Instruction:
Slow waves in EEG activity seen in -
A. Depression
B. Delirium
C. Schizophrenia
D. Mania

Response:
A diagnosis of delirium can be made if the patients EEG finding show a slowing of activity in brain.

So the answer to this question is B


Instruction:
Prognosis of breast cancer is best determined by: March 2011
A. Axillary node involvement
B. Skin infiltration
C. Size of the tumour
D. Estrogen receptor status

Response:
Ans. A: Axillary node involvement The best indicators of likely prognosis in breast cancer remain tumour size and lymph node status; however, it is realized that some large size tumours will remain confined to the breast for decades whereas some very small tumours are inoperable at diagnosis. Hence, the prognosis of a cancer depends not on its chronological age but on its invasive and metastatic potential

So the answer to this question is A


Instruction:
In a female child at bih, oocyte is in a stage of
A. Anaphase of the first meiotic division
B. Prophase of the first meiotic division
C. Anaphase of the second meiotic division
D. Prophase of the second meiotic division

Response:
Inderbir Singh&;s Human embryology; Tenth edition; Pg 24At the time of bih, all primary oocytes are in the prophase of the first meiotic division.

So the answer to this question is B


Instruction:
Fascia around nerve bundle of brachial plexus is derived from:
A. Preveebral fascia
B. Clavipectoral fascia
C. Deep cervical fascia
D. Pectoral fascia

Response:
The preveebral fascia forms a tubular sheath around the veebral column and the preveebral muscles, which are attached to the veebral column. It,Attaches superiorly from the base of the skull and inferiorly to the endothoracic fascia in the thorax.Extends laterally as the axillary sheath, which surrounds the axillary vessels and brachial plexus of nerves to the upper limb.Contains, within its connective tissue fibers, the cervical sympathetic trunk and ganglia.Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 25. Overview of the Neck. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy.

So the answer to this question is A


Instruction:
For salpingitis true is
A. Always bilateral
B. Associated with ove injury
C. Not associated with future infeility
D. Bacterial vaginosis is not a risk factor for pelvic inflammatory disease development

Response:
Ans. is 'd' i.e., Bacterial vaginosis is not a risk factor for pelvic inflammatory disease developmentPelvic inflammatory disease (PlD)It is the infection of upper female reproductive tract organs.As fallopian tube are involved most commonly, it is also called as acute salpingitis.It is associated most commonly with N gonorrhoea and chlamydial infection.Bacterial vaginosis is not a risk factor for PID.PID / acute salpingitis may be unilateral or bilateral.SequelaeofPlDare:-Tubal factor infeilityEctopic pregnancyChronic Pelvic Pain

So the answer to this question is D


Instruction:
At pH 7 the binding of 2,3-BPG to hemoglobin occurs at which site?
A. Sulphydryl group
B. Carboxy terminal
C. Amino terminal
D. Histidine

Response:
2,3-BPG Stabilizes the T Structure of HemoglobinA low Po2 in peripheral tissues promotes the synthesis of 2,3-bisphosphoglycerate (BPG) in erythrocytes. The hemoglobin tetramer binds one molecule of BPG in the central cavity formed by its four subunits (Figure 6-6). However, the space between the H helices of the b chains lining the cavity is sufficiently wide to accommodate BPG only when hemoglobin is in the T state. BPG forms salt bridges with the terminal amino groups of both b chains Val NA1 and with Lys EF6 and His H21.Ref: Harper&;s Biochemistry; 30th edition; Chapter 6 Proteins: Myoglobin & Hemoglobin

So the answer to this question is C


Instruction:
Normal gastric juice contains all except
A. Na+
B. K+
C. Ca++
D. Mg++

Response:
Contents of gastric juice
-        Cations

Na+
K+
Mg+2
H+

-        Anions

Cl-
PO4-2
SO4-2

-        Pepsin
-        Gastric lipase
-        Mucus
-        Intrinsic factor of Castle

So the answer to this question is C


Instruction:
Following surgical opening of the adductor canal, a patient experienced a loss of cutaneous sensation of the medial side of the leg. Which nerve was cut in the procedure?
A. Ilioinguinal
B. Femoral
C. Obturator
D. Saphenous

Response:
The saphenous nerve is a branch of the femoral nerve. This nerve, and the nerve to vastus medialis, are the only nerves found in the adductor canal. So, it makes sense that one of these structures was injured. The saphenous nerve is a sensory nerve only; it supplies the skin on the medial side of the leg. The patient's symptoms, as well as the type of procedure done, both point toward an injury to the saphenous nerve. The femoral nerve does not travel in the adductor canal -- it ends by branching superior to the adductor canal, in the femoral triangle. If this nerve was injured, the quadriceps would be impaired, and the patient would have difficulty extending at the knee. The ilioinguinal nerve is a branch of the lumbar plexus which innervates muscles of the lower abdominal wall. The obturator nerve innervates the medial, adductor compament of the thigh. Neither the symptoms nor the location of injury suggest that any of these other nerves were damaged.

So the answer to this question is D


Instruction:
Drugs used in ADHD are
A. Atomoxetine
B. Methylphenidate
C. Dextro-amphetamine
D. All the above

Response:
ADHD: Attention Deficit Hyperactivity disorder. Difficulty in paying attention, difficulty in controlling behaviour and hyperactivity. Etiology- both genetic and environmental factors. Abnormality in dopamine transpoer and thyroid receptor beta genes in some patients. Inattention behaviour:- 1. Early distraction by extraneous stimuli 2. Careless mistakes in school 3. Difficulty sustaining attention in tasks or play 4. Forgetful in daily activities. 5. Does not seem to listen to what is being said 6. Daydreams, easily confused, move slowly. 7. Fails to finish schoolwork 8. Difficulty in processing information as quickly and accurately as others. Hyperactive behavior:- 1. Runs about or climbs excessively inappropriately 2. Fidgets with hands and feet 3. Trouble sitting still during dinner, school 4. Difficulty doing quiet tasks or activities Impulsive behavior:- 1. Difficulty awaiting turns in games 2. Blus out answers to question 3. Interrupts conversations Three subtypes are known: 1. Predominantly hyperactive impulsive 2. Predominantly inattendive 3. Combined hyperactive impulsive and inattentive. Diagnosis is primarily clinical, using thorough clinical interview of parents and use of behaviour rating scales. Physical examination includes direct observation of child and ruling out chronic systemic illnesses that affect child&;s attention span. Management: Educating the parents Treatment involves combination of behavior therapy and medications. Drugs :- Stimulants ( methylphenidate, anphetamine and their derivatives) are effective in ameliorating inattention, hyperactivity and impulsivity. Atomoxetine, a selective norepinephrine reuptake inhibitor and extended release preparations of selective alpha adrenergic agonists( guanfacine, clonidine) has proved to be effective. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is D


Instruction:
Personal history includes all except:
A. Occupational details
B. Sexual history
C. Academic details
D. Food preferences

Response:
Ans. D. Food preferencesPersonal history includes:* Birth and early development* Education* Occupational history* Substance use* Marital & sexual history (including menstrual history)

So the answer to this question is D


Instruction:
False statement about fetal development-a) Fetal legs develop before upper limbb) Growth in length is very fast in 3-5th monthc) Thumbs are formed in preaxial borderd) Fetus gains maximum weight in 1st trimestere) Upper limb develops before legs
A. b
B. c
C. ad
D. ab

Response:
None

So the answer to this question is C


Instruction:
Ca Breast stage I and II managed by -a) Total mastectomyb) Modified radical mastectomyc) Lumpectomy and axillary clearanced) Lumpectomy, axillary clearance and radiotherapy
A. c
B. d
C. bd
D. ac

Response:
None

So the answer to this question is C


Instruction:
Bronchial asthma is characterized by -a) Inflammatory disease of airwayb) Allergic disease of air wayc) Hyporesponsiveness of airwayd) Hyperresponsiveness of airwaye) Treatment is mostly inhaled steroid
A. abcd
B. bcde
C. acde
D. abde

Response:
Asthma -
"Asthma is a chronic inflammatory disorder of the airway that causes recurrent episodes of wheezing, breathlessness, chest tightness and cough particularly at night or in the early morning. These symptoms are usually associated with wide spread but variable bronchoconstriction and airflow limitation that is at least partly reversible, either spontaneously or with treatment. It is thought that inflammation causes an increase in airway responsiveness (bronchospasm) to a variety of stimuli".
- Inhaled steroid has an important role in the t/t of Asthma.

So the answer to this question is D


Instruction:
In females, which of the following is the last visceral organ to putrefy after death?
A. Prostate
B. Uterus
C. Brain
D. Liver

Response:
Virgin uterus is one of the last visceral organs to putrefy. Gravid uterus or uterus soon after delivery putrefies rapidly. In males prostate resist putrefaction for a very long time. The last organ to putrify is bone.

So the answer to this question is B


Instruction:
In pregnancy peak level of HCG occurs at :
A. Early gestation
B. Mid gestation
C. Late gestation
D. Prelabour

Response:
Early gestation

So the answer to this question is A


Instruction:
Keratic precipitates are on which layer of cornea -
A. Epithelium
B. Endothelium
C. Stroma
D. Bowman's membrane

Response:
KPs are proteinaceous cellular deposits occuring at the back of cornea (corneal endothelial deposits).

So the answer to this question is B


Instruction:
Which of the following is not usually involved in ankylosing spondylitis?
A. Sacroiliac joint
B. Spine
C. Ankle
D. Elbow

Response:
Usually axial skeleton is severely involved. Elbow joint is not involved. Commonest joint involved is Sacroiliac joint.

So the answer to this question is D


Instruction:
"Mad cow" disease is caused by?
A. HIV virus
B. Mycoplasma
C. Chlamydia
D. Prions

Response:
Ans. D. Prions. (Ref. Robbin's pathology 8th/pg. 880)Prion Diseases# This includes sporadic, familial, iatrogenic and variant forms of Creutzfeldt-Jakob disease (CJD).# Several animal diseases from this group are also known, including scrapie in sheep and goats and bovine spongiform encephalopathy in cattle ("mad cow" disease).6# All these disorders are associated with abnormal forms of a normal cellular protein, termed prion protein (PrPc).# The unique pathogenesis of prion diseases is related to changes in the conformation of PrP from its native PrPc form to an abnormal configuration called either PrPsc (for scrapie) or PrPres (for protease resistant).Creutzfeldt-Jakob Disease# CJD is a rare but well-characterized prion disease that manifests clinically as a rapidly progressive dementia.# It is sporadic in about 85% of cases, with a worldwide annual incidence of about 1 per million; familial forms also exist.# The disease has a peak incidence in the seventh decade.# There are well-established cases of iatrogenic transmission by deep implantation electrodes and contaminated preparations of human growth hormone.# The clinical presentation begins with subtle changes in memory and behavior that rapidly progress to dementia. The disease is uniformly fatal, with an average duration of only 7 months.# Morphology:- On microscopic examination, the pathognomonic finding is a spongiform transformation of the cerebral cortex and deep gray matter structures (caudate, putamen); this consists of a multifocal process that results in* the uneven formation of small, apparently empty, microscopic vacuoles of varying sizes within the neuropil and sometimes in the perikaryon of neurons.* In advanced cases, there is severe neuronal loss, reactive gliosis, and sometimes expansion of the vacuolated areas into cystlike spaces ("status spongiosus").* No inflammatory infiltrate is present.- In all forms of prion disease, immunohistochemical staining demonstrates the presence of proteinase K-resistant PrPsc in tissue.- Western blotting of tissue extracts after partial protease digestion allows detection of diagnostic PrPsc.

So the answer to this question is D


Instruction:
The anti-malarial drug belonging to 8-aminoquinoline derivatives?
A. Doxycycline
B. Quinidine
C. Primaquine
D. Chloroquine

Response:
8-aminoquinoline derivatives are primaquine, bulaquine, and tafenoquine.4 Aminoquinoline is Chloroquine.Ref: Sharma and Sharma 2nd edition; pg 809.

So the answer to this question is C


Instruction:
Which one of the following activities cannot be formed by a 7 month old infant-
A. Pivot
B. Cruise
C. Transfer objects
D. Enjoy mirror

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

So the answer to this question is B


Instruction:
Etiology of Pityriasis rosea is: March 2012
A. M. furfur
B. Herpes virus
C. Autoimmune
D. Staphylococcus

Response:
Ans: B i.e. Herpes virus Skin conditions and causative agent Etiological factor for pityriasis versicolor is Malassezia furfur (earlier classified as pityrosporum ovale), a commonest yeast Etiology of pityriasis rosea is unkown. A virus (Human herpes Virus-7 more frequently, HHV-6 less frequently) has often been incriminated Pemphigus vulgaris is an autoimmune disease, characterized by acantholysis, induced by deposition of IgG autoantibodies in an intercellular area of epidermis Staphylococcus aureus, present in either a distant cutaneous focus or in an extracutaneous focus releases an exfoliative toxin that results in peeling of skin (staphylococcal scalded skin syndrome).

So the answer to this question is B


Instruction:
Mechanism of action of thalidomide is: March 2013
A. Antimicrobial
B. Antiemetic
C. Anti-allergic
D. Immunomodulation

Response:
Ans. D i.e. Immunomodulation Thalidomide It is a synthetic derivative of glutamic acid (alpha-phthalimido-glutarimide) with teratogenic, immunomodulatory, anti-inflammatory and anti-angiogenic propeies. Thalidomide acts primarily by inhibiting both the production of tumor necrosis factor alpha (TNF-alpha) in stimulated peripheral monocytes and the activities of interleukins and interferons. This agent also inhibits polymorphonuclear chemotaxis and monocyte phagocytosis. In addition, thalidomide inhibits pro-angiogenic factors such as vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), thereby inhibiting angiogenesis.

So the answer to this question is D


Instruction:
Which of the following topics is principally focused on in cognitive therapy?
A. Unconscious and repressed memories
B. Faulty ideas and beliefs
C. Transference manifestations
D. Dream interpretation

Response:
Cognitive behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders, including phobias, addictions, depression, and anxiety Ref ganong's review of medical physiology 25e p761

So the answer to this question is B


Instruction:
Dribbling of saliva is feature of:
A. Antemoem hanging
B. Strangulation
C. Postmoem hanging
D. Drowning

Response:
Signs of antemoem hanging: Salivary dribbling is seen on the opposite side of the knot. Le facie sympathique : is ipsilateral dilatation of the pupil and paial opening of the eyelids.

So the answer to this question is A


Instruction:
The longest acting, most potent and most toxic LA is:
A. Lidocaine
B. Dibucaine
C. Bupivacaine
D. Tetracaine

Response:
None

So the answer to this question is B


Instruction:
Which of the following is not a feature of Crohn’s disease?
A. Continous lesions
B. Non-caseating granulomas are present
C. Backwash ileitis may be associated with Crohn’s disease
D. Cobblestone appearance

Response:
Ref. Robbins Pathology. 9th edition. Page. 798

Crohns Disease

Present with skip lesions
Earliest lesion – Aphthous ulcers
Can involve whole of GIT – Form oral cavity to amus
Smoking is a risk factor
Fissure, fistula seen
Stricture seen
Gross features – Creeping pad of fat, Cobblestone appearance
Microscopy - Non caseating granuloma under microscopy, Transmural inflammation

So the answer to this question is A


Instruction:
Which is a normal finding in cystometry
A. Absence of systolic detrussor contraction
B. Residual volume of 75 ml
C. Leakage on coughing
D. First sensation of urination at 300 ml

Response:
None

So the answer to this question is A


Instruction:
The most reliable criteria in G uastaf son method of age estimation is:
A. Attrition
B. Secondary dentin deposition
C. Transparency of root
D. Cementum apposition

Response:
C i.e. Transparency of root

So the answer to this question is C


Instruction:
A 55-year-old man complains of severe muscle weakness and drooping eyelids. He states that his symptoms worsen with repetitive movements but then resolve after a sho rest. A chest X-ray reveals an anterior mediastinal mass. A biopsy of this mass would most likely reveal which of the following pathologic changes?
A. B-cell lymphoma
B. Hodgkin lymphoma
C. Metastatic carcinoma
D. Thymic hyperplasia

Response:
- Given clinical features suggests the diagnosis of Myasthenia gravis. Myasthenia gravis -Acquired autoimmune disease characterized by abnormal muscular fatigability, caused by circulating antibodies to acetylcholine receptor at myoneural junction . -Manifests with ptosis (drooping eyelids) or diplopia (double vision) because of weakness in extraocular muscles. -Pattern of weakness is distinctly different from most primary myopathic diseases, in which there is relative sparing of facial & extraocular muscles. -Repetitive firing of muscles makes weakness more severe, whereas cholinesterase inhibitors improve strength markedly - diagnostically useful. - In 2/3rd of patients, thymic hyperplasia is closely associated with myasthenia gravis & 15% have thymoma. - Conversely, 1/3rd to 1/2 of patients with thymoma develop myasthenia gravis. - Thymectomy is often an effective treatment for these patients. - Cholinesterase inhibitors, immunosuppression, plasmapheresis can also be used in treatment.

So the answer to this question is D


Instruction:
Secondary syphilis is manifested by – a) Painless lymphadenopathyb) Pruritic rashc) Mucosal erosiond) Asymptomatic rashe) Mostly asymptomatic
A. bce
B. bde
C. acde
D. abde

Response:
Most common manifestation of syphilis is rash. Rash is usually bilaterally symmetrical macule which is non-pruritic and asymptomatic. The rash may also be papule, papulosquamous or papulopustular.
There may be associated non-tender (non-painful) lymphadenopathy.
Mucous patches (superficial mucosal erosions) may be seen on oral or genital mucosa.
the important feature is condyloma lata.

So the answer to this question is C


Instruction:
Most common cause of aificial hea valve infection?
A. Staphylococcus aureus
B. Streptococcus mutans
C. Staph epidermidis
D. Pneumococcus

Response:
Ans. is 'c' i.e., Staph epidermidis Most common cause of prosthetic valve endocarditis upto 12 months is coagulase - negative staphylococci (staph. epidermidis). Most common causes of infective endocarditis In native wall - Staphylococcus aureus. In early prosthetic valve (up to 12 months after valve surgery) - Staphylococcus epidermidis (coagulase negative staphylococcus). In late prosthetic valve (more than 12 months after valve surgery) - streptococcus viridans. In IV drug abusers - Staphylococcus aureus. In patients with intravenous catheter - coagulase negative staphylococci. After dental procedure (tooth extraction) - streptococcus mutans.

So the answer to this question is C


Instruction:
Methanol attacks ?
A. Cones
B. Rods
C. Ganglion cells of retina
D. Germinal cell layer

Response:
Ans. is 'c' i.e., Ganglion cells of retina Methyl alcohol is metabolised very slowly and thus stays for a longer period in the body. It is oxidised into formic acid and formaldehyde in the tissues. These toxic agents cause oedema followed by degeneration of the ganglion cells of the retina, resulting in complete blindness due to optic atrophy.

So the answer to this question is C


Instruction:
Which of these statements is false for lesions of Erythema nodosum –
A. They are considered as hypersensitivity reaction
B. The skin overlying the lesions is red, smooth and shiny
C. They are usually non tender
D. They can be associated with tuberculosis

Response:
Lesions of erythema nodosum are very tender, and overlying skin is red & shiny.
Erythema nodosum is presumed to be a hypersensitivity reaction, and may occur in association with several systemic diseases, infections (e.g. TB), drugs or it may be idiopathic

So the answer to this question is C


Instruction:
A patient had the following blood biochemical values. Calcium 6; uric acid 13; Phosphorus 12; Creatinine 6. Which could be the possible diagnosis -
A. Krait bite
B. Uric acid nephropathy
C. Hypercalcemic nephropathy
D. Rickets

Response:
Acute uric acid nephropathy (AUAN, also acute urate nephropathy) is a rapidly worsening (decreasing) kidney function (acute kidney injury) that is caused by high levels of uric acid in the urine (hyperuricosuria) . Ref Harrison20th edition pg 267

So the answer to this question is B


Instruction:
Episodic generalized weakness can occur due to all of the following acute electrolyte disturbances, EXCEPT
A. Hypokalemia
B. Hypocalcemia
C. Hyponatremia
D. Hypophosphatemia

Response:
Hypocalcaemia is low calcium levels in the blood serum.The normal range is 2.1-2.6 mmol/L (8.8-10.7 mg/dl, 4.3-5.2 mEq/L) with levels less than 2.1 mmol/l defined as hypocalcemia. Mildly low levels that develop slowly often have no symptoms.Otherwise symptoms may include numbness, muscle spasms, seizures, confusion, or cardiac arrest. Initial treatment for severe disease is with intravenous calcium chloride and possibly magnesium sulfate.Other treatments may include vitamin D, magnesium, and calcium supplements If due to hypoparathyroidism, hydrochlorothiazide, phosphate binders, and a low salt diet may also be recommended. About 18% of people who are being treated in hospital have hypocalcemia. Ref Harrison20th edition pg 2569

So the answer to this question is B


Instruction:
which of the following is a SNRI
A. duloxetine
B. seraline
C. citalopram
D. ironiazid

Response:
SNRI * IMPOANCE Dual antidepressant like TCA but better than TCA has it has no dryness of mouth, hypotension, sedation * MECHANISM Inhibits the reuptake of both serotonin and dopamine * DRUGS VENLEFEXINE DESVENLEFEXINE DULOXETINE * USE Duloxetine===PAIN ASSOSIATED WITH DIABTIC NEUROPATHY and STRESS URINARY INCONTINENCE Milnacipran===Fibromyalgia * SIDE EFFECTS DIASTOLIC HYPEENSION DELAYED ORGASM WITHDRAWL SYNDROME ON DISCONTINUATION, hence should not be abruptly stopped. To try slow tapering Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 955

So the answer to this question is A


Instruction:
The follwing are opioid withdrawl symptoms except:
A. Insomnia
B. Piloerection
C. Rhinorrhea
D. Constipation

Response:
D i.e. Constipation

So the answer to this question is D


Instruction:
Fetal hydrops is most commonly associated with:
A. Cardiac anomalies.
B. Renal anomalies.
C. GI anomalies.
D. Skeletal anomalies.

Response:
Ans. A. Cardiac anomaliesCardiac anomaly is the most common anatomical abnormality associated with fetal hydrops. In general hydrops associated with a structurally abnormal heart carries a poor prognosis, as the anomaly is usually severe. Those hydropic fetuses with arrhythmia but with structurally normal heart usually respond to either transplacental or direct fetal therapy. In these cases, the prognosis is good.

So the answer to this question is A


Instruction:
Epigenetic deals with genetic modifications that do not alter the sequence of DNA. All of the following can detect epigenetic modification except:
A. HPLC
B. Methylation specific PCR
C. Bisulphite method
D. ChIP on Chip

Response:
Ans. a. HPLC (Ref: Robbins 9/e p180, 319-320 8/e p180-181)Methylation specific PCR, Bisulphite method and ChlP on Chip can detect epigenetic modification but not the HPLC.'Epigenetics is defined as the study of heritable chemical modification of DNA or chromatin that does not alter the DNA sequence itself Examples of such modification include the methylation of DNA, and the methylation and acetylation of histones. Since traditional Sanger sequencing alone cannot detect DNA methylation; other techniques have been developed to uncover these chemical modifications. One common approach is to treat genomic DNA with sodium bisulfite, a chemical that converts unmethylated cytosines to uracil, white methylated cytosines are protected from modification. An assay termed methylation-specific PCR uses two PCR primer sets to analyze single DNA loci: one to detect a DNA sequence with unmethylated cytosines (which are converted to uracils after bisulfite treatment) and the other to detect DNA sequences with methylated cytosines (which remain cytosines after bisulfite treatment).Additional techniques are evolving that provide a genome-wide snapshot of epigenetically altered DNA. These techniques are based on the ability to detect histone modifications such as methylation and acetylation (which, like DNA methylation, are important regulators of gene expression) by using antibodies against specifically modified histones. Such antibodies can be used to pull down bound DNA sequences, a method termed chromatin immunoprecipitation (ChIP). These pulled- down sequences can be amplified and analyzed by hybridizing to microarrays ('ChIP on Chip') or sequencing ('ChIP- Seq') to map epigenetically modified genes throughout the genome. - Robbins 8/e p180 Isolation of cells of the immune response* Use the correct number of cells: 1 x 106 x to 10 x 106* Collect biological replicates of cells* Choose an appropriate control for antibody specificity (knockout or RNAi knockdown)Fragmentation by sonication or MNase treatment* Shear chromatin to a size range of ~ 150-300 bp* Sonicate chromatin extracts for non-histone proteinsSonication conditions should be determined empirically for each cell typeTreat chromatin extracts with MNase for analysis of histone modificationsDo not overdigest chromatinChIP analysis of histone modifications, transcription factors or epigenetic regulators* Select antibody: monoclonal versus polyclonal* Choose reference control (Input or IgG)* Perform ChIP with established protocols* Purify DNALibrary construction* Do end repair and adapter ligation* Perform PCR using primers compatible with sequencing platformAvoid overamplifying DNA Sequencing* Determine sequencing depth on the basis of the prevalence of binding throughout the genome: more sequencing tags may be needed for diffuse signals (such as H3K27me3)* Perform single-end or paired-end sequencingEpigenetic AlterationsEpigenetics is defined as the study of heritable chemical modification of DNA or chromatin that does not alter the DNA sequence itself.Examples of such modification include the methylation of DNA. and the methylation and acetylation of histonesQ.Since traditional Sanger sequencing alone cannot detect DNA methylation, other techniques have been developed to uncover these chemical modifications.One common approach is to treat genomic DNA with sodium bisulfite, a chemical that converts unmethylated cytosines to uracil, while methylated cytosines are protected from modificationQ.An assay termed methylation-specific PCR uses two PCR primer sets to analyze single DNA loci: one to detect a DNA sequence with unmethylated cytosines (which are converted to uracils after bisulfite treatment) and the other to detect DNA sequences with methylated cytosinesQ (which remain cytosines after bisulfite treatment).Additional techniques are evolving that provide a genome-wide snapshot of epigenetically altered DNA.These techniques are based on the ability to detect histone modifications such as methylation and acetylation (which, like DNA methylation, are important regulators of gene expression) by using antibodies against specifically modified histones. Such antibodies can be used to pull down bound DNA sequences, a method termed chromatin immunoprecipitation (ChlP).These pulled-down sequences can be amplified and analyzed by hybridizing to microarrays ('ChlP on Chip') or sequencing ('ChIP-Seq') to map epigenetically modified genes throughout the genome.

So the answer to this question is A


Instruction:
Symptomatic treatment is not required in withdrawal of
A. Cannabis
B. Morphine
C. Alcohol
D. Cocaine

Response:
A i.e. Cannabis

So the answer to this question is A


Instruction:
Patient with BP 90/60 mmHg, lips and peripheries are cyanosed; blood drawn was chocolate color. Diagnosis is: DNB 10
A. Methemoglobinemia
B. Hypovolumic shock
C. Metal fume fever
D. Alphos poisoning

Response:
Ans. Methemoglobinemia

So the answer to this question is A


Instruction:
Rapid infusion of blood causes
A. Acute Left heart failure
B. Ankle edema
C. Pulmonary edema
D. Respiratory Distress

Response:
None

So the answer to this question is C


Instruction:
Painful arc syndrome is caused by impingement of ?
A. Sub acromial bursa
B. Sub deltoid bursa
C. Rotator cuff tendon
D. Biceps tendon

Response:
Ans. is 'c' i.e., Rotator cuff tendon Painful arc syndrome Pain in the shoulder and upper arm during mid range of glenohumeral abduction. Causes - supraspinatus tendon tear or tendinitis, subacromial bursitis, fracture of greater tuberosity. The space between the upper end of humerus and the acromion gets compromised so that during mid abduction the tendon of rotator cuff gets nipped between the greater tuberosity and acromion.

So the answer to this question is C


Instruction:
Pure aryans have which type of skull :
A. Mesaticephalic
B. Brachycephalic
C. Dolicocephalic
D. None of the above

Response:
C i.e. Dolicocephalic

So the answer to this question is C


Instruction:
Which of the following is the derivative of tumor from Rathke's pouch?
A. Meningioma
B. Craniopharyngioma
C. Ependymoma
D. Low grade glioma

Response:
Ans. B CraniopharyngiomaRef: Grays Anatomy E-Book 2015 ed. P 431* In embryogenesis Rathke's pouch is an evagination at the roof of the developing mouth in front of buccopharyngeal membrane. It gives rise to anterior pituitary (adenohypophysis).* Craniopharyngioma are benign cystic lesions derived from Rathke's pouch, most frequently in children. It is associated with hypopituitarism, growth retardation and diabetes insipidus.* Clinical features:# Raised ICT# Presents before 20 years of age# Visual field abnormalities# Weight gain# Cranial nerve damage* Investigation: MRI is superior to CT.

So the answer to this question is B


Instruction:
Clinical feature of minimal change glomerulonephritis are all except -
A. Hypeension
B. Edema
C. Non Selective proteinuria
D. Fever

Response:
Minimal change disease -clinical features are Abrupt onset of edema Severe Hypoalbuminemia selective proteinuria -urine predominantly contains albumin with minimal amounts of higher molecular weight protiens. Less common clinical features include-hypeension ,microscopic hematuria ,atopic or allergic symptoms and decreased renal function. Ref:Harrison 20th edition pg no. 2142

So the answer to this question is C


Instruction:
Recurrent corneal erosion seen in-
A. Corneal dystrophy
B. Keratoglobus
C. Keratoconus
D. Peutz- anomalies

Response:
Corneal dystrophies are inherited disorders in which the cells have some inborn defects due to which pathological changes may occur with passage of time leading to development of corneal haze in otherwise normal eyes that are free from inflammation or vascularization. There is no associated systemic disease. Dystrophies occur bilaterally, manifesting occasionally at bih, but more usually during first or second decade and sometimes even later in life.Reference:Comprehensive ophthalmology,AK Khurana,4th edition,page no.117

So the answer to this question is A


Instruction:
Embryo reduction of multiple pregnancy is done at:
A. 8-10 weeks
B. 11-13 weeks
C. 13-15 weeks
D. 16-18 weeks

Response:
Embryo reduction in multifetal pregnancy us done usually at 11-13 weeks of gestation.For more information,refer page no 241 of dutta's text book of obsteics,8 th edition.

So the answer to this question is B


Instruction:
Which is the most common clinical feature of Ewing's sarcoma?
A. Fever
B. Limp
C. Pain
D. Palpable mass

Response:
Ans. C. Pain. (Ref. Practical Orthopedics by Ebnezar/pg.92).Ewing's sarcoma: Clinical history# patient is usually male.# Age grp 4-25 yrs# Long bones most commonly affected# Pain is the presenting feature. Pain may be intermittent and worse at night.# Swelling locally and limp may be present.# PatientCLINICAL FINDINGS of Osteosarcoma and Ewing Sarcoma OsteosarcomaEwing SarcomaLocal tenderness94 (92%)33 (70%)Palpable mass40 (39%)16 (34%)Painful movement of joint40 (39%)16 (34%)Restricted movement of joint23 (23%)8 (17%)Fever (reported or measured)3 (3%)14 (30%)Atrophy of muscle5 (5%)0 (0%)Limpt (noted or reported)28 (31%)19 (40%)

So the answer to this question is C


Instruction:
A hospital has always some beds vacant for emergency, isolation, emergency etc. These vacant beds are known as:
A. Essential bed space
B. Mandatory bed space
C. Dead bed space
D. None of the above

Response:
A hospital has always some beds vacant for emergency, isolation, emergency etc. These vacant beds are known as dead bed space. This accounts for around 15 to 20%. Ref: Textbook of community medicine, S. Lal, 3rd edition pg: 686.

So the answer to this question is C


Instruction:
Nicoladoni branham sign is -
A. Compression cause bradycardia
B. Compression cause tachycardia
C. Hypotension
D. Systolic filling

Response:
None

So the answer to this question is A


Instruction:
An individual has been on a fad diet for 6 weeks and has begun to develop a number of skin rashes, diarrhea, and forgetfulness. These symptoms could have been less severe if the diet contained a high content of which one of the following?
A. Tyrosine
B. Tryptophan
C. Thiamine
D. Thymine

Response:
At least eight different carrier proteins transport different groups of amino acids.a. Sodium-amino acid carrier system(1). A number of transport systems involve the uptake by the cell of a sodium ion and an amino acid by the same carrier protein on the luminal surface (examples are systems A, ASC, N, and B).(2). The sodium ion is pumped from the cell into the blood by the Na+-K+ ATPase, whereas the amino acid travels down its concentration gradient into the blood.(a). Thus, the transport of amino acids from the intestinal lumen to the blood is driven by the hydrolysis of adenosine triphosphate (ATP) (secondary active transport).b. The L-system of amino acid transport is not dependent on sodium for cotransport. The L-system transports branched-chain and aromatic amino acids and will be exploited in a treatment for phenylketonuria (PKU).The individual has developed pellagra caused by a lack of dietary niacin. Although dietary niacin is the major source of the nicotinamide ring of NAD, it may also be produced from excess tryptophan. Tyrosine, thiamine, thymine, and riboflavin cannot contribute to the synthesis of the nicotinamide ring of NAD.

So the answer to this question is B


Instruction:
The sixth complication of diabetes mellitus is
A. Retinopathy
B. Rental failure
C. Ischemic heart diseases
D. Periodontitis

Response:
None

So the answer to this question is D


Instruction:
ST segment elevation is seen in: September 2005
A. Prinzmetal's angina
B. Acute pericarditis
C. Acute MI
D. All of the above

Response:
Ans. D: All of the above Differential Diagnosis of ST Segment Elevation: Ischemic Hea Disease (usually convex upwards, or straightened) - Acute transmural injury (acute anterior MI) Persistent ST elevation after acute MI suggests ventricular aneurysm - ST elevation may also be seen as a manifestation of Prinzmetal's (variant) angina (coronary aery spasm) Acute Pericarditis - Concave upwards ST elevation in most leads except aVR - No reciprocal ST segment depression (except in aVR) - May see PR segment depression, a manifestation of atrial injury Other Causes: - Left ventricular hyperophy (in right precordial leads with large S-waves) - Left bundle branch block (in right precordial leads with large S-waves) - Advanced hyperkalemia - Hypothermia (prominent J-waves or Osborne waves)

So the answer to this question is D


Instruction:
Which of the following structures is most significant in resisting hyperextension of the hip joint?,
A. Pubofemoral ligament
B. Ischiofemoral ligament
C. Iliofemoral ligament
D. Gluteus maximus muscle

Response:
The Iliofemoral Ligament resist both hyperextension and lateral rotation at the hip joint. The Pubofemoral ligament reinforces the joint inferiorly and limits extension and abduction. The Ischiofemoral ligament reinforces the joint posteriorly and limits extension and medial rotation. The Gluteus Maximus muscle extends and laterally rotates the thigh and does not paicularly resist hyperextension

So the answer to this question is C


Instruction:
Which of the following statements are TRUE/FALSE among the statements given below, in relation to surgical wounds? 1. No antibiotics required in clean surgery 2. Incision of abscess is done in contaminated wounds 3. Spillage of stomach content conves a clean/contaminated wound case to a contaminated case 4. In clean/contaminated wounds infection rate is 10% 5. Hernial repair is contaminated wound
A. 1,2,3 true & 4,5 false
B. 3,4,5 true & 1,2 false
C. 1,3,4 true & 2,5 false
D. All are true

Response:
"Prophylactic systemic antibiotics are not indicated for patients undergoing low -risk, straightforward clean surgical operations in which no obvious bacterial contamination or inseion of a foreign body has occured. SSi risk has traditionally been correlated to wound class. The accepted range of infection rate has been 1% to 5% for clean, 3% to 11% for clean/contaminated, 10% to 17% for contaminated, and greater than 27% for diy wounds"- sabiston 18/e page 301-03

So the answer to this question is C


Instruction:
Torsional force is:
A. Compression
B. Tensile force
C. Shear
D. Transverse bending force

Response:
None

So the answer to this question is C


Instruction:
Which of the following nasal spray is very effective in control of enuresis –
A. Pitressin
B. Desmopressin
C. Lipressin
D. None of the above

Response:
None

So the answer to this question is B


Instruction:
What is the single most effective step in resuscitation of babies who fail to breathe at bih?
A. Suction of airways
B. Tactile stimulation
C. Positive pressure ventilation
D. Chest compressions

Response:
Positive pressure ventilation is the single most effective step in the resuscitation of neonates who fail to breathe at bih. Device used for PPV- 'Ambu bag'

So the answer to this question is C


Instruction:
Which of the following are true concerning a young epileptic, who has a grand mal seizure in the dental office?
A. It is generally fatal
B. It is best treated by injecting phenytoin
C. They generally recover if restrained from self injury and oxygen is maintained
D. Use physical restraints judiciously

Response:
DENTAL MANAGEMENT OF EPILEPTIC PATIENTS
Prevention of seizures can be best managed by:

Type and frequency of seizures prior to treatment.
Reduce stress. Diazepam is drug of choice.
Use of dental chair light avoided.
Appropriate drug therapy for seizures.
Due to the use of antiepileptic medication, typical fibrous gingival hyperplasia. Surgical removal necessary.
If seizure occurs in the dental chair, lower the chair to supine position.
Protect the patient from injuring himself.
Maintain a patent airway.
Give Diazepam 1mg/kg IV slowly up to 10mg.
Give oxygen.
If condition does not improve admit to hospital.

So the answer to this question is C


Instruction:
Which of the following is the most common renal cystic disease in infants is?
A. Polycystic kidney
B. Simple renal cyst
C. Unilateral renal dysplasia
D. Calyceal cyst

Response:
The multicystic dysplastic kidney is the commonest form of congenital cystic renal dysplasia and is due to complete ureteric obstruction in fetal life. The condition is usually unilateral; the bilateral disease is lethal.
Multicystic dysplastic kidney

The multicystic dysplastic kidney is a congenital condition in which the entire kidney is dysplastic with a preponderance of cysts.
The kidney is replaced by multiple cysts of varying sizes that do not communicate and no identifiable parenchyma is present.
Contralateral vesicouretral reflux is present in 15% cases.
Contralateral hydronephrosis is present in 5 - 10% cases.
It is the most common cause of an abdominal mass in a neonate. - Nelson

So the answer to this question is C


Instruction:
Krukenberg adenocarcinoma of ovary can occur as result of metastases from all except?
A. Stomach
B. Breast
C. Liver
D. Pancreas

Response:
Ans. is 'c' i.e., Livero Metastatic gastrointestinal & breast neoplasm to ovary are referred to as krukenberg tumors and are characterized by bilateral metastasis composed of mucin-producing signet-ring cells.o The primary sites are --> Stomach (most common), Pancreas, Colon, Gall bladder, Breast.

So the answer to this question is C


Instruction:
All of the following statements regarding 'Menisci' is true except:
A. Medial meniscus is more mobile than lateral
B. Lateral meniscus covers more tibial aicular surface than lateral
C. Medial meniscus is more commonly injured than lateral
D. Menisci are predominantly made up of Type I Collagen

Response:
The medial meniscus is more stable than the lateral one. All the other options are true. Ref: Ohopedic Spo Medicine : Principles and Practice, Fabrizio Margheritini, 2011, Page 398-406; Gray's, 39 Edition, Page 1477.

So the answer to this question is A


Instruction:
How is the Human povey index - 2 (HPI -2) different from Human povey Index - 1 (HPI - 1, as described in UNDP?
A. It also captures the financial inclusion
B. It also captures the social exclusive
C. It also captures the geriatric empowerment
D. It also captures the occupational health

Response:
Human povey index for developing countries (HPI-1) The following three dimensions are taken into account: Deprivation of longevity, measured as a percentage of the individuals with a life expectancy lower than 40 years (P1). Deprivation of knowledge, expressed as a percentage of illiterate adults (P2). Deprivation of decent living standards (P3) HPI-2 also considers a fouh dimension, social exclusion, measured with the long-term unemployment rate (P4), that is the percentage of those unemployed for 12 months or over compared to the total work force (the sum of those working and those seeking a job). Ref : Park&;s textbook of preventive and social medicine; 23rd edition

So the answer to this question is B


Instruction:
Asbestosis is associated with all except-
A. Pleural fibroma
B. Bronchogenic cancer
C. Gastric cancer
D. Mesothelioma

Response:
None

So the answer to this question is A


Instruction:
A urinary tract infection as a result of Proteus mirabilis facilitates the formation of kidney stones because the organism:
A. Destroys blood vessels in the kidney
B. Exhibits "swarming" motility
C. Ferments many sugars
D. Produces a potent urease

Response:
Proteus mirabilis facilitates the formation of kidney stones because the organism produces a potent urease. Proteus: Causes 1-2% of cases of UTI in healthy women. 5% of cases of hospital-acquired UTI. High prevalence of stones is due to bacterial production of urease (Hydrolyzes urea -ammonia - alkalization of the urine-precipitation of struvite and carbonate-apatite crystals- development of calculi). Option 1: Destruction of blood vessels in the kidney is seen in HUS (Haemolytic uremic syndrome) caused by Enteroheamorrhagic Escherichia coli (EHEC). Option 2: Swarming is the propey of Proteus but not associated with stone formation. Option 3: Proteus is lactose non fermenter ie. does not ferment lactose (sugar).

So the answer to this question is D


Instruction:
Radiological findings of scurvy are AJE –
A. Epiphyseal widening
B. Metaphyseal porosis
C. White line
D. Pelkan spur

Response:
None

So the answer to this question is A


Instruction:
In case of cyanide poisoning, antidote of amyl nitrite is given. This is an example of:
A. Receptor antagonism
B. Chemical antagonism
C. Physical antagonism
D. Physiological antagonism

Response:
Cyanide inhibits ETC complex 4 and hence a powerful toxin. In Acute cyanide poisoning Amyl nitrite is given followed by sodium thiosulphate. This is an example of Chemical antagonism i.e. one drug binding to other making it unavailable in body. Mechanism of action of amyl nitrite: Amyl nitrite conves Hb - Met Hb - sequester CN by making complex - complex can be thrown out of body. Hence, Amyl nitrite makes CN unavailable in the body. Other Options:- Receptor antagonism:- In this, a type of receptor ligand/drug = blocks a biological response by binding to and blocking a receptor. Physical antagonist:-It is a type of antagonist that is based on the physical propey of the drug, It can bind to the agonist and prevent its action. Physiological antagonism describes the behavior of a substance that produces effects counteracting those of another substance using a mechanism that does not involve binding to the same receptor.

So the answer to this question is B


Instruction:
Long term tamoxifen therapy may cause :
A. Endometrium Ca
B. Ovary Ca
C. Cervix Ca
D. Vagina Ca

Response:
Ans. is a i.e. Endometrium cancer Long term Tamoxifen therapy is a predisposing factor for Endometrial hyperplasia and cancers. For more details, refer answer 6 Also know : Malignancies caused by Long Term Tamoxifen therapy : Carcinoma endometrium - it is the most common carcinoma associated with it. Uterine sarcoma. Rarely liver cancer with long term high dose. Non Malignant effects of Tamoxifen on uterus : Endometrial hyperplasia Endometriosis Fibroid uterus Ovarian cysts Menstrual irregularities or Amenorrhea.

So the answer to this question is A


Instruction:
Anakinra, used in the treatment of rheumatoid arthritis is
A. IL-1
B. TNF ALPHA
C. TNF BETA
D. IL-7

Response:
(A) IL-1 # Recombinant IL-1 receptor antagonist (IL-1Ra) (anakinra): Inhibit IL-1 and is FDA approved for rheumatoid arthritis. Recombinant TNF-receptor-Ig fusion protein (etanercept): Inhibit TNF-alfa and is FDA approved for rheumatoid arthritis, juvenile rheumatoid arthritis, psoriasis Anti-TNF-alfa monoclonal antibody: Humanized mouse chimeric MAb, infliximab Fully humanized MAb, adalimumab inhibit TNF- alfa FDA approved for rheumatoid arthritis, Crohn's colitis (infliximab); FDA approved for rheumatoid arthritis (adalimumab). No TNF BETA inhibitors used. No IL-7 inhibitors used Anakinra is also useful in: Neonatal onset inflammatory disease, Muckle-Wells syndrome, and familial cold urticaria, Systemic juvenile onset inflammatory arthritis and adult onset Still's disease. Remember: Anakinra should not be combined with an anti-TNF drug (causes high rate of serious infections).

So the answer to this question is A


Instruction:
Patient presenting with abdominal pain, diarrhea taking clindamycin for 5 days. Treated with metronidazole symptoms subsided. What is the causative agent -
A. Clostridium difficile
B. Clostridium perfringens
C. Clostridium welchi
D. Clostridium marneffi

Response:
Ans. is 'a' i.e., Clostridium difficile

So the answer to this question is A


Instruction:
Acute onset of blurred vision and absent pupillary response with rapidly progressive descending muscular weakness manifesting as quadriparesis in an afebrile 20 year old male with preserved sensorium is -
A. Porphyria
B. Botulism
C. Polio
D. Diphtheria

Response:
Ans. is tb' i.e., Botulism Remember these important points about Botulismo Acute onset of weakness in muscles innervated by cranial nerve with prominent bulbar palsy (4D's) i.e. -# Diplopia# Dysphonia# Dysphagia# Dysarthriao Descending symmetrical weakness occurs often leading to weakness,o Sensory' abnormalities are absent because only motor and autonomic nerves affected.o Mental function not affected o Afebrileo Absent pupillaty reflexes

So the answer to this question is B


Instruction:
All of the following are features of hemolytic anemia Except:
A. Decreased RBC life span
B. Decreased Haptoglobin
C. Unconjugated hyperbilirubinemia
D. Bilirubin in urine

Response:
Answer is D (Bilirubin in urine) Presence of bilirubin in urine is not a feature of Hemolytic Anemias. Presence of bilirubin in urine indicates the presence of conjugated bilirubin in the plasma. Hemolytic anemias are associated with unconjugated hvperbiliruhinemia not conjugated hyperbilirubinemia.

So the answer to this question is D


Instruction:
Which of the following is not true about facial nerve & its relations
A. Processus cochleariformis acts as a landmark for geniculate ganglion of facial nerve
B. Tympanic segment of facial nerve lies below round window & above horizontal semi circular canal
C. Mastoid segment of facial nerve lies always behind tympanomastoid suture
D. A patient with lesion between geniculate ganglion & nerve to stapedius will have phonophobia & loss of stapedial reflex & taste sensation

Response:
Tympanic segment of facial nerve lies Above oval window & Below Horizontal SCC FOR MIDDLE EAR AND MASTOID SURGERY Processus cochleariformis- It demarcates geniculate ganglion which lies just anterior to it. Tympanic segment of the nerve stas at this level. Oval window and horizontal canal- Facial nerve runs above oval window (stapes) and below the horizontal canal. Sho process of incus- Nerve lies medial to sho process of incus at level of aditus. Pyramid-Nerve runs behind the pyramid and the posterior tympanic sulcus. Tympanomastoid suture- In veical/mastoid segment, nerve runs behind this suture. Digastric ridge- Nerve leaves the mastoid at the anterior end of digastric ridge.

So the answer to this question is B


Instruction:
Prognosis of lymphoma depends on all of the following except: March 2011
A. Number of lymph node sites
B. Tumour size
C. Tumour stage
D. Associated symptoms

Response:
Ans. D: Associated symptoms

So the answer to this question is D


Instruction:
Recurrent polyps are seen in:
A. Antrochoanal polyp
B. Ethmoidal polyp
C. Nasal polyp
D. Hyperophic turbinate

Response:
Ethmoidal Polyps They are mostly seen in adults. Etiology--usual cause of ethmoidal polyps is allergy Allergic nasal polyps are rarely, if ever seen in childhood. They are only seen in childhood in association with mucoviscoidosis. Ethmoidal polyps are also associated with: Bronchial asthma Aspirin intolerance Cystic fibrosis Nasal mastocystosis - Syndromes like: Kaageners/Young syndrome/Churg-Strauss syndrome It is generally bilateral Appear as multiple, sessile or pedunculated masses like a bunch of grapes Insensitive to touch and do not bleed on probing. Recurrence is common after removal.

So the answer to this question is B


Instruction:
A 40-year-old otherwise healthy gardener presents with several subcutaneous nodules on his right hand, where he had cut himself on rose thorns. Physical exam reveals several erythematous fluctuant lesions. Which of the following organisms is most likely responsible for his condition?
A. Aspergillus
B. Malassezia
C. Onchocerca
D. Sporothrix

Response:
Whenever you see a question on a gardener who works with roses, think "Sporothrix schenckii." This organism is responsible for "rose gardener's disease," known technically as sporotrichosis. The organism enters through skin breaks in the fingers or hands, causing a chancre, papule, or subcutaneous nodule with erythema and fluctuance. Ulcerating lesions appear along lymphatic channels, but the lymph nodes are not commonly infected. Potassium iodide is the treatment of choice for the sub cutaneous manifestations. Aspergillus causes pulmonary aspergillosis ; a systemic mycotic infection. There is an allergic type that is caused by a hypersensitivity reaction to the organism and an infectious type that occurs more commonly in the immunocompromised. Hemoptysis is a common symptom. Malassezia, specifically M. furfur, causes tinea versicolor, a superficial mycotic infection. Onchocerca, specifically O. volvulus, causes river blindness. Ref: Ray C.G., Ryan K.J. (2010). Chapter 44. Dermatophytes, Sporothrix, and Other Superficial and Subcutaneous Fungi. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.

So the answer to this question is D


Instruction:
Catecholamine action on α–receptors causes:
A. Increased atrial contraction
B. Increased heart rate
C. Detrusor relaxation
D. Gastrointestinal sphincter contraction

Response:
None

So the answer to this question is D


Instruction:
Sturm's conoid refers to configuration of the rays refracted through:
A. Concave spherical surface
B. Convex spherical surface
C. Toric surface
D. Irregular surface

Response:
Ans. Toric surface

So the answer to this question is C


Instruction:
Commonest cause of brain abscess -
A. CSOM
B. Pyogenic meningitis
C. Trauma
D. Chr. sinusitis

Response:
None

So the answer to this question is A


Instruction:
The genetic ability of a bacterium to grow in the presence of several antibiotics is passed in vivo from one bacterium to another by:
A. Conjugation
B. Rarefaction
C. Transduction
D. Transformation

Response:
None

So the answer to this question is A


Instruction:
Aeriovenous fistula can safely be ligated if the following is positive:
A. Allen's Test
B. Henle-Coenen sign
C. Tredelenberg test
D. Schwaz Test

Response:
Allen&;s Test: Tests the adequacy of the blood supply to the hand from the radial and ulnar aeries and the arcade between them. Allen&;s test is used to know the integrity of palmar arch (Patency of radial and ulnar aeries). If these are patent, AVF can be safely ligated. Method of Allen&;s Test Elevate the hand and apply digital pressure on the radial and ulnar aeries occlude them. Ask the patient to make a fist several times. The tips of the finger should go pale. Release each aery in turn and observe the return of colour. Ref: Sabiston 20th edition Pgno: 1979

So the answer to this question is A


Instruction:
Essential amino acids are named so:
A. Because they are produced in the body
B. Because they are not produced in the body
C. They are not impoant for life
D. Every food stuff essentially contains them

Response:
Essential amino acids are so called not because they are more impoant to life than the others, but because the body does not synthesize them, making it essential to include them in one's diet in order to obtain them. They are Leucine, Arginine, Histidine, Isoleucine, Meyhionine, Phenylalanine, Threonine, Tryptophan, Valine and lysine. Additionally, cysteine (or sulphur-containing amino acids), tyrosine (or aromatic amino acids), histidine and arginine are required by infants and growing children.

So the answer to this question is B


Instruction:
Percentage of pheochromocytoma that are bilateral is:
A. <1%
B. 1-5%
C. 10%
D. 25%

Response:
Pheochromocytomas often are called the 10 percent tumor because 10% are bilateral, 10% are malignant, 10% occur in pediatric patients, 10% are extra-adrenal, and 10% are familial. Ref: Schwaz's principle of surgery 9th edition, chapter 38.

So the answer to this question is C


Instruction:
A 70 year old male, known case of chronic renal failure suffers from a pathological fracture of Rt femur, the diagnosis is -
A. Primary Hrperparathyroidism
B. Secondary Hyperparathyroidism
C. Scurvy
D. Vitamin D Resistant rickets

Response:
Ans. is 'b' i.e., Secondary Hyperparathyroidism Secondary hyperparathyroidism (Renal osteodystrophy)o Bone and joint pain are common, as are limb deformities.o Pathological fractures are common.Diagnosiso The PTH is elevated due to decreased levels of calcium or 1,25-dihydroxy-vitamin D3. It is usually seen in cases of chronic renal disease.o Elavated creatinine and BUNCauseo Chronic kidney failure is the most common cause of secondary hyperparathyroidism. Failing kidneys do not convert enough vitamin D to its active form, and they do not adequately excrete phosphate. When this happens, insoluble calcium phosphate forms in the body and removes calcium from the circulation. Both processes lead to hypocalcemia and hence secondary hyperparathyroidism.Treatmento If the underlying cause of the hypocalcemia can be addressed, the hyperparathyroidism will resolve. In people with chronic renal failure, treatment consists of dietary restriction of phosphorus, supplements with an active form of vitamin D such as calcitriol, doxercalciferol, paricalcitol, etc. and phosphate binders which can be divided into calcium-based and non-calcium based.o In the treatment of secondary hyperparathyroidism due to chronic kidney disease on dialysis calcimimetics does not appear to affect the risk of early death It does decrease the need for a parathyroidectomy but caused more issues with low blood calcium levels and vomiting.o Most people with hyperparathyroidism secondary to chronic kidney disease will improve after renal transplantation, but many will continue to have a degree of residual hyperparathyroidism (tertiary hyperparathyroidism) posttransplant with associated risk of bone loss, etc.

So the answer to this question is B


Instruction:
Flat capnogram found in A/E
A. Disconnection of anesthetic tubing
B. Accidental extubation
C. Mechanjca1 ventilation failure
D. Bronchospasm

Response:
in bronchospasm,there is prolonged expiratory upstroke(abscence of phase 3 plateau). in tube displacement,disconnection,accidental extubation,ventilation failure,it is flat.

So the answer to this question is D


Instruction:
Complications of chronic duodenal ulcer are all except -
A. Bleeding
B. Stricture
C. Malignancy
D. Perforation

Response:
Ans. is 'c' i.e., Malignancy o Most common complication of peptic ulcer is gastro intestinal bleeding.o It is seen with both chronic and acute type of ulcers. Infact, chronic peptic ulcers are the most common cause of haematemesis and malaena.Complications of peptic ulcer -1) Gastrointestinal bleedingMost common complication of peptic ulcerBleeding is more common in duodenal ulcersIt is commonly seen in posterior duodenal ulcers because of erosion of gastroduodenal artery:2) PerforationIt is the second most common complication of peptic ulcer disease.Perforation occurs commonly in the ulcers located in the anterior part of duodenum.Duodenal ulcers tend to penetrate into pancreas causing pancreatitis.Gastric ulcers tend to penetrate into left hepatic lobe.3) Gastric outlet obstructionIt is the least common ulcer related complication.It is commonly associated with duodenal ulcers.o Tea pot stomach is caused due to longitudinal shortening of the gastric ulcer at the lesser curvature of the stomach (It causes the stomach to look like tea pot).o Hour glass stomach is caused due to cicatricial contraction of a saddle shaped ulcer at the lesser curvature.

So the answer to this question is C


Instruction:
Which of the following is a nonmolar trophoblastic neoplasm?
A. Complete hydatidiform mole
B. Paial hydatidiform mole
C. Invasive mole
D. Choriocarcinoma

Response:
GTD histologically is divided into hydatidiform moles, which are characterized by the presence of villi, and nonmolar trophoblastic neoplasms, which lack villi.Nonmolar trophoblastic neoplasms include choriocarcinoma, placental site trophoblastic tumor,and epithelioid trophoblastic tumor.Reference: William&;s Obstetrics; 25th edition; Chapter 20; Gestational trophoblastic diseases

So the answer to this question is D


Instruction:
Stereotypic moments are
A. Sustained posture against gravity
B. Passive inducible movements
C. Repetitive, spontaneous, nonfunctional movements
D. Resistance to passive movements

Response:
Stereotypic movements are seen in catatonic type of schizophrenia.

So the answer to this question is C


Instruction:
String sign is seen in:
A. Crohn's disease
B. TB of the ileocaecal region
C. Idiopathic hyperophic pyloric stenosis
D. All of the above

Response:
Ans. All of the above

So the answer to this question is D


Instruction:
Most common cause of acute intestinal obstruction in children is
A. Volvulus
B. Inguinal hernia
C. Intussusception
D. None

Response:
None

So the answer to this question is C


Instruction:
Haplike's test is done for
A. Cochleas function
B. Vestibular function
C. Middle Ear function
D. Not related to the Ear

Response:
None

So the answer to this question is B


Instruction:
Which of the following is an autosomal recessive condition
A. A. Ataxia telangectasia
B. B. Peutz jiggers syndrome
C. C. Neurofibromatosis
D. D. Tuberous sclerosis

Response:
Ataxia telangectasia is an autosomal recessive condition Patients have increased sensitivity to x rays induced chromosome abnormalities Characterized by an ataxic dyskinetic syndrome beginning in early childhood ,caused by neural degeneration predominantly in the cerebellum, the subsequent development of telangectasia in the conjunctiva and skin and immunodeficiency The lymph nodes ,thymus, and gonads are hypopladtic Clinical features recurrent spinopulmonary infection and unsteadiness in walking Incteased risk development of lymphoid development of lymphoid malignant disrase. Refer ribbons 8/e p302

So the answer to this question is A


Instruction:
Motility in the upper third of the esophagus is decreased in all except:
A. Pseudo-bulbar palsy
B. Chagas disease
C. Myasthenia gravis
D. Scleroderma

Response:
Classification of Esophageal Motility Disorders Disorders of the Pharyngo-esophageal junction Neurological: Stroke, motor neurone disease, multiple sclerosis, Parkinson&;s disease Myogenic: Myasthenia, muscular dystrophy Pharyngo-esophageal (Zenker&;s diveiculum) Disorders of the body of the esophagus Diffuse esophageal spasm Nutcracker esophagus Autoimmune disorders- Systemic Sclerosis (CREST) Reflux associated idiopathic Allergic Eosinophilic esophagitis Non-specific esophageal dysmotility Disorders of the lower esophageal sphincter Achalasia Incompetent lower sphincter (i.e., GERD) Ref: Bailey and Love 27th edition Pgno: 1096

So the answer to this question is D


Instruction:
A 4-year-old child presented to the OPD with a palpable abdominal mass in the right flank region which was painless and slowly increasing in size along with some episodes of fever and hematuria. On examination, hypeension was noted. CT scan of the abdomen was done. The patient was operated and the mass was resected. The gross specimen and the HPE examination are given below. All of the following genes can be mutated in the above disease except: -
A. WT1
B. CTNNB1
C. AMER1
D. RAS

Response:
This is a case of Wilm's tumour. Wilms tumor is often associated with mutations in the WT1 gene, CTNNB1 gene, or AMER1 gene CT image shows a mass in the right kidney. Gross nephrectomy specimen shows a Wilms tumor pushing the normal renal parenchyma to the side. HPE image shows the characteristic three components:* Malignant small round (blue) cells ~ 2x the size of resting lymphocyte (blastema component) Tubular structures/rosettes (epithelial component) Loose paucicellular stroma with spindle cells (stromal component) The median age at diagnosis of this kidney tumor (see the image below) is approximately 3.5 years. Clinical findings include the following: Asymptomatic abdominal mass (in 80% of children at presentation) Abdominal pain or hematuria (25%) Urinary tract infection and varicocele (less common) Hypeension, gross hematuria, and fever (5-30%) Hypotension, anemia, and fever (from hemorrhage into the tumor; uncommon) Respiratory symptoms related to lung metastases (in patients with advanced disease; rare)

So the answer to this question is D


Instruction:
Positive adsons test is seen in -
A. Thoracic outlet syndrome
B. Burger disease
C. Varicose veins
D. Radial nerve injury

Response:
Ans. is 'a' i.e., Thoracic outlet syndrome Thoracic Outlet Syndrome:* Neurological and vascular symptoms and signs in the upper limbs may be produced by compression of thelower trunk of the brachial plexus (C8 and Tl) and subclavian vessels between the clavicle and the first rib.* Symptoms and signs of thoracic outlet syndrome may be reproduced by variousprovocative manoeuvres. In Adson's test the patient'sneck is extended and turned towards the affected sidewhile he or she breathes in deeply; this compresses theinterscalene space and may cause paraesthesia andobliteration of the radial pulse.* In Wright's test thearms are abducted and externally rotated; again thesymptoms recur and the pulse disappears on theabnormal side.* The examination is continued by askingthe patient to hold his or her arms high abovetheir head and then open and close the fingers rapidlyjthis may cause cramping pain on the affected side(Roos's test). Unfortunately these tests are neither sensitivenor specific enough to clinch the diagnosis.

So the answer to this question is A


Instruction:
Persistent bucconasal membrane result in
A. Cleft lip
B. Choanal atresia
C. Cleft palate
D. T-O Fistula

Response:
Ans. b (Choanal atresia). (Ref. Diseases of ENT, PL Dhingra, 3rd ed., 78, 210, 510)# Persistant bucconasal membrane leads to choanal atresia.Choanal atresia# Is a autosomal recessive trait in which the posterior choanae unilaterally or bilaterally fail to develop properly.# Persistent bucconasal membrane is the basic etiology.# Occurs in 1 in 5,000 births; more common among girls (2:1)# Unilateral > bilateral atresia.# Because newborns are obligate nose breathers, bilateral atresia is immediately apparent as respiratory distress.# Characteristics is the history or failure to pass a rubber catheter or nasogastric tube into the pharynx.# Symptoms of choanal atresia include failure to thrive due to poor feeding and mucoid nasal discharge.# The presence of choanal atresia can be confirmed with visualization of retention material in the posterior part of the nose on a lateral radiograph with the patient in the supine position.# Anatomic characterization of the deformity with CT can be important for planning surgical procedures.# Surgical treatment methods for membranous atresia include puncture of the choanal membrane and placement of a stent for 6 weeks.# If bony atresia is present, the bony wall can be taken down transnasally with microsurgical techniques followed by placement of a stent.# When suboptimal resection for atresia or choanal stenosis occurs, transpalatal repair at 3-4 years age is advised.# The septum usually deviates to the affected side; however, more posterior examination shows atresia.# Transpalatal repair is being replaced by endoscopic techniques of repair of atresia in children and adults.

So the answer to this question is B


Instruction:
All of these pulmonary changes are seen in restrictive lung disease except:
A. |FEV1/FVC
B. |TLC
C. |RV
D. | VC

Response:
Vital capacity is sum of ERV + TV + IRV. All these lung volumes are Reduced in Restrictive lung disease due to pulmonary fibrosis. Do not mix with Timed vital capacity which is a ratio of FEV1/ FVC and is increased in restrictive lung disease.

So the answer to this question is D


Instruction:
All of the following vascular changes are observed in acute inflammation, except
A. Vasodilation
B. Stasis of blood
C. Increased vascular permeability
D. Decreased hydrostatic pressure

Response:
The main vascular reactions of acute inflammation are increased blood flow secondary to vasodilation and increased vascular permeability, both designed to bring blood cells and proteins to sites of infection or injury.Changes in Vascular Caliber and FlowAfter transient vasoconstriction (lasting only for seconds), aeriolar vasodilation occursThe microvasculature becomes more permeable, and protein-rich fluid moves into the extravascular tissuesAs stasis develops, leukocytes (principally neutrophils) begin to accumulate along the vascular endothelial surface--a process called marginationIncreased Vascular PermeabilitySeveral mechanisms may contribute to increased vascular permeability in acute inflammatory reactions ( Robbins Basic Pathology, 9 th edition, page 33 )

So the answer to this question is D


Instruction:
Dose of acyclovir in a patient suffering from herpes genitalis is :
A. 200 mg, three times a day for 5 days
B. 200 mg, five times a day for 5-7 days
C. 600 mg, five times a day for 5 days
D. 800 mg, five times a day for 7 days

Response:
Herpes labialis by HSV-I - T/t acyclovir 200mg 5 T/D 5-7 days or Herpes genitalis by HSV-II Acyclovir 200 mg, five times a day for 5-7 days OR Acyclovir 400mg TDS 5-7 days Herpes zoster- DOC acyclovir 800mg 5 T/D * 7days Chicken pox(varicella zoster)- DOC-Acyclovir 800mg 4T/D 7 days If patient immunocompromised- IV. Acyclovir Incase of acyclovir resistance- foscainet Recurrent (i.e. >6 episodes 1yr) h.labialis -prophylactic Therapy Acyclovir 400mg BD 6 Months

So the answer to this question is B


Instruction:
Antibody diversity is due to -a) Gene rearrangementb) Gene translocationc) Antigenic variationd) CD40 moleculese) Mutation
A. ace
B. bde
C. cde
D. ade

Response:
None

So the answer to this question is A


Instruction:
A 45 years old male presents with complain of black spots on his tooth surface. He gives a history of multiple gold restorations and insists on getting the same for this tooth.The intraoral examination reveals pit and fissure caries in relation to 16. During the condensation of the restorative material, the compacted surface should be
A. Saucer shaped, with the compaction on the external walls slightly ahead of the center
B. Convex in the center with the compaction on the external walls slightly ahead of the center
C. Flat in the center with the compaction on the external walls slightly ahead of the center
D. Flat throughout the floor

Response:
Generally the line of force is perpendicular to the pulpal floor in the center of the mass and at a 45-degree angle to the pulpal floor as the external walls are reached. At this stage and during all building of the restoration, the compacted surface should be saucer shaped, with the compaction of gold on the external walls slightly ahead of the center. The surface should never be convex in the center because this may result in voids in the gold and poor adaptation of the gold  along the external walls when the condenser nib is “crowded out” along the wall by the center convexity. The operator continues building the restoration until the cavosurface margin is covered with foil. One needs to exercise extreme care that gold is always present between the condenser face and the cavosurface margin; otherwise the condenser may injure (i.e., fracture) the enamel margin. The central area of the restoration’s surface is filled in to the desired level. Tooth surface contour of the gold is created to simulate the final anatomic form, and a slight excess of gold is compacted on the surface to allow for the finishing and polishing procedures.
Sturdevant operative dentistry  7th EDITION, Page No:131

So the answer to this question is A


Instruction:
True statement regarding 'at risk baby': September 2009
A. Bih weight less than 2.75 kg
B. Weight less than 70% of the expected weight
C. Bih order more than 3
D. Ist degree malnutrition

Response:
Ans. B: Weight less than 70% of the expected weight The basic criteria for identifying 'at risk' babies include: Bih weight less than 2.5 kg. Twins Bih order 5 and more Aificial feeding Weight below 70% of the expected weight (II and III degrees of malnutrition) Failure to gain weight during three successive months Children with diarrhea, PEM Working mother/ one parent

So the answer to this question is B


Instruction:
A newborn with eyes closed 6 hrs after birth is lustily crying; There are no chest retraction & movements of all four limbs are present. Neonatal behavioral response grading.
A. State 1
B. State 3
C. State 5
D. State 6

Response:
d. State 6(Ref: Nelson's 20/e p 63)As the neonate is lustily, (i.e. strongly) crying, his behavioral response grading is state 6 (prechtl's system)Behavioral StateDescription1Eyes closed, regular respiration, no movements (may have startle) (Quiet sleep)2Eyes closed, irregular respiration, may have small isolated/ gross movements (Active sleep)3Eyes open, regular respiration, no movement (may have small isolated movements) (Drowsy)4Eyes open, gross movements, no cry (Alert)5Fussy6Strong cry

So the answer to this question is D


Instruction:
False about C. diphtheriae
A. Toxin production is chromosome mediated
B. Toxic production is phage mediated
C. Toxic to hea and neuron
D. Toxin inhibitis protein synthesis

Response:
Ans. (a) Toxin production chromosome mediated Already explained Note: Toxicity of corynebacterium is under control of phage gene, but the invasiveness is under control of bacterial gene.

So the answer to this question is A


Instruction:
A 22-year-old man develops the insidious onset of low back pain improved with exercise and worsened by rest. There is no history of diarrhea, conjunctivitis, urethritis, rash, or nail changes. On examination, the patient has loss of mobility with respect to lumbar flexion and extension. He has a kyphotic posture. Which test or group of tests would be most supportive of your suspected diagnosis?
A. MRI of the lumbosacral spine showing spinal compression fractures associated with bony destruction.
B. An elevated sedimentation rate, a mild anemia on CBC, positive HLA-B27 in blood and sclerosis of the sacroiliac joints on plain films of the back.
C. A positive rheumatoid factor, anti-CCP, and an elevated C-reactive protein level.
D. Lumbosacral x-rays showing vertebral joint space narrowing and osteophyte formation at various levels.

Response:
As indicated in the question, insidious back pain occurring in a young male and improving with exercise suggests one of the spondyloarthropathies-ankylosing spondylitis, reactive arthritis (formerly termed Reiter syndrome), psoriatic arthritis, or enteropathic arthritis. In the absence of symptoms or findings to suggest one of the other conditions, laboratory tests that show a mild anemia, a positive HLA-B27 (present in 90% of patients with ankylosing spondylitis), an elevated sedimentation rate, and symmetrical sacroiliitis on x-ray would all be very supportive of the diagnosis of ankylosing spondylitis. The prognosis in ankylosing spondylitis is generally good, with only 6% dying of the disease itself. While pulmonary fibrosis and restrictive lung disease can occur, they are rarely a cause of death (cervical fracture, heart block, and amyloidosis are leading causes of death as a result of ankylosing spondylitis). The MRI described in answer a would be more suggestive of spinal tuberculosis (Pott disease) or metastatic cancer. Rheumatoid factor is negative in all the spondyloarthropathies as would be the anti-CCP test, although the C-reactive protein level could be elevated in any inflammatory condition. Joint space narrowing and osteophytes are the hallmarks of osteoarthritis which would be unusual in a young man. While Crohn disease can cause an enteropathic arthritis, which may precede the GI manifestations, this diagnosis is far less likely in this case than ankylosing spondylitis.

So the answer to this question is B


Instruction:
STYLOHYOID muscle is supplied by ?
A. Facial
B. Glossopharyngeal
C. Ansa cervical
D. Vagus

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

So the answer to this question is A


Instruction:
Calcium requirement in an infant (mg/day) -
A. 100
B. 200
C. 300
D. 500

Response:
Ans. is 'd' i.e., 500 Calcium requirementsAgeRDA - mg/dayAdult600Pregnant1200 (+600)Lactation1200 (+600)Infant500Children 1 - 9 years60010-16 years80016-18 years800

So the answer to this question is D


Instruction:
Gallows traction is used in management of fracture shaft -
A. Femur
B. Tibia
C. Humerus
D. Ulna

Response:
Ans. is 'a' i.e., Femur o Gallow s traction is used for treatment of fracture shaft femur, in infants and children < 2 vrs of age.Fracture shaft femur in infant and young childreno It is published that upto one half of infants and young children who sustain femur fractures are victims of child abuse and child abuse occurs in 50 - 80% of children (< 2 years of age) with femoral fracture.o Other causes of fracture are osteogenesis imperfecta (blue sclera, hearing loss, multiple fracture), bone tumors (eosinophilic granuloma, aneurysmal bone cyst),o Fracture heals within 2 weeks in infant and children upto 2 years of age.o Treatment depends upon the age of the patient : -Conservative : - It is the treatment of choice in children.0-2 yeas Plaster spica or modified Bryant or Gallow^s traction or pavilic harness (< 6 month of age).2-10 years : - Split Russel traction10-15 years : - 90-90deg femoral skeletal traction.SurgicalSurgery is done less commonly in children.It is indicated in older children when closed reduction by conservative treatment is not possible.Intramedullar titanium elastic nailing is the surgery of choice.

So the answer to this question is A


Instruction:
True about Octreotide
A. Is active orally
B. Is not a somatostatin analogue
C. Used in secretory diarrhea
D. Is a growth hormone agonist

Response:
Octreotide is a synthetic octapeptide with actions similar to somatostatin. Routes of administration: - Intravenous (v. sho duration of action) - Subcutaneous - Intramuscular (depot preparation) It is 40 times more potent than somatostatin in suppressing GH secretion. It is being preferred over somatostatin for acromegaly and secretory diarrheas associated with carcinoid, AIDS, cancer chemotherapy or diabetes. Uses Based on propeies of inhibiting secretion of various hormones (GH, TSH, PL, insulin, glucagon), all gi secretions (including gastrin & HCI) and constriction of splanchnic, hepatic and renal blood vessels. Carcinoid and Vipoma induced secretory diarrhea and systemic symptoms such as flushing and wheezing. Diarrhea due to vagotomy and dumping syndrome, sho bowel syndrome or AIDS. GI bleeding Pancreatic fistula, insulinoma, glucagonoma, pancreatic ascites Oncogenic osteomalacia Acromegaly Adverse effects: Abdominal pain, nausea, steatorrhoea, diarrhea, gall stones.

So the answer to this question is C


Instruction:
Stress concentration in Root dentin is least with:
A. Smooth tapered post.
B. Serrated tapered post
C. Smooth parallel post.
D. Serrated parallel post

Response:
None

So the answer to this question is C


Instruction:
Which of the following statement(s) is/are true about phrenic nerve except -
A. It is primary motor supply to diaphragm
B. Accessory phrenic nerve joins the phrenic nerve near the first rib
C. Formed in front of scalenus medius muscle
D. It descends posterior to sternocleidomastoid

Response:
Ans is. 'C i.e., Formed in front of scalenus medius muscle Lies anterior to anterior scalenus muscle Phrenic nerve is a mixed nerve & carries motor fibres to the diaphragm & sensory fibres from the diaphragm, pleura, pericardium & pa of the peritoneum.Origin:It arise in the neck from the ant. rami of the 3rd, 4th & 5th cervical nervesIt is formed at the lateral border of the scalenus anterior, opposite the middle of the sternocleidomastoid at the level of the upper border of the thyroid cailage.Relations:It runs veically downwards on the ant. surface of the scalenus ant. & in this pa it is related anteriorly toPreveebral fasciaInf. belly of omohyoidTransverse cervical aerySuprascapular aeryInternal jugular veinSternocleidomastoid mus.Thoracic duct on left side.After leaving the ant. surface of the scalenus ant. the nerve runs downwards on the cervical pleura behind the commencement of the brachiocephalic vein. (on left side nerve leaves the scalenus ant. at a higher level & crosses in front of the .first pa of the subclan a.). Here it crosses the internal thoracic aery (either anteriorly or posteriorly) & enters the thorax behind the 1st costal cailage.

So the answer to this question is C


Instruction:
Treatment of campyiobacter-
A. Tetracycline
B. Ampicillin
C. Erythromycin
D. Ciprofloxacin

Response:
Ans. is 'd' Le., Ciprofloxacin o Campylobacter infection in usually a mild self limited infection# Given the self limited nature of most Campylobacter infections and the limited efficacy of routine antimicrobial therapy treatment is required only for severe disease or risk for se\rere disease.Treatment of Campylobactor ieiunaeo First line agents for treatment of Campylobacter gastroenteritis include :Fluoroquinolone (if sensitive)Azithromycin Erythromycin was previously favoured although it is no longer favoured as first line agent given its toxicity and potential drug interactionso Azithromycin is particularly favoured over the erythromycin for patients on medications that inhibit CYP3A4.Since concurrent use of erythromycin and such drugs can increase risk of sudden cardiac death.o In patients with uncomplicated Campylobacter infection at risk for severe disease the drugs typically used are:LevofloxacinCiprofloxacin or azithromycinFor systemic infections treatment is empirically started witho Gentamycino Imipenemo Chloramphenicol

So the answer to this question is D


Instruction:
When noting condylar guidance , the incisal pin should be:
A. In contact with guidance table.
B. Out of contact.
C. The cuspal inclines.
D. None of the above.

Response:
None

So the answer to this question is B


Instruction:
Lancefield group of streptococci is based on
A. M proteins
B. Carbohydrate ( C ) antigen on the cell wall
C. Bile solubility
D. Sugar fermentation

Response:
Carbohydrate contained in the cell wall of many streptococci forms the basis of serologic grouping into Lancefield groups A-H and K-U. The serologic specificity of the group-specific carbohydrate is determined by an amino sugar.Jawetz 23e pg: 213

So the answer to this question is B


Instruction:
Most common organism causing ventilator associated pneumonia -
A. Legionella
B. Pneumococcus
C. Pseudomonas
D. Coagulase negative staphylococcus

Response:
None

So the answer to this question is C


Instruction:
"Elschnig Pearl" in papillary aperture is a sign of
A. Acute iridocylitis
B. Pseudoexfoliation syndrome
C. After-cataract
D. Secondary cataract

Response:
Ans. c (After cataract) (Ref. Basak, Ophthalmology, 2nd ed., 182)AFTER CATARACT# Posterior capsular opacification following ECCE & discission of congenital/traumats cataract.# More common in children# Elschning's pearl (Balloon lens-cell)# Soemerring's ring (Ring behind iris formed by lens fibers)# Treatment:- Discission or needling- Capsulotomy/membranectomy Nd-YAG Laser capsulotomy (safe, noninvasive & quick OPD procedure)

So the answer to this question is C


Instruction:
Long QT syndrome- All of the following may be a cause in children except -
A. Romano Ward syndrome
B. Jarvell and Lange Nielson Syndrome
C. Macrolide antibiotics
D. Holt Oram Syndrome

Response:
Ans. is 'd' i.e., Holt Oram Syndrome Long OT syndrome in children Congenitalo Jarvell and Lange Nielson Syndromeo Romano Ward syndromeAcquiredo The acquired causes of long QT syndrome include drugs, electrolyte imbalance, marked bradycardia, cocaine, organophosphorus compounds, subarachnoid hemorrhage, myocardial ischemia, protein-sparing fasting, autonomic neuropathy, and human immunodeficiency virus (HIV) diseaseo Implicated drugs include the followingo Class IA and III antiarrhythmicso Macrolide antibioticso Pentamidineo Antimalarialso Antipsychoticso Arsenic trioxideo Methadone

So the answer to this question is D


Instruction:
Transection at mid pons level results in?
A. Hyperventlation
B. Apneusis
C. Rapid and shallow breathing
D. Hypoxia

Response:
B i.e. Apneusis

So the answer to this question is B


Instruction:
In a foetus, the insulin secretion begins by
A. 3rd month
B. 5th month
C. 7th month
D. 9th month

Response:
Insulin is a peptide hormone, produced by beta cells of the pancreas, and is central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, skeletal muscles, and fat tissue to absorb glucose from the blood. In the liver and skeletal muscles, glucose is stored as glycogen, and in fat cells (adipocytes) it is stored as triglycerides. In mammals, insulin is synthesized in the pancreas within the b-cells of the islets of Langerhans. One million to three million islets of Langerhans (pancreatic islets) form the endocrine pa of the pancreas, which is primarily an exocrine gland. The endocrine poion accounts for only 2% of the total mass of the pancreas. Within the islets of Langerhans, beta cells constitute 65-80% of all the cellsRef: Ganong&;s review of medical physiology; 24th edition; page no-432

So the answer to this question is A


Instruction:
All are true regarding Seminoma EXCEPT
A. Common in age between 35 and 45 years
B. Metastasis to lymphatics
C. Radio resistant
D. Not seen before puberty

Response:
C. i.e. (Radio resistant) (1312 - 13. S. Das 5th) (1385-B & L 25th)* Testicular seminoma is remarkably radiosensitive tumour and vigorous attempt should be made to irradicate the tumour even in patients with advanced diseaseSEMINOMA - is the most common form of testicular tumour in the adult (Between 35 and 45 years). They almost never occur in infancy* Painless swelling is commonest presentation* A seminoma metastasizes almost exclusively by the lymph vessels* Active lymphocytic infiltration of the tumour suggests a good host response and a better prognosisTERATOMA - age between 20 and 35. years* Pulmonary metastasis suggests that the tumour is a teratoma*** Teratoma is less sensitive to radiation* Jaundice and palpable liver may be the only presenting features of a case of teratoma* Most common testicular tumor in prepubertal adults is Yolk sac tumour**

So the answer to this question is C


Instruction:
Cells associated with humoral immunity is: September 2005
A. NK cells
B. B cells
C. T cells
D. Null cells

Response:
Ans. B: B cells Humoral immunity is that aspect of specific immunity which is mediated by B lymphocytes and involves the binding of antibodies to antigens Characteristics: Acquired humoral immunity is the recognition of antigens associated with microorganisms or foreign substances. This recognition is coupled with the ability to initiate appropriate actions (e.g., antibody production) against these microorganisms or foreign substances. Acquired humoral immunity may be subdivided into: - that acquired actively - that acquired passively Cellular immunity: * For immunity mediated by cytoxic T cells, an antigen is always a protein or a poion of a protein. * This is because only peptides (protein fragments) interact with MHC (major histocompatibility complex) and cell mediated immunity requires interaction with these MHC-associated peptides.

So the answer to this question is B


Instruction:
Which of the following is the most common location of hypeensive hemorrhage?
A. Pons
B. Thalamus
C. Putamen/external capsule
D. Subcoical white matter

Response:
Answer is C (Putamen): 'The putamen is the most common site fir hypeensive haemorrhage' - Harrison's

So the answer to this question is C


Instruction:
The most likely complication of prolonged use of nasal decongestant drops is
A. Atrophic rhinitis
B. Naso-pharyngeal moniliasis
C. Hyperophy of nasal mucosa
D. Blockage of eustachian tubes

Response:
NASAL DECONGESTANTS These are a agonists which on topical application as dilute solution (0.05-0.1%) produce local vasoconstriction. The imidazoline compounds-- naphazoline, xylometazoline and oxymetazoline are relatively selective a2 agonist (like clonidine). They have a longer duration of action (12 hours) than ephedrine. side effects:- They may cause initial stinging sensation (Especially naphazoline). Regular use of these agents for long periods should be avoided because mucosal ciliary function is impaired: atrophic rhinitis and anosmia can occur due to persistent vasoconstriction. They can be absorbed from the nose and produce systemic effects, mainly CNS depression and rise in BP. cautious use:- These drugs should be used cautiously in hypeensives and in those receiving MAO inhibitors. Ref:- kd tripathi; pg num:-136

So the answer to this question is A


Instruction:
Cerebellar connection to other parts of the brain is projected through which cell?
A. Golgi cells
B. Basket cells
C. Purkinje cells
D. Oligodendrocytes

Response:
Ans. C Purkinje cellsRef Gray's, 41sted. pg. 335-336* The axons of purkinje cells are the only output through cerebellar cortex.* However, it should be kept in mind that the output from the cerebellum is through deep nuclei, and purkinje cells axons generally pass to deep nuclei.

So the answer to this question is C


Instruction:
A child during anesthesia with Halothane and succincyl coA develops severe stiffness of masseters. What is the most probable diagnosis?
A. Neuroleptic malignant syndrome
B. Malignant hypehermia
C. Anaphylaxis
D. Halothane hepatitis

Response:
Malignant hypehermia is a condition that triggers a severe reaction to ceain drugs used as pa of anesthesia for surgery. Without prompt treatment, the disease can be fatal. The genes that cause malignant hypehermia are inherited. In most cases, no signs or symptoms of the condition exist until you are exposed to anesthesia. Malignant hypehermia is a genetic(autosomal dominant) hypermetabolic muscle disease. Triggering agents include Inhaled general anesthetics Ether Halothane Methoxyflurane Enflurane Isoflurane Desflurane Sevoflurane Depolarizing muscle relaxants Succinylcholine

So the answer to this question is B


Instruction:
Fordyce granules mostly occurs in all of the following areas EXCEPT
A. Vermillion of the lip
B. Posterior tonsillar pillar
C. Alveolar ridge
D. Palate

Response:
None

So the answer to this question is C


Instruction:
A 29-day old child presents with features of congestive cardiac failure and left ventricular hyperophy. Auscultation shows a sho systolic murmur. Most likely diagnosis is:
A. Rheumatic fever
B. Tetralogy of Fallot
C. Transposition of great aeries
D. Ventricular septal defect

Response:
Tetralogy of Fallot and transposition of great aeries are cyanotic hea diseases and rheumatic fever will not occur in this age group. So the answer is ventricular septal defect. When the effective area of the defect is large, there is viually no resistance to flow, and systemic systolic pressure is present in the right ventricle and the pulmonary aery. At bih, pulmonary vascular resistance is high, with little if any left-to-right shunt, despite the presence of a large defect. This resistance gradually falls over the first few weeks of life, permitting a progressively greater amount of blood to flow through the defect, to the pulmonary aeries and back to the left atrium and left ventricle. In many infants, the left ventricular volume overload eventually leads to left ventricular "failure," with elevated left ventricular end-diastolic and left atrial pressures and pulmonary congestion. With a large VSD and a high pulmonary vascular resistance, the systolic murmur becomes soft and sho because there is little left-to-right shunt across a large defect, and a right-to-left shunt across the VSD causes little or no murmur. Ref: Brown D.W., Fulton D.R. (2011). Chapter 83. Congenital Hea Disease in Children and Adolescents. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e.

So the answer to this question is D


Instruction:
In an ablated animal, myeloid series cells are injected. Which of following is seen after incubation period?
A. RBCs
B. Fibroblasts
C. T lymphocytes
D. Hematopoetic stem cells

Response:
Ans. a. RBCs (Ref: Robbins 9/e p580, 8/e p590-593; Harrison 19/e 89e-1, 18/e p539-542)As ablated animal is injected with myeloid series cell, it will show RBC's after incubation period.Hematopoietic Stem CellsHematopoietic stem cells are able to generate every lineage found in the hematopoietic system including RBCs, platelets and a variety of lymphoid cells.Hematopoietic Stem Cells differentiates into Two ProgenitorsCommon Lymphoid Progenitors (CLP)Common Myeloid Progenitors* Generate cells of the lymphoid cells; B and T lymphocytes, Natural killer cellsQ* Generate RBCs, platelets, granulocytes and monocytes, dendritic cells, macrophage progenitorQHematopoiesisStem - Progenitor - Precursor - Adult - MatureCommitted Progenitor Stage to Mature Cell (Erythropoiesis)Common myeloid progenitor - Proerythroblast - Basophilic erythroblasl - Polychromatic erythroblast - Polychromatic erythrocyte (reticulocyte) -Erythrocyte (RBC)(CFV - colony firming unit; SCF Stem cells factor; FIt3L, Flt3 lipand; LIN - Nepatine for lineage specific markers)

So the answer to this question is A


Instruction:
True about C. jejuni (NOT RELATED -MICROBIOLOGY)
A. Gram-positive bacillus
B. Symptoms may initially mimic cholecystitis
C. Most often occurs several days after consumption of undercooked chicken.
D. Penicillin in drug of choice

Response:
Campylobacter species are small motile, non-spore-forming, comma-shaped, gramnegative bacilli, best grown in a microaerophilic environment at 42degC (107.6degF).C. jejuni gastroenteritis is usually self-limited; however, if necessary, erythromycin is the drug of choice.Campylobacter infection most often occurs several days (upto 7 d) after consumption of undercooked chicken.Symptom of fever and abdominal pain may initially mimic appendicitis/ pseudoappendicitis.Guillain-Barre is a rare neurological complication of C. jejuni gastroenteritis.

So the answer to this question is C


Instruction:
HLA - B47 is associated with
A. Myasthenia gravis
B. Behcet's disease
C. Congenital adrenal hyperplasia
D. Abacavir hypersensitivity

Response:
HLA - B8 - Myasthenia gravis
HLA-B51 - Behcet's disease
HLA - B47 - CAH
HLA- B57 - Abacavir hypersensitivity.

So the answer to this question is C


Instruction:
Which of the following is not a feature of APLA?
A. Haemolytic anemia
B. False positive VDRL
C. Thrombocytopenia
D. Decreased PT with increased APTT

Response:
Antiphospholipid syndrome (APS) It is an autoantibody-mediated acquired thrombophilia characterized by recurrent aerial or venous thrombosis and/or pregnancy morbidity. Catastrophic APS (CAPS) is defined as a rapidly progressive thromboembolic disease involving simultaneously three or more organs, organ systems, or tissues leading to the corresponding functional defects. Patients with APS often possess antibodies recognizing Treponema pallidum PL/cholesterol complexes, which are detected as biologic false-positive serologic tests for syphilis (BFP-STS) and Venereal Disease Research Laboratory (VDRL) tests. Lupus anticoagulant (LA) Antibodies recognize b2GPI or prothrombin (PT) and elongate aPTT, implying that they interfere with the generation of thrombin by prothrombin . Prolongation of the clotting times is an in vitro phenomenon, and LA induces thromboses in vivo. Other two antibodies are Antibodies against cardiolipin (aCL) and Antibodies against b2GPI (anti-b2GPI). Clinical Features of Antiphospholipid Syndrome Venous Thrombosis and Related Consequences Deep vein thrombosis Livedo reticularis Pulmonary embolism Superficial thrombophlebitis Thrombosis in various other sites Aerial Thrombosis and Related Consequences Stroke Cardiac valve thickening/dysfunction and/or Libman-Sacks vegetations Transient ischemic attack Myocardial ischemia (infarction or angina) and coronary bypass thrombosis Leg ulcers and/or digital gangrene Aerial thrombosis in the extremities Retinal aery thrombosis/amaurosis fugax Ischemia of visceral organs or avascular necrosis of bone Multi-infarct dementia Neurologic Manifestations of Unceain Etiology Migraine Epilepsy Chorea Cerebellar ataxia Transverse myelopathy Renal Manifestations Due to Various Reasons Renal Aery/Renal Vein/Glomerular Thrombosis Fibrous Intima Hyperplasia Osteoaicular Manifestations Ahralgia Ahritis Obstetric Manifestations (Referred to the Number of Pregnancies) Preeclampsia Eclampsia Fetal Manifestations (Referred to the Number of Pregnancies) Early fetal loss (<10 weeks) Late fetal loss (>=10 weeks) Premature bih among the live bihs Hematologic Manifestations Thrombocytopenia Autoimmune hemolytic anemia Ref: Harrison&;s Principles of Internal Medicine; 20th edition; Chapter 379 Antiphospholipid Syndrome; Page no: 2135

So the answer to this question is D


Instruction:
The carbohydrate not associated with dental plaque is:
A. Dextrose
B. Levans
C. Glucose
D. Rhamnose

Response:
None

So the answer to this question is D


Instruction:
Investigation of choice in appendicitis in adults
A. CT Scan
B. USG
C. Serum ESR
D. MRI Abdomen

Response:
Answer- A. CT Scan

So the answer to this question is A


Instruction:
Protein-A of S.Aureus binds to Fc region of
A. IgD
B. IgE
C. IgG
D. IgA

Response:
Protein-A binds to Fc region of IgG - basis of coagglutination reaction.

So the answer to this question is C


Instruction:
A 11-year-old boy came with history of cough for 15 days. On examination he was found to have cervical lymphadenopathy. The lymph node biopsy is shown below. Which of the following is the most appropriate diagnosis?
A. Tuberculosis
B. Leprosy
C. Sarcoidosis
D. Syphilis

Response:
Cavitation occurs only in secondary tuberculosis. Both primary and secondary tuberculosis are characterized bycaseating granulomas, often with Langhans giant cells, which heal by scarring and calcification. The skin test result for tuberculin sensitivity is positive in both forms.

So the answer to this question is A


Instruction:
Which of the following X-ray should be advised for age determination between 1-13 years of age
A. Shoulder
B. Wrist
C. Elbow
D. Iliac bones

Response:
A bone age study helps doctors estimate the maturity of a child&;s skeletal system. It&;s usually done by taking a single X-ray of the left wrist, hand, and fingers. It is a safe and painless procedure that uses a small amount of radiation. ... The bone age is measured in years . Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is B


Instruction:
Base of the skull fracture presents with involvement of the petrous temporal bone, which of the following important sign:
A. Subconjunctive haematoma
B. CSF rhinorrhoea
C. Raccon eyes
D. Battle sign

Response:
(Battle sign) (595-Baily & Love 24th) (302-B &L 25th)Base of Skull Fractures* Anterior fossa fracture - May open into the frontal or ethmoid air sinuses or run across the cribriform plate.* Presents with sub conjunctival hematoma, anosmia, epistaxis, nasal tip anaesthesia, CSF-rhinorrhea and occasionally carotico-cavernous fistua.* Periorbital haematoma or "raccoon eye" indicate subgaleal haemorrhage.* Middle fossa fracture involving petrous temporal bone presents with CSF otorrhoea, haemotympanum, occicular disruption, Battle sign or VII and VIII cranial nerve palsiesBattle sign - bruising behind the ear appearing 36 hours after a head injury with a petrous temporal base of skull fracture

So the answer to this question is D