Instruction:
Alcohol is metabolized by ?
A. Alcohol dehydrogenase
B. MEOS
C. Catalase
D. All of the above

Response:
Ethyl alcohol (ethanol) is readily absorbed from GIT and degraded by oxidation (oxidative process).Liver is the major site for ethanol oxidation.At least three enzyme systems are capable of ethanol oxidation :-i) Alcohol dehydrogenase (ADH) - Major pathwayii) Microsomal ethanol oxidising system (MEOS) : It involves cytochrome P450.iii) Catalase of peroxisomes.The product of all three oxidation pathways is acetaldehyde, which is rapidly oxidized to acetate by aldehyde dehydrogenase (ALDH).

So the answer to this question is D


Instruction:
Sago grain like lesions between fingers is
A. Pompholyx
B. Erythema multiformae
C. Scabies
D. Papular utricaria

Response:
Dyshidrosis, is a type of dermatitis, that is characterized by itchy blisters on the palms of the hands and bottoms of the feet.Blisters are generally one to two millimeters in size and heal over three weeks.However, they often recur.Redness is not usually present. Repeated attacks may result in fissures and skin thickening. also called as pompholyx Cause: Triggers may include allergens, physical or mental stress, frequent hand washing, or metals.Diagnosis is typically based on what it looks like and the symptoms.Allergy testing and culture may be done to rule out other problems. Other conditions that produce similar symptoms include pustular psoriasis and scabies. Avoiding triggers may be useful as may a barrier cream.Treatment is generally with steroid cream.High strength steroid creams may be required for the first week or two. Antihistamines may be used to help with the itch] If this is not effective steroid pills, tacrolimus, or psoralen plus ultraviolet A (PUVA) may be tried. About 1 in 2,000 people are affected in Sweden.Males and females appear to be affected equally.It explains about one in five cases of hand dermatitis.The first description was in 1873. The name comes from the word "dyshidrotic", meaning "difficult sweating", as problems with sweating was once believed to be the cause Ref Harrison20th edition pg 2345

So the answer to this question is A


Instruction:
All are antioxidants except
A. Vit A
B. Vit C
C. Vit D
D. Vit E

Response:
Antioxidant Vitamin Vitamin E Vitamin C Beta Carotene (Vit A) selenium ref Satyanarayana 4th ed page 661

So the answer to this question is C


Instruction:
Which of the following set is termed as epidemiological triad:
A. Endemic, epidemic and outbreaks
B. Agent, host and environment
C. Incidence, prevalence and disease load
D. Agent, man and disease

Response:
Ans (b) Agent, host and environmentRef : K. Park 23rd ed. / 33-34, Park 19th/ 30A broad concept of disease causation that synthesized the basic factors of agent, host and environment (see adjacent figure)This model--agent, host and environment-- has been in use for many years. It helped epidemiologists to focus on different classes of factors, especially with regards to infectious diseases.

So the answer to this question is B


Instruction:
The minimum level of TSH that can he detected by TSH assay of the third generation thyroid function tests is which of the following?
A. 0.4 lU/ml
B. 0.04 IU/ml
C. 0.004 lU/ml
D. 4 IU/ml

Response:
Functional sensitivities for three generations of TSH assays: First generation: Functional sensitivity is 1-2 IU/mL Second generation: Functional sensitivity is 0.1-0.2 IU/mL Third generation: Functional sensitivity is 0.01-0.02 IU/mL Among the options more appropriate is 0.04 IU/mL Ref: Aicle: Evolution of TSH Assays: A Third Generation Viewpoint

So the answer to this question is B


Instruction:
Blood supply of ventral 2/3rd of interventricular septum of hea is
A. Right coronary aery
B. Left coronary aery
C. Posterior interventricular aery
D. Marginal aery

Response:
The posterior interventricular aery, a branch of right coronary aery, supplies the posterior 1/3 of the interventricular septum. The remaining anterior 2/3 is supplied by the anterior interventricular aery which is a septal branch of the left anterior descending aery, which is a branch of left coronary aery . B D CHAURASIA'S HUMAN ANATOMY UPPER LIMB THORAX-VOLUME-1 SIXTH EDITION Page-265

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 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:
The reflex sympathetic dystrophy or shoulder-hand syndrome is a painful periahritis or adhesive capsulitis of the shoulder ("frozen shoulder"), usually on the left side, associated with erythema, increased sweating, shiny induration, edema, tenderness, pain, and immobility of the ipsilateral hand. Reduction of finger flexion, loss of movement, temperature changes, sensory disturbances, and, hair/nail growth changes are seen. Neurotrophic ulcerations of the fingers and thickening of the palmar aponeurosis with nodules and/or Dupuytren contracture may be late sequelae. Ref: Johnston G.A., Graham-Brown R.A. (2012). Chapter 150. The Skin and Disorders of the Alimentary Tract, the Hepatobiliary System, the Kidney, and the Cardiopulmonary System. In K. Wolff (Ed), Fitzpatrick's Dermatology in General Medicine, 8e.

So the answer to this question is C


Instruction:
The most likely hormone increased in a middle aged female with a mass in sella turcica is:
A. Prolactin
B. Thyroxine
C. Estrogen
D. ADH

Response:
Answer is A (Prolactin): The pituitary gland sits cradled within the sella turcica. The most common cause of a mass in the sella turcica is a Pituitary adenoma. The most frequent type of hyper-functioning pituitary adenomas are Prolactinomas that account for approximately 30 percent of all clinically recognized pituitary adenomas. Elevated levels of Prolactin are characteristic findings 'Hyperprolactinemia is the most common pituitary hormone hypersecretion syndrome in both men and women. Prolactin secreting pituitary adenomas (Prolactinomas) are the most common cause' - Harrison

So the answer to this question is A


Instruction:
Which is not supplied by pelvic splanchnic nerves -
A. Rectum
B. Urinary bladder
C. Appendix
D. Uterus

Response:
Most of the pelvic viscera are supplied by pelvic splanchnic nerve through inferior Hypogastric plexus.
-        Middle rectal plexus

Rectum

-        Prostatic plexus

Prostate
Seminal vesicles
Ejaculatory duct

-        Vesical plexus

Urinary bladder
Terminal part of ureters
Seminal vesicles

-        Utero-vaginal plexus

Uterus
Uterine tube
Ovaries
Erectile tissue of vestibule

So the answer to this question is C


Instruction:
Which drug is not used now in Alzheimer's disease?
A. Tacrine
B. Galantamine
C. Donepezil
D. Rivastigmine

Response:
Ans. (A) Tacrine(Ref: KDT 8th/e p119, 518)Because of hepatotoxicity, and requirement of frequent dosing, tacrine is less often used than other agents.

So the answer to this question is A


Instruction:
Strongest attachment of Zonule is at-
A. Equator
B. Just anterior to equator
C. Posterior to equator
D. Posterior lobe

Response:
Anterior fibers of zonules are strongest and are inseed into the lens capsule just anterior to the equator. Ref: Textbook of clinical ophthalmology p.1139.

So the answer to this question is B


Instruction:
K-complex is seen in which stage of sleep cycle-
A. REM
B. Stage 1 NREM
C. Stage 2 NREM
D. Stage 3 NREM

Response:
Ans. is 'c' i.e., Stage 2 NREM * Full awake and alert state - Beta rhythm* Awake, eye closed and mind wandering but with less attentiveness - Alpha - rhythm* Stage 1 NREM - Theta rhythm* Stage 2 NREM - Sleep spindles, K complex* Stage 3 & 4 NREM (Deep sleep) - Delta rhythm* REM sleep - Beta rhythm and sometimes also reappearance of alpha rhythm.

So the answer to this question is C


Instruction:
Arsenic causes
A. Portal hypertension
B. Cirrhosis
C. Extra hepatic portal vein obstruction
D. Hepatic carcinoma

Response:
None

So the answer to this question is A


Instruction:
Which of the following is contraindicated in CRF –
A. Halothane
B. Enflurane
C. Desflurane
D. Isoflurane

Response:
Enflurane and sevoflurane are considered undesirable for patients with renal disease.

So the answer to this question is B


Instruction:
Not true regarding atropine
A. Used as an eye ointment
B. Used in refraction in less than 5 yr of children
C. Fast action
D. Experimentally used in treatment of myopia

Response:
Atropine is slow acting and not fast acting ATROPINE( antimuscranic) causes cycloplegia as ciliary muscles are supplied by Parasympthetic sytem sho ciliary nerve , branch of 3rd cranial nerve Used as eye ointment Children < 5 yr, Children with Squint slow action Three times for 3 days Peak Effect- 3 Days Complete cycloplegia, but less potent mydriasis Retinoscopy - 3 Days PMT - 14 Days Tonus - 1 D experimentally used in treatment of myopia. Homatropine=> 5 yr

So the answer to this question is C


Instruction:
Ultrasonic devices are instruments for the removal of dentin from root canal walls have proved to be
A. Effective
B. Disappointing
C. Lethal
D. None of the above

Response:
None

So the answer to this question is B


Instruction:
Grey baby syndrome is caused by
A. Amikacin
B. Tetracycline
C. Vancomycin
D. Chloramphenicol

Response:
Amikacin - nephrotoxicity, ototoxicity and neuromuscular blockade Tetracycline - nephrotoxicity when given along with diuretics, phototoxicity, , affect dentition and bones in young children, Fanconi syndrome and Renal tubular acidosis. Vancomycin - red man syndrome Chloramphenicol- grey baby syndrome,nephrotoxicity,ototoxicity.

So the answer to this question is D


Instruction:
Patients with organic hea disease in pregnancy most commonly die during
A. 20-24 weeks of pregnancy
B. First stage of labour
C. Soon following delivery
D. Two weeks postpaum

Response:
Maternal moality in Hea disease complicatin Pregnancy Maternal moality is lowest with rheumatic hea lesions and acyanotic group of hea diseases ie <1% With the elevation of pulmonary vascular resistance especially with cyanotic hea diseases the moality may be raised to 50%( Eisenmengers syndrome) Most of the deaths occur due to cardiac failure and maximum deaths occurs following bih. Management Of Cardiac Failure: The principle if management is same as in the non-pregnant women. A cardiologist should be involved Propped up position O2 Adminstration Monitoring with ECG and pulse oximetry Diuretic: Frusemide (40-80mg) IV - Anticipatory aggresive diuresis is needed to avoid pulmonary congestion. Mechanical Ventilation Injection morphine 15mg IM Digoxin 0.5mg IM followed by Tab.Digoxin 0.25mg P/O Dysrhythmias -Quinidine or electrica cardiaversion Tachyarhymias -Adenosine(3-12mg) IV or DC conversion. Reference: D.C.Dutta's Textbook of Obstetrics; 9th edition; Page no: 258 & 260

So the answer to this question is C


Instruction:
Secondary osteosarcoma are associated with -
A. Paget's disease
B. Osteogenesis imperfecta
C. Melhoreostosis
D. Ankylosing spondylitis

Response:
Ans. is 'a' i.e., Paget's disease Causes of secondary osteosarcomao Pagets Diseaseo Fibrous dysplasiao Radiationo Enchondromatosiso Hereditary multiple exostosiso Chronic osteomyelitiso Bone infarction

So the answer to this question is A


Instruction:
All are required for balancing EXCEPT:
A. Visual system
B. Olfactory system
C. Proprioception
D. Vestibule and cochlea

Response:
Ans. (b) Olfactory systemRef: Dhingra's ENT 5th ed. / 22* Requirements for balancing:# Vision# Vestibule and cochlea# Proprioception# Cerebellum

So the answer to this question is B


Instruction:
The	success	of the	calcium	hydroxide	pulpotomy is
determined by the
A. Formation of calcific bridge
B. Formation of hard base to support restoration
C. Continuation of root formation and Apexogenesis
D. All of the above

Response:
None

So the answer to this question is C


Instruction:
Which among the following simple tests is used to measure/assess urethral hypermobility?
A. Office cystometry
B. Q tip test
C. Voiding diary
D. Postvoid residual urine

Response:
In Q tip test - A cotton swab is introduced into the urethra following which the patient is asked to perform valsalva manoeuver and the angle of urethra is assessed. An angle of excussion of > 300 from the horizontal indicates urethral hypermobility. Note:- Stress test can also be used to assess urethral hypermobility. Ref: Essentials of Gynaecology by Lakshmi Seshadri, Edition 1, page - 338.

So the answer to this question is B


Instruction:
Gynaecomastia may be seen in patient with all except-
A. Climetidine therapy
B. Cirrhosis of liver
C. Klinefelter's syndrome
D. Turner's syndrome

Response:
None

So the answer to this question is D


Instruction:
A 30 year old man presents with 6 month history of nasal discharge, facial pain and fever. On antibiotic therapy, fever subsided. After 1 month again had symptoms of mucopurulent discharge from the middle meatus and the mucosa of the meatus appeared congested and oedematous. Next best investigation would be:
A. MRI of the sinuses
B. Non-Contrast CT of the nose and para-nasal sinuses
C. Plain x-ray of the para-nasal sinuses
D. Inferior meatus puncture

Response:
B i.e., Non contrast CT for nose & paranasal sinuses Bacterial sinusitis is uncommon in patients whose symptoms have lasted for > 7days. This diagnosis is reserved for patients with purulent nasal discharge and persistent symptoms (i.e. symptoms lasting > 7 days in adults or > 10-14 days in children). CT or sinus radiography is not recommended in routine cases, paicularly early in course of disease (< 7 days) d/t high prevalence of acute viral rhinosinusitis. However, CT (noncontrast) of sinuses is the radiological investigation of choice in evaluation of persistent, recurrent, or chronic (lasting > 12 weeks) sinusitisQ. Pott's puffy tumor is advanced frontal sinusitis with soft tissue swelling & pitting edema over frontal bone d/ t communicating subperiosteal abscess.

So the answer to this question is B


Instruction:
The following is true of Giadiasis except -
A. Complement fixation test is diagnostic
B. Stool contain only cysts
C. Habitat is colon
D. Trophozoites and cysts are found in duodenum

Response:
Laboratory diagnosis: Microscopic examination Culture-CPLM Antigen detection-ELISA Molecular methods:nucleic acid hybridization and PCR(refer pgno:34 baveja)

So the answer to this question is A


Instruction:
All of the following pairs regarding adductor canal are true EXCEPT:
A. Roof: Saorius Muscle
B. Contents: Femoral Nerve
C. Floor: Adductor longus and Magnus
D. Antero-lateral boundary: Vastus Medialis

Response:
Femoral nerve is not a content of adductor canal. Saphenous nerve, a branch of femoral nerve is present in the canal and passes anterior to femoral aery Adductor canal- Anteromedial wall -saorius. Posterior wall -adductor longusandadductor magnus. Laterally -vastus medialis. content- The canal contains thesubsaorial aery (superficial femoral aery), subsaorial vein (superficial femoral vein), saphenous nerve, and thenerve to the vastus medialis).

So the answer to this question is B


Instruction:
The Nobel prize in Physiology or Medicine for 2007 was jointly awarded to Mario R. Capecchi, Main J. Evans J. Evans and Oliver Smithies for their discoveries of aEUR'
A. Detection of chemical/growth factors for preventing growth of tumors
B. Principles for introducing specific gene modifications in mice by the use of embryonic stem cells
C. Non genetic method treating muscular dystrophies
D. Not recalled

Response:
Principles for introducing specific gene modifications in mice by the use of embryonic stem cells [Ref : The Nobel prize in physiology or Medicine for 2007 was jointly awarded to Mario R. Capecchi, Main J. Evans and Oliver Smithies for their discoveries of "principles for introducing specific gene modifications in mice by the use of embryonic stem cells". Summary This year's Nobel Laureates have made a series of ground breaking discoveries concerning embryonic stem cells and DNA recombination in mammals. Their discoveries led to the creation of an immensely powerful technology referred to as gene targeting in mice. It is now being applied to viually all areas of biomedicine - from basic research to the development of new therapies. Gene targeting is often used to inactivate single genes. Such gene "knockout" experiments have elucidated the roles of numerous genes in embryonic development, adult physiology, aging and disease. To date, more than ten thousand mouse genes (approximately half of the gene in the mammalian genome) have been knocked out. Ongoing international effos will make "knockout mice" for all genes available within the near future. With gene targeting it is now possible to produce almost any type of DNA modification in the mouse genome, allowing scientists to establish the roles of individual genes in health and disease. Gene targeting has already produced more than five hundred different mouse models of human disorders, including cardiovascular and neurodegenerative diseases, diabetes and cancer.

So the answer to this question is B


Instruction:
Increased IgA levels are seen in
A. Alcoholic hepatitis
B. Alcoholic cirrhosis
C. Microvesicular fatty change
D. Macrovesicular fatty change

Response:
Alcoholic liver cirrhosis is characterised by increasing levels of immunoglobulins. Increased levels of IgA was observed in alcoholic cirrhosis. REFERENCE: NCBI.

So the answer to this question is B


Instruction:
Drug of choice for pheochromocytoma -
A. Propranolol
B. Phenoxybenzamine
C. Prazosin
D. Nitroprosside

Response:
Ans. is 'b' i.e., Phenoxybenzamine Pharmacological treatment of pheochromocvtomao Preoperatively or when tumour cannot be removed, blood pressure control is achieved by cc-adrenoreceptor blockade which reverses peripheral vasoconstriction -Phenoxybenzomine is the DOCo For hypertensive crises or intraoperative control of BP, phentolamine is the DOC. Prazosin is an alternative. Nitroprusside can also be used------Harrison 17th/e p. 1561.o In adrenaline secreting tumors, if tachycardia persists, p-blocker can be added after starting a-blockers.o ACE inhibitor or calcium channel blockers can be used when blood pressure is difficult to control with phenoxybenzamine alone.o Metyrosine has been used with some success to block catecholamine synthesis in malignant pheochromocytoma.o Metaiodobenzylguanidine (MIBG) is actively taken up by adrenergic tissue -123I-MIBG can be used for selective therapeutic irradiation of functioning metastasis.

So the answer to this question is B


Instruction:
Which of the following is a protista-
A. Algae
B. Fungi
C. Protozoa
D. Bacteria

Response:
Protozoa are unicellular,eukaryotic cell.Single protozoan cell performs all the functions I.e, respiration, digestion,excretion,reproduction and locomotion.Protozoal cell consists of plasma membrane,cytoplasm,mitochondria,golgi body,ribosomes,endoplasmic reticulum,nucleus ,nuclear membrane and chromosomes (refer pgno:13. Baveja 3 rd edition)

So the answer to this question is C


Instruction:
A 45 year old female is diagnosed as a case of pneumococcal meningitis.Her blood sample were sent for culture sensitivity. In the mean time best drug to sta as an empirical treatment is
A. Penicillin G
B. Doxycycline
C. Streptomycin
D. Vancomyin + Ceftriaxone

Response:
Harrison's textbook of internal medicine 17th edition . *Treatment of choice for pneumococcal meningitis is cetriaxone (2g q 12h) plus vancomycin (1g q 12h).

So the answer to this question is D


Instruction:
A 38 year old gentleman reports of decreased hearing in the right ear for the last two years. On testing with a 512 Hz tuning fork the rinne's test without masking is negative on the right ear and positive on the left ear. With the weber's test the tone is perceived as louder in the left ear. The most likely patient has -
A. Right conductive hearing loss
B. Right sensorineural hearing loss
C. Left sensorineural hearing loss
D. Left conductive hearing loss

Response:
None

So the answer to this question is B


Instruction:
Necrotising ragged ulceration with no apparent inflammatory response is indicative of:
A. Leucocytosis
B. Polycythemia vera
C. Sickle cell anemia
D. Agranulocytosis

Response:
None

So the answer to this question is D


Instruction:
In an immediate postoperative hysterectomy, a patient develops leakage of urine. What is the most likely cause?
A. Urethral injury
B. Bladder injury
C. Overflow incontinence
D. Stress urinary incontinence

Response:
Immediate postoperative leakage of urine develops due to drainage of the peritoneal collection of urine. Both bladder and ureteral defects can cause leakage of urine into the peritoneal cavity. Bladder injury is more common than ureteral injury with the incidence of 1%. The other presentation may be abdominal pain and ascites. Overflow incontinence is because of detrusor underactivity and is usually not a complication of hysterectomy Stress urinary incontinence is because of urethral hypermobility or intrinsic sphincter deficiency, the causes are usually insufficient to suppo from pelvic floor muscles and neuromuscular damage and hence is uncommon with hysterectomy

So the answer to this question is B


Instruction:
Which of the following is sex linked disorder?
A. Thalassemia
B. Klinefelter's syndrome
C. Hemophilia
D. Neurofibromatosis

Response:
None

So the answer to this question is C


Instruction:
Your examination reveals a probing pocket depth of 6 mm on the facial surface of tooth 30. The free gingival margin is 2 mm apical to the CEJ (there is 2-mm recession on the facial). How much attachment loss has there been on the facial of this tooth?
A. 6 mm
B. 2 mm
C. 8 mm
D. 4 mm

Response:
When the free gingival margin is apical to the CEJ, recession has occurred. Attachment loss is the measure from the CEJ to the base of the periodontal pocket. With the free gingival margin 2 mm apical to the CEJ and the probing pocket depth measurement 6 mm, there has been 8 mm loss of attachment.

So the answer to this question is C


Instruction:
A child is brought to your clinic for a routine examination. She can put on a T-shirt but requires a bit of help dressing otherwise. She can copy a circle well but has difficulty in copying a square. Her speech is understandable and she knows four colors. She balances proudly on each foot for 2 seconds but is unable to hold the stance for 5 seconds. Which of the following is the most likely age of this child?
A. 1 year
B. 2 years
C. 3 years
D. 4 years

Response:
Four- and five-year-old children should be able to copy a square and a cross; children younger than this age have difficulty with this task. By 4 years of age, their language should be fully understandable by the examiner. Children begin to be able to name four colors, define five words, and know three adjectives. A 4-year-old child can stand on each leg for 2 seconds, and by 5 years of age that skill can be maintained for at least 5 seconds. A 4-year-old child may require some help with some clothing, but by 5 years of age they are able to dress themselves independently, skip, and ask questions about word meaning.

So the answer to this question is A


Instruction:
A 10 yr old child is always restless, inattentive to study and always wants to play outside. Parents are extremely distressed. What would you advise?
A. It is a normal behaviour
B. Behaviour therapy
C. It is a serious illness requires medical treatment
D. Needs change in environment

Response:
Behaviour therapy [Ref: Nelson 18thie p. 1481 First, Look at the DSM criteteria for ADHD The American Academy of Child Adolescent Psychiatry (AACAP) considers it necessary that the following be present before attaching the label of ADHD to a child. The behaviors must appear before age 7. They must continue foe at least six months. The symptoms must also create a real handicap in at least two of the following areas of the child's life : ? In the classrrom On the playground At home In the community, or In social settings The information provided in the question is not enough to diagnose it as a case of attention deficit hyperactivity disorder. Most of the parents will complain that their child is always restless and wants to play outside, It is not mentioned that the child suffers from some handicap while playing. The DSM criteria states that behaviour problem must began before age 7 years and must be present for at least 6 months. These features have not been mentioned in the question and without these we cannot diagnose AMID. The behaviour of the child may be problematic to his parents but he falls sho of meeting the full criteria for diagnosis of ADHD. DSM-IV criteria Either A or B A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for development level. I. Often does not give close attention to details or makes careless mistakes in schoolwork. work, or other activities. Often has trouble keeping attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). Often has trouble organizing activities. Often avoids, dislikes, or doesn't want to things that take a lot of mental effo for a long period of time (such as schoolwork or homework). Often loses things needed for tasks and activities (e.g., toys, school assignments. pencils, books or tools). Is often easily distracted. Often foretful in daily activities. B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level : ? Hyperactivity Often fidgets with hands or feet or squirms in seat. Often gets up from seat when remaining in seat is expected. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless). Often has trouble playing or injoying leisure activities quietly. Is often "on the go" or often acts as if "driven by a motor". Often talks excessively Impulsiveness Often blus out answers before questions have been finished. Often has trouble waiting one's turn. Often interrupts or intrudes on others (e.g., butts into conversations or games).

So the answer to this question is B


Instruction:
Spontaneous remission is most frequent with –
A. Herpes labialis
B. Herpes genitalis
C. Herpetic chancroid
D. Herpes gestationis

Response:
Lesions of Herpes gestationis (pemphigoid gestationis) subsides spontaneously after delivery.

So the answer to this question is D


Instruction:
True about Erythema elevatum diutinum:
A. Chronic cutaneous fungal infection
B. Most common site of involvement is trunk
C. A cutaneous marker of glucagonoma
D. Dapsone is drug of choice

Response:
Ans. D. Dapsone is drug of choice.Erythema elevatum diutinum:a. Rare disease; unknown incidence.b. A chronic leukocytoclastic vasculitis typified by a distinctive clinical pattern.c. Symmetric, erythematous, violaceous, or yellow-brown papules/nodules/plaques.d. Most common sites of involvement are the extensor surfaces of the hands, fingers, elbows, knees, legs, and Achilles tendon. Trunk is usually spared.e. Co-occurring diseases include monoclonal paraproteinemias, lymphoproliferative disorders, chronic infection, autoimmune conditions, and connective tissue diseases.f. In the early stage of erythema elevatum diutinum (EED), nonspecific leukocytoclastic vasculitis is observed. In later stages, granulation tissue and fibrosis form with a diffuse mixed-cell infiltrate showing a predominance of neutrophils. The capillaries may still show deposits of fibrinoid material or merely fibrous thickening.g. Dapsone- and sulfone-based therapies are considered first-line treatment choices for EED

So the answer to this question is D


Instruction:
Commonest presentation of Hodgkin's lymphoma is -
A. Painless enlargement of lymph node
B. Pruritis
C. Fever
D. Leuocytosis

Response:
Most patients present with palpable lymphadenopathy that is nontender; in most patients, these lymph nodes are in the neck, supraclavicular area, and axilla. More than half the patients will have mediastinal adenopathy at diagnosis, and this is sometimes the initial manifestation. Subdiaphragmatic presentation of Hodgkin's disease is unusual and more common in older males." - Harrison

So the answer to this question is A


Instruction:
Oxygenated blood to the fetus is carried by –
A. Umblical artery
B. Umblical vein
C. SVC
D. Pulmonary artery

Response:
Fetal circulation

Fetal circulation differs from adult circulation in several ways. Almost all differences are attributable to the fundamental difference in the site of gas exchange.
In the adult, gas exchange occurs in the lungs, while in the fetus placenta provides the exchange of gases and nutrients.

The course of fetal circulation
A) Blood returning to the heart

Blood oxygenated in the placenta returns by way of the umbilical vein, which enter the fetus at the umbilicus and course through to join the portal vein.
The ductus venous is a bypass shunt between the portal vein and IVC.
Most of the umbilical venous blood shunt through the ductus venosus to the IVC.
Blood from IVC (which carries the blood drained from lower extremities, umbilical veins, hepatic veins and renal veins) enters the right atrium.
On reaching the right atrium, about 1/3rd of total inferior vena caval return of blood enters the left atrium through formen oval.
The rest two third mixes with the venous return from SVC (which carries the blood drained from head, neck and upper limbs) to enter the right ventricles.

B) Blood coming out of the heart
1. Right side

The right ventricle pumps out the blood into pulmonary trunk very small amount of this blood enters the pulmonary circulation because the lungs are collapsed and pulmonary vascular resistance is high.
Most of this blood passes to descending aorta through ductus arteriosus, a shunt between pulmonary trunk and descending Aorta.
The descending aorta carries blood to umbilicus through the umbilical artery, for oxygenation.
Descending aorta also supplies the blood to lower limbs, kidney and abdominal viscera.

2. Left side

The left ventricle pumps blood into the ascending aorta for distribution in the coronary circulation, head and upper limbs.

So the answer to this question is B


Instruction:
Commonest cause of systemic hypeension in children is -
A. Coarctation of aoa
B. Acute glomeurlonephritis
C. Nephrotic syndorme
D. Congenital adrenal hyperplasia

Response:
Ans. is 'b' i.e., Acute glomerulonephritis o None of the option is correct because most common cause is chronic glomieulonephritis. o But, amongst the given options acute glomerulonephritis is the most common disease that progresses to chronic glomerulonephritis.

So the answer to this question is B


Instruction:
Which of the following DOES NOT form boundary of triangle of auscultation?
A. Serratus anterior
B. Scapula
C. Trapezius
D. Latissimus dorsi

Response:
The triangle of auscultation is a small triangular space on the back where the relatively thin musculature allows for respiratory sounds to be heard more clearly with a stethoscope. It has the following boundaries: Medial wall is formed by lateral border of trapezius Lateral wall is formed by medial border of scapula Inferiorly by the upper border of latissimus dorsi Floor is formed by: 7th rib, 6th and 7th intercostal spaces, rhomboids major On the left side, the cardiac orifice of the stomach lies deep to the triangle, and in days before X-rays were discovered the sounds of swallowed liquids were auscultated over this triangle.

So the answer to this question is A


Instruction:
Poverty line is defined as expenditure required for daily calorie consumption below
A. 1800
B. 2100
C. 2000
D. 2200

Response:
None

So the answer to this question is B


Instruction:
Relining or rebasing of complete denture is required because
A. Denture base material abrades
B. Ridge resorption is a continuous phenomenon
C. It prolongs the useful Life of the denture
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
True about the following virus: A. Enveloped, Club or petal shaped projections, Positive ss RNA- Largest genome of RNA virus. B. Diseases caused by these viruses are SARS, MERS. C. Reservoir is horseshoe bats for SARS, likely spread from palm-civets cats contact with humans. D. Symptoms of MERS appear within a day following contact with an infected patient. E. SARS is more severe than MERS. F. MERS infection is more servere in individuals who have a preexisting illness like diabetes and hea diseases.
A. Only A, B, D, E, F are True
B. Only A, B, C, D are True
C. A, B, C, F are True
D. All are True

Response:
The given image is of Corona virus. It is an Enveloped virus with Club or petal shaped projections, Positive ss RNA virus. The Wuhan coronavirus or the 2019-nCoV is a positive-sense, single-stranded RNA coronavirus first repoed in late 2019 and linked in the 2019-2020 pneumonia outbreak in Wuhan City in central China. 100-160 nm in size. Disease caused by these viruses are: SARS (severe acute respiratory syndrome) MERS (Middle East respiratory syndrome ) COVID19. Reservoir for SARS is HORSESHOE bats, likely spread from palm-civets cats contact with humans. MERS has a median Incubation Period of 5 days, symptoms appear between 2-14 days. MERS is more severe in individuals who have a preexisting illness like diabetes and hea diseases.

So the answer to this question is C


Instruction:
In allergic pharyngitis granularity in posterior pharynx is due to -
A. Hyperplasia of mucous membrane
B. Hyperplasia of sebaceous glands
C. Hyperplasia of submucosal lymphoid tissue
D. Inspisated mucous

Response:
Ans. is 'c' i.e.. Hyperplasia of submucosal lymphoid tissue Clinical Features of Allergic Rhinitiso Frequent colds, persistently stuffy nose, pale edematous nasal mucosa, loss of sense of smell due to mucosal edema, post nasal drip, chronic cough and hearing impairment due to Eustachian tube blockade or fluid in the middle ear.o Nasal signs: Transverse nasal crease. Turbinates are usually swollen, Thin watery mucoid discharge,o Ocular signs: edema of lids, congestion and cobblestone appearance of conjunctiva, dark circles under the eyes (allergic shiners).o Otologic signs: retracted tympanic membrane, serous otitis media, Eustachian tube blockadeo Pharyngeal signs: granular pharyngitis due to hyperplasia of submucosal lymphoid tissue. Child with prolonged symptoms have mouth breathingo Laryngeal signs: hoarseness of voice and edema of vocal cords.

So the answer to this question is C


Instruction:
Golfers elbow ?
A. Medial epicondylitis
B. Lateral epicondylitis
C. Posterior elbow dislocation
D. Lateral collateral ligament injury

Response:
Ans. is 'a' i.e., Medial epicondylitis Golfer's elbow (Medial epicondylitis) It is about three times less common than tennis elbow. Patient has pain and tenderness on the medial epicondyle of the elbow. The bony attachment of flexor pronator origin is affected. Often there is an associated ulnar nerve neuropathy. A medial collateral ligament injury should be excluded.

So the answer to this question is A


Instruction:
tripple negative ductal invasive carcinoma of breast is ?
A. medullary carcinoma
B. colloidal
C. basal like invasive
D. lobular

Response:
MEDULLARY CARCINOMA breast : * High nuclear grade, aneuploidy, hormone receptors - nt, HER2/neu overexpression -nt. * Lymph node metastases -infrequent. * Syncytial growth pattern and pushing borders - d/t overexpression of adhesion molecules -> intercellular cell adhesion molecule and E-cadherin -) limit metastatic potential. HISTOLOGY : Solid, syncytium-like sheets of large cells with vesicular, pleomorphic nuclei, prominent nucleoli 4 > 75% of the tumor Frequent mitotic figures; Moderate to marked lymphoplasmacytic infiltrate surrounding and within the tumor. Pushing (noninfiltrative) border. * Poorly differentiated. ref : bailey and love 27th ed

So the answer to this question is B


Instruction:
Pseudoepitheliomatous hyperplasia is a feature of:
A. Myoblastoma
B. Blastomycosis
C. Papillary hyperplasia
D. All of the above

Response:
Pseudoepitheliomatous hyperplasia is also seen in

Granular cell myoblastoma
Blastomycosis
Papillary hyperplasia
DLE

So the answer to this question is D


Instruction:
A 36-year-old woman with sickle cell disease presents with increasing pain in her right hip. She has no fever, chills, back or other bone pain, and there is no history of any trauma.On examination, her temperature is 37.3degC, range of motion in the right hip is reduced, she walks with a limp, and the right leg is shorter than the left. Movements of the hip and walking on it are painful. X-rays of the hip are shown in Figure below. Which of the following is the most likely diagnosis?
A. avascular necrosis (AVN) of the femoral head
B. osteomyelitis
C. hip fracture
D. septic arthritis

Response:
The diagnosis is AVN of the femoral head. Bone complications occur frequently in patients with sickle cell anemia. Infarcted areas of bone and bone marrow can become sites of infection (osteomyelitis) with Staphylococcus aureus or salmonella, but the lack of fever and clinical signs in this patient suggest AVN. Infarction of the femoral head nutrient artery leads to AVN and chronic joint pain. The humeral head is also at risk of AVN. Septic arthritis is a less common complication.

So the answer to this question is A


Instruction:
Of the following permanent teeth, which is least likely to have two roots?
A. Maxillary canine
B. Mandibular canine
C. Maxillary first premolar
D. Mandibular first premolar

Response:
None

So the answer to this question is A


Instruction:
The following bowel movement is not seen in normal individual:
A. Peristalsis
B. Peristaltic rush
C. Segmentation contraction
D. Migrating motor complex

Response:
Peristaltic rush is a very intense peristaltic wave, occurs when intestine is obstructed, thus not seen in normal individuals. Peristalsis, segmental contraction, haustrations and migrating motor complex are all normal bowel movements. Ref: Ganong's, review of medical physiology, 22nd edition, Page 480, 482

So the answer to this question is B


Instruction:
Non invasive diarrhea is caused by:
A. Shigella
B. B. Cereus
C. Salmonella
D. Y. enterocolitica

Response:
Answer is B (B. cereus) Bacillus cereus causes non invasive diarrhea due to preformed enterotoxins Shigella, Salmonella and Y. enterocolitica are causes of invasive diarrhea.

So the answer to this question is B


Instruction:
How many osseous walls are present in one walled  vertical defects?
A. One wall present
B. Two walls present
C. There walls present
D. Four walls present

Response:
None

So the answer to this question is A


Instruction:
A 34-year-old woman is admitted to the emergency department after a car crash. Radiographic studies show marked edema and hematoma of the arm, but there are no fractures. During physical examination the patient presents with inability to abduct her arm without first establishing lateral momentum of the limb, and inability to flex the elbow and shoulder. Which of the following portions of the brachial plexus is most likely injured?
A. Superior trunk
B. Middle trunk
C. Inferior trunk
D. Lateral cord

Response:
The superior trunk of the brachial plexus includes C5 and C6, which give rise to the suprascapular nerve, which innervates the supraspinatus muscle. The supraspinatus muscle is the primary muscle involved in abduction of the arm from 0deg to 15deg. The deltoid muscle supplied primarily by C5, abducts the arm from 15 degrees to 90 degrees. The middle trunk is just C7 and has nothing to do with the muscle involved in initial abduction of the arm. The inferior trunk is C8-T1 and does not supply the supraspinatus muscle; therefore, it is not the right answer. The cords are distal to the branching of the supraspinatus muscle; therefore, neither lateral cord nor medial cord is the correct answer.

So the answer to this question is A


Instruction:
Prophylactic therapy should be started against Pneumocystis carinii pneumonia in AIDS patients with CD4 counts below :
A. < 50/microL
B. < 150/ microL
C. < 200/ microL
D. < 400/ microL

Response:
None

So the answer to this question is C


Instruction:
Vaginal atresia is associated with all except:
A. Lack of development of lower part of vagina
B. Normal secondary sexual characteristic
C. Female external genitalia
D. Presence of cervix

Response:
Ans. is d, i.e Presence of cervixRef: Williams gynae 3/e, pg 419* Vaginal atresia is a condition where the urogenital sinus fails to develop hence lower part of vagina is absent & is replaced by a fibrous strand.* Genotype of female =46XX* Gonads = Normal ovaries* Secondary sexual characteristics are normal* Upper reproductive tract is normal (uterus, cervix, etc.)IOC : MRINote: Presence of cervix distinguishes this condition from mullerian agenesis.

So the answer to this question is D


Instruction:
Engaging diameter of well flexed head in vertex presentation is -
A. Suboccipito - bregmatic
B. Suboccipito - frontal
C. Occipito - frontal
D. Mento - vertical

Response:
Ans. is 'a' i.e., Suboccipito - bregmatic DiametersMeasurement in cmAttitude of the headPresentationSuboccipito - bregmatic9[?]5 cmComplete flexionVertexSuboccipito - frontal10 cmIncomplete flexionVertexOccipito - frontal11[?]5 cmMarked deflexionVertexMento - vertical14 cmPartial extensionBrowSubmento - vertical11[?]5 cmIncomplete extensionFaceSubmento - bregmatic9[?]5 cmComplete extensionFace

So the answer to this question is A


Instruction:
Investigation of choice for confirming Henoch Schonlein Purpura is
A. Serum IgA levels
B. CRP levels
C. Renal Biopsy
D. DTPA

Response:
Biopsy of the kidney may be performed both to establish the diagnosis or to assess the severity of already suspected kidney disease. The main findings on kidney biopsy are increased cells and IgA deposition in the mesangium (pa of the glomerulus, where blood is filtered), white blood cells, and the development of crescents.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 1217 - 1218)

So the answer to this question is C


Instruction:
Xenodiagnosis is used in the diagnosis of a disease that is transmitted by the bite of a
A. Body louse
B. Deer tick
C. Reduviid bug
D. Mosquito

Response:
Xenodiagnosis is used in the diagnosis of Chagas disease, which is caused by Trypanosoma cruzi, a hemoflagellate. There are four morphologic forms of hemoflagellates. In man, they may be intracellular, in which they are called leishmanial forms; or, they may be located extracellularly in the blood, in which they are called trypanosomes. The insect vectors may have leptomonads (promastigotes) or crithidial (epimastigote) forms. Leishmaniasis (cutaneous, mucocutaneous/and visceral) only has the leishmania, intracellular forms present in man. In Mrican trypanosomiasis, only the extracellular, or trypanosomal form, is present in man. Chagas disease has both the intracellular (leishmanial) and extracellular (trypanosomal) forms. Chagas disease is rampant in South America and is the major cause of progressive hea failure and death in that area. T cruzi is a flagellated protozoan that is transmitted to man by the bite of the Reduviid bug, or kissing bug, which usually occurs during the night. Sholy after the bite, the bug defecates on the wound site and the sleeping host rubs the organisms into the wound. Periorbital inflammation develops, which is called Romana's sign. Trypanosomes circulate in the blood and leishmanial forms invade (1) the reticuloendothelial cells, producing hepatosplenomegaly; (2) the hea muscle, causing myocarditis and arrhythmias; (3) the brain, producing a meningoencephalitis; and (4) into the gastrointestinal tract, where the leishmania destroy the ganglion cells in the distal esophagus and rectum to produce acquired achalasia and Hirschsprung disease, respectively. Laboratory diagnosis is made by (1) finding trypanosomes in the blood, (2) finding leishmanial forms in tissue, (3) culture, (4) serology, and (5) xenodiagnosis. Xenodiagnosis is a method of inoculation in which sterile Reduviid bugs are fed or offered the blood of an infected patient. After a few weeks, the bug's intestinal contents are examined for presence or absence of the organism. Only 5% of patients die in the acute stage of hea failure, whereas in chronic disease, hea failure is a common cause of death. Nifuimox is the drug of choice.

So the answer to this question is C


Instruction:
A 28-year-old HIV patient presents with non-productive cough and difficulty in breathing which was progressively increasing. Chest X-ray shows diffuse bilateral interstitial infiltrates along with pneumatocele. Gomori's methenamine silver staining of the bronchoalveolar lavage shows the following. The most probable causative organism is
A. H.capsulatum
B. P.jirovecii
C. R.seeberi
D. C.neoformans

Response:
The given clinical picture and the GMS stain showing the black colored stained cysts resembling the crushed ping pong balls are suggestive of pneumocystis pneumonia. It is caused by Pneumocystis jirovecii. Patients with PCP generally present with fever and cough that is usually non-productive. Finding on chest x-ray is either a normal film if the disease is suspected early, or diffuse bilateral interstitial infiltrates. The classic finding of dense perihilar infiltrate is unusual in patients with AIDS. Treatment: Trimethoprim-sulfamethoxazole and pentamidine isethionate. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition

So the answer to this question is B


Instruction:
Both hyperplasia and hyperophy are seen in?
A. Breast enlargement during lactation
B. Uterus during pregnancy
C. Skeletal muscle enlargement during exercise
D. Left ventricular hyperophy during hea failure

Response:
Hyperophy refers to an increase in the size of cells, resulting in an increase in the size of the organ. The increased size of the cells is due to the synthesis of more structural components The massive physiologic growth of the uterus during pregnancy is a good example of hormone-induced increase in the size of an organ that results from both hyperophy and hyperplasia Regarding the 'a' choice, Breast enlargement during lactation;- prolactin and estrogen cause hyperophy of the breasts during lactation. Hormonal hyperplasia is best exemplified by the proliferation of the glandular epithelium of the female breast at pubey and during pregnancy.

So the answer to this question is B


Instruction:
Whisper is
A. 10 db
B. 20 - 30 db
C. 30 - 50 db
D. 60 db

Response:
None

So the answer to this question is B


Instruction:
All muscles of tongue are supplied by hypoglossal nerve except -
A. Geniologlossus muscle
B. Hypoglossus muscle
C. Styloglossus muscle.
D. Palatoglossus muscle

Response:
None

So the answer to this question is D


Instruction:
OCP's are contraindicated in women receiving which of the following drug ?
A. Rifampicin
B. Ethambutol
C. Streptomycin
D. Pyrazinamide

Response:
OCPs are contraindicated in patient on enzyme-inducing drugs like rifampicin, and antiepileptic except sodium valproate. Rifampicin induces cytochrome 450 ,increasing the hepatic hydroxlation of estrogen by which there is a fourfold increase in its metabolism. This causes clearance and deceased effect of estrogen. Reference: Shaw's textbook of Gynaecology 17th edition,page 265.

So the answer to this question is A


Instruction:
Lymphatic drainage of anterior pa of nose is to?
A. Submandibular LN
B. Parotid
C. Pretracheal LN
D. Retropharyngeal LN

Response:
Ans. is 'a' i.e., Submandibular LNAnetrior half of nasal cavity (including anterior pa of nasal septum) drains into submandibular nodes. Submandibular nodes These nodes lie deep to investing layer of deep cervical fascia in submandibular triangle, between the deep fascia and submandibular gland.These nodes receive afferents from centre of forehead; anterior pa of nasal cavity; frontal, maxillary and ethmoidal air sinuses; inner canthus (medial angle of eye); whole of upper lip and anterior pa of cheek with underlying gum and teeth; outer pa of lower lip with lower gums and teeth excluding incisors; anterior two third of tongue excluding the tip; floor of mouth; and angle of mouth.These nodes also receives efferents of submental nodes.Submandibular nodes drain into (efferent) upper and lower deep cervical nodes.

So the answer to this question is A


Instruction:
A 2-week-old female infant has a head circumference of 40 cm (>98%), with a large, tense fontanelle and downward deviation of the eyes. She has been vomiting her formula and she is irritable. Common cause of her symptoms include all EXCEPT:
A. Intraventricular hemorrhage
B. Brain tumor
C. Meningitis
D. Aqueductal stenosis

Response:
Ans. B. Brain tumorThe common causes of hydrocephalus in neonates are intraventricular (subarachnoid) hemorrhage, infection; and congenital malformations (e.g., aqueductal stenosis, Arnold-Chiari malformation). Brain tumors rarely occur in the first year of life, and if present at this age, they are most likely to be supratentorial. When hydrocephalus occurs in infants and is associated with signs of raised intracranial pressure (especially without fever), vomiting, and irritability, an infratentorial brain tumor must be suspected.

So the answer to this question is B


Instruction:
Superior parathyroid derived from
A. Mesoderm of 3rd pouch
B. Endoderm of 3rd pouch
C. Mesoderm of 4th pouch
D. Endoderm of 4th pouch

Response:
None

So the answer to this question is D


Instruction:
The anticoagulant normally present in animal cell is:
A. Vitamin K.
B. Heparin.
C. Hyaluronidase.
D. Dicoumarol.

Response:
Harper – 603
Heparin is used in clinical medicine to inhibit coagulation because it binds to the specific cationic site of antithrombin III, inducing a conformational change and promoting its binding to thrombin as well as to its other substrates.

So the answer to this question is B


Instruction:
Most common type of AML in Down's syndrome
A. M2
B. M3
C. M6
D. M7

Response:
- Megakaryocytic maturation AML - Most common AML in Down's syndrome. - Blast cells in these patients are highly sensitive to medications - show better outcome than AML in those without Trisomy 21.

So the answer to this question is D


Instruction:
The incidence of breast cancer
A. Increases with increasing age
B. Has declined since the 1940s
C. Is related to dietary fat intake
D. Is related to coffee intake

Response:
Breast cancer is rarely seen before the age of 20, but thereafter its incidence increases inexorably. While the prevalence of breast cancer (the raw number of patients alive with disease) is greatest among perimenopausal women, the incidence of breast cancer (the number of new cases per 100,000 population) rises so sharply that it is twice as common among women between 80 and 85 years of age as among those 60 to 65. In addition, the age-adjusted incidence has increased steadily since the mid-1940s. No data is presently available consistently linking the incidence of breast cancer to dietary factors. A possible linkage between breast cancer and alcohol consumption at an early age is being studied.

So the answer to this question is A


Instruction:
All cause myelosuppression except :
A. Docetaxel
B. Vincristine
C. Methotrexate
D. Irinotecan

Response:
None

So the answer to this question is B


Instruction:
The commonest hepatotropic virus causing increased chronic carrier state is
A. HEV
B. HAV
C. HBV
D. HCV

Response:
Ans. is 'd' i.e.,. HCV Most common hepatitis to progress to chronicity is Hepatitis (G). . HCV =It's major feature, however, is its propensity to cause chronic hepatitis in more than 80% of those infected Clinical and epidemiologic features of viral hepatitis Features HAV HBV HCV HDV HEV * Incubation (days)* 15-45 30-180 15-160 30-180 14-60 * Age* Children, young Adults Young adults Any age but more in adult Any age Young adults * Transmission * Fecal-oral* +++ -- -- -- +++ * Percutaneous* unusual +++ +++ +++ -- * Perinatal* -- +++ + + -- * Sexual * + ++ + ++ -- * Clinical * Severity* Mild Occasionally Severe Moderate Occasionally Severe Mild * Fulminant* l% .1%- 1% .1% 5-20% 1-2% * Progression* to chronicity None Occasional (1-10%) Common (50-70%) Common None * Carrier* None. 1-30% 1.5-3.2% Variable None * Prognosis Excellent Worse with age Moderate Acute, good chronic poor Good

So the answer to this question is D


Instruction:
Which is risk factor for cholangiocarcinoma
A. Obesity
B. Primary sclerosing cholangitis
C. Salmonella carrier state
D. HBV infection

Response:
Risk factors include primary sclerosing cholangitis Congenital fibropolycystic disease of biliary tree Infestation by Clonorchis sinensis or Opisthorchis viverrini HCV infection Exposure to Thorotrast TEXT BOOK OF ROBBINS BASIC PATHOLOGY NINTH EDITION PAGE.643

So the answer to this question is B


Instruction:
Regarding respiratory viruses all are true except -
A. RSV is the most comon cause of brochiolitis in infants
B. Mumps causes septic meningitis in adult
C. Measles causes SSPE
D. EBV causes pleuritis

Response:
Mumps has been repoed to cause about 10 to 15 percent of aseptic meningitis. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:508

So the answer to this question is B


Instruction:
A 15-year-old boy presented with 1 day history of bleeding gums, subconjunctival bleed and purpuric rash. Investigations revealed: Hb 6.4 gm/dL; TLC-26,500/mm3; prothrombin time-20 sec with a control of 13 sec; partial thromboplastin time-50 sec; and fibrinogen 10 mg/dL. Peripheral smear was suggestive of acute myeloblastic leukemia. Which of the following is the most likely?
A. Myeloblastic leukemia without maturation
B. Myeloblastic leukemia with maturation
C. Promyelocytic leukemia
D. Myelomonocytic leukemia

Response:
c. Promyelocytic leukemia(Ref: Nelson's 20/e p 2442-2443, Ghai 8/e p 605-607)This patient has complaints of bleeding along with thrombocytopenia, decreased fibrinogen & increased PT & APTT. This is consistent with DIC; DIC is most commonly seen with M3 AML

So the answer to this question is C


Instruction:
Inclusion body in oligodendroglia is a feature of which of the following
A. Progressive multifocal leucoencephalopathy
B. Japanese encephalitis
C. Polio
D. CJD

Response:
Progressive multifocal leukoencephalopathy (PML) is a rare and often fatal viral disease characterized by progressive damage (-pathy) or inflammation of the white matter (leuko-) of the brain (-encephalo-) at multiple locations (multifocal). It is caused by the JC virus, which is normally present and kept under control by the immune system. The JC virus is harmless except in cases of weakened immune systems. In general, PML has a moality rate of 30-50% in the first few months, and those who survive can be left with varying degrees of neurological disabilities PML is a demyelinating disease, in which the myelinsheath covering the axons of nerve cells is gradually destroyed, impairing the transmission of nerve impulses. It affects the subcoical white matter, paicularly that of the parietal and occipital lobes. PML destroys oligodendrocytes and produces intranuclear inclusions. It is similar to another demyelinating disease, MS, but progresses much more quickly. The breakdown of myelin is commensurate with the degree of immunocompromised ref internet

So the answer to this question is A


Instruction:
Which is not seen in Tumour lysis Syndrome?
A. Hypophosphatemia
B. Hypocalcemia
C. Hyperuricemia
D. Hyperkalemia

Response:
TUMOR cells with very high rate ||| of growth - during Chemo Therapy - large no of cells are dyinge TUMOR cell lysis syndrome. i.e. Summary- components of Tumor-Lysis Syndrome HYPERKALEMIA HYPERURICEMIA HYPERPHOSPHATEMIA HYPOCALCEMIA

So the answer to this question is A


Instruction:
Menorrhagia is defined as blood loss per vagina more than -
A. 80 ml
B. 110 ml
C. 150 ml
D. 50 ml

Response:
Ans. is 'a' i.e. 80 ml (Ref Shaws, 13/e, p 291 (12/e, p. 229)). Menorrhagia - when blood loss is more than 80 ml* Oligomenorrhea - when blood loss is less than 20 ml*

So the answer to this question is A


Instruction:
Most common indication of In Vitro Feilization is an abnormality in : Most common indication of In VitroFeilization is an abnormality in :
A. Uterus
B. Fallopian tube
C. Anovulation
D. Azoospermia

Response:
Fallopian tube

So the answer to this question is B


Instruction:
Animal reservoir for swine influenza virus is?
A. Field mice
B. Urban rats
C. Pigs
D. Calomys callosus

Response:
The swine flu virus H1N1 caused a localized outbreak in a military camp in the USA. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:502

So the answer to this question is C


Instruction:
Which of the following has the maximum faciolingual diameter of the crown:
A. Deciduous maxillary 2nd molar
B. Deciduous maxillary 1st molar
C. Deciduous mandibular 2nd molar
D. Deciduous mandibular 1st molar

Response:
None

So the answer to this question is A


Instruction:
Which of the following is associated AV block?
A. Hypothyroidism
B. Hyperthyroidism
C. Pheochromocytoma
D. Cushing syndrome

Response:
Ans. a. HypothyroidismRef: Harrisons Principle of Internal Medicine 19th Ed; Page No-1471ETIOLOGY OF AV BLOCKAutonomic Carotid sinus hypersensitivityVasovagalMetabolic/Endocrine HyperkalemiaHypermagnesemiaHypothyroidism Adrenal insufficiencyDrug-related Beta blockersCalcium channel blockersDigitalisAdenosineAntiarrhythmics (class 1 and III) LithiumInfectious Endocarditis Lyme disease Chagas disease SyphilisTuberculosisDiphtheriaToxoplasmosisInflammatorySLERheumatoid arthritis InfiltrativeAmyloidosisSarcoidosisMCTDSclerodermaHemochromatosisNeoplastic/TraumaticLymphomaMesotheliomaMelanomaDegenerativeLev's diseaseRadiation Catheter ablationLenegre's diseaseCoronary artery diseaseAcute Ml Abbreviations: MCTD, mixed connective tissue disease; Ml myocardial infarction; OMIM, Online mendelian Inheritance in Man (database; designations: , phenotypic description, molecular basis known; % phenotypic description); SLE, systemic lupus erythematosus

So the answer to this question is A


Instruction:
An old man enters the hospital with myocardial infarction and a severe ventricular arrhythmia. The antiarrhythmic drug chosen has a narrow therapeutic window. The minimum toxic plasma concentration is 1.5 times the minimum therapeutic plasma concentration. The half life is 6 hrs. It is essential to maintain the plasma concentration above the minimum therapeutic level to prevent a possible lethal arrhythmia. Of the following, the most appropriate dosing regimen would be
A. Once a day
B. Twice a day
C. Four times a day
D. Constant intravenous infusion

Response:
None

So the answer to this question is D


Instruction:
Which of the following statements is WRONG about amiodarone ?
A. It is longest acting anti–arrhythmic drug.
B. It has positive ionotropic action.
C. It contains iodine
D. It causes pulmonary fibrosis.

Response:
None

So the answer to this question is B


Instruction:
A 54 year old man comes to the emergency room four hours after the onset of severe chest pain radiating to the left arm. Examination of the levels of which of the following serum markers would best aid in the evaluation of this individual's chest pain?
A. Aspaate aminotransferase (AST)
B. Creatine kinase-MB isoenzyme (CK-MB)
C. Lactate dehydrogenase-1 isozyme (LDH1)
D. Troponin

Response:
Cardiac-specific forms of troponin-T and troponin-I are not normally detectable in the blood, but may increase 20-fold following a myocardial infarction. Slight amino acid differences between cardiac and skeletal muscle forms of troponin allow specific association of the troponin with hea muscle damage, rather than skeletal muscle damage. Troponin is the best serum marker for myocardial infarction for the first eight hours, and because levels of the cardiac troponins remain elevated for 7-10 days, it may be useful for evaluation of small, CK-negative infarctions for several days after the event. AST is a nonspecific marker for cardiac, liver, and skeletal muscle. Due to its lack of specificity, it is much less useful as a marker of myocardial infarction than CK-MB or troponin. Both total creatine kinase and its more cardiac specific form CK-MB are most useful from 8 to 24 hours after infarction, typically with peaks at 12-18 hours. LDH1, the cardiac specific form of lactic dehydrogenase, is the test of choice 2 to 7 days after a suspected myocardial infarction. Ref: Green G.B., Hill P.M. (2011). Chapter 52. Chest Pain: Cardiac or Not. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e.

So the answer to this question is D


Instruction:
Left sided lateral gaze is affected in lesion of-
A. Right frontal lobe
B. Right occipital lobe
C. Left occipital lobe
D. Left frontal lobe

Response:
Voluntary horizontal gaze in one direction begins with the contralateral frontal eye field.
If horizontal gaze is affected, the damage may be:-

Cortical center: - Contralateral frontal eye field.
Brainstem center: - Pons (Pontine paramedian reticular) formation.
Cranial nerve nucleus: - Abducens (6th nerve) nucleus.

So the answer to this question is A


Instruction:
Characteristics of BENIGN tumour of lung in X-ray is
A. Size > 5 cms diameter
B. Cavitation
C. Peripheral location
D. Concentric dense calcification

Response:
Central, concentric, laminar, popcorn or homogeneous (diffuse) calcification is seen in benign lesions.

So the answer to this question is D


Instruction:
All pencillins act by: September 2007
A. Inhibiting protein synthesis
B. Inhibiting cell wall synthesis
C. Antifolate
D. Inhibitis DNA gyrase

Response:
Ans. B: Inhibiting cell wall synthesis All penicillin derivatives produce their bacteriocidal effects by inhibition of bacterial cell wall synthesis. Specifically, the cross linking of peptides on the mucosaccharide chains is prevented. If cell walls are improperly made cell walls allow water to flow into the cell causing it to burst and bacterial lysis occurs.

So the answer to this question is B


Instruction:
Vascular congestion over inseions of the rectus muscles (paicularly lateral rectus) is seen in:
A. Lymphoma
B. Hemangioma
C. Graves ophthalmopathy
D. Trauma

Response:
Ans. Graves ophthalmopathy

So the answer to this question is C


Instruction:
Nitroblue Tetrazolium reduction is used for finding out the following:
A. Phagocytes
B. Complement
C. T-cell
D. B-cell

Response:
The initial laboratory screening for phagocyte disorders, mainly impaired neutrophil function, should include a CBC and cell differential to look for neutropenia. A blood smear can detect Howell-Jolly bodies in erythrocytes, indicative of asplenia, and abnormalities in lysosomal granules in neutrophils. An abnormality of the neutrophil respiratory burst, which would lead to impaired neutrophil bactericidal activity, can be tested by nitroblue tetrazolium (NBT) reduction. The dihydrorhodamine (DHR) flow cytometry assay assesses the same function more quantitatively. Ref: Hauk P.J., Johnston, Jr. R.B., Liu A.H. (2012). Chapter 33. Immunodeficiency. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.

So the answer to this question is A


Instruction:
Which of the following ACE inhibitor is not a prodrug -
A. Captopril
B. Enalapril
C. Ramipril
D. All

Response:
Ans. is 'a' i.e., Captopril o All ACE inhibitors are prod rugs except captopril and Lisinopril.

So the answer to this question is A


Instruction:
All of the following statements regarding Diabetes Mellitus are true, Except-
A. Insulin is not used in Type II Diabetes mellitus
B. Insulin levels may be increased in patients with Type II Diabetes mellitus
C. Insulin is essential to reverse Diabetic Ketoacidosis
D. Intravenous Insulin is administered as a sliding scale in the hospital setting

Response:
The longer someone has type 2 diabetes, the more likely they will require insulin . There are several reasons people with type 2 diabetes may want to use insulin: It can quickly bring your blood glucose level down to a healthier range , It has fewer side effects than some of the medications . Insulin is used according to sliding scale in most of the cases . Sliding scale differs accordint to regions or some other reasons . Standard sliding scale protocol is as below Ref - pubmed.com

So the answer to this question is A


Instruction:
Trifoliate appearance is in –
A. Peptic ulcer
B. Pyloric stenosis
C. Carcinoma head of pancreas
D. None

Response:
The appearance of 'trifoliate duodenum' is due to secondary duodenal diverticula which occurs as a result of scarring of peptic ulcer.

So the answer to this question is A


Instruction:
Deep vein thrombosis is more common after
A. Prostatic operation
B. Total hip replacement
C. Neurosurgery
D. Gastrectomy

Response:
The factors which result in increased risk of venous thrombosis include advancing age and greater complexity of surgical treatment. Ohopedic operations on the lower limbs (hip and knee replacements) are especially likely to result in venous thrombosis." - Bailey & Love Ref : Bailey & Love 24/e p969

So the answer to this question is B


Instruction:
True about tamoxifen is-
A. Selective estrogen receptor downregulator
B. Selective estrogen receptor modulator
C. Selective tissue estrogen activator regulator
D. Estrogen antagonist

Response:
Ans. is 'b' i.e., SERM * Has been explained in previous sessions

So the answer to this question is B


Instruction:
Technetium - 99 scan is used for diagnosis of -
A. Meckel's diverticulum
B. Appendix
C. Berry aneurysm
D. Cold abscess

Response:
Ans- A IOC for Meckel's Diverticulum is Technetium 99m pertechnate scan. Sensitivity is 90 %for pediatric population whereas for adults it is 50-55%only. If the Tech scan is normal,then go for enteroclysis

So the answer to this question is A


Instruction:
Average incubation period of AIDS is: March 2011
A. 1 year
B. 3 years
C. 5 years
D. 10 years

Response:
Ans. D : 10 years The median interval from infection to the development of symptoms is around 7-10 years, although subgroups of patients exhibit 'fast' or 'slow' rates of progression.

So the answer to this question is D


Instruction:
Which of the following factors markedly increases the risk of valproate-induced liver toxicity?
A. Male gender
B. Age younger than 2 year
C. Family history of epilepsy
D. Allergic reactions to phenobarbital

Response:
.

So the answer to this question is B


Instruction:
First change of improvement noted after iron therapy is initiated
A. Decreased irritability
B. Reticulcytosis
C. Increase in serum iron levels
D. Replenishment of iron stores

Response:
First change of improvement noted after iron therapy is decreased irritability followed by increased reticulocyte count. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is A


Instruction:
True about slow sand filter is
A. Occupies less space
B. More expensive
C. Requires longer duration
D. Sand size 0.4-0.7 mm

Response:
None

So the answer to this question is C


Instruction:
Which of the following is the earliest warning sign of Magnesium Sulphate toxicity?
A. Respiratory rate < 12
B. Loss of DTRs
C. Altered sensorium
D. Urine output < 25-30 cc/hour

Response:
Ans. B. Loss of DTRs. (Ref Textbook of Obstetrics D.C. Dutta 6th ed, 229)SEIZURE PROPHYLAXIS IN PIH - MAGNESIUM SULFATE# Is not a hypotensive agent# Works as a centrally acting anticonvulsant# Also blocks neuromuscular conduction# Serum levels: 6-8 mg/dL# Magnesium sulfate # Monitor urine output and DTR's- Cervical dilatation of 3 to 5 cm or more, in the presence of uterine contractions, can be taken to reliably represent the threshold for active labor.# With renal dysfunction, may require a lower doseToxicity# Respiratory rate < 12 (respiratory depression develops when levels go lOmEg/L)# DTR's not detectable (earliest warning sign of toxicity =/< 10 mEq/L)# Altered sensorium# Urine output < 25-30 cc/hour# Respiratory paralysis arrest ( 3 12 mEq/L)# Antidote: 10 ml of 10% solution of calcium gluconate IV over 3 minutes- The therapeutic level of serum magnesium is 4-7 mEq/L.- The normal level of serum (blood) magnesium is 1.5 - 2.0 mEq/L (1-2 mg/dl).Hypertension in pregnancy CommentsRxGestational hypertension (pregnancy-induced hypertension)BP > 140/90 mmHg after the 20th week of gestation. No preexisting hypertension. No proteinuria or end-organ damage.Treatment: antihypertensives (a- methyldopa, labetalol, hydralazine, nifedipine), deliver at 39 weeks.Preeclampsia- Defined as hypertension (> 140/90 mmHg) and proteinuria (> 300 mg/24 hr) after 20th week of gestation to 6 weeks postpartum (< 20 weeks suggests molar pregnancy).Severe features include BP > 160/110 mmHg with or without end-organ damage, e.g., headache, scotoma, oliguria,*AST/ ALT, thrombocytopenia.- Caused by abnormal placental spiral arteries, results in maternal endothelial dysfunction, vasoconstriction, or hyperreflexia.- Incidence<<in patients with preexisting hypertension, diabetes chronic renal disease, or autoimmune disorders.- Complications: placental abruption, coagulopathy, renal failure, uteroplacental insufficiency, or eclampsia.Antihypertensives, deliver at 34 weeks (severe) or 37 weeks (mild), IV magnesium sulfate to prevent seizure.EclampsiaPreeclampsia + maternal seizures. Maternal death due to stroke*intracranial hemorrhage or ARDS.Antihypertensives, IV magnesium sulfate, immediate delivery.

So the answer to this question is B


Instruction:
Causes of a cavitating lesion in the chest radiograph are all except -
A. Hamartoma
B. Pulmonary infarction
C. Squamous carcinoma of the bronchus
D. Caplan's syndrome

Response:
Haematoma (not hamartoma) causes lung cavitation.
Pulmonary infarct, squamous cell carcinoma of lung, RA & Caplan's syndrome can also cause lung cavitation.

So the answer to this question is A


Instruction:
Wound contraction is primarily mediated by
A. Smooth muscle cells.
B. Macrophages.
C. Fibroblasts.
D. Myofibroblasts.

Response:
Myofibroblasts, cells with features intermediate between fibroblasts and smooth muscle cells, appear in the wound 2 to 3 days after injury. Their active contraction decreases the size of the defect.

So the answer to this question is D


Instruction:
Sexual gratification obtained by contact of private pas in
A. Masochism
B. Transvestism
C. Fetichism
D. Frotteurism

Response:
Frotteurism In this, sexual gratification is obtained by contact. The person is obtaining the gratification by rubbing his private pas against a female's body. It is punishable according to Sec 354A IPC Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 312

So the answer to this question is D


Instruction:
Which of the following statements is TRUE about Rabies Virus:
A. It is double stranded RNA virus
B. Contains a DNA-dependent RNA polymerase
C. Negative sense RNA Genome
D. Affects motor neurons

Response:
The Rabies virus belongs to the Rhabdoviridae family, and is the prototypic member of the genus lyssavirus. It has a single-stranded, non-segmented, negative-sense RNA genome. The helical nucleocapsid is composed of a single-stranded negative-sense RNA genome and an RNA-dependent RNA polymerase enclosed in a matrix protein covered by a lipid bilayer envelope containing knob-like glycoprotein. Note - Negative-sense RNA virus replicates in the cytoplasm Ref: Microbiology By Jawetz, 20th Edition, Page 482 ; Rabies By Alan C. Jackson, William H. Wunner, 2007, Page 24

So the answer to this question is C


Instruction:
Which of the following lipids is found exclusively in mitochondria?
A. Cephalin
B. Phosphatidylserine
C. Cardiolipin
D. Phosphatidylinositol

Response:
Cardiolipin Is a Major Lipid of Mitochondrial Membranes
Phosphatidic acid is a precursor of phosphatidylglycerol, which in turn gives rise to cardiolipin. This phospholipid is found only in mitochondria and is essential for the mitochondrial function. Decreased  cardiolipin levels or alterations in its structure or metabolism cause mitochondrial dysfunction in aging and in pathological conditions including heart failure, hypothyroidism, and Barth syndrome (cardioskeletal myopathy).
HARPERS ILLUSTRATED BIOCHEMISTRY30th ed, Page No:343

So the answer to this question is C


Instruction:
Wind velocity is normally recorded at a height of –
A. 1 metre
B. l0 metres
C. 15 metres
D. 20 metres

Response:
None

So the answer to this question is B


Instruction:
A 54-year-old male nonsmoker is seen with complaints of a flulike illness. Initial symptomatic treatment is provided. Two days later, he returns, as he is still not feeling well. His primary physician prescribes a macrolide along with the symptomatic treatment. After 5 days of this treatment, the patient says he is running a fever and has increasing fatigue, weakness, and cough. He also complains of pain in the right wrist with some difficulty in motion. He has left groin pain and is unable to walk more than a few steps. On physical exam, vital signs are: pulse 110 bpm; temperature 102degF; respirations 24/min; blood pressure 10/68 mm Hg. He looks weak and says he has lost about 8 lb in the last 10 days. Peinent findings: lung exam reveals area of egophony, and E to A changes in the left anterior and posterior lung field. The patient has swelling with some areas of skin sloughing in the right wrist and tenderness with limitation of movement in the left groin area. Laboratory data: Hb 11 g/dL; Hct 33%; WBCs 16.0/uL; differential 90% segmented neutrophils; BUN 42 mg/dL; creatinine 1.1 mg/dL; sodium 142 mEq/L; potassium 3.4 mEq/L. ABGs on room air: pH 7.45, PCO2 34 mm Hg; PO2 65 mm Hg. CXR is shown.Associated findings may include all of the following except?
A. Septic ahritis
B. Endocarditis
C. Brain abscess
D. Reye syndrome

Response:
This x-ray shows a nonhomogeneous airspace density in the left middle and lower zones with areas of incomplete consolidation and evolving pneumatocele formation. The left diaphragm is raised and the trachea appears shifted to the left, suggesting loss of volume of the left lung. There is minimal blunting of the left costophrenic angle, suggesting a left pleural effu-sion. This CXR is consistent with the left lower lobe necrotizing pneumonia with loss of volume, which can be seen in staphylococcal pneumonia. The prodrome of a flulike illness and the development of pneumonia along with multisystem involvement suggest a bacteremic process. Both staphylococcal and pneumococcal pneumonia can produce this picture. However, the signs of the loss of volume in the left lung along with the necrotizing airspace disease or pneumatoceles suggest that this is more likely staphylococcal pneumonia. Associated conditions include septic ahritis, endocarditis, and brain abscess. Reye syndrome is unlikely in an adult and is not an applicable choice here.

So the answer to this question is D


Instruction:
Which of the following does not conduct spermatozoa?
A. Ampulla of the ductus deferens
B. Duct of the seminal vesicle
C. Epididymis
D. Prostatic Urethra

Response:
The duct of the seminal vesicle carries seminal fluid, a basic fluid containing fructose. The contents of the seminal fluid buffers the acid in the vagina and provides nutrients for sperm. The duct of the seminal vesicle joins with the ampulla of the ductus deferens (which is carrying sperm) to form the ejaculatory duct. This is the first place where seminal fluid mixes with sperm. Sperms are first formed in the seminiferous tubules. They then travel from the head to the tail of the epididymis, through the ductus deferens, into the ejaculatory duct where they mix with seminal fluid, into the prostatic urethra, through the rest of the urethra, and then out the penis. So, all of the other answer choices are places that are impoant for the passage of sperm. Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 19. Evaluation of the Infeile Couple. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.

So the answer to this question is B


Instruction:
Which of the following is a known adverse effect of lithium?
A. Agranulocytosis
B. Altered judgement
C. Aplastic anemia
D. Hypothyroidism

Response:
Patients on lithium chronically may develop iatrogenic hypothyroidism. (Approx. 5% of patients taking the drug > 18 months.) Lithium exes this effect by interfering with the synthesis and release of thyroid hormone. Thus any patient experiencing prolonged depressive symptoms while taking lithium needs to have his/her thyroid assessed Agranulocytosis is commonly repoed for patients taking the atypical antipsychotic drug clozapine or carbamazepine, which is sometimes employed as a second-line treatment for bipolar disorder. Altered judgement is incorrect. Neurological side effects of lithium include tremor, chorea athetosis, ataxia, motor hyperactivity, dysahria, and aphasia. Lithium is not known to cause aplastic anemia. Aplastic anemia is a serious potential adverse effect of the mood stabilizer carbamazepine. Carbamazepine would present an alternative to lithium in this patient, but a periodic blood count must be performed to assess for aplastic anemia Ref: Meyer J.M. (2011). Chapter 16. Pharmacotherapy of Psychosis and Mania. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.

So the answer to this question is D


Instruction:
All are true about pyogenic meningitis except -
A. Increased CSF protein
B. Pleocytosis
C. Markedly decreased CSF glucose
D. Decreased CSF C- reactive protein

Response:
None

So the answer to this question is D


Instruction:
A patient has sensation of bugs crawling all over his body; this may be an effect of:
A. Cocaine
B. Alcohol
C. Cannabis
D. Benzodiazepines

Response:
This patient is having sensation of 'cocaine bugs' crawling in his body which is the effect of chronic cocaine poisoning. Ref: Parikh's Textbook of Medical Jurisprudence Forensic Medicine and Toxicology, 5th Edition, Page 917 and 6th Edition, Page 119 ; The Essentials of Forensic Medicine and Toxicology By K.S. Narayana Reddy, 27th Edition, Page 536

So the answer to this question is A


Instruction:
Which of the following is based on ionic charge -
A. Filtration
B. Dialysis
C. Electrophoresis
D. Ultracentrifugation

Response:
Ans. is 'c' i.e., Electrophoresis Property of protein usedMethodMolecular charge (Ionic charge)o Ion exchange chromatographyo High performance liquid chromatography (HPLC)o Electrophoresis (simple on cellulose acetate starch gel)o Isoelectric focusing (a variant of electrophoresis)Protein solubility''Salting out' or salt extraction (precipitation of protein by ammonium sulfateQ)Molecular size0o Gel filtration chromatographyQ (molecular-sieve chromatography or size exclusion chromatography)o Ultracentrifugationo SDS-PAGE (Sodium dodecvl sulphate-polyacry lamide gel electrophoresis)Qo DialysisQMolecular charge (Ionic charge)o Ion exchange chromatographyo High performance liquid chromatography (HPLC)o Electrophoresis (simple on cellulose acetate starch gel)o Isoelectric focusing (a variant of electrophoresis)Molecular charge and molecular weightPAGE : polyacrylamide gel electrophoresisAffinity bindingAffinity chromatographyHydrophobicityHydrophobic interaction chromatography

So the answer to this question is C


Instruction:
Superior oblique is supplied by -
A. Upper branch of 3rd N
B. Lower branch of 3rd N
C. Trochlear
D. Abducens

Response:
None

So the answer to this question is C


Instruction:
The most impoant example of a compensated hemolytic anemia becomes decompensated, is when:
A. Infected with TB
B. Infected with parvovirus B19
C. Liver disease
D. Renal cell carcinoma

Response:
A patient with a hemolytic condition may present without anemia (Compensated hemolytic anemia) It becomes decompensated in Pregnancy Folate deficiency Renal failure (Interfering with adequate EPO production). Also in Acute infections- which depresses erythropoiesis. The most dramatic example is parvovirus B19 infection, which may lead to aplastic crisis. Ref: Harrison, E-18,P-873.

So the answer to this question is B


Instruction:
A patient with traumatic paraplegia due to the injury of the thoracic cord of 'T3 level' is observed to have a blood pressure of 210/120. What should be the initial management?
A. Subcutaneous LMWH
B. Steroids
C. Nifedipine
D. Normal saline / Dextrose

Response:
None

So the answer to this question is C


Instruction:
Denosumab is a monoclonal antibody used for the treatment of:
A. Osteomalacia
B. Osteoahritis
C. Osteoporosis
D. Breast carcinoma

Response:
Denosumab is a monoclonal antibody against RANK - ligand which inhibits binding to RANK receptor and inhibits the activation of osteoclasts and inhibits bone resorption so it is used in treatment of Osteoporosis.

So the answer to this question is C


Instruction:
A 66 year old female is posted for subtotal gastrectomy for adenocarcinoma. The important procedure related complication:
A. Pneumothorax
B. Constipation
C. Hemolytic anemia
D. Bilious vomiting

Response:
Ans. (d) Bilious vomitingRef: Sabiston 20th Edition, Page 1212Complications of Gastric Surgeries:* Dumping syndrome* Afferent loop syndrome* Efferent loop syndrome* Malabsorption syndrome (Anemia, hypocalcemia, B12 deficiency)* Alkaline reflux gastritis* Bile reflux gastritis* Gastric atony* Duodenal stump blow out.

So the answer to this question is D


Instruction:
Rivastigmine is used in -
A. Dementia
B. Dissociation
C. Depression
D. Delusions

Response:
Ans. is 'a' i.e., Dementia Cognition Enhancers iCerebroactive drugs)o These are a heterogenous group of drugs developed for use in dementia and other cerebral disorders,o Drugs are1 .Cholinergic activaters - Tacrine, Rivastigmine, Donepezil, Galantamine.2. Glutamate (NMDA) antagonist - Memanite3. Miscellaneous - Piracetam, Pyritinal (pyrithioxine), Piribedil, Dihydroergotoxine (Codergocrine).Important points about some important drugs.Tacrineo It was the first centrally active anticholinesterase to be used in AD.o Hepatotoxicity has restricted its use.Rivastigmineo It is carbamate derivative of physostigmine.o It inhibits both acetylcholinesterase and butylcholinesterase.o It is selective for G1 isoform of AchE which predominates in brain,o It is used in AD.Donezepilo It is reversible inhibitors of cerebral AchE.o It has long t 1/2 (70 hours) - Single daily dose can be given.o It is used in AD.Galantamineo It inhibits cerebral AchE.o It has some direct action on nicotinic receptors as well.Acetyl -1 - carnitineo It has antioxidant property,o It also increases cholinergic transmission.o It decreases symptoms of AD as well as it decreases disease progression.Memantineo A NMDA receptor antagonist, used in AD.

So the answer to this question is A


Instruction:
Nuclosomes are -
A. DNA-RNA
B. DNA-Histones
C. RNA+Histones
D. DNA+RNA+Histones

Response:
Ans. is 'b' i.e., DNA+Histones o Nucleosomes are primary structural units of chromatin.o It consists of DNA bound to protein histonesQ, i.e. core of protein histones wrapped with DNAQ.o Histones are basic proteins rich in lysine and argininine2.o These positively charged amino acids interact with negatively charged phosphate group of DNA.o There are five types of histones HI, H2A, H2B, H3 and H4.o Two molecules of each H2A, H2B, H3 and H4 associate one another to form histone octomer.o Around histone octomer a segment of the DNA helix is wound nearly twice forming nucleosome core.o A nucleosome associated with histone H1 is called chromatosome.o A series ofnucleosome ("beads on a string") form a polynucleosome or chromatin.o The DNA connecting two nucieosomes is called linker (or spacer) DNA. To linker DNA, HI histone is attached to stabilize the complex.o Non-histone proteins are also attached to linker DNA.o These repeating units of nucieosomes, connected with linker DNA, form chromatin fiber.

So the answer to this question is B


Instruction:
About Brown-Sequard syndrome all are true EXCEPT
A. Ipsilateral hemiplegia
B. Ipsilateral loss of position and vibration
C. Ipsilateral loss of pain and temperature
D. Contralateral loss of pain and temperature

Response:
BROWN SEQUARD SYNDROME : The signs are d/o injury to 1/2 of the spinal cord (hemisection of spinal cord ) BELOW LEVEL OF INJURY : Ipsilateral UMN paralysis d/o damage to pyramidal tract. Ipsilateral loss of conscious proprioception, pressure, vibration. Ipsilateral loss of pain & temperature d/o damage to lateral spinothalamic & anterior spinothalamic tract. AT LEVEL OF INJURY : Ipsilateral LMN paralysis ( d/o damage to ventral roots ) Ipsilateral anesthesia over their of the segment d/o injury to ventral nerve roots.

So the answer to this question is C


Instruction:
Delirium tremens is caused by?
A. Chronic alcoholism
B. Alcohol withdrawal
C. Cocaine abuse
D. Cocaine withdrawal

Response:
ANSWER: (B) Alcohol withdrawalREF: Kaplan & Sadocks Synopsis of Psychiatry 9th edition page 396-413ALCOHOL INDUCED CONDITIONSAlcohol withdrawal syndromeChronic use syndromes* Hangover (most common)* Alcoholic Hallucinosis* Alcoholic seizures (Rum fits)* Delirium Tremens* Wernicke's Encephalopathy* Korsakoff's Psychosis* Marchiafava Bignami disease

So the answer to this question is B


Instruction:
Sensory innervation of larynx as far as the vocal
folds is by _________ nerve
A. External laryngeal
B. Recurrent laryngeal
C. Internal laryngeal
D. Glossopharyngeal

Response:
None

So the answer to this question is C


Instruction:
True regarding Munro Micro Abscess is all EXCEPT:
A. Seen in stratum corneum
B. Debris consists of Eosinophils
C. Associated Pustule may be present
D. Seen in Psoriasis

Response:
ANSWER: (B) Debris consists of EosinophilsREF: Rook's 7th e p. 35.1MUNRO'S MICROABSCESS:Neutrophils form aggregates as a slightly spongiotic foci of superficial epidermis (spongiform pustules) and within parakeratotic stratum corneum which are called munro's microabcesses seen in psoriasis

So the answer to this question is B


Instruction:
Pain insensitive structure
A. Middle cerebral aery
B. Choroid plexus
C. Dural sheath
D. Falx cerebri

Response:
The cranium, brain parenchyma, ependymal lining of the ventricles, and choroid plexus are all pain insensitive Ref Harrison20th edition pg 2345

So the answer to this question is B


Instruction:
Which of the following is most common cause of vitreous haemorrhage in children?
A. Diabetic Retinopathy
B. Trauma
C. Eales disease
D. Coat's disease

Response:
Trauma is the most common cause of vitreous hemorrhage in children. Vitreous Hemorrhage Blood in vitreous cavity Causes: Intraocular surgery Ocular tumors Trauma Vasculitis Proliferative diabetic retinoopathy Neovascularization Intravitreal injections Most Common Most common cause of vitreous hemorrhage in adults: Proliferative diabetic retinopathy. Most common cause of vitreous hemorrhage in children: Trauma.

So the answer to this question is B


Instruction:
Muehrcke lines in nails are seen in
A. Nephrotic syndrome
B. Barer syndrome
C. Nail patella syndrome
D. Acute tubular necrosis

Response:
Ans. is 'a' i.e., Nephrotic syndrome

So the answer to this question is A


Instruction:
Lysozyme is present in all except:
A. Lacrimal secretions
B. CSF
C. Saliva
D. Respiratory tract secretions

Response:
Lysozyme is a heat-labile protein which acts as a muraminidase and hence has bactericidal activity. It is present in tears, saliva and all mucosal secretions, but is absent in CSF, sweat and urine

So the answer to this question is B


Instruction:
Children born to mothers with systemic lupus erythematosis are likely to have one of the following anomalies -
A. Atrial septal defect
B. Tetralogy of fallot
C. Transposition of great vessels
D. Complete hea block

Response:
Ans. is 'd' i.e., Complete hea block o Maternal lupus erythmatosus has been associated with a high incidence of congenital hea block in offspring.

So the answer to this question is D


Instruction:
Fluoride content is least in
A. Enflurane
B. Isoflurane
C. Sevoflurane
D. Desflurane

Response:
(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.170-171)

So the answer to this question is D


Instruction:
A 25 year old female comes to OPD with history of spots, red bumps that are located principally on the proximal cheeks, central chin, nose and central forehead. It gets aggravated on sun exposure. On examination, telangiectasia is seen on cheeks. What is the most probable cause ?
A. Polymorphic light eruption
B. SLE
C. Acne vulgaris
D. Rosacea

Response:
The given clinical scenario is of Rosacea as it gets aggravated on exposure to sunlight, redness seen on face convexities and telangiectasia Rosacea has 4 subtypes : Subtype 1: Erythematotelangiectatic rosacea (ETTR). Subtype 2: Papulopustular rosacea (PPR). Subtype 3: Phymatous rosacea (PR). Subtype 4: Ocular rosacea (OR). In SLE, rash spares Nasolabial fold

So the answer to this question is D


Instruction:
Which of the following can lead to Megaloblastic anemia?
A. Dorzolamide
B. Chlorthiazide
C. Triamterene
D. Canrenone

Response:
Triamterene is a ENaC blocker and also a folate antagonist, hence can lead to megaloblastic anemia.

So the answer to this question is C


Instruction:
Cobalt forms a component of which of the following vitamins?
A. Biotin
B. Vitamin B12
C. Vitamin A
D. Tocopherol

Response:
Central poion of vitamin B12 consists of four reduced and extensively substituted 'pyrrole rings' surrounding a single cobalt atom(Co). This central structure is called 'corrin ring system'. When cyanide is bound to cobalt atom is called as cyanocobalamin. Cobalt is required only as a constituent of vitamin B12. While biotin, vitamin A and tochopherol has no metal as constituent pa. Also Know: Strict vegetarians (vegans) are at risk of developing B12 deficiency. Vitamin B12 is absorbed bound to intrinsic factor, a small glycoprotein secreted by the parietal cells of the gastric mucosa. Vitamin B12 is absorbed from the distal third of the ileum receptors that bind the intrinsic factor-vitamin B12 complex, but not free intrinsic factor or free vitamin. Ref: Bender D.A. (2011). Chapter 44. Micronutrients: Vitamins & Minerals. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.

So the answer to this question is B


Instruction:
A farmer visiting a orchard gets unconscious, excessive salivation , constricted pupils and fasciculation of muscles, treatment staed with
A. Atropine
B. Neostigmine
C. Physostigmine
D. Adrenaline

Response:
A i.e. Atropine

So the answer to this question is A


Instruction:
All of the following are side effects of growth hormone (supplements) therapy except
A. Slipped capital femoral epiphysis
B. Gynaecomastia
C. Hypoglycemia
D. Pseudotumour cerebri

Response:
Ans. c. Hypoglycemia

So the answer to this question is C


Instruction:
To synthesize insulin on a large scale basis, the most suitable staing material obtained fro the beta cells of the pancreas is:
A. Genomic DNA
B. Total cellular RNA
C. CDNA of insulin
D. MRNA of insulin

Response:
D i.e. mRNA of insulin Insulin is synthesized on a large scale basis from complementary DNA's (cDNA), using recombinant technology. But cDNA is not the staing material. cDNA are derived from mRNAQ.Thus mRNA is staing material for insulin synthesis on a large scale basis.Construction of cDNA from mRNA

So the answer to this question is D


Instruction:
Zollinger-Ellison syndrome is due to tumor of the -
A. α cells
B. β cells
C. PP cells
D. G-cells

Response:
None

So the answer to this question is D


Instruction:
Investigation to be done immediately when an unstable patient comes with blunt abdominal trauma is -
A. USG
B. CT Scan
C. Complete Hemogram
D. Abdominal Xray

Response:
Ans. is 'a' i.e., USG Stable patient - CT Unstable patient - FAST

So the answer to this question is A


Instruction:
A total number of ...... tablets of iron with folk acid is given to a pregnant women by the Health worker?
A. 70
B. 90
C. 100
D. 150

Response:
Ans. is 'c' i.e., 100 o This fact has been omitted from I 9th/e and 20th of work. It was given in 18thie of Park. o In 20th/e, the number of tablets for children has been mentioned. "Current programme guidelines instructs the health workers to provide 100 tablets to children clinically found to he anaemic".

So the answer to this question is C


Instruction:
Contents of the suboccipital triangle are formed by all of the following structures, EXCEPT?
A. Veebral aery
B. Suboccipital nerve
C. Greater occipital nerve
D. Lesser occipital nerve

Response:
The contents of the suboccipital triangle are veebral aery, suboccipital nerve and greater occipital nerve.The suboccipital triangle is the area in the suboccipital region between the rectus capitis posterior major and the obliquus capitis superior and inferior muscles. It is covered by a layer of dense fibro-fatty tissue, deep to the semispinalis capitis muscle. Its floor is formed by the posterior occipitoatlantal membrane and the posterior arch of the C1 veebrae. The suboccipital muscles are:Obliquus capitis superior muscleObliquus capitis inferior muscleRectus capitis posterior major muscleRectus capitis posterior minor muscle

So the answer to this question is D


Instruction:
Blood : Gas paition coefficient is a measure of ?
A. Potency of anaesthetic agent
B. Speed of induction and recovery
C. Lipid solubility of agent
D. None

Response:
Ans. is 'b' i.e., Speed of induction and recovery Minimum alveolar concentration (MAC) --> Measure of potency. Blood : Gas paition coefficient Blood solubility of anaesthetic agent and determines the speed of induction & recovery. Oil : Gas paition coefficient -4 Lipid solubility of anaesthetic agent and is related to potency of anaesthetic agent.

So the answer to this question is B


Instruction:
A 10-month-old child can do all the following EXCEPT
A. Speaks Bisyllables (Like dada, mama)
B. Walks unsupported
C. Creep and crawl
D. Pincer grasp

Response:
Ans. b (Walks unsupported) (Ref. Nelson Pediatrics 17th ed. 34; and OP Ghai Paediatrics 6th ed., p 48)DEVELOPMENTAL MILESTONESApproximate AgeMotor MilestoneCognitive/Social MilestoneInfant 3 mo4-5 mo7-9 mo12-14 mo15 moHolds head up, Moro reflex disappearsRolls front to back, sits when proppedSits alone, crawlsUpgoing Babinski disappearsWalksSocial smileRecognizes peopleStranger anxiety, orients to voiceFew words, separation anxietyToddler 12-24 mo18-24 mo24-48 mo24-36 moClimbs stairs, stacks 3 blocksStacks 6 blocksParallel playCore gender identityObject permanenceRapprochementPreschool 30-36 mo3 yrs4 yrsStacks 9 blocksRides tricycle, copies line or circle drawingSimple drawings (stick figure), hops on 1 footToilet trainingGroup playCooperative play, imaginary friendsSchool age 6-11 yrsReads; understands deathDevelopment of conscience(superego), same-sex friends, identification with same-sex parent.Milestones summaryAgeMotorAdaptiveLanguageSocial10 moStands alonePlay 'peek a boo'Pick up a pellet with thumb and index finger.Bizarre words-15 moWalks aloneMakes line with crayonJargonIndicates desires/needs by pointing18 moWalks up stairs with 1 hand heldImitates scribblingIdentifies>/=1 body partsFeeds self24 moRuns wellCircular scribblingPuts 3 words togetherHandlespoon well30 moGoes up stairs alternating feetMake horizontal vertical strokeRefers to self by pronounTHelps to put things away36 moRides tricycle, stands on 1 foot momentarilyTower of 10 cubes, imitates cross.Known age & sex dressingWash hands, Helps in48 moHops on one foot, climbs wellNames longer of 2 lines copies cross & squareTells a storyRole playing, goes to toilet alone

So the answer to this question is B


Instruction:
Now–a–days, the selective serotonin reuptake inhibitors are the preferred drugs for which of the following psychiatric disorder apart from their role in the treatment of depression :
A. Phobias
B. Obsessive compulsive disorder
C. Post-traumatic stress disorder
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
Chocking is constricting device within the barrel at the muzzle end of -
A. Revolver
B. 303 rifle
C. Shot gun
D. Semiautomatic pistol

Response:
The synopsis of forensic medicine & toxicology ; Dr k.s narayan reddy ; 28th edition ; pg.no 122 The choke bore present in a shot gun ,the distal 7-10 cm of the barrel is narrow . There are some shotguns which have a small poion of their bore near the muzzle end rifled ,which are called "paradox gun" .

So the answer to this question is C


Instruction:
Amino acid abundant in collagen:
A. Glycine
B. Lysine
C. Leucine
D. Isoleucine

Response:
Ans. A Glycine* Collagen is rich in glycine and proline amino acid.* Glycine is the smallest amino acid, present in every third position of chain, therefore it fits into the spaces where the three chains of helix comes together.* This repeating structure, represented as (Gly-X-Y) n, is an absolute requirement for the formation of the triple helix. While X and Y can be any other amino acid, about 100 of the X positions are proline and about 100 of the Y positions are hydroxyproline. Proline and hydroxyproline confer rigidity on the collagen molecule.

So the answer to this question is A


Instruction:
The pathological feature in Wegener&;s granulomatosis on renal biopsy
A. Nodular glomerulosclerosis
B. Focal necrotizing glomerulonephritis
C. Granulomas in the vascular wall
D. Granuloma of parenchyma of kidney

Response:
Wegener's granulomatosis is a necro-inflammatory lesion having 4 components granulomas of the upper respiratory tract, granulomas of the lungs, systemic vasculitis (page 403) and focal necrotizing glomerulonephritis. Ref: Harsh Mohan textbook of pathology 6th edition page 495.

So the answer to this question is B


Instruction:
Bartonella henselae causes all except -
A. Oroya fever
B. Cat scratch disease
C. Bacillary angiomatosis
D. SABE

Response:
B. henselae is associated with Cat-scratch disease, bacillary angiomatosis, bacillary peliosis, bacteremia, endocarditis

So the answer to this question is A


Instruction:
The most sensitive method for detecting cervical chlamydia trachomatis infection is
A. Direct fluorescent antibody test
B. Enzyme immunoassay
C. PCR
D. Culture on irradiated McConkey cells

Response:
PCR

So the answer to this question is C


Instruction:
Brain is stored in preservative...... for autopsy
A. Saline
B. EDTA
C. NaF
D. Formalin

Response:
Formalin

So the answer to this question is D