Instruction:
Which one of the following is closely associated with Myasthenia gravis?
A. Thymoma
B. Lymphoma
C. Adenoma
D. None

Response:
(A) Thymoma # MYASTHENIA GRAVIS is a neuromuscular disorder characterised by weakness and fatigability of skeletal muscles.> Up to 75% of patients have an abnormality of the thymus; 25% have a thymoma, a tumor (either benign or malignant) of the thymus, and other abnormalities are frequently found.> The disease process generally remains stationary after thymectomy (removal of the thymus).# Disorders Associated with Myasthenia Gravis & Recommended LaboratoryTests> Associated disorders Disorders of the thymus: thymoma, hyperplasia Other autoimmune disorders: Hashimoto's thyroiditis, Graves' disease, rheumatoid arthritis, lupus erythematosus, skin disorders, family history of autoimmune disorder> Disorders or circumstances that may exacerbate myasthenia gravis: hyperthyroidism or hypothyroidism, occult infection, mec ical treatment for other conditions (aminoglycoside antibiotics, quinine, antiarrhythmic agents)> Disorders that may interfere with therapy: tuberculosis, diabetes, peptic ulcer, gastrointestinal bleeding, renal disease, hypertension, asthma, osteoporosis, obesity# Recommended laboratory tests or procedures> CT or MRI of mediastinum> Tests for lupus erythematosus, antinuclear antibody, rheumatoid factor, antithyroid antibodies Thyroid-function tests PPD skin test Chest radiography Fasting blood glucose measurement Pulmonary-function tests Bone densitometry in older patients

So the answer to this question is A


Instruction:
In a patient with gouty ahritis, synol fluid aspiration will show -
A. Monosodium Urate crystals
B. Calcium Pyrophosphate crystals
C. Mononuclear Leucocytosis
D. Polymorphonuclear Leukocytosis

Response:
Gout: Disturbed purine metabolism leading to ecxessive accumulation of uric acid in the blood -an inherited disorder ;or impaired excretion of uric acid by kidneys.result is accumulation of sodium bicarbonte crystals in soft tissues. Tisues of predliction are cailages,tendon ,bursa. Patient ,beyond 40 years of age, presents as 1.ahritis-MP joint of big toe is ourite site,acute severe pain 2.bursitis-commonly of olecranon bursa 3.tophi formation deposit of uric acid salt in soft tissue. Confirmation of diagnosis: urate crystals in aspirate from a joint or bursa,high serum uric acid levels Treatment: NSAIDS,uricosuric drugs,uric acid inhibitors. IMAGE SHOWING MONOSODIUM URATE CRYSTALS IN NEGATIVELY BIFRINGENT REF:Essential Ohopaedics.Maheswari &Mhaskar.Edition 9 .Pg no:293

So the answer to this question is A


Instruction:
Stage of labor lasting from full dilatation of cervix to complete bih of baby is?
A. 1st stage
B. 2nd stage
C. 3rd stage
D. 4th stage

Response:
2nd stage.

So the answer to this question is B


Instruction:
Direction of Nasolacrimal Duct is
A. Downward,Backward and Medially
B. Downward,Backward and Laterally
C. Downward,Forward and Medially
D. Downward,Forward and Laterally

Response:
O Nasolacrimal duct opens in anterior pa of inferior meatus. O Direction of nasolacrimal duct is Backwards (Inwards),laterally and downwards (pneumonic: NLD). It courses anterior to maxillary ostium O Opening of nasolacrimal duct is guarded by Hasner's mucosal valve

So the answer to this question is B


Instruction:
Rat bite fever may be caused by -a) Leptospira canicolab) Streptobacillus moniliformisc) Borrelia recurrentisd) Spirillum minus
A. c
B. d
C. ab
D. bd

Response:
None

So the answer to this question is D


Instruction:
A 2 year old child presents with scattered lesions in the skull. biopsy revealed Langerhans giant cells. The most commonly associated is marker with this condition will be :
A. CD1a
B. CD57
C. CD3
D. CD68

Response:
The presence of Birbeck granules in the cytoplasm of tumor cells is characteristic of langerhans cell histiocytosis.
As Birbeck granules are not seen in all tumor cells by electron microscopy, the detection of S - 100 and CD la expression by immunohistochemical technique aids in the diagnosis.

So the answer to this question is A


Instruction:
Dimorphic fungi behaves like yeast at:
A. < 10degC
B. Body temperature
C. > 40degC
D. In vitro

Response:
Ans. b. Body temperature

So the answer to this question is B


Instruction:
Maximum iron absorption occurs in-
A. Duodenum
B. Jejunum
C. Ileum
D. Caecum

Response:
Ans. is 'a' i.e., Duoenumo Iron is absorbed from upper small intestine mainly duodenum. In diet iron occurs in two forms, haeme iron and inorganic (non-haeme) iron. Haem iron is better absorbed than inorganic iron, but the major fraction of diet is inorganic iron. Inorganic iron is mostly in ferric form; needs to be reduced to ferrous form because iron is absorbed in ferrous form.o After absorption ferrous form is once again oxidized to ferric form inside enterocytes. A fraction of absorbed iron is rapidly delivered to plasma transferrin. However, most of the iron is deposited in the enterocytes as ferritin, some to be transferred more slowly to plasma transferrin, and some to be lost when senescent mucosal cells (enterocytes) are sloughed into the intestine.o Iron absorption is regulated according to the demand, e.g., when there is iron deficiency, absorption increases. This regulation is mediated by "iron metabolism regulatory hormone", i.e., hepcidin that inhibit iron absorption. When there is iron deficiency, concentration of hepacidin falls and there is increase iron absorption. Hepacidin also decreases release of iron from storage sites.

So the answer to this question is A


Instruction:
Which of the following is NOT true about electroconvulsive therapy (ECT)?
A. Mainly used for the treatment of major depressive disorder
B. No absolute contraindications to the use of ECT
C. Should not be used in pregnancy
D. Pheochromocytoma is a relative contraindication

Response:
Between 80% and 90% of all ECT treatments are performed for the treatment of major depressive disorder. There are no absolute contraindications to the use of ECT. With appropriate preparation, ECT can be used effectively and safely in both pregnant and elderly patients. Pheochromocytoma is a relative contraindication for ECT. Ref: Loosen P.T., Shelton R.C. (2008). Chapter 18. Mood Disorders. In M.H. Ebe, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e.

So the answer to this question is C


Instruction:
A 33 year old suffers from blunt trauma to the eye. Fundoscopy shows cherry red spot, the probable diagnosis is
A. Retinoblastoma
B. Commotio Retinae
C. Optic nerve transection
D. Posterior Vitreous Detachment

Response:
Answer- B. Commotio RetinaeBerlin's oedema, also called commotio retinae, occurs in blunt trauma to eye. It manifests as milky white cloudiness involving a considerable area of the posterior pole with a'cherry-red'spot in the foveal region.

So the answer to this question is B


Instruction:
Sibutramine is indicated for
A. Smoking cessation
B. Obesity
C. weight loss
D. Mania

Response:
Ref: HL Sharma 3rd ed pg no: 334 sibutramine is used for obesity as it decreases appetite rimonabant also could be used, but it is banned

So the answer to this question is B


Instruction:
Sphincter and dilator pupillae develops from
A. Neuroectoderm
B. Surface ectoderm
C. Mesoderm
D. Endoderm

Response:
HUMAN EMBRYOLOGY-INDERBIR SINGH tenth edition Derivatives of neuroectoderm: R-Retina O-Optic stalk/optic nerve M-Muscles of iris(sphicter and dilator pupillae) E-Epithelium of iris/ciliary body

So the answer to this question is A


Instruction:
A patient presents with pain in the thigh, relieved by aspirin. X-ray shows a radiolucent mass surrounded by sclerosis. Diagnosis is -
A. Osteoma
B. Osteoid osteoma
C. Osteoblastoma
D. Osteoclastoma

Response:
Radioluscent lesion with surrounded sclerosis and pain relived by a salicylate are characteristic of Osteoid osteoma Refer Maheshwari 9TH ED p 235

So the answer to this question is B


Instruction:
Antibiotic gramicidin S is derived from ?
A. Bacillus brevis
B. Cl difficle
C. S epidermidis
D. Streptococcus bovis

Response:
Ans. is'a'i.e., Bacillus brevisGramicidin-s is an antibiotic effective against some Gram positive and Gram negative bacteria as well as some fungi.It is a derivative of gramicidin, produced by the Gram positive bacterium Bacillus brevis.

So the answer to this question is A


Instruction:
Submandibular salivary duct calcification treatment includes
A. Longitudinal incision and suturing the duct
B. Longitudinal	incision	and	suturing	the	wound leaving the duct open
C. Transverse incision and suturing the duct
D. Transverse incision and suturing the wound leaving the duct open

Response:
None

So the answer to this question is B


Instruction:
In cephalometric analysis of children with malocclusion,
The angle ANB is frequently used in patients with severe class II malocclusions, This angle is
A. Large
B. Small
C. Normal
D. Negative

Response:
None

So the answer to this question is A


Instruction:
Most common cause of idiopathic interstitial pneumonia is-
A. Sarcoidosis
B. Organizing pneumonia
C. Idiopathic pulmonary fibrosis
D. Lipoid pneumonia

Response:
Ans. is 'c' i.e., Idiopathic pulmonary fibrosis Diffuse parenchymal lung disease | | | | |DPLD of known cause eg, drugs or association eg, rheumatic diseaseIdiopathic interstitial pneumonia (lIPs)Granulomatous DPLD eg, sarcoidosisOther forms of DPLD eg, LAM, PLCH, etc | Non-familial(>80 percent)Familial(2 to 20 percent) | | | | ChronicfibrosingAcute/subacutefibrosingSmokingrelated|||o Idiopatic pulmonary fibrosiso Idiopathic nonspecific interstitial pneumoniao Cryptogenic organizing pneumoniao Acute interstitial pneumoniao Respiratory bronchiolitis interstitial lung diseaseo Desquamative interstitial pneumonia o Diffuse parenchymal lung diseases consist of disorders of known causes (rheumatic disease, environmental or drug related) as well as disorders of unknown cause.o The latter include idiopathic interstitial pneumonias, granulomatous lung disorders (eg, sarcoidosis), and other forms of interstitial lung disease including lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis/ histiocytosis X, and eosinophilic pneumonia.o The interstitial pneumonias are further categorized as chronic fibrosing, acute or subacute fibrosing, or smoking related.o Lymphocytic interstitial pneumonia is typically associated with other disease processes, such as rheumatic disease or immunosuppression; idiopathic lymphocytic pneumonia is rare.o DPLD: diffuse parenchymal lung disease; IIP: idiopathic interstitial pneumonia; LAM: lymphangioleiomyomatosis; PLCH: pulmonary Langerhans cell histiocytosis/histiocytosis X.

So the answer to this question is C


Instruction:
Which of the following OPV vials are usable?
A. Only 1
B. Only 1,2
C. Only 1,2, 3
D. Only 3, 4

Response:
(b) Only 1, 2Rules for VVM use in India* Rule 1: If the inner square is lighter than the outer circle, the vaccine may be used (Vials 1, 2)* Rule 2: If the inner square is the same colour as, or darker than, the outer circle, the vaccine must not be used (Vials 3,4).

So the answer to this question is B


Instruction:
Which of the following tumors arise from epiphysis
A. Ewing's sarcoma
B. Osteoclastoma (GCT)
C. Chendromyxoid fibroma
D. Osteosarcoma

Response:
Ans. is 'b' i.e. Osteoclastoma * Chondroblastoma and giant cell tumor are located in the epiphysis. Chondroblastoma is a rare tumor seen in children and adolescents with open growth plates. GCT involves epiphysis in skeletally mature individuals with closed growth plates. GCT often shows metaphyseal extension. Sites of origin of Primary bone neoplasm Epiphysis Metaphysis Diaphysis Chondroblastoma Giant cell tumor Osteosarcoma Chondroma Chondrosarcoma Osteoid osteoma Osteochondroma Brodie's abscess (not a tumor) Ewing's sarcoma Lymphoma Myeloma Adamantinoma Osteoid osteoma Giant Cell Tumor (MRI scan shows a giant cell tumor at the upper end of the shinbone.) Osteoid osteoma is more common in diaphysis (Maheshwari 3/e, p 215) OBSTETRICS AND GYNAECOLOGY

So the answer to this question is B


Instruction:
Which is NOT an oncogenic virus-
A. HTLV- 1
B. Herpes simplex
C. Papilloma virus
D. None

Response:
Ans. is 'None'

So the answer to this question is D


Instruction:
Hyaline membrane disease is associated with:
A. Respiratory distress syndrome
B. Bronchopulmonary dysplasia
C. Sudden infant death syndrome
D. Bronchiolitis obliterans

Response:
(Respiratory distress syndrome): Ref: 470-HM, 48J-83-R (257- Basic pathology 8th)* The fundamental defect in RDS is a deficiency of pulmonary surfactant* Surfactant synthesis is modulated by a variety of hormones and growth factors, including cortisol, insulin, prolactin, thyroxin, and TGF b45. The role of glucocorticoid is particularly important* Increased risk for developing complications are1. Patent ductus arteriosus2. Intraventricular hemorrhage3. Necrotizing enterocolities

So the answer to this question is A


Instruction:
Which is the EEG wave recorded in a subject who is awake but eyes closed?
A. Alpha waves
B. Beta waves
C. Theta waves
D. Delta waves

Response:
Alpha waves are recorded best in the parieto-occipital region in adults at rest, i.e., awake but relaxed with eyes closed. EEG Waves Frequency (in HZ) Amplitude (in mV) Location where it is best-recorded Alpha Rhythm 8-13 50-100 Parieto-occipital regions Beta Rhythm 13-30 5-10 Frontal region Theta Waves 4-8 <200 Parietal and temporal regions in children Delta Waves 0.5-4 20-200 (large amplitude) Occipito-temporal Ref: Ganong's Review of Medical Physiology 25th edition Pgno: 272-273

So the answer to this question is A


Instruction:
Deficiency of which of the following is associated with hemolytic anemia in pre term babies?
A. Vitamin K
B. Vitamin C
C. Vitamin E
D. Vitamin D

Response:
Vitamin E deficiency is associated with hemolytic anemia in pre term babies and also causes progressive neuropathy and paralysis of external ocular muscles. Vitamin D deficiency results in rickets. Also know Vitamin K and C deficiencies are associated with hemorrhagic diseases. Ref: Meharban Singh, Edition 3, Page 35.

So the answer to this question is C


Instruction:
Dietary cholesterol is transpoed from intestine to liver by:
A. Apo-A
B. Apo-B
C. Apo-C
D. Apo-E

Response:
Dietary cholesterol is transpoed from intestine to liver with the help of Apo-E Dietary lipids (TG +cholesterol) is transpoed from intestine to blood chylomicron. Chylomicron acquires apo E from HDL in circulation. They later get conveed to chylomicron remnants after the action of lipoprotein lipase. Apo-E is the ligand for chylomicron remnants for uptake by liver which brings dietary cholesterol from the intestine to the liver. Even though chylomicron contain Apo B48 mainly, but uptake of chylomicron remnant in liver is due to Apo E. Therefore, Apo E is the answer here.

So the answer to this question is D


Instruction:
In bishop score, all are included except
A. Effacement of cervix
B. Dilatation of cervix
C. Station of head
D. Interspinal diameter

Response:
The Bishop score can be used to evaluate the condition of cervix and station of presenting pa, as a prognostic index for the success of induction. The different components of currently used scoring systems are dilatation, effacement, station, consistency, and position(refer page: 558 Sheila 2nd edition)

So the answer to this question is D


Instruction:
Which of the following is most characteristic of exudative retinal detachments?
A. Demarcation lines
B. Tobacco dusting
C. Fixed folds
D. Shifting fluid

Response:
Exudative RD is characterized by the accumulation of Sub retinal fluid in the absence of retinal breaks or traction. It may occur in a variety of vascular, inflammatory and neoplastic diseases involving the retina, RPE and choroid in which fluid leaks outside the vessels and accumulates under the retina. As long as the RPE is able to compensate by pumping the leaking fluid into the choroidal cir-culation, RD does not occur. However, when the mechanism is overwhelmed or functions subnormally, fluid accumulates in the subretinal space. Sign in exudative RD: The detached retina is very mobile and exhibits the phenomenon of 'shifting fluid' in which SRF detaches the area of retina under which it accumulates . For example, in the upright position the SRF collects under the inferior retina, but on assuming the supine position for several minutes, the inferior retina flattens and SRF shifts posteriorly, detaching the superior retina. Demarcation lines are present in long standing retinal detachmemts. Tobacco dusting is a sign of rhegmatogenous retinal detachmemt. Fixed folds are seen in tractional retinal detachmemt.

So the answer to this question is D


Instruction:
Actinomycosis most commonly affects
A. Thorax
B. Facio - cervical region
C. Liver
D. Pelvis

Response:
Facio - cervical Actinomycosis is most common type.

So the answer to this question is B


Instruction:
Constrictive pericarditis is associated with each of the following except
A. Radiation therapy for Hodgkins disease
B. Tuberculosis
C. Bacterial (purulent) pericarditis
D. Hypothyroidism

Response:
Constrictive pericarditis is a condition in which the filling of the hea is limited by the compressive nature of the pericardium. The pericardium acts as a rigid shell around the hea, imposing continuous positive pressure. The filling is, therefore, compromised specifically in diastole when filling is at its maximum. This results in an early diastolic descent followed by a rise and plateau (dip and plateau or square root sign). There are several disease processes that have been attributed to constrictive pericarditis including rheumatic hea disease, radiation therapy, tuberculosis, and purulent pericarditis. Hypothyroidism, however, causes pericardial effusion

So the answer to this question is D


Instruction:
A 65 year old man presented with vocal cord palsy. He is a pan chewer since childhood. On examination, his abducting function of vocal cord is impaired. The nerve affected is:
A. External laryngeal nerve
B. Recurrent laryngeal nerve
C. Mandibular nerve
D. Vagus nerve

Response:
The sole abductor of the vocal cords is the posterior cricoarytenoid muscle which is innervated by recurrent laryngeal nerve. Innervation of the Vocal Cord: Muscle Nerve Adductors (lateral cricoarytenoid, thyroarytenoid, interarytenoids) Recurrent laryngeal (adductor branch) Posterior cricoarytenoid Recurrent laryngeal (abductor branch) Cricothyroid External laryngeal

So the answer to this question is B


Instruction:
After heart attack CK-MB levels rises most significantly around
A. 4-10 hrs
B. 3-6 hrs
C. 24 hrs
D. 48 hrs

Response:
None

So the answer to this question is A


Instruction:
Congenital heart lesion(s) in rubella are –  a) VSD b)  ASDc)  PDAd)  Pulmonary stenosis
A. abc
B. acd
C. abcd
D. acd

Response:
Congenital heart lesions in rubella are FDA, PS, VSD, ASD, TOF, AS, and Pulmonary artery hypoplasia.

So the answer to this question is C


Instruction:
At autopsy, the cyanide poisoning case will show the following features, except:
A. Characteristic bitter lemon smell.
B. Congested organs.
C. The skin may be pinkish or cherry red in colour.
D. Erosion and haemorrhages in oesophagus and stomach

Response:
A i.e. Characteristic bitter lemon smell Cyanide poisoning is associated with a characteristic smell of bitter almonds and not of bitter lemon

So the answer to this question is A


Instruction:
True statement regarding twin delivery is:
A. First twin has more chances of asphyxia
B. Second twin has more chances of developing polycythemia
C. Second twin has more chances of developing hyaline membrane disease.
D. Increased mortality in first twin.

Response:
Twin pregnancy in general is associated with higher incidence of perinatal morbidity and mortality.
Perinatal mortality in twins is 5 times greater than in singleton pregnancies.
Perinatal mortality in twins varies with birth order and the type of placentation.
 “Second twins do not do as well as the first twin…perinatal mortality being 9% for the first twin and 14% for the second twin”.

Fernando Arias 3/e, p 297

Also monochorionic—monoamniotic twins have a poor prognosis, perinatal mortality being 50%.
Now with this background lets see each option separately.

Option a: First twin has more chances of asphyxia—incorrect as:

“Asphyxia and stillbirth are more common (in twin pregnancy) due to increased prevalence of pre-eclampsia, malpresentations, placental abruption and increased operative interferences. The second baby is more atrisk.

Dutta Obs. 7/e, p 206
Option b: Second twin has more chances of developing polycythemia:

This statement can be true as second baby has more chances of asphyxia which can stimulate erythropoeisis in the second twin. Also there are chances of bleeding from the first twin into the second twin in case of monochorionic twins which can cause polycythemia.

Option c: Second twin has more chances of developing hyaline membrane disease—this is incorrect as is evident from the following lines of Williams:

“As measured by determination of the lecithin and sphingomyelin ratio, pulmonary maturation is usually synchronous in twins.”

Williams 23/e, p 880

Hence second twin does not have increased chances of developing hyaline membrane disease.
Coming to the last option—Increased mortality in first twin (option d)

So the answer to this question is B


Instruction:
Lenticular shaped hemorrhage is seen in?
A. Extradural hemorrhage
B. Subdural hemorrhage
C. Subarachnoid hemorrhage
D. Intracerebral hemorrhage

Response:
Blood accumulates betweem rigid skull and the dura giving it a biconvex (lenticular shape) in extradural hemorrhage.

So the answer to this question is A


Instruction:
Which of the following is associated with antiglomerular basement membrane antibody ?
A. IgA nephropathy
B. Membranous glomerulonephritis
C. Goodpasture's syndrome
D. Membrano-proliferative glomerulonephritis

Response:
Ans. is 'c' i.e., Goodpasture's syndrome

So the answer to this question is C


Instruction:
Botulinum toxin acts on -
A. Synapse
B. Smooth muscle of intestine
C. Central nervous system
D. Sensory nerves

Response:
Ans. is 'a' i.e., Synapseo Botulinum toxin affectsNeuromuscular junction.Postganglionic parasympathetic nerve endings.Peripheral ganglia.o Central nervous system is not involved and there is no sensory involvement.o Botulinum toxin acts by inhibiting the calcium mediated exocytosis of ACh from the vesicles in the synapse.

So the answer to this question is A


Instruction:
Sensory supply of the palm is from which nerves -
A. Median nerve and Radial nerve
B. Radial nerve and ulnar nerve
C. Ulnar nerve and Median nerve
D. Musculocutaneous nerve and Radial nerve

Response:
Ans. is'c'i.e., Ulnar nerve and Median nerve(Rel BDC 5'h/e VoL I p. 108-111)On Palm side:Lateral 2/3 of the palm and lateral three and half fibers - Median nerve.Medial 1/3 of the palm and medial one and half fingers - Ulnar nerve.

So the answer to this question is C


Instruction:
All of the following may occur in Noonan's syndrome except -
A. Hyperophic cardiomyopathy
B. Cryptoorchidism
C. Infeility in females
D. Autosomal dominant transmission

Response:
Ans. is 'c' i.e., Infeility in females Term 'Noonan Syndrome' has been applied to males and females who have some phenotypic features that resemble females with turner's syndrome (45 X, 0), but themselves have apparently normal sex chromosomes (46 XX or 45 XY). o Females usually show normal sexual maturation but it is delayed 2 years on an average.

So the answer to this question is C


Instruction:
Best antagonist of morphine is –
A. Nalorphine
B. Naloxone
C. Buprenorphine
D. Pentazocine

Response:
Naloxone is the preferred specific antidote for morphine poisoning.

So the answer to this question is B


Instruction:
Capnography is used for assessment of -
A. Oxygen saturation of blood
B. Amount of C02 transported in blood
C. Ventilation of lung after intubation
D. Myocardial perfusion

Response:
Ans. is 'c' i.e., Ventilation of lung after intubation Capnographvo Capnography is the continuous measurement of end tidal CO2 (ETCO2), i.e., CO2 in exhaled air. Normal value is 35-45 mm Hg (4% to 6%).o Capnography works on the principle that infrared light is absorbed by carbon dioxide. A beam of infrared light is passed across the gas sample to fall on to a sensor. The presence of CO2 in the gas leads to a reduction in the amount of light falling on the sensor which changes the voltage in the circuit.Uses of CapnographyIt is the surest confirmatory sign of correct intubation in trachea. Incorrect position of tube in esophagus instead of trachea (esophageal intubation) will yield ETC02 = 0.Intraoperative displacement of endotracheal tube - ETCO2 will become zero.Obstruction or disconnections of endotracheal tube - ETCO2 will fall.Diagnosing malignant hyperthermia - ETCO2 increases significantly (more than 100 mg Hg).

So the answer to this question is C


Instruction:
Which of the following is an absolute contraindication to adrenal steroid therapy?
A. Severe hypeension
B. Osteoporosis
C. Diabetes mellitus
D. Cushing's syndrome

Response:
Cushing's syndrome is an absolute contraindication to coicosteroid therapy. Relative contraindications includes peptic ulcer, hypeension, hypeension with congestive hea failure, diabetes mellitus, herpes simplex infection, osteoporosis and glaucoma. Ref: Textbook of Pharmacology By Seth 3rd edition page 61

So the answer to this question is D


Instruction:
Which of the following tests is not used for detection of specific aneuploidy?
A. FISH
B. #NAME?
C. QF-PCR
D. Microarray

Response:
Microarray is not used for detecting aneuploidy. It is used to detect the presence of gene variation or patterns of gene expression. Ref: Molecular Biology : Genes to Proteins By Buon E. Tropp, David Freifelder, Page 189; The Washington Manual of Oncology By Ramaswamy Govindan, Washington University (Saint Louis, Mo), School of Medicine, Page 100; Molecular Diagnostics : For the Clinical Laboratorian By William B. Coleman, Gregory J. Tsongalis, Page 70.

So the answer to this question is D


Instruction:
Schilling's test is false + ve in (PGI June 2008)
A. Celiac sprue
B. Renal insufficiency
C. Short bowel syndrome
D. Diverticulosis

Response:
Ans. B (Renal insufficiency) D-Xylose TestPositive TestDecreased D-Xylose excretion in urine due to malabsorption from gastrointestinal mucosal diseaseCauses IncludeCeliac diseaseTropical sprueWhipple's diseaseAnother mucosal diseaseFalse Positive TestDecreased D-Xylose excretion in urine due to causes other than malabsorption from small bowel mucosal diseaseCauses Include# Bacterial overgrowth# Renal insufficiency# Delay gastric emptying# Rapid intestinal transit# Vomiting# Ascites / Pleural effusion (Third space collections) o causes other than malabsorption from small bowel mucosal diseaseTable (Harrison) : Results of Diagnostic Studies in Different Causes of Steatorrhoea. D-XyloseTestSchilling TestDuodenalMucosalBiopsyChronic pancreatitisnormal50% abnormal; if abnormal, normal with pancreatic enzymes1NormalQBacterial overgrowth syndromeNormal or only modestly abnormalQOften abnormal; if abnormal, normal after antibioticsUsuallynormalIleal diseasenormalAbnormal5NormalCeliac sprueDecreasedNormalAbnormal: probably 'flat"QIntestinal lymphangiectasiaNormalNormalAbnormal:"dilatedlymphaticsSchilling Test Resultsnormal.Patient ConditionStage I WaterStage II Intrinsic FactorStage III AntibioticStage IV Pancreatic ExtractHealthynormal.mmPerniciousanemiaLowNormaQ- Bacterial overgrowthLowLowNormal-Pancreatic insufficiencyQ LowLowLowQNormalDefect in ileumQLowLowLowLow

So the answer to this question is B


Instruction:
The most widely used substance dependence causing drug is:
A. Amphetamines
B. Opium
C. Cocaine
D. Cannabis

Response:
Substance dependenceis a cluster of physiological, behavioral and cognitive phenomenon in which the use of a substance or a class of substances taken on a much higher priority for a given individuals than other behaviors that once had greater value. Psychoactive substances or drugs of dependence and abuse are classifiedas: Ethanol Tobacco Opioids Cannabis Cocaine Amphetamines and others Hallucinogens -- LSD, phencyclidine Tranquillizers, sedatives and hypnotics -- barbiturates, benzodiazepines etc. Inhalants -- solvents, ethers etc. Miscellaneous: caffeine, Datura, analgesics etc. Alcohol remains the preferredagentover the years, however many newer psychoactive drugs have joined. These drugs are called as recreational drugs and includesmarijuana (ganja), LSD, amphetamine etc. VariousPreparations of Cannabissativaare: Bhang: also called as sidhi, patti, sabji. Ganja: is derived from flowering tops. Charas: also known as hashish or hash and is derived from resinous exudates of plant Majun: a sweet prepared with any of the above preparation Added. Marijuana

So the answer to this question is D


Instruction:
In 1st week of parenteral nutrition, patient becomes: March 2013 (f)
A. Overweight
B. Underweight
C. Normal weight
D. Variable

Response:
Ans. B i.e. Underweight Total parenteral nutrition TPN is used as a primary therapy in: - Severe burns, - Sho bowel syndrome etc. Complications of TPN: - Air embolism, - Weight loss in 7 days etc. Metabolic changes in TPN: - Essential fatty acid deficiency, - Electrolyte disorder etc.

So the answer to this question is B


Instruction:
A 2 old boy with fever and rhinorrhea developed a maculopapular rash, to the face, the neck, chest, arms in that order. Diagnosis includes
A. Measles
B. Meningococcal septicaemia
C. Haemophilia
D. Chicken pox

Response:
The disease is most common in preschool children; infants are protected by transplacental antibodies, which generally decay by 9 months The prodromal phase is characterized by fever, rhinorrhea, conjunctiva! congestion and a dry hacking cough. Koplik spots, considered as pathognomonic of measles, appear opposite the lower second molars on the buccal mucosa on the second or third day of the illness as grey or white lesions resembling grains of sand with surrounding erythema. The rash, usually appears on the fouh day with a rise in fever, appears as faint reddish macules behind the ears, along the hairline and on the posterior aspects of the cheeks. The rash rapidly becomes maculopapular and spreads to the face, the neck, chest, arms, trunk, thighs and legs in that order over the next 2-3 days. It then stas fading in the same order that it appeared and leaves behind branny desquamation and brownish discolouration, which fade over 10 days Refer : O.P Ghai 8e pg:213

So the answer to this question is A


Instruction:
A 70 year old male known case of a certain malignancy presents with elevated erythropoietin levels and PCV of 52%. Most likely tumour is -
A. Renal Cell Carcinoma
B. Medullary thyroid carcinoma
C. Gastric Carcinoma
D. Colorectal CA

Response:
Ans. is 'a' i.e., Renal Cell Carcinoma Paraneoplastic syndromes in RCCParaneoplastic syndormesi) Fever of unknown originii) Anemiaiii) Erythrocytosis (d/t secretion of erythropoietin by RCC) (but anemia is a more common finding)iv) Hypertensionv) Abnormal liver function (Stauffers syndrome ie non metastatic hepatic dysfunction)vi) Hypercalcemiavii) Neuromyopathyviii) Amyloidosisix) Increased ESR (MC paraneoplastic syndrome)x) Dysfibrogenemiaxi) Galactorrhoeaxii) Feminization and masculanization

So the answer to this question is A


Instruction:
All are true about postreptococcal glomerulonephritis except ?
A. Crescent formation
B. Subepithelial deposits
C. Granular deposits of IgG
D. Deposition of IgA

Response:
Ans. is 'd' i.e., Deposition of IgA Post streptococcal (Acute proliferative) glomerulonephritis Post streptococcal glomerulonephritis (PSGN) is an acute proliferative glomerulonephritis which is characterized by diffuse proliferation of glomerular cells, associated with influx of leukocytes. PSGN is characterized by - Enlarged, hypercellular glomeruli that is caused by Infiltration of leukocytes, both neutrophils and monocytes. Proliferation of endothelial cells and mesangial cells. Proliferation and leukocyte infiltration is diffuse, i.e. involving all lobules of all glomeruli. In sever form -Crescent formation. By immunofluorescence microscopy, there are granular deposits of IgG, IgM and C3 in the mesangium and along the basement membrane. The characteristic electron microscopic findings are discrete, amorphous, electron dens deposits on the epithelial side of the membrane, often having the appearance of humps- Subepithelial humps. Subendothelial, intramembranous (within GBM) and mesangial deposits may be present. Also know In its severe form acute diffuse proliferative GN may show rapid deterioration of renal function with formation of crescent in the glomeruli it is referred as rapidly progressive glomerulonephritis.

So the answer to this question is D


Instruction:
Bile salts act as-
A. Emulsifying agent
B. Detergent
C. Surface tension lowering agents
D. All of the above

Response:
Ans. is'd' i.e., All of the aboveBile saltso Bite salts are the most important constituents of the bile.o They are sodium and potassium salts of bile acids, conjugated to amino acids, glycine or taurine,o The important bile acids are cholic acid and chenodeoxycholic acid.o Bile acids are derived from cholesterol.o Bile salts help in digestion and absorption of fat by emulsification and micelles formation,o Bile salts act as detergents, i.e., they have surface tension lowering action.o Detergent action is dne to amphipathic nature of bile salts (Note : Amphipathic molecules are molecules that contain both hydrophobic non-polar as well as hydrophilic-polar ends).

So the answer to this question is D


Instruction:
Creutzfeldt-Jacob disease is caused by -a) Prionb) JC virusc) Genetic factorsd) Nutritional deficiency
A. ac
B. bc
C. ad
D. b

Response:
None

So the answer to this question is A


Instruction:
All of the following are known to cause hyperprolactenemia except :
A. Methyldopa
B. Phenothiazines
C. Bromocriptine
D. Metoclopramide

Response:
Answer is C (Bromocriptine) : Bromocriptine is a potent dopamine agonist. It decreases prolactin release from pituitary by activating inhibitory dopaminergic receptors on lactotrope cells, a strong anti-galactopoietics action. Etiology of Hyperprolactinemia I. Physiologic hypersecretion Pregnancy Lactation Chest wall stimulation Sleep Stress II. Pituitary hypersecretion Prolactinoma Acromegaly III. Systemic disorders Chronic renal failure Hypothyroidism Cirrhosis Pseudocyesis Epileptic seizures IV. Drug-induced hypersecretion Ref previous question V. Hypothalamic-pituitary stalk damage Tumors - Craniopharyngioma - Suprasellar pituitary mass extension - Meningioma - Dysgerminoma - Metastases Empty sella Lymphocytic hypophysitis Adenoma with stalk compression Granulomas Rathke's cyst Irradiation Trauma - Pituitary stalk section - Suprasellar surgery

So the answer to this question is C


Instruction:
Inferior parathyroid develops from which Pharyngeal Pouch -
A. 1st
B. 2nd
C. 3rd
D. 4th

Response:
Ans. is 'c' i.e., 3rd o Parathyroid gland, 4 in number (a superior pair and an inferior pair) are located on the posterier border of thyroid gland. o The superior parathyroids are also referred to as 'parathyroid IV' because they develop from the fourth pharyngeal pouch, and inferior parathyroids are also referred to as 'parathyroid III' because they develop from the third pharyngeal pouch. o Each parathyroid is oval or lentiform in shape, measuring 6 4 2 mm, and each weighs about 50 mg.

So the answer to this question is C


Instruction:
Will's gauge is used to measure
A. Vertical height
B. Bi-zygomatic width
C. Inter condylar distance
D. Inter papillary width

Response:
None

So the answer to this question is A


Instruction:
"Biphasic pattern" on histology is seen in which tumor-
A. Rhabdomyosarcoma
B. Synol cell sarcoma
C. Osteosarcoma
D. Neurofibroma

Response:
Ans. is 'b' i.e., Synol cell sarcomaIn synol cell Sarcoma characteristic biphasic pattern seen i.e., Epithelial cells sharply segregated by sarcomatoid cells.

So the answer to this question is B


Instruction:
Morphine can be given by all the following routes except:
A. Intravenous
B. Intramuscular
C. Subcutaneous
D. Sublingual

Response:
None

So the answer to this question is D


Instruction:
Feature of septic shock is -
A. Acute tubular necrosis
B. Acute cortical necrosis
C. Acute glomeruloneplu-itis
D. Acute papillary damage

Response:
None

So the answer to this question is A


Instruction:
In a patient with renal cell carcinoma with a thrombus in the IVCrenal vein, which of the following is the best for diagnosis?
A. CT scan
B. Angiography
C. Colour Doppler imaging
D. IVP

Response:
Ans. CT scan

So the answer to this question is A


Instruction:
Which among the following is not a cause for cyanosis?
A. Methemoglobin
B. Sulfhemoglobin
C. Cirrhosis
D. Carboxyhemoglobin

Response:
Cyanosis is caused by reduced hemoglobin. CO poisoning doesn't cause cyanosis. Approximately 5 g/dL of unoxygenated hemoglobin in the capillaries generates the dark blue color appreciated clinically as cyanosis. Causes: Central Nervous System: Intracranial hemorrhage, Cerebral anoxia Respiratory System: Pulmonary Hypeension, Pulmonary embolism, Hypoventilation, COPD Cardiac Disorders: Congenital hea disease, Hea failure, Hea valve disease Blood: Methemoglobinemia, Polycythaemia Others: High altitude, Hypothermia, Congenital cyanosis (HbM Boston), Obstructive sleep apnea

So the answer to this question is D


Instruction:
Most common abused substance is:
A. Datura
B. Marijuana
C. Cocaine
D. Heroin

Response:
Cannabis / marijuana:Most commonly abused substance in India Opium: Derived from Papaver somniferum; poison of choice for suicide Heroin / brown sugar: Synthetic derivative of opium Datura: Roadside poison or railway poison Cocaine: Obtained from dried leaves of Erythroxylum coca

So the answer to this question is B


Instruction:
Who gave the model for demineralization & remineralization of white spot lesion?
A. Miller
B. Moreno
C. Martin
D. Massler

Response:
The physiochemical process of white spot lesions was difficult to understand until the Moreno model was described. In this model, acids formed by cariogenic bacteria dissolve the surface as well as subsurface enamel. The calcium and phosphate ions from the subsurface dissolution diffuse downwards toward the surface and reprecipitate on the surface making the enamel surface appear unaltered.

So the answer to this question is B


Instruction:
Sialogram of a normal salivary gland appears as:
A. Leafy tree
B. Leafless tree
C. Sialolithiasis
D. Sialgectasia

Response:
None

So the answer to this question is B


Instruction:
All are seen in vitamin C deficiency except:
A. Swollen bleeding gums
B. Delayed wound healing
C. Anemia
D. Infeility

Response:
Vitamin C/Ascorbic acid deficiency leads toScurvy Clinical manifestation of scurvy: Swollen and bleeding gums Subcutaneous bleeding and brushing into skin/joints Delayed wound healing Anemia Weakness.

So the answer to this question is D


Instruction:
A 20 year old male presents with features of acute renal failure 5 days after an episode of diarrhea. Blood examination shows thrombocytopenia and Hb10 gm%. Likely cause is:
A. Haemolytic uremic syndrome
B. Hereditary spherocytosis
C. Haemolytic crises
D. Chronic glomerulonephritis

Response:
Answer is A (Hemolytic uremic syndrome): Patient presents with Renal failure 5 days after an episode of diarrhea. He has associated Anemia and Thrombocytopenia and thus qualifies the triad of HUS i.e. Anemia Thrombocytopenia Renal failure Remember In contrast to TTP, the HUS remains localized to the kidney, where hdyaline thrombi are seen in the afferent aerioles and glomerular capillaries. Such thrombi are not present in other vessels and neurologic symptoms, other than those associated with uremia are uncommon. DIC is not seen in both TTP & HUS

So the answer to this question is A


Instruction:
Drug of choice for anti-psychotic induced Parkinsonism
A. Pimavanserin
B. Trihexyphenidyl
C. Droxidopa
D. Pramipexole

Response:
Central anticholinergics  are used for treatment of drug induced parkinsonism

So the answer to this question is B


Instruction:
MC optic nerve tumor in children causing blindness:
A. Glioma
B. Meningioma
C. Craniopharyngioma
D. Astrocytoma

Response:
a. Glioma(Ref: Nelson's 20/e p 3059, Ghai 8/e 612-613)High Yield Points about Optic GliomaOptic nerve glioma is the most frequent tumor of optic nerve in childhood; it is a benign hamartoma;Principal clinical manifestations are unilateral loss of vision, proptosis, deviation of the eye & optic atrophy

So the answer to this question is A


Instruction:
A patient of total parenteral nutrition develops delayed wound healing, loss of taste, deficient immunity and diarrhea. It could be due to deficiency of:
A. Selenium
B. Copper
C. Zinc
D. Iron

Response:
Zinc, a trace mineral, plays a fundamental role in the overall success of many body functions and zinc deficiency can negatively affect wound healing. Plays a rolein cell division, cell growth, wound healing, and the breakdown of carbohydrates. Zincis also needed for the senses of smell and taste

So the answer to this question is C


Instruction:
In SLE, true are -a) Autoimmune hemolytic anaemiab) Joint deformityc) ↑ed ANAd) Anti-ds DNAe) Raynaud's phenomena
A. acde
B. bde
C. abcd
D. abde

Response:
None

So the answer to this question is A


Instruction:
A child come with fever, cold, cough, membrane over tonsils; nasal swab is taken, culture should be done on which medium for earliest diagnosis ?
A. Loffelers serum slop
B. L. J. media
C. MC Conkey's Agar
D. Citrate media

Response:
Ans. is 'a' i.e., Loffelers serum slop Diphtheria bacilli grow on Loeffler's serum slope very rapidly and colonies can be seen in 6-8 hours, long before other bacteria grow.

So the answer to this question is A


Instruction:
The HLA important in IDDM is -.
A. HLA-A3
B. HLA-B27
C. HLA-DR3/DR4
D. HLA-W1

Response:
95% of IDDM (Type I Diabetes Mellitus) patients express either HLA DR3 or HLA DR4 or the heterozygous DR3 / DR4 configuration.
No HLA association is seen with Type II Diabetes mellitus or NIDDM.

So the answer to this question is C


Instruction:
The preferred material for repair of fractured denture base is:
A. Chemically cured resin
B. Heat cured resin
C. Light cured resin
D. Vinyl resin

Response:
REPAIR OF ACRYLIC RESIN DENTURES
An acrylic denture fractured in service can be repaired. Repair resins maybe:

Heat cure (OR)
Self cure

Heat cured resin
These resins are cured at 74oC for 8 hours or more. The use of a heat-cured resin will tend to warp the denture during processing.
Self-cured resin
Although the repair with a self-cured resin invariably has a lower transverse strength than that of the original heat-cured denture base resin, self-cured resins are usually preferred because warpage is insignificant as curing is done at room temperature.
Reference: Mannapallil Basic SCIENCE OF DENTAL MATERIALS, 4th ed page no 561

So the answer to this question is A


Instruction:
Determination of Pulp vitality by pulse oximeter based on:
A. Beer's law.
B. Pascal's law.
C. Doppler law.
D. Poisslues law.

Response:
Pulse oxymetry-

Based on Beer Lambert law
Utilization of a probe that transmits red (640 mm) and infrared light
Photo detector as a receptor site
Different absorption ability of light by oxygenated and deoxygenated haemoglobin leads to changes in the amount of light differently absorbed by the vascular bed before reaching the photo detector.

So the answer to this question is A


Instruction:
A 65 years old male diagnosed by biopsy a case of lung carcinoma, with paraneoplastic syndrome and increased PTH. Probable cause is-
A. Parathyroid
B. Parathyroid related peptide
C. Calcitonin
D. Calcitonin related peptide

Response:
Hypercalcemia is seen in squamous cell carcinoma of lung. The causal mechanism is the production of calcemic humoral substances, most impoantly parathyroid hormone-related protein ( PTHRP) . It has sone biological action similar to PTH. Several other factors like IL-1, TGF, TNF and dihydroxy vitamin D have also been implicated ( Pathologic basis of Disease, 8 th edition)

So the answer to this question is B


Instruction:
Which of the following is a sterilizing agent?
A. Diethyl ether
B. Ethylene oxide
C. Chlorhexidine
D. Ethyl alcohol

Response:
Ethylene oxide (ETO) is a sterilizing agent, Chlorhexidine and ethyl alcohol are disinfectant Sterilisation - Removal of all living microbes including spores from an object. Disinfection - Removal of all pathogenic microbes from the surface of an object Antisepsis - Removal of pathogenic microbes from the skin and mucous membrane Ref : Ananthanarayana textbook of Microbiology 9th edition Pgno : 33

So the answer to this question is B


Instruction:
Which of the following about severe combined immunodeficiency is not true -
A. Due to deficiency of adenylate kinase
B. Toxicity to leucocytes due to accumulation of dAMP
C. Both cellular and humoral immunity affected
D. Bone marrow transplantation is the treatment

Response:
Ans. is 'a' i.e., Due to deficiency of adenylate kinase

So the answer to this question is A


Instruction:
Hardening solutions are used with impression made of:
A. Hydrocolloid
B. Impression compound
C. Elastomer
D. Zinc oxide eugenol

Response:
Agar impression material contains borax, which is a known retarder for setting of gypsum products. The gelation process of alginate impressions produces not only insoluble calcium alginate but also sodium sulfate, which is a gypsum-setting accelerator at low concentration, but becomes a retarder at a higher concentration. In addition, polysaccharide also inhibits the setting of gypsum. Because of retardation, the surfaces of the gypsum models prepared from hydrocolloid may be too soft for use as dies or casts.
The deficiency of gypsum setting can be overcome in two ways:

By immersing the agar impression in a solution containing a gypsum accelerator, such as 2% potassium sulfate solution, prior to pouring the impression with the gypsum-forming product or
By incorporating a gypsum surface hardener in the material, such as the sulfate used in the formulation for agar hydrocolloid and the potassium titanium fluoride used in alginate.

Reference: PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 175

So the answer to this question is A


Instruction:
Splenic infarction is associated with -a) Typhoidb) Infectious mononucleosisc) CMLd) Paroxysmal nocturnal hemoglobinuria
A. a
B. c
C. ac
D. bc

Response:
None

So the answer to this question is D


Instruction:
Man is definitive host for -
A. Echinococcus
B. Malaria
C. Filariasis
D. Rabies

Response:
W.bancrofti passes its life cycle in two host Man -definite host Mosquito-intermediate host The adult worms are harboured in the lymphatic system of man. The lymph provides nutrition to adult worms (refer pgno:166 baveja 3 rd edition)

So the answer to this question is C


Instruction:
Effect of Potassium ionophore valinomycin on beta cells of pancreas is?
A. Decrease the secretion of insulin
B. Insulin secretion increases
C. C-peptide secretion increases
D. Increase secretion of both insulin and C- peptide

Response:
(a) Decrease the secretion of insulinRef: style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif"> and http://www. eje-online. org/content/88/1/113Valinomycin interferes with the insulin releasing effect of glucose by increasing the potassium permeability of the B cell membrane.About ValinomycinIt is a member of the group of natural neutral ionophores because it does not have a residual charge. It is highly selective for potassium ions within the cell membrane and functions as a potassium-specific transporter. It facilitates the movement of potassium ions through lipid membranes "down" the electrochemical potential gradient. A very little literature is available regarding valinomycin.Theoretically, hyperpolarization of beta cells due to increased K+ permeability caused by valinomycin may lead to inhibition of insulin release (depolarization is needed for insulin release from beta cells).

So the answer to this question is A


Instruction:
Pregnancy should be strongly discouraged in women with :
A. Mitral stenosis
B. ASD
C. VSD
D. Eisenmenger's

Response:
Eisenmenger's

So the answer to this question is D


Instruction:
False statement about post-dural puncture headache (PDPH):
A. Breach of dura
B. Onset of headache is usually 12-72 hours following procedure
C. Commonly occipito - frontal in location
D. Headache is relieved in sitting standing position

Response:
Post Dural puncture Headache Pathophysiology - CSF leak - ICP |es - Traction on nerve fibres originating from piamater Site - Occipital > Frontal > Retrorbital Duration - 7-10 days Pathognomic sign - Change in posture aggravates headache Predisposing conditions - Dura cutting needle (spinal needle)* Most commonly seen with 22G Quincke needle Wide bore needle * Multiple attempts * Pregnancy (In pregnancy dura mater is very fragile- venous engorgement fragility increases chances of PDPH is more) Note- Early ambulation never predispose to PDPH

So the answer to this question is D


Instruction:
Intrinsic muscles of the tongue are derived from?
A. 2 nd branchial cleft
B. Pharyngeal arch mesenchyme
C. Occipital somites
D. Cervical somites

Response:
Most of the tongue muscles are derived from myoblasts that migrate from the occipital somites.The tongue's embryonic orgin is derived from first 4 pharyngeal arches contributing different components.Anterior 2/3" or body of tongue: is derived from 3 lingual buds- the median tongue bud (tuberculum impar) and 2 lateral lingual swellings developing at each side of the median tongue bud. (Taste sensation to the anterior 2/3rd of the tongue is provided by the chorda tympani branch of the facial nerve).Post 1/3" or root of the tongue: is formed from two median elevations;

So the answer to this question is C


Instruction:
Isotonic solution which supplies calories but not electrolytes:
A. 5% dextrose.
B. 0.9% Nacl solution.
C. Ringer's Lactate solution.
D. Darrow's solution.

Response:
None

So the answer to this question is A


Instruction:
Which of the following conditions is most likely to lead to a dry tap during bone marrow aspiration-
A. Acute lymphoblastic leukemia
B. Multiple myeloma
C. Megaloblastic anaemia
D. Idiopathic myelofibrosis

Response:
bone marrow aspiration is generally unsuccessful and yields "dry tap" in idiopathic myelofibrosis. Reference textbook of Pathology 7th edition author Harsha Mohan page number 340 see laboratory findings

So the answer to this question is D


Instruction:
Which one of the following statement regarding Chlamydia pneumoniae is TRUE?
A. Fifteen serovars have been identified as human pathogens
B. It is transmitted through the inhalation of bird excreta
C. The cytoplasmic inclusions present in the sputum specimen are rich in glycogen
D. The group specific antigen is responsible for the production of complement fixing antibodies

Response:
Chlamydiae possess group specific antigens. These are heat-stable lipopolysaccharides with 2-keto-3-deoxyoctanoic acid as an immunodominant component. Antibody to these genus-specific antigens are detected by complement fixation (CF) and immunofluorescence. Ref: Harrisons Internal Medicine, 18th Edition, Chapter 176; Jawetz, Melnick and Adelberg's Medical Microbiology, 25th Edition, Chapter 27

So the answer to this question is D


Instruction:
A 8.5-year-old child with missing 11 reported to your clinic. 21 erupted at 6.5 years of age. The child had trauma to 21, 4 months back and got it endodontically treated for that. What is your further treatment about missing teeth?
A. Take radiograph and rule out a supernumerary tooth
B. Plan RPD
C. Advise FPD
D. Do orthodontic treatment, create space and plan FPD

Response:
In question patient is of 8.5 years of age with missing right maxillary central incisor and has his Maxillary left Central Incisor Erupted on Schedule.

Now non-eruption of a tooth beyond normal possible age of eruption while the contralateral tooth is being erupted on usual time can be due to its presence in impacted state or it can be congenitally missing.
To rule out of these conditions radiographic examination is essential
If tooth is impacted due to presence of any supernumerary tooth or due to any other region or tooth is congenitally missing we can plan further treatment with that situation.

So the answer to this question is A


Instruction:
The most infectious variety of diptheria is -
A. Anterior nasal diptheria
B. Posterior nasal diptheria
C. Faucial diptheria
D. Laryngeal diptheria

Response:
None

So the answer to this question is A


Instruction:
Most diffusible ion in excitable tissue is
A. Na+
B. K+
C. Ca++
D. Cl-

Response:
Most diffusible ion in excitable tissue skeletal muscle and nerve cell is potassium Ref: www.gradestack.com

So the answer to this question is B


Instruction:
The most common site of fracture neck of femur that cause Avascular necrosis is-
A. Sub- capital zone of head of femur
B. Interochanteric zone
C. Trans-cervical area
D. Basal pa of head of femur

Response:
The more proximal the location of a femoral neck fracture, the more likely there is to be nonunion and/or AVN. *Thus non-union and AVN will be most common in subcapital fracture and least in basicervical fracture. M/c affects => Femoral Head M/c site => Anterolateral aspect (Being principal Wt. bearing poion) Incidence&;d/t t Steroid usage & Trauma AVN only occurs in FATTY MARROW, which contains a Sparse vascular supply. In contrast to Hematopoietic marrow which has a rich blood supply CAUSES * Trauma * Alcohol consumption * Coicosteroid intake * Gout and hyperuricemia * Hypercholesterolemia * Hypercoagulable states Hypercoisolism * Hyperlipidemia * Cushing disease * Hyperparathyroidism * Hemoglobinopathies * Intravascular coagulation (SCD;Hb S/C;Polycythemia) * Organ transplantation * Caisson disease * Pregnancy (Dysbaric osteonecrosis) * Congenital dislocation Hip * Pancreatitis * Ehlers-Danlos synd * Neoplasms * Heredity dysostosis * CRF * Legg-Calve-Pehes dis * Hemodialysis * Fabry disease * Cigarette smoking * Gaucher disease * Collagen Vascular dis * Giant cell aeritis * SLE * Thrombophlebitis * Idiopathic Ref: maheswari 9thed p.311

So the answer to this question is A


Instruction:
Umbilical vesicle attains full development in?
A. 2 week
B. 4 week
C. 6 week
D. 7 week

Response:
B i.e. 4 week

So the answer to this question is B


Instruction:
False about case fatality rate: March 2011
A. Represents the killing power of disease
B. Denominator is mid-year population
C. Indicates virulence power of causative agent
D. Not much useful for chronic diseases

Response:
Ans. B: Denominator is mid-year population Case fatality rate= Total number of deaths due to a disease X 100/ Total number of cases due to that disease Case fatality/Fatality rate: It is the ratio of deaths within a designated population of people with a paicular condition, over a ceain period of time. An example of a fatality rate would be 9 deaths per 10,000 people at risk per year. This means that within a given year, out of 10,000 people formally diagnosed with a disease, 9 died. Rabies, if contracted by an unvaccinated individual who does not seek prophylactic treatment, is also an extremely deadly virus, with a case fatality rate approaching 100%. Moality rate: It is a measure of the number of deaths (in general, or due to a specific cause) in a population, scaled to the size of that population, per unit time. Moality rate is typically expressed in units of deaths per 1000 individuals per year; thus, a moality rate of 9.5 in a population of 100,000 would mean 950 deaths per year in that entire population, or 0.95% out of the total. It is distinct from morbidity rate, which refers to the number of individuals in poor health during a given time period (the prevalence rate) or the number of newly appearing cases of the disease per unit of time (incidence rate). The term "moality" is also sometimes inappropriately used to refer to the number of deaths among a set of diagnosed hospital cases for a disease or injury, rather than for the general population of a country or ethnic group. This disease moality statistic is more precisely referred to as "case fatality". One Distinguishes: The crude death rate, the total number of deaths per year per 1000 people. The perinatal moality rate, the sum of neonatal deaths and fetal deaths (stillbihs) per 1000 bihs. The maternal moality ratio, the number of maternal deaths per 100,000 live bihs in same time period. The maternal moality rate, the number of maternal deaths per 1,000 women of reproductive age in the population (generally defined as 15-44 years of age). The infant moality rate, the number of deaths of children less than 1 year old per 1000 live bihs. The child moality rate, the number of deaths of children less than 5 years old per 1000 live bihs. The standardized moality rate (SMR)- This represents a propoional comparison to the numbers of deaths that would have been expected if the population had been of a standard composition in terms of age, gender, etc. The age specific moality rate (ASMR) - This refers to the total number of deaths per year per 1000 people of a given age.

So the answer to this question is B


Instruction:
RCM is caused by all except?
A. Fatty infiltration of myocardium
B. Amyloidosis
C. Ergotamine
D. Carcinoid syndrome

Response:
Causes of Restrictive Cardiomyopathy: Amyloidosis Hemochromatosis Fabry's disease Glycogen storage disease (II, III) Radiation Scleroderma Tropical Endomyocardial Fibrosis Hyper-eosinophilic syndrome (Loffler's endocarditis) Carcinoid syndrome Radiation Drugs: e.g., serotonin, Ergotamine

So the answer to this question is A


Instruction:
Interpeducular fossa contains all except :
A. Mammiallary bodies
B. Posterior perforated substance
C. Occulomotor nerve
D. Opthalmic nerve

Response:
D i.e. Ophthalmic nerve

So the answer to this question is D


Instruction:
A 42 yr old engineer developed redness of the glans and radial fissuring of the prepuce 2 weeks ago. A potassium hydroxide preparation of scrapings from the glans showed pseudohyphae and buds. Which one of the following systemic illness should he be screened for?
A. Pulmonary tuberculosis
B. Diabetes mellitus
C. Systemic candidiasis
D. Chronic renal failure

Response:
Visualization of pseudohyphae s/o candidiasis and DM is a predisposing factor for it. Candidiasis Predisposing factors or conditions (especially for disseminated form): DM Antibacterial agents Indwelling urinary catheters Parenteral glucocoicoids Neutropenia Abdominal and thoracic surgery Immunocompromised state Patients with severe burns low-bih-weight neonates persons using illicit IV drugs

So the answer to this question is B


Instruction:
Nasolacrimal duct will not be formed with oblique facial cleft due to n on fusion of which of the following ridges?
A. A to B
B. B to C
C. A to C
D. C to D

Response:
Ans. B. B to Ca. B (failure of fusion of lateral nasal process to maxillary process)1/1000. Clefts may also occur between the lateral nasal process and the maxillary prominence (oblique cleft) exposing the nasolacrimal duct or between the maxillary and mandibular primordial (lateral clefts). Although extremely rare, clefts can also form along the midline of the two mandibular prominences (median mandibular cleft). As the facial prominences fuse, the opposing epithelium disintegrates. Remnants of these epithelial seams may result in cyst formation.

So the answer to this question is B


Instruction:
Which of the following is false about elongation of cervix?
A. The supravaginal portion is stretched and elongated
B. Usually associated with second and third degree prolapse of uterus
C. It is uncommon for the gland to elongate beyond 5cms
D. It is invariably associated with retroverted uterus

Response:
Ans. is 'c' i.e., It is uncommon for the gland to elongate beyond 5cms Elongation of the Cervixo In this condition the supravaginal portion of the cervix is well supported by Mackenrodt ligaments but the vaginal portion of the cervix prolapses with the vagina so the supravaginal portion gets stretched and elongatedo This usually happens with second degree and third degree prolapse of the uteruso With procidentia, the entire uterus slides with the vagina and hence the cervix retains its normal lengtho It is not uncommon for the cervix to elongate to as much as 10 cm in lengtho The cervix may show hypertrophy and congestiono The uterus is invariably retroverted.

So the answer to this question is C


Instruction:
Which one of the following statement is true about Dipivefrine?
A. It is not a prodrug
B. It causes vasodilation
C. It penetrates the cornea and gets conveed to epinephrine
D. It increases intraocular pressure

Response:
Dipivefrine penetrates the cornea and is then hydrolysed to epinephrine by esterase enzymes. It increases outflow of the aqueous humour and also reduces its formation (mediated by its action on a1 and a2 receptors), thus reducing pressure inside the eye. Ref Davidson 23rd edition pg 457

So the answer to this question is C


Instruction:
Clue cells are found in ?
A. Candidial vaginosis
B. Bacterial vaginosis
C. Trichomoniasis
D. Chlamydial infection

Response:
Bacterial vaginosis Repeat from Nov 09 Q no.159

So the answer to this question is B


Instruction:
ECG finding of Hyperkalemia:
A. T wave inversion
B. ST depression
C. P pulmonale
D. Wide QRS complex

Response:
Ans.(d) Wide QRS complexRef: Harrison 19th ed. / 310ECG Findings of Hyperkalemia* The first ECG finding in hyperkalemia is tall tented T waves followed by slowing of depolarization of heart.* This results in prolonged PR interval with QRS widening.* Subsequently the P waves start becoming smaller.* Sine wave pattern leading to ventricular fibrillation/ diastolic arrest of heart.

So the answer to this question is D


Instruction:
A child is having nocturnal asthmatic attack 2 times a day in a week, daytime attack in 3 times or more, can be categorised as?
A. Severe persistent Asthma
B. Moderate persistent asthma
C. Mild intermittent
D. Mild persistent

Response:
Classification Of Childhood Asthma: Asthma Severity Days with symptoms Nights with symptoms Lung function Long term control Quick relief Medication Step 1 : Mild intermittent < 3 per week < 3/month FEV1 or PEF =80% of predicted; PEF variably <20% No daily medication needed Sho acting Beta- agonist as needed and before exercise; use =3 times /week may indicate need to initiate long term control therapy Step 2:Mild persistent = 3/week 3-4 /month FEV1 or PEF =80% of predicted; PEF variability 20 - 30% Anti-inflammatory: either low dose inhaled glucocoicoids, cromoglycate. nedocromil, or leukotriene modifier. Sustained-release theophylline is an alternative Sho acting Beta- agonist as needed and before exercise; daily use or increasing use may indicate need for additional long term control therapy Step 3: Moderate persistent Daily symptoms, daily use of sho acting beta- agonists >1 time/week FEV1 or PEF 60-80% of predicted; PEF variability >30% Anti inflammatory: inhaled coicosteroids (median dose) or inhaled glucocoicoids ( low dose) and either long acting beta agonist (LABA ), leukotriene modifier, sustained release theophylline, or LABA tablets Sho acting beta agonist as needed and before exercise; daily use or increasing use may indicate eed for additional long term control therapy. Step 4: severe persistent Continual symptoms, limited physical activity, frequent exacervations Frequent FEV1 or PEF =60% of predicted; PEF variability>30% Anti inflammatory: inhaled glucocoicoids (high dose) and either long acting beta- agonist (LABA ), leukotriene modifier, sustained release theophylline, or LABA tablets Oral glucocoicoids if needed. Sho acting beta agonists as needed and before exercise; daily use or increasing use may indicate need for additional long term control therapy Ref: Nelson's Pediatrics 17/e, Page 767.

So the answer to this question is B


Instruction:
All of these cells are found in small intestine except -
A. Stem cells
B. Goblet cells
C. Neck cells
D. Paneth cells

Response:
Mucus secreting brunner’s gland in submucosa are seen in duodenum; solitary lymphatic nodules in submucosa are seen in jejunum and submucosal aggregated lymphatic follicles (peyer's patch) are seen in ileum.

So the answer to this question is C


Instruction:
The CSF findings in TB meningitis include:
A. High sugar + low protein
B. Low sugar + high protein and lymphocytosis
C. High sugar + high chloride
D. Low sugar + high protein and lymphopenia

Response:
b. Low sugar + high protein and lymphocytosis(Ref: Nelson's 20/e p 2936-2948, Ghai 8/e p 563-565)Lymphocytosis is seen in Tuberculous meningitis, though in early stages, CSF neutrophilia may be seen

So the answer to this question is B


Instruction:
The selective MAO-B inhibitor among the following is
A. Selegiline
B. Clorgyline
C. Moclobemide
D. Tranylcypromine

Response:
MAO is mono amine oxidase exists in two isoforms MAO A and MAO B. MAO A inhibitors are used in treatment of depression where as MAO B in treatment of parkinsons MAO B inhibitors include selegeline and rasagiline. Ref: KD Tripathi 8th ed.

So the answer to this question is A


Instruction:
The first sign of sexual maturation in a girl is -
A. Menarche
B. Pubarche
C. Enlargement of breast
D. Maturation of breast

Response:
Ans: C Telarche-enlargement of breast buds is the first sign

So the answer to this question is C


Instruction:
Tear strength for impression material is highest for:
A. Condensation silicone
B. Alginate
C. Poly sulfide
D. Addition silicone

Response:
None

So the answer to this question is C


Instruction:
Sterilization & disinfection of blood spills is done by:
A. Formaldehyde
B. Sodium hypochlorite
C. Tincture iodine
D. Phenols

Response:
Halogens (hypochlorites) Cheap, effective and act by release of free chlorine and effective against viruses.
Chlorine-releasing agents are chemicals disinfectants which are effective against blood-borne viruses and are rapid in action.
They are considered the disinfectant of choice in the event of a spillage of blood or body fluid.
Rapidly inactivated by organic matter.
Chlorine-releasing agents must never be mixed with acids or used on spills of urine as chlorine gas will be released.
Dilutions should not be mixed with any other cleaning agents, or with hot water but only made up with cold or tepid water

Chlorine concentrations:
Strength Uses
1. 10,000 parts per million (ppm) Decontamination of spillages of blood and/or body fluids stained with blood
2. 1,000 parts per million (ppm) Disinfection of surfaces following contamination with other body fluids e.g commodes (to be used after cleaning)

So the answer to this question is B


Instruction:
Commonest extracranial complication of CSOM
A. Petrositis
B. Labyrinthitis
C. Subperiosteal abscess
D. Facial nerve paralysis

Response:
Pus may break through mastoid coex leading to subperiosteal abscess which may even burst on surface leading to a discharging fistula It occurs as a sequence of mastoiditis which is a most common complication Ref: Dhingra 7e pg 84.

So the answer to this question is C


Instruction:
Procedure of choice for evaluation of an aoic aneurysm
A. USG
B. CT
C. MRI
D. Angiography

Response:
. CT scan is more reliable and precise investigation of choice -gives better information regarding extent on sides or neck,size,dimensions,size and site of the thrombus,calcification,relation of renal aeries ,inflammation and fibrosis and adjacent tissues.MRI may be better only in renal failure patients. Refer page no 198 of SRB's manual of surgery 5 th edition.

So the answer to this question is B


Instruction:
Which of the following is not a derivative of the middle ear cleft?
A. Semicircular canal
B. Mastoid air cell
C. Tympanic cavity
D. Eustachian tube

Response:
The middle-ear cleft in the temporal bone includesEustachian tubeThe middle ear (tympanic cavity)Aditus which leads posteriorly to the mastoid antrum and air cellsRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 5

So the answer to this question is A


Instruction:
Corynebacterium diphtheriae is
A. Gram positive
B. Resistant to penicillin
C. Gram negative
D. Resistant to chloramphenicol

Response:
Corynebacterium diphtheriae is a gram-positive bacillus that is unencapsulated, nonmotile, and nonsporulating. The bacteria have a characteristic club-shaped bacillary appearance and typically form clusters of parallel rays, or palisades, that are referred to as "Chinese characters."Recommended treatment options for patients with respiratory diphtheria are as follows:* Procaine penicillin G, 600,000 U IM q12h (for children: 12,500-25,000 U/kg IM q12h) until the patient can swallow comfoably; then oral penicillin V, 125-250 mg qid to complete a 14-day course* Erythromycin, 500 mg IV q6h (for children: 40-50 mg/kg per day IV in two or four divided doses) until the patient can swallow comfoably; then 500 mg PO qid to complete a 14-day courseRef: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 175; Diphtheria and Other Corynebacterial Infections

So the answer to this question is A


Instruction:
Grisel&;s syndrome is
A. Glucosaminidase deficiency
B. Atlanto-axial joint dislocation
C. Hexosaminidase deficiency
D. L4-L5 displacement

Response:
Grisel's syndromeSpontaneous subluxation of the atlantoaxial joint following peri-pharyngeal inflammation is known as Grisel's syndrome Children are most frequently affected and classically have toicollis associated with neck stiffness or pain upon neck movement(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 3297, 3298)

So the answer to this question is B


Instruction:
Rett's syndrome is characterized by all except:
A. Regression of acquired sills
B. Breath holding spells
C. Autistic behavior
D. Macrocephaly

Response:
Rett's syndrome Rett's syndrome is a rare developmental disorder of females which bears more resemblance to a neurodegenerative disorder than a psychiatric condition * Till 5-month development is normal Microcephaly Loss of acquired hand function and speech The loss of purposeful hand movements are replaced by stereotypic motions such ashand wringing Poorly coordinated gait and ataxia * Breathing problems--hyperventilation, breath holding, and sighing--are common, and help to distinguish Rett's from autism.

So the answer to this question is D


Instruction:
Methyl alcohol causes blindness by acting on?
A. Ganglion cells
B. Nerve fibers
C. Rods & Cones
D. Rods only

Response:
Ganglion cells REF: khurana 4th ed p. 296 "Methyl alcohol is oxidized into formic acid and formaldehyde and it causes degeneration of ganglion cells of retina resulting in optic atrophy"

So the answer to this question is A


Instruction:
Henoch - Schonlein purpura is characterized by the deposition of the following immunoglobulin around the vessels :
A. IgM
B. IgG
C. IgA
D. IgE

Response:
Answer is C (IgA): The presumptive pathogenic mechanism for Henoch-Schonlein purpura is immune complex deposition on endothelium of blood vessels throughout the body and within glomerular mesangial regions. IgA is the antibody class most often seen in the immune complexes and has been demonstrated in the renal biopsies of these patients' - Harrison.

So the answer to this question is C


Instruction:
Bih weight of a child doubles at five months of age while the bih length doubles at the age of -
A. 1 year
B. 2 years
C. 3 years
D. 4 years

Response:
Ans. is 'd' i.e., 4 year

So the answer to this question is D


Instruction:
Salicylate overdose in children causes:
A. Crystalluria
B. Rye's syndrome
C. Kernicterus
D. None of the above

Response:
None

So the answer to this question is B


Instruction:
EB Virus is associated with which carcinoma:
A. Carcinoma of larynx
B. Carcinoma of bladder
C. Nasopharyngeal carcinoma
D. Chronic lymphocytic leukemia

Response:
None

So the answer to this question is C


Instruction:
Which of the following differentiates Hodgkin's lymphoma from non Hodgkin's lymphoma?
A. Fever, night sweat, weight loss
B. Generalized lymphadenopathy
C. Elderly
D. Reed stern berg cells

Response:
In classic Hodgkin lymphoma, the neoplastic cell is the Reed-Sternberg (RS) cell. Reed-Sternberg cells comprise only 1-2% of the total tumor cell mass. Most Reed-Sternberg cells are of B-cell origin. The Reed-Sternberg cells consistently express the CD30 (Ki-1) and CD15 (Leu-M1) antigens. Age-specific incidence rates of Hodgkin lymphoma and non-Hodgkin lymphoma have a bimodal distribution in both sexes, peaking in young adults (aged 15-34 y) and older individuals (>55 y). Asymptomatic lymphadenopathy may be present in both. Constitutional symptoms (eg, unexplained weight loss, fever, night sweats) are present in 40% of patients.

So the answer to this question is D


Instruction:
True about relative refractory period is:
A. Response can't be generated at all
B. Due to closure of inactive gates of sodium channals
C. Due to opening of potassium channals
D. All

Response:
Stronge stimulus can produce response in relative refractory period Cause: it is because potassium channals are open and the membrane potential is more close to resting membrane Begins after the end of absolute refractory period Ref:Guyton and Hall textbook of medical physiology 12th edition,page number: 70

So the answer to this question is C


Instruction:
Malignant otitis externa is caused by
A. Hemophilus influenzae
B. Pseudomonas aeroginosa
C. Streptococcus pyogenes
D. E. coli

Response:
Malignant otitis externa is often caused by difficult to treat bacteria such as Pseudomonas aeruginosa. Only are cases of malignant otitis externa due to S.aureus, Proteus mirabilis and Aspergillus fumigates have been repoed.Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 55

So the answer to this question is B


Instruction:
Which of the following committees suggested training in preventive and social medicine for doctors?
A. Srivastava committee
B. Bhore committee
C. Kaar Singh committee
D. Mudaliar committee

Response:
Bhore committee formed in 1946 proposed changes in medical education to include three months training in preventive and social medicine to produce social physicians. Ref: Park 22nd edition pg: 816.

So the answer to this question is B


Instruction:
The following monoclonal antibody is directed against alpha 4 integrin?
A. Efalizumab
B. Natalizumab
C. Ibalizumab
D. Toclizumab

Response:
NatalizumabNatalizumab is a humanized IgG4 monoclonal antibody that binds to the a4-subunit of a4b1 and a4b7 integrins expressed on the surfaces of all leukocytes except neutrophils and inhibits the a4-mediated adhesion of leukocytes to their cognate receptor. It is indicated for patients with multiple sclerosis and Crohn's disease who have not tolerated or had inadequate responses to conventional treatments.Ref: Katzung 13th ed.pg 993.

So the answer to this question is B


Instruction:
Kanavel's sign is seen in
A. Tenosynovitis
B. Trigger finger
C. Dupuytrens contracture
D. Carpal tunnel syndrome

Response:
Ans. is 'a' i.e. Tenosynovitis Kanavel's sign is seen in acute suppurative tenosynovitis of the little finger. It is tenderness elicited at a point in between the two palmar crease about 2.5 cm proximal to the base of the little finger.There are also 4 Cardinal signs of Kanavel seen in acute suppurative tenosynovitis of fingers. These are:finger held in slight flexion,fusiform swelling involving entire finger,tenderness along the flexor tendon sheath, andpain with passive extension of the digit.Tenosynovitis is inflammation of the tendon and tendon sheath.

So the answer to this question is A


Instruction:
Two sisters are diagnosed with hemolytic anemia. Their older brother was previously diagnosed with the same disorder. Two other brothers are asymptomatic. The mother and father are second cousins. Deficiency of which of the following enzymes would be most likely to cause this disorder?
A. Debranching enzyme
B. Glucose-6-phosphatase
C. Glucose-6-phosphate dehydrogenase
D. Pyruvate kinase

Response:
In general, you should associate hemolytic anemia with defects in glycolysis or the hexose monophosphate shunt (pentose phosphate pathway). Only two enzymes of those listed in the answer choices specifically involve these pathways and cause hemolytic anemia: pyruvate kinase and glucose-6-phosphate dehydrogenase. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is inherited as an X-linked recessive trait, so females would not be affected. Pyruvate kinase is a glycolytic enzyme; pyruvate kinase deficiency is an autosomal recessive disorder, affecting males and females approximately equally. If this enzyme is deficient, red cells have trouble producing enough ATP to maintain the Na+/K+ pump on the plasma membrane, secondarily causing swelling and lysis. Debranching enzyme defects produce Cori's disease, one of the glycogen storage diseases. Defects in glucose-6-phosphatase produce Von Gierke's disease, one of the glycogen storage diseases. Glucose-6-phosphate dehydrogenase deficiency produces an X-linked hemolytic anemia.

So the answer to this question is D


Instruction:
Dobutamine acts on all of the following receptors except
A. β1
B. β2
C. D1
D. α1

Response:
Dobutamine has no action on Dopamine receptors.

So the answer to this question is C


Instruction:
All are true regarding treatment of Guillain-Barre syndrome EXCEPT:
A. Coicosteroid used for early recovery and prevent long stay
B. High-dose intravenous immune globulin (IVIg) can be initiated
C. Plasmapheresis can be done
D. High-dose intravenous immune globulin (IVIg) and plasmapheresis are equally effective

Response:
Coicosteroid used for early recovery and prevent long stay REF: Harrison's 17th ed chapter 380 In the vast majority of patients with GBS, treatment should be initiated as soon after diagnosis as possible. Each day counts; -2 weeks after the first motor symptoms, immunotherapy is no longer effective. Either high-dose intravenous immune globulin (IVIg) or plasmapheresis can be initiated, as they are equally effective. A combination of the two therapies is not significantly better than either alone. Glucocoicoids have not been found to be effective in GBS. Occasional patients with very mild forms of GBS, especially those who appear to have already reached a plateau when initially seen, may be managed conservatively without IVIg or PE.

So the answer to this question is A


Instruction:
Normal waist hip ratio of a female is below
A. 0.7
B. 0.8
C. 0.9
D. 1

Response:
WHO CUT-OFF POINTS OF WHR Indicator CUT-OFF points Risk of metabolic complications Waist circumference >94 cm (M) >80 cm (W) Increased Hip cirrcumference >102 cm (M) >88 cm (W) Substantially increased Waist-Hip ratio >= 0.95(M) >= 0.80(W) Substantially increased Ref: Park 23rd edition Pgno : 400 WC & WHR, WHO Consultation 2008

So the answer to this question is B


Instruction:
Amino acid involved in urea synthesis:
A. Glutamine
B. Aspaic acid
C. Valine
D. Phenylalanine

Response:
Ans:B.)Aspaic Acid Urea has 2 amino (-NH2) groups, one derived from NH3 and other from aspaate.UREA CYCLE* Location: Cytosol and mitochondria of hepatocytes.* Substrates: NH 3 (as derived from oxidative deamination of glutamate); CO2 ; aspaate; three ATP.* Products: Urea; fumarate; H2O.* Purpose: The urea cycle allows for the excretion of NH 4+ by transforming ammonia into urea, which is then excreted by the kidneys.* Impoant enzymes:Carbamoyl phosphate synthetase I: Conves ammonium and bicarbonate into carbamoyl phosphate. This is the rate-limiting step in the urea cycle. This reaction requires two ATP and occurs in the mitochondria.Ornithine transcarbamoylase: Combines ornithine and carbamoyl phosphate to form citrulline. Located in mitochondria.Argininosuccinate synthetase: Condenses citrulline with aspaate to form arginosuccinate. This reaction occurs in the cytosol and requires one ATP.Argininosuccinate lyase: Splits argininosuccinate into arginine and fumarate. Occurs in the cytosol.Arginase: Cleaves arginine into one molecule of urea and ornithine in the cytosol. The ornithine is then transpoed back into the mitochondria for entry back into the cycle.* Regulation: Carbamoyl phosphate synthetase I catalyzes the rate-limiting step of the cycle and is stimulated by N -acetylglutamate.* Diseases:Hyperammonemia occurs when there is a deficiency in one of more of the urea cycle enzymes, causing insufficient removal of NH 4+ .Ammonia intoxication leads to CNS deterioration in the form of mental retardation, seizure, coma, and death.

So the answer to this question is B


Instruction:
A patient has a GFR of 100 ml/min, her urine flow rate is 2.0 ml/min, and her plasma glucose concentration is 200 mg/100 ml. If the kidney transpo maximum for glucose is 250 mg/min, what would be her approximate rate of glucose excretion?
A. 0 mg/min
B. 50 mg/min
C. 100 mg/min
D. 150 mg/min

Response:
The filtration rate of glucose in this example is: = GFR x plasma glucose concentration =(100 ml/min) x (200 mg/100 ml, or 2 mg/ml) =200 mg/min. Because the transpo maximum for glucose in this example is 250 mg/min, All of the filtered glucose would be reabsorbed and the renal excretion rate for glucose would be zero(0 mg/min).

So the answer to this question is A


Instruction:
Immunohistochemical examinations of a patient shows positive for HMB 45. She may have:
A. Sarcoma
B. Melanoma
C. Carcinoma
D. None of the above

Response:
S-100 and HMB-45 are commonly used tumor markers for melanoma. Select Immunohistochemical Stains: Immunohistochemical Stain Neoplasms that Stain Positive Cytokeratin Carcinomas Desmin Benign and malignant neoplasms of smooth and skeletal muscle Glial fibrillary acidic protein (GFAP) Astrocytomas HMB-45 Melanoma *-Fetoprotein (AFP) Hepatocellular carcinoma, yolk sac tumor Chromogranin A Small cell carcinoma Ref: Wyatt C., Kemp W.L., Moos P.J., Burns D.K., Brown T.G. (2008). Chapter 20. Dermatopathology. In C. Wyatt, W.L. Kemp, P.J. Moos, D.K. Burns, T.G. Brown (Eds), Pathology: The Big Picture.

So the answer to this question is B


Instruction:
ASHA gets remuneration on all except:
A. Institutional delivery
B. Zero dose of OPV and BCG
C. Recording birth weight
D. Birth registration

Response:
ASHA payments :

6 visits in Institutional deliveries (Day 3,7,14,21,28,42)
7 visits in home deliveries (Day 1,3,7,14,21,28,42)
Birth weight record
Immunized with BCG, First dose of OPV & DPT
Birth registration
Mother and child are safe.

So the answer to this question is B


Instruction:
A 23-year old young boy with schizophrenia is well maintained on risperidone for the last 2 months. He has no family historv of the disease. For how long medication should be continued in this patient?
A. 5 years
B. 6 months
C. 2 years
D. 12 months

Response:
Ans. c. 2 years (Ref: Niraj Ahuja 7/e p67)Multiple randomized trials have found that maintenance of antipsychotic medication reduces the risk of relapse over a period of up to two years."A meta-analysis of 6493 patients with schizophrenia in 65 randomized trials of 7 to 12 months duration found that patients who continued on an antipsychotic experienced a lower relapse rate compared to patients withdrawn from an antipsychotic and receiving placebo (27 versus 64 percent; number needed to treat to benefit = 3, 95% Cl 2--3). Other studies of up to two years have found similar resultsAlthough the current consensus is that antipsychotic should be prescribed for 1-2 years after 1st episode of schizophrenia. Gitlan et al found that withdrawing the antipsychotic leads to relapse at rate of 80 % after one years of medication free and relapse at rate of 98% after 2 years of medication free. "-- Maudsley Prescribing Guidelines in Psychiatry 12/e p31Treatment Duration for Schizophrenia* 1st episode: 1-2 yearsQ* 2nd episode: 2-5 yearsQ* 3rd/Recurrent: LifetimeQ

So the answer to this question is C


Instruction:
A 48 year of woman was admitted with a history of weakness for two months. On examination cervical lymph nodes were found enlarged and spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dl. platelet count 237 x 109/L, and total leukocyte count 40 x 109/L, which include 80% mature lymphoid cell with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD19, CD5, CD20 and were negative for CD79B and FMC(-7). Which one of the following statements in not true about this disease?
A. Trisomy 12 correlates an aggressive clinical course
B. Abnormalities of 13q 14 are associated with long term survival
C. Case with 11q22-23 deletions have excessive lymphadenopathy
D. t (11;14) translocation is present in most of the cases

Response:
None

So the answer to this question is D


Instruction:
Radiographically, the lesion shown in color plate could be:
A. Osteosarcoma
B. Fibrous dysplasia
C. Garre's osteomyelitis
D. Cherubism

Response:
Formation of layers of new subperiosteal bone produces onion skin appearance which is seen in Garre's osteomyelitis, Ewing’s Sarcoma and Chondrosarcoma.
In fibrous dysplasia, "ground glass" or "peau d’orange" appearance is seen radiologically.

So the answer to this question is C


Instruction:
Scalogram is other name for
A. Likert Scale
B. Guttman Scale
C. Thurstone scale
D. Senatic Differential Scale

Response:
None

So the answer to this question is B


Instruction:
What is the latest reference to body length in ICD-10 to call it perinatal moality rate?
A. 28cm
B. 30cm
C. 35cm
D. 38cm

Response:
parks textbook of preventive and social medicine 23rd edition * ninth revision of international classification of diseases (ICD) added that :(1) babies choosen for inclusion in perinatal statistics should be tjose above a minimum bih weight ie1000g at bih. (2)if bihweight is not available ,a gestational period of atleast 28weeks should be used if (1)&(2)is not available ,body length of atleast 35cm should be used .

So the answer to this question is C


Instruction:
A triad of features consisting of multifocal bony defects,diabetes insipidus and exophthalmous is termed  as:
A. Hand-schulles-christian disease.
B. Letterer-siwe disease.
C. Hypersplenism.
D. Burkitt’s lymphoma.

Response:
Hand-Schuller-Christian Disease
A triad of features consisting of multifocal bony defects, diabetes insipidus and exophthalmos is termed Hand-Schuller-Christian disease. The disease develops in children under 5 years of age. The multifocal lytic bony.

So the answer to this question is A


Instruction:
A 30 year old woman presents with hemoptysis, nose bleed , decreased urine output. nasal mucosal ulcer was seen on inspection - Chest X - ray shows three cavitary Lesions. She is positive for ANCA. Diagnosis is.
A. Good pasture's syndrome
B. Wegener's granulomatosis
C. Berger's nephropathy
D. Alport's disease

Response:
None

So the answer to this question is B


Instruction:
A 50 year old man has presented with pain in back, lack of interest in recreational activities, low mood, lethargy, decreased sleep and appetite for two months. There was no history suggestive of delusions or hallucinations. He did not suffer from any chronic medical illness. There was no fami-ly history of psychiatric illness. Routine investigations including haemogram, renal function tests, liver function tests, electroca-rdiogram did not reveal any abnormality. This patient should be treated with:
A. Haloparidol
B. Seraline
C. Alprazolam
D. Olanzapine

Response:
B i.e. Seraline

So the answer to this question is B


Instruction:
First sign of hydrocephalus in children is :
A. Post clinoid erosion
B. Large ffiead
C. Sutural diastasis
D. Thinned out vault

Response:
C i.e. Sutural diastasis In infants, the diagnosis of hydrocephalus is confirmed by USG (as the fontanel are open)Q and in most cases, it tells about the level of obstruction & cause (like Dandywalker & arachnoid cyst.) Also Remember Aqueductal StenosisQ is m.c. of obstructive / non-communicating hydrocephalus. Subarachnoid hemorrhageQ (which is usually a result of intraventricular hemorrhage in premature infant) is m.c. of nonobstructive / communicating hydrocephalus. In an infant accelerated rate of enlargement of head is the most prominent sign. Clinical presention is: open anterior fontanelQ, setting sun eye signQ, UMN signs & cracked pot / macewen signQ on percussion. Skull X Ray shows copper beaten sign, indicative of chronic raised intra cranial pressure (ICP)Q. In adults, erosion of dorsum sellaeQ occurs earliest in hydrocephalus.

So the answer to this question is C


Instruction:
An affected male infant born to normal parents could be an example of all of the following, except -
A. An Autosomal dominant disorder
B. An Autosomal recessive disorder
C. A polygenic disorder
D. A veically transmitted disorder

Response:
Ans. is 'a' i.e., Autosomal dominant disorder In Autosomal dominant disorders individuals are affected in successive generations. The disease does not occur in the offspring of unaffected individuals' ? Autosomal dominant o If both parents are normal, the disease cannot be autosomal dominant because it is manifested in Heterozygous state, So, even a single gene affection amongst the allel will cause the disease to be manifested. To be normal, a person should have normal copy of both allel. If both parents are normal, that means there is no abnormal gene. Autosomal recessive o In autosomal recessive disorder, if both parents are carrier (phenotypically normal) 25% of child will develop disease. Polygenic disorder o A trait is called `polygenic' if multiple genes on thought to contribute to the phenotype. o Polygenic disorders include Hypeension Diabetes, Asthma o A male infant with asthma or diabetes may will be born to normal parents Veically transmitted disorder o Passage of disease causing agent (pathogen) `veically' from mother to baby during the perinatal period is called 'veical transmission'. o A veically transmitted agent might lie dormant in the mother and not manifest in her clinically (normal mother) but may manifest in the child.

So the answer to this question is A


Instruction:
Dawn phenomenon refers to-
A. Early morning hyperglycemia
B. Early morning hypolgycemia
C. Hypoglycemia followed by hyperglycemia
D. High insulin levels

Response:
Question repeated The dawn phenomenon, sometimes called the dawn effect, is an early-morning (usually between 2 a.m. and 8 a.m.) increase in blood sugar (glucose) relevant to people with diabetes. It is different from chronic Somogyi rebound in that dawn phenomenon is not associated with nocturnal hypoglycemia. The dawn phenomenon can be managed in many patients by avoiding carbohydrate intake at bedtime, adjusting the dosage of medication or insulin, switching to a different medication, or by using an insulin pump to administer extra insulin during early-morning hours. In most of the cases, there is no need to change insulin dosing of patients who encounter the dawn phenomenon.

So the answer to this question is A


Instruction:
The most sensitive investigation for air embolism is:
A. Deceased tidal volume of CO2
B. TEE
C. Decreased tidal volume of NO2
D. Central venous pressure

Response:
Ans. TEE

So the answer to this question is B


Instruction:
Quadrungular septum is seen in which of the following?
A. Larynx
B. Nose
C. Cranium
D. Palate

Response:
Ans. is 'b' i.e., Nose "Cartilage of the septum, also known as the quandragular cartilage because it is roughly quadrilateral in shape - separates the nostrils".Medial nasal wall or Nasal septum* Nasal septum is the osseo - cartilaginous partition between the two halves of the nasal cavity.* Nasal septum consists of1) Columellar septum It is formed by columella containing the medial crura of alar cartilages united together by fibrous tissue.2) Membranous septum It consists of double layer of skin with no bony or cartilaginous support.3) Septum properThis forms the major portion of nasal spetum and consists of osteocartilagenous framework which is coverd by mucous membrane. Its constituents arei) Osseous part# The vomer# Perpendicular plate of ethmoid# Nasal spine of frontal bone# Rostrum and crest of sphenoid# Nasal crest of nasal bone# Nasal crest of palatine bone# Nasal crest of maxillary bone ii) Cartilaginous part# Septal (Quadrilateral or Quadrangular) cartilage.

So the answer to this question is B


Instruction:
Eruption of Deciduous Mandibular Lateral incisor occur at
A. 8-9 months
B. 10-11 months
C. 19-20 months
D. 15-16 months

Response:
None

So the answer to this question is A


Instruction:
What is the function of a promoter site on DNA?
A. Transcribes repressor
B. Initiates transcription
C. Codes for RNA polymerase
D. Regulates termination

Response:
Promoter sites are initiation sites for transcription. Transcription stas when RNA polymerase binds to the promoter. It then unwinds the closed promoter complex, where DNA is in the form of a double helix, to form the open promoter complex in which about 17 base pairs of template DNA are unwound. RNA synthesis then begins with either a pppA or a pppG inseed at the beginning 5'-terminus of the new RNA chain, which is synthesized in the 5' to 3' direction. Ref: Weil P. (2011). Chapter 36. RNA Synthesis, Processing, & Modification. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds),Harper's Illustrated Biochemistry, 29e.

So the answer to this question is B


Instruction:
Banana shaped gametocytes in peripheral smear are seen in infection with:
A. Plasmodium vivax
B. Plasmodium malaria
C. Plasmodium falciparum
D. Plasmodium ovale

Response:
Banana shaped or crescent shaped gametocytes are seen in P. Falciparum.

So the answer to this question is C


Instruction:
Pellagra is caused by -
A. Hartnup's disease
B. Cystinuria
C. Cystinosis
D. Type I Tyrosinemia

Response:
Ans. is 'a' i.e., Hartnup's diseaseHartnup's disease* It is a defect of neutral aminoacid transporter which is specific for tryptophan. This transporter is responsible for tryptophan absorption along intestine as well as tryptophan reabsorption across renal tubules.* When tryptophan is not absorbed, tryptophan can not be converted into niacin (Niacin is endogenously synthesised from tryptophan). Hence it presents as pellagra.* As the transporter is also related to tryptophan reabsorption along renal tubules, tryptophan will be lost in the urine. Hence it presents as aminoaciduria.

So the answer to this question is A


Instruction:
A 30 years old male patient presents with complaints of weakness in right upper and both lower limbs of last 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side and 5th finger on left side. On examination, BP was 160/140 mm Hg, all peripheral pulses were palpable and there was asymmetrical neuropathy. Investigations showed a Hb 12 gm, TLC -- 12000 Cu mm, Platelets 430,000; ESR -- 49 mm. Urine examination showed proteinuria and RBC -- 10-15/hpf with no casts. Which of the following is the most likely diagnosis?
A. Wegener's granulomatosis
B. Mixed cryoglobulemia
C. Polyaeritis nodosa
D. SLE

Response:
In PAN, there is development of digital infarcts even in the presence of good peripheral pulses. Hypeension is due to involvement of renal aeries. Ref : Harrison's Principles of Internal Medicine 21st ed

So the answer to this question is C


Instruction:
All the following structures pass through Jugular Foramen except
A. Internal Jugular vein
B. 9th, 10th and 11th cranial nerves
C. Meningeal branch of ascending pharyngeal aery
D. Superior petrosal sinus

Response:
The jugular foramen transmits the following structuresAnterior paMiddle paPosterior paa. Inferior petrosal sinusb. Meningeal branch of ascending pharyngeal aery IXth, Xth and Xlth cranial nervesa. Internal jugular vein.b. Meningeal branch of the occipital aeryReference: Chourasia; 6th edition; 18th page

So the answer to this question is D


Instruction:
Most common cause of hypernatremia
A. Adipsic diabetes insipidus
B. Carcinoid syndrome
C. Renal losses
D. Sweating

Response:
Ans. is `c' i.e., Renal losses Major causes of hypernatremia Unreplaced water loss (which requires an impairment in either thirst or access to water) Insensible and sweat losses Gastrointestinal losses Central or nephrogenic diabetes insipidus o Osmotic diuresis Glucose in uncontrolled diabetes mellitus Urea in high-protein tube feedings Mannitol Hypothalamic lesions impairing thirst or osmoreceptor function Primary hypodipsia Reset osmostat in mineralocoicoid excess Water loss into cells Severe exercise or seizures Sodioutn overload Intake or administration of hypeonic sodium solutions

So the answer to this question is C


Instruction:
An 8 yr old child is having fever with pain and swelling in mid thigh. On Xray lamellated appearance and Codman's triangle is present. Histopathologic examination shows small round cells positive for MIC-2. What is the most likely diagnosis?
A. Osteosarcoma
B. Ewings sarcoma
C. Chondroblastoma
D. Chondrosarcoma

Response:
Child is showing features of Ewing's sarcoma. Ewing sarcoma is the fouh most common primary malignancy of bone, but it is the second most common (after osteosarcoma) in patients younger than 30 years of age and the most common in patients younger than 10 years of age. Features of Ewings sarcoma: Is a small round blue cell malignancy. It involves diaphysis of long bones. Patients usually presents with pain, with or without swelling and erythema. Radiologic features are similar to that of osteosarcoma such as Codman's triangle (periosteal new bone formation with lifting of bony coex). Biopsy shows sheets of undifferentiated cells with hyperchromatic nuclei, well-defined cell borders, and scanty cytoplasm. Positive immunoreactivity for CD99 (MIC2)is a hallmark of Ewing's sarcoma.

So the answer to this question is B


Instruction:
Which of the following is an important etiological factor for nasopharyngeal carcinoma?
A. Cytomegalovirus
B. Epstein Barr virus
C. Human Herpes Virus
D. Varicella

Response:
Ans. is 'b' i.e., Epstein Barr virusEtiology of Nasophary ngeal carcinomao Nasopharyngeal carcinoma is multifactorial in origin, the three risk factors are1) Genetic: Chinese have a higher genetic susceptibility to nasopharyngeal cancer. Even after migration to other countries2) Viral: Epstein- Bar virus is closely associated with nasopharyngeal cancer. Specific viral markers are being developed to screen people in high incidence areas.3) Environmental: Air pollution, smoking of tobacco and opium, nitrosamines from dry salted fish, smoke from burning of incense and wood have all been incriminated.

So the answer to this question is B