Instruction:
Which of the following helps in generating oxygen burst in the neurophils ?
A. NADPH oxidase
B. Sod (superoxide dismutase)
C. Catalase
D. Glutathione peroxidose

Response:
NADPH oxidase Although oxygen is the lifeline of all cells and tissues, its molecular form i.e., oxygen free radicals (or reactive oxygen intermediate) are devastating for cells. Cells generate energy by reducing molecular oxygen to water. During this process small amounts of paially reduced reactive oxygen forms are produced as a byproduct of respiration. They are called free radicals or reactive oxygen species. Free radicals are chemical species that have single unpaired electron in an outer orbit. This makes them highly reactive. Free radicals are devastating for the cell as they damage lipids, proteins and nucleic acids. Examples of free radical or reactive oxygen species Superoxide 02- Hydroxyl radical OH? Hydrogen peroxide (H202) The noxious effect of free radicals on various cellular material is being utilized by neutrophils to kill bacterias or other microorganisms. Once the neutrophils phagocytize the bacterias there is rapid respiratory burst in the neutrophils which leads to increased oxygen consumption, glycogenolysis and increased glucose oxidation. These reactions lead to rapid burst of superoxide (and other. free radical) production as a by product of the oxidation. This rapid burst in oxidative respiration is made possible by the rapid activation of an enzyme complex, NADPH oxidase, which oxidizes NADPH and in the process reduces oxygen to superoxide anion (024 NADPH oxidase is an enzyme complex that consists of at least seven proteins. The enzyme consists of two complex ? a) Membrane complex b) Cytosolic complex In resting neutrophils various components of this enzyme complex is located in the plasma membrane and cytoplasm. When the neutrophils are activated the enzyme complex shifts to the phagosomal membrane. The H202generated by the NADPH oxidase system is generally not able to efficiently kill microbes by itself However, azurophilic granules of neutrophils release the enzyme myeloperoxidase (MPO) which in presence of halides such as Cl- conves 11202 to HOCL. The latter is a potent antimicrobial agent that destroys microbes by halogenation. The H202 - MPO halide system is the most efficient bactericidal system in neutrophils.

So the answer to this question is A


Instruction:
Failure to pass meconium within 48 hrs of birth in a newborn with no obvious external abnormality should lead to the suspicion of –
A. Anal atresia
B. Congenital pouch colon
C. Congenital aganglinosis
D. Meconium ileus

Response:
Read what Nelson says about Hirschsprung's disease (Congenital aganglionosis).
"Ninety-nine per cent of full-term infants pass meconium within 48hrs of birth. Hirschsprung disease should be suspected in any fill term infant with delayed passage of stool".

So the answer to this question is C


Instruction:
Most common cause of vulval hematoma-
A. Episiotomv
B. Vault rupture
C. Lower segment uterine rupture
D. Rupture of paravaginal sinuses

Response:
Ans. is 'a' i.e., Episiotomy Causes of vulval hematoma:o Improper haemostasis during repair of vaginal or perineal tear or episiotomy wound (me)o Failure to obliterate the dead space while suturing the vaginal walls.o Rupture of paravaginal plexus spontaneously or due to instrumental injury.

So the answer to this question is A


Instruction:
A woman treated for infertility presents with 6-week amenorrhea with urinary retention. The most likely etiology is:
A. Retroverted uterus
B. Pelvic hematocoele
C. Impacted Cervical Fibroid
D. Carcinoma Cervix

Response:
The patient in the question:

Was being treated for infertility.
Now H/O 6 weeks of amenorrhea.
Presents with urinary retention.
The first diagnosis which comes in our mind is the retroverted gravid uterus.
Points which favour the diagnosis are: The woman is pregnant and has complained of urinary retention.
But friends, here it is important to understand that retroverted gravid uterus causes urinary retention at 14-15 weeks of gestation (not 6 weeks).

So Option "a" is ruled out
Option "b" Pelvic hematocele

"Pelvic hematocele is formed in a patient complaining of 6 weeks amenorrhea in case of ectopic pregnancy." Though pelvic hematocele causes urine retention but then other symptoms (pain) and signs of ectopic pregnancy should be present.

Option "c" Impacted cervical fibroid

"A cervical fibroid impacted in the pouch of Douglas can cause retention of urine. The onset of retention is acute and usually occurs immediately before menstruation when the uterus is further enlarged by congestion or during early pregnancy."
The fibroid is associated with infertility.
Thus, an impacted cervical fibroid can explain all features seen this woman and is our option of choice.

So the answer to this question is C


Instruction:
Nephrotic syndrome is characterised by
A. Proteinuria
B. Hyperlipidemia
C. Oedema
D. All

Response:
Ans. is 'a' i.e., Proteinuria; 'b' i.e., Hyperlpidemia; 'c' i.e., Oedema Pathophvsiologv of nephrotic syndrome Proteinuria o The most impoant feature of nephrotic syndrome is massive proteinuria (>3.5 gm/day) o Proteinuria results from altered permeability of glomerular filtration barrier for protein. o The largest propoion of protein lost in the urine is albumin but globulins are also excreted in some diseases. The ratio of low to high molecular weight proteins in urine in various cases of syndrome is a manifestation of the selectivity of proteinuria. A highly selective proteinuria consists mostly of low molecular weight proteins, i.e. albumin & transferrin, where as apoorly selective proteinuria consists of higher molecular weight globulin in addition to albumin. Edema o Proteinuria leads to hypoalbuminemia that results in decreased colloid osmotic pressure edema. Hyperlipidemia o Increased synthesis of lipoproteins by liver. o Decreased catabolism of lipids. o There is increased cholesterol, triglycerides VLDL, and LDL. Lipiduria o Hyperlipidemia results in lipiduria due to excessive leakiness of glomerular filtration barrier.

So the answer to this question is D


Instruction:
All of the following are causes of cicatrizing alopecia except:
A. Lichen planus
B. Discoid lupus erythematosus
C. Alopecia areata
D. Lupus vulgaris

Response:
C i.e. Alopacia aerate

So the answer to this question is C


Instruction:
Cause of congestive splenomegaly is -
A. Visceral Leishmaniasis
B. Budd Chiari Syndrome
C. Gaucher's Disease
D. Hodgkin's Lymphoma

Response:
Ans. is 'b' i.e., Budd Chiari Syndrome Causes of congestive splenomegalyo Budd Chiari Syndromeo Hepatic vein obstruction\o Portal vein obstruction

So the answer to this question is B


Instruction:
Maximum radiation dose tolerable tissue is -
A. Hemopoietic tissue
B. Testis
C. Ovary
D. Bone

Response:
Ans. is 'd'i.e., BoneRadio sensitivity of tissuesHighly radiosensitiveModerately radiosensitiveLeast radiosensitive (radioresistant)o Lymphoid tissue o Bone marrowo GIT epithelium o Gonads (Testis, ovary)o Embryonic tissueo Skin o Vascular endotheliumo Stomach, Small intestine, colon. Rectum o Lungo Kidney o Livero Lens (eye)o CNS o Muscleo Pancreas o Bone & cartilageo Connective tissue o Vagina & Uteruso Radiation sensitivity of some human tissues (in discending order)Embryo (most sensitive) > Fetus, lymphatic & hemopoietic organs (lymphocytes > RBCs > platelets) > Bone marrow > intestinal tract > ovaries (ovum) > Testis (sperm cells) > capillaries (vascular endothelium > Mucous membrane & salivary glands > Hair follicles > Bone growth zone (epiphysis) > Breasts > Eye lens > Sweat and sebaceous glands > Epidermis > thyroid > liver and kidneys > Adult bones > Cartilage > Lungs and serous membranes > Vagina > CNS (Brain & spinal cord)> Peripheral nerve > Muscle.

So the answer to this question is D


Instruction:
True regarding vitamin B3 are all except: March 2012
A. Tryptophan is a precursor
B. Milk is a rich source
C. Pellagra results due to deficiency
D. Not excreted in urine

Response:
Ans: B i.e. Milk is a rich source

So the answer to this question is B


Instruction:
The factor which promotes virulence of mycobacteria tuberculosis-
A. wax D
B. Cord factor
C. Muramyl dipeptide
D. Mycolic acid

Response:
None

So the answer to this question is B


Instruction:
True regarding breath holding spells is all except ?
A. Antiepileptic treatment is necessary
B. Atropine is sometimes used
C. Attacks of cyanosis can occur
D. Occurs between 6 months to 5 years

Response:
Ans. is 'a' i.e., Antiepileptic treatment is necessary Breath holding spells o Breath holding spell is a paroxysmal event occuring in 0.1% - 5% of healthy children from the age of 6 months to 6 years. o The name for this behaviour may be misnomer in that it connotes prolonged inspiration. Infact, breath-holding occurs during expiration and is reflexive (not volitional) in nature. o There are two major types of breath holding spells ? Cynotic form (more common) Pallid form

So the answer to this question is A


Instruction:
Most sensitive test for diagnosing pheochromocytoma is :
A. MRI
B. 24 hour urinary xma
C. MIBG scan
D. Plasma free metanephrines

Response:
Plasma free metaneprines is the most sensitive test.
24 hour urinary VMA is used for screening.
MRI is the IOC for extraadrenal pheochromocytomos.

So the answer to this question is D


Instruction:
Drug induced myopathy can be caused by all of the following except -
A. Atrovastaine
B. d- penicillamine
C. Ciprofloxacin
D. Chloroquine

Response:
Ans. is `c' i.e., Ciprofloxacin Drugs causing myopathy o Clofibrate o Gemfibrozil o Cyclosporine o Danazol o Statin o Chloroquine o D penicillamine o Cimetidine

So the answer to this question is C


Instruction:
Agent used for treatment of heparin induced thrombocytopenia -
A. Lepirudin
B. Abciximab
C. Warfarin
D. Alteplase

Response:
Ans. is 4a' i.e., Lepirudin Heparin induced thrombocytopenia (HIT)o Heparin induced thrombocytopenia is an important adverse effect of heparin administration, usually caused by unfractionated heparin, but may also be seen with the use of low molecular weight heparin (LMWH).o HIT may be of two types :Type 1 (Non-immune mediated) It is mild and heparin may be continued.Type 2 (Immune mediated)It is due to formation of antibodies against platelets. Paradoxical thrombosis can occur. Heparin must be discontinued immediately. Warfarin and LMWare contraindicated. Lepirudin (a direct thrombin inhibitor) is anticoagulant of choice. Alternatives are danaparoid, hirudin and A rgatroban.

So the answer to this question is A


Instruction:
EMLA for newborns is:
A. Contraindicated
B. Safe
C. Does not cause methemoglobinemia
D. Should be given in reduced doses

Response:
Standard dosing of the topical local anesthetic EMLA (a mixture of lidocaine and prilocaine) in term newborns produced minimal amounts of methemoglobin, and EMLA should be regarded as very safe in the great majority of newborns Ref: Miller's anesthesia-7th ed , Chapter 30.

So the answer to this question is B


Instruction:
False about Charcots joint in diabetes mellitus is
A. Limitation of movements with bracing
B. Ahrodesis
C. Total ankle replacemnt
D. Ahrocentesis

Response:
Charcot Joints * Two theories * Neurotraumatic * Cumulative mechanical trauma * Insensate joint * Neurovascular (autonomic neuropathy) * Neurally stimulated vascular reflex * Bone resorption, ligament weakening Neuropathic joint disease or Charcots joint is an absolute Contraindication for Total Ankle replacemnt Treatment of Charcots ahropathy is limitation of joint movements by bracing or casting,, joint debridement and fusion of joint Refer Miller :Review of ohopedics 4th/e p 56

So the answer to this question is C


Instruction:
The intrinsic potency as local anesthetic is the lowest in
A. Lidocaine
B. Procaine
C. Prilocaine
D. Tetracaine

Response:
None

So the answer to this question is B


Instruction:
World Tuberculosis Day is celebrated on ?
A. 24th March
B. 7th April
C. 22nd April
D. 1st December

Response:
Impoant dates Impoant days 24th March World Tuberculosis day 7th April World health day 22nd April World eah day 1st December World AIDS day 5th June World environment day 1st July Doctors day - Theme of World TB day 2018 :"Wanted, Leaders for TB-free world"

So the answer to this question is A


Instruction:
What is this condition known as?
A. Preiser's disease
B. Kienbock's disease
C. Felon
D. Kaplan's lesion

Response:
Ans. C. FelonA felon is an abscess between the specialized fingertip septae in the distal pulp. It may lead to terminal phalanx osteomyelitis. Incision and drainage covered by intravenous antibiotics are recommended.

So the answer to this question is C


Instruction:
Acoustic shadow in USG is due to
A. Aefact
B. Absorption
C. Reflection
D. Refraction

Response:
C i.e. Reflection

So the answer to this question is C


Instruction:
Catlan's appliance is given for a period NOT more than 6 weeks because it
A. Causes attrition of upper anteriors
B. Causes periodontitis of anteriors
C. Causes gingival recession in lower anteriors
D. Causes over eruption of posterior teeth

Response:
None

So the answer to this question is D


Instruction:
Brown color of contusion is due to:
A. Biliverdin
B. Reduced hemoglobin
C. Hemosiderin
D. Bilirubin

Response:
Color Pigment Time Duration Red Oxy hemoglobin Fresh Blue Deoxy hemoglobin Few hours - 3 days Brown Hemosiderin 4 -5 days Green Biliverdin/ hematoidin 6 -7 days Yellow Bilirubin 7 - 14 days

So the answer to this question is C


Instruction:
True regarding rennin angiotensin system is A/E
A. Angiotonin is octapeptide
B. Renin splits Leucine- valine bond
C. Aspaic acid is essential for rennin activity
D. All

Response:
B i.e. Renin splits Leucine- valine bond

So the answer to this question is B


Instruction:
Number of line angles and point angles are seen in class 4 cavity are respectively:
A. 3 & 6.
B. 4 & 8.
C. 6 & 11.
D. 8 & 14.

Response:
None

So the answer to this question is C


Instruction:
The neurosurgeon had removed a portion of the dense tissue (dura mater) covering the brain of the patient when she removed the tumor that had invaded the skull. To replace this important tissue covering of the brain, she took a band of the aponeurotic tissue of the lateral aspect of the thigh, covering the vastus lateralis muscle. What muscle, supplied by the inferior gluteal nerve, inserts into this band of dense tissue as part of its insertion?
A. Gluteus medius
B. Gluteus minimus
C. Gluteus maximus
D. Tensor fasciae latae

Response:
The tensor fasciae latae (which is innervated by the superior gluteal nerve) and the iliotibial tract are dense, wide aponeurosis that receives the insertion of the tensor fasciae latae and about 75% of the gluteus maximus. The gluteus maximus is the only one of the muscles listed that is supplied by the inferior gluteal nerve; in fact, it is the only muscle innervated by the inferior gluteal nerve. Gluteus medius and minimus insert on the greater trochanter and are innervated by the superior gluteal nerve. The rectus femoris, supplied by the femoral nerve, inserts via the quadriceps tendon on the patella and tibial tuberosity.

So the answer to this question is C


Instruction:
A 40 year old female patient presented with dysphagia to both liquids and solids and regurgitation for 3 months. The dysphagia was non-progressive was non-progressive. What is the most likely diagnosis?
A. Carcinoma of the esophagus
B. Lower esophgeal mucosal ring
C. Achalasia cardia
D. Reflux esophagitis with esophageal stricture

Response:
Presence of dysphagia to both solids and liquids suggests the diagnosis of achalasia Functional Grades of Dysphagia: Grade Definition I Eating Normally II Requires liquids with meals III Able to take semisolids but unable to take any solid foods IV Able to take liquids only V Unable to take liquids, but able to swallow saliva VI Unable to swallow saliva Ref: Sabiston 20th edition Pgno: 1049

So the answer to this question is C


Instruction:
Watson's DNA model is :
A. Right handed, parallel
B. Left handed, anti parallel
C. Left handed, parallel
D. Right handed, anti parallel

Response:
Chemically, DNA consists of two long polymers of simple units called nucleotides, with backbones made of sugars and phosphate groups joined by ester bonds.This common form of DNA is said to be right handed because as one looks down the double helix, the base residues form a spiral in a clockwise direction.These two strands run in opposite directions to each other and are therefore anti-parallel.

So the answer to this question is D


Instruction:
Position of vocal cord in cadaver is:
A. Median
B. Paramedian
C. Intermediate
D. Full Abduction

Response:
The vocal fold of the excised larynx is known to be located at an intermediate position(the so-called cadaver position).

So the answer to this question is C


Instruction:
All are used in treatment for PPH except :
A. Oxytocin
B. Carboprost
C. Ergometrine
D. Ritodrine

Response:
Ritodrine

So the answer to this question is D


Instruction:
In a patient with pelvic inflammatory disease due to tuberculosis, which of the following statements is true :
A. Mycobacterium can be grown from menstrual blood
B. Associated with infeility
C. Ectopic pregnancy is common
D. All of These

Response:
All of These Mycobacterium can be grown from menstrual blood; Associated with infeility; and Ectopic pregnancy is common Most common symptom of TB is infeility. It is seen in 35 - 60% of cases. Cause of infeility : Blockage of the fallopian tube or Altered tubal and Endometrial function in presence of patent tubes. Ectopic pregnancy : Every woman who had or has, a tubal pregnancy should be suspected of having tubal tuberculosis active or healed. Dysmenorrhea : Shaw does not specify whether dysmenorrhea is common or uncommon in TB. "Dysmenorrhea rarely, if occurs." For diagnosis : Dilatation and curettage is done in the premenstrual phase and specimen sent for histo pathological examination and culture. First day menstrual blood can also be used but the results are not as satisfactory as premenstrual tissue. deg It For more details about Genital Tuberculosis, see previous answer

So the answer to this question is D


Instruction:
Hair fall seen after chemotherapy due to
A. Anagen effluvium
B. Telogen effluvium
C. Androgenic alopecia
D. Catagen effluvium

Response:
Hair disorders 1) Anagen effluvium: - Diffuse shedding of anagen hair seen after chemotherapy | Shedding 2) Telogen effluvium: - Increased telogen hair loss seen in 3 months after pregnancy, typhoid fever or any chronic illness. 3) Androgenic alopecia- Testosterone | 5aReductase DHT -most potent form- responsible for hair loss. There is nothing called catagen effluvium.

So the answer to this question is A


Instruction:
Alcohol Dehydrogenase comes under which class of enzyme?
A. Oxidoreductase
B. Dehydrogenase
C. Hydrolase
D. Oxidase

Response:
Ans. A. OxidoreductaseHere the question is asking about class of enzyme, hence answer oxidoreductase. Dehydrogenase is the subclass not class of enzyme.

So the answer to this question is A


Instruction:
PQLI included are -a)  Literacyb)  Infant mortalityc)  Incomed)  Life expectancy at birth
A. ac
B. ab
C. abc
D. c

Response:
Life expectancy at 1 year (not at birth) is included

So the answer to this question is B


Instruction:
Which of the following results in bitemporal hemianopia?
A. Craniopharyngioma
B. Optic nerve glioma
C. Posterior cerebral aery occlusion
D. AION

Response:
- Tumors of the pituitary body are MCC of bitemporal hemianopia, Suprasellar tumors like: Craniopharyngioma and Suprasellar meningioma also results in bitemporal hemianopia

So the answer to this question is A


Instruction:
UMN includes:
A. Pyramidal cells
B. Peripheral nerves
C. Anterior horn cells
D. Glial Cells

Response:
A i.e. Pyramidal cells

So the answer to this question is A


Instruction:
Opisthotonus posture is caused by wof
A. Ricinus communis
B. Papaver somniferum
C. Coccaine
D. Strychnous nux vomica

Response:
STRYCHNOS NUX VOMICA Strychnine ( kuchila) is a powerful alkaloid obtained from the seeds of strychnos nux vomica. The seeds contain two principal alkaloids; strychnine and brucine. Mech of Action: It competitively blocks ventral horn motor neurone postganglionic receptor sites in the spinal cord and brainstem and prevents the effects of glycine (the presumed inhibitory transmitter). Widespread inhibition in the spinal cord results in &;release&; excitation. The action is paicularly noted in the anterior horn cells. It stimulates the cerebralcoex. GABA, the neurotransmitter for presynaptic inhibitory neurons is not affected. Signs and Symptoms: When crushed seeds are taken, the symptoms are delayed for an hour or more. If the alkaloid is swallowed, the symptoms occur very rapidly, usually within five to fifteen minutes. Bitter taste in the mouth, sense of uneasiness and restlessness, feeling of suffocation and fear, and difficulty in swallowing occur. The convulsions are preceded by such prodromal symptoms as increased acuity of perception, increased rigidity of muscles, and muscular twitchings. Convulsions are produced due to direct action on the reflex centres of spinal cord, and affect all the muscles at a time. These are at first clonic, but eventually become tonic. During the convulsions, the face is cyanosed and has anxious look, eyes are staring, eyeballs prominent and pupils are dilated. Risus sardonicus results from contraction of the jaws and facial muscles in which the corners of the mouth are drawn back. The mouth is covered with froth, frequently bloodstained. The convulsions are most marked in anti-gravity muscles, so that the body typically arches in hyperextension (opisthotonos). In supine position, the body is suppoed by the heels and head. The legs are adducted and extended, the arms are flexed over the chest or rigidly extended, and the hands are tightly clenched. The head is bent backwards, and the whole of the body becomes rigid, often assuming a bow-like form. Sometimes, the spasm of the abdominal muscles may bend the body forward (emprosthotonos), or to the side (pleorosthotonos). Consciousness is not lost and the mind remains clear till death. Ref:- k s narayan reddy; pg num:-612,613, image plate14

So the answer to this question is D


Instruction:
Contraindication of OC Pills
A. Liver disease
B. PID
C. Renal disease
D. Epilepsy

Response:
Contraindications of OCP's Absolute contraindications Relative contraindications: (Require medical surveillance) Breast cancer Genital cancer Liver disease H/o thromboembolism Cardiac abnormalities Congenital hyperlipidemia. Undiagnosed abnormal uterine bleeding Pregnancy Age >40 years Smoking and age >35 years Mild hypeension Chronic renal disease Epilepsy Migraine Nursing mothers (0-6 months) Diabetes mellitus Gall bladder disease History of infrequent bleeding Amenorrhoea Ref: Park 25th edition Pgno : 537

So the answer to this question is A


Instruction:
While performing culdocentesis in female patient ,needle should be most efficiently inseed through which of the following structures ?
A. Anterior fornix of the vagina
B. Posterior fornix of the vagina
C. Anterior wall of the rectum
D. Posterior wall of the uterine body

Response:
A needle should be inseed through the posterior fornix, just below the posterior lip of cervix while the patient is in supine position, to aspirate abnormal fluid i the cul-de-sac of Douglas(rectouterine pouch). Rectouterine excavation is not most efficiently aspirated by puncture of other structures.

So the answer to this question is B


Instruction:
Sensory nerve supply of larynx below the level of vocal cord is:
A. External branch of superior laryngeal nerve
B. Internal branch of superior laryngeal nerve
C. Recurrent laryngeal nerve
D. Inferior pharyngeal

Response:
Nerve supply of larynx

Sensory:

––The internal laryngeal nerve supplies the mucous membrane up to the level of the vocal folds.
––The recurrent laryngeal nerve supplies below the level of the vocal folds.

Motor:

––All intrinsic muscles of the larynx are supplied by the recurrent laryngeal nerve except for the cricothyroid
which is supplied by the external laryngeal nerve.

So the answer to this question is C


Instruction:
Wide fixed S2 is seen in
A. ASD
B. VSD
C. PDA
D. All of above

Response:
If splitting does not vary with inspiration, it is termed a "fixed split S2" and is usually due to a septal defect, such as an atrial septal defect (ASD)The ASD creates a left to right shunt that increases the blood flow to the right side of the hea, thereby causing the pulmonary valve to close later than the aoic valve independent of inspiration expiration.(Refer: OP Ghai's Textbook of Pediatrics, 8th edition, pg no. 401)

So the answer to this question is A


Instruction:
32 year old Kalpana presented with complaints of difficulty in breathing, chest pain, and increased rate of breathing. Pulmonary thromboembolism is suspected. Investigation useful in acute pulmonary thromboembolism is:
A. ECG
B. Perfusion scan
C. Pulmonary angiography
D. X-ray chest

Response:
The ventilation-perfusion scan (V/Q) has been the most common diagnostic test for suspected pulmonary embolism. 99Tc-radiolabeled albumin is injected intravenously into the pulmonary capillary bed followed by inhalation of a radioactive gas to assess ventilation. A diagnosis of pulmonary embolism is based on the pattern of ventilatory and perfusion defects with PE causing large segmental decrease in perfusion with preserved ventilation. Major disadvantages of this test are the limitations posed by the presence of comorbid lung disease and the test's lack of sensitivity for small clots. Ref: Nana-Sinkam P. (2003). Chapter 19. Pulmonary Thromboembolism. In M.E. Hanley, C.H. Welsh (Eds), CURRENT Diagnosis & Treatment in Pulmonary Medicine.

So the answer to this question is B


Instruction:
True regarding non accidental traumatic fractures,all except:
A. Costochondral joint fracture
B. Sternal fracture
C. Parietal fracture
D. Metaphyseal corner fracture

Response:
Parietal skull fractures are more suggestive of accidental injury.

So the answer to this question is C


Instruction:
1CD 10 has..............chapters:
A. 2
B. 12
C. 22
D. 32

Response:
22

So the answer to this question is C


Instruction:
Major metabolism of saturated fatty acids in the mitochondria is called as -
A. b-oxidation
B. a-oxidation
C. o-oxidation
D. None of the above

Response:
Ans. is 'a' i.e., b-oxidation o b-oxidation is the principal pathway for catabalism of saturated fatty acids. b-oxidation mainly occurs in mitochondrial matrix (whereas fatty acid synthesis occurs in cytosol).o b-oxidatioon consists of repeated cycles of a series of reactions. With each cycle a two carbon unit (i.e. acetyl CoA molecule) is removed, started at the carboxyl end. Thus complete oxidation of the 16-Carbon fatty acid (e.g. palmitic acid) requires seven such cycles and generates eight molecules of acetyl CoA. In first 6 cycle, 6 acetyl CoA molecules (total 12 carbons) are removed leaving 4- carbon molecules for the last (7th) cycle. In 7th cycle, this 4 carbon molecules is cleaved into 2 acetyl CoA, making the total number of acetyl CoA molecules to eighto It is called b-oxidation because oxidation of fatty acids occurs at the b-carbon atom (3rd carbon and cleavage occurs between 2nd carbon (a-carbon) and 3rd carbon (b-carbon).o The pathway occurs in three stages: (i) Activation of fatty acid in the cytosol; (ii) Transport of activated fatty acid into mitochondria; and (iii) Standard b-oxidation process in mitochondrial matrix.

So the answer to this question is A


Instruction:
Uterosacral ligament contains
A. Mainly plain muscle
B. Sympathetic and parasympathetic nerves
C. Contain uterine vessels
D. Ureters

Response:
Uterosacral ligaments are composed almost entirely of connective tissue and very little plain muscle. They contain sympathetic and parasympathetic nerves.

So the answer to this question is B


Instruction:
Starvation and Diabetes mellitus can lead to ketosis. Which of the following features are in or of ketosis in diabetes mellitus:
A. Increase in glucagon / insulin ratio, increased cAMP and increased blood glucose
B. Decreased insulin, increased free fatty acid which is equivalent to blood glucose
C. Decreased insulin, increased free fatty acid which is not equivalent to blood glucose
D. Elevated insulin and free fatty acid, equivalent to blood glucose

Response:
=Diabetic situation is same like fasting or starvation i.e. catabolic situation in the body. =There is relative or absolute deficiency of insulin. =This leads to increased Glucagon, increased cAMP & increased Blood Glucose. Insulin dependent GLUT-4 is not working in Diabetes, so blood glucose cannot enter peripheral tissues. Plasma free fatty acid levels will be raised as catabolic enzyme - Hormone Sensitive Lipase (HSL) will be active in adipose tissues, which breaks down TGs into fatty acid & glycerol. Fatty acids travel to blood and liver, where beta oxidation of fatty acids takes place. In a chronic diabetes patient, plasma TG and VLDL will also be raised. Pathways which are activated in diabetes are : Beta oxidation of fatty acids Gluconeogenesis Ketone body synthesis Lipolysis of adipose tissues

So the answer to this question is A


Instruction:
A man presented with diarrhea and lower abdominal pain. The stool is heme-positive. Investigation of choice for amoebiasis is?
A. ELISA
B. Colonoscopy
C. Microscopy
D. Microscopy + ELISA

Response:
Amebiasis is infection with the parasitic intestinal protozoan Entamoeba histolytica (the "tissue-lysing ameba"). The most common extraintestinal manifestation of amebiasis is amebic liver abscess. Microscopy, often combined with enzyme-linked immunosorbent assays (ELISAs), remains the standard diagnostic approach. Ref: Stanley, S.L. (2012). Chapter 209. Amebiasis and Infection With Free-Living Amebas. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.

So the answer to this question is D


Instruction:
Association of sexual precocity, multiple cystic bone lesions and endocrinopathies are seen in
A. McCune-Albright's syndrome
B. Granulosa cell tumor
C. Androblastoma
D. Hepatoblastoma

Response:
mc cube Albright syndrome characterized by recurrent ovarian cyst, cutaneous, skeletal & endocrine abnormalities. Figure : Cafe-au-lait skin pigmentation. (a) Skin lesions in a newborn demonstrating the characteristic association with the midline of the body, and distribution reflecting patterns of embryonic cell migration (developmental lines of Blaschko). (b) A typical lesion on the chest, face, and arm demostrating the irregular "coast of Maine" borders, relationship with the midline of the body, and distribution following developmental lines of Blaschko. (c). Typical lesions frequently found on the nape of the neck and crease of the buttocks Reference: Ghai essential of pediatrics, eighth edition, p.no:532.

So the answer to this question is A


Instruction:
Tensile strength of wound after laparoscopic cholecytectomy in a 30 years old Woman depends upon
A. Replacement of type 3 collagen
B. Extensive crosslinking of procollagen
C. Macrophage activity\/invasion
D. Granulation tissue

Response:
"Covalent cross linking of the lysine residues provides tensile strength. The extent and type of cross linking vary from tissue to tissue. In tissues such as tendons, in which tensile strength is crucial, collagen cross linking is extremely high." Sabiston 26th edition Pg: 139

So the answer to this question is B


Instruction:
Vaginal PH in the newborn is -
A. 7
B. 8
C. 6
D. 4

Response:
Ans- C 6

So the answer to this question is C


Instruction:
If radius of a vessel is doubled then the blood flow is increased by?
A. 8 times
B. 16 times
C. 32 times
D. 256 times

Response:
Ans. B 16 timesRef: Ganong: 26th ed. P 563* The influence of lumen diameter on resistance is dramatic. This is because resistance is inversely proportional to the radius of the blood vessel (one-half of the vessels diameter) raised to the fourth power (R=1/r4).* This means, that if an artery or arteriole constricts to one-half of its original radius, the resistance to flow will increase 16 times. And if an artery or arteriole dilates to twice its initial radius, then resistance in the vessel will decrease to 1/16 of its original value and flow will increase 16 times.

So the answer to this question is B


Instruction:
Drug of choice for idiopathic intracranial hypeension
A. Acetazolamide
B. Glycerol
C. Mannitol
D. Dexamethasone

Response:
Idiopathic intracranial hypeension is treated with acetazolamide. It should not be given in first trimester, in rest of the peroids it is safe. This condition worsens during pregnancy due to weight gain. Reference : Harrison20th edition pg 2334

So the answer to this question is A


Instruction:
A 27-year old male presents wio backache,that occurs early in the morgiii ited withstiffness, and persists for more than lutes. Onexamination. chest expansion is also icted. Thep,ol-)111-' ,,:,psis is:
A. Rheumatoid ahritis
B. Oteoahritis
C. Gouty ahritis
D. Ankylosing spondylitis

Response:
Ans. d. Ankylosing spondylitis A 27-year old male presents with low backache that occurs early in the morning, associated with stiffness, and persists for more than 30 minutes. On examination, his chest expansion is also restricted. The most probable diagnosis is ankylosing spondylitis.

So the answer to this question is D


Instruction:
Round, ribbon-shaped, ovoid, bowling pin and kidney-bean are all types of root canals seen on
A. Oblique section
B. Longitudinal section
C. Sagittal section
D. Cross section

Response:
None

So the answer to this question is D


Instruction:
Under the revised National Tuberculosis Control Programme, schedule of treatment for category I patients is -
A. 2 (HRZE)3 + 4(HR)3
B. 2 HRZE+ 4 HRE
C. 2(HRZES)3 + 1(HRZE)3 + 5(HRE)3
D. 2(HRZ)3 + 4 (HR)3

Response:
In RNTCP , the principle of treatment for TB with daily regimen is to administer daily fixed dose combinations of first line anti tuberculosis drugs in appropriate weight brands. New :- 2HRZE + 4 HRE Previously treated : - (2 HRZES + 1 HRZE) + 5 HRE Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 199

So the answer to this question is B


Instruction:
Genetic defect in Klinefelter's syndrome?
A. XYY
B. XXY
C. XXX
D. XO

Response:
Ans. b (XXY) (Ref. H-17th/2340)KLINEFELTER'S SYNDROME# Most common chromosomal disorder associated with testicular dysfunction and male infertilty.# 1 in 1000 live-bom males.# Azoospermia is the rule in men with Klinefelter syndrome who have the 47, XXY karyotype.# Testicular histology :hyalinization of seminiferous tubules and absence of spermatogenesis. But number of Leydig cells appears to increase.# Testosterone is decreased and estradiol is increased.# Features:- Undervirilization and gynecomastia- Markedly reduced testicular volumes (1-2 mL)- Osteoporosis.# Increased risk of:- Breast cancer- NHL- Lung cancer.# Reduced risk of:- Prostate cancer.

So the answer to this question is B


Instruction:
Virchow method of organ removal is
A. Organs removed en masse
B. Organs removed one by one
C. In-situ dissection
D. En-block removal of viscera

Response:
In Virchows method organs are removed one by one. Cranial cavity is exposed first then thoraxic, cervical and abdominal organs. Dr. Narayana Reddys Synopsis of Forensic Medicine & Toxicology 27 th edition pg. 57.

So the answer to this question is B


Instruction:
Follicular carcinoma of thyroid is best treated by
A. Hemi thyroidectomy
B. Near total thyroidectomy
C. Sub total thyroidectomy
D. Radiotherapy alone

Response:
None

So the answer to this question is B


Instruction:
In triple response, flare is mediated by which reflex?-
A. Axon reflex
B. Capillary reflex
C. Arterial reflex
D. Venous reflex

Response:
The triple response of Lewis is a cutaneous response that occurs from firm stroking of the skin, which leads to the following sequence of events.
1) Red spot: due to capillary dilatation
2) Flare: redness in the surrounding area due to arteriolar dilatation mediated by axon reflex.
3) Wheal: due to exudation of fluid from capillaries and venules
The triple response of Lewis is due to the release of histamine.

So the answer to this question is A


Instruction:
Stimulus Response Theory (SR theory) is also known as:
A. Physical Restraint
B. Aversive conditioning
C. Behaviour shaping
D. Tender Love and Care (TLC)

Response:
None

So the answer to this question is C


Instruction:
A 25year old male presents with painless sudden loss of vision, ocular and systemic examination is not contributory. What is probable diagnosis
A. Retinal detachment
B. Eale's disease
C. Glaucoma
D. Cataract

Response:
Ans is Eale's disease Both Eale's disease and Retinal detachment are causes of painless sudden loss of vision, however Eale's disease is a much more common cause than RD in a young male. Ocular and systemic examinations in both the conditions may be normal.Eale's diseaseIt is a disease of young adult males, who otherwise are healthy, in developing countries (especially India).It is an idiopathic inflammation of peripheral retinal veins; characterized by recurrent vitreous hemorrhage.(Periphlebitis leads to obliteration of the affected vessels. Hypoxia leads to neovascularization which lead to recurrent vitreous hemorrhage)The etiology is unknown. Hypersensitivity to tuberculin protein has been reported, however no clear relationship to tuberculosis has been found.Usually bilateral.The common presenting symptoms are sudden appearance of floaters or painless loss of vision.The vitreous hemorrhage clears spontaneously, but after a few recurrence the hemorrhage may organize, and may cause fractional retinal detachment or secondary glaucoma.Treatment:systemic steroids in early vasculitis stageLaser photocoagulation for abnormal vessels is used in neovascularization stagevitreoretinal surgery is required for marked vitreous traction threatening the macula.Causes of sudden, painless loss of visionUnilateralBilateralSubluxation or dislocation of lensVitreous hemorrhageRetinal hemorrhageRetinal detachmentRetinal vascular occlusionExudative age-related macular degenerationPosterior uveitis Diabetic retinopathyGrade IV hypertensive retinopathy with macular star Atypical optic neuritis Toxic optic neuropathy Bilateral occipital infarction

So the answer to this question is B


Instruction:
Which of the following is the diagnosis of the condition shown?
A. Hairy tongue
B. Fissured tongue
C. Geographical tongue
D. Fordyce spots

Response:
Ans. is 'c' i.e., Geographical tongue Geographical tongue* It is characterized by erythematous areas, devoid of papillae, surrounded by an irregular keratotic white outline.* The lesions keep changing their shape and hence the condition is also called "migratory glossitis."* The condition is asymptomatic and may not require any treatment.

So the answer to this question is C


Instruction:
Air-borne contact dermatitis can be diagnosed using which of the following investigation?
A. Skin biopsy
B. Patch test
C. Prick test
D. Estimation of serum IgE levels

Response:
The most widely available method for confirming the diagnosis of air borne contact dermatitis(ACD) is patch testing. Patch test documents the presence of delayed type hypersensitivity, the results of which are read at 48 and 96 hours after placement of the allergen. Patch tests are especially indicated in cases characterized by recurrent episodes of ACD, in cases in which there is a need to identify the offending allergen, and in cases recalcitrant to conventional therapy. Positive patch test does not definitively identify the cause of ACD. False positives may be due to an irritant effect. In these cases, patch testing in control individuals can be of great value. Ref: Clinical Immunology,Principles and Practice (Expe Consult - Online and ... edited by Robe R. Rich, page 541.

So the answer to this question is B


Instruction:
Drug that binds bile acids in the intestine and prevents their return to liver the enterohepatic circulation is-
A. Niacin
B. Fenofibrate
C. Cholestyramine
D. Gugulipid

Response:
Ans. is 'c' i.e., Cholestyramine "Chlestyramine is a bile acid sequesterant"

So the answer to this question is C


Instruction:
In a patient of acute cholecystitis, referred pain to the shoulder is k/a
A. Murphy's sign
B. Gray Turner sign
C. Boa's sign
D. Cullen's sign

Response:
Boa's sign is the area of hyperaesthesia between 9th and 11th ribs posteriorly on the right side,i.e.,below the right scapula,sign of acute cholecystitis. Murphy's sign is right upper quadrant tenderness that is exacerbated during inspiration by the examiner's right subcostal palpation.It's also a sign of acute cholecystitis. Grey turner sign is the skin discolouration in the left flank in cases of acute hemorrhagic pancreatitis. Cullen's sign is the discolouration of umbilicus and surrounding skin(umbilical black eye).It's due to hemoperitoneum & seen in conditions like ruptured ectopic pregnancy,acute hemorrhagic pancreatitis. Reference:SRB's manual of surgery,5th edition,page no:644;Bailey & Love's manual of surgery,25th edition,page no:1121.

So the answer to this question is C


Instruction:
Anthracosis is due to inhalation of-
A. Coal dust
B. Asbestos dust
C. Silica dust
D. Berylium dust

Response:
Ref:Textbook of pathology (Harsh mohan)6th edition, page no. 488 Anthracosis is not a lung disease in true sense but is the common, benign and asymptomatic accumulation of carbon dust in the lungs of most urban dwellers due to atmospheric pollution and cigarette smoke (anthacite refers to coal). Anthracotic pigment is deposited in the macrophages in the alveoli and around the respiratory bronchioles and into the draining lymph nodes but does not produce any respiratory difficulty or radiologic changes

So the answer to this question is A


Instruction:
X-linked inheritance the risk of a female carrier having an affected child is
A. 25
B. 50
C. 75
D. 100

Response:
None

So the answer to this question is A


Instruction:
Pantothenic acid containing coenzyme is involved in:
A. Carboxylation
B. Acetylation
C. Decarboxylation
D. Dehydrogenation

Response:
Pantothenic acid containing coenzyme is Coenzyme A, which is involved in Acetylation reactions. Biochemical Role of Pantothenic Acid- Acyl carrier protein: Role in fatty acid synthesis CoA: has role in TCA, haem synthesis, lipogenesis, fatty acid oxidation. Active group of CoA is a free SH group or Thiol to which acyl groups can be covalently linked to form thio ester bond. E.g. Acetyl CoA .

So the answer to this question is B


Instruction:
After taking ceain medications a patient noticed yellowing of eyes. Which of the following most often causes cholestatic jaundice?
A. INH
B. Erythromycin estolate
C. Pyrazinamide
D. Ethionamide

Response:
Cholestatic jaundice caused by erythromycin estolate (and rarely by the stearate) appears to be specifically related to the propionyl ester linkage of the 29 position. Thus, a history of cholestatic jaundice during therapy with oral erythromycin estolate is not an absolute contraindication to intravenous therapy with erythromycin gluceptate or lactobionate. Ref: Aoki F.Y. (2005). Chapter 45. Principles of Antimicrobial Therapy and the Clinical Pharmacology of Antimicrobial Drugs. In Hall J.B., Schmidt G.A., Wood L.H.(Eds), Principles of Critical Care, 3e.

So the answer to this question is B


Instruction:
All are true regarding propeies of common disinfectants, EXCEPT:
A. Glutaraldehyde is sporicidal
B. Hypochlorites are viricidal
C. Alcohol is fungicidal, bactericidal not sporicidal
D. Phenol usually requires organic matter to act

Response:
Phenol and its derivatives acts by denaturing proteins, especially in cell membrane. It is active aginst gram positive bacteria but its activity is reduced in presence of organic matter. Glteraldehyde is considered a chemical sterilant since it has a broad spectrum of activity inluding being sporicidal. It acts by alkylating microorganism proteins. Hypochlorites are bactericidal, myocabactericidal, fungicidal and virucidal. Alcohols are among the most widely used disinfectant and antiseptic. They are bactericidal and fungicidal not sporicidal. They are also effective against some lipid containing viruses.

So the answer to this question is D


Instruction:
A person is very impatient, competitive and works like a perfectionist. He/ she can be best described as:
A. Type A personality
B. Type B personality
C. Type C personality
D. Type D personality

Response:
Type A personality is characterized by competitiveness, time urgency, hostility and anger. The people with Type A personality are ambitious, impatient and hard working workaholics. Do not confuse type A, B, C,D personality with Custer A, B and C personality disorders. Both of these are different classifications Apa from Type A Personality there are also Type B and D Personalities Type B Personality - Easy going and relaxed (lower chances of CAD) Type D Personality- Negative affectivity and social inhibition. Type A and D have higher risk of CAD.

So the answer to this question is A


Instruction:
Which disease comes under international surveillance -
A. Typhoid fever
B. Salmonellosis
C. Chikungunya fever
D. Hepatitis B

Response:
Ans. is 'b' i.e., Salmonellosis

So the answer to this question is B


Instruction:
Primary prevention includes all, except:
A. Marriage counselling
B. Health education
C. Self breast examination
D. Health promotion

Response:
Pap smear and self breast examination are screening methods Ref: Park, 20th Edition, Page 39

So the answer to this question is C


Instruction:
A 3-year-old girl is brought by her parents into the pediatrician for an urgent evaluation. The child recently started running a high fever in addition to refusing to eat or drink anything. She appears uncomfortable on her mom's lap, leaning very far forward. She is also drooling a fair amount. A cervical radiograph is shown. What is the most likely explanation for this finding?
A. Thumb sign
B. Batwing sign
C. Air-fluid levels
D. Honeycombing

Response:
Ans. (a) Thumb sign.Epiglottitis is an infection of the epiglottis which can lead to upper airway obstruction. It is most commonly seen in ages 3 to 6 years, and is most commonly caused by Haemophilus influenza B (HIB). The incidence has decreased 90% since the introduction of the HIB vaccine. Children present with fever, sore throat, and severe odynophagia. They appear sitting up and leaning forward, drooling. They may have biphasic stridor, especially when presenting later. Epiglottitis can be detected radiographically with a lateral cervical plain film, which shows the characteristic "thumbprint sign.' This sign is caused by the thickened epiglottis.Image source- style="font-family: Times New Roman, Times, serif">

So the answer to this question is A


Instruction:
A 30 year old male is having Attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following will be the operation of choice?
A. Intact canal wall mastoidectomy
B. Simple mastoidectomy with Tympanoplasty
C. Canal wall down mastoidectomy
D. Mastoidectomy with cavity obliteration

Response:
(CWD) Canal wall down is usually done is cases of Attic cholesteotoma with complications. The indications for a canal wall down procedure would be a large cholesteatonma involving the mastoid cavity, or a patient with chronic otitis media who has already failed a canal wall up procedure. There is a category of canal wall down procedures based on intracranial complications of chronic ottitis media, due to cholesteamoma, For etample brain abscess or meningitis from ear disease or even a sigmoid sinus thrombosis from ear disease these would merit a canal wall down procedure

So the answer to this question is C


Instruction:
Calculous cholecystitis is associated with all of the following except: March 2005
A. Oral contraceptives
B. Oestrogen
C. Obesity
D. Diabetes

Response:
Ans. D: Diabetes Risk factors for calculous cholecystitis mirror those for cholelithiasis and include the following: Female sex Ceain ethnic groups Obesity or rapid weight loss Drugs (especially hormonal therapy in women) Pregnancy Increasing age

So the answer to this question is D


Instruction:
Effect of efferent aeriole constriction and afferent aeriole dilatation on GFR is?
A. Increases
B. Decreases
C. No change
D. First increase then decrease

Response:
Increases REF: Ganong's 22" chapter 38 Increase in renal blood flow increases GFR. Afferent aeriole brings blood to the nephron hence its dilation will increase renal blood flow, and efferent aeriole takes blood away from the nephrons, hence its constriction will cause increase filtration, hence increase in GFR.

So the answer to this question is A


Instruction:
Coronary vasodilatation is caused by ?
A. Adenosine
B. Bradykinin
C. Histamine
D. Ergotamine

Response:
Ans. is 'a' i.e., Adenosine o Adenosine is used to induce brief coronary vasodilatation during ceain procedures.

So the answer to this question is A


Instruction:
Castleman's disease is associated with?
A. Necrotizing vasculitis
B. Benign lymphoid hyperplasia
C. Necrotizing lymphadenitis
D. Coagulation defect

Response:
Answer- B. Benign lymphoid hyperplasiaCastleman disease (CD)It is arare bmignlymphoproliferctive dborder.Although Castleman disease is not cancerous, it may also be associated with malignancies such as Kaposi sarcoma, non-Hodgkin lymphoma, Hodgkin lymphoma and POEMS syndrome

So the answer to this question is B


Instruction:
IOC for Bronchiectasis :
A. HRCT scan
B. Spiral CT
C. Bronchoscopy
D. Pulmonary angiography

Response:
Ans.(a) HRCT scanRef: Harrison 19th ed. / 308e-3f 1694* The best test to evaluate the destruction and dilatation of large airways which are filled with pus in Bronchiectasis is HRCT* Spiral CT is preferred for pulmonary embolism* Pulmonary angiography is done for lung sequestration and is gold standard for pulmonary embolism.

So the answer to this question is A


Instruction:
Which of the following is the right choice of treatment for portasystemic encephalopathy?
A. Diuretics
B. High protein diet
C. Emergency portosystemic shunt surgery
D. Lactulose

Response:
None

So the answer to this question is D


Instruction:
High speed includes the R.P.M between
A. 20000-50000
B. 50000-100000
C. 100000-200000
D. above 200000

Response:
None

So the answer to this question is B


Instruction:
The activity of which of the following enzymes is directly affected by citrate?
A. Fructose-2,6-bisphosphatase
B. Isocitrate dehydrogenase
C. Phosphofructokinase I
D. Pyruvate carboxylase

Response:
Citrate is produced by citrate synthase from acetyl CoA and oxaloacetate. This reaction takes place in the mitochondria, but citrate can move freely from the mitochondria into the cytosol. When the citric acid cycle slows down, citrate accumulates. In the cytosol, it acts as a negative allosteric regulator of phosphofructokinase I, the enzyme that catalyzes the committed step of glycolysis. Fructose-2,6-bisphosphatase breaks down fructose-2,6-bisphosphate, a potent allosteric activator of phosphofructokinase I. Fructose-2,6-bisphosphatase is activated by cyclic AMP-dependent protein kinase. Isocitrate dehydrogenase conves isocitrate to alpha-ketoglutarate in the citric acid cycle. It is allosterically stimulated by ADP and inhibited by ATP and NADH. This reaction produces NADH and CO2. Pyruvate carboxylase is a mitochondrial enzyme that conves pyruvate to oxaloacetate. It is impoant in gluconeogenesis and replenishes the oxaloacetate in the citric acid cycle. Ref: Bender D.A., Mayes P.A. (2011). Chapter 20. Gluconeogenesis & the Control of Blood Glucose. 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 C


Instruction:
SI unit for measuring Blood Pressure is :
A. Torr
B. mmHg
C. kPa
D. Barr

Response:
C i.e. KPa

So the answer to this question is C


Instruction:
In census literacy rate is assessed by -
A. Attended literacy classes for one year
B. Ability to write signature
C. Ability to read and write
D. Ability to read newspaper

Response:
The United Nations Educational, Scientific and Cultural Organisation (UNESCO) has drafted a definition of literacy as the "ability to identify, understand, interpret, create, communicate, compute and use printed and written materials associated with varying contexts. Literacy involves a continuum of learning in enabling individuals to achieve their goals, to develop their knowledge and potential, and to paicipate fully in their community and wider society." The National Literacy Mission defines literacy as acquiring the skills of reading, writing and arithmetic and the ability to apply them to one's day-to-day life. The achievement of functional literacy implies (i) self-reliance in 3 R's, (ii) awareness of the causes of deprivation and the ability to move towards amelioration of their condition by paicipating in the process of development, (iii) acquiring skills to improve economic status and general well being, and (iv) imbibing values such as national integration, conservation of environment, women's equality, observance of small family norms. The working definition of literacy in the Indian census since 1991 is as follows Literacy rate Also called the "effective literacy rate"; the total percentage of the population of an area at a paicular time aged seven years or above who can read and write with understanding. Here the denominator is the population aged seven years or more Crude literacy rate The total percentage of the people of an area at a paicular time who can read and write with understanding, taking the total population of the area (including below seven years of age) as the denominator. Ref: https://en.m.wikipedia.org/wiki/Literacy_in_India

So the answer to this question is C


Instruction:
How long can blood be stored with CPD -A -
A. 21 days
B. 28 days
C. 35 days
D. 42 days

Response:
None

So the answer to this question is C


Instruction:
55-year-old lady, both upper limb, both lower limb, perineum 3rd degree burns. How much fluid will you give in first 8 hours?
A. 6710 mL
B. 8120 mL
C. 9120 mL
D. 10,120 mL

Response:
Ans. (a)6710mL Ref: Bailey and Love 27th edition, page 625Parkland formula =4x weight in Kg x TBSATotal body surface area is calculated based on Lund andBrowder Chart in this case:So* Upper limb =1.5+1.5+2+1.5+1.5+2=10%for each upper limb* Lower limb =4.75+3.5+1.75+4.75+3.5+1.75=20%.for each lower limb* So total burns =10+10+20+20+1=61%* Parkland formula total fluid needed =4x55x61=13420/2=6710mL in 8 hours +6710mL in next 16 hours.

So the answer to this question is A


Instruction:
Best view for nasal bone ?
A. Lateral
B. Towne's
C. Cald-well
D. Submentoveical

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

So the answer to this question is A


Instruction:
Which of the following antihypeensives is not given in pregnancy(REPEAT)
A. Enalapril
B. Alphamethyldopa
C. Labetalol
D. Nifedipine

Response:
Ref - GOODMAN and GILMAN12/e p736 ACE inhibitors like enalapril are contra indicated in pregnancy. This are teratogenic drugs . Other drugs given in ghe option are safe in pregnancy.

So the answer to this question is A


Instruction:
Drug of choice for choriocarcinoma is?
A. Nitrosourea
B. Gemcitabine
C. Methotrexate
D. Melphalan

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

So the answer to this question is C


Instruction:
The narrowest pa of trachea in a newborn is at the level of:
A. Cricoid
B. Thyroid
C. Vocal cords
D. Subglottic

Response:
Neonates and infants have, compared with older children and adults, a propoionately larger head and tongue, narrower nasal passages, an anterior and cephalad larynx (the glottis is at a veebral level of C4 versus C6 in adults), a longer epiglottis, and a shoer trachea and neck. These anatomic features make neonates and young infants obligate nasal breathers until about 5 months of age. The cricoid cailage is the narrowest point of the airway in children younger than 5 years of age; in adults, the narrowest point is the glottis. One millimeter of mucosal edema will have a propoionately greater effect on gas flow in children because of their smaller tracheal diameters. Ref: Butterwoh IV J.F., Butterwoh IV J.F., Mackey D.C., Wasnick J.D., Mackey D.C., Wasnick J.D. (2013). Chapter 42. Pediatric Anesthesia. In J.F. Butterwoh IV, J.F. Butterwoh IV, D.C. Mackey, J.D. Wasnick, D.C. Mackey, J.D. Wasnick (Eds), Morgan & Mikhail's Clinical Anesthesiology, 5e.

So the answer to this question is A


Instruction:
The best suited anticogulant for osmotic fragility test is:
A. Heparin
B. EDTA
C. Trisodium citrate
D. Potassium oxalate

Response:
Ans. (a) Heparin(Ref: Dacie 11th/pg246)Best suited anticogulant for osmotic fragility test is Heparin.Heparinized venous blood or defibrinated blood may also be usedOxalated or citrated blood is not suitable because of the additional salts added to it.

So the answer to this question is A


Instruction:
A patient with systemic lupus erythematosus very much wants to become pregnant. What should her physician tell her regarding pregnancy in lupus patients?
A. There is no increased risk to the baby.
B. There may be an increase in cardiovascular malformations
C. There may be an increase in nervous system malformations.
D. There may be an increase in spontaneous aboions and prematurity.

Response:
Systemic lupus erythematosus (SLE) predominantly affects younger women, and so the question of lupus and pregnancy may arise frequently in clinical practice. Patients with SLE have an increased incidence of spontaneous aboion, fetal death in utero, and prematurity. The mother may experience an exacerbation in the activity of her disease in the third trimester or peripaum period, and it may be difficult to distinguish between active SLE and preeclampsia. Therapy of pregnant patients with SLE is problematic, and the generalist should consult the literature or a specialist when such a patient is encountered.Congenital malformations (choices B, C, and D) are not a complication of pregnancies in patients with SLE. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 54. Connective-Tissue Disorders. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

So the answer to this question is D


Instruction:
Time sparing methods of Preoxygenation described is-
A. Four vital capacity breath is 30 secs.
B. Eight vital capacity breath is 1 min
C. Two breath breaths
D. None of the above

Response:
Preoxygenation before anesthetic induction and tracheal intubation is a widely accepted maneuver, designed to increase the body oxygen stores and thereby delay the onset of aerial hemoglobin desaturation during apnea. Because difficulties with ventilation and intubation are unpredictable, the need for preoxygenation is desirable in all patients. During emergence from anesthesia, residual effects of anesthetics and inadequate reversal of neuromuscular blockade can lead to hypoventilation, hypoxemia, and loss of airway patency. In accordance, routine preoxygenation before the tracheal extubation has also been recommended. time sparing method is to ask patient to take 4 full vital capacity breaths.

So the answer to this question is A


Instruction:
A 34-year-old female presents with hypertension, pinched facies and progressive dysphagia with decreased tone of lower esophageal sphincter (LES) The clinical diagnosis is?
A. Scleroderma
B. Hiatus hernia
C. Rolling hernia
D. Diffuse esophageal spasm

Response:
Ans. A SclerodermaRef: CMDT 2019 page 323* Pinched facies with hypertension points to presence of scleroderma. The tone of LES is reduced in scleroderma due to fibrosis.* Choice B and C can lead to GERD but it does not have other features like systemic hypertension.* Choice D presents with chest pain and dysphagia and is hence ruled out.

So the answer to this question is A


Instruction:
Which of the following are false diverticulae
A. Zenker diverticulum
B. Epiphrenic diverticulum
C. Both of the above
D. None of the above

Response:
There is only mucosal herniation in both of them.

So the answer to this question is C


Instruction:
MHC I, II and III function for:
A. Intracellular antigen, extracellular antigens and complement
B. Extracellular antigens, intracellular antigens, toxins
C. Cytokines
D. Macrophages

Response:
Ans. C. CytokinesMHC I, II and III function for Intracellular antigen (CD8 T cells), extracellular antigens (CD4 T cells) and complement

So the answer to this question is C


Instruction:
The following Hysteroscopy view shows presence of:
A. Normal uterine cavity
B. Asherman syndrome
C. Septate uterus
D. Uterine perforation

Response:
Ans. (c) Septate uterus.* The image shows uterine cavity with two separate cavities indicating a septate uterus. It is considered the commonest uterine anomaly (accounts for -55% of such anomalies).* It is classified as a class V Mullerian duct anomaly. Septate uterus is the most common anomaly associated with reproductive failure (67%).* It results from partial or complete failure of resorption of the uterovaginal septum after fusion of the paramesonephric ducts. The septum is usually fibrous but can also have varying muscular components.Hysteroscopic imageDiagnosisNormal uterine cavity Ashermann syndrome Septate uterus.Uterine perforation

So the answer to this question is C


Instruction:
Which of the following vitamins does not participate in oxidative decarboxylation of pyruvate to acetyl CoA -
A. Thiamine
B. Niacine
C. Riboflavin
D. Biotin

Response:
Ans. is 'd' i.e.. Biotin o Oxidative decarboxylation of pyruvate to acetyl CoA occurs only in mitochondria.o Pyruvate, formed in cytosol, is transported into the mitochondria by a proton svmporter. In side the mitochondria, it is oxidatively decarboxylated to acetyl CoA by a multienzyme complex, i.e., py ruvate dehydrogenase (PDH) complex.o PDH complex is located in the mitocondria! matrix.o PDH complex is made up of three enzymes and requires five coenzymes.o The enzymes are: (i) E : Pyruvate dehydrogenase or pyruvate decarboxylase, (ii) E,: dihydrolipoyl transacetyl as e, and (iii) E,: dihydrolipoy l dehy drogenase.o The coenzymes required are thiamine pyrophosphate (TPP), lipoic acid. FAD, NAD, and CoA.Coming to the questiono Niacin is used as NAD, Riboflavin is used as FAD and thiamine is used as TPP.

So the answer to this question is D


Instruction:
Which one of the following drugs is used for fetal therapy of congenital adrenal hyperplasia?
A. Hydrocortisone
B. Prednisolone
C. Fludrocortisone
D. Dexamethasone

Response:
Recommendations for pregnancy at risk consists of administration of dexamethasome a steroid that readily crosses the placenta'

So the answer to this question is D


Instruction:
1st evidence of calcification of Maxillary Lateral incisor occurs
A. 10-12 months
B. 16-17 months
C. 17-19 monhts
D. 15 months

Response:
None

So the answer to this question is A


Instruction:
Anticoagulant produced by mast cells -
A. Antithrombin III
B. Protein C
C. Protein C
D. Heparin

Response:
Ans. is 'd' i.e., Heparin Mast cells Mast cells are bone marrow derived cells. They are found predominantly near blood vessels and nerves and in subepithelial sites, where local immediate hypersensitivity reaction tend to occur. Mast cells have cytoplasmic membrane-bound granules that contain a variety of biologically active mediators. These granules are referred as metachromatic granules. Mast cells are central to the development of immediate hypersensitivity.

So the answer to this question is D


Instruction:
Lingula is which part of lung?
A. Left lower lobe
B. Left upper lobe
C. Right lower lobe
D. Right upper lobe

Response:
Ans. B Left upper lobeRef: Kulkarni Clinical Anatomy, 2nd ed. pg. 943* Left upper lobe is divided into apical lobe and lingular lobe.* The Lingula is a part of the Left upper lobe of lung* It forms left cardiac border.

So the answer to this question is B


Instruction:
In Thyrotoxicosis, β-blockers do not control-
A. Anxiety
B. Termors
C. Tachycardia
D. Oxygen consumption

Response:
None

So the answer to this question is D


Instruction:
Muscle attached to the marked area
A. Masseter
B. Temporalis
C. Medial pterygoid
D. Lateral pterygoid

Response:
Masseter arises from zygomatic arch and inses onto lateral aspect of ramus and angle of the mandible.Its innervated by the masseteric nerve from the anterior division of the mandibular nerve.Action is to elevate and protract the angle of the mandible

So the answer to this question is A


Instruction:
Dietary fluoride supplements should be provided to children if water fluoride ppm is
A. 0.6 ppm or lower
B. 0.7 ppm or lower
C. 0.8 ppm or lower
D. 1.0 ppm or lower

Response:
The natural fluoride content of the water should first be determined. If the natural fluoride content is 0.6 ppm or higher, supplements should not be administered. If the fluoride content is below 0.6 ppm, the administration of fluoride should be considered.

So the answer to this question is A


Instruction:
S. mutans is involved in dental caries initiation. Other bacteria also involved is:
A. S. sarcinus
B. S. macae
C. S. sanguis
D. S. salivarius

Response:
None

So the answer to this question is C


Instruction:
BASDAI criteria is indicated in
A. Ankylosing spondylitis
B. Rheumatic Ahritis
C. Kawasaki Disease
D. Any autoimmune disease

Response:
BASDAI(Bath Ankylosing Spondylitis disease activity index) Used to know effectiveness of drug therapy On a scale of 1-10 it is measured by various factors like discomfo, pain, morning stiffness etc If the value is >4 there is suboptimal control of disease

So the answer to this question is A


Instruction:
Major criteria for rheumatic fever - includes All except
A. Carditis
B. Increased ESR & CRP
C. Erythema marginatum
D. Subcutaneous nodule

Response:
Ans- B Increased ESR & CRP Ref- The famous Jones criteria for diagnosis of Acure Rhemaric Fever are recently revised in 2015 by AHA with emphasis on doppler echocardiogarphy for involvement of heart. It is the first substantial revision to the Jones Criteria by the American Heart Association since 1992. It is technology driven (ECHO) and focuses on epidemiological differences in high-risk and low-risk populations. This is a effort to summarize important points for Pediatric post graduates exams. link to article : Here (For any discrepancy refer original Article) Epidemiological Background 1. During the 20th century, the incidence of ARF and the prevalence of RHD declined substantially in Europe, North America, and developed nations. 2. Attributed to improved hygiene, improved access to antibiotic drugs and medical care, reduced household crowding, and other social and economic changes. 3. However, in developing countries the incidence remains high. In summary, the global distribution of ARF/RHD is clearly disproportionate. As per epidemiological data, cases are divided into: Low risk should be defined as having an ARF incidence <2 per 100 000 school-aged children (usually 5-14 years old) per year. Or an allege prevalence of RHD of <=1 per 1000 population per year. Children not clearly from a low-risk population are at moderate to high risk depending on their reference population. Revised Jones Criteria A. Diagnosis For all patient populations with evidence of preceding GAS infection initial ARF - 2 Major or 1 major plus 2 minor recurrent ARF - 2 Major or 1 major and 2 minor or 3 minor B. What are Major criteria ? C. What are the Minor criteria Evidence of Preceding Streptococcal Infection " Laboratory evidence of antecedent group A streptococcal infection is needed whenever possible, and the diagnosis is in doubt when such evidence is not available " Exceptions include chorea, chronic, indolent rheumatic carditis with insidious onset and slow progression. This latter problem refers to patients without an identifiable history of ARF who have had subclinical carditis that was not detected previously. Interpretation of streptococcal serology results can be difficult in populations with endemic skin or upper respiratory group A streptococcal infections. In these settings, a negative streptococcal antibody test helps to exclude a recent infection, but a positive test does not necessarily indicate an infection in the past few months. Any 1 of the following can serve as evidence of preceding infection, per a recent AHA statement : 1. Increased or rising anti-streptolysin O titer or other streptococcal antibodies (anti-DNASE B). A rise in titer is better evidence than a single titer result. 2. A positive throat culture for group A b-hemolytic streptococci. 3. A positive rapid group A streptococcal carbohydrate antigen test in a child whose clinical presentation suggests a high pretest probability of streptococcal pharyngItis. Clinical Manifestations of ARF 1. Generally, the clinical profile of ARF in low- and middle-income countries closely resembles that of high-income countries. 2. Most common major manifestations during the first episode of ARF remain carditis (50%-70%) and arthritis (35%-66%). 3. These are followed in frequency by chorea (10%-30%), which has been demonstrated to have a female predominance, and then subcutaneous nodules (0%-10%) and erythema marginatum (<6%), which remain much less common but highly specific manifestations of ARF. However in very high-risk populations, such as the indigenous Australian population, variability in typical Jones criteria manifestations has been described. As discussed below, these include presentations with 1. aseptic monoarthritis 2. polyarthralgia and 3. low-grade (as opposed to traditionally considered high-grade) fevers. 1. Carditis 1. As per 1992 AHA revised Jones criteria statement, carditis as a major manifestation of ARF was mostly a clinical diagnosis based on the auscultation of typical murmurs that indicate MR or AR, at either or both valves. (Valvulitis is by far the most consistent feature of ARF, and isolated pericarditis or myocarditis should rarely, if ever, be considered rheumatic in origin.) 2. With declining auscultatory skills and widespread use of ECHO, the concept of subclinical carditis has become incorporated into other guidelines and consensus statements as a valid rheumatic fever major manifestation. 3. Subclinical carditis refers exclusively to the circumstance in which classic auscultatory findings of valvar dysfunction either are not present or are not recognized by the diagnosing clinician but Doppler studies reveal mitral or aortic valvulitis. 4. Specific Doppler Findings in Rheumatic Valvullitis and Morphological Findings on Echocardiogram in Rheumatic Valvulitis (both acute and chronic) are distinctly defined in the guidelines. Additional recommendations include: 1. Echocardiography with Doppler should be performed in all cases of confirmed and suspected ARF. 2. Reasonable to consider performing serial echocardiography/Doppler studies in any patient with diagnosed or suspected ARF even if documented carditis is not present on diagnosis. 3. Echocardiography/Doppler testing should be performed (strictly fulfilling the findings defined) to assess whether carditis is present in the absence of auscultatory findings, particularly in moderate- to high-risk populations and when ARF is considered likely. 4. Echocardiography/Doppler findings not consistent with carditis should exclude that diagnosis in patients with a heart murmur otherwise thought to indicate rheumatic carditis. 2. Arthritis 1. Migratory polyarthritis 2. Most frequently involved are larger ones, including knees, ankles, elbows, and wrists. Involvement of small joints of the hands and feet and the spine is much less common in ARF than in other arthritic illnesses. 3. Rapid improvement with salicylates or nonsteroidal anti-inflammatory drugs is characteristic. 4. Self-limited course, even without therapy, lasting [?]4 weeks. 5. No long-term joint deformity. Aseptic Monoarthritis Studies from India, Australia, and Fiji have indicated that aseptic monoarthritis may be important as a clinical manifestation of ARF in selected high-risk populations. Polyarthralgia Polyarthralgia is a very common, highly nonspecific manifestation of a number of rheumatologic disorders. No compelling evidence to amend this conclusion in low risk. But Children with polyarthralgia are more likely to have ARF if they come from a population with a high incidence population. Therefore, it is minor criteria for low risk, major for high risk! Chorea (Sydenham Chorea) 1. Purposeless, involuntary, nonstereotypical movements of the trunk or extremities. 2. Associated with muscle weakness and emotional lability. Skin Findings 1.Erythema marginatum. a. Unique, evanescent, pink rash seen with pale centers and rounded or serpiginous margins. b. Usually is present on the trunk and proximal extremities and is not facial. Heat can induce its appearance, and it blanches with pressure. Harder to detect in dark-skinned individuals. 2. Subcutaneous nodules 1. Firm, painless protuberances found on extensor surfaces at specific joints, including the knees, elbows, and wrists, and occiput and along the spinous processes vertebrae. Common in those who also have carditis, and as with erythema marginatum, subcutaneous nodules almost never occur as the sole major manifestation of ARF. Rheumatic Fever Recurrences As stated in the 1992 guidelines, patients who have a history of ARF or RHD are at high risk for "recurrent" attacks if reinfected with group A streptococci. "Possible" Rheumatic Fever A given clinical presentation may not fulfill these updated Jones criteria, but the clinician may still have good reason to suspect that ARF is the diagnosis. This may occur in high-incidence settings. In such situations, clinicians should use their discretion and clinical acumen to make the diagnosis that they consider most likely and manage the patient accordingly. AHA recommendations for management of ''possible'' rheumatic fever are: 1. In genuine uncertainty, 12 months of secondary prophylaxis followed by reevaluation including careful history and physical examination with repeat echo. 2. In recurrent symptoms (particularly involving the joints) who has been adherent to prophylaxis recommendations but lacks serological evidence of group A streptococcal infection and lacks echo evidence of valvulitis, it is reasonable to conclude that the recurrent symptoms are not likely related to ARF, and discontinuation of antibiotic prophylaxis may be appropriate.

So the answer to this question is B


Instruction:
Which of the following is the earliest sign of magnesium toxicity in a patient with eclampsia on treatment with magnesium sulphate?
A. Loss of deep tendon reflexes
B. Respiratory Depression
C. Cardiac arrest
D. Decreased urine output

Response:
Throughout the administration of magnesium, the patient needs continuous clinical monitoring for magnesium toxicity. Toxicity is manifested by loss of deep tendon reflexes (patellar), decrease in respiratory rate, oliguria and altered mental status. Comparatively, loss of deep tendon reflexes appears to be the earliest of all the signs and it occurs when the magnesium level exceeds 5 mmol/L. Ref: 'John Hopkins' Textbook of Obstetrics 2nd edition, Page 20; Core Topics in Critical Care Medicine By Fang Gao, Page 345; Danfoh's obstetrics and gynecology By Ronald S. Gibbs, David; Newton Danfoh, Beth Y. Karlan, Ahur F. Haney, Page 270 - 271

So the answer to this question is A


Instruction:
Antibiotic prophylaxis is indicated in all the following for prevention of endocarditis EXCEPT
A. Cardiac catheterization
B. Prostatectomy
C. Cystoscopy
D. Dental procedures

Response:
The most common cause of endocarditis for dental, oral, respiratory tract, or esophageal procedures is S viridans (alpha-hemolytic streptococci). Antibiotic regimens for endocarditis prophylaxis are directed toward S viridans, and the recommended standard prophylactic regimen is a single dose of oral amoxicillin Antibiotic prophylaxis is not routinely indicated for cardiac catheterization. Antibiotic prophylaxis should be considered for any immunocompromised patient or for any patient with probable or definite wound contamination during the procedure. Thus, great care should be taken to prevent large hematomas Ref Davidson 23rd edition pg 942

So the answer to this question is A


Instruction:
Definitive renal artery arises from -
A. Common iliac artery
B. Internal iliac artery
C. External iliac artery
D. Aorta

Response:
Ans. is 'd' i.e., Aorta o Due to ascent of kidneys during development, the blood supply of kidney changes:-1) Initially when the kidneys are in pelvis, the renal arteries are branches of common iliac arteries.2) With progressive ascent, the arteries to kidneys are derived from different levels of aorta.o Upto 5th week of intrauterine life, kidney is in lumbar region and renal arteries are branches of common iliac arteryo After that, differential growth of abdominal wall causes the kidney to ascent to lumbar region. Adult position (lumbar region of abdomen) is attained by 9th week. Druing progressive ascent, the arteries to kidney are derived from different levels of aorta.o After full ascent, definitive renal artery is branch of aorta at 2nd lumbar segmento Thus, neonatal kidney is supplied by aorta.

So the answer to this question is D


Instruction:
Investigation of choice for assessing a child with vesicoureteric reflux is:
A. Antegrade IVP
B. Retrograde IVP
C. Micturating cystourethrogram
D. Cystoscopy

Response:
Ans. Micturating cystourethrogram

So the answer to this question is C


Instruction:
Reye's Syndrome is cause by all except-
A. Adeno virus
B. RSV
C. Herpes
D. Influenza

Response:
Ans. is 'b' i.e., RSV Reye's syndrome Reye's syndrome is a metabolic mitochondria! disorder characterized by - i) Fatty infiltration of liver ii) Encephalopathy iii) Sometimes fatty infiltration of kidney o So, it so also known as Encephalopathy with fatty degeneration of viscera. Etiology o It is an acute self limiting metabolic insult resulting in generalized mitochondrial dysfunction due to inhibition of fatty acid oxidation. o Precipitating factors - o Viral infection --> Influenza B & A, Varicella (Herpes type 3), Echovirus - 2, Adenovirus, EBV, Coxsackievirus A

So the answer to this question is B


Instruction:
A pt presents with engorged neck veins, BP 80/50 and pulse rate of 100 following blunt trauma to the chest: Diagnosis is
A. Pneumothorax
B. Right ventricular failure
C. Cardiac tamponade
D. Hemothorax

Response:
The accumulation of fluid in the pericardial space in the quantity sufficient to cause serious obstruction to inflow of blood into ventricles results in cardiac tamponade. The three principal features of cardiac tamponade termed as BECK'S TRIAD. Hypotension Absent or muffled hea sounds Elevated JVP with prominent x descent but absent y descent. The impoant clue to presence of cardiac tamponade consists of greater than normal(10mmHg) inspiratory decline in systolic blood pressure termed as PARADOXICAL PULSE. Ref Harrison 20th Ed pg 1445

So the answer to this question is C


Instruction:
Ventricular aneurysm has one of the following characteristic features
A. Persistent ST segment elevation
B. Persistent ST segment depression
C. Left bundle branch block
D. Right bundle branch block

Response:
A left ventricular aneurysm can be diagnosed on ECG when there is persistent ST segment elevation occurring 6 weeks after a known transmural myocardial infarction (usually an anterior MI). Without knowing the past medical history, the ECG changes of an aneurysm may mimic an acute anterior MI. With an anterior or apical aneurysm, the persistent ST elevation is in lead V1 and V2 with associated Q waves indicating the old anterior MI. In an inferior aneurysm it would be in lead II, III and aVF, although this is less common. The only way to be sure that the ECG changes present are from an LV aneurysm (not ST elevation from an acute MI) is to have the patient's history of a prior MI and cardiac imaging to document the presence of an aneurysm. The shape of the ST elevation is also relatively unique and has been described as "coving" as seen below Ref Harrison 20th edition pg 1435

So the answer to this question is A


Instruction:
When the rectum is inflated with air through a rectal tube, pain and tenderness occur in the right iliac fossa in case of appenidicitis. This is known as?
A. Aaron's sign
B. Battle's sign
C. Bastedo's sign
D. Mc Burney's sign

Response:
Ans. is 'c' i.e., Bastedo's sign

So the answer to this question is C


Instruction:
Low bih weight statistics of a hospital is best shown by :
A. Bar chas
B. Histogram
C. Pictogram
D. Frequency polygon

Response:
histogram

So the answer to this question is B


Instruction:
Not true about viral envelop?
A. Lipid is derived from host cells
B. Protein is derived from virus itself
C. Dissolves in solvent
D. Propagates in next generation

Response:
Ans. is 'd' i.e., Propagates in next generation Envelope is lipoprotein in nature, lipid is derived from host cell, while protein is virus coded. Enveloped viruses are susceptible to the action of lipid solvents like ether, chloroform and bile salts. Envelop is not propagated in next generation. Rather progeny virions synthesize new envelop (by self protein and host lipid).

So the answer to this question is D


Instruction:
Expansile lytic osseous metastases are characteristic of
primary malignancy of:
A. Kidney
B. Bronchus
C. Breast
D. Prostate

Response:
None

So the answer to this question is A


Instruction:
A 6-month-old child presents with recurrent seizures and poor development. The evaluation reveals a baby with hydrocephalus, impaired movement of the extremities, hypotonia, and retinal abnormalities. A computerized tomography (CT) scan demonstrates large ventricles and calcified lesions. Which of the following is the most likely diagnosis?
A. Tay-Sachs disease
B. congenital hydrocephalus
C. kernicterus
D. toxoplasmosis

Response:
Toxoplasmosis is the most likely diagnosis. The infection has a predilection for the CNS and the eye, and produces encephalitis in utero. Symptoms can be evident in the first few days of life. Infants born with active disease may have fever, rash, seizures, and hepatosplenomegaly at birth.

So the answer to this question is D


Instruction:
While playing football, a 19-year-old college student receives a twisting injury to his knee when being tackled from the lateral side. Which of the following conditions most likely has occurred?
A. Tear of the medial meniscus
B. Ruptured fibular collateral ligament
C. Tenderness on pressure along the fibularcollateral ligament
D. Injured posterior cruciate ligament

Response:
The "unhappy triad" of the knee joint is characterized by: tear of the medial meniscus, rupture of the tibial collateral ligament, and rupture of the anterior cruciate ligament. This injury may occur when a cleated shoe, as worn by football players, is planted firmly in the turf and the knee are struck from the lateral side. Tenderness along the medial collateral ligament and over the medial meniscus and swelling on the front of the joint are due to excessive production of synol fluid, which fills the joint cavity and the suprapatellar bursa.

So the answer to this question is A


Instruction:
Not an indication for blood transfusion
A. Severe anemia at 36 weeks
B. Moderate anemia at 24-30 weeks
C. Blood loss anemia
D. Refractory anemia

Response:
Indications for Blood Transfusion To correct anemia due to blood loss and to combat postpaum hemorrhage Patient with severe anemia seen in later months of pregnancy (beyond 36 weeks) Refractory anemia: Anemia not responding to either oral or parenteral therapy in spite of correct treatment Associated infection Reference: Textbook of Obsteics; Sheila balakrishnan; 2nd edition; Page no: 288

So the answer to this question is B


Instruction:
Most common nerve involvement in fracture surgical neck humerus -
A. Axillary nerve
B. Radial nerve
C. Ulnar nerve
D. Median nerve

Response:
Axillary nerve is particularly vulnerable, both from the injury and from surgery.

So the answer to this question is A


Instruction:
Mental retardation is not seen in-
A. Downs syndrome
B. Cretinism
C. Hypopituitarism
D. Bih asphyxia

Response:
Ans. is `c' i.e., Hypopituitrism

So the answer to this question is C


Instruction:
The term restriction map primarily refers to the mapping of sites of
A. Action of bacteriophages
B. Cleavage of restriction enzymes
C. Mutational hotspot
D. DNA fingerprinting

Response:
Restriction map of DNA mapping of sites of cleavage of restriction enzymes on a DNA fragment. Identifies fragments of DNA that contain specific genes or sequences. Example of a restriction map of bacteriophage DNA

So the answer to this question is B


Instruction:
The suppoing cells of the testes are the following:
A. Spermatogonia
B. Leydig cells of testes
C. Cells of Seoli
D. Spermatids

Response:
All cells of the spermatogenic lineage are closely associated with the extended surfaces of Seoli cells and depend on them for metabolic and physical suppo. Each Seoli cell suppos 30 to 50 developing germ cells. Impoant in Seoli cell function are elaborate tight occluding junctions between their basolateral membranes that form a blood-testis barrier within the seminiferous epithelium. Ref: Mescher A.L. (2013). Chapter 21. The Male Reproductive System. In A.L. Mescher (Ed), Junqueira's Basic Histology, 13e.

So the answer to this question is C


Instruction:
Following hormones are produced by endocrinal part of pancreas, except:
A. Insulin
B. Somatostatin
C. Glucagon
D. Bombesin

Response:
Bombesin is a 14 amino acid peptide isolated from amphibian skin, which was found to have stimulatory effects upon gastric and pancreatic secretions, release of gastrointestinal hormones,  gallbladder contraction and bronchoconstriction.

So the answer to this question is D


Instruction:
A study to evaluate the relationship between smoking exposures taken during PNC visit and the child bih weight after delivery. This type of study is-
A. Case control
B. Prospective coho
C. Cross sectional
D. Clinical trial

Response:
.a prospective coho study is one in which the outcome has not yet occurred at the time when investigation began.begin in the present and continue into the future.examples of this type of study,includes Framingham&;s hea study, DOLL AND HILLS prospective study on smoking and lung cancer. study of oral contraceptives and health by the royal college of general practioners. ref:park&;s textbook,ed 22,pg no 73

So the answer to this question is B


Instruction:
During inhibition of SA node by vagal stimulation, which of the following occurs:
A. Acting on K+ channels resulting in T efflux
B. Acting on K+ channels resulting in T influx
C. Acting on Ca2+channels resulting in T efflux
D. Acting on Ca2+ channels resulting in T influx

Response:
Ans: a (acting on K+channels resulting in increased efflux) Ref: Ganong, 22nd ed,p. 548, 549Vagal stimulation of SA node causes hyperpolarization by | K+ efflux.Stimulation of parasympathetic vagal fibres to SA node* Vagal nerve endings release acetyl choline which T the K+ conductance of the SA node* This is mediated by M, muscarinic receptors which opens a special set of K+ channels resulting in hyperpolarization and also | the slope of prepotential.Stimulation of sympathetic fibres to SA node* Membrane potential falls more rapidly and the rate of spontaneous discharge |* Norepinephrine | the intracellular cAMP that facilitates the opening of L (long acting) calcium channels.* This results in increased intracellular calcium which leads to a rapid depolarization and | the slope of pre potential.

So the answer to this question is A


Instruction:
A 49-year-old man seeks a prescription for erectile dysfunction. He is 168 cm (5 feet 6 inches) tall and weighs 93 kg (body mass index 33). On physical examination, there are bilateral carotid bruits and a midline palpable abdominal pulsatile mass. Decreased hair is noted over the lower extremities, and a 1-cm shallow ulceration is present in the skin over the right first metatarsal head. He has decreased sensation to light touch and pinprick in the lower extremities. Laboratory findings include hemoglobin, 12.9 g/dL; hematocrit, 42%; WBC count, 8950/ mm3; and creatinine, 1.7 mg/dL. Which of the following laboratory findings is most likely to be present in this man?
A. Oligoclonal IgG bands in CSF
B. Hemoglobin A1c, 8.8%
C. Plasma ACTH, 119 pg/mL
D. Plasma homocysteine, 23 mmol/L

Response:
Hemoglobin A1c elevation occurs in diabetes mellitus. The patient has complications of type 2 diabetes mellitus that are typical of obesity: a "diabetic foot" as a consequence of peripheral neuropathy and decreased sensation, advanced atherosclerosis with carotid arterial occlusion, and an atherosclerotic aortic aneurysm. Autonomic dysfunction with neuropathy can lead to erectile dysfunction. The oligo- clonal bands of IgG are characteristic for multiple sclerosis, which usually has more focal CNS involvement. Cushing disease owing to an ACTH-secreting pituitary adenoma leads to truncal obesity, skin that is easily bruised, and possibly to secondary diabetes mellitus, but not to advanced atherosclerosis. Hyperchromocysteinemia is a risk factor for atherosclerosis, but not for neuropathy. Anti-parietal cell antibodies occur in pernicious anemia with vitamin B12 deficiency, which can lead to decreased sensation in the lower extremities, but not to atherosclerotic complications.

So the answer to this question is B


Instruction:
Uncrossed diplopia in seen in :
A. Exotropia
B. Exophoria
C. Esotropia
D. Esophoria

Response:
C i.e. Esotropia Uncrossed (homonymous) diplopia means that the detion & tilt of second image is in the same direction* as the action of the affected muscle. It is seen in convergent (Esotropia) squints eg lateral rectus palsyQ * If right LR is affected false (2nd) image is on the right side Diplopia Detion & tilt of 2nd (falses) image Seen in Homonymous or uncrossed In same direction as that of affected muscle Convergent squint (Esotropia) Q e.g. lateral rectus muscle palsyQ Hetronymous or crossed In opposite direction as that of affected muscle Divergent squint (Exotropia) Q e.g. 3rd nerve palsyQ

So the answer to this question is C


Instruction:
Early dumping consists of following except
A. Abdominal and vasomotor symptoms found in about 5%-10% of patient following gastrectomy or vagotomy and drainage
B. The small bowel is filled with foodstuffs from the stomach, which have a high osmotic load
C. This leads to the sequestration of fluid from the circulation to the gastrointestinal tract
D. This can be observed by the fall in the packed cell volume while the symptoms are present

Response:
Early dumping syndrome or post-cibal syndrome is common in females,seen after Billroth II surgery. It is more severe type; characterised by vasomotor symptoms appearing immediately after food,lasts for 30-40 minutes,aggravated by bulky food. It is relieved by lying down, aggravated by more food. Clinical features:  Sweating, tachycardia, colicky pain and diarrhoea  Hypotension and features of hypovolaemia. Pathogenesis: It is a primary disorder of carbohydrate metabolism wherein initial transient hyperglycaemia prevents fuher absorption of glucose, which in turn draws fluid from the bowel wall by high osmolarity resulting in increased intestinal activity, resulting in diarrhoea and fall in blood volume. Treatment: Small, dry, more frequent food, with avoidance of carbohydrates.Octreotide 100 ug given subcutaneously before meals is found to be beneficial Reference : page 839 SRB's manual of surgery 5th edition

So the answer to this question is D


Instruction:
Which of the following statements regarding acarbose is FALSE ?
A. It acts by inhibiting the enzyme alpha-glucosidase
B. It reduces post-prandial hyperglycemia
C. It decreases the progression of impaired glucose tolerance to overt diabetes mellitus
D. It can cause hypoglycemia

Response:
None

So the answer to this question is D


Instruction:
Which of the following is the least vascular pa of uterus :
A. Lateral
B. Middle
C. Upper
D. Lower

Response:
Middle

So the answer to this question is B


Instruction:
Kashima 's operation done for all conditions except:
A. Vocal cord dysplasia
B. Ca larynx
C. Nasophargyneal Ca
D. Bilateral abductor palsy

Response:
Kashima's operation: A transverse Endoscopic transverse chordectomy/ Posterior paial chordectomy using CO2 laser- performed for treating the respiratory difficulty caused as a result of bilateral abductor vocal fold paralysis. It is done in case of: - B/L Recurrent Laryngeal nerve palsy. - Dysplastic vocal folds - Malignancies (not a mainstay treatment for malignancies)

So the answer to this question is C


Instruction:
True about methicillin-resistance Staphylococcus aureus (MRSA) is
A. Isoxazolyl penicillin is highly effective
B. All MRSA are multidrug resistance
C. Vancomyin is effective
D. MRSA are more virulent then sensitive strains

Response:
Penicillin resistance may also be due to alterations in penicillin-binding protein PBP2a and changes in bacterial surface receptors, reducing the binding affinity 0f beta-lactam antibiotics to cells. This mechanism impas resistance to all beta-lactam antibiotics and has been named methicillin-resistant S.aureus{MRSA}as it was found to be resistant to penicillinase-resistant penicillins like methicillin and cloxacillin. The majority of these strains also show resistance to other antibiotics like erythromycin, tetracyclines, aminoglycosides and cause outbreaks of hospital infection. Ref: Textbook of Microbiology; Ananthanarayanan and Panicker; Tenth Edition pg no 202

So the answer to this question is B


Instruction:
A 15-year-old girl is seen by a dermatologist for removal of multiple squamous cell carcinomas of the skin. The patient has nearly white hair, pink irises, very pale skin, and a history of burning easily when exposed to the sun. This patient's condition is caused by a disorder involving which of the following substances?
A. Aromatic amino acids
B. Branched chain amino acids
C. Glycolipids
D. Glycoproteins

Response:
The disease is albinism. The most common form of albinism is caused by a deficiency of copper-dependent tyrosinase (tyrosine hydroxylase), blocking the production of melanin from the aromatic amino acid tyrosine. Affected individuals lack melanin pigment in skin, hair, and eyes, and are prone to develop sun-induced skin cancers, including both squamous cell carcinomas and melanomas. Maple syrup urine disease is an example of a disorder of branched chain amino acids causing motor abnormalities and seizures. Tay-Sachs disease is an example of a disorder of glycolipids. In this disorder, a deficiency of hexosaminidase A leads to accumulation of ganglioside GM2. Hunter's disease is an example of a disorder of glycoproteins. This mucopolysaccharidosis is inherited as an autosomal recessive trait. Ref: Murray R.K. (2011). Chapter 1. Biochemistry & Medicine. 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 A


Instruction:
Vitamin B 12  deficiency is likely to cause -
A. Bitemporal hemianopia
B. Binasal hemianopia
C. Heteronymous hemianopia
D. Centrocecal scotoma

Response:
The predominant cause of nutritional optic neuritis is thought to be deficiency of B - complex vitamins, particularly thiamin (vitamin B1) and cyanocobalamin (Vitamin B12). Deficiency of pyridoxin (vitamin B6), niacin (vitamin B3), riboflavin (vitamin B2), and / or folic acid also seems to play a role.
Most common visual field defect is central or centrocaecal scotoma.

So the answer to this question is D


Instruction:
All of the following are seen in MEN 2b except ?
A. Hyperparathyroidism
B. Neuromas
C. Medullary carcinoma thyroid
D. Pheochromocytoma

Response:
MEN 2B syndrome includes medullary carcinoma thyroid, pheochromocytoma along with phenotypic changes including marfanoid habitus, skeletal abnormalities, abnormal dental enamel, multiple mucosal neuromas. MEN 2A includes Primary hyperparathyroidism, Medullary carcinoma of thyroid and Pheochromocytoma. Pituitary tumours are a pa of MEN 1 (Wermer's )syndrome along with Primary hyperparathyroidism and Pancreatic neuro-endocrine tumours (insulinomas, gastrinomas). Reference : page 795 Davidson's Principles and practice of Medicine 22nd edition and page 829 Textbook of pathology Harshmohan 6th edition .

So the answer to this question is A


Instruction:
One of the following is NOT transmitted by hard tick: September 2004
A. Hemorrhagic fever
B. Relapsing fever
C. Tick typhus
D. Tularemia

Response:
Ans. B i.e. Relapsing fever

So the answer to this question is B


Instruction:
Cellular adaptation is maintained even after liver is partially resected is known as:(6-R)
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia

Response:
(Hyperplasia): Ref: 6-R (4- Basic pathology 8th)HYPERPLASIA(Hyperplasia is an increase in the number of cells in an organ or tissue, usually resulting in increased volume of the organ or tissue)|||Physiologic HyperplasiaPathologic Hyperplasia1. Hormonal HyperplasiaEg. (i) Breast at puberty and during pregnancy(ii) Pregnant uterus2. Compensatory hyperplasiaEg. (i) Partial hepatectomy(ii) Partial nephrectomyEg: 1. Endometrial hyperplasia2. Benign prostatic hyperplasiaHypertrophy refers to an increase in the size of cells, resulting in an increase in the size of the organ.

So the answer to this question is A


Instruction:
Investigation of choice of diptheria carrier is :
A. Throat swab culture
B. Gram’s stain
C. Albert’s stain
D. Zeil Nelson’s stain

Response:
• Carriers can be detected only by the cultural method.
•The swab should be taken from both the nose and throat

So the answer to this question is A


Instruction:
Whipple's disease is caused by.
A. Bacteria
B. Virus
C. Protozoa
D. Helminths

Response:
Whipple disease is cause by bacteria called tropheryma whippli. It is responsible fot causing influx of lot of macrophages leading to compression of lacteals and impairment in absorption of nutrients. Rod shaped bacillis in macrophage is seen. Patient complains of malabsorption. Pas +ve diastase resistant is seen in macrophage. Treatment with antibiotic will show dramatic improvement.

So the answer to this question is A


Instruction:
. What percent of cases with injury to kidney require surgical exploration -
A. 20%
B. 90%
C. 50%
D. 70%

Response:
None

So the answer to this question is A