Instruction:
Erection is associated with all except
A. Sacral plexus
B. Hypogastric plexus
C. Pudendal nerves
D. Nervi erigentes

Response:
Autonomic control In the presence of mechanical stimulation, erection is initiated by the parasympathetic division of the autonomic nervous system (ANS) with minimal input from the central nervous system. Parasympathetic branches extend from the sacral plexus into the aeries supplying the erectile tissue; upon stimulation, these nerve branches release acetylcholine, which, in turn, causes release of nitric oxide from endothelial cells in the trabecular aeries. Nitric oxide diffuses to the smooth muscle of the aeries (called trabecular smooth muscle), acting as a vasodilating agent. The aeries dilate, filling the corpora spongiosum and cavernosa with blood. The ischiocavernosus and bulbospongiosus muscles also compress the veins of the corpora cavernosa, limiting the venous drainage of blood. Erection subsides when parasympathetic stimulation is discontinued; baseline stimulation from the sympathetic division of the ANS causes constriction of the penile aeries, forcing blood out of the erectile tissue. After ejaculation or cessation of stimulation, erection usually subsides, but the time taken may vary depending on the length and thickness of the penis. Voluntary and involuntary control The cerebral coex can initiate erection in the absence of direct mechanical stimulation (in response to visual, auditory, olfactory, imagined, or tactile stimuli) acting through erectile centers in the lumbar and sacral regions of the spinal cord. The coex may suppress erection, even in the presence of mechanical stimulation, as may other psychological, emotional, and environmental factors.Ref: Ganong&;s review of medical physiology 23rd edition Page no: 405

So the answer to this question is C


Instruction:
The highest incidence of ectopic pregnancy amongst contraceptive users is observed with:
A. Combined contraceptive pills
B. Copper T intrauterine contraceptive device
C. Progestase intrauterine device
D. Levonorgestrel intrauterine system

Response:
- There is a slight increase in propoion of ectopic pregnancy post-failure of IUCD. The failure is highest with progesterone IUD. Progestase intrauterine device: - Rate of progesteron release = 65 mcg/day - Total progesteron content = 38mg - Shelf life = 1 to yrs - MC side effect is bleeding - 2nd MC side effect - pain

So the answer to this question is C


Instruction:
Which of the following is an exception of Courvoisier's law?
A. Double Impaction
B. Poal lymphadenopathy
C. Periampullary Carcinoma
D. None of the above

Response:
Exceptions to courvoisier's Law Double impaction of stones i.e. one in the cystic duct and other in CBD. Oriental cholangiohepatitis Pancreatic calculus obstructing the ampulla of Vater Mucocele due to stone in the cystic duct

So the answer to this question is A


Instruction:
A pregnant female presented with itching in genital area. What is the MOST common vaginal infection in pregnancy?Gonorrhoea z
A. Gonorrhoea
B. Trichomoniasis
C. Candidiasis
D. Bacterial vaginosis

Response:
Candida species are normal flora of the oropharynx, bowel, and vagina. Candida overgrowth of these surfaces may arise in the setting of broad spectrum antibiotics, diabetes mellitus, or HIV infection, resulting in oral thrush, Candida esophagitis, and vaginal candidiasis. High estrogen states, such as pregnancy or oral contraceptive use, are an additional risk factor for vaginal yeast infection. Candida skin infections are often seen in moist, macerated interigenous folds, such as in the groin, perineum (diaper rash), pannus, axillae, and breasts. Ref: Matloff J. (2012). Chapter 192. Candida and Aspergillus. In G.V. Lawry, S.C. McKean, J. Matloff, J.J. Ross, D.D. Dressler, D.J. Brotman, J.S. Ginsberg (Eds), Principles and Practice of Hospital Medicine.

So the answer to this question is C


Instruction:
Histological benign lesion can be fatal if
A. Induce organ dysfunction
B. Transform to carcinoma
C. Metastasize to different organs
D. All of the above

Response:
CharacteristicsBenignMalignantDifferentiation Well differentiated; structure may be typical of tissue of origin Some lack of differentiation with anaplasia; structure is often atypicalRate of growth Usually progressive & slow; may come to a standstill or regress; mitotic figures are rare & normal Erratic & may be slow to rapid; mitotic figures may be numerous & abnormal Local invasion Usually cohesive & expansile well-demarcated masses that do not invade or infiltrate surrounding normal tissuesLocally invasive, infiltrating the surrounding normal tissues; sometimes may be seemingly cohesive & expansile Metastasis Absent Present; the larger and more differentiated the primary , the more likely are metastases

So the answer to this question is B


Instruction:
In ankle sprain, the commonest ligament torn is?
A. Tibio-talar ligament
B. Deltoid ligament
C. Posterior talo-fibular ligament
D. Anterior talo-fibular ligament

Response:
Ankle sprain is an inversion injury and anterior talo-fibular ligament is first to be damaged. More severe injury can also damage origin of extensor digitorum brevis and calcaneo-fibular ligament.

So the answer to this question is D


Instruction:
Adenocarcinoma in oesophagus occurs in
A. Midline oesophagus
B. Upper oesophagus
C. Barrett's esophagus
D. Zenkers diveiculum

Response:
BARRETT's ulcer is an ulcer in columnar epithelium lined Barrett's oesophagus. It is more prone for Bleeding, Perforation, and Adenocarcinoma of oesophagus( very high, more than 40 times). Treatment for Barrett's ulcer is endoscopic biopsy and resection. Reference: SRB's Manual of Surgery, 6th Edition, page no= 788.

So the answer to this question is C


Instruction:
Sarcoma botryoides is also known as?
A. Embryonal Rhabdomyosarcoma
B. Alveolar Rhabdomyosarcoma
C. Leiomyosarcoma
D. Lipoblastomatosis

Response:
Embryonal Rhabdomyosarcoma REF: Devita's oncology 6th edition p. 1325, Gynecologic Pathology By Marisa R. Nucci, Esther Oliva page 325 Benign tumors of striated muscle are rare. There are three main types of Rhabdomyosarcoma; Embryonal, Pleomorphic and Alveolar. 1. Embryonal Rhabdomyosarcoma (Sarcoma botryoides) Usually arises in the orbit or genitourinary tract in children. The botryoid type of Embryonal Rhabdomyosarcoma, which frequently originates in mucosa-lined visceral organs such as the vagina and the urinary bladder, generally grows as a polypoid tumor. These tumors may disseminate widely, but are responsive to chemotherapy and radiation. Embryonal Rhabdomyosarcoma occasionally arise in adults. Although regression of tumor in response to pediatric chemotherapy regimens usually occurs, age is an impoant prognostic factor for survival, with worse outcomes in older patients. 2. Alveolar Rhabdomyosarcoma Extremity Rhabdomyosarcoma in adolescents and young adults often has an alveolar histology. Alveolar Rhabdomyosarcoma is composed of ill-defined aggregates of poorly differentiated round or oval cells that frequently show central loss of cellular cohesion and formation of irregular alveolar spaces. These tumors appear to have a worse prognosis than Embryonal Rhabdomyosarcoma in younger children, but not in adults. A specific translocation, t (2, 13) (q37; q14) involving the PAX3 gene on chromosome 2 and the FKHR gene on chromosome 13, is seen in the majority of alveolar Rhabdomyosarcoma. 3. Pleomorphic Rhabdomyosarcoma In adults, Pleomorphic Rhabdomyosarcoma is the most common form of Rhabdomyosarcoma.

So the answer to this question is A


Instruction:
A child with protein-energy malnutrition is brought to the outpatient depament. TRUE about Gomez classification of malnutrition of children is:
A. Weight is compared with height
B. Height is the only parameter
C. Weight is the only parameter
D. It doesn't take account of height and weight

Response:
The degree of malnutrition is almost always based on the child's percentage of standard weight for age. The child's weight is compared to that of a normal child (50th percentile) of the same age. It is useful for population screening and public health evaluations. Percent of reference weight for age = ((patient weight)/(weight of normal child of same age)) x 100. According to Gomez classification, Classification Percentage of standard weight for age Normal Grade I (Mild malnutrition) Grade II (Moderate malnutrition) Grade III (Severe malnutrition) >90 75-89.9 60-74.9 <60 Ref: Achars Textbook Of Pediatrics (4Th Edn) By Swarna Rekha Bhat (ed.), Page 46 ; Essence of Paediatrics Prof. MR Khan, Page 72.

So the answer to this question is C


Instruction:
The principle used in radiotherapy is:
A. Cytoplasmic coagulation
B. Ionising the molecules
C. DNA damage
D. Low dose causes tissue necrosis

Response:
Ans. DNA damage

So the answer to this question is C


Instruction:
Voissus ring is seen in:
A. Cornea
B. Retina
C. Anterior capsule
D. Posterior capsule

Response:
Anterior capsule

So the answer to this question is C


Instruction:
Alpha-fetoprotein is increased in following except:
A. Open neural tube defect
B. Down's syndrome
C. Oesophageal atresia
D. Exomphalos

Response:
Down's syndrome

So the answer to this question is B


Instruction:
Karyotype of a patient shows the following. What is the clinincal abnormality that is expected? NOT RELATED-MEDIICNE
A. Gynecomastia with long thin limbs
B. Sho stature with polydactyly
C. Webbed neck with widely spaced nipples
D. Rockerbottom feet

Response:
.

So the answer to this question is D


Instruction:
Earliest sign of Diabetic retinopathy is
A. Micro-aneurysm
B. Cotton wool spots
C. Hard exudates
D. Flame shaped haemorrhage

Response:
(Microaneurysm) (295-Person 20th) (260-62-Khurana 4th)* Earliest detactable lesion is microaneurysm in the macular area in NPDRDIABETIC RETINOPATHYOphthalmoscopic features of Non-proliferativediabetic retinopathy (NPDR)* Microaneurysm at the macular area (the earliest detectable lesion)*** Retinal haemorrhage both deep (dot and blot haemorrhage) and superficial haemorrhages (flame shaped)* Hard exudates** - yellowish- white- waxy looking patches are arranged in clumps or in the circinate pattern - seen in macular area* Retinal oedema characterized by retinal thickening* Cotton -wool spots** (if >8, there is high risk of PDR)* Venous abnormalities - beading, looping and dilatation* Intraretinal microvascular abnormalities (IRMA)* Dark-blot haemorrhages representing haemorrhagic retinal infarctsThe hall mark of proliferative diabetic retinopathy (PDR) is the occurrence of neovascularization over changes of very severe NPDRComments cause of moderate (diminuation) of vision is Macular oedema*** Advanced diabetic eve disease - It is marked by complication such as- Persistent vitreous haemorrhage**- Tractional retinal detachment**- Neovascular glaucoma**Most common cause of vitreous hemorrhage in adults is - Diabetes (PDR) (297-Parson 20th)HARD EXUDATES - seen in -DR, Hypertensive retinopathy, coat's disease, circinate retinopathySoft exudates seen in - Hypertensive retinopathy DR, Toxemic retinopathy of pregnancy, Anemia, collagen vascular disease like- SLE, PAN, SclerodermaManagement of diabetic retinopathyType of retinopathyTherapy* Background* MaculopathyCSME* Difuse leak around macula- Circinate* Preproliferative retinopathy* Proliferative retinopathy* Advanced diabetic eye diseaseControl of diabetic, regular reviewFocal photocoagulation- Grid laserFocal photocoagulation**- Frequent reviewPan retinal photocoagulation**- Vitreo, retinal surgery** with photocoagulation* Gentamicin - can cause macular or retinal toxicity even at therapeutic and low doses when given intravitreally* NIDDM with history of DM for years should have an ophthalmic examination - As early as feasible in IDDM- 5 years after the onset of diabetes

So the answer to this question is A


Instruction:
Discoloration and accelerated wear is seen in composite restoration, if a patient is using a toothpaste having:
A. Stannous flouride
B. Calcium carbonate
C. Chloroform
D. Both 2 and 3

Response:
Calcium carbonate is a surface abrasive and causes wear.
Chloroform causes softening of the composite matrix and causes discoloration.

So the answer to this question is D


Instruction:
Which of the following is a pan T lymphocite marker -
A. CD2
B. CD3
C. CD 19
D. CD 25

Response:
The TCR is a disulfide-linked membrane-anchored heterodimeric protein normally consisting of the highly variable alpha (a) and beta (b) chains expressed as pa of a complex with the invariant CD3 chain molecules. Reff: Ananthanarayanan & Panikers textbook of microbiology 9th edition pg: 133

So the answer to this question is B


Instruction:
False statement about Familial Adenomatous polyposis is
A. Most common genetic polyposis syndrome
B. >100 polyps may be seen in colon
C. Colon cancer usually develops around 20 years of age
D. Caused by mutation in APC gene

Response:
Familial Adenomatous Polyposis
They are precancerous lesion and without intervention risk of developing colon cancer is 100% by 5th decade of life that is around 40 years.

So the answer to this question is C


Instruction:
Which of the following is used as epidural anaesthetic agent commonly?
A. Chloroprocaine
B. Lidocaine
C. Mepivacaine
D. All of the above

Response:
Commonly used sho- to intermediate-acting agents for epidural anesthesia include, Chloroprocaine Lidocaine Mepivacaine Longer acting agents include, Bupivacaine Levobupivacaine Ropivacaine Ref: Butterwoh IV J.F., Butterwoh IV J.F., Mackey D.C., Wasnick J.D., Mackey D.C., Wasnick J.D. (2013). Chapter 45. Spinal, Epidural, & Caudal Blocks. 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 D


Instruction:
"Nerve terminals release chemicals" release chemicals" ? discovered by:
A. Dale
B. Withering
C. Domagk
D. Loewi

Response:
D i.e. Loewi Otto Loewi discovered that nerve terminals or synapse release chemicals. In his most famous experiment, Loewi took fluid from one frog hea and applied it to another, slowing the second hea and showing that synaptic signaling used chemical messengers. Before Loewi's experiments, it was unclear whether signalling across the synapse was bioelectrical or chemical. Loewi's famous experiment, published in 1921, largely answered this question. He dissected out of frogs two beating heas: one with the vagus nerve which controls hea rate attached, the other hea on its own. Both heas were bathed in a saline solution (i.e. Ringer's solution). By electrically stimulating the vagus nerve, Loewi made the first hea beat slower. Then, Loewi took some of the liquid bathing the first hea and applied it to the second hea. The application of the liquid made the second hea also beat slower, proving that some soluble chemical released by the vagus nerve was controlling the hea rate. He called the unknown chemical Vagusstoff. It was later found that this chemical corresponded to Acetylcholine

So the answer to this question is D


Instruction:
Mother to child transmission in vectors is called?
A. Transovarian
B. Mechanical transmission
C. Propagative transmission
D. Cyclodevelopmental transmission

Response:
Ans. is 'a' i.e., Transovarian When the infectious agent is transmitted veically from the infected female to her progeny in the vector, It is known as trasnovarian transmission. Transovarian transmission is seen in :- Scrub typhus Rickettsial pox Rocky mountain spotted fever Indian tick typhus Q. fever Yellow fever Note : In Q fever also, there is transovarial transmission in tick. (But no ahropod is involved in its transmission to man). Also know Transmission of the disease agent from one stage of life cycle to another as for example nymph to adult is known as trans-stadial transmission.

So the answer to this question is A


Instruction:
All are associated with paraneoplastic syndromes except -
A. Cerebeller degeneration
B. Progressive multifocal leucoencephalopathy
C. Amyotropic lateral sclerosis
D. Opsoclonus myoclonus

Response:
None

So the answer to this question is B


Instruction:
The most impoant cells in type I hypersensitivity
A. Macrophages
B. Mast cells
C. Neutrophils
D. Lymphocytes

Response:
Ans. is 'b' i.e., Mast cells Type I hypersensitivity (Immediate hypersensitivity) o It is a rapidly developing immunological reaction occuring within minutes after the combination of an antigen with antibody bound to mast cells in individuals previously sensitized to the antigen. o Immediate hypersensitivity reactions are mediated by Ig E, but T and B cells play impoant role in the development of these antibodies. o Type I reaction requires prior sensitization to a specific antigen (allergen). o Most exposures occur either by inhalation (respiratory route) or ingestion (GIT) of antigen. o Type one hypersensitivity has two phases :- 1.Initial response o After first antigen exposure, this antigen is presented to CD-4 helper T cells (TH2 type) by antigen presenting cells. These primed TH2 cells release IL-4 that acts on B-cells to form Ig E specific for that paicular antigen. The antigen specific lg E antibodies then bind to the surface receptors of mast cells and basophils. The process from first antigen exposure to the coating of mast cells by Ig E acts as sensitization (prior sensitization) and first exposure is also called priming or sensitizing exposure (dose). Subsequent exposure (shocking dose) to same antigen then result in activation of mast cells and basophils with release of mediator from these cells that leads to ? Smooth muscle spasm Increase mucus secretion from the epithelial cells. Vasodilatation Increased vascular permeability Recuritment of inflammatory cells Note - Most of the clinical effects are due to smooth muscle spasm. 2. Late phase response In this phase additional leukocytes are recruited. These cells amplify and sustain the inflammatory response without additional exposure to the triggred antigen. Among the cells that are recruited in the late-phase reaction, eosinophils are paicularly impoant. Eosinophils produce major basic protein and eosinophilic cataionic protein that are toxic to epithelial cells. Platelet activating factor (PAF) recruits and activates inflammatory cells and is most impoant cytokine in the initatiation of late phase response. Type I hypersensitivity occurs in two forms Anaphylaxis --> Acute, potentially fatal, systemic. Atom --> Chronic, Nonfatal, Lacalized. Remember o Mast cells are the most impoant cells in type I hypersensitivity. o Eosinophils are the most impoant cells in the late phase reaction of type I hypersensitivity. o Histamine is the most impoant mediator in type I hypersensitivity. o IL-4 is paicularly impoant, it is essential for turning on IgE secreting B cells. o PAF is the most impoant cytokine in the initiation of late phase reaction. o Most potent eosinophilic activating cytokine is IL-5.

So the answer to this question is B


Instruction:
Which of the following antimalarial is a slow acting schizonticide-
A. Aemether
B. Mefloquine
C. Pyrimethamine
D. Quinine

Response:
Ans. is 'c' i.e., Pyrimethamine o Antimalarials that act on erythrocytic phase of schizogony are called erythrocytic schizontocides. The available drugs can be divided into ? 1. Fast acting - Chloroquine, amodiaquine, quinine, mefloquine, halofantrine, lumefantrine, atovaquone, aemisinin. 2. Slow acting - Pyrimethamine, Proguanil, sulfonamides, tetracyclines.

So the answer to this question is C


Instruction:
Substrate-level phosphorylation seen in a reaction catalysed in
A. Succinate dehydrogenase
B. Alpha-ketoglutarate dehydrogenase
C. Succinyl CoA thiokinase
D. Malate dehydrogenase

Response:
Substrate level phosphorylation is catalysed by : (i) In glycolysis: Phosphoglycerate kinase, pyruvate kinase; and (ii) In TCA cycle: Succinate thiokinase.

So the answer to this question is C


Instruction:
Following is not used in the management of Post dural headache -
A. Propped up position
B. Sumatriptan
C. Hydration
D. Epidural blood patch

Response:
Ans. is 'a' i.e., Propped up position * Supine (recumbent) position and not propped up is recommended for the management of post dural headache.* Post dural puncture headache is due to CSF leak. Typical location is bifrontalor occipital.* Headache gets worsen on sitting or upright posture and is relieved by lying down position and abdominal pressure - The hallmark of postdural puncture headache i.e., association with body position.* The onset of headache is usually 12-72 hours following the procedure, however, it may be seen almost immediately. In most cases it lasts for 7-10 days.* PDPH is believed to result from leakage of CSF from a dural defect and decreased ICT. Loss of CSF at a rate faster that it can be produced causes traction on structure supporting the brain, particularly dura and tentorium. Traction on cranial nerve (particularly 6th nerve) produces diplopia.* Factors that increase the incidence of PDPH are young age, female sex, Pregnancy, large bore needle and multiple punctures. Timing of ambulation has no effect on incidence of PDPH* Use of small bore needle can prevent PDPH.* Intially conservative treatment is given which includes analgesics (NSAIDs), oral or i.v. fluids, Sumatriptan, cosyntropin, caffeine and recumbent position.* If conservative treatment fails, epidural blood patch can be used. It involves injecting 15-20 ml of autologous blood into the epidural space which stop leakage of CSF by coagulation and mass effect.

So the answer to this question is A


Instruction:
Patient is having bronchodilation, increased temperature, constipation and tachycardia. The diagnosis is:
A. Organophosphate poisoning
B. Paracetamol poisoning
C. Mushroom poisoning
D. Atropine poisoning

Response:
Atropine poisoning All the symptoms mentioned in this question are seen with anticholinergic compounds. Atropine, hyoscine (scopolmaine) & hyoscyamine are natural alkaloids with anticholinergic action. They are found in Dhatura, Atropa belladena, Hyoscyamus niger. Poisoning with these substances are characteristically described as - Dry as a bone (Dryness of mouth & skin) - Red as a beet (Flushed face) - Blind as a bat (Dilated pupil) - Hot as a hare (Hyperpyrexia) - Mad as a wet hen (Delirium) Symptoms can also be described as 8D's Other symptoms which can occur are tachycardia, constipation, bronchodilation and reduced airway resistance (esp. in COPD and asthma patients) and urinary retention.

So the answer to this question is D


Instruction:
The most common presentation of IgA nephropathy
A. Nephritic syndrome
B. Nephrotic syndrome
C. Microscopic hematuria
D. Repeated gross hematuria

Response:
The two most common presentations of IgA nephropathy are - Recurrent episodes of macroscopic hematuria during or immediately following an upper respiratory infection often accompanied by proteinuria . Persistent asymptomatic microscopic hematuria. Nephrotic syndrome is uncommon . Ref:Harrison 20 th edition pg no 2140

So the answer to this question is D


Instruction:
All of the following are present in sweat except -
A. Calcium
B. Lactic acid
C. Urea
D. Uric acid

Response:
Ans D- Uric acidnote : calcium is excreted in sweat daily by 140 mg/day

So the answer to this question is D


Instruction:
Malignant hyperthermia is a rare complication of the use of the following anaesthetic:
A. Ketamine
B. Thiopentone sodium
C. Halothane
D. Ether

Response:
Rarely, halothane can cause malignant hyperthermia, which is treated with dantrolene.

So the answer to this question is C


Instruction:
Best site to demonstrate capillary filling in infants?
A. Nail bed
B. Sternum
C. Ear lobule
D. Great toe

Response:
Ans. is 'b' i.e., Sternum o The state of microcirculation can be assessed by capillary filling time (CFT) o Firm pressure is applied over sternum or forehead by a ball of the thumb for 5 seconds. This leads to blanching. o On removal of pressure color returns. The time taken for complete return of color is designated as capillary filling time, the normal is less than or equal to 3 sec. o Prologed CFT is the earliest sign signifying impairment or microcirculation.

So the answer to this question is B


Instruction:
Bull's neck is characteristically seen in:
A. Hamaoma of Lung
B. Diphtheria
C. Glaucoma
D. Hepatic Candidiasis

Response:
Faucial diphtheria : commonest type of diphtheria. Characterized by fever, sore throat, pseudo membrane over fauces. Cervical adenitis with sub-mandibular edema is called bull neck.

So the answer to this question is B


Instruction:
Not a feature of Congenital rubella syndrome is
A. Congenital Cataract
B. Microphthalmia
C. Salt and pepper retinitis
D. Anterior Uveitis

Response:
Anterior Uveitis is Not a feature of Congenital rubella syndrome.

So the answer to this question is D


Instruction:
A 30 year old patient presented with history of jaundice for 10 days. His liver function tests showed bilirubin of 10 mg/dl, SGOT/SGPT - 1100/1450, serum alkaline phosphatase - 240 LU. He was positive for Hbs Ag. What should be the confirmatory test to estabilish acute hepatitis B infection -
A. Ig M anti-HBc antibody
B. Hbe Ag
C. HBV DNV by PCR
D. Anti-HBc antibody

Response:
Ans. is 'a' i.e., Ig M anti-HBc antibody . Has been explained . Ig M anti-HBc antibody is the marker of acute or recent HBV infection.

So the answer to this question is A


Instruction:
Immunoglobulins are produced by -
A. Macrophages
B. B-cells
C. T-cells
D. NK-cells

Response:
Immunoglobulin (Ig),is a large, Y-shaped protein produced mainly by plasma cells that is used by the immune systema Ref: Ananthanarayan & Panikers textbook of microbiology 9th edition pg:94

So the answer to this question is B


Instruction:
A 5 year old child is admitted with headache, vomiting and difficulty in walking. Physical findings include truncal ataxia, papilloedema and left lateral rectus palsy. No finger-to-nose ataxia could be detected on the left side or right side. The most likely diagnosis is –
A. Dandy walker syndrome
B. Syringobulbia
C. Arnold-chiari malformation
D. Medulloblastoma

Response:
Congenital lesions would present Hydrocephalus since birth (for a & c)

So the answer to this question is D


Instruction:
Osteoid osteoma consists of -
A. Osteoblasts
B. Osteoclasts
C. Both of above
D. None of the above

Response:
Ans. is 'c' i.e., Both of above Osteoid Osteoma Osteoid osteoma is the most common true benign tumor of the bone. This is a benign circumscribed lesion that may arise in the coex of long bones or occasionally in the cancellous bone of spine. The characteristic feature is the formation of a small nidus of osteoid tissue, surrounded by a reactive zone of dense sclerosis (Sclerotic new bone formation). Microscopically, the tumor is composed of thin, irregular, trabeculae within a cellular granulation tissue containing osteoblasts and osteoclasts.Trabeculae are more mature in the center, which is often paially calcified. Reactive, sclerotic bone surrounds the nidus. Clinical features of osteoid osteoma The tumor occurs between 10-30 years of age and is more common in males. The diaphysis of long bones is involved, most common bone involved is the tibia followed by femur. Posterior elements of the veebrae may also be involved. The presenting complaint is a nagging pain, worst at night, and is relieved by salicylates or other NSAIDs, a diagnostic feature. On X-ray, there is a small radiolucent area (nidus) surrounded by dens sclerosis. X-ray, in some cases, show local sclerotic thickening of the shaft that may obscure the small central nidus within the area of rarefaction. Bone scan shows increased uptake in the nidus. The only treatment is wide en block excision along with internal fixation with or without bone grafting.

So the answer to this question is C


Instruction:
The most common manifestation of congenital toxoplasmosis:
A. Hydrocephalus
B. Chorioretinitis
C. Hepatosplenomegaly
D. Thrombocytopenia

Response:
Characteristic triad of Congenital Toxoplasmosis: Chorioretinitis (most common) Hydrocephalus Cerebral calcifications.

So the answer to this question is B


Instruction:
Birth weight of all 10 babies born an in a nursing home on a day was 2.7 kg. Standard deviation is -
A. 0
B. 1
C. 0. 27
D. 2.7

Response:
Standard deviation is a measure of dispersion from central value.
In the question, there is only one central value (2.7 Kg) as all 10 babies have same weight. Thus, there is no dispersion.

So the answer to this question is A


Instruction:
Apple core appearance on barium enema is seen in?
A. Carcinoma Colon
B. TB caecum
C. Crohns disease
D. Ulcerative colitis

Response:
Ans. (a) Carcinoma ColonRef: Bailey 26th ed. 170* On double contrast barium enema of the rectum and distal sigmoid colon demonstrates a typical annular constricting carcinoma of the colon with overhanging edges on both the proximal and distal margins forming a so called "apple-core" lesion.

So the answer to this question is A


Instruction:
First symptom in vulval cancer is-
A. Pain
B. Pruritus
C. Ulceration
D. Bloody discharge

Response:
Ans. is 'b' i.e., Pruritus o Women with VIN and vulvar cancer commonly present with pruritus and a visible lesion.# However, pain, bleeding, and ulceration may also be initial complaints.

So the answer to this question is B


Instruction:
For treatment of paucibacillary leprosy drugs used are -
A. Rifampicin & dapsone
B. Rifampicin, dapsone, steroids
C. Rifampicin, clofazimine, dapsone
D. None

Response:
Paucibacillary cases should also recieve combined therapy in the view of primary dapsone resistance .The recommended standard adult regimen includes rifampicin and dapsone Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 341

So the answer to this question is A


Instruction:
Which among Following drugs does not commonly produce fixed drug eruptions:
A. Tetracycline
B. Ibuprofen
C. Sulphonamides
D. Mepacrine

Response:
Mepacrine

So the answer to this question is D


Instruction:
Findings of trigeminal nerve injury include -
A. Pupillary dilation
B. Loss of blinking reflex of eye
C. Normal jaw reflex
D. Ptosis

Response:
Shining a bright light into one eye causes reflex closure of both eyes the blink reflex ophthalmic division of trigeminal nerve. Pupillary dilation and ptosis is seen in 3rd nerve injury In trigeminal nerve injury their is loss of jaw reflex which is mediated by mandibular nerve

So the answer to this question is B


Instruction:
the distention media used in diagnostic hysteroscopy with bipolar couesy is
A. CO2
B. NS
C. Dextran 70
D. Glycine

Response:
ref : gynecology shaw

So the answer to this question is B


Instruction:
Which of the following anticholinergic is used for peptic ulcer disease
A. Dicyclomine
B. Methacoline
C. Pirenzepine
D. Aclidinium

Response:
Pirenzepine is a M1 receptor antagonist.
Acetyl choline acts on M1 receptors present on gastric glands to increase acid secretion and Pirenzepine is used to treat peptic ulcer disease by blocking these receptors.

So the answer to this question is C


Instruction:
Inverse agonist of benzodiazepine receptor is :
A. Phenobarbitone
B. Flumazenil
C. Beta carboline
D. Gabapentin

Response:
None

So the answer to this question is C


Instruction:
The Millennium Development Goals (MUG) is to be achieved by the year -
A. 2010
B. 2015
C. 2020
D. 2030

Response:
Ans. is 'b' i.e., 2015

So the answer to this question is B


Instruction:
Treatment for peritonsillar abscess is -
A. Tonsillectomy
B. Incision and drainage
C. Antibiotics alone
D. I & D + antibiotics

Response:
None

So the answer to this question is D


Instruction:
Which of the following is not a trace element?
A. Zinc
B. copper
C. Selenium
D. calcium

Response:
Definition of trace elements : Elements present at concentrations of mg/dl in body fluids and mg/kg in tissues are referrd to as trace elements . Calcium reference range in blood : 8.6 - 10.3 mg/dl. Teitz textbook of clinical biochemistry, chapter Vitamins and trace elements.

So the answer to this question is D


Instruction:
D-tubocurarine acts by -
A. Inhibiting nicotinic receptors at myoneural junction
B. Inhibiting nicotinic receptors at autonomic ganglion
C. Producing depolarizing block
D. By inhibiting reuptake of acetylcholine

Response:
Ans. is 'a' i.e., Inhibiting nicotinic receptors at myoneural junction o D-tubocurarine is a skeletal muscle relaxant that acts by competitive inhibition of NM receptors at neuron-muscular junction.

So the answer to this question is A


Instruction:
Most common cause of biliary stricture is
A. CBD stone
B. Trauma
C. Asiatic cholangitis
D. Congenital

Response:
Most common cause of benign biliary stricture is laparoscopic cholecytectomy I.e., operative trauma Incidence of bile duct injury during laparoscopic cholecystectomy is 0.3-0.85 % Ref:Sabiston 20th edition Pgno :1502

So the answer to this question is B


Instruction:
Trolly tract sign is seen in -
A. Achondroplasia
B. Psoriatic ahritis
C. Osteopetrosis
D. Ankylosing spondylitis

Response:
Trolly track sign : The Central radiodense line on frontal radiographs is related to ossification of supraspinous and interspinous ligaments. In addition, there are two more lateral veical linear lines, which represent ossification of the apophyseal joint capsules. The three veical ossified lines together make up the trolley-track sign. Radiological features of Ankylosis spondylitis are : Sacroiliitis Enthesopathy Romanus lesions Bamboo spine Rugger Jersy spine Interveebral disc calcification Dagger sign Trolley track sign Squarring of veebrae.

So the answer to this question is D


Instruction:
A girl presents with, primary amenorrhea, grade V thelarche, grade II pubarche, no axillary hair, likely diagnosis is:
A. Testicular feminization
B. Mullerian agenesis
C. Turners syndrome
D. Gonadal dysgenesis

Response:
Tanner's Stage V thelarche means : 'Mature' breast development Stage II pubarche means : Sparse growth; We therefore have to look for a condition where development of breast is unaffected despite poor development of pubic hair. Thus, testicular feminization is the only condition out of these with well developed breast & poorly developed axillary hair or pubic hair. Ref: Textbook of Gyanaecology By Copeland, Page 601 ; Harrison's Principles of Internal Medicine, 14th Edition, Page 2122 and 15th Edition, Page 2181-2

So the answer to this question is A


Instruction:
A 38-year-old man has had thyroid surgery to remove his papillary carcinoma. The external laryngeal nerve that accompanies the superior thyroid aery is damaged during the surgery.This injury could result in a severe impairment of function of which of the following
A. Relaxing the vocal cords
B. Rotating the arytenoid cailages
C. Tensing the vocal cords
D. Widening the rima glottidis

Response:
The External laryngeal nerve innervates the cricothyroid muscle (major tensor), which tenses the vocal cord. Hence damage to this nerve will lead to inability to tense the vocal cords.

So the answer to this question is C


Instruction:
Which of the following has the largest relative mesiodistal dimension of the root canal?
A. Maxillary Lateral incisor
B. Mandibular second premolar
C. Palatal root of maxillary 1st molar
D. Distal root of the mandibular 1st molar

Response:
None

So the answer to this question is D


Instruction:
All the following factors stimulate Growth hormone secretion except
A. Deep sleep
B. Increased blood amino acids
C. Exercise
D. Increased blood glucose

Response:
Factors That Stimulate or Inhibit Secretion of Growth HormoneStimulate Growth HormoneSecretionInhibit Growth HormoneSecretionDecreased blood glucoseIncreased blood glucoseDecreased blood free fattyacidsIncreased blood free fattyacidsIncreased blood aminoacids (arginine)AgingStarvation or fasting,protein deficiencyObesityTrauma, stress, excitement, ExerciseGrowth hormone(exogenous)Testosterone, estrogenSomatomedins (insulin-likegrowth factors)Deep sleep (stages II and IV)Growth hormone inhibitoryhormone (somatostatin)Growth hormone-releasinghormoneIncreased blood glucoseGhrelinIncreased blood free fattyacidsRef: Guyton; 13th edition; Chapter 76; Pituitary Hormones and Their Control by the Hypothalamus

So the answer to this question is D


Instruction:
Eczema herpeticum seen with:
A. HSV
B. EBV
C. CMV
D. VZV

Response:
A (HSV) ECZEMA HERPATICUM/KAPOSi'S VARICEL1FORM ERUPTIONS KVE is wide spread cutaneous infection with a virus which normally causes localized or mild vesicular eruption occurring in patients with pre-existing skin disease | | |Infectious agentPredisposing factor (damaged skin)||* Herpes simplex virus (HSV1) is mostcommon cause (Eczema berpaticum)* Coxsackie A 16* Vaccinia* Small pox vaccination (Eczema vaccinatum)^ * Atopic eczema (most common predisposing factor). Allergic contact dermatosis, Darrier's disease* Pemphigus foliaceous, benign familial pemphigus* Icthysosis vulgaris, congenital ecthyosiform erythroderma* Mycosis fungiodes, Sezary synodrome* Bums (2nd and 3rd degree) Eczema HerpeticumIt is a disseminated herpes infection generally at sites of epidermal disruption such as atopic dermatitis, burns, eczema etc.The causative organism is herpes simplex virus type 1Exzema herpeticum results in a severe disseminated infection, involving multiple organs - eyes, brain, lung, liver and others and can be fatal.Treatment of choice is systemic antiviral drugs, such as acyciovir or vataeyclovir.When smallpox vaccination was still being routinely administered, the vaccinia virus used in the smallpox vaccine could cause a similar syndrome if the patient had an active eczema. This condition is called eczema vaccinatum.Eczema herpeticum and eczema vaccination are collectively known as Kaposi's varicelliform eruption

So the answer to this question is A


Instruction:
A 37-day-old baby presented to the Pediatrics ER with increased respiratory effo along with grunting. Mother says he is always irritable, feeds very poorly and has not gained weight. History of frequent respiratory infections in the past 2 weeks O/E, Wide pulse pressure along with bounding peripheral pulses Hyperkinetic apex Continuous murmur in 2nd left intercostal space. The structure involved in the above condition develops from which embryological structure: -
A. Left sixth arch
B. Right sixth arch
C. Left fifth arch
D. Right fifth arch

Response:
Chest x-ray shows marked cardiomegaly with dilatation of the main pulmonary aery and bilateral pulmonary plethora ECG tells la dilatation, LV hyperophy and left axis detion which points towards the diagnosis of PDA. The left sixth aoic arch is responsible for the development of both the pulmonary aeries and the ductus aeriosus. Without regression of the ductus aeriosus, a patent connection remains between aoa and the pulmonary trunk. The ductus aeriosus often reaches functional closure within 24 hours after bih, whereas anatomic closure and subsequent formation of the ligamentum aeriosum often occur by the twelfth postnatal week.

So the answer to this question is A


Instruction:
Commonest cause of nosocomial infection
A. Pseudomonas
B. Staphylococci
C. Klebsiella
D. Enterobacteriacea

Response:
Controversial MCQ, no where there is clear cut reference for MC agent of HAI
Initially hospital outbreaks were caused by Gram positive organisms like Streptococcus pyogenes and the methicillin resistant Staphylococcus aureus (MRSA)
Presently Gram negative enteric pathogens (Enterobacteriaceae) including Escherichia coli, Klebsiella and Enterobacter species have emerged as an important cause
Pseudomonas and Acinetobacter species are also common nosocomial pathogens and are extremely resistant to common antibiotics and antiseptics.

So the answer to this question is B


Instruction:
Primary biliary cirrhosis is most commonly associated with______
A. Systemic sclerosis
B. Sjogren syndrome
C. Ulcerative colitis
D. Pancreatitis

Response:
Primary Biliary Cirrhosis Autoimmune disorder Clinical manifestation - obstructive jaundice F > M Antibody seen in antimitochondrial ab which is formed against E2 subunit of PDH enzyme. Interlobular bile ducts are actively destroyed by lymphoplasmacytic inflammation with or without granulomas.

So the answer to this question is B


Instruction:
The mechanism responsible for sustained vascular smooth muscle contraction is
A. Sustained calcium release from SERCA pump
B. Vascular smooth muscle tone
C. Latch bridge mechanism
D. Henneman principle

Response:
Latch bridge mechanism: - Once smooth muscle has developed full contraction, the amount of continuing excitation can usually be reduced to far less than the initial level even though the muscle maintains its full force of contraction. Fuher the energy consumed to maintain contraction is often miniscule, sometimes as little as 1/ 300 the energy required for comparable sustained skeletal muscle contraction. This mechanism is k/a 'latch' mechanism. The impoance of latch mechanism is that it can maintain prolonged toxic contraction in smooth muscle for hours with little use of energy. Little continued excitatory signal is required from nerve fibres or hormonal source.

So the answer to this question is C


Instruction:
A 50 year old male presents with cicatricial entopion of uper and lower eyelid. On eversion of upper eyelid, linear conjunctival scars - Arlt line are seen. What is the diagnosis?
A. Trachoma
B. Sprisng catarrah
C. Ligneous conjunctivitis
D. Parinaud oculoglandular syndrome

Response:
Arlt line is a feature of trachoma. Ref: Kanski 8th/e Chap.5, p.138

So the answer to this question is A


Instruction:
The most common primary cause of intraocular tumor in children -
A. Retinoblastoma
B. Rhabdomyosarcoma
C. Neuroblastoma
D. Melanoma

Response:
Malignant tumor arising from the neurosensory cells of retina due to deletion of RB gene located on the long arm of chromosome 13(13q14). Ref: ak khurana 6th edition

So the answer to this question is A


Instruction:
Mirror test is used to
A. Assessment of cessation of respiration
B. Assessment for tremors
C. Assessment for hea function
D. Assessment for brain function

Response:
Cessation of respiration : this should be complete and continuous. Complete stoppage of respiration for more than 5 minutes usually causes death. Respiration may stop for very sho period without causing death. Feather test, mirror test and Winslow's test have only historical impoance. Ref: Dr. NARAYANAN REDDYS TEXTBOOK OF FORENSIC MEDICINE PAGE 144

So the answer to this question is A


Instruction:
Average central aortic pressure in full-term neonate is_____ mm Hg?
A. 75/50
B. 60/40
C. 40/20
D. 20/10

Response:
Ans. a (75/50) (Ref. Nelson Paediatrics 18th/1856; OP Ghai 6th/393)Nelson pediatrics 18th/p. 1856 under heading Neonatal Circulation:# The average central aortic pressure in a term neonate is 75/50 mm Hg.THE NEONATAL CIRCULATION# At birth, the fetal circulation must immediately adapts to extrauterine life as gas exchange is transferred from the placenta to the lung.- After an initial slight fall in systemic blood pressure, a progressive rise occurs with increasing age.0- The heart rate slows as a result of a baroreceptor response to an increase in systemic vascular resistance when the placental circulation is eliminated.- The average central aortic pressure in a term neonate is 75/50 mm Hg.- The onset of ventilation, pulmonary vascular resistance is markedly decreased as a consequence of both active (PO2 related) and passive (mechanical related) pulmonary vasodilation.* The major decline in pulmonary resistance from the high fetal levels to the low "adult" levels in the human infant at sea level usually occurs within the 1st 2-3 days but may be prolonged for 7 days or more.* Over the 1st several weeks of life, pulmonary vascular resistance decreases even further, secondary to remodeling of the pulmonary vasculature, including thinning of the vascular smooth muscle and recruitment of new vessels.Significant differences between the neonatal circulation and that of older infants include:- right-to-left or left-to-right shunting may persist across the patent foramen ovale;- in the presence of cardiopulmonary disease, continued patency of the ductus arteriosus may allow left-to-right, right-to-left, or bidirectional shunting;- the neonatal pulmonary vasculature constricts more vigorously in response to hypoxemia, hypercapnia, and acidosis;- the wall thickness and muscle mass of the neonatal left and right ventricles are almost equal; and- newborn infants at rest have relatively high oxygen consumption, which is associated with relatively high cardiac output.# The newborn cardiac output is about 350 mL/kg/min.# CO falls in the 1st 2 months of life to about 150 mL/kg/min# Then more gradually to the normal adult cardiac output of about 75 mL/kg/min.# The foramen ovale is functionally closed by the 3rd mo of life.# Functional closure of the ductus arteriosus is usually complete by 10--15 hr in a normal neonate0# The normal ductus arteriosus differs morphologically from the adjoining aorta and pulmonary artery in that the ductus has a significant amount of circularly arranged smooth muscle in its medial layer.# During fetal life, patency of the ductus arteriosus appears to be maintained by the combined relaxant effects of low oxygen tension and endogenously produced prostaglandins, specifically prostaglandin E2# In a full-term neonate, orygen is the most important factor controlling ductal closure.0# 'When the PO2 of the blood passing through the ductus reaches about 50 mm Hg, the ductal wall constricts.

So the answer to this question is A


Instruction:
Marcus gunn jaw winking phenomenon due to relation between which cranial nerves
A. VII + VIII
B. III + V
C. V + VII
D. III + VI

Response:
Ans. is 'b' i.e., III + V Marcus Gunn phenomenon (a.k.a. Marcus Gunn Jaw-Winkingor Trigemino-oculomotor Synkineses) IT is an autosomal-dominant condition with incomplete penetrance, in which nursing infants will have rhythmic upward jerking of their upper eyelid. This condition is characterized as a synkinesis: when two or more muscles that are independently innervated have either simultaneous or coordinated movements.

So the answer to this question is B


Instruction:
Phenytoin is a drug that follows zero order kinetics at high doses and first order kinetics at low doses. Suppose, 400 mg phenytoin is present in the body and its rate of elimination at this dose is 200 mg/hr, how much will remain in plasma after 2 hours?
A. 200 mg
B. 100 mg
C. Zero
D. Can not be predicted from this information

Response:
* We cannot predict because we don't know when it will sta following first order kinetics. Order of kinetics: FIRST ORDER ZERO ORDER Constant fraction of drug is eliminated Constant amount is eliminated Rate of elimination is directly propoional to plasma concentration Rate of elimination is constant Clearance is constant Clearance is inversely propoional to plasma concentration Half life is constant Half life is directly propoional to plasma concentration.

So the answer to this question is D


Instruction:
What is the best guide for the management of fluid resuscitation?
A. CVP
B. Blood pressure
C. Oxygen saturation
D. Urine output

Response:
None

So the answer to this question is D


Instruction:
Indication for prophylaxis in pneumocystis carini pneumonia include
A. CD4 count < 200
B. Tuberculosis
C. Viral load > 25,000 copies/ml
D. Oral candidiasis

Response:
Ans. is 'a' i.e., CD4 count < 200 PROPHYLAXIS OF PNEUMOCYSTIC CARINH PNEUMONL4 Primary prophylaxis is indicated for Patients with CD4- cell counts of< 200/4 History of oropharyngeal candidiasis Secondary prophylaxis is indicated for Both HIV infected and non HIV infected patients. Who have recovered from pneumocystosis. Primary and secondary prophylaxis may be discontinued in HIV infected persons once. CD4+ counts have risen to > 200/p1 and remained at that level for 3 months. Also know First choice agent for prophylaxis Trimethoprim, sulphamethoxazole. Other agents used in prophylaxis. Dapsone, pentamidine.

So the answer to this question is A


Instruction:
A patient presented with unilateral proptosis, which was compressible and increases on ending forward. No thrill or bruit was present. MRI shows a retro-orbital mass with enhancement. The likely diagnosis is:
A. AV malformations
B. Orbital encephalocoecle
C. Orbital varix
D. Neurofibromatosis

Response:
Ans. Orbital varix

So the answer to this question is C


Instruction:
IL -1 helps in:
A. Stimulation of T-lymphocytes
B. Inhibits of B-lymphocytes
C. Inhibits the chemotaxis of neutrophils and macrophages
D. Decreases fibroblast and bone resorption activity

Response:
None

So the answer to this question is A


Instruction:
Regression of Mullerian duct in males occurs at:
A. 5 weeks
B. 6 weeks
C. 7 weeks
D. 8 weeks

Response:
Ans. is d, i.e. 8 weeksRef: Leon Speroff 8th/ed, p342"AMH gene expression is induced by SOX-9 in sertoli cells and results in the ipsilateral regression of mullerian ducts by 8 weeks in males"

So the answer to this question is D


Instruction:
Approved drug for prostate cancer is
A. Bicalutamide
B. Apalutamide
C. Ibalizumab
D. Ivacaftor

Response:
Apalutamide was approved by FDA in 2018 for the treatment of HIV. It is androgen antagonist. Nilutamide, flutamide, bicalutamide are old drugs used in prostate cancerRef: <a href="

So the answer to this question is B


Instruction:
In complete 3
rd
Nerve palsy-a) Eye Deviated Mediallyb) Superior and inferior recti affectedc) Dilated pupild) Ptosise) Conversion/accommodation is lost
A. bce
B. bcde
C. abcd
D. acde

Response:
Abduction and some depression is spared, therefore the eye is deviated laterally and downward. All adduction, elevation and extorsion is lost, so patient cannot lookup or medially.

So the answer to this question is B


Instruction:
Bluish discoloration of flank is known as:
A. Grey turner sign
B. Cullen sign
C. Trousseau sign
D. None

Response:
Ans. (a) Grey Turner signRef: Sabiston 20th edition Page 1526* Flank discoloration -- Grey turner* Peri umbilical -- Cullen sign* Inguinal -- Fox sign

So the answer to this question is A


Instruction:
Mechanical advantage provided by lever action of malleus
A. 2:01
B. 1.3 : 1
C. 1.8 : 1
D. 1:01

Response:
The handle of the malleus is 1.3 times longer than the long process of the incus, providing a mechanical advantage of 1.3. (Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra 6th edition; page no.14)

So the answer to this question is B


Instruction:
In health management, cost-benefit analysis is an example of
A. Critical path method
B. Program evaluation and review technique
C. Management by objectives
D. Quantitative methods

Response:
Management techniques are many, can be based on principles of behavioural sciences as well as quantitative methods.Quantitative methods are derived from the field of economics, operation research and budgeting.Cost-benefit analysis is a quantitative management technique, which has attracted the widest attention for application in the health field.Cost-benefit analysis, in which benefits are compared to cost of the program. The benefits are expressed in monetary termsThe main drawback of this technique is that benefits in the health field, as a result of a paicular programme, cannot always be expressed in monetary terms.Park 23e pg:871

So the answer to this question is D


Instruction:
Fibrosis is due to ?
A. TGF beta
B. TNF alpha
C. IL 7
D. IL l0

Response:
Ans. is 'a' i.e., TGF beta

So the answer to this question is A


Instruction:
All of the following are absolute contraindications for neuraxial anaesthesia, EXCEPT:
A. Patient on anticoagulants
B. Fixed output state
C. Hypovolaemic shock
D. Bowel perforation

Response:
In patients on anticoagulants there is a risk of pressure damage to the cord from bleed/hematoma, so neuraxial anaesthesia is absolutely contraindicated. In shock and fixed output states there is effective reduction in circulating volume due to vasodilation, so neuraxial anaesthesia is again absolutely contraindicated. In bowel perforation there is a theoretical risk of increased parasympathetic activity, peristalsis and peritoneal soiling but is only a relative contraindication for all neuraxial anaesthesia. Ref: Oxford Handbook of Clinical Specialities, Edition 8, Page - 635

So the answer to this question is D


Instruction:
The commonest cause of intestinal obstruction and abdominal pain in children between 3 months to 6 years of age:
A. Intussusception
B. Meckel's diverticulum
C. Intestinal polyp
D. Nonspecific cause

Response:
Ans. A. IntussusceptionIntussusception occurs when a portion of the alimentary tract is telescoped into an adjacent segment. It is the most common cause of intestinal obstruction between 3 month and 6 yr. of age.

So the answer to this question is A


Instruction:
Which of the following is false regarding Frey's syndrome?
A. It is also called gustatory sweating
B. It is caused by injury to auriculotemporal nerve
C. It occurs immediately after the parotid surgery
D. It is caused by aberrant regeneration of post

Response:
Ans. is 'c' i.e., It occurs immediately after the parotid surgery Frey's syndrome (gustatory sweating) Gustatory sweating or Frey's syndrome involves post-parotidectomy facial sweating and skin flushing while eating. The symptoms usually occur several months or even years after parotid surgery. The likely pathophysiology is aberrant regeneration of postganglionic secretomotor parasympathetic nerve fibres (originating from the otic ganglion) misdirected through several axonal sheaths of post-ganglionic sympathetic fibres feeding the sweat glands. These sympathetic fibres are to the sweat glands of the skin in the dissected field. The frey's syndrome is likely due to injury to auriculotemporal nerve with faulty regeneration, therefore Frey's syndrome is also known as Auriculotemporal syndrome. A variant of Frey's syndrome in which there is gustatory facial flushing but not sweating, occurs following facial paralysis due to faulty regeneration following injury to the facial nerve. So, Frey's syndrome is not limited to parotid surgery with injury to auriculotemporal nerve.

So the answer to this question is C


Instruction:
The most radiosensitive tumor among the following is-
A. Bronchogenic carcinoma
B. Carcinoma parotid
C. Dysgerminoma
D. Osteogenic sarcoma

Response:
Ans. is 'c' i.e. Dysgerminoma Dysgerminoma is the ovarian counterpa of the seminoma of testis and is highly radiosensitive tumor similar to seminomas. Radiosensitivity of different tumors (a) Highly sensitive (c) Relatively resistant Lymphoma Squamous cell carcinoma of lung Seminoma Hypernephroma Myeloma Rectal carcinoma Ewing's sarcoma Bladder carcinoma Wilm's tumour Soft tissue sarcoma (b) Moderately sensitive Carcinoma of cervix Small cell lung cancer (d) Highly resistant Breast cancer Melanoma Basal cell carcinoma Osteosarcoma Medulloblastoma Pancreatic carcinoma Teratoma Ovarian cancer

So the answer to this question is C


Instruction:
A child presents with right ear hearing loss of three month duration. On examination, foul smelling purulent discharge is seen with perforation in pars flaccida. What is the MOST appropriate management?
A. Topical antibiotics and decongestants for 4 weeks
B. Tympano-mastoid exploration
C. Aural toileting
D. Type I tympanoplasty.

Response:
The history and examination of the patient suggests atticoantral type of CSOM. It is also called unsafe or dangerous type; it involes posterosuperior pa of the cleft and is associated with attic or marginal perforation. The discharge is usually scanty, but always fouls smelling due to bone destruction. The mainstay of treatment for this type is surgery. The primary aim is to remove the disease process by tympano-mastoid exploration and render the ear safe.

So the answer to this question is B


Instruction:
Gluten-sensitive enteropathy is most strongly associated with -
A. HLA-DQ2
B. HLA-DR4
C. HLA-DQ3
D. Blood group B

Response:
Almost all individuals with celiac disease share the major histocompatibility complex II HLA-DQ 2 or HLA - DQ8.
Gliadin is deamidated by the enzyme transglutaminase and deamidated gliadin peptides bind to DQ2 and DQ8.
Recognition of these peptides by CD4 + T cells leads to secretion of IFN-γ, which damages the intestinal wall.

Pathophysiology

Celiac disease is caused by the action of acidic peptides containing the gliadin fraction of wheat.
The basic abnormality is thought to be an increased rate of loss of epithelial cells. Crypt cells show increased activity. This causes hypertrophy of crypt. But even this increased activity cannot keep pace with the loss of cells, resulting in a progressive decrease in height of villi causing villous atrophy
 The epithelial cells show decreased cytoplasm and mucus
The intestinal biopsy shows a decrease in the villas: crypt ratio. Normally the villi are 3-4 times the height of the crypts (ratio of 3-4: 1); in celiac disease, the ratio decreases progressively (partial, subtotal and total villous atrophy). Total villous atrophy is seen in severe celiac disease and is quite characteristic of celiac disease (partial villous atrophy may be seen in many other conditions).

So the answer to this question is A


Instruction:
A partial agonist at acetylcholine nicotinic receptors that can be used in smoking cessation programs is
A. Acamprosate
B. Varenicline
C. Buprenorphine
D. Nalbuphine

Response:
None

So the answer to this question is B


Instruction:
All of the following contains Bipolar neurons except
A. Retina
B. Sensory ganglia of cochlear and Vestibular Nerve
C. Dorsal root ganglion
D. Olfactory epithelium

Response:
Dorsal root ganglion contains pseudounipolar neurons, not bipolar neurons.

So the answer to this question is C


Instruction:
Numerator in maternal mortality ratio -
A. Female deaths in a given year
B. Female death during pregnancy
C. Female death during pregnancy 8c puerperium
D. Female death in puerperium

Response:
Ans. is 'c' i.e., Female death during pregnancy & puerperium * Maternal mortality ratio is defined as total number of maternal deaths i.e. deaths due to complications of child birth, pregnancy or within 42 days of delivery from 'puerperal causes' in the area during a given year Per 1000 or (100,000) live births in the same area during the same year.MMR =Total no. of female death due to complications of pregnancy, childbirth or with 42 days of delivery from puerperal causes in an area during a given year----------------------------------------------------------------Total no. of live birth in the same area & yearx 1000 (or 100,000)

So the answer to this question is C


Instruction:
You are asked to review the ECG below, for a 72-year-old male who has presented to ER with falls. Based on your ECG interpretation, what is the likely diagnosis?
A. Hyperkalaemia
B. Second degree - Mobitz Type 2 - hea block
C. First degree hea block
D. Second degree - Mobitz Type 1 - hea block

Response:
Missed beat in ECG, PR interval-before & after missed beat are unequal in size-patient have serial prolongation of PR interval F/B drop beat - MOBITZ-I Hea Block

So the answer to this question is D


Instruction:
DNA fingerprinting was first used by Jeffrey in a criminal case for detecting: MAHE 11
A. Murder
B. Rape
C. Disputed paternity
D. Immigration purpose

Response:
Ans. Rape

So the answer to this question is B


Instruction:
Madura foot is caused by
A. Parasites
B. Fungal infection
C. Viral infection
D. Bacterial infection

Response:
(Fungal infectiuons): (618 Anant narayan 7th edition; 626-27-Chakraborty 2nd/ caused by)Madura foot or Maduramycosis caused by filamentous fungiImportant Causative agents of mycetoma (557- Baveja 4th)Causative agentColour of the grainsA. Eumycetoma Acremonium falciformeWhite - yellowMadurella mycetomiBlackM. griseaBlackPseudo allescheria boydiiWhite - yellowExophiala jeanselmeiBlackB. Actinomycetoma Actinomadura maduraeWhite -yellowA.pelletieriRedNocardia brasiliensisWhiteStreptomyces somaliensisYellow* Presence of grains in pus or biopsy material is diagnostic*** Mycetoma granules often elicit an immunologic response in tissue called Splendore-Hoeppli reaction"Sulphur granules" section of tissue showing an actinomycotic colony. The clubs at the periphery giving a"sun ray appearance"***

So the answer to this question is B


Instruction:
Neuropathy is not see in-
A. Tuberculosis
B. SLE
C. Polyarteritis nodosa
D. Sarcoidosis

Response:
None

So the answer to this question is A


Instruction:
Which hepatitis virus had been called as enterovirusa
A. HAV
B. HBV
C. HCV
D. HEV

Response:
Ans. is 'a' i.e. HAV . HAV has been classified in genus Hepatovirus in the family picornavirus. . It was originally designated as enterovirus 72.

So the answer to this question is A


Instruction:
Pictorial diagram of Frequency distribution is
A. Histogram
B. Pic chart
C. Spot map
D. Bar chart

Response:
Histogram is pictorial diagram of frequency distribution.
Histogram represent condineous quantitative data.

So the answer to this question is A


Instruction:
Desks provided with table top to prevent neck problems is an example of:
A. Primordial prevention
B. Primary prevention
C. Specific protection
D. Disability limitation

Response:
Primary prevention

So the answer to this question is B


Instruction:
The Millennium Development Goals (MPG) is to be achieved by the year –
A. 2010
B. 2015
C. 2020
D. 2030

Response:
The millennium development Goals (MDG)

More recently in September 2000, representive for 189 countries met at the millennium summit in New York, to adopt United Nations Millennium Declaration.
The goals in the area of development and poverty eradication are now referred to as "Millennium development Goals" (MDGs).
Governments have set a date of 2015 by which they would meet the MDGs.

So the answer to this question is B


Instruction:
Most common cause of glomerulonephritis is?
A. Berger disease
B. Acute Glomerulonephritis
C. Chronic glomerulonephritis
D. Focal segmental Glomerulosclerosis

Response:
Most common cause of glomerulonephritis is Berger disease. Focal segmental glomerulosclerosis is most common cause of nephrotic syndrome.

So the answer to this question is A


Instruction:
Saturated fatty acid is present in high quantity –
A. Coconut oil
B. Sunflower oil
C. Safflower oil
D. Soyabeen

Response:
None

So the answer to this question is A


Instruction:
Causes of dysfunctional uterine bleeding can be:a) Uterine polypb) Fibroidc) Granulosa cell tumourd) Irregular ripening of endometriume) Irregular shedding of endometrium
A. ab
B. bc
C. cd
D. de

Response:
DUB is defined as a state of abnormal uterine bleeding without any clinically detectable organic pelvic pathology.
DUB is of 2 types:      1. Anovulatory (80%)
                                      2. Ovulatory (20%)
Anovulatory (80%):   • Threshold bleeding of puberty menorrhagia
                                     • Metropathia hemorrhagica/ cystic glandular hyperplasia
                                     • Premenopausal DUB (Atrophy of endometrium).
Ovulatory (20%):       • Irregular ripening of corpus luteum
                                     • Irregular shedding of corpus luteum
                                     • IUCD insertion
                                     • Following sterilization operation.

So the answer to this question is D


Instruction:
The following statements are true about DPT vaccine except :
A. Aluminium salt has an adjuvant effect
B. Whole killed bacteria of Bordetella pertussis has an adjuvant effect
C. Presence of acellular pertusis component increases its immunogenecity
D. Presence of H.influenza type B component increases its immunogenicity

Response:
Lets consider each choice one by one.
Option ‘a’ : Two types of Diphtheria toxoid are in use now. ... Ananthnarayan 7/e, p 238

Fluid toxoid
Adsorbed toxoid

Adsorbed toxoid is purified toxoid adsorbed into insoluble aluminium compounds usually aluminium phosphate less often the hydroxide. Adsorbed toxoid is much more immunogenic than fluid toxoid.
Option ‘b’ : Pertussis component in DPT (whole killed bacteria of bordetella pertusis) vaccine enhances the potency of the diptheria toxoid.
Park 18/e, p 135
Most serous complication of DPT is neurological which is primarily due to pertusis component. Duration of immunity after whole cell pertusis vaccination is short lived, with little protection remaining after 10-12 years.
Option ‘c’ : To reduce complications of whole killed bacteria of pertusis in DPT, acellular vaccine developed.

Protection against pertussis by vaccines correlated best with the production of antibody to pertactin, fimbriae and pertussis toxin.
All acellular pertussis vaccines currently available contain pertussis toxoid. Acellular vaccine is more immunogenic has less adverse effects. It is given as DTaP.

CMDT ‘06, p 1304
Option ‘d’ : Quadriple vaccine of DPT with H.influenza B is available in India but conjugate vaccine (eg. HIb vaccine) do not interfere with immunogenicity of simultaneously given other vaccines.

So the answer to this question is D


Instruction:
Which of the following is the indication for using phenyl-substituted prostaglandin F2 alpha, Latanoprost:
A. Maintenance of ductus aeriosus
B. Pulmonary hypeension
C. Gastric mucosal protection
D. Glaucoma

Response:
Latanoprost is a derivative of PGF2 alpha that reduces intraocular pressure (IOP) by increasing uveoscleral outflow without effects on aqueous flow. It is indicated in reduction of elevated IOP in patients with open angle glaucoma, ocular hypeension and capsular glaucoma. The only apparent side effect is darkening of the pigment of the eyes, such as hazel, that are made up of multiple colors. Ref: Clinical Ophthalmology: Contemporary Perspectives By Gupta, 2009, Page 80; Desk Reference of Clinical Pharmacology, Second Edition By Manuchair S. Ebadi, 2008, Page 381; Goodman and Gillman's 11th edition, Page 1103.

So the answer to this question is D


Instruction:
False about Barrett’s oesophagus is:
A. In short – segment Barrett’s there is less than 3 cm of columnar epithelium
B. Barrett’s ulcer occurs just above the squamocolumnar junction
C. If a peptic stricture occurs in Barrett’s oesophagus it always occurs at the new squamocolumnar junction
D. It is a premalignant condition

Response:
Barrett’s ulcer is an ulcer in the columnar lined portion of a Barrett’s oesophagus.
These are distinct from the more usual erosions of reflux oesophagitis that always occur at or just above the squamocolumnar junction.

So the answer to this question is B


Instruction:
A child had pustular lesion on leg. On gram staining gram positive cocci are seen. To establish the diagnosis of Group A streptococcal erythroderma, the test used is?
A. Bile solubility test
B. Novobiocin sensitivity
C. Optochin sensitivity
D. Bacitracin sensitivity

Response:
Streptococcal erythroderma is caused by streptococcus pyogenes. Sensitivity to bacitracin is employed as a convenient method for differentiating str.pyogenes from other hemolytic streptococci. Pustule: A vesicle filled with leukocyte. Most common cause is virus. Most common bacterial cause is str.pyogenes. Str.pyogenes is the etiological agent in most of streptococcal skin infection. Vancomycin is the drug of choice. Ref: Ananthanarayan 7th Ed Page 205

So the answer to this question is D


Instruction:
PICA is associated with poisoning of ?
A. Lead
B. Arsenic
C. Mercury
D. Phosphorus

Response:
Ans. is 'a' i.e., Lead Pica involves repeated or chronic ingestion of non-nutritive substances, which includes plaster, charwal, clay, wool, ashes, patent & eah. It can result in serious health problems like iron deficiency anemia and lead poisoning.

So the answer to this question is A


Instruction:
Hypoglycemia is defined in newborn when
A. Blood glucose < 45mg/dL
B. Plasma glucose < 45mg / dL
C. Blood glucose < 54 mg/ dL
D. Plasma glucose < 45mg / dL

Response:
Hypoglycemia is when plasma glucose < 45mg/ dL
Management:

Asymptomatic individual
	If plasma glucose
	a) > 25 mg / dL ⇒ Continue breast feed
	b) < 25 mg / dL ⇒ 2ml / kg of 10% dextose given
Symptomatic individual
	Give iv fluids 2ml /kg of 10% dextrose.

So the answer to this question is B


Instruction:
Cephalosporin with anti pseudomonal activity ?
A. Cefazoline
B. Cefoperazone
C. Ceftriaxone
D. Cefuroxime

Response:
Ans. is 'b' i.e., Cefoperazone Drugs acting against Pseudomonas. Penicillins - Piperacillin, Carbenicillin, Ticarcillin, Mezlocillin. Cephalosporins - Ceftazidime, Cefoperazone, Cefepime. Carbapenems - Imipenem, meropenem Monobactams - Aztreonam. Aminoglycosides - Tobramycin, Gentamycin, Amikacin. Fluroquinolones - Ciprofloxacin, Levofloxacin, Norfloxacin.. Other - Polymixin B, Colistin.

So the answer to this question is B


Instruction:
Tunica reaction is positive in ?
A. R prowazekii
B. R typhi
C. R tsutsugamushi
D. R akari

Response:
Ans. is 'b' i.e., R typhi Neill - Mooser (Tunica) reaction When male guinea pigs are inoculated intraperitoneally with blood from a case of endemic typhus or with a culture of R. typhi (R. mooseri) they develop fever and a characteristic scrotal inflammation. This reaction is used to differentiate R. typhi and R. prowazekii.

So the answer to this question is B


Instruction:
For therapeutic effect in manic depressive illness, steady-state serum lithium concentration should be maintained between
A. 0.2-0.4 mEq/L
B. 0.5-0.8 mEq/L
C. 1.0-1.3 mEq/L
D. 1.5-2.5 mEq/L

Response:
The margin of safety is narrow for lithium. monitoring of serum lithium concentration is essential for optimising therapy. Serum lithium level is measured 12 hours after the last dose to reflect the steady-state concentration; 0.5-0.8 mEq/L is considered optimum for main- tenance therapy in bipolar disorder, while 0.8-1.1 mEq/L is required for episodes of acute mania. Toxicity symptoms occur frequently when serum levels exceed 1.5 mEq/L. Ref:- kd tripathi;pg num:-449

So the answer to this question is B


Instruction:
All are true about cohort studies except -
A. Prospective
B. Useful for rare diseases
C. Necessary for incidence
D. Costly

Response:
None

So the answer to this question is B


Instruction:
The sputum examination under DTP is done when the patient present with – a) Cough of 1–2 wks durationb) Persistent cough of 1–2 wks durationc) Hemoptysisd) Chest paine) Intermittent fever
A. ab
B. bc
C. bd
D. cd

Response:
Sputum exam. done under DTP if :
Persistent cough of about 3-4 weeks duration.
Continuous fever
Chest pain
Haemoptysis
Unexplained weight loss
Reduced appetite

So the answer to this question is D


Instruction:
Widely accepted theory of dental caries
A. Proteolytic theory
B. Proteolytic chelation theory
C. Acidogenic theory
D. Autoimmune theory

Response:
None

So the answer to this question is C


Instruction:
Which of the following is a synol joint of the condyloid variety?
A. First carpometacarpal joint
B. Metacarpal phalanges joint
C. Interphalangeal joint
D. Radiocarpal joint

Response:
A condyloid joint is a modified ball and socket joint that allows primary movement within two perpendicular axes, passive or secondary movement may occur on third axes. These joints allow flexion, extension, abduction, and adduction movements (circumduction). Examples include the wrist-joint (Radiocarpal joint ) metacarpophalangeal joints metatarsophalangeal joints Carpometacarpal joint of the thumb is saddle joint

So the answer to this question is D


Instruction:
Which of the following antibiotic can cause cholestatic jaundice
A. Erythromycin
B. Isoniazid
C. Amikacin
D. Azithromycin

Response:
Antibiotics like Erythromycin, Nitrofurantoin, Flucloxacillin can lead to cholestatic jaundics.

So the answer to this question is A


Instruction:
Which of the following constitute grevious injury :
A. Incised wound of scalp
B. Incised wound of thigh
C. Fracture Tibia
D. Laceration of the scalp

Response:
C i.e. Fracture tibia

So the answer to this question is C


Instruction:
Which of the following is false?
A. Cofactors have functions similar to those of prosthetic groups.
B. Cofactors bind in a transient,dissociable manner to enzymes
C. The most common cofactors are metal ions
D. Enzymes that require metal ion cofactors are termed as metalloenzymes

Response:
Enzymes that require metal ion cofactor are termed metal activated enzymes,whereas enzymes for which metal ions serve as prosthetic groups are termed as metalloenzymes. If a metal is tightly bound to an enzyme(prosthetic group),it is called metalloenzyme, while an enzyme(without the metal ion)showing enhanced activity on the addition pf a metal ion(co factor)is called as metal ion activated enzyme/metal activated enzyme. Metalloenzymes:Cytochromes(Fe,Cu),aldehyde oxidase(Mo),catechol oxidasse(Cu),Carbonic anhydrase(Zn). Cofactors: A cofactor is a non protein chemical compound or metallic ion that is required for an enzymes activity. cofactor bind in a transient,dissociable manner to enzymes.Therefore,unlike associated prosthetic groups,cofactors must be present in the medium surrounding the enzyme for catalysis to occur. The most common cofactors are metal ions Reference: Harpers illustrated biochemistry 31st edition pg 58

So the answer to this question is D


Instruction:
The intermediate syndrome in organophosphorus poisoning refers to the occurence of which of the following?
A. Cholinergic syndrome with hypersecretion
B. Organophosphate induced polyneuropathy
C. Organophosphate induced delayed neuropathy
D. Motor cranial nerve palsies

Response:
Intermediate Syndrome: This has been repoed in some patients and is characterized by weakness of the upper extremities and neck musculature, cranial nerve palsies and secondary respiratory arrest. It may occur between 24 and 96 hours after ingestion.Delayed Neuropathy: May sometimes occur 1-4 weeks after exposure. The symptoms occur distally and progress proximally. The neuropathy is usually mixed with the patients complaining paraesthesias and motor weakness.Krishan Vij textbook of forensic medicine and toxicology 5e pg:533

So the answer to this question is B


Instruction:
Vaccine CONTRAINDICATED in pregnancy is: March 2013 (d, h)
A. Hepatitis A vaccine
B. MMR
C. Tetanus toxoid
D. Hepatitis B vaccine

Response:
Ans. B i.e. MMR No evidence exists of risk to the fetus from vaccinating pregnant women with inactivated virus or bacterial vaccines or toxoids. Live vaccines administered to a pregnant woman pose a theoretical risk to the fetus; therefore, live, attenuated virus and live bacterial vaccines generally are contraindicated during pregnancy.

So the answer to this question is B


Instruction:
Blood pressure measured using a sphygmomanometer
A. May be falsely low with too narrow cuff
B. May be falsely low in patients with badly stiffened aeries
C. May be falsely high in obese patients
D. Gives a direct reading of mean aerial pressure

Response:
If the cuff is too small, it takes a falsely high pressure in the cuff to transmit sufficient pressure to the vessel wall for total occlusion of the aery.Blood pressure may be falsely high in patients with badly stiffened aeries because of the extra pressure needed to compress the aeries.

So the answer to this question is C


Instruction:
True about Hirschsprung's disease:a) Pathology of myenteric plexus of Auerbachb) Blood in stoolsc) May involve small intestine rarelyd) Involved segment of intestine is dilatede) Present only in infant & children
A. a
B. ac
C. ad
D. b

Response:
Small intestine may be involved rarely (~5%) - CSDT 13/e p1180 (11/e p1321)

So the answer to this question is B


Instruction:
A 60-year-old female present with history of recurrent abdominal pain. Imaging shows multiple small cystic lesions like bunch of grapes in the head of pancreas with a grossly dilated main pancreatic duct. The most likely diagnosis is:
A. SCN
B. MCN
C. IPMA
D. Pancreatic pseudocyst

Response:
Ans. (c) Intraductal papillary mucinous neoplasm* Bunch of grapes appearance in Head of Pancreas - Typical of IPMN* Dilated Pancreatic duct typical of IPMN* Fish mouth lesion on Endoscopy seen in IPMN

So the answer to this question is C


Instruction:
The earliest manifesation in the fatty streak of Atherosclerosis is -
A. Collection of lipid in endothelial cells
B. Collection of lipid in smooth muscule
C. Endothelial cell damage
D. Noneof the above

Response:
None

So the answer to this question is A


Instruction:
A 30 year old lady c/o sudden onset breathlessness, anxiety, palpitation & feeling of impending doom. Physical examination is normal. What is the diagnosis -
A. Panic attack
B. PTSD
C. Conversion disorder
D. Acute psychosis

Response:
Ans. is 'a' i.e., Panic attack DSM-IV Criteria for a Panic AttackA panic attack is a period of intense fear or discomfort, developing abruptly and peaking within 10 minutes, and requiring at least four of the followingChest pain or discomfortQChills or hot flushesDerealization (feeling of unreality) or depersonalization (being detached from oneself)Fear of losing controlFeeling of chokingNausea or abdominal distressPalpitations or tachycardia QParesthesiasSensations of shortness of breath Q or smotheringSense of impending doomQSweatingTrembling or shaking

So the answer to this question is A


Instruction:
The immediate treatment of unstable tibial plateau fracture is:
A. Internal fixation with plate & screw
B. Internal fixation with nail
C. External fixator
D. Complete bed rest

Response:
(Internal fixation with plate & screw) (720-ApIey's 8th)* Unstable fracture of Tibial plateau - In younger patient, and more so those with a central depression of more than 5 mm, open reduction with elevation of the plateau and internal fixation with a buttress plate is preferred.* Stable fracture - depression is slight (less than 5 mm), if the patient is old and frail or osteoporotic the fracture is treated with closed reduction (Skeletal traction for 3-4 weeks and then hinged cast brace for another 6 weeks.

So the answer to this question is A


Instruction:
Posterior capsulotomy after cataract is done using-
A. Argon Laser
B. Nd YAg
C. Holmium
D. Diode laser

Response:
Ans. is 'b' i.e., Nd YAg o After cataract, if thin, can be cleared centrally by Nd: YAG laser capsulotomy. Discission with cystitome or zeigler's knife may also be used. Thick membranous after cataract needs surgical membranectomy.

So the answer to this question is B


Instruction:
Taurine is synthesized from which amino acid?
A. Tryptophan
B. PhenylAlanine
C. Cysteine
D. Alanine

Response:
Taurine, a major constituent of bile is synthesized from cysteine

So the answer to this question is C


Instruction:
Which of the following is not a component of cell rich zone
A. Collagen Type 1
B. Collagen type 3
C. Collagen type 5
D. Stem cells

Response:
Collagen fibers type 1 and type 3 are present in cell rich zone while type 5 is absent.

So the answer to this question is C


Instruction:
Pitying testing for lower motor neuron lesion involving nucleus ambiguous; uvula
A. Is deted to the affected side
B. Is deted to the normal side
C. Remains in midline
D. Is not used in testing

Response:
Answer- B. Is deted to the normal sideIt is the column of cells running almost the entire length of medulla.Motor neurons in the nucleus ambiguous innervate the constrictor muscles of the pharynx, muscles of the velopharynx (such as constrictor veli palatine), intrinsic muscle of the larynx, and single muscle of the tongue.In case of unilateral lower motor neuron lesion, when the patient phonates the soft palate will raise asymmetrically, with higher elevation on the healthy side and the uvula pulled of the midline in the same direction i.e. it is deted to the normal unaffected side.

So the answer to this question is B


Instruction:
A 30 year old male had severely itchy papula-vesicular lesions on both knees, elbows, upper back and buttocks for one year. Direct immunofluorescence staining of the lesions showed IgA deposition at dermoepidermal junction and dermal papilla. The most probable diagnosis is :
A. Pemphigus vulagris
B. Bullous pemphigoid
C. Dermatitis herpetiforms
D. Nummular eczema

Response:
C i.e. Dermatitis herpetiformis

So the answer to this question is C


Instruction:
50 years old patient development wound infection post laparotomy for pyoperitoneum, was treated conservatively. Now granulation tissue is seen in the wound. what is the next step of management?
A. Daily dressing
B. Mesh repair
C. Incision and drainage
D. Resulting with interrupted stitches

Response:
After the developpment of granulation tissue in thw wound, resulting with interrupted stitches done.

So the answer to this question is D


Instruction:
The Sengstaken tube must maintain a pressure of ...... to stop bleeding from varices:
A. 20 mm Hg
B. 25 mm Hg
C. 35 mm Hg
D. 45 mm Hg

Response:
Sengstaken tube - have 2 balloon 1)Gastric balloon 2)Esophageal balloon It is triple lumen; double ballooned tube. It is used mainly during transpoation of patient. Total amount of air inseed in gastric balloon = 50 + 250 ml (min air) =300 ml Maximum pressure exeed by esophageal balloon = 35-40 mm of Hg Every 12 hrs the esophageal balloon has to be deflated to prevent Ischemia & necrosis of the esophagus.

So the answer to this question is C


Instruction:
Treatment modalities which are carried out to cure ANUG are all except:
A. 3%H2O2.
B. Gingivoplasty.
C. Gingivectomy.
D. None.

Response:
None

So the answer to this question is C


Instruction:
Ligament below head of talus is
A. Spring
B. Deltoid 13
C. Cervical
D. None

Response:
SPRING LIGAMENT:- Also known as plantar calcaneonavicular ligament. Attachments-Anteriorly: plantar surface of navicular bone.Posteriorly: anterior margin of sustentaculum tali. Head of talus directly rests on upper surface of the ligament. The plantar surface of the ligament is suppoed by tendon of tibialis posterior medially,and by tendons of flexor hallucis longus and flexor digitorum longus laterally. Most impoant ligament for maintaining the medial longitudinal arch of foot. TALUS:-Second largest tarsal bone.Head, neck and body. Tibia above and calcaneum below, Attachments:-Devoid of muscular attachment.Numerous ligaments attached to it because it takes pa in three joints- ankle, talocalcanean, and talonavicular .Neck:- Capsular ligament of ankle joint.Dorsal talonavicular Interosseus talocalcanean and cervical ligament.Anterior talofibular ligament. Medial surface of body:- deep fibres of deltoid. Medial tubercle - superficial fibres of deltoid ligament. Groove on posterior surface lodges flexor hallucis tendon. Posterior talofibular ligament attached to posterior process.Plantar border: posterior talocalcanean ligament. <img src=" /> {Reference: BDC 6E pg no. 30}

So the answer to this question is A


Instruction:
Telefona is:
A. Pulling of hairs
B. Beating of soles
C. Beating on both ears
D. Beating on head

Response:
ANSWER: (C) Beating on both earsREF: Reddy 5th edition page 257See list of corporal punishment in Forensic medicine, June 2010"Telefona is simultaneous beating of both ears by both palms of hand, which may leads to torn external ear, rupture of tympanic membrane causing pain, bleeding and hearing loss"

So the answer to this question is C


Instruction:
All of the following are features if CD4 count drop below 50cells/ mmcubic, except
A. HIV associated dementia.
B. CMV retinitis.
C. Disseminated mycobacterium avium intracellulare.
D. None.

Response:
None

So the answer to this question is A


Instruction:
A young female patient presented with symptoms related to anemia. Peripheral blood smear showed neutrophil hypersegmentation and bone marrow aspirate smear showed giant myelocytes. Which of the following is the likely etiology?
A. Sideroblastic anemia
B. Iron deficiency anemia
C. Thalassemia
D. Folic acid deficiency

Response:
Both the above mentioned findings are features of megaloblastic anemia. Folic acid deficiency is one of the causes of megaloblastic anemia. Ceain peripheral blood findings are common to all forms of megaloblastic anemia: Macrocytic red cells which may lack central pallor Macro-ovalocytes Low reticulocyte count Neutrophils are also larger than normal and show nuclear hypersegmentation, having 5 or more nuclear lobules instead of the normal 3-4 The marrow is hypercellular with megaloblastic changes detected at all stages of erythroid development. As DNA synthesis is impaired in all proliferating cells, granulocytic precursors also display dysmaturation in the form of giant metamyelocytes and band forms.

So the answer to this question is D


Instruction:
Investigation of choice for ureteric stones for ureteric stone
A. CT scan
B. USG
C. MIBG scan
D. DMSA scan

Response:
Ans. is `a' i.e., CT scan CT scan has become the diagnosis of choice for ureteric stones The "gold standars" diagnostic test is holical CT without contrast. All of routine methods have become less usefull with the advent of more sensitive and specific nonenhanced computed tomography (CT) scanning. When CT is available, it is now considered the examination of choice for the detection and localization of urinary stones

So the answer to this question is A


Instruction:
The left testicular vein drains into which of the following veins?
A. Left internal iliac vein
B. Left common iliac vein
C. Inferior vena cava
D. Left renal vein

Response:
The left testicular vein drains into the left renal vein. The right testicular vein drains directly into the inferior vena cava. This difference in venous drainage is believed to explain the greater incidence of varicocele on the left side than on the right. The venous drainage from the penis is to the internal vein, which then drains into the internal iliac vein.

So the answer to this question is D


Instruction:
The mydriatic drug with a short duration of action is:
A. Cyclopentolate
B. Tropicamide
C. Homatropine
D. Atropine

Response:
None

So the answer to this question is B


Instruction:
Which of the following are not included in Gurd's criteria?
A. Central nervous system depression dispropoionate to hypoxaemia
B. Tachycardia<1l0bpm
C. Deep vein thrombosis
D. Axillary or subconjunctival petechiae

Response:
Ans. c. Deep vein thrombosis

So the answer to this question is C


Instruction:
A 32-year-old woman has had a chronic cough with fever for the past month. On physical examination, her temperature is 37.5deg C. A chest radiograph shows many small, ill-defined nodular opacities in all lung fields. A transbronchial biopsy specimen shows interstitial infiltrates with lymphocytes, plasma cells, and epithelioid macrophages. Which of the following infectious agents is the most likely cause of this appearance?
A. Candida albicans
B. Cytomegalovirus
C. Enterobacter aerogenes
D. Mycobacterium tuberculosis

Response:
These findings suggest a granulomatous inflammation, and tuberculosis is a common cause. Candida is often a commensal organism in the oropharyngeal region and rarely causes pneumonia in healthy (non-immunosuppressed) individuals. Viral infections tend to produce a mononuclear interstitial inflammatory cell response. Bacteria such as Enterobacter and Staphylococcus are more likely to produce acute inflammation. Plasmodium produces malaria, a parasitic infection without a significant degree of lung involvement.

So the answer to this question is D


Instruction:
Anaesthesia for Cesarean delivery of patients with stable placenta pre is-
A. Spinal Anaesthesia
B. Epidural Anaesthesia
C. General Anaesthesia
D. Combined spinal + Epidural

Response:
Indications of general anesthesia:General anesthesia is preferred in ceain emergency conditions such as - Massive bleeding (placenta pre or accreta, abruption placentae, or uterine rupture) Coagulopathy Hemodynamic instabilty Severe fetal distress when placenta pre patient is stable then epidural is preferred.

So the answer to this question is B


Instruction:
Which of the following has small representation in somatosensory area of cerebral cortex
A. Lips
B. Thumb/fingers
C. Tongue
D. Trunk

Response:
Ans. (d) Trunk(Ref: Ganong, 25th ed/p.169)Lips and thumb has got the maximum representation in somatosensory areaRepresentations for trunk and back are small

So the answer to this question is D


Instruction:
True about IgM
A. Fix Complement
B. Increased in primary response
C. Fab region is composed of variable region
D. Fc is antibody - binding option

Response:
IgM Produced in the primary response to an antigen Fixes complement.Does not cross the placentaAntigen receptors are on the surface of B cells.IgG is also involved in complement fixationReference: Harper biochemistry 30th edition page no 681

So the answer to this question is A


Instruction:
Hampton hump is seen in:
A. Pulmonary TB
B. Bronchogenic carcinoma
C. Pulmonary embolism
D. Pulmonary hemorrhage

Response:
Ans. (c) Pulmonary embolismRef: Harrison 19th ed. /1633HAMPTON HUMP is a radiologic sign which consists of a shallow wedge-shaped opacity in the periphery of the lung with its base against the pleural surface.

So the answer to this question is C


Instruction:
Paralytic ileus caused by
A. Hypokalemia
B. Hypoglycemia
C. Hyperkalemia
D. Hypercalcemia

Response:
Hypokalemia leads to decreased smooth muscle contraction leading to decreased peristalsis and thus paralytic ileus. Pg NO.1296 BAILEY 27TH EDITION

So the answer to this question is A


Instruction:
DPT is contraindicated in
A. Family history of convulsions
B. Acute respiratory tract infections
C. Progressive neurological illness
D. Mild diarrhea

Response:
C. i.e. (Progressive neurological illness) (191 - Ghai 6th) (168- 69- Ghai 7th)Following are NOT contraindication for administration of vaccine1. Mild acute illness2. Low grade fever3. Mild diarrheal4. Current antibiotic therapy5. Prematurity6. Recent exposure to an infectious disease7. History of allergies8. Allergy to penicillin9. Malnutrition* Children suffering from progressive neurological disorders or with history of convulsions to a previous dose are at a higher risk of adverse reactions following whole cell pertuessis vaccine* The vaccine is relatively contraindicated in children with progressive neurological disease, but children with stable neurological disease like developmental delay cerebral palsy and idiopathic epilepsy may be vaccinated (169 - Ghai 7th)

So the answer to this question is C


Instruction:
Trichomoniasis is transmitted through which stage
A. Cyst
B. Oocyst
C. Sporozoite
D. Trophozoite

Response:
Trichomonas vaginalis exists only as a trophozoite; no cyst stage has been identified.

So the answer to this question is D


Instruction:
All are indicators of active bleeding from varices during endoscopy, EXCEPT:
A. Active bleeding from a varix
B. White nipple overlying a varix
C. Clots overlying a varix
D. Yellow nipple

Response:
Classification of the varices: Size of varix Two-size classification Three-size classification 1. Small < 5 mm Minimally elevated veins above the esophageal mucosal surface 2. Medium Touous veins occupying less than one-third of the esophageal lumen 3. Large > 5 mm Occupying more than one-third of the esophageal lumen Variceal hemorrhage is diagnosed on the basis of one of the following findings on endoscopy: Active bleeding from a varix White nipple overlying a varix Clots overlying a varix Varices with no other potential source of bleeding Ref: WGO Practice Guidelines Esophageal varices

So the answer to this question is D


Instruction:
After laproscopic appendicectomy, patient had fallen from bed on her nose after which she had swelling in nose and difficulty in breathing. Next step in management:
A. IN antibiotics for 7-10 days
B. Observation in hospital
C. Surgical drainage
D. Discharge after 2 days and follow up of the patient after 8 weeks

Response:
She has possibly developed septal hematoma. A septal hematoma has to be drained as early as possible (Generally within 72 hrs) or else it can lead to necrosis of septal cailage and loss of suppo of dorsum leading to sadding of nose. It can also get infected and lead to formation of septal abscess.

So the answer to this question is C


Instruction:
Victim was strangled with elbow around neck. It is called as: NEET 13
A. Garrotting
B. Mugging
C. Bansadola
D. Burking

Response:
Ans. Mugging

So the answer to this question is B


Instruction:
After using transdermal nitroglycerin skin patches for 1 week, a patient with an 8-month history of chronic stable angina pectoris observes an increasing frequency of mild angina episodes during exeion. The patient has been conscientiously applying a new patch every morning immediately after removing the old one. The patient's increased frequency of anginal attacks is most likely because of
A. A sudden onset of vasospastic angina
B. Engaging in vigorous exercise
C. Cellular tolerance to organic nitrates
D. Induction of cytochrome P450 enzyme by nitroglycerin

Response:
Tolerance to organic nitrates may develop in a few days or less, depending on the dose and frequency of administration. Continuous exposure to nitroglycerin through use of a transdermal skin patch has frequently caused nitrate tolerance. A daily 10-to-14-hour drug-free period will prevent nitrate tolerance. Nitrate tolerance is a cellular tolerance caused by depletion of sulfhydryl groups required for receptor signal transduction. The drug-free interval allows time for these groups to replenish before the next period of drug exposure. Nitrates are metabolized by hepatic nitroreductase, and there is neither evidence of cytochrome P 450 involvement nor of induction of this enzyme by drugs. Although the patient's symptoms could be caused by increased physical activity or onset of vasospasm, these are less likely causes in a patient with continuous nitroglycerin exposure. Vasospasm is also unlikely because the episodes occurred during exeion. Ref - Harrison's principles of internal medicine 20e pg427,1860 / researchgate.net

So the answer to this question is C


Instruction:
Regarding syphilis, all are true, except -a) VDRL titre decreases or even absent after treatmentb) VDRL becomes positive after 10-14 days of infectionc) Earliest serological test to become positive in untreated primary syphilis is TPHAd) Yaws and Pinta cannot be differentiated
A. bc
B. c
C. ac
D. ad

Response:
None

So the answer to this question is A


Instruction:
Normal expiratory reserve volume of adult-
A. 500 ml
B. 3000 ml
C. 1200 ml
D. 4500 ml

Response:
Ans. is 'c' i.e., 1200 ml o Inspiratory reserve volume - 3000 mlo Expiratory reserve voulume - 1200 mlRespiratory Volumes and Capacities for an Average Young Adult MaleMeasurementTypical valueDefinition Respiratory volumes1. Tidal volume (TV)500 mlAmount of air inhaled or exhaled in one breath during relaxed, quiet breathing2. Inspiratory reserve volume (IRV)3000 mlAmount of air in excess of tidal inspiration that can be inhaled with maximum effort3. Expiratory reserve volume (ERV)1200 mlAmount of air in excess of tidal expiration that can be exhaled with maximum effort4. Residual volume (RV)1200 mlAmount of air remaining in the lungs after maximum expiration, keeps alveoli inflated between breaths and mixes with fresh air on next inspiration Respiratory Capacities5. Vital capacity (VC)4700 mlAmount of air that can be exhaled with maximum effort after maximum inspiration (ERV+TV+IRV); used to assess strength of thoracic muscles as well as pulmonary function6. Inspiratory capacity (IC)3500 mlMaximum amount of air that can be inhaled after a normal tidal expiration (TV + IRV)7. Functional residual capacity (FRC)2400 mlAmount of air remaining in the lungs after a normal tidal expiration (RV + ERV)8. Total lung capacity (TLC)5900 mlMaximum amount of air the lungs can contain (RV + VC)

So the answer to this question is C