Instruction:
Chest radiograph obtained from a male patient with hypeension, What could be the probable diagnosis?
A. Mitral Stenosis
B. Coarctation of Aoa
C. Transposition of Great Aeries
D. Aoic Stenosis

Response:
The CXR shows "3-sign" which is characterstic of Coarctation of aoa Coarctation of Aoa Inferior rib noching is seen and is due to pressure erosion by intercoastal aeries Rib notching is usually bilateral but assymetrical and mostly spares first two ribs The 3-sign appearance in CXR is due to enlargement of left subclan aery above the coarctation. Reverse 3 sign is seen in barium swallow in coarctation of aoa.

So the answer to this question is B


Instruction:
Which protein is defective in dialated cardiomyopathy?
A. Myosin
B. Troponin
C. Tropomysoin
D. Dystrophin

Response:
Ans. is 'd' i.e., Dystrophin o Dialated cardiomyopathy occus due to defective cytoskeleton proteins. Most important protein inovolved is dystrophin. Other proteins affected are1) Desmin2) MLP Protein3) ab crystalline proteins

So the answer to this question is D


Instruction:
Drug given to reduce the uterine contraction during preterm labour with LEAST side effect is:
A. Ritodrine
B. Nifedipine
C. Magnesium sulphate
D. Progesterone

Response:
Administration of progesterone inhibits the secretion of pro-inflammatory cytokines and delays cervical ripening. Thus, progesterone and its derivatives have long been advocated to diminish the onset of preterm labor in women at increased risk due to previous preterm delivery. Specific tocolytic agents include beta adrenergic receptor agonists, MgSO4, Ca2+ channel blockers, COX inhibitors, oxytocin-receptor antagonists, and nitric oxide donors. Among the given options progesterone is the drug with the least side effect. Ref: Schimmer B.P., Parker K.L. (2011). Chapter 66. Contraception and Pharmacotherapy of Obstetrical and Gynecological Disorders. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.

So the answer to this question is D


Instruction:
Square root of detion is called as
A. Standard detion
B. Standard error
C. Mean detion
D. Range

Response:
The standard detion Most frequently used measure of detion Widely used measure of variability or diversity used in statistics and probability theory Ref : Park&;s Textbook of Preventive and Social Medicine; 23rd edition - Pgno. 848

So the answer to this question is A


Instruction:
Ability of a screening test to diagnose true positive refers to: March 2010
A. Relative risk
B. Sensitivity
C. Specificity
D. Attributable risk

Response:
Ans. B: Sensitivity

So the answer to this question is B


Instruction:
PAN-SH site of fatty acid synthase complex accepts
A. Acetyl CoA
B. Malonyl CoA
C. Propionyl CoA
D. All

Response:
Malonyl - CoA

Central thiol or Pan -SH or 4-phosphopantetheine of ACP →  Accepts malonyl group
Peripheral thiol or cysteine -SH group of 3-ketoacyl synthase  → Accepts acetyl group

So the answer to this question is B


Instruction:
The occurrence of hyperthyroidism following administration of supplemental iodine to subject with endemic iodine deficiency goitre is known as
A. jod – basedow effect
B. wolff- chalkoff effect
C. thyrotoxicosis facticia
D. dequervain’s thyroiditis

Response:
None

So the answer to this question is A


Instruction:
Xanthoproteic reaction involves
A. Nitric acid
B. HCl
C. H2SO4
D. Carbolic acid

Response:
Xanthoproteic reaction is method for determination of amount of protein soluble in solution, using concentrated nitric acid.

So the answer to this question is A


Instruction:
Carcinoma that doesnot arise from thyroid follicles
A. Medullary carcinoma-thyroid
B. Papillary carcinoma-thyroid
C. Anaplastic carcinoma-thyroid
D. Huhle cell carcinoma-thyroid

Response:
Medullary carcinoma thyroid arise from parafollicular &;C&; cells. 20-30% of these occur in familial basis as pa of MEN 2A and MEN 2B syndromes Papillary, follicular and anaplastic carcinomas arise from follicular cells Huhle cell crcinoma is a subtype of follicular carcinoma and has more aggresive biological behaviour, compared to other follicular carcinomas of thyroid.

So the answer to this question is A


Instruction:
Flexibility of clasp depends on
A. Length & Cross section of clasp
B. Amount of tempering & Cold working
C. Composition & structure of material
D. All of above

Response:
None

So the answer to this question is D


Instruction:
Sleep walking is seen in which stage of sleep ?
A. REM
B. Stage 1-2 NREM
C. Stage 2-3 NREM
D. Stage 3-4 NREM

Response:
Impoant events occuring during sleep Deep sleep/slow wave sleep disorder : - These events occur during stage 3 & 4 of NREM. Impoant disorders are : Somnambulism (Night walking) : - Patient walks during sleep. Sleep terror or night terrors (pavor nocturnes) : - The patient suddenly gets up screaming, with autonomic arousal (tachycardia, sweating). Sleep terrors are rarely remembered in the morning (in contrast to night mares). No treatment is required only reassurance is required. However, in severe cases benzodiazepine can be used. Sleep-related enuresis (Nocturnal enuresis/bed wetting) : - Repetitive voiding occurs during sleep. First line of treatment is behaviour therapy. If behavioral therapy fails, desmopressin (DOC) and Imipramine can be used. Bruxism (Teeth grinding) Sleep-talking (Somniloquy). Ref: Guyton 12th Ed.

So the answer to this question is D


Instruction:
Shivering is controlled by
A. Medulla
B. Hypothalamus
C. Thalamus
D. Basal ganglia

Response:
Temperature Regulation Center: hypothalamic temperature regulation center acts as both a very sensitive sensory center (sensing brain temperature) and as an integration center, to maintain core temperature. Action: Compares input information on brain temperature (very sensitive) and skin temperature (less sensitive) with some "Reference" value or temperature ("Set Point"), and adjusts effectors to maintain actual temperature at the reference value (negative feedback loop). Fever: 1. Mechanism: Most common fevers are due to an increase in temperature regulation set point, due to agents called "pyrogens" pyrogen => hypothalamic set point increase 2. Pyrogenic Agents bacterial endotoxin bacterial debris antigen-antibody complexes neoplastic disease mechanical tissue trauma etc. 3. Body Temperature Changes a. Onset: actions to raise body temperature b. Termination: actions to lower temperature Ref: guyton and hall textbook of medical physiology 12 edition page number 856,857,858

So the answer to this question is B


Instruction:
The term 'Social Medicine' was first introduced by?
A. John Snow
B. David Morley
C. Jules Guerin
D. C.E.A. Winslow

Response:
Ans. is 'c' i.e., Jules Guerin The term social medicine was first introduced by Jules Guerin, a French physician in 1848.

So the answer to this question is C


Instruction:
Most common cause of acquired AV fistula is
A. Bacterial infection
B. Fungal infection
C. Blunt trauma
D. Penetrating trauma

Response:
. Ans : (d) Penetrating Trauma Penetrating injuries are the most common cause , but fistulas are sometimes seen after blunt trauma . Fungal and bacterial infections are not much common as penetrating trauma in acquired AV fistula.

So the answer to this question is D


Instruction:
Which of the following is not a broad spectrum antibiotic
A. Tetracycline
B. Chloramphenicol
C. Doxycycline
D. Penicillin G

Response:
None

So the answer to this question is D


Instruction:
Kuss mauls sign is seen in all except
A. Constrictive pericarditis
B. Right vericular infarct
C. Restictive cardiomyopathy
D. Cardiac tamponade

Response:
Kussmaul sign is a paradoxical rise in jugular venous pressure (JVP) on inspiration, or a failure in the appropriate fall of the JVP with inspiration. It can be seen in some forms of hea disease and is usually indicative of limited right ventricular filling due to right hea dysfunction. Ref Davidson 23rd edition pg 450

So the answer to this question is D


Instruction:
Coagulative necrosis is seen in A/E -
A. M.I.
B. T.B.
C. Thermal
D. Zenker's degeneration

Response:
Ans. is (B) Tuberculosis Coagulative necrosis: Coagulative necrosis typically occurs in ischemic injury to solid organs such as kidney, heart (myocardium) and adrenal gland. It is also seen with other types & injury e.g. * Coagulative necrosis of liver cells due to viruses or toxic chemicals and coagulative necrosis of skin in burns (thermal injury). "Caseous necrosis seen in T.B. is a distinctive form of coagulative necrosis", page 17 6th/e, Robbins illustrated

So the answer to this question is B


Instruction:
Drugs that do not increase QT interval: (PGI Nov 2010)
A. Amiodarone
B. Quinidine
C. Digitalis
D. Amitryptyline

Response:
Ans: C (Digitalis) "Digitalis cause shortening of QT interval"- KDT 6th/495Drugs that Prolong Q-T intervalAntiarrhythmicsQuinidineQ, procainamideQ, disopyramide. propafenone, AmiodaroneQ, SotalolAntimicrobialQuinine, mefloquine, artemisinin, halofan- trine, sparfloxacin, gatifloxacinAntihistaminicTerfenadineQ, astemizole, ebastineAntidepressantsAmitryptyline & other tricyclicsAntipsych oticsThioidazine, risperidoneProkineticsCisaprideQ

So the answer to this question is C


Instruction:
Typically bilatyeral inferior subluxations of the lens is seen in -
A. Marfan's syndrome
B. Homocystinuria
C. Hyperinsulinemia
D. Ocular trauma

Response:
In Homocystinuria there is inferomedial (inferonasal) dislocation of lens. (Ref: Khurana 7th/e p.222 & 4th/e p.202)

So the answer to this question is B


Instruction:
A middle aged person presented with the complaints of fear of leaving home, fear of travelling alone and fear of being in a crowd. He develops marked anxiety with palpitations and sweating, if he is in these situations. The most likely diagnosis is:
A. Generalized anxiety disorder
B. Schizophrenia
C. Personality disorder
D. Agoraphobia

Response:
Ans. D. AgoraphobiaAgoraphobia fear or avoidance of places like crowds, public places, being outside alone, public transpoation, from which escape would be difficult in the event of panic symptoms.Treatment includes:Pharmacotherapy -Benzodiazepines, SSRIs, TCAsPsychotherapy -Suppoive, Insight-oriented, Behavior, Cognitive and Viual therapyOther types of phobia:Claustrophobia: Fear of closed spacesAerophobia: Fear of flyingXenophobia: Fear of strangers

So the answer to this question is D


Instruction:
Classical triad of Budd-Chiari syndrome:
A. Fever, jaundice, abdominal pain
B. Fever, ascites, jaundice
C. Hepatomegaly, abdominal pain, ascites
D. Abdominal pain, jaundice, Hepatomegaly

Response:
BUDD-CHIARI SYNDROME TRIAD- Ascites + Hepatomegaly + Abdominal pain . Treatment Side to Side Poo-caval Shunt is the most effective therapy.

So the answer to this question is C


Instruction:
Losaan is similar to enalapril in all of the following features except:
A. Anti-hypeensive efficacy
B. Potential to reverse left ventricular hyperophy
C. Lack of effect on carbohydrate tolerance
D. Potential to induce cough in susceptible individuals

Response:
Losaan belongs to the class of ARB'sEnalapril belongs to the class of ACEI ARB's differs from ACE inhibitors in: They do not interfere with degradation of bradykinin: no rise in level of bradykinin, substance P occurs. ARB does not produce cough. With Losaan no significant effect on plasma lipid profile, carbohydrate tolerance or insulin sensitivity has been noted. A mild probenecid- like uricosuric action is produced.

So the answer to this question is D


Instruction:
The posterior urethra is best visualized by –
A. Static cystogram
B. Retrograde urethrogram
C. Voiding cystogram
D. CT cystogram

Response:
Micturating / Voiding cystourethrography is the best method to visualize posterior urethra, posterior urethral valve and vesico ureteric reflux.

So the answer to this question is C


Instruction:
Under the Medical Termination of Pregnancy Act the opinion of two registered medical practitioners is necessary to terminate the pregnancy. Where the pregnancy exceeds :
A. 6 weeks
B. 8 weeks
C. 10 weeks
D. 12 weeks

Response:
12 weeks

So the answer to this question is D


Instruction:
A 40 year old female patient complains of breathlessness. Patient gives a history of chest trauma 4 hours ago. General physical examination reveals altered mental status. Further investigations suggest-
Blood pressure-80/60 mmHg.
Heart rate- 120 bpm.
Muffled heart sound.
Jugular venous pressure- raised.
Pulsus paradoxus - present.
The patient is in which type of shock?
A. Neurogenic
B. Obstructive
C. Distributive
D. Hypovolemic

Response:
Note- Jugular venous pressure is high in cardiogenic and obstructive shock.
Cardiac tamponade caused by chest trauma may lead to obstructive shock.
Muffled heart sound, hypotension, raised JVP → Beck’s triad → symbolises cardiac tamponade a cause for obstructive shock.

So the answer to this question is A


Instruction:
ASD patient with murmur similar to MR and left axis detion of 40 degrees is having?
A. TGA
B. Ostium secundum
C. Ostium primum
D. Flappy mitral valve

Response:
Floppy mitral valve REF: Pediatrics: A Concise Text - SK Kabra, RN Srivastava Page 135 Repeat in December 2009, December 2011 The murmur is the clinching point here as the patient is having ostium primum type of ASD with MR and Ostium primum defect alone cannot produce such murmur and in question it is already mentioned that the patient is having ASD, Floppy mitral valve should be the answer. "Presence of pansystolic murmur of mitral regurgitation (MR) in a patient with ASD suggests the presence of ostium primum defect with cleft mitral laeflet or floppy mitral valve with mitral valve prolapsed" "ECG shows right axis detion in ostium secundum ASD and extreme left axis detion in ostium primum ASD" "Clinical presentation of ostium primum is similar to ostium secundum except that there may be a mitral systolic murmur due to MR and ECG shows left axis detion"

So the answer to this question is D


Instruction:
Onanism is: TN 07
A. Natural sexual offence
B. Unnatural sexual offence
C. Perversion
D. Indecent assault

Response:
Ans. Perversion

So the answer to this question is C


Instruction:
Enterobacteriacae is classfied based on?
A. Mannitol fermentation
B. Catalase and oxidase reaction
C. Oxygen requirment
D. Lactose fermentation

Response:
Ans. is 'd' i.e., Lactose fermentation Initially Enterobacteriacea was classifed on the bases of their lactose fermenting ability on MacConkey's medium, the most popular medium for the isolation of fecal bacilli. Lactose fermenters produce pink/bright red colonies on MacConkey's agar , while lactose non-fermenters produce pale colonies : i) Lactose fermenters (rapid) : These are Coliforms, e.g. Escherichia, Klebsiella and Enterobacter aerogenes. ii) Late lactose fermenters (slow) : These are Shigella Sonnei, Serratia, Citrobacter, Arizona, Providencia and Ervinia. iii) Non-lactose fermenters : Shigella except Shigella Sonnei, Salmonella, Proteus.

So the answer to this question is D


Instruction:
A patient of schizophrenia on neuroleptics, his psychotic symptoms get relieved but developed sadness, talks less to others, remain on the bed, all of following are likely causes except -
A. Parkinsonism
B. Major depression
C. Negative symptoms are still persisting
D. He is reacting to external stimuli

Response:
In post-schizophrenic depression, the depressive symptoms become florid as an outcome of schizophrenic illness and not as a reaction to it. Schizophrenia resolves to a great extent but some symptoms still persist. For diagnosis, there should be a positive history of schizophrenia within the previous year. If schizophrenic symptoms are not present, a depressive episode is to be considered.
Differential diagnosis of post-schizophrenic depression includes residual phase (negative symptoms) of schizophrenia, Schizoaffective disorder (Depressive type), adverse effects of antipsychotics (Parkinsonism, akathisia).

So the answer to this question is D


Instruction:
Surgeon excise a poion of liver to the left of the attachment of the falciform ligament. The segments that have been resected are
A. Segment 1a and 4
B. Segment 1 and 4b
C. Segment 2 and 3
D. Segment 1 and 3

Response:
Segmental anatomy of the liver Understanding the internal anatomy of the liver has greatly facilitated safe liver surgery. Couinaud, a French surgeon,described the liver as being divided into eight segments . Each of these segments can be considered as a functional unit, with a branch of the hepatic aery, poal vein and bile duct, and drained by a branch of the hepatic vein. It is the concept of these segments as distinct functional units that guides 'anatomical' liver resection. The overall anatomy of the liver is divided into a functional right and left 'unit'along the line between the gallbladder fossa and the middle hepatic vein (Cantlie's line). Liver segments (V-VIII) to the right of this line are supplied by the right hepatic aery and the right branch of the poal vein, and drain bile the right hepatic duct. To the left of this line (segments I-IV), functionally, is the left liver, which is supplied by the left branch of the hepatic aery and the left poal vein branch, and drains bile the left hepatic duct. Resections can be performed of indi- vidual segments or of the whole of the left or right hemiliver Ref: Bailey and love 27th edition Pg no :1153

So the answer to this question is C


Instruction:
A 23-year-old lady presents with acute right sided lower abdominal pain since 4 hours. There is tenderness at McBurney's point. Which investigation is best suited to confirm the diagnosis of appendicitis
A. CT scan
B. Plain X-ray
C. Serum ESR
D. MRI abdomen

Response:
Ans. (a) CT scanRef: Sabiston 20th edition, Page 1299Various investigations done for acute appendicitis:* X-ray abdomen erect -- Fecalith can be seen in 5% cases only* USG abdomen -- noncompressible appendix +sensitivity +78-83%, Specificity = 83-93%.* CECT abdomen with only IV contrast -- sensitivity and specificity is high (90-100%) -- Thickened appendix 7mm diameter+, most accurate imaging used.* MRI abdomen -- is 100% sensitive and, 98% sensitive. Used only in pregnant females. Operator dependent.

So the answer to this question is A


Instruction:
Sullivan index is an index for
A. Life free of disability
B. Life Expectancy
C. Earning capacity
D. Population index

Response:
Sullivan's index also known as Disability Free Life Expectancy (DFLE) is a method to compute life expectancy free of disability. It is calculated by formula:Life expectancy minus duration of disability Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 26

So the answer to this question is A


Instruction:
Lipofuschin is an insoluble endogenous pigment, also known as
A. Lipochrome
B. Wear and tear pigment
C. Aging pigment
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
Screening for Down's syndrome should be done in the age group in pregnancy:
A. 30
B. 35
C. All in the reproductive age group
D. None of the above

Response:
Ans. is c, i.e. All in reproductive age groups.Ref. Williams Obs. 23/e, p 296, Fernando arias 2/e, p 26Most important factor for Down syndrome is maternal ageAs age of mother increases risk of down syndrome increases. Current recommendations for screening of Down syndrome are universal screening, i.e. it should be done in all pregnant females of all age.In 30 years : 1 in 1000In 35 years : 1 in 350In 40 years : 1 in 10045 years : 1 in 30

So the answer to this question is C


Instruction:
A child with fever presents with multiple tender erythematous skin lesions. n microscopic examination the skin lesions are seen to have neutrophilic infiltration in the dermis. What is the diagnosis -
A. Sweet syndrome
B. Behcet's syndrome
C. Pyoderma gangrenosum
D. Juvenile dermatosis

Response:
A child with fever and multiple tender erythematous skin lesions with neutrophilic dermal infiltrate suggest the diagnosis of the sweet syndrome, a neutrophilic dermatosis.

So the answer to this question is A


Instruction:
Active form of Vitamin D
A. Cholecalciferol
B. Calciferol
C. Calcitriol
D. 25-hydroxy cholecalciferol

Response:
(C) Calcitriol # Vitamin D Is Metabolized to the Active Metabolite, Calcitriol, in Liver & Kidney.> Cholecalciferol, either synthesized in the skin or from food, undergoes two hydroxylations to yield the active metabolite, 1,25-dihydroxyvitamin D or calcitriol.> Ergocalciferol from fortified foods undergoes similar hydroxylation to yield calcitriol.> In the liver, cholecalciferol is hydroxylated to form the 25-hydroxy-derivative, calcidiol.> This is released into the circula-tion bound to a vitamin D binding globulin, which is the main storage form of the vitamin.> In the kidney, calcidiol undergoes either 1 -hydroxylation to yield the active metabolite 1,25-dihydroxyvitamin D (calcitriol), or 24-hydroxylation to yield a probably inactive metabolite, 24,25-dihydroxyvitamin D (24-hydroxycaicidiol).> Some tissues, other than those that are involved in calcium homeostasis, take up calcidiol from the circulation and synthesize calcitriol that acts within the cell in which it was synthesized.

So the answer to this question is C


Instruction:
The characteristic Nail finding in lichen planus is :
A. Pitting
B. Pterygium
C. Beau's lines
D. Hyperpigmentation of the Nails

Response:
Ans. is 'b' Pterygium//?e/. Page 191, 4/e, Pasricha]* Nail Findings in lichen planusNail involvement is seen in 10% of pts with lichen planusMild form of Nail involvement * Onychorrhexis - Slight roughness of Nail plate with longitudinal ridging and brittleness.Severe form of Nail involvement:* Anychia-Complete absence of nail plate* Pterygium-Skin fold from post nail fold starts overgrowing the nail plate to form pterygium.Other Disorders of Nail 1) Beau's Line-*Any severe systemic illness.2) Oncholysis-*Psoriasis* *Fungal infection *Thyrotoxicosis * *Tetracycline *Trauma3) Pitting-*Psoriasis* *Alopecia Areata *Lichen Planus *Eczema4) Ridging-*Lichen Planus*5) Koilonychia-*Iron deficiency Anaemia* *Lichen planus *Repeated exposure to detergents.6) Muehrcke's nail-*Severe hypoalbuminemia as in Nephrotic syndrome.7) Blue nails-*Wilsons disease* *Hemochromatosis *Antimalarial drug8) Brown nail-*Addison's disease* *Arsenic poisoning*9)Leukonychia-*Liver disease*10) Mee's Line-*Arsenic poisoning*Note : Nail involvement is not seen in DLE.

So the answer to this question is B


Instruction:
The rate-limiting step in the synthesis of cortisol is catalyzed by:
A. 21-Hydroxylase
B. 3b-Hydroxysteroid dehydrogenase
C. Cholesterol side-chain cleavage enzyme
D. 11b-Hydroxylase

Response:
Ans. C. Cholesterol side-chain cleavage enzymeThe first and rate-limiting step in all steroid biosynthesis is catalyzed by cholesterol sidechain cleavage enzyme, resulting in pregnenolone and iso caproic acid. 17a-hydroxylase, 3b-hydroxysteroid dehydrogenase, 21-hydroxylase, and 11b- hydroxylase are all involved in the synthesis of cortisol, but are not rate-limiting. 3-Hydroxy-3-methylglutaryl CoA reductase catalyzes the rate-limiting step in de novo cholesterol synthesis.

So the answer to this question is C


Instruction:
Keivms skin test is used for diagnosis of
A. Sarcoidosis
B. Wegeners granulomatosis
C. Graves disease
D. None

Response:
Ans. is 'a' i.e., Sarcoidosis Kveim test (Nickerson-kveim or Kveim-Siltzbach test) was a skin test used to detect sarcoidosis. It is not used know.

So the answer to this question is A


Instruction:
Deep inguinal ring is formed in:
A. Transversus abdominis
B. Transversalis fascia
C. External oblique aponeurosis
D. Internal oblique aponeurosis

Response:
Ans. B Transversalis fascia* Deep inguinal ring is an oval opening formed in transversalis fascia.# It lies about 0.5 inch (1.3 cm) above inguinal ligament midway between anterior superior iliac supine and symphysis pubis.# Medial to deep inguinal ring is inferior epigastric vessels.Extra Mile# Superficial inguinal ring: A triangular shaped opening in the aponeurosis of external oblique muscle and lies immediately above and medial to pubic tubercle.

So the answer to this question is B


Instruction:
Which of the following is/are branch of facial nerve?
A. Chorda tympani
B. Lesser petrosal nerve
C. Greater petrosal nerve
D. Zygomatic nerve

Response:
Ref:BD Chaurasia's HUMAN ANATOMY, Volume 3, 4th edition. The facial nerve leaves the skull by passing through the stylomastoid foramen and within the facial canal.It divides into (1) Greater petrosal nerve (2) the nerve to the stapedius; and (3) the chorda tympani.

So the answer to this question is A


Instruction:
Which of the following is not true about Beurger's disease
A. Common in lower extremities
B. Superficial thrombophlebitis is common
C. Cigarette cessation is definitive treatment
D. Usually below 30yrs of age

Response:
Ans) c (Cigerette cessation is....) Ref bailey 25th ed p 923-924Thrombo angitis obliterens/ Beurger's diseaseCharacterised by occlusive disease of the small and medium sized arteries (plantar, tibial, radial etc), thrombophlebitis of the superficial or deep veins and Raynaud's syndrome.Occurs in male smokers usually under the age of 30yrs.Often only one or two of the three manifestations are present.Histologically there are inflammatory changes in the walls of arteries and veins, leading to thrombosis.Treatment is total abstinence from smoking which arrests, but cloesn reverse, the disease.Established arterial occlusions are treated as for atheromatous disease, but amputations may eventually be required.Smoking cessation is not the definitive treatment.

So the answer to this question is C


Instruction:
Anterior uveitis in a hypertensive patient, the drug of choice to decrease IOP –
A. Latanoprost
B. Pilocarpine
C. Epinephrine
D. Timolol

Response:
β-blockers (Timolol) are the DOC to reduce IOT in a patient with uveitis.

So the answer to this question is D


Instruction:
A down syndrome child is mentally retarded. All cytogenetic abnormalities may occurs except ?
A. Deleted 21
B. Trisomy 21
C. Robesonia translocation
D. Mosaic

Response:
In approximately 95% cases down syndrome is due to presence of 3 copies of chromosome 21. Approximately 1% cases with trisomy 21 are mosaics . Another 4% have a translocation that involves chromosome 21. Majority of translocation are fusions at the centromere between chromosome 13,14,15,21, and 22 known as robesonial translocation. Reference : Nelson TB of pediatrics edition 19 pg 402.

So the answer to this question is A


Instruction:
Endemic ascitis is associated with the following -
A. Pyrrolizidine
B. Aflatoxin
C. Sanguinarine
D. Beta oxalylamino alanine (BOAA)

Response:
Ans. is 'a' i.e. Pyrrolizidine Repeat from Nov 06Endemic ascites is caused by a hepatotoxin - pyrrolizidine alkaloid found in weed seeds of Crotolaria (Jhunjhunia).These weed seeds of Jhunjhunia contaminate the millet seeds Panicum milare (locally k/a Gondhli)Endemic ascites presented in Sarguja district of Madhya Pradesh during 1973 & 1976 as outbreak of rapidly developing ascites and jaundice with high mortality.Preventive measureseducating the people de weeding of Jhunjhunia plants which grow along with the staple food-millet.sieving to separate out the Jhunjhunia seeds from millet seeds.Other food toxicant diseases:Neurolathyrism - caused by toxin Beta oxalyl amino alanine (BOAA) found in seeds of pulse Lathyrus sativum (Khersari dal)Epidemic dropsy - caused by toxic alkaloid Sanguinarine found in argemone mexicana seeds. Argemone oil contaminates mustard oil.Aflatoxicosis is due to ingestion of aflatoxins produced by certain fungi, Aspergillus flavus and A. parasiticus. Aflatoxins are Hepatotoxins & also carcinogenic.

So the answer to this question is A


Instruction:
The impoant fatty acid present in breast milk which is impoant for growth is
A. Docosahexaenoeic acid
B. Palmitic acid
C. Linoleic acid
D. Linolenic acid

Response:
Breast milk is rich in docosahexaenoic acid. It is necessary for the myelination of the nervous system and thus helps in brain development. Ref: Page 151; Ghai Essential Pediatrics; 8th edition

So the answer to this question is A


Instruction:
A 30 years old patient of head injury was brought to the emergency. NCCT was performed and the findings are given below. All of the following are true about this condition except:
A. Aerial bleeding
B. Lucid interval is positive
C. Full recovery is rare even after the treatment
D. Immediate surgical evacuation should be done

Response:
The given NCCT image showsbiconvex/lentiform hyperdensity, which is a characteristic feature of Epidural hematoma (EDH) Epidural Hematoma Due to rupture of middle meningeal aery Happens due to of Pterion (H shaped suture) Has lucid interval Treatment: Immediate surgical evacuation should be done - BURR HOLE Has good prognosis

So the answer to this question is C


Instruction:
The amount of estrogen in low dose oral contraceptive pills is:
A. 30 micrograms
B. 40 micrograms
C. 50 micrograms
D. 20 micrograms

Response:
Over time, the estrogen and progestin contents of COCs have been reduced remarkably to minimize hormone-related adverse effects. Currently, the lowest acceptable dose is limited by their ability to prevent pregnancy and unacceptable breakthrough bleeding. Although daily estrogen content varies from 20 to 50 g of ethinyl estradiol, most contain 35 ug or less. Low-dose COCs usually contains 20 ug ethinyl estradiol. Ref: Leveno K.J., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 32. Contraception. In K.J. Leveno, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

So the answer to this question is D


Instruction:
Which of the following is associated with acute hemorrhagic conjunctivitis -
A. Rhabdovirus
B. Enterovirus
C. Calcivirus
D. Echovirus

Response:
Acute hemorhagic conjunctivitis is caused by Enterovirus 70. REF:ANATHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:493

So the answer to this question is B


Instruction:
LCAT deficiency increases the following
A. Chylomicrons
B. IDL
C. VLDL
D. HDL

Response:
* HDL is synthesized and secreted from both liver and intestine * Lecithin:cholesterol acyltransferase (LCAT) activity is associated with HDL containing apo A-I. * As cholesterol in HDL becomes esterified, it creates a concentration gradient and draws in cholesterol from tissues and from other lipoproteins thus enabling HDL to function in reverse cholesterol transpo * Absence of LCAT leads to block in reverse cholesterol transpo. HDL remains as nascent disks incapable of taking up and esterifying cholesterol. Ref:- Harper 30/e; pg num:- 249, 272

So the answer to this question is D


Instruction:
The walls of full gold crown preparation should:
A. Be parallel
B. Angle of convergence 5°
C. Angle of divergence 5°
D. Roughened to increase retention

Response:
None

So the answer to this question is A


Instruction:
End stage Lung disease seen in -
A. Sarcoidosis
B. Interstitial lung disease
C. Langerhans cell histiocytosis
D. All

Response:
Ans. is 'a' i.e., Sarcoidosis; 'b' i.e., Interstitia lung disease; 'c' i.e., Langerhan's cell histiocytosis End-stage lung disease o When the lung can no longer keep the blood supplied with oxygen it is referred to as end-stage lung disease. o Causes of end stage lung disease - ARDS Pulmonary circulatory diseases Tuberculosis Cystic fibrosis Pneumoconiosis (Asbestosis and others) COPD (emphysema, chronic bronchitis) Interstitial lung diseases (e.g. sarcoidosis) o Pulmonary Langerhans cell histiocytosis is a progressive disease, and leads to endstage lung disease.

So the answer to this question is D


Instruction:
Coefficient of thermal expansion of the wax is:
A. 30×10-6/°C
B. 50×10-6/°C
C. 350×10-6/°C
D. 35×10-6/°C

Response:
Waxes have low thermal conductivity and a high coefficient of thermal expansion.

So the answer to this question is C


Instruction:
\r\nBruises are due to effusion of blood into the tissues, due to the rupture of blood vessels. In which pa of the body a lesser impact causes maximum bruise?
A. Face
B. Sole
C. Back
D. Palm

Response:
If the pa is vascular and loose, such as face, vulva, scrotum a slight degree of violence may cause a large bruise because there is sufficient space for blood to accumulate. If the tissues are strongly suppoed, and contain firm fibrous tissues and covered by thick dermis, such as abdomen, back, scalp, palms and soles, a blow of moderate violence may produce a comparatively small bruise. Ref: The Essentials of Forensic Medicine and Toxicology by Narayan Reddy, 27th edition, Page 160-161.

So the answer to this question is A


Instruction:
Hypercapnia is NOT seen in: March 2013
A. Severe asthma
B. Anaphylaxis
C. Inhalational burn injury
D. ARDS

Response:
Ans. D i.e. ARDS

So the answer to this question is D


Instruction:
Wilms tumor - most common presenting symptom-
A. Haematuria
B. Asymptomatic abdominal mass
C. Abdominal pain
D. Headache

Response:
Ans. is 'b' i.e., Asymptomatic abdominal massWilm's tumor (Nephroblastoma)Most common malignant tumor of kidney, 80% of tumor present below 5 year of age.PresentationAsymptomatic abdominal mass (M. C.).Haematuria (10-25%).Hypertension (25%).Abdominal pain (30%).Fever (20%).

So the answer to this question is B


Instruction:
Haversian systems (osteons) are found primarily in the
A. Spongy bone
B. Periosteum
C. Alveolar bone proper
D. Endosteum

Response:
None

So the answer to this question is C


Instruction:
Regarding schick's test which of the following is false
A. Erythematous reaction in both arms indicates
B. Positive test means that person is immune to hypersensitivity diphtheria
C. Diphtheria antitoxin is given intradermal
D. None of the above

Response:
None

So the answer to this question is B


Instruction:
A 13-year-old female is brought to the emergency department with a complaint of severe, deep pelvic discomfort. Physical examination reveals that the patient has an intact hymen. Incision of the hymen reveals hematocolpos. Which of the following conditions is associated with hematocolpos?
A. Cyst of Bartholin gland
B. Bleeding from an ectopic pregnancy
C. Imperforate hymen
D. Indirect inguinal hernia with cremasteric arterial bleeding

Response:
Hematocolpos is characterized by filling of the vagina with menstrual blood. This commonly occurs due to the presence of an imperforate hymen. Bartholin gland ducts open into the vestibule of the vagina; therefore, a cyst in Bartholin gland would not cause hematocolpos. Blood from a ruptured ectopic pregnancy most often drains into the rectouterine pouch (of Douglas). Females often have a diminutive cremaster muscle and cremasteric artery and vein, but none of these is associated with hematocolpos. The cremasteric artery provides a small branch to the round ligament of the uterus (sometimes called "Samson's artery"), which must be kept in mind during a hysterectomy, with division of the round ligament. Bleeding from the uterine veins would not flow into the vagina.

So the answer to this question is C


Instruction:
Variant of papillary carcinoma thyroid
A. Medullary
B. Wahin
C. Columnar cell
D. Insular

Response:
Papillary carcinoma common in female and younger age group . Its called hormone dependend tumour. Types: tall cell type - very aggresive type show capsular and vascular invasion. Columnar type- seen in males . Treatment :total oe near total thyroidectomy Suppresive dose of L thyroxine. SRB's Manual of Surgery.Edition -5. Pg no:480

So the answer to this question is C


Instruction:
Ramsay Hunt syndrome is caused by infection of:
A. Herpex simplex
B. Varicella zoster
C. Adenovirus
D. Picornavirus

Response:
Varicella zoster virus may also cause facial nerve paralysis when the virus reactivates from dormancy in the nerve. This condition, known as Ramsay Hunt syndrome, is characterized by severe otalgia followed by the eruption of vesicles of the external ear. Treatment is similar to Bell's palsy, but full recovery is only seen in approximately two thirds of cases. Ref: Schwaz's principle of surgery 9th edition, chapter 18.

So the answer to this question is B


Instruction:
Niemann-pick disease is due to the disturbance in:
A. Lipid metabolism
B. Protein metabolism
C. Carbohydrate metabolism
D. Mineral metabolism

Response:
Progressive lysosomal accumulation of glycosphingolipids in the central nervous system leads to neurodegeneration, storage in visceral cells can lead to organomegaly, skeletal abnormalities, pulmonary infiltration, and other manifestations. Such diseases are due to defect in lipid metabolism.

So the answer to this question is A


Instruction:
Carpet tacking is characteristically seen in
A. DLE
B. SLE
C. Lichen planus
D. Dermatitis herpetiformis

Response:
Discoid lupus erythematosus (DLE, also called chronic cutaneous LE) is characterized by discrete lesions, most often found on the face, scalp, and/or external ears. The lesions are erythematous papules or plaques with a thick, adherent scale that occludes hair follicles (follicular plugging). When the adherent scale is removed from the lesions of discoid lupus erythematosus, the undersurface of the scale shows horny plugs that have occupied patulous hair follicles. (Carpet tack sign) Ref Harrison 20th edition pg 1244

So the answer to this question is A


Instruction:
All are true about Hypothyroidism except:
A. Delayed dentition
B. Widened fontanelle
C. Distended abdomen
D. All are true

Response:
d. All are true(Ref: Nelson's 20/e p 2669-2773, Ghai 8/e p 516-521)If left untreated, a child with Hypothyroidism develops the following features:Growth will be stunted, the extremities are shortFace: Depressed bridge of nose, swollen eyelids, thick, broad, protruding tongueDelayed Dentition, hoarse voice; Broad hands with short fingers; Dry and scaly skin with little perspiration

So the answer to this question is D


Instruction:
Epidemic ty phus cause & vector -
A. Rickettessiae prowazki & Louse
B. R. typhi & mite
C. R. conorii & tick
D. R. akari & mite

Response:
Ans. is 'a' i.e.. Rickettessiae prowazki & Louse Rickettsial diseasesDiseaseAgentInsect vectorMammalian reservoir1. Typhus groupa. Epidemic typhusb. Murine typhus (Endemic typhus)c. Scrub typhusR. prowazekiiR. typhiR. tsutsugamushiLouseFleaMiteHumansRodentsRodents2. Spotted fever groupa. Indian tick typhusb. Rocky mountain spotted feverc. Rickettsia] poxR.conoriiR.rickettsiiR.akariTickTickMiteRodents, dogsRodents, dogsMice3. Othersa. Q feverb. Trench feverC.bumetiiRocholimacaquintanaNilLouseCattle, sheep, goats.Humans

So the answer to this question is A


Instruction:
Pirenzepine is used in:-
A. Peptic ulcer disease
B. Bronchial asthma
C. Rheumatoid ahritis
D. Motion sickness

Response:
Pirenzipine is selective M1 receptor antagonist .so, it is used for peptic ulcer disease. * For Bronchial asthma M3 blocker such as Ipratropium is used. * For motion sickness Hyoscine is used which is M1 blocker

So the answer to this question is A


Instruction:
Malti, a 45 years female pt. with a family h/o breast carcinoma, showed diffuse microcalcification on mammography. Indraductal carcinoma in situ was seen on biopsy. Most appropriate management is -
A. Quadrantectomy
B. Radical mastectomy
C. Simple mastectomy
D. Chemotherapy

Response:
None

So the answer to this question is C


Instruction:
Pencil-in-cup deformity is seen in
A. Rheumatoid Arthritis
B. Psoriatic Arthritis
C. Ankylosing spondylitis
D. Gouty Arthritis

Response:
(B) Psoriatic Arthritis # Psoriatic Arthritis (PsA): The peripheral and axial arthropathies in PsA show a number of radiographic features that distinguish them from RA & AS, respectively.> Characteristics of peripheral PsA include DIP involvement, including the classic "pencil-in-cup" deformity; marginal erosions with adjacent bony proliferation ("whiskering"); small joint ankylosis; osteolysis of phalangeal and metacarpal bone, with telescoping of digits; and periostitis and proliferative new bone at sites of enthesitis> Characteristics of axial PsA include asymmetric sacroiliitis

So the answer to this question is B


Instruction:
A patient complained to his dentist about a draining lesion in his mouth. A Gram's stain of the pus showed a few Gram-positive cocci, leukocytes, and many branched Gram-positive rods. The most likely cause of the disease is
A. Actinomyces israelii
B. Actinomyces viscosus
C. C. diphtheriae
D. Propionibacterium acnes

Response:
The patient presented with typical symptoms of actinomycosis. Actinomyces israelii is normal flora in the mouth. However, it causes a chronic draining infection, often around the maxilla or the mandible, with osteomyelitic changes. Treatment is high-dose penicillin for 4 to 6 weeks. The diagnosis of actinomycosis is often complicated by the failure of A. israelii to grow from the clinical specimen. It is an obligate anaerobe. Fluorescent antibody (FA) reagents are available for direct staining of A. israelii. A rapid diagnosis can be made from the pus. FA conjugates are also available for A. viscosus and A. odontolyticus, anaerobic actinomycetes that are rarely involved in actinomycotic abscesses.

So the answer to this question is A


Instruction:
A 55-year-old male with history of repeated attacks of UTI, x-ray KUB showing radio opaque shadow:
A. Ureteric pathology
B. Prostate pathology
C. Testicular pathology
D. Stricture urethra

Response:
Ans. (a) Ureteric pathologyRef Bailey and love 26lh Edition, Page 1272* X-ray KUB showing radio opaque shadow pathology lies in Kidney, Ureter and Bladder

So the answer to this question is A


Instruction:
Nerve of Wrisberg contain all except:
A. Motor fibers
B. Sympathetic fibers
C. Secretory fibers
D. Parasympathetic fibers

Response:
Facial nerve has two pas: motor to facial expression muscles and nervus intermedius. The motor pa carries SVE component, while nervus intermedius carries GSA, SVA, and GVE fibers. Nervus intermedius (nerve of Wrisberg) carries fibers for taste, salivation, lacrimation, and general sensation (from the external ear).This is the sensory pa of facial nerve. The first-order sensory neurons are found in the geniculate ganglion within the temporal bone.

So the answer to this question is A


Instruction:
Which of the following does not predispose to cholangiocarcinoma
A. Ulcerative colitis
B. Clonorchis sinensis
C. Choledochal cyst
D. Chronic pancreatitis

Response:
None

So the answer to this question is D


Instruction:
A 12-year-old child who is having difficulty in school is given an intelligence test. The test determines that the child is functioning mentally at the level of an 8-year-old child. What category of intellectual function best describes this child?
A. Severely Retarded
B. Moderately Retarded
C. Mildly retarded
D. Borderline

Response:
Using the IQ formula, IQ = MA/CA x 100, the IQ of this child is 8 years (mental age)/12 years (chronological age) x 100, that is, about 66 (IQ). An individual with an IQ of 66 is classified with mild mental retardation (IQ 50-70). ICD 10 LEVEL IQ ICD 10 code Mild (Educable) 50-70 F70 Moderate (Trainable) 35-49 F71 Severe (Dependent) 20-34 F72 Profoun <20 F73 Severity unspecified Untestable by standard tests F78

So the answer to this question is C


Instruction:
Auerbanchs plexus and Meissners ganglion cell are derived from
A. Yolk sac
B. Primordial germ cell
C. Neural Crest
D. Fetal GIT

Response:
C i.e. Neural Crest

So the answer to this question is C


Instruction:
Cataract is caused by ?
A. Hypoparathyroidism
B. Cigrate smoking
C. Non-ionizing radiation
D. All of the above

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

So the answer to this question is D


Instruction:
A 34 years old female after thyroidectomy was under observation in post operations ward after shows she developed tense swelling in neck and become breathless. How do you treat this patient?
A. Intubate the patient and administer epinephrine
B. Infuse 10% calcium gluconate over 10 min
C. Open the sutures and evacuate the hematoma
D. Turn the patient sideways and give inj.salbutamol subcutaneously

Response:
Breathlessness within few hans of thyroidectomy and swelling in the neck suggest of tension hematoma, which is treated by removal of stucture & evacuating the hematoma.

So the answer to this question is C


Instruction:
A young lady presented with bilateral nodular lesions on shins. She was also found to have bilateral hilar lymphadenopathy on chest X-ray. Mantoux test reveals indurations of 5 mms. Skin biopsy would reveal -
A. Non caeseating Granuloma
B. Vasculitis
C. Caseating Granuloma
D. Malignant cells

Response:
Ans. is 'a' i.e., Non caseating granulomas o Skin lesions in this patient in Erythema nodosum. o Erythema nodosum, bilateral hilar lymphadenopathy negative mantoux test in strongly suggestive of sarcoidosis. Skin biopsy (or biopsy from hilar nodes, conjunctiva, lip, or spleen, intraabdominal nodes) would reveal non-caseating granulomas. Signs and symptoms of sarcoidosis Any organ system of the body can be involved. However lungs with lymph nodes, skin and eye are the three most common sites involved in sarcoidosis. 1. Lungs with lymph nodes (95%) o Respiratory complaints including cough and dysnea are the most common presenting symptoms. o Usually the infiltrate in sarcoidosis are predominantly an upper lobe process. o There is bilateral hilar lymphadenopathy. 11. Skin (24%-43%) o Erythma nodosum o Maculopapular lesions o Hyper-or hypopigmentation o Keloid formation and subcutaneous nodules o Lupus pernio --> Involvement of the bridge of the nose, the area beneath the eyes and check. It is diagnostic for a chronic form of sarcoidosis. o Lofgren's syndrome --> Erythma nodosum with hilar adenopathy and uveitis. HI. Eye (12-29%) o Uveitis o Retinitis Cause Photophobia, blurred vision, increased tearing o Pars planitis IV. Non-specific constitutional symptoms are fatigue (most common), fever, night sweat and weight loss. Other organs/systems involved are o Liver o Parotid glands o Hea Spleen o Brain (Neurosarcoidosis) o Endocrine --> Granuloma can secret 1-25 (OH)2 Vit D which causes hypercalcemia. Uveoparotid fever ---> Uveitis + parotitis + VII nerve palsy, it is associated with Heerfordt - waldenstrom syndrome.

So the answer to this question is A


Instruction:
Commonest type of cancer of the renal pelvis and upper ureter is -
A. Transitional cell carcinoma
B. Adenocarcinoma
C. Squamous cell carcinoma
D. Nephroblastoma

Response:
None

So the answer to this question is A


Instruction:
Pityriasis rosea  is caused by
A. Autoimmune etiology
B. HHV 3 & 4
C. HHV 4 & 5
D. HHV 6 & 7

Response:
Pitryiasis rosea is caused by HHV 7 > HHV 6

So the answer to this question is D


Instruction:
Progress of the labour is assessed with the help of March 2005, March 2013
A. Cervicograph
B. Paogram
C. Dilatation cha
D. Growth curve

Response:
Ans. B: Paogram The paogram is a series of chaed measurements which are used to assess the progress of labour. Paograms are designed to encourage a universal manner of dealing with labour and to give an early, easy way of recognising problems in labour. Information recorded includes: Maternal - BP (2 hourly), hea rate (half hourly), temperature (once unless abnormal), Contractions - length, frequency, strength Baby - hea rate (2 hourly) State of membranes and colour of liquor. Also - maternal state of mind, drugs administered etc.

So the answer to this question is B


Instruction:
There is outbreak of infection with staphylococcus in a burn ward. Best site to take a swab ?
A. Skin
B. Oral cavity
C. Nose
D. Conjunctiva

Response:
Ans. is 'c' i.e.,Nose S. aureus is pa of normal human flora. The anterior nares is the most frequent site of human colonization although the skin (especially when damaged), vagina, axilla, perineum and oropharynx may also be colonized.Staphylococci are pa of normal human bacterial flora with about 30% of general population being nasal carriers and another 10% carrying it on the perineal skin.

So the answer to this question is C


Instruction:
Oxygen dissociation curve shifts to left in all except:
A. Alkalosis
B. Hypercapnia
C. Fetal Hb
D. CO poisoning

Response:
When the O2 affinity for Hb is increased, the dissociation curve shifts to the left. O2 has less affinity for Hb which is in "T-state". When Hb is snapped into "R-state", O2 affinity for it increases. Increased affinity of O2 for Hb/shift to the left Decreased H+/alkalosis Decreased PCO2 Decreased temperature Decreased 2,3-DPG HbF CO poisoning Stored blood (2,3-DPG decreases) NO & H2S (bind to Hb; snap it into "R-state")

So the answer to this question is B


Instruction:
LE cell is seen in -
A. Lupus erythmatosus
B. Lupus vulgaris
C. HNPCC
D. Medullaiy carcinoma of thyroid

Response:
Ans. is 'a' i.e., Lupus erythematosus o In SLE, antinuclear antibodies (ANPs) cannot penetrate intact cells,o However, nuclei are exposed, ANA can bind to them.o In tissues, nuclei of damaged cells react with ANAs, lose their chromatin pattern, and become homogeneous, to produce lupus - erythematosus (LE) bodies or hemotoxylin bodies,o When these LE bodies are engulfed by phagocytic cells (neutrophil or macrophage/monocyte), the phagocytic cells are called LE cells.

So the answer to this question is A


Instruction:
Combined oral pills protect the woman against all except -
A. Menorrhagia
B. Benign breast disease
C. Pelvic inflammatory disease
D. Venous thromboembolism

Response:
Ans. is 'd' i.e., Venous thromboembolism

So the answer to this question is D


Instruction:
In which of the following conditions pulsations or
murmur may be detected
A. Capillary hemangioma
B. Osteogenic sarcoma
C. Epidermoid carcinoma
D. Osteoid osteoma

Response:
None

So the answer to this question is A


Instruction:
True regarding pseudomembranous colitis are all except:
A. It is caused by Clostridium difficile
B. The organism is a normal commensal of gut
C. It is due to production of phospholipase A
D. It is treated by vancomycin

Response:
“Cl. difficile cause pseudomembranous colitis (PMC) due to the production of toxin A (enterotoxin) and toxin B (cytotoxin), not phospholipase A.”

Toxin A is a potent neutrophil chemoattractant and both toxin A and B glucosylate the GTP binding protein of Rho subfamily resulting in disruption of cytoskeleton causing loss of cell shape adherence with consequent fluid leakage.
Asymptomatic fecal carriage of Cl. difficile in healthy neonates is very common. It also colonizes the colon of 3% of healthy adults.

CMDT’ 08, p 543

For Cl. difficile associated diarrhea (CDAD), three events are essential:

So the answer to this question is C


Instruction:
Which of the following is a component of rapid sequence induction of anaesthesia?
A. Mandatory pre-oxygenation
B. Sellick's maneuver is not required
C. Suxamethonium is contraindicated
D. Patient is mechanically ventilated before endotracheal intubation

Response:
Rapid sequence induction(RSI) is a technique of choice in the establishment of a secure airway in the emergency depament. The process is broken into six phases which is to be carried out in order. They are pre oxygenation, preparation, pre medication, paralysis and sedation, passage of tube and post intubation care. Pre oxygenation is a vital pa of RSI. As it allows the development of an oxygen reserve within the alveoli of the lungs and also within the circulation and tissues by displacing nitrogen with oxygen. Pre oxygenation is done by breathing 100% oxygen a tight fitting mask for 3 minutes. Ref: Oxford Desk Reference - Major Trauma By Jason Smith, Page 50 ; Miller's Anesthesia, 7th Edition, Chapter 73 - Anesthesia and Prehospital Emergency and Trauma Care

So the answer to this question is A


Instruction:
Which of the following is not used in the treatment of pulmonary hypertension?
A. Calcium channel blockers
B. Alpha blockers
C. Prostacyclins
D. Endothelin receptor antagonists

Response:
Ans. (B) Alpha blockers(Ref: CMDT 2010/381)Management of Idiopathic Pulmonary Hypertension*If the patient responds to vasodilators, then calcium channel blockers (including amlodipine, diltiazem, and nifedipine) are the first-line therapy.Other drugs that can be used are:-Phosphodiesterase inhibitors (e.g. sildenafil)-Prostacyclin analogs (e.g. epoprostenol)-endothelin receptor blockers (e.g. bosentan)

So the answer to this question is B


Instruction:
Prolongation of QRS complex in ECG represents:
A. Acute cor pulmonale
B. Chronic cor pulmonale
C. Left ventricular hypertrophy
D. Bundle branch block

Response:
Intrinsic impairment of conduction in either the right or the left bundle system (intraventricular conduction disturbances) leads to prolongation of the QRS interval.

With complete bundle branch blocks, the QRS interval is >120 ms in duration.
With incomplete blocks, the QRS interval is between 100 and 120 ms.

So the answer to this question is D


Instruction:
A young couple has been unsuccessful in conceiving a child over a 4-month period. The 28-year-old wife had been extensively investigated by a female reproductive specialist, and no abnormalities were detected. The husband, who initially refused to undergo semen analysis now agreed to this investigation, which revealed a low volume and azotemia. Follicle-stimulating hormone (FSH) level is normal. What is the most likely diagnosis?
A. Bilateral testicular atrophy
B. Congenital absence of the vas deferens
C. Hydrocele
D. Varicocele

Response:
In congenital absence of the vas deferens, mutation of the cystic fibrosis transmembrane receptor gene (CFTg) occurs. The epididymis vas deferens, seminal vesicle, membranous urethra, part of the trigone of the bladder, and ureter arise from the mesonephric duct. In the presence of a normal FSH level, testicular biopsy would most likely confirm normal sperm formation. In the presence of a Sertoli cell tumor, spermatozoa are unlikely to form, and the FSH level is elevated.

So the answer to this question is B


Instruction:
Best investigation for acute cholecystitis is
A. ERCP
B. Oral cholecystography (OCG)
C. HIDA scan
D. IV cholangiography

Response:
C i.e. HIDA Scan HIDA Scan & PIPIDA are best test to rule out acute cholecystitisQ with.--400% negative predictive value. It can be pseudo positive in chronic malnutrition, & Parenteral nutrition & alcoholic liver disease.

So the answer to this question is C


Instruction:
Which structure can be felt at the lower part of the medial border of sternocleidomastoid -
A. Subclavian artery
B. Common carotid artery
C. Internal mammary artery
D. Maxillary artery

Response:
Carotid pulse (common carotid artery) can be felt along the anterior margin of sternoleidomastoid at the level of laryngeal prominence of cricoid cartilage.

So the answer to this question is B


Instruction:
Anesthetic agent contraindicated in raised ICT is?
A. Ketamine
B. Sevoflurane
C. Thiopentone
D. Etomidate

Response:
Ans. is 'a' i.e., Ketamine * Ketamine increases cerebral metabolic rate, cerebral blood flow and intracranial tension.Neurophysiology and anaesthesiaA. Intravenous inducing anaesthetics# All intravenous inducing agents except for ketamine (i.e., etomidate, thiopentone, methohexitone and propofol) decrease cerebral metabolic rate, cerebral blood flow and intracranial tension. Maximum decrease in cerebral blood flow and cerebral protection is caused by thiopentone - IV agent of choice for neurosurgery.B. Inhalational agents# All inhalational agents: -i) Increase intracranial tension and cerebral blood flow.ii) Decrease cerebral metabolic rate - There by provide cerebroprotection.iii) Amongst inhalational agents, isoflurane provides maximum cerebroprotection, therefore it is the inhalational agent of choice for neurosurgery.C. Lidocaine# Lidocaine decreases ICT, Cerebral blood flow and metabolic rate.

So the answer to this question is A


Instruction:
Patient is able to recognize voice but not face
A. Temporal lobe
B. Occipital
C. Frontal lobe
D. Parietal lobe

Response:
Memory and language problems after temporal lobectomy. Temporary double vision after temporal lobectomy. Increased number of seizures after corpus callosotomy, but the seizures should be less severe. Reduced visual field after a hemispherectomy. Ref: guyton and hall textbook of medical physiology 12 edition page number:835,836,837

So the answer to this question is A


Instruction:
All of the following belongs to gene family of desmosomal protein except :
A. Cadherin
B. Clathrin
C. Plakin
D. Armadillo

Response:
Clathrin doesn't belong to gene family of desmosomal protein Desmosomal protein Gene family are Cadherin Plakin Armadillo Eg : Desmoglein in pemphigus Desmocollin Desmoplakin Plakoglobin Plakophilin

So the answer to this question is B


Instruction:
Basiliximab is a monoclonal antibody against :
A. IL-2 receptor
B. CD20
C. INF - α
D. IL-6

Response:
Basiliximab  & Daclizumab are monoclonal antibody against IL-2 receptor (CD25) used as immunosuppresants.

So the answer to this question is A


Instruction:
A 48-year-old male complains of abdominal pain that began about 6 months previously which is constant in nature, especially after meals and is located in the upper mid abdomen superior to the umbilicus. He also repos some heaburn that occurred during the previous year. He has been under significant stress and has been self-medicating himself with over-the-counter antacids, with some relief. He states that his stools have changed in colour over the previous 2 months and now are intermittently dark and tarry in consistency. The physician tests the patient's stool and finds following result. What organs are likely to be affected?
A. NONE
B. C
C. A
D. B

Response:
A- Stomach B- Gallbladder C- Distal Ileum and caecum This patient has a history typical for peptic ulcer disease, that is, constant mid epigastric pain after meals. The patient also has symptoms consistent with gastro-esophageal reflux disease. The dark and tarry stools reflect blood in the stools; that is, hemoglobin has been conveed to melena. This is suggestive of an upper gastrointestinal bleeding disorder. The next step would be an upper endoscopy to visualize the suspected ulcer. If the stomach is the site, a biopsy is usually performed to assess concurrent malignancy. Treatment includes a histamine-blocking agent, proton pump inhibitor, and antibiotic therapy. The bacterium Helicobacter pylori has been implicated in most cases of peptic ulcer disease. If an ulcer occurs in the duodenum, the posterior wall of the ampulla of the duodenum (duodenal cap) is the usual site. The gastro-duodenal aery lies posterior to the duodenum at this point and is at risk in the event of ulcer perforation.

So the answer to this question is C


Instruction:
Resting membrane potential of neuron is
A. +70mv
B. -70mv
C. +90mv
D. -90mv

Response:
The magnitude of resting membrane potential from tissue to tissue ranges from - 9 to - 100.RMP of nerve Fibre is - 70mV(REF: TEXTBOOK OF MEDICAL PHYSIOLOGY GEETHA N 2 EDITION, PAGE NO 22)

So the answer to this question is B


Instruction:
Which of the following does not cross the blood-brain barrier?
A. Pralidoxime
B. Obidoxime
C. Diacetyl-monoxime
D. Physostigmine

Response:
Ref: KD Tripathi pharmacology 7th edition (page.no: 111) Katzung 11/e p121 Pralidoxime has positively charged quaternary nitrogen. Quaernary molecules are heavy and can't penetrate the blood-brain barrier Pralidoxime or 2-PAM, usually as the chloride or iodide salts, belongs to a family of compounds called oximes that bind to organophosphate-inactivated acetylcholinesterase. It is used to treat organophosphate poisoning in conjunction with atropine and diazepam

So the answer to this question is A


Instruction:
Incubation period of swine flu -
A. 1-3 days
B. 2-3 weeks
C. 10-15 days
D. 5 weeks

Response:
Swine flu

Swine flu, also called swine influenza, or pig influenza, is caused by influenza virus.
It is mainly occurs in swines (pigs) and occasionally transmitted to human.
It is usually caused by influenza virus type A (H1-N1).
Incubation period is about 1-3 days and the symptoms of swine flu in humans are similar to most influenza infections, e.g. fever, cough, rhinorrhea, fatigue and headache.

So the answer to this question is A


Instruction:
Mc bone to get fractured in fall on outstretched hand is:
A. Lower End Ulna
B. Lower End Radius (Colles fracture)
C. 5th Metacarpal
D. Capitate

Response:
(b) Lower End Radius (Colles fracture)"FOOSH" (Fracture due to fall on outstretched hand)- Fracture clavicle- Surgical neck of humerus fracture- Supracondylar fracture humerus and lateral condyle fracture humerus- Head and neck fracture of radius- Galeazzi fracture dislocation- Colie's fracture (Most common)- Radial styloid fracture- Fracture scaphoid

So the answer to this question is B


Instruction:
Moderately hard water has hardness level
A. <1
B. 3-Jan
C. 6-Mar
D. >6

Response:
Ref: 25th Ed K.Park's Textbook Of Preventive and Social Medicine Pgno : 763

So the answer to this question is B


Instruction:
The most effective method for motivating a couple for adopting family planning practices is -
A. Printed material
B. Films and television
C. Group discussion
D. Inter-personal communication

Response:
Traditional way of communication has been by word of mouth.The advent of written and printed matter are comparatively recent origin .Direct verbal communication by word of mouth may be loaded with hidden meanings (refer pgno:855 park 23 rd edition)

So the answer to this question is D


Instruction:
Which type of thyroid carcinoma has the best prognosis -
A. Papillary Ca
B. Anaplastic Ca
C. Follicular Ca
D. All

Response:
Ans is 'a' i.e., Papillary Carcinoma "In general pts. with PTC have an excellent prognosis with a greater than 95% 10-year survival rate." - Schwaz Papillary carcinoma of thyroid is a slow growing tumor, usually not associated with blood borne metastasis, and hence has a better prognosis than the other varieties. Follicular, Medullary and Anaplastic carcinomas are all associated with a greater incidence of blood borne metastasis and a poorer prognosis.

So the answer to this question is A


Instruction:
A 31 year old female patient complains of bilateral impairment of hearing for the 5 year. On examination, tympanic membrane is normal and audiogram shows a bilateral conductive deafness. Impedance audiometry shows As type of curve and acoustic reflexes are absent. All constitute pa of treatment, except:
A. Hearing aid
B. Stapedectomy
C. Sodium fluoride
D. Gentamicin

Response:
Gentamicin is used to treat Meniere's disease.

So the answer to this question is D


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

Response:
Ans. is 'a' i.e., Sedation and wait * It is a case of prolonged latent phase of the labourLatent phase of the labourLatent phase of the labour is difficult to define.It starts with onset of painful regular uterine contractions and end when the cervix starts dilating at an active rate.A latent phase exceeding 6 hours in primigravida or 4 hours in multigravida is considered prolonged. Secondary arrest of active phaseActive phase of the labour is defined as phase when active cervical dilatation occurs.Secondary arrest of cervical dilatation occurs when cervical dilatation ceases after a normal portion of active phase dilatation.This is believed to be due to cephalopelvic disproportion.Prolonged latent phaseThe diagnosis of prolonged labour is made when there is little progress in cervical dilatation for several hours. (In the question the cervix is dilated for 1 cm for the last 10 hrs).More common than the diagnosis of prolonged latent phase is the need to differentiate whether a patient is in false labour or in the latent phase.This differentiation may be achieved by continuous observation of the patient for at least 2 hours. Patients in false labour will show a pattern of irregular uterine contractions that eventually decrease in frequency and intensity and there are no cervical changes during the observation periods.Whereas patients in latent phase will show persistent regular uterine contractions that usually increase in intensity and frequency. In addition, patient in latent phase will show some cervical changes.A second method used to differentiate false labour from the latent phase of labour is therapeutic restFor this purpose the patient is given a 15 mg dose of morphine sulfate.Patients in false labourSleep for a few hours and awake without contractions.Patients in latent phase continue with contractions and show cervical changes after the sleeping period.The second most common practical problem related to the latent phase of labour occurs when patients have 3 or 4 cm of cervical dilatation and regular uterine contractions and no progress is observed during the following few hours.These patients may be in a late stage of their latent phase or have an early secondary arrest of dilatation.To distinguish between late latent phase and early secondary arrest it is necessary to take into consideration the patient's parity.Multipara making little progress at 4 cm of dilatation most likely will be in latent phase.A nullipara under the same circumstances most likely will be in early secondary arrest.The degree of cervical dilatation is also important.60% of the patient will be in active phase if the cervix is 4 cm dilated and 90% if it is 5 cm.Finally cervical effacement is a good criterion for recognizing patients in active phase.Most patients will be in active phase if their cervix is dilated 3 cm or more and 100% effaced.If effacement is 50% or less most likely they are in latent phase.ManagementThere are two modes of management for patients with prolonged latent phase.Therapeutic restOxytocin stimulation.

So the answer to this question is A


Instruction:
Antemoem bruise is differentiated from postmoem bruise by: AIIMS 09
A. Well-defined margin
B. Capillary rupture with extravasation of blood
C. Yellow color
D. Gaping

Response:
Ans. Capillary rupture with extravasation of blood

So the answer to this question is B


Instruction:
Peripheral smear of neonate with ABO incompatibility will show?
A. Microspherocytes
B. Elliptocytes
C. Fragmented RBCs
D. Polychromatosis

Response:
Microspherocytes are seen in the peripheral smear of a neonate with ABO incompatibility. Microspherocytes are erythrocytes smaller in diameter and spheroidal in shape but with increased thickness. It is also seen in Hereditary spherocytosis, autoimmune hemolytic anemia. Reference : page 293 Textbook of pathology Harshmohan 6th edition

So the answer to this question is A


Instruction:
Shortest acting muscle relaxant -
A. Pancuronium
B. Atracurium
C. Mivacurium
D. Vecuronium

Response:
Ans. is 'c' i.e., Mivacurium Mivacuriumo Mivacurium is the shortest acting competitive blockers.o It does not need reversal - can be used as an alternative to SCh for endotracheal intubation.o It is metabolized rapidly by plasma cholinesterases - prolonged paralysis can occur in pseudocholinesterase deficiency.o Mivacurium is the only nondepolarising (competitive) blocker that is metabolized by plasma cholinesterase (pseudocholinesteres).

So the answer to this question is C


Instruction:
The mucosa of the posterior third of the tongue is supplied by
A. Facial nerve
B. Trigeminal nerve
C. Mandibular nerve
D. Glossopharyngeal nerve

Response:
None

So the answer to this question is D


Instruction:
Systemic miliary TB occurs when spread occurs ?
A. Aerial
B. Venous
C. Lymphatic
D. Direct dissemination

Response:
Ans. is 'a' i.e., Aerial Systemic miliary tuberculosis occurs when tubercle bacteria disseminate through the systemic aerial system. Miliarytuberculosis is most prominent in the liver, bone marrow, spleen, adrenals, meninges, kidneys, fallopian tubes, and epi- didymis, but could involve any organ. Miliary pulmonary disease occurs when organisms draining through lymphatics enter the venous blood and circulate back to the lung.

So the answer to this question is A


Instruction:
A normal, healthy, 25-year-old man lives at the beach. His twin brother has been living in a mountain cabin for the past 2 years. Which of the following indices would be expected to be higher in the man living at sea level?
A. Diameter of pulmonary vessels
B. Erythropoietin production
C. Mitochondrial density in a muscle biopsy
D. Respiratory rate

Response:
A number of physiologic changes occur in a person living at high altitude. The diminished barometric pressure at high altitude causes alveolar hypoxia and aerial hypoxia. Pulmonary vasoconstriction occurs in response to alveolar hypoxia; therefore, the diameter of the pulmonary vessels would be greater in the brother living at sea level. All the other choices describe physiologic processes that would be enhanced by living at high altitude. Increased erythropoietin production, caused by aerial hypoxia, leads to increases in hematocrit in people living at high altitude. Mitochondrial density increases in people chronically exposed to the hypoxemia caused by living at high altitude. Increasing the rate of respiration is a very useful adaptation to the hypoxic conditions of high altitude. The primary stimulus is the hypoxic stimulation of peripheral chemoreceptors. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 35. Gas Transpo & pH. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds),Ganong's Review of Medical Physiology, 24e.

So the answer to this question is A


Instruction:
Nasolacrimal duct is directed:
A. Downwards, slightly outwards and backwards
B. Downwards, slightly inwards and backwards
C. Downwards, slightly outwards and forwards
D. Downwards, slightly inwards and forwards

Response:
Ans. Downwards, slightly outwards and backwards

So the answer to this question is A


Instruction:
A 60 year old man underwent phacoemulsification surgery and placement of foldable intraocular lens in the left eye a year back . He now presents to OPD with complaints of hazy vision in that eye. There is no associated redness , pain or watering of eye. The most common cause is:
A. Posterior capsular opacification
B. Cystoid macular edema
C. Neovascular glaucoma
D. Chorioretinits

Response:
1. Posterior capsular opacification- Most common complication of cataract surgery which usually present after 1 year of cataract surgery. 2.Neovascular glaucoma usually occurs in conditions which predisposes to hypoxia like DM and CRVO . 3. Chorioretinitis usually occurs in toxoplasma ,herpes, CMV ,TB and other infectious and autoimmune conditions. It does not occur as a complication of cataract surgery. 4. Cystoid macular edema can occur as a complication of cataract surgery, but it presents within 2-3 months of surgery.

So the answer to this question is A


Instruction:
All among the following are OCD related disorder except :
A. Skin picking
B. Temper tantrums
C. Hoarding disorder
D. Hair pulling disorder

Response:
Temper tantrums is not an OCD related disorder Obsessive- compulsive and related disorders are : OCD Skin picking disorder Hair pulling disorder Hoarding disorder Body Dysmorphic disorder

So the answer to this question is B


Instruction:
What is the most common cause of preload disorders in children?
A. Distributive shock
B. Hypovolemic shock from vomiting and diarrhea
C. Congestive hea failure
D. Severe anemia

Response:
Preload is the amount of blood that the hea receives to distribute to the body. In addition to hea rate, afterload, and cardiac contractility, preload determines cardiac output. In children, the most common cause of decreased preload is hypovolemia, usually from vomiting and diarrhea. Distributive shock secondary to sepsis, neurogenic spinal shock, or anaphylaxis is a less common cause of preload reduction. Acute anemia may also be associated with decreased preload. Congestive hea failure is a frequent complication in children with congenital hea disease. Increased preload results in elevation of left atrial pressure leading to pulmonary edema and decreased oxygenation. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is B


Instruction:
Digitalis toxicity enhanced by A/E -
A. Renal failure
B. Hyperkalemia
C. Hypercalcemia
D. Hypomagnesemia

Response:
Hyperkalemia Hypokalemia enhances digitalis toxicity It is the most common precipitating cause of digitalis intoxication. This often occurs in patients with hea failure as a result of diuretic therapy and secondary hyperaldosteronism. Remember this, Digitalis toxicity causes hyperkelemia but hypokalemia enhances digitalis toxicity. Other factors precipitating digitalis toxicity: ? Advanced age Acute myocardial infarction or ischemiaQ HypoxemiaQ HypomagnesemiaQ HypercalcemiaQ Renal insufficiency Hypothyroidism and hypehyroidism Electrical cardioversionQ Also know The administration of following drug raises the serum concentration of Digoxin by reducing both the renal and nonrenal elimination of digoxin and by reducing its volume of distribution thus precipitating digitalis toxicity. - QuinidineQ - VerapamilQ - AmiodaroneQ - PropafenoneQ

So the answer to this question is B


Instruction:
Pancreatitis is an ADR of which antidiabetic?
A. Vildagliptin
B. Metformin
C. Glibenclamide
D. Insulin

Response:
Pancreatitis can be seen with DPP4 inhibitors like vildagliptin. Other drugs in this group are sitagliptin, saxagliptin. They inhibit the DPP4 enzyme and increse the t half of incretins to increase the insulin production. Ref: KD Tripathi 8th ed.

So the answer to this question is A


Instruction:
Following are seen in CRA occlusion except:
A. Gradual loss of vision
B. Headache
C. Sudden loss of vision
D. Retained central vision

Response:
A i.e. Gradual loss of vision

So the answer to this question is A


Instruction:
ANCA positive vasculitis -
A. Henoch schonlein purpura
B. Behcet's syndrome
C. Wegener's granulomatosis
D. None

Response:
Ans. (c) Wegener's granulomatosis(Ref: Robbins 9th/pg 507, Harrison 18thed p-2786-87)Option a and b are immune-mediated small-vessel systemic vasculitis. C-ANCA positive vasculitis

So the answer to this question is C


Instruction:
Schwartz operation is also called as -
A. Cortical mastoidectomy
B. Modified radical mastoidectomy
C. Radical mastoidectomy
D. Fenestration operation

Response:
Mastoidectomy is defined as a surgical procedure which opens up the mastoid cavity, cleans up the infected air cells, improves middle ear ventilation by widening of the aditus.
There are several types of mastoidectomy.

Cortical mastoidectomy (simple mastoidectomy or schwartz operation)

The mastoid air-cell system is exenterated, including epitympanum.
But the posterior meatal wall (canal wall) is left intact.

So the answer to this question is A


Instruction:
Multinucleate giant cells on Tzanck test are seen in all Except?
A. Varicella
B. Herpes zoster
C. Pemphigus
D. Molluscum contagiosum

Response:
Tzanck test is popular for rapid identification of multinucleate giant cells, used for Herpes simplex infection which are not pathognomonic Also seen in varicella, herpes zoster and pemphigus. Diagnosis of herpes simplex infection depends on clinical suspicion suppoed by electron microscopy of fresh lesional fluid, DNA hybridization, immunofluorescence, PCR and viral culture For Molluscum contagiosum : Henderson Paterson inclusion bodies.

So the answer to this question is D


Instruction:
What is Dohlman's Procedure in Zenker's Diverticulum?
A. Endoscopic Stapling of Septum
B. Endoscopic Suturing of Pouch
C. Resection of Pouch
D. Laser excision

Response:
Ans. (a) Endoscopic Stapling of septumRef: Surgery Sixer 3rd Edition Page 322* Endoscopic Stapling Technique for Pharyngeal Pouch (Zenker's Diverticulum) is known as Dohlman's Procedure.

So the answer to this question is A


Instruction:
If a patient gets an attack of veigo by loud noise, he is having
A. Tullio phenomenon
B. Dysplacusis
C. Hyperacusis
D. Paracusis

Response:
Tullio phenomenon - A condition in which loud sound produces veigo. It can occur in syphilis. (Ref: Diseases of EAR, NOSE AND THROAT by PL DHINGRA - 6th Edition)

So the answer to this question is A


Instruction:
Most common cause of unilateral diaphragmatic paralysis is
A. Surgical trauma
B. Poliomyelitis
C. Polyneuritis
D. Tumour

Response:
(A) Surgical trauma # UNILATERAL DIAPHRAGMATIC PARALYSIS may be idiopathicl or secondary to multiple causes, among which the most common is a tumour with phrenic nerve involvement or surgical trauma,> Causes of unilateral paralysis are diseases of the cervical spinal cord affecting the anterior horn cells of the fourth segment, such as poliomyelitis, tumour, progressive muscular atrophy, myelitis, haemorrhage, and injuries and caries of the cervical vertebrae.> Peripheral lesions of the phrenic nerve or its roots include neck wounds, polyneuritis (usually diphtheritic), destruction by neoplastic masses (usually near the hilum of the lung), and avulsion from birth injury as an extension of Erb's palsy.> Unilateral diaphragmatic paralysis is often discovered incidentally in patients undergoing chest radiography for some other reason Patients usually are asymptomatic at rest but experience dyspnea upon exertion and have a decrease in exercise performance.> If the patient has an underlying lung disease, dyspnea may occur at rest.> Some patients may develop orthopnea, which is less intense than bilateral diaphragmatic paralysis.

So the answer to this question is A


Instruction:
Normal serum uric acid levels in males is
A. 3.1 - 7 mg/dl
B. 2.5-5.6 mg/dl
C. 1.2-3.3 mg/dl
D. 1.8-4.4 mg/dl

Response:
serum uric acid male 3.1-7.0 mg/dL female 2.5-5.6 mg/dL Ref: RAM DAS NAYAK EXAM PREPARATORY MANUAL FOR UNDERGRADUATES 2nd ed. pg no: 784

So the answer to this question is A


Instruction:
ROME III criteria is for?
A. IBS
B. Ulcerative colitis
C. Colonic cancer
D. Colonic hemangiomatas

Response:
Rome III criteria is for the diagnosis of irritable bowel syndrome(IBS). It is as follows: Recurrent abdominal pain or discomfo at least 3 days/month in last 3 months, associated with 2 or more of the following : * Improvement with defecation. * Onset associated with a change in frequency of stool. * Onset associated with a change in form (appearance) of stool. Reference : page 907 Davidson's principles and practice of Medicine 22nd edition

So the answer to this question is A


Instruction:
A 72-year-old man is recently found to have hypocalcemia and Osteomalacia is suspected based on the decrease in the cortical bone thickness and osteopenia seen on x-rays. Which of the following is the most likely mechanism of the resistance to the effects of vitamin D?
A. excess parathyroid hormone secretion
B. insufficient parathyroid hormone secretion
C. defective receptors for 25(OH) vitamin D
D. defective receptors for 1,25OH2 vitamin D

Response:
Deficient or defective 1,25(OH)2 vitamin D receptors will result in vitamin D resistance. Parathyroid hormone levels increase secondary to decreased vitamin D effect. The 1(OH) vitamin D is an intermediate metabolite.

So the answer to this question is D


Instruction:
Erythroplasia of Queyrat occurs in: September 2008
A. Scrotum
B. Testes
C. Penis
D. Bladder

Response:
Ans. C: Penis Paget's disease/Erythroplasia of Queyrat is a carcinoma in situ that mainly occurs on the glans penis, the prepuce, or the urethral meatus of elderly males. The cause of erythroplasia of Queyrat is largely unknown. Human papillomavirus type 16 DNA has previously been detected only in very few distinctly characterized patients Up to 30% progress to squamous cell carcinoma. Treatment is by circumcision, observation and excision if the lesion does not resolve.

So the answer to this question is C


Instruction:
Which of the following is not seen in haemolytic anemia?
A. Hemosiderosis
B. Hemochromatosis
C. Cholelithiasis
D. None of the above

Response:
Ceain changes are seen in hemolytic anemias regardless of cause or type. Anemia and lowered tissue oxygen tension trigger the production of erythropoietin, which stimulates erythroid differentiation and leads to the appearance of increased numbers of erythroid precursors (normoblasts) in the marrow. Compensatory increases in erythropoiesis result in a prominent reticulocytosis in the peripheral blood. The phagocytosis of red cells leads to hemosiderosis, which is most pronounced in the spleen, liver, and bone marrow. If the anemia is severe, extramedullary hematopoiesis can appear in the liver, spleen, and lymph nodes. With chronic hemolysis, elevated biliary excretion of bilirubin promotes the formation of pigment gallstones (cholelithiasis). Ref: Robbins 8th edition, Chapter 14.

So the answer to this question is B


Instruction:
Multiple loose bodies are seen in -a) Osteochondritis dessicansb) Synovial chondromatosisc) Osteoarthritisd) Rheumatoid arthritis e) Osteogenesis imperfecta
A. abc
B. bc
C. acd
D. bcd

Response:
Causes of loose bodies include :-

Osteoarthritis
Osteochondritis dessicans
Osteochondral fracture (injury)
Charcot's disease
Synovial chondromatosis

Among these, osteochondral fracture causes single loose bodies, while all other can cause multiple loose bodies, maximum by synovial chondromatosis (up to hundred’s).

So the answer to this question is A


Instruction:
Commonest cause of deafness is -
A. Trauma
B. Wax
C. Acute mastoiditis
D. Meniere's disease

Response:
None

So the answer to this question is B


Instruction:
Most common enzymatic tool in genetic engineering-
A. Halicase
B. Topoisomerase
C. DNALigase
D. Restriction endonuclease

Response:
Ans. is 'd' i.e., Restriction endonuclease o At the heart of genetic engineering is the ability to cut DNA molecules at precisely defined sites, o This is usually done with purified bacterial enzyme, the restrication endonuclease.o Restriction endoncleases were called restriction enzymes because their presence in a given bacterium restricted the growth of foreign (non-bacterial) DNA, e g. bacteriophages, o Restriction endonuclease (also called restrition enzyme) cut DNA at specific DNA sequence within the molecule in a sequence specific manner. The site cleaved by restriction endonuclease is called its restriction siteo These enzymes recognize certain palindromic sequences in the DNA, ie. the short sequence (4-7 base pairs) which has got two fold rotational symmetry. In simple language, a short sequence (4-7 bp) of duplex DNA that is same when two strands are read in opposite direction is called palindrome.o Palindrome serves as the target for most restriction endonucleases. Each restriction enzyme (restriction endonuclease) recognizes specific nucleotide sequence, ie. each restriction enzyme has specific palindromic sequence to recognizeo Restriction endonucleases cleave (cut) both strands of DNA.o Some restriction enzymes cut both strand at same level, so as to leave no unpaired bases on either end. These ends are called blunt ends.o On the other hand, some restriction enzyme cut two strands in staggered manner, leaving two to four nucleotides of one strand unpaired at each end. Thses ends are referred to as cohesive ends (or sticky ends or staggered ends).o Sticky ends are particularly useful in constructing hybrid (or chimeric) DNA molecule. Restriction fragments of different DNAs can base pair with each other if they have sticky ends which are complementary. Therefore two unrelated DNA fragments can base pair with each other, if they were cleaved by the same restriction endonucleases (because each restriction endonuclease cuts same and specific palindromic sequence on diferent DNAs).

So the answer to this question is D


Instruction:
The poor prognostic factor associated with ALL in children is –
A. Total leucocyte count 4000-100000
B. Age less than 2 years
C. Testicular involvement
D. Blast in peripheral smear

Response:
Testicular involvement is a poor prognostic factor.

So the answer to this question is C


Instruction:
A 40 year old diabetic presents with blackish nasal discharge and a mass in the nose, likely diagnosis is:
A. Mucormycosis
B. Actinomycosis
C. Rhinosporiodosis
D. Histoplasmosis

Response:
Mucomycosis is an oppounistic infection which is, common in diabetics, presenting with blackish nasal discharge.

So the answer to this question is A


Instruction:
Post herpetic neuralgia most commonly involves:
A. Maxillary division of trigeminal nerve.
B. Mandibular division of trigeminal nerve.
C. Ophthalmic division of trigeminal nerve.
D. None.

Response:
None

So the answer to this question is C


Instruction:
"Rail Road pattern" in Neuroimaging is seen in :-
A. Tuberous sclerosis
B. Sturge weber syndrome
C. Ataxia Telengiectasia
D. Neurofibromatosis

Response:
Powine stain is in the distribution of the first branch of the trigeminal nerve is a/w ipsilateral rail road pattern (also known as tram track pattern) of intracranial calcification and glaucoma. -presentation is with contralateral hemiparesis , focal seizures and/or intellectual disability features of Sturge:- weber syndrome includes (a) intracranial calcifications in left hemisphere on CT. ; and (b)Hemi-facial angioma or po wine stain

So the answer to this question is B


Instruction:
which of the following is a essential amino acid ?
A. Lysine
B. Alanine
C. Asparagine
D. Glycine

Response:
Essential amino acids are tryptophan valine threonine leucine lysine phenylalanine &methionine-total 8amino acids (TV TILL 8 PM). their carbon skeleton cannot be synthesized by human beings &so preformed amino acid are to be taken in food for normal growth. Normal growth will not occur if one such amino acid is deficient in the diet. Ref: DM Vasudevan - Textbook of Biochemistry for Medical Students, 7th edition, page no: 27

So the answer to this question is A


Instruction:
Mycobacterial species differentiated by all except
A. Catalase test
B. Amidase
C. Niacin
D. Oxidase

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

So the answer to this question is D


Instruction:
Cyst arising from dental lamina
A. Radicular cyst
B. Paradental cyst
C. Eruption cyst
D. Glandular odontogenic cyst

Response:
None

So the answer to this question is D


Instruction:
Anatomical dead space is increased by all /except
A. Atropine
B. Halothane
C. Massive pleural effusion
D. Inspiration

Response:
C i.e. Massive Pleural effusion - Pleural effusion normally tends to decrease physiological dead space initially. However when massive it also decreases anatomical dead space. Atropine, halothane are bronchodialators, so T anatomical dead space. Inspiration may also streatch airways to anatomical dead space.

So the answer to this question is C


Instruction:
Ultimate tensile strength refers to:
A. Stress before rupture
B. Stress after rupture
C. Longitudinal compressive strength
D. Horizontal compressive strength

Response:
Tensile strength (ultimate tensile strength)—Tensile stress at the instant of fracture.
The ultimate tensile strength is defined as the tensile stress within a structure at the point of rupture.
Phillips dental materials 12th edition page no 49,57

So the answer to this question is A


Instruction:
The most common cause of conductive deafness in children is
A. ASOM
B. Wax
C. Serous otitis media
D. Otosclerosis

Response:
SEROUS OTITIS MEDIA, SECRETORY OTITIS MEDIA, MUCOID OTITIS MEDIA, "GLUE EAR" This is an insidious condition characterized by accumulation of nonpurulent effusion in the middle ear cleft. The fluid is nearly sterile. The disease affects children of 5-8 years of age. Hearing loss. This is the presenting and sometimes the only symptom. It is insidious in onset and rarely exceeds 40 dB. Deafness may pass unnoticed by the parents and may be accidentally discovered during audiometric screening tests. Ref : Diseases of ENT by Dhingra 6th edition Pgno : 64

So the answer to this question is C


Instruction:
Failure rate of Copper IUCD is -
A. 3-4%
B. 0.01-0.03%
C. 0.5-1.5%
D. 4-5%

Response:
Ans. is 'C' i.e., 0.5-1.5% Pearl Index of IUD * IUDs can be divided into three groups according to the pregnancy rate, indicating their contraceptive efficacy: 1) Group I (pregnancy rates greater than 2.0 per 100 women-year): Lippes loop, Cu 7 T 200 2) Group II (pregnancy rates less than 2.0 but more than 1 per 100 women-year): Nova T, ML Cu 250, and Cu T 220C 3) Group III (pregnancy rates less than 1 (mostly less than 0.5) per 100 women-year): Cu T 380A, Cu T 380S, ML Cu 375, and LNG 20

So the answer to this question is C


Instruction:
When two different chemical set on two different receptors and their response is opposite to each other on the same cell,this is called as
A. Physiological antagonism
B. Chemical antagonism
C. Reversible antagonism
D. Competitive antagonism

Response:
Ref-KDT 6/e p56 Physiological agonism describes the action of a substance which ultimately produces the same effects in the body as another substance--as if they were both agonists at the same receptor--without actually binding to the same receptor

So the answer to this question is A


Instruction:
Not a risk factor for primary open angle glaucoma among the following is
A. Hereditary
B. diabetes mellitus
C. Cigarette smoking
D. Hypermetropia

Response:
Myopia is a risk factor for primary open angle glaucoma, not Hypermetropia.

So the answer to this question is D


Instruction:
True about blunt abdominal trauma with splenic rupture:a) Kehr's sign-discoloration around umbilicusb) Spleen is most common organ to be involvedc) Splenectomy is treatment of choice for splenic ruptured) Cullen's sign seen
A. c
B. d
C. bd
D. ac

Response:
None

So the answer to this question is C


Instruction:
A 35-year-old man developed a brown pigmentation on the face after taking nonsteroidal anti-inflammatory drug (NSAID) for fever, joint pain and malaise. What is the diagnosis?
A. Dengue fever
B. Chikungunya
C. Fixed drug eruption
D. Melasma

Response:
ANS. C* The image shows a hyperpigmented lesion, and with the history of drug intake, the diagnosis is fixed drug eruption.Close differentials of hyperpigmented lesions in faceMelasma (brown pigmentation in face)

So the answer to this question is C


Instruction:
Role of creatine phosphate in muscle -
A. Helps in gluconeogenesis
B. Provides instant energy'
C. Involved in action-contraction coupling
D. Helps in stretch reflex

Response:
Ans. is 'b' i.e., Provides instant energy o In muscles, creatine phosphate occurs as a reservoir of high-energy phosphate groups,o It provides a quick source of energy for muscle fibres to contract when they need an initial burst of energy,o Creatine phosphate helps generation of ATP in exercising muscles bv substrate level phosporvlation.

So the answer to this question is B


Instruction:
Vascular portion of disc is:
A. Posterior.
B. Intermediate.
C. Anterior.
D. None of the above.

Response:
None

So the answer to this question is A


Instruction:
Dextromethorphan is an:
A. Antihistaminic
B. Antitussive
C. Expectorant
D. Antiallergic

Response:
Drugs for cough includes: 1. Pharyngeal demulcents: Lozenges, cough drops linctuses containing syrup, glycerine, 2.Expectorants (Mucokinetics) : bronchial secretion enhancers- Sodium or Potassium citrate, Potassium iodide, Ammonium chloride. 3.mucolytics: Bromhexine, Ambroxol, Acetylcysteine, Carbocisteine 3. Antitussives (Cough center suppressants)- used for dry cough (a) Opioids Codeine: Pholcodine. (b) Nonopioids: Noscapine, Dextromethorphan, Chlophedianol. (c) Antihistamines: Chlorpheniramine, Diphen hydramine, Promethazine. (d)peripherally acting: prenoxdiazine 4. Adjuvant antitussives -Bronchodilators Salbutamol, Terbutaline. ESSENTIALS OF MEDICAL PHARMACOLOGY 7TH EDITION KD TRIPATHI Page No:218

So the answer to this question is B


Instruction:
Cephalic phase of gastric secretion can be demonstrated by the following experiment:
A. Heidenhain's pouch
B. Condition reflex
C. Pavlov's pouch
D. None of the above

Response:
A part of stomach is incompletely separated from the main portion and made into a small bag like pouch, which is called as pavlov's pouch.

So the answer to this question is C


Instruction:
Drug contraindicated in pregnancy :
A. Angiotensin receptor blockers
B. Beta blockers
C. Calcium channel blockers
D. Thiazides

Response:
Ans. (a) Angiotensin receptor blockersRef KDT 6th ed. 553* ACEs are the drugs which inhibit the conversion of angiotensin-I to angiotensin-II. They can cause severe fetal malformations when given in the second and third trimesters.* These include: Hypocalvaria and renal dysfunction and are also teratogenic and because of this, they are not recommended during pregnancy* Angiotensin-receptor blockers act in a similar manner.But, instead of blocking the production of angiotensin- II, they inhibit binding to its receptor. They are presumed to have the same fetal effects as ACE inhibitors and thus are also contraindicated.Antihypertensive to be avoided during pregnancyAntihypertensive safer during pregnancy* ACE inhibitors (Ex- captopril, enelapril etc.)* Angiotensin antagonist (losartan, telmesartan)* Thiazide diuretics (Ex- hydrochlorthiazide)* Furosemide* Propanolol* Nitroprusside* Hydralazine* Methyldopa* Atenolol* Metoprolol* Labetalol-DOC* Nifedipine* Prazosin and ClonidineDrugs and their respective risk* Diuretics: tend to reduce blood volume; increase risk of placental infarcts, fetal wastage, stillbirth.* ACE inhibitors, ATI antagonists: growth retardation and fetal damage risk.* Propranolol: causes low birth weight, neonatal hypoglycemia and bradycardia.* Nitroprusside: contraindicated in eclampsia.

So the answer to this question is A


Instruction:
Anteversion of uterus is maintained by:-
A. Cardinal ligament
B. Uterosacral ligament
C. Pubocervical ligament
D. Round ligament

Response:
Normally, the uterus lies in anteversion and anteflexion, maintained by Round ligament> uterosacral ligament Anteversion: angle between uterus and vagina- 90o Anteflexion: angle between uterus and cervix (at internal os)- 120o

So the answer to this question is D


Instruction:
Progressive dysphagia for solids and liquids is found in carcinoma of?
A. Oropharynx
B. Hypopharynx
C. Nasopharynx
D. All

Response:
ANSWER: (B) HypopharynxREF: Harrison s 16th ed p. 217Intermittent dysphagiaProgressive dysphagia* Diffuse esophageal spasm* Ca esophagus (hypopharynx)* Pharyngeal diverticulum* Stricture* Schatzki ring* Achalasia cardia* Esophagitis

So the answer to this question is B


Instruction:
Which one of the following may NOT be used during the
flanking of dentures:
A. petroleum
B. tin foil
C. tin foil substitute
D. silicone lubricant

Response:
None

So the answer to this question is A


Instruction:
Edwards syndrome is
A. Trisomy 21
B. Trisomy 18
C. Trisomy l3
D. 5P

Response:
TRISOMY 18: EDWARDS SYNDROME Characterised by Prominent occiput Mental retardation Micrognathia Sho neck Overlapping fingers Congenital hea defects Renal malformations Limited hip abduction Low set ears (Robbins Basic Pathology,9th edition,pg no. 238)

So the answer to this question is B


Instruction:
Choose the appropriate lettered structure in this angiogram of the cerebral vasculature and collateral circulations are discounted. Aneurysm of which artery causes a perichiasmal lesion that may cause nasal hemianopia?
A. A
B. B
C. C
D. D

Response:
(d) Nasal hemianopia is blindness in the nasal field of vision of the eye because of a perichiasmal lesion such as an aneurysm of the internal carotid artery.

So the answer to this question is D


Instruction:
Which of the following are signs of good attachment:
A. Baby's chin close to the breast
B. Baby's mouth is wide open
C. Baby is sucking around the areolar circumference
D. All of the above

Response:
Ans. D. All of the aboveSigns to good attachment include: baby's chin is close to the breast and is sucking around the areolar circumference, baby's mouth is wide open and the lower lip turned outwards, more areola is visible above the baby's mouth than below it. There should be no pain while breastfeeding.

So the answer to this question is D


Instruction:
Asthenospermia means: September 2005
A. Reduction in number of sperms
B. Reduction in motility of sperms
C. Absence of sperms
D. Absence of semen

Response:
Ans. B: Reduction in motility of sperms Asthenozoospermia/"asthenospermia" is the term for reduced sperm motility. It decreases the sperm quality and is therefore one of the major causes of infeility or reduced feility in men

So the answer to this question is B


Instruction:
Respiratory rate in a 2 month old, to label it tachypnea is –
A. 40
B. 50
C. 60
D. 70

Response:
Tach nea

< 2 months --->             60 or more RR/min
2-12 months —>          50 or more RR/min
12-60 months -3      40 or more RR/min

So the answer to this question is C


Instruction:
Dark field microscopy used in ?
A. Vibrio
B. Syphilis
C. TB
D. Brucellosis

Response:
Ans. is 'b' i.e., Syphilis Dark field microscopy is used for spirochetes (for example T pallidum which causes syphilis). Dark ground/ Dark field microscope Very slender organisms such as spirochetes and filamentous organs such as flagella are not visible under ordinary illumination. The contrast in dark field microscopy gives an illusion of increased resolution so that these structures can be seen under the dark field mcroscope. In dark field microscopy reflected light is used instead of the transmitted light used in the ordinary microscope.

So the answer to this question is B


Instruction:
Which of the follow ing is not a major criteria for rheumatic fever-
A. Carditis
B. Arthralgia
C. Erythema marginatum
D. Subcutaneous nodule

Response:
Ans. is 'b' i.e., Arthralgia Guidelines for the Diagnosis of Initial Attack of Rheumatic Fever (Jones Criteria, Updated 1992)Major manfestationsMinor manfestationsSupporting evidence of antecedent group A Streptococal infectionCarditisClinical features:Positive throat culture or rapid streptococcal antigen testPolyarthritisArthralgia FeverElevated or increasing streptococcal antibody titerErythema marginatumLaboratory features: Subcutaneous nodulesElevated acute phase reactants : Erythrocyte sedimentation rate C-reactive protein Prolonged PR interval Chorea o From Jones criteria, updated 1992. JAMA 1992;268:2069-2073. Copyright American Medical Association.o The presence of 2 major or of 1 major and 2 minor manifestations indicates a high probability of acute rheumatic fever if supported by evidence of preceding group A streptococcal infection.

So the answer to this question is B


Instruction:
Mechanism of action of terbinafine is ?
A. Binds to ergosterol
B. Prevents formation of purine
C. Inhition of micro-tubule formation
D. Inhibition of ergosterol synthesis

Response:
None

So the answer to this question is D