Instruction:
For radiotherapy an isotope is paced in or around canecr site. It is called as:
A. Brachytherapy
B. Tefetberapy
C. External beam therapy
D. Intensity Medulated radiotherapy

Response:
Ans: A (Brachytherapy) Types of radiotherapy Grainger & Allison's Diagnostic Radiology 6thfl 737-44External beam radiotherapy: It refer to any situation where the source of the radiation is located at a distance from the patient & the beam of radiation is then directed towards a defined treatment area. Approximately 85% of all therapeutic radiation exposures are delivered using externa! beam techniques.Conventional external beam radiotherapyThree dimensional conformal radiotherapyIntensity-modulated radiotherapy: In this the intensity of radiation beam is modulated across each treatment beamStereotactic body radiotherapy: The distribution of radiation beam is in 3-dimensions & not in two as in traditional radiotherapyBrachytherapy: 11 refers to situation in which a radioisotope is placed onto or inside the patient. The source can be placed into the target tissues or tumour itself such as prostate or breastfinterstitial brachytherapy, into a body cavity such as the uterine cavity, oesophagus or bronchus (intracavity/ intraluminal brachytherapy) otonto the skin surface to treat a cutaneous malignancyParticle therapy: Also known as Hadron therapy. It is an external beam radiation technique in which highly energetic particle such as protons, neutrons or positive ions are directed at the tumorTeletherapy: Treatment in which the radiation source is at a distance from the body. Linear accelerators & cobalt machines are used in teletherapy. Also called external beam therapy"-'"Brachy therapy: A type of radiation therapy is which radioactive materials are placed in direct contact with the tissue being treated. Broadly it is of two types- interstitial or intracavity"- Review of Radiology by Sumer Sethi 6thfl 76Types of brachytherapyMold brachytherapy*3 Superficial tumours can be treated using sealed sources placed close to the skinInterstitial brachytherapy13 Here the sources are inserted into tissueIntracavitary brachytherapy13 places the sources inside a pre-existing body cavityIntravascular brachytherapy places a catheter inside the vasculature through which sources are sent and returnedElectronic brachytherapy places a miniature low energy (< SOkVp) x-ray tube source into a pre-positioned applicator within body/tumor cavities to rapidly deliver high doses to target tissues while maintaining low doses to distant non-target tissuesTHERAPEUTIC RADIATION Harrison 19thTherapeutic radiation is delivered in three ways: (1) teletherapy, with focused beams of radiation generated at a distance and aimed at the tumor within the patient; (2)brachytherapy, with encapsulated sources of radiation implanted directly into or adjacent to tumor tissues; and (3)systemic therapy, with radionuclides administered, for example, intravenously but targeted by some means to a tumor site.Teletherapy with x-ray or gamma-ray photons is the most commonly used form of radiation therapy.

So the answer to this question is A


Instruction:
Bone resorption markers are except:
A. Taarate resistant alk. phosphatase (TRAP)
B. Osteocalcin
C. Cross linked-N-telopeptides
D. Urine total free deoxypyridinoline

Response:
Osteocalcin Osteocalin is a non-collogenous protein secreted by osteoblasts. It is thought to play a role in mineralization and calcium ion hemostasis. "Thus it is a bone formation marker i.e. osteoblastic marker". A large number of studies have shown that the circulating level of osteocalcin reflects the rate of bone formation (not resorption). Biochemical markers of bone resorption Abbr. Name Mechanism Company NTX Aminoterminal cross-linking telepeptide of bone collagen Collagen-based Ostex (Osteomark) CTX Carboxyterminal cross-linking telopeptide of bone collagen Pyridinoline Collagen-based Collagen-based Cross-laps (Osteometer) PYD DPD Free Lysyl-pyridinoline (deoxypyridinoline) Collagen-based Metra (PyrilinksD) TRACP Tarate-resistant acid phosphatase Secreted by osteoclasts Hyp Hydroxy-proline (not very specific) Collagen-based Bone ALP Bone-specific alkaline phosphatase Secreted by osteoblasts Hybritech (Ostase) BAP Metra (Alkphase-B) Orion, Metra (Prolagen) PINP PICP Procollagen type IC propeptide Collagen-based Procollagen type 1 N propeptide Collagen-based Iscstar OC Osteocalcin (bone gla-protein) Secreted by osteoblasts Nichols, Cis Biointer national ALP Alkaline phosphatase (not very specific) Secreted by osteoblasts

So the answer to this question is B


Instruction:
Which of the following does not have a Tm value?
A. Na+
B. Urea
C. Creatinine
D. Glucose

Response:
Transpo maximum (Tm) or tubular maximum : is the maximum amount of a substance that can be transpoed across the tubule (reabsorbed or secreted) per unit time.E.g., glucose has a Tm value of 320 mg/min. Reabsorption or secretion of most substances is mediated by their respective carrier proteins in the wall of the tubules. Tm implies saturation of the carrier. Since Na+ reabsorption primarily involves the activity of Na+/K+ pump which does not exhibit saturation kinetics, Na+ reabsorption does not have a Tm value.

So the answer to this question is A


Instruction:
An 18 year old boy came to the Psychiatry OPD with a complaint of feeling changed from inside. He described himself as feeling strange as if he is different from his normal self. He was very tense and anxious yet could not point out the precise change in him. This phenomena is best called as -
A. Delusional mood
B. Depersonalization
C. Autochthonous delusion
D. Over valued idea

Response:
Feeling strange as if different from oneself, i.e. feeling of detached from self is seen in depersonalization disorder.

So the answer to this question is B


Instruction:
"Crescents" on histopathologic examination of glomerulus are seen in
A. Minimal change disease
B. Rapidly proliferative GN
C. Membranous glomerulonephritis
D. MPGN

Response:
Ans. b (RPGN). (Ref. Robbin, Pathology 8th ed., 545)Rapidly Progressive (Crescentic) Glomerulonephritis# RPGN is a clinical syndrome and not a specific etiologic form of GN.# Clinically, it is characterized by rapid and progressive loss of renal function with features of the nephritic syndrome, often with severe oliguria and (if untreated) death from renal failure within weeks to months.# Regardless of the cause, the histologic picture is characterized by the presence of crescents (crescentic GN).# These are produced in part by proliferation of the parietal epithelial cells of Bowman's capsule in response to injury and in part by infiltration of monocytes and macrophages.Type I (Anti-GBM Antibody)IdiopathicGoodpasture syndromeType II (Immune Complex)IdiopathicPostinfectious/infection relatedSystemic lupus erythematosusHenoch-Schonlein purpura/IgA nephropathyType III (Pauci-Immune) ANC A AssociatedIdiopathicWegener granulomatosisMicroscopic angiitis

So the answer to this question is B


Instruction:
Myosin and actin filaments are kept in place by
A. Tropomyosin
B. Troponin
C. Actinin
D. Titin

Response:
Titin keeps actin and myosin in place It povides elasticity It is present in skeletal and cardic muscles Ref:Guyton and Hall textbook of medical physiology 12th edition ,pag number:85,86,87

So the answer to this question is D


Instruction:
For reduction of cholesterol, the best management includes:
A. Cholesterol restricted diet
B. High fiber diet
C. Diet with high unsaturated FA and low saturated FA
D. Cholesterol restricted diet, high fiber and diet with low saturated FA to unsaturated FA ratio

Response:
D i.e. Cholesterol restricted diet, high fiber diet with low saturated FA to unsaturated FA ratio.

So the answer to this question is D


Instruction:
55 year old female a known case of thryotoxicosis in control posted for abdomino perineal resection during surgery there was sudden drop in B.P., and end tidal CO2 decreased from 40 to 10 mmHg. On auscultation there was a mill wheel murmur, what is the diagnosis –
A. Thyroid storm
B. Bleeding
C. Hypoxia
D. Air embolism

Response:
Presence of Mill wheel murmur and decrease in End tidal CO2 during surgery suggests Air embolism:-
"If air enters the vein in sufficient amount, it will go to the right heart and lung causing an air-lock obstruction in the pulmonary artery. This may result in a loud continuous precordial murmur, the so called "Mill wheel murmur".

So the answer to this question is D


Instruction:
Macrosomia is/are associated with:a) Gestational diabetes mellitusb) Maternal obesityc) Hypothyroidism d) Hyperbilirubinemia e) Fetal goitre
A. ac
B. a
C. ad
D. ab

Response:
The recommended definition is fetal (neonatal) weight exceeding two standard deviations or above 90th centile for the appropriate normal population.
According to ACOG: birth weight of > 4500 gm is called as macrosomia.
In Indian context birth weight of > 4000 gm is called as macrosomia.

So the answer to this question is D


Instruction:
A person restricts himself to house and fears about trains, elevators, and shopping malls. It is a feature of
A. Generalised Anxiety disorder
B. Agoraphobia
C. Claustrophobia
D. Acrophobia

Response:
(B) Agoraphobia # Agoraphobia is an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives the environment to be unsafe with no easy way to get away.> These situations can include open spaces, public transit, shopping malls, or simply being outside the home. Being in these situations may result in a panic attack.> Symptoms occur nearly every time the situation is encountered and lasts for more than six months.> Those affected will go to great lengths to avoid these situations. In severe cases people may become unable to leave their homes.# Cause of agoraphobia is a combination of genetic and environmental factors. Condition often runs in families and stressful events such as the death of a parent or being attacked may be a trigger. In the DSM-5 agoraphobia is classified as a phobia along with specific phobias and social phobia. Other conditions that can produce similar symptoms include separation anxiety, posttraumatic stress disorder, and major depressive disorder. Those affected are at higher risk of depression and substance use disorder.> Treatment: Without treatment it is uncommon for agoraphobia to resolve. Treatment is typically with a type of counselling called cognitive behavioral therapy (CBT). CBT results in resolution for about half of people# Claustrophobia is the fear of having no escape and being in closed or small spaces or rooms.> It is typically classified as an anxiety disorder and often results in panic attack, and can be the result of many situations or stimuli, including elevators crowded to capacity, windowless rooms, and even tight-necked clothing.> Onset of claustrophobia has been attributed to many factors, including a reduction in the size of the amygdala, classical conditioning, or a genetic predisposition to fear small spaces.> Claustrophobia is typically thought to have two key symptoms: Fear of restriction Fear of suffocation> A typical claustrophobic will fear restriction in at least one, if not several, of the following areas: small rooms, locked rooms, cars, aeroplanes, trains, tunnels, cellars, elevators, caves.# Acrophobia is an extreme or irrational fear or phobia of heights, especially when one is not particularly high up.> It belongs to a category of specific phobias, called space and motion discomfort, that share both similar etiology and options for treatment.

So the answer to this question is B


Instruction:
The occlusal outline of the permanent mandibular first molar is usually similar to
A. Circle
B. Square
C. Trapezoid
D. Parallelogram

Response:
None

So the answer to this question is C


Instruction:
Which of the following is not a modification for the class III cavity preparation to receive direct filling gold restorations?
A. Ferrier design
B. Loma Linda design
C. Ingraham design
D. Moustache extensions

Response:
Class V with unilateral or bilateral “moustache” extensions occlusally:
Sometimes surface defects occlusal to the height of contour are continuous with a gingival third lesion, necessitating their involvement in the Class V cavity preparation and their restorations. So one or two occlusal extensions are added to the basic trapezoidal Class V cavity preparation.

So the answer to this question is D


Instruction:
In case of vesicoureteric reflux which will be inv. Of choice -
A. Micturating cystourethrogram
B. IVP
C. Cystography
D. Radionucletide study

Response:
None

So the answer to this question is A


Instruction:
Which of the following statements best describes the colon?
A. The majority is derived from the primitive hindgut.
B. It is usually invested with peritoneum on all sides.
C. The hepatic flexure is related directly to the liver and right kidney.
D. The ascending and descending colon are always retroperitoneal.

Response:
The hepatic flexure is directly in contact with the liver and the right kidney; it is therefore at risk in a right nephrectomy. The majority of the colon is derived from the midgut, which extends to a point just proximal to the splenic flexure. The descending colon and sigmoid are derived from the hindgut. The ascending and descending colon are usually in contact with the abdominal wall posteriorly and with peritoneum on the rest of the surface. The posterior pa is therefore free from peritoneum.

So the answer to this question is C


Instruction:
Renal artery lumen is reduced by half, what will be the blood flow?
A. Reduce by 1/2
B. Reduce by 1/4
C. Reduce by 1/16
D. Come to normal after autoregulation

Response:
Ans: C. Reduce by 1/16Option c is correct because the flow of fluids can be described by Poiseuille's Law.In which flow of liquid is directly proportional to R4, So if lumen is reduced to half then blood flow will get reduce by 1/16.Other points related to blood flow...Poiseuille's Law states that the flow (Q) of fluid is related to a number of factors:The viscosity (n) of the fluidThe pressure gradient across the vessel (P)Length (L) and diameter(r) of the vesselDiameter: Doubling the diameter of tube increases the flow rate by 16 fold (r4). The larger the vessels's diameter greater is the blood flow.Viscosity: Flow is inversely proportional to the viscosity of the fluid.Viscosity of blood increases with increasing hematocrit and decreasing temperaturePressure: Increasing pressure further maximizes flow as described by Poiseuille's equation.The relationship is given by Poiseuille-Hagen formula:F=(PA -PB )x(8p )x(e1 )x(Lr4 )WhereF = FlowPA - PB = Pressure difference between two ends of the tube q = Viscosity r = Radius of tube L = Length of tubeRelationship between arterial blood pressure and blood flow given in graph below:

So the answer to this question is C


Instruction:
Sterility in man is when sperm count falls below (in
millions)
A. 20
B. 40
C. 60
D. 80

Response:
None

So the answer to this question is A


Instruction:
Which of the following muscles carries out shoulder abduction from 15 to 90 degrees?
A. Suprapinatus
B. Trapezius
C. Deltoid
D. Serratus Anterior

Response:
Ans. is 'c' i.e., Deltoid Abduction of shoulder* Abduction is initiated by supraspinatus, which is responsible abduction upto 15 degrees.* After that deltoid (acromial or middle fibers) is the major abductor upto 90 degrees of abduction. These two muscles, supraspinatus and deltoid are the prime movers for abduction.* Overhead abduction (> 90 degrees) is caused by trapezius and serratus anterior, which act by causing upward rotation of glenoid cavity.* In abduction, out of total 180 degree elevation, humerus moves 120o at the shoulder joint and the remaining 60 degree is done by rotation of scapula. In every 15o elevation, shoulder joint contributes lOo and scapular rotation 5o, in the ratio of 2:1. Rotation of scapula is facilitated by movements at sternoclavicularand acromioclavicular joints. In higher ranges of abduction there is lateral rotation of humerus. Lateral rotation of scapulaincreases the range of humeral elevation.

So the answer to this question is C


Instruction:
A 45 year old man presents to a physician with back pain and facial pain. Physical examination demonstrates coarse facial features and kyphosis. Laboratory examination is remarkable for elevated alkaline phosphatase. .X-ray studies demonstrate skull thickening with narrowing of foramina, and bowing of the femur and tibia. Bone biopsy reveals a mosaic pattern of bone spicules with prominent osteoid seams. Which of the following neoplasms occurs at an increased frequency in patients with this disorder?
A. Astrocytoma
B. Hodgkin's lymphoma
C. Meningioma
D. Osteosarcoma

Response:
The phrase "mosaic pattern" of newly formed woven bone is a specific tip-off for Paget's disease of bone, and is not seen in other bone conditions. The clinical and radiologic presentation are typical; an increased hat size may also be a clue. In its early stages, Paget's disease is characterised by osteolysis, producing patchwork areas of bone resorption with bizarre, large osteoclasts. In the middle stage of the disease, secondary osteoblastic activity compensates with new bone formation, producing the mosaic pattern. In late Paget's, the bones are dense and osteosclerotic. Paget's disease is suspected to be related to prior viral infection, but the cause remains mysterious. Complications include myelophthisic anemia, high output cardiac failure, pain secondary to nerve compression, deformities secondary to skeletal changes, and in about 1% of patients, osteosarcoma or other sarcoma, typically involving the jaw, pelvis, or femur. An increased incidence of astrocytomas is associated with tuberous sclerosis.Hodgkin's lymphoma is usually a disease of young adults, although older patients may have the lymphocyte-depleted form.Meningiomas are mostly benign tumors that affect adults, especially females. There may be an association with breast cancer, possibly related to high estrogen states. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 19. Pathology of the Bones and Joints. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture.

So the answer to this question is D


Instruction:
A police officer brings the aboed product of conception of size 2 cm and weight 10 gm. For all forensic purposes what will he the age of the fetus
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. 8 weeks

Response:
Ans. c. 6 weeks Rule of Hasse Rule of Hasse is used to determine the age of fetus from crown to heel length in cm. During first five months, Length in cm = (Age in months)2 After age of >5 months, Age in months = (Length in cm)/5 Age of the Fetus End of first month Length 1 cm, weight two and half gram Eyes are seen as two dark spots and mouth as a cleft End of second month Length 4 cm, weight 10 gms Hands and feet are webbeddeg Anus is seen as a dark spot Age of the Fetus End of third month Length 9 cm, Weight 30 gms Eyes are closeddeg, pupillary membrane appears Nails appear and neck is formed End of fouh month Length 16 cm, weight 120 gmsdeg Sex can be recognized End of fifth month Length 25 cm, weight 400 gms Nails are distinct and softdeg Light hairs appear on headdeg End of sixth month Length 30 cm, weight 700 gms Eyebrow and eyelashes appeardeg Subcutaneous fat begins to be depositeddeg Testes are seen close to kidney End of seventh month Length 35 cm, weight 900-1200 gms Nails are thick Eyelids open and pupillary membrane disappearsdeg Testes found at external inguinal ringdeg End of eighth month Length 40 cm, weight one and half to two kg Nails reach the tips of fingersdeg Left testes in scrotumdeg End of ninth month Length 45 cm, weight two and half to three kg Scalp hair is dark and 4 cm longdeg Scrotum is wrinkled and contains both testesdeg End of tenth month Length 50-53 cm, weight 2.5-5 kg The nails project beyond the end of fingers but reach only the tip of the toes

So the answer to this question is C


Instruction:
NOT a sign of POTT's spine
A. Tenderness
B. Sensory loss
C. Paravertebral muscle sparm
D. Loss of Deep tendon reflexes

Response:
None

So the answer to this question is D


Instruction:
CA125 is used for?
A. Follow up of ovarian cancer
B. Diagnosis of pancreatic cancer
C. Diagnosis of stomach cancer
D. Diagnosis of ovarian cancer

Response:
ANSWER: (A) Follow up of ovarian cancerREF: Robbins pathology ch: 7Biochemical assays for tumor-associated enzymes, hormones, and other tumor markers in the blood cannot be used for definitive diagnosis of cancer; however, they contribute to the detection (screening) of cancer and in some instances are useful in determining the effectiveness of therapy or the appearance of a recurrence. Remember tumour markers are always used for screening or prognosis, never for diagnosis.Conditions associated with raised CA-125Best known tumour marker for ovarian ca. endometrial cancer, fallopian tube cancer, lung cancer, breast cancer and gastrointestinal cancer.CA-125 may also be elevated in a number of relatively benign conditions, such as endometriosis several diseases of the ovary, menstruation and pregnancy. It also tends to be elevated in the presence of any inflammatory condition in the abdominal area, both cancerous and benign.Role of CA-125 in ovarian carcinoma:[?] Early detection and prognosis[?] Monitor responses to chemotherapy, relapse, and disease progression.[?] Levels of CA125 can be elevated in the serum before clinical development of primary and recurrent ovarian carcinoma[?] An important characteristic of CA125 is the ability to reflect changes in tumor mass during chemotherapy or in the follow-up period after completion of therapy[?] The postoperative serum CA125 level is an independent prognostic factor in patients with invasive ovarian cancer

So the answer to this question is A


Instruction:
37 weeks primi with uterine contraction for 10 hours, cervix is 1 cm dilated and poorly effaced management is:
A. Cesarean section
B. Amniotomy
C. Oxytocin drip
D. Sedation and wait

Response:
Ans. is d, i.e. Sedation and waitRef. Fernando Arias 3/e, p 376The patient is presenting at 37 weeks with mild labor pains for 10 hours. Cervix is 1 cms dilated and is not effaced. Now this can either be a case of false labor pains or it can be prolonged latent phase of labor.False labor can be differentiated from latent phase of labor by therapetuic rest, i.e. patient is sedated with morphine.Patient in false labor|Sleeps for a few hours and wakes-up without contractionsPatient in latent phase|Continues contracting and show cervical changes following the restSo the correct option is Sedate and Wait.

So the answer to this question is D


Instruction:
A 9-year-old male comes in for a routine physical examination. The pediatrician notices that the right testis is enlarged and without tenderness. The examination reveals following finding: This fluid most likely occupies which space?
A. D
B. A
C. B
D. C

Response:
The image shows the classical finding of transillumination seen in hydrocoele. A- Epididymis B- Cremasteric layer C- Tunica vaginalis D- External spermatic fascia This patient most likely has a hydrocele, which is a fluid collection in the tunica vaginalis. This is a congenital condition formed when the testis descends through the inguinal canal together with some peritoneum. Peritoneal fluid sometimes accumulates in this space.

So the answer to this question is D


Instruction:
Sample collection for renal tuberculosis is
A. Single early morning urine sample
B. 24 hours urine collection
C. 3 random urine collection
D. 3 morning sample of urine

Response:
BACTERIOLOGICAL:- The diagnosis of genitourinary TB is confirmed on a tuberculin test or atleast three consecutive early morning samples of urine are collected and sent for microscopy (Ziehl-Neelsen staining), culture on Lowenstein-Jensen medium. RADIOGRAPHY:- A plain abdominal radiograph may show calcified lesions of CEMENT KIDNEY. INTRAVENOUS UROGRAPHY:-EARLY:-Normally clear cut outline of renal papillae may be rendered indistinct by presence of ulceration. TUBERCULOUS ABSCESS:-Appears as SOL , which causes adjacent calyces to splay out. LATE:- Dilatation of contralateral ureter from obstruction where the ureters passes through thickened and oedmatous bladder wall. CYSTOSCOPY:- GOLF-HOLE ureteric orifice. CXR:-Active Lung lesion. Reference : Bailey27th edition . chapter 76 , pg no: 1405

So the answer to this question is D


Instruction:
MAO inhibitors should not be used with -
A. Buprenorphine
B. Pethidine
C. Pentazocin
D. Morphine

Response:
Ans. is 'b' i.e., Pethidine o Nonselective MAO inhibitors interact with many food constituents and drugs : 1-Cheese reaction o Ceain varieties of cheese, beer, wines, picked meat and fish, yeast extract contain large quantities of tyramine, dopa. o In MAO inhibited patients these indirectly acting sympathomimetic amines escape degradation in the intestinal wall and liver --> reaching into systemic circulation they displace large amount of NA from adrenergic nerve endings Hypeensive crisis, cerebrovascular accidents. This can be treated by Lv. injection of a rapidly acting a-blocker eg, phentolamine. Prazosin and chlorpromazine are alternative. 2. Reserpine, guanethidine, tricyclic antidepressant. o Rise in BP and body temprature can occur when these drugs are given with MAO inhibits --> due to their initial NA releasing or uptake inhibiting action. 3. Levodopa Excitement and hypeension occur due to increase V" of DA that is produced from levodopa. 4. Antiparkinsonism anticholinergic Symptoms of atropine poisoning occur. 5. Brabiturates, opoids, alcohol, antihistamininc o Action of these drugs is intensified and prolonged. 6. Pethidine o High fever, sweating, excitation, delirium, convulsion and respiratory depression occur. o This is due to excess production of norpethidine (normally it is minor metabolites). o MAO inhibitors inhibit hydrolysis but not detmethylation more norpethidine is produced. 7. SSRIs o MAO inhibitors produce serotonine syndrome when given with SSRIs.

So the answer to this question is B


Instruction:
Renal aery stenosis is caused by all except
A. Atherosclerosis
B. Fibromuscular dysplasia
C. Takayasu aeritis
D. Buerger's disease

Response:
Renal aery stenosis: aCauses- Atherosclerotic disease(most common cause) - Fibromuscular Dysplasia(FMD) - Extrinsic compression of the vessel a It is considered a specifically treatable "secondary" cause of hypeension a Pathogenesis: Critical levels of stenosis - reduction in perfusion pressure - Activation of the renin-angiotensin system and sympathetic adrenergic pathways - systemic hypeensiona LVH and renal fibrosis (later stages) a Renal aery stenosis is also labelled ischemic nephropathy; ARAS and SHT tend to affect both the poststenotic and contralateral kidneys, reducing overall (GFR) in ARAS Fibromuscular Dysplasia(FMD Atherosclerotic renal aery stenosis (ARAS) - Occurs in 3-5% of normal subjects - Presents clinically with hypeension in younger individuals (age 15-50), most often women. - lesions are frequently bilateral and, tend to affect more distal poions of the renal aery. - Usually does not affect kidney function, but may cause total occlusion and can be associated with renal aery aneurysms - Common in the general population, prevalence increases with age and in patients with CAD, PAD. - obstruction most commonly at the origin - If untreated may progress to total occlusion in 50% cases - It is a strong predictor of morbidity- and moality-related cardiovascular events a Evaluation: -Captopril renography with technetium 99m Tc meiatide (99mTc MAG3) a Normal study excludes renovascular hypeension-Nuclear imaging with technetium meiatide or technetium-labelled pentetic acid (DTPA)a Allows calculation of single-kidney GFR -Duplex ultrasonographyaInexpensive, non-invasive - Magnetic resonance angiographyaExpensive; not nephrotoxic but gadolinium toxicity excludes use in GFR<30 ml/min, unable to visualize stented vessels -computed tomographic angiographyaExpensive, potentially nephrotoxic, stents do not cause aefacts -Intra-aerial angiographyaConsidered "gold standard" for diagnosis of large vessel disease; Expensive, associated risk of atheroemboli, contrast toxicity, procedure-related complications, e.g., dissection a Treatment: -blockade of the renin-angiotensin system, attainment of goal blood pressures, cessation of tobacco, statins, and aspirin -percutaneous transluminal renal angioplasty (PTRA) (for FMD), endovascular stenting or surgical renal revascularization(for ARAS) Ref: Harrison's 18/e p2048

So the answer to this question is D


Instruction:
A child has respiratory distress, chest X-ray shows multiple air-filled space, the differential diagnosis is all except –
A. Congenital lung cyst
B. Congenital diaphragmatic hernia
C. Congenital lobar aplasia of lung
D. Congenital adenomatous malformation

Response:
Congenital lobar aplasia does not produce air-filled spaces on chest X-ray. All other three options produce air-filled space on chest X-ray.

So the answer to this question is C


Instruction:
Which of the following is false about WPW syndrome
A. Accessory bundle between atria and ventricles without conduction delay
B. Short PR interval
C. Epsilon waves
D. Wide QRS complexes

Response:
Delta waves are seen in WPW syndrome.

So the answer to this question is C


Instruction:
Commonest thyroid tumor in MEN (multiple endocrine neoplasia) -
A. Follicular
B. Papillary
C. Anaplastic
D. Medullary

Response:
Ans. is 'd' i.e., Medullary o Thyroid tumor is seen in MEN II, and is medullary carcinoma of thyroid.

So the answer to this question is D


Instruction:
Tetracycline inhibits protein synthesis by?
A. Inhibiting initiation and causing misreading of mRNA
B. Binding to 30 S subunit and inhibits binding of aminoacyltRNA
C. Inhibiting peptidyltransferase activity
D. Inhibiting translocation

Response:
Ans. is 'b' i.e., Binding to 30 S subunit and inhibits binding of aminoacyl tRNA Tetracycline interact with small ribosomal subunits, blocking access of aminoacyl- tRNA to the mRNA-ribosome complex.

So the answer to this question is B


Instruction:
Fetal middle cerebral artery Doppler is most useful in the evaluation of -
A. intrauterine growth restriction
B. Preeclampsia
C. Fetal anemia
D. Fetal metabolic disorders

Response:
Ans-CMCA - PSA for fetal anemia in Rh- pregnancy.

So the answer to this question is C


Instruction:
Most common muscle to be congenitally absent -
A. Teres major
B. Pectoralis major
C. Gastrosoleus
D. Semimembranosus

Response:
Congenital absence of Pectoralis major is the most common.

So the answer to this question is B


Instruction:
Ibalizumab was approved by FDA in 2018 April for ( REPEAT)
A. HIV
B. TB
C. Leprosy
D. Malaria

Response:
Ibalizumab was approved for HIV in 2018 Ibalizumab belongs to a new class of HIV drugs called post-attachment inhibitors. Post-attachment inhibitors work by attaching to CD4 receptor on the surface of the immune cells. When ibalizumab attaches to the CD4 receptor, HIV cannot attach to, enter, or infect the cell.

So the answer to this question is A


Instruction:
Sistrunk's operation is excision of
A. Thyroglossal cyst.
B. Thyroglossal fistula.
C. Thyroglossal fistula along with thyroglossal tract.
D. All of the above.

Response:
None

So the answer to this question is C


Instruction:
The child , Pretends in play at the age of __________
A. 18 months
B. 24 months
C. 30 months
D. 36 months

Response:
Emerging patterns of social behaviour from 1-5years of age 15months Indicates some desires or needs by pointing Hugs parents 18months Feeds self Seeks help when in trouble May complain when wet or soiled Kisses parent with pucker 24months Handles spoon well Often tells about immediate experiences Helps to undress Listens to stories when shown pictures 30months Helps put things away Pretends in play 36months Plays simple games (in "parallel" with other children) Helps in dressing (unbuttons clothing and puts on shoes) Washes hands 48months Plays with several children, with the beginning of social interaction and role-playing Goes to the toilet alone 60months Dresses and undresses Asks questions about the meaning of words Engages in domestic role-playing Ref: Nelson paediatrics; Table 11-1

So the answer to this question is C


Instruction:
The half-life of Amiodarone is
A. 3-8 min
B. 3-8 hours
C. 3-5 weeks
D. 3-8 weeks

Response:
After oral administration, amiodarone only has a bioavailability of 30%. It also has a half-life of approximately 50 days, so it can take weeks for therapeutic effects to appear.

So the answer to this question is D


Instruction:
A female patient is presenting with BP of 90/60 and pulse rate 150/minutes after blunt abdominal trauma. How would you assess the patient
A. USG
B. CT scan
C. X-ray
D. MRI

Response:
Answer- A. USGThe diagnosis of abdominal injury by clinical examination is unreliable. Blunt abdominal trauma requires dessive investigation and management:If patient is hemodynmically stable and can be shifted - CT scan is the best.If patient is hemoilynamically unstable (cannot be shifted) - USG is the investigation of choice.

So the answer to this question is A


Instruction:
The most common cause of hypovolemic shock is
A. Haemorrhage
B. Decreased RBC formation
C. Bone marrow suppression
D. None of the above

Response:
None

So the answer to this question is A


Instruction:
Cardiac output is determined by
A. Ratio of organ to total peripheral resistance
B. Mean stroke volume
C. Mean BP
D. Contractility of hea

Response:
Cardiac o/p=stroke volume*Hea rate Therefore cardiac o/p is collectively regulated by Stroke volume and Hea rate Ref: Ganong's Review of Medical Physiology Twenty-Third Edition Page No: 514

So the answer to this question is B


Instruction:
Glue ear is
A. Painful
B. Painless
C. Naf is useful
D. Radical mastoidectomy is required

Response:
Otitis media with effusion/ Serous OM/Glue ear/Secretory OM is a painless condition following accumulation of non-inflammatory exudate in the middle ear. Commonly seen in children.OME is the commonest cause of conductive deafness in children, and due to adenoid hyperophyIn adults, Nasopharyngeal carcinoma is to be ruled out.Treatment of choice- Myringotomy with grommet inseion.Ref: Hazarika; 3rd ed; Pg 146

So the answer to this question is B


Instruction:
Which of the following markers is specific for gastro intestinal stromal /tumors (GIST)?
A. CD 117
B. CD34
C. CD23
D. S-100

Response:
Marker in GIST CD117-( c-kit)- 95% CD34-70% Smooth muscle Actin-5%

So the answer to this question is A


Instruction:
All of the following statements are true about Wiskott Aldrich syndrome, except:
A. Autosomal recessive disorder
B. Low serum IgM level
C. Thrombocytopenia
D. Eczema

Response:
Wiskott-Aldrich syndrome X-linked recessive disease Characterized by thrombocytopenia, eczema, and a marked vulnerability to recurrent infection Mutation in gene encoding Wiskott-Aldrich syndrome protein (WASP), which is located at Xp11.23. IgM levels in the serum are low, but levels of IgG are usually normal. Paradoxically the levels of IgA and IgE are often elevated. The only treatment is HSC transplantation.

So the answer to this question is A


Instruction:
A 38-year-old male presents with increasing weakness and is found to have a markedly elevated peripheral leukocyte count. Laboratory testing on peripheral blood finds a decreased leukocyte alkaline phosphatase (LAP) score, while chromosomal studies on a bone marrow aspirate find the presence of a Philadelphia chromosome. This abnormality refers to a characteristic chromosomal translocation that involves the oncogene
A. bcl-2 erb-B
B. c-abl
C. c-myc
D. erb-B

Response:
Chronic myeloid leukemia (CML) is one of the four chronic myeloproliferative disorders, but, unlike myeloid metaplasia or polycythemia vera, CML is associated with the Philadelphia chromosome translocation t(9;22) in over 90% of cases. This characteristic translocation, which involves the oncogene c-abl on chromosome 9 and the breakpoint cluster region on chromosome 22, results in the formation of a new fusion protein (P210) that is a non-receptor tyrosine kinase. In differentiating CML from a leukemoid reaction, several other features are impoant in addition to the presence of the Philadelphia chromosome: lack of alkaline phosphatase in granulocytes, increased basophils and eosinophils in the peripheral blood, and, often, increased platelets in early stages followed by thrombocytopenia in late or blast stages. Other well-known features of CML include marked splenomegaly, leukocyte counts greater than 50,000/uL, and mild anemia. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition.

So the answer to this question is B


Instruction:
Otitic barotrauma results due to
A. Ascent in air
B. Descent in air
C. Linear acceleration
D. Sudden acceleration

Response:
Otitic barotrauma is a nonsuppurative condition resulting from the failure of the eustachian tube to maintain middle ear pressure at ambient atmospheric level. The usual cause is rapid descent during an air flight, underwater diving or compression in a pressure chamber. Reference: Diseases of Ear, Nose and Throat, PL Dhingra, Shruthi Dhingra,7th edition, pg no.71

So the answer to this question is B


Instruction:
In terms of birth defect potential, the safest of the following drugs is
A. Alcohol
B. Isotretinoin (Accutane)
C. Tetracyclines
D. Progesterone

Response:
Alcohol is an enormous contributor to otherwise preventable birth defects. Sequelae include retardation of intrauterine growth, craniofacial abnormalities, and mental retardation. The occasional drink in pregnancy has not been proved to be deleterious. Isotretinoin (Accutane) is a powerful drug for acne that has enormous potential for producing congenital anomalies when ingested in early pregnancy; it should never be used in pregnancy. Tetracyclines interfere with development of bone and can lead to stained teeth in children. Progesterone have been implicated in multiple birth defects, but controlled studies have failed to demonstrate a significant association with increased risk. Patients who have inadvertently become pregnant while on birth control pills should be reassured that the incidence of birth defects is no higher for them than for the general population. Phenytoin (Dilantin) is used for epilepsy and can be associated with a spectrum of abnormalities, including digital hypoplasia and facial abnormalities.

So the answer to this question is D


Instruction:
Fastest method for diagnosis of TB ?
A. Gene expe
B. LI medium
C. TB MGIT
D. BAC IEC

Response:
Ans. is 'a' i.e., Gene expe

So the answer to this question is A


Instruction:
The oxygen buffer function of hemoglobin is related to
A. Dissociation curve shape
B. Haldane effect
C. Bohr effect
D. Respiratory exchange ratio

Response:
Acid and base shifts in the blood are largely controlled by three main buffers in blood: (1) proteins, (2) hemoglobin, and (3) the carbonic acid-bicarbonate system. Plasma proteins are effective buffers because both their free carboxyl and their free amino groups dissociate. The second buffer system is provided by the dissociation of the imidazole groups of the histidine residues in hemoglobin. In the pH 7.0-7.7 range, the free carboxyl and amino groups of hemoglobin contribute relatively little to its buffering capacity. However, the hemoglobin molecule contains 38 histidine residues, and on this basis--plus the fact that hemoglobin is present in large amounts--the hemoglobin in blood has six times the buffering capacity of the plasma proteins. In addition, the action of hemoglobin is unique because the imidazole groups of deoxyhemoglobin (Hb) dissociate less than those of oxyhemoglobin (HbO2), making Hb a weaker acid and therefore a better buffer than HBO.Ref: Ganong's Review of Medical Physiology Twenty-Third Edition Page no: 614

So the answer to this question is A


Instruction:
Which of the following is true about carcinoma of colon
A. Left colon tumors usually present with anaemia which is severe & unyielding to treatment
B. Mucinous carcinoma has excellent prognosis
C. Duke 'A' stage tumours need adjuvant chemotherapy
D. Solitary superficial hepatic metastasis is not a contraindication for resection

Response:
.* 40% of carcinoma colon spreads to liver poal veins. * Secondaries may be either solitary or multiple, present as liver with hard, umbilicated nodules. - Rarely it spreads to bone, lung, skin.* 20% of cases present as an acute intestinal obstruction. * 20% of colonic/colorectal cancer has stage IV disease at the time of first presentation. * Right sided growth commonly presents with anaemia, palpable mass in the right iliac fossa, which is not moving with respiration, mobile, nontender, hard, well localized with impaired resonant note. * Left sided growth presents with colicky pain, altered bowel habits (alternating constipation and diarrhoea), palpable lump, distension of abdomen due subacute/ chronic obstruction. Later may present like complete colonic obstruction. ref:SRB's manual of surgery,ed 5,pg no 907

So the answer to this question is D


Instruction:
Which one of the following organisms is the most frequent cause of acute pyogenic meningitis in adults:
A. Streptococcus pneumoniae
B. Neisseria meningitis
C. Haemophilus influenza
D. Listeria monocytogenes

Response:
Ans. (a) Streptococcus pneumoniaeRef: Dhingra 5th ed. /61y 81

So the answer to this question is A


Instruction:
Which of the following is the commonest tumour of thyroid -
A. Anaplastic carcinoma
B. Follicular carcinoma
C. Papillary carcinoma
D. Medullary carcinoma

Response:
Ans. is 'c' i.e., Papillary 'Papillary carcinoma accounts for 80% of all thyroid malignancies in iodine-sufficient areas and is the predominant thyroid cancer in children and individuals exposed to external radiation." - SchwartzIncidence of primary malignant tumors of thyroid gland (Harrison 17/e)Type of thyroid carcinomaApproximate PrevalencePapillary Carcinoma80-90%Follicular Carcinoma5-10%Medullary Carcinoma10%Anaplastic CarcinomaRareLymphomas1-2%* Also rememberThyroid carcinoma is the most common malignancy of the endocrine system (Ref: Harrison, 17/e, p 2243)

So the answer to this question is C


Instruction:
Cataract is NOT seen with
A. Steroids
B. Vitamin B12 deficiency
C. Diabetes mellitus
D. Homocystinuria

Response:
(B) Vitamin B12 deficiency # CAUSES OF CATARACT> Age: Age is the most common cause> Trauma: Blunt trauma, Electrical injuries> Radiation: Ultraviolet light: glassblowers, Lasers> Genetics Chromosome abnormalities associated with cataracts -- 1 q21.1 deletion syndrome, cri-du-chat syndrome, Down synd ome, Patau's syndrome, trisomy 18 (Edward's syndrome), and Turner's syndrome, and Neurofibromatosis type 2. Examples of single-gene disorder -- Alport's syndrome, Conradi's syndrome, myotonic dystrophy, and oculocerebrorenal syndrome or Lowe syndrome.> Skin diseases: Atopic dermatitis & Eczema: Ichthyosis (cuneiform cataracts); Basal-cell nevus & Pemphigus> Smoking and alcohol> Medications: Corticosteroids, Antipsychotics, Miotics> Post-operative: Vitrectomy, Cataract Surgery> Metabolic and nutritional diseases: Aminoaciduria or Lowe's syndrome, Diabetes mellitus, Fabry's disease, Galactosemia /galactosemic cataract, Homocystinuria, Hyperparathyroidism, Hypoparathyroidism, Hypervitaminosis D, Hypothyroidism, Hypocalcaemia, Mucopolysaccharidoses, Wilson's disease> Congenital: Congenital syphilis, Cytomegalic inclusion disease, Rubella, Cockayne syndrome\> Genetic syndromes: Down syndrome, Patau syndrome, Edwards syndrome> Infections: Cysticercosis, Leprosy, Onchocerciasis, Toxoplasmosis, Varicella> Secondary to other eye diseases: Retinopathy of prematurity, Aniridia, Uveitis, Retinal detachment, Retinitis pigmentosa

So the answer to this question is B


Instruction:
In Caldwell- Luc operation the nasoantral window is made through-
A. Superior meatus
B. Inferior meatus
C. Middle meatus
D. None of the above

Response:
Caldwell-Luc operation is a process of opening the maxillary antrum through canine fossa by sublabial approach and dealing with the pathology inside the antrum.
In this surgery, antrum is reached through an incision in gingivolabial sulcus (from lateral incisor to 2nd molar) and then opening of antrum in this area.
During the surgery a nose-antral window is made through the inferior meatus so that after the surgery, packing of sinus can be removed through this window.

So the answer to this question is B


Instruction:
True about E. coil is -
A. Sereny test is done to diagnose Enterotoxigenic E.coli (ETEC)
B. Enteropathogenic E. coli (EPEC) are also enteroinvasive
C. UTI is caused by single serotype at a time usually
D. E. coli is the most common causative organism to infect burn wounds

Response:
None

So the answer to this question is C


Instruction:
What is the basis of soing X-chromosome bearing and Y-chromosome bearing sperm?
A. X-chromosome has 2.8% more DNA
B. Y-chromosome has 2.8% more DNA
C. X-chromosome has 0.28% more DNA
D. Y-chromosome has 0.28% more DNA

Response:
Ans. is 'a' i.e.,X-chromosome has 2.8% more DNAA sperm-soing technology (the microso method) is the most effective procedure yet devised at separating X-bearing and Y-bearing sperm.X sperm have only 2.8% more DNA than those carrying a Y chromosome, fluorescent dye that attaches to DNA and glows under laser light in sperm soer then separates the sperm, sending X sperm down one tube and Y sperm into another.The soed sperm can then be placed in the woman's uterus (aificial insemination) or used for in vitro feilization.

So the answer to this question is A


Instruction:
Ranking students from the individual which the highest
grade — point average to the lowest is an example of a (an)
A. Ordinal scale
B. Nominal scale
C. Interval scale
D. Ratio scale

Response:
None

So the answer to this question is A


Instruction:
Amyloid deposits in liver are initially seen in: March 2009
A. Space of disse
B. Hepatic parenchyma
C. Intrahepatic ducts
D. Poal tract

Response:
Ans. A: Space of disse Kidney-Histologically, the mesangium and capillary basement membrane of glomeruli are the most frequent renal sites of amyloid deposition, followed by involvement of aeriolar and aerial walls and peritubular interstitial tissues. As the extent of the amyloid deposition increases, the glomerular capillary tufts become obliterated and replaced by functionless spherical masses of amyloid material Liver- Microscopically, amyloid is initially deposited in the spaces (of Disse) between the hepatocytes and vascular sinusoids. As more amyloid accumulates, it compresses the hepatic cords and sinusoids. The hepatic cords undergo nutritional and pressure atrophy and become displaced or replaced by bands and nodules of amyloid. Spleen-Amyloidosis of the spleen has two different anatomical patterns. Most commonly, the amyloid deposition is limited to the splenic follicles, resulting in the gross appearance of a moderately enlarged spleen dotted with gray nodules (so called "sago" spleen). Alternatively, the amyloid deposits may spare the follicles and mainly infiltrate the red pulp sinuses, producing a large, firm spleen mottled with waxy discolorations ("lardaceous" spleen).

So the answer to this question is A


Instruction:
Patent vitello-intestinal duct should preferably be operated at:
A. Bih
B. 6 months of age
C. 12 months of age
D. 3 years of age

Response:
Patent Vitello-intestinal Duct The resulting umbilical fistula discharges mucus and rarely, feces A patent vitello-intestinal duct should be excised, together with a Meckel&;s Diveicula if present, preferably when the child is about 6 months old Ref: Bailey 27th edition Pgno : 1044

So the answer to this question is B


Instruction:
Acrodermatitis enteropathica is inherited as?
A. X-linked recessive
B. X-linked dominant
C. Autosomal recessive
D. Autosomal dominant

Response:
Answer- C. Autosomal recessiveAcrodermatitis enterooathica is inherited as an autosomal recessive disorder.Cystic fibrosisPhenylketonuriaGalactosemiaHomocystinuriaLysosomal storage disease.alpha 1-antitrypsin deficiencyWilson diseaseHemochromatosisGlycogen storage disordersAcrodermatitis enteropathica

So the answer to this question is C


Instruction:
Type Ad curve is seen in -
A. Eustachian tube obstruction
B. After stapedectomy
C. Middle ear tumours
D. Secretory otitis media

Response:
Ans. is 'b' i.e., After stapedectomy

So the answer to this question is B


Instruction:
Local anaesthetic usually used for retrobulbarblock?
A. Bupivacaine
B. Procaine
C. Tetracaine
D. Lidocaine

Response:
Ans. is 'a' i.e., Bupivacaine Retrobulbar anaesthesia In this technique local anaesthetic is injected behind the eye into the cone formed by extraocular muscles. Retrobulbar injection is given with a special needle which is having a rounded tip. This needle penetrates the lower lid at the junction of the middle and lateral one third of the orbit (usually. 5 cm medial to the lateral canthus). Choice of local anaesthetic varies, but lidocaine 2% and bupivacaine 0.75% are most common. To enhance the retrobulbar spread of local anaesthetic Hyaluronidase, a hydrolyzer of connective tissue polysaccharide is frequently added. A properly placed retrobulbar injection is effective within second and blocks all extraocular muscles except the superior oblique muscle, affects the ciliary ganglion (resulting in pupillary dilatation) and anesthetizes the entire globe.

So the answer to this question is A


Instruction:
Small vessel vasculitis are -a)  Classical PANb)  Wegner's granulomatosisc) Giant cell arteritis d) HSPe) Churg-strauss syndrome
A. bde
B. ade
C. ace
D. bce

Response:
a) Large vessel vasculitis: Giant cell arteritis (temporal arteritis), Takayasu arteritis, Cogan syndrome.
b) Medium vessel vasculitis: PAN (classical PAN), kawasaki disease, Buerger’s disease.
c) Small vessel vasculitis ; HSP, Wegner’s granulomatosis, microscopic polyangitis, churg strauss syndrome, Cryoglobulinemia, SLE, idiopathic crescentic glomerulonephritis, Bechet’s syndrome, renal limited vasculitis

So the answer to this question is A


Instruction:
In a population of 100000, 100 people have pulmonary tuberculosis. Out of 100 people, 10 died . What is the case fatality rate of TB-
A. 5%
B. 10%
C. 0.50%
D. 1%

Response:
Ans. is 'a' i.e., 5% CFR =Total no. of deaths due to a disease--------------------------------Total no. of cases of the same diseasex 100 CFR due to TB =5------100x 100 = 5%.

So the answer to this question is A


Instruction:
A patient admitted in casualty after RTA- shows bruising behind the mastoid- This sign is known as.
A. Prehn sign
B. Battle sign
C. Catel Sign
D. Dietel's sign

Response:
Ans. (b) Battle sign* Battle sign is due to Fracture of base of skull* Middle cranial fossa fracture is associated with Battle sign

So the answer to this question is B


Instruction:
A 24 years old primigravida wt = 57 kg, Hb 11.0 gm % visits an antenatal clinic during 2nd trimester of pregnancy seeking advice on dietary intake. She should be advised -
A. Additional intake of 300 K. Cal
B. Additional intake of 500 K. Cal
C. Additional intake of 650 K. Cal
D. No extra K. Cal

Response:
- the energy requirements of women are increased during pregnancy and lactation. - additional 350kcal daily is needed during pregnancy. Reference: Park's textbook of preventive and social medicine, 23rd edition, pg no:633 <\p>

So the answer to this question is A


Instruction:
Which is not a feature of pancreatic Ascites
A. Low protein
B. Somatostatin is the drug of choice
C. Communication with pancreatic duct is 80%
D. Raised amylase levels

Response:
Pancreatic Ascites: Management Pancreatic ascites occurs from a pancreatic duct disruption or from a leaking pseudocyst High amylase levels are found in the ascitic fluid Initial treatment : Non operative (elimination of enteral feeding, institution of nasogastric drainage, and administration of somatostatin) Recent paracentesis may also be helpful Roughly 50%-60% of patients can be expected to respond to this treatment with resolution of pancreatic Ascites within 2 to 3 weeks Ref: Bailey and love 27th edition Pgno :1228

So the answer to this question is A


Instruction:
Xiphisternum is present at what level ?
A. T5
B. T6
C. T9
D. T10

Response:
Ans. is'c'i.e., T9(Ref. Keithl. Moore Clinically Oriented Anatomy Ple p. 84)Level of xiphisternum - T9

So the answer to this question is C


Instruction:
Which of the following is not a cause for multiple painful ulcers in tongue
A. TB
B. Sarcoidosis
C. Herpes
D. Behcet disease

Response:
The presence of sarcoidosis in the bones typically correlates with cutaneous lesions and progressive disease. When present, symptoms include focal pain, swelling and erythema in the subcutaneous tissue around the involved bone site. Painful mouth sores that look similar to canker sores are the most common sign of Behcet's disease. They begin as raised, round lesions in the mouth that quickly turn into painful ulcers. The sores usually heal in one to three weeks, though they do recur. Genital herpes can cause pain, itching and sores in your genital area. But you may have no signs or symptoms of genital herpes Multiple painful ulcers are not seen in TB Ref Harrison20th edition pg 1056

So the answer to this question is A


Instruction:
In which one of the following diseases are intestinal polyps associated with malignancy ?
A. Ulcerative colitis
B. Crohn's disease
C. Gardner's colitis
D. Peutz-jegher's syndrome

Response:
None

So the answer to this question is C


Instruction:
Function of endonucleases:
A. Cut DNA at specific DNA sequences
B. To point out the coding regions
C. Enhancers
D. To find out antibiotic resistance

Response:
Ans. A. Cut DNA at specific DNA sequences(Ref: Harper 31/e page433)Restriction endonuclease cut DNA at specific palindromic sites.These enzymes are isolated from bacteria.They restrict the entry of phages into the bacteria.

So the answer to this question is A


Instruction:
Treatment of resistant depression is ?
A. ECT
B. SSRI
C. TCAs
D. Venalafexine

Response:
Ans. is 'a' i.e., ECT Treatment of depression Drugs : - The treatment of major depression usually requires staing pharmacotherapy with antidepressants. Antidepressants are : - Tricyclic antidepressants (TCAs) : - Imipramine, Amitriptyline, Trimipramine, Clomipramine, Desipramine, Noriptyline, Amoxapine, Reboxetine. SSRI (selective serotonin reuptake inhibitors) : - Fluoxetine, Paroxetine, sealine, Citalopram, Escitalopram. These drugs devoid of side effects seen with TCAs and are safe in elderly. Atypical antidepressants : - Trazodone, Mianserine, Mitrazapine, Venlafaxine, Duloxetine, Tianeptine, Amineptine, Bupropion.Not all patient recover completely after treatment; about 25% cases are refractory to treatment. Recurrence rate is 50% after 1st episode and 90% after 3rd episode. ECT (Electroconvulsive therapy) : - Indications of ECT in depression are : - Suicidal risk (AI1MS 01, 00, Al 94, MAHE 01) Depression with psychotic feature Resistant depression Severe agitated or stuporous depression with lack of self care. Psychotherapy : - Suppoive psychotherapy, connitive behavioral psychotherapy.

So the answer to this question is A


Instruction:
Investigation of choice in upper GI bleeding is
A. Ba swallow
B. X-ray
C. Endoscopy
D. Ultrasound

Response:
"Upper endoscopy is the test of choice in patients with UGIB" "Whenever GI haemorrhage is thought to derive from a source proximal to the ligament of Treitz, or whenever the issue is in doubt, the first invasive diagnostic maneuvre should be upper GI flexible endoscopy. This technique has a diagnostic accuracy of approximately 95% and an overall complication rate of less than 1%. Endoscopy also allows a qualitative assessment of bleeding rate, provides prognostic information regarding rebleeding potential, and offers numerous therapeutic interventions for specific lesions" - maingot's 10/e, p 291 Other investigations for Upper GI bleedingAngiography (Celiac axis angiography) it is rarely used, when upper endoscopy is unavailable or nonrevealing and the bleeding site still thought to be proximal to the ligament of Treitz. it also has the potential for therapeutic intervention by embolization of the feeding vessel. Barium study "Barium contrast radiography is no longer peinent to the diagnosis of acute hemorrhage. It should be reserved for those patients with chronic or intermittent bleeding that probably is due to an ulcer or mass lesion." Ref : CSDT 13/e p494 , Harrison 17/e p259

So the answer to this question is C


Instruction:
A man with a history of fall presented with a deformity which is resembling 'a waiter who waits for receiving his tip'. This posture is characteristically seen in?
A. Erb's paralysis
B. Klumpke's paralysis
C. Radial nerve paralysis
D. Ulnar nerve paralysis

Response:
The upper trunk (C5 and C6) of brachial plexus is the most common area injured and results in the classic Erb palsy. It has been described as the "waiter's tip posture" and is characterized by shoulder weakness with internal rotation and adduction of the upper arm. The elbow is extended and the wrist flexed. There is good preservation of hand function.

So the answer to this question is A


Instruction:
A patient with obstructive jaundice due to pancreatic cancer might have all of the following clinical findings except
A. A palpable gallbladder
B. Pain is early in the course of the disease
C. Pulmonary metastasis
D. Thrombocytopenia

Response:
Carcinoma pancreas Symptoms include unexplained episodes of pancreatitis, painless jaundice, nausea, vomiting, steatorrhoea and unexplained weight loss. With fuher spread beyond the pancreas, these patients may note upper abdominal or back pain when peripancreatic nerve plexuses are involved and ascites when carcinomatous is or poal vein occlusion develops Ref: Sabiston 20th edition Pgno :1544

So the answer to this question is B


Instruction:
Elschnig's pearls are a sign of:
A. Chronic uveitis
B. Secondary cataract
C. Cystoid macular oedema
D. All of the above

Response:
Ans. Secondary cataract

So the answer to this question is B


Instruction:
Angiographically, the typical "beaded" or "pile of plates" appearance involving the internal carotid artery is seen in -
A. Takayasu's Disease
B. Non-specific aorto-arteritis
C. Fibromuscular dysplasia
D. Rendu-Osler-Weber Disease

Response:
None

So the answer to this question is C


Instruction:
Which is not true about cystic hygroma
A. Aspiration is diagnostic
B. About 50% of them are present at bih
C. Presents as posterior cervical swelling
D. Sequestration of lymphatic tissue

Response:
Cystic hygroma Cystic hygroma is a swelling usually occurring in the lower third of the neck It is most commonly seen in the posterior triangle of the neck, but may also occur in axilla, groin & mediastinum It results due to sequestration of a poion of the jugular lymph sac from the lymphatic system. It usually manifests in the neonate or in early infancy (occasionally present at bih) The swelling is soft and paially compressible and invariably increases in size when the child coughs or cries. The characteristic that distinguishes it from all other neck swellings is that it is brilliantly translucent. The cysts are filled with clear lymph and are lined by endothelium. Mostly these are multiple cysts but occasionally they can be unilocular. It may show spontaneous regression. "Roughly 50% to 65% of hygromas prsent at bih, with most becoming apparent by the second year of life." Ref : Sabiston 18/e p2052

So the answer to this question is A


Instruction:
All are the complications of hydatid cyst in the liver except
A. Jaundice
B. Suppuration
C. Cirrhosis
D. Rupture

Response:
Complications-- Rupture of the cyst into biliary tree ( most common) or bronchial tree Free rupture into peritoneal, pleural or pericardial cavities

So the answer to this question is C


Instruction:
What is true in case of perforation of pars flaccida -
A. CSOM is a rare cause
B. Associated with cholesteatoma
C. Usually due to trauma
D. All of the above

Response:
Tympanic membrane can be divided in 2 parts:
Parstensa : It forms most of the tympanic membrane. Its periphery is thickened to form fibro cartilaginous ring called as annulus tympanicus.
Pars Falccida : It is situated above the lateral process of malleus between the notch of Rivinus and the anterior and posterior malleolar fold.
Ref. Dhingra 6/e p59, 5/e p 78

So the answer to this question is B


Instruction:
Which of the following features in liver biopsy is seen in alpha 1 antitrypsin deficiency?
A. PAS positive and diastase resistant globules are seen
B. Cirrhosis of liver
C. Mallory hyaline
D. All

Response:
Ans. is 'a' i.e., PAS positive and diastase resistant globules are seen; 'b' i.e., Cirrhosis of liver; `c' i.e., Mallory hyaline

So the answer to this question is D


Instruction:
Eiosinophilic meningoencephalitis is causes by -
A. Gnathostoma spinigerum
B. Naegleria
C. Toxocara canis
D. Angiostrongylus cantonesis

Response:
The larva infects mollusc Human infection is acquired by eating infected molluscs The larva penetrate the gut and are carried to the brain There is an inflammatory reaction in the brain and meninges to produce meningoencephalitis (refer pgno:177 baveja 3 rd edition)

So the answer to this question is A


Instruction:
Howell-jolly bodies are seen in: September 2005
A. Sickle cell anemia
B. Splenectomy
C. Both of the above
D. None of the above

Response:
Ans. C: Both of the above Howell-Jolly bodies are histopathological findings of basophilic nuclear remnants (clusters of DNA) in circulating erythrocytes. During maturation in the bone marrow erythrocytes normally expel their nuclei, but in some cases a small poion of DNA remains Howell-Jolly bodies are present in some red cells due to asplenia. Common causes of asplenia are splenectomy due to trauma and autosplenectomy caused by sickle cell anemia.

So the answer to this question is C


Instruction:
Non-cardiac causes of raised central venous pressure include the following except -
A. Abdominal compartment syndrome
B. Tension pneumothorax
C. Positive pressure ventilation
D. Hypervolaemia

Response:
None

So the answer to this question is D


Instruction:
Which of the following is true about menopausal hormonal change :
A. LH/TSH |
B. Gonadotropins |, estrogens |
C. Estrogens and Gonadotropins both |
D. Estrogens and Gonadotropins both |

Response:
Gonadotropins |, estrogens |

So the answer to this question is B


Instruction:
Frie's test is useful for diagnosis of
A. Mycoplasma
B. Rickettsia
C. Sarcoidosis
D. Chiamydia

Response:
None

So the answer to this question is D


Instruction:
The earliest immunoglobulin to be synthesized by the fetus is -
A. IgA
B. IgG
C. IgE
D. IgM

Response:
Option 1, 3, 4 IgM: IgM is the first immunoglobulin to be synthesized by a neonate in about 20 weeks of age. IgM is not transpoed across the placenta; hence, the presence of IgM in the fetus or newborn indicates intrauterine infection. The first immunoglobulin produced in response to an antigen is IgM. after 3 monts of bih class switching is staed and then other class of immunoglobulins are synthesised. IgM is secreted as a pentamer and is composed of five H2L2 units (similar to one IgG unit) and one moleculeof a J chain.. It is the most efficient Because its interaction with antigen can involve all 10 binding sites, it has the highest binding capacity and cross-linking of all the immunoglobulins. Option 2 IgG is the only immunoglobulin class to cross the placenta and therefore is the most abundant immunoglobulinin newborns.( this is not the the first to be synthesised in newborn)

So the answer to this question is D


Instruction:
Obnoxious smell and hallucination is seen in?
A. Temporal lobe lesion
B. Frontal lobe lesion
C. Parietal lobe lesion
D. Occipital lobe lesion

Response:
Temporal lobe lesion REP: Harrison's 17th ed chapter 30 Tumors and hamaomas may induce seizures with olfactory hallucinations, indicating involvement of the uncus of the temporal lobe.

So the answer to this question is A


Instruction:
Which of the following drug can cause Delayed Bone Marrow Suppression leading to Sustained Neutropenia?
A. Vincristine
B. Carboplatin
C. Melphalan
D. Carmustine

Response:
NITROSOUREAS : MOA: Alkylating agent DRUGS: CARMUSTINE, LOMUSTINE, SEMUSTINE. USES: Can cross BBB thereby used in Brain tumors. S/E: Delayed Bone Marrow Suppression resulting in Sustained Neutropenia.

So the answer to this question is D


Instruction:
Focal length of head mirror used in ENT OPD
A. 9 Inch
B. 10 Inch
C. 11 Inch
D. 12 Inch

Response:
Head mirror: It is a concave mirror used to reflect light from the Bull's eye lamp onto the pa being examined. It has a focal length of approximately 25 cm. The examiner sees through the hole in the centre of the mirror. Diameter of the mirror is 89 mm (3 1/2 ") and that of the central hole is 19 mm (3/4") Ref: Dhingra 7e pg 427.

So the answer to this question is B


Instruction:
If a complete denture patient has genial tubercle at the Level of the crest of mandibular ridge, the denture base:
A. Can cover them
B. Should not cover them
C. Should cover them but relief is not necessary
D. Should cover them and relief is must

Response:
None

So the answer to this question is D


Instruction:
A 7-year-old child is taken to the emergency depament because he is feeling sho of breath. The episode began about an hour previously while the child was playing spos, when he abruptly developed paroxysms of wheezing and coughing. As the physician enters the room, he notes that the child is sitting leaning forward and is using his accessory respiratory muscles. Physical examination demonstrates tachypnea and tachycardia. On auscultation, a prolonged expiratory phase with relatively high-pitched wheezes through much of the respiratory cycle are heard. No fine crackles are heard. Which of the following medications will have the fastest onset if the 7-year-old child has an acute attack of his condition?
A. Albuterol inhalation
B. Beclomethasone inhalation
C. Ephedrine oral
D. Salmeterol inhalation

Response:
Albuterol is indicated for use in the treatment of acute signs and symptoms of asthma since its onset is in less than 5 minutes. Beclomethasone is a glucocoicoid agent, and not a sympathomimetic. It would not have the rapid onset of action required in this case. You should immediately recognize that any medication administered orally must be absorbed from the intestinal tract and then reach the site of action. Therefore, you should be able to conclude that oral ephedrine will not begin to work for at least 1/2 hour after administration. Salmeterol inhalation has an onset of action of around 20 minutes and has a duration of action of approximately 12 hours. Salmeterol is indicated for the "chronic" treatment/prevention of asthma signs and symptoms.

So the answer to this question is A


Instruction:
Which of the following is false regarding acute conjuctivitis
A. Vision is not affected
B. Cornea is infiltrated
C. Topical antibiotics is the treatment of choice
D. Pupil is not affected

Response:
Among all four options, option A seems the most appropriate as any corneal infiltration will lead to decreased vision though in conjunctivitis it is commonly reversible Refer: Khurana 6th edition page number 76

So the answer to this question is A


Instruction:
Which of the following is used for permanent interstitial implant brachytherapy –
A. Boron
B. Cesium – 131
C. Phosphorus
D. Iridium

Response:
Permanent implants of interstitial brachytherapy :- Cesium -131, Yttrium, Gold - 198 (Au - 198), 125I, Radon - 222 (Rn - 222), Pallidum -103 (Pd -103).
Temporary implants of Interstitial brachytherapy :- Iridium -  192 (Ir - 192), Cesium - 137 (Cs - 137), Cobalt - 60 (Co - 60),

           Californium, Radium - 226 (Ra - 226), Tantolum.

So the answer to this question is B


Instruction:
Space of Disse is seen in-
A. Spleen
B. Liver
C. Lung
D. Heart

Response:
Ans. is 'b' i.e., Liver Histology of the Livero Liver is covered by Glisson's capsule.o Liver is divided into hexagonal lobules oriented around the terminal tributaries of the hepatic vein (Terminal hepatic veins), i.e. Terminal hepatic vein is in the centre of the lobule and area around the hepatic vein is called centriJobular zone.o At peripheri of lobule, lies the portal tract containing hepatic artery, bile duct and portal vein. Area around portal tract is called periportal zone.o Area between periportal zone and centrilobular zone is called midzonal area,o All around the central vein are the major parenchymal cells, i.e. hepatocytes.o Lobule contains sinusoid (sinusoidal capillaries) which have fenestrated endothelium covering the subendothelial space of Disse. This space contains stellate cell processes and hepatocellular microvilli,o Other important cells of liver are Kupffer cells, which belong to monocytic-macrophage sytem and function as phagocytic cells.

So the answer to this question is B


Instruction:
SIDA functions for
A. Leprosy
B. TB
C. Blindness
D. Agriculture

Response:
Swedish International Development Agency (SIDA) is assisting the National tuberculosis control programme. SIDA assistance is usually spent on procurement of supplies like X-ray unit, microscopes and anti-tuberculosis drugs.Park 23e pg: 924

So the answer to this question is B


Instruction:
Least common joint to be affected in ankylosing spondylitis is:
A. Sacroiliac joint
B. Temporomandibular joint
C. Costovertebral joint
D. Hip joint

Response:
Ans: B (Temporomandibular joint) Ref: Harrison's Principles of internal Medicine, 18th edExplanation:"Sacroiliitis is often the earliest manifestations of AS"AS primarily affects the axial skeleton and peripheral jointsCommon sites include the:Sacroiliac jointCostostemal junctionsSpinous processesIliac crestsGreater trochantersIschial tuberositiesTibial tuberclesHeelsArthritis in the hips and shoulders ("root" joints) occurs in 25-35% of patients.Severe isolated hip arthritis or bony chest pain may be the presenting complaint.

So the answer to this question is B


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

Response:
C i.e. Succinyl CoA thiokinase

So the answer to this question is C


Instruction:
In which of the following disorders, administration of barbiturates is contraindicated
A. Anxiety disorders
B. Acute intermittent porphyria
C. Kernicterus
D. Refractory status epilepticus

Response:
Barbiturates induce the rate-limiting enzyme δ-amino clavulanic acid synthase' in porphyrin synthesis. This increased synthesis of porphyrins can precipitate an acute attack of AIP.

So the answer to this question is B


Instruction:
The corpus luteum of menstruation presents for:
A. 5 days
B. 10 days
C. 14 days
D. 30 days

Response:
14 days

So the answer to this question is C


Instruction:
Mesothelioma associated with which variety of asbestos ?
A. Serpentine
B. Amphibole
C. Both the above
D. None of the above

Response:
Ans. is 'b' i.e., Amphibole Asbestos-Related DiseasesAsbestos is a family of proinflammatory crystalline hydrated silicates that are associated with pulmonary fibrosis, carcinoma, mesothelioma, and other cancers.There are two distinct geometric forms of asbestosi) Serpentine (chrysolite) - most of the asbestos used in industryii) Amphibole (crocidolite)Both serpentine and amphibole can cause all asbestos related diseases except for mesothelioma, which is usually associated with amphibole (crocidolite).

So the answer to this question is B


Instruction:
Acute hemorrhagic conjunctivitis occurs due to -
A. Poliovirus
B. Hepadnavirus
C. Enterovirus 70
D. Coxackie B virus.

Response:
Ans. is 'c' i.e., Enterovirus 70 o Enterovirus 70 causeso Coxsackie A-24 causeso Adenovirus causes---Acute hemorrhagic conjunctivitisAcute hemorhagic conjunctivitisEpidemic keratoconjunctivitisAcute Follicular conjunctivitisPharyngoconjunctival fever

So the answer to this question is C


Instruction:
A 56-year-old patient presents after 3 days of cataract surgery with a history of increasing pain and diminished vision after an initial improvement. The most likely cause would be –
A. Endophthalmitis
B. After cataract
C. Central retinal vein occlusion
D. Retinal detachment

Response:
Symptoms and signs of bacterial endophthalmitis are generally present between 48 and 72 hours after surgery and include: ocular pain, diminished vision, lid oedema, conjunctival chemosis and marked circumciliary congestion, corneal oedema, exudates in the pupillary area, hypopyon and diminished or absent red pupillary glow.

So the answer to this question is A


Instruction:
Congenital Rubella syndrome may have the following clinical features, except
A. Intrauterine growth retardation
B. Neonatal hepatitis
C. Congenital cataract
D. Hydrocephalus

Response:
Microcephaly is more common.

So the answer to this question is D


Instruction:
Kaposi sarcoma occurs with infection due to ?
A. 1-1HV8
B. HHV4
C. HHV2
D. HHV1

Response:
Ans. is 'a' i.e., HHV8 HHV 8 has been proposed in the etiology of Kaposi Sarcoma in AIDS patients

So the answer to this question is A


Instruction:
Impairment is defined as -
A. Loss of anatomic structure
B. Inability to perform activity
C. Failure of fullfillment of normal role
D. Abnormal condition in the body

Response:
Ans. is 'a' i.e., Loss of anatomic structure o According to WHO definitions,# Disease: Any abnormal condition of an individual that impairs function# Impairment'. Any loss or abnormality of psychological, physiological or anatomical structure or function# Disability: (Because of impairment,) any restriction or inability to perform an activity in a range considered normal for a human being# Handicap: A disadvantage for a given individual, resulting from an impairment/disability, that limits/prevents fulfillment of a role considered normal (depending on age, sex, social, cultural factors) for that individualFor example,EventClassification InterpretationAccidentDiseaseImpairs function of a personLoss of footImpairmentLoss of anatomical structure in the form of footCannot WalkDisabilityWalking is a normal routine daily activity of a human beingUnemployedHandicapLoses out his job because he cannot walk, so cannot fulfill his role in the society, i.e, earning for his family members

So the answer to this question is A


Instruction:
Following spinal subarachnoid block a patient develops hypotension. This can be managed by the following means except:
A. Lowering the head end
B. Administration of 1000 ml of Ringers lacate before the block
C. Vasopressor drug like methoxamine
D. Use of ionotrope like dopamine

Response:
A. i.e. Lowering the head end

So the answer to this question is A


Instruction:
Anemia is caused by deficiency of which micronutrient?
A. Iron
B. Potassium
C. Phosphorus
D. Nickel

Response:
ANSWER: (A) IronREF: Ganong 24th ed page 560, Guyton 12th ed pg 420Anemia is the deficiency of hemoglobin in the blood which can be caused by either too few red blood cells or too little hemoglobin in the cells. 30% of the world suffers from iron deficiency anemia, due to inadequate intake or absorption of iron from the diet. Iron is needed for the synthesis of hemoglobin. Deficiency caused due to inadequate intake or blood loss causes iron deficiency' anemia.

So the answer to this question is A


Instruction:
Lubiprostone is a:
A. Chloride channel activator
B. Chloride channel inhibitor
C. Sodium channel activator
D. Sodium channel inhibitor

Response:
Lubiprostone :- selectively stimulates type 2 chloride channels in epithelial cells thereby causing an efflux of chloride into the intestinal lumen. - The resultant fluid secretion into the gastrointestinal lumen provides a bolus effect that softens stool, increases intestinal transit, and improves symptoms of constipation. - Lubiprostone acts locally within the intestinal tract, is rapidly metabolized, and has very low systemic bioavailability.

So the answer to this question is A


Instruction:
A second para is admitted in advanced labor at a period of amenorrhea of 40weeks.she has a single fetus in transverse lie.The fetal hea beat is absent. On vaginal examination the cervix is fully dilated . The presenting pa is shoulder. What is the most appropriate management?
A. Await spontaneous delivery of the dead fetus
B. Perform a cesarean section immediately
C. Perform a decapitation operation
D. Perform an external cephalic version

Response:
In this case patient is presenting in advanced labor with IUD and transverse lie. Management is immediate cesaream section

So the answer to this question is B


Instruction:
Which of the following is not a feature of extramedullary syndrome?
A. Root pain
B. Sacral sparing
C. Abnormal
D. Early coicospinal tract involvement

Response:
Intramedullary tumors arising from the central pa of the cord often spare sensation over the sacral region ("sacral sparing") because of the somatotopic organization of the spinal cord, in which the sacral sensory fibers are at the most peripheral position within the spinal cord. Ref Davidson 23rd edition pg 455

So the answer to this question is B


Instruction:
Non-union is common in fracture of
A. Scapula
B. Talus
C. Neck of femur
D. Tibial fracture

Response:
The following are some of the clinical findings which suggest delayed union and non union : Persistent pain Pain on stressing the fracture Mobility (in non-union) Increasing deformity at the fracture site (in non-union). Ref essential ohopaedic maheshwari and mhaskar 9TH ED p 48

So the answer to this question is C


Instruction:
Web based program for monitoring TB is:
A. Nikshay
B. Nischay
C. Nikusth
D. e-DOTS

Response:
Ref. Foundations of Community medicine. Page. 740

To keep a track of the TB patients across the country, the Government of India has introduced a system called NIKSHAY.

The word is combination of two Hindi words NI and KSHAY meaning eradication of tuberculosis.
NIKSHAY (www.nikshay.gov.in) is a web enabled application, which facilitates monitoring of universal access to TB patients data by all concerned.
The system has been developed jointly by the Central TB Division of the Ministry of Health and Family Welfare and National Informatics Centre (NIC) and it was launched by the Government of
India in June 2012 with issue of required administrative directions from Central TB Division for use of NIKSHAY

So the answer to this question is A


Instruction:
A double headed monster is known as a:
A. Diplopagus
B. Dicephalus
C. Craniopagus
D. Heteropagus

Response:
Conjoined twins are always monozygotic and caused by incomplete division occurring after 13 days .They can be classified into thoracopagus,craniopagus,omphalopagus,pyopagus and ischiopagus depending upon the area of fusion.Prenatal diagnosis is impoant to councel patients regarding termination and to plan the type of delivery (reference pgno:185 sheila textbook of obstetrics 2 nd edition)

So the answer to this question is B


Instruction:
Health education is the responsibility of
A. Health educationalist
B. Doctor
C. Paramedical staff
D. Every health worker

Response:
None

So the answer to this question is D


Instruction:
All are features of hepatocellular carcinoma, except?
A. Not common in Asian
B. Liver biopsy is diagnostic
C. Raised titre of HBV and HCV antibodies
D. Fibrolameller type is having good prognosis

Response:
Ans. is 'a' i.e., Not common in Asians Hepatocellular carcinoma Primary hepatocellular carcinoma is especially prevalent in regions of Asia and Africa. The largest number of cases are found in Asia followed by Africa. o More than 85% of cases of HCC occurs in countries with high rates of chronic HBV infection. In these regions HBV carrier state begins in infancy following veical transmission of virus from infected mothers, conferring a 200 fold increased risk for HCC by adulthood. Other major etiological associations for liver carcinoma are ? o Chronic alcoholism o Tyrosinemia o Food contaminants (primarily aflatoxins derived from Aspergillus flavus) o Hereditary hemochromatosis Clinical features of hepatocellular carcinoma ? o The clinical manifestations of hepatocellular carcinoma are not characteristic of hepatocellular carcinoma. The symptoms of hepatocellular carcinoma are often masked by symptoms of chronic hepatitis or cirrhosis. o In most cases hepatocellular carcinoma presents as an ill defined upper abdominal pain and an abdominal mass. o Elevated level of serum alphafetoproteins are seen in 50 - 75% cases. o Hepatocellular carcinomas have a strong propensity for invasion of vascular channels. Extensive intrahepatic metastasis occurs and the tumour occasionally invades the poal vein or inferior venacava. o Unresected hepatocellular carcinoma has a very poor prognosis. Patients rarely survive beyond 4 months after the diagnosis. The 5 year survival rate after curative resection is 35% to 50%. o The fibrolamellar variant of the HCC is associated with a more ourable prognosis. It arises in otherwise healthy young adults and may be discovered while still amenable to surgical resection.

So the answer to this question is A


Instruction:
Busacca and Koeppe&;s nodules are characteristically seen in
A. Residual uveitis
B. Recurrent uveitis
C. Granulomatous uveitis
D. Non-granulomatous uveitis

Response:
Non-granulomatous uveitisGranulomatous uveitisBehcet disease HLA - B27 associated ankylosing spondylitis Reiter syndrome Inflammatory bowel disease Idiopathic Infections - Lyme disease, Kawasaki disease, rickettsia, mumps, measles, Chlamydia, influenza, adenovirusPsoriatic ahritis Secondary syphilis Trauma UGH syndrome Glaucomatocyclitic crisis Lens-induced uveitis Corneal graft rejection Sarcoidosis Sympathetic ophthalmitis Phacoanaphylaxis Vogt - Koyanagi - Harada syndrome Infections - Tuberculosis, Leprosy, Syphilis, Leptospirosis, Brucellosis, Herpes simplex, herpes zoster, varicella, systemic mycosisKoeppe' s nodules- situated at papillary border -posterior synechiae smaller in sizeBusacca' s nodules- situated at the collarette; larger in size(Refer: AH Khurana, Comprehensive Textbook of Ophthalmology,5thedition, pg no: 149)

So the answer to this question is C


Instruction:
Hardener among the following is:
A. Sodium sulfite
B. Ammonium sulfite
C. Aluminium salts
D. None of the above

Response:
None

So the answer to this question is C


Instruction:
What is the diagnosis in this patient who appeared sick, had a bull neck, and was tachycardic?
A. Diphtheria
B. Epiglottitis
C. Infectious mononucleosis
D. Rheumatic fever

Response:
Answer A. DiphtheriaThe patient's features are typical of diphtheria. Her throat culture was positive for Corynebacterium diphtheriae. The patient recovered after the initiation of treatment with penicillin.

So the answer to this question is A


Instruction:
A 70-years-old retired military person with good previous medical record complains of bi-temporal headache which is decreased in lying down position. He states that he gets relief by giving pressure over bilateral temples. The patient also complains of loss of appetite with feeling feverish. Diagnosis is:
A. Chronic tension headache
B. Temporal arteritis
C. Migraine
D. Fibromyalgia

Response:
Ans. a. Chronic tension headache (Ref: Harrison 19/e p107t, p2587t, 2593-2594, 18/e p122, 2849)Tension-type Headache:Tension-type headache (TTH) is commonly used to describe a chronic head-pain syndrome characterized by bilateral tight, bandlike discomfortQ.Pain typically builds slowly, fluctuates in severity, and may persist more or less continuously for many daysQ.Headache maybe episodic or chronic (present >15 days per month)Q.A useful clinical approach is to diagnose TTH in patients whose headaches are completely without accompanying features such as nausea, vomiting, photophobia, phonophobia, osmophobia, throbbing, and aggravation with movementQ.Such an approach neatly separates migraineTemporal arteritis:Women account for 65% of casesMigraine:Pain often preceded by auraQFibromyalgia:Fibromyalgia (FM) is characterized by chronic widespread musculoskeletal pain and tenderness.Patients with FM have an increased prevalence of other syndromes associated with pain and fatigueQ.More common in womenQCommon Causes of HeadachePrimary HeadacheSecondary Headache* Tension-type (69%)* Migraine (16%)* Idiopathic stabbing (2%)* Exertional (1%)* Cluster (0.1%)* Systemic infection (63%)* Head injury (4%)* Vascular disorders (1%)* SAH (<1%)* Brain tumor (0.1%)Tension-Type Headache (TTH)Tension-type headache (TTH) is commonly used to describe a chronic head-pain syndrome characterized by bilateral tight, handlike discomfortQ.Pathophysiology:Pathophysiology is incompletely understoodQ.It seems likely that TTH is due to a primary disorder of CNS pain modulation alone, unlike migraine, which involves a more generalized disturbance of sensory modulation.Clinical Features:TTH: Chronic head-pain syndrome characterized by bilateral tight, bandlike discomfortQ.Pain typically builds slowly, fluctuates in severity, and may persist more or less continuously for many daysQ.Headache maybe episodic or chronic (present > 15 days per month)Q.A useful clinical approach is to diagnose TTH in patients whose headaches are completely without accompanying features such as nausea, vomiting, photophobia, phonophobia, osmophobia. throbbing, and aggravation with movementQ.Such an approach neatly separates migraine.Treatment: Tension-Type HeadacheAnalgesics (acetaminophen, aspirin, or NSAIDs).Behavioral approaches including relaxation can also be effective.Chronic TTH: Amitriptyline is the only proven treatmentQThere is no evidence for the efficacy of acupuncture.MigraineCluster Headache* LateralizedQ usually frontotemporal, can be generalized* All age groupsQ are affected* FemalesQ are affected more than males* Family history presentQPresentation:* Pain often preceded by auraQ* Builds up graduallyQ* May lasts for several hoursQ or longer* Usually throbbingQ but maybe dull* Onset is after awakeningQ and quietened by sleepQ* Lateralized, periorbitalQ or less commonly temporal* All ages >10 yearsQ with peak at 30-50 yrsQ* Male preponderanceQ (90%): Men affected 7-8 times more than females.* Hereditary factors usually absentQPresentation:* Pain (periodic attacks 1-2/day)* Begins without warningQ* Reaches crescendo within 5 minutesQ* Lasts for 45 minutesQAssociated symptoms:* Nausea, vomiting, diarrheaQ* Photophobia and visual disturbance in the form of photopsia and fortification spectraQ* Paraesthesia with tingling and numbnessQ* Other focal neurological symptoms such as clumsiness and weaknessQ.* Excruciating, deep, explosive pain but only rarely pulsatileQ* Commonly awakens patients from sleepQAssociated symptoms:* Homolateral lacrimationQ* Reddening of eyeQ* Nasal stuffinessQ* PtosisQ* NauseaQTemporal ArteritisAverage age of onset is 70 yearsQWomen account for 65% of cases.Typical presenting symptoms: Headache, polymyalgia rheumatica, jaw claudication, fever, and weight lossQ.Headache is the dominant symptom, often appears in association with malaise and muscle achesQ.Head pain maybe unilateral or bilateralQ and is located temporally in 50% of patients but may involve any and all aspects of the cranium.Pain usually appears gradually over a few hours before peak intensity is reached; occasionally, it is explosive in onset.The quality of pain is only seldom throbbing; it is almost invariably described as dull and boring, with superimposed episodic stabbing pains similar to the sharp pains that appear in migraine.Most patients can recognize that the origin of their head pain is superficial, external to the skull, rather than originating deep within the cranium (the pain site for migraineurs).Scalp tenderness is present, often to a marked degree; brushing the hair or resting the head on a pillow maybe impossible because of painQ.Headache is usually worse at night and often aggravated by exposure to coldQ.Additional findings may include reddened, tender nodules or red streaking of the skin overlying the temporal arteriesQ, and tenderness of the temporal or, less commonly, the occipital arteries.ESR is often, though not always, elevatedQ; a normal ESR does not exclude giant cell arteritis.A temporal artery biopsy followed by immediate treatment with prednisone 80 mg dailyQ for the first 4-6 weeks should be initiated when clinical suspicion is high.FibromyalgiaFibromyalgia (FM) is characterized by chronic widespread musculoskeletal pain and tenderness.Patients with FM have an increased prevalence of other syndromes associated with pain and fatigueQ.More common in womenQClinical Features:MC presenting complaint: "Pain all over."QPain is typically above and below the waist on both sides of the body and involves the axial skeletonQ (neck, back, or chest).Pain is poorly localized, difficult to ignore, severe in its intensity, and associated with a reduced functional capacity.QFibromyalgia classification criteriaHistory of chronic widespread pain > 3 monthsQ>11 of 18 tender pointsQNeuropsychological Symptoms: Fatigue, stiffness, sleep disturbance, cognitive dysfunction, anxiety, and depressionQ.

So the answer to this question is A


Instruction:
In the reconstruction following excision of previously irradiated cheek cancer, the flap will be:
A. Local tongue
B. Cervical
C. Forehead
D. Pectoralis major myocutaneous

Response:
RECONSTRUCTION OF CHEEK: - For check reconstruction, mucosal flaps are used. - PMMC (pectoralis major myocutaneous) flap: Most widely used flap for head and neck reconstructionQ Males Females - Forehead flap based on anterior branch of superficial temporal aery can be used - Deltopectoral flap based on perforating branch of internal mammary aery is used.

So the answer to this question is D


Instruction:
All of the following are cariogenic substances except:
A. Selenium.
B. Vanadium.
C. Lead.
D. Magnesium.

Response:
None

So the answer to this question is B


Instruction:
Nicotinic acid acts by -
A. Nicotinic acid acts by -
B. Inhibiting HMG-CoA synthatase
C. Inhibiting HMG CoA reductase
D. Decreasing absorption of cholesterol

Response:
Ans. is 'a' i.e., Inhibiting lipolysis o Niacin (Nicotinic acid) inhibits intracellular lipolysis by inhibiting hormone sensitive lipase --> intracellular FFA to liver --> triglyceride synthesis.

So the answer to this question is A


Instruction:
Tec 6 vaporizer is used with.........
A. Halothane
B. Desflurane
C. Isoflurane
D. Trielene

Response:
The most common such vaporizer is the Ohmeda Tec 6, designed specifically for use with desflurane. Desflurane has two physical propeies, making it unsuitable for use with a conventional vaporizer. First, it has a very high SVP (88.5 kPa at 20degC). A conventional vaporizer would require high fresh gas flows to dilute it to within clinically useful concentrations, making it uneconomical. Secondly, it has a low boiling point (23.5degC). At room temperature, it will intermittently boil resulting in large fluctuations in agent delivery. When boiling, there will be excessive agent delivery; however, it will then cool due to a large loss of latent heat of vaporization, resulting in an exponential decrease in SVP and under-delivery of agent. The Ohmeda Tec 6 overcomes these problems by using an electrical filament that heats the desflurane to 39degC, raising its SVP to 194 kPa, that is, nearly 2 atm. In addition to providing a stable SVP, this high pressure removes the need for a pressurized carrier gas--instead, the fresh or diluent gas is entirely separate from the vaporizing chamber

So the answer to this question is B


Instruction:
True is all except
A. Renin - liver
B. Renin- kidney
C. Renin substrate - liver
D. ACE- lung endothelium

Response:
A i.e. Renin - liver

So the answer to this question is A


Instruction:
First active metabolite of chloral hydrate is?
A. Ethanol
B. Dichloroethanol
C. Trichloroethanol
D. Monochloroethanol

Response:
None

So the answer to this question is C


Instruction:
Malaria is transmitted in Rural areas by ?
A. Anopheles stephensi
B. Anopheles dirus
C. Anopheles culicifacies
D. None

Response:
Ans. is 'c' i.e., Anopheles culicifacies

So the answer to this question is C


Instruction:
All are true for gradenigo's syndrome except ?
A. Associated with intermittent ear discharge
B. Associated with conductive hearing loss
C. Causes diplopia
D. Leads to retro orbital pain

Response:
Ans. is 'a' i.e., Associated with intermittent ear discharge Gradenigo's syndrome, also called Gradenigo-Lannois syndrome, is a complication of otitis media and mastoiditis involving the apex of the petrous temporal bone. Symptoms Components of the syndrome include: retroorbital pain due to pain in the area supplied by the ophthalmic branch of the trigeminal nerve (fifth cranial nerve), abducens nerve palsy (sixth cranial nerve) otitis media Other symptoms can include photophobia, excessive lacrimation, fever, and reduced corneal sensitivity. The syndrome is classically caused by the spread of an infection into the petrous apex of the temporal bone.

So the answer to this question is A


Instruction:
Which statement regarding glaucoma is true?
A. If recognized early, the optic neuropathy of glaucoma is reversible
B. Topical B-adrenergic antagonists have few if any side effect due to their systemic absorption
C. The initial symptom oh optic neuropathy due to glaucoma is loss of central vision
D. None of the above

Response:
Glaucoma is the leading cause of irreversible blindness in the world. When sufficient axinal loss occurs, peripheral vision declines. Loss of central vision occurs much later in the disease process. Retinopathy due to glaucoma is irreversible. Treatment is focused on lowering intraocular pressure. Reduction in intracecular pressure has been demonstrated to protect against fuher damage to the optic nerve. Primary open-angle is by far the most common type of glaucoma in the United States. Closed-angle glaucoma is more common among Asians. The Schijltz tonometer, due to the fact that it is inexpensive, is the most frequently used device to measure intraoccular pressure in the United States. It is used in both hospitals and outpatient clinics. b-Adrenergic antagonists are one of the more commonly used drugs and are initially staed as a topical agent. Unfounately, excess drug drains through the nasolacrimal duct into the nose and is absorbed into the systemic circulation. Therefore systemic side effects can occur and may be severe. It is not unusual for patients to be treated with a bronchodilater drug for new-onset bronchospasms without the physician considering the use of topical b-adrenergic antagonist, used for glaucoma treatment, which may have contributed to the condition.

So the answer to this question is D


Instruction:
The time period that elapses between the physical emotional stress arid the hair loss is about -
A. 21 days
B. 30 days
C. 3 months
D. 6 months

Response:
Ans-C

So the answer to this question is C


Instruction:
Which is best for diagnosis of small intestinal mucosal disease?
A. Small bowel Series using barium contrast
B. Urinary D- xylose test
C. Small intestinal mucosal biopsy
D. Breath hydrogen test

Response:
Mucosal disease of small intestine : Infection (esp. Giardia, Whipple's disease, tropical sprue), inflammatory diseases (esp. Crohn's disease), radiation enteritis, eosinophilic enteritis, ulcerative jejunitis, mastocytosis, tropical sprue, infiltrative disorders (amyloidosis, scleroderma, lymphoma, collagenous sprue, microscopic colitis), biochemical abnormalities (gluten-sensitive enteropathy, disaccharidase deficiency, hypogammaglobulinemia, abetalipoproteinemia, amino acid transpo deficiencies), endocrine disorders (diabetes mellitus, hypoparathyroidism, adrenal insufficiency, hypehyroidism, Zollinger-Ellison syndrome, carcinoid syndrome) For some small intestinal disorders that are characterized by diarrhea or malabsorption, the biopsy findings may be distinctive and lead to a specific diagnosis. Whipple Disease- -PAS positive inclusions that is Schiff reagent positive inclusion inside the macrophages of lamina propria - Caused by bacteria - Tropheryma whipplei Note Gluten sensitive enteropathy is strongly associated with HLA DQ2 and HLA DQ8

So the answer to this question is C


Instruction:
An increase in which of the following parameters will shift the O2 dissociation curve to the left?
A. Temperature
B. Paial pressure of C02
C. 2,3 DPG concentration
D. Oxygen affinity of hemoglobin

Response:
Oxygen dissociation curve demonstrates the percentage of haemoglobin bound with oxygen (saturation) as the oxygen concentration increases. It represents the affinity of haemoglobin for oxygen. A shift of the curve to the left indicates increased affinity of hemoglobin for oxygen. Three impoant factors which affect the oxygen hemoglobin dissociation curve are pH, temperature and the concentration of 2,3 bisphosphoglycerate (2,3, BPG). Fall in temperature, low levels of 2,3 BPG and rise in pH cause shift of the curve to left. Fall in Pco2 result in an increase in pH and shift of the curve to left. Ref: Textbook of Medical Physiology By Guyton, 10th Edition, Page 466; Ganong's Review of Medical Physiology, 23rd Edition, Page 667-9.

So the answer to this question is D


Instruction:
Which is the most common type of female pelvis:
A. Gynaecoid
B. Anthropoid
C. Android
D. Platypelloid

Response:
Gynaecoid

So the answer to this question is A


Instruction:
Which is not a characteristic of a typical cervical vertebra?
A. Has a triangular vertebral canal
B. Has foramen transversarium
C. Superior articular facet is directed backwards and upwards
D. Has a large vertebral body

Response:
None

So the answer to this question is D


Instruction:
The following is true for Mycoplasmas except ?
A. Multiply by binary fission
B. Are sensitive to beta-lactam group of drugs
C. Can grow in cell free media
D. Require sterols for their growth

Response:
Ans. is 'b i.e., Are sensitive to beta lactam drugs

So the answer to this question is B


Instruction:
Whichof the following signs is seen in Crohn's disease?
A. String sign of Kantor
B. Strought's sign
C. Pincer sign
D. Inveed 3 sign

Response:
The term "string sign" may be applied to other narrowed loops of small bowel in Crohn's disease. Carcinoid tumors may produce similar findings in the ileum and "string sign" may be seen in an elongated and narrowed pylorus caused by hyperophic pyloric stenosis.

So the answer to this question is A