Instruction:
All are components of bile, except
A. Bile salts
B. Bile pigment
C. Stercobilinogen
D. Bilirubin

Response:
Stercobilinogen is a chemical created by bacteria in the gut. It is made of broken-down hemoglobin. It is fuher processed to become the chemical that gives feces its brown color while all other things are components of bile Ref: guyton and hall textbook of medical physiology 12 edition page number:420,421,422

So the answer to this question is C


Instruction:
True about confounding factor
A. It is found equally between study and the control groups
B. It is itself a risk factor for the disease
C. Confounding can be eliminated by selecting a small group
D. It is associated with either the exposure or the disease

Response:
.a "confounding factor"is defines as one which is associated both with exposure and disease and is distributed unequally in study and control groups.a cofounding factor by itself is a risk factor for the disease independently of any association. ref:park&;s textbook,ed22,pg no 63

So the answer to this question is A


Instruction:
A reasonable explanation for the therapeutic effects of ibuprofen or naproxen in primary dysmenorrhea is that these drugs
A. |PGE, and PGF2a
B. selectively inhibit COX 2
C. |LTB,
D. inhibit PLA2

Response:
PGE, and PGF2a both increase in primary dysmenorrhea, and the therapeutic effects of NSAIDs appear to be due to inhibition of the synthesis of these prostaglandins. Both ibuprofen and naproxen are nonselective COX inhibitors that can inhibit the synthesis of prostacyclin (PGI2 ). NSAIDs do not inhibit phospholipase A2 , and they do not decrease leukotrienes.

So the answer to this question is A


Instruction:
Reflex sympathetic dystrophy true is-
A. Osteoporosis
B. Increased skin temp
C. Common in athletes
D. Vasoconstriction

Response:
Ans. is 'a' i.e., Osteoporosis o RSD is a condition that features a group of typical symptoms, including pain (often burning type), tenderness, and swelling of an exterimity associated with varying degrees of sweating, warmth and/or shiny skin. It is an abnormal sympathetic response following trauma. This is commonly encountered in colie's fracture. However, RSD may be seen in other injuries also.Clinical manifestations of RSDo The onset of the RSD symptoms may be rapid or gradual. There are several stagesStage 1 (Acute) :- Burning pain, flushing, sweating, swelling, erythema, increased heat, hyperesthesia, spotty osteoporosis.Stage 2 (dystrophic) :- Cyanotic extremity, thickened & shiny skin, Increased sweating (hyperhidrosis), contracture; but diminished swelling & flushing. There is diffuse osteoporosis. Stage 3 (Atrophic) :- Stiffness of joints, contracture of the involved hand or foot. Pale & cool extremity, skin is dry, tight skin, homogenous osteoporosis with thinned cortices at the joint.Prognosiso The prognosis varies from person to person. Spontaneous remission from symptoms occur in certain people. Others can have unremitting and crippling, irreversible changes inspite of treatment.Treatment of RSDo Physical therapy :- gradually increasing exercise programo Psychotherapyo Sympatholytic drugs :- Phentolamine (a - blocker), Propranolol (p-blocker)o Sympathetic nerve block :- Stellate ganglion block for upper extremity RSD and L,- L. block for lower extremity,o Medications :- Topical analgesics, antidepressants, corticosteroids, opioids, o Surgical sympathectomy.

So the answer to this question is A


Instruction:
A 12-year-old girl presents to the casualty with symptoms of fever, shoness of breath, and cough. A chest X-ray reveals complete consolidation of the lower lobe of the left lung. Cultures of the lower lobe of the left lung would most likely reveal which organism?
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Klebsiella pneumoniae
D. Pseudomonas aeruginosa

Response:
The history and findings are consistent with a lobar pneumonia. The most common etiologic agent of lobar pneumonia is Streptococcus pneumoniae. ESSENTIALS OF DIAGNOSIS Productive cough, fever, rigors, dyspnea, early pleuritic chest pain Consolidating lobar pneumonia on chest radiograph Lancet-shaped gram-positive diplococci on Gram stain of sputum Ref: Papadakis MA, McPhee SJ, "Pneumonia, Pneumococcal." Quick Medical Diagnosis & Treatment

So the answer to this question is A


Instruction:
True about malignant melanoma
A. Lymphatic spread
B. Lymph node biopsy is done always
C. Block dissection to be done when sentinel node is involved
D. Microsatellitism

Response:
No answer All the 4 options are true

So the answer to this question is A


Instruction:
Indications of FESS -a) Inverted papilloma b) Nasal Allergic polyposisc) Mucoceled) Ca maxilla
A. ab
B. bc
C. acd
D. abc

Response:
Indications of FESS

Chronic bacterial sinusitis unresponsive to adequate medical treatment.
Recurrent acute bacterial sinusitis.
Polypoid rhinosinusitis (diffuse nasal polyposis).
Fungal sinusitis with fungal ball or nasal polypi.
Antrochoanal polyp and Ethmoid polyp
Mucocele of frontoethmoid or sphenoid sinus.
Control of epistaxis by endoscopic cautery.
Removal of foreign body from the nose or sinus.
Endoscopic septoplasty.
Removal of benign tumours, e.g. inverted papillomas or angiofibromas.
Orbital abscess or cellulitis management.
Dacryocystorhinostomy.
Repair of CSF leak.
Pituitary surgery
Optic nerve decompression.
Orbital decompression for Graves disease.
Control of posterior epistaxis (endoscopic clipping of sphenopalatine artery).
Choanal atresia.

So the answer to this question is D


Instruction:
True about DNA methylation -
A. Alters gene expression
B. Role in carcinogenesis
C. Protective mechanism against cleavage by restriction endonuclease
D. All of these

Response:
DNA methylation alters the gene expression pattern in cells-for example it may cause X-chromosome inactivation, tumor suppressor gene silencing (in cancer cells), suppresion of expression of repetitive elements/deleterious elements/ viral genes that have been incorporated into genome of host over time.
E. coli has 2 DNA methylation system, both using s-adenosyl methionine as methyl group donor.

Adenine or cytosine methylation serve as a part of defence mechanism against cleavage by restriction endonuclease.
Dam (DNA adenine methylation) mediates mismatch repair which improves overall fidelity of DNA replication.

So the answer to this question is D


Instruction:
Which of the following is a pa of Mobius syndrome except?
A. Decreased chest movements
B. Bilateral facial involvement
C. Unilateral or bilateral abducent nerve involvement
D. Ataxia

Response:
The classically accepted diagnostic criteria include: 1) facial paralysis or weakness affecting at least one but usually both sides of the face (7th cranial nerve), 2) paralysis of sideways (lateral) movement of the eyes (6th cranial nerve); and 3) preservation of veical movements of the eyes. Other symptoms that sometimes occur with Mobius syndrome are: Limb abnormalities--clubbed feet, missing fingers or toes Chest-wall abnormalities (Poland Syndrome) Crossed eyes (strabismus) Difficulty in breathing and/or in swallowing Corneal erosion resulting from difficulty in blinking Moebius syndrome is a rare neurological condition that primarily affects the muscles that control facial expression and eye movement. The signs and symptoms of this condition are present from bih. Weakness or paralysis of the facial muscles is one of the most common features of Moebius syndrome Ref Harrison20th edition pg 2345

So the answer to this question is D


Instruction:
Inhibition of prolactin is caused by: (Repeat)
A. Dopamine
B. Dobutamine
C. TRH
D. AT-II

Response:
Ans: A (Dopamine) Ref: Pal GK, Pituitary Gland: The Anterior Pituitary. In: Textbook of Medical Physiology, Abuja Publishing House, 2007: 44:332Explanation:Regulation of Prolactin SecretionProlaction Increased by:PRFSleep, stress, breast feedingAlso released by TRH and hormones in the glucagon family (secretin, glucagon, VIP and gastric inhibitory polypeptide )AT-IIOxytocinDopamine antagonist (phenothiazine)Adrenergic blockersSerotonin agonistsProlactin Decreased by:DopamineSomatostatinProlactinGABA

So the answer to this question is A


Instruction:
Uncommon cause of upper GI bleed -
A. Varices
B. Erosive gastritis
C. Peptic ulcer
D. Carcinoma stomach

Response:
None

So the answer to this question is D


Instruction:
All of the following muscles are attached to oblique line of thyroid cailage except
A. Superior constrictor
B. . Inferior constrictor
C. Thyrohyoid
D. Stern thyroid

Response:
Superior constrictor MUSCLE Superior constrictor (Constrictor of pharynx) ORIGIN i. Pterygoid hamulus ii. Pterygomandibular raphe iii. Medial surface of mandible (near lower attachment of pterygomandibular raphe INSEION Median raphe on posterior wall of pharynx Inferior constrictor (Constrictor of Two pas: pharynx) i. Thyropharyngeus - from thyroid cailage (oblique line of thyroid cailage) ii. Cricopharyngeus - from cricoid cailage Median raphe on posterior wall of pharynx Sternothyroid (Infrahyoid muscle) i. Posterior surface of manubrium sterni ii. Adjoining pa of first costal cailage Oblique line of thyroid cailage Thyrohyoid (Infrahyoid muscle) Oblique line of thyroid cailage Lower border of body and greater cornua of hyoid bone

So the answer to this question is A


Instruction:
Which system is primarily affected by tetanus?
A. Hematological
B. Nervous
C. Skeletal
D. All

Response:
Nervous REF: Harrison's Internal Medicine 17th edition chapter 133 "Tetanus is a neurologic disorder, characterized by increased muscle tone and spasms that is caused by tetanospasmin, a powerful protein toxin elaborated by Clostridium tetani"

So the answer to this question is B


Instruction:
All are true regarding staphylococcal toxin except ?
A. Beta haemolysin shows hot cold phenomenon
B. Mainly endotoxin
C. Enterotoxin causes food poisoning
D. Exfoliative toxin causes Reiter's syndrome

Response:
Ans. is 'b' i.e., Mainly endotoxin Impoant facts about virulence factors . Clumping factor is bound coagulase which is responsible for the slide coagulase test. . Coagulase (free coagulase) - Acts along with a coagulase reacting factor (CRF) in plasma. - Eight type of coagulase have been identified, most human strains form coagulase A. - Most constant association of virulence is production of enzyme coagulase and to lesser extent with mannitol fermentation. . Heat stable nuclease (DNAase) is a characteristic feature of staph aureus. . Staphylococcus produces five cytolytic toxins, consisting of four hemolysins (alpha, beta, gamma and delta) and a leucocidin. . a - hemolysin is the most impoant hemolysin. . Beta - hemolysin is a sphingomyelinase. It exhibits a hot-cold phenomenon, the hemolysis being initiated at 37degC, but becoming evident only after chilling. . Leucocidin is also called the Panton-valentine toxin. . Staphylococcal leucocidin and gamma lysin have been grouped as synergohymenotropic toxins. . Toxic shock syndrome toxin (TSST) and enterotoxins are superantigens which are potent activators of T lymphocytes and lead to an excessive and dysregulated immune response with release of cytokines IL-1, IL-2, TNF-a and IFN - y. . Enterotoxin is responsible for food poisoning. . Exfoliative (epidermolytic toxin) - Responsible for staphylococcal scalded skin syndrome (S.S.S.S.). - Severe form of SSSS is known as Ritter disease in newborn and toxic epidermal necrolysis in older patients. Milder forms are pemphigus neonatorum and bullous impetigo. . Staphylococcus does not produce endotoxin. Endotoxin is produced by gram (-) ye organisms, the only gram (+) ye organism secreting endotoxin is listeria.

So the answer to this question is B


Instruction:
IFA tablets given during pregnancy contains.
A. 60mg elemental iron and 500ug Folic acid
B. 100mg elemental iron and 400ug Folic acid
C. 60mg elemental iron and 400ug Folic acid
D. 100mg elemental iron and 500ug Folic acid

Response:
None

So the answer to this question is D


Instruction:
Differential expression of the same gene depending on parent of origin is referred to as –
A. Genomic imprinting
B. Mosaicism
C. Anticipation
D. Nonpenetrance

Response:
The phenomenon referred to as genomic imprinting leads to pereferential expression of an allele depending on its parental origin - Harrisons

Genomic imprinting

Human inherits two copies of each gene, i.e. two alleles, from homologous maternal and paternal chromosomes.
There is no functional difference between the genes derived from the mother or the father.
But, with respect to some genes, there are functional differences between the paternal gene and maternal gene.
These differences result from an epigenetic process, called genomic imprinting.
In most cases, genomic imprinting selectively inactivates either the maternal or paternal allele.

1. Maternal genomic imprinting

Selective inactivation of the maternal allele
An example is an Angelman syndrome

2. Paternal genomic imprinting

Selective inactivation of paternal allele.
An example is Prader-Willi syndrome.

So the answer to this question is A


Instruction:
Waddell's trial does not include
A. Head injury
B. C1 vertebrae injury
C. Fracture shaft femur
D. Intra abdominal injury

Response:
None

So the answer to this question is B


Instruction:
Underwater autopsy of the hea is done in cases of: DNB 09
A. Myocardial infarction
B. Pulmonary embolism
C. Air embolism
D. Pneumothorax

Response:
Ans. Air embolism

So the answer to this question is C


Instruction:
Nova T has the following :
A. Silver core
B. Copper core
C. Platinum core
D. Iron core

Response:
Silver core

So the answer to this question is A


Instruction:
Paucity of pus is seen in
A. Quinsy
B. Ludwig's angina
C. Carbuncle
D. Milroy disease

Response:
None

So the answer to this question is B


Instruction:
All of the following structures pierce the buccinator muscle except -
A. Parotid duct
B. Molar glands of the cheek
C. Buccal branch of facial nerve
D. Buccal branch of the mandibular nerve

Response:
Structures piercing the buccinator are :-

Parotid duct
Buccal branch of mandibular nerve
Four or five molor mucous glands lying on the bucco-pharyngeal fascia around the parotid duct.

So the answer to this question is C


Instruction:
Death of unborn child by an act of parents comes under IPC ?
A. 302
B. 316
C. 300
D. 314

Response:
Ans. is 'b' i.e., 316Death of quick unborn child by act amounting to culpable homicide (10 years imprisonment + fine) - 316 IPC.

So the answer to this question is B


Instruction:
A 26-yr-old primigravida with a twin gestation at 30 weeks presents for a USG.The sonogram indicates that the fetuses are both male and the placenta appears to be diamniotic and monochorionic.Twin B is noted to have oligohydramnios and to be much smaller than twin A.In this clinical scenario ,all of the following are concerns for twin A except:
A. CHF
B. Anemia
C. Hydramnios
D. Widespread thromboses

Response:
This scenario represents a typical case of twin to twin transfusion syndrome.
Twin to twin transfusion syndrome (TTTS)

It is always seen in monochorionic placenta. M/C in monochorionic diamniotic pregnancy than monochorionic monoamniotic pregnancy.
There is an arteriovenous malformation such that there exists a communication from the umbilical arterial system of the “donor” twin to the umbilical vein of the “recipient” twin.
The donor twin is growth restricted, hypovolemic, has oligohydramnios and is anemic because it gives blood to the recipient twin. The recipient is larger, hypervolemic, has polyhydramnios and is plethoric. It has also been termed as Twin Oligohydramnios/Polyhydramnios Sequence (TOPS).
The earlier the TOPS appears, worse will be the prognosis.
TTTS is more common in female fetuses.
TTTS can cause preterm delivery due to polyhydramnios, IUGR or fetal demise.
Coming to the question—Twin A is the recipient twin and Twin B is the donor twin since it has oligohydramnios.

Thus twin A can have CHF—due to volume overload, can have hydramnios and can have thrombosis since it has polycythemia which can lead to thrombosis, but it will never have anemia.

So the answer to this question is B


Instruction:
Subpoena is a:
A. Legal document
B. Medicolegal document
C. Medical document
D. First information repo (FIR)

Response:
Summon/ Subpnoea Summon: legal document compelling the attendance of a witness in a cou of law, under penalty, on a paicular day, time and place for the purpose of giving evidence. Types of summons: Subpoena duces tecum: Witness is required to bring the relevant documentary evidences to the cou specified in the subpoena. Subpoena ad testificandum: Requires the individual to testify before the cou. sections deal with summon: Section 61 - 69 Cr PC

So the answer to this question is A


Instruction:
Positive health in today world -
A. Dependent on social, economic and culture
B. Mirage because of changing environment
C. Body and mind at peace
D. Changing behavior with respect to change in future

Response:
Ans. is 'b' i.e., Mirage because of changing environment Positive health o The state of positive health implies the notion of "perfect functioning" of the body and mind. o In canceptualizes heath Biologically, as a state in which every cell and every organ is functioning at optimum capacity and in perfect hormony with the rest of the body. ii) Psychologically, as a state in which the individual feels a sense of perfect well-being and of mastery over his environment. iii) Socially, as a state in which the individual's capacities for paicipation in the social system are optimal. o These ideas were widely ventilated some years ago but now appears slightly ridiculous. o Dubos said, "The concept of perfect positive health cannot become a reality because man will never be so perfectly adapted to his environment that his life will not involve struggles, failures and sufferings". o Positive health will, therefore, always remain a mirage, because everything in our life is subject to change. o Health in this context has been described as a potentiality-the ability of an individual or a social group to modify himself or itself continually, in the face of changing conditions of life.

So the answer to this question is B


Instruction:
All the following are neoplasms found in patients with HIV infection Except
A. Kaposi sarcoma
B. Primary lymphoma of brain
C. Invasive cancer of uterine cervix
D. Hepatocellular carcinoma

Response:
Patients with AIDS have a high incidence of ceain tumors, especially Kaposi sarcoma (KS), B-cell lymphoma, cervical cancer in women, and anal cancer in men.It is estimated that 25% to 40% of untreated HIV-infected individuals will eventually develop a malignancy. A common feature of these tumors is that they are caused by oncogenic DNA viruses, specifically Kaposi sarcoma herpesvirus (Kaposi sarcoma), EBV (B-cell lymphoma), and human papillomavirus (cervical and anal carcinoma).Ref: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 6; Diseases of the Immune System; Page no: 253

So the answer to this question is D


Instruction:
Psammoma bodies show which type of calcification:
A. Metastatic
B. Dystrophic.
C. Secondary
D. Any of the above

Response:
Dystrophic

So the answer to this question is B


Instruction:
Selenocysteine is synthesized from
A. Alamine
B. Cysteine
C. Arginine
D. Histidine

Response:
Selenocysteine is the 21st amino acid. Biosynthesis of Selenocysteine is by replacing the oxygen by selenium in Serine which in turn formed from Cysteine.Ref: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 214

So the answer to this question is B


Instruction:
The movement of bone in response to its own growth is termed as:
A. Rotation
B. Secondary displacement
C. Primary displacement
D. Differentiation

Response:
None

So the answer to this question is C


Instruction:
Rokitansky-Aschoff sinuses are seen in which of the following conditions?
A. Acute cholecystitis
B. Chronic cholecystitis
C. Xanthogranulomatous cholecystitis
D. Gallbladder carcinoma

Response:
Rokitansky-Aschoff sinuses are seen in Chronic cholecystitis. It is due to outpouchings of mucosal epithelium through the wall of the gallbladder forming these sinuses. Can contain fragmented bill pigment stones.

So the answer to this question is B


Instruction:
Efalizumab is used in treatment of:
A. Acne vulgaris
B. Atopic dermatitis
C. Psoriasis
D. All of the above

Response:
Efalizumab (Raptiva) is an immunosuppressive recombinant humanized IgG1 kappa isotype monoclonal antibody that binds to the CD11a subunit of leukocyte function antigen-1. This binding affects the activation, adhesion, and migration of T lymphocytes. The recommended dosage in psoriasis is a single 0.7 mg/kg subcutaneous injection conditioning dose followed by weekly subcutaneous injections of 1 mg/kg not to exceed a maximum single dose of 200 mg. Ref: Katzung 11th edition Chapter 61.

So the answer to this question is C


Instruction:
The following are true regarding primary gastric lymphoma except:
A. B symptoms are very rare.
B. H. pylori is implicated especially in MALT type
C. Mostly of B cell origin
D. Clinically can be easily differentiated from gastric adenocarcinoma by the presence of early satiety and prominent lymph node metastases.

Response:
GASTRIC LYMPHOMA Stomach is MC site for lymphoma in the GIT MC gastric lymphoma is diffuse large B-cell lymphoma (55%) >extranodal marginal cell lymphoma (MALT) (40%) > Burkitts lymphoma (3%) > mantle cell and follicular lymphomas. Clinical Features: Vague symptoms, namely epigastric painQ, early satiety, and fatigue. B symptoms are very rare. Diagnosis: Endoscopy: Nonspecific gastritis or gastric ulcerations, with mass lesions being unusual.

So the answer to this question is D


Instruction:
PNDT Act 1994 deals with
A. Prohibition of sex selection
B. Age determination
C. Fetal viability
D. Congenital abnormalities

Response:
(A) Prohibition of sex selection# PRE-NATAL DIAGNOSTIC TECHNIQUES (Regulation and Prevention of Misuse) Act, 1994 (PNDT), was amended in 2003 to Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition Of Sex Selection) Act (PCPNDT Act) to improve the regulation of the technology used in sex selection.> Implications of the amendment are: Amendment of the act mainly covered bringing the technique of pre conception sex selection within the ambit of the act Bringing ultrasound within its ambit Empowering the central supervisory board, constitution of state level supervisory board Provision for more stringent punishments Empowering appropriate authorities with the power of civil court for search, seizure and sealing the machines and equipments of the violators Regulating the sale of the ultrasound machines only to registered bodies

So the answer to this question is A


Instruction:
Impulses from SA node to the left atrium and AV node passes through:
A. Bundle of His
B. Bachmann bundle
C. Purkinje fibres
D. None

Response:
There are three bundles of atrial fibers that contain Purkinje-type fibers and connect the SA node to the AV node: the anterior, middle (tract of Wenckebach), and posterior (tract of Thorel) tracts.
Bachmann bundle is sometimes used to identify a branch of the anterior internodal tract that connects the right and left atria.

Key Concept
3 INTERNODAL TRACTS:
Connects SA node to AV node:

Anterior – Bachman’s bundle
Middle – Wenckebach’s bundle
Posterior – Thorel’s bundle

Reference: Ganong’s Review of Medical Physiology T W E N T Y - F I F T H   E D I T I O N page no 519

So the answer to this question is B


Instruction:
Reason for the chronic recurrent subluxation or luxation:
A. Laxity of joint capsule.
B. Eroded articular eminence.
C. Trauma to the joint.
D. All of the above.

Response:
1) Laxity of Joint capsule
 condyle will move without Restriction.
2) Shollow | Flat | eroded Articular eminence (Height↓)
Condyle – jump – eminence
3) Trauma to the Joint
Integrity of ligament – ruptured.

So the answer to this question is D


Instruction:
A 40 year old male complained of pain and mobility of tooth, associated with swelling and pus discharge from gingiva. What is the diagnosis?
A. Periapical granuloma
B. Periodontal abscess
C. Periodontal cyst
D. Periapical cyst

Response:
Radiograph reveals periapical radiolucency associated with bone loss suggestive of periodontal abscess.

So the answer to this question is B


Instruction:
Treatment of choice for old non-united fracture of shaft of femur
A. Compression plating
B. Bone grafting
C. Nailing
D. Compression plating with bone grafting

Response:
D i.e. Compression plating with bone grafting

So the answer to this question is D


Instruction:
All of the following may be used in pregnancy- associated hypertension, EXCEPT:
A. Nifedipine
B. Captopril
C. Methyldopa
D. Hydralazine

Response:
Ans. is 'b' i.e., Captopril * Antihypertensives in pregnancy:1) Alpha methyldopa2) Nifedipine3) Hydralazine4) Labetalol* Angiotensin-converting enzyme (ACE) inhibitors are contraindicated as they are a/w: Oligohydramnios, renal anomalies, neonatal renal failure, pulmonary hypoplasia, hypocalvaria, growth restriction, and death.

So the answer to this question is B


Instruction:
True about Pseudoclaudication is
A. Pain increases on walking uphill
B. Pain decreases on standing still
C. Leaning forward reduces pain
D. Pulses may be feeble or absent

Response:
Psedoclaudication Or Lumbar canal stenosis OPaicular dermatomal pain, associated with motor weakness, OIncreases in standing long duration and relieved by the change in positions like leaning forwards. OAlso, pain is less on walking uphill but increases on walking downhill.

So the answer to this question is C


Instruction:
A patient gives a history of symptoms continuing over several weeks and reports episodes of pain and swelling in the jaw. On palpation, lymphadenopathy is observed. On clinical examination, evidence of sinus formation is also seen. The radiograph of the patient is shown below. What will be the diagnosis?
A. Chronic suppurative (or rarefying) osteomyelitis
B. Acute osteomyelitis
C. Garre's osteomyelitis
D. Sclerosing osteomyelitis

Response:
Chronic suppurative (or rarefying) osteomyelitis:
The disease can occur de novo or represent a progression from the acute stage into a chronic form.
Radiological signs
The periphery of the lesion may be irregular and ill-defined or, in more established cases, a peripheral sclerosis may be seen separating normal from infected bone. Adjacent teeth, if involved in the inflammatory process, will show loss of the lamina dura. The involved bone shows ill-defined patchy radiolucency separated by loci of apparently “normal” bone. As the disease progresses, these radiolucent areas will coalesce and enlarge, often involving the cortex of the bone. The dense radiopacities are islands of non-vital necrotic bone or sequestra. The disease can induce new bone formation, a process referred to as proliferative periostitis or involucrum formation This is seen as one or more radiopaque lines parallel to the cortex and to each other.
Key Concept

So the answer to this question is A


Instruction:
Post-exposure prophylaxis is indicated in ?
A. HBV
B. Rabies
C. Diphtheria
D. All

Response:
Ans. is 'a' i.e., HBV; 'b' i.e., Rabies; 'c' i.e., Diphtheria Read the question carefully, examinar is asking about postexposure prophylaxis (not post-exposure immunization). o In previous explanation, I have explained the diseases for which post-exposure prophylaxis is done by immunization (vaccine or immunoglobulin or both). o In some diseases post-exposure prophylaxis is done by drugs, i.e., post-exposure chemoprophylaxis : - i) HIV --> Antiretroviral therapy ii) Herpes --> Famciclovir iii) Diphtheria iv) Miningococcal meningitis

So the answer to this question is D


Instruction:
Changes in middle ear after birth are observed in-
A. Werdin'stest
B. Ploucquet's test
C. Fodere's test
D. Breslau's test

Response:
Ans. is 'a' i.e., Werdin's test * Werdin's test: Before birth middle ear contains gelatinous embryonic tissue which is replaced by air after respiratioTests used in infanticidePloucquet's test:* Weight of lung is measured in relation to body wieght. Before birth weight of lung is 1/70 of body weight and after respiration it becomes 1/35 of body weight due to increased blood flow in lung beds.Static test or Fodere's test:* The average weight of both lungs before respiration is 30-40 gm and after respiration is 60-70 cm.Hydrostatic test (Raygat's test, 1st life test):* The specific gravity of a non-respired lung is 1040-1050 and of a respired lung is 940-950, so, after respiration lung floats on water (specific gravity of water is 1000).* False positive hydrostatic test may occur (i.e.non-respired lung may float) in decomposition and in attempted artificial respiration.* False negative hydrostatic test (i.e. respired lung may sink down) may occur in atelectasis, pulmonary oedema, bronchopneumonia, and congenital syphylis.Breslau's second life test:* It assumes that a live born child would respire and therefore, would also swallow some air into the stomach and bowel.* Hence they float on water. This test is falsely positive in putrefaction (due to putrefied gases) or in cases of attempted artificial respiration.Werdin's test:* Before birth middle ear contains gelatinous embryonic tissue which is replaced by air after respiration.

So the answer to this question is A


Instruction:
All among the following are markers of Wilms' tumor except:
A. Desmin
B. Vimentin
C. TTF 1
D. Cytokeratin

Response:
Wilms' tumor has it's origin from following: Blastema origin Epithelial origin Stromal origin Intermediate filament Tissue types Keratin Epithelium Vimentin Mesenchyme Desmin Muscle GFAP Neurofilament Neuroglia Neurons Therefore markers of Wilms' tumor from given option are Desmin.Vimentin, Cytokeratin TTF 1 is a immunohistochemical marker used for diagnosis of small cell lung carcinoma, adenocarcinoma of lung and thyroid cancer

So the answer to this question is C


Instruction:
Defects in which of the following doesn’t cause blistering
A. Collagen Vll and pectin
B. Filaggrin
C. Laminin
D. Keratin

Response:
Filaggrin defects causes icthyosis and atopic dermatitis, but not blistering disease.

So the answer to this question is B


Instruction:
Maximum cervical dilatation during labor is: March 2013
A. 6 cm
B. 8 cm
C. 10 cm
D. 12 cm

Response:
Ans. C i.e. 10 cm

So the answer to this question is C


Instruction:
Injection of muscarinic agonist in conjunctival sac will lead to all of the following except
A. Conjunctival and uveal hyperemia
B. Ciliary spasm
C. Miosis
D. Decreased secretion from ciliary epithelium

Response:
(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 449)Effects of muscarinic agentsBlood vessel dilation causing conjunctival and uveal hyperemiaCiliary spasmMiosisIncreased aqueous outflow due to the opening of trabecular meshwork due to ciliary muscle contraction

So the answer to this question is D


Instruction:
Treatment of choice in Pustular psoriasis -
A. Psorialin - UV therapy
B. Systemic steroid
C. Methotrexate
D. Estrogen

Response:
Ans-Cillustrated Synopsis of Dermatology and Sexually Transmitted Diseases - Neena Khanna. TOC of Pustular Psoriasis - 1.Hands and Feet involvement - Topical high-potency steroids + Salicylic acid Topical PUVA/PUVA sol. 2 . Generalized PP- Methotrexate + emollients.

So the answer to this question is C


Instruction:
True stereopsis is perceived due to the following-
A. Overlay of contours
B. Motion parallax
C. Bi- nasal disparity
D. Linear perspective

Response:
Stereopsis is defined as the relative ordering of visual objects in depth, that is, in the third dimension.
It will be very lengthy to explain the physiology of stereopsis here. You remember following facts about stereopsis:-

It is the visual perception of three dimensions during binocular vision.
Nasal disparity (binasal disparity) gives the impression of remoteness of an object.
Temporal disparity (bitemporal disparity) gives the impression of nearness of an object.

So the answer to this question is C


Instruction:
DMF index was given by:
A. Mien, Palmar, Knutson and Henry in 1938
B. Moller in 1966
C. Gruebbel in 1994
D. Katz in 1980

Response:
None

So the answer to this question is A


Instruction:
A patient with Antral Ca repeatedly vomits. Not seen is -
A. Acidosis
B. Hypokalemia
C. Hyponatremia
D. Hypochloremia

Response:
None

So the answer to this question is A


Instruction:
All of the following are true for traditional solution liner, except:
A. It is not necessary in moderately deep cavities under glass ionomer restoration
B. Have Film thickness of 1 -50 microns
C. Do not provide thermal or electric insulation
D. Protect the pulp from reaction products leaching out of restoration

Response:
None

So the answer to this question is B


Instruction:
Somnambulism is mostly seen in which age group?
A. Children
B. Adolescents
C. Adults
D. All age group

Response:
Somnambulism - Sleep walking, seen in stage 4 and 3 of NREM sleep. - It is mostly seen in children and is mostly prevalent in ages 4 to 8 years.

So the answer to this question is A


Instruction:
A five day old, full term male infant was severely cyanotic at bih. Prostaglandin E was administered initially and later ballooned atrial septosomy was done which showed improvement in oxygenation. The most likely diagnosis of this infant is -
A. Tetralogy Fallot
B. Transposition of great vessels
C. Truncus Aeriosus
D. Tricuspid Atresia

Response:
Ans. is 'b' i.e., Transposition of great vessels Transposition of Great vessels is a condition characterized by aoa arising from the right ventricle and pulmonary aery from the left ventricle. This results in complete separation of systemic and pulmonary circulation. Since systemic and pulmonary circulations are separate, survival depends on mixing of oxygenated pulmonary blood and deoxygenated systemic blood which can occur: At Atrial level Through ASD At Ventricle level Through VSD At Great vessel level . Through Patent ductus aeriosus Oxygenation is normal in foetus but after bih as ductus aeriosus closes severe hypoxia occurs and in the absence of VS.D, or ASD child presents with cyanosis and tachypnea at bih. Jantene aerial switch procedure is surgical treatment of choice and should be performed within first 2 weeks of life. Aoa and pulmonary aery are divided just above the sinuses and reanastomosed in correct anatomical positions. The coronary aeries are then removed from old aoic root along with a button of aoic wall and reimplanted in the old pulmonary root. Other operations available : Aerial switch operation by Mustard and Senning.

So the answer to this question is B


Instruction:
Rapid change of presbyopic glass is a feature of
A. Senile cataract
B. Retinal detatchment
C. Intumescent cataract
D. Open angle glaucoma

Response:
D i.e. Open angle glaucoma Conditions associated with altered refraction Feature Found in Frequent change of presbyopic glasses Open angle glaucoma Q Second sight/ Myopic Shift/Improvement in near vision Senile immature nuclear cataract Fluctuation of refractory error Diabetic cataract Frequent change of glasses Coical or nuclear cataract Primary Open Angle Glaucoma/ Chronic Simple Glaucoma It is chronic, slowly progressive, bilateral disease characterized by - adult onset, 10P > 21 mmHg at some point in the course of disease, an open angle, glaucomatous optic nerve head damage and visual field loss. It presents with painless progressive loss of vision Q, frequent change in presbyopic glasses Q and difficulty in near work owing to accommodative failure.

So the answer to this question is D


Instruction:
Lymes disease all are true except
A. Borellia bourgdroferi replicates locally and invades locally
B. Infection progresses inspite of good humoral jmmunity
C. Polymorphonuclear lymphocytosis in CSF suggest meningial involvement
D. IgA intrathecally confirms meningitis

Response:
Polymorphonuclear leucocytosis in C.S.F. suggests meningeal involvement Spread of infection and immune response in Lyme disease Lyme disease is caused by Borrelia Burgdorferi. Borrelia burgdorferi is transmitted to humans the bite of ixodes tick vector. Borrelia burgdorferi is inoculated in the skin, where local replication takes place locally and outward migration in the dermis occurs. Days to week after the tick bite, hematogenous dissemination to secondary sites (like joints, hea eye, nervous system) takes place. If untreated, the bacteria may persist in the body for months or even years, despite the production of anti-Borrelia burgodorferi antibodies by the immune system. The following mechanisms have been described - i) Tick saliva, which accompanies the spirochete into the skin during the feeding process, contains substances that disrupt the immune response at the site of the bite. - This provides a protective environment where the spirochete can establish the infect on. ii) Once inside the body, Borrelia burgdorferi becomes a "stealth invader" i.e., it changes shape. In the tick and mice which host the bacterium through most of its life cycle, the bacterium has a thick cell wall and spiral shape. If it maintains its thick cell wall and its spiral shape, immune system can control infection. However, in the human body, it can shed its cell wall and can take a different shape. When under attack from immune system, it simply changes shape so it is not recognized. iii) Borrelia burgdorferi produces antigenic variation in a "cell surface lipoprotein VIsE", during the course of infection The VIsE system presents a challenge to immune system because after an immune response is generated to one version of VIsE protein, a different version is quickly produced. By using this type of antigenic variation, B. burgdorferi can escape the adaptive immune system. Lyme meningitis Meningitis (meningeal involvement) is the most common neurological event that occurs in the setting of early lyme dissemination. - In this clinical setting CSF is always abnormal and shows: I) Pleocytosis with predominantly lymphocytosise (not polymorphonuclear leukocytosis). 2) Increased protein 3) Glucose content is usually normal, but it falls below the serum concentration in 20% of patients. Immunoglobulin abnormalities are common in the CSF of patients with lyme meningitis. - Specific IgM, IgG or IgA antibody against B. burgdorferi appears in CSF and indicates intrathecal antibody synthesis.

So the answer to this question is C


Instruction:
Maximum number of unusual base pairs are seen in
A. rRNA
B. tRNA
C. mRNA
D. snRNA

Response:
The transfer RNA show extensive internal base pairing and acquire clover leaf like structures. They contain a significant propoion of unusual bases. These include dihydrouracil (DHU) pseudouridine (Ps) and hypoxanthine. Moreover, many bases are methylated. REFERENCE : DM.VASUDEVAN.TEXTBOOK SEVENTH EDITION ; PAGE NO : 596.

So the answer to this question is B


Instruction:
Most common organ to be injured in primary blast injuries is:
A. Liver
B. Spleen
C. Skin
D. Tympanic membrane

Response:
Ans: D (Tympanic membrane) Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy. 29th edition. 2010.Explanation:Primary blasts can be air blast, underwater blast or solid blast.The injury is a result of the wave of pressure created during a blast.Most common organ involvement:Air blast - Tympanic membrane. Lung, Middle ear, cochlea, eyes. bowelsUnderwater blast - GIT, lungsSolid blast - Skeleton, GIT. Lungs

So the answer to this question is D


Instruction:
TRUE about Gestational Trophoblastic Disease is?
A. Most common site of metastasis is vagina
B. Presence of Lung metastasis classifies as stage 4 GTN
C. Liver metastasis carries a poor prognosis similar to brain metastasis
D. GTN following a term pregnancy has a better prognosis than that with previous molar pregnancy

Response:
Most common site of metastasis in choriocarcinoma is lung, which is classified as stage 3. Brain and liver metastasis are stage 4 and carry poor prognosis GTN following term pregnancy carries worse prognosis than that following a molar pregnancy or an aboion

So the answer to this question is C


Instruction:
Best diagnostic sign in CDH
A. Oolani's test
B. Telescopy
C. Asymmetry in gluteal skin fold
D. Limitation of abduction of hip with thigh flexed

Response:
OOLANI&;STEST is used to test DDH in infants In this test the baby&;s thighs are held with the thumbs medially and the fingers resting on the greater trochanters; the hips are flexed to 90 degrees and gently abducted. In NORMAL baby, there is smooth abduction to almost 90 degrees. In CONGENITAL DISLOCATION the movement is usually impeded,but if pressue is applied to the greater trochantehere is a soft &;CLUNK&; as the dislocation reduces,and then the hip abducts fully(JERK OF ENTRY) If abduction stops halfway and there is no jerk of entry, there may be an irreducible dislocation . ref:APLEY&;S 9th edition page no.499

So the answer to this question is A


Instruction:
According to ICDS, supplements given to a pr eganant woman are -
A. 200 kcal and 10g protein
B. 250 kcal and 12g protein
C. 300 kcal and 15g protein
D. 330 kcal and 15g protein

Response:
Park's textbook of preventive and social medicine 23rd edition. * Each pregnant and nursing woman to get 600 cal and 18-20 G of protein per day.

So the answer to this question is A


Instruction:
In DMF index, F indicates a tooth with:
A. Zinc oxide eugenol filling
B. Silver amalgam filling
C. Caries below an existing restoration
D. Permanent filling in a deciduous tooth

Response:
Indicates the number of permanent teeth that have been attacked by caries, but which have been restored to keep them in a healthy condition in mouth.
A tooth may have several fillings, but it is counted as one tooth.
If a tooth has a filling but shows evidence of recurrent decay, it is counted as a decayed tooth. (Option 3 is eliminated)
Temporary restorations are considered as Decayed (Option 1 is eliminated)
Only permanent teeth are considered (Option 4 is eliminated).

Essentials of preventive and community dentistry
5th edition
Soben Peter

So the answer to this question is B


Instruction:
In withdrawing a blood sample from the median cubital vein the needle passes slightly deep and medial; which nerve might possibly be injured?
A. Dorsal ulnar cutaneous
B. Lateral antebrachial cutaneous
C. Medial antebrachial cutaneous
D. Posterior antebrachial cutaneous

Response:
The medial antebrachial cutaneous nerve is a direct branch from the medial cord of the brachial plexus. Since it provides cutaneous sensation to the medial side of the anterior forearm, it is slightly medial to the medial cubital vein and could be injured by a needle. If the needle had gone laterally, it might have injured the lateral antebrachial cutaneous nerve, which is running down the lateral side of the anterior forearm. This nerve is a branch of the musculocutaneous nerve. The posterior antebrachial cutaneous nerve runs on the posterior surface of the arm. It comes from the radial nerve. The dorsal ulnar cutaneous nerve is the nerve which runs on the dorsal side of the hand, providing cutaneous innervation to the ulnar side of the wrist, hand, and the medial 1.5 fingers. Finally, the superficial radial nerve innervates the dorsum of the radial side of the hand.

So the answer to this question is C


Instruction:
Commonest presentation of Wilm's tumour is:
A. Hematuria
B. Abdominal lump
C. Hydronephrosis
D. Pain in abdomen

Response:
WILMS TUMOR Wilm's Tumor: MC primary renal tumor of childhood (2-5 Years) Wilm's Tumor: 2nd MC malignant abdominal tumor in children (MC is neuroblastoma). Arise from kidney, composed of three elements- Blastema, Epithelium & Stroma. (BESt) MC presenting feature is asymptomatic abdominal mass or swelling.

So the answer to this question is B


Instruction:
The Most common site of cerebral hemorrhage in hypertension is
A. Pons
B. Cerebrum
C. Putamen
D. Thalamus

Response:
(C) Putamen > Most common sites are:- Basal ganglia (putamen, thalamus). Deep cerebellum. Pons.

So the answer to this question is C


Instruction:
Pugilistic attitude is seen in:
A. Drowning
B. Burns
C. Lightening
D. Hanging

Response:
Ans. (b) BurnsRef: The Essentials ofFSM by K.S. Narayan Reddy 31st ed. / 299* Pugilistic attitude is seen in case of burns.* It is also known as Boxing or fencing attitude.* Pugilistic attitude is due to coagulation of proteins other than those affected by rigor mortis.* It is seen in both antemortem as well as postmortem burns.Also know* Most common finding of antemortem drowning: Clenched Fist.* In case of Lightning: Branching tree pattern seen.

So the answer to this question is B


Instruction:
Vesicular transpo is atype of:
A. Active transpo
B. Passive transpo
C. Diffusion
D. Osmosis

Response:
Vesicular transpo utilizes atp and is atype of active transpo It includes exocytosis and endocytosis

So the answer to this question is A


Instruction:
Denominator in maternal mortality rate (MMR) is
A. Total no of females in Reproductive age group
B. Total population
C. No. of live Births
D. Total no of pregnant women

Response:
None

So the answer to this question is C


Instruction:
Long term use of lithium causes -
A. Hypopituitarism
B. Diabetes mellitus
C. Hypothyroidism
D. Hyperthyroidism

Response:
Ans. is 'c' i.e., Hypothyroidism o Lithium can cause hypokalemia.Side effects of lithium1) Neurological: - Tremor is the commonest side effect of lithium. Other CNS side effects are giddiness, ataxia, motor incordination, hyperreflexia, mental confusion, nystagmus.2) Renal: - Nephrogenic diabetes insipidus with polyuria & polydipsia. Amiloride is the DOC for Lithium induced nephrogenic DI.3) Cardiovascular: - Effects are similar to hypokalemia which causes arrhythmia. Most common ECG change is T wave depression.4) Endocrine: - Goitre, hypothyroidism.5) GIT: - Nausea, vomiting, diarrhoea, metallic test, abdominal pain.6) Dermatological: - Acneiform eruptions, papular eruption, exacerbation of psoriasis.7) Teratogenicity: - Ebstein's anomaly in fetus.

So the answer to this question is C


Instruction:
Which is seen in RNA but not seen in DNA?
A. Adenosine
B. Guanine
C. Uracil
D. Thymine

Response:
In the Watson-Crick base pairing, adenine (A) forms a base pair with thymine (T), as does guanine (G) with cytosine (C) in DNA.In RNA, thymine is replaced by uracil (U).Alternate hydrogen bonding patterns also occur -- paicularly in RNA -- giving rise to complex and functional teiary structures.

So the answer to this question is C


Instruction:
Santushti strategy is associated with:
A. Female literacy
B. Population control
C. Rural infrastructure
D. None of the above

Response:
Santushti is an incentive and public private panership for private sector surgeon and gynaecologist who get accredited facilities with 100 sterilization surgeries. Ref: National Health Programmes in India, J.Kishore, 10th edition pg: 751

So the answer to this question is B


Instruction:
Acanthosis involves
A. Stratum corneum
B. Stratum spinosum
C. Stratum granulosum
D. Stratum lucidum

Response:
Acanthosis is used to describe increase in the number of cells in the Malphigian or prickle cell layer of the epidermis Acanthosis is diffuse epidermal hyperplasia (thickening of the skin). It implies increased thickness of the Malpighian layer (stratum basale and stratum spinosum). Acanthosis nigricans is often associated with type 2 diabetes, and is usually observed in the back of neck, axilla, and other folded regions of the skin. Ref: Harrison 20th edition pg 1246

So the answer to this question is B


Instruction:
Patient with blood group O receive plasma from
A. Group A only
B. Group B only
C. Group AB only
D. From Group A,B, AB

Response:
Persons with a given antigen do not make antibodies against their own antigen, but will against the other antigens in that group. For example, if a person has type A blood, he (or she) will make antibodies against the B antigen, but not against the A antigen. That means that if this person is given either type B red blood cells or type AB red blood cells, his or her antibodies will attack and destroy the foreign red cells possessing the B antigen, causing a transfusion reaction. Similarly, a person having the RhD antigen will not make antibodies against RhD antigen, but the RhD negative person will make antibodies against blood with RhD positive red cells. Recipient Blood Type Matching Donor Blood Type A+ A+, A-, O+, O- A- A-, O- B+ B+, B-, O+, O- B- B-, O- AB+ Compatible with all blood types AB- AB-, A-, B-, O- O+ O+, O- O- O- Antibodies in the plasma of donors with different blood types cause a reverse situation. For example, since a person with Type AB blood makes no antibodies against Type A or Type B cells, his or her plasma can be given to a person with Type A, Type B, Type AB, or Type O blood

So the answer to this question is D


Instruction:
The following statements are related to occipitopos- terior except:
A. Malrotation of occiput may cause occipitosacral arrest
B. 10% cases are associated with anthropoid or android pelvis
C. Incomplete forward rotation of occiput may cause deep transverse arrest
D. Nonrotation of occiput may cause are associated

Response:
All the options given in the question are correct except – option b
“In more than 50%, the occipitoposterior position is associated with either on anthropoid or android pelvis”
Dutta Obs 7/e, p 365

So the answer to this question is B


Instruction:
The risk of complex hyperplasia of the endometrium with atypia progressing to malignancy in a postmenopausal woman is about:
A. 3%
B. 8%
C. 15%
D. 28%

Response:
Ans. is 'd' i.e., 28% Endometrial hyperplasia The glandular hyperplasia's of the endometrium are benign conditions that may produce symptoms clinically indistinguishable from early endometrial carcinoma. Because of their association with hyperestrogenic states, some of the hyperplasias even though reversible, are considered premalignant lesions. Hyperplasias can be classified as simple or complex and with or without atypia. The rate of progression of these hyperplasia's to malignancy is. Hyperplasia without atypia Simple -1% Complex -3% Hyperplasia with atypia Simple -8% Complex -29% More about Endometria hyperplasia. Since endometrial hyperplasia and endometrial carcinoma present clinically as abnormal bleeding, thorough endometrial sampling or fractional curettage is always necessary when hyperplasia is present to rule out coexisting carcinoma. A) Hyperplasia without Atypia No nuclear atypia In general hyperplasia without atypia are considered nonmalignant or benign. B) Hyperplasia with Atypia Atypia present (Increased nuclear / Cytoplasmic ratio) Nucleus irregular with coarse chromatin clumping Generally considered premalignant

So the answer to this question is D


Instruction:
All are to be done in case of 20 years old female coming to casualty with right iliac fossa pain, with local guarding and tenderness, EXCEPT ?
A. IV glucose
B. Pethidine 100 mg. I.M.
C. Nill orally
D. None

Response:
Ans is None Answer was Pethidine according to Harrison 14/e, p 67, but it has changed in the 15th, 16th and 17th editions. See bel ow? Harrison 14/e --> "Narcotics or analgesics should be withheld until a definitive diagnosis or a definitive plan has been formulated, because these agents often make it more difficult to secure and to interpret the history and physical finding." Harrison 15/e, 16/e and 17/e --> "Narcotics or analgesics should not be withheld until a definitive diagnosis or a definitive plan has been formulated; obfuscation of the diagnosis by adequate analgesia is unlikely."

So the answer to this question is D


Instruction:
Characteristic of an ideal gas is
A. Volume is directly propoional to change in pressure
B. Volume is inversely propoional to change in temperature
C. At absolute temp. volume of gas is 1
D. Obeys Carles, Byles and Avagadro' laws

Response:
D i.e. Obeys Charles, boyle's & avogadro's laws

So the answer to this question is D


Instruction:
Caranial nerve passing through foramen ovale includes
A. Mandibular nerve
B. Oculomotor nerves
C. Greater petrosal nerve
D. Sympathetic nerve fibres

Response:
structures passing through foramen ovale: Mandibular nerve Accessory meningeal aery Lesser petrosal nerve Emissary vein connecting cavernous sinus with pterygoid plexus. Ref BDC volume 3; 6th edition pg 56

So the answer to this question is A


Instruction:
A deterministic effect
A. Has a threshold in dose but the severity of the effect is otherwise dose-independent
B. Has a threshold in dose and the severity of the effect increases with dose
C. Has no threshold in dose and the severity of the effect is a constant function of dose
D. Has no threshold in dose and the severity of the effect increases with dose

Response:
Deterministic effect: severity increases with dose; practical threshold; the probability of occurrence increases with dose; e.g., cataract.Stochastic effect: severity independent of dose; probability of occurrence increases with dose; no threshold; e.g., cancerReference: Eric J Hall Textbook of Radiobiology for Radiologist; 5th edition

So the answer to this question is B


Instruction:
Pulsus bisiferiens is seen in all, except -
A. Aoic regurgitation + Aoic stenosis
B. obstructive cardiomyopathy
C. Hyperophic cardiomyopathy
D. Tetralogy of Fallot

Response:
pulsus bisferiens, , is a sign where, on palpation of the pulse, a double peak per cardiac cycle can be appreciated. Bisferious means striking twice. Classically, it is detected when aoic insufficiency exists in association with aoic stenosis, but may also be found in isolated but severe aoic insufficiency and hyperophic obstructive cardiomyopathy. Normally, aerial pulses are best felt in radial aeries but character is better assessed in carotid aery. Pulsus bisferiens is best felt in brachial and femoral aeries. Ref Harrison 20th edition pg 1432

So the answer to this question is D


Instruction:
World diabetes day is celebrated on ?
A. 8th may
B. 8th march
C. 14th November
D. 1" december

Response:
Ans. is 'c' i.e., 14th November8 May - World Red Cross Day8th March - International Women's Day14th November -/ World Diabetes Dayl' December - World AIDS Day

So the answer to this question is C


Instruction:
Reason for shock in uterine inversion -
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock

Response:
Ans. is 'd' i.e., Neurogenic shock Uterine inversiono It is an extremely rare but a life-threatening complication in third stage in which the uterus is turned inside out partially or completely. The incidence is about 1 in 20,000 deliveries. The obstetric inversion is almost always an acute one and usually complete.o Shock in patients with uterine inversion is neurogenic and occurs due to the following:# Tension on nerves due to stretch on neurovascular bundles# Pressure on ovaries as they are dragged# Peritoneal irritation

So the answer to this question is D


Instruction:
Level II axillary lymph node:
A. Lateral to pectoralis major and minor
B. Behind pectoralis minor
C. Medial to pectoralis minor
D. Superomedial to pectoralis major

Response:
Level II axillary lymph node is located behind pectoralis minor. Axillary LN Levels in relation with Pectoralis minor Level Relation with Pectoralis minor Axillary LNs Included I Below or lateral Anterior, posterior, lateral II Posterior (behind) Central, Interpectoral (Rotter's nodes) III Medial or above Apical

So the answer to this question is B


Instruction:
The commonest cause of vomiting in a one month old infant is
A. Pyloric stenosis
B. Cardiac chalasia
C. Aerophagy
D. Gastro-esophageal reflux

Response:
Aerophagia (var. aerophagy) is a condition of excessive air swallowing, which goes to the stomach. Aerophagia may also refer to an unusual condition where the primary symptom is excessive flatus, belching is not present, and the actual mechanism by which air enters the gut is obscure.Aerophagia in psychiatry is sometimes attributed to nervousness or anxiety. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is C


Instruction:
A 36-year-old male comes with a 2-day history of chest pain. The pain has been continuous and does not change with activity. Vital signs show normal BP, mild tachycardia and tachypnea, and an oxygen saturation of 90% on room air. Cardiopulmonary exam is normal. An ECG shows a rate of 106 beats/min, left axis detion, left ventricular hyperophy, PR depression, and T wave inversions in V2 to V5. Troponin and CPK-MB are minimally elevated. What is the most likely diagnosis.
A. Pulmonary embolism
B. Costochondritis
C. Pericarditis
D. Unstable angina

Response:
Option A: Pulmonary embolism= Ruled out because PE ECG findings are S1Q3T3/Sinus tachycardia Option C: PR segment depression = Atrial myocardium damage T wave inversion - Ventricular myocardium damage This is talking about diffuse damage in the hea. Option D: ECG of unstable angina= ST normal Sometimes ST | T wave inversion & hemodynamic parameters are normal so it unlikely to be unstable angina.

So the answer to this question is C


Instruction:
Serum lactate dehydrogenase (LDH) increased with normal alpha fetoprotein (AFP) is seen with:
A. Dysgerminoma
B. Yolk sac tumor
C. Brenner's
D. Mucinous cystodenocarcinoma

Response:
ANS. A# Histology slides of gynecological malignanciesGranulosa cell tumor (coffee bean nuclei)Yolk sac tumorKrukenberg tumor (spindle cells)

So the answer to this question is A


Instruction:
Laudanosine is the metabolite of:
A. Suxamethonium
B. Pancuronium
C. Atracurium
D. Vecuronium

Response:
Atracurium

So the answer to this question is C


Instruction:
A 33-year-old woman presents with black stools. Laboratory studies demonstrate a hypochromic, microcytic anemia. Upper GI endoscopy reveals a duodenal ulcer. Which of the following best describes the stools in this patient with peptic ulcer disease?
A. Hematemesis
B. Hematobilia
C. Hematochezia
D. Melena

Response:
Melena (black stool) is a symptom of upper gastrointestinal bleeding. Blood from ruptured esophageal varices or a peptic ulcer is partially digested by hydrochloric acid. Hemoglobin is transformed into a black pigment (hematin), which imparts a typical "coffee-grounds" color to the stool. Hematemesis (choice A) is vomiting of blood. Hematobilia (choice B) is bleeding into the biliary passages, as a complication of trauma or neoplasia. Hematochezia (choice C) is passage of bloody stools caused by lower gastrointestinal hemorrhage. Steatorrhea (choice E) is passage of fatty stools caused by pancreatic disease and malabsorption.Diagnosis: Peptic ulcer disease

So the answer to this question is D


Instruction:
Hilton method is best used in
A. Breast abscess
B. Axillary abscess
C. Paronychia
D. Pulp abscess

Response:
Answer- B. Axillary abscessHilton's method of abscess drainage is chosen when there are plenty of impoant structures like nerves and yessels around the abscess caity, like axilla. In this method incision is made only through the skin and subcutaneous tissue. The deep fascia is not incised.

So the answer to this question is B


Instruction:
Electroplate silver die material is best compatible with all EXCEPT
A. Addition silicones
B. Polysulfides
C. Polyethers
D. Condensation silicones

Response:
None

So the answer to this question is C


Instruction:
A verbal statement recorded by magistrate without oath by an assaulted person narrating the sequence of events responsible for his condition, is called as ?
A. Summon
B. Punchnama
C. Dying deposition
D. Dying declaration

Response:
Ans. is 'd' i.e.,Dying declaration

So the answer to this question is D


Instruction:
Tooth whitening strip is
A. H2O2
B. HF
C. Carbamide peroxide
D. Sodium perborate

Response:
None

So the answer to this question is A


Instruction:
Perforins are produced bya) Cytotoxic T cellsb) Suppressor T cellsc) Memory helper T cellsd) Plasma cellse) NK cells
A. a
B. b
C. ae
D. ad

Response:
Perforins

Perforins are hole forming proteins, cause transmembrane pores through which cytotoxic factors enter the cell and destroy it by apoptosis.
Perforins are produced by:

Cytotoxic T cells   → Robbin's 218
N.K. Cells → Ananthanarayan 126

So the answer to this question is C


Instruction:
All of the following statements about congenital rubella are true except
A. IgG persists for more than 6 months
B. IgM antibody present at bih
C. Most common anomalies are hearing and hea defects
D. Increased risk of congenital malformation if infection occur after 16 weeks.

Response:
The classical triad of symptoms consists of deafness , cataract and congenital hea disease . Delayed manifestations such as diabetes mellitus and renal disease have also been described . Diagnosis is by demonstrating Ig M antibodies in cord or neonatal blood or ig G after 6 months . Reference : GHAI essential paediatrics 9 th edition pg : 264

So the answer to this question is D


Instruction:
A 3 hours old neonate with apnea is on bag and mask ventilation for last 30 seconds, now showing spontaneous breathing with heart rate 110/min. The next step should be –
A. Discontinue ventilation
B. Continue ventilation
C. Give chest compression
D. ET intubation

Response:
None

So the answer to this question is A


Instruction:
Disease not under integrated disease surveillance project is?
A. TB
B. Meningoencephalitis
C. Cholera
D. Herpes Zoster

Response:
Ans. is `d' i.e., Herpes Zoster

So the answer to this question is D


Instruction:
Suppos of the uterus are all except
A. Utero sacral ligament
B. Broad ligament
C. Mackenrodt's ligament
D. Mackenrodt's ligament

Response:
Mackenrodt's ligament

So the answer to this question is B


Instruction:
Congenital adrenal hyperplasia most commonly presents as
A. Male pseudohermaphroditism
B. Female pseudohermaphroditism
C. True hermaphroditism
D. 46, XY intersex

Response:
Female pseudohermaphroditism is genotypically female (46,XY ) but external genitalia looks like that of male.

So the answer to this question is B


Instruction:
The main complication associated with multiple pregnancy:
A. PPH
B. Twin interlocking
C. Foetus papyraceous
D. Eclampsia

Response:
Ans. A. PPHPPH is the real danger in twins due to:a. Atony of uterine muscles due to overdistension of uterus.b. Longer time taken by big placenta to separate.c. Bigger surface area of the placenta exposing more uterine sinuses.d. Implantation of a part of placenta in lower segment which is less retractile.

So the answer to this question is A


Instruction:
All are cellular adaptations except ?
A. Hyperophy
B. Hyperplasia
C. Necrosis
D. Metaplasia

Response:
Ans. is 'c' i.e., Necrosis

So the answer to this question is C


Instruction:
Prions disease all are true except aEUR'
A. They are caused by infectious proteins
B. Biopsy of brain diagnostic
C. Neurodegenrative desease
D. Myoclonus found only in 10% cases

Response:
Myoclonus found only in 10% cases Prions are infectious proteins that cause degeneration of the central nervous system They are infectious paicles that lack nucleic acid Prions are composed largely, if not entirely of PrP molecules

So the answer to this question is D


Instruction:
The programme Kalyani on Doordarshan deals with:
A. Health
B. Agriculture
C. Spos
D. All of the above

Response:
Kalyani is a health programme telecast in 9 capital Doordarshan stations and 12 sub regional stations by PrasarBharati targeting those living in the most populous states. Ref: Health policies and programmes in India, D.K. Taneja 11th edition page: 353

So the answer to this question is A


Instruction:
Profound MR the IQ is below
A. 50
B. 40
C. 20
D. 10

Response:
Just learn the IQ ranges

So the answer to this question is C


Instruction:
Which is not a constituent of juxtaglomerular complex:September 2011
A. Macula densa
B. Glomerulus
C. juxtaglomerular cells
D. Extraglomerular mesangial cells

Response:
Ans. B: GlomerulusThe JGA is composed of JG cells, macula densa cells and mesangial/Lacis cellsJuxtaglomerular apparatusThere are 3 different types of cells in the Juxtaglomerular Apparatus: Granular Cells/ juxtaglomerular cells, Macula Densa Cells and Mesangial Cells.Granular Cells/ juxtaglomerular cellsGranular cells are modified pericytes of glomerular aerioles.They are also known as Juxtaglomerular cells.The Juxtaglomerular cells secrete renin in response to:- Betal adrenergic stimulation- Decrease in renal perfusion pressure (detected directly by the granular cells)- Decrease in NaC1 absorption in the Macula Densa (often due to a decrease in glomerular filtration rate, causing slower filtrate movement through the proximal tubule and thus more time for reabsorption. This results in a lower NaC1 concentration by the time the filtrate reaches the Macula Densa).Macula Densa CellsMacula densa cells are columnar epithelium thickening of the distal tubule.The macula densa senses sodium chloride concentration in the distal tubule of the kidney and secretes a locally active (paracrine) vasopressor which acts on the adjacent afferent aeriole to decrease glomerular filtration rate (GFR), as pa of the tubuloglomerular feedback loop.Specifically, excessive filtration at the glomerulus or inadequate sodium uptake in the proximal tubule / thick ascending loop of Henle brings fluid to the distal convoluted tubule that has an abnormally high concentration of sodium.Na/Cl cotranspoers move sodium into the cells of the macula densa.The macula densa cells do not have enough basolateral Na/K ATPases to excrete this added sodium, so the cell's osmolarity increases.Water flows into the cell to bring the osmolarity back down, causing the cell to swell.When the cell swells, a stretch-activated non-selective anion channel is opened on the basolateral surface.ATP escapes through this channel and is subsequently conveed to adenosine.Adenosine vasoconstricts the afferent aeriole Al receptors and vasodilates (to a lesser degree) efferent aerioles A2 receptors which decreases GFR.Also, adenosine inhibits renin release in JG cells A2 receptors on JG cells using Gi pathway.Also, when macula densa cells detect higher concentrations of Na and Cl they inhibit Nitric Oxide Synthetase (decreasing renin release).Mesangial cells/ Lacis cellsMesangial cells are structural cells in the glomerulus that under normal conditions serve as anchors for the glomerular capillaries.The mesangial cells within the glomerulus communicate with mesangial cells outside the glomerulus (extraglomerular mesangial cells), and it is the latter cells that form pa of the juxtaglomerular apparatus.These cells form a syncytium and are connected with glomerular mesangial cells gap junctions.They contain actin and myosin, allowing them to contract when stimulated by renal sympathetic nerves, which may provide a way for the sympathetic nervous system to modulate the actions of the juxtaglomerular apparatus.

So the answer to this question is B


Instruction:
Homocystinuria is caused by deficiency of
A. Riboflavin
B. Biotin
C. Pyridoxine
D. Thiamine

Response:
PLP is the coenzyme for many reactions if amino acids containing sulphur. PLP plays an impoant role in methionine and cysteine metabolism. Homocysteine + Serine - Cystathionine. (Enzyme Cystathionine synthase) Cystathionine - Homoserine + Cysteine (Enzyme Cystathionase) Both these reactions require PLP. Hence in vitamin, B6 deficiency homocysteine in the blood is increased. Homocysteine level is correlated with myocardial infarction. Therefore, pyridoxine is used to prevent homocysteinemia. Ref: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 471

So the answer to this question is C


Instruction:
Principles of treatment of Pyogenic infection of skeletal system are
A. Analgesics
B. Antibiotics
C. Steroids
D. Non-operative

Response:
. Treatment is antibiotics,radical wound excision with removal of pus and all necrosed muscle and compament release haemodialysis is needed until recovery if there is renal failure later secondary suturing or skin grafting is needed. (Ref: SRB's Manual of surgery,5th edition,pg no.65)

So the answer to this question is B


Instruction:
Diffusion capacity for carbon monoxide is decreased in all of the following Except:
A. Chronic Bronchitis
B. Emphysema
C. Interstitial lung disease
D. Pulmonary embolism

Response:
Answer is A (Chronic Bronchitis): Diffusion capacity for carbon monoxide (DLCO) is usually normal in chronic bronchitis and other obstructive lung diseases with the exception of Emphysema where it is decreased. Diffusion capacity for carbon monoxie (DLCO) Diffusion capacity is altered in disease affecting the functional integrity of the alveolar capillary membrane. In Emphysema, alveolar walls are destroyed, so the surface area of alveolar-capillary bed is diminished resulting in diminished DL CO. Three main categories are associated with lowered DLCO Emphysema Q Interstitial Lung Disease Q Pulmonary vascular disease (Recurrent Pulmonary emboli or Primary Pulmonary Hypeension)Q

So the answer to this question is A


Instruction:
Which anesthetic induction agent produces cardiac stability. In other words cardiostable anesthesia is.
A. Ketamine
B. Propofol
C. Thiopental
D. Etomidate

Response:
D. i.e. Etomidate

So the answer to this question is D


Instruction:
An elderly male presents with pain in his shoulders and hips. Temporal arteries are tender to palpation. ESR is 105 mm/L.
A. Churg-Strauss syndrome
B. Cryoglobulinemic vasculitis.
C. Temporal arteritis
D. Granulomatosis with polyangiitis (Wegener granulomatosis)

Response:
The large vessel vasculitides include temporal (giant cell) arteritis and Takayasu arteritis. Temporal arteritis typically occurs in older patients and is accompanied by aching in the shoulders and hips, jaw claudication, and a markedly elevated ESR. Takayasu arteritis, a granulomatous inflammation of the aorta and its main branches, typically occurs in young women. Symptoms are attributed to local vascular occlusion and may produce arm or leg claudication. Systemic symptoms of arthralgia, fatigue, malaise, anorexia, and weight loss may precede the vascular symptoms. Surgery may be necessary to correct occlusive lesions.

So the answer to this question is C


Instruction:
Following name is associated with Psychodynamic theory -
A. Carl Jung
B. Sigmund Freud
C. Emil Craplein
D. Eugen Bleuler

Response:
None

So the answer to this question is B


Instruction:
In a small child diagnosed with H. influenzae meningitis, what investigation must be done before discharging him from the hospital?
A. BERA
B. MRI
C. CT scan
D. X-ray skull

Response:
- Sensorineural hearing loss is the most common sequelae of bacterial meningitis, - It is a result of cochlear infection and occurs in as many as 30% of patients with pneumococcal meningitis, 10% with meningococcal, and 5-20% of those with H. influenzae type b meningitis. - So hearing evaluation with BERA should be done in all cases of bacterial meningitis before or soon after discharge from the hospital.

So the answer to this question is A


Instruction:
National Family Health Survey has successfully completed
A. One rounds
B. Two rounds
C. Three rounds
D. Four rounds

Response:
Is a large-scale, multi-round survey conducted in a representative sample of households throughout India
3 rounds of the survey have been conducted till 2006:
NFHS–1: 1992–93
NFHS–2: 1998–99
NFHS–3: 2005–06

So the answer to this question is C


Instruction:
An 8-year-old child presented with pain at shoulder and arm. A X-ray reveals a uniform well-defined lucent lesion at the metaphysis. Most likely diagnosis is?(AIIMS 2016)
A. Simple bone cyst
B. Aneurysmal bone cyst
C. Giant cell tumour
D. Osteoid osteoma

Response:
Ans. A Simple bone cystLucent geographic lesion seen in humeral metaphysis in a child is most commonly a simple bone cyst. Trapdoor signQ/Fallen fragment signQ/Hinged fragment signQ may be seen.

So the answer to this question is A


Instruction:
All of the following are methods of cellular adaptation EXCEPT -
A. Atrophy
B. Hyperplasia
C. Hypertrophy
D. Dysplasia

Response:
(D) (Dysplasia) (5-Robbins-Basic Pathology 9th)Cellular Adaptations to stressAdaptations are reversible changes in the number, size, phenotype, metabolic activity, or functions of cells in response to changes in the their environment.Physiologic AdaptationPATHOLOGIC ADAPTATION* Hormones* Endogenous chemical mediators e.g. Hormone induced enlargement of the breast and uterus during pregnancy.* Modulate their structure and function and thus escape injury.CELLULAR ADAPTATIONS TO STRESS:* Hypertrophy: Increased cell and organ size, often in response to increased workload; induced by growth factors produced in response to mechanical stress or other stimuli; occurs in tissues incapable of cell division.* Hyperplasia: Increased cell numbers in response to hormones and other growth factors; occurs in tissues whose cells are able to divide or contain abundant tissue stem cells.* Atrophy: Decreased cell and organ size, as a result of deceased nutrient supply or disuse; associated with decreased synthesis of cellular building blocks and increased breakdown of cellular organelles.* Metaplasia: Change in phenotype of differentiated cells, often in response to chronic irritation, that makes cells better able to with stand the stress; usually induced by altered differentiation pathway of tissue stem cells; may result in reduced functions or increased propensity for malignant transformation.

So the answer to this question is D


Instruction:
Melasma, during pregnancy is seen on: March 2011
A. Breast
B. Face
C. Abdomen
D. Limbs

Response:
Ans. B: Face Chloasma gravidarum/ pregnancy mask is an extreme form of pigmentation around the cheek, forehead and around the eyes, during pregnancy Signs of pregnancy: Chadwick's sign: Congestion of pelvis causes bluish/ purplish hue of vagina/ cervix Goodell's sign: Cyanosis of softening of cervix Hegar's sign: Compressibility of isthmus on bimanual examination Piskacek's sign: Softening of cervix with lateral implantation Osiander's sign: Pulsations in lateral vaginal fornix Palmer's sign: Rhythmic contractions of uterus Weinberg sign: Abdominal pregnancy

So the answer to this question is B


Instruction:
A 25 - year - old lady presented with curdy white discharge from vagina with itching over vulva, is likely to be suffering from:
A. Gonococcal vulvovaginitis
B. Candidiasis
C. Trichomoniasis
D. Chlamydia trachomatis

Response:
Candidiasis Dimorphic fungi Blastospores(spread) Mycelia( invasive and adherent) Occur in acidic pH Curdy white discharge Plaques on vaginal wall -On removal- Petechiae Out of propoion Pruritis Rx: Azoles Oral Fluconazole Rx both female and male

So the answer to this question is B


Instruction:
The abduction contracture at the hip joint is evaluated clinically by the:
A. Thomas test
B. Gerhardt's test
C. Ober's test
D. Ely's test

Response:
Ans. C. Ober's testa. Ober's test determines the tightness of the fascia lata or in other words is used to determine abduction contracture of the hip. This is performed by placing the patient on the unaffected side, flexing the hip (affected) then widely abducting and extending the hip and finally allowing the thigh to drop towards the adducted position.b. When the tensor is tight, the thigh will be sustained momentarily in the abducted position before falling towards the table.

So the answer to this question is C


Instruction:
Sputum smear is diagnostic if?
A. > 25 neutrophils and >10 squamous epithelial cells
B. <25 neutrophils and <10 squamous epithelial cells
C. > 25 neutrophils and <10 squamous epithelial cells
D. <25 neutrophils and >10 squamous epithelial cells

Response:
Ans. (c) > 25 neutrophils and <10 squamous epithelial cells* Expectorated sputum is necessarily contaminated by upper respiratory secretions as it passes through the oropharynx and mouth.* When examining the Gram stain of such a specimen, the examiner should determine whether it is mostly purulent material from the lung or mainly saliva.* Since squamous epithelial cells line the upper airway but not the tracheo-bronchial tree, their presence indicates that upper airway secretions have contaminated the specimen to some degree.* Several criteria have been proposed for determining that a sputum specimen is not excessively contaminated with oropharyngeal flora and is therefore acceptable for culture.* For example:# Fewer than 10 squamous epithelial cells per field when viewed through a low-power (10x) lens (total magni- fication 100x) and more than 25 neutrophils per low-power field, or- a ratio of neutrophils to epithelial cells greater than 5:1* Even if the specimen conforms to those standards, the patient doesn't necessarily have pneumonia.* That diagnosis depends upon clinical and radiographic information. Patients with viral bronchitis, chronic obstructive lung disease, or tracheal intubation, for example, can have purulent sputum with a predominant organism in the absence of infection of the lung parenchyma.* In some clearly satisfactory sputum specimens collected from patients with pneumonia due to a single organism (e.g., Streptococcus pneumoniae), not only is the infecting organism visible with Gram stain, but often small numbers of other types of bacteria are also present.* A common mistake is to conclude that the Gram stain shows "mixed flora" and therefore does not help establish a diagnosis.

So the answer to this question is C


Instruction:
Cigar bodies are seen in?
A. Sporotrichosis
B. Chromoblastomycosis
C. Mycetoma
D. Basidiomycosis

Response:
In sporotrichosis, direct microscopic examination of KOH mounts of necrotic materials or histopathological examination of tissue section stained by methamine silver stain may yield a diagnosis. The characteristics feature is the asteroid body or cigar body: a rounded or oval, basophilic,yeast-like, cigar-shaped body 3-5micron in diameter, with rays of an eosinophilic substance radiating from the yeast cell. Ref:Anantha Narayan and Panickers Textbook of Microbiology, 9th edition, page no.602

So the answer to this question is A


Instruction:
A 50 year old male presented with blurring of vision. Urine examination showed proteinuria. Fundus examination showed dot and blot haemorrhages, microaneurysm and cotton wool spots. Histopathology pic of kidney given below. Your diagnosis?
A. Kimmelstiel Wilson nodules
B. Crescents
C. Amyloid
D. Segmental sclerosis

Response:
Ans. (a) Kimmelstiel Wilson nodules(Ref: Robbins 9th edp 1118)Diabetic Nephropathy:The renal lesions include mainly: Glomerular lesions:*Basement membrane thickening and increased mesangial matrix in patients*Diffuse glomerulosclerosis#Increase in mesangial matrix associated with PAS+ basement membrane thickening, eventually obliterates mesangial cells, found in most individuals with disease of more than 10 years duration*Nodular glomerulosclerosis#Intercapillary glomerulosclerosis or Kimmelstiel- Wilson diseas

So the answer to this question is A


Instruction:
3 months old infant, no chest indrawing with respiratory rate 52/minute. Diagnosis is-
A. No pneumonia
B. Pneumonia
C. Severe pneumonia
D. Very severe disease

Response:
Ans. is 'b' i.e., Pneumonia This infant has:- i) Fast breathing ( 50 per minute between 2 months to 1 years). No chest indrawing. o Diagnosis is Pneumonia.

So the answer to this question is B


Instruction:
The organism shown below is:
A. Aspergillus
B. Candida
C. Histoplasma
D. Paracoccidiomycosis

Response:
ANS. A (Aspergillus has septations and it has acute branching)# Histoplasma (feathery finger like projections)# Blastomycosis (figure of 8 appearance)# Coccidiomycosis (spherules with spores)# Paracoccidiomycosis (captain wheel or Mickey Mouse appearance)# Cryptococcus (negative staining, polysaccharide capsule)# Sporothrix schenki (Flower shaped conidia and cigar bundles)# Candida albicans (germ tube formation)# Pneumocystis carinii (Gomori methanamine stain, cup-shaped cyst)

So the answer to this question is A


Instruction:
The surgical procedure most commonly associated with postoperative acute kidney injury is:
A. Cardiac surgery with cardiopulmonary bypass
B. Neurosurgery
C. TURP
D. Carcinoma breast surgery

Response:
The procedures most commonly associated with AKI are 1. Cardiac surgery with cardiopulmonary bypass 2. Vascular procedures with aoic cross clamping 3. Intraperitoneal procedures. Severe AKI requiring dialysis occurs in approximately 1% of cardiac and vascular surgery procedures. Ref: Harrison-E-18, P-2295.

So the answer to this question is A


Instruction:
A systematic observation and recording of activities of one or more individuals at random interval is done in –
A. Systems analysis
B. Network analysis
C. Work sampling
D. Input–Output analysis

Response:
Work sampling

It is systematic observation and recording of activities of one or more individuals, carried out at predetermined or random intervals.
It provides quantitative measurement of various activities.
It helps in standardizing the methods of performing jobs and determining the manpower needs in any organization.

Input-out analysis

Input → All health service activities which consume resources (manpower, money, material and time).
Output → Useful outcomes (cases treated, lives saved).
Input-output analysis shows how much of each "input" is needed to produce a unit amount of each "output".

Systemic analysis

Systemic analysis is essentially finding the cost-effectiveness of the available alternatives.

So the answer to this question is C


Instruction:
Murphy's Sign is seen in?
A. Acute appendicitis
B. Acute cholecystitis
C. Acute Pancreatitis
D. Ectopic pregnancy

Response:
Ans. (b) Acute cholecystitisRef: Bailey and love 25th edition page 967 & 1140, Schwartz's 8th edition chapter 34, Sabiston Textbook of Surgery, 18thed chapter 55

So the answer to this question is B


Instruction:
'Boxer's attitude' is seen in person dying of:
A. Fear
B. Poisoning
C. Burns
D. Strangulation

Response:
Burns

So the answer to this question is C


Instruction:
Enzyme activated by decrease in Insulin: glucagon ratio:
A. Glucokinase
B. Hexokinase
C. PFK
D. Glucose 6 phosphatase

Response:
Low Insulin: Glucagon ratio means=Catabolicstate (Aslow insulinmeansFasting stateor catabolic state).Insulinis released in Fed state. So, in fasting stateglucose-6-phosphatasewill be active as this enzyme is involved ingluconeogenesis,which occurs duringfasting. OTHER OPTIONS OPTION A: Glucokinase phosphorylates glucose in liver and pancreas, active in fed state and is induced by insulin. OPTION B: Hexokinase also phosphorylates glucose and is present in all cells of the body. It is active in any situation in body as it is a general enzyme to phosphorylate glucose OPTION C: Phospho fructokinase is involved in glycolysis. PFK-1 is active in any situation and PFK-2 is active only in fed state.

So the answer to this question is D


Instruction:
Kalu, a 6-year-old child, received tetracycline. Noticeable discoloration will be seen in:
A. Premolars, incisors and 1st molars
B. Canine and 2nd molars
C. Canines, premolars and 2nd molars
D. Incisors and 1st molars

Response:
None

So the answer to this question is C


Instruction:
Mechanism of action of apixaban is:-
A. Inhibition of factor Xa
B. Inhibition of thrombin
C. Stimulation of antithrombin
D. Vitamin K antagonism

Response:
Apixaban is factor XA blocker. Other XA blockers are:(-xaban) * Rivaroxaban * Edoxaban * Batrixaban Indirect thrombin inhibitor like heparin act by stimulating anti-thrombin 3. Vitamin K antagonists are warfarin, acenocoumarin, bis-hydroxycoumarin.

So the answer to this question is A


Instruction:
The part most commonly involved Otosclerosis is -
A. Oval window
B. Round window
C. Tympanic membranes
D. Malleus

Response:
None

So the answer to this question is A


Instruction:
Which of the following has propensity to metastasize through lymph nodes ?
A. Alveolar rhabdomyosarcoma
B. Osteosarcoma
C. Both
D. None

Response:
Ans. is 'a' i.e., Alveolar rhabdomyosarcoma

So the answer to this question is A


Instruction:
Gray baby syndrome is caused by -
A. Penicillin
B. Chloramphenicol
C. Rifampicin
D. Erythromycin

Response:
Ans. is 'b' i.e., Chloramphenicol o Chloramphenicol causes gray baby syndrome in premature neonates due to blockade of electron transpo in liver, myocardium and skeletal muscle. Remember o Chloramphenical is the most common cause of aplastic anemia. o Tetracyclines are the most common cause of superinfections.

So the answer to this question is B


Instruction:
Urine urobilinogen is absent in:
A. Obstructive jaundice
B. Viral hepatitis
C. Hemolytic jaundice
D. All of the above

Response:
Formation and Fate of Urobilinogen:

Once in the intestine, about half of the “conjugated” bilirubin is converted by bacterial action into the substance urobilinogen, which is highly soluble.
Some of the urobilinogen is reabsorbed through the intestinal mucosa back into the blood, and most is re-excreted by the liver back into the gut, but about 5 percent is excreted by the kidneys into the urine.
After exposure to air in the urine, the urobilinogen becomes oxidized to urobilin; alternatively, in the feces, it becomes altered and oxidized to form stercobilin.

Obstructive jaundice:

Occurs due to obstruction of bile flow at any level of biliary system - Eg: Gall stones, CA biliary system or pancreas.
Thus, bile cannot be excreted into small intestine, instead released into circulation. Hence, the blood contains more amount of conjugated bilirubin.
When total obstruction of bile flow occurs, no bilirubin can reach the intestines to be converted into urobilinogen by bacteria. Therefore, no urobilinogen is reabsorbed into the blood, and none can be excreted by the kidneys into the urine.
Consequently, in total obstructive jaundice, tests for urobilinogen in the urine are completely negative. Also, stools become clay colored owing to a lack of stercobilin and other bile pigments.

So the answer to this question is A


Instruction:
A 36-year-old G1P0 woman presents for her first prenatal visit late in her first trimester of pregnancy; she complains of persistent vaginal bleeding, nausea, and pelvic pain. Physical examination is notable for a gravid uterus larger than expected for gestational age. Fetal heart tones are absent.Which of the following is most likely to be true?
A. b-hCG levels will be higher than normal
B. b-hCG levels will be lower than normal
C. Uterus will be of normal levels
D. TSH levels will be increased

Response:
Ans. is a, i.e b-hCG levels will be higher than normalIn the given question patient is presenting late in her first trimester of pregnancy with complains of persistent vaginal bleeding, nausea, and pelvic pain. Physical examination is notable for a gravid uterus larger than expected for gestational age. Fetal heart tones are absent.D/D of height of uterus larger than the period of gestation:Wrong datesTwin pregnancyMolar pregnancyConcealed variety of Abruptio placentaPolyhydramnios.Twin pregnancy can be ruled out because it does not explain persistent vaginal bleeding and moreover in twin/multiple pregnancy fetal heart tones are not absent...2 or more FHS are heard depending on the number of fetuses.Concealed variety of APH does not occur in late first trimester. APH by definition means any bleeding which occurs after 28 weeks of pregnancy and uptil the birth of the child and hence it can be ruled out although absent fetal tones and Fundal height more than the gestational age are seen.Polyhydramnios again can be ruled out since bleeding cannot be explained by it ...so we are left with molar pregnancy which explainds all the findings.Always remember: Patient complaining of extremes of nausea, vomiting + bleeding in first trimester + size of uterus more than the period of amenorrhea-think of Molar pregnancy.The USG shown in the plate is typical snow storm appearance. Hence diagnosis is confirmed.

So the answer to this question is A


Instruction:
A lady presented to your with a history of recurent early pregnancy loss. What are the investigation to be ordered:
A. VDRL
B. Toxoplasma serology
C. Hemogram/Blood grouping
D. Rubella screening

Response:
Ans. is C i.e. Hemogram /blood grouping? As discussed in previous answer? Complete blood counts along with platelet count are done in case of recurrent pregnancy loss. VDRL-To test for syphilis Rubella-virus screening are not done because as discussed earlier, infections rarely lead to recurrent Toxoplasma serology pregnancy loss. "Few infection are firmly associated with early pregnancy loss- moreover, if any of these infections are associated with miscarriage, they are even less likely to cause recurrent miscarriage because maternal antibodies usually develop with primary infection. Thus, there appears no concrete indication to screen for infection in asymptomatic women with recurrent miscarriage" "Routine serological lests, cervical cultures and endometrial biopsy to detect genital infections in women with recurrent pregnancy loss cannot be justified. Evaluation should be limited to women with clinical cervicits, chronic or recurrent bacterial vaginosis or other symptoms of pelvic infections" As far as Blood glucose testing is concerned- Neither Novaks, Leon speroff, nor Williams- say that blood glucose levels should be tested in patients with recurrent pregnancy loss - Leon speroff says? " In women with recurrent pregnancy loss, evaluation with blood glucose and HbA,C AIC level is indicated for those with known or suspected diabetes, but otherwise it is unwarranted" So for our exams purposes we have to learn & remember the list of investigations mentioned in previous question in case of recurrent aboions.

So the answer to this question is C


Instruction:
`Duret Hemorrhages' are seen in :
A. Brain
B. Kidney
C. Hea
D. Lung

Response:
Answer is A (Brain): The term `Duret Hemorrhage' is used for all secondary mechanically induced hemorrhages within the brainstem Duret Hemorrhages Duret hemorrhages refer to secondary mechanically induced hemorrhages within the brainstem They are believed to result from damage to perforating branches of the basilar aery as a result of mechanical injury during trans-tentorial herniation of brainstem Duret hemorrhages are usually found in the ventral and paramedian upper brainstem (mesencephalon & pons) after transtentorial and subfalcine herniations due to supra-tentorial mass lesions During transtentorial herniations when the uncus slides under the tentorium, the midbrain is stretched. This ruptures small perforating vessels and produces hemorrhages. Duret hemorrhages are typically diagnosed on CT scan on MRI of the brain (as midline lesions) and carry a poor prognosis.

So the answer to this question is A


Instruction:
HAIR-AN syndrome consists of
A. Hyperandrogenism
B. Acanthosis nigricans
C. Insulin resistance
D. All of above

Response:
HAIR-AN syndrome consists of hyperandrogenism (HA), insulin resistance (IR), and acanthosis nigricans (AN)It is a subset of polycystic ovarian syndrome(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition)

So the answer to this question is D


Instruction:
Young age diabetics presenting with blackish nasal discharge, diagnosis is :
A. Aspergillosis
B. Mucormycosis
C. Rhinosporidiosis
D. Moniliasis

Response:
Ans. is 'b' i.e Mucormycosis Remember:Black necrotic mass in nose or black turbinates - fungal Infection is of Mucormycosis*Leafy Polypoidal mass, pink or purple in color, bleeds on Touch, in nasal cavity* - fungal infection of Rhinosporidium seeberi (Rhinosporidiosis)*White mucosal patches in nose - fungal infection of Candida*

So the answer to this question is B


Instruction:
Bisiferien pulse is seen in -
A. AS+AR
B. Hyperophic cardiomyopathy
C. Severe AR
D. All of above

Response:
Bisferiens pulse: This is a pulse with double peak, both being felt in systole. Mechanism: This is due to a combination of the slow rising pulse and collapsing pulse. Ref: Harrison 20,th edition pg 1445

So the answer to this question is D


Instruction:
A 22-year-old man is admitted to the emergency department after falling from his bicycle. Radiographic examination reveals a fracture of the tibia above the ankle. MRI and physical examination reveal that the tibial nerve is severed on the posterior aspect of the tibia. Which of the following signs will most likely be present during physical examination?
A. Sensory loss of the dorsum of the foot
B. Sensory loss on the sole of the foot
C. Foot drop
D. Paralysis of the extensor digitorum brevis

Response:
The tibial nerve divides into the medial and lateral plantar nerves on the medial side of the ankle. These two nerves provide sensation for the sole of the foot. Sensory supply to the dorsum of the foot is provided mostly by the superficial fibular (peroneal) nerve, with the deep fibular (peroneal) nerve providing sensation for the skin between the first and second toes. Foot drop would be caused by interruption of the common fibular (peroneal) nerve. Sensory loss to the lateral side of the foot results from loss of the sural nerve. Paralysis of the extensor digitorum brevis would be attributed to injury to the terminal motor branch of the deep fibular (peroneal) nerve.

So the answer to this question is B


Instruction:
Treatment of choice for stab injury caecum -
A. Caecostomy
B. Ileo-transverse anastomosis
C. Transverse colostomy
D. Sigmoid colostomy

Response:
• Sabiston says “Stab and low-velocity wounds to the colon with minimal contamination and hemodynamic stability can be managed by primary repair.”

So the answer to this question is B


Instruction:
Impared Renal Function is assessed by
A. MAG3
B. IodoHippurate
C. DMSA Scan
D. DTPA

Response:
A i.e. MAG3

So the answer to this question is A


Instruction:
All of the following statements about Nasopharyngeal carcinoma are true EXCEPT:
A. Bimodal age distribution
B. Nasopharyngectomy with radical neck dissection is the treatment of choice
C. IgA antibody to EBV is observed
D. Squamous cell carcinoma is the most common histological subtype

Response:
Irradiation is the treatment of choice for nasopharyngeal carcinoma

So the answer to this question is B


Instruction:
A 30 year old woman presented with secondary amenorrhoea for 3 years along with galactorrhoea. The most likely cause of her symptoms would be:
A. Craniopharyngioma
B. Prolactinoma
C. Meningioma
D. Sub-arachnoid haemorrhage

Response:
Answer is B (Prolactinoma): Menstrual cycle disturbance in the form of amenorrhea along with galactorrhea suggests a diagnosis of hyperprolactinemia. Amongst the options provided the tumor most likely to produce above endocrine manifestation is a prolactinoma. Prolactinomas: Most common functional pituitary adenomas Q

So the answer to this question is B


Instruction:
Strength of gypsum can be measured with:
A. Vicat needle
B. Gillmore needle
C. Kreb's penetrometer
D. Universal testing machine

Response:
A typical universal testing machine can analyze materials in tension, compression, or shear.

So the answer to this question is D


Instruction:
Hard exudates not seen in:
A. Hypeension
B. DM
C. Toxemia of pregnancy
D. None

Response:
C. i.e. Toxemia of pregnancy

So the answer to this question is C


Instruction:
During post mortem period fracture of cervical spine is called?
A. Pond fracture
B. Signature fracture
C. Undertakers fracture
D. Hangman's fracture

Response:
ANSWER: (C) Undertaker's fractureREF: Principles of Forensic Medicine and Toxicology Rajesh Bardale Page 130Rough handling of dead bodies by undertaker leads to fracture dislocation of C6-C7. This fracture dislocation is called as undertaker's fracture and may resembles antemortem injury.

So the answer to this question is C


Instruction:
Retinoblastoma is bilateral in:
A. 1% of cases
B. 50% of cases
C. 100% of cases
D. 30% of cases

Response:
Ans. 30% of cases

So the answer to this question is D


Instruction:
Calcium absorption is aided by all of the following except
A. Vitamin D
B. Vitamin C
C. Lactose
D. Fat

Response:
Fat cannot be aided with the absorption of calcium Reference: GHAI Essential pediatrics, 8th edition Nutrition Chap

So the answer to this question is D


Instruction:
Retinoblastoma gene is located on chromosome -
A. 6
B. 9
C. 13
D. 21

Response:
Harshmohan textbook of pathology 7th edition RB gene is located on long arm chromosome 13. This is the first ever tumor suppressor gene identified and this has been amply studied..

So the answer to this question is C


Instruction:
Condition associated with obesity are all except -
A. Pheochromocytoma
B. Hypothyroidism
C. Insulinoma
D. Cushing's syndrome

Response:
None

So the answer to this question is A


Instruction:
Mercury poisoning is characterized by all EXCEPT:
A. Tremor
B. K F ring
C. Anterior lens capsule deposits
D. pink disease

Response:
Kayser-Fleischer Ring: Seen in Copper poisoning Sign: Brownish-yellow ring visible around the corneo-scleral junction(limbus). Cause: Deposition of copper in Descemet's membrane, extending into the trabecular meshwork. First appears at the superior pole, then develops inferiorly and ultimately becomes circumferential. Detected by slit lamp examination in early stages.

So the answer to this question is B


Instruction:
Most unstable leprosy is ?
A. BB
B. BL
C. BT
D. TT

Response:
Ans. is'a'i.e., BBStable forms of leprosy -> polar forms of leprosy, i.e., Tuberculoid leprosy (TT) and lepromatous leprosy (LL).Unstable forms of leprosy -+ Borderline forms of leprosy, i.e., Borderline tuberculoid (BT), borderline (BB) and Borderline lepromatous (BL). BB is the most unstable form.

So the answer to this question is A


Instruction:
Iron is maximum in
A. Pista
B. Cashewnut
C. Meat
D. Milk

Response:
Ans. is 'c' i.e., Meat

So the answer to this question is C


Instruction:
Holt Gram syndrome is characterized by
A. ASD
B. VSD
C. TGA
D. AR

Response:
None

So the answer to this question is A


Instruction:
Deep peroneal nerve doesn't supply -
A. Tibialis anterior
B. Extensor hallucis longus
C. Extensor digitorum longus
D. Peroneus brevis

Response:
Muscles of anterior compartment of leg are supplied by deep peroneal nerve.
Muscles of lateral compartment of leg (Peroneus longus, peroneus brevis) are supplied by superficial peroneal nerve.

So the answer to this question is D


Instruction:
Which of the following is not a coagulative necrosis -
A. Myocardial infarct
B. Kidney infarct
C. Brain infarct
D. Adrenal infarct

Response:
Ans. is 'c' i.e., Brain infarct

So the answer to this question is C


Instruction:
The thinnest pa of lens capsule is:
A. Anterior pa
B. Posterior pa
C. Peripheral pa
D. All of the above

Response:
Posterior pa

So the answer to this question is B


Instruction:
Increased permeability in acute inflammation is due to?
A. Histamine
B. IL-2
C. TGF-(3
D. FGF

Response:
Ans. is 'a' i.e., Histamine Formation of endothelial gaps in venules, i.e. immediate transient response is the most common mechanism causing increased vascular permeability in acute inflammation. Mediators involved in this mechanism are :- Immediate (more impoant) : Histamine, bradykinin, leukotrienes, neuropeptide substance P. Somewhat delayed: IL-1, TNF, IFN-y

So the answer to this question is A