Instruction:
Which of the following is the most likely cause of a woman presenting with shock in immediate post paum period
A. PPH
B. Post paum eclampsia
C. Uterine inversion
D. Amniotic fluid embolus

Response:
The question has been discussed in many ways since the exact choice asked was not recalled properly: In the aforementioned format, The most frequent cause of obstetrical hemorrhage is failure of the uterus to contract sufficiently after delivery and to arrest bleeding from vessels at the placental implantation site Data from Al-Zirqi, 2008; Berg, 2010; Chichakli, 1999; Zwa, 2008 If the question was 'sudden un explained death', then an amniotic fluid embolism can be the answer The true incidence of AFE is unknown, but has been repoed to range from 1:8 000 to 1:80 000 pregnancies. Amniotic fluid embolism (AFE) it as a syndrome of sudden peripaum shock. This is a catastrophic obstetric emergency that can present as sudden, profound, and unexpected maternal collapse associated with hypotension, hypoxaemia, and disseminated intravascular coagulation (DIC). It occurs when amniotic fluid, fetal cells, hair, or other debris enter the maternal circulation. Risk Factors: Advanced maternal age; multiparity; meconium stained liquor; intrauterine fetal death; polyhydramnios; strong frequent or tetanic uterine contractions; maternal history of allergy or atopy; chorioamnionitis; AFE is caused by fetal antigens in the amniotic fluid stimulating a cascade of endogenous immune mediators, producing a reaction similar to anaphylaxis

So the answer to this question is A


Instruction:
The posterior focal point of the reduced eye situated on the retina is how many millimetre behind the anterior surface of cornea:
A. 22.9 mm
B. 24.4 mm
C. 23 mm
D. 21 mm

Response:
Ans. 24.4 mm

So the answer to this question is B


Instruction:
Lisch nodules in neurofibromatosis are -
A. Iris pearls
B. Hamartomas
C. Granulomas
D. None of the above

Response:
None

So the answer to this question is B


Instruction:
Which is not a feature of Apoptosis:
A. Cellular shrinkage.
B. Nuclear compaction.
C. The plasma membrane is disturbed
D. The plasma membrane is intact.

Response:
Apoptosis vs Necrosis:

So the answer to this question is C


Instruction:
All of the following are components of urogenital diaphragm except:
A. Sphincter urethrae
B. Superficial transverse perineii
C. Deep transverse perineii
D. Superficial fascia of urogenital diaphragm

Response:
Between the 2 fascial layers (fatty/ superficial and deep/ Colle's fascia) of the urogenital diaphragm lie deep transverse perineii; superficial to the proximal urethral sphincter mechanismUrogenital diaphragmIt is a triangular musculo fascial diaphragm situated in the anterior pa of perineum filling the gap of the pubic arch.Components of urogenital diaphragm:- Deep transverse perinei musclesSphincter urethrae- Superior/ superficial fascia of urogenital diaphragm- Inferior/ deep fascia of urogenital diaphragm (Perineal membrane)Colles fascia does not form a pa of urogenital diaphragm, but it is attached to the posterior border of urogenital diaphragm

So the answer to this question is B


Instruction:
Vulvar atrophy and itching are treated by-
A. Estrogen ointment
B. Antihistamines
C. Tamoxifen
D. Oral antifungal treatment

Response:
Vulvar atrophy and itching in menopausal age group are due to deficiency of estrogen that cause dryness of vulva which causes itching. Ideal treatment of this manifestation of post menopausal urogenital atrophy is some form of Hormone Replacement. Topical estrogen is most effective with minimal systemic side effects

So the answer to this question is A


Instruction:
The peri-orbital view is carried out for ?
A. Petrous apex
B. Mastoid process
C. Bilateral mastoid pathologies
D. Internal auditory meatus

Response:
Ans. is 'd' i.e., Internal auditory meatus The posteroanterior periorbital projection enables the best evaluation of the internal auditory canal in its full length.

So the answer to this question is D


Instruction:
For untreated Myocardial infarction condition, select the blood or urine value that best distinguishes Myocardial infarction condition from the others. All values are measured after an overnight fast and are compared with those of a normal individual.
A. Increased troponin I
B. Increased blood ketone bodies
C. Decreased creatinine in the urine
D. Decreased blood lactate

Response:
Tissues contain characteristic isozymes or mixtures of isozymes. Enzymes, such as lactate dehydrogenase and creatine kinase (CK), differ from one tissue to another. Lactate dehydrogenase contains four subunits. Each subunit may be either of the heart (H) or the muscle (M) type. Five isozymes exist (HHHH, HHHM, HHMM, HMMM, and MMMM). CK contains two subunits. Each subunit may be either of the muscle (M) or the brain (B) type. Three isozymes exist (MM, MB, and BB). The MB fraction is most prevalent in heart muscle.Troponin I is found in large amounts in muscle cells. When a tissue is damaged, cellular enzymes leak into the blood. Heart muscle will release cardiac troponin I into the blood in response to a heart attack. In the absence of insulin, a person with type 1 DM will behave metabolically like a person undergoing prolonged starvation, except that blood glucose levels will be elevated. Lipolysis in adipose tissue will produce fatty acids, which will be converted to ketone bodies in the liver if the diabetes is left untreated. Because the blood glucose levels are also elevated, the brain continues to use glucose as a fuel, and the ketone bodies accumulate in the blood. Hepatitis and chronic alcoholism damage the liver, which would interfere with the urea cycle, leading to decreased BUN and increased ammonia in the circulation. Renal failure would display reduced creatinine in the urine and elevated creatinine in the blood.

So the answer to this question is A


Instruction:
Which of the following statements is true
A. Chronic myeloid leukemia occurs beyond 50 years of age
B. Hairy cell leukemia in less than 50 years has a good prognosis
C. Acute lymphoid leukemia in less than 1 year has a poor prognosis
D. Chronic lymphocytic leukemia occurs in less than 50 years of age

Response:
There are 4 main types of leukemia, based on whether they are acute or chronic, and myeloid or lymphocytic: Acute myeloid (or myelogenous) leukemia(AML) Chronic myeloid (or myelogenous) leukemia(CML) Acute lymphocytic (or lymphoblastic) leukemia (ALL) Chronic lymphocytic leukemia (CLL)

So the answer to this question is C


Instruction:
Which of the following causes decrease in BP
A. Thromboxane A2
B. Vasopressin
C. NO
D. PGF2

Response:
NOSubstances which cause vasodilatation can cause fall in BP.Substances which cause vasoconstriction can cause a rise in BP.Among the given options only NO (nitric acid) is vasodilator (causes fall in BP). Other three options cause vasoconstriction (cause rise in BP).

So the answer to this question is C


Instruction:
Drug of choice for treatment of infections caused by MRSA is :
A. Metronidazole
B. Vancomycin
C. Imipenem
D. Clindamycin

Response:
None

So the answer to this question is B


Instruction:
An electrode of a cochlear implant is placed in
A. Horizontal semicircular canal
B. Scala media
C. Scala tympani
D. Scala vestibule

Response:
Pas of the implant: External pa- Microphone, Speech processor, and Transmitter coilInternal pa- Receiver stimulator, Electrode arrayThe electrode array is inseed into the scala tympani by widening the round window (Cochleostomy)Ref: Hazarika; 3rd ed; Pg: 87

So the answer to this question is C


Instruction:
Hennebert's Sign is seen in-
A. Congenital Syphilis
B. AcousticNeuroma
C. Glomus Tumour
D. Otosclerosis

Response:
Ans. is 'a' i.e., Congenital Syphiliso Repeat from previous sessions.

So the answer to this question is A


Instruction:
Regarding vaginal candidiasis which of the following is FALSE:
A. Cottage cheese like secretions are seen
B. Intense pruritus
C. Occuring in pregnancy is classified as uncomplicated candidiasis
D. Budding yeast cells and pseudohyphae are seen in KOH preparation

Response:
CANDIDIASIS caused by Candida albicans which thrives in an acidic medium with an abundant supply of carbohydrates. Classification of Vulvovaginal Candidiasis Uncomplicated Complicated Sporadic or infrequent in occurrence Recurrent symptoms Mild to moderate symptoms Severe symptoms Likely to be Candida albicans Non-albicans Candida Immuno-competent women e.g., diabetic women Immuno-compromised, diabetic, pregnant SYMPTOMS vulvar pruritus associated with vaginal discharge that typically resembles cottage cheese. The discharge can vary from watery to homogeneously thick. Vaginal soreness dyspareunia vulvar burning and irritation External dysuria ("splash" dysuria) may occur when micturition leads to exposure of the inflamed vulvar and vestibular epithelium to urine. DIAGNOSIS A presumptive diagnosis can be made in the absence of fungal elements confirmed by microscopy A fungal culture is recommended to confirm the diagnosis. A 10% KOH smear shows the buds and hyphae of the Candida organism. Pregnancy is a classical situation where the pH is still acidic and the immuno-suppression will actually lead to more resistant type of candidiasis manifestation.

So the answer to this question is C


Instruction:
Most common neuroendocrine tumour of pancreas is
A. Insulinoma
B. Gastrinoma
C. Non-functional tumours
D. VIPoma

Response:
TumourIncidence%Insulinoma70-80Gastrinoma20-25Non-functional tumours30-50VIPoma4Glucagonoma4Somatostatinoma<5Carcinoid<1ACTHoma<1GRFoma<1Ref: Bailey and Love 27e pg: 846

So the answer to this question is A


Instruction:
A 24 year old female working in a office thinks his boss is secretly in love with her. Even though he denies the facts, she feels he is hiding it from her. This disorder is suggestive of
A. Declerembault syndrome
B. Cotard syndrome
C. Othello syndrome
D. Capgrass syndrome

Response:
Declerembault syndrome also called as Erotomania is where a female usually of lower socioeconomic status believes that  a high profile male is secretly in love with her.

Cotard syndrome : Delusion of Nihilism.
Othello syndrome : Delusion of Infidelity.
Capgrass syndrome : Delusion of Doubles.

So the answer to this question is A


Instruction:
Which of the following is not a method for providing enteral nutrition?
A. PEG
B. PICC
C. Sip feeding
D. Nasojejunal tube

Response:
PICC stand for Peripherally inseed central venous catheter It is not a method for providing enteral nutrition instead it provides parenteral nutritionthrough an peripherally inseed catheter in one of the central veins. Enteral feeding refers to delivery of nutrients into the GIT by means of following techniques: Sip feeding Nasogastric/Ryle's tubes Surgical or Percutaneous endoscopic gastrostomy.

So the answer to this question is B


Instruction:
A new born presented with jaundice. Most diagnostic investigation of choice is –
A. Total and Direct bilirubin
B. Conjugated bilirubin
C. Serum, Bilirubin
D. Uroporphyrin levels

Response:
None

So the answer to this question is A


Instruction:
What is the normal pH of the blood
A. 7.30–7.40
B. 7.35–7.45
C. 7.20–7.30
D. 7.45–7.55

Response:
Option B: The normal blood pH is tightly regulated between 7.35 and 7.45.

So the answer to this question is B


Instruction:
Critical temperature for liquid nitrogen is ?
A. 36.5degC
B. -20degC
C. -147degC
D. -242degC

Response:
Ans. is 'c' i.e., -147deg C Critical temperature (Tc) of a substance is the temperature at and above which vapour of that substance can not be liquified, no matter how much pressure is applied (Note : Below critical temprature a substance can exist as a liquid or gas depending on pressure). Critical temperature of N2 is -146.9deg C; that means N2 can be liquified below -146.9deg C --> So, liquid nitrogen must be stored below -146.9deg C.

So the answer to this question is C


Instruction:
Pre-exposure prophylaxis for rabies with HDVC involves how many doses of vaccine
A. 1
B. 2
C. 3
D. 4

Response:
New Recommended regimens/Schedules (New Guidelines) Type of prophylaxis Regimen Post Exposure Intramuscular Essen Regimen (1-1-1-1-1) Day 0,3,7,14,28 Post Exposure Intradermal Updated Thai Red Cross Regimen (2-2-2-0-2) Day 0,3,7,28 Post exposure in vaccinated individuals Day 0,3 Pre-Exposure prophylaxis Day 0,7,21/28 Ref: Park 25th edition Pgno : 296

So the answer to this question is C


Instruction:
A 68 years old lady thinks that she has done a sin, she is not worth to live this world, she is also having anorexia and insomnia, she is suffering from -
A. Exogenous depression
B. Endogenous depression
C. Neurotic depression
D. Dissociate disorder

Response:
Diagnostic criteria for Major depression

Five or more of the following symptoms for at least 2 weeks.

Depressed mood
Loss of interest or pleasure in all
Decreased or increased appetite
Insomnia or hypersomnia
Psychomotor retardation or agitation
Fatigue or loss of energy
Feeling of worthlessness or excessive guilt
Diminished concentration
Suicidal thoughts or attempts

Diagnosis of Minor depression

If less than five but more than two (i.e. 2-4) of the above symptoms are present for at least 2 weeks then the diagnosis is minor depression.

Coming to question

This patient has:-

i) Excessive guilt (she has done a sin)
ii) Suicidal thoughts (not worth to live this world)
                iii) Anorexia (decreased appetite)
                iv) Insomnia

So, this patient has less than 5 symptoms but more than 2 symptoms but more than 2 symptoms Diagnosis is minor depression.
Now the question arises, which type of depression is it?

Endogenous depression :- No external precipitating event or stressors.
Reactive (neurotic/exogenous) :- Precipitated by external events or stressors, e.g. loss of a loved one, failure in love etc.

As no external precipitating factor has been mentioned in the question, this patient is having endogenous depression.
So, the final diagnosis is endogenous minor depression. (If the symptoms would have been 5 or more --> endogenous major depression).

So the answer to this question is B


Instruction:
An 8-month-old male infant is admitted to the hospital because of a bacterial respiratory infection. The infant responds to appropriate antibiotic therapy, but is readmitted several weeks later because of severe otitis media. Over the next several months, the infant is admitted to the hospital multiple times for recurrent bacterial infections. Workup reveals extremely low serum antibody levels. The infant has no previous history of viral or fungal infections. The most likely diagnosis for this infant is
A. Isolated IgA deficiency
B. X-linked agammaglobulinemia of Bruton
C. Chronic granulomatous disease
D. DiGeorge's syndrome

Response:
In X-linked agammaglobulinemia of Bruton, B cells are absent but numbers and function of T cells are normal. This abnormality results from defective maturation of B lymphocytes beyond the pre-B stage. This maturation defect leads to decreased or absent numbers of plasma cells, and therefore immunoglobulin levels are markedly decreased. Male infants with Bruton's disease begin having trouble with recurrent bacterial infections at about the age of 9 months, which is when maternal antibodies are no longer present in the affected infant. Therapy for Bruton's disease consists primarily of IV gamma globulin. Isolated deficiency of IgA is probably the most common form of immunodeficiency. It is due to a block in the terminal differentiation of B lymphocytes. Most patients are asymptomatic, but some develop chronic sinopulmonary infections. Patients are prone to developing diarrhea (Giardia infection) and also have an increased incidence of autoimmune disease, such as Hashimoto's thyroiditis. In patients with chronic granulomatous disease (CGD), the neutrophils and macrophages have deficient H2O2production due to abnormalities involving the enzyme NADPH oxidase. These individuals have frequent infections that are caused by catalase-positive organisms, such as S. aureus, because the catalase produced by these organisms destroys the little hydrogen peroxide that is produced DiGeorge's syndrome is a T cell-deficiency disorder that results from hypoplasia of the thymus due to abnormal development of the third and fouh pharyngeal pouches. The parathyroid glands are also abnormal, and these individuals develop hypocalcemia and tetany. Congenital hea defects are also present. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition.

So the answer to this question is B


Instruction:
What is not a part of triad of Renal Cell Carcinoma?
A. Loin Mass
B. Hematuria
C. Loin Pain
D. Oliguria

Response:
Ans. is 'd' i.e., Oliguria o The three classical diagnostic features (classical triad) of renal cell carcinoma are costovertebral pain, palpable mass and hematuria. The most reliable of three is hematuria.Signs and Symptoms of Renal Cell Carcinoma (In decreasing order of frequency)o Hematuriao Flank Masso Anaemiao Hypertensiono Hypercalcemiao Neuromyopathyo Increased ESRo Flank Paino Weight losso Fevero Abnormal Liver functiono Erytjhrocytosiso Amyloidosis

So the answer to this question is D


Instruction:
Which of the following enzyme acts by a 'Ping-Pong' mechanism?
A. Alanine amino transferase
B. Hexokinase
C. Lactate Dehydrogenase
D. Pyruvate Dehydrogenase

Response:
Ping pong displacement: One or more products are released before all the substrate binds the enzyme

So the answer to this question is A


Instruction:
Transitional cell carcinoma of bladder is associated with -
A. Schistosomiasis
B. Naphthylamine
C. Smoking
D. All

Response:
Ans 'a' Schistosomiasis; 'b' Naphthylamine ; 'c' Smoking Risk factors for Transitional cell ca of Bladder 1) Cigarette smoking - is the main etiological factor and accounts for about 50% of bladder cancers. 2) Occupational exposures to chemicals the following compounds may be carcinogenic - 2 naphthylamine - combustion gases and soot from coal - 4-aminobiphenyl - chlorinated aliphatic hydrocarbons - 4-nitrobiphenyl - ceain aldehydes such as acrolein - 4-4-diaminobiphenyl (benzidine) - aniline dyes - 2-ami-1 -naphthol Occupation repoed to be associated with increased risk of bladder cancer - autoworkers - metal workers - painters - textile worker - truck drivers - dye workers drill press operator - petrol workers leather workers rodent exterminators & sevage workers 3) Schistosoma haemotobium - it's a risk factor for both transitional cell ca & squamous cell ca. 4) Drugs such as phenacetin & chlornaphazine 5) Cyclophosphamide therapy 6) Pelvic irradiation Vitamin A supplements appear to be protective.

So the answer to this question is D


Instruction:
Aseptate hyphae are seen in -
A. Phycomycetes
B. Ascomycetes
C. Basidiomycetes
D. Deutromycetes

Response:
- Lower fungi (Phycomycetes or Zygomycetes) - Aseptate hyphae - Mucor, Rhizopus and Absidia etc. - Higher fungi (Ascomycetes, Basidiomycetes, Deutromycetes) - Septate hyphae - Dermatophytes, Aspergillus, etc.

So the answer to this question is A


Instruction:
What is amethocaine:
A. It is ester local anesthetic
B. It is other name of tetracaine
C. It is also typically very effective on local application
D. All are true

Response:
Amethocaine is an ester local anaesthetic tetracaine. It is a very effective surface anesthetic. Tetracaine, also known as amethocaine, is a local anesthetic used to numb the eyes, nose, or throat. It may also be used before staing an intravenous to decrease pain from the procedure. Typically it is applied as a liquid to the area.

So the answer to this question is D


Instruction:
Following are precursors of endometrial carcinoma except :
A. Atypical adenomatous hyperplasia
B. Atrophic endometrium
C. Adenocarcinoma in situ
D. Cystic hyperplasia

Response:
Endometrial atrophy is the most common cause of post menopausal bleeding Reference :Textbook of Gynaecology; Sheila balakrishnan; 2nd edition; Pg no:245

So the answer to this question is B


Instruction:
Which of the following diagnostic procedure is not done in dilated pupil?(AIIMS November 2014, May 2014)
A. Gonioscopy
B. Fundus examination
C. Laser inferometry
D. Electroretinography

Response:
Ans. a. Gonloscopy (Ref: Khurana5/e 578; Basics and Clinical Science Course, American Academy of Ophthalmology, 2012-13; Sec 10, p46)Gonioscopy is not done in a dilated pupil. (AllMS May 2014 repeat)Gonioscopy is done in dark room with minimum slit lamp light. Pupil contraction will falsely open up the angle. Likewise pupillary dilatation will cause crowding of the iris at angle and angle appears as closed.'By gonioscopy angle structures are assessed, especially relationship of root of iris and trabecular mesh work in normal physiological state. To avoid pupillary contraction, it is done in dark room with minimum slit lamp light.' - Basics and Clinical Science Course, American Academy of Ophthalmology, 2012-13; Sec 10, p46

So the answer to this question is A


Instruction:
Fulminant hepatic failure can be caused by
A. Halothane
B. Isoflurane
C. Nitrous oxide
D. Phenobarbitone

Response:
The first modern halogenated volatile anesthetic, halothane, was introduced in 1955. Clinical exposure to halothane is associated with two distinct types of hepatic injury. Subclinical hepatotoxicity occurs in 20% of adults who receive halothane. It is characterized by mild postoperative elevations in alanine aminotransferase and aspaate aminotransferase, but is reversible and innocuous. Anaerobic halothane reduction by CYP2A6 to a 2-chloro-1,1,1-trifluoroethyl radical is thought to mediate this mild hepatic injury. The fulminant form of hepatotoxicity, commonly known as halothane hepatitis, is characterized by elevated alanine aminotransferase, aspaate aminotransferase, bilirubin, and alkaline phosphatase levels, massive hepatic necrosis following the administration of halothane. Halothane hepatitis is rare (1 in 5000 to 35,000 administrations in adults), but is fatal in 50% to 75% of these cases. Because of the potential for fatal hepatitis, halothane is no longer used in adult patients in many countries. Halothane hepatitis is caused by a hypersensitivity reaction associated with the oxidative metabolism of halothane. The highly reactive trifluoroacetyl chloride metabolite of halothane oxidation can react with nearby liver proteins. In most patients who developed hepatic necrosis after halothane anesthesia, antibodies against TFA-modified proteins were detected, suggesting that the hepatic damage is linked to an immune response against the modified protein, which acts as a neoantigen. Accordingly, patients who develop halothane hepatitis often have a history of prior exposures to halothane or other volatile anesthetics, together with symptoms suggestive of immune reactivity, such as fever, rash, ahralgia, and eosinophilia. A current hypothesis is that TFA-protein adducts induce a cytotoxic T cell reaction in sensitized individuals, which leads to liver damage. However, the immune responses observed in halothane hepatitis might not mediate liver injury. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e

So the answer to this question is A


Instruction:
Long term steroid therapy can lead to suppression of hypothalamic-pituitary-adrenal axis. lt can be overcome by using alternate day therapy with coicosteroids. Which of the following steroids are unsuitable for alternate day therapy for such purpose?
A. Coisol
B. Prednisolone
C. Betamethasone
D. Hydrocoisone

Response:
(Ref: KDT 6/e p282, 287) Steroids with long half life like betamethasone and dexamethasone cannot be used for alternate day therapy because even in alternate day therapy there will be sufficient blood levels of these steroids to cause suppression of HPA axis.

So the answer to this question is C


Instruction:
FALSE about Leprosy eradication programme is –
A. Early detection of cases
B. Disability limitation
C. Long term multi drug therapy
D. Health education

Response:
In leprosy eradication programme the multidrug therapy is not long term but short term therapy.
Shorter therapy has added advantage of patient compliance, cost-effectiveness and decreased work load

So the answer to this question is C


Instruction:
Pin code index of nitrous oxide is: March 2013 (c)
A. 1, 6
B. 2, 5
C. 2, 6
D. 3, 5

Response:
Ans. D i.e. 3, 5

So the answer to this question is D


Instruction:
Acute osteomyelitis of long bones commonly affects the
A. Epiphysis
B. Diaphysis
C. Metaphysis
D. Aicular surfaces

Response:
Metaphysis of long bones is the earliest and most common site involved in osteomyelitis. x ray showing acute osteomyliyis of long bones ref : maheswari 9th ed

So the answer to this question is C


Instruction:
Krebs cycle and Urea cycle are linked at
A. Ornithine
B. Fumarate
C. Oxaloacetate
D. Arginine

Response:
Reference: Harpers illustrated biochemistry 30th edition

So the answer to this question is B


Instruction:
A 32-year-old patient received a badly placed intramuscular injection to the posterior part of his gluteal region. The needle injured a motor nerve in the area. Later, he had great difficulty rising to a standing position from a seated position. Which muscle was most likely affected by the injury?
A. Gluteus maximus
B. Gluteus minimus
C. Hamstrings
D. Iliopsoas

Response:
The gluteus maximus is innervated by the inferior gluteal nerve, and this muscle is responsible for extension and lateral rotation of the thigh. It is the primary muscle used to rise from a seated position. The gluteus minimus is innervated by the superior gluteal nerve and is responsible for abduction of the thigh. Hamstring muscles are innervated by the tibial portion of the sciatic nerve, and these are responsible for extension of the thigh and flexion of the leg. The iliopsoas muscle is innervated by L1 and L2 and the femoral nerve, and it flexes the thigh. The obturator internus is innervated by the nerve to the obturator internus and is a lateral rotator of the thigh.

So the answer to this question is A


Instruction:
Troglitazone i? the drug used in the treatment of:
A. Petit mal epilepsc
B. Type 2 diabetes meliitus
C. Hyperlipidaemia
D. D. Osteoporosis

Response:
Ans: B (Type 2 diabetes meliitus) Ref: Goodman tfi Gillman v Tin Pharmacological Basis of Therapeutics 2011, 12th Edition, McGrow Hill. Burton LL.P 1261-62Explanation:TroglitazoneAs a Monotherapy it is not useful in Type 1 diabetes beeause it needs presence of insulin for its action.Troglitazone is withdrawn from the market because it is known to cause severe fatal hepatic failure.The newer thiazolidenidiones like Pioglitazone and rosiglitazone are known to cause CHF as a result of fluid retention.Rosiglitazone is found to be associated with increased risk of cardiovascular events.Pioglitazone can reduce the TG levels by 10- 15% because of its action on PPARA

So the answer to this question is B


Instruction:
Gum hyperophy is seen in which type of AML?
A. Myelogenous leukaemia
B. Myelomonocytic leukaemia
C. Megakaryocytic leukaemia
D. Erythroleukemia

Response:
Infiltration of the gingivae, skin, soft tissues, or the meninges with leukemic blasts at diagnosis is characteristic of the monocytic subtypes (M4 and M5). Significant gastrointestinal bleeding, intra-pulmonary hemorrhage, or intracranial hemorrhage occur in M3 AML. Bleeding associated with coagulopathies occur in M5 AML.

So the answer to this question is B


Instruction:
Sandhoff's disease is d/t absence of which enzyme?
A. Beta-hexosaminidase
B. Beta-glucuronibase
C. Aryl sulphatase
D. Alpha galactosidase

Response:
It is a lipid storage disease.Due to deficiency of hexaminidase.Leads to accumulation of globoside (Table;14.4)Ref: DM Vasudevan, 7th edition, page no: 193

So the answer to this question is A


Instruction:
Which laboratory determinations would be most helpful in distinguishing iron deficiency anemia from anemia of chronic disease?
A. Erythrocyte: granulocyte ratio in bone marrow
B. Presence or absence of polychromatophilic target cells
C. Presence or absence of stippled erythrocytes
D. Serum ferritin

Response:
This is a common clinical scenario in real life. Serum ferritin is markedly decreased in iron deficiency anemia and is normal to modestly elevated in anemia of chronic disease. This difference makes this test very useful in this setting. You should be aware that serum ferritin may behave like an acute phase reactant. Therefore, in an acute inflammatory situation, erythrocyte ferritin may be more reliable if serum ferritin is equivocal. Also, do not forget that iron deficiency anemia can complicate the anemia of chronic disease (e.g., gastrointestinal bleeding can complicate gastrointestinal cancers); in this situation, most physicians treat the apparent iron deficiency anemia and see to what degree the anemia corrects. The erythrocyte: granulocyte ratio in bone marrow is slightly decreased in both iron deficiency anemia and anemia of chronic disease, but may be markedly increased in sideroblastic anemias. Polychromatophilic target cells and stippled erythrocytes are absent in both iron deficiency anemia and anemia of chronic disease, but may be present in sideroblastic anemias and other iron-utilization anemias. Ref - Harrison's principles of internal medicine 20e pg 685,686,688

So the answer to this question is D


Instruction:
Ivermectin is a
A. Cysticide
B. Taenicide
C. Filaricide
D. Anti-amoebic

Response:
Ivermectin is the drug of choice for Strongyloides and Onchocerca volvulus. It is a filaricide (effective against W. bancrofti and malayi).Ivermectin, a semisynthetic macrocyclic lactone, a mixture of avermectin B1a and B1b. It is derived from the soil actinomycete Streptomyces avermitilisIvermectin is used only orally in humans. The drug is rapidly absorbed, reaching maximum plasma concentrations 4 hours after a 12mg dose. Ivermectin appears to paralyze nematodes and ahropods by intensifying g-aminobutyric acid (GABA)-mediated transmission of signals in peripheral nervesReference: Katzung Pharmacology; 13th edition; Chapter 53; Clinical Pharmacology of the Antihelminthic Drugs

So the answer to this question is C


Instruction:
Which of the following is false regarding cell free DNA
A. Detected in maternal blood
B. Prenatal diagnosis of Down's syndrome can be made
C. Used for liquid biopsy
D. It is one of the invasive techniques for  prenatal diagnosis of certain genetic diseases

Response:
Prenatal diagnosis can be made by invasive and non invasive techniques.
Invasive techniques include aminocentesis, chorionic villous sampling, cord blood sampling. Cell free DNA is a non invasive method.

So the answer to this question is D


Instruction:
Epithelioid hemangioendothelioma of nose is -
A. Carcinoma
B. Sarcoma
C. Carcinosarcoma
D. Hamartoma

Response:
Ans. is 'b' i.e., Sarcomao Soft tissue sarcoma arise from mesenchyme, like muscles (myoma), endotha/ialcells (endothelioma) and cartilage (chondroma)o Epithelioid hemangioendothelioma (EHE) is a soft tissue sarcoma.o It arises from distinct type of endothelial cells which exhibit epitheloid morphology.

So the answer to this question is B


Instruction:
All of the following statement about &;yaws&; are true, except -
A. Caused by Treponema peenue
B. Transmitted non venerally
C. Secondary yaws can involve bone
D. Late stages of yaws involve hea and nerves

Response:
Late stages of yaws includes destructive lesions of the skin and bone. Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 359

So the answer to this question is D


Instruction:
Ring scotoma is a feature of:
A. Blue dot cataract
B. Diabetic retinopathy
C. Nuclear cataract
D. Retinitis pigmentosa

Response:
D i.e. Retinitis pigmentosa

So the answer to this question is D


Instruction:
Autoclaving is done at what temperature for 15 minutes: March 2010
A. 118 degree C
B. 121 degree C
C. 126 degree C
D. 134 degree C

Response:
Ans. B: 121 degree C

So the answer to this question is B


Instruction:
Histopathology of a lung cancer shows 'Clara cells' probable diagnosis is -
A. Squamous cell cancer
B. Bronchio alveolar cancer
C. Large cell cancer
D. Papillary carcinoma

Response:
Bronchioloalveolar carcinoma

It is a histological type of adenocarcinoma.
It occurs in the pulmonary parenchyma in the terminal bronchioloalveolar pattern.
The tumor is almost always in the peripheral portion of the lung.
More often it occurs as multiple diffuse nodules that sometimes coalesce to produce a pneumonia-like consolidation.
The key feature of bronchioloalveolar carcinomas is their growth along preexisting structures without destruction of the alveolar architecture. This growth pattern has been termed "lepidic" an allusion to the neoplastic cells resembling butterflies sitting on a fence.
Stromal, vascular or pleural invasion is characteristically absent.
Bronchioloalveolar carcinoma consists of mucin-secreting bronchiolar cells, Clara cells, or rarely type II pneumocytes.
These tend to have aerogenous spread and patient usually dies of suffocation (not by metastatic spread).
Bronchioloalveolar carcinoma has two subtypes -

i) Non-mucinous → Rare aerogenous spread and therefore amenable to surgical resection.
ii) Mucinous → Tend to spread aerogenously, forming satellite tumors.

So the answer to this question is B


Instruction:
Following are causes of papulosquamous lesions except:
A. Seborrheic dermatitis
B. Parapsoriasis
C. Lichen nitidus
D. Congenital syphilis

Response:
PAPULOSQUAMOUS SKIN DISORDERS Psoriasis Parapsoriasis Lichen planus Lichen nitidus Pityriasis rosea Pityriasis rubra pilaris Secondary syphilis NOT Congenital syphilis. Nummular eczema Drug eruptions Seborrheic dermatitis Reiter's syndrome Acrodermatitis enteropathica

So the answer to this question is D


Instruction:
The minimum age for giving consent for medical termination of pregnancy is :
A. 16 years
B. 18 years
C. 20 years
D. 24 years

Response:
18 years

So the answer to this question is B


Instruction:
Radiological appearance of rickets include all except
A. Fraying
B. Cupping
C. Splaying
D. Pelkan spur

Response:
Radiological findings in rickets : cupping of metaphysis splaying of metaphysis Fraying of metaphysis widening of growth plate widening of epiphysis coical thining generalised osteopenia Triradiate pelvis Note : Pelkan spur is a radiological feature of Scurvy

So the answer to this question is D


Instruction:
All of them are true about the 4th nerve EXCEPT
A. The only nerve to emerge from the dorsal aspect of brain
B. The only nerve to cross over to opposite side
C. It is the thickest cranial nerve
D. It has the fewest axons of any cranial nerve

Response:
The trochlear nerve has several features that make it unique from the other cranial nerves: Thinnest cranial nerve. Is the only nerve to exit from the dorsal surface of the brain. Is the only nerve in which all the lower motor neuron fibers decussate. Has the longest intracranial course. Has the smallest number of axons.

So the answer to this question is C


Instruction:
Abdominal surgery under LA, patient suddenly felt pain due to
A. Liver
B. Gut
C. Parietal peritoneum
D. Visceralperitoneum

Response:
.pas of peritoneum mainly includes 1. Parietal peritoneum: It lines the inner surface of the abdominal wall, under surface of diaphragm and pelvic wall. It is loosely attached to the overlying walls and can be easily stripped off. It is innervated by the somatic nerves, so pain sensitive. Anterior peritoneum is most sensitive when compared to pelvic peritoneum. 2. Visceral peritoneum: It lines the outer surface of the abdominal viscera, firmly adherent, cannot be stripped off. It is innervated by autonomic nervous system; hence not pain sensitive. ref:SRB&;s manual of surgery,ed 3,pg no 498

So the answer to this question is C


Instruction:
Tension band wiring is used for?
A. Fracture humerus
B. Olecranon fracture
C. Fracture tibia
D. Fracture spine

Response:
ANSWER: (B) Olecranon fractureREF: Apley's orthopedics 8th e p. 607Treatment plan for fracture olecranonNon displaced transverse fracture : cast immobilization for 2-3 weeksComminuted fracture with triceps intact: sling for a weekDisplaced oblique fractures : tension band wiringOld non united fracture, non-articular fracture : excision of fragment and triceps repair

So the answer to this question is B


Instruction:
The right coronary artery supplies all of the following parts of the conducting system in the heart except -
A. SA node
B. AV node
C. AV bundle
D. Right bundle branch

Response:
Area supplied by right coronary artery
-        SA node (in 65%)
-        Conducting system (AV bundle, bundle of His, part of left bundle branch) except RBB and part of left branch of AV bundle.
-        Posterior 1/3rd of interventricular septum
-        Right ventricle except part adjoining anterior interventricular groove and small part of left ventricle adjoining posterior interventricular groove.
 Area supplied by left coronary artery
-        Left atrium
-        Left ventricle including apex
-        Part of right ventricle adjoining anterior interventricular groove.
-        Anterior 2/3rd of interventricular septum
-        RBB, LBB
-        SA node (in 35%)

So the answer to this question is D


Instruction:
Anesthetic drug of choice in asthmatic: ( Repeat )
A. Ketamine
B. Propofol
C. Etomidate
D. Propofol

Response:
Ans: B (Ketamine) Ref: Miller '? Anesthesia, 7th ed. & Ajay YadavExplanation:KetamineCauses Dissociative anesthesiaPhencyclidine derivativeNMDA receptor agonistAnesthetic PropertiesOnset of Action: 30 - 60 secondsEarly regain of consciousness after 15 - 20 min due to RedistributionElimination half life: 2-3 hoursStrong analgesic propertyMetabolised in Liver and products exreted in urineNot a muscle relaxantPrimary site of action - Thalamo-neo-cortical projectionsCardiovascular SystemIncreases arterial BP,Increases heart rate &Increases cardiac outputIV agent of choice in SHOCKRespiratory SystemPotent BronchodilatorGood induction agent for asthmaticsUpper airway reflexes remain largely intactIncreases salivatory & Tracheo bronchial secretionsUsing glycopyrollate or atropine becomes necessaryCentral Nervous SystemIncreases Intracranial pressure and can precipitate seizuresEmergence reactions:These are seen at emergenceVivid dreamingIllusionsExtracorporeal experiences like floatingExcitementConfusionEuphoriaFearHallucinations:Auditory and Visual hallucinations (Most common side effect of Ketamine)Treated with BenzodiazepineOther SystemsEyeIncrease intraocular tensionPupils dilate moderatelyNystagmusGITIncreases intragastric pressureSalivary secretions increasedMuscluarIncreases muscle toneIncreased non-puposeful movementsDoseCan be given IV. IM, oral. Rectal and intrathecal routeIV -- 2mg/kgIM- 5-10mg/kg AdvantagesInduction Agent of Choke inAsthmaticsShock (HYPOTENSION)Children ( Now Sevoflurance is DOC)Constrictive pericarditisCardiac tamponadeCan be used as SOLE agentCan be used safely at remote places and in inexperienced hands since does not depress heart or respirationPreferred agent when patient is in FULL STOMACH (Preserves laryngo- pharyngeal reflexes)Contraindicated inHead injuryICSOLEye injuryOpthal pathologyIschemic heart diseaseVascular aneurysmPsychiatric diseasesDrug addictsHypertensives

So the answer to this question is A


Instruction:
True about Sentinel Lymph node biospy ?
A. Special OT is requried
B. Blue dyes injected
C. Contraindicated if axillary LN is involved
D. All

Response:
Ans. is 'b' i.e. Blue dyes injected No special OT is required, SLN biopsy is usually done intraoperatively by using isosulphan blue dye (lymphazurin) or radioactive colloid. Accuracy in detection of SLN is best when both the methods are combined. When radioactive colloid is used, the SLN is detected by a gamma-camera. The blue dye colours the afferent lymphatics and the SLN, hence aids in the identification SLN Biopsy (for breast ca) is contraindicated in : palpable lymphadenopathy prior axillary surgery, chemotherapy or radiation therapy multifocal breast cancers

So the answer to this question is B


Instruction:
Which of the following is single most impoant indicator of likilihoodness of progresion of hepatitis to liver cirrhosis -
A. Etiology
B. Associated serological findings
C. Presence of bridging necrosis
D. Presence of mallary hyaline

Response:
Ans. is 'a' i.e., Etiologyo The single most indicator of the likelihoodness of rapid progression chronic hepatitis to cirrhosis is underlying etiology.

So the answer to this question is A


Instruction:
Index case is the ?
A. First case in a community
B. Case getting infection from primary case
C. Case getting infection from secondary case
D. First case detected by investigator

Response:
Ans. is 'd' i.e., First case detected by investigator Primary case - First case of communicable disease introduced into the population. Index case - First case to come to attention of the investigator. It is not always necessary that primary case will be index case : - When the first case noticed by the investigator is also the first case of the population - Primary case and index case are the same. When the first case nociced by the investigator is not the first case of the population (primary case) - Index case and primary case are different. Secondary cases - Cases those developing from contact with primary case.

So the answer to this question is D


Instruction:
Average incubation period of typhoid is?
A. 2-3 days
B. 5-8 days
C. 10-15 days
D. 15-30 days

Response:
<p> Typhoid fever:- Typical continuous fever for 3-4 weeks,relative bradycardia with involvement of lymphoid tissue. Without effective treatment, typhoid kills over 10% of those infected. Causative agent- Salmonella typhi. S.paraA and S.paraB are infrequent. Reservoir- man Case - a case is infectious as long as bacilli appear in stools /urine. Carriers:- 1. Convalescent carriers-excrete bacilli for 6-8 weeks,after which their number dimnishes rapidly. 2. Chronic carriers- persons who excrete bacilli for more than a year after a clinical attack. In most chronic carriers,the organism persists in gall bladder and in biliary tract. Source of infection- faeces and urine of cases/carriers. Age group involved mostly is 5-19 yrs old. Males affected more than females. Incubation period- 10-14 days. Mode of transmission: faecal oral route/ urine oral routes. Treatment of carriers:- Intensive course of ampicillin/ amoxycillin (4-6g/day) together with probenecid for 6 weeks. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.235}</p>

So the answer to this question is C


Instruction:
Which of the following treatment modalities are used in the treatment of tics, hair pulling and nail biting?
A. Mind fullness
B. Social habit training
C. Habit and response prevention
D. No intervention required

Response:
Habit disorder is the term used to describe several related disorders linked by the presence of repetitive and relatively stable behaviors that seem to occur beyond the awareness of the person performing the behavior. The first group of habit disorders is tic disorders (TDs). Tics are involuntary movements, sounds, or words that are "sudden, rapid, recurrent, nonrhythmic". In addition to TDs, body-focused behaviors, such as recurrent hair pulling (trichotillomania ) and skin picking (SP), and nail biting are also included within the habit disorders.

So the answer to this question is D


Instruction:
STEP wise approach to surveillance for Non - Communicable diseases step 2 is
A. Behavioural measurement
B. Physical measurement
C. Biochemical Measurement
D. Emotional Assessment

Response:
STEPS Compriser or 3steps

Step 1 = Behavioural measurements
Step 2 = Physical measurements
Step 3 = Biochemical measurements

So the answer to this question is B


Instruction:
Typical histology in benign hypertension?
A. Intimal proliferation and hyalinization of media of medium arteries
B. Fibrinoid necrosis of small arteries
C. Loss of endothelial cells of arterioles
D. Formation of new vessels

Response:
Ans. (a) Intimal proliferation and hyalinization of media of medium arteries(Ref: Robbins 9th/pg 490; 8th/pg 495)There is increased myofibroblastic tissue in the intima along with hyaline deposits in benign hypertension. Intimal proliferation is usually the universal response of a vessel to injury.

So the answer to this question is A


Instruction:
X-rays are produced in:
A. Anode
B. Cathode
C. Glass wall
D. Molybdenum focusing cup

Response:
None

So the answer to this question is A


Instruction:
Post exposure prophylaxis in health care professionals is indicated in infections with all except?
A. HBV
B. Rabies
C. Diptheria
D. Measles

Response:
Post exposure prophylaxis is used in HIV, HBV, Measles, Rabies, Tetanus, H.influenzae and Meningococcus. Ref: Park, 20th Edition, Pages 139, 189, 240, 283.

So the answer to this question is C


Instruction:
Most common operation done by an Ophthalmologist in district hospital:
A. Phacoemulsification
B. Trabeculectomy
C. Bilateral lamellar tarsal rotation
D. Dacrocystorhinostomy

Response:
Most common Ophthalmologic services at District hospital: Cataract surgery with IOL implantation is the most common surgery at District hospital ECCE + IOL is most commonly followed by phacoemulsifaction.

So the answer to this question is A


Instruction:
Although more than 400 blood groups have been identified, the ABO blood group system remains the most important in clinical medicine because :
A. It was the first blood group system to be discovered.
B. It has four different blood groups A, B, AB, O (H).
C. ABO(H) antigens are present in most body tissues and fluids.
D. ABO(H) antibodies are invariably present in plasma when persons RBC lacks the corresponding antigen.

Response:
Ans. is 'd' i.e. ABO (H) antibodies are invariably present in plasma when persons RBC lacks the corresponding antigen The basic difference between ABO blood group system and other blood group systems (such as Rh, Kell, Duffy, MNSs blood groups), which makes the ABO group so important is that -preformed ABO antibodies (agglutinins) are present in person serum when his RBCs lack the corresponding antigen (ie. anti B antibody would be present in a person of type A and type O blood groups. These two blood groups do not have the 'B' antigen on the RBCs)This is not the case with other blood groups. Preformed antibodies are not present. They are formed only after an exposure to the antigen, for example, an Rh-negative person do not have anti- Rh antibodies, these antibodies are formed only after an exposure to Rh-positive blood (by a blood transfusion, i.e. this makes the first blood transfusion safe even if mismatched)These preformed antibodies, rapidly destroy the RBCs of any mismatched blood transfusion.Read the following lines from the Journal of Hematology- "In clinical transfusion practice, the ABO blood groups are the most important and can never be ignored in red cell transfusion, because individuals who genetically lack any antigen, have antibodies against the red cell types that they have not inherited. These antibodies can destroy red cells rapidly in circulation"

So the answer to this question is D


Instruction:
Treatment of snakebite all, except AFMC 11
A. Firm bandage to occlude lymphatic
B. Incision over wound
C. Reassure the patient
D. Immobilization of bitten pa

Response:
Ans. Incision over wound

So the answer to this question is B


Instruction:
A coin is struck at 25 cm from incisor in the esophagus, this place coincides with-
A. Cricopharyngeal junction
B. Bronchial bifurcation
C. Aortic arch
D. Oesophago-gastric junction

Response:
Esophagus shows three normal constriction which are narrower portions of esophagus and foreign body can be held there.
These constrictions are : -

At pharyngo-esophageal junction (C6) - 15 cm from the upper incisors.
At crossing of arch of aorta and left main bronchus (T4) - 25 cm from upper incisors.
Where it pierces the diaphragm (T10) - 40 cm from upper incisors.

So the answer to this question is C


Instruction:
FAST USG focuses on all of the following areas except
A. Splenic
B. Hepatic
C. Pleura
D. Pelvic

Response:
Answer- C. PleuraFAST focus only on four areas : -Subxiphoid area (pericardium)Right upper quadrant (liver)Left upper quadrant (spleen)Pelvis

So the answer to this question is C


Instruction:
What is seen on x-ray with posterior elbow dislocation
A. Coronoid process posterior to humerus
B. Coronoid process anterior to humerus
C. Coronoid process below humerus
D. None

Response:
Refer Ebnezar 4thp 158 In posterior elbow dislocation, Coronoid process of ulna is posterior to the condyles of humerus

So the answer to this question is A


Instruction:
Feature of exudates pleural effusion is
A. Pleural fluid protein: Serum protein ratio> 0.5
B. Pleural fluid protein: Serum protein ratio> 0.8
C. Pleural fluid protein: Serum protein ratio<0.5
D. Pleural fluid protein: Serum protein ratio> 1.0

Response:
According to Light's criteria for distinguishing pleural transudate from exudate,exudate is likely if one or more of the following criteria are met-Pleural fluid protein:serum protein ratio>0.5;Pleural fluid LDH:serum LDH ratio>0.6;Pleural fluid LDH>2/3 rds of the upper limit of normal serum LDH. Reference:Davidson's medicine-22nd edition,page no:662.

So the answer to this question is A


Instruction:
Most common malignancy of liver in children is:
A. Hepatoblastoma
B. Hepatocellular carcinoma
C. Lymphoma
D. None of the above

Response:
Hepatoblastoma is the most common malignancy of the liver in children, with most of these tumors diagnosed before 4 years of age. Hepatocellular carcinoma is the next most common, with a peak incidence between 10 and 15 years of age. Ref: Schwaz's principle of surgery 9th edition, chapter 39.

So the answer to this question is A


Instruction:
A 22yrs old male suffer from decreased sleep, increased sexual activity, excitement and spending excessive money for 8 days. The diagnosis is
A. Confusion
B. Mania
C. Hyperactivity
D. Loss of memory

Response:
Symptomatic profile of the patient suggests the diagnosis, Characteristic Feature of Mania: Elation of Mood Delusion of Grandeur Increased psychomotor activity (usually goal oriented) Speech and thought: More talkative Pressure of speech, use playful language Flight of ideas Reduced sleep Over activity and poor judgment - this person is involved in high risk activities like buying sprees, reckless driving, foolish business investments, distributing money or aicles of unknown persons.

So the answer to this question is B


Instruction:
Osteoma of PNS is commonest in:
A. Ethmoidal
B. Maxillary
C. Sphenoid
D. Frontal

Response:
Ans. D Frontal sinus Craniofacial osteomas are benign tumors often originating in the paranasal sinuses The frontal sinus is the most frequent location followed by the ethmoid, maxillary and sphenoid sinus, respectively Age of presentation = second to fifth decade with a male-femate ratio - 3:1. Presentation: - Generally they are an incidental finding on radiography - It may produce symptoms like - - Visual impairment - Intracranial neurological complications like meningitis or pneumocephalus with seizure. Ref. Scott Brown 7th/ed Vol2 p 1521 Management Removal by endoscopic sinus surgery.

So the answer to this question is D


Instruction:
Which one of the following methods for induction of labour should not be used in patient with previous lower segment caesarean section?
A. Prostaglandin gel
B. Prostaglandin tablet
C. Stripping of the membrane
D. Oxytocin drip

Response:
Ans. is b, i.e. Prostaglandin tabletRef Dutta Obs. 7/e, p 524; Fernando Arias 3/e, p 286Prostglandin tablet is misoprostol (PGE1 ) which is contraindicated in women with previous cesarean births.MisoprostolIt is an analogue of Prostaglandin E1 .Indications:Medical abortion in the first trimester of pregnancy.Evacuation of uterus in case of anembryonic pregnancies or early fetal demise.Ripening of cervix prior to second trimester abortions.Ripening of cervix and induction of labour in term pregnancies.For treatment and prevention of postpartum bleeding.Pharmakokinetics:It is available in tablet form.Metabolized in liver.Complication:Nausea, vomiting, diarrhea.Uterine hyperstimulation.TachysystoleMeconium passagePossibly uterine ruptureContraindication:Women with previous uterine surgery particularly cesarean section.

So the answer to this question is B


Instruction:
Shoulder with bevel margin is indicated for
A. Facial margin of posterior metal ceramic crowns with supra gingival margins
B. Facial margin of posterior metal ceramic crowns with deep sub gingival margins
C. Cast metal restorations on the posterior teeth
D. Facial margin of a maxillary partial veneer crown

Response:
None

So the answer to this question is A


Instruction:
Statistical method of calculate death rate among two population with different age groups-
A. Crude death rate
B. Standardized death rate
C. Case fatality rate
D. Age specific death rate

Response:
.

So the answer to this question is B


Instruction:
A 36-year-old white female nurse comes to the ER due to a sensation of fast heart rate, slight dizziness, and vague chest fullness. Blood pressure is 110/70. The following rhythm strip is obtained, which shows?
A. Atrial fibrillation
B. Atrial flutter
C. Supraventricular tachycardia
D. Ventricular tachycardia

Response:
(c) Source: (Fuster, 10/e, pp 809-812, 820-825, 837-841.) Paroxysmal supraventricular tachycardia due to AV nodal reentry typically displays a narrow QRS complex without clearly discernable P waves, with a rate in the 160 to 190 range. The atrial rate is faster in atrial flutter, typically with a classic sawtooth pattern of P waves, with AV conduction ratios most commonly 2:1 or 4:1, leading to ventricular rates of 150 or 75/min. Atrial fibrillation would show an irregularly irregular rhythm. Wide QRS complexes would be expected in ventricular tachycardia.

So the answer to this question is C


Instruction:
Which area of thalamus is involved in Wernicke's encephalopathy?
A. Mammilary Bodies
B. Dorsomedial Nucleus
C. Ventroposterolateral nucleus
D. Anterior Nucleus

Response:
Dorsomedial nuclei of the thalamus and mamillary body of the hypothalamus is involved in Wernicke's encephalopathy. The mammillary bodies, hypothalamus, medialthalamic nuclei (adjacent to the third ventricle), tectal plateand periaqueductal gray matter are most commonly affected. Caused by a deficiency of vitamin B1 (thiamine). The classic clinical triad of ocular dysfunctions (nystagmus, conjugate gaze palsy, ophthalmoplegia), ataxia and confusion is observed only in 30% of cases. MRI AXIAL FLAIR images showing involvement of different areas of brain in a case of wernickes encephalopathy.

So the answer to this question is B


Instruction:
A 28-year-old man is evaluated in the primary care office for new onset rash on both legs for 1 week. He is a healthy person with no past medical illness and is not taking any medications. There is no history of recent fever but he has noticed occasional gum bleeding and one episode of nosebleed 4 days ago. He does not smoke, drinks alcohol only socially, and does not use any recreational drug. On physical examination, he is a healthy appearing man with no lymphadenopathy or hepatosplenomegaly. Laboratory studies reveal hemoglobin 14.8 gm/dL, hematocrit 42, MCV 86 fL, leukocyte count 6,000/mL, and platelet 22,000/mL. Liver function and renal function studies are normal. Peripheral smear reveals decrease in platelet count and no red cell abnormalities. What is the most probable diagnosis?
A. Acute lymphoblastic leukemia
B. Immune thrombocytopenic purpura
C. Leukemoid reaction
D. Chronic lymphocytic leukemia

Response:
Chronic lymphocytic leukemia is monoclonal proliferation of mature lymphocytes, often found incidentally during routine checkup. Some patients may have constitutional symptoms such as weight loss, fever, night sweats, and fatigue. Painless lymphadenopathy is the most common physical finding. Hepatosplenomegaly can occur as well. Lymphocytosis is the most striking feature, and peripheral smear usually contains numerous mature lymphocytes. Bone marrow usually contains lymphocytes accounting for >30% of all nucleated cells.Immune thrombocytopenic purpura is a common cause of thrombocytopenia in otherwise normal individual; it is caused by immune-mediated destruction of platelets by antibodies against platelet antigens. Other causes of thrombocytopenia including sepsis, viral and other infections, drugs, pregnancy, liver disease, and hypersplenism should be ruled out. Patients may present with petechiae, purpura, epistaxis, or severe hemorrhage. Glucocorticoids and intravenous immune globulin (IVIG) are usually the first choice to treat this condition. Anti-D (RhoGAM) can be used instead of IVIG in patients with Rh-positive blood. Thrombotic thrombocytopenic purpura (TTP) usually presents with microangiopathic hemolytic anemia, nonimmune thrombocytopenia, fever, renal insufficiency, and CNS involvement. The peripheral smear in TTP contains schistocytes and decreased number of platelets.Hemophilia is an X-linked recessive disorder resulting is Factor VIII or Factor IX deficiency. It mainly manifests as bleeding in joints, muscles, subcutaneous tissue, and from the gastrointestinal tract; the bleeding may be spontaneous or trauma-related, depending on the severity of deficiency. A normal platelet count and prothrombin time but prolonged activated partial thromboplastin time (aPTT) are suggestive of hemophilia. Mild cases may escape detection until adulthood. Obtaining a detailed family history is very important. Specific assays for Factor VIII and Factor IX will confirm the diagnosis.Acute lymphoblastic leukemia is primarily a malignancy of childhood and young adulthood and presents commonly with bone pain and lymph-adenopathy. The peripheral smear and bone marrow usually contain a large number of lymphoblasts. Leukemoid reaction is a reactive leukocytosis with increased number of myelocytes, metamyelocytes, and bands in the peripheral circulation.

So the answer to this question is B


Instruction:
Most common malignancy of vulva is -
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Melanoma
D. Bartolin's gland tumor

Response:
Ans. is 'a' i.e., Squamous cell carcinoma Vulvar Carcinomao Squamous cell carcinoma is the most common histologic typeo Most patients are asymptomatic at diagnosis.o If symptoms exist, vulvar pruritis, mass, lump are the most common findingso Bleeding, ulcerative lesion, discharge, pain, dysuria - less frequent symptomso Large metastatic mass in the groin - Occasional symptom.Sites involvedo Labia majora and minora (60%)o Clitoris (15%)o Perineum (10%)o Too extensive to determine the site (10%)o Multifocal (5%)Staging of vulvar carcinomaStage ITumor confined to vulvaIALesions </= 2 cm in size, confined to the vulva or perineum and with stromal invasion <= 1mm, no nodal metastasis.IBLesions > 2cm in size or with stromal invasion > 1mm, confined to the vulva or perineum, with negative nodes.Stage IITumor of any size with extension to adjacent perineal structures (one - third lower urethra, one - third lower vagina, anus) with negative nodes.Stage IIITumor of any size with or without extension to adjacent perineal structures (one - third lower urethra, one - third lower vagina, anus) with positive inguino - femoral lymph nodes.Stage IVDistant metastasis.

So the answer to this question is A


Instruction:
Duffy antigen is associated with
A. Plasmodium falciparum
B. Plasmodium ovale
C. Plasmodium vivax
D. Plasmodium malariae

Response:
The Duffy glycoprotein is a receptor for chemicals that are secreted by blood cells during inflammation. It also happens to be a receptor for Plasmodium vivax, a parasite that invades red blood cells (RBCs) and causes malaria. Ref ananthnarayana and panikers microbiology textbook 8/e

So the answer to this question is C


Instruction:
Sections 312 to 315 deal with-
A. Kidnapping & abduction
B. Attention & abetment to suicide
C. Causing grevious hu
D. Voluntary miscarriage

Response:
Ans. is 'd' i.e., Voluntary miscarriage 312 IPC- causing miscarriage (3 years imprisonment with or without fine). 313 IPC- causing miscarriage without consent of lady (10 years imprisonment which can extend upto life with or without fine). 314 IPC- death of patient caused by miscarriage (10 years imprisonment with or without fine). 315 IPC- death of child during miscarriage (10 years imprisonment with or without fine).

So the answer to this question is D


Instruction:
Which among the following is the most common site of Felon?
A. Index finger
B. Ring finger
C. Little finger
D. Thumb

Response:
Felons are closed-space infections of the fingeip pulp. Staphylococcus aureus is the most common cause. Thumb and index finger are the most commonly affected digits. Felons are characterized by marked throbbing pain, tension, and edema of the fingeip pulp.

So the answer to this question is D


Instruction:
Which set of aerial blood values describes a heavy smoker who is a COPD patient becoming increasingly somnolent?
A. pH: 7.65; HCO3-: 48meq/L; PCO2: 45mmHg
B. pH: 7.5; HCO3-: 12meq/L; PCO2: 20mmHg
C. pH: 7.4; HCO3-: 18meq/L; PCO2: 40mmHg
D. pH: 7.2; HCO3-: 30meq/L; PCO2: 60mmHg

Response:
Respiratory acidosis can occur from pathological conditions that damage the respiratory centers or that decrease the ability of the lungs to eliminate CO2. For example, damage to the respiratory center in the medulla oblongata can lead to respiratory acidosis. Also, obstruction of the passageways of the respiratory tract, pneumonia, emphysema, or decreased pulmonary membrane surface area, as well as any factor that interferes with the exchange of gases between the blood and the alveolar air, can cause respiratory acidosis.

So the answer to this question is D


Instruction:
Medical ceificate is :
A. Documentary evidence
B. Oral evidence
C. Hearsay evidence
D. Parole

Response:
A i.e. Documentary evidence Medical ceificate is simplest form of documentary evidence. In case of death ceificate doctor - Must issue ceificate & cannot charge any fees for itQ Can not delay it even if his professional charges are not paid Must mention the exact cause of death instead of vague terms.

So the answer to this question is A


Instruction:
Procalcitonin is used as a marker for?
A. Sepsis
B. Medullary carcinoma of thyroid
C. Vitamin D resistant rickets
D. parathyroid adenoma

Response:
Answer is option 1, sepsis Prompt diagnosis and treatment with appropriate antimicrobial chemotherapy is of paramount impoance to reduce morbidity and moality associated with sepsis. Inflammatory markers currently in use, such as C-reactive protein (CRP) do not reliably differentiate between the systemic inflammatory response and sepsis. Procalcitonin (PCT), a precursor of calcitonin, is a 116 amino acid protein that has been proposed as a marker of disease severity in conditions such as septicaemia, meningitis, pneumonia, urinary tract infection (UTI) and fungal and parasitic infection. Ref :

So the answer to this question is A


Instruction:
Which of the following infestation leads to malabsorption-
A. Giardia lamblia
B. Ascaris lumbricoides
C. Necater Americana
D. Ancylostoma duodenale

Response:
G.lamblia is present within the glandular crypts of duodenal jejunal mucosa and doesnot invade the tissues.The parasite attaches itself to the epithelial surface of duodenum and jejunum by means of sucking disc.It may cause a disturbance of intestinal function,leading to malabsorption of fat (refer pgno:32 baveja 3rd edition)

So the answer to this question is A


Instruction:
Enzyme catalase is found in -
A. Lysosome
B. Mitochondria
C. Peroxisomes
D. Cytosol

Response:
Ans. is 'c' i.e., Peroxisomes Organelle or fractionMarkersMitochondriaInner membrane:- ATP synthase, Succinate dehydrogenaseIntermembrane space:- Creatine kinase, Adenyl kinase.Matrix:- Glutamate dehydrogenase, Pyruvate dehydrogenase, enzymes of TCA cycle & b-oxidation of fatty acidsPlasma membrane51-Nucleotidase, Adenyl cyclase, Na+K+ ATPaseLysosomeAcid phosphataseGolgi ApparatusGalactosyl transferase, Golgi mannosidase II,Sialyl transferase, GlcNAc transferase IEndoplasmic reticulumGlucose-6-phosphatasePeroxisomeCatalase, Urate (uric acid) oxidaseCytosolLactate dehydrogenaseNucleusDNARibosomeHigh content of RNA

So the answer to this question is C


Instruction:
The standard of care in splenctomy patients involves use of all the above vaccines except
A. H Influenzae type b
B. Meningococcal vaccine
C. Pneumococcal vaccine
D. Typhoid vaccine

Response:
Answer- D. Typhoid vaccineThe standard of care for postsplenectomy patients includes immunization within 2 weeks of splenectomy with:Polyvalent pneumococcal vaccine (PPV23),H. influenzae type b conjugate, andMeningococcal polysaccharide vaccine

So the answer to this question is D


Instruction:
Most common site for opening of TAPVC is -
A. Supracardiac
B. Cardiac
C. Infracardiac
D. Multiple

Response:
Ans. is 'a' i.e., Supracardiac TAPVCo Total anomalous pulmonary venous connection (TAPVC) is characterized by abnormal drainage of pulmonary veins into the right heart either by direct connection into the right atrium or into its tributarieso According to the site or level of connection of the pulmonary veins to the systemic venous system TAPVC has been classified into four typeso Type I (most common: 45%): Anomalous connection at supracardiac level (PV drains into left innominatevein or SVC)o Type II (25%): Anomalous connection at cardiac level (PV joins the coronary sinus or enter right atrium directly)o Type III (25%) : Anomalous connection at infracardiac level (PV drain into portal vein)?o Type IV (5%) : Anomalous connection at multiple levels.o In supracardiac TAPVC the pulmonary veins join to form a single trunk (common pulmonary vein) which than drain through anomalous connection

So the answer to this question is A


Instruction:
Target in RNTC P case detection for tuberculosis:
A. 90%
B. 95%
C. 85%
D. 70%

Response:
Ans- A Recent changes in Tuberculosis guidelines 2016 1. 3 new goals - cure, prevent resistance and break chain of transmission 2. Introduction of daily regime 3. Definition and treatment of mono and poly resistance apart from MDR and XDR Tuberculosis 4. Treatment in CAT 1 - 2(HRZE) + 4 (HRE): Continue ethambutol in continuation phase too 5. Treatment in CAT 2 - 2(HRZES) + 1(HRZE) + 5 (HRE) 6. Introduction of Bedaquiline as a new drug: ATP synthase inhibitor specifically targets myc. Tb Indicated in age more than 18 years Contraindicated in pregnancy and those taking hormonal OCP It may be given in patients with stable arrythmia 7. Definition of presumptive tuberculosis: Duration > 2 weeks etc. 8. New algorithm to diagnose Tuberculosis - pulmonary, extrapulmonary, drug resistant. 9. Introduction of Newer molecular methods like CBNAAT and line probe assay in diagnostic algorithm apart from smear microscopy and chest Xray 10. Diagnosis of tuberculosis based on X-ray will be called as Clinically diagnosed tuberculosis. 11. Sputum should be around 2ml and preferably be mucopurulent 12. Follow up - New and previously treated Drug sensitive pulmonary tuberculosis - No need to extend Intensive phase, sputum microscopy at end of IP and end of treatment, weight monthly, chest x-ray if required 13. Follow up - MDR tuberculosis - sputum smear monthly 3,4,5,6,7 months in intensive phase and at 3 months interval in continuation phase 9,12,15..., extend IP phase by maximum 3 months total of 9 months Monitoring health status of Tb treated patients (for recurrence of TB) for 24 months after treatment Online monitoring of treatment adherence through 99dots programme (currently it is on pilot basis running for TB- HIV patients) Intensified TB case finding in clinically, socially and geographically vulnerable population. It's a provider initiated activity Now 'TB suspect' term is replaced by 'presumptive TB case' In diagnostic algorithm sputum examination along with chest x-ray is recommended 'NSP' term is replaced by 'microbiologically confirmed case' NSN and others r called now onwards 'clinically diagnosed TB' case. (terms replaced) Definitions of cured, defaulted, treatment completed, failure, failure to respond, loss to follow up are some what changed Cat I, Cat II, Cat IV terminologies are obsolete and replaced by drug sensitive (new or previously treated) and drug resistant TB categories

So the answer to this question is A


Instruction:
Fully embryonated egg of trichuris trichiura contains
A. Eight blastomeres
B. Unsegmented ova
C. Rhabditiform larva
D. Ciliated embryo

Response:
None

So the answer to this question is C


Instruction:
Fracture of 1st metacarpal bone: (Repeat)
A. B arton' s fractu re
B. Bennett's fracture
C. Chauffer's fracture
D. Boxer's fracture

Response:
Ans: B (Bennett's fracture) Ref: Apley's Orthopedics, 9th ed. & Internet SourcesExplanation:FractureDescriptionAviator fractureFracture of neck of TalusBankart's fractureFracture of anterior glenoid associated with anterior shoulder dislocationBarton's fractureDistal radius fracture involving the articular surface with dislocation of the rad ocarpai jointBennett's fractureIntra-articular fracture of base of Thumb metacarpalBosworth fractureFracture of distal fibula with posterior dislocation of the proximal fibula behind the SibiaBoxer's fractureFracture of neck of little metacarpalBumper fracture tibial plateauCompression fracture of lateralChance fractureHorizontal fracture of vertebral bodyChauffeur's fractureIntra-articular fracture of radial styloidChopart's fracture- dislocationFoot dislocation through talonavicular and calcaneocuboid joints with associated fractures, usually after ankle twisting.treated in a non weight bearing cast for 6-8 weeksClay shoveller'sfractureSpinous process fracture of C6, C7 or T1Colles' fractureDistal radius fracture with dorsal angulation, impaction and radial driftDuverney fractureIsolated fracture of She iliac wingEssex-LoprestifractureComminuted radial head fracture with interosseous membrane disruption and distal radioulnar oint suciuxai onGaleazzi fractureRadius shaft fracture with dislocation of d stal radioulnar jo n:Gosselin fractureV-shaped distal tibia fracture extending into the tibial plafondHangman's fractureFracture of both pedicles of C2Hill-Sachs fractureImpacted posterior humeral headfracture cccumng during anterior shoulder dislocationHolstein-LewisfractureFracture of the distal third of thehumerus resulting in entrapment of the radial nerveHoldsworth fractureUnstable spinal fracture-d slocation at the thoracolumbar junctionHume fractureOlecranon fracture with anterior dislocation of radial headJefferson fractureFracture of first cervical vertebraJones fractureFracture of base of 5th metatarsalextend ng into intermetatarsai jointLe Fort fracturesSeries of facial fracturesLe Fort's fracturethe ankleVertical fracture of distal fibula with of avulsion of medial nnalleo usLisfranc fractureFracture dislocation of midfootMaisonneuvefractureSpiral fracture of proximal fibulaMalgaigne'sfractureVertical pelvic fracture through both pubic rami and the ilium orsacroiHiac joint with vertical displacementMarch fractureStress fracture of a metatarsal shaftMonteggia fractureProximal ulna fracture with dislocation of radial headMoore's fractureDistal radius fracturewith ulnar dislocation and entrapment ofstyloid process under annular ligamentPipkin fracture- dislocationPosterior dislocation of hip with avulsion fracture of fragment of femoral head by the igamentun teresPott's fractureBimalleolar fracture of the ankleRolando fractureComminuted fracture of base of first metacarpalRunner's fractureStress fracture of distal fibula 3-8 cm above the lateral malleolusSalter-HarrisfractureFractures involving a growth plateSegond fractureLateral tibial plateau avulsion fracture with anterior cruciate ligament tearShepherd'sfractureFracture of the lateral tubercle of the posterior process of the talusSmith's fractureDistal radius fracture with volar disolacementStieda fractureAvulsion fracture of the medial femoral condyle at the origin of the med al collateral ligamentTillaux fractureSalter-Harns Ml fracture of the tibiaToddler's fractureUndisplaced spiral fracture ofdistal tibia ir children under 8 years old

So the answer to this question is B


Instruction:
Annual Under-five deaths globally repoed are:
A. 6 million
B. 8 million
C. 10 million
D. 12 million

Response:
Under-five Deaths: Burden: 6.3 million Under-five deaths in world (2014) Leading causes of deaths: (45% associated with PEM) Pneumonia Low bih weight and prematurity Bih asphyxia Diarrhoea Malaria Ref: WHO population data, WHO website, 24th edition Pgno: 609

So the answer to this question is A


Instruction:
All are true of water shed infarcts except
A. Seen at junction of major cerebral aeries
B. Seen at sub ganglionic White matter
C. Cerebral vasospasm may cause it
D. Associated With hypoxic ischemic encephatopathy

Response:
Harrison's principles of internal medicine. *Occur at distal territories between the major cerebral aeries and can cause cognitive deficits,visual agnosia and weakness that is greater in proximal than in distal muscle groups. watershed stroke is defined as a brain ischemia that is localized to the vulnerable border zones between the tissues supplied by the anterior, posterior and middle cerebral aeries. The actual blood stream blockage/restriction site can be located far away from the infarcts. Watershed locations are those border-zone regions in the brain supplied by the major cerebral aeries where blood supply is decreased. Watershed strokes are a concern because they comprise approximately 10% of all ischemic stroke casesThe watershed zones themselves are paicularly susceptible to infarction from global ischemia as the distal nature of the vasculature predisposes these areas to be most sensitive to profound hypoperfusion Ref Harrison20th edition pg 2234

So the answer to this question is B


Instruction:
Velocity of sperms in female genital tract is?
A. 1- 3mm/day
B. 4-6 mm/day
C. 6-8 mm/day
D. 8-10 mm/day

Response:
1-3mm/day REF: Ganong's 22' ed p. 427, Guyton 11th edition page 999 Speed of sperm is 3mm/day (Ganong) The normal motile, feile sperm are capable of flagellated movement though the fluid medium at velocities of 1 to 4 mm/min. (Guyton)

So the answer to this question is A


Instruction:
A 35-year-old man has had recurrent attacks of abdominal pain and proximal motor neuropathy since puberty. The episodes are precipitated by infections and certain medications. During one of the attacks, the plasma porphobilinogen levels were increased. Which of the following medications is not considered safe in patients with this condition?
A. chlorpromazine
B. sulfonamide antibiotics
C. penicillin and derivatives
D. narcotics

Response:
In patients with acute intermittent porphyria, oral phenothiazines may be used for abdominal or muscle pains, and narcotics may also be used, but barbiturates should be avoided. Sulfonamides are unsafe, but penicillin and its derivatives are safe. Other unsafe medications include alcohol, carbamazepine, valproic acid, and synthetic estrogens and progestagens. Most heterozygotes remain asymptomatic unless a precipitating factor such as a drug or weight loss is present. Poorly localized abdominal pain is the most common symptom

So the answer to this question is B


Instruction:
Sulfonylureas act by:
A. Decreasing glucagon secretion from pancreas
B. Decreasing insulin secretion from pancreas
C. Increasing gluconeogenesis
D. Increasing insulin secretion from pancreas

Response:
Ans. (D) Increasing insulin secretion from pancreas(Ref: KDT 8/e p294)Sulfonylureas stimulate the release of insulin by the beta cells of the islets of Langerhans by blocking K+ channels. Glucagon secretion is also reduced by sulfonylureas, but it is a minor action.

So the answer to this question is D


Instruction:
The eye condition for which the World Bank assistance was provided to the National Programme for Control of Blindness (1994-2001) is:
A. Cataract
B. Refractive errors
C. Trachoma
D. Vitamin A deficiency

Response:
A i.e. Cataract World bank assisted cataract blindness control project was launched in 1994 to reduce the cataract back log in 7 states with highest prevalence of cataract blindness. These states in descending order are - Uttar Pradesh (U.P.), Tamil Nadu, Madhya Pradesh (M.P.), Maharashtra, Andhra Pradesh (A.P.), Rajasthan, Orrisa There is evidence of reduction of prevalence in all states except U.P.

So the answer to this question is A


Instruction:
Which fungus is not dimorphic
A. Blastomycosis
B. Histoplasmosis
C. Candida
D. Sporotrix schenkii

Response:
Candida is a yeast like fungi Reference: Textbook of Microbiology; Baveja; 4th edition

So the answer to this question is C


Instruction:
Regarding Dead space Volume in a normal individual
A. Anatomical dead space>Physiological dead space
B. Anatomical dead space=Physiological dead space
C. Anatomical dead space<Physiological dead space
D. Anatomical dead space is not related to Physiological dead space

Response:
The space in the trachea, bronchi, and other air passages which contains air that does not reach the alveoli during respiration, the amount of air being about 140 milliliters. Also known as anatomical dead space. (physiology) A calculated expression of the anatomical dead space plus whatever degree of overventilation or underperfusion is present; it is alleged to reflect the relationship of ventilation to pulmonary capillary perfusion. Also known as physiological dead space.Ref: Ganong&;s review of medical physiology; 23ed edition, page no:599

So the answer to this question is C


Instruction:
Fungus not isolated in culture ?
A. Cryptococcus
B. Dermatophyte
C. Candida
D. P. jiroveci

Response:
Ans. is 'd' i.e., P. jiroveci Culture of fungi Culture media used in mycology are : Sabouraud's glucose agar (most common) Czapek - Dox medium Corn meal agar Culture media are supplemented with chloramphenicol to minimize bacterial contamination and cycloheximide to reduce contamination with saprophitic fungi. Cultures are incubated at 22 - 30degC and 37degC. Rhinosporidium seebri and Pneumocystis jiroveci (formerly P. carinii) can not be cultivated in media. Malassezia furfur does not grow on regular sabouraud's medium. It requires complex media to grow. Malassezia furfur does not grow on regular sabouraud's medium. It requires complex media to grow M. furfur is a lipid dependent fungus and 1% emulsified olive oil is added to sabouraud medium for its cultivation Two media are now widely employed for all malassezia species. Dixon medium Modified dixon medium

So the answer to this question is D


Instruction:
Which of the following is true about case-control study?
A. Multiple outcomes can be studied
B. Rapid and inexpensive
C. Less prone to bias
D. Risky to subjects

Response:
A case-control study is designed to help determine if an exposure is associated with an outcome (i.e., disease or condition of interest). In theory, the case-control study can be described simply. First, identify the cases (a group known to have the outcome) and the controls (a group known to be free of the outcome). Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 79

So the answer to this question is B


Instruction:
40 year old men is suffering from fever & pain in scrotum which is not relieved by elevation of testis. 3 days before had sexual contact with a young female ?
A. Testicular tumour
B. Acute epididymitis
C. Torsion of testis
D. Acute orchitis

Response:
Ans is 'c' ie Torsion of testis Torsion of testis can be differentiated from acute epididymitis by Prehn's sign. ie. On elevation of testis the pain increases in --> Torsion On elevation of testis the pain decreases in epididymoorchitis. Dont be confused with fever, it can also occur in torsion, especially in older patients.

So the answer to this question is C


Instruction:
Characteristic nail finding in lichen planus?
A. Pitting
B. Pterygium
C. Beau's lines
D. Hyperpigmentation of nails

Response:
The nail changes in Lichen planus include: - Irregular longitudinal grooving and ridging of the nail plate. - Pterygium formation(Most characteristic) - Shedding of the nail plate with atrophy of nail bed. - Subungual hyperkeratosis. - Subungual Hyperpigmentation. Pterygium: Loss of small area of the nail plate with proximal nail fold epidermis adherent to the nail bed epidermis (pterygium unguis). Inverse pterygium is seen in systemic sclerosis. 1. Pitting- (i) Psoriasis- Irregular deep pits (Thimble pitting)(ii) Alopecia- Superficial regular pits (iii) Eczema 2. Beau's lines- trauma, hypocalcaemia, malnutrition3. Hyperpigmentation of nails- infection,drugs, dyes, melanoma, etc

So the answer to this question is B


Instruction:
Rathi, 26 years old female diagnosed to be suffering from depression. Now for the past 2 days had suicidal tendency, thought & ideas. The best treatment is -
A. Amitryptiline
B. Selegiline
C. Haloperidol + CPZ
D. ECT

Response:
Treatment of choice for suicidal depression is ECT.

So the answer to this question is D


Instruction:
Cytosolic cytochrome C plays an impoant function in:
A. Apoptosis
B. Cell necrosis
C. Electron transpo chain
D. Cell division

Response:
. Apoptosis

So the answer to this question is A


Instruction:
The most radiosensitive tissue among the following?
A. Skin
B. Gut epithelium
C. Germinal cells of the ovary and testis
D. Bone marrow

Response:
RELATIVE TISSUE RADIOSENSITIVITY Radiosensitive tissues Radio-resistant tissues Bone marrow Liver Gut epithelium Kidney Germinal cells of the ovary andtestis Brain Skin Connective tissue Foetal tissues Bone Many tumours Muscle Note: epiphyseal plate is the most radiosensitive area of bone, and the site, which if irradiated, is most likely to result in growth abnormalities.

So the answer to this question is D


Instruction:
A girl has primary amenorrhea with normal ovaries, absent internal genitalia but normal external genitalia. Most probable diagnosis :
A. Mayer-Rokitansky-Kuster-Hauser syndrome
B. Turner's syndrome
C. Noonan's
D. Androgen insensitivity syndrome

Response:
Mullerian agenesis, also called Mayer-Rokitansky-Kuster-Hauser syndrome or MRKH, named after August Franz Josef Karl Mayer, Carl Freiherr von Rokitansky, Hermann Kuster (1879-1964), and Georges Andre Hauser (1921-2009), is a congenital malformation characterized by a failure of the Mullerian duct to develop, resulting in a missing uterus and variable degrees of vaginal hypoplasia of its upper poion. Mullerian agenesis (including absence of the uterus, cervix and/or vagina) is the etiology in 15% of cases of primary amenorrhoea. Because most of the vagina does not develop from the Mullerian duct, instead developing from the urogenital sinus along with the bladder and urethra, it is present even when the Mullerian duct is completely absent. Ovaries are normal Hormonal levels are normal

So the answer to this question is A


Instruction:
In which one of the following conditions Dactylitiscan not be seen?
A. Sickle - cell anemia
B. Beta thalassemia
C. Congenital syphilis
D. Tuberculosis

Response:
Ans. is 'b' i.e., Beta thalassemia Dactylitis is inflammation of the digits. It is seen typically in sickle cell ds. & tuberculosis Other causes are - Sarcoidosis - infection : leprosy, salmonella, yaws, syphillis

So the answer to this question is B


Instruction:
A child presented with difficulty in seeing the blackboard in school. His teachers say that he frequently squeezes his eyes. Most probable cause is –
A. Hypermetropia
B. Myopia
C. Presbyopia
D. Astigmatism

Response:
Difficulty in seeing distant object (blackboard) and frequent squeezing of eye are features of myopia.

So the answer to this question is B


Instruction:
A drug effect that is produced by therapeutic doses of both timolol and amiodarone is blockade of:
A. Cardiac Na+ channels
B. Cardiac K+ channels
C. Beta adrenoceptors
D. Alpha-adrenoceptors

Response:
Amiodarone has wide spectrum of antiarrhythmic actions. It acts by all the four mechanisms: blockade of Na+ channels blockade of b receptors blockade of K+ channels blockade of Ca2+channels. Timolol is a b blocker. Therefore, common action of these two drugs is inhibition of b-receptors.

So the answer to this question is C


Instruction:
Type III Budd Chiari syndrome refers to:
A. Obstruction of IVC with or without secondary hepatic vein occlusion
B. Obstruction of major hepatic veins
C. Obstruction of the small centrilobular venules
D. None of the above

Response:
Budd-Chiari syndrome is a manifestation of hepatic venous outflow obstruction that was first described by George Budd in 1845. Primary Budd-Chiari syndrome -obstruction of the hepatic venous outflow tract is the result of an endoluminal venous lesion (thrombosis or web) Secondary when the obstruction results from the presence in the lumen of material not originating from the venous system or from extrinsic compression by a neighboring tumor. MUST KNOW: Classification of BCS According to the Level of Obstruction Type I - Obstruction of IVC with or without secondary hepatic vein occlusion Type II - Obstruction of major hepatic veins Type III - Obstruction of the small centrilobular venules (considered by some as veno-occlusive disease). Ref: J Ultrasound Med 2006; 25:373-379.

So the answer to this question is C


Instruction:
In Buggery, the victim in called paederasty if he is
A. Young boy
B. Young girl
C. Old woman
D. Old man

Response:
Ans. a (Young boy) (Ref. Reddy's essentials of FMT 23rd 1346)Sodomy (buggery) is anal intercourse between two males or, between a male and female. It is also called buggery. It is called gerontophilia when the active agent is an adult and paederasty, when the passive agent is a young boy, who is known as catamite.# A paedophile is an adult who repeatedly engages in sexual activities with children below the age of puberty.# The consent of sodomy is of no value, as both partners are punishable.# Incest: Incest is a sexual intercourse by a man with a woman, who is closely related to him by blood, e.g., a daughter, grand daughter, sister, stepsister, aunt and mother. In India, incest as such is not an offence.# Paraphilias: Abnormal and unorthodox sex play by using unusual objects or parts of the body are known as paraphilia.# Unnatural Offences (Voluntary sexual intercourse against the order of nature with any man or woman or animal is an unnatural sex offence . These offences are punishable with imprisonment for life or up to 10 y and also with fine).A. HomosexualityMeans persistent emotional and physical attraction to members of same sex.B. Sodomy (buggery)Is anal intercourse between two males or, between a male and female. It is also called buggery.It is called gerontophilia when the active agent is an adult and paederasty, when the passive agent is a young boy, who is known as catamite.0A paedophile is an adult who repeatedly engages in sexual activities with children below the age of puberty.The consent of sodomy is of no value, as both partners are punishable.C. Buccal coitus (coitus per os or sin of Gommorrah)The male organ is introduced into mouth, usually of a young child.1. Male prostitutes are called --Eunuchs.2. Castrated Eunuchs--Hijrahs.3. Eunuchs with intact genitalia--Zenana.D. TribadismFemale homosexuality is known tribadism or lesbianism.Sexual gratification of a woman is obtained by another woman by simple lip kissing, generalized body contact, deep kissing, manual manipulation of breast and genitalia, genital apposition, friction of external genital organs etc. In some cases, enlarged clitoris is used as an organ of passion or some artificial penis or phallus may be used. Many lesbians are masculine in type, possibly because of endocrine disturbances. The practice is usually indulged in by women who are mental degenerates or who suffer from nymphomania (excessive sexual desire).Lesbians who are jealous of one another, when rejected may commit homicide, suicide or both.E. BestialityBestiality is sexual intercourse by a human being with a lower animal. Dogs and cats are common animals for female. Usually the animal manipulates the genitalia with its mouth and the actual coitus is very rare.Sexual Perversions .UranismPerversion of sexual instinct.SadismIn sadism, sexual gratification is obtained or increased from acts of physical cruelty or causing of pain upon one's partner. The term is derived from the name of a French nobleman, the Marquis de Sade, infamous for his crimes and writings. Many of his stories were about sexuality, cruelty, and torture.MasochismOnly on receiving painful stimulus from sexual partner. Sexual asphyxia (autoerotic hanging) is seen. Autoerotic death may occur.BondageSadism and masochism are foound together with one type dominant over other.Fetichism QSexual gratification asociated with contact and site of central parts of female body or even clothings or other objects known as fetish objects.ExhibitionismIt is a willful and intentional exposure of the genitalia in a public place while in the presence of others, to obtain sexual pleasure. This is punishable under Sec 294 IPC with imprisonment up to 3 months or fine.Transvestism or eonism UranismDesire to be identified with the opposite sex or some find sexual pleasure in wearing clothes of opposite sex.Sexual gratification by fingering, fondling, fellatio, cunnilingus, etc.Voyeurism/ scotophilia /peeping tomsDesire to watch sexual intercourse or to observe genitals of others.TrolismExtreme degree of Voyeurism. A perverted husband stimulated by watching his wife having sexual intercourse with another man.Frotteurism Urolangia/Sexual gratification by rubbing genitalia aganist another person.coprophilisSexual excitement provoked by sight or odour of urine/feaces.Lust murderIn extreme cases of sadism, murder serves as a stimulus for sexual act and becomes equal to coitus.Sexual oraltsmIt is the obtaining of sexual pleasure from the application of the mouth to the sexual organs. Sin of Gommorrah - Buccal coitus, coitus per os.Felatio - is the oral stimulation or manipulation of the penis either by the female or male. Cunnilingus is the oral stimulation of the female genitalia.Masturbation (Onanism, ipsation)Masturbation is the deliberate self stimulation, which effects sexual arousal. In females, a finger is gently and rhythmically moved over clitoris or labia minora or steady pressure is applied over these parts with several fingers or whole hand. Masturbation is an offence when practiced openly e.g. in telephone booth, lavatories etc.IndecentIndecent assault is an offence committed on a female, with the intention or knowledge to outrageAssaulther modesty.This includes: Kissing of any part of female body, Pressing the breasts or private parts, Touching private parts or thereabout including thighs, Exposing her genital parts or breasts, A medical practitioner can be accused of indecent assault if he examines a female patient by stripping her clothes without her consent and even with her consent in the absence of a female attendant (viz. nurse). Such assaults are punishable under Sec 354 IPC up to 2 years imprisonment and/or fine.

So the answer to this question is A


Instruction:
The enzymes level used for evaluation of myopathies is
A. Gamma-glutamyl transferase (GGT)
B. Creatine kinase (CK)
C. Lactic dehydrogenase (LDH)
D. Alnine amino transferase (ALT)

Response:
Clinical suspicion for a myopathy is high, generally corroborated by elevated creatine kinase (CK) levels, it is often reasonable to skip or limit the extent of the EDX studies. Finally, EDX studies may be normal in selected muscle diseases (ceain endocrine, metabolic, congenital, and mitochondrial myopathies). Thus, in the appropriate clinical context, normal EDX studies do not necessarily rule out the presence of a myopathy.

So the answer to this question is B


Instruction:
ECT is absolutely contraindicated in
A. Raised ICT
B. Heart disease
C. Pregnancy
D. Very will patients

Response:
(A) Raised ICT # ECT is treatment of choice in severe depression.# indication of ECT in depression are:> Depression with suicidal risk> Severe refractory depression> Delusional depression> Depression with significant antidepressant side effects.> The response is rapid. Usually 6-8 ECTs are given three times a week along with antidepressants.# Contraindications of ECT:> The only absolute contraindication is the presence of raised intracranial tension.> Relative contraindications are: Recent myocardial infarction, Severe hypertension, Cerebrovascular accident, Severe pulmo iary disease, Retinal detachment, Pheochromocytoma.

So the answer to this question is A


Instruction:
Which of the following sphingolipidoses  has a characteristic presentation of exaggerated startle response
A. Fabry's Disease
B. Tay Sachs disease
C. Niemann Pick disease
D. Gaucher disease

Response:
Refer the byte "Sphingolipidoses"

So the answer to this question is B


Instruction:
Gross hematuria, 3 days following an attack of UI in a young female is likely due to?
A. Post streptococcal glomerulonephritis
B. IgA nephropathy
C. Minimal change disease
D. Membranous glomerulonephritis

Response:
The two most common presentations of IgA nephropathy are recurrent episodes of macroscopic hematuria during or immediately following an upper respiratory infection often accompanied by proteinuria or persistent asymptomatic microscopic hematuria. So the most likely diagnosis in this patient is IgA nephropathy. IgA nephropathy is an immune complex-mediated glomerulonephritis defined by the presence of diffuse mesangial IgA deposits often associated with mesangial hypercellularity. A renal biopsy is necessary to confirm the diagnosis. There is no optimal treatment. Angiotensin-conveing enzyme (ACE) inhibitors are given in patients with proteinuria or declining renal function. Poststreptococcal glomerulonephritis due to impetigo develops 2-6 weeks after skin infection and 1-3 weeks after streptococcal pharyngitis. This rules out Poststreptococcal glomerulonephritis from the diagnosis in this case. Minimal change disease and Membranous Glomerulonephritis does not produce gross hematuria but instead microscopic hematuria. Ref: Harrison's Internal Medicine, 18th Edition, Pages 2342-2343, 2340, 2345, 2347

So the answer to this question is B


Instruction:
During a pelvic examination, a gynecologist discovers an adnexal mass in a 32 year old woman. Resection of the mass demonstrates a malignant ovarian tumor. The tumor suppressor gene strongly associated with this tumor is also associated with cancer of which other organ or tissue?
A. Breast
B. Colon
C. Pancreas
D. Peripheral nerve

Response:
The tumor suppressor gene most strongly associated with ovarian carcinoma is BRCA-1, which is also associated with breast cancer. This tumor suppressor gene is located on 17q. Associate APC (5q), DCC (18q), and p53 (17p) with colon cancer . Associate DPC (18q) with pancreatic cancer.Associate NF-1 (17q) with neurofibromatosis type I, which is associated with peripheral nerve tumors. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 57. Neoplastic Diseases. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

So the answer to this question is A