Instruction:
A patient presents with a large wound to his right forearm that is the result of a chain saw accident. You treat his wound appropriately and follow him in your surgery clinic at routine intervals. Initially his wound is filled with granulation tissue, which is composed of proliferating fibroblasts and proliferating new blood vessels (angiogenesis). A growth factor that is capable of inducing all the steps necessary for angiogenesis is
A. Epidermal growth factor (EGF)
B. Basic fibroblast growth factor (FGF)
C. Transforming growth factor a (TGF-a)
D. Transforming growth factor b (TGF-b)

Response:
fibroblast growth factor (FGF) can induce the growth and proliferation of fibroblasts. Additionally, one type of FGF, basic FGF, is capable of inducing all of the stages of angiogenesis (basement membrane and extracellular matrix degradation, endothelial migration, endothelial proliferation, and endothelial differentiation). The epidermal growth factor family includes epidermal growth factor (EGF) and transforming growth factor a (TGF-a). These substances can cause proliferation of many types of epithelial cells and fibroblasts. TGF-b, produced by platelets, endothelial cells, T cells, and macrophages, is associated with fibrosis. In low concentrations it causes the synthesis and secretion of PDGF, but in high concentrations it inhibits growth due to inhibition of the expression of PDGF receptors. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition.

So the answer to this question is B


Instruction:
The optic nerve is a tract of the diencephalon that is not completely myelinated until
A. 5 years after bih
B. 2 years after bih
C. 1 year after bih
D. 3 months after bih

Response:
The axons of the optic nerve are not completely myelinated until 3 months after bih. Myelinated axons are normally not found in the retina. The optic nerve is not a true peripheral nerve but a tract of the diencephalon; when severed, the optic nerve does not regenerate. Myelination in the central nervous system (CNS) is accomplished by oligodendrocytes; oligodendrocytes are not found in the retina.

So the answer to this question is D


Instruction:
All are risk factors for Ca stomach except
A. H.Pylori infection
B. Gastric atrophy
C. Adenomatous polyp
D. Alcohol

Response:
Factors Associated With Increased Risk for Developing Stomach CancerNutritionalLow fat or protein consumptionSalted meat or fishHigh nitrate consumptionHigh complex carbohydrate consumptionEnvironmentalPoor food preparation (smoked, salted)Lack of refrigerationPoor drinking water (e.g., contaminated well water)SmokingSocialLow social classMedicalPrior gastric surgeryH. pylori infectionGastric atrophy and gastritisAdenomatous polypsOtherMale sexSabiston 20e pg: 1239

So the answer to this question is B


Instruction:
Lipoprotein A resembles:
A. Plasminogen
B. Plasmin
C. Thrombin
D. Prothrombin

Response:
Ans. A. Plasminogen(Ref: Chatterjea and Shinde 8/e page 448)LpaAlmost silmilar to LDL.Apo (a) is attached to apo B100 by disulphide bond.Major site of clearance of Lp(a) is liver.Strongly associated with Atherosclerosis and myocardial infarction.Apo A has significant homology with plasminogenQ.It interferes with activation of plasminogen to plasmin,Hence fibrin clot is not lysed.Susceptible to Intravascular thrombosis.

So the answer to this question is A


Instruction:
A cook prepares sandwitches for 10 people going for picnic. Eight out of them develop severe gastroenteritis within 4-6 hrs of consumption of the sandwitches. It is likely that on
investigations, the cook is found to be carrier of:
A. Salmonella typhi
B. Vibrio cholerae
C. Entamoeba histolytica
D. Staphylococcus aureus

Response:
Learn this table by heart, every year there is a question on food poisoning.

So the answer to this question is D


Instruction:
Which of the following bacterium is non-motile?
A. Klebsiella spp
B. Citrobacter spp
C. Escherichia spp
D. Salmonella spp

Response:
(Refer: Anantha Narayanan and Paniker’s Textbook of Microbiology, 9th edition, pg no: 19-20)
Motility of Enterobacteriaceae members

So the answer to this question is A


Instruction:
All of the following features can be observed after the injury to axillary nerve, except:
A. Loss of rounded contour of shoulder
B. Loss of sensation along lateral side of upper arm
C. Loss of overhead abduction
D. Atrophy of deltoid muscle

Response:
C i.e. Loss of overhead abduction

So the answer to this question is C


Instruction:
Recurrent aspiration pneumonia is caused by:
A. Dermatomyositis/polymyositis
B. Rheumatoid ahritis
C. Progressive systemic sclerosis
D. Systemic lupus erythematosus

Response:
Systemic sclerosis is characterized by fibrosis of lower esophageal sphincter | Leading to decrease in tone of LES | Resultant GERD | Leads to Recurrent Aspiration Pneumonia

So the answer to this question is C


Instruction:
A 30 year old women pretests a history of amenorrhoea and impaired vision of six month' duration. Physical examination shows everything except for pale optic discs and diminished visual acuity. The most likely diagnosis is -
A. Pituitary adenoma
B. Craniopharyngioma
C. Hypothalamic glioma
D. Benign intracranial hypeension

Response:
pituitary adenoma inhibits GnRH causes imbalance in FSH and LH causing amenorrhea and increased ICT causes compression of optic disc & visual field defects ( harrison 17 2205 )

So the answer to this question is A


Instruction:
S2 is best appreciated in:
A. 3rd left intercostal space
B. 2nd right intercostal space
C. 4th left intercostal space
D. 5 left intercostal space

Response:
Answer is A (3rd left intercostal space) Best areas to auscultate for both components of the second hea sound (A2 and P2) are either the left sternal border at the level of second intercostal space (Pulmonic area) or the left sternal border at the level of third intercostal space (Erb's point). The second hea sound has two components A2 (from Aoic closure) and P2 (from pulmonary closure). P2 is a soft sound that is poorly transmitted. It is best heard at the pulmonic area and is transmitted only as far as the Erb's point. A2 is a loud sound best heard over the aoic area but since it is widely transmitted it may be heard across all areas of the chest even as far as the apex. Second hea sound (S2) is best heard over the pulmonic area (Since both A2 and P2 can be heard at the pulmonic area). Note that even at the pulmonic area A2 is louder than P2. The other area to auscultate for both components of the second hea sound is at the left sternal border of the third intercostal space (Erb 's point)

So the answer to this question is A


Instruction:
All of these hormones use cAMP as second messenger except
A. Coicotropin
B. Dopamine
C. Glucagon
D. Vasopressin

Response:
Refer Katzung 11/e p301 Vasooressor acts by V1 and V2 receptors V1 receptors use IP3-DAG-Ca2+ pathway Whereas V2 use CAMP as second messenger. All other drugs mentioned in the question act by cAMP pathway only. Thus all these use cAMP as second messenger, but if we need to choose option we can answer vasooressor as it acting through IP3-DAG -Ca2+ pathway

So the answer to this question is D


Instruction:
A 17 year old female patient has hirsutism, hyperglycemia, obesity, muscle wasting, and increased circulating levels of ACTH. The most likely cause of her symptoms is:
A. Primary adrenocoical insufficiency
B. Primary overproduction of ACTH
C. Exogenous steroids
D. Hypophysectomy

Response:
This female patient's symptoms are classic for a primary elevation of ACTH (Cushing's Disease). Exogenous steroids would produce similar symptoms, except that circulating ACTH would be low because of negative feedback suppression at both hypothalamic (CRF) and anterior pituitary levels (ACTH). Addison's Disease is caused by glucocoicoid deficiency, not excess. Hypophysectomy would lead to a decrease in ACTH or remove the source of it.

So the answer to this question is B


Instruction:
Which one of the following is not advocated in the management of hepatic encephalopathy?
A. Oral Lactulose
B. I.V. Glucose drip
C. High protein diet more than 60 grams/day
D. If tests for blood in stool are positive then give colonic washout

Response:
Treatment of hepatic encephalopathy In the setting of acute gastrointestinal bleeding, blood in the bowel should be promptly evacuated with laxatives (and enemas if necessary) in order to reduce the nitrogen load. Hydration and correction of electrolyte imbalance Protein should be excluded from the diet and constipation should be avoided. Ammonia absorption can be decreased by the administration of lactulose, a non-absorbable disaccharide that acts as an osmotic laxative. Zinc supplementation is sometimes helpful

So the answer to this question is C


Instruction:
Increased Radio - isotope uptake is seen in
A. Osteoclastoma
B. Enchondroma
C. Pseudoarthrosis
D. Ewing's sarcoma

Response:
None

So the answer to this question is C


Instruction:
True regarding blood group A
A. Can be safely transfused with blood group AB
B. Will have only A offsprings if the paner is A
C. Can receive safe O group transfusion
D. Irrespective of the paner, all the child would be A group

Response:
. Can receive safe OA group transfusion

So the answer to this question is C


Instruction:
A 3-year-old boy is brought by his parents to the emergency depament because they are concerned that he has had a high fever for several days. On examination, the boy has conjunctival and oral erythema. He has palpable cervical lymphadenopathy and erythema of his palms and soles. What is a potential life-threatening complication of this disorder?
A. Aneurysm of the abdominal aoa
B. Aneurysm of the coronary aeries
C. Dissection of the thoracic aoa
D. Rupture of a berry aneurysm

Response:
The patient presents with mucocutaneous lymph node syndrome, or Kawasaki disease. It is often a self-limiting condition, although as many as 20% of patients develop an aneurysm of the coronary vessels. Dissection of the thoracic aoa is associated with hypeension. Rupture of a berry aneurysm can result in a subarachnoid hemorrhage. Aneurysm of the abdominal aoa is associated with atherosclerosis.

So the answer to this question is B


Instruction:
Fixed pelvic tumour occurs in :
A. Malignancy
B. Endometriosis
C. Growth extension into ligaments
D. All of the above

Response:
All of the above

So the answer to this question is D


Instruction:
Marked bleeding is seen in which of following conditions?
A. VMA disease
B. Haemophilia A
C. Haemophilia B
D. ALL

Response:
Bleeding disorders can be inherited or acquired. Inherited disorders are passed down through genetics. Acquired disorders can develop or spontaneously occur later in life. Some bleeding disorders can result in severe bleeding following an accident or injury. In other disorders, heavy bleeding can happen suddenly and for no reason. There are numerous different bleeding disorders, but the following are the most common ones: Hemophilia A and B are conditions that occur when there are low levels of clotting factors in your blood. It causes heavy or unusual bleeding into the joints. Though hemophilia is rare, it can have life-threatening complications. Factor II, V, VII, X, or XII deficiencies are bleeding disorders related to blood clotting problems or abnormal bleeding problems. von Willebrand&;s disease is the most common inherited bleeding disorder. It develops when the blood lacks von Willebrand factor, which helps the blood to clot REF : HARRISONS 21ST ED

So the answer to this question is D


Instruction:
In methyl alcohol poisoning there is CNS depression, cardiac depression and optic nerve atrophy. These effects are produced due to ?
A. Formaldehyde and formic acid
B. Acetaldehyde
C. Pyridine
D. Acetic acid

Response:
Ans. is 'a' i.e., Formaldyhyde and formic acid o Methyl alcohol (methanol) is metabolized to formaldehyde by alcohol dehydrogenase and then to formic acid by aldehyde dehydrogenase. These compounds are responsible for the toxicity. Formic acid can lead to coma and blindness also. Therefore, inhibitor of alcohol dehydrogenase, Femepizole is used for treatment of methanol over dose.

So the answer to this question is A


Instruction:
Multiple pencil ulcers are seen in all except
A. Aphthous ulcers
B. Herpes ulcers
C. Tuberculous ulcers
D. Carcinomatous ulcers

Response:
Carcinomatous ulcers are painless but may become painful in advanced stages, with extension into surrounding tissues.

So the answer to this question is D


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

Response:
Ans. is 'a' i.e., Trachoma * Arlt line is a feature of trachoma.Signs of Trachoma* Conjunctival signs Congestion, conjunctival follicles (boiled sagograin like), Papillary hyperplasia, conjunctival scarring (Arifs line), concretion.* Corneal signsSuperficial keratitis, Herbert follicles, Pannus, Corneal ulcer, Herbert pits, Corneal opacity.

So the answer to this question is A


Instruction:
Gasless abdomen in X-ray is a sign of:-
A. Acute pancreatitis
B. Necrotizing enterocolitis
C. Chronic Pancreatitis
D. Intussusception

Response:
Radiological appearance Acute pancreatitis Chronic pancreatitis Ca pancreas Renal halo sign Gasless abdomen Ground glass appearance Colon cut off sign Sentinel loop Chain of lakes appearance String of pearl appearance Beaded appearance Numerous irregular calcification are pathognomonic Double contour of medical border of duodenal C loop Double duct sign Dilated / widening of duodenal C loop Mucosal irregularity Scrambled egg appearance Inveed / reverse 3 sign of frostberg; seen in Ca head of pancreas Rose thorning of medial wall of 2nd pa of duodenum

So the answer to this question is A


Instruction:
All of the following are true about MRKH (Mayer - Rokitansky - Kuster - Hauser) syndrome, EXCEPT:
A. Absent uterus
B. Absent cervix
C. Absent ovary
D. Absent vagina

Response:
Congenital absence of both the uterus and vagina is termed mullerian aplasia, mullerian agenesis, or Mayer-Rokitansky-Kuster-Hauser syndrome. In classic mullerian agenesis, patients have a shallow vaginal pouch, only measuring 1 to 2 inches deep. In addition, the uterus, cervix, and upper pa of the vagina are absent. Typically, a poion of the distal fallopian tubes are present. Also, normal ovaries are expected, given their separate embryonic source. Most patients with mullerian agenesis have only small rudimentary mullerian bulbs without endometrial activity. However, in 2 to 7 percent of women with this condition, active endometrium develops and patients typically present with cyclic abdominal pain. Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 18. Anatomic Disorders. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.

So the answer to this question is C


Instruction:
Following clostridia are saccharolytic except -
A. Welchii
B. Sporogenes
C. Septicum
D. Oedematiens

Response:
None

So the answer to this question is B


Instruction:
All are true about FTA-ABS in Syphilis, except ?
A. FTA - ABS becomes negative after treatment
B. Present in secondary syphilis
C. It is a specific test
D. May be positive in Lyme's disease

Response:
Ans. is 'a' i.e., FTA-ABS becomes negative after treatment . Specific treponemal tests (FTA-ABS, TPHA, TPI) are of little value as indicators of clinical cure, as they tend to remain positive inspite of treatment.

So the answer to this question is A


Instruction:
A flat discoloration on the skin about 1 cm is called
A. Papule
B. Macule
C. Plaque
D. Boil

Response:
None

So the answer to this question is B


Instruction:
Which one of the following is the most common extrauterine site to be affected by endometriosis:
A. Vagina
B. Rectovaginal septum
C. Sigmoid colon
D. Broad ligament (except tubes and ovaries)

Response:
Broad ligament (except tubes and ovaries)

So the answer to this question is D


Instruction:
A man, after skinning a dead animal, developed a pustule on his hand. A smear prepared from the lesion showed the presence of Gram positive bacilli in long chains which were positive for McFadyean's reaction. The most likely aetiological agent is-
A. Clostridium tetani
B. Listeria monocytogenes
C. Bacillus anthracis
D. Actinomyces sp

Response:
None

So the answer to this question is C


Instruction:
Which is the only serological marker present during window period in hepatitis B infection?
A. Anti HBc
B. HBsAg
C. Anti HBsAg
D. HBeAg

Response:
Following hepatitis B infection, HBsAg appear in the serum and is the first sign of infection. Antibodies to HBsAg i.e anti HBs occur after clearence of HBsAg. Window period refers to the time after the disappearence of HBsAg and appearence of anti HBs. During this window period, IgM anti HBc is positive. IgM anti HBc can persist for 3-6 months. HBeAg appear in the serum during the incubation period sholy after the detection of HBsAg. It indicates viral replication and infectivity.

So the answer to this question is A


Instruction:
In solitary thyroid nodule true is/are :
A. THR-Ab
B. Lined by columnar epithelium
C. Diffuse hyperplasia of thyroid
D. Common in female

Response:
Ans. is 'd' i.e. Common in female A solitary thyroid nodule is a palpably discrete swelling within an otherwise apparently normal thyroid gland. Ceain imp. points about solitary thyroid nodules : STN are more common in women than in men The incidence of STN increases with age Solitary nodules, in general, are more likely to be neoplastic than are multiple nodules. Nodules in younger patients are more likely to be neoplastic than are those in older patients. Nodules in males are more likely to be neoplastic than are those in females. A history of radiation treatment to the head & neck region is associated with an increased incidence of thyroid malignancy. Functional nodules that take up radioactive iodine in imaging studies (hot nodules) are significantly more likely to be benign than malignant.

So the answer to this question is D


Instruction:
In cryptorchism histological changes appear in testis
A. 4 months
B. 6 months
C. 8 months
D. 1 year

Response:
Answer- B. 6 months

So the answer to this question is B


Instruction:
Nightmare is seen in:
A. REM sleep
B. Stage II NREM sleep
C. Stage IV NREM sleep
D. Stage I NREM sleep

Response:
Nightmare: REM sleep.
Night terrors: NREM stage 3.

So the answer to this question is A


Instruction:
All are reducing sugars except
A. Sucrose
B. Lactose
C. Glucose
D. Fructose

Response:
Ans: a (sucrose) Ref: Vasudevan 4th ed/ p.68Any sugar with free aldehyde/ keto group will reduce the Benedict's reagent and is called a reducing sugar.All reducing sugars will form osazone with excess of phenylhydrazine when kept at boiling temperature. Osazones may be used to differentiate sugars in biological fluids like urine.Examples of reducing sugars:-GlucoseLactoseFrutoseMaltoseSucrose and trehalose are not reducing sugars.Note:Benedict's reagent - Sodium bicarbonate, Copper sulphate and sodium ci

So the answer to this question is A


Instruction:
Red velvety appearance of gastric mucosa is seen in poisoning with:
A. Abrus precatorius
B. Lead
C. Arsenic
D. Copper

Response:
C i.e. Arsenic Red velvety mucosa of stomachQ is typically seen in arsenic poisoning

So the answer to this question is C


Instruction:
Treatment of chronic phase of CML is
A. Imatinib
B. Hydroxyurea
C. Interferon
D. Cytarabine

Response:
(A) Imatinib # Standard treatment for chronic phase CML is a tyrosine kinase inhibitor (TKI) such as imatinib, Nilotinib, or Dasatinib.> For imatinib, the usual starting dose is 400 mg per day.> If the first drug stops working (or it never really worked well at all) the dose may be increased or the patient may be switched to one of the other TKIs (including Bosutinib/Bosulif).> Ponatanib is an option after all of the other TKIs have been tried or if the leukemia cells later develop the T315I mutation.> Switching to another TKI is also an option if the patient can't take the first drug because of side effects.> Some people in chronic phase may be treated with an allogeneic stem cell transplant (SCT).

So the answer to this question is A


Instruction:
Mammography is performed in
A. First half of the menstrual cycle
B. Second half of the menstrual cycle
C. 3rd day
D. 5th day

Response:
Mammography is preferred in first of the menstrual cycle.
Usually two views are taken craniocaudal and mediolateral oblique.

So the answer to this question is A


Instruction:
Irreversible aromatase inhibitor -
A. Anastrazole
B. Exmestane
C. Letrozole
D. Vorozole

Response:
Ans. is 'b' i.e., Exmestane Aromatase inhibitors are of two types:o Type I (steroidal) aromatase inhibitor - They cause irreversible inhibition of aromatase, e.g. Exmestane, formestane.o Type II (non-steroidal) aromatase inhibitor - They cause reversible inhibition of aromatasxe e.g. Anastrazole, Letrozole, vorozale.

So the answer to this question is B


Instruction:
Most common size of osteoma ?
A. Frontal sinus
B. Ethmoid sinus
C. Maxillary sinus
D. Aryepiglotic folds

Response:
Ans. is 'd' i.e., Aryepiglotic folds Inlet of larynx It is an oblique opening bounded : - Anteriorly : - Free margins of epiglottis On the sides : - Aryepigloftic folds Posteriorly : - Interarytenoid folds Vestibular folds (False vocal cords) Two folds of mucous membrane extending anteroposteriorly across the laryngeal cavity. It contains vestibular ligament, a few fibres of thyroarytenoides muslce and mucous glands. Vocal folds (Vocal cords or true vocal cords) Two pearly-white sharp fibroelastic bands extending from the middle of thyroid angle to vocal process of arytenoids They are formed by reflection of the mucosa over vocal ligaments. They have stratified squamous epithelium with no submucous layer. Their blood supply is poor and are almost devoid of lymphatics, this gives vocal cord a pale apperance. Vocal cords along with the upper pa of the vestibule is the only pa of laryngeal mucous membrane which is lined by epithelium of stratified squamous type. Elsewhere in the larynx epithelium of the mucous membrane is ciliated columinar type. Glottis (rima glottidis) It is the opening between the true vocal cords (anteriorly). It is the narrowest pa of larynx in adults. Rima vestibuli It is the space between two vestibular folds.

So the answer to this question is D


Instruction:
Blow out fracture refers to -
A. Fracture of orbit
B. Fracture of nasal septum
C. Fracture base of skull
D. Fracture of mandible

Response:
Ans. is 'a' i.e., Fracture of orbit o Isolated fractures of orbital floor, when a large blunt object strikes the glob, are called "blow out fractures". Fractures of the floor of the orbito Zygomatic fracture and Le fort II maxillary fractures are always accompanied by fractures of orbital floor,o Isolated fractures of orbital floor, when a large blunt object strikes the globe, are called "blow out fractures".Clinical featureso Ecchymosis of lid, conjunctiva and sclera.o Endophthalmos with inferior displacement of the eye-ball. This becomes apparent when oedema subsides,o Diplopia, which may be due to displacement of the eyeball or entrapment of inferior rectus and inferior oblique muscles.o Hypoaesthesia or anaesthesia of cheek and upper lip, if infraorbital nerve is involved.Diagnosiso Water's view show a convex opacity bulging into the antrum from above, i.e., Tear drop opacity.o CT scan is diagnostic.

So the answer to this question is A


Instruction:
Drug used in acute iron poisoning is:
A. BAL
B. Desferrioxamine-B
C. Methylene blue
D. EDTA

Response:
(Desferrioxamine-B): Ref: 11-30 - PPoisoningTreatments* Iron salt* Iodine* Lead* Hydrocyanic acid* Opium* Paracetamol* Copper sulphate- Gastric lavage, leave dilute NaHCO3 in stomach, Electrolyte correction, desferrioxane - B- Sodium thiosulfate orally, Demulcents- EDTA, Penicillamine- Dicobalt tetracemate, Methylene blue- Methadone- Cysteamine- Potassium ferrocyanide, BAL, Cuprimine Magnesium sulfate

So the answer to this question is B


Instruction:
All of the following are Opsonins, Except
A. IgG
B. C3b
C. LTB4
D. Mannose binding Lectin

Response:
Leukotriene B4 (LTB4) is not an Opsonin. The major opsonins are IgG antibodies, the C3b breakdown product of complement , and ceain plasma lectin , notably mannose-binding lectin, all of which are recognized by specific receptors on leukocytes. Three major Opsonins IgG Opsonin (The Fc Fragment of immunoglobulin G) C3b Opsonin is the fragment generated by activation of complement pathway Lectins are carbohydrate-binding proteins in the plasma which bind to bacterial cell wall. Opsonisation with Opsonins: Opsonins are specific proteins in the serum that enhance the process of phagocytosis by coating the surface of target bacteria or microorganisms. This process is called opsonisation (meaning preparing for eating). Opsonins establish a bond between bacteria and the cell membrane of phagocytic cell. If the surface of the target is prepared (opsonized) by plasma proteins, phagocytosis is made easier, though some targets can be taken up without this coating. The efficiency of phagocytosis is greatly enhanced when microbes are opsonized by these proteins Phagocytes such as Neutrophils express high affinity receptors for opsonin protein. Neutrophils have membrane receptors for IgG and C3b. These are three major types of Opsonins: IgG antibody C3b fragment of Complement Non-specific opsonins This is the most impoant opsonin IgG antibody works like a ligand. The Fab pa of the globulin binds to the surface of the microorganism while the Fc poion sticks out and fits into the membrane receptors of the phagocyte Benign Fragment of C3, C3b is set free when complement is activated Like IgG, C3b has a tail end that fits into a receptor on the surfaces of phagocytic cells Several proteins have opsonic propeies Lectins (Mannose-Binding Lectins) are carbohydrates binding proteins in the plasma which bind to bacterial cell wall C-reactive protein Hageman Factor Serum amyloid A Ref: Robbins 9th edition Pgno: 78

So the answer to this question is C


Instruction:
Most common organs involved in the wagners granulomatosis are
A. Skin and nose
B. Lung and kidney
C. Hea and kidney
D. Kidney and nervous system

Response:
Refer robbins 9/e p511 Granulomatosis with polyangiitis (formerly called Wegener's) is a rare disease of unceain cause that can affect people of all ages. It is characterized by inflammation in various tissues, including blood vessels (vasculitis), but primarily pas of the respiratory tract and the kidneys. The areas most commonly affected by GPA include the sinuses, lungs, and kidneys, but any site can be affected

So the answer to this question is B


Instruction:
Most common infection in a child nephrotic syndrome-
A. Spontaneous bacterial peritonitis
B. Pneumonia
C. UTI
D. Cellulitis

Response:
Ans. is 'a' i.e., Spontaneous bacterial peritonitis

So the answer to this question is A


Instruction:
At the end of 1 year of age, the number of carpal bones seen in the skiagram of the hand is –
A. Nil
B. 1
C. 2
D. 3

Response:
None

So the answer to this question is C


Instruction:
A 4 yr old paially immunized boy came to OPD with history of bouts of coughing. On staining the sputum sample an organism with bipolar staining was seen. Which among the following organism it would be ?
A. Y. Pestis
B. B. peussis
C. S. Agalactae
D. K. Pneumonae

Response:
Ans. is 'b' i.e., B. peussis Bouts of Coughing and bipolar staining suggest the diagnosis of whooping cough (peussis).

So the answer to this question is B


Instruction:
Psammoma bodies are seen in all except -
A. Seminoma
B. Meningioma
C. Pappilary carcinoma of thyroid
D. Pappillary serous cystadenocarcinoma of the ovary

Response:
Psammoma bodies represent a process of dystrophic calcification.
Single necrotic may constitute seed crystals that become encrusted by the mineral deposits. The progressive acquisition of outer layers may create lamellated configurations, called psammoma bodies because of their resemblance to grains of sand.
Psammoma bodies are seen in :

Papillary cancer of the thyroid
Meningioma
Papillary serous cystadenocarcinoma of the ovary

So the answer to this question is A


Instruction:
The threshold for prophylactic platelet transfusion is __________platelets / mL.
A. 5000
B. 10000
C. 15000
D. 50000

Response:
The threshold for prophylactic platelet transfusion is 10,000/mL. For invasive procedures, the target level is 50,000/mL. Note: Shelf life of donor platelets is 5 days.It is stored on a special agitator at 20-24 degC. The half-life of transfused platelets is 3-5 days. One unit of pooled platelets should be infused over a period of time less than 30 minutes because of the risk of bacterial proliferation.

So the answer to this question is B


Instruction:
True statement/ s regarding sevoflurane are all except
A. Ideal agent for pediatric anaesthesia
B. Can interact with sodalime and forms compound A
C. Can be used safely in malignant hyperpyrexia
D. Causes tachycardia

Response:
All potent inhalational agents are contraindicated in malignant hypehermia. It has sweet smell so very useful in pediatrics for induction. Sevoflurane reacts with strong bases like sodium hydroxide and potassium hydroxide present in soda lime and baralyme leading to the formation of a haloalkene (fluoromethyl-2,2-difluoro-1- vinyl ether), known as compound A. Compound A has the potential to cause proximal tubular necrosis.

So the answer to this question is C


Instruction:
EMLA cream is effective in relieving pain of:-
A. Venipuncture
B. Aerial cannulation
C. Lumbar puncture
D. All of the above

Response:
Any procedure causing pain involving 2-4 mm skin depth can be effectively relieved by EMLA cream. EMLA can provide adequate dermal analgesia for procedures like: Split thickness skin-graft harvesting Venipuncture Laser removal of po wine stains Lithotripsy Circumcision

So the answer to this question is D


Instruction:
Contact isolation is done for:
A. Mumps
B. MRSA
C. Diphtheria
D. Typhoid

Response:
Contact isolation is done for methicillin-resistant staphylococcus auerus. MRSA should not be touched with bare hands because risk of infectivity is very high. MRSA is produced due to alteration of penicillin binding proteins in the gene mec A. The drug of choice for MRSA is vancomycin.

So the answer to this question is B


Instruction:
HPV-related cervical intraepithelial neoplasia can be diagnosed by the presence of which of the following histologic features?(NOT RELATED-PATHOLOGY)
A. Central, basophilic intranuclear cellular inclusions
B. Cowdry type A intranuclear cellular inclusions
C. Enlarged multinucleated cells
D. Cytoplasmic vacuolization and nuclear enlargement of cells

Response:
HPV produces characteristic cytoplasmic vacuolization and nuclear enlargement of squamous epithelial cells referred to as koilocytosis. Both Cowdry type A intranuclear inclusions and enlarged multinucleated cells can be seen with herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections; central, basophilic intranuclear inclusion bodies are seen in CMV infections, whereas the presence of atypical lymphocytes is seen specifically in Epstein-Barr virus (EBV) infections.

So the answer to this question is D


Instruction:
In transaminases, PLP is covalently attached to which amino acid?
A. Glutamate
B. Lysine
C. Alanine
D. Threonine

Response:
Transaminases:- Transfer amino groups in reactions Coenzyme required is Vitamin B6 i.e. active form PLP (Pyridoxal phosphate) The PLP is linked with a e-amino group of a lysine residue, at the active site of the enzyme forming a Schiff base (imine linkage) ping pong bi bi mechanism is involved in transamination reaction. NOTE: Threonine does not undergo transamination. All the amino acids undergo transamination except: Proline Lysine Threonine Hydroxyproline

So the answer to this question is B


Instruction:
Steeple sign is characteristis of ?
A. Acute epiglotitis
B. Laryngotrancheobronchitis
C. In both
D. None of above

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

So the answer to this question is B


Instruction:
Thyrotoxic periodic paralysis leads to extreme muscle weakness due to?
A. Hypokalemia
B. Hypocalcemia
C. Hypomagnesemia
D. Hyponatremia

Response:
T3| T4| - Positive Na- K+ ATPase activity in the cells (3 Na outside 2 K+ inside) | K Influx | K| | Thyrotoxic Periodic Paralysis

So the answer to this question is A


Instruction:
Human is dead end host for-
A. Malaria
B. Typhoid
C. Bubonic plague
D. Filaria

Response:
Ans. is 'c' i.e., Bubonic plague o A dead end host is an infected person from wrhich infectious agents are not transmitted to other susceptible host or from which a parasite cannot escape to continue its life cycle.o The diseases in which human acts as dead end host, i.e., dead and disease : -1. Japanies encephalitis3. Trichinosis5. Bubonic plaque2. Echynococcosis (hydatid disease))4. Tetanus

So the answer to this question is C


Instruction:
In a fetus highest oxygen concentration is found in?
A. Inferior vena cava
B. Superior vena cava
C. Left ventricle
D. Ascending aoa

Response:
Among the following options, highest oxygen conc is found in IVC Saturation of Oxygen in fetal structures - Umbilical vein - 80% (PO2 of 30-35 mm Hg ) ( Max. in entire body of fetus ) Inferior vena cava - 70% (PO2 of 26-28 mm Hg) Left ventricle - 65% Right Ventricle - 55-60% Umbilical aery - very low SVC - (PO2 of 12-14 mm Hg)

So the answer to this question is A


Instruction:
All are complication of Typhoid ulcer except ?
A. Perforation
B. Stricture
C. Haemorrhage
D. Sepsis

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

So the answer to this question is B


Instruction:
All are true regarding fetal skeletal mineralization except
A. Approximately 30g of calcium is needed especially during 3rd trimester.
B. Calcium required by fetus is only 10 % of maternal, skeletal calcium.
C. Amount of calcium absorbed increases to 400mg / day in the third trimester.
D. PTH plasma concentration is decreased in first trimester, but increases progressively later.

Response:
Fetal calcium requirement is only 3 % of total calcium held within maternal skeleton.

So the answer to this question is B


Instruction:
Most common coupling agent used in composite is:
A. Organosilanes
B. Zirconates
C. Titanates
D. None

Response:
Coupling agent

A bonding agent applied to the surfaces of reinforcing particles (filler) to ensure that they are chemically bonded to the resin matrix. Organo-silane compounds are the more common class of dental composite coupling agents.

Phillips 12th edition page 275

So the answer to this question is A


Instruction:
Which of the following is not an adverse effect of chronic amiadarone therapy -
A. Pulmonary Fibrosis
B. Hypothyroidism
C. Hypehyroidism
D. Systemic Lupus erythematosus

Response:
Ans. is 'd' i.e., Systemic Lupus erythematosis

So the answer to this question is D


Instruction:
Best diagnosis of pancreatic cancer (head) is by -
A. Ultrasound
B. ERCP
C. CAT scan
D. PTC

Response:
None

So the answer to this question is B


Instruction:
A few days after bih, a child becomes lethargic, refuses feeds and vomits during breast feeding. On examination he is pot bellied. Benedict's test is positive in urine. What is the likely reducing sybstance present in urine:
A. Glucose
B. Fructose
C. Sucrose
D. Galactose

Response:
D i.e. Galactose

So the answer to this question is D


Instruction:
A 30-year old patient presented with features of acute meningoencephalitis in the casualty. His CSF on wet mount microscopy revealed motile unicellular microorganisms. The most likely organism is -
A. Naegleria fowleri
B. Acanthamoeba castellani
C. Entamoeba histolytica
D. Trypanosoma cruzi

Response:
Provided history of acute meningoencephalitis with demonstration of motile trophozoites in CSF wet mount suggests diagnosis of N.fowleri.
Eventhough Acanthamoeba also causes meningoencephalitis, it is not acute in nature and it occurs mainly in immunocompromised host.

So the answer to this question is A


Instruction:
All of the following are ELG changes seen in Left sided pneumothorax except:
A. Amplitude variations in QRS complexes
B. T-wave inversions
C. Reduced amplitude in R wave
D. Left axis deviation

Response:
In left sided pneumothorax Mediastinum is pushed towards right side. Hence, there will be right axis deviation.
Left axis deviation is seen in Right sided Pneumothorax.

So the answer to this question is D


Instruction:
Most of the neurons in the Autonomic Nervous System are
A. Cholinergic
B. Adrenergic
C. Noradrenergic
D. Dopaminergic

Response:
Ans: a (cholinergic) Ref: Ganong 22nd ed/ p.226Most of the neurons in ANS are cholinergic.Autonomic Nervous System:Parasympathetic preganglionic fibres have a long course.Parasympathetic postganglionic fibres have a short course. This is because the parasympathetic ganglions are located near the tissues it supplies.Each preganglionic axon diverges to an average of 8 or 9 postganglionic neurons.Preganglionic: Postganglionic = 1:8 or 9.Conduction speed in different fibres:* Autonomic preganglionic axons are B type* Autonomic postganglionic axons are C type* Conduction speed A>B>CPreganglionic fibres are myelinated, whereas, postganglionic fibres are unmyelinated.Cholinergic neuronso All preganglionic neuronso Parasympathetic postganglionic neuronso Sympathetic postganglionic neurons which innervate sweat glands and vessels in skeletal muscles.Remaining sympathetic postganglionic neurons are adrenergic or noradrenergic.Types of nerve fibresFibre typeFunctionsA alphaProprioception; somatic motorA betaTouch, pressureA gammaMotor to muscle spindlesA deltaPain, coId, touchBPreganglionic autonomicC- Dorsal rootPain, temperature, some mechano- reception, reflex responsesC - SympatheticPostganglionic sympathetic Relative susceptibility of nerve fibres Most susceptibleIntermediateLeast susceptibleHypoxiaBACPressureABCLocal anaestheticsCBA

So the answer to this question is A


Instruction:
Which of the following enzymes becomes deficient following an episode of severe infectious gastroenteritis:
A. Lactase
B. Amylase
C. Trypsin
D. Lipase

Response:
Ans. A. LactaseLactose intolerance is an inability to digest lactose, the main sugar in milk, which gives rise to gastrointestinal symptoms. Lactose intolerance is caused by a deficiency of the intestinal enzyme lactase that splits lactose into two smaller sugars, glucose and galactose, and allows lactose to be absorbed from the intestine. Lactase deficiency can be either congenital or acquired. Congenital lactase deficiency due to complete lack of the enzyme is a rare condition that presents with severe symptoms in newborns. In addition, lactase malabsorption may be secondary to acquired conditions including small bowel bacterial overgrowth, infectious enteritis (i.e. giardiasis), or mucosal damage due to coeliac disease, inflammatory bowel disease, drugs, gastrointestinal surgery, short bowel syndrome, or radiation enteritis, conditions that lead to either reduction of absorptive capacity or downregulation of lactase expression in the small intestine. Typical gastrointestinal complaints resulting due to lactose intolerance are diarrhoea, nausea, bloating, borborygmi, and abdominal pain.

So the answer to this question is A


Instruction:
All are TRUE regarding Net Protein Utilisation, except?
A. It is the increase in weight per unit weight of protein consumed
B. NPU of cow - milk is 81%
C. NPU of average Indian foods is 50 - 80%
D. If NPU is low, more protein is required

Response:
Ans. is 'a' i.e., NPU is the increase in weight per unit weight of protein consumed Net protein utilization NPIJ is the percentage of ingested protein retained inside the body (not an increase in weight) o It is a product of digestibility coefficient and biological value divided by 100. o The protein requirement varies with the NPU of dietary proteins. If the NPU is low, the protein requirement is high, and vice versa. o NPU of protein for Indian diets varies between 50 and 80. o NPU is 100 for egg (best protein) and about 75 for milk.

So the answer to this question is A


Instruction:
Which of the following is the longest acting ocular beta blocker ?
A. Timolol
B. Betaxolol
C. Carteolol
D. Metoprolol

Response:
Beta blockers used in Glaucoma- Timolol, levobunolol, Carteolol, betaxolol
Metoprolol, though a beta blocker is not used for glaucoma because of its local anaesthetic property. Drugs having local anaesthetic property will increase the risk of corneal ulcers.
Betaxolol is longer acting than Timolol or others.

So the answer to this question is B


Instruction:
Sensory nerve supply of middle ear cavity is provided by:
A. Facial
B. Glossopharyngeal
C. Vagus
D. Trigeminal

Response:
(b) Glossopharyngeal(Ref. Scott Brown, 8th ed., Vol 2 page 535)The sensory supply of the middle ear is by the tympanic plexus which is formed by the Jacobson's nerve which is the tympanic branch of Glossopharyngeal (IX) along with sympathetic plexus from around the internal carotid.

So the answer to this question is B


Instruction:
Vit. A deficiency is characterized by – a)  Bitot's spotb)  Xerophthalmiac)  Night blindnessd)  Tranta's spot
A. abc
B. bc
C. acd
D. bcd

Response:
None

So the answer to this question is A


Instruction:
All of the following are true about saccharolytic fermentation, EXCEPT:
A. Undigested fat conveed into sho chain fatty acids (SCFAs)
B. Action of GUT flora
C. Acetic acid, butyric acid and propionic acid are it products
D. SCFAs inhibit the growth of intestinal epithilial cells

Response:
Saccharolytic fermentation: The GUT flora have ceain enzymes which the humans lack these enzymes helps in the breakdown of ceain polysaccharides and conveing them into sho chain fatty acids (SCFAs) by a form of fermentation. Products include acetic acid, butyric acid and propionic acid. Gases and organic acids such as lactic acids are also produced. These products are used by the host cells. Sho chain fatty acids (SCFAs) increases the growth of intestinal epithelial cells and control their proliferation and differentiation. Ref:Ganong's Review of Medical Physiology, 23rd Edition, Page 458

So the answer to this question is D


Instruction:
The fingerprint pattern may be impaired permanently in cases of
A. Eczema
B. Scalds
C. Scabies
D. Leprosy

Response:
Fingerprints are usually lost in leprosy, electric injury and after exposure to radiation. It cannot be removed by wounds or burns. It may also produce additional characteristics.Dr.K.S.Narayana Reddys Synopsis of Forensic Medicine & Toxicology 27th edition pg. 48.

So the answer to this question is D


Instruction:
The indicator of active multiplication of Hepatitis B virus is -
A. HbsAg
B. HbcAg
C. HbeAg
D. None of the above

Response:
HBeAg reflects active multiplication of the virus in the liver Davidson page 952

So the answer to this question is C


Instruction:
Wiskott Aldrich not true is -a) Raised IgEb) Raised IgMc) Reduced IgAd) CD4 and CD8 defect
A. a
B. c
C. ac
D. bc

Response:
None

So the answer to this question is D


Instruction:
Esophageal motility disorder is best diagnosed is?
A. Barium studies
B. Esophagoscopy
C. 24 hour pH monitoring
D. Manometry

Response:
Davidson&;s principles and practice of medicine 22nd edition. *Manometry confirms the high pressure non relaxing oesophageal sphincter with poor contractility of the oesophageal body.

So the answer to this question is D


Instruction:
Mildly elevated bilirubin, normal liver enzy mes are seen in-
A. Malaria
B. Thalassemia
C. G-6 PD deficiency
D. All of above

Response:
Ans. is 'd' i.e., AH of above o Mildly elevated bilirubin especially indirect and normal liver enzyme seen in hemolytic anemia,o In above question all causes hemolytic anemiao In severe hemolysis or hemolysis which cause liver damage may derange LFT.o Other causes of hemolysisHemolytic Anemias and Their TreatmentDIAGNOSISDEFECTL ABORATORY TESTSTREATMENTCELLULAR DEFECT'SMembrane Defects HereditaryspherocytosisCytoskeletal protein defectsSpherocytes on blood filmIfHb> lOg'dL and reticulocyte count < 10%-none Frequently involve vertical interactions of spectrin ankyrin, protein 3Negative Coombs test eliminates immune hemolysisIf severe anemia, poor growth, aplastic crises, and age <2 yr- transfusion Increased incubated osmotic fragility.'Folic acid, 1 mg qd Abnormal cytoskeletal protein analysis HereditaryelliptocytosisCytoskeletal protein defectsElliptocytes on blood filmMild types-no- treatment Frequently involveRBCs mildly heat-sensitiveChronic hemolysis-horizontal interactions of spectrin, protein 4.1, and glycophorin cAbnormal cytoskeletal protein analysistransfusion and splenectomy as recommended for spherocytosis (see above) Folic acid, 1 mgqdHereditarypyropoikilo-cytosisCytoskeletal protein defectssize and shape on bloodExtreme variation in RBC splenectomy as filmTransfusion andrecommended for spherocytosis (see above) Homozygous or double heterozygous abnormality in horizontal interactions of a spectrinThermal sensitivity7 fragmentation at45degC for 15 minFolic acid, 1 mg qdHereditarystomatocytosisCytoskeletal protein defectsStomatocytes on blood filmSplenectomy should be avoided (see text) Decreased protein 7.2b (1 subset)Abnormal RBC cation and water content Folic acid, 1 mgqdParoxysmal nocturnal hemoglobinuriaPrimary' acquired marrow disorderDecreased WBC CD55 and CD59 or decreasedFolic acid, l mg qd RBCs unusually sensitive to compl ement-medi ated lysisRBC CD59 by flow cytometryMild cvtopenias-no treatment Ham's test, sucrosis lysis testMarrow aspirate and biopsy to assess cellularityChronic hemolysis and other cytopenias- prednisone, 60 mg qd initially, then taper if possible; maintenance therapy 15-40 mg qod Decreased decay- accelerating factorIron for secondary iron deficiency Androgen s- fluoxymesterone Anticoagulation Marrow transplant for pancytopeniaEnzyme Deficiencies Pyruvate kinase deficiencyDecreased or abnormal enzymePyruvate kinase assay-decreased or rarely high Km variantIf severe anemia with symptoms, poor growth and age <2 yr-trans fusion Splenectomy > age 6 yr, but earlier if necessaryFolic acid, 1 mg qdG6PD deficiencyA- type:age-labile enzymeMediterranean type: no enzyme activity in circulating RBCsG6PDAvoid oxidant stress to RBCsTransfusion if acute anemia is symptomaticHemoglobin Abnormalities (For discussion of hemoglobinopathies, see sections on these topics)EXTRACELLULAR DEFECTS AutoimmuneAutoimmune hemolytic anemiaAlteration in membrane surface antigen (Rh) or abnormal response of B lymphocytes, causing autoantibody formationSpherocytes on blood filmIf Hb < 10 g/dL and reticulocyte count > 10%-nonePositive direct Coombs test to IgG "warm" antibody antibody directed aeainst RBCsSevere anemia may require transfusion"Warm" antibody Prednisone, 2 mg-kg/24 hrPositive indirect Coombs test and antibody detectable in plasmaIVIGDanazolThermal amplitude 35-40degC Some complement (C3b) may be detected on RBCsSplenectomyImmunosuppressivesTests for underlying diseaseFolic acid, 1 mg.;24 hr if chronic"Cold" antibody"Cold" or IgM autoantibody directed against I/i antigen systemAgglutination or rouleaux on blood filmIfHb> 10g/dLand reticulocyte count < 10%-none Positive direct Coombs test to complement (C3b)Severe anemia may require transfusionTests for underlying diseaseAvoid exposure to coldSerology for infectious mononucleosis; anti-i presentIf severe-immunosuppressives and plasmapheresisSerology for Mycoplasma pneumoniae; anti-I presentPrednisone is less effective Splenectomy is not useful Folic acid, 1 mg/24 hr if chronicFragmentationHemolysis DIC, TTP, HUSDirect damage to RBC membraneFragments on blood filmTreat underlying condition Transfusion, but transfused cells also will have shortened life spanExtracorporealDirect damage to RBCFragmentsSupportivemembraneoxygenationmembraneon blood filmTransfusion until ECMO is discontinuedProsthetic heart valveDirect damage to RBC membraneFragments on blood filmFolic acid, 1 mg/24 hr Iron for secondary iron deficiencyBurns-thermal injuryDirect damage to RBC membraneSpherocytes on blood filmSupportive TransfusionHypersplenism Effects of sequestration, i pH. lipases and other enzymes, and macrophages on RBCsThrombocytopenia and neutropeniaTreat underlying condition- cytopenias alt usually mild Splenectomy if complicating other anemia (e.g., thalassemia major) Folic acid, 1 mg/24 hrPlasma Factors Liver diseaseAlteration in plasma cholesterol and phospholipidsTarget cells or speculated RBCs on blood filmTreat underlying condition Abnormal liver function testsTransfusion, but transfused cells also will have shortened life span Folic acid, 1 mg/24 hrAbetalipoproteinemiaAbsence of apo lipoprotein bAcanthocytes on blood filmVitamin E (A, K, and D) Vitamin E deficiency and heightened sensitivity to oxidative damageAbsent chylomicrons, VLDL, and LDLFolic acid, 1 mg''24 hrDietary restriction of triglyceridesInfectionsToxic effects on RBCsAssociated symptoms and signsAntibiotics CulturesSupportiveWilson DiseaseEffect of copper on RBC membrane, usually self-limitedSpherocytes on blood filmPenicillamineCopper, ceruloplasminSupportive Penicillamine challenge and urine copper excretionTransfusion if acute anemia is symptomatic

So the answer to this question is D


Instruction:
Siffert katz sign seen in
A. Chondromalacia patella
B. Blount's disease
C. CTEV
D. Rocker Bottom foot

Response:
None

So the answer to this question is B


Instruction:
Probability of Mr. Ram developing Acute MI in his lifetime is 0.75. What are his Odds of developing Acute MI in his lifetime?
A. 3:01
B. 3:04
C. 4:03
D. 1:03

Response:
None

So the answer to this question is A


Instruction:
Most common determinant of energy expenditure in a resting state is:
A. Lean Body Mass
B. Adipose tissue
C. Resting Hea Rate
D. Exercise

Response:
Energy expended in the resting state depends primarily on the lean body mass and the metabolic cost for processing ingested nutrients. Ref: New Developments in Obesity Research By Lawrence F. Ditmier, Page 131; Handbook of Obesity: Etiology and Pathophysiology By George A. Bray, Page 705

So the answer to this question is A


Instruction:
A male child presents with repeated urinary infections and failure to gain weight. A MCU was carried out as shown in plate R2, most probable diagnosis is ?
A. Post urethral valve
B. Meatal stenosis
C. Bladder diveicula
D. Bladder polyp

Response:
Posterior urethral valves are a problem with the urethra in a boy. The urethra is the tube that drains urine from the bladder to the outside of the body. These valves are small leaflets of tissue in the urethra. They paly block urine flow because not enough urine can get through them to leave the body. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is A


Instruction:
Corpus delicti stands for -
A. Body of cou proceedings
B. Body of offence
C. Body of proof
D. Body of evidence

Response:
Corpus delicti (Latin: corpus-main body or mass of the structure, delictus - offence or fault) means the essence of crime or the body of offence. It includes facts and elements of a criminal offence for example murder, road traffic accident, place of suicide etc. The main pa of corpus delicti is the establishment of the identity of the dead body, and infliction of violence in a paicular way, at a paicular time and place, by the person or persons charged with a crime and none other. Ref: Dr K.S Narayana Reddy, The Essentials of Forensic Medicine & Toxicology, 34th edition, 2017, pg. 55.

So the answer to this question is B


Instruction:
Structure with highest refractive index:
A. Cornea
B. Lens
C. Aqueous humor
D. Vitreous humor

Response:
Lens - 1.41 As opposed to maximum refraction taking place at CORNEA - hence maximum Refractive Power Variable Refractive Power -LENS - due to accomodation

So the answer to this question is B


Instruction:
1 month old newborn presents with conjugated Hyperbilirubinemia, intrahepatic cholestasis and high alkaline phosphatase. Eosinophilic, PAS positive cytoplasmic granules are seen in liver biopsy specimen. Diagnosis is?
A. Alpha 1 AT deficiency
B. Cong hepatic fibrosis
C. Extrahepatic biliary atresia
D. Ductal plate defect

Response:
a. Alphal AT deficiency(Ref: Nelson's 20/e p 871-879, Ghai 8/e p 172-176)The given clinical features & investigation findings are suggestive of Alphal Antitrypsin deficiency.Alphal AT deficiencyIt usually presents as neonatal cholestasis or later-onset childhood cirrhosisal -Antitrypsin, a protease inhibitor synthesized by liver, protects lung alveoli from destruction by neutrophil elastaseNormal phenotype is PiMM; In affected patients with PiZZ, polymers of, AT are retained in the ER of hepatocytesIn liver biopsy, periodic acid-Schiff (PAS)-positive diastase-resistant globules are seen, primarily in periportal hepatocytes

So the answer to this question is A


Instruction:
Indication for surgery in a case of adrenal incidentaloma:
A. Size>5 cm
B. Bilateral adrenal metastasis
C. Functional tumor
D. All of the above

Response:
Indications of surgery in Incidentaloma: Suspicious imaging characterstics (irregular margins) Size>5 cm Bilateral adrenal metastasis Functional tumor Young age Few surgical risk factors Interval tumor growth Patient preference.

So the answer to this question is D


Instruction:
Declaration of Helsinki is related to ?
A. Torture, cruel treatment of prisoners
B. Organ Transplantation
C. Medical research involving human subjects
D. Therapeutic abortion

Response:
Declaration of HELSINKI is related to Human Experimentation.

So the answer to this question is C


Instruction:
Parakeratosis is:
A. Absence of nucleus in stratum corneum
B. Persistence of nucleus in stratum corneum
C. Thickening of corneum layer
D. Thickening of prickle cell layer

Response:
Ans. B. Persistence of nucleus in stratum corneum* Stratum corneum is the most superficial layer of the skin and is devoid of nucleus.* Parakeratosis is retention of nucleus in stratum corneum* If there is presence of nucleus in this layer it can be a normal case or can be associated with some pathology.* Normally nucleus in corneum persists in vagina and in mucous membrane of mouth.* Pathologies having nucleus in stratum corneum: seborrheic dermatitis, squamous cell CA, Actinic keratosis, psoriasis, etc.

So the answer to this question is B


Instruction:
Pressure on aery proximal to fistula leading to diminished swelling is known as:
A. Murray sign
B. Frei sign
C. Darrier sign
D. Branham sign

Response:
Nicoladoni's or Branham's sign: Pressure on aery proximal to fistula causes the swelling to diminish in size, a thrill or bruit to cease, the pulse rate to fall and the pulse pressure returns to normal.

So the answer to this question is D


Instruction:
A 63-year-old woman is seen in the emergency room with acute shortness of breath. There is no history of heart or lung problems in the past. She was recently diagnosed with breast cancer and is undergoing active treatment. On examination, her blood pressure is 120/80 mm Hg, pulse 100/min, and heart and lungs are normal. There are no clinical signs of deep venous thrombosis (DVT). Which of the following investigations is most likely to rule out a pulmonary embolism (PE)?
A. normal CXR
B. normal electrocardiogram (ECG)
C. normal ventilation-perfusion lung scan
D. normal ventilation scan

Response:
The perfusion lung scan is most valuable in ruling out a PE. If properly performed early in the course of symptoms, a normal scan rules out the diagnosis. High-probability scans are usually considered enough evidence of PE to warrant definitive treatment. Intermediate- or low-probability scans may require further investigation (e.g., with pulmonary angiography), depending on the prior probability of disease. More recent data suggest that a normal high-resolution chest CT with contrast rules out clinically significant PE and is replacing perfusion scanning since the lung images may provide an alternate diagnosis for the patient's symptoms.

So the answer to this question is C


Instruction:
True about endodermal sinus tumors :
A. Schiller duval bodies seen
B. It is a benign tumour
C. HCG
D. It is seen in young individuals

Response:
-endodermal sinus tumors are also termed yolk sac tumors as they are derived from the primitive yolk sac. - the characteristic microscopic finding is the endodermal sinus or Schiller Duval body. - this is a cystic space lined with a layer of flattened endothelium into which projects a glomerulus like tuft with a central vascular core. Reference : textbook of gynaecology Sheila balakrishnan, 2nd edition, pg no: 283

So the answer to this question is A


Instruction:
Poal of entry of poliovirus in mainly -
A. Gastrointestinal tract
B. Nasal mucosa
C. Lung
D. Skin

Response:
Polio virus is transmitted by feco oral route through ingestion.multiply i the alimentaty canal <\p> REF:MICROBIOLOGY ANANTHA NARAYANAN NINTH EDITION PAGE.486

So the answer to this question is A


Instruction:
All are true regarding 5th cranial nerve except
A. Arises from midbrain
B. It is whole sensory supply of face
C. It supply the muscles of mastication
D. Supplies parasympathetic to saliva glands

Response:
The parotid gland receives its parasympathetic input from the glossopharyngeal nerve the otic ganglion while the submandibular and sublingual glands receive their parasympathetic input from the facial nerve the submandibular ganglion.

So the answer to this question is D


Instruction:
All of the following drugs can cause hearing loss except:
A. Vancomycin
B. Kanamycin
C. Metronidazole
D. Quinine

Response:
Ans. c. Metronidazole (Ref: Goodman Gillman I2/e p1512,1542.1407, Katzung 12/e p824)Metronidazole does not cause hearing loss."All aminoglycosides are ototoxic and nephrotoxic. Ototoxicity and nephrotoxicity are more likely to be encountered when therapy is continued for more than 5 days, at higher doses, in the elderly, and in the setting of renal insufficiency. Concurrent use with loop diuretics (eg, furosemide, ethacrynic acid) or other nephrotoxic antimicrobial agents (eg. vancomycin or amphotericin) can potentiate nephrotoxicity and should be avoided if possible. Neomycin, kanamycin, and amikacin are the most ototoxic agents. Streptomycin and gentamicin are the most vestibulotoxic, bleomycin, tobramycin, and gentamicin are the most nephrotoxic. --Katzung 12/e p824"Vestibular and auditory dysfunction can follow the administration of any of the aminoglycosides, and ototoxicity may become a dose-limiting adverse effect. Aminoglycoside induced ototoxicity results in irreversible, bilateral high-frequency hearing loss and temporary vestibular hypofunction. "--Goodman Gillman 12/e p1512"Auditory impairment, sometimes permanent, may follow the use of vancomycin or teicoplanin. Ototoxicity is associated with excessively high concentrations of these drugs in plasma (60-100 ug/mL of vancomycin). "-Goodman Gillman 12/e p1542"The fatal oral dose of quinine for adults is ~2-8 g. Quinine is associated with a triad of dose-related toxicides when given at full therapeutic or excessive doses. These are cinchonism, hypoglycemia, and hypotension. Hearing and vision are particularly affected Functional impairment of the eighth nerve results in tinnitus, decreased auditory acuity, and vertigo. Visual signs consist of blurred vision, disturbed color perception, photophobia, diplopia, night blindness, constricted visual fields, scotomata, mydriasis, and even blindness. "--Goodman Gillman 12/e p1407Drugs causing OtotoxicityAntibiotics* AminoglycosidesQ* VancomycinQChemotherapeutic drugs* CisplatinQDiuretics* Ethacrynic acidQ* FurosemideQOthers* QuinineQ* SalicylatesQ Aminoglycosides Side-Effects MaximumMinimumOtotoxicity* AmikacinQ (Auditory)* StreptomycinQ (Vestibular)* NetilmycinQNephrotoxicity* Neomycin >GentamicinQ* StreptomycinQNeuromuscular Blockade* Neomycin >StreptomycinQ* TobramycinQ

So the answer to this question is C


Instruction:
CD4 count refers to ?
A. T helper cells
B. B cells
C. Cytotoxic cells
D. Both B And T Cells

Response:
Ans. is 'a' i.e., T helper cells

So the answer to this question is A


Instruction:
Tuberculate spores are features of?
A. Candidia
B. Histoplasma
C. Coccidiodomyces
D. Cryptococcus

Response:
Laboratory diagnosis of Histoplasmosis: - 1. Demonstration of oval yeast cells within macrophages in bone marrow aspirates and in tissue biopsy specimens. Biopsy of oropharyngeal ulcers is usually diagnostic. - 2. Culture of sputum and blood on SDA at 25degC shows hyphae with thick Tuberculoid macroconidia (characteristic), thin microconidia and at 37degC shows yeasts. Coccidiodomyces - fragmented hyphae consisting barrel shaped ahrospore are seen Cryptococcus - on gram staining microscopy ,budding yeast is seen Candida - gram positive oval budding yeast cells with pseudohyphae

So the answer to this question is B


Instruction:
Drug of choice for prevention of infection by animal bite ?
A. Amoxicillin/clavulanate
B. Tetracycline
C. Ciprofloxacin
D. Cotrimazole

Response:
Ans. is 'a' i.e., Amoxicillin/clavulanate

So the answer to this question is A


Instruction:
All are developed from muscles of 1 arch except
A. Tensor tympani and tensor veli palatini
B. Posterior belly of digastric
C. Masticatory muscles
D. Mylohyoid

Response:
None

So the answer to this question is B


Instruction:
Cataract is seen in all except
A. Rheumatoid ahritis
B. Glucocoicoid admistration
C. Galactosemia
D. Hypoparathyroidism

Response:
Rheumatoid ahritis causes thinning and melting of the peripheral cornea and sclerosing keratitis called scleromalcia perforans Refer: Khurana 6th edition page number 198

So the answer to this question is A


Instruction:
Lower end of the femur can help to determine the
A. Age
B. Height
C. Weight
D. Stature

Response:
A i.e. Age Dead born (intrauterine dead) child may show aseptic autolysis/maceration (most common & early feature, seen in fresh > 24 hr ILTD), mummification (late feature seen in late IUD)Q, rigor mois (d/t antenatal hemorrhage after attaining 7 months age) Q, putrefaction (very rare) and adipocere formation (almost not seen)Q. - Spalding sign (radiological loss of alignment & overriding of skull bones) and Robe's sign (gas in great vessels & hea chamber) are seen in macerated (IUD) fetusQ. - Ossification centre of talus (1deg) at the end of 7 months and ossification centre of lower end of femur at end of 9 months if present indicate age of bility.

So the answer to this question is A


Instruction:
Formation of Etiological Hypothesis is
A. Destriptive Epidemiology
B. Analytical Epidemiology
C. Experimental epidemiology
D. None of the above

Response:
None

So the answer to this question is A


Instruction:
Exudative retinal detachment occurs in
A. Myopia
B. Diabetes mellitus
C. Pregnancy induced hypeension
D. Trauma

Response:
Myopia and trauma causes rhegmatogenous retinal detachment proliferative diabetic retinopathy causes tractional retinal detachment PIH causes bilateral exudative retinal detachment. Ref:khurana 6th edition, page no. 298

So the answer to this question is C


Instruction:
A patient with sinus infection develops chemosis,B/L proptosis and fever, the diagnosis goes in or of:
A. lateral sinus thrombosis
B. Frontal lobe abscess
C. Cavernous sinus thrombosis
D. Meningitis

Response:
Angular vein which begins from medial angle of eye,continues as the facial vein.The facial vein communicates with the cavernous sinus through the deep facial vein and pterygoid plexus of veins. B/L proptosis,fever and chemosis point towards cavernous sinus thrombosis. Ref Dhingra 6/e,p 201.

So the answer to this question is C


Instruction:
What is most common cause of death in amyloidosis?
A. Cardiac failure
B. Renal failure
C. Sepsis
D. None

Response:
Hea. Amyloidosis of the hea may occur either as isolated organ involvement or as pa of a systemic distribution. When accompanied by systemic involvement, it is usually of the AL form. The isolated form (senile amyloidosis) usually is confined to older persons. The deposits may not be evident on gross examination, or they may cause minimal to moderate cardiac enlargement. The most characteristic gross findings are gray-pink, dewdrop-like subendocardial elevations, paicularly evident in the atrial chambers. On histologic examination, deposits typically are found throughout the myocardium, beginning between myocardial fibers and eventually causing their pressure atrophy Robbins 9 th edition page no. 157

So the answer to this question is A


Instruction:
Acronym 'POEMS' stand for -
A. Oesophageal dysmotility
B. Polyneuropathy
C. Endocrinopathy
D. M-protein

Response:
None

So the answer to this question is B


Instruction:
A 56-year-old man attends having knocked his finger while working in the garage. He repos having had a small lump on his finger for some months and, since knocking his finger, this has been leaking, as shown below. What is the single most likely diagnosis?
A. Keratoacanthoma
B. Myxoid cyst
C. Pyogenic granuloma
D. Sebaceous cyst

Response:
Myxoid cysts Ganglions of the distal interphalangeal joint. They grow slowly and often cause grooving of the nail as they grow. They are benign but can become painful. Treatment is by aspiration of the thick jelly inside or injection with steroid, or surgical excision if they recur. A keratoacanthoma has a plug of keratin in the center. Pyogenic granuloma usually grows rapidly at the site of trauma. Sebaceous cysts are not typically seen on digits.

So the answer to this question is B


Instruction:
All of the following statement are true regarding idiopathic pulmonary fibrosis, except:
A. Pleural surfaces developed "cobblestoned" appearance
B. Areas of fibrosis, occur preferentially in the lower lobes and subpleural regions
C. Fibroblastic foci are the earliest lesion
D. Masson bodies are characteristic

Response:
Idiopathic Pulmonary Fibrosis (also known as cryptogenic fibrosing alveolitis): Grossly, the pleural surfaces of the lung are cobblestoned as a result of the retraction of scars along the interlobular septa. The cut surface shows firm, rubbery white areas of fibrosis, which occurs preferentially in the lower lobes the subpleural regions, andalong the interlobular septa. Histologically,the hallmark is patchy interstitial fibrosis. The earliest lesions contain exuberant fibroblastic proliferation (fibroblastic foci). With time these areas become more collagenous and less cellular. Prognosis - poor Treatment - Immunosuppresive drugs; Lung transplant is the only definitive therapy. Newer drugs useful in IPF are: Nintedanib and Pirfenidone Masson bodies are seen in Cryptogenic Organising Pneumonia.

So the answer to this question is D


Instruction:
All are considered to be poor prognostic factors in liver metastasis except
A. Synchronous lesions
B. Metachronous lesions
C. Extra-hepatic metastasis
D. CEA>200ng/ml

Response:
Poor prognostic or factors affecting outcome Four or more tumors Extra hepatic disease Size >5cm Disease free interval <1 year Lymph node positive primary lesion CEA >200ng /ml Synchronous liver metastasis Ref:Sabiston 20th edition Pgno :1464-1465

So the answer to this question is B


Instruction:
A 54-year-old man with emphysema presents to his physician with a blood pressure of 157/101 mmHg. Over the next several months the physician prescribes angiotensin conveing enzyme inhibitors, diuretics, and calcium channel blockers, but the patient has to discontinue each agent because of undesirable side effects. The physician then decides to prescribe a beta antagonist. Which of the following would be most appropriate for this paicular patient?
A. Metoprolol
B. Nadolol
C. Propranolol
D. Sotalol

Response:
Patients with nonallergic bronchospastic conditions, such as emphysema and chronic bronchitis, are generally not prescribed beta-receptor blocking agents since these agents can cause bronchoconstriction by blocking beta-2 receptors. However, relatively low doses of selective beta-1 receptor antagonists, such as metoprolol and atenolol, are relatively well tolerated in patients with emphysema. As a precautionary measure, emphysema patients receiving beta-1-selective blocking agents should use a bronchodilator with beta-2-stimulating activity. All the other answer choices are non selective beta receptor blocking agents and should not be used in the treatment of hypeension in patients with nonallergic bronchospasm since they are likely to exacerbate the signs and symptoms of the condition.

So the answer to this question is A


Instruction:
Genetic analysis is done a patient which showed a loss of function mutation in a gene that leads to accumulation of misfolded proteins. which of the following biochemical process is most likely affected
A. Glucuronidation
B. Ubiquitination
C. Acetylation
D. Phosphorylation

Response:
Ubiquitination is a ATP dependent pathway for protein degradation. Impairment of this process leads to accumulation of misfolded proteins.

So the answer to this question is B


Instruction:
Fasciculations are seen in -
A. Motor neuron disease
B. Duchenne's muscular dystrophy
C. Polymyositis
D. None of the above

Response:
None

So the answer to this question is A


Instruction:
Following cailage are derivative fo Second arch except
A. Smaller cornu of hyoid
B. Greater cornu of hyoid
C. Styloid process
D. Stylohyoid ligament

Response:
Human embryology Tenth edition Inderbir Singh's Pg 132 The cailage of the second arch forms the following: Stapes Styloid process Stylohyoid ligament Smaller cornu of hyoid bone Superior pa of body of hyoid bone The following structures are derived from cailage of third arch Greater cornu of hyoid bone Lower pa of body of hyoid bone

So the answer to this question is B


Instruction:
Lung to lung metastasis is seen in ?
A. Adenocarcinoma of lung
B. Squamous cell carcinoma
C. Small cell carcinoma
D. Neuroendocrine tumor of lung

Response:
Ans. is 'a' i.e., Adenocarcinoma of lung o Bronchoalveolar carcinoma (BAC) is a relatively unusual (5% of all lung cancer) subtype of adenocarcinoma that has a unique growth pattern that differs from adenocarcinoma. Rather than invading and destroying contiguous lung parenchyma tumor cells multiply and fill the alveolar spaces. Because of their grwoth within alveoli, BAC tumor cells from one site can aerogenously seed other pas of the same lobe or lung, or the contralateral lung. This growth pattern and tendency to seed can produce three radiographic presentation: a single nodule, multiple nodules (in single or multiple nodes), or a diffuse form with an appearance mimicking that of a lobar pneumonia. Because tumorcells fill the alveolar spaces and envelop small airways rather than destroying them, air bronchograms can be seen, unlike with other carcinomas. o it has the best prognosis of all the cell types.

So the answer to this question is A


Instruction:
All are seen in hysterical somatisation except:
A. Positive physical signs
B. Hemiplegia
C. Blindness
D. Fugue

Response:
A ref: Ahuja, 4th/e p. 91-93 and 5th/e p. 102-103 and Kaplan's, 8th/ep. 1510

So the answer to this question is A


Instruction:
A 60 year female present with tender irreducible mass immediately bellow and lateral to the pubic tubercle. plain abdominal x- ray shows intestinal obstruction
A. Small bowel carcinoma
B. Adhesions
C. Strangulated inguinal hernia
D. Strangulated femoral hernia

Response:
None

So the answer to this question is D


Instruction:
Tensile strength of wound becomes normal after:
A. 6 weeks
B. Never
C. 4 months
D. 6 months

Response:
Ans. (b) Never* At the end of the 1st week wound strength is approximately 10%.* Strength increases rapidly over next 4 weeks and about 70- 80% at 3 months.* At 70-80% there is plateau and the original tensile strength cannot be obtained ever.

So the answer to this question is B


Instruction:
Preanesthethetic Medication is for A/E
A. Secretion decrease
B. .Anxiety
C. dose of inducing agent
D. Allay Anxiety

Response:
C i.e. dose of inducing agent Preanesthetic medication is for the Amnesia, Antiemesis, Analgesia; Decreasing Anxiety, Seretions & Acidity. It has nothing to do with induction.

So the answer to this question is C


Instruction:
A patient presents with intermittent headache. On examination there is hypeension and a thyroid nodule. Which of the following steps is to be taken next :
A. Urine HIAA levels
B. Urine VMA and aspiration of the thyroid nodule
C. Ultrasound abdomen
D. Echocardiography

Response:
Answer is B (Urine VMA and aspiration of the thyroid nodule) : Intermittent headache (most common symptom of Phaeochromocytoma) and presence of Thyroid Nodule point towards the occurrence of Phaeochromocytoma with Medullary Carcinoma Thyroid suggesting a diagnosis of MEN II syndrome. Next logical step to be taken is to confirm the provisional diagnosis and hence the following investigations are recommended. For diagnosis of phaeochromocytoma For diagnosis of Medullary Ca Thyroid Demonstrate excretion of Catecholamine metabolites in urine such as VMA, Metanephrine or free Catecholamines. Aspiration of thyroid nodule

So the answer to this question is B


Instruction:
All of the following ligaments contribute to the stability of ankle (talocrural) joint except
A. Calcaneonavicular (spring)
B. Deltoid
C. Lateral
D. Posterior talofibular

Response:
A. i.e. Calcaneonavicular ligament

So the answer to this question is A


Instruction:
Gingival biopsy is used for diagnosis of ?
A. Scurvy
B. Sarcoidosis
C. Amyloidosis
D. SLE

Response:
Ans. is 'c' i.e., Amyloidosis Biopsy of gingiva (gingival biopsy) is used in the diagnosis of systemic amyloidosis. Diagnosis of amvloidosis The most definitive investigation for amyloidosis is biopsy. The diagnosis of amyloidosis is made by detecting the characteristic amyloid protein in a biopsy specimen of involved tissue. For many years rectal biopsy was the first procedure of choice. However, the capillaries in the subcutaneous fat are aften involved in patients with systemic amyloidosis and can often provide sufficient tissues for the diagnosis of amyloidosis. Therefore, a needle aspiration biopsy of fat just under the skin of the belly (fat pad aspiration) offers a simple and less invasive method to diagnose systemic amyloidosis and biopsy of the organ with the most severe clinical involvement is often unnecessary. When the subcutaneous fat aspiration biopsy does not provide information to reach a final diagnosis, biopsy samples can be collected from other organs. The best sites of biopsy are abdominal fat pad (90% sensitivity) and rectal mucosa (70-80% sensitivity). Other sites are salivary glands, gingiva, skin, tongue, bone marrow, stomach.

So the answer to this question is C


Instruction:
Internuclear ophthalmoplegia is caused due to lesion in which of the following:
A. Occipital lobes
B. Pretectal fibres
C. Medial longitudinal fasciculus
D. Para pontine reticular fibres

Response:
Internuclear ophthalmoplegia is caused due to lesion in the medial longitudinal fasciculus ascending from the abducens nucleus in the pons to the oculomotor nucleus in the midbrain. Damage to fibers carrying the conjugate signal from abducens interneurons to the contralateral medial rectus motoneurons results in a failure of adduction on attempted lateral gaze. Patient with a left internuclear ophthalmoplegia will show slowed or absent adducting movements of the left eye. Patients with bilateral injury to the medial longitudinal fasciculus will have bilateral internuclear ophthalmoplegia. One-and-a-half syndrome occur due to a combined lesion of the medial longitudinal fasciculus and the abducens nucleus on the same side. In this patient the only horizontal eye movement is abduction of the eye on the other side. Ref: Harrison's Principles of Internal Medicine, 18e chapter 28.

So the answer to this question is C


Instruction:
Which of the following is the investigation of choice for evaluation of acute head injury?
A. NCCT Head
B. CECT Head
C. MRI Braind
D. PET scan

Response:
Ans. a. NCCT Head (Ref: Schwartz 9/e p1519)Investigation of choice for evaluation of acute head injury is NCCT Head.'The non-contrast CT scan of the head is an extremely useful diagnostic tool in the setting of new focal neurologic deficit, decreased mental status, or trauma. It is rapid and almost universally available in hospitals in the United States. Its sensitivity allows for the detection of acute hemorrhage. A contrast-enhanced CT scan will help show neoplastic or infectious processes. In the current era, contrast CT generally is used for those patients who cannot undergo magnetic resonance imaging (MRI) scanning due to pacemakers or metal in the orbits. - Schwartz 9/e p1519'MRI provides excellent imaging of soft tissue structures in the head and spine. MRI angiograms can detect stenosis of the cervical carotid arteries or intracranial aneurysms > 3 mm in diameter. MRI venograms can assess the dural venous sinuses for patency or thrombosis.'- Schwartz 9/e p1519

So the answer to this question is A


Instruction:
Parathormone is useful in which of the following?
A. Hyperparathyroidism
B. Paget's disease
C. Osteoporosis
D. Osteomalacia

Response:
Histologically, patients presented with a broad range of bone turnover abnormalities as determined by activation frequency and bone formation rate/bone surface.
Results of the five iPTH assays in each patient correlated but were significantly different.
There were also significant differences between iPTH measurements at the same bone turnover level. Using Kidney Disease Outcome Quality Initiative recommended iPTH ranges, all assays showed comparably poor diagnostic performance.
At 80% specificity, cut-off values of the 5 iPTH assays for low bone turnover varied from 165 to 550 pg/ml and for high bone turnover from 404 to 1,003 pg/ml. Sensitivities at these cutoffs remained below acceptable standards.
Addition of AP measurements to iPTH did not improve diagnostic accuracy.

So the answer to this question is A


Instruction:
Many of our bad habits of day to day life can be removed by-
A. Positive conditioning
B. Negative conditioning
C. Bio feed back
D. Generalization

Response:
Reinforcement (Positive conditioning) → to promote desired behavior (good habits).
Punishment (Negative conditioning) → to remove undesired behavior (bad habits).

So the answer to this question is B


Instruction:
PDA true is all except ?
A. More common in preterm baby
B. Left to right shunt
C. Acyanotic congenital hea disease
D. More common in term baby

Response:
Ans. is 'd i.e., More common in term baby During fetal life, most of the pulmonary aerial blood is shunted through the ductus aeriosus into the aoa . Functional closure of the ductus normally occurs soon after bih, but if the ductus remains patent when pulmonary vascular resistance falls, aoic blood is shunted into the pulmonary aery. The aoic end of the ductus is just distal to the origin of the left subclan aery, and the ductus enters the pulmonary aery at its bifurcation Female patients with PDA outnumber males 2 : 1. PDA is also associated with maternal rubella infection during early pregnancy. It is a common problem in premature infants, where it can cause severe hemodynamic derangements and several major sequelae

So the answer to this question is D


Instruction:
A 25 year old female presents with generalized restriction of eye movement in all direction, intermittent ptosis, proximal muscle weakness and fatigability.Which is the MOST useful test in making the diagnosis?
A. CPK
B. Edrophonium test
C. EMG
D. Muscle biopsy

Response:
This patient is showing signs and symptoms of Myasthenia gravis. Edrophonium test is the most useful test in making a diagnosis of this condition because of the rapid onset and sho duration of its effect. This test is considered to be positive if there is any improvement in the weakness of this patient after administration of edrophonium. Other diagnostic tests used for diagnosing myasthenia gravis are: Acetyl choline receptor antibodies: Presence of this antibodies is viually diagnostic of MG, but a negative test does not exclude the disease. Rapid nerve stimulation test: In this test electric shocks are delivered at a rate of 2 or 3 per second to the appropriate nerves, and action potentials are recorded from the muscles. In these patients there is a rapid reduction of >10-15% in the amplitude of the evoked responses. Ref: Drachman D.B. (2012). Chapter 386. Myasthenia Gravis and Other Diseases of the Neuromuscular Junction. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.

So the answer to this question is B


Instruction:
Impacted wisdom teeth may produce referred pain :
A. Lingual nerve
B. Facial nerve
C. Branch of the Auriculotemporal nerve
D. None of the above

Response:
Unerupted wisdom teeth, erupting teeth, and malocclusion can cause ear pain secondary to direct impingement of the Auriculotemporal nerveQ.

So the answer to this question is C


Instruction:
The etiology of anterior ethmoidal neuralgia is:
A. Inferior turbinate pressing on the nasal septum
B. Middle turbinate pressing on the nasal septum
C. Superior turbinate pressing on the nasal septum
D. Causing obstruction of sphenoid opening

Response:
Sluder's neuralgia or the anterior ethmoidal syndrome is pain around the bridge of the nose radiating into the forehead. It is said to originate from the middle turbinate (pa of ethmoid bone) pressing on the deted septum. This is a rare cause of headache and also k/a contact point headache.

So the answer to this question is B


Instruction:
A patient is to undergo angiography for unstable angina. His routine evaluation revealed his serum creatinine to be elevated. All of the following can be used to prevent contrast nephropathy, EXCEPT:
A. Haemofiltration
B. Fenoldopam
C. N-acetylcysteine
D. 1/2 N saline

Response:
Strategies for the Prevention of Contrast-Induced Nephropathy: Strategies that do not work: Mannitol Furosemide Dopamine Atrial natriuretic factor Fenoldopam Hemodialysis Strategies that may work: Calcium channel blockers Theophylline N-Acetylcysteine Hemofiltration Sodium bicarbonate Ascorbic acid Iso-osmolar contrast media Current recommended strategies: Employ non iodinated contrast studies Avoid nonsteroidal anti-inflammatory agents Space between contrast administrations Minimize contrast volume Hydration Low osmolar contrast media Ref: Brunelli S., Rudnick M.R. (2009). Chapter 12. Contrast-Induced Nephropathy. In E.V. Lerma, J.S. Berns, A.R. Nissenson (Eds), CURRENT Diagnosis & Treatment: Nephrology & Hypeension.

So the answer to this question is B


Instruction:
Which of the following is not seen in obstructive jaundice
A. Dark color stools
B. Pruritis
C. Raised ALP levels
D. Elevated bilirubin

Response:
Obstructive jaundice has clay colored stools.

So the answer to this question is A


Instruction:
MCardle's syndrome is due to
A. Deficiency of glucose-6-phosphatase
B. Absence of muscle phosphorylase
C. Deficiency of liver phosphorylase
D. Deficiency of liver phosphorylase kinase

Response:
McArdle disease (also known as glycogen storage disease type V) is a disorder affecting muscle metabolism. The condition is caused by the lack of an enzyme called muscle phosphorylase. This results in an inability to break down glycogen 'fuel' stores. McArdle disease leads to pain and fatigue with strenuous exercise. Ref Robbins 9/e pg 153

So the answer to this question is A


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

Response:
The swine flu virus H1N1 caused a localised outbreak in a militiary camp in USA.

So the answer to this question is C


Instruction:
Cotton wool spots in diabetic retinoaEUR' pathy are due to:
A. Retinal nerve infarcts
B. Retinal holes
C. Retinal haemorrhage
D. Macular degeneration

Response:
Retinal nerve infarcts

So the answer to this question is A


Instruction:
True about inhaled nitric oxide
A. Causes generalized (systemic) vasodilation
B. Dilates pulmonary aeries
C. Causes hypotension, increase pulmonary aery pressure
D. All

Response:
B i.e, Dilates pulmonary aeries

So the answer to this question is B


Instruction:
Kaposi sarcoma associated herpes virus causes all of the following, except
A. Primary effusion lymphoma
B. Burkitt's lymphoma
C. Castleman disease
D. Kaposi sarcoma

Response:
Kaposi sarcoma, primary effusion lymphoma, castlman disease is caused by HHV 8.
Buritt's lymphoma is caused by HHV4(EBV).

So the answer to this question is B


Instruction:
Anaemia, punctate basophilia, constipation, blue line and abdominal colic are characreristic of -
A. Opium addiction
B. Arsenic poisoning
C. Mercuric poisoning
D. Lead poisoning

Response:
Anemia, punctuate basophilia, constipation, blue line on gums and abdominal colic suggest the diagnosis of chronic lead poisoning.

So the answer to this question is D


Instruction:
Commonest cause of loss of vision in non-proliferative diabetic retinopathy is:
A. Vitreous haemorrhage
B. Macular edema
C. Detachment of retina
D. Subretinal haemorrhage

Response:
Ans. Macular edema

So the answer to this question is B


Instruction:
Which of the following is not true about Japanese encephalitis?
A. About 80% of the patients are children below 5 years of age
B. In epdidemics, cases scatter with no more than 1-2 pe village
C. Ove disease to unparrent cases ratio is 1:100
D. Bite from infected mosquito alwasy leads to the disease

Response:
<p> Not all individuals bitten by infected mosquitoes develop disease. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:286. <\p>

So the answer to this question is D


Instruction:
SPECT Stands for
A. Single Proton Emission Computed Tomography
B. Single Positron Emission Computed Tomography
C. Single Photon Emission Computed Tomography
D. Single Positive Emission Computed Tomography

Response:
SPECT stands for Single Photon Emission Computed Tomography, It uses a 360 degree revolving Gamma Camera and Acquires 3D images using Tc99m labelled radioisotopes like HMPAO (Hexamethylpropyleneamine oxime).

So the answer to this question is C


Instruction:
A pt. operated for direct inguinal hernia developed anethesia at the root of the penis and adjacent pa of the scrotum the nerve likely to be injured is ?
A. Genital br. of genitofemoral nerve (supply daos muscle)
B. Femoral br. of genitofemoral nerve
C. Iliohypogastric nerve
D. Ilioinguinal nerve

Response:
Ans. is 'd' i.e. ilioinguinal nerve All the three nerves ie genifotemoral, ilioinguinal & iliohypogastric are branches of the lumbar plexus and all may be injured in op. for hernia.llioinguinal-Nerveenters the inguinal canal by piercing the internal oblique muscle (not through the deep ring)*it then emerges from the superficial inguinal ring to supply skin ofproximomedial skin of the thighskin over the penile root.upper pa of the scrotumIliohypogastric nervesdivides into two branches - lateral cutaneous and anterior cutaneous.lateral cutaneous supplies - posterolateral gluteal skinAnterior cutaneous supplies - suprapubic skinGenitofemoral nerve divides into two branchesGenital andFemoralGenital br of Genitofemoral nerve - enters the inguinal canal at its deep ring and supplies- the Cremaster*- the scrotal skin*Femoral br of genitofemoral nerve- passes behind the inguinal ligament, enters the femoral sheath lateral to femoral aery*, pierces the ant layer of the femoral sheath and fascia lata and supplies the skin anterior to the upper pa of femoral triangle.From these descriptions it is obvious that the nerve likely to be injured is ilioinguinal nerve.

So the answer to this question is D


Instruction:
Which of the following cardiac valves is not commonly involved in rheumatic fever?
A. Mitral
B. Aoic
C. Pulmonary
D. Tricuspid

Response:
In chronic disease the mitral valve is viually always involved. The mitral valve is affected in isolation in roughly two thirds of RHD, and along with the aoic valve in another 25% of cases. Tricuspid valve involvement is infrequent, and the pulmonary valve is only rarely affected.

So the answer to this question is C


Instruction:
In which of the following are linear IgA deposits in mesangium noted?
A. Henoch Schoenlein Purpura
B. Malaria
C. Good Pasture's Syndrome
D. Wegener's Granulomatosis

Response:
Ans. A. Henoch Schoenlein Purpura. (Ref. Harrison's 17th/pg. 1813, 1789)Ref. Harrison's 17th/pg. 1789........."Henoch-Schonlein purpura is distinguished clinically from IgA nephropathy by prominent systemic symptoms, a younger age (<20 years old), preceding infection, and abdominal complaints. Deposits of IgA are also found in the glomerular mesangium in a variety of systemic diseases, including chronic liver disease, Crohn's disease, gastrointestinal adenocarcinoma, chronic obstructive bronchiectasis, idiopathic interstitial pneumonia, dermatitis herpetiformis, mycosis fungoides, leprosy, ankylosing spondylitis, relapsing polychondritis, and Sjogren's syndrome. IgA deposition in these entities is not usually associated with clinically significant glomerular inflammation or renal dysfunction and thus is not called IgA nephropathy"Discussion:IgA nephropathy:# Berger first described it. It is classically characterized by episodic hematuria with the deposition of IgA in the mesangium. IgA nephropathy is one of the most common forms of glomerulonephritis worldwide. There is a male preponderance, a peak incidence in the second and third decades, and rare familial clustering.# The two most common presentations of IgA nephropathy are recurrent episodes of macroscopic hematuria during or immediately following an upper respiratory infection in children (Henoch-Schonlein purpura) or asymptomatic microscopic hematuria most often seen in adults.# Rx: - ACE inhibitors in patients with proteinuria or declining renal function.- Tonsillectomy, steroid therapy, and fish oil have all been suggested to benefit some patients.- When presenting as RPGN, patients need steroids, cytotoxic agents, and plasmapheresis.RENAL INVOLVEMENT in Hemolytic Uremic Syndrome (HUS) and Thrombotic Thrombocytopenic Purpura (TTP)# Microscopic hematuria (78%) and subnephrotic proteinuria (75%) are the most consistent findings.# The characteristic lesion in HUS/TTP is thrombotic microangiopathy.# Microthrombi are demonstrated in renal arterioles and capillaries.# In TTP, microthrombi are composed mainly of platelet aggregates and thin layer of fibrin and stain strongly for vWF, implicated in its pathogenesis. In contrast, microthrombi in HUS contain predominantly fibrin.# Subendothelial hyaline deposits and endothelial cell swelling also contribute to vascular occlusion. Glomerular lesions are ischemic. The glomerular capillary walls are wrinkled, the glomerular tuft may be atrophied, and the Bowman capsule is thickened. Acute cortical or tubular necrosis may occur.# Immunofluorescence studies invariably demonstrate fibrinogen along the glomerular capillary walls and in arterial thrombi. Granular deposits of C3 and IgM may be observed in vessel walls and glomeruli.# Electron-microscopic studies demonstrate swelling of the glomerular endothelial cells and detachment from the glomerular basement membrane.

So the answer to this question is A


Instruction:
A young female presented with consumption of some substance in the emergency department. Greenish blue froth was seen coming out of her nostrils and oral cavity. The poisoning is most likely due to which of the following?
A. Arsenic poisoning
B. Copper poisoning
C. Mercury poisoning
D. Lead poisoning

Response:
Ans. b. Copper poisoning (Ref: Reddy 33/e p547, 29/e p490)Greenish blue froth from nostrils and oral cavity is seen in copper poisoning.PoisoningColour of Hair and SkinArsenic (As)* Yellow colour of skin, hair and mucous membraneQ* Milk rose (Brownish pigmentation)QCopper (Cu)* Jaundiced skin* Green-Blue skin, hair and perspirationQ* Green-Purple line of gumsQMercury (Hg)* Brown/Black-Blue line on gumsQ with loosening of tooth and necrosis of jaw* Brown deposits on anterior tens capsuleQ (Mercuria lends)* Acrodynia (Pink disease)QLead (Pb)* Blue stippled burtonian line on gumsQ, especially on upper jaw near dirty and infected teethCopper PoisoningCopper (Cu) as a metal is not poisonous. Poisonous salts include:SubstanceColorFatal DoseFatal periodCopper subacetate (Verdigris, zangal)Blue green15 gm1-3 daysQ(Usually 12-24 hours or may be up to 3-5 days or even a week)Copper sulphate (blue vitriol, nila tutia)Blue30 gmVerdigris is formed by the action of vegetable acids while cooking in copper cooking utensils, which have been not properly tin lined.Acute PoisoningChronic Poisoning* Symptoms start in 15-30 minutes of ingestion/inhalation and include metallic taste, increased salivation, thirst, burning/colic abdomen pain, nausea, eructations and blue-green vomiting* Diarrhea with liquid and brown but not bloody motions* Renal failure may lead to oliguria, albuminuria, hematuria, acidosis and uremia. Hemolysis, hemoglobinuria, methhemoglobinuria, jaundice, pancreatitis, leg cramps, spasms and convulsions may occur in severe cases.* Common among industrial workers e.g. metal fume fever in copper welders, histiocytic granulomatous lung and liver due to chronic inhalation of CuSO4 spray (vineyard' sprayer's lung disease)* Symptom complex is called Wilson's disease, hemochromatosis, bronzed diabetes and pigment cirrhosis. Presence of copper deposits in tissues is called chalcosis.* Symptoms consist of gradual anemia, purple (blue-green) line on gumsQ, nausea, vomiting with blue/green vomitusQ, colic, diarrhea, malaise, peripheral neuritis, muscle degeneration and atrophy.* Skin is jaundiced; urine, hair, froth, mucosa, and perspiration become green (blue-greenQ.

So the answer to this question is B


Instruction:
Police inquest is done in all except -
A. Suicidal death
B. Homicidal death
C. Dowry death
D. Accidental death

Response:
Ans. is 'c' i.e., Dowry deatho In dowry death, magistrate inquest is carried out.Police inquest (See 174 CrPC)o It is the commonest type of inquest in India. It is inferior to other types inquest. Police inquest is carried out by a police officer, not below the rank of head constable (usually a sub-inspector). Such police officer (PO) is known as investigating officer (IO). After informing the nearest executive magistrate, he goes to the place of offence and conducts the inquest. In presence of two or more respectable inhabitants (panchas), then prepare the report of the apparent cause of death (Panchnama) signed by IOand witnesses. If no foul play is suspected, the body is handed over to the relatives, otherwise body is sent for postmortem examination to find out the cause of death. IO (police) may summon the person, the summoned person is bounded to attend and answer questions. Refusal to answer questions by the police is punishable under section 179 IPC. Police inquest is done inDeath by sucideDeath by killing by another person (murder) or an animal or machineryDeath by accidentDeath under circumstances raising a reasonable suscpicion that some other person has commited an offence.Magistrate inquest (Sec 176, CrPC)o Magistrate's inquest is carried out by an executive magistrate, district magistrate (DM) or sub-divisional magistrate (SDM). It is done in cases ofDeath in prison, reformatories, Brostal school.Death in police custody, while under police interrogation.Death due to police firing.Dowry death, i.e. death of a married female less than 30 years of age or death within 7 years of marriage.Exhumation.Death in pscychiatry hospital.Any person dies or disappears, or rape is alleged to have been committed on any woman, while such person or woman is the custody of police or any other custody authorized by court (Sections 174(4), 176 and 176, 1-A CrPC).

So the answer to this question is C


Instruction:
Vidian neurectomy is used for the treatment of-
A. Chronic vasomotor rhinitis
B. Benign positional paroxysmal vertigo
C. Meniere's disease
D. Otosclerosis

Response:
Ans. is 'a' i.e., Vasomotor rhinitis Vasomotor rhinitiso Vasomotor is a nonallergic condition that involves a constant runny nose, sneezing and nasal congestion, i.e., the nose is stuffy or runny for reasons other than allergies and infections. The exact etiology is unknown, but triggers include emotions, odors, poor air quality, spicy foods, and medication side effects. Pathogenesis include:-Parasympathetic overactivityHyperactive nasal mucosa to several non-specific stimuli especially in women of 20-40 years.o Symptoms of vasomotor rhinitis include excessive clear rhinorrhoea, nasal obstruction/congestion, irritation, paroxysmal sneezing and post-nasal drip. Nasal mucosa is hypertrophied & congested: and mucosa of turbinates may give mulberry like appearance and is pale to dusky red in colour.o Complications of vasomotor rhinitis include hypertrophic rhinitis & sinusitis, and nasal polyp.Treatmento Treatment of vasomotor rhinitis includes : -Conservative treatmentAvoidance of physical factors which provoke symptoms.Antihistaminics and oral or nasal decongestants.Topical or systemic steroidsSurgical treatmentNasal obstruction can be relieved by measures which reduce the size of hypertrophied nasal turbinate : - Cryosurgery, submucosal diathermy, Linear cauterization, partial or total turbinectomy, submucosal resection of turbinate.Excessive rhinorrhoea in vasomotor Rhinitis not corrected by medical therapy and bothersome to the patient, is relieved by sectioning the parasympathetic secretomotorfibres to nose i.e., vidian neurectomy.

So the answer to this question is A


Instruction:
Acidic drug is more ionized at-
A. Alkaline
B. Acidic pH
C. Neutral pH
D. None

Response:
Ans. is 'a' i.e., Alkaline pH Implication of ionization Acidic drugs ionize more at alkaline pH. o Basic drugs ionize more at acidic pH. o Unionized drug is lipid-soluble and diffusible. o Ionised drug is lipid-insoluble and nondiffusible. o Acidic drugs (salicylates, barbiturates) are predominently unionized in acid gastric juice and are absorbed from stomach. Basic drugs (morphine, quinine) are predominently unionized in intestinal alkaline pH and are absorbed from intestine. o In the stomach acidic drug (aspirin, pKa - 3.5) arc unionised (lipid soluble & diffusable) and so diffuses into gastric epithelial cells. In gastric epithelial cell, it will ionize (pH-7.4) becomes less diffusable and so will localize there. This ion trapping is one mechanism where by aspirin is concentrated in, and so harms, gastric mucosa. o Basic drugs attain higher concentration intracellularly (pH 7.0 Vs 7.4 of plasma). o Acidic drugs are ionized more in alkaline urine - do not back diffuse in the kidney tubules and arc excreted faster. o Similarly basic drugs are excreted faster in acidic urine.

So the answer to this question is A