Instruction:
A 35-year-old woman presents with pancreatitis. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) reveals the congenital cystic anomaly of her biliary system illustrated in the film below. Which of the following statements regarding this problem is true?
A. Treatment consists of internal drainage via choledochoduodenostomy
B. Malignant changes may occur within this structure
C. Most patients present with the classic triad of epigastric pain, an abdominal mass, and jaundice
D. Cystic dilation of the intrahepatic biliary tree may coexist and is managed in a similar fashion

Response:
Choledochal cysts are congenital cystic dilations of the extrahepatic biliary ducts. Intrahepatic cystic dilation can coexist (Caroli's disease), but it represents a distinct problem and is managed differently. Patients may present with symptoms at any age, but the classic triad of epigastric pain, abdominal mass, and jaundice is not frequently seen. Rather, most patients present with other conditions such as cholecystitis, cholangitis, or pancreatitis. Ultrasonography or endoscopic retrograde cholangiopancreatography (ERCP) is helpful in demonstrating cysts. Nonsurgical treatment of these cysts results in high morbidity and mortality, and therefore surgery is advised in all cases. The present recommendation is for complete resection of the cyst and Roux-en-Y choledochojejunostomy. Since malignant changes in choledochal cysts have been frequently described, complete resection rather than the performance of an internal drainage procedure is preferred whenever the resection can be done safely.

So the answer to this question is B


Instruction:
Duration of second stage of labour in a multipara is
A. 10 minutes
B. 20 minutes
C. 40 minutes
D. l hour

Response:
Ans. is 'b' i.e., 20 minutes o Second stage begins with full dilatation of the cervix and ends with expulsion of the fetus.o Mean duration of second stage is 50 minutes for nullipara and 20 minutes in multipara. Prolonged second stage is diagnosed if the duration exceeds 2 hours in nullipara and 1 hour in multipara when no regional anaesthesia is usedo One hour or more is permitted in both the groups when regional anaesthesia is used during labour.

So the answer to this question is B


Instruction:
Amino acid with dissociation constant closest to physiological pH is:
A. Serine
B. Histidine
C. Threonine
D. Proline

Response:
Histidine has dissociaion constant close to physiologic pH of 7.4 Ref: Textbook of Biochemistry By DM Vasudevan, 3rd Edition, Page 15 ; Lippincott Biochemistry, 2nd Edition, Pages 9-10 ; Pulmonary Biology in Health and Disease By E. Edward Bittar, 2002, Page 277

So the answer to this question is B


Instruction:
Pulmonary fibrosis is an adverse effect of which of the following anti-cancer drugs?
A. Mitomycin C
B. Hydroxyurea
C. Bleomycin
D. Cisplatin

Response:
Anticancer drugs causing pulmonary fibrosis are Bleomycin Busulfan Methotrexate Cyclophosphamide Carmustine

So the answer to this question is C


Instruction:
Cobra head appearance is seen in:
A. Ureterocele
B. Wilm's Tumor
C. Horse shoe kidney
D. Vesicoureteral reflux

Response:
Ans: A (Ureterocele) Ref: Harrison is online. 18th edExplanation:Some Important Features in ContrastRadiographsSpider leg appearance -- Polycystic kidneyCobra head appearance -- UreteroceleFlower vase appearance of ureters -- Horse shoe kidneySandy patches -- Schistosomiasis of bladderSoap bubble appearance -- HydronephrosisApple core lesion on barium -- Ca colonClaw appearance on barium enema -- IntussusceptionSaw tooth appearance -- Diverticula of colonBirds beak appearance of esophagus on barium meal -- AchalasiaCork screw appearance of esophagus on barium meal -- Diffuse esophageal spasmString sign of kantor -- Crohn's disseaseThumb printing sign -- Ischemic colitisEGG SHELL CALCIFICATION------ Silicosis, Sarcoidosis. Scleroderma, Histoplasmosis, Amyloidosis, lymphoma following radiotherapy

So the answer to this question is A


Instruction:
Para amino benzoic acid of breast milk prevent the infection of –
A. Plasmodium vivax
B. Kleibsella-pneumonia
C. Giardia
D. E.coli

Response:
None

So the answer to this question is A


Instruction:
Which muscle is responsible for abduction of vocal cord, in the given diagram
A. A
B. B
C. C
D. D

Response:
A - Lateral cricoarytenoid muscle. B - Inter arytenoid muscle C - Posterior cricoarytenoid muscle D - Cricothyroid muscle

So the answer to this question is C


Instruction:
A 10 year boy presents with discharge and hearing disturbance in the left ear. On examination of the left ear, a central perforation is noted. Which of the following is the surgical management of choice in this patient?
A. Myringoplasty
B. Modified radical mastoidectomy
C. Radical mastoidectomy
D. Clearance and antibiotics

Response:
Ans. A. Myringoplasty

So the answer to this question is A


Instruction:
Number of Golgi tendon organs per 100 extrafusal muscle fibres
A. 20-Oct
B. 200-400
C. 50-60
D. 80-100

Response:
About 1 golgi tendon organ is responsible for 10 to 20 extrafusal fibers Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:689

So the answer to this question is A


Instruction:
All of the following are seen in persisting vomitting EXCEPT
A. Hypokalemia
B. Decreased K+ in urine
C. Elevated pH of blood
D. Metabolic alkalosis

Response:
Presistant vomitting causes loss of hydrochloric acid, K+ Na+ ions and body fluids. Loss of HCl leads to metabolic alkalosis. Loss of K+ leads to hypokalemia which fuher increases the pH of blood (intracellular K+ ions come out in the ECF by exchanging with H+ ions of ECF). Hypokalemia should lead to decreased K+ in urine but this does not happen - Low Na+ and hypovolemia would lead to increased aldosterone secretion which would increase the reabsorption of Na+ ions in the distal renal tubular in exchange of K+ ions. Thus K+ ions excretion in urine is increased despite hypokalemia.

So the answer to this question is B


Instruction:
Uronic acid pathway is impoant for the formation of?
A. GAG (glycosamine glycans)
B. Glycoproteins
C. Conjugation of bilirubin
D. All of the above

Response:
UDP-glucuronate (a product of uronic acid pathway) is a donar of glucuronate residue for various conjugation and synthetic processes.

So the answer to this question is D


Instruction:
Most common site of bony metastases in Retinoblastoma-
A. Skull bones
B. Hip bones
C. Ribs
D. Veebrae

Response:
*Metastasis by blood stream occurs to skill bone and distal bones. Ref: AAO- Ophthalmic pathology and Intraocular Tumors, section 4, 2014-15 p.304.

So the answer to this question is A


Instruction:
Space of cloquet is phylogenetically related to -
A. Hyaloid artery
B. Central Retinal artery
C. Central retinal vein
D. Iris

Response:
Ans. is 'a' i.e., Hyaloid artery Cloquet's canalo It is the embryonic remnant of hyaloid artery.o It runs from the optic nerve, where it originates in shape of funnel and creates the peripappiiary space of Martegiani, and narrows as it passes through the central vitreous until it reaches the retrocrystalline lens zone,o The anterior vitreous space, or anterior hyaloid is inserted in the posterior capsule of crystalline lens forming a circular zone 8-9 mm in diameter known as Weigershyaioidocapsular ligament,o This ligament constitutes the union between the anterior hyaloid and the anteriormost portion of the Cloquet's canal, leaving a space between the two, called Berger's space.

So the answer to this question is A


Instruction:
Bleomycin toxcity is characterized by destruction of-
A. Endothelial cells
B. Type I pneumocytes
C. Type II pneumocyutes
D. Alveolar macrophages

Response:
Ans. is 'b' i.e., Type I Pneumocytes Bleomycin is well known to cause pulmonary toxicity.The incidence of bleomycin induced pulmonary toxicity is 5% for a total cumulative dose of450 units and 15% for higher dosages.Bleomycin is concentrated preferentially in the lung and is inactivated by hydrolase enzyme. This enzyme is relatively deficient in lung tissue.This may explain relative sensitivity of bleomycin to lung tissuePathological features of bleomycin toxicityEarly endothelial cell damageDestruction of type I pneumocytes^Migration of type II pneumocytes into alveolar spaces inducing interstitial changesType I epithelial cells are more vulnerable to bleomycin toxicity and are destroyed by bleomycin QFollowing destruction of type I pneumocytes repair is characterized by hyperplasia and dysplasia of type II pneumocytesFibroblast proliferation with subsequent pulmonary fibrosis is probably the basis for irreversible changes induced by bleomycin.Also knowHistopathology of lung in Bleomycin toxicityEndothelial cell edema and blebbingNecrosis of type I pneumocytesHyperplasia and metaplasia of type II pneumocytesInflammatory infiltrate with PMNProliferation of fibroblast and fibrosis

So the answer to this question is B


Instruction:
In non hemolytic jaundice, urobilinogen is seen in ?
A. Obstructive jaundice
B. Hepatic fibrosis
C. Fatty liver
D. Infective hepatitis

Response:
Ans. is 'd' i.e., Infective hepatitis

So the answer to this question is D


Instruction:
A 40-year-old intravenous drug user presents to the emergency depament with a 2 days history of right knee pain with associated swelling and erythema. The patient is febrile with a holosystolic murmur at the right lower sternal border. Complete blood count reveals leukocytosis. Blood and synol fluid cultures are sent, and broad-spectrum antibiotics are staed. Synol fluid analysis is pending. What is the most likely pathogen causing these symptoms
A. Neisseria gonorrhoeae
B. Pseudomonas aeruginosa
C. Borrelia burgdorferi
D. Staphylococcus aureus

Response:
Gram-positive bacteria remain the most common cause of septic ahritis. Staphylococcus aureus accounts for the majority of culture-positive septic ahritis, especially within ceain patient subgroups such as hemodialysis patients and intravenous drug abusers. The predominance of S. aureus in septic ahritis has remained unchanged for many years.

So the answer to this question is D


Instruction:
Which one of the following types of stomach cancers carries the best prognosis
A. Superficial spreading type
B. Ulcerative type
C. Linitis plastic atype
D. Polypoidal type

Response:
In early gastric carcinoma which has undergone good surgical resection and lymphadenectomy. has 5 yr survival rate and 95% overall cure rate. Reference SRB edition:5 page:847

So the answer to this question is A


Instruction:
Metaplasia occurs in all of the following except:
A. Stem cells
B. Squamous cells
C. Columnar cells
D. Transitional cells

Response:
Ref: Chapter 1. Cellular responses to stress and toxic insults; page: 11: Robbins and Cot ran Pathologic Basis of Disease: 8th editionExplanation:Metaplasia is the results of reprogramming of stem cells that are known to exist in normal tissues, or of undifferentiated mesenchymal cells present in the connective tissue.Metaplasia is a reversible adaptive change in which one differentiated epithelial cell type is replaced by another epithelial cell type of mature type.Example of columnar to Squamous Metaplasia: in chronic smokers, the normal ciliated columnar epithelial cells of trachea and bronchi are replaced by squamous cells.Example of Squamous to columnar Metaplasia: in Barrett esophagus, in which esophageal Squamous epithelium is replaced by intestinal like columnar cells under the influence of refluxed gastric acid.Transitional /uro-epithelium can also undergo Squamous Metaplasia by chronic irritation like in urinary bladder stones.Hence, Metaplasia is basically due to reprogramming of stem cells as adaptive mechanism.Metaplasia is basically classified into two types:- Epithelial Metaplasia- Mesenchymal Metaplasia.The epithelial cells can undergo Metaplasia due to chronic irritation, if they have stem cell reserve component.Mesenchymal Metaplasia is rare: example is Myositis Ossificans, where muscles will undergo chondroid Metaplasia due to improper fracture healing.

So the answer to this question is A


Instruction:
Which of the following type of RNA is involved in splicing?
A. mRNA
B. sn RNA
C. r RNA
D. t RNA

Response:
snRNA is involved in RNA splicing i.e removal of introns from hnRNA, regulation of transcription factors or RNA polymerase II and in the maintenance of telomeres. snRNA is a class of small RNA molecules that are found within the nucleus of eukaryotic cells. They are transcribed by RNA polymerase II or RNA polymerase III. Ref: Maternal, Fetal and Neonatal Physiology: A Clinical Perspective By Susan Tucker Blackburn, Page 5; Essentials of Pathophysiology: Concepts of Altered Health States By Carol Mattson Poh, Page 93

So the answer to this question is B


Instruction:
Axial reduction in a posterior three quarter crown imparts:
A. Retention and Resistance
B. Structural durability
C. Periodontal preservation
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
A 6-year old child has an accident and had # elbow, after 4 years presented with tingling and numbness in the ulnar side of the finger, the fracture is -
A. Supracondylar # humerus
B. Lateral condylar # humerus
C. Olecranon #
D. Dislocation of elbow

Response:
This child has : -

Fracture around elbow
Tingling and numbness in ulnar nerve distribution after 4 years.

That means the child has developed tardy ulnar nerve palsy (late onset ulnar nerve palsy).
Now you must be thinking option 'a, b & d' all can cause tardy ulnar nerve palsy, then why the answer is '13'.
Here the age of the child, at the time of fracture, is 6 years.
Elbow dislocation occurs usually in adults and uncommon in children.
The age matches with both supracondylar fracture (5-7 years) and fracture lateral condyle (5-10 years).
However, Tardy ulnar nerve palsy is more common in malunited fracture lateral condyle (cubitus valgus) and occurs only occasionally in malunited supracondylar fracture (cubitus varus).
Therefore, answer of choice here is fracture lateral condyle humerus.

So the answer to this question is B


Instruction:
The most common hormone other than gastrin, contained in the gastrin-secreting islet cell tumor is -
A. ACTH
B. Glucagon
C. Melanocyte stimulating hormone
D. Growth hormone releasing factor

Response:
None

So the answer to this question is A


Instruction:
A 14-year-old girl presents with quadriparesis, facial palsy, winging of scapula and ptosis. There is h/o similar illness in father and brother but less severe. Her CPK level is also raised (500IU/L). She is probably suffering from?
A. Emery-Dreifuss muscular dystrophy
B. Becker muscular dystrophy
C. Limb-girdle dystrophy
D. Scapulofaciohumeral dystrophy

Response:
Facial muscle involvement is not seen with Becker and Limb-girdle muscular dystrophy Emery Dreifuss and Becker are XLR disease so can't be present in a girl child. Hence by exclusion the diagnosis is Dx: Scapulo-Faciohumeraldystrophy. Facio-Scapulo-humeral dystrophy Autosomal dominant inheritance and has an onset in childhood or young adulthood. Facial weakness is the initial manifestation-->inability to smile, whistle or fully close the eyes. Weakness of the shoulder girdles-->makes arm elevation difficult. Scapular winging becomes apparent with attempts at abduction and forward movement of the arms. The serum CK level may be normal or mildly elevated. No specific treatment is available, ankle-foot ohoses are helpful for foot-drop.

So the answer to this question is D


Instruction:
Total iron binding capacity is increased in
A. Iron deficiency anaemia
B. Anaemia of chronic disease
C. Sideroblastic anaemia
D. β - thala ssemia

Response:
Iron deficiency anaemia.
Serum  ↓.
Serum ferritin ↓.
TIBC ↑.

So the answer to this question is A


Instruction:
Risk of malignancy in cold nodule of thyroid is
A. 0.10%
B. 2%
C. 20%
D. 30%

Response:
Risk of malignancy in hot nodule is 4%.
Risk of malignancy in cold nodule is 20%.

So the answer to this question is C


Instruction:
Which of the following disorders mimic each other
A. Iron deficiency anemia and sickle cell anemia
B. Sickle cell anemia and Thalassemia
C. Thalassemia and Iron deficiency anemia
D. Iron deficiency anemia and vitamin B12 deficiency anemia.

Response:
Both present with microcytic hypochromic anemia.
Mentzer index is used to diffeentiate between the two. It is less than 13 in Thalassemia. (MCV / RBC Count).

So the answer to this question is C


Instruction:
Alkaline phosphatase contains
A. Cobalt
B. Zinc
C. Iron
D. Copper

Response:
ALP is a nonspecific enzyme which hydrolyzes aliphatic, aromatic or heterocyclic compounds. the pH optimum for the enzyme reaction is between 9 and 10.it is activated by magnesium and manganese. zinc is a constituent ion of ALP.Ref: DM Vasudevan Biochemistry, page no: 305

So the answer to this question is B


Instruction:
The example of syndesmosis type of joint is ?
A. Sacroiliac
B. Inferior tibiofibular
C. Superior tibiofibular
D. Mid tarsal

Response:
B i.e. Inferior tibiofibular

So the answer to this question is B


Instruction:
Charcot's triad
A. Fever, abdominal pain, jaundice
B. Fever, vomiting, jaundice
C. Fever, jaundice, abdominal distension
D. Fever, diarrhoea, jaundice

Response:
Charcot's triad is seen in cholangitis It is characterized by Abdominal pain Jaundice Fever Reynold's pentad Charcot's triad Altered mental status. Shock (hypotension) Ref: Sabiston 20th edition Pgno :1507

So the answer to this question is A


Instruction:
The magnetic field in an MRI machine is measured in -
A. Housefield units
B. Tesla
C. MHz
D. None

Response:
Strength of magnetic field used in MRI is measured by Telsa units CT attenuation values are measured by Hounsfield units. Frequency of sound waves used in USG are measured by MHz

So the answer to this question is B


Instruction:
Waste water from kitchen is:
A. Sullage
B. Sewage
C. Garbage
D. Kitchen water

Response:
The term "sullage" is applied to waste water which does not contain human excreta, e.g., waste water from kitchens and bathrooms.
Essentials of preventive and community dentistry
Soben Peter
5th edition

So the answer to this question is A


Instruction:
A 10-year-old girl has exhibited muscular weakness since early childhood that has not worsened. She can ambulate unassisted but does not participate in strenuous physical activities. On examination, she has 4/5 motor strength in proximal muscles and 5/5 in distal muscles. There is no muscle pain on palpation. A biopsy of the deltoid muscle is obtained, and with Gomori trichrome stain, microscopic analysis shows subsarcolemmal aggregates of rod-shaped intracytoplasmic inclusions. Laboratory studies show a normal serum creatine kinase. Which of the following is the most likely form of muscle disease she has?
A. Channelopathy
B. Congenital myopathy
C. Glycogen storage disease
D. Inflammatory myopathy

Response:
Nemaline rod myopathy, one form of congenital myopathy, may present in infancy or childhood and maybe nonprogressive or slowly progressive. Congenital myopathies are often named for their characteristic histologic features. Channelopathies typically present as periodic paralysis with abnormalities in serum potassium. The two glycogen storage diseases most often affecting striated muscle include Pompe disease (type II) and McArdle disease (type V). There are increased glycogen deposits seen with periodic acid-Schiff (PAS) stain. Neuropathies affect muscle through denervation, leading to groups of atrophic muscle fibers. Polymyositis and dermatomyositis are inflammatory myopathies that are accompanied by myalgia and fiber degeneration with increased serum creatine kinase. Mitochondrial myopathies may appear in childhood but are usually progressive, and often other organs such as the heart or brain are involved.

So the answer to this question is B


Instruction:
Air travel in Pregnancy is permitted up to ________ weeks period of gestation:-
A. 28
B. 32
C. 36
D. 40

Response:
WHO IHR's guidelines for air travel in pregnancy upto 36 weeks of period of gestation with single baby.(If twins upto 32 weeks POG) After 28 weeks, mother should carry EDD ceificate.

So the answer to this question is C


Instruction:
In one of the following condition cavities filled with
fluid is seen in the centre of spinal cord:
A. Multiple sclerois
B. Syringo myelia
C. Tabes Dorsalis
D. Meningovascular syphilis

Response:
None

So the answer to this question is B


Instruction:
Largest lung volume is defined by
A. Vital capacity
B. Functional residual capacity
C. Inspiratory capacity
D. ERV+IRV

Response:
Ans: a (Vital capacity) Please go through diagram given below & make the facts clear. LUNG VOLUMES INSPIRATORY CAPACITY (IC)FUNCTIONAL RESIDUAL CAPACITYVITAL CAPACITYTOTAL LUNG CAPACITY= TV + IRV= ERV + RV= ERV + TV + IRV= ERV+ TV + IRV + RV. Male (L)Female (L)Residual volumeExpiratory reserve volume1.211.10.7Tidal volume0.50.5Inspiratory reserve volumeTotal lung capacity3.361.94.2 Respiratory minute volume= 6 LI minAlveolar ventilation= 4.2L/ minMaximum voluntary ventilation= 125-170 L/minMax work done in breathing=10 kg-m/breathNormal work done in breathing= 0.5 kg-m/ minTimed vital capacity / secFEV1=83% FEV3= 97%REMEMBERTotal lung capacity is measured by1) helium dilution method2) body plethismographyResidual volume is measured by1) N2 washout method.

So the answer to this question is A


Instruction:
Basic emergency obstetric services includes all, except:
A. Parenteral oxytocics
B. Antibiotics and anticonvulsants
C. Manual extractions of the placenta
D. Blood transfusions

Response:
None

So the answer to this question is D


Instruction:
Red degeneration in uterine fibroid is most common in:
A. Second trimester
B. Third trimester
C. Puerperium
D. First trimester

Response:
Ans. is a, i.e. Second trimesterRef: Jeffcoate 7th/ed p502Read for yourself what - Ref: Dutta Obs. 6th/ed p309 has to say"Red degeneration; It predominantly occurs in a large fibroid during the second half of pregnancy or puerperium."From the above statement answer could be second trimester, third trimester or puerperium."Red degeneration; manifests typically about mid pregnancy when the leiomyoma suddenly become acutely painful, enlarged and tender." - Ref: Jeffcoate 7th/edp502This clears the doubts and confirms our answer, i.e. red degeneration is most common during second trimester (mid pregnancy).You should also keep in mind the following important points regarding-Fibroids and pregnancy.* Most fibroids do not increase in size during pregnancy.* Only 5% females with fibroid have degeneration during pregnancy.

So the answer to this question is A


Instruction:
According to Scammon’s growth curves, which of the following tissues has a growth increase that can be used to help predict timing of the adolescent growth spurt?
A. Neural tissues
B. Lymphoid tissues
C. Reproductive tissues
D. None of the above

Response:
Reproductive tissues grow at the same time as the adolescent growth spurt, and the appearance of secondary sexual characteristics can be used to help predict the timing of growth.

So the answer to this question is C


Instruction:
Not included in Gredenigo syndrome
A. Retro-orbital pain
B. Ear discharge
C. Nystagmus
D. Diplopia

Response:
None

So the answer to this question is C


Instruction:
Which one of the following in the characteristic feature of juvenile myoclonic epilepsy ?
A. Myoclonic seizures frequently occur in morning
B. Complete remission is common
C. Response to anticonvulsants is poor
D. Associted absence seizures are present in majority of patients

Response:
Ans. is 'a' i.e., Myoclonic seuzures frequently occur in morning Juvenile myoclonic epilepsy-is an epilepsy syndrome. Epilepsy syndromes are disorders in which epilepsy is a predominant feature and there is sufficient evidence to suggest a common underlying mechanism. Juvenile Mvoclonic Epilepsy o It is characterized by: Appearance in early adolescence Bilateral myoclonic jerks that may be single or repetitive Most frequent in morning after awakening Can be provoked by sleep deprivation Consciousness is usually preserved unless myoclonus is specially severe Association with generalised tonic-clonic seizures and absence seizures is seen Absence seizures occur in 1/3rd of patients Benign condition although complete remission is uncommon Seizure responds well to appropriate anticonvulsant medication Family history of epilepsy is common EEG show 4-6/s irregular spike Treatment is with valproate

So the answer to this question is A


Instruction:
Which of the following is the complimentary sequence of 5' TTAAGCTAC 3'?
A. 5' GTACGCTTAA 3'
B. 5' AATTCGCATG 3'
C. 5' CATGCGAATT 3'
D. 5' TTAAGCGTAC 3'

Response:
The complementary sequence of 5' TTAAGCTAC 3' is 3'AATTCGCATG 5'or 5' GTACGCTTAA 3'. Complementary sequence of 5'-3' end always proceeds from 3'- 5. In the double stranded DNA, the bases of one strand of DNA pairs with the bases of the second strand in such a way that Adenine (A) always pairs with Thiamine (T) and Cytosine (C) always pairs with Guanine (G). Ref: Harper Illustrated Biochemistry, 26th Edition, Chapter 35, Page 303 ; Lippincott's Illustrated Reviews: Biochemistry, 3rd Edition, Chapter 29, Page 395

So the answer to this question is A


Instruction:
An 81-year-old female falls and presents to the emergency department. What injury to this tissue or structure causes lower leg extremities to be externally rotated?
A. Sacroiliac joint
B. Neck of femur
C. Lateral meniscus
D. Intertrochanteric

Response:
Both subcapital and intertrochanteric fractures present with external rotation of the lower extremity. The lateral rotators are attached to the bone distal to the fracture line to cause this typical clinical sign. Trochanteric fractures have a better prognosis because the blood supply to the proximal segment remains intact.

So the answer to this question is C


Instruction:
Which of the following agents can be used in day care surgery
A. Fentanyl, Midazolam, Propofol
B. Morphine, Midazolam, Propofol
C. Midazolam, Alfentanil, Propofol
D. Morphine, Diazepam, ketamine

Response:
Drugs used for day care surgery are Desflurane Midazolam Sevoflurane Isoflurane Alfentanil Propofol Mivacurium

So the answer to this question is C


Instruction:
Investigation of choice for detection and characterization of interstitial lung disease is
A. MRI
B. Chest x-ray
C. Venlaon perfusion scan
D. High resoluon CT

Response:
High Resoluon CT (HRCT) is investigation of choice for interstitial lung disease as it can delineate the lung parenchyma upto the level of secondary pulmonary lobule.

So the answer to this question is D


Instruction:
Pityriasis rotunda is:
A. Fungal infection
B. Bacterial infection
C. Pityriasis affecting nail
D. Variant of Ichthyosis

Response:
Pityriasis rotunda - Pityriasis rotunda is described as a persistent, large, sharply defined circular patch of dry ichthyosiform scaling with no inflammatory changes. Variant of Ichthyosis Fixed, annular, scaling, dry-skin change More often seen in the African and Asian races Associated with neoplasia, paicularly Hepatocellular carcinoma.

So the answer to this question is D


Instruction:
Which of the following is not a component of thoracoscore ?
A. Performance status
B. Complication of surgery
C. ASA grading
D. Priority of Surgery

Response:
Complication of surgeryis not a component of THORACOSCORE Based on Thoracoscore , risk factors for in hospital moality in adult patients after thoracic surgery are: Variable Risk factors Age >55 yrs Gender Male ASA physical status >2 Performance statusclassification(WHO) >3 Dyspnea score(MRC) >3 Procedure class Pneumonectomy Surgical priority Urgent or emergency Diagnosis Malignant Comorbid diseases >3

So the answer to this question is B


Instruction:
Apple jelly nodules on the nasal septum are found in cases of -
A. Tuberculosis
B. Syphilis
C. Lupus Vulgaris
D. Rhinoscleroma

Response:
Characteristic feature of lupus vulgaris is the presence of apple- jelly nodules (Brown gelatinous nodules) in skin.

So the answer to this question is C


Instruction:
Antinuclear antibodies are seen in:
A. SLE
B. RA
C. Sjogrens syndrome
D. All

Response:
Ans: d (All) Ref: Harrison, 16th ed, p. 1563Antinuclear antibodies are directed against a variety of nuclear antigens and can be grouped into four antigens1. Antibodies to DNA2. Antibodies to histones3. Antibodies to non histone proteins bound to DNA4. Antibodies against nuc leolar antigensMost commonly used method to diagnose antinuclear antibodies - Indirect immunofluorescenceThey are associated with SLE as well as other autoimmune diseases basic patterns of ANA# Homogenous or diffuse nuclear staining - antibodies to histone chromatin# Rim or peripheral staining - antibodies to DS DNA# Speckled pattern - eg: Sm antigen, SS-A, SS-B# Nucleolar pattern - systemic sclerosis# Best screening test for sle - ANA# Most specific in sle - anti ds DNA# Autoantibody in sle with decreased risk of nephritis - anti ro, anti la# Autoantibody in drug induced sle - antihistone antibody ( aiims nov 2007)# Autoantibody associated with depression or psychosis in SLE - anti ribosomal p# Autoantibody associated with subcutaneous and neonatal lupus - anti ro antibody# Autoantibody in SLE correlating with active CNS lupus - antineuronal antibodyAntinuclear antibodies in various autoimmune diseases# Primary biliary cirrhosis- antimitochondrial antibody# Inflammatory myopathy- antihistidyl t-RNA synthetase (anti Jol)# Sjogrens syndrome- anti Ro and anti La# Diffuse scleroderma- anti topoisomerase antibody# CREST syndrome- anti centromere antibody # Celiac disease- antiendomysial antibody# Crohn disease- anti saccharomyces cervisea antibody# Ulcerative colitis- ANCA # Rheumatoid arthritis- anti ccp antibody

So the answer to this question is D


Instruction:
The occlusal surface of a primary mandibular first molar often has a prominent faciolingual ridge. This transverse ridge connects which two cusps?
A. Buccal and distolingual.
B. Mesiolingual and distobuccal.
C. Mesiobuccal and mesiolingual.
D. Distobuccal and distolingual.

Response:
Transverse ridge connecting MB and ML cusps.

So the answer to this question is C


Instruction:
All of the following are tumor necrosis factor blocking agents, except :
A. Adalimumab
B. Eternacept
C. Infliximab
D. Abciximab

Response:
None

So the answer to this question is D


Instruction:
True about endotoxin ?
A. Protein
B. Highly antigenic
C. No enzymatic activity
D. Produced by gram positive bacteria

Response:
Ans. is 'c' i.e., No enzymatic activity

So the answer to this question is C


Instruction:
Splenectomy is done to tide over the acute crises of uncontrollable:
A. ITP
B. TTP
C. HUS
D. All of the above

Response:
Indications of splenectomy in ITP: Failure of medical therapy Prolonged use of steroids with undesirable effects Most cases of first relapse Splenectomy provides a permanent response without subsequent need for steroids in 75-85% of patients. Laparoscopic splenectomy has become the gold standard for ITP patients. Responses usually occur within the first postoperative week.

So the answer to this question is A


Instruction:
Which of the following agent decreases cardiac afterload?
A. Nicorandil
B. Glyceryl trinitrate
C. Isosorbide dinitrate
D. None

Response:
Nicorandil reduces afterload and preload, while in the coronary circulation it dilates both the large epicardial and smaller resistance vessels. Because Nicorandil is an anteriolar dilator and hence primarily decrease after load. Hydralazine and minoxidil reduce afterload by relaxing aeriolar smooth muscle. The venodilators and diuretics are used to decrease preload. The venodilators include nitroglycerine and isosorbide dinitrite. Drugs that reduce both prelod and afterload include nitroprusside, prazosin, ACE inhibitors and angiotensin II receptor blockers.

So the answer to this question is A


Instruction:
True about Larynegeal mask airway – a) More reliable than face maskb) Prevent aspirationc) Alternative to Endotracheal tube (E.T.T)d) Does not require laryngoscope & visualisatione) Can be used in full stomach
A. acd
B. ad
C. bc
D. bde

Response:
LMA is intermediate between the face mask and Endotracheal intubation in terms of reliability, invasiveness and facilitation of gas exchance (face mask has minimum and endotracheal intubation has maximum).
LMA does not prevent aspiration -4 should not be used in full stomach patients.
LMA can be used as an alternative to endotracheal intubation for minor surgeries, where anaesthetist wants to avoid intubation.
LMA is introduced blindly (without laryngoscopy).

So the answer to this question is A


Instruction:
Most common fungal infection in neutropenic patient is: September 2005
A. Candidiasis
B. Aspergillosis
C. Histoplasmosis
D. None of the above

Response:
Ans. A: Candidiasis The most common fungal pathogens associated with invasive disease in humans are oppounistic yeasts (e.g., Candida albicans) or filamentous fungi (e.g., Aspergillus spp.).

So the answer to this question is A


Instruction:
Posterior wall of Rectus sheath below Arcrate line is formed by
A. Posterior lamina of Internal oblique aponeurosis and Transverse abdominis aponeurosis
B. Fascial transversalis
C. Transverse abdominis aponeurosis and Fascia transversalis
D. Internal oblique Aponeurosis

Response:
None

So the answer to this question is B


Instruction:
A 24 week pregnant female developed gestational diabetes. Which of the following is the MOST characteristic congenital anomaly of diabetic pregnancy
A. Multicystic kidneys
B. Oesophageal atresia
C. Caudal regression
D. Duodenal atresia

Response:
Ans. is 'c' i.e. Caudal regression [Ref: Obstetrics Fernando Areas 2nd/e page 289; Williams Obstetrics 21st/e page 13691 Most common single organ system anomaly with diabetes Heart Most common congenital anomaly seen in diabetic mother anencephaly Most common heart anomaly associated with diabetes Transposition of great vessels The most characteristic or specific lesion associated with diabetes Caudal regression syndrome (sacral agenesis) Remember sacral agenesis or caudal regression syndrome is the lesion most specifically associated with diabetes. It is not the most common congenital anomaly seen in diabetic mother. The table given on page 1369, 21st/e Williams compares the incidence of congenital anomalies in diabetic mother with that of normal population.

So the answer to this question is C


Instruction:
Disc prolapse involving L4 nerve root typically presents with: (Repeat)
A. Weakness of hip flexion
B. Absent ankle jerk
C. Weakness of hip extension
D. Absent knee jerk

Response:
Ans: D (Absent ankle jerk) Ref: Harrison's Principles of Internal Medicine, 18th ed.Explanation:Lumbosacral Radiculopathy--Neurologic Features (Sec Table 16}Neurologic ExaminationDeep Tendon ReflexesL4 Nerve Root (L3-4 disc): Patellar Reflex or Knee jerkSI Nerve Root (L5-SI disc): Achilles Reflex or Ankle jerkMotor ExamL4 Nerve Root (L3-4 disc): Ankle dorsiflexionL5 Nerve Root (L4-5 disc ): Great toe dorsiflexion (extensor haihicis longus)S1 Nerve Root (L5-S l disc): Ankle plantar flexion (gastrocnemius-soleus complex)Sensory ExamL4 Nerve Root (L3-4 disc): Medial malleolusL5 Nerve Root (L4-5 disc): Dorsal third metatarsophalangeal jointSI Nerve Root (L5-S1 disc): Lateral heelRadicular patterns by disc herniation typeCentral Disk herniationNerve root affected is ABOVE the discExample: Central L3 di.,c herniation causes findings above the L2-3 Nerve rootParacentral disk herniationNerve root affected is AT the discExample: Paracentral ' ' disc herniation causes findings at the L2-3 Nerve rootLateral disk herniationNerve root affected is BELOW the disc (foraminal effects) Table 16Examination FindingsLumbosacral Nerve RootsReflex AbsentSensoryMotorPain DistributionL2--Upper anterior thighPsoas (hip flexion)Anterior thighL3--Lower anterior thigh Anterior KneePsoas (hip flexion) Quadriceps (knee extension} Thigh adductionAnterior thigh, kneeL4Quadriceps (Knee reflex)Medial calfQuadriceps (knee extension) Thigh adduction Tibialis anterior (foot dorsiflexion)Knee medial calf Anterolateral thighL5 Dorsal surface- foot Lateral calfPeroneii (foot eversion) Tibialis anterior (foot dorsiflexion) Gluteus medius (hip Auction) Tne dorsiflexorsLateral calf dorsal foot, teral thigh,buttocksS1Gastrocnemius/soleus (Ankle reflex)Plantar surface-- foot Lateral aspect -footGastrocnemius/soleus (foot plantar flexion) Abductor hallucis (toe flexors) Gluteus maximus (hip extension)Bottom foot, posterior calf, posterior thigh, buttocksExample: Lateral L3 disc herniation causes findings at the L3-4 Nerve root

So the answer to this question is D


Instruction:
Trials stage for experimentation of adverse drug reaction in large scale population is ?
A. I
B. II
C. III
D. IV

Response:
Ans. is 'd' i.e., IV o Long-term adverse effects on large number of patients -f Phase IV clinical trial.

So the answer to this question is D


Instruction:
In a population of 10,000, literate people are 4000. In same population 2000 are 0-6 years old. What is the literacy rate of that population -
A. 30%
B. 40%
C. 50%
D. 60%

Response:
Ans. is 'c' i.e., 50% * The term literacy rate is used for the population relating to seven years age & above.* In the given question, population 7 years 8c above is 8000. Out of which 4000 are literate thus literacy rate is 50%.

So the answer to this question is C


Instruction:
The most common cause of proptosis in adults is
A. Preseptal cellulitis
B. Orbital cellulitis
C. Thyroid eye disease
D. Capillary hemangioma

Response:
Proptosis:- Ref:- A K Khurana Comprehensive Ophthalmology 7th edition; pg num:- 398

So the answer to this question is C


Instruction:
Following is indication for colposcopy :
A. Suspicious pap smear
B. Obvious mass seen
C. Suspected invasive carcinoma
D. Patient who refuse biopsy

Response:
Colposcopy is a method of visualization of cervix under magnification While Pap smear detects abnormal cells, Colposcopy locates the abnormal lesion The aims of colposcopy are: To study the cervix when Pap smear detects abnormal cells To locate abnormal areas and take a biopsy To study the extent of abnormal lesion Conservative surgery under colposcopic guidance Follow-up of conservative therapy cases. Reference : Textbook of Gynaecology; Sheila balakrishnan; 2nd edition; Pg no:299,302

So the answer to this question is A


Instruction:
Spring water cyst is another name for –
A. Hydatid cyst of lung
B. Lung amoebic cyst
C. Pleuropericardial cyst
D. Enterogenous cyst

Response:
Pleuropericardial cyst has many synonyms: pericardial cyst, coelomic cyst, spring water cyst, serosal cyst, mesothelial cyst, parapericardial cyst, simple cyst, and hydrocele of the mediastinum.

So the answer to this question is C


Instruction:
A curvature of gingiva towards the roots found in the middle of the interproximal area between molars is termed as
A. Col
B. Self cleansing area
C. Interproximal embrasure
D. Cervix

Response:
None

So the answer to this question is A


Instruction:
Arginine enters TCA Cycle by forming which substrate
A. Fumarate
B. α Ketoglutarate
C. Oxaloacetabe
D. Succinyl CoA

Response:
None

So the answer to this question is B


Instruction:
All are risk factors of preeclampsia except
A. Diabetes in pregnancy
B. Hydatidiform mole
C. Primipara
D. Previous history of pre eclampsia

Response:
Primiparous is at a higher risk than multiparous lady H.mole due to abnormal trophoblastic proliferation and uterine distension is at higher risk. Infact h.mole is associated with early onset preeclampsia. Previous h/o preeclampsia also increases risk.

So the answer to this question is A


Instruction:
Bimatoprost is used in -
A. Glaucoma
B. Barrett oesophagus
C. Hyperichosis of eyelid
D. NSAIDS ulcer

Response:
Ans. is 'a' i.e., Glaucoma o Lantanoprost, bimatoprost, travoprost and unoprostone are prostaglandin analogues used for glaucoma treatment.

So the answer to this question is A


Instruction:
Which symptom of schizophrenia respond earliest to treatment
A. Negatavism
B. Paranoid delusions
C. Auditory hallucinations
D. Apathy

Response:
C i.e. Auditory hallucinations

So the answer to this question is C


Instruction:
The use of long cone is adjunct in parallel technique:
A. To minimize the superimposition of anatomical structures
B. To prevent the shortening of image
C. To prevent the distortion of image
D. To prevent the elongation of image

Response:
None

So the answer to this question is C


Instruction:
Factor present in final common terminal complement pathway
A. C4
B. C3
C. C5
D. Protein B

Response:
Ref Harrison 17/e p2030 _2032 C5a is a protein fragment released from cleavage of complement component C5 by protease C5-convease into C5a and C5b fragments. C5b is impoant in late events of the complement cascade, an orderly series of reactions which coordinates several basic defense mechanisms, including formation of the Membrane Attack Complex (MAC), one of the most basic weapons of the innate immune system, formed as an automatic response to intrusions from foreign paicles and microbial invaders. It essentially pokes microscopic pinholes in these foreign objects, causing loss of water and sometimes death. C5a, the other cleavage product of C5, acts as a highly inflammatory peptide, encouraging complement activation, formation of the MAC, attraction of innate immune cells, and histamine release involved in allergic responses

So the answer to this question is C


Instruction:
Candida is most often implicated in causation of
A. Conjunctivitis
B. Tinea capitis
C. Dese rheumatism
D. Thrush

Response:
Candida infection causes mucosal lesion like vaginitis and oral thrush. oral thrush found commonly in bottle-fed infants and aged and debilitated. This condition is characterised by creamy white patches appear on the tongue and buccal mucosa following removal, this leaves a red oozing surface. Tinea capitis is caused by dermatophytes. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition

So the answer to this question is D


Instruction:
Which of the following drugs should not be administered concomitantly with warfarin as it decreases the effect of oral anticoagulants ?
A. Broad spectrum antibiotic
B. Cimetidine
C. Aspirin
D. Oral contraceptive

Response:
None

So the answer to this question is D


Instruction:
All ICUD's are changed every 4-5 year except:
A. Cu 280
B. Cu 320
C. Multiload devices
D. Progestasert

Response:
None

So the answer to this question is D


Instruction:
A 5-year-old girl presents with difficulty breathing. On examination, of the oral cavity a 3 cm mass is found in the midline on the posterior aspect of the tongue. The most likely diagnosis is:
A. Lingual tonsil
B. Lingual thyroid
C. Foreign body stuck to the tongue
D. Dermoid

Response:
An ectopic thyroid gland can be located anywhere from the base of the tongue to the mediastinum. It often results in the failure of descent resulting in either a linginal thyroid or ectopic thyroid in the midline of the neck. The so called lateral aberrant thyroid is usually a metastasis from papillary carcinoma of the thyroid.Angioneurotic edema is an acute allergic reaction, which causes a sudden swelling of the whole tongue with airway obstruction.

So the answer to this question is B


Instruction:
Which of the following Lacks sexual phase
A. Deuteromycota
B. Basidiomycota
C. Ascomycota
D. Zygomycota

Response:
Deuteromycota (Fungi imperfectii) - sexual state is absent.

So the answer to this question is A


Instruction:
According to AHA/American college of cardiology which is not surgery with high risk in patients with known coronary aery disease-
A. Emergency surgery
B. Peripheral vascular surgery
C. Carotid endaerectomy
D. Aoic aneurysm Sx

Response:
Risk stratification Procedure examples Vascular (repoed cardiac risk >5%) Aoic and other major vascular surgery Peripheral vascular surgery Intermediate risk (repoed cardiac risk 1%-5%) Intraperitoneal and intrathoracic surgery Carotid endaerectomy Head and neck surgery Ohopedic Surgery Prostate surgery Low risk (repoed cardiac risk <1% Endoscopic procedures Superficial procedures Cataract surgery Breast surgery Ambulatory surgery

So the answer to this question is C


Instruction:
True about dual sex therapy is:
A. Patient alone is not treated
B. Uses sildenafil
C. It treats sexual perversion
D. It is used for people with dual gender identities

Response:
In dual sex therapy, the couple is treated and not an individual. It is also known as Masters and Johnson technique As per this therapy, sensory awareness between the couple needs to be improved to treat them . Communication also needs to be improved between the couple This therapy is used in cases of erectile dysfunction and premature ejaculation. Technique named as Sensate focus was given for sensory awareness

So the answer to this question is A


Instruction:
Apoptosis is characterized by all of the following EXCEPT
A. DNA fragmentation
B. Chromatin condensation
C. Cell shrinkage
D. Inflammation

Response:
(D) Inflammation # Cell undergoing apoptosis shows a characteristic morphology:> Cell shrinkage and rounding are shown because of the breakdown of the proteinaceous cytoskeleton by caspases.> Cytoplasm appears dense, and the organelles appear tightly packed.> Chromatin undergoes condensation into compact patches against the nuclear envelope (also known as the perinuclear envelope) in a process known as pyknosis, a hallmark of apoptosis,> Nuclear envelope becomes discontinuous and the DNA inside it is fragmented in a process referred to as karyorrhexis.> Nucleus breaks into several discrete chromatin bodies or nucleosomal units due to the degradation of DNA.> Cell membrane shows irregular buds known as blebs.> Cell breaks apart into several vesicles called apoptotic bodies, which are then phagocytosed.

So the answer to this question is D


Instruction:
Functional matrix theory revisited by Moss includes all except
A. The role of mechanotransduction.
B. The role of osseous connected cellular network
C. The Genomic thesis
D. The epigenetic thesis and the resolving synthesis

Response:
Functional matrix theory revisited by Moss includes 4 concepts

The role of mechanotransduction.
The role of an osseous connected cellular network.
The genomic thesis.
The epigenetic antithesis and the resolving synthesis.

So the answer to this question is D


Instruction:
True statement about inheritence of an X linked recessive trait is -
A. 50% of boys of carrier mother are affected
B. 50% of girls of diseased father are carrier
C. Father transmits disease to the son
D. Mother transmits the disease to the daughter

Response:
Ans. is 'a' i.e., 50% of boys of carrier mother are affected

So the answer to this question is A


Instruction:
Which of the following statements about Pseudohypoprathyroidismistrue-
A. Caused by 'Gain of!ftmction' inherited mutation in Gsa subunit
B. Decreased formation of cyclic GMP is observed
C. Decreased formation of Inositol triphosphate is observed
D. Decreased formation of c-AMP is observed

Response:
decreased urinary cyclic AMP responses to PTH , presumably with a post -GS alpha defect in adenyl cyclase stimulation ( Harrison 17 pg 2394)

So the answer to this question is D


Instruction:
Which of the following drug is commonly used in narcoanalysis ?
A. Atropine sulfate
B. Scopolamine hydrochloride
C. Phenobarbitone
D. Morphine

Response:
Controlled administration of intravenous hypnotics to obtain information from subjects who are unable or unwilling to provide it otherwise, is known as Narcoanalysis or Narcosynthesis.
Drugs used for narcoanalysis are:

Ethanol
Scopolamine
Temazepam
Barbiturates like Thiopentone and Amobarbital

These drugs are also known as truth drug or truth serum.

Phenobarbitone is not used, rather amobarbital is used for narcoanalysis.

So the answer to this question is B


Instruction:
Feature indicative of anti-moem drowning is -
A. Cutis anserine
B. Rigor mois
C. Washerwomen feet
D. Grass and weeds grasped in the hand

Response:
Reff: The synopsis of forensic medicine & Toxicology 28th edition pg:192 Cadaveric spasm: Presence of weeds, grass,sticks,twigs etc.,floating in water may be firmly grasped in the hands due to cadaveric spasm. It strongly suggest that the person was alive when drowned, because it indicates the struggle of the person for his life.

So the answer to this question is D


Instruction:
According to Labyrinthine reflex, when head is tilted backwards it will cause the:
A. Back to stiffen or arch backwards
B. Legs straighten and push together
C. Arms to bend at elbows and hands to become fisted.
D. All of the above.

Response:
None

So the answer to this question is D


Instruction:
Vicarious responsibility peains to -
A. Patient's contribution towards negligence
B. Hospitals contribution towards patient's damages
C. Responsibility for actions of a colleague
D. Responsibility of senior for actions of Junior

Response:
Vicarious liability or respondeat superior is the doctrine that an employer is responsible not only for his own negligence but also of his employees. The conditions to be satisfied are there must be an employer-employee relationship, the employees' conduct must occur within the scope of employment and should occur while on the job. Liability will be fixed upon those actually at fault and those whose control over negligent is proved. REF: Dr.K.S.Narayana Reddys Synopsis of Forensic Medicine & Toxicology 29th edition Pg.26.

So the answer to this question is B


Instruction:
A 14 year old boy has difficulty in expressing himself in writing and making frequent spelling mistakes, does not follow instruction and cannot wait for his turn while playing a game. He is likely to be suffering from
A. Mental retardation
B. Lack of interest in studies
C. Specific learning disability
D. Examination anxiety

Response:
The Child may suffer from Specific learning disability If one find difficulty in expressing himself in writing and making frequent spelling mistakes, does not follow instruction and cannot wait for his turn while playing a game. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is C


Instruction:
Triangular shaped heart is a radiological finding of
A. Constrictive pericarditis
B. Mitral incompetence
C. TAPVC
D. Ebstein's anomaly

Response:
Triangular shaped heart - Constrictive Pericarditis.
Pentagon shaped heart - Mitral incompetence.

So the answer to this question is A


Instruction:
Revised strategy for NPCB includes all except ?
A. Fixed facility surgery
B. TOL implantation for cataract
C. Mobile surgical camps
D. Uniform distribution

Response:
Ans. is 'c' i.e. Mobile surgical camps o The National Programme for Control of Blindness (NPCB) was launched in the year 1976 as a 100 per cent centrally sponsored programme and incorporates the earlier trachoma control programme. o Based on survey conducted during 1998-99 & 1999-2000, following measures were included under revised strategy. o Revised strategies - a)To make NPCB more comprehensive by strengthening services for other causes of blindness like corneal blindness (requiring transplantation of donated eves), refractive errors in school going children, improving follow-up services of cataract operated persons and treating other causes of blindness like glaucoma: To shift from the eye camp approach to a fixed facility surgical approach and from conventional surgery to 101., implantation for better quality of post operative vision in operated patients; b)To expand the World Bank project activities like construction of dedicated eye operation theatres, eye wards at district level, training of eye surgeons in modem cataract surgery and other eye surgeries and supply of ophthalmic equipments etc. to the whole country; c)To strengthen paicipation of Voluntary Organizations in the programme and to earmark geographic areas to NGOs and Government Hospitals to avoid duplication of effo and improve the performance of Government Units like Medical Colleges, District Hospitals, Sub Divisional Hospitals, community Health Centres, Primary Health Centres etc. d)To enhance the coverage of eye care services in tribal and other under-served areas through identification of bilateral blind patients, preparation of village-wise blind register and giving preference to bilateral blind patients for cataract surgery.

So the answer to this question is C


Instruction:
Diagnosis of x linked agammaglobulinamia should be suspected if
A. Absent tonsils and no palpable lymph nodes on physical examination
B. Female sex
C. High iso hemagglutinin titers
D. Low CD3

Response:
Ref Robbins 9/e p240-241 Classically, this disease is characterized by the following: * Absent or markedly decreased numbers of B cells in the circulation, with depressed serum levels of all classes of immunoglobulins. The numbers of pre-B cells in the bone marrow may be normal or reduced. * Underdeveloped or rudimentary germinal centers in peripheral lymphoid tissues, including lymph nodes, Peyer patches, the appendix, and tonsils * Absence of plasma cells throughout the body * Normal T cell-mediated responses

So the answer to this question is A


Instruction:
Collagen most abundant in Hyaline cailage ?
A. Type I
B. Type I I
C. Type III
D. Type IV

Response:
Ans. is `b' i.e., Type II

So the answer to this question is B


Instruction:
The efferent limb of the gag reflex is?
A. Facial nerve
B. Glossopharyngeal nerve
C. Trigeminal nerve
D. Vagal nerve

Response:
The gag reflex involves a brisk and brief elevation of the soft palate and bilateral contraction of pharyngeal muscles evoked by touching the posterior pharyngeal wall The vagus nerve (CN X) provides the efferent limb of the gag reflex (muscles of the soft palate). The glossopharyngeal nerve provides the afferent limb of the gag reflex.

So the answer to this question is D


Instruction:
Extended-spectrum beta-lactamases (ESBLs) are characterized by activity against all except :
A. Penicillinases
B. Cephalosporinases
C. Oxyimino–cephalosporinases
D. Carbapenems

Response:
Carbapenems like imipenem are the only beta-lactams reliably efficacious against ESBL producing bacteria.

So the answer to this question is D


Instruction:
In young permanent teeth the best method of sensitivity testing for traumatized teeth is Carbondioxide snow which can go up to temperature of
A. —20°C
B. —30°C
C. —40°C
D. —78°C

Response:
None

So the answer to this question is D


Instruction:
Simple paial seizures DOC
A. Phenytoin
B. Valproate
C. Barbiturate
D. Carbamazepine

Response:
CBZ is used for simple paial seizures

So the answer to this question is D


Instruction:
Metabolic disorder leading to acute pancreatitis
A. Hypoparathyroidism
B. Hyperparathyroidism
C. Hypothyroidism
D. Hyperthyroidism

Response:
(B) Hyperparathyroidism# Causes of Acute Pancreatitis> Common Causes Gallstones (including microlithiasis) Alcohol (acute and chronic alcoholism); Hypertriglyceridemia Endoscopic retrograde cholangiopancreatography (ERCP), especially after biliary manometry Trauma (especially blunt abdominal trauma) Postoperative (abdominal and non-abdominal operations) Drugs (azathioprine, 6-mercaptopurine, sulfonamides, estrogens, tetracycline, valproic acid, anti-HIV medications) Sphincter of Oddi dysfunction> Uncommon causes Vascular causes and vasculitis (ischemic-hypoperfusion states after cardiac surgery) Connective tissue disorders and thrombotic thrombocytopenic purpura (TTP) Cancer of the pancreas Hypercalcemia Periampullary diverticulum Pancreas divisum Hereditary pancreatitis Cystic fibrosis Renal failure> Rare causes Infections (mumps, coxsackievirus, cytomegalovirus, echovirus, parasites) Autoimmune (e.g., Sjogren's syndrome)> Causes to consider in patients with recurrent bouts of acute pancreatitis without an obvious etiology Occult disease of the biliary tree or pancreatic ducts, especially microlithiasis, sludge Drugs Hypertriglyceridemia Pancreas divisum Pancreatic cancer Sphincter of Oddi dysfunction Cystic fibrosis Idiopathic

So the answer to this question is B


Instruction:
An adult patient with a Class II molar relationship and a cephalometric ANB angle of 2 degrees has which type of malocclusion?
A. Class II dental malocclusion
B. Class II skeletal malocclusion
C. Class I dental malocclusion
D. Class II skeletal malocclusion

Response:
The molars are Class II but the skeletal relationship described by a normal ANB measurement is normal, so the malocclusion is dental in origin.

So the answer to this question is A


Instruction:
An edentulous patient had carcinoma of the oral cavity infiltrating into the lower alveolar margin. All the following are possible treatment options except:
A. Segmental mandibulectomy
B. Marginal mandibulectomy with removal of outer table
C. Radiotherapy
D. Commando

Response:
(c) Radiotherapy(Ref. Cummings, 6th ed., 1372)Since radiation to the mandible carries risk of osteoradionecrosis, carcinoma lower alveolus/ mandible is dealt with surgically in all the stages.Chemotherapy may be given in T3 T4 tumours.

So the answer to this question is C


Instruction:
Prostaglandin that can be used to induce labour at term is
A. PGE2
B. PGF2
C. PGI2
D. PGD2

Response:
Ans. a. PGE2. (Katzung Clinical Pharmacology 11th edition./, Ch.l8/page 410)Dinoprostone, a synthetic prep of PGE2, is administered vaginally for oxytocic use. It is used for inducing abortion in the second trimester of pregnancy, for missed abortion, for benign hydatidiform mole, and for ripening of the cervix for induction of labor in patients at or near term. An analog of PGF2a (carboprost tromethamine) is also used in obstetrics - used to induce second-trimester abortions and to control PPH not responding to conventional methods of Rx.PROSTAGLANDINS# Have very short half-life.# Arachidonic acid is common precursor (acylic fatty acid derivatives).# The subscript numeral after the letter (e.g., PGE2) indicates degree of unsaturation.# PGF2 alpha acts predominantly on myometrium, while PGE2 on cervix due to its collagenolytic property. (Hint: F for fundus and E for effacement of cervix.).# Carboprost is effective in refractory cases of PPH.# Misoprostol is methyl ester of PGE1, rapidly absorbed and more effective than oxytocin and prostaglandins in induction of labour, also effective in treatment in NSAID induced peptic ulcer.# Inflammatory mediators from arachidonic are:- TxA2, PGD2, PGE2, PGF2 alpha, PGI2 (Cycloxygenase pathway) leukotrienes (Lipoxygenase)--LTB4 is a neutrophil chemotactic agent. LTC4, D4 and E4 (SRS-A) function in broncho-constriction, vasoconstriction, contractions of smooth muscle and increased vascular permeability.PgActionsPGE2Bronchoconstriction, platelet aggregation.PGE2Potent inducer of bone resorption and releases Ca++ from bones and cervical effacement.PGE2Bronchoconstriction, role in uterine and ovarian function (fundal contraction).PGI2Bronchodilation, vasoconstriction, and platelet aggregation.TXA2Bronchodilation, vasoconstriction, and platelet aggregation stimulation (Bradykinin and histamine are potent vasodilators)USES OF PROSTAGLANDINS IN OBSTETRICS# Induction of abortion (MTP and missed abortion); Antiprogestins (eg, mifepristone) have been combined with an oral oxytocic synthetic analog of PGE1 (misoprostol) to produce early abortion.# Induction of labour# Termination of molar pregnancy# Cervical ripening before induction of labour/abortion# Acceleration of labour# Management of atonic PPH# Management of tubal ectopic pregnancyActionArachidonic Acid Metabolites (Eicosanoids)VasodilationPGI2 (prostacyclin), PGE1, PGE2, PGD2VasoconstrictionThromboxane A2, leukotrienes C4, D4, E4Increased vascular permeabilityLeukotrienes C4, D4, E4Chemotaxis, leukocyte adhesionLeukotriene B4

So the answer to this question is A


Instruction:
In spinal anaesthesia the segmental level of:
A. Sympathetic block is lower than the sensory block
B. Sympathetic block is higher than the sensory block
C. Motor block is higher than the sensory block
D. Sympathetic, motor and sensory block has the same level

Response:
Spinal anaesthesia creates a zone of differential blockade in which sympathetic fibres are blocked two segments higher and motor fibres are blocked two segments lower than the level of sensory block.

So the answer to this question is B


Instruction:
Most common hymen tear in sexual assault is
A. Posterolateral
B. Anterior
C. Anterolateral
D. Posteromedial

Response:
Ans. is 'a' i.e., Posterolateral * In virgin rupture (tears) of hymen due to sudden stretching occurs in posterior half of membrane usually at the sides (i.e. posterolaterally) in 4 or 8'0 clock or 5 or 7'0 clock position, or in the midline of hymen (6'0 clock position).* Posterolateral rupture is more common than posterior rupture.Position of rupture of hymenReason of rupture5 - 7 O'clockSexual intercourse11-1 O'clockMasturbation

So the answer to this question is A


Instruction:
Sporulation occurs in which phase of bacterial growth curve:
A. Stationary phase
B. Lag phase
C. Log phase
D. Decline phase

Response:
Lag phase - Adaptation phase to culture media |sed Accumulate nutrient size Log(2)n - Exponential es in number Stationary phase - Sta of Accumulation of toxic metabolites = Dead Live -Sporulation occur in stationary phase (S-S) Decline: Complete accumulation of Toxin metabolites

So the answer to this question is A


Instruction:
HIV in children, characteristic finding is –
A. Kaposi sarcoma is common
B. Recurrent candidiasis
C. Recurrent chest infection
D. Cryptococcal diarrhoea is common

Response:
" Pneumonia caused by pneumocystis carinii is the most common AIDS defining diagnosis in children with unrecognized HIV infection"

So the answer to this question is C


Instruction:
Which among the following is increased during sleep induction ?
A. | Acetyl choline
B. | Histamine
C. | Norepinephrine and serotonin
D. | GABA

Response:
Stimulation cholinergic neurons in pontine reticular formation is responsible for sleep induction. When the activity of norepinephrine and serotonin containing neurons in locus coeruleus and raphe nuclei is increased, the activity of ACH-containing neurons in the pontine reticular formation decreases, leading to wakefulness. The reverse of this pattern leads to REM sleep. An even balance in the activity of these groups of neurons is associated with NREM sleep

So the answer to this question is A


Instruction:
A patient was staed on antihypeensive medications; developed renal failure, the drug offended is -
A. Beta-blocker
B. Alpha-blocker
C. Calcium channel blocker
D. ACE inhibitor

Response:
Ans. is 'd' i.e., ACE inhibitors o ACE inhibitors and angiotensin receptor antagonists can cause acute renal failure in patients with bilateral renal aery stenosis, stenosis of the aery to a single remaining kidney, hea failure, or volume depletion owing to diarrhea or diuretics.

So the answer to this question is D


Instruction:
In a Teritary level Lab it is observed that chronic, increased exposure to ionizing radiation results in damage to cellular DNA. As a consequence, a protein is now absent that would arrest the cell in the G1 phase of the cell cycle. Subsequent to this, the cell is transformed to acquire the propey of unregulated growth. The absent protein is most likely the product of which of the following genes?
A. RAS
B. VHL
C. p53
D. MYC

Response:
p53

So the answer to this question is C


Instruction:
Commonest variety of carcinoma stomach is
A. Squamous carcinoma
B. Adenocarcinoma
C. Colloid carcinoma
D. None

Response:
Ans. is 'b' i.e., Adenocarcinomao About 85% of stomach cancers are adenocarcinoma.o Louren classified gastric adenocarcinoma into two subtypes :?Intestinal Variant --> Composed of neoplastic intestinal gland resembling those of colonic adenocarcinoma.Diffuse variant - Composed of gastric type mucous cells, which generally do not form glands. The appearance of the cells is "Signet ring" appearance because the mucin in the cell pushes the nucleus to the periphery. It is seen more frequently with E-Cadherin mutation.Following information have been added in 81/e of Robbins o Overall incidence of gastric adenocarcinoma is falling. On the other hand, cancer of gastric cardia is on the rise. This is probably related to Barrett esophagus and may reflex the increasing incidence of chronic GERD and obesity.o The remarkable decrease in gastric incidence applies only to intestinal type. As a result, the incidences of intestinal and diffuse types of gastric cancer are now similar.

So the answer to this question is B


Instruction:
Treatment of choice in a perimenopausal woman with bleeding PV due to multiple fibroids Is :
A. TAH with BSO
B. TAH
C. Vaginal hystrectomy
D. Enucleation of fibroids

Response:
TAH

So the answer to this question is B


Instruction:
The most common symptom of AIDS in an infant is
A. Gastrointestinal infection
B. Persistent cough
C. Failure to thrive
D. Lymphadenopathy

Response:
Clinical features in an HIV infected infant is:Recurrent GI infection and oral thrush is commonly foundClinical features in older children:Growth failureFeverDiarrheaSecondary infection(Refer: OP Ghai's Textbook of Pediatrics, 8th edition, pg no. 202)

So the answer to this question is A


Instruction:
Most common metal in contact allergic dermatitis is-
A. Gold
B. Silver
C. Aluminium
D. Nickel

Response:
Ans. is 4d' i.e., Nickel Contact dermatitiso Contact dermatitis is localized rash or irritation of skin caused by contact with a foreign substance. Contact dermatitis is a localized disease, i.e., lesion occurs at the site of contact. However, in sever cases, the lesions may extend outside the contact area or it may become generalized (referred to as id eruption).o Contact dermatitis is mainly of two types : -Irritant contact dermatitisDue to direct irritant action of the material e.g. Solvents, Alkalis, Detergents. Most common sites are hands & forearms.Allergic contact dermatisIt is due to delayed hypersensitivity (type IV hypersensitivity) to a particular antigen in a sensitized individual. The most common allergens causing allergic contact dermatitis are pollen and metals : -Parthenium (Congress grass)Nickel

So the answer to this question is D


Instruction:
Testes completely descend in the scrotum by the aha of
A. Ends of 7th month of intrauterine life
B. End of 8th months of intrauterine life
C. End of 9th months of intrauterine life
D. After bih

Response:
Testis lies at superficial ring at 8th month and enters the scrotum at the beginning of 9th month. It reaches the final position in the scrotum just before bih.

So the answer to this question is C


Instruction:
True about Adrenal Pheochromocytoma
A. Chromaffin negative
B. Mostly malignant
C. Bilateral in 10% of cases
D. Unilateral

Response:
.

So the answer to this question is C


Instruction:
Which of the following drugs is useful for the treatment of advanced prostate cancer?
A. Ganirelix
B. Cetrorelix
C. Abarelix
D. Goserelin

Response:
US Brand Name Zoladex Goserelin is a hormone similar to the one normally released from the hypothalamus gland in the brain. It is used to treat a number of medical problems. These include: Cancer of the prostate in men Cancer of the breast in women if it develops before or around the time of menopause Endometriosis, a painful condition caused by extra tissue growing inside or outside of the uterus, and Thinning of the lining of the uterus before surgery on the uterus. When given regularly as an implant, goserelin works every day to decrease the amount of estrogen and testosterone in the blood. Reducing the amount of estrogen in the body is one way of treating endometriosis and cancer of the breast, and can help thin the uterus lining before surgery. Goserelin prevents the growth of tissue associated with endometriosis in adult women during treatment and for up to 6 months after treatment is discontinued. Reducing the amount of testosterone in the body is one way of treating cancer of the prostate. Suppressing estrogen can thin the bones or slow their growth. This is a problem for adult women whose bones are no longer growing like the bones of children. This is why goserelin is used only for up to 6 months in adult women treated for endometriosis. This medicine is to be given only by or under the supervision of doctor. REFERENCE: www.mayoclinic.org

So the answer to this question is D


Instruction:
The most specific immunohistochemical marker to rule out invasive ductal carcinoma would be?
A. Ki-67
B. p 63
C. Desmin
D. HER 2 / neu

Response:
p63 is a marker for myoepithelial cells. When neoplastic cells are identified outside the myoepithelial layer around the ducts, the lesion is said to be invasive. So p63 is most specific marker.

So the answer to this question is B


Instruction:
First investigation for solitary thyroid nodules is: (Or) Investigation of choice in discrete thyroid swelling is
A. Thyroid scan
B. CT scan
C. MRI
D. FNAC

Response:
None

So the answer to this question is D


Instruction:
In sickle cell anaemia, sickle shapes occur due to polymerization of
A. Oxyhemoglobin
B. Deoxyhemoglobin
C. Methoxyglobin
D. Cyanohemoglobin

Response:
The substitution of hydrophilic glutamic acid by hydrophobic valine causes a localized stickiness on the surface of the molecule. The deoxygenated HbS may be depicted with a protrusion on one side and a cavity on the other side, so that many molecules can adhere and polymerize.Ref: D M Vasudevan 7th edition Page no: 291,292

So the answer to this question is B


Instruction:
Meera is a 43-year-old woman with a body mass index (BMI) of 32. She presented with abnormal uterine bleeding to her gynecologist, who performed an endometrial biopsy that indicated endometrial cancer, specifically endometrial adenocarcinoma of endometrioid histology.Meera's family history is significant for colon cancer. Her mother was diagnosed with colon cancer at age 66. Her paternal aunt was diagnosed with endometrial cancer at age 67. Suspecting hereditary disease which of the following DNA repair mechanism is defective in Meera?
A. Nucleotide excision repair
B. Homologous recombination
C. Mismatch repair
D. Base excision repair

Response:
The following clinical scenerio suggests of LYNCH SYNDROME Mismatch repair is defective in Lynch syndrome also called Hereditary nonpolyposis colorectal cancer(HNPCC). It is an autosomal dominant genetic condition that is associated with a high risk of colon cancer as well as other cancers including endometrial cancer(second most common). Reference: Harpers illustrated biochemistry 30th edition

So the answer to this question is C


Instruction:
Which of the following is/are not included in management of intra aicular fracture: Ahrodesis Excision Aspiration K- wire Plaster of paris cast
A. 1,2,3
B. 2,4,5
C. 1,2,3,4
D. None

Response:
"All listed methods are used in the management of intra aicular fracture" Intra aicular fracture Intra aicular fracture are those in which the break crosses into the surface of a joint. They always result in some degree of cailage damage. Ideally the joint surface should be restored to their original position and held there strongly enough that movement may be staed in the early postoperative period. some permanent loss of motion is to be expected and joint may develop degenerative ahritis as a result of the injury. Principles of intra aicular fracture Immobilization of intra aicular fracture results in joint stiffness Immobilization of aicular fracture, treated by open reduction and internal fixation, results in much greater stiffness. Depressed aicular fragments, which do not reduce as a result of closed manipulation and traction, are impacted and will not reduced by closed means. Major aicular depression do not fill with fibrocailage and the instability which results from their displacement, is permanent. Anatomical reduction and stable fixation of aicular fragment is necessary to restore joint congruity. Immediate motion is necessary to prevent joint stiffness and to ensure aicular healing and recovery. This require stable internal fixation. Radius fracture treatment ( of distal end i.e. intra aicular pa) K wire fixation may be helpful for smaller fragments. cast immobilization is indicated for nondisplaced fracture, displaced fractures with a stable fracture pattern. The cast should be worn approximately 6 weeks or until radiographic evidence of union has occured. Ahrodesis In this operation, fusion is achieved between the bones forming a joint so as to eliminate any motion at the joint. An ahrodesis is used most often for a painful, stiff joint. It is also performed for grossly unstable joints in polio etc. It is also used for grossly unstable joint due to trauma. Excision and aspiration of hematoma excision of damaged poion of bone and aspiration of intra aicular hematoma, are also included in management of intra aicular fracture. Ref: AO principles of fracture management by Raudi, Page 106-09.

So the answer to this question is D


Instruction:
Southern blot is used to visualize
A. RNA
B. DNA
C. Protein
D. Antibody

Response:
A Southern blot is a method used in molecular biology for detection of a specific DNA sequence in DNA samples. Southern blotting combines transfer of electrophoresis-separated DNA fragments to a filter membrane and subsequent fragment detection by probe hybridization. Ref-D.M.Vasudevan 7/e p546

So the answer to this question is B


Instruction:
Which of the following types of multiple myeloma is maximally and most commonly associated with increased risk of hyperviscosity syndrome?
A. IgM
B. IgG
C. IgD
D. IgA

Response:
Ans. a (IgM) (Ref. H-17th/704; Robbin's 7th/680)Lymphoplasmacytic lymphoma is the tissue manifestation of Waldenstrom's macroglobulinemia. This type of lymphoma has been associated with chronic hepatitis C virus infection, and an etiologic association has been proposed. Patients typically present with lymphadenopathy, splenomegaly, bone marrow involvement, and occasionally peripheral blood involvement. The tumor cells do not express CD5. Patients often have a monoclonal IgM protein, high levels of which can dominate the clinical picture with the symptoms of hyperviscosity. Treatment of lymphoplasmacytic lymphoma can be aimed primarily at reducing the abnormal protein, if present, but will usually also involve chemotherapy. Chlorambucil, fludarabine, and cladribine have been utilized. The median 5- year survival for patients with this disorder is ~60%.HYPERVISCOSITY SYNDROME IN MULTIPLE MYELOMA (MM)# Hyperviscosity syndromes may develop in MM depending on the physical properties of the M component.# It is most common with IgM, IgG3, and IgA paraproteins.# Hyperviscosity is defined on the basis of the relative viscosity of serum as compared with water.# Normal relative serum viscosity is 1.8 (i.e., serum is normally almost twice as viscous as water).# Symptoms of hyperviscosity occur at a level of 5-6, a level usually reached at paraprotein concentrations of ~- 40 g/L (4 g/dL) for IgM,- 50 g/L (5 g/dL) for IgG3, and- 70 g/L (7 g/dL) for IgA.# Hypercalcemia may produce lethargy, weakness, depression, confusion, headache, fatigue, visual disturbances, and retinopathy.# Raynaud's phenomenon and impaired circulation may result if the M component forms cryoglobulins.# Note: Sensory neuropathy is also a side effect of thalidomide and bortezomib therapy.Additional Educational Points# Light chain disease is associated with Bence Jones proteinuria=m chain disease.# IgM type of lymphoplasmacytoid lymphoma = is most closely associated with monoclonal gammopathy.# Primary livedo reticularis with ulceration is also called atrophie blanche en plaque. The ulcers are painful and may take months to heal. Secondary livedo reticularis can occur with atheroembolism, SLE and other vasculitides, anticardiolipin antibodies, hyperviscosity, cryoglobulinemia, and Sneddon's syndrome (ischemic stroke and livedo reticularis).# Similar bihemispheral damage is produced by disorders that occlude small blood vessels throughout the brain; examples include cerebral malaria, thrombotic thrombocytopenic purpura, and hyperviscosity.# Blood viscosity increases logarithmically at hematocrits >55%.# Concern that the hemoglobin level may be abnormally high is usually triggered at 170 g/L (17 g/dL) for men and 150 g/ L (15 g/dL) for women. Hematocrit levels >50% in men or >45% in women may be abnormal. Hematocrits >60% in men and >55% in women are almost invariably associated with an increased red cell mass.# A decrease in the AG can be due to hyperviscosity and severe hyperlipidemia.

So the answer to this question is A


Instruction:
Dorsal column lesions are associated with loss of:
A. Ankle jerk
B. Knee jerk
C. Proprioception
D. Superficial abdominal reflexes

Response:
Ans: C (Proprioception) Ref: Harrison's Principles of Internal Medicine, 18th ed.Explanation:The posterior column (dorsal column)It refers to the area of white matter in the dorsomedial side of the spinal cord.It is made up of the fasciculus gracilis and fasciculus cuneatusIt is part of an ascending pathway that is important for well-localized fine touch and conscious proprioception called the posterior column-medial lemniscus pathway.Joint capsules, tactile and pressure receptors send a signal through the dorsal root ganglia up through the fasciculus gracilis for lower body sensory impulses and the fasciculus cuneatus for upper body impulses.Once the fasciculus gracilis reaches the nucleus gracilis and the fasciculus cuneatus reaches the nucleus cuneatus in the lower medulla, they begin to cross over the medulla as the internal arcuate fibers.When they reach the contralateral side, they become the medial lemniscus, which is the second part of the posterior column-medial lemniscus pathway.Lesions in this pathway can diminish oi completely abolish tactile sensations and movement or position sense below the lesionTests of sensationModalityPathwayLight touchLarge fast-conducting axonsProprioceptionDorsal columnsVibrationMedial lemniscusTwo-point discrimination Pinprick (superficial pain)Smaller slower-conducting axonsSpinothalamic tracts Deep painTemperature StereognosisParietal cortex (only valid if peripheral sensory function intact)GraphaesthesiaTwo-point discrimination

So the answer to this question is C


Instruction:
In which of the following condition is tardy ulnar nerve palsy seen?
A. Malunited supra condylar fracture
B. Malunited lateral condylar fracture
C. Malunited medial condylar fracture
D. Fracture both bones of forearm

Response:
Tardy ulnar nerve palsy may develop after malunited fractures of the lateral humeral condyle in children, displaced fractures of the medial humeral epicondyle, dislocations of the elbow and contusions of the nerve. Tardy ulnar nerve palsy may also develop in patients who have a shallow ulnar groove on the posterior aspect of the medial humeral epicondyle. Complications associated with pediatric lateral condylar fracture include cubitus varus, cubitus valgus, fishtail deformity, and tardy ulnar nerve palsy.

So the answer to this question is B


Instruction:
Which drug should be avoided in the management of traumatic hyphema in a dark race individual?
A. Timolol
B. Acetazolamide
C. Atropine
D. Steroids

Response:
Traumatic hyphema presents with raised intraocular pressure.Timolol will help to control raised IOP. Atropine will provide cycloplegic action and will provide relief from pain. Steroids will help to prevent rebleed. Acetazolamide is not given in dark race patients due to risk of sickling as a result of metabolic acidosis caused by acetazolamide.

So the answer to this question is B


Instruction:
Which among the following is a secondary brain injury?
A. Coical lacerations
B. Brainstem and hemispheric contusions
C. Diffuse axonal injury
D. Intercerebral haematoma with raised intracranial pressure

Response:
.Effects of Brain Injuries - 1. Brain oedema is accumulation of fluid, both intracellular and extracellular. It is due to congestion and dilatation of blood vessels. It may be diffuse or localized. 2. Brain necrosis is of severe variety with destruction and is due to haemorrhagic infarction. 3. Extradural haematoma occurs usually in temporoparietal region. It is commonly due to tear in middle meningeal veins and often middle meningeal aery. It causes intracranial hypeension, displacement, Kernohan's effect and often death. 4. Subdural haematoma is due to tear of veins between cerebrum and dura due to shearing forces. It is diffuse and commonly associated with cerebral injury. 5. Intracerebral haematoma can occur in different pas of cerebrum may be in frontal lobe, temporal lobe. ref:SRB&;s manual of surgery,ed 3,pg no 1038

So the answer to this question is D


Instruction:
A 54-year-old man has a total cholesterol of 272 and LDL level of 210. His therapy is initiated with dietary modification and an exercise regimen, but he is unresponsive and so is prescribed nicotinic acid (Niacin). Which of the following symptoms will this patient likely experience from this drug?
A. Bradycardia
B. Facial flushing
C. Hypoalbuminemia
D. Hypoglycemia

Response:
Niacin, or vitamin B3, is an agent that results in the following physiologic changes: LDL reductions tend to occur in 5-7 days with the maximal effect seen in 3-5 weeks; triglycerides and VLDL are reduced by 20% to 40% in 1-4 days; and HDL levels can increase by 20%. This agent is indicated as adjunctive therapy in patients with elevated cholesterol and triglycerides when diet and other nondrug therapies are inadequate. The most common adverse effect of this agent is generalized flushing with a sensation of warmth, especially in the facial area. This reaction may be so severe in some patients that they discontinue therapy. Other common adverse effects include hepatotoxicity, tachycardia, hypoalbuminemia, hyperglycemia, nausea, vomiting, hyperuricemia, glucose intolerance, pruritus, peptic ulcer disease, and dry skin.

So the answer to this question is B


Instruction:
Fracture of talus without displacement in x-ray would lead to -a) Osteoarthritis of ankleb) Osteonecrosis of head of talusc) Avascular necrosis of body of talusd) Avascular necrosis of neck of taluse) Non union
A. ac
B. bc
C. ad
D. b

Response:
Complicatiosn of Talar neck fracture

Malunion
Avascular necrosis (osteonecrosis) of body.
Non-union
Secondary osteoarthritis of ankle and subtalar joint.

So the answer to this question is A


Instruction:
Open neural tube defects are best detected by increase in which of the following enzyme ?
A. Acetylcholinesterase
B. Pseudocholinesterase
C. AFP
D. hCG

Response:
Spina bifida is defined as a defect in neural arch,which results in exposure of the contents of the neural canal.In case of open spina bifida, acetyl cholinestetase level is increased. Refer page no 487 of text book of obstetrics, sheila balakrishnan, 2nd edition.

So the answer to this question is A


Instruction:
Which biochemical reaction does not occur in the mitochondria:
A. Kreb's cycle
B. Urea cycle
C. Gluconeogenesis
D. Fatty acid synthesis

Response:
D i.e. Fatty acid synthesis

So the answer to this question is D


Instruction:
A 7 years girl, parents gave history of fever for which she was treated with Paracetamol following which the fever subsided. Later she developed seizures and altered sensorium. The urine examination revealed oxalate crystals on microscopy, Blood anion gap and osmolality were increased. The diagnosis is:
A. Lactic acidosis
B. Ethylene glycol poisoning
C. Renal tubular acidosis
D. Paracetamol poisoning

Response:
Ref: Harrison’s 18/e p367, 17/e p291

Ingestion of antifreeze causes high AG acidosis.
 Due to ethylene glycol and its metabolites oxalic acid, glycolic acid.
 Diagnosis is facilitated by presence of oxalate crystals in urine.

So the answer to this question is B


Instruction:
A 6 weeks pregnant primigravida is brought to the emergency depament with severe, acute abdominal pain. USG shows ectopic pregnancy. Which of the following has the LEAST risk of ectopic pregnancy?
A. Tubectomy
B. Infeility >1 year
C. Copper T
D. Condoms

Response:
Condoms reduces the incidence of tubal infeility and ectopic pregnancy. Risk factors of ectopic pregnancy: Prior ectopic pregnancy Prior tubal surgery Smoking >20 cigarettes per day Prior STD with confirmed PID by laparoscopy and/or positive test for Chlamydia trachomatis Three or more prior spontaneous miscarriages Age 40 years Prior medical or surgical aboion Infeility >1 year Lifelong sexual paners >5 Previous IUD use Ref: Textbook of Obstetrics by D C Dutta, 6th edition, Page 533.

So the answer to this question is D


Instruction:
Slow acetylators of isoniazid are more prone to develop :
A. Failure of therapy
B. Peripheral neuropathy
C. Hepatotoxicity
D. Allergic reactions

Response:
Acetylator status of a person determines the response of drugs metabolized by acetylation (e.g. isoniazid, sulfonamides, procainamide and hydralazine). Isoniazid is metabolized to acetyl-isoniazid and then to acetyl hydrazine. Accumulation of isoniazid is responsible for peripheral neuropathy whereas acetylhydrazine accumulation may cause hepatotoxicity. Thus, slow acetylators will not be able to metabolize the drug quickly and there can be an accumulation of parent drug (isoniazid in this case), leading to peripheral neuropathy. On the other hand, fast acetylators are more prone to develop hepatotoxicity.

So the answer to this question is B


Instruction:
Curschmann spirals and flattening of diaphragm is seen in:
A. Asthma
B. COPD
C. Silicosis
D. Pulmonary embolism

Response:
Ans. (a) AsthmaRef: Harrison 19th ed. /1675* Flattening of diaphragm is seen with obstructive airway diseases due to the process of air trapping.* The point that clinches the diagnosis in favor of asthma is the curschmann spirals which represent the cast of the airways formed by mucus plugs in small airways in these patients.

So the answer to this question is A


Instruction:
Dichotomy means -
A. Erasure of name
B. Disclosure of secrets of patients
C. Fee-splitting
D. Adultery

Response:
Dichotomy means fee splitting or bribery or commissioning.
Receiving commissions on referral of a patient to a doctor or forwarding commissions, both are included under dichotomy.
Dichotomy is infamous conduct as defined under the rules and regulations of MCI, 2002.
If a doctor repeatedly indulges in dichotomy, a warning notice could be issued against him, if he still indulges in dichotomy, his name could be erased from the medical register and it is called as professional death sentence.

So the answer to this question is C


Instruction:
The best time to do chorionic villous sampling is:
A. Between 6-8 weeks
B. Between 7-9 weeks
C. Between 9-11 weeks
D. Between 11-13 weeks

Response:
Chorionic villus sampling prenatal diagnosis of genetic disorders transcervical done:at 10-12 weeks transabdominal done from 10 weeks to term diagnosis can be obtained by 24 hours complications like fetal loss,oromandibular limb deformities,vaginal bleeding are higher D.C.DUTTA'S TEXTBOOK OF OBSTETRICS,Pg no:107,7th edition

So the answer to this question is D


Instruction:
All are risk factors for the development of surgery associated chronic kidney disease, EXCEPT:
A. Older age
B. CCF
C. Emergency procedures
D. Spinal anaesthesia

Response:
Common risk factors for postoperative AKI include 1. Underlying chronic kidney disease, 2. Older age, 3. Diabetes mellitus, 4. Congestive hea failure 5. Emergency procedures. Cardiopulmonary bypass is a hemodynamic state characterized by nonpulsatile flow and exposure of the circulation to extracorporeal circuits. Longer duration of cardiopulmonary bypass is a risk factor for AKI. Ref: Harrison-E-18, P-2296.

So the answer to this question is D


Instruction:
Salivary protein, which prevents transmission of human immunodeficiency virus via saliva is:
A. Sialoperoxidase
B. Secretory IgA
C. Salivary leukocyte proteinase inhibitor
D. Histidine rich proteins

Response:
Secretory leukocyte protease inhibitor (SLPI) is found in human saliva, nasal secretions, tears, cervical mucus and seminal fluid. It is believed to be responsible for the anti-HIV properties of external secretions.

So the answer to this question is C


Instruction:
Which of the following is true about autosomal dominant:
A. Variable age of onset
B. Reduced penetrance
C. Variable expressibility
D. All of the above

Response:
Autosomal dominant disorders:

Variable age of onset.
Reduced penetrance.
Variable expressibility.

So the answer to this question is D


Instruction:
Cretinism is _____________
A. Dispropoionate dwarfism
B. Sho stature with long trunk
C. Sho stature with sho trunk
D. Long stature with long trunk

Response:
Congenital iodine deficiency syndrome, previously known as cretinism, is a condition of severely stunted physical and mental growth owing to untreated congenital deficiency of thyroid hormone (congenital hypothyroidism) usually owing to maternal hypothyroidism. Results in Dispropoionate dwarfism Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is A


Instruction:
Delayed eruption of teeth occurs in
A. Craniofacial dysostosis
B. Hyperthyroidism
C. Cleidocranial dysostosis
D. Osteitis deformans

Response:
None

So the answer to this question is C


Instruction:
IVP should be cautiously performed in:
A. Multiple myeloma
B. Bone secondaries
C. Neuroblastoma
D. Leukemia

Response:
Ans. Multiple myeloma

So the answer to this question is A


Instruction:
Blunting of affect is seen in
A. Schizophrenia
B. Depression
C. Mania
D. Delirium

Response:
Ans. a (Schizophrenia). (Ref. Harrison, Medicine, 15th ed., 2554; Psychiatry by Niraj Ahuja, 5th ed., 55)EUGEN BLEULER'S FUNDAMENTAL SYMPTOMS OF SCHIZOPHRENIA (4 A'S)# Ambivalence (marked inability to decide for or against)# Autism (withdrawal into self)# Affect blunting (disturbance of affect)# Association disturbances (loosening of association, thought disorder)

So the answer to this question is A


Instruction:
The characteristic changes in the radiographic appearance of the alveolar bone is seen in:
A. Monostotic fibrous dysplasia
B. Hemifacial hyperplasia
C. Segmental odontomaxillary dysplasia
D. Both 1 and 3

Response:
Fibrous dysplasia
The density and trabecular pattern of fibrous dysplasia lesions vary considerably. The variation is more pronounced in the mandible and more homogeneous in the maxilla. The internal aspect of bone may be more radiolucent, more radiopaque, or a mixture of these two variations compared with normal bone. The internal density is more radiopaque in the maxilla and the base of the skull.
Segmental odontomaxillary dysplasia
The density of the maxillary alveolar process is increased, with a greater number of thick trabeculae that appear to be aligned in a vertical orientation.
Oral radiology White & Pharaoh 7th edition page no 402,624

So the answer to this question is D


Instruction:
The most common cause of superficial throm-bophlebitis is
A. Intravenous catheters / infusion
B. DVT
C. Varicose veins
D. Trauma

Response:
None

So the answer to this question is A


Instruction:
Most common genetic cause of mental retardation is
A. Down's syndrome
B. Fragile X syndrome
C. Frederich's ataxia
D. Ataxia telangietasia

Response:
Most common cause of mental retardation is Down syndrome followed by Fragile X syndrome.

So the answer to this question is A


Instruction:
In hepatic cirrhosis, which of the following is increased -
A. Alpha 1 globulin
B. Alpha 2 globulin
C. Gamma globulin
D. All of the above

Response:
None

So the answer to this question is C


Instruction:
Dehydration is the common concern in elderly edentulous patients because of
A. Reduced ability to sense thirst
B. Poor absorption of fluids
C. Vitamin deficiency
D. Osteopenia

Response:
None

So the answer to this question is A


Instruction:
Crocodile tears are ssen in
A. Frey's syndrome
B. Conjunctivitis
C. Ophthalmia neonatorum
D. Abnormal facial nerve regeneration

Response:
Crocodile tear syndrome The mechanism appears to be a misdirection of regenerating gustatory fibers destined for the salivary glands, so that they become secretory fibers to the lacrimal gland and cause homolateral tearing while the patient is eating. A simple procedure, involving subtotal resection of the palpebral lobe of the involved lacrimal gland, proved to be an effective corrective measure in these cases.

So the answer to this question is D


Instruction:
A female at 37 wks of gestation has mild labour pain for 10 hours and cervix is persistently 1CM dilated but non effaced. What will be the next appropriate management?
A. Sedation and wait
B. Augmentation with syntocin
C. Cesarean section
D. Amniotomy

Response:
This is a nulliparous patient and is in latent phase of labor. Latent phase duration normally in a nulliparous female is less than 20hrs and in a multiparous female its is 14 hours. The optimal treatment for this patient is administer sedation and observe the patient. Prolonged latent phase occur when the duration exceeds the above parameters. It could be due to unripe cervix, false labor or sedation. Prolonged first stage of labor occur when cervix dilates less than 1 cm/hr in nulliparous women and less than 1.5cm/hr in multiparous women. Management of prolonged first stage includes observation, augmentation by amniotomy or oxytocin, and continuous suppo. Cesarean delivery is warranted if maternal or fetal status become non reassuring. Ref: Obstetrics and Gynecology edited by Charles R. B. Beckmann page 106

So the answer to this question is A


Instruction:
A known case of pancreatitis presents on Day 4 with breathlessness, basal crepitations. Diagnosis is:
A. Lung collapse
B. Pleural effusions
C. ARDS
D. Aspiration pneumonia

Response:
Ans. C ARDSPerihilar fluffy opacities - Bat wing opacitiesQ seen in pulmonary edema (cardiogenic/non-cardiogenic), ARDS. Common pulmonary complications of pancreatitis are ARDS, pleural effusion (mostly left sided) and consolidation.

So the answer to this question is C


Instruction:
Which of the following side effects are seen with etomidate-
A. Myoclonus, Adrenal suppression, Haemodynomic imbalance(HI)
B. Myoclonus, adrenal suppression, pain on IV injection
C. Pain on IV injection, Adrenal suppression, HI
D. Pain on IV injection, HI ,Myoclonus.

Response:
Etomidate a intravenous anaesthetic agent is Milky white in colour , imidazolone derivative, causes pain on iv injection. Major advantages over other intravenous agents is cardiovascular stability thus use cardiac compromised patients Routinely not in clinical use since it is adrenal suppressant. Other side effects myoclonus and increased nausea and vomiting.

So the answer to this question is B


Instruction:
A 40 year old male patient on long term steroid therapy for systemic disease, presents with recent onset of severe pain in the right hip. Imaging modality of choice for this problem is-
A. CT scan
B. Bone scan
C. MRI
D. Plain X-ray

Response:
Long term steroid therapy for systemic disease + severe pain in the right hip = AVASCULAR NECROSIS IOC for Avascular Necrosis: MRI Snow cap sign on plain radiograph: AVN of humerus or femur head Figure: snow cap sign due to AVN of humerus head

So the answer to this question is C


Instruction:
TTKG in hypokalemia is -
A. < 3-4
B. > 6-7
C. > 9-10
D. > 10-15

Response:
Answer- A. < 3-4A normal TTK in normal subjects on normal diet is 8-9Without other disease, hypokalemia should produce a TTKG <3

So the answer to this question is A


Instruction:
Opening of Eustachian tube in middle ear is in
A. Medial wall
B. Lateral wall
C. Anterior wall
D. Posterior wall

Response:
Anterior wall has 2 openings, the lower one for eustachian tube and the upper one for the canal of tensor tympani muscle. 2. Opening for Eustachian tube. Reference: Dhingra 6th edition

So the answer to this question is C


Instruction:
A dead body with suspected poisoning is having hypostasis of red brown in color. It is suggestive of poisoning due to: Maharashtra 08; DNB 10; PGI 07, 08, 10, 11
A. Nitrites/Aniline
B. CO
C. Cyanides
D. Hydrogen sulfide

Response:
Ans. Nitrites/Aniline

So the answer to this question is A


Instruction:
The half-life of oxytocin is
A. 2-3 min
B. 3-5 min
C. 5-6 min
D. 7-8 min

Response:
OxytocinIn general, oxytocin should be discontinued if the number of contractions persists with a frequency of more than five in a 10-minute period or more than seven in a 15-minute period or with a persistent nonreassuring fetal hea rate pattern.When oxytocin is stopped, its concentration in plasma rapidly falls because of the half-life is approximately 3 to 5 minutes.Ref: William&;s Obstetrics; 25th edition

So the answer to this question is B


Instruction:
Agnus Hunt traction used in
A. Flexion deformity of hip
B. Fracture femur shaft
C. Fracture neck of femur
D. Intertrochanteric fracture

Response:
None

So the answer to this question is A


Instruction:
Drug that can be used against anaerobic: streptococci: March 2007
A. Penicilin
B. Erythromycin
C. Vancomycin
D. Clindamycin

Response:
Ans. D: Clindamycin Clindamycin is used primarily to treat infections caused by susceptible anaerobic bacteria, including infections of the respiratory tract, skin and soft tissue infections, and peritonitis. In patients with hypersensitivity to penicillins, clindamycin may be used to treat infections caused by susceptible aerobic bacteria as well. It is also used to treat bone and joint infections, paicularly those caused by Staphylococcus aureus. Topical application of clindamycin phosphate can be used to treat mild to moderate acne

So the answer to this question is D


Instruction:
Antitubercular drug which is least hepatotoxic: September 2010
A. Rifampicin
B. Pyrazinamide
C. Ethambutol
D. INH

Response:
Ans. C: Ethambutol The single biggest problem with TB treatment is drug-induced hepatitis, which has a moality rate of around 5%. Three drugs can induce hepatitis: PZA, INH and RMP (in decreasing order of frequency). It is not possible to distinguish between these three causes based purely on signs and symptoms.

So the answer to this question is C


Instruction:
Clinical evidence of dentinogenesis imperfecta is
A. Defective enamel and dentine
B. Defective dentine and obliterated pulp chamber
C. Increased rate of caries
D. Oligodontia

Response:
None

So the answer to this question is B


Instruction:
Which of the following is true about direct filling gold
A. Properly condensed mat gold has no voids
B. Whatever may be the type voids are inherent
C. Voids can be avoided with manual condensation
D. None of the above

Response:
None

So the answer to this question is B


Instruction:
Emergence delirium is characteristic of:
A. Midazolam
B. Ketamine
C. Thiopentone
D. Opioids

Response:
None

So the answer to this question is B


Instruction:
Placido disc is useful for detecting:
A. Microcornea
B. Megalocornea
C. Corneal scars
D. Keratoconus

Response:
Placido disc Placido disc is a type of video-keratoscopy which helps understand details about the corneal surface and anterior curvature -In normal cornea , there is no distoion of reflected pattern - In keratoconus , there is distoion of reflected pattern

So the answer to this question is D