Instruction:
With increase in age which of the following is true for lungs
A. Pulmonary compliance increases
B. Residual volume decreases
C. Mucocillary clearance increases
D. The alveolar dead space decreases

Response:
Ageing and Lung Changes * Decreased chest wall compliance is counter balanced by a loss of elastic recoil of the lungs (increased lung compliance), which is due to a decrease in the number of parenchymal elastic fibers. * Chest wall and thoracic spine deformities which leads to increase work of breathing. * Dilation of air spaces: "senile emphysema". * Respiratory muscle strength decreases with age and this impairs effective cough, which is impoant for airway clearance. * Clearance of paicles from the lung through the mucociliary elevator is decreased and associated with ciliary dysfunction. * The alveolar dead space increases with age, affecting aerial oxygen without impairing the carbon dioxide elimination. * The airways receptors undergo functional changes with age and are less likely to respond to drugs used in younger counterpas * Decreased sensation of dyspnea and diminished ventilatory response to hypoxia and hypercapnia, making them more vulnerable to ventilatory failure during high demand states (ie, hea failure, pneumonia, etc) * Decreases in the volume of the thoracic cavity and reduced lung volumes. Hence Residual volume increases. Ref:- Relationship between chest wall and pulmonary compliance and age Charles Mittman, Norman H. Edelman, Ahur H. Norris, and Nathan. Pg num:- 202

So the answer to this question is A


Instruction:
A luminal cell membrane Na+ channel is the main pathway for Na+ reabsorption in:
A. Proximal tubule cells
B. Thick ascending limb cells
C. Distal convoluted tubule cells
D. Collecting duct principal cells

Response:
Ans D. Collecting duct principal cellsNa+ reabsorption by collecting duct principal cells occurs via a Na+ channel called ENaC (epithelial sodium channel). Na+ reabsorption in proximal tubule cells is coupled to transport of solutes via cotransport (e.g., Na-glucose) and antiport (e.g., Na+/H+ exchanger) mechanisms. Na+ reabsorption in the thick ascending limb involves a Na-K-2Cl cotransporter and, in the distal convoluted tubule, a Na-Cl cotransporter. Collecting duct intercalated cells are primarily concerned with acid-base, not Na+, transport.

So the answer to this question is D


Instruction:
Calculus is most common in which salivary gland?
A. Submandibular
B. Sublingal
C. Parotid
D. Minor salivary glands

Response:
Ans. is 'a' i.e., Submandibular Salivary calculio Calculi may form in the ducts of the submandibular or parotid glands.o They are formed by the deposition of calcium phosphate on the organic matrix of mucin or cellular debris,o About 90% of the stones are seen in the submandibular and 10% in the parotid glands,o Stones my form in the duct or parenchyma of the gland.

So the answer to this question is A


Instruction:
Which of the following dorsiflexes the foot -
A. Tibialis posterior
B. Tibialis anterior
C. Peroneus brevis
D. Extensordigitorum brevis

Response:
Ans. is 'b' i.e., Tibialis anterior Ankle movementPrincipal musclesAccessory musclesDorsiflexionTibialis anteriorEDL, EHL, Peroneus tertiusPlantar flexionGastrocnemius, SoleusPlantaris. Tibialis posterior, FDL, FHL

So the answer to this question is B


Instruction:
The size of actual focal spot is:
A. 1x3 mm
B. 1x1 mm
C. 1x4 mm
D. 1X2 mm

Response:
None

So the answer to this question is A


Instruction:
Which of the following structures is common to all sphingolipids?
A. Carnitine
B. Ceramide
C. Diacylglycerol
D. Sphingomyelin

Response:
Sphingolipids are a class of lipids that are structural components of membranes. Ceramide is a component of sphingolipids. Ceramide is composed of sphingosine, a long-chain amino alcohol with a saturated fatty acid linked to the amino group. Sphingolipids can be differentiated on the basis of the "X" group that is esterified to the terminal hydroxyl group of ceramide. Carnitine is involved in the oxidation of fatty acids. Carnitine is impoant in transferring fatty acids from the cytoplasm into the mitochondria (the carnitine shuttle). Diacylglycerol is the alcohol common to all phospholipids. The second alcohol (e.g., choline, ethanolamine, serine) contributes the polar head that distinguishes the different classes of phospholipids. Like sphingolipids, phospholipids are found in membranes. Sphingomyelin is a sphingolipid with phosphocholine as its "X" group. It is a component of the myelin sheath. Ref: Botham K.M., Mayes P.A. (2011). Chapter 24. Metabolism of Acylglycerols & Sphingolipids. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.

So the answer to this question is B


Instruction:
Brain damage in phenylketonuria is due to accumulation of-
A. Tyrosine
B. Phenylalanine
C. Tryptophan
D. None

Response:
Ans. is 'b' i.e., Phenylalanine "The primary symptom of untreated phenylketonuria (i.e. mental retardation) is the result of consuming foods that contain phenylalanine, which is toxic to brain tissue "Phenviaketonuriao It is an autosomal recessive disorder due to deficiency of phenylalanine hydroxylase.o As a result phenylalanine is not metabolized by hydroxylase, and metabolism is shifted to alternative pathvway and there is increased concentration of phenylalanine, phenylpyruvate, phenylacetate and phenyl-lactate.o Because phenylalanine is not converted into tyrosine, tyrosine becomes art essential amino acid.o Classical phenylketonuria is due to deficiency ofphenylalanine hydroxylase. Milder form may be caused by deficiency of dihydrobiopterin reductase that produces tetrahydrobiopterin, a cofactor for phenylalanine hydroxylase.Clinical presentationo The babies are normal at birth but may present with vomiting. Gradually mental retrardation and growth retardation develop. Baby has light complexion with blue iris. Other features are microcephaly, rash, hypertonia, seizures, exaggerated tendon reflex, wide spaced teeth, enamel hypoplasia and hyperactivity.o There is musty or mousy odour of urine and other body secretions due to presence of phenylketones.o Pregnant females with increased pheynlalanine (maternal phenylketonuria) may cause mental retardation, microcephaly, growth retardation and CHDs in babies.Diagnosiso Elevated phenylalanine levelso Elevated blood tyrosine levelo Presence of urinary metabolites of phenylalanineo Guthrie's Test - It detects the presence of phenylalanine in serumo FeCl3 - It detects the presence of phenylalanine in urine. FeCl3 is added to patients urine. If it contains phenylalanine, it will turn green.o 2-4 Dinitrophenol hydrazine - gives yellow precipitate with old urine.Treatmento Administration of low phenylalanine is the mainstay of treatment (but phenylalanine should not be completely restricted as it is necessary for growth). Tetrahydrobiopterin can be used in milder form.

So the answer to this question is B


Instruction:
Which of the following is the sign of increased intracranial tension in skull x-ray in an infant?
A. Separation of the sutures
B. Tense anterior fontanelle
C. Macewen's sign
D. All of the above

Response:
In increased intracranial tension (ICT), there is separation of the cranial sutures, wide fontanels and increased head circumference. The Macewen's or crackpot sign indicates raised intracranial pressure after sutures and fontanel have closed. Papilledema is unusual in infant unless the increase in intracranial pressure is very rapid. Ref: Ghai Essential Pediatrics, 6th edition, Page 525.

So the answer to this question is D


Instruction:
Delayed afterdepolarization implies-
A. Increased intracellular Ca2+
B. Excessive catecholamines
C. Digitalis toxicity
D. All of the above

Response:
Ans. is 'd' i.e., All of the above Triggered Activity* Triggered activity occurs when abnormal action potentials are triggered by a preceding action potential, and can result in either atrial or ventricular tachycardia. The abnormal impulses are seen as spontaneous (yet triggered) depolarizations that occur during either phase 3 or 4 of an action potential (called "afterdepolarizations"). Triggered activity is more likely to occur when the action prolonged action potential manifested as a long Q-T interval on the electrocardiogram (long Q-T syndrome). Drugs that prolong the action potential duration, such as potassium-channel blockers (class III antiarrhythmics) can sometimes precipitate triggered activity.* After depolarizations can be either early or delayed. Early afterdepolarizations occur during late phase 2 or phase 3 and can lead to a salvo of several rapid action potentials or a prolonged series of action potentials. This form of triggered activity is more likely to occur when the action potential duration is increased. Therefore, drugs that decrease action potential duration (e.g., lidocaine) are often effective against tachyarrhythmias generated by this mechanism. Calcium channel blockers, by decreasing gCa++ can also be effective in their treatment.* Delayed afterdepolarizations occur in late phase 3 or early phase 4 when the action potential is nearly of fully repolarized. The mechanism is poorly understood; however, this type of arthythmia is found to be associated with high intracellular Ca++ concentrations as occurs with digitalis toxicity or excessive catecholamine stimulation. The triggered impulse can lead to a series of rapid depolarizations (i.e. a tachyarrhythmia).

So the answer to this question is D


Instruction:
False about paial mole
A. Caused by triploidy
B. Can be diagnosed very early by USG
C. Can present as missed aboion
D. Rarely causes persistent GTD

Response:
Ans. is b i.e. can be diagnosed very early by USG Paial moles Paial moles or incomplete molar pregnancy means that along with the hydatidiform changes some element of fetal tissue is present They have a triploid karyotype (69 chromosomes)deg, the extra haploid set of chromosomes usually is derived from the fatherdeg. Characteristic pathological features of paial mole Chorionic villi of varying sizes with focal hydatiform swelling, cavitation and trophoblastic hyperplasia Marked villous scalloping Prominent stromal trophoblastic inclusions Identifiable embryonic or fetal tissue. Clinical features -- hey generally do not have the dramatic clinical features characteristic of complete pt general these patients have the signs and symptoms of incomplete or missed aboion, and paial mole can be diagnosed after histologic review of tissue obtained by curettage". Features like hyperemesis, hypehyroidism and Theca lutein cysts are rare in paial mole. Prognosis "The risk of persistent trophoblastic disease after a paial mole is substancially lower than following a complete molar pregnancy. Moreover, persistent disease is seldom a choriocarcinoma." The risk of persistent trophoblastic disease in a case of paial mole is 1-5% wherease with complete mole, it is 15-20% Hence option d i.e. it rarely causes persistent trophoblatic disease is paially correct Diagnosis -- of paial mole by USG is not that easy as is in the case of complete mole because it does not give the characteristic vesicular & ultrasonographic appearance like a complete mole. "Sonographic features of a paial mole include a thickened, hydropic placenta with fetal tissue. Impoantly, in early pregnancy, sonographv will demon t te the rho raeristic appearance in as few as third of women with a paial mole" ... Williams Obs 23/ed pg-260 Hence Option b i.e. it can be diagnosed very early by USG is incorrect Remember - - The USG criteria for diagnosis of paial mole is Presence of focal cystic areas in the placental tissues . Increase in transverse diameter of gestational sac. The combination of above two criterias have a positive predictive value of 90% for paial moles . (This means USG can diagnose paial mole but not in early pregnancy) The nonble fetus associated with a triploid paial mole typically has multiple malformations, like syndactyly and hydrocephaly and have symmetrical growth retardation. 13 hcg levels > 200 m IU/rni, after evacuation of paial mole in the third through the eighth week are associated with a 35% risk of persistent trophoblastic disease. Extra edge The most significant recent development in the pathological analysis of H. mole is the use of P57kip2 immunostaining to make a definitive diagnosis of androgenetic complete H. Mole as opposed to an hydropic aboion or a paial mole. P57kip2 is a paternally imprinted gene. which is maternally expressed. The absence of maternal genes in androgenetic complete mole means that the gene cannot be expressed in a complete mole cytotrophoblast Hence V kip2 staining is negative in complete mole in contrast to paial moles, hydropic aboion & normal placenta. This technique is well validated, easy and inexpensive to perform.

So the answer to this question is B


Instruction:
Least mobile metatarsal of foot
A. 1st metatarsal
B. 2nd metatarsal
C. 3rd metatarsal
D. 4th metatarsal

Response:
2nd metatarsal is longest and least mobile among all metatarsals, hence more prone for March fracture

So the answer to this question is B


Instruction:
Long term fluctuation is
A. Secular
B. Cyclical
C. Seasonal
D. Periodic fluctuation

Response:
Ans. is 'a' i.., Secular

So the answer to this question is A


Instruction:
Function of I cells of kidney -
A. Na+ reabsorption
B. Cl- reabsorption
C. H+ secretion
D. K+ secretion

Response:
Ans. is'c'i.e., H+ secretionCollecting duct has :-Principal cells (P cells), which are involved in Na+ reabsorption and ADH stimulated water reabsorption.Intercalated cells (I cells) which are concerned with acid (H.) secretion and HCO transPo

So the answer to this question is C


Instruction:
Ileocecal tuberculosis is associated with
A. Megaloblastic anemia
B. Iron deficiency anemia
C. Sideroblastic anemia
D. Normocytic normochromic anemia

Response:
.* Abdominal pain is the most common symptom (90%). It is dull in mesenteric type; colicky in intestinal type. * Common in 25-50 years age group. Equal in both sexes. * Anaemia,megaloblastic type , loss of weight and appetite (80%). * Diarrhoea--10-20%. * Fever--50-70%. ref:SRB&;s manual of surgery,ed 3,pg no 514

So the answer to this question is A


Instruction:
Specific role of endoplasmic reticulum
A. Lipid biosynthesis
B. Lipid catabolism
C. Maintenance of calcium store
D. Pentose phosphate pathway

Response:
None

So the answer to this question is A


Instruction:
A boy presented with weakness in lower limbs, calf hyperophy, positive Gower's sign and an elevated CPK value of 10,000. The most likely diagnosis is:
A. Duchenne Muscular Dystrophy
B. Spinal Muscular Atrophy
C. Myotonia congenita
D. Myotonic Dystrophy

Response:
A male child presenting with lower limb weakness, calf hyperophy, Postive Gower's sign associated with high levels of CPK suggests the diagnosis of DMD. Ref: Essential of Pediatrics By O P Ghai, 6th Edition, Page 547-548

So the answer to this question is A


Instruction:
Udai Pareek scale does not include
A. Education
B. Family members
C. House
D. Income

Response:
None

So the answer to this question is D


Instruction:
Secondary deposits from prostatic carcinoma is commonest in -
A. Bone
B. Kidney
C. Liver
D. Brain

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

So the answer to this question is A


Instruction:
Interferon interferes with replication of virus at the time of:
A. Protein synthesis
B. DNA/RNA replication
C. When virus enters the cell
D. Uncoating of the virus protein capsule

Response:
Interferons are proteins that can induce a nonspecific resistance to viral infection by several mechanisms, including the inhibition of protein synthesis, inactivation of viral RNA, and enhancement of phagocytic and cytotoxic mechanisms.

So the answer to this question is A


Instruction:
Not involved in damage to cerebellum:March 2010
A. Posture
B. Equilibrium
C. Asthenia
D. Tone

Response:
Ans. C: AstheniaSigns of Cerebellar DisordersAtaxia, Reeling, wide-based gait- decomposition of movements, Inability to correctly sequence fine, coordinated actsDysahria-Inability to aiculate words correctly, with slurring and inappropriate phrasingDysdiadochokinesia-Inability to perform rapid alternating movementsDysmetria-Inability to control range of movementHypotonia-Decreased muscle toneNystagmus-Involuntary, rapid oscillation of the eyeballs in a horizontal, veical, or rotary direction, with the fast component maximal toward the side of the cerebellar lesionScanning speech-Slow enunciation with a tendency to hesitate at the beginning of a word or syllableTremor-Rhythmic, alternating, oscillatory movement of a limb as it approaches a target (intention tremor) or of proximal musculature when fixed posture or weight bearing is attempted (postural tremor)Asthenia: (Weakness/Lack of energy and strength/Loss of strength). It is a prominent pa of myasthenia gravis

So the answer to this question is C


Instruction:
Tuberculous arthritis of a joint in sites other than the spine in advanced cases leads to whcih of the following -
A. Bony ankylosis
B. Fibrous ankylosis
C. Loose joints
D. Charcot's joints

Response:
Ans- B Fibrous ankylosis is usual outcome of healed tuberculosis of joints except in spine where bony ankylosis takes place.

So the answer to this question is B


Instruction:
End product of catecholamine metabolism is -
A. Metanephrine
B. Vanillyl Mandelic Acid
C. Normetanephrine
D. Dihydroxyphenyl glycol

Response:
Ans. is 'b' i.e., Vanillyl Mandelic Acid* Catecholamines are monoamines with amino group attached to dihydroxybenzene.* They include Epinephrine , Norepinephrine and Dopamine* They are specialised products obtained from the two aromatic aminoacids - phenylalanine and tyrosine.* Dopamine is acted upon by Monoaminooxidase (MAO) in the dopaminergic nerves first and then by catecholamine O methyl transferase (COMT) in liver to form Homovandellic acid.* Norepinephrine of noradrenergic nerve endings are also acted upon by Monoamine Oxidase to form Dihydoxyphenylglycol. Dihydroxyphenyl glycol reaches liver, where it is converted by Catecholamine - O Methyl transferase to form Vanillyl Mandelic Acid.* Epinephrine and norepinephrine of adrenal medullary chromaffin cells are acted upon by catecholamine O methyl transferase and is converted to metanephrine and normetanephrine. Metanephrine and normetanephrine through circulation reach liver. In liver, metanephrine and normetanephrine are acted upon monoamine oxidase and are converted to Vanillyl Mandelic Acid (VMA).

So the answer to this question is B


Instruction:
An eight years old boy presents with progressive swelling around the knee joint of two months duration following mild trauma . Local examination reveals an irregular bony swelling over the upper end of tibia, with raised local temperature and of variable consistency and defined margins. The most likely diagnosis is -
A. Giant cell tumour
B. Ewing's sarcoma
C. Osteogenic sarcoma
D. Secondary metastasis

Response:
The clinical presentation in question can occur both in Ewing's sarcoma and osteosarcoma.

History of trivial trauma
Progressive swelling
Raised local temperature
Variable consistency
ill defined margins.

However, swelling is around the knee joint at upper end of tibia, which favours the diagnosis of osteosarcoma (metaphyseal lesion).
Ewing's sarcoma usually occurs in the diaphysis of the bone (middle of the shaft).

So the answer to this question is C


Instruction:
Sentinel lymph node biopsy is used for ?
A. Melanoma
B. Basal cell carcinoma
C. Squamous cell carcionoma
D. Thyroid carcinoma

Response:
Ans. is 'a' i.e., Melanoma Sentinel lymph node biopsy is used for breast carcinoma and melanoma.

So the answer to this question is A


Instruction:
What is Laser tubes-
A. It is tube made up of PVC wrapped in two layers, one metallic and other non - reflective layer
B. It is tube made up of red rubber
C. It is a metallic tube to prevent any airway fire
D. It is tube made up of laser resistant material

Response:
Like standard endotracheal tubes, laser tubes are made of polyvinylchloride (PVC), which is flammable in the presence of oxygen and an ignition source, i.e. laser light.The PVC core of the laser tubes is therefore wrapped in two layers, one metallic foil layer which protects the actual tube from the laser light, and an outer non-reflective layer. It is used for Laser surgery.

So the answer to this question is A


Instruction:
L–Thyroxine is used in:
A. Thyroid storm
B. Cretinism
C. Endemic goiter
D. Grave's disease

Response:
None

So the answer to this question is B


Instruction:
Which of these fatty acids is found exclusively in breast milk
A. Linoleic acid
B. Linolenic acid
C. Palmitic acid
D. Docosahexaenoic acid

Response:
Docosahexaenoic acid

Up to 5-10% of fatty acids in human milk are polyunsaturated. Most of these are linoleic acid with smaller amounts of linolenic acid.
Docosahexaenoic acid is found in human milk and brain lipids and is required for the development of our nervous system and visual abilities during the first six months of life.
Lack of sufficient docosahexaenoic acid may be associated with impaired mental and visual functioning as well as attention deficit hyperactivity disorder.

So the answer to this question is D


Instruction:
Hard palate contains:
A. Keratinized, submucosa, minor salivary gland
B. Keratinized, absent submucosal layer, minor salivary gland
C. Nonkeratinized, submucosal layer, minor salivary gland
D. Nonkeratinized, absent submucosa, minor salivary gland

Response:
Ref. Gray’s anatomy.  41st edition. Page. 510
Hard Palate

The hard palate is located on the roof of the oral cavity, posterior and medial to the alveolar process of the maxilla.
The bony structure is formed by the palatine processes of the maxilla and the horizontal plates of the palatine bones.
The periosteum is covered by a firmly attached mucosa centrally, although a submucosa is apparent laterally containing vessels. The hard palate is continuous with the soft palate posteriorly.

Macroscopic Features
The hard palate is typically a pale pink colour and may have an orange peel appearance from the palatine salivary glands (more common posteriorly).
Microscopy
The hard palate is lined with a keratinising stratified squamous epithelium, tightly bound to the underlying periosteum of the palatine bone/maxilla. There is minimal submucosa, which becomes more prominent posteriorl

So the answer to this question is A


Instruction:
Which type of RPD definitely requires an indirect retainer?
A. Class I,II R.P.D
B. Class II, IV R.P.D
C. Class I & IV R.P.D
D. Class III & IV R.P.D

Response:
None

So the answer to this question is A


Instruction:
Patch on tonsil is not caused by:
A. Vincent's angina
B. Candida
C. Staphylococcus
D. Ludwig's angina

Response:
(d) Ludwig's angina(Ref. Scott Brown, 8th ed., Vol 3; 550)Ludwig's angina does not involve tonsil. The other options can lead to patch/pseudomembrane on the tonsil.

So the answer to this question is D


Instruction:
Maximum oxygen is transpoed in blood
A. In dissolved form
B. By albumin
C. By hemoglobin
D. By WBC

Response:
About 99% of the O2 transpoed combines with the O2carrying protein hemoglobinRef: Ganong's Review of Medical Physiology Twenty-Third Edition Page No:609

So the answer to this question is C


Instruction:
In which of these patients can a medial episiotomy be considered superior to a medio lateral episiotomy during delivery of fetus?
A. Nulligravida with thick perineum
B. Second stage arrest
C. Second gravida with moderate anemia
D. Before application of forceps

Response:
A midline episiotomy is associated with higher risk of third and fouh degree lacerations and following factors are associated with an increased risk.: Nulliparity Second-stage arrest of labor Persistent occiput-posterior position, Midorlowforceps Use of local anesthetics Asian race. A medio lateral episiotomy should beperformed in these mentioned situations A multiparous patient with anemia does not have increased risk for third or fouh degree laceration and since the patient is anemic, with a midline episiotomy, blood loss is less and healing is better, making it a better option.

So the answer to this question is C


Instruction:
The pin diameter of Minim (inch/mm) is:
A. 0.019/0.48
B. 0.024/0.61
C. 0.015/0.38
D. 0.027/0.78

Response:
None

So the answer to this question is B


Instruction:
Nipple confusion means?
A. Baby fed with a bottle finding it difficult and confusing to suckle at breast
B. Baby not able to suckle with bottle
C. Baby not able to feed with spoon
D. Baby not able to feed with paladin

Response:
Ans. (a) Baby fed with a bottle finding it difficult and confusing to suckle at breastRef: OP Ghai 8th ed./153* A problem that may beset a bottlefed baby in which it forgets how to nurse on mother' nipple* Breastfeeding requires far more vigorous mouth and tongue motions and greater muscle coordination than bottlefeeding.* On bottle nipples or even pacifiers, a newborn can forget how to nurse properly.* This confusion can lead to diminished or discontinued nursing. Nipple confusion is usually not a concern after the early weeks, once the baby is nursing well.

So the answer to this question is A


Instruction:
Which type of RNA has the highest percentage of modified base?
A. mRNA
B. tRNA
C. rRNA
D. snRNA

Response:
The transfer RNAs show extensive internal base pairing and acquire cloverleaf-like structureThey contain significant propoion of unusual basesThese include dihydrouracil, pseudouridine, and hypoxanthineRef: DM VASUDEVAN, 7th edition, page no: 596,597

So the answer to this question is B


Instruction:
Resolution of corpus luteum occurs because of:
A. Increased levels of progesterone
B. Increased levels of estrogen
C. Decreased levels of LH
D. Decreased levels of FSH

Response:
Continued corpus luteum function depends on continued LH production. In the absence of this stimulation, the corpus luteum will invariably regress after 12 to16 days and form scar-like corpora albicans. In the absence of pregnancy, the corpus luteum regresses, and estrogen and progesterone levels wane. If pregnancy occurs, HCG from the placenta will mimic LH action and the corpus luteum continues to secrete progesterone.

So the answer to this question is C


Instruction:
All are indications of methotrexate except?
A. Leukemia
B. Breast cancer
C. Rheumatoid ahritis
D. Renal failure

Response:
Ans. is 'd' i.e., Renal failure o MTX, usually in combination with other drugs, is effective against acute lymphocytic leukemia, choriocarcinoma, Burkitt's lymphoma in children, breast cancer, and head neck carcinomas.

So the answer to this question is D


Instruction:
Measures of central tendency is given by all, EXCEPT:
A. Mean
B. Median
C. Range
D. Mode

Response:
Measures of central tendency is given by mean, median & mode. Range gives measure of dispersion.

So the answer to this question is C


Instruction:
If stage lb cervical cancer is diagnosed in a young woman, while performing radical hysterectomy which structure would you not remove
A. Uterosacral and uterovesical ligament
B. Pelvic Lymph nodes
C. periureteral tissues
D. Upper third of vagina

Response:
Ovaries are not removed in radical hysterectomy if not diseased Types of Hysterectomy Type I : Extrafascial Hysterectomy Simple total abdominal hysterectomy with or without bilateral salpingo-oophorectomy Type II: Modified Radical Hysterectomy Removes the medial half of cardinal and uterosacral ligaments Type II differs From Type III by Uterine aery is transected at the level of ureter; Preserving the ureteral branch to the ureter Cardinal ligament is divided close to the midpoion near the ureteral dissection Anterior vesicouterine ligament is divided but posterior vesicouterine ligament is conserved Smaller margin of vagina is removed Type III Removal of most of the uterosacral, cardinal ligaments and upper one-third of the vagina Associated with Pelvic lymphadenectomy Extended Radical Hysterectomy Type IV: Additional structures removed Periureteral tissue Superior vesicle aery Three fouhs of vagina Type V: Poions of distal ureter and bladder are resected Reference: Berek and Novak's Gynecology; 15th edition; Chapter 36

So the answer to this question is C


Instruction:
Birth rate is -
A. Live birth/1000 mid yr. population
B. Birth/1000 mid yr population
C. Live birth/10000 mid yr. population
D. Live birth/10,000 population of reproductive age group (15-45)

Response:
Fertility

By fertility is meant the actual bearing of children.
A woman's reproductive period is roughly from 15 to 45 years - a period of 30 years.
Measurement of fertility are :-

Birth rate
General fertility rate (GFR)
General marital fertility rate (GMFR)
Age specific fertility rate (ASFR)
Age specific marital fertility rate (ASMFR)
Total fertility rate (TFR)
Total marital fertility rate (TMFR)
Gross reproduction rate (GRR)
Net reproduction rate (NRR)
Child woman ratio
Pregnancy rate
Abortion rate
Abortion ratio
Marriage rate

Birth rate

Birth rate defined as "the number of live birth per 1000 estimated mid yr. populations in a give yr."

Birth rate = Number of live birth during the year / Estimated mid year population x 1000

So the answer to this question is A


Instruction:
Treatment for poosystemic encephalopathy is all except
A. High protein diet
B. Lactulose
C. Oral neomycin
D. Enema

Response:
It most often results from high gut protein or acute metabolic stress (eg, GI bleeding, infection, electrolyte abnormality) in a patient with poosystemic shunting. Symptoms are mainly neuropsychiatric (eg, confusion, asterixis, coma). Diagnosis is based on clinical findings. Ref Davidson edition23rd pg 864

So the answer to this question is A


Instruction:
Most common cause of cerebrovascular accident is:
A. Embolism
B. Arterial thrombosis
C. Venous thrombosis
D. Hemorrhage

Response:
Ans. (a) Embolism* MC cause of cause of CVA- Ischemia (85% cases) due Embolism (75%) > Thrombosis (25%)* CVA may also be due to hemorrhage (<15%) - Parenchymal, Subarachnoid, Epidural or Subdural hemorrhage* Stroke in young women in India are predisposed by Cortical venous thrombosis due to OCP consumption.

So the answer to this question is A


Instruction:
The most common source of pulmonary embolism
A. Amniotic fluid embolism
B. Renal artery embolism
C. Large veins of leg
D. Cardio thoracic surgery

Response:
None

So the answer to this question is C


Instruction:
AH of the following are true about lymphocyte depletion variety of HL except:
A. Least common
B. CD 20 expression
C. CD 15 & CD 30 expression
D. Pleomorphic RS cell

Response:
Ans: b (CD 20 expression) Ref: Robbins, 7th ed, p. 688CD20 expression is classical of lymphocyte predominant variety of HL and not lymphocyte depletion variety.L & H variant is seen in lymphocyte predominant variety of HL and it classically expresses CD20 and germinal centre transcription factor BCL 6.HODGKIN LYMPHOMA (REAL CLASSIFICATION)|||Classical subtypes1) Nodular sclerosis2) Mixed cellularity3) Lymphocyte rich4) Lymphocyte depletionLymphocyte predominance(Distinct immunophenotype) SubtypesMorphologyImmunophenotypeNodular sclerosisLacunar variantsOccasional RS cellsCD 15 (+), CD 30(+)Mixed cellularityMononuclear variantRS cells (+)CD 15(+),CD 30(+)Lymphocyte richMononuclear variantRS cells (+)CD 15(+),CD 30(+)Lymphocyte depletionReticular variant(Pleomorphic variant)CD 15(+),CD 30(+)LymphocytepredominanceL&H (Popcorn cells)CD20 (+)CD 15(-),CD 30(-)

So the answer to this question is B


Instruction:
Rhinolith can cause?
A. Nasal obstruction
B. Epistaxis
C. Epiphora
D. All the above

Response:
Rhinoliths are more common in adults. The presentation is usually unilateral nasal obstruction and foul smelling discharge which is very often bloodstained. Frank epistaxis and neurologic pain may result from ulceration of the surrounding mucosa mass are seen between the septum and nasal turbinates, the mass surface is irregular and brittle, may break off. Maybe surrounded by granulations also. Ref - PL DHINGRA diseases of ear nose and throat, 6th edition, page no 161

So the answer to this question is D


Instruction:
A 34 year old patient presented with thyroid nodule. Ultrasonography of the thyroid nodule shows foci of calcification. Histological features are shown in the diagram below, what is your likely diagnosis?
A. Follicular carcinoma
B. Medullary carcinoma
C. Papillary carcinoma
D. Anaplastic carcinoma

Response:
Given histopathological slide shows branching papillae having a fibrovascular stalk covered by a single to multiple layers of cuboidal epithelial cells. These features along with given history point towards papillary carcinoma of thyroid. Nuclei of papillary carcinoma cells contain finely dispersed chromatin, which impas optically clear / empty appearance, giving rise to ground-glass nuclear appearance or Orphan annie eye nuclei. In addition, invagination of cytoplasm may give appearance of intranuclear inclusions ("pseudo-inclusions") / intranuclear grooves. These nuclear features are sufficient for diagnosis of papillary carcinoma,even in absence of papillary architecture. Concentrically calcified structures termed Psammoma bodies are often present, usually within cores of papillae.

So the answer to this question is C


Instruction:
Which among the following is a typical intercostal nerve?
A. First
B. Second
C. Third
D. Seventh

Response:
Typical intercostal nerves are the ones that are confined to their own intercostal spaces in the thoracic wall. The course of the third, fouh, fifth, and sixth intercostal nerves can be regarded as typical. They run forwards in the intercostal spaces lying between the second and third layers of the muscles. A typical intercostal nerve has four major branches. The first branch is made up of the unmyelinated postganglionic fibers of the gray rami communicantes, which interfaces with the sympathetic chain. The second branch is the posterior cutaneous branch, which innervates the muscles and skin of the paraspinal area. The third branch is the lateral cutaneous division, which arises in the anterior axillary line. It provides most of the cutaneous innervation of the chest and abdominal wall. The fouh branch is the anterior cutaneous branch supplying innervation to the midline of the chest and abdominal wall.

So the answer to this question is C


Instruction:
Chief extensor of thigh at hip joint is supplied by:
A. Inferior gluteal nerve
B. Superior gluteal nerve
C. Sciatic nerve
D. Peroneal nerve

Response:
Ans. A Inferior gluteal nerveRef: Netter's Clinical Anatomy, 3rd ed. pg. 279-280* The chief extensor of thigh at hip joint is gluteus maximus and helps in rising from sitting position.* It is supplied by inferior gluteal nerve (L5, S1, S2). (mnemonic: M.I.G- 512)* Gluteus medius are minimus are powerful abductor of thigh and are supplied by superior gluteal nerve (L4, 5, S1).

So the answer to this question is A


Instruction:
Biological value is used for assessment of -
A. Fat quality
B. Protein quality
C. Carbohydrate quality
D. None

Response:
-the net protein utilisation is considered of more practical value for evaluation of protein because it is the product of biological value and digestibility coefficient divided by 100. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:610 <\p>

So the answer to this question is B


Instruction:
After tonsillectomy, secondary haemorrhage occurs
A. Within 24 hours
B. After 2 weeks
C. 5-10 post operative days
D. After a month

Response:
After tonsillectomy primary haemorrhage occurs during surgery reactionary bleeding with in 24 hrs, secondary haemorrhage between 5-10 days Secondary haemorrhage is the result of sepsis and premature separation of the membrane Simple measures like removal of clots, application of adrenaline or hydrogen peroxide usually suffice. For profuse bleeding, electrocoagulation is done Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition; Pg no: 430

So the answer to this question is C


Instruction:
After suffering a severe bout of pneumonia, a 46-year-old renal transplantation patient develops a lung abscess. She has been receiving immunosuppression therapy since her last kidney transplantation 3 years ago. What is the most appropriate treatment?
A. Needle aspiration
B. Urgent thoracotomy
C. Antituberculous therapy
D. Antibiotics and vigorous attempts to obtain bronchial drainage

Response:
Antibiotics and vigorous attempts to obtain bronchial drainage will treat the abscess adequately in the majority of cases. Lung abscesses commonly are associated with aspiration pneumonia, where the abscess is found posteriorly. In the presence of an unexplained lung abscess, bronchoscopy is essential to exclude a foreign body or tumor that could cause bronchial obstruction.

So the answer to this question is D


Instruction:
Cereal protein is deficient in which amino acid
A. Leucine
B. Lysine
C. Phenylalanine
D. Tryptophan

Response:
Ans. is 'b' i.e., Lysine Supplementary action of proteins Cereals are deficient in essential amino acid Lysine & threonine. Pulses are deficient in essential amino acid Methionine. So if cereals are eaten with pulses, their proteins complement each other & provide a more balanced and complete protein intake.

So the answer to this question is B


Instruction:
Radio graphically Mental foramen lies between the roots of
A. Canine and first premolar
B. First and second premolars
C. Second premolar and first molar
D. In the incisor region

Response:
None

So the answer to this question is B


Instruction:
Squamous cell carcinoma spreads commonly via -
A. Implantation
B. Hematogenous spread
C. Lymphatic spread
D. Trancoelomic spread

Response:
None

So the answer to this question is C


Instruction:
Which of the following connections are found between Odontoblasts in Odontoblastic layer?
A. Zonula adherence
B. Zonula occludence
C. Nexus
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
Regarding rabies, true is:
A. Incubation period depends on the site of bite
B. Diagnosis is by eosinophilic intranuclear inclusion
C. It is a DNA virus
D. Caused only by dogs

Response:
Ans. is 'a' i.e., Incubation period depends on the site of bite(Ref: PSM Park, 19th/e, p. 228)Variability of Incubation Period* Incubation period of rabies depends on:- The site of bite.- Number of wounds.- Species of biting animal.- Severity of bite.- Amount of virus injected.- Protection provided by clothing and treatment undertaken.ABOUT OTHER OPTIONS* Pathognomonic Negri bodies are intracytoplasmic (not intranuclear) eosinophilic inclusion bodies. Q* Rabies virus is a RNA virus.* It can be caused by many wild animals (not only by dogs).

So the answer to this question is A


Instruction:
Treatment of CMV retinitis in AIDS patient is -
A. Amantadine
B. Fludrabine
C. Oseltamivir
D. Valganciclovir

Response:
Ans. is 'd' i.e. Valganciclovir o CMV retinitis is the most common ophthalmic manifestation of CMV, occuring as a congenital infection in infants or an opportunistic infection in the immunocompromised hosto Adults commonly affected include those individuals with acquired immunodeficiency syndrome (AIDS), oncology patients, and patients on immunosuppresive therapy. There is characteristic hemorrhagic, full thickness retinitis. In early stage there are yellow-white exudates (areas of retinal necrosis) associated with areas of vasculitis and retinal hemorrhage. There may be exudative retinal detachment and ultimately, there occurs total retinal atrophyo Treatment of CMV retinitis -# HAART.# Valganciclovir- pro-drug of ganciclovir that is taken orally and is as effective for both induction (900 mg twice daily for up to 3 weeks) and maintenance (900 mg daily). Neutropenia is a common side effect due to bone marrow suppression, but can be effectively treated with filgrastim (granulocyte colony-stimulating factor.# Ganciclovir, foscamet and cidofovir given intravenously were formerly key therapeutic agents.# Ganciclovir slow-release intravitreal implant.

So the answer to this question is D


Instruction:
True about apoptosis is all except?
A. Considerable apoptosis may occur in a tissue before it becomes apparent in histology
B. Apoptotic cells appear as round mass of the intensely eosinophilic cytoplasm with dense nuclear chromatin fragments
C. Apoptosis of cells induce inflammatory reaction
D. Condensation of chromatin

Response:
Ans. (c)Apoptosis of cells induce inflammatory reactionRef: Robbin's pathology 9th ed. 152-53Remember Important Features of Apoptosis* Formation of cytoplasmic blebs and apoptotic bodies* Cell shrinkage: The cells are smaller in size and the cytoplasm is dense* Chromatin condensation: This is the most characteristic feature of apoptosis* Absence of inflammation* Gel Electrophoresis of DNA shows 'Step ladder Pattern.

So the answer to this question is C


Instruction:
Intramuscular route is precluded during the medication of:
A. Anti-hypertensives
B. Anti-diabetics
C. Anticoagulants
D. Anti-fibrinolytics

Response:
None

So the answer to this question is C


Instruction:
Danger space of pharynx is bounded by
A. Buccopharyngeal fascia anteriorly and alar fascia posteriorly
B. Preveebral fascia anteriorly and veebral body posteriorly
C. Alar fascia anteriorly and preveebral fascia posteriorly
D. Tonsils anteriorly and superior constrictor muscle posteriorly

Response:
Ref:- Dhingra; pg num:-268

So the answer to this question is C


Instruction:
A learned behaviour which is permanent and consistent but liable to change –
A. Attitude
B. Knowledge
C. Practice
D. Cultural belief

Response:
Practice/Habit → Liable to change by motivation
Attitude → Not liable to change by motivation

So the answer to this question is C


Instruction:
A patient with recent–onset primary generalized epilepsy develops drug reaction and skin rash due to phenytoin sodium. The most appropriate course of action is :
A. Shift to clonazepam
B. Restart phenytoin sodium after 2 weeks
C. Shift to sodium valproate
D. Shift to ethosuximide

Response:
None

So the answer to this question is C


Instruction:
A person had an episode of dengue serotype 1, after 2 years with serotype 2. What will be effect of this episode?
A. Mild ds d/t neutralizing abs present
B. Increased chances of DHF
C. No chances of DHF
D. No effect on present illness

Response:
Ans. b. Increased chances of DHFPATHOGENESIS OF DENGUE VIRUSPrimarily dengue infection occurs when a person is infected with dengue virus for the first time with any one serotype.Months to years later, a more severe form of dengue illness may appear (Called secondary dengue infection) due to infection with another second serotype which is different from the first serotype causing primary infection.The severity of secondary dengue infection occurs due to a unique immunological phenomenon called antibody dependent enhancement (ADE), i.e. non-neutralizing antibody produced against the first serotype will combine, cover and protect the second serotype from host immune response.ADE is remarkably observed when serotype 1 infection followed by serotype 2, which also claims to be the most severe form and prone to develop into Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS).Serotype 2 is more apparently more dangerous than other serotype.

So the answer to this question is B


Instruction:
What would tend to decrease GFR by more than 10% in a normal kidney?
A. Decrease in renal aerial pressure from 100 to 85 mm Hg
B. 50% decrease in afferent aeriolar resistance
C. 50% decrease in efferent aeriolar resistance
D. 50% increase in the glomerular capillary filtration coefficient

Response:
50% reduction in efferent aeriolar resistance would cause a large decrease in GFR--greater than 10%. A decrease in renal aery pressure from 100 to 85 mm Hg would cause only a slight decrease in GFR in a normal, autoregulating kidney. A decrease in afferent aeriole resistance, a decrease in plasma colloid osmotic pressure, or an increase in the glomerular capillary filtration coefficient would all tend to increase GF

So the answer to this question is C


Instruction:
False about Marbel bone disease
A. Associated with Type II Renal Tubular Acidosis
B. Pancytopenia
C. Mandible osteomyelitis
D. Treated with bone marrow transplantation

Response:
Osteopetrosis / Marbel bone disease is associated with Type IRTA

So the answer to this question is A


Instruction:
Clindamycin acts by inhibiting -
A. Cell wall synthesis
B. Protein synthesis
C. Cell membrane synthesis
D. Glucose utilization

Response:
Ans. is 'b' i.e., Protein synthesis o It inhibits protein synthesis by binding to 50-S ribosome.

So the answer to this question is B


Instruction:
Direct Coomb's test detects:
A. Antibodies attached to RBC Surface
B. Antibodies in the serum
C. Antigens attached to RBC Surface
D. Antigens in the serum

Response:
Answer is A (Antibodies attached to RBC Surface) Direct Coomb's test detects IgG Antibodies (or complements) attached to the surface of RBCs. Indirect Coomb's test detects IgG antibodies in the serum (e.g. Anti-D Antibodies).

So the answer to this question is A


Instruction:
True regarding myocardial O2 demand?
A. Inversely related to heart rate
B. Has constant relation to external cardiac work
C. Directly proportional to duration of systole
D. Is negligible at rest

Response:
Oxygen demand depends on the work being done. The work done is to pump the blood which is in the ventricles (preload) against the resistance in the aorta (afterload).
 So, myocardial oxygen demand depends on

Rate - Directly proportional
Contractility - Directly proportional
Intramyocardial tension - Directly proportional
After load - Directly proportional
Preload - Directly proportional
Wall thickness - Inversely proportional

The oxygen demand of myocardium is not having the same change with varying external works.

So the answer to this question is C


Instruction:
26 year old female patient presents to OPD with inability to focus on close objects, but can clearly see the distant objects . Most likely damage to which structure will lead to following condition ?
A. Ciliary ganglion and oculomotor nerve
B. Oculomotor nerve and long ciliary nerve
C. Sho ciliary nerves and ciliary ganglion
D. Oculomotor and trochlear nerve

Response:
Damage to parasympathetic ciliary ganglion and parasympathetic fibres in sho ciliary nerve impairs the ability to focus on close objects (accommodation). Because the patient can move his eyeballs normally, the oculomotor nerve is not damaged even if this nerve contains preganglionic parasympathetic fibres. Patient can see distant objects clearly because the long ciliary nerve also carries sympathetic fibres to the dilator pupillae. Ability to move eyeball normally indicates that the oculomotor, trochlear, and abducens nerves are intact.

So the answer to this question is C


Instruction:
Swollen belly syndrome is caused by
A. Strongyloides stercoralis
B. Stongyloides fuelleborni
C. Necator Americanus
D. Ancyclostoma duodenale

Response:
Strongyloides Fuelleborni causes swollen belly syndrome.

So the answer to this question is B


Instruction:
Metastasis of ca buccal mucosa goes to
A. Hea
B. Brain
C. Regional lymph node
D. Lungs

Response:
Tumors in this area have a propensity to spread locally and to metastasize to regional lymphatics . Lymphatic metastasis of Buccal ca go to submandibular and later upper jugular nodes. MC type of Buccal ca - Squamous cell ca Commonest site of origin - angle of mouth or the line of occlusion of upper and lower teeth

So the answer to this question is C


Instruction:
All are features of nephrotic syndrome in children except -
A. Lipiduria
B. Hyperlipidemia
C. Hyperalbuminemia
D. Proteinuria

Response:
Ans. is 'c' i.e., Hyperalbuminemia Nephrotic syndrome o Nephrotic syndrome is a group of disease having different pathogenesis and characterized by 1) Proteinuria (> 3.5 gm/day) 4) Hyperlipidemia 2) Hypoalbuminemia 5) Lipiduria --> lipid casts Edema 6) Hypercoagulability

So the answer to this question is C


Instruction:
A female at 37 week of pregnancy comes with grade 3 placenta pre, bleeding per vaginum with uterine contractions. What is the MOST appropriate management in this patient?
A. Dexamethasone and nifedipine
B. Bed rest and sedation
C. Wait and watch
D. Emergency LSCS

Response:
The best management in this patient presenting with grade 3 placenta pre, bleeding per vagina and uterine contraction is emergency LSCS. Also know: Other indications of LSCS in patients with placenta pre are: Severe degree of placenta pre (type II posterior, type III, type IV) Lesser degree of placenta pre when amniotomy fails to stop bleeding or fetal distress appears. Complicating factors associated with lesser degrees of placenta pre where vaginal delivery is unsafe. Ref: Textbook of Obstetrics By D.C Dutta, 6th edn, page 252

So the answer to this question is D


Instruction:
Evans's syndrome refers to which of the follwoing?
A. Autoimmune hemolytic anemia with autoimmune neutropenia
B. Autoimmune hemolytic anemia with autoimmune thrombocytopenia
C. Autoimmune hemolytic anemia with marked bone marrow suppression
D. Autoimmune hemolytic anemia with hypersplenism

Response:
In some cases, Autoimmune hemolytic anemia (AIHA) can be associated with autoimmune thrombocytopenia (Evans's syndrome). Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 881

So the answer to this question is B


Instruction:
Ifosfamide belong to which class?
A. Alkylating agent
B. Antimetabolite
C. Taxanes
D. Antibiotics

Response:
None

So the answer to this question is A


Instruction:
The most significant adverse effect of ACE inhibition is:
A. Hypotension
B. Hypertension
C. Hypocalcemia
D. Hypercalcemia rate

Response:
Ans. is 'a' i.e. Hypotension [Ref: KDT 5th/e, p 449 _First dose hypotension is a significant adverse effect of ACE inhibitorA steep fall in blood pressure may occur following the first dose of an ACE inhibitor particularly in patients with elevated peripheral resistance.Care should be exercised in patients who are salt depletedbeing treated with multiple antihypertensive drugs having congestive heart failure on diureticsIn the above mentioned situations, t/t should be initiated with very small doses of ACE inhibitors or salt intake should be increased and diuretics should be withdrawn before beginning the therapy.Other adverse effects of ACE inhibitorsHyperkalemiaIs an important risk factor in patients withimpaired renal functionon K+ sparing diureticsCoughPersistent brassy coughCaused by inhibition of bradykininRashes, urticaria Angioedema DysgeusiaReversible loss of taste sensationMore common with captoprilFetopathicTeratogenic when given in 2nd trimesterSafe in first half.Granulocytopenia and proteinuria Acute renal failureIt is precipitated by ACE inhibitors in patients with bilateral renal artery stenosis due to dilatation of efferent arterioles and fall in glomerular filtration pressure.

So the answer to this question is A


Instruction:
Which of the following does not present antigens:
A. NK cells
B. Dendritic cells
C. Langerhans cells
D. Macrophages

Response:
APC (Antigen-presenting cell):

Most common APC → Immature dendritic cell.
The most potent stimulator of native T cell → Mature dendritic cell.
APCs are – Dendritic cells, Langerhan’s cells, B-cell.

So the answer to this question is A


Instruction:
What is the recommended duration of quarantine for yellow fever?
A. 3 days
B. 6 days
C. 9 days
D. 12 days

Response:
A traveller should be placed in a mosquito proof ward for 6 days from the date of leaving an infected area. Ref: Park 21st edition, page 259.

So the answer to this question is B


Instruction:
Treatment of choice for glue ear is -
A. Conservative
B. Myringotomy with cold knife
C. Myringotomy with ventilation tube insertion
D. Myringotomy with diode laser

Response:
Ans. is 'c' i.e. Myringotomy with ventilation tube insertion Treatment of choice for glue ear is - Myringotomy and aspiration of effusion with placement of ventilation tube.Glue ear or Otitis media with effusion (OME)(also k/a Serous otitis media, secretory otitis media, Mucoid otitis media)OME is characterized by a non-purulent effusion of the middle ear that may be either mucoid or serous.Symptoms usually involve hearing loss or aural fullness but typically do not involve pain or fever. In children hearing loss is generally mild and is often detected only with an audiogram.The fluid is nearly sterile.The condition is commonly seen in school-going children. It is the leading cause of hearing loss in children. PathogenesisTwo main mechanisms are thought to be responsible.Eustachian tube dysfunctionIncreased secretory activity of middle ear mucosa TreatmentTreatment may be medical or surgicalMedical measures are controversial and involveDecongestantsAntiallergic measuresAntibioticsMiddle ear aerationValsalva manoeuvrepolitzerisation or eustachian tube catheterizationchewing gumSurgicalMyringotomy and aspiration of fluidGrommet or ventilation tube insertionSurgical t/t of causative factor - adenoidectomy, tonsillectomy, and/or wash out of maxillary antra.

So the answer to this question is C


Instruction:
An 8 month female baby presented with 1 day h/o lethargy. She had vomited several times. Her drug addict mother said she appeared "intoxicated".O/E: baby was obtunded but she was easily arousable and muscle tone was normal. RR = 60/min. Pupils are normal. BP was 112/62.Ix: Na+= 135 K+ = 4.2 ,Glucose 5.9 mmol/l , Cl- = 116 ,Urinalysis: pH = 5.0; negative for glucose & ketones, positive for calcium oxalate crystals. ABG: pH = 7.19, pCO2 = 20, PO2 = 100 , HCO3 = 6.2 ?
A. Metabolic acidosis compensated
B. Metabolic acidosis paially compensated
C. Metabolic alkalosis compensated
D. Metabolic alkalosis paially compensated

Response:
Impoant points in history: * Drug addict mother * Tachypnea * Pupils normal - no CNS depression by opioids * Calcium oxalate crystal - d/t ethylene glycol poisoning Ethylene glycol poisoning - leads to - acute tubular necrosis ABG: pH = 7.19, pCO2 = 20, PO2 = 100 , HCO3 = 6.2 Calculation: Anion gap: Na - (Cl- + HCO3) = 135-(116+6) = 135-122 = 13 pH is 7.19 acidic.(normal pH 7.35-7.45) pCO2 is 16( low )that cannot explain acidotic PH (normal pco2 40) HCO3 is 6.2 which is low that explain low pH. therefore acidic pH is metabolic problem.i.e.metabolic acidosis in this CASE compensation is going on which is hyperventilation leading to CO2 washout.low PCo2 since is PH is not normalised so paial compensation From ABG: metabolic acidosis paially compensated. expected PCO2 =15+HCO3=15+6=21 actual PCO2 is almost equal to expected value this implies compensation is going fine.

So the answer to this question is B


Instruction:
Untoff phenomenon is
A. Worsening of symptom with cold
B. Relief of symptom with cold
C. Worsening of symptom with heat and exeion
D. Palsy of symptom with heat and excretion

Response:
Harrison's principles of internal medicine 17th edition. *U/l visual blurring may occur following a hot shower or with physical exercise. Uhthoff's phenomenon (also known as Uhthoff's syndrome, Uhthoff's sign, and Uhthoff's symptom) is the worsening of neurologic symptoms in multiple sclerosis (MS) and other neurological, demyelinating conditions when the body gets overheated from hot weather, exercise, fever, or saunas and hot tubs. Ref Harrison20th edition pg 2345

So the answer to this question is C


Instruction:
Drug of choice in nocturnal enuresis is
A. Imipramine
B. Diazepam
C. Amoxapine
D. Reboxetine

Response:
(Imipramine) (449-KDT 6th)Enuresis - In children above 5years, imipramine at bed time is effective, but bed wetting may again start when the drug is stopped* Elderely subjects with bed wetting have also benefittcd* Imipramine is most likely and nortriptyline is least likely to cause orthostatic hypotension (145-LP3rd)

So the answer to this question is A


Instruction:
Chest X-ray, most common view is -
A. AP
B. PA
C. RAO
D. LAO

Response:
Ans. is 'b' i.e., PA o Posteroanterior view of the chest is most commonly used view for chest X-ray."The best view of the chest is the postero-anterior view with the patient standing and lung fully expanded"--Toriano

So the answer to this question is B


Instruction:
What is epicolic node?
A. Node draining colon
B. Adjacent to aoa
C. Epitracheal node
D. None

Response:
.Lymphatic Drainage of colon * Mucosa contains no lymph channels, so mucosal cancers rarely metastasize. * Nodes are epicolic (located in the colonic wall), paracolic (located along the inner margin), intermediate (located near mesenteric vessels), principal (located near main mesenteric vessles). ref:SRB&;s manual of surgery,ed 3,pg no 818

So the answer to this question is A


Instruction:
Which of the following should not be used in the ROSACEA?
A. Isoetretin
B. Metronidazole
C. Steroids
D. Benzoyl peroxide

Response:
ROSACEA is a Vascular disorder predominantly affecting flush areas of face manifesting as erythema and telangiectasia, punctuated with episodes of inflammation during the episodes of inflammation papules, pustules and swelling develop. It has a chronic course. Treatment: a. Oral tetracyclines are drug of choice. b. Topical erythromycin and benzoyl peroxide are also helpful. c. Topical metronidazole is also effective. oral doxycycline and minocycline can also be given. d. The role of topical steroids is limited. e. With halogenated steroids rebound phenomenon and perioral dermatitis is known to occur. Hence their use is not justified. f. Isotretinoin can be used if no response to above drugs. The use of the topical steroid should be limited to the condition. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) does not necessary prevent steroid induced rosacea. Similar conditions have been seen with both Elidel and Protopic, possibly from immunosuppression and Demodex or bacterial growth. Ref Robbins 9 e pg 456

So the answer to this question is C


Instruction:
Vidian nerve passes through
A. Inferior orbital fissure
B. Incisive foramen
C. Tympanomastoid fissure
D. Pterygoid canal

Response:
In the anterior pa of the foramen lacerum,the greater petrosal nerve unites with the deep petrosal nerve to form the nerve of the pterygoid canal(the vidian nerve)which leaves the foramen by entering the pterygoid canal in the anterior wall of the foramen lacerum. REF.BDC VOL.3,FIFTH EDITION

So the answer to this question is D


Instruction:
Gluteus medius muscle is supplied by -
A. Obturator artery
B. ilio-inguinal artery
C. Superior gluteal artery
D. Inferior gluteal artery

Response:
Superior gluteal artery supplies gluteus medius and gluteus minimus. Inferior gluteal artery supplies gluteus maximus.

So the answer to this question is C


Instruction:
Males and females show difference in the age of onset of pubey. The difference in the age of onset of pubey amongst males may be explained by
A. Increased Activin - A levels
B. Decreased Follistatin levels
C. Increased Inhibin levels
D. Easily releasable FSH pool

Response:
One of several proteins that paicipate in differentiation and growth. Two glycoproteins, inhibin A and inhibin B, are secreted by Seoli cells in the testis and granulosa cells in the ovary, inhibiting FSH secretion by direct action on the pituitary.Ref: Ganong&;s review of medical physiology; 24th edition; page no:-427

So the answer to this question is C


Instruction:
Spontaneous regression though rare is seen in
A. Burkits lymphoma
B. Wilms tumor
C. Neuroblastoma
D. Melanoma

Response:
Neuroblastoma is a cancer often found in the small glands on top of the kidneys (adrenal glands). It can develop in the stomach, chest, neck, pelvis and bones. Children aged five or younger are most commonly affected. Most children with neuroblastoma in Noh America have been treated according to the In the previous COG risk system, each child was assigned to a low-risk, intermediate-risk, or high-risk group (refer to Tables INSS stage. Age. International Neuroblastoma Pathologic Classification (INPC). Ploidy. Amplification of the MYCN oncogene within tumor tissue.[Other biological factors that influenced treatment selection in previous COG studies included unbalanced 11q loss of heterozygosity and loss of heterozygosity for chromosome 1p.[Generally, treatment is based on whether the tumor is classified as low, intermediate, or high risk, as follows: Low risk. For patients with low-risk tumors, the approach is either observation or resection, with chemotherapy restricted to symptomatic patients with low-risk biology. Five-year overall survival (OS) was 97% in a large COG study.[Intermediate risk. For patients with intermediate-risk tumors, chemotherapy is often given before definitive resection, and the number of chemotherapy cycles is based on clinical and tumor biological risk factors and response to therapy. In recent studies, select patients have been observed without undergoing chemotherapy or attempted resection. The 3-year OS rate for intermediate-risk patients was about 96% in a large COG study.[High risk. For high-risk patients, treatment has intensified to include chemotherapy, surgery, radiation therapy, myeloablative therapy and stem cell transplant (SCT), isotretinoin, and immunotherapy, resulting in survival rates of about 50%. Statistically significant improvement in survival was observed in a randomized phase III COG study ( COG Risk-Group Assignment Treatment Options COG = Children's Oncology Group; GM-CSF = granulocyte-macrophage colony-stimulating factor; 131I-MIBG = iodine I 131-metaiodobenzylguanidine; SCT = stem cell transplant. Recurrent Neuroblastoma Locoregional recurrence in patients initially classified as low risk Metastatic recurrence in patients initially classified as low risk Locoregional recurrence in patients initially classified as intermediate risk Metastatic recurrence in patients initially classified as intermediate risk Recurrence in patients initially classified as high risk Recurrence in the central nervous system <a style="box-sizing: border-box; margin: 0px; padding: 0px; border: 0px; font: inherit; veical-align: baseline; color: ; text-decoration-line: none;" href=" therapeutic approaches. Refer robbins 8/e p477

So the answer to this question is C


Instruction:
Best prognosis in nerve injury
A. Neuropraxia
B. Axonotemesis
C. Neurotemesis
D. Complete transaction

Response:
Neurapraxia is a disorder of the peripheral nervous system in which there is a temporary loss of motor and sensory function due to blockage of nerve conduction, usually lasting an average of six to eight weeks before full recovery.Ref: Ganong&;s review of medical physiology 23rd edition

So the answer to this question is A


Instruction:
The most characteristic eye lesion in diabetes is:
A. Flame haemorrhages
B. Papilledema
C. Capillary aneurysm
D. Cataracts

Response:
Ans. Capillary aneurysm

So the answer to this question is C


Instruction:
Miliaria arises from obstruction of ?
A. Eccrine sweat glands
B. Apocrine sweat glands
C. Sebaceous glands
D. Ectopic sebaceous glands

Response:
Ans. is 'a' i.e., Eccrine sweat glands Milliria Occur as a result of either obliteration or disruption of the eccrine sweat duct. Three forms :- Miliaria crystallina- Clear, thin-walled vesicles, 1-2 mm in diameter, without an inflammatory areola, are usually symptomless and develop in crops, mainly on the trunk. Miliaria rubra- erythematous papules especially in areas of friction with clothing, and in flexures, produce intense pricking sensation. Miliaria profunda- This nearly always follows repeated attacks of miliaria rubra, o Complications :- Secondary infection and disturbance of heat regulation

So the answer to this question is A


Instruction:
Methotrexate is used in high doses in -
A. Osteosarcoma
B. Retinoblastoma
C. Rhabdomyosarcoma
D. Ewig's sarcoma

Response:
Ans. is 'a' i.e., Osteosarcoma o High dose methotrexate with leucoverin is indicated for chemotherapy in osteosarcoma.

So the answer to this question is A


Instruction:
Nicotinic acid is useful in all types of hyperlipoproteinemias, EXCEPT:
A. Type-I
B. Type-II
C. Type-Ill
D. Type-IV

Response:
Niacin is a drug (Vitamin B3) that causes a decrease in LDL cholestrol, VLDL and triglycerides along with an increase in HDL cholesterol. It acts by inhibiting lipolysis in the adipose tissue. Fuher, it can also decrease lipoprotein(a) and fibrinogen. It is useful for type IIb, III and IV hyperlipoprotein disorders. Also Know: Niacin is the best agent available for increasing HDL-C (30-40%). In patients with diabetes mellitus, niacin should be used cautiously because niacin-induced insulin resistance can cause severe hyperglycemia. Niacin also elevates uric acid levels and may reactivate gout. A history of gout is a relative contraindication for niacin use. Ref: Bersot T.P. (2011). Chapter 31. Drug Therapy for Hypercholesterolemia and Dyslipidemia. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e

So the answer to this question is A


Instruction:
A child is able to build blocks of 5 Cubes developmental age is -
A. 12 months
B. 15 months
C. 18 months
D. 24 months

Response:
Ans. is 'c' i.e., 18 month

So the answer to this question is C


Instruction:
A person has poor performance in front of his seniors in public place, has tachycardia when he has to deliver a lecture, avoids going to parties. The diagnosis is -
A. Panic disorder
B. Schizophrenia
C. Social phobia
D. Avoidant personality

Response:
None

So the answer to this question is C


Instruction:
All of the following are true about intestinal motility except
A. Increased by distension
B. Depends on gastric motility
C. Increased by cholecystokinin
D. Increased by secretin

Response:
"Peristaltic activity of the small intestine is greatly increased after a meal. This increased activity is caused paly by the beginning entry of chyme into the duodenum, causing stretch of the duodenal wall. In addition, peristaltic activity is increased by the so-called gastroenteric reflex that is initiated by distention of the stomach and conducted principally through the myenteric plexus from the stomach down along the wall of the small intestine." "In addition to the nervous signals that may affect small intestinal peristalsis, several hormonal factors also affect peristalsis. These factors include gastrin, CCK, insulin, motilin, and serotonin, all of which enhance intestinal motility and are secreted during various phases of food processing. Conversely, secretin and glucagon inhibit small intestinal motility." Reference: Guyton Physiology, 13th ed, Page: 813

So the answer to this question is D


Instruction:
Polyuria is defined as?
A. 30 ml / Kg/ day
B. 40 ml / Kg/ day
C. 50 ml/ kg / day
D. 60 ml/ kg / day

Response:
Polyuria 40 ml/kg/day Polydipsia >100 ml/kg/day

So the answer to this question is B


Instruction:
All of the following statements regarding ductus deference are true except
A. The terminal pa is dilated to form ampulla
B. It crosses ureter in the region of ischial spine
C. It passes lateral to inferior epigastric aery at deep inguinal ring
D. It is separated from the base of bladder by the peritoneum

Response:
The ductus deferens is the continuation of the tail of the epididymis and runs in the spermatic cord through the scrotum, inguinal canal and into the abdominal cavity, where it is extra-peritoneal. There it travels laterally through the pelvis, passing anterior to the ureter and inferior to the bladder, where it unites with the duct of the seminal vesicle to form the ejaculatory duct in the prostate In the prostate, the ejaculatory duct empties into the prostatic urethra. Ref - BDC 6th edition Vol2 pg227

So the answer to this question is D


Instruction:
A patient with alkaline urine which is cloudy with plenty of pus cells is suffering from:
A. E. coli
B. Proteus
C. TB
D. None

Response:
Ans: b (Proteus)Ref: Bailey & Love, 24th ed, p. 1324 & 23rd ed, p. 1191Proteus and Staphylococcus split urea, forming ammonia which makes the urine alkaline and promotes formation of calculi.

So the answer to this question is B


Instruction:
Which of the following drugs has been found to be useful in acute severe asthma ?
A. Magnesium Sulphate
B. Anti-leukotrine
C. Cromolyn Sodium
D. Cyclosporine

Response:
A high concentration of oxygen should be given by face mask to achieve oxygen saturation of >90%.Magnesium sulfate given intravenously or by nebulizer has been found to be effective in acute severe asthma,when added to inhaled beta2 -agonists & is well tolerated.It can provide additional bronchodilation in patients whose presenting PEF(peak ejection fraction)is below 30% predicted. Reference:Harrison's medicine-18th edition,page no:2113;Davidson's medicine-22nd edition,page no:672.

So the answer to this question is A


Instruction:
Bajaj committee in 1986 proposed?
A. Multipurpose health worker
B. Manpower and planning
C. Rural Health Service
D. Integrated health services

Response:
<p> Manpower and planning. Reference:India health repo 2010,page no;132. <\p>

So the answer to this question is B


Instruction:
Kveim test is used for-
A. Tuberculosis
B. Systemic lupus erythematosis tissue
C. Sarcoidosis
D. Cystic fibrosis

Response:
The Kveim test, Nickerson-Kveim or Kveim-Siltzbach test is a skin test used to detect sarcoidosis, where pa of a spleen or lymphnode from a patient with known sarcoidosis is injected into the skin of a patient suspected to have the disease. If non caseating granulomas are found (4-6 weeks later), the test is positive . Ref - pubmed.com

So the answer to this question is C


Instruction:
Most common cause of diarrhea in children of developing countries is:
A. EHEC
B. ETEC
C. EAEC
D. EIEC

Response:
ETEC Most frequent bacterial cause of diarrhea in children of developing countries. Most common cause of traveler's diarrhea. EPEC Cause infantile diarrhea (outbreaks) Rarely sporadic diarrhea in adults.

So the answer to this question is B


Instruction:
Snowstorm appearance in Ultrasound is seen in:
A. Hydatiform mole
B. Twins
C. Hydronephrosis
D. Downs syndrome in fetus

Response:
Explanation:On ultrasound, the Hydatiform mole resembles a bunch of grapes ('cluster of grapes" or ''honeycombed uterus" or "snow-storm appearance) (See table below) Partial and Complete Hydatiform Mole PARTIAL MOLECOMPLETE MOLEFetus, Fetal vessels, PlacentaPresentAbsentKaryotype69 XXY (triploid)46 XXHydropic changesFocalMarkedMalignant potentialRare1 5-20%Ultrasound featuresFocal cystic spaces in placentaFetus and placenta are seenTransverse diameter of uterus increasesSnowstorm appearance

So the answer to this question is A


Instruction:
Incomplete uterine rupture is defined as?
A. Disruption ofpa ofscar
B. Disruption of entire length of scar
C. Disruption of scar including peritoneum
D. Disruption of scar with peritoneum intact

Response:
Ans. is'd' i.e., Disruption of scar with peritoneum intact Incomplete rupture :In an Incomplete uterine rupture, the mother's peritoneum remains intact.The peritoneum is the membrane that lines the abdominal cavity to suppo abdominal organs.It also acts as a channel for blood vessels and nerves.An incomplete uterine rupture is significantly less dangerous with fewer complications to the delivery process.Complete rupture:During a Complete uterine rupture, the peritoneum tears and the contents of the mother's uterus can spill into her peritoneal cavity.The peritoneal cavity is the fluid-filled gap that separates the abdomen walls and its organs.It is suggested that delivery cesarean section (C- section) should occur within approximately 10 to 35 minutes after a complete uterine rupture occurs.The fetal morbidity rate increases dramatically after this period.

So the answer to this question is D


Instruction:
A G2P1 on warfarin presents at 38 weeks in labor: Next step
A. Stop warfarin, proceed with vaginal delivery
B. Stop warfarin, proceed with caesarean section
C. Replace warfarin with heparin and proceed with vaginal delivery
D. Replace warfarin with heparin & proceed with cesarean section

Response:
Ans. is b i.e. Stop warfarin, proceed with caesarean sectionSince the patient is presenting in labor on warfarin, now management is to stop her warfarin and do caesarean section.Note: If patient is on warfarin at the time of labor or within 2 weeks of labour, then caesarean section should % be done

So the answer to this question is B


Instruction:
All are true about scrub typhus, Except
A. Causative organism is O. Tsutsugamoshi
B. Vector is trombiculide mite
C. Adult female feeds on veebrate hosts
D. Tetracycline is the drug of choice

Response:
"Mite feeds on serum of warm blood animals only during there larval stage (chiggers) and adult mites feed only on plants"Scrub typhus :Caused by O. tsutsugamushiTransmitted by trombiculid mite which also shows transovarian spreadClinical features:Fever, headache, myalgia, cough and GI symptoms.Classic case includes an eschar, regional lymphadenopathy, and a maculopapular rash.Tetracycline is the drug of choice

So the answer to this question is C


Instruction:
BIRADS stands for
A. Breast Imaging Repoing and Data System
B. Best Imaging Repoing and Data System
C. Brain Imaging Repoing and Data System
D. Blood Imaging Repoing and Data System

Response:
Category 1 Incomplete assessment, need additional imaging evaluation Category 2 Negative, routine mammogram in 1yr is recommended Category 3 Benign findings, routine management in 1 year is recommended Category 3 Probably benign findings, sho term follow up suggested Category 4 Suspicious abnormality, biopsy should be considered Category 5 Highly suggestive of malignancy, appropriate action should be taken Category 6 Known biopsy - proven malignancy

So the answer to this question is A


Instruction:
A 25 years old female comes to your clinic for evaluation of infertility. A hysterosalpingogram reveals Asherman's syndrome. What symptoms will the patient have?
A. Menorrhagia
B. Oligomenorrhea
C. Polymenorrhea
D. Hypomenorrhea

Response:
Ans. is d, i.e. HypomenorrheaThe typical presenting symptom in adenomyosis is hypomenorrhea, i.e. less blood loss during menstruation.

So the answer to this question is D


Instruction:
IPC 319 deals w ith -
A. Definition of hurt
B. Voluntarily causing hurt
C. Definition of grievous hurt
D. Voluntarily causing grievous hurt

Response:
Ans. is 'a' i.e.. Definition of hurt Section of IPCDescription319Defines hurt320Defines grievous hurt321Voluntarily causing hurt322Voluntarily causing grievous hurt323Punishment for voluntarily causing hurt324Voluntarily causing hurt by dangerous weapons or means325Punishment for voluntarily causing grievous hurt326Voulntarily causing grievous hurt by dangerous weapon or means

So the answer to this question is A


Instruction:
The longest transit time in GIT is seen in
A. Stomach
B. Jejunum
C. Colon
D. Ileum

Response:
The longest transit time is seen in the colon. Average Transmit Time Segment Transit time Esophagus 2-3 seconds Stomach 2-5 hours Small intestine 3-6 hours Caecum 4 hours First third of colon 6 hours Second third of colon 9 hours Sigmoid colon 12 hours Ref: Ganong&;s Review of medical physiology 26th edition pgno: 493-494

So the answer to this question is C


Instruction:
Which of the following is not an inflammatory mediator
A. Tumor necrosis factor
B. Myeloperoxidase
C. Interferons
D. Interleukins

Response:
steps: (1) migration and proliferation of fibroblasts into the site of injury and (2) deposition of ECM proteins produced by these cells. The recruitment and activation of fibroblasts to syn- thesize connective tissue proteins are driven by many growth factors, including PDGF, FGF-2 (described earlier), and TGF-b. The major source of these factors is inflamma- tory cells, paicularly macrophages, which are present at sites of injury and in granulation tissue. Sites of inflamma- tion are also rich in mast cells, and in the appropriate chemotactic milieu, lymphocytes may be present as well. Each of these cell types can secrete cytokines and growth factors that contribute to fibroblast proliferation and activation. As healing progresses, the number of proliferating fibroblasts and new vessels decreases; however, the fibro- blasts progressively assume a more synthetic phenotype, so there is increased deposition of ECM. Collagen synthe- sis, in paicular, is critical to the development of strength in a healing wound site. As described later, collagen syn- thesis by fibroblasts begins early in wound healing (days 3 to 5) and continues for several weeks, depending on the size of the wound. Net collagen accumulation, however, depends not only on increased synthesis but also on diminished collagen degradation (discussed later). Ulti- mately, the granulation tissue evolves into a scar composed of largely inactive, spindle-shaped fibroblasts, dense collagen, fragments of elastic tissue, and other ECM com- ponents (Fig. 2-30, B). As the scar matures, there is proA A gressive vascular regression, which eventually transforms the highly vascularized granulation tissue into a pale, largely avascular scar. Growth Factors Involved in ECM Deposition and Scar Formation Many growth factors are involved in these processes, including TGF-b, PDGF, and FGF. Because FGF also is involved in angiogenesis, it was described earlier. Here we briefly describe the major propeies of TGF-b and PDGF. * Transforming growth factor-b (TGF-b) belongs to a family of homologous polypeptides (TGF-b1, -b2, and -b3) that includes other cytokines such as bone morphogenetic proteins. The TGF-b1 isoform is widely distributed and is usually referred to as TGF-b. The active factor binds to two cell surface receptors with serine-threonine kinase activity, triggering the phosphorylation of transcription factors called Smads. TGF-b has many and often oppo- site effects, depending on the cell type and the metabolic state of the tissue. In the context of inflammation and repair, TGF-b has two main functions: TGF-b stimulates the production of collagen, fibro- nectin, and proteoglycans, and it inhibits collagen degradation by both decreasing proteinase activity and increasing the activity of tissue inhibitors of pro- teinases known as TIMPs (discussed later on). TGF-b is involved not only in scar formation after ref Robbins 9/e p83

So the answer to this question is B


Instruction:
Wrist X-ray is given below. What is the probable diagnosis:
A. Rickets
B. Colles fracture
C. Scaphoid fracture
D. Osteoporosis

Response:
Fig. X-ray wrist--rickets Fig. Rickets knee RADIOGRAPHIC FINDINGS The characteristic feature of rickets are thickening and widening of growth plate (physis). Indistinct and hazy metaphysis that is abnormally wide (splaying) with cupping or flaring (Brush like appearance). Bowing of diaphysis, with thinning of coices. Looser's zone in 20%. Persistent hypocalcemia may cause secondary hyperparathyroidism.N NOTE:Lower limb deformities appear when the child stas to walk. Hence, bowing of legs will be less commonly seen in infants.

So the answer to this question is A


Instruction:
The most common type of anorectal malformation is
A. Imperforate anus
B. Anal agenesis
C. Anorectal agenesis
D. Rectal atresia

Response:
The most common type of malformation involving the anal canal and rectum is anorectal agenesis, in which the rectum ends as a blind sac above the puborectalis muscle. The anal canal may form normally but does not connect with the rectum. This malformation is accompanied by various fistulas.

So the answer to this question is C


Instruction:
Newborn commonly has following except-
A. Milia
B. Mongolian spots
C. Epstein pearls
D. None of the above

Response:
Ans. is 'd' i.e., None of the above o There are some minor clinical problems which can occur in normal newborn and require no treatment. o The problems are ? 1. Mina White dots on nose and face due to distended sebaceous glands. These diseappear spontaneously. 2. Erythema toxicum Erythematous papules on trunk & face. Appear on 2nd & 3rd day and disappear spontaneously. 3. Mongolian spots Bluish spots on the buttocks and trunk. Disappear before first bihday. 4. Stork bites Pinkish gray capillary hemangiomas on the nape of neck, upper eyelids, forehead & nose. These disappear spontaneously. 5. Peeling of skin More frequent in post-term infants, but can also occur in term infants. 6. Subconjuctival hemorrhages Disappear spontaneously 7. Breast engorgment Due to transplacentally acquired maternal hormones. Seen on 3rd or 4th day. 8. Epstein pearl Epithelial inclusion cysts, which appear as whitish spots. These are of two types - i) Palatal --> On hard palate or on either side of median raphe. ii)Prepucial --> At the tip of prepuce at 6 '0' clock position. 9. Pre-deciduous (natal) teeth Supernumerary teeth in the lower incisor position. These are shed before the primary dentition. 10. Vaginal bleeding On 3rd to 7th day Due to withdrawl of maternal hormones after bih. 11. Vaginal mucoid discharge Because of transplacentally acquired estrogen on vaginal mucosa. Hymenal tags --> around margins of hymen Physiological phymosis

So the answer to this question is D


Instruction:
Thyroplasty Type I is done for vocal cord.........
A. Medialisation
B. Lateralisation
C. Shortening
D. Lengthening

Response:
Ans: a (Medialisation) Ref: Dhingra, 3rded, p. 364 & 4thed, p. 278Laryngeal frame work surgery - Isshiki's classificationType I thyroplastyType II thyroplastyType III ThyroplastyType IV thyroplasty- Medial displacement- Lateral displacement- Shortening (relaxation)- Elongation (tensioning) Indications: Type III thyroplastyIndications: Type IV thyroplasty1) Adductor spasmodic dysphonia2) Mutational falsetto3) Gender transformation (female to male)1) Androphonia2) Post surgical defects3) Gender transformation (male to female)

So the answer to this question is A


Instruction:
The most serious complication of acute hemolytic anemia in G6PD deficiency is:
A. Acute renal failure
B. Congestive cardiac failure
C. Cerebral infarction
D. Acute liver failure

Response:
The most serious threat from acute hemolytic anemia is the development of ARF. Ref: Harrison's principles of internal medicine, 18th edition ; Page :879

So the answer to this question is A


Instruction:
In follicular carcinoma chromosomal translocation is?
A. PAX8 -PPARrl
B. RET - PTC
C. ALK -NMP1
D. JAK - TEL

Response:
Ans. is 'a' i.e., PAX8- PPARrl Various genes involved in thyroid carcinomas arePapillaryo Tyrosine kinase receptors RET or NTRK1o RAS mutationo BRAF oncogeneFollicularo RAS oncogene (NRAS, HRAS and KRAS)o PAX8- PPARrl translocationMedullaryo RETprotooncogne.

So the answer to this question is A


Instruction:
Muscle attached to navicular tuberosity is
A. Tibialis anterior
B. Tibialis posterior
C. Peroneous longus
D. Extensor hallucis longus

Response:
Navicular bone Medial surface has a blunt and prominent tuberosity directed downwards.The tuberosity is separated from the plantar surface by a groove. Tuberosity receives the inseion of Tibialis posterior.The groove below the tuberosity transmits a pa of the tendon of this muscle to another bones. <img src=" /> {Reference: BDC 6E pg no.34}

So the answer to this question is B


Instruction:
The gene for folic acid transpoer is located on which chromosome:
A. 5
B. 15
C. 21
D. X

Response:
C i.e. 21Folic acid transpoer gene (SLC 19 AI solute carrier family 19) is located on long arm of chromosome 21 (21q) Q at band 22.3. Transpo of folate occurs by potocytosis which functionally couples folate receptor, folate transpoer and V- type h+ pump.

So the answer to this question is C


Instruction:
Diffusion hypoxia seen during ?
A. Induction of anesthesia
B. Reversal of anesthesia
C. Post operative period
D. None of the above

Response:
Ans. is 'b' i.e., Reversal of anaesthesia Second gas effect and diffusion hvpoxia In initial pa of induction, diffusion gradient from alveoli to blood is high and larger quantity of anaesthetic is entering blood. If the inhaled Concentration of anaesthetic is high (eg N20), Substantial loss of alveolar gas volume will occur and it creates negative intralveolar pressure that leads to removal of more gas from cylinder to alveoli Concentration effect. If another inhalation agent is (eg Halothane) is being given at the same time, it also will be delivered to lung from the cylinder (due to negative intraalveolar pressure) Second gas effect. During recovery reverse occurs - N20 having low blood solubility, rapidly diffuses into alveoli and dilutes the alveolar air --> paial pressure of oxygen in alveoli is reduced. The resulting hypoxia is known as diffusion hypoxia. Diffusion hypoxia can be prevented by continuing 100% 02 inhalation for a few minutes after discontinuing N20, instead of straight away switching over to air.

So the answer to this question is B


Instruction:
Naloxone for opioid receptor acts as:
A. Pure agonist
B. Pure antagonist
C. Paial agonist
D. Agonist antagonist

Response:
Naloxone is a pure antagonist and is preferred over older weak agonist-antagonist agents that had been used primarily as antagonists, eg, nalorphine and levallorphan. Ref: Katzung, 11th edition, Chapter 31.

So the answer to this question is B


Instruction:
Present "General fertility rates"
A. 84
B. 118
C. 128
D. 138

Response:
None

So the answer to this question is A


Instruction:
Suspended animation:
A. Is apparent death from which a person can be aroused
B. Is true death from which person cannot be aroused
C. May last for days or weeks
D. Cannot be produced voluntarily

Response:
Ans. (A). Is apparent death from which a person can be arousedSuspended animation lasts for few seconds to 1/2 hoursQIt is apparent death from which person can be arousedYoga practitioners produce suspended animation like state voluntarilyThere is no cell deathQ in suspended animation.

So the answer to this question is A


Instruction:
All of the following are the criteria for overcrowding except:-
A. Per capita space if <70-90 ft2/person
B. If >1 persons/room
C. If sex separation is absent
D. 2 people of opposite sex >9 years & not husband and wife are made to sleep in 1 room

Response:
Housing: Overcrowding criteria:- Per capita space if <70-90 ft 2 /person If >2 persons/room If sex separation is absent i.e. when 2 people of opposite sex >9yrs & not husband and wife are made to sleep in 1 room Persons per room 1 room 2 persons 2 rooms 3 Persons 3 rooms 5 Persons 4 rooms 7 Persons 5 or more 10 persons (additional 2 for each fuher room)

So the answer to this question is B


Instruction:
All of the following are risk factors for carcinoma gall bladder, EXCEPT -
A. Typhoid carriers
B. Adenomatous gall bladder polyps
C. Choledochal cysts
D. Oral contraceptives

Response:
None

So the answer to this question is D


Instruction:
In a patient with acute leukemia, immunophenotype pattern is CD 19+ve, CD 10+ve, CD33+ve, CD13+ve.He may probably have-
A. Biphenotypic leukemia
B. ALL
C. AML-M2
D. AML-M0

Response:
None

So the answer to this question is A


Instruction:
Most significant indicator of fertility is -
A. Net reproductive rate
B. Family size
C. Gross reproduction rate
D. General fertility rate

Response:
Net reproduction rate

Net reproductive rate is defined as

"The no. of daughters a new born girl will bear during her lifetime assuming fixed age specific fertility and mortality rates"

It is the only fertility related statistics which also takes mortality rates into consideration.
NRR of one is equivalent to attaining approximately the two child norms.
Goal of NRR=1 can be achieved only if at least 60%* of the eligible couples are effectively practicing family planning.

Gross reproduction rate (GRR):

Average number of girls that would be born to a married woman if she experiences the current fertility pattern throughout her reproductive span (15-44 or 49 year) assuming no mortality.

So the answer to this question is A


Instruction:
Immune complex mediated reaction
A. Type I
B. Type II
C. Type III
D. Type IV

Response:
Ans. is 'c' i.e., Type III reactions Type III hypersensitivity o Type III hypersensitivity reaction is antigen-antibody immune complex mediated that are deposited in postcapillary venules of various tissues with subsequent complement fixation. o Immune complexes produce tissue damage mainly be eliciting inflammation. Type III hypersensitivity may be of two types A. Systemic or generalized Immune complex disease (serum sickness) - It occurs in three phases :? Phase I --> Formation of antigen - antibody immune - complex in the blood. Phase II --> Traveling of immune complex through blood and deposition in various tissues. Phase III ---> Induction of inflammation by immune complex. Generally, common sites of deposition of immune complex incude - Skin Joints Lungs Kidney Blood vessels B. Localized immune complex disease (Ahus reaction) Ahus reaction is a localized area of tisue necrosis resulting from acute immune - complex vasculitis, usually elicited in the skin.

So the answer to this question is C


Instruction:
Most common cause of hirsutism in a teenage girl:
A. Ovarian disease
B. Pheochromocytoma
C. Obesity
D. Adrenogenital syndrome

Response:
As explained earlier PCOD is the most common cause of hirsutism.
PCOD most common affects teenage girls (15–25 years). Therefore, In teenage girls most common cause of hirsutism is PCOD.

So the answer to this question is A


Instruction:
A very preterm baby on 30 mL/kg of enteral feeding developed sudden severe abdominal distension with visible bowel loops on day 6 of life. The baby also showed temperature instability and lethargy. s-ray of the abdomen showed poal venous gas. The staging of NEC is:
A. lb
B. 2a
C. 2b
D. 3a

Response:
Ans. c. 2b

So the answer to this question is C


Instruction:
The Lymph node to be involved in Cancer Gall bladder to be called as M1 Stage?
A. Inter aortocaval node
B. Superior mesenteric node
C. Coeliac node
D. Pancreatico duodenal node

Response:
Ans. (a) interaortocaval NodeRef: Blumgart 6th Edition Page 788, 799* The first Manuever during Extended Cholecystectomy is to do Kocherisation and assess Aortocaval and Retro pancreatic nodes. The coeliac node must also be assessed; and Suspicious nodes sent for Frozen Section and if positive the procedure is terminated.* N1 = Metastases to nodes along cystic duct, common bile duct, hepatic artery, and/or portal vein* N2 = Metastases to periaortic, pericaval, superior mesenteric artery, and/or celiac artery nodes* M1 = Interaortocaval nodes

So the answer to this question is A


Instruction:
A recurrent Chalazion should be subjected to histopathologic evaluation to exclude the possibility of-
A. Squamous cell carcinoma
B. Sebaceous cell carcinoma
C. Malignant melanoma
D. Basal cell carcinoma

Response:
*A recurrent Chalazion in old age should arouse suspicion of malignant change into meibomian gland adenocarcinoma (Sebaceous cell carcinoma). Ref: Kanski 5th/e p.13

So the answer to this question is B


Instruction:
Seen in B/L congenital hip dislocation is/are -a) Short stratureb) Wandering acetabulumc) Waddling gaitd) Lumbar lordosis
A. acd
B. ad
C. bc
D. bde

Response:
In a bilateral dislocation the gait is described as 'duck like waddle' or 'sailor's gait and consists of an inclination to the side on which the weight is born (lurching gait on both side). In unilateral cases the child lurches towards affected side. This is known as abductor lurch or Trendelenburg gait.

Lordosis is particularly noticeable in bilateral cases & is often presenting complaint.

There short stature with both lower limbs appear too short for the body.
There is compensatory genu valgum. As both hips are adducted patient tries to keep the feet outside, which causes bilateral compensatory genu valgum.

Shenton's line is broken.

So the answer to this question is A


Instruction:
Kevorkian sign is seen in
A. Cornea
B. Retinal vessels
C. Pupil
D. Vitreous humour

Response:
Kevorkian sign is seen as a postmoem change that occurs in the retinal *it is characterized by fragmentation of blood column in the retinal vessels *it appears within minutes after and last for about 1 *it can be visualised by using an opthamalscope Other postmoem changes in eye : Cornea -dull, opaque, hazy, wrinkled Flaccidity of eyeballs occurs due to fall in intraocular pressure Tache :One of the post Moem where a film of cell debris and mucus forms two yellow triangles on sclera on either side of ,with base towards the margin of ,appearing 3-4 hours after death Refer:The essentials of Forensic Medicine and Toxicology ,33rd edition, page 154

So the answer to this question is B


Instruction:
Disposable syringes are sterilized by
A. 2% glutaraldelyde
B. Autoclave
C. Hot air oven
D. Ionizing radiation

Response:
Disposable plastics eg : Rubber or plastic syringes infusion sets, catheters are sterilized by Ionizing radiation.

So the answer to this question is D


Instruction:
A 4-month-old infant with Tetralogy of Fallot presents with fever and loose stools. Which of the following is compatible with the diagnosis of Tetralogy spells?
A. O2 saturation < 70% in room air
B. Inability to hear a murmur
C. Hepatomegaly
D. S3 gallop rhythm

Response:
Paroxysmal hypercyanotic attacks (hypoxic, "blue," or "tet" spells) are a paicular problem during the first 2 years of life. The infant becomes hyperpneic and restless, cyanosis increases, gasping respiration ensue, and syncope may follow. The spells occur most frequently in the morning on initially awakening or after episodes of vigorous crying. Temporary disappearance or a decrease in intensity of the systolic murmur is usual as flow across the right ventricular outflow tract diminishes.

So the answer to this question is B


Instruction:
As per the latest guidelines which of the following dehydration status requires ORT prescription –
A. Mild dehydration
B. Moderate dehydration
C. Some dehydration
D. Any dehydration

Response:
None

So the answer to this question is D


Instruction:
The following immunoglobulin is not known to fix complement
A. IgE
B. IgM
C. IgA
D. IgG

Response:
None

So the answer to this question is A


Instruction:
Daughter cells formed from the cleavage of zygote are
A. Morula
B. Gastrula
C. Blastula
D. Blastomere

Response:
Zygote first divide into blastomere, 16 cell stage is known as Morula.

So the answer to this question is D


Instruction:
C-3 nephritic factor is associated with which of the following conditions?
A. MPGN Type 1
B. MPGN Type 2
C. Membranous nephropathy
D. Minimal change disease

Response:
Dense-Deposit Disease (type II MPGN) Resulting in excessive activation of the alternative complement pathway. Normally, this C3 convease is labile, but more than 70% of patients with dense-deposit disease have a circulating autoantibody termed C3 nephritic factor (C3NeF) that binds the alternative pathway C3 convease and protects it from inactivation.

So the answer to this question is B


Instruction:
All of the following muscles are derived from 6th branchial arch EXCEPT:
A. Lateral cricoarytenoid
B. Posterior cricoarytenoid
C. Interarytenoid
D. Cricothyroid

Response:
Ans. D CricothyroidRef: I.B. Singh, 9th ed. pg. 116* Cricothyroid muscle is derived from fourth branchial arch. It is the only intrinsic laryngeal muscle not derived from 6th branchial arch* Nerve supply: Superior laryngeal nerve

So the answer to this question is D


Instruction:
All are true about Neuroendocrine tumor of pancreas except:
A. Insulinoma is MC
B. VIP cause diarrhea
C. Diarrhea is MC symptom of gastrinoma
D. Somatostatinoma cause gall stone formation

Response:
“Insulinomas are the most common pancreatic endocrine neoplasms and present with a typical clinical syndrome known as Whipple’s triad" - Schwartz
Gastrinoma (Zollinger-Ellison Syndrome); The most common presenting symptoms are an abdominal pain (70-100%), diarrhea (37-73%). and gastroesophageal reflux disease (GERD) (30- 35%); 10-20% have diarrhea only"-Harrison
Table: GI Neuroendocrine Tumor Syndrome

So the answer to this question is C


Instruction:
Benzyl peroxide acts in acne vulgaris by:
A. Decreased sebum production
B. Acts as oxidizing agent
C. Reduces epithelial proliferation
D. Decreasing bacterial count

Response:
Ans. D. Decreasing bacterial countTopical Therapy for acne:This is designed to produce peeling of the skin, restore normal keratinization and produce a bactericidal action Topical antibiotics include erythromycin (12%) clindamycin (12%) and benzyl peroxide (510%). Benzyl peroxide has bacterio static properties in addition to its action as a peeling agent.

So the answer to this question is D


Instruction:
Acetyl CoA cannot be conveed to:
A. Fatty Acids
B. Glucose
C. Ketone Bodies
D. Cholesterol

Response:
Acetyl CoA is a staing material for Fatty Acid Synthesis, Cholesterol Synthesis & Ketone Body Synthesis (option a, c & d). But Acetyl CoA is never a substrate for Gluconeogenesis i.e. it can never form glucose (option b). Because Acetyl CoA can never be conveed back to Pyruvate as Link reaction or Pyruvate Dehydrogenase is irreversible. However, acetyl-CoA can stimulate gluconeogenesis by activating pyruvate carboxylase (see fig) Extra Edge: Acetyl CoA is NOT:- Not The intermediate of TCA. The first substrate of TCA. The carrier of TCA .

So the answer to this question is B


Instruction:
Hirschsprung's disease is due to:
A. Loss of ganglion cells in the sympathetic chain
B. Atrophy of longitudinal muscles
C. Failure of migration of neural crest cells from cranial to caudal direction
D. Malformed taenia coli

Response:
The cause of Hirschsprung's disease remains incompletely understood, although current thinking suggests that the disease results from a defect in the migration of neural crest cells, which are the embryonic precursors of the intestinal ganglion cell. Under normal conditions, the neural crest cells migrate into the intestine from cephalad to caudad.
The process is completed by the twelfth week of gestation, but the migration from the midtransverse colon to anus takes 4 weeks. During this latter period, the fetus is most vulnerable to defects in the migration of neural crest cells. This may explain why most cases of aganglionosis involve the rectum and rectosigmoid.
The length of the aganglionic segment of bowel is therefore determined by the most distal region that the migrating neural crest cells reach. In rare instances, total colonic aganglionosis may occur.

So the answer to this question is C


Instruction:
Epithelium lining of lingual surface of epiglottis is
A. Simple Columnar
B. Pseudostratified ciliated columnar
C. Simple Cuboidal
D. Stratified squamous epithelium

Response:
Stratified squamous epithelium is present in pharynx, lingual surface of epiglottis which is non keratinised in nature whereas in laryngeal surface of epiglottis it is lined by pseudostratified ciliated columnar epithelium (respiratory epithelium).

So the answer to this question is D