Instruction:
Muscle shown in the illustration predominantly uses:
A. GLUT 1
B. GLUT 2
C. GLUT 3
D. GLUT 4

Response:
Ans. D. GLUT 4a. Muscle shown is the skeletal muscle.b. Glucose transporter type 4, also known as GLUT 4, is a protein encoded in humans, by the GLUT4 gene. GLUT4 is the insulin-regulated glucose transporter found primarily in adipose tissues and striated muscle (skeletal and cardiac). The first evidence for this distinct glucose transport protein was provided by David James in 1988. The gene that encodes GLUT4 was clone and mapped in 1989.c. Recent reports demonstrated the presence of GLUT4 gene in central nervous system such as the hippocampus. Moreover, impairment in insulin-stimulated trafficking of GLUT4 in the hippocampus result in decreased metabolic activities and plasticity of hippocampal neurons, which leads to depressive like behaviour and cognitive dysfunction.GLUT4 is primarily found in: -a. Skeletal muscleb. Cardiac musclec. Adipose tissue

So the answer to this question is D


Instruction:
A woman presents to the Gynecology outpatient department with a history suggestive of stress incontinence. Which of the following is the treatment of choice for genuine stress incontinence -
A. Burch Colposuspension
B. Kelly's Procedure
C. Sling Suspension Procedure
D. Tension Free Vaginal Taping

Response:
Ans-D Tension Free Vaginal Taping (Ref. Shaw Gynecology 14th/pg. 175; TeLinde 9th/pg. 1052-1056; Novak's Gynecology 13th/pg. Chapter 20) Treatment of choice for genuine stress incontinence -Tension Free Vaginal Taping Gold standard treatment /Treatment with highest success rate is of Burch Colposuspension Operations for stress incontinence can be classified into four broad categories a. Traditional anterior vaginal colporrhaphy. b. Operations to correct stress incontinence resulting from anatomic hypermobility (retropubic bladder neck suspension operations, needle suspension procedures, tension-free vaginal tape, and some sling procedures). c. Operations for stress incontinence resulting from intrinsic sphincteric weakness or dysfunction (sling operations and periurethral injections). d. Salvage operations (intentionally obstructive sling operations, implantation of an artificial urinary sphincter, urinary diversion). Cure rates of different surical procedures for stress incontinence Operation Longterm cure (%) Kelly's repair Bladder buttress operation 67.8 MMK (Marshall-Marchetti-Krantz) operation 89.5 Burch colposuspension 89.8 Endoscopic suspension 86.7 Tension-free vaginal T-tape (TVT) 88-90 Vaginal sling operations 93.9 I. Sling Operations: a. After reviewing reports that included patient follow-up for more than 48 months, the American Urological Association and the Female Stress Urinary Incontinence Guidelines Panel concluded that the two most effective surgical treatments for stress incontinence are retropubic bladder neck suspensions and sling procedures. b. This panel confirmed that the use of sling operations in women with complex or recurrent stress urinary incontinence is a safe and effective treatment. II. Anterior Colporrhaphy Anterior vaginal repair is the oldest operation for stress incontinence in gynecology. It was described by Howard Kelly in 1914. He believed that stress incontinence was caused by an open vesical neck rather than from loss of urethral support, and he designed an operation to cure this condition by pulling the bladder neck closed using periurethral Kelly plication sutures. The problem with most techniques of anterior colporrhaphy is that they do not hold up well over time. Most surgical series that have evaluated techniques of anterior colporrhaphy for stress incontinence show long-term success rates of only 35% to 65%, a figure that most would regard as unacceptably low. Anterior colporrhaphy should be reserved primarily for patients requiring cystocele repair who do not have significant stress incontinence.

So the answer to this question is D


Instruction:
An ideal root-canal filling material should satisfy all of the following except which one?
A. The material should be well tolerated by periradicular tissues
B. The material should be easily placed
C. The material should be absorbable
D. The material should be visible radiographically

Response:
Grossman's Requirements for an Ideal Root Canal Filling Material

The material should be easily introduced into the root canal.
It should seal the canal laterally as well as apically.
It should not shrink after being inserted.
It should set slowly.
It should be impervious to moisture.
It should be bactericidal or, at least, should discourage the growth of bacteria.
It should be radiopaque.
It should not stain the tooth structure.
It should not irritate periradicular tissues or affect the tooth structure.
It should be sterile, or easily and quickly sterilized immediately before insertion.
It should be easily removable from the root canal if necessary.

Ref: Grossman endodontics 13th ed page no 343

So the answer to this question is C


Instruction:
Gold criteria for very severe airflow obstruction in COPD is
A. FEV1/FVC<0.7 & FEV1>=80% predicted
B. FEV1/FVC<0.7 & >=50% FEV1 but <80% predicted
C. FEV1/FVC<0.7 & FEV1>=30% but <50% predicted
D. FEV1/FVC<0.7 and FEV1<30% predicted

Response:
(D) FEV1/FVC<0.7 and FEV1<30% predicted [?]Hallmark of COPD is airflow obstruction.oPulmonary function test shows airflow obstruction with a reduction in FEV1 and FEV/FVC.oWith worsening disease severity, lung volumes may increase, resulting in an increase in total lung capacity, functional residual capacity, and residual volume.oIn patients with emphysema, the diffusing capacity may be reduced, reflecting the lung parenchymal destruction characteristic of the disease.oDegree of airflow obstruction is an important prognostic factor in COPDoIt is the basis for the Global Initiative for Lung Disease (GOLD) severity classificationGOLD CRITERIA FOR COPD SEVERITYGold StageSeveritySymptomsSpirometry0At riskChronic cough, sputum, productionNormalIMildWith or without chronic cough or sputum productionFEV1 /FVC<0.7 & FEV1 >80% predictedIIAModerateWith or without chronic cough or sputum productionFEV1 /FVC<0.7 & >=50%FEV1 but <80% predictedIIISevereWith or without chronic cough or sputum productionFEV1 /FVC<0.7SFEV1 >=30% but <50% predictedIVVery SevereWith or without chronic cough or sputum productionFEV1 /FVC<0.7 & FEV1 <30% predicted or FEV1 <50% predicted with respiratory failure or signs of right heart failure[?]Stage IV: Very Severe COPD:oSevere airflow limitation (FEV1/FVC<70%;FEV1<.30% predicted) or FEV1<50% predicted plus chronic respiratory failure.-Quality of life is appreciably impaired.-Exacerbations may be life-threatening.oAvoid risk factorsoOffer influenza vaccinationoAdd short-acting bronchodilators as neededoAdd rehabilitationoAdd inhaled glucocorticoids if repeated exacerbationsoAdd long-term oxygen if chronic respiratory failureoConsider surgical treatments-Arterial blood gases & Oximetry may demonstrate resting or exertional hypoxemia.-Radiographic studies may assist in the classification of the type of COPD.-CT scan is the current definitive test for establishing the presence or absence of emphysema in living subjects.-Recent guidelines have suggested testing for a, AT deficiency in all subjects with COPD or asthma with chronic airflow obstruction.-Only three interventions-smoking cessation, oxygen therapy in chronically hypoxemic patients & lung volume reduction surgery in selected patients with emphysema have been demonstrated to i influence the natural history of patients with COPD.

So the answer to this question is D


Instruction:
Coloured halo is seen in all except:
A. Open angle glaucoma
B. Closed angle glaucoma
C. Cataract
D. Any of the above

Response:
A i.e. Open angle glaucoma

So the answer to this question is A


Instruction:
Which of the following statements about confidence limits/ interval is TRUE?
A. Smaller the confidence level larger will be the confidence interval
B. Less variable the data, wider will be the confidence interval
C. Sample size does not affect the confidence interval
D. 95% confidence interval will cover 2 standard errors around the mean

Response:
The confidence interval is derived from the standard error of the mean. It is used to measure the dispersion of distribution. The confidence interval is often called as percentage confidence. The 95% critical value of confidence limit/interval covers +/- 1.96 (approx 2 S.E.) around the mean. Ref: Choosing and Using Statistics : A Biologist's Guide By Calvin Dytham, Pages 56-57; Introductory Econometrics : A Modern Approach By Jeffrey M. Wooldridge, Pages 138-140; Schaum's Outline of Theory and Problems of Probability and Statistics By Murray R. Spiegel, John J. Schiller, R. Alu Srinivasan, Pages 205-208.

So the answer to this question is D


Instruction:
All of the following drug is CYP3A inhibitor except-
A. Erythromycin
B. Itraconazole
C. Ritonavir
D. Saquinavir

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

So the answer to this question is D


Instruction:
Most common cause of small intestine obstruction is?
A. Intussception
B. Idiopathic adhesions
C. Tumors
D. Postoperative adhesions

Response:
ANSWER: (D) Postoperative adhesionsREF: Bailey & Love 25th edition page 1188, overview"The most common cause of small-bowel obstruction (SBO) is postsurgical adhesions"

So the answer to this question is D


Instruction:
Highest mortality in pregnancy
A. Fallot's tetrologv
B. Coarctation of aorta
C. Marfan’s syndrome
D. Eisenmenger syndrome

Response:
Eisenmenger syndrome

These patients have pulmonary hypertension with shunt (right to left) through an open ductus or ASD or VSD.
Maternal mortality is high i.e. 50% & so is a perinatal loss (50%).
Fallot’s tetralogy, coarctaion of aorta & Marfan's syndrome hav mortality’ rate of 5-10%, 3-9% & 25% respectively

So the answer to this question is D


Instruction:
In which of the following chronic Conditions, degenerative changes in the brain are Seen which are not a pa of normal ageing?
A. Dementia
B. Pseudodementia
C. Amnestic synrome
D. Delirium

Response:
Amnesia is a deficit in memory caused by brain damage or disease, but it can also be caused temporarily by the use of various sedatives and hypnotic drugs. The memory can be either wholly or paially lost due to the extent of damage that was caused.There are two main types of amnesia: retrograde amnesia and anterograde amnesia. Retrograde amnesia is the inability to retrieve information that was acquired before a paicular date, usually the date of an accident or operation.In some cases the memory loss can extend back decades, while in others the person may lose only a few months of memory. Anterograde amnesia is the inability to transfer new information from the sho-term store into the long-term store. People with this type of amnesia cannot remember things for long periods of time. These two types are not mutually exclusive; both can occur simultaneously People with amnesia can learn new information, paicularly non-declarative knowledge. However, some people with dense anterograde amnesia do not remember the episodes during which they previously learned or observed the information. Declarative information Some patients with anterograde amnesia can still acquire some semantic information, even though it might be more difficult and might remain rather unrelated to more general knowledge. H.M. could accurately draw a floor plan of the home in which he lived after surgery, even though he had not lived there in years. The reason patients could not form new episodic memories is likely because the CA1 region of the hippocampus was a lesion, and thus the hippocampus could not make connections to the coex. After an ischemic episode following surgery, an MRI of patient R.B. showed his hippocampus to be intact except for a specific lesion restricted to the CA1 pyramidal cells. Non-declarative information Some retrograde and anterograde amnesics are capable of non-declarative memory, including implicit learning and procedural learning. For example, some patients show improvement on the pseudorandom sequences experiment as healthy people do. Therefore, procedural learning can proceed independently of the brain system required for declarative memory. According to fMRI studies, the acquisition of procedural memories activates the basal ganglia, the premotor coex and the supplementary motor area, regions which are not normally associated with the formation of declarative memories. This type of dissociation between declarative and procedural memory can also be found in patients with diencephalic amnesia such as Korsakoff's syndrome. Another example demonstrated by some patients, such as K.C. and H.M, who have medial temporal damage and anterograde amnesia, still have perceptual priming. Those patients did well in the word fragment completion test. Ref Harrison20th edition pg 2134

So the answer to this question is C


Instruction:
Retinopathy of prematurity is commonly predisposed by-
A. Less gestation age
B. Low birth weight
C. O2 toxicity
D. Carbohydrate excess

Response:
Ans. is less gestation age (Ref Nelson, 17/e, p 2113, 2114 (16/e, p. 1925); O.P. Ghai, 6/e, p 629 (5/e, p. 504)).There is always the confusion between pre-maturity (less gestation age) and O2 toxicity, as the predisposing factor (Some are also confused with low birth weight).Read these lines from Nelson. They will clear away most of your doubts."Retinopathy of prematurity occurs almost exclusively in pre-term infants."The risk factor's associated with ROP are not fully known, but prematurity and the associated retinal immaturity at birth represents the major factors.Hyperoxia is also a major factor but other problems, such as respiratory distress, apnea, bradycardia, heart disease, infection, hypoxia, hypercarbia, acidosis, anemia and the need for transfusion are thought by some to be contributory factors".Crux is Predisposing factor for ROP -Prematurity (les gestation age)* Precipitating factor -Hyperoxia*

So the answer to this question is A


Instruction:
Nerve to which of the following extraocular muscle gives rise to a branch of ciliary ganglion:
A. Superior rectus
B. Inferior oblique
C. Rectus medialis
D. Rectus lateralis

Response:
Ciliary ganglion is a parasympathetic ganglion located near the apex of the orbit between the optic nerve and lateral rectus. It has three roots parasympathetic or motor, sympathetic and sensory roots. The motor root arises from the nerve to inferior oblique, sympathetic root arises from the nasociliary nerve and sympathetic root is a branch from the internal carotid plexus. Ref: Human Anatomy by B.D Chaurasia, 4th Edition, Vol 3, Page 114.

So the answer to this question is B


Instruction:
All of the following are true about Primary CNS Lymphoma except:
A. Most common type in immunocompetent patients is DLBCL
B. Glucocoicoids should be given before biopsy to reduce the risk of edema
C. Stereotactic biopsy is necessary for histologic diagnosis
D. High-dose methotrexate is used for the treatment

Response:
PCNSL: Has increased incidence in immunocompromised patients Most common type in immunocompetent patients is DLBCL Lymphoma anywhere in the body- Biopsy is needed for diagnosis In PCNL - Stereotactic biopsy is necessary for histologic diagnosis Steroids are C/I as they have cytolytic effect on tumor PCNL is also known as Ghost tumor - tumor disappear if given steroids Treatment: Chemotherapy - high dose Methotrexate

So the answer to this question is B


Instruction:
True about nocardia are all EXCEPT:
A. Penicillin is drug of choice
B. Most common disease caused is pneumonia
C. Aerobic
D. Acid fast

Response:
Penicillin is drug of choice REF: Harrsion's 18th ed chapter 162 NOCARDIA: Aerobic, gram positive, urease, catalase positive, paially acid fast. Most common species: N. ASTEROIDES Most common risk factor: contact with soil or vegetable Most common manifestation: pneumonia Most common site of extra pulmonary dissemination: brain DOC: Trimethoprim - sulphamethoxazole

So the answer to this question is A


Instruction:
Propylthiouracil is preferred over Methimazole in treatment of Thyroid storm because
A. It is more potent antithyroid drug.
B. It is less plasma protein bound
C. It decreases peripheral conversion of T4 to T3
D. All of the above

Response:
Propylthiouracil is preferred over Methimazole in treatment of Thyroid storm because: Propylthiouracil impairs peripheral conversion of T4 - T3 However, PTU is less potent and has higher plasma protein binding as compared to methimazole.

So the answer to this question is C


Instruction:
Bilious vomiting is seen in all except:
A. Jejunal atresia
B. Volvulus of small intestine
C. Duodenal atresia
D. Pyloric stenosis

Response:
Ans: d (Pyloric stenosis)Ref: Bailey & Love, 24th ed, p. 1033 & 23rd ed, p. 899

So the answer to this question is D


Instruction:
True statement regarding Pulmonary ventilation is
A. PaO2 is maximum at the apex.
B. V/Q is maximum at the base.
C. Ventilation per unit lung volume is maximum at the apex
D. Blood circulation is minimum at the base

Response:
A i.e. PaO2 is maximum at apexVentilation perfusion ratio is maximum at the Apex of lungQ and minimum at base.In an upright positionVentilation per unit lung volume is greatest at basePerfusion per unit lung volume is greatest at base- a 2 is maximum at apex.High V- p ratio at the apex accounts for predilection of the tuberculosis for this area.In patient with unilateral lung disease the patient is positioned such that the good lung is in dependent position. Aerial oxygenation is improved in this position due to effect of gravity on ventilation.(The situation in infants is opposite. i.e. infants do better with the diseased lung in the dependent position)

So the answer to this question is A


Instruction:
All of the following decrease with age except:-
A. Total lung capacity
B. PaO2
C. FRC
D. FEV1

Response:
With increasing age, total lung capacity decreases : decrease in lung volumes d/o* Decrease strength of respiratory muscles : decrease TV, decrease TLC* Decrease elasticity of lung : decrease IRC, decrease TLC* Decrease inspiratory capacity : decrease PaO2* Airway remodeling : decrease FEV1 * Increase FRC k/o airway remodeling, more air tends to Increase RV stay trapped in the alveoli. FRC will increase with age, because of loss of elastic tissue and airway remodelling, more amount of air is trapped in alveoli.

So the answer to this question is C


Instruction:
An asymptomatic male came for USG abdomen for medical fitness. A focal lesion was found in his liver on ultrasound as shown here. The patient was told that this is the most common benign hepatic tumor. Which of the following is a false statement about this lesion?
A. The most sensitive and specific investigation CT Triphasic Contrast
B. Most of these lesions are asymptomatic
C. Characteristic Centripetal fill-in appearance is seen on postcontrast study.
D. Angiography shows characteristic "cotton-wool" appearance.

Response:
Ans. A. The most sensitive and specific investigation CT Triphasic ContrastHemangiomas are the commonest benign hepatic tumors with a prevalence at postmortem of between 4 per cent and 20 per cent. Multiple hemangiomas occur in up to 10 per cent of cases. They are composed of vascular channels of varying size (cavernous to capillary), lined with endothelium, often with intervening fibrous tissue of varying amounts. Most hemangiomas are asymptomatic, incidental findings on imaging. Those between approximately 2 and 4 cm in diameter are most likely to possess characteristic features allowing a confident diagnosis by imaging alone.

So the answer to this question is A


Instruction:
A child presents with antimongoloid slant, pulmonary stenosis, sho stature and undescended testis. The likely diagnosis is-
A. Hypoparathyroidism
B. Noonan syndrome
C. Klinefelter syndrome
D. XYY sex chromosomes

Response:
Ans. is 'b i.e., Noonan Syndrome

So the answer to this question is B


Instruction:
A woman at 8 months of pregnancy complains of abdominal pain and slight vaginal bleed. On examination the uterine size is above the expected date with absent fetal heart sounds. The diagnosis:
A. Hydramnios
B. Concealed hemorrhage
C. Active labor
D. Uterine rupture

Response:
Ans. is b, i.e. Concealed hemorrhageRef Dutta Obs. 7/e, p 255, 212, 429Let's analyse all options separately to see which suits the best.OptionsPoints in favourPoints against* Option "a" Hydramnios* Size of uterus > gestational age.* Absent fetal heart sounds (in polyhydramnios fetal heard sound is not distinctly heard) 05* Abdominal pain and vaginal bleeding (Main complain of patient with hydramnios is difficulty in breathing and swelling over legs Option "a" ruled out* Option "c" Active labor* Complain of abdominal pain and slight vaginal bleed (Which can be show of active labor)* Height of uterus > than the period of gestation (Height of uterus = period gestation in normal labor)* Absent fetal heart sound (FHS is present in normal laborOption "d"Rupture uterus Since period of gestation is 8 month i.e. rupture is occurring during pregnancy and since no H/o scared uterus is given we are taking it as spontaneous rupture during pregnancy* Height of uterus more than period of gestation* Absent fetal heart sounds* In rupture patient complains of acute pain in abdomen accompanied by fainting attack/collapse* Acute tenderness on abdominal examination* Palpation of superficial fetal parts Spontaneous rupture during pregnancy of un-scarred uterus occurs in high parous women and is not commonOption "b" Concealed hemorrhage* Abdominal pain and vaginal bleeding* Height of uterus more than period of gestation* Absent fetal heart sound So, concealed hemorrhage is the diagnosis.

So the answer to this question is B


Instruction:
Marcus Gunn pupil is due to ?
A. Total afferent pupillary defect
B. Relative afferent pupillary defect
C. Efferent pathway defect
D. Cerebral lesion

Response:
Ans. is 'b' i.e., Relative afferent papillary defect Marcus Gunn pupil Marcus Gunn pupil is seen in relative afferent pathway defect (RAPD) An incomplete optic nerve lesion or retinal disease cause it (in contrast to amaurotic light reflex, where there is total afferent pathway defect). It is best tested by swinging flash light test. To perform this test, a bright flash light is shone to one pupil and constriction of that pupil is noted. Then the flashlight is quickly moved to the contralateral pupil and the response in that pupil is noted. This swinging to and fro of the flashlight is repeated several times while the pupillary response is observed. Normally, both pupils constrict equally and the pupil to whom light is transferred remains tightly constricted. In the presence of relative afferent pupillary defect in one eye, both the pupil will dilate when the flash light is moved from the normal to the abnormal eye. This is a paradoxical resposne. This is called Marcus Gunn pupil and is the earliest indicator of optic nerve disease even in the presence of a normal visual acuity. Relative afferent papillary defect (RAPD) or Marcus Gunn pupil is a reliable and objectve sign of unilateral or assymmetric disease or any lesion in afferent papillary pathway, i.e., retina, optic nerve, optic chiasma, optic tract or midbrain (pretectal nucleus). However, RAPD is most characteristic of lesions in the optic nerve.

So the answer to this question is B


Instruction:
Treatment of pouch of Douglas abscess is -
A. Laparotomy
B. Posterior colpotomy
C. Antibiotics
D. Extraperitoneal drainage

Response:
None

So the answer to this question is B


Instruction:
M in 99Tc"' stands for?
A. Micro
B. Mega
C. Metastable
D. Metastatic

Response:
Metastable REF: Nuclear Physics: Principles And Applications by Lilley Page 20 "In 99Tcm the superscript M denotes that the technetium 99 is not in its ground state but a long lived metastable excited state"

So the answer to this question is C


Instruction:
A 35-year-old alcoholic presents with diarrhoea and scaly rash on his neck, hands and feet. He will improve if he is treated with which one of the following?
A. Vitamin A
B. Thiamine
C. Folic acid
D. Nicotinic acid

Response:
None

So the answer to this question is D


Instruction:
Which of the following minerals potentiates the action of insulin?
A. Molybdenum
B. Chromium
C. Manganese
D. Selenium

Response:
The total human body contains about 6 mg chromium. The Chromium content of blood is about 20 Mg/dl. Cr performs several biochemical functions such as
In association with insulin, Cr promotes the utilization of glucose.
Cr is a component of a protein namely chromodulin which facilitates the binding of insulin to cell receptor sites.
Cr lowers the total serum cholesterol level.
lt is involved in lipoprotein metabolism.
Cr decreases serum low density lipoproteins (LDL) and increases high density lipoproteins (HDL) and, thus, promotes health.
lt is believed that Cr participates in the transport of amino acids into the cells (heart and liver).
It is estimated that an adult man consumes about 10 to 100 mg/day.
The good sources of Cr include brewer's yeast, grains/ cereals/ cheese and meat.
Chromium deficiency causes disturbances in carbohydrate, lipid and protein metabolisms.
Excessive intake of Cr results in toxicity, leading to liver and kidney damage.

Key Concept:
Chromium in the form of chromodulin facilitates the binding of insulin to cell receptor sites.
Ref : Textbook of Biochemistry, Satyanarayana

So the answer to this question is B


Instruction:
All are associated with MEN 2 except:
A. Pheochromocytoma
B. Islet cell hyperplasia
C. Medullary carcinoma thyroid
D. Parathyroid adenoma

Response:
Answer is B (Islet cell hyperplasia): Pituitary islet cell tumors/hyperplasia are associated with MEN- I syndromes and not with MEN II syndromes.

So the answer to this question is B


Instruction:
Most common nosocomial infection is
A. Respiratory tract infection
B. Gastrointestinal tract infection
C. Urinary tract infection
D. Throat infection

Response:
None

So the answer to this question is C


Instruction:
"Bracket Calcification" on Skull X-Ray is seen in –
A. Tuberous Sclerosis
B. SturgeWebeSyndrome
C. Lipoma of corpus callosum
D. Meningioma

Response:
Bracket calcification is seen in lipoma of the corpus callosum.

So the answer to this question is C


Instruction:
A 7 yrs old child has conservative behavior, not playing quitely with peers, and difficulty in organization. He also interrupts others in school and easily gets distracted. Which of the foiling is likely diagnosis?
A. Learning disorder
B. Autistic disorder
C. Attention deficit hyperactivity disorder
D. Conduct disorder

Response:
Ans. C. ADHD. (Ref: Kaplan & Sadock's Synopsis of Psychiatry, Xth/Ch.43, Page no, 1208.)A 7-year-old child has conservative behavior, not playing quietly with peers, and difficulty in organization. He also interrupts others in school and easily gets distracted. The most likely diagnosis is ADHD (Attention deficit hyperactivity disorder).Kaplan, pg. 576............"Excessive motor activity, usually with intrusive and annoying qualities, poor sustained attention, difficulties inhibiting impulsive behaviors in social situations and on cognitive tasks, and difficulties with peers are the main characteristics of ADHD, combined type. Symptoms must be present in two or more settings (in this case, home and school) and must cause significant impairment. The Rx of choice for ADHD is CNS stimulants, primarily detroamphetamine, methylphenidate, and pemoline.**.Discussion:Conduct disorder# Children with conduct disorder display a persistent disregard for rules and other people's rights that lasts at least one year.# Aggression toward people and animals, destruction of property, deceit and illegal activities, and frequent truancy from school are the main characteristics of the disorder.# Patients with antisocial personality disorder display a pervasive pattern of disregard for and violation of the rights of others since the age of 15 years, with evidence of a conduct disorder before age 15. Substance abuse is just one facet of conduct disorder.# Children with oppositional defiant disorder are problematic and rebellious but do not routinely engage in aggressive, destructive, or illegal activities.Autistic disorder# Autistic disorder is characterized by lack of interest in social interactions, severely impaired verbal and nonverbal communication, stereotyped behaviors, and a very restricted range of interests.# Children with autism do not involve themselves in imaginative and imitative play and can spend hours lining and spinning things or dismantling toys and putting them together.# Patients with obsessive-compulsive disorder may spend hours on repetitive tasks (such as lining up toys) but do not show the difficulties with language and social interaction that this patient displays.# Patients with Asperger's syndrome show no clinically significant delay in spoken or receptive language development, making this diagnosis unlikely.# Patients with Rett's disorder by the age of 5 would be expected to have microcephaly and a disordered gait (unsteady and stiff).Attention-deficit hyperactivity disorderOnset before age 12. Limited attention span and poor impulse control. Characterized by hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of worship, etc.). Normal intelligence, but commonly coexists with difficulties in school. Continues into adulthood in as many as 50% of individuals. Associated with*frontal lobe volume/ metabolism. Treatment: methylphenidate, amphetamines, atomoxetine, behavioral interventions (reinforcement, reward).Conduct disorderRepetitive and pervasive behavior violating the basic rights of others (e.g,, physical aggression, destruction of property, theft). After age 18, many of these patients will meet criteria for diagnosis of antisocial personality disorder.Oppositional defiant disorderEnduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms.Tourette syndromeOnset before age 18. Characterized by sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for > 1 year. Lifetime prevalence of 0.1-1.0% in the general population. Coprolalia (involuntary obscene speech) found in only 10-20% of patients. Associated with OCD and ADHD. Treatment: antipsychotics and behavioral therapy.Separation anxiety disorderCommon onset at 7-9 years. Overwhelming fear of separation from home or loss of attachment figure. May lead to factitious physical complaints to avoid going to or staying at school. Treatment: SSRIs and relaxation techniques/behavioral interventions.

So the answer to this question is C


Instruction:
In multibacillary leprosy, the follow-up examination after adquate Rx should be done early for -
A. 3 years
B. 5 years
C. 10 years
D. 2 years

Response:
None

So the answer to this question is B


Instruction:
All are true about humerus attachment except?
A. Supraspinatus at LT
B. Subscapularis at LT
C. Teres minor at GT
D. Infraspinatus at GT

Response:
Supraspinatus is inseed into the uppermost impression on the greater tubercle. The subscapularis is multipennate and is inseed into the lesser tubercle. Teres major is inseed into the lower impression on the greater tubercle. The infraspinatus is inseed into the middle impression on the greater tubercle. Reference:page no: 16 ,BD Chaurasia- upper limb& thorax, 6th edition Figure :2.15,2.16 , page no:16 - BD Chaurasia - upper limb & thorax , 6 the edition

So the answer to this question is A


Instruction:
"Bad-trip" is associated with:
A. Bhang
B. Ganja
C. Cocaine
D. LSD

Response:
Ans. (d) LSDRef.: Harrison 19th ed. / 469e-4* LSD intoxication causes bad trips, which is acute panic reaction in which the individual experience a loss of control over his self.* Spontaneous recurrence of LSD, or sometimes cannabis use experience even during a withdrawal state is known as Flash back.

So the answer to this question is D


Instruction:
Which of the following disease is NOT caused by exposure to cold?
A. Trench fever
B. Trench feet
C. Chilblains
D. Frost bite

Response:
Exposure to cold causes frost bite, chilblains and trench feet. Trench fever (also known as "Five day fever", "Quintan fever") is a disease transmitted by body lice. Ref: Park 21st edition, page: 746.

So the answer to this question is A


Instruction:
On barium swallow Leiomyoma shows following characteristic appearance-
A. Rat tail appearance
B. Cork screw appearance
C. Oval mass lined by barium
D. String sign

Response:
Ans. is 'c' i.e., Oval mass lined by barium * On barium swallow, leiomyoma may be seen as a discrete round or ovoid submucosal mass that is well outlined by barium. Its borders form slightly obtuse angles with the oesophageal wall.* Oesophageal leiomyoma is a benign smooth-muscle neoplasm of the oesophagus. It is the most common benign tumor of the oesophagus.* They typically involve the mid-to-distal oesophagus.

So the answer to this question is C


Instruction:
Common source of staph in hospital -a) IV fluidsb) Infective woundsc) Hands of hospital personneld) Bed linene) Instruments
A. a
B. c
C. bc
D. ad

Response:
Hospital infection

For staphylococci most common source of infection are human and carriers, animal and inanimate objects being less common. Patients with superficial infections (i.e., infective wounds) and respiratory infections disseminate large numbers of staphylococci into the environment.

Transmission of staphylococci results most frequently from transient colonization of hands of hospital personnel, who then transfer strains from one patient to another. (Harrison 17th/e p. 873)
The cocci shed by patients and carriers contaminate fomites such as handkerchiefs, bed linen and blankets and may persists on them for day and week.

Don't get confused by option 'd', bed linen is a source of infection but it is not a common source - "inanimate objects are less common source of infection."

So the answer to this question is C


Instruction:
Management of carcinoma breast in 2nd trimester are all except
A. Chemotherapy Doxirubicin+cyclophosphamide+5FU
B. Mastectomy
C. Focal 3D
D. Breast Conservative surgery is a valid option

Response:
If the diagnosis of breast cancer is made in the first or early second trimester of pregnancy, lumpectomy and axillary dissection can be followed by chemotherapy after the first trimester and radiation after delivery. Chemotherapy is indicated for node-positive cancers or node-negative tumors greater than 1 cm. Current chemotherapeutic regimens are relatively safe after the first trimester, when the teratogenic risk is greatest. Generally, treatment regimens are the same as for non- pregnant patients with dose alterations because the increased plasma volume, the hypoalbuminemia, and the fact that almost all chemotherapeutic agents cross the placenta change the pharmacokinetics of the drugs. Ref: Sabiston 20th edition Pgno: 2060

So the answer to this question is C


Instruction:
IgG4-related disease is a newly recognized entity. Which of the following thyroid abnormality is associated with this condition?
A. De quervain thyroiditis
B. Postpaum thyroiditis
C. Reidel thyroiditis
D. Hashimoto thyroiditis

Response:
- Riedel thyroiditis, a rare disorder associated with IgG4 characterized by extensive fibrosis involving thyroid & contiguous neck structures. - The presence of a hard & fixed thyroid mass clinically simulates a thyroid carcinoma; but unlike thyroid carcinoma it is seen in young pts. - It may be associated with fibrosis in other sites like trachea, esophagus etc resulting in stridor, dysphagia etc. - Treated by rituximab/ tomoxifen/ steroids. EXTRA EDGE: - IgG4-Related diseases are: Mikulicz syndrome (enlargement and fibrosis of salivary & lacrimal glands) Riedel thyroiditis idiopathic retroperitoneal fibrosis autoimmune pancreatitis, and inflammatory pseudotumors of orbit, lungs & kidneys.

So the answer to this question is C


Instruction:
Not true about Medullary breast CA: -
A. Good prognosis
B. Around 3rd-4th decade
C. BRCA 1
D. Desmoplasia less than typical breast Cancer

Response:
Ans. (d) Desmoplasia less than typical breast Cancer(Ref. Bailey 27th Page 872)* Medullary cancer is comparatively common in young females* Soft in consistency* Poor prognosis* Triple negative ER, PR and HER 2 Negative tumor* Associated with BRCA 1 commonly* Desmoplasia is more than typical ductal adeno carcinoma breast

So the answer to this question is D


Instruction:
Which of the following drugs is most effective against an organism producing aminoglycoside inactivating enzymes?
A. Amikacin
B. Streptomycin
C. Gentamicin
D. Tobramycin

Response:
(Ref: KDT 6/e p724) Amikacin is most resistant to aminoglycoside inactivating enzymes. Aminoglycosides are not effective against anaerobes.

So the answer to this question is A


Instruction:
complication of acute sinusitis:
A. orbital cellulitis
B. Potts puffy tumor
C. Conjunctival chemosis
D. Subduram abscess

Response:
A,B,C and D mucocele and pyocele and pnuematocele are complications of chronic sinusitis. local complications of acute sinusitis: subperiosteal abscess osteomyelitis orbital cellulitis preseptal cellulitis post septal cellulitis orbital abscess cavernous sinus thrombosis maxillary sinusitis sphenoid sinusitis Systemic complications: Brain abscess meningitis toxic shock syndrome Ref Scott Brown 7/e,Vol 2,p 1539,1540.

So the answer to this question is B


Instruction:
A 75 year old man with no past medical history presents with increasing shortness of breath over 6 months. He previously worked at a shipyard where he had significant exposure to asbestos. He has a large right-sided pleural effusion. Pleural aspiration is performed and reveals an exudate but cytopathological examination identifies no malignant cells. CT scanning reveals circumferential pleural thickening but no other abnormalities.
Which test is most likely to give a diagnosis?
A. Thoracoscopy
B. Bronchoscopy
C. Echocardiogram
D. Repeat pleural aspiration

Response:
Direct visualisation and targeted biopsy of any pleural lesion provides the best chance of a tissue diagnosis. Mesothelioma cannot b~ diagnosed on cytopathological examinatipn of pleural fluid. Bronchoscopy would not help with pleural disease but may be helpful if there were an endobronchial lesion with pleural metastases. Echocardiogram is not c6nsidered helpful because there is pleural thickening as well as a right-sided pleural effusion, so heart failure is an unlikely cause.

So the answer to this question is A


Instruction:
What is the effect of calcitonin on bone resorption
A. Inhibits resorption
B. Promotes resorption
C. Both propeies
D. Enhances mineralisation

Response:
Physiologic Effects of Calcitonin Bone: Calcitonin suppresses resorption of bone by inhibiting the activity of osteoclasts, a cell type that "digests" bone matrix, releasing calcium and phosphorus into blood. Kidney: Calcium and phosphorus are prevented from being lost in urine by reabsorption in the kidney tubules. Calcitonin inhibits tubular reabsorption of these two ions, leading to increased rates of their loss in urine .R Ref - Harrisons internal medicine 20e p2923

So the answer to this question is A


Instruction:
All of the following structures come in relation with the urethral crest which is situated in the prostatic pa of the urethra, EXCEPT?
A. Ejaculatory ducts
B. Prostatic utricle
C. Prostatic sinus
D. Colliculus seminalis

Response:
Urethral crest is a midline longitudinal ridge on the posterior wall of the prostatic urethra. Prostatic sinus is a groove on each side of urethral crest. About 15-20 prostatic ducts open into the prostatic sinus to pour secretion of prostate into the urethra.Colliculus seminalis is an elevation at the middle of urethral crest. It has three openings on it, a median for prostatic utricle and lateral for ejaculatory duct of each side.Prostatic urethra is the proximal 3cm of the male urethra lying inside of the prostate gland. It pierces the base of prostate and leaves it at the apex. It lies near the anterior surface. It is the most dilatable and wide pa of the male urethra.

So the answer to this question is C


Instruction:
Muscle relaxant with ganglion blocker action is
A. Pancuronium
B. Trimethoprim
C. Curare
D. Halothane

Response:
Curare is an example of a non-depolarizing muscle relaxant that blocks the nicotinic acetylcholine receptor (nAChR), one of the two types of acetylcholine (ACh) receptors, at the neuromuscular junction

So the answer to this question is C


Instruction:
World Health Organization 2010 criteria for morphology (strict criteria) for semen analysis includes -
A. >15% normal forms
B. >=4% normal forms
C. >=25% normal forms
D. >=32% normal forms

Response:
Normal Semen Analysis: World Health Organization 2010 Guideline Volume >=1.5 mL Sperm concentration >=15 million/mL Total sperm number >= 39 million/ ejaculate Sperm motility >40%motile, >32%progressive Morphology >=4% normal forms (kruger's strict criteria) Vitality 58 % White blood cells <1 million/mL Immunobead/Mixed antiglobulin Reaction <50% coated with antibodies reaction

So the answer to this question is B


Instruction:
Radiographically, the normal horizontal plane of alveolar bone interdentally is related to
A. Cemento enamel junction of adjacent teeth
B. Epithelial attachment of adjacent teeth
C. Trabecular pattern of bone
D. All of the above

Response:
None

So the answer to this question is A


Instruction:
Neurons of first order for visual sensations are:
A. Rods and cones
B. Bipolar cells
C. Ganglion cells
D. None of the above

Response:
Ans. Bipolar cells

So the answer to this question is B


Instruction:
True about solitary rectal ulcer syndrome is all/except
A. Increased muscle layer proliferation
B. Crypt distortion
C. Lamina propria infiltration with lymphocyte
D. Subepithelial fibrosis

Response:
Histopathology of solitary rectal ulcer syndrome shows hypocellular lamina propria. There is relative absence of inflammatory cells. Surgical Pathology & Cytopathology writes - "There may be crypt architectural distortion and branching similar to that evident in idiopathic irritable bowel syndrome (IBD), but without the dense lamina propria inflammation".
Solitary Rectal Ulcer Syndrome

The pathogenesis of mucosal prolapse syndrome or solitary rectal ulcer syndrome is unclear. It has been postulated that there is a dysfunction of the neuromuscular control of defecation. This necessitates an increase in intraabdominal pressure to achieve expulsion of the stool. The pressure then forces a rectal mucosal fold to prolapse into the anal canal. Localized ischemia of the prolapsed mucosa as a result of local vascular compromise then produces the characteristic histological change of SRUS.
SRUS affects both sexes, over a wide range, but is most common in women 20-40 years of age.
Most lesions occur on the anterior or anterolateral rectal wall, but SRUS may involve the bowel anywhere from the sigmoid to the anorectal junction.
Despite the designation solitary rectal ulcer, in 10 to 15% of cases multiple ulcers may be present within a single patch of diseased mucosa.
Endoscopically only about half of the patients with SRUS have an actual ulcer. The remaining patients have an area of mucosal erythema, mucosal nodules, or frank polyps, which may or may not have surface ulceration.
The histological features can be correlated to the underlying pathogenesis of the disorder. Prolapsed mucosa becomes ischemic due to compression of the vascular supply, particularly the small veins. This leads to detachment of the surface epithelium and withering of the superficial portion of the crypts, similar to ischemia from any cause. Since the prolapse is typically intermittent, during intervals of normal blood flow regrowth of the mucosa is stimulated, resulting in mucosal hyperplasia due to elongation of the crypts. As an additional response to the ischemic injury, fibrosis of the lamina propria occurs. There may be crypt architectural distortion and branching similar to that evident in idiopathic irritable bowel syndrome, but without the dense lamina propria inflammation. The muscularis mucosa also becomes thickened and disorganized and tongues of muscle extend upwards from the muscularis mucosa to the surface epithelium.
In some cases the ischemia is severe enough to lead to erosion or ulceration, often with a scanty overlying pseudo membrane. The cells show enlarged, hyper chromatic nuclei, excess mitotic activity, and mucin-depleted goblet cells.

So the answer to this question is C


Instruction:
By spirometry, one can measure -
A. Residual volume
B. FRC
C. TLC
D. Tidal volume

Response:
Ans. is 'd' i.e., Tidal volume o Pulmonary ventilation can be studied by recording the volume movement of air into and out of the lungs, a method called spirometry.o A spirometer is a device in which, one breathes into and out of the device.o The volume of air breathed in or out are measured.o Spirometry can measure (spirometric measurement are) : - Tidal volume (TV), inspiratory reserve volume (IRV), expiratory reserve volume (ERV), and vital capacity (VC)r /FEV1.o As residual air (residual volme) can not be expired (residual volume is the amount of air remaining in the lung after maximum possible expiration), residual volume cannot be measured by spirometry ,o Therefore, the capacities which have residual volume as one of their components, cannot be measured by spirometry.o These capacities are functional residual capacity (ERV + RV) and total lung capacity (VC + RC).o The commonly employed methods for functional residual capacity (FRC) estimation are: -i) Gas-dilution methods : - Helium dilution technique, nitrogen washout technique.ii) Plethysmography

So the answer to this question is D


Instruction:
A patient presents with polyuria and elevated prolactin levels. There is family history of father died due to renal stones. He has Ca2+of 12 g% and PTH levels of 260 IU/L. Most likely diagnosis is:
A. MEN 1
B. PGA 1
C. MEN 2
D. Autoimmune polyendocrinopathy

Response:
None

So the answer to this question is A


Instruction:
Which of the following disorders has the potential to develop myeloid leukemia
A. Micro angiopathic hemolytic anemia
B. Sideroblastic anemia
C. Paroxysmal nocturnal Hemoglobinuria
D. Megaloblastic anemia

Response:
PNH can transform into AML or Myelodysplastic syndrome.

So the answer to this question is C


Instruction:
True about benzodiazepines ?
A. Increased release of GABA
B. Antagonzing release of GABA
C. Lorazepam is shoer acting than temazepam
D. Atropine is its antagonist

Response:
Ans. is 'c' i.e., Lorazepam is shoer acting than temazepam Lorazepam has VA 10-20 hours, while Temazepam has VA 10-40 hours. About other options BZDs do not increase or decrease the release of GABA, they bind on GABAA receptors and increase Cl- conductance - GABA facilitatory action. Flumazenil (not atropine) is the antagonist of BZDs.

So the answer to this question is C


Instruction:
C.P.I.T.N is used in
A. Biggest population
B. Smallest population
C. Diagnostic tool
D. Screening purposes

Response:
None

So the answer to this question is D


Instruction:
Which is the principal virulence factor in Clostridium tetani
A. Tetanolysin
B. Tetanospasmin
C. Tetanotactin
D. Immobility factor

Response:
C.tetani produces two distinct toxins- a hemolysin(tetanolysin), and neurotoxin(tetanospasmin). Tetanospasmin: This is the toxin responsible for tetanus. This toxin acts pre-synaptically. The abolition of spinal inhibition causes an uncontrolled spread of impulses initiated anywhere in the central nervous system. This results in muscle rigidity and spasms. Tetanolysin: it is not relevant in the pathogenesis of tetanus. Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th Edition; Pg: 265

So the answer to this question is B


Instruction:
Suture least adherent to tissue and have a property of
plasticity
A. Nylon
B. Prolene
C. PDS
D. Silk

Response:
None

So the answer to this question is B


Instruction:
A patient with clustered, white lesions on the buccal mucosa (opposite the upper 1st & 2nd molars) pathognomonic for measles. These are:-
A. Leukoplakia
B. Koplik spots
C. Kaposi spots
D. None

Response:
Koplik spots - These are white lesions on buccal mucosa opposite the first and second lower molars. They are small, bluish-white spots on a red base, smaller than the head of a pin It is pathognomonic of measles. Measles- Causative organism - RNA paramyxovirus Incubation period - 10-14 days Pathognomic c/f - Koplik spots Clinical feature- retroauricular origin of rash M/c complication- serous otitis media

So the answer to this question is B


Instruction:
Most common type of gastric polyp is -
A. Hyperplastic polyp
B. Hamaomatous polyp
C. Malignant polyp
D. Familial polyosis

Response:
Hyperplastic or inflammatory polyps are regenerative, nonneoplastic lesions which are the most common type (90%).. Hamaomatous polyp are not true neoplasms but are malformations. Eg: Peutz-Jeghers syndrome, juvenile polyp, pancreatic heterotopia, heterotopia of Brunner's glands and inflammatory fibroid polyps. TEXTBOOK OF PATHOLOGY HARSH MOHAN 6TH EDITION PAGE.554 IMAGE Ref : TEXT BOOK OF PATHOLOGY HARSH MOHAN 6TH EDITION Table 20.4 PAGE :554

So the answer to this question is A


Instruction:
Which of the following statements regarding liver enzymes is true
A. ALT is less specific indicator of liver injury than AST
B. Absolute levels of aminotransferase correlate with outcome
C. Glutathione-S- Transferase is used as a hepatic prognostic marker after surgery
D. None of the above

Response:
Answer is C (Glutathione-S- Transferase is used as a hepatic prognostic marker after surgery) Glutathione - S - Transferase is an emerging enzyme marker for post-transplant monitoring (surgery) as an aid to the diagnosis of acute allagraft rejection ALT is a more specific indicator of liver injury than AST and absolute levels of aminotransferase do not correlate with outcome. ALT is a more specific indicator of Liver injury than AST AST (Aspaate Aminotransferase) is found in the liver, cardiac muscle, skeletal muscle, kidneys, brain, pancreas, lung, leukocytes and erythrocytes in decreasing order of concentration. ALT is found primarily in the liver and is therefore a more specific indicator of Liver injury - Harrison's 186/2528 Absolute level of Aminotransferase elevation do not correlate with outcome `There is poor correlatation between extent of Liver cell Necrosis and the elevation of serum aminotransferase levels in chronic liver diseases. Similarly, absolute elevation of aminotransferase levels is of little value in predicting the outcome of acute hepatocellular disorders' - Schiff's Deseases of the Liver Serum Glutathione - S- Transferase may be used as a prognostic marker after transplant surgery 'Serum Alpha - Glutathione - S - Transferase is an emerging static test indicating hepatocellular damage. As in vivo plasma half life of this enzyme is less than 60-90 minutes, this enzyme offer advantages in post-transplant monitoring as an aid to the diagnosis of acute allagraft rejection. Recent investigations have indicated that monitoring of GST reduced both moality and morbidity in liver transplant recipients. GST showed a distinct higher sensitivity (81%) for acute rejection than conventional liver function tests (the specificity however was relatively low (45%). Glutathione - S-Transferase (GST) - Miller's Anesthesia (Elsevier) 2010/426 Glittathione-S-Transferase is a sensitive and specific test for some patterns of Liver injury. The enzyme has a brief plasma half life (90 minutes) and is released rapidly into circulation following hpatocellular injury. Thus serial GST measurements can reveal time course of hepatic injury from its onset to its resolution. In contrast to AST and ALT which reside in Acinar Zone I, GST localizes in Acinar Zone III (centrilobular region). This zone contains the hepatacyte population with highest susceptibility to injury from hypoxia or reactive drug metabolites. Accordingly GST would be more sensitive than AST or ALT as a marker of contrilobular necrosis in its incipient stage.

So the answer to this question is C


Instruction:
In a pregnant woman with heart disease, all of the following are to be done except:
A. IV methergin after delivery
B. Prophylactic antibiotic
C. IV frusemide postpartum
D. Cut short 2nd stage of labor

Response:
Ans. is a, i.e. IV methergine after deliveryRef. Dutta Obs. 7/e, p 278As discussed in the chapter overview all the options given in the question are correct except for 'c' i.e. methergine after delivery. Methylergometine is contraindicated in patient of heart desease.

So the answer to this question is A


Instruction:
Not a feature of Stein Leventhal syndrome is
A. Increased androgens
B. Increased or normal oestrogens
C. Galactorrhoea
D. Increased LH

Response:
Stein-Leventhal syndrome is another term for polycystic ovarian disease (PCOD). In this condition, androgens are raised due to hypehecosis leading to hirsutism. Oestrogen level is normal but LH level and LH / FSH ratio is raised. It is an impoant cause of secondary amenorrhoea and infeility in young women. Clomiphene is the drug of choice for infeility in PCOD and cyproterone acetate is the drug of choice for hirsutism. ref Katzung 12th ed.

So the answer to this question is C


Instruction:
In case of chronic lead poisoning, the levels of which of the following is elevated: NIMHANS 11
A. Porphobilinogen
B. 6-amino levulinic acid
C. Bilirubin
D. Urobilinogen

Response:
Ans. 6-amino levulinic acid

So the answer to this question is B


Instruction:
Which of the following drugs is not used for H.pylori treatment?
A. Oxytetracycline
B. Bismuth compounds
C. Amoxicillin
D. Omeprazole

Response:
(ref :KDT 6/e p637)

So the answer to this question is A


Instruction:
The difference in molecular weight between Phenylalanine & Tyrosine is by :
A. 17
B. 16
C. 64
D. 32

Response:
Usually students tend to mark 17 as the answer. Phenylalanine gets conveed to Tyrosine by enzyme Phenylalanine Hydroxylase. Most Hydroxylases are Mono-oxygenases i.e. EC No. 1. In hydroxylation reactions, only one oxygen atom from the molecular oxygen is added because H was already present in the phenylalanine. So, change in molecular weight is by 16 and NOT 17. Extra Information: Phenylalanine is an essential amino acid and its only role in the body is to give rise to tyrosine.

So the answer to this question is B


Instruction:
Geographic tongue is of red colour because of
A. Infiltration of eosinophils
B. Infiltration of neutrophils
C. Both of the above
D. None of the above

Response:
None

So the answer to this question is D


Instruction:
The impression material with lowest viscosity is
A. Plaster of paris
B. Agar-agar
C. Zinc oxide eugenol
D. Elastomers

Response:
Impression plaster is a β-calcium sulfate hemihydrate used at a water/powder ratio of approximately 0.5 to 0.6. Its fluidity makes it suitable for making impressions of soft tissues in the uncompressed state, a characteristic of mucostatic impression material.
Ref: Phillips 12 ed page no 177

So the answer to this question is A


Instruction:
Sentinel surveillance; TRUE is:
A. Data is itself reported to the health system
B. Active collection of data
C. Employed to identify the missing case
D. All of the above

Response:
Surveillance:

Ongoing systematic collection, analysis & interpretation of data and use of this information to take action for prevention and control of disease.
Used for purpose of 'health planning'.

Types of Surveillance:

So the answer to this question is C


Instruction:
In Alzheimer's disease (AD) which of the following is not seen:
A. Aphasia
B. Acalculia
C. Agnosia
D. Apraxia

Response:
B i.e. Acalculia

So the answer to this question is B


Instruction:
A 30 year old male patient presents with bleeding per rectum.
He complains of Hemorrhoids which are reduced spontaneously.
Treatment of choice Is
A. Open hemorroidectomy
B. Sitz bath
C. Sclerotherapy
D. Stapled hemorroidopexy

Response:
2nd degree hemorrhoids are treated by sclerotherapy which is done without anesthesia.

So the answer to this question is C


Instruction:
Epidermal growth factor is required for:
A. Epithelium proliferation and tooth eruption
B. Angiogenesis
C. Collagen formation
D. Fibroblast formation

Response:
None

So the answer to this question is A


Instruction:
Urate crystals are deposited in small joints of the hands & feets in: September 2003
A. Gout
B. Still's disease
C. Retropharyngeal abscess
D. Ankylosing spondylitis

Response:
Ans. A i.e. Gout

So the answer to this question is A


Instruction:
Substance commonly used for organ/tissue preservation for histopathological examination is?
A. Ethyl alcohol
B. Formalin
C. Saturated salt solution
D. Normal saline

Response:
ANSWER: (B) FormalinREF: Parikh 6th edition page 2.62Repeat in December 2009"10% formalin is used as a preservative for tissue meant for histopathological examination"

So the answer to this question is B


Instruction:
Prophylactic intracranial radiation is given in
A. Small cell carcinoma
B. Testicular carcinoma
C. Breast carcinoma
D. Gastric carcinoma

Response:
This aggressive form of lung cancer most commonly occurs in smokers. It usually starts in the breathing tubes (bronchi) and grows very quickly, creating large tumours and spreading (metastasising) throughout the body.
Symptoms include bloody phlegm, cough, chest pain and shortness of breath.
Treatment includes surgery (for small tumours) as well as chemotherapy, sometimes in combination with radiation therapy.

So the answer to this question is A


Instruction:
L-aspraginase is used in which type of Leukemia -
A. AML
B. CML
C. ALL
D. CLL

Response:
None

So the answer to this question is C


Instruction:
Haemobilia is charactericed by all except
A. Jaundice
B. Biliary colic
C. Melaena
D. Fever

Response:
Hemobilia,i,.e.,bleeding from the liver or occasionally from the gallbladder into the biliary tract. Hemobilia is characterised by Triad of Sandloom/Quincke's which includes Jaundice(60%);Colicky pain (70%) and Upper GI bleed with melaena(90%),haematemesis(60%).All three features of triad are seen only in 20% cases. Reference :SRB's manual of surgery,5th edition,page no:663.

So the answer to this question is D


Instruction:
First ocular sign of Vitamin A deficiency ?
A. Bitot's spot
B. Conjunctival xerosis
C. Night blindness
D. Keratomalacia

Response:
Ans. is 'b' i.e., Conjunctival xerosis

So the answer to this question is B


Instruction:
Which of the following would be associated with parallel changes in aldosterone and coisol secretion?
A. Addison's disease
B. Cushing's disease
C. Cushing's syndrome
D. Conn's syndrome

Response:
Addison's disease results from an inability of the adrenal coices to produce sufficient adrenocoical hormones. Persons with Addison's disease have diminished secretion of both glucocoicoids (coisol) and mineralocoicoids (aldosterone). Hypersecretion by the adrenal coex causes a complex cascade of hormone effects called Cushing's syndrome. When Cushing's syndrome is secondary to excess secretion of ACTH by the anterior pituitary, this condition is referred to as Cushing's disease. In persons with Cushing's disease or Cushing's syndrome, coisol secretion is elevated but aldosterone secretion is normal. Occasionally a small tumor of the zona glomerulosa cells occurs and secretes large amounts of aldosterone; the resulting condition is called primary aldosteronism or Conn's syndrome.

So the answer to this question is A


Instruction:
A 43-year-old woman has had a 10-year history of severe and recurrent peptic ulcer disease (PUD) that is refractory to medical therapy. She has had ulcers at multiple sites of the small bowel including the distal duodenum and jejunum. She also has chronic diarrhea, but not enough fat to make the diagnosis of steatorrhea. Evaluation for Helicobacter pylori infection is negative.For the above patient with GI symptoms, select the possible diagnoses and associated findings.
A. celiac sprue
B. gastrinoma
C. associated with decrease in pancreatic enzymes
D. hypersensitivity reaction

Response:
Zollinger-Ellison syndrome is caused by a non-beta islet cell tumor of the pancreas. It may be associated with the syndrome of multiple endocrine neoplasia, type I (MEN I). The syndrome should be suspected in patients with multiple ulcers, ulcers resistant to therapy, ulcers in unusual locations, strong family history of ulcers, unexplained diarrhea, or evidence of MEN I.

So the answer to this question is B


Instruction:
All are true about Madura mycetoma except
A. Fungal infection
B. Presented as painful nodular lesion for many months
C. Discharging sinuses
D. Bone involvement seen

Response:
Clinical features of mycetoma include - painless multiple nodular swellings which may be suppurative and drain through sinuses, feet and lower legs are commonly affected. Bone involvement may lead to osteomyelitis and deformities. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition

So the answer to this question is B


Instruction:
Which of the following the characteristic feature of subdural hematoma -
A. Convex hyper density
B. Biconvex hypo density
C. Convexo-concave hypo density
D. Concavo-convex hyper density

Response:
Ans. is 'd' i.e. Concavo-convex hyperdensity .On CT Scan Subdural hematoma - Concavo convex* hyperdensity Epidural hematoma - Biconvex hyperdensity *

So the answer to this question is D


Instruction:
Anterior compament of leg contains all except
A. Peroneus brevis
B. Tibialis anterior
C. External hallucis longus
D. External digitorum longus

Response:
ANTERIOR COMPAMENT:- Muscles:-1. Tibialis anterior 2. Extensor hallucis longus3. Extensor digitorum longus 4. Peroneus teius. Aery: anterior tibial aery. The blood supply of anterior compament is reinforced by the perforating branch of peroneal aery. Nerve:-Deep peroneal nerve. {Reference: BDC 6E vol2 pg 93}

So the answer to this question is A


Instruction:
In osteomyelitis, solid periosteal reaction seen in the X-ray at
A. 1st week
B. < 2 +  hours
C. 2nd week
D. 3rd week

Response:
None

So the answer to this question is A


Instruction:
Insulin dependent glucose uptake is not seen in ?
A. Skeletal muscles
B. Hea
C. Adipose tissue
D. Kidney

Response:
Insulin dependent glucose uptake is through GLUT-4 and is seen in :? 1) Skeletal muscles 2) Cardiac muscles (hea) 3) Adipose tissue

So the answer to this question is D


Instruction:
All the following effects are produced by inhibitors of prostaglandin synthesis except
A. Prolongation of bleeding time
B. Prolongation of prothrombin time
C. Prolongation of labour
D. Gastric mucosal damage

Response:
(Ref:. KDT 6/e p186) Prothrombin time is increased by the drugs interfering with the coagulation pathway (e.g. warfarin). As cox has no role in coagulation, inhibitors,of PG svnthesis do not prolong PI. However, bleeding time (BT) is prolonged by the drugs interfering with platelet function. Aspirin increases,.BT by acting as an antiplatelet agent.

So the answer to this question is B


Instruction:
Which of the following coding system used in ICD-10 is used for “Schizophrenia, schizotypal and delusional disorders”?
A. F10-F19
B. F20-F29
C. F30-F39
D. F40-F48

Response:
F20-F29
(Ref : ICD-10 WHO)

So the answer to this question is B


Instruction:
Which of the following is most commonly involved in Hypersensitivity vasculitis:
A. Capillaries
B. Aerioles
C. Post-capillary venules
D. Medium sized aeries

Response:
Answer is C (Post-capillary venules): Post-capillary venules are most commonly involved in Hypersensitivity vasculitis Hypersensitivity vasculitis Hypersensitivity vasculitis refers to small vessel vasculitis that is restricted to the skin and not associated with any other form of primary or secondary vasculitis. Implicit in the definition is that this condition is not associated with medium or large vessel disease at other sites, nor with small vessel disease in other organs (only skin) Microscopic polyangitis affects the skin and also internal organs and hence is not considered pa of hypersensitivity vasculitis The typical histopathological feature of cutaneous vasculitis is the presence of leukocytoclastic vasculitis of small vessels. Vasculitis is charachterized by Leukocytoclasis -- Harrison's Synonyms for Hypersensitivity vasculitis include: cutaneous small vessels vasculitis, leucocytoclastic vasculitis, cutaneous leucocytoclastic angitis etc. 'Post-capillary venules are the most commonly involved vessels. Capillaries and aerioles may be involved less frequently' -- Harrison American College of Rheumatology 1990 Criteria for the Classification of Hypersensitivity Vasculitis Laboratory and Radiographic Work-up of Patients with Possible Hypersensitivity Vasculitis Age at disease onset > 16 years Medication at disease onset Palpable purpura Maculopapular rash Biopsy including aeriole and venule, showing granulocytes in a perivascular or extravascular location For purposes of classification, hypersensitivity vasculitis may be diagnosed if the patient meets at least three of these five criteria.

So the answer to this question is C


Instruction:
Pyruvate dehydrogenase is inhibited allosterically by ?
A. AMP
B. Pyruvate
C. NADH
D. `Insulin

Response:
Ans. is 'c' i.e., NADH

So the answer to this question is C


Instruction:
Characteristic feature of Otosclerosis are all except:
A. Conductive deafness
B. Positive Rinne's test
C. Paracusis willisii
D. Mobile ear drum

Response:
Tuning Fork Tests in OtosclerosisRinnes test-negativeWebers test-lateralised to ear with greater conductive lossAbsolute bone conduction-normal (It is decreased in cochlear otosclerosis)Pure tone audiometry-shows loss of air conduction more for lower frequency. * Tympanic membrane is normal and mobile in 90% cases. Schwaz sign--Flammingo cases pink colour of tympanic membrane is seen in 10% cases. It indicates active focus with increased vascularity.Stapes footplate--Shows a rice grain / biscuit type appearanceBlue mantles are seen histopathologically.

So the answer to this question is B


Instruction:
AU ER rods seen in -
A. Ml AML
B. M3 AML
C. M6AML
D. ALL

Response:
Ans. is 'b' i.e., M3 AMLAcute myelogenous leukemia (AML)o AML is a cancer of myeloid line of WBCs, characterized by the rapid proliferation of abnormal cells which accumulate in the bone marrow and interfere with the production of normal blood cells,o AML is the most common acute leukemia affecting adults.o The diagnosis of AML is based on finding that myeloid blasts make up more than 20% of the cells in the marrow,o Myeloblasts are myeloperoxidase (peroxidase positive)o Auer rods (represent abnormal azurophilic granule) are also present in myeloblasts and their presence is taken to be definitive evidence of myeloid differentiation.o In some AMLs, blast cells exhibit differentiation of other myeloid stem cell line (other than myeloblast), e.g.,Monoblast - Lack auerrods, peroxidase negative, but nonspecific esterase positive.Megakaryocytic differentiationErythroblast

So the answer to this question is B


Instruction:
All of the following are true regarding enoxaparin EXCEPT:
A. It has higher and predictable bioavailability
B. It act by inhibiting both factor Ila and factor Xa
C. Monitoring is not required
D. It has more favorable pharmacokinetics

Response:
Ref KDT, 6th ed. pg. 599-600* Low molecular weight heparin, Enoxaparin, inhibits only factor Xa whereas unfractionated heparin inhibits both factor IIa and factor Xa.

So the answer to this question is B


Instruction:
What will be the line of treatment, if coronal pulp dies?
A. Extraction
B. Surgical removal of apical fragment
C. RCT of coronal fragment and treat the apical fragment with apexification
D. All of the above

Response:
None

So the answer to this question is C


Instruction:
Both Vitamin K and C are involved in
A. The synthesis of clotting factors
B. Post translational modifications
C. Antioxidant mechanisms
D. The microsomal hydroxylation reactions

Response:
Vitamin C plays the role of a coenzyme in the hydroxylation of proline and lysine while procollagen is conveed to collagen (i.e. post-translational modification). The functions of vitamin K are concerned with the blood clotting process. It brings about the posttranslational (after protein biosynthesis in the cell) modification of ceain blood clotting factors ii, vii, ix, x ref Satyanarayana 4th ed page 130, 132

So the answer to this question is B


Instruction:
All of the following measure the plaque index except:
A. Ramjford index
B. Moller's index
C. OHI-S index
D. Loe and Silness

Response:
None

So the answer to this question is B


Instruction:
Level of iodisation in salt according to PFA at Consumer level :
A. 10 ppm
B. 15 ppm
C. 30 ppm
D. 45 ppm

Response:
Production level - 30 ppm.
Consumer level - 15 ppm.

So the answer to this question is B


Instruction:
Roll back malaria included all except -
A. Insecticides nets
B. Strengthening health system
C. Develop new insecticide
D. Training health workers

Response:
Insecticides nets, Strengthening health system, Develop new insecticide,. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 21ST EDITION. PAGE NO - 243

So the answer to this question is D


Instruction:
A child aged 3 yrs, presented with severe sensorineural deafness was prescribed hearing aids, but showed no improvement. What is the next line of management:
A. Fenestration surgery
B. Stapes mobilisation
C. Choclear implant
D. Conservative

Response:
Ans. is 'c' Cochlear implant Any person who fails to benefit from hearing aids in given , cochlear implant. Here the child does not benefit from hearing aid so he should be given cochlear implant.Note : Make sure that the patient is not prelingually deaf because Cochlear implants are not useful in prelingually deaf patient.

So the answer to this question is C


Instruction:
All of the following disease may be acquired by ingestion except -
A. Taeniasis
B. Guinea worm
C. Toxoplasmosis
D. Leishmaniasis

Response:
None

So the answer to this question is D


Instruction:
A 12 year old boy rapidly develops hypoglycemia after moderate activity. On physical examination, kidney and liver are found to be enlarged. Histopathology of liver shows deposits of glycogen in an excess amount. Blood examination reveals raised ketone bodies, lactic acid and triglycerides. What is the diagnosis?
A. Von Gierke's disease
B. Pompe's disease
C. McArdle's disease
D. Cori's disease

Response:
Type Ia Glycogen Storage Disease-Von Gierke’s Disease

Most common Glycogen Storage Disorder in childhood.
Autosomal recessive.

The biochemical hallmarks are:

Hypoglycemia
Lactic acidosis
Hyperlipidemia
Hyperuricemia

Clinical Presentation
Most commonly present at 3–4 months of age with:

Doll like facies with fat cheeks
Relatively thin extremities
Short stature, protuberant abdomen
Massive hepatomegaly
Kidneys are also enlarged
No splenomegaly
Plasma may be milky due to associated hypertriglyceridemia

Reference- Harper’s illustrated biochemistry. 30th edition page no: 179

So the answer to this question is A


Instruction:
Which of the following is the most cranial structure in the root of left lung?
A. Bronchus
B. Pulmonary artery
C. Pulmonary vein
D. Bronchial artery

Response:
Ans. is 'b'i.e. Pulmonary artery Root of the lung is a short broad pedicle which connects the medial surface of the lung to the mediastinum.Contents of RootPrincipal bronchus on the left side, and eparterial and hyparterial bronchi on right side.One pulmonary artery.Two pulmonary veins, superior and inferior.Bronchial arteries, one on the right side and two on the left side.Bronchial veins.Anterior and posterior pulmonary plexuses of nerves.Lymphatics of the lung.Bronchopulmonary lymph nodes.Areolar tissue.Arrangement of Structures in the RootFrom before backwards. It is similar on the two sides.Superior pulmonary veinPulmonary arteryBronchusFrom above downwards. It is different on the two sides. Right side Left side Eparterial bronchus 1 .Pulmonary artery Pulmonary artery 2.Bronchus Hyparterial bronchus 3 .Inferior pulmonary vein Inferior pulmonary vein Relations of the Root Anterior Posterior Common on the two sides a. Common on the two sides 1 . Phrenic nerve 1 .Vagus nerve2. Pericardiophrenic vessels 2.Posterior pulmonary plexus 3 . Anterior pulmonary plexus b. On left side On the right side 1 .Descending thoracic aortaSuperior vena cavaA part of the right atrium. Superior Inferior On right side Pulmonary ligament Terminal part of azygos vein On left side Arch of the aorta

So the answer to this question is B


Instruction:
The following are live attenuated vaccine, except-
A. Oral poilio
B. Yellow fever
C. Measles
D. Influenza

Response:
oral polio vaccines were first introduced by Sabin in 1957.it contains live attenuated strains of virus type 1,2, and 3.grown in primary monkey kidney or h7man diploid cell cultureref;parks tectbook,ed22,pg 187

So the answer to this question is A


Instruction:
Macular edema is caused by all except –
A. Micro aneurysm
B. Capillary dilatation
C. Neovascularization
D. None

Response:
Causes of macular edema :-

Metabolic alteration :- Diabetes, retinitis pigmentosa, inherited cystoid macular edema (CME).
Ischemia CRVO, Diabetic retinopathy, severe hypertensive retinopathy, HELLP syndrome, vasculitis.
Mechanical force :- Vitreous traction on the macula.
Inflammation :- Intermediate uveitis, post-operative CME, choroidal inflammatory diseases.
Pharmacotoxicity :- Epinephrine (in Aphakia), Betaxolol, latanoprost..

So the answer to this question is D


Instruction:
You decide not to give sildenafil to patient who is on antianginal drug, which of the following drug it can be?
A. Calcium channel blockers
B. Beta blockers
C. Nitrates
D. ACE inhibitors

Response:
Ans. C. NitratesNitrates act by increase CGMP and sildenafil decrease the breakdown of this compound. Marked increase in CGMP results in profound hypotension and reflex tachycardia.

So the answer to this question is C


Instruction:
Ramu presents with recurrent attacks of cholelithiasis, USG examination shows dilated CBD of 1 cm. The next line of management is
A. ERCP
B. PTC
C. Cholecystostomy
D. Intravenous cholangiogram

Response:
ERCP Endoscopic clearance of CBD stones can avoid the need for an open operation if expeise in laparoscopic common bile duct exploration is not available Indications of preoperative ERCP Patients with worsening cholangitis Ampullaru stone impaction Biliary pancreatitis Cirrhosis Contraindications of endoscopic sphincterectomy CBD diameter >2cm Long suprasphincteric stricture >15mm Peri-Vaterian Diveiculum Duodenal Wall and head of the pancreas severely inflamed Ref: Sabiston 20th edition Pgno : 1511

So the answer to this question is A


Instruction:
Burking includes: NEET 13
A. Choking
B. Ligature
C. Overlaying
D. Traumatic asphyxia

Response:
Ans. Traumatic asphyxia

So the answer to this question is D


Instruction:
Na+ uptake at basolateral surface of apical cells is by
A. Active transpo
B. Passive transpo
C. Diffusion
D. Osmosis

Response:
Ans. is 'a' i.e., Active transpo

So the answer to this question is A


Instruction:
Which of the following configuration is used in designing an RPD with Kennedy — Class II edentulous arch?
A. Bilateral
B. Tripod
C. Quadrilateral
D. Unilateral

Response:
None

So the answer to this question is B


Instruction:
Which is a most likely complication of lUD?
A. Hypofibrinogenemia
B. Sterility
C. Cervical tear
D. None of the above

Response:
The most common complication seen in intrauterine fetal death is hypo fibro gene mia due to consumption coagulopathy.
It occurs due to the release of thromboplastin from dead fetus and placenta into the maternal circulation.

So the answer to this question is D


Instruction:
Botox Is used in treatment of:
A. Achalasia cardia
B. Toicollid
C. Both
D. None

Response:
Botox is derived from botulinum toxin It decreases acetyl choline release by degrading synaptobrevin

So the answer to this question is C


Instruction:
A 70-year-old male patient with intentional tremor, drunken gait, and past pointing is having a lesion in which of the following structures
A. Basal ganglia
B. Pyramidal tract
C. Cerebellum
D. Thalamus

Response:
"Most abnormalities associated with damage to the cerebellum are apparent during movement Ataxia is manifest not only in the wide-based, unsteady, "drunken" gait of patients but also in defects of the skilled movements involved in the production of speech, so that slurred, scanning speech results. Voluntary movements are also highly abnormal when the cerebellum is damaged. For example, attempting to touch an object with a finger results in overshooting. This dysmetria or past-pointing promptly initiates a gross corrective action, but the correction overshoots to the other side, and the finger oscillates back and foh. This oscillation is called an intention tremor."

So the answer to this question is C


Instruction:
Antibiotic that can be used as  antiplaque agent is/are:
A. Penicillin.
B. Vancomycin.
C. Kanamycin.
D. All of the above.

Response:
Penicillin, vanomycin, kanamycin have been used as antiplaue agents but their use has been considerably reduced due to bacterial resistance and hypersensitivity reactions.

So the answer to this question is D


Instruction:
On X-ray of the abdomen, soap bubble appearance is seen in:
A. Multiple cystic kidney
B. Meconium ileus
C. Cystic lymphangiectasis
D. Volvulus

Response:
Ans. Meconium ileus

So the answer to this question is B


Instruction:
Which is the most common functioning tumour of pituitary?
A. GH secreting tumor
B. Prolactinoma
C. ACTH producing adenoma
D. Oncocytoma

Response:
MC Functioning tumour of pituitary: Prolactinoma MC tumor of pituitary: Non- functioning adenoma

So the answer to this question is B


Instruction:
This type of psoriasis is commonly seen in children and may follow a streptococcal sore throat –
A. Guttate
B. Stable plaque
C. Pustular
D. Arthropathic

Response:
Guttate psoriasis occurs in children and adults. It is precipitated by URTI (e.g. streptococcal tonsilitis)

So the answer to this question is A


Instruction:
Which one of the following is true regarding HIV infection -
A. Following needle stick injury infectivity is reduced by adminsitration of nucleoside analogues
B. CD4 counts are the best predictors of disease progression
C. Infected T cells survive for a month in infected patients
D. In latent phase HIV has minimal replication

Response:
Pathogenesis of HIV infection and AIDS
Primary infection of cells through the blood and mucosa.

The initial entry of the virus may be through a mucosal surface, as in sexual intercourse (via rectal or cervical mucosa) or via blood exposure e.g. (after intravenous drug abuse).
From the mucosa the virus is carried to the regional lymph nodes by dendritic cells while the virus initially inoculated into the blood is rapidly cleared by the spleen and lymph nodes.
Thus, with either mode of entry, the virus initially replicates in the lymphoid organs and then spills over into the blood.

Infection established in lymphoid tissue e.g, lymph node

After the infection is established in the lymph node the virus spills into the blood the patient will now experience the acute HIV syndrome.

Acute HIV syndrome, the spread of infection throughout the body

This phase is characterized initially by high levels of virus in plasma and widespread seeding of the virus in lymphoid tissues.
Sometimes there is an abrupt reduction in CD4+ T cells.
During this period, the HIV virus can be readily isolated from the blood, and there are high levels of HIV p24 antigen in serum.
Soon, however virus specific immune response develops

Immune response

The viremia is readily controlled by the development of an antiviral immune response.
It is estimated that 40% to 90% of individuals who acquire a primary infection develop the viral syndrome 3-6 weeks after infection and this resolves spontaneously in 2 to 4 weeks.
The resolution of viremia occurs due to the immune response.
Virus-specific antibodies develop evidenced by seroconversion (usually within 3-7 weeks of presumed exposure) and more importantly virus-specific CD8+ cytotoxic T cells also develop.
HIV specific CD8+ T cells are detected in the blood, at this time, viral titres begin to fall and are most likely responsible for containment of HIV infection.
As viral replication stops CD4+ T cells return to near normal numbers, signalling the end of the acute phase.

Clinical Latency

The clinical latency or the middle chronic phase represents a stage of relative containment of the virus.
Although the plasma viremia declines, there is widespread dissemination and seeding of the virus, especially in the lymphoid organs.
The viral load at the end of the acute phase reflects the equilibrium reached between the virus and the host after the inital battle and in a given patient may remain fairly stable for several years.
This level of steady state viremia, or the viral "set point" is a predictor of the rate of decline of CD4+ T cells and therefore progression of HIV disease.
In one study, only 8% of patient with a viral load of less than 4350 copies of viral mRNA/ 1 progressed to full blown AIDS in 5 years, where as 62% of those with a viral load of greater than 36, 270 copies had developed AIDS in the same period.
From a practical standpoint, therefore the extent of viremia, measured as IIIV-tRNA is a useful surrogate marker of HIV disease progression and is of clinical value in the management of people with HIV infection.
However, in patients treated with highly active antiretroviral therapy (HAART), clinical improvement is often greater than the decrease in plasma viremia and it is generally accepted that virenzia as well as the blood CD4+ T cell counts should be considered in the management.
Regardless of the viral burden, during the middle or chronic phase, there is continuing battle between HIV and the host immune system.
The CD8+ cytotoxic T cell response remains activated and extensive viral and CD4+  cell turnover continues.
However, because of immune regenerative capacity of the immune system a large proportion of the lost CD4+ cells is replenished.
Thus the decline in CD4+ cell count in blood is modest.
After an extended variable period, there begins a gradual erosion of CD4+ T cell and full blown AIDS ensues AIDS
In this phase the host defence begins to wane.
There is loss of CD4+ T cells.
Concomitant with this loss, the proportion of the HIV virus in the blood increases.
It is characterized by a breakdown of the host defence, a dramatic increase in plasma virus and clinical disease.
Typically the patient presents with long lasting fever (> 1 months), fatigue, weight loss and diarrhoea.
After a variable period, serious opportunistic infections, secondary neoplasms or clinical neurological disease (grouped under the rubric AIDS indicator disease, discussed below), supervene and the patient is said to have developed AIDS.
It should be evident from our discussion that in each of the three phases of HIV infection, viral replication continues to occur .
Even in the chronic phase, before the severe decline in CD4+ cell count and the development of AIDS, there is extensive turnover of the virus.
In other words HIV infection lacks a phase of true microbiologic latency, thus it is a phase during which all the HIV is in the form of proviral DNA and no cell is productively infected.

So the answer to this question is A


Instruction:
Unwinding Enzyme in DNA synthesis:
A. Helicase
B. Primase
C. DNA Polymerase
D. Transcriptase

Response:
Ans. A. Helicase(Ref: Harper 31/e page 364)Classes of proteins involved in DNA replicationProteinFunctionDNA polymerasesDeoxynucleotide polymerizationHelicasesProcessive unwinding of DNATopoisomerasesRelieve torsional strain that results from helicase-induced unwindingProteinFunctionDNA primaseInitiates synthesis of RNA primersSingle-strand binding proteinsPrevent premature reannealing of dsDNADNA ligaseSeals the single strand nick between the Nascent chain and Okazaki fragments on lagging strand

So the answer to this question is A


Instruction:
Which of the following is the optimal position for inseing an IOL during a cataract surgery?
A. Anterior chamber
B. Posterior chamber
C. Iris clip
D. Any of the above

Response:
The lens should be placed in the capsular bag of the posterior chamber. Intraocular lens implants can easily be inseed behind the iris and in front of the posterior lens capsule. This is safest and most secure place for intraocular lens implants to rest within the eye.

So the answer to this question is B


Instruction:
Nasal perforation in bony part seen in
A. Syphilis
B. Tuberculosis
C. Wegner's granuloma
D. Allergic rhinitis

Response:
A. (Syphilis) (144 - Dhingra 4th) (189 - Maqbool 11th)Lupus, tuberculosis and leprosy - causes perforation in the cartilaginous part while syphilis involves the bony part**PERFORATION OF NASAL SEPTUM1. Traumatic perforations - Trauma is the most common cause*a. Surgical (during and after SMR) or accidentalb. Constant habit of nose pickingc. Tight nasal packingd. Repeated cauterization with chemicals or galvanocautrye. Haematoma and abscess formation due to necrosis of the septal cartilage2. Pathologic perforationsa. Septal abscessb. Nasal myiasis, allergic rhinitisc. Rhinolith or neglected foreign body causing pressure necrosisd. Chronic granulomatous conditions like lupus, tuberculosis and leprosy, syphilise. Wegener's granuloma is a midline destructive lesion which may cause total septal destruction**f. Irritants like tobacco or cocaine snuff and fumes such as those of chronic acid and mercuryg. Tumours of the septum eg chondrosarcoma, granuloma.* Perforation of posterior septum is commonly seen in syphilis**Treatment - Inactive small peforation can be surgically closed by plastic flaps - larger perforations are difficult to close.

So the answer to this question is A


Instruction:
Most common site of occurrence of Craniopharyngioma is?
A. Infrasellar
B. Suprasellar
C. Posterior fossa
D. Nasopharyx

Response:
Ans. is 'b' i.e., Suprasellar* Location of craniopharyngiomas can bei) Sellar - suprasellar (most cases) - most commonly arising on the pituitary stalk and projecting into the hypothalamus.ii) Infrasellar or intrasellar.iii) Prechiasmic.iv) Retrochiasmic.* Rare locations include extradural and extracranial-nasopharyngeal, posterior fossa or extending down the cervical spine.

So the answer to this question is B


Instruction:
A 28 year old female presents with acute abdominal pain,vaginal bleeding,severe pallor, hypotension after having induction of ovulation 2 months back for infeility. The provisional diagnosis is:
A. Uterine fibroid
B. Ovarian cyst
C. Ruptured ectopic pregnancy
D. inevitable aboion

Response:
fig-Ruptured ectopic pregnancy in the right Fallopian tube with surrounding blood clots Infeility, per se, as well as the use of Assisted reproductive technology ,is linked to substantively increased risks for ectopic pregnancy After one ectopic the chance of a second ectopic is 10% A "classic" presentation is characterized by the triad of delayed menstruation, pain, and vaginal bleeding or spotting.

So the answer to this question is C


Instruction:
Which of the following swelling moves on protrusion of tongue -
A. Thyroglossal cyst
B. Branchial cyst
C. Ranula
D. Cyst in hyoid bone

Response:
None

So the answer to this question is A


Instruction:
In PCOD, which is true
A. Increase FSH, decrease LH
B. Increase LH, decrease estrogen
C. Increase FSH/LH ratio, decrease estrogen
D. Increase LH, increase estrogen

Response:
(D) Increase LH, increase estrogen > The ratio of LH (Luteinizing hormone) to FSH (Follicle stimulating hormone) is greater than 1:1, as tested on Day 3 of the menstrual cycle due to increase in LH.Oestrogen levels are incresed.

So the answer to this question is D


Instruction:
True statement about fibrous cartilage is
A. This is the strongest kind of cartilage.
B. It is made of alternating layers of hyaline cartilage matrix and thick layers of dense collagen fibers oriented in the direction of functional stresses
C. It does not have perichondrium as it is usually a transitional layer between hyaline cartilage and tendon or ligament
D. All of the above

Response:
all these statements are true for fibrous cartilage.

So the answer to this question is D


Instruction:
Triage means -
A. Soing out of cases on availability of medical resources and seventy of patients condition
B. Patients are divided into 3 groups
C. Severely injured patients are attended first in military camps
D. None of the above

Response:
Triage is the name of the system that is used to so when and where patients will be seen in an emergency depament. The triage system exists because, while all patients at emergency depaments may be experiencing serious illness or injury, those with life-threatening and severe conditions must be treated first. Ref Davidson 23rd edition pg 1337

So the answer to this question is A


Instruction:
Malignancy is typically associated with disordered differentiation and maturation. Which of the following mentioned option best describe anaplasia?
A. Hepatic tumors synthesizing bile
B. Skin tumor producing keratin pearl
C. Bronchial epithelium cell producing keratin pearl
D. Colonic tumor cell producing mucin

Response:
Lack of Differentiation is called Anaplasia. Hepatic tumors synthesizing bile - The actual function of the hepatocytes is to produce bile.(Normal state) Skin tumor producing keratin pearl - Skin has the presence of Squamous epithelium and that is going to have the presence of keratin pearl (Again normal) Bronchial epithelium cell producing keratin pearl- The ciliated columnar epithelium of the bronchi is producing something which is the function of squamous epithelium, this is referred as disordered function which signifies anaplasia. Colonic tumor cell producing mucin- colonic epithelium is columnar epithelium and it is its normal function to produce mucin.

So the answer to this question is C


Instruction:
Which of the following is a mineralocoicoid antagonist -
A. Spironolactone
B. Inamrinone
C. Nicorandil
D. Ketorolac

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

So the answer to this question is A


Instruction:
"Risk ratio" is utilized to calculate :-
A. Relative risk
B. Attributable risk
C. Population attributable risk
D. Odds ratio

Response:
- Risk ratio is the ratio of incidence of disease in exposed to incidence of disease in non-exposed. - It is utilized to calculate relative risk. EXTRA EDGE: - R.R. = Ie / Ine - A.R. = x 100 - P.A.R. = x 100

So the answer to this question is A


Instruction:
In normal immune system, the epithelioid cells are derived from:
A. TH1
B. TH2
C. Macrophages
D. TH19

Response:
Ref: Robbins Basic Pathology, E-book, P 85* Epithelioid cells are defined as cells that resemble epithelial cells (keratinocytes). They have large oval, pale, vesicular nuclei and abundant eosinophilic cytoplasm.* The best-known epithelioid cells are those derived from macrophages within granulomas, but tumor cells can also be described as epithelioid. Immunostaining may be needed to identify the type of epithelioid cell.MOST COMMON LESIONS WITH EPITHELIOID CELLS* Granulomas* Squamous cell carcinoma* Spitz nevus (spindle and epithelioid cell nevus)* Melanoma

So the answer to this question is C


Instruction:
Wheal and flare reaction is: September 2005
A. Type I hypersensitivity
B. Type II hypersensitivity
C. Type III hypersensitivity
D. Type IV hypersensitivity

Response:
Ans. A: Type I hypersensitivity

So the answer to this question is A


Instruction:
Antiperistalsis is more commonly seen in
A. Colon
B. Jejunum
C. Ileum
D. Duodenum

Response:
Excessive distention or irritation of the duodenum provides an especially strong stimulus for vomiting. In the early stages of excessive gastrointestinal irritation or overdistention, antiperistalsis begins to occur, often many minutes before vomiting appears.

So the answer to this question is D


Instruction:
Sperm get nutrition from:
A. Fructose
B. Glucose
C. Sucrose
D. Amylase

Response:
Seminal vessels secrete a mucoid material containing abundance of fructose, citric acid and other nutrient substance. This adds to the bulk of semen & fructose in the seminal fluid is of nutrient value to the sperm GLUT- 5: fructose transpo.

So the answer to this question is A


Instruction:
A 3-month-old child has moderate fever and non productive cough and mild dyspnea. After a course of antibiotic, the condition of the child improved transiently but he again develops high fever, productive cough and increased respiratory distress. CXR shows hyperlucency and PFT shows obstructive pattern. Most probable diagnosis is:
A. Alveolar microlithiasis
B. Postviral syndrome
C. Follicular bronchitis
D. Bronchiolitis obliterans

Response:
d. Bronchiolitis obliterans(Ref: Nelson's 20/e p 2044-2047, Ghai 8/e p 381-382)Bronchiolitis obliterans (BO)What is it?A chronic obstructive lung disease of bronchioles and smaller airways, that results from an insult to the lower respiratory tract leading to fibrosis of small airwaysPathogenesis* After the initial insult, inflammation affecting terminal bronchioles, respiratory bronchioles and alveolar ducts can result in the obliteration of the airway lumen* Epithelial damage resulting in abnormal repair is characteristic of BO* Complete or partial obstruction of the airway lumen can result in air trapping or atelectasisClinical features* Cough, fever, cyanosis, dyspnea, chest pain and respiratory distress followed by initial improvement* It is easily confused with pneumonia, bronchitis, or bronchiolitis* Progression of disease with increasing dyspnea, chronic cough, sputum production and wheezing seenDiagnosis* Chest X-ray may be normal or can demonstrate hyperlucency and patchy infiltrates* Occasionally, a Swyer-James syndrome (unilateral hyperlucent lung) develops* PFT shows obstructive pattern

So the answer to this question is D


Instruction:
Unpaired laryngeal cartilage-
A. Arytenoid
B. Corniculate
C. Cuneiform
D. Epiglottis

Response:
Ans. is 'd' i.e., Epiglottis o The skeletal supports of larynx is provided by Six cartilages, 3 out of which are paired (so there are total 9 cartilages). i) Unpaired Thyroid, cricoid, epiglottis. ii) PairedArytenoid, Corniculate, cuneiform.

So the answer to this question is D


Instruction:
Mottled enamel is due to:
A. Vitamin A deficiency
B. Excess of fluoride
C. Vitamin D deficiency
D. Teratogens

Response:
None

So the answer to this question is B


Instruction:
A woman presents with a thick curdy-white vaginal discharge. The best treatment for her is:
A. Miconazole
B. Metronidazole
C. Nystatin
D. Doxycycline

Response:
Candidiasis Its seen in Immuno-compromised women, Pregnancy, Chemotherapy, T.B, etc Is a Yeast like fungi Has Thick curdy discharge Petichiae hemorrhages when white are removed Treatment Clotrimazole cream/ pessary Miconazole cream/ pessary Oral: fluconazole, itraconazole, ketoconazole

So the answer to this question is A


Instruction:
Virulence factors for meningococci
A. Capsule
B. Pili
C. Endotoxin
D. Coagulase

Response:
Meningococci are capsulated, unlike Neisseria. Based on their capsular polysaccharide antigens, they are classified into 13 subgroups, of which groups A, B, C, X, Y and W-135 are the most impoant Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 231

So the answer to this question is A


Instruction:
Advantages of median episiotomy over mediolateral episiotomy are all except: March 2005
A. Less blood loss
B. Easy repair
C. Extension of the incision is easy
D. Muscles are not cut

Response:
Ans. C: Extension of the Incision is Easy Mediolateral episiotomy is performed by making a diagonal incision across the midline between the vagina and anus This method is used much less often. The disadvantages are: Apposition of the tissues is not so good. May require more healing time than the midline incision. Blood loss is little more Postoperative discomfo is more Relative increased incidence of wound disruption Dyspareunia is comparatively more The advantages are: If necessary the incision can be extended. Relative safety from rectal involvement from extension.

So the answer to this question is C


Instruction:
In which stage of the syphilis, nose is involved commonly ?
A. Primary
B. Secondary
C. Teiary
D. Equally involved in all stages

Response:
Ans. is 'c' i.e., Teiary Nasal syphilis Nasal syphilis may be : i) Acquired or ii) Congenital. Teiary stage in which nose is involved most commonly. There is formation of gumma followed by bony perforation of nasal septum. Bridge of the nose collapses causing a saddle deformity. Atrophic rhinitis may occur as a complication.

So the answer to this question is C


Instruction:
Vitamin E prevents rancidity by virtue of its---------property:
A. Antioxidant
B. Oxidant
C. Sulfuration
D. Hydrogenation

Response:
A Harper, 26th ed, p. 486 & 25th ed. p. 647

So the answer to this question is A