Instruction:
Herpes zoster is commonly seen in –
A. Cervical region
B. Thoracic region
C. Lumber region
D. Geniculate ganglion

Response:
None

So the answer to this question is B


Instruction:
Veebral aeries are derived from:
A. Axillary aery
B. Subclan aery
C. Internal carotid aery
D. None of the above

Response:
The veebral aeries are derived from the subclan aeries. They ascend through the neck in the foramina transversaria of the upper six cervical veebrae and enter the cranial cavity through the foramen magnum, close to the anterolateral aspect of the medulla Ref: Gray's anatomy 40th edition, Chapter 17.

So the answer to this question is B


Instruction:
The blood pressure measured by a sphygmomanometer
A. Is lower than the intraaerial pressure
B. Is higher than the intraaerial pressure
C. Is same as the intraaerial pressure
D. Is the same with different cuff sizes

Response:
At the point at which systolic pressure in the aery just exceeds the cuff pressure, a spu of blood passes through with each heabeat and, synchronously with each beat, a tapping sound is heard below the cuff.Ref: Ganong&;s Review of Medical Physiology 25th Edition. Page: 577

So the answer to this question is B


Instruction:
Risk factors of pulmonary embolism
A. 30 yrs female on OCP's
B. Pregnancy
C. Leg paralysis
D. All

Response:
Ans. is 'a' i.e. 30 yrs female on OCP's, 'b' i.e. Pregnancy, 'c' i.e. Leg paralysis

So the answer to this question is D


Instruction:
A married middle aged female gives history of repeated aboions for the past 5 years. The prenatal karyogram of the conceptus is given below: This karyogram suggests the following:
A. Klinefelter's syndrome
B. Turner's syndrome
C. Down's syndrome
D. Patau's syndrome

Response:
Karyogram shows 3 chromosomes at 21 instead of a pair. It is called Trisomy 21. Trisomy 21 Synonymous with Down's syndrome Most common of the chromosomal disorders. Major cause of mental retardation. -Other trisomies Edward syndrome (Trisomy 18) Patau syndrome (Trisomy 13) Turners syndrome (45 X0)

So the answer to this question is C


Instruction:
Sucheta, a 29-year-old nulliparous women complains of severe menorrhagia and lower abdominal pain for 3 months. On examination, there was a 14 weeks size uterus with fundal fibroid. The treatment of choice is:
A. Myomectomy
B. GnRH analogs
C. Hystrectomy
D. Wait and watch

Response:
First, let us see whether we would like to go for medical management or surgical intervention.
The patient is presenting with:

Severe menorrhagia
Chronic lower abdomen pain
These indications are strong enough for surgical intervention. Earlier size of fibroid >12 weeks was also an indication for surgery but nowadays it is not.
Now comes the question - whether myomectomy or hysterectomy should be done.

An indication of Myomectomy:

Myomectomy is specifically indicated in an infertile woman or woman desirous of bearing child and wishing to retain her uterus.

So the answer to this question is A


Instruction:
Tissue f r om rat used for detection of antinuclear antibodies
A. Kidney
B. Brain
C. Stomach
D. Liver

Response:
Serum antinuclear antibodies bind to corresponding antigents present in the rat liver section.the antigen-antibody complexes are detected by means of fluorescent labeled anti human immunoglbulin .and visualised with the aid of a fluorescence microscopy ref Robbins 9/e immunity chapter p131 and internet

So the answer to this question is D


Instruction:
Main MOA brimonidine in glaucoma -
A. Decreased aqueous secretion
B. Increased trabecular outflow
C. Increased uveoscleral outflow
D. Reduce vitreous volume

Response:
Brimonidine (0.2% : 2 times/day). It is a selective alpha-2-adrenergic agonist and lowers IOP by decreasing aqueous production. Because of increased allergic reactions and tachyphylaxis rates it is not considered the drug of first choice in POAG. It is used as second drug of choice and also for combination therapy with other drugs. Ref.AK Khurana 4th edition page no 223

So the answer to this question is A


Instruction:
Which one of the following blood fractions is stored at - 40degC?-
A. Cryprecipitate
B. Human albumin
C. Platelet concentrate
D. Packed red cells

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

So the answer to this question is A


Instruction:
A patient of acute myocardial infarction being treated in intensive care unit developed left ventricular failure with raised central venous pressure. It was decided to use nitroglycerine. Which route of administration would be most suitable ?
A. Sublingual
B. Oral
C. Intravenous bolus injection
D. Slow intravenous infusion

Response:
None

So the answer to this question is D


Instruction:
Capnography is used for assessment of
A. Oxygen saturation of blood
B. Amount of CO2 transpoed in blood
C. Ventilation of lung after intubation
D. Myocardial perfusion

Response:
Capnography is the method of determining CO2 levels in exhaled gases (PACO2) but NOT blood.It is the ideal confirmatory method of endotracheal intubation(VENTILATION OF LUNG AFTER INTUBATION) Aeral blood gas analysis is used to measure CO2 levels in Blood (PaCO2) Pulse oxymetry is used to measure oxygen saturation of blood and hea rate.

So the answer to this question is C


Instruction:
Quarantinable disease
A. Diphteria
B. Yellow fever
C. Infectious TB
D. All of the above

Response:
Quarantinable diseases
SARS
Yellow fever
Diphtheria
Plague
Infectious TB
Small pox
Viral hemorrhagic fever

So the answer to this question is D


Instruction:
Max Joseph&;s space is a histopathological feature of
A. Psoriasis vulgaris
B. Lichen planus
C. Pityriasis rosea
D. Parapsoriasis

Response:
Max Joseph's space is a characteristic histological finding seen in lichen planus. These are small clefts formed due to dermoepidermal separation and basal cell degeneration character histopathology in lichen planus basal cell degeneration interface lymphocyte infiltration compact hyperkeratosis wedge shaped hypergranulosis- wickham straie saw tooth appearence Civattee bodies/ hyaline bodies-apoptosis basal cells. IADVL textbook of dermatology page 1078

So the answer to this question is B


Instruction:
Owl' eye nucleus is seen in which type of lymphoma?
A. Non- Hodgkin's lymphoma
B. Hodgkin's lymphoma
C. Burkitt's lymphoma
D. Cutaneous T-cell lymphoma

Response:
Ans is 'b' i.e., Hodgkin's lymphoma o "Owl's eye" appearance of entire nucleus is seen in Reed-Sternberg cells.o Reed-Sternberg cells are giant cells with multinucleated or have a bilobed nucleus with prominent eosinophilic inclusion-like nucleoli (thus resembling an "owl's eye"appearance). These are positive for CD 15 and CD 30, and also PAX-5 (B-cell transcription factor).o Hodgkin's disease is characterized by presence of Reed-sternberg cells (Classical Reed-sternberg cells) and its variants.o They can also be found in reactive lymphadenopathy (such as infectious mononucleosis immunoblasts which are RS like in appearance], carbamazepine associated lymphadenopathy) and very rarely in other types of non-Hodgkin lymphofnas. Anaplastic large cell lymphoma may also show RS like cells.

So the answer to this question is B


Instruction:
All are true about gout except -
A. Is caused by purine metabolism disorder
B. Causes scleritis
C. Causes tophi in the extraocular muscle tendon
D. Is directly related to alcohol consumption

Response:
None

So the answer to this question is D


Instruction:
Oral candidiasis is divided into primary and
A. Secondary infections
B. Subsidiary infections
C. Subclinical infections
D. All of the above

Response:
None

So the answer to this question is A


Instruction:
All of the following cinical features are seen in acute intermittent porphyria, EXCEPT:
A. Abdominal pain
B. Photosensitivity
C. Seizures
D. Constipation

Response:
Photosensitivity of porphyrias is due to the accumulation of porphyrins which can absorb light. However, in Acute intermittent porphyria metabolic block is earlier to the production of porphyrins. Porphobilinogen accumulated in this condition do not contain a conjugated double bond system so it can't absorb light. So, there is no photosensitivity In Acute intermittent porphyria, the accumulation of ALA and PBG block the action of GABA hence produce neurological symptoms such as excitation of visceral pain fibers leading to acute pain crisis, abdominal pain, vomiting, constipation, hypeension and tachycardia

So the answer to this question is B


Instruction:
Plasma cells are activated:
A. B cells
B. T cells
C. Macrophages
D. Monocytes

Response:
Ans: a (B cells) Ref: Robbins,7th ed, p. 199; Ananthanarayan, 7th ed, p. 125When B lymphocytes are activated by antigens (protein/non-protein) they get differentiated into antibody secreting cells, called plasma cells.Plasma cells:Cartwheel appearanceLifespan-2-3 daysMakes Ab of single specificity, single Ig clan & allotype.Immune mechanism: Produce only a single light chain only.B lymphocytes-plasma cells- ImmunoglobulinT lymphocytes- lymphokine production - Cell mediated immunity.Differentiation between B lymphocyte and T lymphocyte.* T cells form E rosette/SRBC rosette; B cells form EAC rosette* B cells carry Ig on their surface; T cells have T cell receptors (TCR)* B cell blast transformation with bacterial endotoxin, staph, aureus, EBV; T cell blast transformation with phytohemagglutinin, concanavalin A

So the answer to this question is A


Instruction:
All are components of Cushing triad Except
A. Hypeension,
B. Raised ICP
C. Bradycardia
D. Irregular respiration

Response:
The rapid increase in intracranial pressure (as in trauma) which accompanies the exhaustion of compensation mechanisms ultimately results in herniation of brain tissue. The uncus of the temporal lobe may herniate over the tentorium resulting in pupil abnormalities, usually occurring first on the side of an expanding haematoma.Cerebellar tonsillar herniation through the foramen magnum compresses medullary vasomotor and respiratory centres, classically producing Cushing's triad ofhypeension, bradycardia and irregular respiration.**Raised ICP causes Cushing&;s triad, but it is not a componentBailey and Love 26e pg: 310

So the answer to this question is B


Instruction:
Which of the following is NOT an important/ frequent/well-known manifestation of an adverse drug reaction?
A. Agranulocytosis
B. Aplastic anaemia
C. Haemolysis
D. Leukaemia

Response:
None

So the answer to this question is D


Instruction:
Which vitamin deficiency is seen in vegetarians especially -
A. Vitamin B12
B. Vitamin B6
C. Vitamin B3
D. Vitamin B2

Response:
Ans. is 'a' i.e., Vitamin B12* Dietary sources of vitamin B12 are of animal origin only and include meat, eggs, milk, diary products, fish, poultry etc. Vitamin B12 is absent in plant foods. Small amount of vitamin B12 is synthesized in the intestine by the action of intestinal flora.

So the answer to this question is A


Instruction:
Which of the following is not a typical feature of autoimmune hepatitis?
A. Interface hepatitis
B. Emperipolesis
C. Hepatic rosette formation
D. Ground glass hepatocytes

Response:
"Ground glass" hepatocytes are seen in chronic hepatitis B. Diagnostic features of autoimmune hepatitis: Autoantibodies (ANA or ASMA or LKM > 1 : 80) IgG (or gammaglobulins) level >1.10 times normal limit Liver histology typical for autoimmune hepatitis Interface hepatitis, lymphocytic/lymphoplasmacytic infiltrates in poal tracts and extending in the lobule emperipolesis (active penetration by one cell into and through larger cell) hepatic rosette formation Absence of viral hepatitis

So the answer to this question is D


Instruction:
Green colour blindness is called -
A. Protanopia
B. Deuteranopia
C. Tritanopia
D. Dyschromatopsia

Response:
(B) (Deuteranopia) (347-Nema 6th) (326 Khurana 5th)* Protanopia - ie Complete red colour defect* Deoteranopia - ie Complete defect for green colour* Tritanopia - ie Absence of blue colour apreciationTESTS FOR COLOUR VISION1) Pseudo-isochromatic charts (Ishihara's plate, Hardy - Rand Rittler plates, American optical colour plates).2) Farnsworth munsell 100 hue test3) Edridge Green lantern test4) City university colour vision test5) Nagel's anomaloscope6) Holmgren's wool testA maurosis fu2ax - sudden temporary and painless monocular visual loss occurring due to transient failure of etinal circulation.

So the answer to this question is B


Instruction:
Quaer of postnatal mother death is caused by ?
A. Infection
B. Bleeding
C. Eclampsia
D. Anemia

Response:
Ans. is `b' i.e., Bleeding o 25% of maternal death are caused by severe bleeding, generally occuring post-paum.

So the answer to this question is B


Instruction:
The drug that is not useful in congestive hea failure is:
A. Adrenaline
B. Digoxin
C. Hydrochlorothiazide
D. Enalapril

Response:
Ref:KDT 6/e p493,503-504 Medications Diuretic Increases urine production to get rid of excess salt and water. Beta blocker Slows hea rate and decreases blood pressure. When taken in eye-drop form, it reduces eye pressure. ACE inhibitor Relaxes blood vessels, lowers blood pressure and prevents diabetes-related kidney damage. Antihypeensive drug Lowers blood pressure. Dietary supplement Works alone or in conjunction with other treatments to promote health. Blood pressure suppo Helps increase blood pressure when it's too low. Vasodilator Widens blood vessels. Hea Medication Helps reduce chest pain or pressure caused by blockages in the aeries of the hea.

So the answer to this question is A


Instruction:
During the delivery, it is necessary to cut an episiotomy. The tear extends through the sphincter of the rectum, but the rectal mucosa is intact. How would you classify this type of episiotomy?
A. First degree
B. Second degree
C. Third degree
D. Fouh degree

Response:
A first-degree tear involves the vaginal mucosa or perineal skin, but not the underlying tissue. In a second-degree episiotomy, the underlying subcutaneous tissue is also involved, but not the rectal sphincter or rectal mucosa. In a third-degree tear, the rectal sphincter is affected. A fouh-degree episiotomy involves a tear that extends into the rectal mucosa. Ref:Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 23. Forceps Delivery and Vacuum Extraction. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

So the answer to this question is C


Instruction:
Best for prevention of risk factor:
A. Primordial prevention
B. Primary prevention
C. Secondary prevention
D. Tertiary prevention

Response:
Ans. (a) Primordial preventionRef : K. Park 23rd ed. / 41, 21sted. 139-40* Primordial level of prevention is defined as prevention of emergence or development of risk factors in countries or population groups in which disease entity is not yet appeared, or population group which are not yet exposed.* Modes of intervention:# Individual education# Mass education* Primordial level is considered as best level of prevention for non-communicable diseases

So the answer to this question is A


Instruction:
The plasma half life of aspirin:
A. Is independent of dose
B. Is longer for anti-inflammatory doses compared to that for analgesic dose
C. Is shoer for anti-inflammatory doses compared to that for analgesic dose
D. Can be increased by alkalinizing the urine

Response:
Aspirin and other salicylates show saturation kinetics (zero order) and thus, their half life is not constant. Clearance at high doses (anti-inflamatory) is lesser than at low (analgesic) doses. Thus t1/2 is more for anti-inflammatory dose than for analgesic dose.

So the answer to this question is B


Instruction:
A patient with Crohn's disease was opened for and an inflammed appendix found. The treatment of choice is?
A. Appendicectomy
B. Ileocolic resection and anastamosis
C. Close the abdomen and sta medical treatment
D. None of the above

Response:
Ans. is 'a' i.e., Appendicectomy Sabiston writes - "Patients who undergo exploration for presumed appendicitis and have evidence of Crohn's disease should undergo appendectomy. Although there is theoretical concern for the development of an enterocutaneous fistula, this is extremely rare. Moreover appendectomy prevents fuher diagnostic confusion."

So the answer to this question is A


Instruction:
A 35 yr. old male presented with a 15 day history of proptosis in his right eye and pain on eye movement. There is difficulty in upwards and down wards gaze movements. CT scan showed a cystic lesion with a hyperdense opacity within it, located in the superior oblique muscle. Most probable diagnosis is :
A. Dermoid
B. Hemangioma
C. Pseudotumor
D. Cysticercosis cellulosae

Response:
Ans. is 'd' ie Cysticercosis cellulosae [Ref Kanski, 4/e, p572, General ophthalmics, 15/e, p 239; Parson 19th/e, p 512Let's see each option one by oneDermoidit can be easily ruled out as it is not found within the musclesIt is located subcutaneously along the embryonic lines of closure*Hemangiomacan be of two typesCapillary orCavernousCapillary hemangiomasare seen in the infants (90% of them present before the age of 6 months)The cavernous hemangiomamay present in the middle life but in slow growing and would not present so rapidly (within 15 days) as in this patientIt is mostly located within the muscle conePseudotumoralso k/a Idiopathic orbital inflammatory disease (IOID)Though it's a frequent cases of proptosis in adults and children, its signs and symptom easily rule it out.It is non-infections, non-neoplastic inflammatory condition characterized by :periorbital swellingchemosis andconjunctival inflammationophthalmoplegiaCysticercosis cellulosaeThough cysticercosis cellulosae commonly lodges in the subretinal space causing retinitis, but may also invade the extraocular muscles.On CT scan it appears as a cystic lesion with a hyperdense scolex inside.Orbital USG - Demonstration of a cystic lesion with a central hyperechoic highly reflective scolex is diagnostic.

So the answer to this question is D


Instruction:
Which of the following condition is most commonly associated with cholesteatoma formation?
A. Central perforation
B. Attico-antral perforation
C. Tubo-tympanic disease
D. Otosclerosis

Response:
Atticoantral type of CSOM is most commonly associated with cholesteatoma, granulations or osteitis. It is associated with an attic or marginal perforation. Tubotympanic type of CSOM is associated with central perforation.

So the answer to this question is B


Instruction:
Which of the following is false for the given specimen?
A. Bilateral in 10% to 15%
B. About 10% undergo malignant transformation
C. Unilocular cysts
D. Common during the active reproductive years.

Response:
The specimen is of a Dermoid cyst.Most benign teratomas are cystic and are often referred to as dermoid cysts because they are almost always lined by skin-like structures. Cystic teratomas are usually found in young women during the active reproductive years.Benign teratomas are bilateral in 10% to 15% of cases.Characteristically they are unilocular cysts containing hair and sebaceous material. In most cases, tissues from other germ layers can be identified, such as cailage, bone, thyroid, and neural tissue. About 1% of the dermoids undergo malignant transformation, most commonly to squamous cell carcinoma, but also to other cancers as well (e.g., thyroid carcinoma, melanoma).Robbins pathology 9e 1029

So the answer to this question is B


Instruction:
Posterior communicating aery is branch of
A. Internal carotid aery
B. External carotid aery
C. Middle cerebral aery
D. Posterior cerebral aery

Response:
Posterior communicating aery arises close to the termination of internal carotid aery. Other branches of cerebral pa internal carotid aery are: Ophthalmic aery Anterior cerebral aery Middle cerebral aery Anterior choroidal aery Posterior cerebral aery is a branch of basilar aery. (Ref: Vishram Singh textbook of clinical neuroanatomy 2nd edition, pg- 176)

So the answer to this question is A


Instruction:
Sulcular membrane acts as a semipermeable membrane through which:
A. Bacterial products pass into gingiva
B. Fluid from gingiva seeps into sulcus
C. Both of the above
D. None of the above

Response:
None

So the answer to this question is C


Instruction:
Barriers to communication are all Except
A. Cultural
B. Environmental
C. Psychological
D. Mobile devices

Response:
Barriers to communication can be : Physiological, Psychological, Environmental, and cultural.Park 23e pg: 856

So the answer to this question is D


Instruction:
Cervical was are seen with which HPV ?
A. 11,13
B. 6, 11
C. 17,18
D. 5, 8

Response:
Ans. is 'b' i.e., 6, 11

So the answer to this question is B


Instruction:
Mechanism of action of clonidine is mediated by which of the following receptors?
A. Alpha 1
B. Alpha 2
C. Beta 1
D. Beta 2

Response:
None

So the answer to this question is B


Instruction:
Patient presents with severe hearing loss. For the amount of decibel loss he has, which of the following sound can be heard by him?
A. Rustling of leaves
B. Sta of car engine at 10 feet
C. Sound of Niagara falls
D. Noisy environment night street

Response:
WHO CLASSIFICATION Till 25 dB Hz Normal 26 - 40 dB Hz Mild 41 - 60 dB Hz Moderate 61 - 80 dB Hz Severe Over 81 dB Profound Source Decibels Anything on the verge of being Audible 0 Whisper 30 Normal conversation 60 Busy traffic 70 Niagara Falls 90 Train 100 Construction noise 110 Rock conce 120 Machine gun 130 Jet take off 150 Rocket take off 180

So the answer to this question is C


Instruction:
Which type of Resin Bonded FPD is shown in the colour plate?
A. Rochette Bridge
B. Maryland Bridge
C. Cast Mesh FPD
D. Virginia Bridge

Response:
Cast mesh fixed partial denture
A nylon mesh is placed on the palatal/ lingual surface of the abutment die and the pattern is fabricated over this mesh. The mesh gets incorporated and following casting provides retention for resin to metal.

So the answer to this question is C


Instruction:
Lesion in occipital lobe will cause?
A. Binasal hemianopia
B. Bitemporal hemianopia
C. Homonymous superior quadrantonopia
D. Homonymous hemianopia with macular sparing

Response:
Ans. (d) Homonymous hemianopia with macular sparingRef.: Harrisons 19th ed. /198-199Please look at the diagram carefully to understand the visual pathway and its corresponding pathology.* Unilateral optic nerve lesion: Unilateral blindness* Binasal hemianopia: Bitemporal optic chiasma lesion. Two different lesions compressing the chiasma from the lateral parts.* Bitemporal hemianopia: Binasal retinal damaged optic chiasmal lesion. Commonest lesion is pituitary adenoma.* Homonymous hemianopia: lesion at optic tract AND optic radiation* Homonymous superior quadrantonopia: All superior quadrantonopia goes to the temporal lobe (pie in the sky).* Homonymous inferior quadrantonopia: All inferior quadrantonopia goes to the parietal lobe (Pie on the floor).* Homonymous hemianopia w/ macular sparing: Lesion in occipital cortex les

So the answer to this question is D


Instruction:
Rate limiting step of glycogenolysis is:
A. Phosphorylase
B. Glucan transferase
C. Debranching enzyme
D. Glucose-6-phosphatase

Response:
Harper -145,146, 147
Glycogen phosphorylase catalyzes the rate-limiting step in glycogenolysis by promoting the phosphorolytic cleavage by inorganic phosphate of the 1-4 linkages of glycogen to yield glucose-1-phosphate. The terminal glucosyl residues from the outermost chains of the glycogen molecule are removed sequentially until approximately four glucose residues remain on either side of the 1,6 branch. Another enzyme( glucan transferase) transfers a trisaccharide unit from one branch to the other, exposing the 1,6 linkages requires the debranching enzyme. Further phosphorylase action can then proceed. The combined action of phosphorylase and these other enzymes leads to the complete breakdown of glycogen.

So the answer to this question is A


Instruction:
maximum air volme in the lu ng -
A. 1200 ml
B. 2400ml
C. 3000ml
D. 5900ml

Response:
Ans. is 'd* i.e., 5900 ml.# Total lung capacity (TLC): - It is the maximum volume of air in the lung at the end of maximal inspiration, i.e,, maximum amount of air the lung can contain. In other words, TLC = TV + 1RV + ERV + RV or TLC = VC + RV (because VC = TV + IRV + ERV). TLC is about 5900 ml.

So the answer to this question is D


Instruction:
Albans test is an example of
A. Caries activity test
B. Acid producing test
C. Caries susceptibility test
D. None of the above

Response:
None

So the answer to this question is A


Instruction:
The most common complication seen in hiatus hernia is
A. Esophagitis
B. Aspiration pneumonitis
C. Volvulus
D. Esophageal stricture

Response:
Ans. is 'a' i.e. Esophagitis There are 4 types of hiatal herniaType I : Sliding hernia (most common type -- 70 - 80%)Type II : Paraesophageal or rolling herniaType III : MixedType IV : these hernias are distinguished by the presence of other abdominal viscera wihin the defect i.e. omentum, transverse colon.Type I or Sliding hiatal hernia- this is characterized by upward dislocation of the cardioesophageal junction into the posterior mediastinum.Type II or Rolling Paraesophageal hernia- the cardioesophageal junction is undisplaced the whole or pa of stomach herniates into the thorax immediately adjacent and to the left of the undisplaced cardioesophageal junction.- since the normally located gastroesophageal junction functions normally in most of these hernias, reflux is uncommon

So the answer to this question is A


Instruction:
In a child, non-functioning kidney is best diagnosed by:
A. Ultrasonography
B. IVU
C. DTPA renogram
D. Creatinine clearance

Response:
In order to assess function of an apparent non-functioning kidney, the best modality would be DTPA renogram. About other options: a. Ultrasonography: initial modality for imaging of the kidney and urinary tract. Good for anatomic details and not functional details of kidneys ureter and bladder. b. IVP (Intravenous pyelography) gives valuable information about renal anatomy and function. But due to the risk of anaphylaxis with the contrast material use of IVP has declined following the availability of radionuclide imaging. d. 24 hrs creatinine clearance can be calculated by collecting a timed urinary specimen and taking a blood sample around the mid-collection period. In children, in addition to problem with urine collection, this overestimates the actual GFR and can't be used to assess isolated kidney function.

So the answer to this question is C


Instruction:
Myelofibrosis leading to a dry tap on bone marrow aspiration is seen with ach of the following condition
A. Burkitt's lymphoma
B. Acute erythroleukemia
C. Acute megakaryocytic leukemia
D. Acute myelomonocytic leukemia

Response:
Ans. c. Acute megakaryocytic leukemia Bone marrow maybe difficult to aspirate in Acute megakaryocytic leukemia and more than 2/3rd of patients have significant fibrosis caused by release of fibrogenic cytokine Erythroleukemia (M6) FAB Bone marrow findings: Usually hypercellular with megaloblastic changesdeg - Erythroid precursors commonly have multicentricity (65%), karyorrhexis (53%), morulae (25%) and cytoplasmic inclusionsdeg. MC immunophenotypic marker for erythroleukemia: Glycoprotein 7 and transferring receptor (CD-71 Acute Megakaryocytic Leukemia (M7) FAB Bone marrow findings: Bone marrow maybe difficult to aspirate and more than 2/3' of patients have significant fibrosisdeg caused by release of fibrogenic cytokine Burkitt's Lymphoma Bone marrow findings: When the bone marrow is involved, aspirates reveal tumor cells with slightly clumped nuclear chromatindeg, 2-5distinct nucleoli and royal blue cytoplasm containing clear cytoplasmic vacuole Acute Myelomonocytic Leukemia (M4) FAB Bone marrow findings: Ultra-structures are present in association with monocytosis and myeloblastic/monoblastic infiltration of bone

So the answer to this question is C


Instruction:
All of the following are true about incontinentia pigmenti, except:
A. Ocular involvement is seen in almost 100% cases and is typically unilateral
B. Avascularity of peripheral retina
C. Primary skin abnormality
D. X-linked dominant

Response:
Ocular involvement is seen in about 20-35 percent of the cases of incontinentia pigmenti but not in 100 percent cases as mentioned in the option. Incontinentia pigmenti is a X-linked dominant primary skin disease that leads to avascularity of the retina. Ref: Rook's Textbook of Dermatology 7th Edition, Pages 39.20-3.22; The Retinal Atlas By Lawrence A. Yannuzzi, Page 38

So the answer to this question is A


Instruction:
Popliteal aery injury is commonly seen in which type of traumatic knee dislocation?
A. Anterior dislocation
B. Posterior dislocation
C. Medial dislocation
D. Lateral dislocation

Response:
*Make it very clear in your mind that popliteal aery injury can occur with both anterior and posterior dislocation of knee. But it is more common in posterior dislocation. Clinical evaluation : (vascular exam) -Measure Ankle-Brachial Index (ABI) if ABI >0.9 >>>> then monitor with serial examination if ABI <0.9 >>>> -If pulses are absent or diminished confirm that the knee joint is reduced or perform immediate reduction and reassessment - Immediate surgical exploration if pulses are still absent following reduction &;schema time >8 hours has amputation rates - If pulses present after reduction then measure ABI then consider observation vs. angiography Clinical evaluation : (vascular exam) -Priority is to rule out vascular injury on exam both before and after reduction serial examinations are mandatory. - Palpate the dorsalis pedis and posterior tibial pulses if pulses are present and normal , >> it does not indicate absence of aerial injury. Ref: Campbell's 13th/e p.2257

So the answer to this question is B


Instruction:
What is the most likely cardiac lesion in a young adult who complains of headache, dizziness and intermittent claudication with exercise?
A. TOF
B. ASD
C. PDA
D. Coarctation of aoa

Response:
The symptoms relating to this patient are suggestive of Coarctation of aoa. i.e; Intermittent claudication, dizziness and headache. Ref: Clinical Echocardiography By Michael.Y.Henein, Mary Sheppard, Page 227 ; Harrison's Internal Medicine, 18th Edition, Page 1925

So the answer to this question is D


Instruction:
A 30 year-old male was bought to the emergency depament after a car accident. He sustained a severe injury to the anterior chest wall from the impact caused by the steering wheel. X-ray revealed fracture of the body of the sternum. Which of the following pa of the hea is most likely to be injured.
A. Left atrium
B. Left Ventricle
C. Right Ventricle
D. Right atrium

Response:
The area posterior to the sternum is occupied by the right ventricle and hence is most likely to be injured in this case. The convex anterosuperior surface of the right ventricle makes up a large pa of the sternocoastal aspect of the hea, and is seperated from the thoracic wall only by the pericardium. Ref: Gray&;s Anatomy 41st edition Pgno: 1001

So the answer to this question is C


Instruction:
Lenalidomide co-administration with which another drug increases the risk of thrombosis?
A. Alcohol
B. Barbiturates
C. Glucocoicoids
D. Antibiotics

Response:
Recently, combination regimens incorporating lenalidomide plus dexamethasone or prednisone have been shown to be more effective as first-line therapy. Lenalidomide was approved by the Food and Drug Administration (FDA) in late 2005 as a consequence of trials that showed its effectiveness in the treatment of the myelodysplastic syndrome with the chromosome 5q31 deletion. Clinical trials using lenalidomide to treat newly diagnosed as well as relapsed or refractory multiple myeloma showed similar efficacy, leading to FDA approval for myeloma as well. Its side effect profile is similar to that of thalidomide, although with less teratogenic effect and fewer thromboembolic events.

So the answer to this question is C


Instruction:
Investigation of choice for bronchiectasis is-
A. X-ray
B. Endoscopy
C. M.R.I.
D. HRCT

Response:
Ans. is 'd' i.e., HRCT * HRCT is the investigation of choice for bronchiectesis* The CT criteria for diagnosis include 'signet -ring' sign (bronchus being larger than accompanying vessel), bronchial wall thickening, and bronchi visible within 1 cm of the pleura.* Three types are described according to Their appearance :-A. Cylindrical:- Mild diffuse dilatation of the bronchi. Radiologically there is Tram - Trank appearance, i.e. lack of peripheral tapering.B. Varicose:- Cystic bronchial dilatation interrupted by focal areas of narrowing, giving radiological appearance of'String of pearl (string of beads).C. Saccular (cystic):- Clusters of bronchi with marked saccular dilatation. Cystic bronchiectasis in any region is easily recognized as clusters of rounded lucencies, often containing air - fluid levels; this appearance has been linked to a 'cluster of grapes'.Investigations of choice in respiratory systemDiseaseInvestigation* Interstitial lung disease* HRCT* Bronchiectasis* HRCT (1st choice)* Bronchography (2nd choice)* Pulmonary embolism* CT with i.v. Contrast (1st choice)* V/Q scan (2nd choice)* Solitary pulmonary nodule* CT scan* Calcification* CT scan* Pulmonary malignancy* CT scan (except in superior sulcus or pancoast tumor)* Superior sulcus or pancoast tumor* MRI

So the answer to this question is D


Instruction:
Source of aerial supply to testis:
A. Internal pudendal aery
B. Deep external pudendal aery
C. Superficial external pudendal aery
D. Testicular aery

Response:
Blood supply of testesThe testicular aery is a branch of the abdominal aoa given off at the level of L2.The testicular veins emerge from the testis and the epididymis as a venous network, the pampiniform plexus.This becomes reduced to a single vein as it ascends through the inguinal canal. The right testicular vein drains into the inferior vena cava, and the left vein joins the left renal vein.

So the answer to this question is D


Instruction:
All of the following cranial nerves traverse through the cavernous sinus, EXCEPT?
A. Occulomotor
B. Trochlear
C. Maxillary division of trigeminal
D. Abducens

Response:
The cranial nerves traversing the cavernous sinus are oculomotor, trochlear, abducens and ophthalmic division of the trigeminal nerve together with trigeminal ganglion. Cavernous sinuses are seen on either side of the sella turcica. They receive drainage from ophthalmic and facial veins and blood leaves the cavernous sinuses the petrosal sinuses.

So the answer to this question is C


Instruction:
Sensation transmitted by pacinian corpuscles is:
A. Cold
B. Warmth
C. Touch
D. Vibration

Response:
Ans. D. VibrationSENSE ENDINGS ACTIVATEDPain Cutaneous nociceptorsTemperature, heat Cutaneous thermoreceptors for hotTemperature, cold Cutaneous thermoreceptors for coldTouch Cutaneous mechanoreceptors, also naked endingsVIBRATION Mechanoreceptors, especially PACINIAN CORPUSCLES (Pressure also) QJoint position Joint capsule and tendon endings, muscle spindles

So the answer to this question is D


Instruction:
Drug commonly used in the treatment of iridocyclitis is
A. Phenylephrine
B. Atropine
C. Darifenacin
D. Solifenacin

Response:
Atropine is used in iridocyclitis to break adhesions in the uveal tract Ref: KDT 6th ed pg 116

So the answer to this question is B


Instruction:
How to differentiate ASD from VSD in X-ray:
A. Enalrged LA
B. Normal LA
C. Pulmonary Congestion
D. Aoic shadow

Response:
B i.e. Normal LA Characteristic findings of ASD include enlarged hea, RA, RV, PA and PV with normal LA & LV and decreased aoa and SVCQ Characteristic findings of VSD include enlarged hea, RA, RV, PA, PV and LAQ. So pulmonary overcirculation/congestion occurs both in ASD & VSD but LA remains normal in ASD & enlarges in VSDQ. Atrial Septal Defect (ASD) In atrial septal defect (ASD), there is a defect between both atrium leading to left to right (L-->R) shunt from left atrium to right atrium, to right ventricle (RV), pulmonary aery (PA) and then pulmonary circulation. Increased blood flow through pulmonary circulation causes hilar dance (increased pulsations of central pulmonary aery), pulmonary plethoraQ, increased size of pulmonary veins & anteries with size larger than accompanying bronchus (kissing cousin sign), dimeter of right descending pulmonary aery > trachea just above aoic knob, enlarged hilar vessels and visualization of vessels below 10th posterior rib (all indicating prominent pulmonary vasculature d/t over circulation). ASD may show cardiomegaly, normal sized left atrium & left ventricle and enlarged right atrium, right ventricle and main pulmonary aeryQ. Due to RV hyperophy, there is clockwise rotation of hea lit loss of visualization of superior venacava (S VC) and small appearing aoa with normal aoic knob. - Pulmonary pressure remains normal for decades and usually after 40 years of age onset of pulmonary hypeension causes increased R-sL shunting (Eisenmenger syndrome). Ventricular Septal Defect (VSD) - In VSD, there is a defect between both ventricles leading to L-sR shunt from left ventricle (LV) to right ventricle (RV) to pulmonary aery (PA) --> pulmonary vein -s left atrium (LA) -*LV. So all these chambers enlarge with pulmonary vessels being affected last - In nonrestrictive large shunts (>75% of aoic diameter) pulmonary aery hypeension Eisenmenger syndrome develops early. Calcification of PA is vathognomic of PAH.

So the answer to this question is B


Instruction:
Which of these is not true regarding guttapercha?
A. 60-70% Gutta Percha
B. It can't be heat sterilized
C. Can stain the crown
D. 25 size cone is used for sinus tracing

Response:
None

So the answer to this question is A


Instruction:
All of the following are properties of synovial fluid except :
A. It is a pale yellow , clear and sufficiently viscous fluid that droplets expelled from a needle tip fall in a long string
B. It is a Non Newtonian fluid
C. It doesn’t clot since it lacks in fibrinogen
D. Normal WBC count in synovial fluid is 350 – 3500 / mm3

Response:
Normal WBC Count - 0-300 / ml of synovial fluid

So the answer to this question is D


Instruction:
A baby presents with diarrhea and perianal diaper area redness. Diagnosis is
A. Lactose intolerance
B. Shigella diarrhea
C. Salmonella
D. Fungal

Response:
In Lactose intolerance, there is a deficiency of the enzyme lactaseSo there is no natural breakdown of lactose - a carbohydrate present in milkThis causes diarrheaThe stool contains reducing sugar which causes perianal excoriation(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 1876)

So the answer to this question is A


Instruction:
All of the following paranasal sinuses are present at birth EXCEPT:
A. Maxillary sinus
B. Ethmoid sinus
C. Sphenoid sinus
D. None

Response:
Ans. (c) Sphenoid sinusRef: Dhingra 5th Ed. / 203Development and Growth of paranasal sinusesSinusesStatus at the birthGrowthFirst radiologic evidenceMaxillaryPresent at birthRapid growth from birth to 3 years and from 7-12 years. Adult size-15yrs4-5 months after birthEthmoidPresent at birthReach Adult size by 12 years1 yearsFrontalNot presentInvades frontal bone at the age of 4 years. Size increases until teens6 yearsSphenoidNot presentReaches sella turcica by the age of 7 years.Reaches full size between 15 years to adult age4 years

So the answer to this question is C


Instruction:
In a child with acute liver failure, the most important abnormal serum biochemical test that indicates poor prognosis:
A. Increasing transaminases
B. Increasing bilirubin
C. Increasing prothrombin time
D. Reversal of serum albumin-globulin ratio

Response:
C. Increasing prothrombin time(Ref: Nelson's 20/e p 1967)Hepatic synthetic function is reflected in serum albumin and protein levels and in the PT or INRUnresponsiveness of PT to vitamin K suggests severe hepatic diseasePersistently low levels of factor VII are evidence of a poor prognosis in fulminant liver diseaseSerum aminotransferase activities do not correlate well with the severity of the illness.

So the answer to this question is C


Instruction:
A 25 year old male after road traffic accident was brought to emergency depament. On examination, the patient was moaning with inability to speak but patient was able to understand what he wanted to speak. Which of the following marked area of brain is involved in this?
A. A
B. B
C. C
D. D

Response:
Inability to speak - Motor aphasia Stroke of superior division of MCA i.e. Broca's area affected. A = Contraversive eye center B = Broca's area- inferior frontal gyrus - MCA: sup. division C = Wernicke's area -superior Temporal gyrus - MCA: inf division D = Occipital coex

So the answer to this question is B


Instruction:
A lady presents with swelling of hands with shiny skin. She has a history of fracture radius and kept on the POP cast for 4 weeks after which she develops this. Give the most likely diagnosis -
A. Myositis ossification
B. Rupture of external pollicis longus tendon
C. Reflex sympathetic dystrophy
D. Malunion

Response:
Swelling of hands with shiny skin and history of trauma (fracture radius) suggest the diagnosis of RSD.

So the answer to this question is C


Instruction:
A testicular tumor in a man aged 60 years is ; most likely to be:
A. Germ cell tumor
B. Seoli cell tumor
C. Teratocarcinoma
D. Lymphoma

Response:
A testicular mass in a male > 50 yrs should be regarded as lymphoma until proven otherwise. Ref: Harrison's Internal Medicine, 18th Edition, Page 806; Bailey and Love's Sho Practice of Surgery, 23rd Edition, Page 1278.

So the answer to this question is D


Instruction:
Terminal branches of facial nerve are all EXCEPT:
A. Mandibular nerve
B. Marginal branch
C. Temporal
D. Cervical

Response:
After it gives off the posterior auricular nerve, the facial nerve divides within the parotid gland into its terminal branches. The terminal branches are; Temporal Zygomatic Buccal Marginal (along the mandible) Cervical (A traditional mnemonic device for the five terminal branches of the facial nerve is, "Ten Zebras Bit My Cat")

So the answer to this question is A


Instruction:
Urachus fistula is :
A. Patent allantois
B. Ectopic hernia
C. Patent vitello-intestinal tract
D. Meckel's diveicum

Response:
A i.e. Patent allantoisUrorectal septum separates cloaca into (anterior) primitive urogenital sinus and (posterior) primitive anorectal canalQ. Urachzis fistula develops from patent allantoisQ.

So the answer to this question is A


Instruction:
The flying range of Aedes aegypti is
A. 100 meters
B. 200 meters
C. 300 meters
D. 400 meters

Response:
Flight range studies suggest that most female Ae. aegypti may spend their lifetime in or around the houses where they emerge as adults and they usually fly an average of 400 metres. This means that people, rather than mosquitoes, rapidly move the virus within and between communities and places. * Different sources may have given a different distance, WHO mentions it as 400 meters Ref: Park 23rd edition Pgno : 771

So the answer to this question is D


Instruction:
Parietal peritoneum is lined by
A. Simple squamous
B. Stratified squamous
C. Cuboidal
D. Columnar

Response:
SIMPLE SQUAMOUS EPITHELIUM - The cells of this epithelium are flattened. In sections they appear so thin that bulgings are produced on the surface by nuclei. In surface view the cells have polygonal outlines that interlock with those of adjoining cells. A simple squamous epithelium lines the alveoli of the lungs, the free surfaces of peritoneum, pleura and pericardium. Here it is given the name mesothelium. It also lines the inside of blood vessels,where it is called endothelium, and Of the hea where it is called endocardium. REF : Inderbir Singh's Textbook of Human Histology, seventh edition, pg.no., 2.

So the answer to this question is A


Instruction:
Compared to high molecular weight heparin following is true about low molecular weight heparin ?
A. Monitoring is not needed for low molecular weight heparin
B. Daily two subcutaneous doses are essential
C. They are easily filtered at the glomerulus
D. They do not interact with plasma proteins

Response:
Ans. is 'b' i.e., Daily two subcutaneous doses are essential Advantages of LMWH Longer, more consistent and predictable response --> Single daily dose is sufficient by subcutaneous route. o Lower risk of osteoporosis and HIT syndrome. Bleeding chances are less : LMW heparins have a different anticoagulant profile. They selectively inhibit factor Xa with little effect on antithrombin and coagulation in general. They act only by inducing conformational change in AT III. They appear to have lesser antiplatelet action. As a result they have a small effect on a PTT and whole blood clotting time. Since a PTT/clotting times are not prolonged (much) laboratory monitoring is not needed, and the incidence of haemorrhagic complication is less. They are easily filtered from glomerular capillaries because of there smaller molecular weight. LMW heparins do not interact with plasma proteins.

So the answer to this question is B


Instruction:
Section of the vagus nerve results in
A. Increased rate of respiration
B. Decreased depth of respiration
C. Irregular breathing patterns
D. Increases in breath - holding time

Response:
Vagus nerve causes contraction of bronchial muscle helping in expiration. Section of vagus nerve leads to difficulty in expiration and therefore increasing breath holding time. Ref: Ganong&;s review of medical physiology; 23rd edition; pg: 267; table 17-1.

So the answer to this question is D


Instruction:
Which of the following is the treatment of choice for Atrial fibrillation in patients with WPW syndrome who are hemodynamically unstable
A. Procainamide
B. Digoxin
C. DC Cardioversion
D. Radio-frequency ablation of the bypass tract

Response:
Administration of AV nodal-blocking agents including oral or intravenous verapamil, diltiazem, beta block- ers, intravenous adenosine, and intravenous amiodarone are contra- indicated. Preexcited tachycardias should be treated with electrical cardioversion or intravenous procainamide or ibutilide, which may terminate or slow the ventricular rate. Ref Harrison 20th edition pg 1532

So the answer to this question is C


Instruction:
Type of collagen fibres found in the pulp is:
A. Type 1 & Type 4
B. Type 1 & Type 3
C. Type 2 & Type 3
D. Type 2 & Type 4

Response:
Pulp has type 1 and type 3 collagen.
Note: All oral hard and soft (gingival) tissues have type 1 (predominantly) and type 3 collagen.

So the answer to this question is B


Instruction:
Following sensory impairments occur in extensive damage to somatosensory area of cerebral coex. EXCEPT-
A. Pressure
B. Sensory localization
C. Exact weight determination
D. Pain

Response:
Damage to the sensory coex results in decreased sensory thresholds, an inability to discriminate the propeies of tactile stimuli or to identify objects by touch. The secondary somatosensory coex (SII; area 40) is in the lower parietal lobe Somatosensory Coex Primary somatosensory coex (SI; areas 3,1,2) is located in the post central gyrus. This receives somatotopic input from the VPL and VPM of the thalamus. Histologically, this area would consist of granular coex. The sensory homunculus includes coical representation of the body based on the degree of sensory innervation. There are actually four submaps, one each in area 3a, 3b, 1 and 2. Very sensitive areas such as the lips and the fingeips have a huge representation. Neurons within each coical site (paicularly layer IV) are arranged in columns representing specific body regions. If a region is amputated (such as a finger) there is reorganization with neurons responding to stimulation of adjacent body pas. This can also happen as the result of increased use of a body pa. Damage to the sensory coex results in decreased sensory thresholds, an inability to discriminate the propeies of tactile stimuli or to identify objects by touch.but the pain sensation is less effected . The secondary somatosensory coex (SII; area 40) is in the lower parietal lobe. This receives connections from the primary sensory coex and also less specific thalamic nuclei. This responds to sensory stimuli bilaterally, although with much less precision than the primary coex. Nonetheless, lesions to this area may impair some elements of sensory discrimination. The somatosensory association coex (areas 5 and 7) is directly posterior to the sensory coex in the superior parietal lobes. This receives synthesized connections from the primary and secondary sensory coices. These neurons respond to several types of inputs and are involved in complex associations. Damage can affect the ability to recognize objects even though the objects can be felt (tactile agnosia). Coical damage, paicularly in the area of coex where the posterior parietal lobe meets the anterior occipital and the posterior, superior temporal lobe, can cause neglect of the contralateral side of the world. This typically happens with nondominant hemisphere lesions since this hemisphere appears necessary to distribute attention to both sides of the body. The dominant hemisphere appears to only "pay attention" to the associated (usually right) side of the world. Therefore, neglect usually involves the left side and can be so severe that the individual even denies that their left side belongs to them. Ref Harrison20th edition pg 2456

So the answer to this question is D


Instruction:
When planning home care for a client with hepatitis A, which preventive measure should be emphasized to protect the client’s family?
A. Keeping the client in complete isolation
B. Using good sanitation with dishes and shared bathrooms
C. Avoiding contact with blood-soiled clothing or dressing
D. Forbidding the sharing of needles or syringes

Response:
Hepatitis A is transmitted through the faecal-oral route or from contaminated water or food.
Measures to protect the family include good handwashing, personal hygiene and sanitation, and the use of standard precautions.
Complete isolation is not required. Avoiding contact with blood-soiled clothing or dressings or avoiding the sharing of needles or syringes are precautions needed to prevent transmission of hepatitis B.

So the answer to this question is B


Instruction:
The mainstay of treatment of vitiligo is?
A. PUVA
B. Imiqinod
C. Acyclovir
D. Coal tar

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

So the answer to this question is A


Instruction:
Threshold radiation dose for hematological syndrome is?
A. 2 Gy
B. 6 Gy
C. 15 Gy
D. 50 Gy

Response:
Ans. is'a'i.e., 2 GyBone marrow or hematological syndrome:- Full syndrome occurs with a dose between 0.7 and 3 Gy (70-300 rads).The destruction of bone marrow cells results in pancytopenia.

So the answer to this question is A


Instruction:
Predictable and dose related drug induced hepatic injury is seen with all, EXCEPT:
A. Carbon tetrachloride
B. Acetaminophen
C. INH
D. Oral contraceptive agent

Response:
There are two major types of chemical hepatotoxicity Direct toxicity-Predictable with sho latent period Idiosyncratic-Not predictable and it can happen at any time Examples of direct hepatotoxic effects Carbon tetrachloride Acetaminophen OCP INH causes idiosyncratic type reaction Hepatitis is infrequent and unpredictable Ref: Harrison, Edition-18, Page-2558

So the answer to this question is C


Instruction:
Rupture of Berry aneurysm causes
A. Extradural hemorrhage
B. Subdural hemorrhage
C. Subarachnoid hemorrhage
D. Intracerebral hemorrhage

Response:
Subarachnoid hemorrhage Rupture of sacular Berry aneurysm which is usually located in one of the vessels in the Circle of Willis. Berry aneurysm occurs due to congenital defect or degenerative change in the muscle layer and internal elastic lamina. Only the initimal layer and adventitia of the aery form the dome of the aneurysm. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 174

So the answer to this question is C


Instruction:
Double Bubble sign is seen with:
A. Pyloric stenosis
B. Duodenal atresia
C. Ileal atresia
D. Esophageal atresia

Response:
Ans is 'b' i.e. Duodenal atresia "The ultrasound hallmark of duodenal atresia is the 'double bubble sign'. This consists of two adjacent, fluid-filled cavities in the upper abdomen: a lateral and usually somewhat larger cavity representing the dilated stomach, and a medial cavity representing the distended proximal duodenum between the pylorus and the stenosis."- Ultrasound in obstetrics and gynecology By Eberhard Merz, F. Bahlmann 2/e p298Double bubble sign:The double bubble sign is a finding observed on radiographs of newborns and infants. It is reproducible with a variety of other imaging modalities, including upper gastrointestinal studies and prenatal sonography. The finding depicts two air-filled structures in the upper abdomen, with little or no air distally. Horizontal-beam radiographs will demonstrate air and fluid levels in both bubbles.The first bubble (proximal and left sided) is - stomachThe second bubble (to the right of the midline) is - duodenumThe detection of the double bubble sign leads to suspicion of a number of structural anomalies, all of which cause duodenal obstruction.Causes:Intrinsic causes areExtrinsic causes are- duodenal atresia,- annular pancreas,- duodenal stenosis,- malrotation of the gut with obstruction produced byandmidgut volvulus or by Ladd bands, and- duodenal webs;- preduodenal position of the portal vein.The specific duodenal structural anomaly causing the obstruction determines the appearance, prominence, and presence of air distal to the obstruction. Duodenal atresia produces complete obstruction, partially obstructing anomalies, such as duodenal web or duodenal stenosis, allow passage of some air distal to the obstruction and a less dramatic double bubble.

So the answer to this question is B


Instruction:
Hashimoto's thyroiditis,all are TRUE except-
A. Neutrophilic infiltration
B. Maximum incidence in children
C. Pain in hyoid
D. None of the above

Response:
In Hashimoto's thyroiditis, there is a marked lymphocytic infiltration of the thyroid with germinal center formation, atrophy of the thyroid follicles accompanied by oxyphil metaplasia, absence of colloid, and mild to moderate fibrosis. Its incidence increases with age (mean age at diagnosis is 60 yrs). Patients with Hashimoto's thyroiditis may present because of goiter rather than symptoms of hypothyroidism. The goiter may not be large, but it is usually irregular and firm in consistency. Reference : page 2290-91 Harrison's Principles of Internal Medicine 19th edition

So the answer to this question is D


Instruction:
Which of the following type of hypersensitivity reaction is found in the given condition?
A. Anaphylactic type
B. Cytotoxic type
C. Type III hypersensitivity
D. Cell mediated hypersensitivity

Response:
*ADCC (Antibody dependent cellular cytotoxicity) - NK cells by identifying Fc receptors of antibody*Clinical examplesOTransfusion reactionsOErythroblastosis fetalis OAutoimmune hemolytic anemia

So the answer to this question is B


Instruction:
In osteoarthtitis, Bouchard nodes and Heberden's nodes seen respectively,
A. DIP and PIP
B. PIP and DIP
C. Palm and DIP
D. DIP and MCP

Response:
None

So the answer to this question is B


Instruction:
In which of the following conditions, MTP can be indicated -a) Pregnancy caused by rapeb) Husband is willing but mother is not agreeingc) If maternal health is in dangerd) Pregnancy after contraceptive failuree) Pregnant women have received cytotoxic drugs
A. bce
B. bde
C. acde
D. abde

Response:
Pregnancy due to rape, danger to maternal health, receiving cytotoxic drugs (can cause fetal damage and risks of a born child with physical/mental abnormalities) and pregnancy due to contraceptive failure are indications for abortion under MTP act.

So the answer to this question is C


Instruction:
Which of the following is true of lepromatous leprosy  a) Bacterial index + to ++  b) Involvement of earlobes  c) Symmetrical involvement  d) Only a few bacilli are seen in the lesion  e) Loss of eyebrows
A. abc
B. bce
C. ade
D. cde

Response:
None

So the answer to this question is B


Instruction:
Endolymph is seen in ?
A. Scala vestibule
B. Scala media
C. Scala tympani
D. Helicotrema

Response:
Ans. is 'b' i.e., Scala media * The scala vestibuli and scala tympani are filled with perilymph and the scala media is filled with endolymph.

So the answer to this question is B


Instruction:
Pin index system for oxygen
A. 1,5
B. 2,5
C. 4,5
D. 3,5

Response:
Ans: (b) 2,5Ref: Miller's Anaesthesia 7th ed. / 675* Pin index for oxygen is 2, 5.* Cylinder of oxygen is black body with white shoulder.GasColor CodePin index positionBodyShoulderOxygenBlackWhite2,5Nitrous oxideBlueBlue3, 5CO2GrayGray1,6HeliumBrownBrown2,5AirGreyWhite/black quartered1,5

So the answer to this question is B


Instruction:
Extensor carpi radialis longus is a/an -
A. Wrist extensor
B. Wrist adductor
C. Extensor of MCP joint
D. Extensor of IP joint

Response:
Ans. is 'a' i.e., Wrist extensoro Extensor carpi radialis longus causes :-i) Extension of wristii) Abduction of wristo It is supplied by radial nerve.

So the answer to this question is A


Instruction:
A 50-year-old patient with ischemic hea disease develops chest pain. ECG shows ST segment elevation and Q waves. Myocardial necrosis in this patient can be best demonstrated by:
A. Technetium 99 tetrofosmin
B. Sestambi scan
C. Technetium 99 Pyrophosphate
D. Thallium 201

Response:
Myocardial infarct imaging: Tc99m pyrophosphate is used to localize the area of infarct in hea. Area of infarct On thallium scan (Perfusion image) Cold spot Pyrophosphate scan (Infarct image) Hot spot

So the answer to this question is C


Instruction:
Acinar cells of the Exocrine Pancreas secrete
A. Glucagon
B. Lysozyme
C. Insulin.
D. Proteases

Response:
Several Proteases are synthesized by Pancreatic Acinar Cells and are delivered the Pancreatic Duct to the Duodenum

So the answer to this question is D


Instruction:
A 30-year-old pregnant woman and her 2-year-old child are residing in high altitude area. The child is sho in stature, has a potbelly and enlarged protruding tongue, and is developmentally delayed. Iodine is prescribed for mother and child, with the hope of preventing mental retardation in the developing fetus. All are true about oxidation of iodide except
A. Conversion of iodide to iodine
B. Promoted by enzyme peroxidase
C. Iodide transpoed to follicular lumen by Na-I sympoer
D. Propylthiouracil blocks this step

Response:
Conversion of iodide ions to an oxidized form of iodine, either nascent iodine (I0) or I3-, which is then capable of combining directly with the amino acid tyrosine. This oxidation of iodine is promoted by the enzyme peroxidase and its accompanying hydrogen peroxide, which provide a potent system capable of oxidizing iodides. Iodide exit from the thyrocyte across the apical membrane to access the colloid is mediated by a Cl-/I- exchanger known as pendrin. The mechanism of action of propylthiouracil is paly to block the peroxidase enzyme that is required for iodination of tyrosine and paly to block the coupling of two iodinated tyrosines to form thyroxine or triiodothyronine. Reference: Guyton; 13th edition; Page no: 953, 960Reference: Ganong's Review of Medical Physiology; 25th edition; Page no: 339

So the answer to this question is C


Instruction:
Most common cause of renal papillary necrosis is
A. Analgesic nephropathy
B. Sickle cell disease
C. Diabetes mellitus
D. Chronic pyelonephritis

Response:
Renal papillary necrosis is a form of nephropathy involving the necrosis of the renal papilla. Lesions that characterize renal papillary necrosis come from an impairment of the blood supply and from subsequent ischemic necrosis that is diffuse. In terms of cause, almost any condition that involves ischemia can lead to renal papillary necrosis. A mnemonic for the causes of renal papillary necrosis is (POSTCARDS: pyelonephritis, obstruction of the urogenital tract, sickle cell disease, tuberculosis, cirrhosis of the liver, analgesia/alcohol abuse, renal vein thrombosis, diabetes mellitus, and systemic vasculitis.) Often, a patient with renal papillary necrosis will have numerous conditions acting synergistically to bring about the disease. Refer robbins 9/e936

So the answer to this question is C


Instruction:
The component of vitreous humour that is most useful in determining time since death:
A. Sodium
B. Potassium
C. Magnesium
D. Calcium

Response:
Ans. b (Potassium). (Ref. Parikh's textbook of FMT, 6th ed., 2.66)The relationship between the rise of potassium concentration in the vitreous humour and the time since death has been studied by several workers. To improve the accuracy of the method cases with possible ante-mortem electrolyte disturbances can be excluded. Having eliminated these cases with possible ante-mortem electrolyte imbalance, there is a linear relationship between potassium concentration in vitreous and time after death up to 120 hours, but the 95% confidence limits are +- 22 hours.

So the answer to this question is B


Instruction:
In burns management, which of the following is the medium of choice:
A. Dextrose 5%
B. Normal saline
C. Ringer lactate
D. Isolyte-M

Response:
Ans. C: Ringer lactate

So the answer to this question is C


Instruction:
C wave in JVP is due to -
A. Atrial contraction
B. Tricuspid valve bulging into right atrium
C. Right atrial filling
D. Rapid ventricular filling

Response:
Atrial pressure rises during atrial systole and continues to rise during isovolumetric ventricular contraction when the AV valves bulge into the atria. When the AV valves are pulled down by the contracting ventricular muscle, pressure falls rapidly and then rises as blood flows into the atria until the AV valves open early in diastole. The return of the AV valves to their relaxed position also contributes to this pressure rise by reducing atrial capacity. The atrial pressure changes are transmitted to the great veins, producing three characteristic waves in the record of jugular pressure . The a wave is due to atrial systole. As noted above, some blood regurgitates into the great veins when the atria contract. In addition, venous inflow stops, and the resultant rise in venous pressure contributes to the a wave. The c wave is the transmitted manifestation of the rise in atrial pressure produced by the bulging of the tricuspid valve into the atria during isovolumetric ventricular contraction. The v wave mirrors the rise in atrial pressure before the tricuspid valve opens during diastole. The jugular pulse waves are superimposed on the respiratory fluctuations in venous pressure. Venous pressure falls during inspiration as a result of the increased negative intrathoracic pressure and rises again during expiration. Ref Harrison 20th edition pg 1436

So the answer to this question is B


Instruction:
Uterine bleeding at 12 weeks gestation without any cervical dilation is an indication of
A. Incomplete aboion
B. Threatened aboion
C. Missed aboion
D. Inevitable aboion

Response:
Bleeding occurs in about 30 to 40%of human gestations before 20 weeks of pregnancy, with about half of these pregnancies ending in spontaneous aboion. A threatened aboion takes place when this uterine bleeding occurs without any cervical dilation or effacement

So the answer to this question is B


Instruction:
Which of the following is not a complication of EALE's disease?
A. Rubeosis iridis
B. Retinal detachment
C. Neurovascular glaucoma
D. Optic neuritis

Response:
Eale's diseaseis a nonspecific inflammation of veins of the peripheral retina. Optic neuritis does not occur as a complication of Eale's disease. Common eye manifestations includes retinal hemorrhage, vitreous hemorrhage, retinal detachment, rubeosis iridis, complicated cataract and neovascular glaucoma. Reference: Textbook of Ophthalmology By H V Nema, 6e page 311.

So the answer to this question is D


Instruction:
All of the following statement regarding measles are true except -a) Rash appears first on legb) Koplik spot are seen on retinac) Long term complication may be seen in form of SSPEd) Caused by RNA viruse) I-P is 2-3 days
A. abc
B. bcd
C. cde
D. abe

Response:
Measles

Measles is caused by a RNA virus of paramyxovirus.
Measles in also known as rubella
The only source of infection is a case of measles, carriers are not known to occur.
Infective period → 4 days before and 5 days after the appearance of rash.
Infective material → Secretions of nose, throat and respiratory tract
Age group → 6 month to 3 years.
Immunity → One attack of measles generally confers lifelong immunity.
Transmission →

Droplet infection through respiratory tract
Infection through conjunctiva.

Incubation period →

10 days from exposure to onset of fever.
14 days from exposure to appearance of rash.
7 days for live vaccine of measles.

Clinical manifestations
1) Prodromal stage

Begins 10 days after the infection and lasts until day 14.
Characterized by fever, coryza with sneezing and nasal discharge, redness of the eyes, lacrimation and photophobia.
A day or two before the appearance of rash, Koplik's spots appear on buccal mucosa opposite the 1st and 2nd lower molars.
Koplik's spots are pathognonzonic of measles.

2)    Eruptive phase

Maculopapular rash which begins behind the ear and spread rapidly in a few hour over the face and neck extends doWn the body.

3) Post measles stage

Weight loss
Growth retardation
Diarrhea
Cancrum oris
Reactivation of pulmonary TB
Candidiasis

So the answer to this question is D


Instruction:
Cause of Farmer's lung –
A. Cotton dust
B. Grain dust
C. Sugarcane dust
D. Iron

Response:
Farmer's lung is caused by Hay or grain dust.

So the answer to this question is B


Instruction:
High frequency audiometry uses frequency higher than the frequency region required to understand speech. It is used to monitor which of the following?
A. Otosclerosis
B. Ototoxicity
C. Otospongiosis
D. Meniere's disease

Response:
High-frequency audiometry is specifically for ototoxicity monitoring, comprises air conduction thresholds from 10,000 to 20,000 Hz. Most ototoxic hearing losses will first occur in that frequency region, which is higher than the speech range.

So the answer to this question is B


Instruction:
"Sycosis barbae" is caused by
A. Streptococcus aureus
B. Pseudomonas
C. Trichophyton rubrum
D. Staphylococcus aureus

Response:
It is the repeated infection of bearded region by Staphylococcus.aureus.

So the answer to this question is D


Instruction:
Type of graft, best suited for renal transplantation ?
A. Allograft
B. Autograft
C. Xenograft
D. Isograft

Response:
Ans is 'd' i.e., Isograft Although the best graft is autograft, a renal graft can obviously not be an autograft. So the best renal graft is an isograft.

So the answer to this question is D


Instruction:
An increased incidence of cholangiocarcinoma is seen in all of the following except
A. Hydatid cyst of liver
B. Polycystic disease of liver
C. Sclerosing cholangitis
D. Liver flukes

Response:
None

So the answer to this question is A


Instruction:
Excessive desire for substance abuse in a drug addict is: called:
A. Craving
B. Impulse
C. Dependence
D. Compulsion

Response:
Ans: A (Craving) Ref: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th editionExplanation:AddictionIt is a lay-man term no longer preferred in medical literature.There is a range in the use of any substance (here "substance" is the term denoting anything which has some effect on body, usually brain) viz., - misuse (excessive, unwarranted use of medicines). harmful use (persistent use despite adverse health problems due to substance), abuse (persistent use despite adverse social/financial consequences).DependenceIt is a broader term covering above plus others.Two types of dependence noted:o Psychico PhysicalPsychic dependence is characterised by:o Craving: Craving denotes excessive,''persistent desire to use the substance,o Loss of control.Physical dependence is characterised by:o Tolerance (higher amount of substance needed to produce the original effect/kickl).o "Withdrawal symptoms'" (unique for each substance),o Dependence is a syndrome covering all (as per ICD-10, 3/6 criteria is enough for it).CompulsionIt is a repeated activity mostly due to an obsession.It is seen in OCD. where the person considers his compulsion as irrational (ego-dystonic)ImpulseIt is an irresistible urge to do something (usually harmful to self/others).Impulse- control disorders (ICD) are a group of disorders characterised by repetitive impulsive behaviour like pyromania, pathological gamblingCompulsion Vs ImpulseThe key difference between compulsion and impulse is the aim of the act- in compulsion the aim is to get rid of the anxiety and in impulse - no aim at all or a pleasure.Even though "repetitive" behaviour is common and central theme in all these three (Substance abuse, OCD, ICD) compulsion and impulse are not used in substance psychology widely and that too in same meaning.

So the answer to this question is A


Instruction:
A hyperplastic mass containing neuroendocrine cells in an area of chronic inflammation and scarred tissue of lung is called?
A. Carcinoid
B. Tumorlet
C. Hamartoma
D. Teratoma

Response:
Ans. (b) Tumorlet(Ref: Robbins 9th/pg 719-720; 8th/pg 729)Benign tumorlets of lungs are small, insignificant, hyperplastic nests Q of neuroendocrine cells seen in areas of scarring or chronic inflammation Q

So the answer to this question is B


Instruction:
A patient with history of chronic pancreatitis comes to you for regular follow up. Which vitamin deficiency can be expected in the patient
A. Vit B1
B. Vit K
C. Vit B6
D. Vit B3

Response:
Chronic pancreatitis is associated with malabsorption and steatorrhea and can lead to deficiency.
Fat soluble vitamins (A, D, E, K) though it is rare.

So the answer to this question is B


Instruction:
A 58-year-old female smoker with end-stage chronic obstructive pulmonary disease and osteoarthritis is on ipratropium bromide and albuterol inhalers, and hydrocodone-acetaminophen. She presents with respiratory distress for 2 days accompanied by increased thick, yellow sputum production, low grade fever, and increasing confusion. On examination she is mildly obtunded but arousable, BP 160/100, pulse 115/min, RR 30/min, O2 saturation 84% on her usual 3 L/min nasal cannula oxygen. She is using accessory muscles to breath, has diffuse wheezing and rhonchi bilaterally, a prolonged expiratory phase, distant but regular heart sounds, and no peripheral edema.Arterial blood gases (ABGs) on arrival are as follows:pH: 7.20,PO2: 70 mm HgPCO2: 65 mm Hgcalculated HCO3 29 mEq/L.Electrolytes return shortly thereafter as follows:Na: 140 mEq/LK: 5.1 mEq/LHCO3: 29 mEq/LCl: 100 mEq/LBUN 20 mg/dL creatinine 1.5 mg/dLglucose 89 mg/dL.After prompt initiation of noninvasive positive pressure ventilation (Bi-pap), blood cultures, toxicology screen, intravenous fluids, and IV antibiotics, you have time to consider the patient's metabolic situation. Choose the answer which best describes the acid-base condition and its etiology.
A. The patient has acute, severe respiratory acidosis caused by the sudden deterioration in her respiratory status.
B. The patient has an underlying metabolic acidosis caused by her renal insufficiency now compounded by a respiratory alkalosis.
C. The patient ingested abundant amounts of aspirin which caused a severe metabolic acidosis and respiratory failure.
D. The patient has a baseline chronic respiratory acidosis with metabolic compensation, now with a superimposed further respiratory acidosis caused by decreased ventilation.

Response:
Patients with severe COPD often have a baseline chronic respiratory acidosis with a PCO2 in the 50 to 60 mm Hg range. They are unable to ventilate sufficiently to correct the acidotic situation this creates. The kidney then compensates by retaining HCO3 . This results in a new steady state in which the patient has a near-normal pH on their blood gas despite the chronically elevated CO2 . In this question the further deterioration in the patient's respiratory status due to COPD exacerbation has caused further CO2 retention and a superimposed acute respiratory acidosis on top of the chronic respiratory acidosis. Salicylate overdose normally causes an anion gap acidosis and the AG is normal here. Volume depletion, especially due to recurrent vomiting, can lead to a contraction alkalosis, but this patient's acidosis indicates that the elevated bicarbonate level is caused by renal compensation for her chronic CO2 retention.

So the answer to this question is D


Instruction:
All of the following antiepileptic agents act Na+ channel except -
A. Vigabatrin
B. Phenytoin
C. Valproate
D. Lamotrigine

Response:
Ans. is 'a' i.e., Vigabatrin Mechanism of action of different antiepileptics. Prolongation of Na+ channel inactivation Facilitation of GABA mediated Cl- channel opening Inhibition of T type Ca++ current Decrease of excitatory neurotransmission o Phenytoin o Carbamazepine o Valproate o Lamotrigine o Topiramate o Zonisamide o Barbiturates o Benzodiazepine o Vigabatrin o Valproate o Gabapentin o Tiagabine o Ethosuximide o Trimethadione o Valproate o Felbamale

So the answer to this question is A


Instruction:
Best treatment of the large cyst:
A. Enucleation
B. Marsupialisation
C. Marsupialisation followed by Enucleation
D. Enucleation followed by marsupialisation

Response:
None

So the answer to this question is C


Instruction:
HPV type least commonly associated with carcinoma cervix :
A. 6
B. 35
C. 16
D. 18

Response:
HPV High oncongenicity: Types 16,18, 31, 33, 35, 45, 56 Low oncogenecity: Types 6,11, 42, 43 Ref: D.C.DUTTA&;S TEXTBOOK OF GYNAECOLOGY; 6th edition; Pg no:323

So the answer to this question is A


Instruction:
Index case refers to
A. First case of a communicable disease introduced into the population unit being studied
B. First case to come to attention of investigator
C. Developing from contact with primary case
D. An individual who has signs and symptoms connected to the suspected pathogens

Response:
First case of a communicable disease introduced into the population unit being studied Primary case First case to come to attention of investigator Index case Developing from contact with primary case Secondary case An individual who has signs and symptoms connected to the suspected pathogens Suspect case

So the answer to this question is B


Instruction:
Which of the following cell does not have cytotoxic activity ?
A. NK cells
B. Cytotoxic T-cells
C. Helper T-cells
D. Antibody dependent cells

Response:
Ans. is 'c' i.e.,Helper T-cells

So the answer to this question is C


Instruction:
The term "balanced anaesthesia" has been given by?
A. Simpson
B. Fischer
C. Lundy
D. Moan

Response:
Ans. is 'c' i.e., Lundy Term 'balanced anaesthesia' was introduced by Lundy in 1926. Balanced anaesthesia The cardinal feature of general anaesthetics are : ? Loss of all sensations, especially pain Sleep (unconciousness) and amnesia Immobility and muscle relaxation Abolition of reflexes In modern practice of balanced anaesthesia these modalities are achieved by using combination of inhaled and iv.drugs.

So the answer to this question is C


Instruction:
Test tube baby is produced by:
A. Sperm and ovum are directly implanted into fallopian tube
B. Sperm and ovum are fertilized in test tube and implanted
C. Fetus is grown in test tube
D. Only sperm is transferred

Response:
None

So the answer to this question is B


Instruction:
Which of the following statement regarding typhoid in children is false?
A. Splenomegaly may be seen
B. Neutropenia may be present
C. Urine and stool culture may show the organism after 2 weeks of illness
D. Relative bradycardia is invariably seen in children

Response:
Relative bradycardia is not always present in a child with typhoid fever. Typhoid is diagnosed using blood culture which is positive during the 1st week of illness, urine culture during 2nd or 3rd week or using widal test during 3rd week of illness. Ref: Textbook of Microbiology By Ananthanarayan, 8e page 296.

So the answer to this question is D


Instruction:
Which of the following is most suggestive of neonatal small bowel obstruction -
A. Generalized abdominal distension
B. Failure to pass meconeum in the first 24 hours
C. Bilious vomiting
D. Refusal of feeds

Response:
Generalized abdominal distention is more indicative of large bowel obstruction. In small bowel obstruction the distention is mild to massive depending on the site of obstruction (minimal or absent in proximal & mild to massive in distal) and is usually central and not generalized.
Failure to pass meconium in the first 24 hrs is a feature of obstruction as in Hirschprung's disease.
Refusal to feed is a common but nonspecific symptom.
The most common symptom suggestive of small bowel obstruction is bilious vomiting.

So the answer to this question is C


Instruction:
A drug that blocks the uptake of dopamine and norepinephrine into presynaptic nerve terminals and also blocks sodium channels in the axonal membrane is:
A. Cocaine
B. Ephedrine
C. Imipramine
D. Fluoxetine

Response:
It is a local anaesthetic agent (acts by inhibiting Na+ channel in the axonal membrane) that also possesses indirect sympathomimetic activity.

So the answer to this question is A


Instruction:
Initial 2cm of Duodenum does not get arterial supply by
A. Right gastric artery
B. Superior pancreaticoduodinal artery
C. Right Gastroepiploic artery
D. Common hepatic artery

Response:
Initial 2cm of Duodenum ( Duodenal Cap) is not supplied by Superior pancreaticoduodinal artery.

So the answer to this question is B


Instruction:
A 31-year-old woman has experienced increasing malaise for the past 4 months. Physical examination yields no remarkable findings. Laboratory studies show total serum protein of 6.4 g/dL, albumin of 3.6 g/dL, total bilirubin of 1.4 mg/dL, AST of 67 U/L, ALT of 91 U/L, and alkaline phosphatase of 99 U/L. Results of serologic testing for HAV, HBV, and HCV are negative. Test results for ANA, anti-liver kidney microsome-1 and anti-smooth muscle antibody are positive. A liver biopsy is done; microscopically, there are minimal portal mononuclear cell infiltrates with minimal interface hepatitis and mild portal fibrosis. What is the most likely diagnosis?
A. a1-Antitrypsin deficiency
B. Autoimmune hepatitis
C. Chronic alcoholism
D. HDV infection

Response:
Autoimmune hepatitis is a chronic liver disease of unknown cause in which antibodies to hepatocyte structural components cause progressive necrosis of hepatocytes, leading to cirrhosis and liver failure. Patients tend to improve with glucocorticoid therapy. a1 -Antitrypsin deficiency and Wilson disease can lead to chronic hepatitis and cirrhosis, but autoimmune markers are absent. Chronic alcoholism is not associated with the formation of autoantibodies. Because this patient does not have evidence of HBV infection, there can be no superinfection with HDV. Isoniazid may cause acute or chronic hepatitis, but without autoantibodies. Patients with primary biliary cirrhosis often have antimitochondrial antibody (which also can be seen in autoimmune hepatitis), but the bilirubin concentration and alkaline phosphatase level would be much higher in primary biliary cirrhosis.

So the answer to this question is B


Instruction:
In a case of glomerulonephritis (GN) , C3 is normal in all the following except?
A. Diffuse lupus nephritis
B. Good pasteur's syndrome
C. IgA nephropathy
D. HSP

Response:
Low C3 nephritis is observed in: Post-infectious GN, MPGN(Membranoproliferative GN) SLE Subacute bacterial endocarditis Cryoglobulinemia, shunt nephritis

So the answer to this question is A


Instruction:
Protein content in 100 grams of cow milk
A. 4.3
B. 3.2
C. 2.2
D. 1.2

Response:
Ans. is 'b' i.e., 3.2

So the answer to this question is B


Instruction:
Neurogenic cause of dysphagia includes following except:
A. Multiple sclerosis
B. Tetanus
C. Parkinsons's disease
D. Tetany

Response:
None

So the answer to this question is D


Instruction:
All of the following statement are true regarding Q fever except-
A. it is zoonotic disease
B. Human disease is characterized by an interstitial pneumonia
C. No rash is seen
D. Weil felix reaction is very useful for diagnosis

Response:
None

So the answer to this question is D


Instruction:
A mother is HB&;sAg positive at 32 weekds of pregnancy. What should be given to the newborn to prevent neonatal infection -
A. Hepatitis B vaccine + immuniglobulins
B. Immunoglobulins
C. Hepatitis B vaccine only
D. immunoglobulin followed by vaccine 1 month later

Response:
<p> Hepatitis B vaccine and immunoglobulins are given to the newborn to prevent infection. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:216. <\p>

So the answer to this question is A


Instruction:
Schwaz operation is done in
A. CSOM
B. Serous otitis media
C. Otosclerosis
D. Acute mastoiditis

Response:
Coical mastoidectomy, known as simple or complete mastoidectomy or Schwaz operation It is complete exenteration of all accessible mastoid air cells and conveing them into a single cavity. The posterior meatal wall is left intact and Middle ear structures are not disturbed. INDICATIONS 1. Acute coalescent mastoiditis. 2. Incompletely resolved acute otitis media with reservoir sign. 3. Masked mastoiditis. Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition; Pg no: 401

So the answer to this question is D


Instruction:
Which of the following condition is associated with hypokalemic metabolic alkalosis with hypeension:
A. Liddle's syndrome
B. Bater syndrome
C. Gitelman syndrome
D. Renal tubular acidosis

Response:
None

So the answer to this question is A


Instruction:
Endodontic therapy should preferably be initiated within______ post trauma.
A. 2-3weeks
B. 3-4weeks.
C. 2 months
D. 4 months.

Response:
None

So the answer to this question is B


Instruction:
True about saphenous vein
A. 1cm anterior to medial malleolus process
B. 1cm inferior to medial malleolus process
C. 1cm posterior medial malleolus process
D. 1cm superior to medial malleolus process

Response:
None

So the answer to this question is A


Instruction:
Leukoerythroblastic reaction is seen in following, except:
A. Secondaries in bone
B. Multiple myeloma
C. Hemolytic anemia
D. Lymphoma

Response:
Lymphoma

So the answer to this question is D


Instruction:
True about primary lymphoedema
A. Lymphangiosarcoma may occur
B. A/W Milroy's disease
C. Onset b/w 2-35 years indicates lymphoedema tarda
D. Onset > 35 years indicates praecox variety

Response:
<p> Lymphoedema Accumulation of fluid in extracellular and extravascular fluid compament , commonly in subcutaneous tissue. Classification: 1. Primary - without any identifiable disease. 2. Secondary- acquired due to definitive cause. Primary lymphoedema:- Affects commonly females. Common in lower limb and left side. It can be familial , syndromic ( Turners , Klinefelter&;s , Down&;s, Klipple Trenauy weber) It can be 1. Lymphoedema congenital : present at bih (<2yrs). Familial type is called Nonne- Milroy disease. 2. Lymphoedema praecox- present at pubey (2-35 years). Familial type is called Letessier- Meige&;s syndrome. 3. Lymphoedema tarda- present in adult life after 35 years. Complications: Skin thickening, abscess, maggot formation. Recurrent cellulitis Lymphangiosarcoma Recurrent streptococcal infection. {Reference: SRB&;s manual of surgery, 5th edition , page no. 247}

So the answer to this question is A


Instruction:
Bilirubin is absent in urine because it is?
A. Distributed in the body fat
B. Conjugated with glucoronide
C. Not filterable
D. d) Lipophilic

Response:
Bilirubin in the blood is normally almost all unconjugated and, because it is not water soluble, is bound to albumin and does not pass into the urine. Bilirubin is conjugated in hepatocytes. Reference : Davidson, 23rd Edition, page no : 851

So the answer to this question is C


Instruction:
Chronic Active Hepatitis is most reliably distinguished from chronic Persistent hepatitis by the presence of
A. Extrahepatic manifestation
B. Significant titre of antismooth muscle antibody
C. Characteristic liver histology
D. Hepatitis B surface antigen

Response:
Minimal chronic hepatitis (previously called chronic persistent hepatitis).
The portal chronic inflammation is mild and is restricted to the portal triads without extension into the Liver lobule across the limiting plate.
Chronic active hepatitis → characterized by continuing necrosis of Liver cells. The severe inflammation disrupts the limiting plate.

So the answer to this question is C


Instruction:
The structures passing posterior to diaphragm are all except:
A. Aoa
B. Azygous vein
C. Thoracic duct
D. Greater splanchnic nerve

Response:
D i.e. Greater splanchnic nerve

So the answer to this question is D


Instruction:
Bowler hat sign is seen in
A. Sigmoid volvulus
B. Midgut volvulus
C. Intussusception
D. Sessile colonic polyp

Response:
BOWLER HAT SIGN: Cup shaped filled defect seen on air contrast barium enema that represents POLYP if it points towards lumen. The "bowler-hat sign" represents the appearance of a sessile colonic polyp observed at an oblique angle on a double contrast barium enema. The bowler-hat sign is formed by a ring of barium adjacent to the base of the polyp surrounding a domed layer of barium coating the surface of the polyp.

So the answer to this question is D


Instruction:
Schwannoma arises most frequently from:
A. Vestibular Nerve
B. Trigeminal nerve
C. Cochlear Nerve
D. Facial Nerve

Response:
A schwannoma (also known as acoustic neuroma, acoustic neurinoma, or acoustic neurilemoma) is a benign, usually slow-growing tumor that develops from the vestibular nerves supplying the inner ear. The tumor comes from an overproduction of Schwann cells--the cells that normally wrap around nerve fibers like onion skin to help suppo and insulate nerves. As the vestibular schwannoma grows, it presses against the hearing and balance nerves, usually causing unilateral (one-sided) or asymmetric hearing loss, tinnitus (ringing in the ear), and dizziness/loss of balance. It comprises 5-10% of all intracranial neoplasms in adults. Incidence peaks in the fifth and sixth decades and both sexes are affected equally.

So the answer to this question is A


Instruction:
The pathogenesis of acute proliferative glomerulonephritis -
A. Cytotoxic T-cell mediated
B. Immune complex mediated
C. Antibody mediated
D. Cell-mediated (Typer IV)

Response:
Ans. is 'b' i.e., Immune complex mediated o Postinfectious acute proliferative glomerulonephritis is due to immune-complex mediated (Type III) hypersensitivity.Rapidly progressive glomerulonephritiso Rapidly progressive glomerulonephritis (RPGN) is a syndrome associated with severe glomerular injury and does not denote a specific etiology form of glomerulonephritis,o RPGN is defined by 2 criteria.Presence of epithelial crescentsOccurrence of rapidly progressive renal failure.o In most cases, the glomerular injury is immunologically mediated,o RPGN is divided into three groupsType I (Anti-GBM antibody)Characterized by the presence of autantibodies directed against the glomerular basement membrane (GBM).It is also called anti-GBM glomerulonephritis.The antibodies are directed against a particular protein found in GBM, type IV collegen, specifically the noncollagenous region of its a3 chain.Type II (Immune complex)Caused by deposition of immune complex.Thus immune complex disease causes type II RPGN.Type III (Pauci-immune)Most common type of RPGN.Defined by the lack of anti-GBM antibodies or immune complex.Instead, the glomeruli are damaged in an undefined manner, perhaps through activation of neutrophils in response to anti-neutrophilic cytoplasmic antibodies (ANCA).RAPIDLY PROGRESSIVE GLOMERULONEPHRITISTypeIRPGN(anti GBM antibody)o Idiopathico Goodpasture syndromeTypelIRPGN(Immune complex)o Idiopathico Post infectiouso Systemic lupus erythematouso Henoch schonlein purpurao IgA nephropathyo Membranoproliferative GNo CryoglobulinaemiaType III RPGN(Pauci immune)o ANCA associatedo Idiopathico Wegener granulomatosiso Microscopic PANo Microscopic polyangitis Note - Post infectious glomerulonephritis may be post streptococcal or post infective endocarditis.

So the answer to this question is B


Instruction:
What is the microscopic finding of cervical mucus during post-ovulatory period?
A. Shows pattern on drying
B. Is thick
C. Is thin and cellular
D. Is thin and alkaline

Response:
Dried cervical mucus examined microscopically has characteristic patterns dependent on the stage of the ovarian cycle. Mucus crystallization necessary for the production of the fern pattern is dependent on an increased sodium chloride concentration. Cervical mucus is relatively rich in sodium chloride when estrogen, but not progesterone, is being produced. Thus, during post-ovulatory cycle from approximately the 7th to the 18th day of the cycle, a fernlike pattern is seen. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 8. Prenatal Care. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

So the answer to this question is A


Instruction:
A 25 year old married nullipara undergoes laproscopic cystectomy for ovarian cyst which on histopath reveals ovarian serous cisadeno-carcinoma. What should be the next management?
A. Serial Ca-125 measurement and follow up
B. Hysterectomy and bilateral ping000phorectomy
C. Hysterectomy + Radiotherapy
D. Radiotherapy

Response:
Here the patient is 25 years old nullipara and cystectomy sample shows serous cysadenocarcinoma - Probably the disease is limited to the ovary removed, hence to be called stage Ia.
Doing an oophorectomy here will suffice as the patient is young and nullipara. Next step is to follow the patient with regular CA 125 estimations. Though the levels of CA 125 are not specific but in this condition where the follow up is after a known cause there is ample sensitivity.
“Fertility preservation in early stage ovarian cancer - The uterus and the contralateral ovary can be preserved in women with stage Ia, grade 1 to 2 disease who desire to preserve fertility. The conditions of the women should be monitored carefully with routine periodic pelvic examination and determinations of serum CA 125 levels. Generally, the other ovary and the uterus are removed at the completion of childbearing.”

So the answer to this question is A


Instruction:
What does PACS in medical imaging stands for?
A. Planned archiving common system
B. Planned archiving computerized system
C. Picture archiving and communication system
D. Picture archiving or computerized system

Response:
Historically, radiographic images were printed on film. However, with widespread adoption of PACS (picture archiving and communications system), images can be electronically processed and viewed on computer work screens. These images then can be transmitted anywhere electronically the Internet. Ref: Wasserman P.L., Pope T.L. (2011). Chapter 7. Imaging of Joints. In M.Y. Chen, T.L. Pope, D.J. Ott (Eds), Basic Radiology, 2e.

So the answer to this question is C


Instruction:
Atypical pneumonia is caused by all except
A. Mycoplasma
B. Adeno virus
C. Chlamydia
D. Hemophilus

Response:
Haemophilus influenza causes lobar pneumonia .it is one of the frequent cause of fatal pneumonia in the pandemic of influenza in 1918 _1919 where as atypical pneumonia is not as serious as typical pneumonia Ref:anantnarayan and paniker's microbiology 10th edition

So the answer to this question is D


Instruction:
False statement regarding Red Cross sign:
A. Can be used by army medical services
B. Punishable to use it without permission
C. Used by members of Red Cross
D. Can be used by doctors and ambulances

Response:
Red Cross emblem can be used only by members of army medical services. Usage of Red Cross emblem by doctors is Punishable with fine & forfeiture of Propey.

So the answer to this question is D


Instruction:
All of the following are true regarding LMWH (Low Molecular Weight Heparin) except :
A. It has higher and predictable bioavailability
B. It inhibits both factor IIa and Xa
C. PT; aPTT monitoring is not required
D. It has more favorable pharmacokinetics

Response:
None

So the answer to this question is B


Instruction:
Drug of choice for infantile spasms in a patient with tuberous scleosis is -
A. Vigabatrin
B. Tiagabine
C. Lamotrigine
D. Levetiracetam

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

So the answer to this question is A


Instruction:
Most common cause of bone malignancy
A. Secondaries
B. Osteosarcoma
C. Ewings sarcoma
D. Osteoclastoma

Response:
Metastatic bone disease is the most commonest malignancy of bones and is much more than primary bone tumors Metastatic Bone Diseases(MBD) Cancer that begins in an organ, such as the lungs. breast, or prostate, and then spreads to bone is called metastatic bone disease (MBD). More than 1.2 million new cancer cases are diagnosed each year. Approximately 50% of these tumours can spread (metastasize) to the skeleton. With improved medical treatment of many cancers --especially breast. lung, and prostate -- patients are living longer. However, the primary cancers in more of these patients are spreading to bone. The tumours that result are called bone metastases. Organs involved in MBD * The most common cancers that arise from organs and spread to bone include: * Breast * Lung * Thyroid * Kidney * Prostate Pathophysiology of MBD : MBD causes pain in the area of spread. damages and weakens bone, and puts the patient at a greater risk for broken bones. It can make it hard to paicipate in daily activities. The biggest concern for patients with MBD is the general loss in quality of life. How much of an effect MBD has on a patient will vary and is associated with how much the cancer has spread. which bones are affected, and how severe the bone damage is. There are a range of treatment options, however. that can help patients manage pain and maintain their independence and activity levels. After the lung and the liver, the skeleton is the most common site of spread of cancers that begin in organs. Metastases to the lung and liver are often not detected until late in the course of disease because patients experience no symptoms. In contrast. bone metastases are generally painful when they occur. Cancer most commonly spreads to these sites in the skeleton: Spine Pelvis Ribs Skull Upper arm Symptoms Pain. The most common symptom of MBD is pain. Patients may have pain in the spine, pelvis, or extremities because the bone has been weakened by the tumour. Fractures. Weakened bones break more easily. A fracture from a minor injury is another possible sign of MBD. Anaemia. The most common sites of spread -- spine, pelvis, ribs, skull, upper arm, and long bones of the leg --correspond to areas of bone marrow that produce high levels of red blood cells, the cells responsible for carrying oxygen to tissues in the body. Anaemia (decreased red blood cell production) is a common blood abnormality in patients with MBD. A cancer patient who experiences any pain, especially in the back, legs, and arms, should notify his or her doctor immediately. Pain that occurs without activity (i.e., walking or lifting an object) is paicularly concerning. Refer Apleys 9th/e p 216

So the answer to this question is A


Instruction:
An antiepileptic drug 'A' can also be used for the treatment of post–herpetic neuralgia and pain due to diabetic neuropathy. Which of the following can be the agent 'A' ?
A. Carbamazepine
B. Gabapentin
C. Lamotrigine
D. Primidone

Response:
None

So the answer to this question is B


Instruction:
Which virus causes hepatocellular carcinoma ?
A. Arbo
B. Herpes
C. Hepatitis-A
D. Hepatitis-B

Response:
Ans. is 'd' i.e., Hepatitis-B Hepatitis-B and hepatitis-C can cause hepatocellular carcinoma.

So the answer to this question is D


Instruction:
Cataracta brunescens result due to deposition of
A. Copper
B. Iron
C. Melanin
D. Keratin

Response:
Nuclear senile cataract: The usual degenerative changes are intensification of the age- related nuclear sclerosis associated with dehydration and compaction of the nucleus resulting in a hard cataract. It is accompanied by a significant increase in water insoluble proteins. However, the total protein content and distribution of cations remain normal. There may or may not be associated deposition of pigment urochrome and/or melanin derived from the amino acids in the lens. The nucleus may become diffusely cloudy (greyish) or tinted (yellow to black) due to deposition of pigments. In practice, the commonly observed pigmented nuclear cataracts are either amber, brown (cataracta brunescens) or black (cataracta nigra) and rarely reddish (cataracta rubra) in colour. Ref:- A K Khurana; pg num:- 176,178

So the answer to this question is C


Instruction:
Neuroendocrine lesions of the lung are -
A. Carcinoid tumor
B. Alveolar carcinoma
C. Hamartoma
D. Asthma

Response:
The normal lung contains neuroendocrine cells within the epithelium as single cells or as clusters, the neuroepithelial bodies.
Neuroendocrine lesions of the lung may be of following types -

A. Non-Neoplastic
(i) Reactive neuroendocrine cell hyperplasia in response to inflammation or scarring.
(ii) Idiopathic pulmonary neuroendocrine cell hyperplasia → a precursor lesion of tumorlets and carcinoids.

B. Neoplastic
(a) Benign
(i) Tumorlets → Small, inconsequential hyperplastic neuroendocrine cells seen in areas of scarring or chronic inflammation.

(b) Malignant
(i) Carcinoid tumor
(ii) Small cell carcinoma of the lung
(iii) Large cell neuroendocrine carcinoma of the lung.

So the answer to this question is A


Instruction:
NK cells kill the viral infected cells due to:
A. Increased expression of MHC class I molecules
B. Decreased expression of MHC class I molecules
C. Increased expression of MHC class II molecules
D. Decreased expression of MHC class II molecules

Response:
Ans. (a) Increased expression of MHC class I molecules Features of target cell killing by NK cell: Inversely related to target cell expression of MHC class I molecule. So, it kills the cell that expresses little or no HLA class I molecule (provide immunosurveillance) such as virus infected cells, ceain tumor cells and allogenic cells. Non-immune, i.e. without previous sensitization, MHC unrestricted and non-antibody mediated. It kills host cell infected with intracellular bacteria, e.g. Mycobacteria, TB. Listeria, monocytogens. Do not kill cells which express class I MHC (all normal nucleated cells express it).

So the answer to this question is A