vulva and penis, where they are called Tyson's gland, i.e., an ectopic sebaceous gland at penis (prepuce) and vulva is called Tyson's gland. o Thus Fox Fordyces spots: the disease of apocrine sweat glands wile fordyces spots: ectopic sebaceous glands.

So the answer to this question is B


Instruction:
Anaesthetic agent(s) safe to use in↑ICP –
A. Halothane
B. Thiopentone
C. Ketamine
D. Ether

Response:
All IV inducing agents (including thiopentone) except for ketamine decrease ICT.
Ketamine increases ICT.
Inhalational agents (Ether, Halothane) increase ICT.

So the answer to this question is B


Instruction:
A 15-year-old female presents with primary amen-orrhea. Her breasts are Tanner 4 but she has no ax-illary or pubic hair. The most likely diagnosis is:
A. Turner's syndrome
B. Mullerian agenesis
C. Testicular feminization syndrome
D. Premature ovarian failure

Response:
None

So the answer to this question is C


Instruction:
This patient was a former smoker and was being treated for essential hypertension, hypercholesterolemia, and hyperuricemia. Oral examination during the three follow up visits are being shown What is the most likely diagnosis of the tongue involvement?
A. Geographic tongue
B. Oral candidiasis
C. Lichen planus
D. Oral hairy leukoplakia

Response:
Ans. A. Geographic tongue* Geographic tongue, also known as benign migratory glossitis and migratory stomatitis, is the correct answer.* The changing lesions are suggestive of a geographic map (hence geographic tongue) with pink continents surrounded by whiter oceans.* It is a recurrent, benign, usually asymptomatic, inflammatory condition, of unknown etiology, of the tongue, affecting nearly 2% of the general population.* Geographic tongue typically presents with migratory red lingual patches, which are irregularly shaped erythematous patches bordered by a white keratotic band. Tongue lesions exhibit central erythema because of atrophy of the filiform papillae of tongue epithelium.* Lesions may last days, months, or years. THE LESIONS DO NOT SCAR.* It being a benign asymptomatic condition, therefore requires no treatment.

So the answer to this question is A


Instruction:
A 75-year-old woman lives alone and eats sparingly because of her low fixed retirement income. For the past 2 weeks, she has noticed pain in her right leg. On physical examination, there is marked tenderness to palpation over the lateral aspect of the right shin, a poorly healed cut on the right hand, and a diffuse hyperkeratotic skin rash. A radiograph shows a right tibial diaphyseal subperiosteal hematoma. Laboratory studies show a hemoglobin level of 11.3 g/dL. A deficiency of which of the following nutrients is most likely to explain these findings?
A. Ascorbic acid
B. Folate
C. Niacin
D. Riboflavin

Response:
Signs and symptoms of scurvy can be subtle. The diet must contain a constant supply of vitamin C (ascorbic acid) because none is produced endogenously. Older individuals with an inadequate diet are as much at risk as younger individuals. Folate deficiency can lead to anemia, but it does not cause capillary fragility with hematoma formation or skin rash. Niacin deficiency can lead to an erythematous skin rash in sun-exposed areas, but not to anemia. Riboflavin deficiency can lead to findings such as glossitis, cheilosis, and neuropathy. Vitamin A deficiency can produce a skin rash, but it does not cause anemia. Vitamin K is important in maintaining proper coagulation, but a deficiency state is not associated with anemia or skin rash.

So the answer to this question is A


Instruction:
Legacy effect is related to which of the diabetes complication ?
A. Renal
B. Neuropathy
C. Retinopathy
D. Cardiovascular

Response:
.

So the answer to this question is D


Instruction:
In secondary syphilis, which one of the following features is not found -
A. Maculopapular rashes
B. Generalised non tender lymphadenopathy
C. Aoitis
D. Follicular syphilides

Response:
Ans. is 'c' i.e., Aoitis Aoitis is seen in teiary syphilis.

So the answer to this question is C


Instruction:
Commonest cause of Nephritic syndrome in children is
A. Minimal change disease
B. Membranous GN
C. IgA nephropathy
D. Mesangioproliferative GN

Response:
There are many conditions that may cause nephritic syndrome, and it can occur in people of all ages. Common causes are infections, immune system disorders and inflammation of the blood vessels. The main symptoms are passing less urine than normal, leading to a fluid buildup in the body, and having blood in the urine. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is A


Instruction:
The number of openings per square inch of a standard mosquito net should be:
A. 100
B. 150
C. 250
D. 175

Response:
The material of the mosquito net should be white for easy detection of mosquitoes. The best pattern is the rectangular net. The size of the opening of mosquito net is of utmost impoance, the size should not exceed 0.0475 inch in any diameter. The number of holes in one square inch is usually 150.

So the answer to this question is B


Instruction:
The symptoms of Hyperparathyroidism include ?
A. Constipation & muscle weakness
B. Anorexia & weight loss
C. Polydipsia & polyuria
D. All of the above

Response:
Ans. is 'd' i.e., All of the above

So the answer to this question is D


Instruction:
The normal biting force in natural dentition and complete denture is
A. 200 N and 600 N
B. 9000 N and 7000 N
C. 100 N and 30 N
D. 600 N and 110 N

Response:
None

So the answer to this question is D


Instruction:
Which of the following statements about prostaglandins is true?
A. They are precursors to arachidonic acid
B. They release arachidonic acid from membranes through the action of phospholipase A
C. They were first observed to cause uterine contraction and lowering of blood pressure
D. Although found in many organs, they are synthesized only in the prostate and seminal vesicles

Response:
Although prostaglandins were originally isolated from prostate glands, seminal vesicles, and semen, their synthesis in other organs has been amply documented; indeed, few organs have failed to demonstrate prostaglandin release. Prostaglandins cause platelet aggregation, smooth-muscle contraction, vasodilation, and uterine contraction. Prostaglandins are synthesized from arachidonic acid, a 20-carbon fatty acid with interspersed carbon double bonds. Signals such as angiotensin II, bradykinin, epinephrine, and thrombin can activate phospholipase A2 and release arachidonic acid from membrane lipids. The arachidonic acid is cyclized by cyclooxygenase to form prostaglandins. Arachidonic acid can also be oxidized to leukotrienes by the action of lipoxygenases.

So the answer to this question is C


Instruction:
Adenovirus 40/41
A. Cervical tissue
B. Synovial fluid
C. Blood
D. Stool

Response:
The diagnosis of a viral infection is made easier by the creation of a greater number of diagnostic virology laboratories during the past few decades. In order for viral diagnosis to be successful, the most appropriate specimen must be collected for the disease in question.Many viruses can be isolated from feces. Of the viral groups in these questions, adenovirus 40/41 is the most common stool isolate. Norwalk agent and other caliciviruses may also be isolated or detected from stools, but usually only in specialized laboratories.

So the answer to this question is D


Instruction:
The fascia seperating rectum from coccyx is called
A. Scarpa's fascia
B. Waldeyer's fascia
C. Denonvillier's fascia
D. Colle's fascia

Response:
The lower third of the rectum is separated by a fascial condensation - Denonvilliers' fascia - from the prostate/vagina in front, and behind by another fascial layer - Waldeyer's fascia - from the coccyx and lower two sacral veebrae (Table 68.1). These fascial layers are surgically impoant as they are a barrier to malignant invasion . Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1219

So the answer to this question is B


Instruction:
Treatment for pertussis contacts children for
A. Prophylactic antibiotic for 11 days
B. Prophylactic antibiotic for 14 days
C. Prophylactic antibiotic for 12 days
D. Prophylactic antibiotic for 10 days

Response:
None

So the answer to this question is D


Instruction:
Main transpoer of cholesterol to peripheral tissue is:
A. HDL
B. LDL
C. IDL
D. VLDL

Response:
B i.e. LDL- Maximum content of triglycerides (& exogenous TG) is present in chylomicrons which carries exogenous dietary TG's to peripheral tissuesQ.Highest amount of cholesterol is present in LDL which is the most impoant carrier of cholesterol and provides (transpos) choelestrol to extrahepatic peripheral tissueQ.

So the answer to this question is B


Instruction:
Rain, a 10 yr old boy is having difficulty in learning at school. He has sho lapses of awareness with eyelid fluttering that occur every 5-10 minutes. EEG studies reveal brief 3 Hz spike and wave discharges appearing synchronously in all the leads. Which of the following drugs would be effective but has the disadvantage that it causes sedation and tolerance?
A. Diazepam
B. Ethosuximide
C. Clonazepam
D. Valproic acid

Response:
(Ref: KDT 6/e p411, 412) Diagnosis of the patient is petit mal epilepsy (absence seizures). Drugs effective against absence seizures are: - Ethosuximide - Valproate - Clonazepam - Lamotrigine Clonazepam is a benzodiazepine that can cause sedation and tolerance.

So the answer to this question is C


Instruction:
Shovel shaped pulp chamber is found in:
A. Maxillary central incisor
B. Maxillary lateral incisor
C. Mandibular central incisor
D. Mandibular lateral incisor

Response:
Maxillary central incisor → pulp is shovel shaped + has pulp horn.

So the answer to this question is A


Instruction:
Alcholholic Hyaline Seen in alcoholic liver disease is composed of
A. Lipofuscin
B. Eosinophilic intracytoplasmic inclusions
C. Basophilic intracytoplasmic inclusions
D. Hemazoin

Response:
Refer Robbins page no 843

So the answer to this question is B


Instruction:
Which of the following is the MOST impoant factor in the prevention of the endophthalmitis due to cataract surgery?
A. Preoperative preparation with povidone iodine
B. One week antibiotic therapy prior to surgery
C. Trimming of eyelashes
D. Use of intravitreal antibiotics

Response:
Clinical studies have proven that use of 5% povidone iodine cream to clean conjunctiva and eyelids before cataract surgery has significant benefits in reducing the rate of endophthalmitis. Therefore it should be applied to eyes before surgery to reduce the incidence of endophthalmitis. Studies have shown some efficacy of intracameral antibiotics in prevention of postoperative endophthalmitis. The addition of gentamicin and vancomycin to the irrigating fluid during phacoemulsification may result in significant reduction in the microbial contamination of anterior chamber aspirates. Ref: Modern Ophthalmology: The Highlights By Benjamin F. Boyd, page 273-4.

So the answer to this question is A


Instruction:
Angular vein infection causes thrombosis in?
A. Cavernous sinus
B. Suprasaggital sinus
C. Inferior saggital sinus
D. Straight sinus

Response:
ANSWER: (A) Cavernous sinusREF: Gray's anatomy 40th ed ch: 29Angular vein is related to the danger area of the face. It is formed by junction of supra orbital and supra trochlear vein. It can be seen 8mm medial to medial canthus. it pierces orbucalis oculi. It drains into anterior facial vein. Angular vein communicates with the cavernous sinus through a communicating vein and it gives a tributary to formation of superiorophthalmic vein. Deep facial vein from the pterygoid plexus joins the anterior facial vein. The pterygoid plexus is connected to cavernous sinus through communicating veins which pass through foramen of vesalvius.

So the answer to this question is A


Instruction:
A patient of acute myocardial infarction being treated in intensive care unit developed left ventricular failure with raised central venous pressure. It was decided to use nitroglycerine. Which route of administration would be most suitable?
A. Sublingual
B. Oral
C. Intravenous bolus injection
D. Slow intravenous infusion

Response:
(Ref: KDT 6/e p527) Nitrates can be used in acute LVF by slow i.v. infusion.

So the answer to this question is D


Instruction:
The following structures may be injured during surgery to repair an inguinal hernia:
A. The ilioinguinal, genitofemoral, Iliohypogastric, and lateral femoral cutaneous nerves
B. The femoral nerve
C. The popliteal nerve
D. The nerve to the psoas major muscle

Response:
Any of these nerves may be divided, crushed, or entrapped by suture or mesh during repair of a groin hernia. The lateral femoral cutaneous nerve is vulnerable especially during laparoscopic hernia repair.

So the answer to this question is A


Instruction:
Occlusal view of upper canine is
A. Diamond as angles are accentuated
B. Diamond as angles are decreased
C. Ovoid as angles are rounded
D. Rhomboid as angles are accentuated

Response:
None

So the answer to this question is A


Instruction:
Electron microscopy findings of renal biopsy shows permeation of the lamina densa of the glomerular basement membrane (GBM) by a ribbon-like, homogeneous, extremely electron-dense material of unknown composition. Which of the following is the likely diagnosis?
A. Dense-deposit disease (DDD)
B. Collapsing glomerulopathy
C. Minimal change disease
D. Focal segmental glomerulosclerosis (FSGS)

Response:
Dense-deposit disease (formerly called Type II MPGN) Excessive activation of the alternative complement pathway. Electron M/E - Permeation of the lamina densa of the GBM by a ribbon-like, homogeneous, extremely electron-dense material of unknown composition. By immunofluorescence, C3 is present in irregular granular or linear foci in the basement membranes on either side but not within the dense deposits. C3 is also present in the mesangium in characteristic circular aggregates (mesangial rings). IgG is usually absent, as are components of the classical pathway of complement activation (such as C1q and C4).

So the answer to this question is A


Instruction:
Pink teeth is seen in
A. Asphyxial deaths
B. Carbon monoxide poisoning
C. Putrefaction
D. Cyanide poisoning

Response:
Pink teeth: In putrefied bodies, the teeth are sometimes seen to be pink in color, especially near the gum line as a result of hemolysis of extravasated blood in the dentinal tubules.

So the answer to this question is C


Instruction:
Best prognosis in reversibility occurs in :
A. lsthmo - Isthmic type
B. lsthmo - ampullary type
C. Ampullary - foreacial type
D. Ampullary fimbrial type

Response:
lsthmo - Isthmic type

So the answer to this question is A


Instruction:
Pulled Elbow is:
A. Disaiculation of elbow
B. Disaiculation of elbow
C. Subluxation of proximal radio ulnar joint
D. None of the above

Response:
C i.e. subluxation of proximal radio ulnar joint

So the answer to this question is C


Instruction:
In normal NST, the time period for two or three accelerations that peak at 15 bpm or more above baseline is:
A. 3
B. 15
C. 20
D. 60

Response:
Definition of nonstress test (NST) currently recommended by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics: Two or more accelerations that peak at 15 bpm or more above baseline, each lasting 15 seconds or more, and all occurring within 20 minutes of beginning the test. Accelerations with or without fetal movements be accepted, and that a 40-minute or longer tracing--to account for fetal sleep cycles--should be performed before concluding that there was insufficient fetal reactivity. Although a normal number and amplitude of accelerations seems to reflect fetal well-being, "insufficient acceleration" does not invariably predict fetal compromise. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 15. Antepaum Assessment. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

So the answer to this question is C


Instruction:
Amyloidosis of kidney may be seen in the following except -
A. Enteric fever
B. Ulcerative colitis
C. Suppurative lung disease
D. Hansen's disease

Response:
TEXT BOOK OF PATHOLOGY HARSH MOHAN 6THEDITION PG NO 86 Secondary/Reactive (AA) Systemic Amyloidosis The second form of systemic or generalised amyloidosis is reactive or inflammatory or secondary in which the fibril proteins contain AA amyloid. Secondary or reactive amyloidosis occurs typically as a complication of chronic infectious (e.g. tuberculosis, bronchiectasis, chronic osteomyelitis, chronic pyelonephritis, leprosy, chronic skin infections), non-infectious chronic inflammatory conditions associated with tissue destruction (e.g. autoimmune disorders such as rheumatoid ahritis, inflammatory bowel disease), some tumours (e.g. renal cell carcinoma, Hodgkin's disease) and in familial Mediterranean fever, an inherited disorder (discussed below). Secondary amyloidosis is typically distributed in solid abdominal viscera like the kidney, liver, spleen and adrenals. Secondary reactive amyloidosis is seen less frequently in developed countries due to containment of infections before they become chronic but this is the more common type of amyloidosis in underdeveloped and developing countries of the world. Secondary systemic amyloidosis can occur at any age including children. AA amyloid occurs spontaneously in some birds and animals; it can also be experimentally induced in animals. <\p>

So the answer to this question is A


Instruction:
Investigation of choice for Posterior urethral valves:
A. Micturating Cystourethrography (MCU)
B. Ultrasound
C. Intravenous Pyelography
D. Retrograde urethrography

Response:
Ans. a (MCU). (Ref. Sutton Radiology 7th ed. 1017, 1061)- MCU is IOC for PU valve and VUR.Posterior urethral valves (PUV)# Varying degree of chronic urethral obstruction due to fusion and prominence of plicae colliculi, normal concentric folds of urethra.# Usually located in posterior urethra just distal to the level verumontanum.c;# It is the most common cause of severe obstructive uropathy in infants and children.# MCU is 'gold standard' in diagnosis of PUV.# Rx: Cystoscopic fulguration of the valves.Three types of PUV are described :

So the answer to this question is A


Instruction:
Minimum time duration for the diagnosis for mania is?
A. 1 week
B. 2 week
C. 3 week
D. 4 week

Response:
ANSWER: (A) 1 weekREF: Kaplan 8f Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition, American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. 4th editionRepeat from June 2010Time frame of mood disorders:ConditionMinimum timeMajor depressive episode2 weeksMajor depressWe disorder, Recurrent2 episodes separated by 2 monthsDysthymic disorder2 yearsCyclothymic disorder2 yearsManic episode1 weekMixed episode1 weekHypomanic episode4 daysRapid cycling bipolar IAt least 4 episodes/yearSlow cyclers bipolar I1-3 episodes/yearPostpartum mood disturbanceOnset within 4 weeks postpartumDSM-IV-TR Criteria for Manic EpisodeA distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:Inflated self-esteem or grandiosityDecreased need for sleep (e.g., feels rested after only 3 hours of sleep)More talkative than usual or pressure to keep talkingFlight of ideas or subjective experience that thoughts are racingDistractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitationExcessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)The symptoms do not meet criteria for a mixed episode.The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism). Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, and light therapy) should not count toward a diagnosis of bipolar I disorder.

So the answer to this question is A


Instruction:
For the prevention of parent to child transmission of HIV, the NACO's recommendation is to give –
A. Niverapine 200 mg in active labour to mother
B. Niverapine 200 mg, four hours after rupture to membranes, to mother
C. Niverapine 200 mg in active about to mother and syrup niverapine 2 mg/kg body weight to newborn with 72 hours of delivery
D. Syrup niverapine 2 mg/kg body weight to newborn within 72 hours of birth

Response:
None

So the answer to this question is C


Instruction:
A 12-year-child, who has intellectual disability, is having large face, large jaw, large ear and macroorchidism. Diagnosis?
A. Mc Cune Albright syndrome
B. Down's syndrome
C. Cri-du chat syndrome
D. Fragile X syndrome

Response:
Fragile X syndrome- CGG trinucleotide repeats. Intellectual disability, large face, large jaw, large ear and macro-orchidism. Cri-du chat syndrome- high pitched cry, microcephaly, intellectual disability, hypotonia Mc Cune Albright syndrome- cafe au lait pigmentation, fibrous dysplasia, endocrine dysfunction Down's syndrome- mongloid slant, epicanthal folds, depressed nasal bridge

So the answer to this question is D


Instruction:
High risk HPV types are:
A. 16 and 18
B. 6 and 11
C. 42 and 44
D. 70 and 72

Response:
Risk Classification HPV Types Lesions Low risk 6, 11, 42, 43, 44, 54, 61, 70, 72, 81 Condyloma, LSIL High risk 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 61, 66, 68, 73, 82 LSIL, HSIL, carcinoma Abbretions: HSIL - high grade intraepithelial lesion LSIL-low grade squamous intraepithelial lesion

So the answer to this question is A


Instruction:
Which of the following is the BEST way to treat medullary carcinoma of thyroid?
A. Near total thyroidectomy + Radioiodine
B. Subtotal thyroidectomy + Radiotherapy
C. Total thyroidectomy + Radioiodine
D. Total thyroidectomy + Radiotherapy

Response:
Treatment of choice for the medullary carcinoma of thyroid is the Total thyroidectomy + modified radical neck dissection. But the option is not provided among options. As total thyroidectomy is provide in option 3 and 4 so answer should be either 3 or 4 Now as far as radioiodine is concerned, it is clearly mentioned in the schwaz that radioiodine is ineffective and about radiotherapy, it has been mentioned that "External beam radiotherapy is controversial, but is recommended for patient with unresectable residual or recurrent tumor" So option 4 i.e. Total thyroidectomy + radiotherapy is the answer here. Ref: Schwaz Surgery 9/e, Page 1368.

So the answer to this question is D


Instruction:
Opsoclonus as a paraneoplastic manifestation is most commonly seen in
A. Renal cell carcinoma
B. Colon cancer
C. Hepatocellular cancer
D. Neuroblastoma

Response:
Opsoclonus affects children more frequently than adults. Screening for occult neuroblastoma is necessary in all patients with opsoclonus.

So the answer to this question is D


Instruction:
Neurological symptoms and premature graying of hair is
associated with:
A. Folic acid deficiency
B. Pernicious anaemia
C. Plummer-Vinson syndrome
D. Paterson-Kelly syndrome

Response:
None

So the answer to this question is B


Instruction:
Aspirin-sensitive asthma is associated with
A. Obesity
B. Uicaria
C. Nasal polyp
D. Extrinsic asthma

Response:
`Aspirin associated Asthma usually begins with perennial vasomotor rhinitis that is followed by hyperplastic rhinosinusitis with nasal polyps&; -- Harrisons Aspirin associated Asthma: Primarily affects adults, although the condition may occur in childhood. Usually begins with perennial vasomotor rhinitis that is followed by hyperplastic rhinosinusitis with nasal polyps. Progressive asthma then appears. On exposure to even very small quantities of aspirin, affected individuals typically develop ocular and nasal congestion and acute, often severe episodes of airways obstruction. Death may follow ingestion of aspirin. REF: Harrison book of internal medicine 21ST EDITION

So the answer to this question is C


Instruction:
Which Immunoglobulin is involved in anaphylaxis: March 2007 & September 2011 March 2013
A. IgA
B. IgE
C. IgG
D. IgM

Response:
Ans. B: IgE

So the answer to this question is B


Instruction:
All are true about spontaneous bacterial peritonitis except
A. High ascitic fluid protein increases the risk
B. E coli is the commonest organism
C. Due to bacterial translocation from normal gut flora
D. Neutrophil count >250/mL in ascitic sample is diagnostic

Response:
SBP is a common and severe complication of ascites characterized by spontaneous infection of the ascitic fluid without an intraabdominal source. When levels of ascitic fluid proteins are very low, patients are at increased risk for developing SBP.Bacterial translocation is the presumed mechanism for development of SBPThe most common organisms are Escherichia coli and other gut bacteria; however, gram-positive bacteria, including Streptococcus viridans, Staphylococcus aureus, and Enterococcus sp., can also be foundThe diagnosis of SBP is made when the fluid sample has an absolute neutrophil count >250/mL.Ref: Harrison 19e pg: 2066

So the answer to this question is A


Instruction:
Which of the following represent frequency of continuous variables?
A. Line diagram
B. Histogram
C. Simple bar chart
D. Component bar chart

Response:
None

So the answer to this question is B


Instruction:
Drugs which produce gynecomastia are all EXCEPT:
A. Cimetidine
B. Digoxin
C. Coisol
D. Spironolactone

Response:
Drugs causing gynecomastia anti-androgens used to treat prostate enlargement, prostate cancer-flutamide, nilutamide finasteride, dutasteride Anabolic steroids like stanozolol Anti-anxiety medications, such as diazepam (Valium). Tricyclic antidepressants. cimetidine spironolactone digoxin metochlopromide ESSENTIAL of MEDICAL PHARMACOLOGY SIXTH EDITION -KD TRIPATHI Page:298d

So the answer to this question is C


Instruction:
A hypertensive patient with BP 160/90 mm of Hg presents with increased level of Lipoprotein a. Which Hypolipidemic drug will you prescribe?
A. Fenofibrate
B. Pitavastatin
C. Niacin
D. Ezetimibe

Response:
Ans: (c) NiacinRef: SN Narasingan, Newer Lipid Guidelines: Interpretation and Applications for Indians. ttp://www.apiindia.org/pdf/medicine_update_2017/mu_155.pdfNiacin is the only drug that lowers lipoprotein (a).So, niacin may be preferable for individuals with lipoprotein (a) elevations.It causes maximum HDL increase among drugs used in dyslipidemia treatment.Other options:FenofibrateIt is a fibric acid derivative, acting through PPAR alpha receptor and activates lipoprotein lipase.It reduces triglycerides.PitavastatinHMG CoA Reductase inhibitor.Causes maximum reduction of LDL.EzetimibeIt is a cholesterol ester transport inhibitor, inhibiting transport of cholesterol from intestine to circulation.It is used along with statins.

So the answer to this question is C


Instruction:
Growth factor needed for salmonella -
A. Tryptophan
B. Niacin
C. B-12
D. Citrate

Response:
Ans. is 'a' i.e., Tryptophan

So the answer to this question is A


Instruction:
Which one of the following local anaesthetics belongs to the ester group?
A. Procaine
B. Buovacaine
C. Lignocaine
D. Mepivacaine

Response:
None

So the answer to this question is A


Instruction:
Slowest acting buffer system in the body ?
A. PCO, buffer
B. Respiratory buffer
C. Chemical buffer
D. Renal buffer

Response:
Ans. is 'd' i.e., Renal buffer(Re/ Principles of medical physiology p. 712)Not all buffer systems begin work at the same time.Chemical buffers respond first, followed by the respiratory system and finally, the renal system.

So the answer to this question is D


Instruction:
Repeated transcranial magnetic stimulation (rTMS) of brain is used in the treatment of which of the following conditions?
A. Depression
B. Resistant schizophrenia
C. Resistant OCD
D. Acute psychosis

Response:
Repeated transcranial magnetic stimulation (rTMS) is a non-invasive method that has been introduced as a treatment alternative for depression. Ref: Depression And Dementia: Progress In Brain Research, Clinical Applications ... By S. N. Sarbadhikari, 2006, Page 198; Kaplan and Sadock's Concise Textbook of Clinical Psychiatry By Benjamin J. Sadock, Virginia A. Sadock, 2008, Page 566

So the answer to this question is A


Instruction:
A boy presents with an injury to the medial epicondyle of the humerus. Which of the following would not be seen -
A. Weakness of the ulnar deviation and flexion
B. Complete paralysis of the IIIrd and IV th digits
C. Atrophy of the hypothenar eminence.
D. Decreased sensation of the hypothenar eminence

Response:
Medial epicondyle fracture causes injury to the ulnar nerve.
In ulnar nerve palsy only following muscles of 3rd & 4th fingers are paralysed:-

i) Palmar & Dorsal interossei
ii) 3rd & 4th lumbricals
iii) Hypothenar muscles

However, extensors of these two fingers are not paralysed which are supplied by the radial nerve.

About other options

The weakness of ulnar deviation & flexion is due to paralysis of FCU and medial half of FDP.
There atrophy of hypothenar eminence and sensory loss over the hypothenar area.

So the answer to this question is B


Instruction:
All are true about rabolazine except
A. It causes hypotension
B. It is recommended as first-line treatment for angina
C. It improve glycemic control
D. It is not indicated for acute attack of angina

Response:
Refer CMDT 2014/347 Ranolazine is the first new anti anginal drug to be approved by the FDA in many years and is approved as treatment for first line chronic angina Ranolazine has no effect on hea rate and blood pressure It is safe to use in erectile dysfunction drug It also decreases the occurrence of atrial fibrillation and results in small decrease in haemoglobin It can cause QT prolongation

So the answer to this question is A


Instruction:
Polychromatic lusture is seen in
A. Zonular cataract
B. Posterior subscapular cataract
C. Nuclear cataract
D. Anterior subscapular cataract

Response:
Polychromatic luster is a pathognomic feature of complicated cataract which is most commonly posterior subcapsular Refer: Khurana 6th edition page number 187

So the answer to this question is B


Instruction:
who gave the concept of saftey needs in the heirachy of motivation
A. lorenz
B. seligman
C. freud
D. maslow

Response:
ABRAHAM MASLOW Gave the hierarchy of needs It is also called as hierarchy of motivation According to Maslow the basic needs should be met to move on to the next stage Once the basic step is attained, we work on to the higher stage The final stage is self-actualization, that is acceptance of your positives, negatives, sho comings, doing things that you are good at and working with satisfaction. Ref, kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 485

So the answer to this question is D


Instruction:
A patient developed paraplegia. On routine examination and X-ray it was found that there are osteoblastic lesion in his spine. Most probable diagnosis is
A. Carcinoma thyroid
B. Ca. Prostate
C. Renal cell Ca
D. Pancreatic Ca.

Response:
Ans. is 'b' i.e Ca prostate Metastasis in bone may produce osteolytic lesion or osteoblastic (osteogenesis) lesion. Most metastatic lesions produce both types of lesions and may go through stages where one or other predominate, Although some tumors mainly produce osteolytic lesion---- Renal cell Ca*. And some mainly osteoblastic ----Prostate Ca*. Also know Bone metastasis is most common from-----Ca Breast* Ca prostrate* Bone metastasis is most common in -----vertebrae*, Pelvis, Rib, Proximal femur.

So the answer to this question is B


Instruction:
A severely injured patient with multiple injuries is brought to casualty. Primary survey done and patient is stabilized. What is the preferred investigation?
A. Whole body CT with IV contrast
B. CT head, abdomen and Xray of suspected limb fractures
C. CT head, FAST scan with Xray C-spine and Pelvis
D. CT head and neck, FAST scan chest and pelvis Xray

Response:
Computed tomography(CT) from the head to pelvis with IV contrast, the so called 'whole body CT' (WBCT) is the gold standard investigation in patients with signs or symptoms of multiple injury or deranged physiology.There is no role for scanning selective bodysystems in the severely injured trauma patient. Wherever possible,WBCT should be performed as soon as possible during the patient's resuscitation. A provisional 'hot repo' can be issued within minutes to identify immediate life-threatening pathology to the trauma team. A more detailed definitive repo should be available within 30-60 minutes.Bailey and love 27e 324

So the answer to this question is A


Instruction:
For Arsenic poisoning Antidote is
A. Penicillamine
B. E.D.T.A
C. Desferrixamine
D. B.A.L

Response:
None

So the answer to this question is D


Instruction:
One month old baby is referred for failure to thrive. On examination there are features of congestive cardiac failure. Femoral pulses are feeble compared to brachial pulses. The likely diagnosis is
A. Coarctation of aoa
B. Patent ductus aeriosus
C. Congenital aoic stenosis
D. Congenital aoa-iliac disease

Response:
In coarctation of aoa there will be radiofemoral delay. Ghai essential of pediatrics, eighth edition, p.no:432

So the answer to this question is A


Instruction:
Cryptomenorrhoea is most commonly seen with:
A. Imperforate hymen
B. Asherman syndrome
C. PCOD
D. Vaginal agenesis

Response:
Ans: a (Imperforate hymen) Ref: Shaw, 13th ed,p.280In women with cryptomenorrhoea presenting as primary amenorrhoea the commonest cause is a intact hymen.Imperforate hymenClinical features1deg amenorrhoeaUrinary retentionPeriodic lower abdominal painSign: Visualization of tense bluish bulging membrane on separation of labia.Newborn - Mucocolpos (with in one week of birth)Diagnosis: USG pelvisTreatment of imperforate hymen: Cruciate incision on hymen(Commonest site at which hymen ruptures during intercourse - postero lateral area)

So the answer to this question is A


Instruction:
All of the following are contraindications for root
planning EXCEPT
A. deficient or overhanging margins of amalgam restorations
B. erosion and /or abrasion
C. recession
D. root caries

Response:
None

So the answer to this question is C


Instruction:
Acute lung injury in caused by all of the following except
A. Aspiration
B. Toxic gas inhalation
C. Cardiopulmonary bypass with hea lung machine
D. Lung contusion

Response:
ARDS, most cases (>80%) are caused by a relatively small number of clinical disorders: severe sepsis syndrome and/or bacterial pneumonia (~40-50%), trauma, multiple transfusions, aspiration of gastric contents, and drug overdose. Among patients with trauma, the most frequently repoed surgical conditions in ARDS are pulmonary contusion, multiple bone fractures, and chest wall trauma/flail chest, whereas head trauma, near-drowning, toxic inhalation, and burns are rare causes. Ref Davidson edition23rd pg 606,199,170

So the answer to this question is C


Instruction:
Ash leaf maculae is found in :
A. Tuberous sclerosis
B. Neurofibromatosis
C. Lymphangioma
D. None

Response:
A i.e. Tuberous sclerosis

So the answer to this question is A


Instruction:
Causes of a transudate ascites include all the following except:
A. Tuberculosis
B. Nephrotic syndrome
C. Hypoproteinemia
D. Congestive cardiac failure

Response:
None

So the answer to this question is A


Instruction:
All of the following statements are TRUE about second generation antihistaminic agents EXCEPT :
A. These do not impair psychomotor performance
B. These possess high anti–motion sickness activity
C. These lack anticholinergic actions
D. These may possess additional antiallergic mechanisms

Response:
Anti-motion sickness activity is related to the anticholinergic property. This property is exhibited by first-generation compounds whereas second-generation antihistaminics lack this potential.

So the answer to this question is B


Instruction:
Which of the following blood gas results is most likely in a patient with hyperventilation caused by anxiety?
A. increased PCO2
B. decreased PO2
C. decreased pH
D. decreased PCO2

Response:
The behavioral respiratory control system of the brain drives the hyperventilation, which leads to decreased PCO2 and increased pH. If alkalemia is present with the hypocarbia, symptoms can be quite significant. They include dizziness, visual impairment, syncope, and seizures secondary to cerebral vasoconstriction; paresthesia's, carpopedal spasm, and tetany (secondary to decreased free serum calcium); muscle weakness (secondary to hypophosphatemia); and cardiac arrhythmias (secondary to alkalemia).

So the answer to this question is D


Instruction:
Hard Tick causes a/e –
A. Relapsing fever
B. KFD
C. Indian tick typhus
D. Tularemia

Response:
None

So the answer to this question is A


Instruction:
Which of the following is not a cardioselective beta blocker?
A. Esmolol
B. Nebivolol
C. Acebutolol
D. Oxprenolol

Response:
Ans. is 'd' i.e., Oxprenoiol Selective b1 blockers are (cardioselective):1. Atenolol3. Bisoprolol5.Celiprolo!7. Metoprolol2. Acebutalol4. Betoxolol6. Esmolol8. Nebivolol

So the answer to this question is D


Instruction:
DOC for acute attack of asthma in patients on Beta blockers
A. Salbutamol
B. Theophylline
C. Ipratropium bomide
D. Chlorpheniramine

Response:
Respiratory airway has beta adrenergic receptors(beta 2 receptors). Beta 2 agonists cause bronchodilatation, and beta 2 blockers cause bronchoconstriction. ipratropium bromide:- Atropine like drugs cause bronchodilatation by blocking M3 receptor mediated cholinergic constrictor tone; act primarily in the larger airways which receive vagal innervation. Ipratropium bromideis a sho acting (duration 4-6 hours) inhaled anticholinergic bronchodilator, while tiotropium bromide is long acting (duration 24 hours). They are the bronchodilators of choice in COPD. Ref:- kd tripathi;pg num:- 227,228

So the answer to this question is C


Instruction:
What is not associated with DIC -
A. Thrombocytopenia
B. Increased PT
C. Hyperfibrinogenemia
D. Increased FDP

Response:
Plasma fibrinogen levels are reduced due to consumption in microvascular coagulation by which intravascular clotting occurs. Reference to earlier comments on normal blood coagulation (Chapter 3) may be helpful at this point. It suffices here to recall that clotting can be initiated by either the extrinsic pathway, which is triggered by the release of tissue factor (tissue thromboplastin); or the intrinsic pathway, which involves the activation of factor XII by surface contact, collagen, or other negatively charged substances. Both pathways lead to the generation of throm- bin. Clotting normally is limited by the rapid clearance of activated clotting factors by the macrophages and the liver, endogenous anticoagulants (e.g., protein C), and the con- comitant activation of fibrinolysis. DIC usually is triggered by either (1) the release of tissue factor or thromboplastic substances into the circulation or (2) widespread endothelial cell damage (Fig. 11-28). Throm- boplastic substances can be released into the circulation from a variety of sources--for example, the placenta in obstetric complications or ceain types of cancer cells, paicularly those of acute promyelocytic leukemia and adenocarcino- mas. Cancer cells can also provoke coagulation in other ways, such as by releasing proteolytic enzymes and by expressing tissue factor. In gram-negative and gram-positive sepsis (impoant causes of DIC), endotoxins or exotoxins stimu- late the release of tissue factor from monocytes. Activated monocytes also release IL-1 and tumor necrosis factor, both of which stimulate the expression of tissue factor on endo- thelial cells and simultaneously decrease the expression of thrombomodulin. The latter, you may recall, activates protein C, an anticoagulant (Chapter 3). The net result of these alterations is the enhanced generation of thrombin and the blunting of inhibitory pathways that limit coagulation. Severe endothelial cell injury can initiate DIC by causing the release of tissue factor and by exposing subendothelial col- lagen and von Willebrand factor (vWF). However, even subtle forms of endothelial damage can unleash procoagulant activity by stimulating the increased expression of tissue factor on endothelial cell surfaces. Widespread endothelial injury can be produced by the deposition of antigen-antibody complexes (e.g., in systemic lupus erythematosus), by tem- perature extremes (e.g., after heat stroke or burn injury), or by infections (e.g., due to meningococci or rickettsiae). As discussed in Chapter 3, endothelial injury is an impoant consequence of endotoxemia, and, not surprisingly, DIC is a frequent complication of gram-negative sepsis. Disorders associated with DIC are listed in Table 11-12. Of these, DIC is most often associated with sepsis, obstetric complications, malignancy, and major trauma (especially trauma to the brain). The initiating events in these conditions are multiple and often interrelated. For example, in obstetric conditions, tissue factor derived from the placenta, retained dead fetus, or amniotic fluid enters the circulation; however, shock, hypoxia, and acidosis often coexist and can lead to widespread endothelial injury. Trauma to the brain releases fat and phospholipids, which act as contact factors and thereby activate the intrinsic arm of the coagulation cascade. Whatever the pathogenetic mechanism, DIC has two con- sequences. First, there is widespread fibrin deposition within the microcirculation. The associated obstruction leads to ischemia in the more severely affected or vulnerable organs and hemolysis as red cells are traumatized while passing through vessels narrowed by fibrin thrombi (micro- angiopathic hemolytic anemia). Second, a bleeding diathesis results from the depletion of platelets and clotting factors and the secondary release of plasminogen activators. Plasmin cleaves not only fibrin (fibrinolysis) but also factors V and VIII, thereby reducing their concentration fuher. In addition, fibrinolysis creates fibrin degradation products. These inhibit platelet aggregation, have antithrombin activity, and impair fibrin polymerization, all of which contribute to the hemostatic failure (Fig. 11-28). Reference: textbook of Pathology, 7th edition, Author :Harsha Mohan, page number 317 Ref Robbins 9/e pg 450

So the answer to this question is C


Instruction:
Inferior rib notching is seen in
A. Coarctation of aoa
B. Rickets
C. ASD
D. Multiple myeloma

Response:
A i.e. Coarctation of aoa Inferior rib notching in coarctation of aoa is d/t pressure erosion of intercostal aeriesQ It usually takes several years to develop, so is unusual before 10 years of age.

So the answer to this question is A


Instruction:
Which state has the lowest IMR
A. Uttar Pradesh
B. Kerala
C. Tamil Nadu
D. Maharashtra

Response:
Ref:Park's Textbook of Preventive and Social Medicine 25th Ed

So the answer to this question is B


Instruction:
Absolute contraindication to ECT is:
A. Glaucoma
B. Brain tumor
C. Aoic aneurism
D. MI

Response:
There are no absolute contraindications for ECT. Earlier, raised intracranial tension and space occupying lesions were considered as absolute contraindications, hence the best answer here is brain tumor.

So the answer to this question is B


Instruction:
True about diabetic nephropathy -
A. Microalbuminiuria is not an indicator of long term cardiovascular morbidity.
B. Strict glycemic control cannot prevent microalbuminuria
C. b-islet cell\/pancreatic transplantation can improve the proteinuria in early stage.
D. Angiotensin receptor blockers have no additive advantage over other drugs except B.P. control.

Response:
Beta islet cell/ pancreatic transplantation can improve proteinuria in early stages.. Strict control of blood glucose retards the progression of any diabetes related complication Early pathological change and albumin excretion abnormalities is reversible with normalization of plasma glucose Administration of ACE inhibitors or ARB&;s, is also effective in slowing progression from Microalbuminuria to ove nephropathy Ref Harrison 17/e p 2287-88

So the answer to this question is C


Instruction:
SRK formula is used to calculate
A. Power of intraocular lens
B. Corneal curvature
C. Corneal endothelial cell count
D. Extent of retinal detachment

Response:
Answer- A. Power of intraocular lensIntraocular lens power calculation :- Which requires Keratometry (K), Axial length of eyeball or Biometry (L) and aconstant (A). It is calculated by SRK formula:Power of IOL= A- 2.5L -0.9K

So the answer to this question is A


Instruction:
Cells of parafollicular cells are derived from?
A. 1st branchial pouch
B. 2nd hrahchial pouch
C. 5th brachial pouch
D. 4th brachial pouch

Response:
C i.e. 5th brachial pouch

So the answer to this question is C


Instruction:
Anesthetic agent known to cause pain on intravenous injection:
A. Ketamine
B. Etomidate
C. Thiopentone
D. Propofol

Response:
Ans: (d) PropofolRef: Stoelting's Pharmacology and Physiology in Anesthetic Practice, 4th editionPropofol: Causes pain on intravenous injection due to presence of egg lecithin in its commercial preparation.Etomidate - Pain and venous irritation has been virtually eliminated with the use of lipid emulsion vehicle and avoid in propylene glycol.Ketamine and Thipenthol Na are not emulsion preparations and do not cause pain on IV injection.Composition of 1% Propofol Emulsion:1% propofol o 10% soyabean oil2.25% Glycerol o 1.2% egg lecithin0.005% di sodium edetate (to prevent bacterial growth)Prevention of pain duration IV injection of Propofol:Should be given in large bore cannula and in running fluidAdd 1% lidocaine with 10 ml of propofol before injectionGive fentanyl before propofol injectionUse lipid based formulation of propofolFospropofol (Aquavan): Is a phosphorylated prodrug of propofolNo pain on IV injectionLonger shelf half lifeSlight longer peak effect and more prolong duration of action1 mg Fospropofol=0.54mg propofol

So the answer to this question is D


Instruction:
Exclamation mark hairs are seen in:
A. Syphilis
B. Alopecia areata
C. Psoriasis
D. Dermatophytosis

Response:
Ans is 'b' i.e, Alopecia areata

So the answer to this question is B


Instruction:
Lady with recent delivery engorged shiny mass on breast under nipple fever -
A. Breast abscess
B. Fibroadenosis
C. Sebaceous cyst
D. Fibroadenoma

Response:
Ans. is 'a' i.e., Breast abscess * Features favouring breast abscess:# Lactating woman# Tender swelling# Pyreia# Tense shiny overlying skin* Diagnosis- Ultrasound would be the most useful investigation to diagnose the condition and in delineating the required extent of the drainage procedure.

So the answer to this question is A


Instruction:
Digoxin is useful in -
A. Atrial fibrillation in thyrotoxicosis
B. Complete hea-block with CHF
C. Ventricular tachycardia
D. Myocarditis

Response:
Ans. is 'b' i.e., Complete hea-block with CHF Digitalis has depressant action on AV node -4 it delayes the conduction through AV node by increased ERP. If paial block is present, digitals may conve it into complete block. But, if complete block is already present, digitalis cannot worsen the condition (as conduction is blocked to maximum block, i.e., complete hea block). So, in this condition digitalis can be used for hea failure. About other options In thyrotoxicosis and myocarditis there is reduced responsiveness and patient becomes more prone for digitalis induced arrhythmias. Digitalis is contraindicated in ventricular tachycardia as ventricular fibrillation may be precipitated.

So the answer to this question is B


Instruction:
Occupational hazards to the dentists result from
A. Posture
B. Accidental infection
C. Dermatitis
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
In ETC, oxidative phosphylartion (ATP formation) is regulated by
A. NADH Co-Q reductase
B. Cytochrome C oxidase
C. Co-Q cytochrome C reductase
D. All of these

Response:
NADH Co-Q reductase; 'b' i.e., Cytochrome C oxidase & `e' i.e., Co-Q cytochrome C reductase

So the answer to this question is D


Instruction:
Which of the following is content of Littre's hernia?
A. Urinary bladder
B. Meckel's diverticulum
C. Circumference of intestinal wall
D. Appendix

Response:
Ans. b (Meckel's diverticulum). (Ref. Bailey & Love, Surgery, 25lh/pg. 969, Ritcher Hernia (MH'2000)A Meckel's diverticulum = a Littre's hernia;An aphorism attributed to Dr. Charles Mayo: 'a Meckel's diverticulum is frequently suspected, often sought for and seldom found'.HerniasLittre's herniaMeckel's diverticulum is found in an inguinal or a femoral hernia sacRichter's herniaSac contains only a portion of the circumference of the intestine (usually small intestine). It usually complicates femoral and, rarely, obturator hernias.Dual(saddie bag; pantaloon)herniaConsists of two sacs which straddle the inferior epigastric artery, one sac being medial and the other lateral to this vessel.MAYDL'S hernia (SYN. HERNIA-IN-W).Strangulated loop of the "W" lies within the abdomen, thus local tenderness over hernia is not marked.Spigelian herniaA variety of interparietal hernia occurring at the level of the arcuate line, it is very rare with only 1000 cases reported in the literature.The fundus of the sac, clothed by extraperitoneal fat, may lie beneath the internal oblique muscle where it is virtually impalpable. More often it advances through that muscle and spreads out like a mushroom between the internal and external oblique muscles, and gives rise to a more evident swelling. The patient is often corpulent and usually over 50 years of age, men and women being equally affected. Typically, a soft, reducible mass will be encountered lateral to the rectus muscle and below the umbilicus.Diagnosis is confirmed by computerised tomography (CT) or ultrasound scanning, the latter having the advantage of being able to stand the patient upright if no defect is visible in the reclining position. Owing to the rigid fascia surrounding the neck, strangulation may occur.Lumbar herniaMost primary lumbar hernias occur through the inferior lumbar triangle of Petit, bounded below by the crest of the ilium, laterally by the external oblique and medially by the latissimus dorsi.Less commonly, the sac comes through the superior lumbar triangle which is bounded by the twelfth rib above, medially by the sacrospinalis and laterally by the posterior border of the internal oblique.More commonly lumbar hernias are secondary to renal operations, when extensive incisional sacs may be present.Educational Points:The rule that constipation is present in intestinal obstruction does not apply in:# Richter's hernia;# Gallstone obturation;# Mesenteric vascular occlusion;# Obstruction associated with a pelvic abscess;# Partial obstruction (faecal impaction/colonic neoplasm) where diarrhoea may often occur.

So the answer to this question is B


Instruction:
Testicular lymphatics drain into -
A. Deep inguinal lymphnodes
B. Internal iliac lymph nodes
C. Para aortic lymph nods
D. Superficial inguinal lymphnodes

Response:
Ans. is 'c' i.e., Para aortic lymph nods o Testicular lymphatics drain into paraaortic and prearotic group of lymph nodes at level of L2.o The lymphatics from the cervix drain into the external iliac, internal iliac and sacral nodes,o Lymphatic Drainage of uterus:Fundus and upper body - aortic nodes and superficial inguinal nodesLower body - external iliac nodesCervix - external iliac, internal iliac and sacral nodes,o Lymphatic drainage of Vagina:Upper 1/3 - external iliac nodesMiddle 1/3 - internal iliac nodesLower 1/3- superficial inguinal nodesOrganDraining Lymph nodeGians Penis & ClitorisRest of PenisDeep inguinal nodes of cloquefQSuperficial inguinal nodesTestis and ovaryPre & Para aortic lymph nodesParotid & ThyroidDeep cervical lymph nodesPharynxDeep cervical & Retropharyngeal lymph n.Palatine tonsilJugulo-diagastric lymph nodesTongue TipAnt 2/3Post 1/3rdSubmental lymph nodesSubmandibular lymph nodesJugulo-omohyoid lymph nodesAll finally reach deep cervical lymph nodesUterus & Cervix* Fundus & upper part of body o Mainly to aortic lymh nodeso Partly to superficial inguinal lymph nodes along round ligamento External iliac lymph nodeso External iliac lymph nodeso Internal iliac lymph nodeso Sacral lymph nodes* Lower part of body* CervixSuprerenal glando Lateral Aortic lymph nodesRectum & Anal Canal above pectinate line Anal canal below pectinate lineo Internal iliac lymph nodeso Superficial inguinal lymph nodes

So the answer to this question is C


Instruction:
Laryngeal mask Airway (LMA) is used for;
A. Maintenance of the airway
B. Facilitating laryngeal surgery
C. Prevention of aspiration
D. Removing oral secretions

Response:
A i.e. Maintenance of airway

So the answer to this question is A


Instruction:
True about parosteal osteosarcoma -
A. Same prognosis as medullary type
B. Never go to medulla
C. May involve medulla
D. All of the above

Response:
This question is quite different from previous one.
Though medullary cavity is not involved in parosteal osteosarcoma, some dedifferentiated type (grao sarcoma may involve medullary cavity. -- DD of bone tumor.

So the answer to this question is C


Instruction:
Nuclear family consist of -
A. Husband, wife and son
B. Husband, wife and dependent children
C. Husband and wife only
D. Fathermother husband and wife

Response:
- nuclear or elementary family consist of married couples and their children while they are still regarded as dependents. - husband plays the dominant role in nuclear family. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:683,684 <\p>

So the answer to this question is B


Instruction:
True regarding PKU is all except:-
A. Due to deficiency of phenyl alanine hydroxylase
B. Neurological symptoms are due to excess phenyl alanine
C. Blood phenyl alanine level >20 mg/dl causes severe disease
D. Method of choice for screening is urinary phenyl alanine by Guthrie;s test

Response:
Diagnosis of PKU was detected by screening the new-born babies for the increased plasma levels of phenylalanine (PKU, 20-65 mg/dl; normal 1-2mg/dl). This was carried out by Guthrie test, which is a bacterial (Bacillus subtilis) bioassay for phenylalanine. Phenylpyruvate in urine can be detected by ferric chloride test (a green colour is obtained). Method of Choice is Tandem Mass Spectrometry, also for all the Inborn metabolic Error disease

So the answer to this question is D


Instruction:
The "Ugly duckling" stage of the transitional dentition
is characterized by all of the following except
A. Deep overbite
B. Distoangular axial inclination of the maxillary incisors
C. Mandibular lateral incisors erupting lingual to the mandibular central incisors
D. Possible overjet

Response:
None

So the answer to this question is C


Instruction:
Which of the following drugs is best for reducing proteinuria in a diabetic patient ?
A. Metoprolol
B. Perindopril
C. Chlorothiazide
D. Clonidine

Response:
None

So the answer to this question is B


Instruction:
Delusion is a disorder of:
A. Thinking
B. Memory
C. Perception
D. Intellect

Response:
Ans. is 'a' Thinking Cognition (Thought) Disorders are -Schizophrenia*Obsessive compulsive neurosis*Delusions* & phobias*Also rememberHallucinations are disorder of - perception*

So the answer to this question is A


Instruction:
Characteristic feature of still's disease:
A. Prominent kidney involvement
B. Rashes
C. Positive Rheumatoid factor
D. Neutropenia

Response:
Ans. is 'b' Rashes Stills disease is a variant of rheumatoid commonly occurring in adults in 20's and 30's patients characteristics clinical features are:High spiking fever often upto 40deg C.Sore throatEvanescent salmon coloured non pruritic rash, seen on chest & abdomenLymphadenopathyPericardial effusionWrist joint involvementChances are that you might confuse it with Felty's syndrome so I am giving the important features of both these conditions togetherStills ds Feltv's syndromeRheumatoid arthritis * Rheumatoid arthritisSplenomegaly * SplenomegalyLeucocytosis * NeutropeniaRash * High titres of rheumatoid factorRheumatoid factor is usually not present

So the answer to this question is B


Instruction:
Organism most likely to cause "fever of unknown origin" in a farmer who raises goats
A. Brucella melitensis
B. Clostridium novyi
C. Histoplasma capsulatum
D. Mycobacterium tuberculosis

Response:
Human brucellosis is acquired from animals, directly or indirectly. Goats, sheep, cattle, buffalos, and swine are common sources. Most human infections in various pas of India are due to B.melitensis acquired from goats and sheep. Ref: Textbook of microbiology; Ananthanarayana and paniker's; 10th edition; Pg: 348

So the answer to this question is A


Instruction:
"Active management of third stage of labour" includes all of the following steps, except ?
A. Controlled cord traction
B. Uterine massage
C. Oxytocin
D. Methergine

Response:
WHO definition of PPH - Blood loss of 500 ml or more following vaginal delivery or blood loss 1000 ml or more following a caesarean section. Third stage of labor includes the period from delivery of the baby to delivery of placenta and membranes. Active management of third stage of labor for prevention of postpaum hemorrhage (PPH) includes: Intramuscular oxytocin 10 U given at the delivery of anterior shoulder. Controlled cord traction to deliver the placenta. Uterine massage holding the fundus of uterus after delivery of placenta. Recently, delayed cord clamping has be advocated for all deliveries to make sure the fetus gets maximum blood from the placenta (except cases like R. isoimmunisation and fetal distress, see table below). The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice, 2017 January repo, makes the following recommendations regarding the timing of umbilical cord clamping after bih: In term infants, delayed umbilical cord clamping increases hemoglobin levels at bih and improves iron stores in the first several months of life, which may have a orable effect on developmental outcomes. Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage. Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after bih. There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician-gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice. Delayed umbilical cord clamping does not increase the risk of postpaum hemorrhage. (Students to Please note the last point: This is the reason why 'early cord clamping' is not a pa of AMTSL)

So the answer to this question is D


Instruction:
A chronic alcoholic is presenting with clinical features of meningitis. Most likely organism which will grow on CSF culture:
A. Streptococcus pneumoniae
B. N. meningitidis
C. Listeria monocytogenes
D. E coli

Response:
Streptococcus pneumoniae REF : ananthanarayana 10th ed

So the answer to this question is A


Instruction:
Third coronary aery is -
A. Right coronary aery
B. Left coronary aery
C. Conus aery
D. Anterior interventricular aery

Response:
Ans. is 'c' i.e.,Conus aeryThird coronary aery is seen only in 50% of human heas. It is also called conus aery.The conus aery is a small early branch off the right coronary aery (RCA) circulation.

So the answer to this question is C


Instruction:
Waste types not to be incinerated are
A. Pressurized gas containers
B. Reactive chemical waste
C. Radiographic waste
D. All of the above

Response:
Categories of bio-medical waste in IndiaCategory NoWaste category1Human anatomical waste2Animal waste3Microbiology and biotechnology waste4Sharps5Discarded medicines and cytotoxic drugs6Solid waste 7Solid waste 8Liquid waste9Incineration ash10Chemicals used in the production of biologicalsColor codingType of containerWaste categoryTreatment optionsYellowPlastic bagCat 1, 2, 3 & 6Incineration/deep burialRedDisinfected container/plastic bagCat 3, 6 & 7Autoclaving/Microwaving/Chemical treatmentBlue/White translucentPlastic bag/Puncture proof containerCat 4 & 7Autoclaving/Microwaving/Chemical treatment and Destruction/ShreddingBlackPlastic bagCat 5, 9 & 10 Disposal in secured landfillRef: Park; 23rd ed; Pg 793, 794

So the answer to this question is D


Instruction:
Clara cells are seen in:
A. Bronchoalveolar cell Ca
B. Small cell Ca
C. Squamous cell Ca
D. Non small cell Ca

Response:
Ans: a (Bronchoalveolar cell Ca) Ref: Robbins, 7th ed, p. 761Clara cells are seen in bronchoalveolar carcinomaBronchoalveolar cell Ca1 -9% of lung tumoursAffect terminal bronchoalveolar regionsGrowth pattern is referred to as "Lepdic"Types:Non mucinous - Columnar, peg shaped or cuboidal cellsMucinous - Distinct columnar with cytoplasmic & intra-alveolar mucinAerogenous spread presentG/A: Single or multiple nodules coalescing to form pneumonia like consolidationM/E: Mucin secreting bronchoalveolar cellsClara cellsType II pneumocytes.

So the answer to this question is A


Instruction:
A female patient presented with left iliac fossa pain for the past 6 months. On investigation, a 3 cm left renal pelvic stone was found with no hydroureteronephrosis, normal functioning kidneys on both sides and no distal obstruction. The ideal management would be
A. Percutaneous nephrolithotomy (PCNL)
B. Extra-corporeal shock wave lithotripsy (ESWL)
C. Laparoscopic nephrolithotomy
D. Medical dissolution therapy with oral potassium citrate

Response:
Ans. a. Percutaneous nephrolithotomy

So the answer to this question is A


Instruction:
The thickness of the spacer used in special tray is
A. 2.5 mm
B. 2.0 mm
C. 1.5 mm
D. 1.0 mm

Response:
None

So the answer to this question is B


Instruction:
The most common cardiovascular lesion in Down&;s syndrome is:
A. VSD
B. Endocardial cushion defect
C. TOF
D. COA

Response:
The most common cardiovascular lesion in Down&;s syndrome is endocardial cushion defect. Other associated defects are atrial septum defects(ASD), ventricular septum defect(VSD), and patent ductus aeriosus(PDA), aberrant subclan aery, and pulmonary hypeension. Clinical Features: Intellectual disability/Incurved or sho fifth finger with clinodactyly Congenital hea disease Acute megakaryoblastic leukemia/Alzheimer&;s disease/Atlantoaxial instability/Atresia of the duodenum Protruding tongue Round face Occiput flat/Open wide fontanelle/Open mouth Brachycephalic/Brushfiel&;s spots Low (depressed) nasal bridge Epicanthal fold/Ears low set and dysplastic Mongoloid slant (Oblique palpebral fissure) Simian palmar crease and wider gap between first and second toes. Ref: Nelson textbook of pediatrics 21st edition Pgno: 660

So the answer to this question is B


Instruction:
Which of the following drug can be used topically in eye: September 2007
A. Erythromycin
B. Ganciclovir
C. Clindamycin
D. Tetracyclines

Response:
Ans. D: Tetracyclines Tetracyclines are broad spectrum antibiotics with considerable bacteriostatic action against both gram-positive and gram-negative organisms as well as some fungi, rickettsiae and the chlamydiae. They are essentially used in the form of drops or ointment for superficial ocular infections such as trachoma. They get deposited in bones and teeth and hence not to be used in children and pregnant/lactating women.

So the answer to this question is D


Instruction:
Regarding the use of halothane in obsteric surgery,which is true –
A. There is increased risk of PPH
B. It has no effect on uterine musculature
C. Best used in caesarean section
D. None is true

Response:
As halothane causes uterine relaxation, post-partum hemorrhage can occur.

So the answer to this question is A


Instruction:
Study time, place, and person of a disease is ________________ study-
A. Descriptive
B. Analytic
C. Association
D. Comparison

Response:
.DESCRIPTIVE STUDIES are usually the first phase of epidemiological investigation.these studies are concerned with observing the distribution of disease or healthrelated charecteristics in human populations.procedures in descriptive epidsemiology mainly includes,defining the population to be studied,defining the disease under study,describing the disease by time,place,person and measurement of disease. etc. ref:park&;s textbook of preventive and social medicine,22nd edition,pg no 60

So the answer to this question is A


Instruction:
Dicrotic notch is due to ?
A. AV valve closure
B. Mitral valve closure
C. Pulmonary valve closure
D. Tricuspid valve closure

Response:
dicrotic notch. : a secondary upstroke in the descending pa of a pulse tracing corresponding to the transient increase in aoic pressure upon closure of the aoic valve. -- called also dicrotic wave Ref Davidson 23rd edition pg 430

So the answer to this question is A


Instruction:
The number of girls a woman would bear if she passes through her reproductive age with the same feility rate gives: March 2009
A. Total feility rate
B. Feility rate
C. Gross reproductive rate
D. Net reproductive rate

Response:
Ans. C: Gross reproductive rate The net reproduction rate (NRR) measures the effective feility in a population, taking account not only of bihs but also of the fact that not all women born will survive to their own reproductive years. The NRR is the average number of daughters of reproductive age that a woman would have if she experienced over her lifetime the prevailing age-specific rates of feility and if her daughters experienced the prevailing rates of moality. The gross reproduction rate (GRR) for a paicular year is the average number of daughters that a woman would have if she experienced over her lifetime the age-specific feility rates of that year. In that it refers only to the number of daughters born to women, not the total number of children, it is a special case of the (period) total feility rate; in most circumstances (unless the sex ratio at bih is highly unequal) the GRR equals roughly half the TFR. The general feility rate is similar to the crude bih rate except that it uses a more restricted denominator, the female population of childbearing age, ages 15 to 49. Age-specific feility rates (also called age-specific bih rates) are similar to the crude bih rate but are calculated for specific age groups of women of childbearing age. The range of childbearing ages is conventionally considered to be ages 15 to 49 (sometimes 15 to 44 is used), and a full set of age-specific feility rates would span this interval-usually either in single-year age groups or, more commonly, in five-year groups: 15 to 19, 20 to 24, ..., 45 to 49. Marital feility rates can be calculated either for the full range of reproductive ages (15 to 49 or 15 to 44) or as age-specific rates. The numerator is usually taken as the total number of live-bihs to women in the specified age range, regardless of the marital status of the mother; the denominator is the number of currently married women in the specified age range The total feility rate (TFR) at a given time (technically referred to as the period total feility rate) is the average number of children a woman would bear in her life if she experienced the age-specific feility rates prevailing at that time.

So the answer to this question is C


Instruction:
Which is not seen in polycythemia vera -
A. Increased vitamin B12 binding capacity
B. Increase erythropoietin level
C. Increase RBC count
D. Ocular congestion

Response:
None

So the answer to this question is B


Instruction:
Conclusive test for semen: Jharkhand 11
A. Acid phosphatase test
B. Barberio test
C. Florence test
D. Phenolphthalein test

Response:
Ans. Acid phosphatase test

So the answer to this question is A


Instruction:
Which of the following is not a surgical method for tubal ligation ?
A. Pomeroy
B. Parkland
C. Essure
D. Irving

Response:
Various methods are Pomeroy method, Parkland procedure, madlener procedure, Irwing, Uchida, Aldridge, Shirodkar etc. THE TEXTBOOK OF GYNAECOLOGY SHEILA BALAKRISHNAN SECOND EDITION PAGE NO 388

So the answer to this question is C


Instruction:
Intravenous Mannitol is indicated in
A. Normal tension glaucoma
B. Acute angle closure glaucoma
C. Sympathetic ophthalmitis
D. Primary Open angle glaucoma

Response:
* Iv mannitol is an hyperosmotic agents which acts by increasing the osmotic pressure in the plasma thereby imbibing water from the vitreous . Indications:- * Acute rise in IOP --> Primary angle closure glaucoma, Secondary angle closure glaucoma , Posner Schlossman syndrome * In the pre-operative period to reduce IOP in case of lens induced glaucomas, trabeculectomy, etc. Dosage:- * 1-2 mg /kg body weight ; 20% solution Adverse Effects:- * Volume overload in cardiac patients * Increase in BP Other Hyperosmotic Agents: - * Glycerol - increases blood glucose, Contraindicated in Diabetics. * Urea - not routinely used * Isosorbide Ref:- Parson's Diseases of the eye 22nd edition; pg num:- 53,76

So the answer to this question is B


Instruction:
Candidiasis is a complication of all of the following except
A. Prolonged antibiotic therapy
B. Corticosteroid therapy
C. Immuno compromised disease
D. Aspiration pneumonia

Response:
None

So the answer to this question is D


Instruction:
Serum enzyme used for MI -
A. CPK
B. Alkaline phosphatase
C. Acid phosphatase
D. Lipase

Response:
Ans. is 'a' i.e., CPK Organ/dtseaseSerum Enzymes used for assayHeart (Myocardial infarction)o Commonly used: - Creatine phosphokinae (CK or CPK Q), Aspartate transaminase (AST or SCOT Q), LDH Qo Not commonly used : - g-glutamyl transpeptidase, Histaminase. Pseudocho 1 inesteraseMusclesSGOT (AST) Q, SGPT (AJLT) Q, aldolase, CPK QBoneAlkaline phosphatasePancreatitisAmylase, lipaseLiverSGOT (AST), SGPT (ALT), Alkaline phosphatase, g-glutamyl transferase, LDH (isozyme-5).

So the answer to this question is A


Instruction:
Medical treatment of unruptured ectopic pregnancy is contraindicated in :
A. Sac size 3 cm
B. HCG level 3000 IU
C. Foetal hea activity present
D. 70 ml blood collection in pelvis

Response:
Foetal hea activity present

So the answer to this question is C


Instruction:
False about Tinea versicolor
A. It is superficial fungal infection caused by Malassezia
B. Scratch sign is positive
C. Lesions can be both hypo & hyperpigmented
D. Wood's lamp examination gives Apple green Fluorescence

Response:
The lesions show "Pale yellow" Flourescene on Wood's lamp examination.

So the answer to this question is D


Instruction:
Which is most common side effect of inhaled beclometh- asone dipropionate:
A. Pneumonia
B. Oropharyngeal candidiasis
C. Atrophic rhinitis
D. Pituitary adrenal suppression

Response:
Ans. (b) Oropharyngeal candidiasis* Most of the side effects of steroids are mainly hoarseness, orophyrangeal candidiasis, decreased growth in children with adrenal suppression.* The plausible explanation is that since these drugs are inhaled, they avoid the first pass metabolism that orally administered steroids undergo and hence have preponderance to cause the usual manifestations of steroid toxicity.

So the answer to this question is B


Instruction:
All of the following drugs act on ionic channels except:
A. Nicotine
B. Insulin
C. Glibenclamide
D. Diazepam

Response:
Ans. B. Insulina. insulin acts on enzymatic (tyrosine kinase) receptorsb. Nicotine acts on NM and NN receptors which are ion channel receptorsc. Diazepam acts on GABA-BZD-Cl channel complex that mediates entry of chlorided. Glibenclamide is a sulfonylurea that acts on ACh sensitive K+ channels.

So the answer to this question is B


Instruction:
Sialyl-Lewis X is linked to  __________.
A. Selectin
B. ICAM
C. CD31
D. VCAM

Response:
The two major families of molecules involved in leukocyte adhesion and migration are the selectins and integrins
These  molecules  are  expressed  on leukocytes and endothelial cells.
Selectins mediate the initial weak interactions between leukocytes  and  endothelium.

So the answer to this question is A


Instruction:
Meissner's corpuscle is for-
A. Touch
B. Temperature
C. Pressure
D. Proprioception

Response:
Ans. A. TouchCUTANEOUS MECHANORECEPTORS: -Sensory receptors can be specialized dendritic endings of afferent nerve fibers, and they are often associated with non- neural cells that surround them forming a sense organ. Touch and pressure are sensed by four types of mechanoreceptors.a. Meissner corpuscles are dendrites encapsulated in connective tissue and respond to changes in texture and slow vibrations.b. Merkel cells are expanded dendritic endings, and they respond to sustained pressure and touch.c. Ruffini corpuscles are enlarged dendritic endings with elongated capsules, and they respond to sustained pressure.d. Pacinian corpuscles consist of unmyelinated dendritic endings of a sensory nerve fiber, 2 um in diameter, encapsulated by concentric lamellae of connective tissue that give the organ the appearance of a cocktail onion. These receptors respond to deep pressure and fast vibration.e. The sensory nerves from these mechanoreceptors are large myelinated Aa and Ab fibers whose conduction velocities range from ~ 70-120 to ~ 40-75 m/s, respectively.a. Sensory systems encode four elementary attributes of stimuli: modality, location (receptive field), intensity, and duration (timing).b. The human hand has four types of mechanoreceptors; their combined activation produces the sensation of contact with an object. Selective activation of Merkel cells and Ruffini endings causes sensation of steady pressure; selective activation of Meissner and Pacinian corpuscles causes tingling and vibratory sensation.c. Location of a stimulus is encoded by spatial distribution of the population of receptors activated. A receptor fires only when the skin close to its sensory terminals is touched. These receptive fields of mechanoreceptors (shown as red areas on fingertips) differ in size and response to touch. Merkel cells and Meissner corpuscles provide the most precise localization as they have the smallest receptive fields and are most sensitive to pressure applied by a small probe.d. Stimulus intensity is signaled by firing rates of individual receptors; duration of stimulus is signaled by time course of firing. The spike trains indicate action potentials elicited by pressure from a small probe at the center of each receptive field. Meissner and Pacinian corpuscles adapt rapidly; the others adapt slowly.

So the answer to this question is A


Instruction:
Modafinil is approved by FDA for treatment of all, except:
A. Narcolepsy
B. Shift work syndrome (SWS)
C. Obstructive sleep apnea syndrome (OSAS)
D. Lethargy in depression

Response:
Modafinil is an FDA approved drug in the treatment of obstructive sleep apnea, shift work disorder and narcolepsy. It is not FDA approved in the treatment of lethargy in major depression. Ref: Sleepiness: Causes, Consequences and Treatment By Michael J. Thorpy, Pages 415-6

So the answer to this question is D


Instruction:
Which of the following is true regarding thyrotoxicosis?
A. In Grave’s disease, antibodies are formed to TSH receptors, which result in excessive thyroxine secretion
B. Hashimoto's thyroiditis occur in young males
C. In primary hypothyroidism, decreased TSH levels are seen
D. All of the above

Response:
Pathophysiology of Graves’ thyrotoxicosis
The thyrotoxicosis results from the production of immunoglobulin G (IgG) antibodies directed against the TSH receptor on the thyroid follicular cell, which stimulate thyroid hormone production and proliferation of follicular cells, leading to goitre in the majority of patients. These antibodies are termed thyroid-stimulating immunoglobulins or TSH receptor antibodies (TRAb) and can be detected in the serum of 80–95% of patients with Graves’ disease.
The concentration of TRAb in the serum is presumed to ﬂuctuate to account for the natural history of Graves’ thyrotoxicosis. Thyroid failure seen in some patients may result from the presence of blocking antibodies against the TSH receptor, and from tissue destruction by cytotoxic antibodies and cell-mediated immunity.
Hashimoto’s thyroiditis is characterised by destructive lymphoid inﬁltration of the thyroid, ultimately leading to a varying degree of ﬁbrosis and thyroid enlargement. Hashimoto’s thyroiditis increases in incidence with age and affects approximately 3.5 per 1000 women and 0.8 per 1000 men each year.
In the vast majority of cases, hypothyroidism results from an intrinsic disorder of the thyroid gland (primary hypothyroidism). In this situation, serum T 4  is low and TSH is elevated, usually in excess of 20 mIU/L. Measurements of serum T 3  are unhelpful since they do not discriminate reliably between euthyroidism and hypothyroidism.
Reference: : Davidson P R I N C I P L E S   and Practice O F M E D I C I N E 23rd edition page no  643,646, 640

So the answer to this question is A


Instruction:
Somatomedin mediates which of the following process?
A. Deposition of chondroitin sulfate
B. Lipolysis
C. Gluconeogenesis
D. Decreased rate of glucose uptake by cells

Response:
Somatomedins are polypeptide growth factors secreted by the liver and other tissues. The first of these factors isolated was called sulfation factor because it stimulated the incorporation of sulfate into cailage. However, it also stimulated collagen formation, and its name was changed to somatomedin. It then became clear that there are a variety of different somatomedins and that they are members of an increasingly large family of growth factors that affect many different tissues and organs. The principal (and in humans probably the only) circulating somatomedins are insulin-like growth factor I (IGF-I, somatomedin C) and IGF-II. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 18. The Pituitary Gland. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds),Ganong's Review of Medical Physiology, 24e.

So the answer to this question is A


Instruction:
Which one of the following statements regarding collagen is true?
A. It is composed of Tropocollagen.
B. Reticular Fibers are composed of type II collagen.
C. It is synthesized mostly by Mast cells.
D. Elastic Fibers are composed of type IV collagen.

Response:
Collagen is composed of closely packed Tropocollagen Molecules. Reticular Fibers are composed of type III collagen, Elastic Fibers are composed of Elastin microfibrils rather than collagen. Collagen is synthesized by Fibroblasts not mast cells.

So the answer to this question is A