Instruction:
Vocal cord palsy in thyroid surgery is due to injury to
A. Superficial laryngeal nerve
B. Recurrent laryngeal nerve
C. Ansa cervicalis
D. Vagus nerve

Response:
Reccurent laryngeal nerve injury is classically described as a paralyzed vocal cord with loss of movement from the midline (supplies all the intrinsic muscles of the larynx, except cricothyroid muscles). Injury to the external branch of the superior laryngeal nerve leads to loss of tension in the vocal cord (supplies cricothyroid) with diminished power and range in the voice Source : Bailey and Love 26th edition Pg: 762

So the answer to this question is B


Instruction:
True regarding rhinitis medica mentosa is/are?
A. Caused by 132 - agonist sprays
B. Caused by coicosteroids spray
C. Spray itself can cause terbinate hyperophy
D. There is inferior terbinate hyperophy

Response:
Answer- D. There is inferior terbinate hyperophyIt is a condition characterized by nasal congestion that is triggered by the extended use of topical decongestants and ceain oral medications that constrict blood vessels in the lining of the nose: recreational use of intranasal cocaine malt also cause a similar condition.The classic Presentation is that the nasal mucous membranes appear "beefy-red," inflamed, and may show areas of punctate bleeding and scant mucus.The swelling of the nasal Passages caused by rebound congestion may eventually result in permanent turbinate hyperophy.ToPical intranasal coicosteroids aPPear to have beneft in rhinitis medicamentosa to control the inflammation caused by chronic vasoconstrictor use.

So the answer to this question is D


Instruction:
WHO recommend evaluation of child vaccination in age group?
A. 0-12m
B. 6-12 m
C. 12-23 m
D. 9-12 m

Response:
.in case of mass immunisation programmes implemented by WHO ,including the immunisation programmes ,evaluation of the aaccessibility of such programmes to the populations is usually done among children of age 12 to 23 months. ref:park&;s textbook,22 nd ed,pg 189

So the answer to this question is C


Instruction:
A 45-year-old male having a long history of cigarette smoking presented with gangrene of left foot. An amputation of the left foot was done. Representative sections from the specimen revealed presence of aerial thrombus with neutrophilic infliltrate in the aerial wall. The inflammation also extended into the neighbouring veins and nerves. The most probable diagnosis is:
A. Takayasu aeritis
B. Giant cell aeis
C. Hypersensitivity angitis
D. Thrmoboangitis obliterans

Response:
Ans. is 'd' i.e. Thromboangitis obliterans About other options Takayasu's Aeritis : - does not involve the peripheral limb vessels. Its an inflammatory and stenotic disease of medium and large-sized aeries characterized by a strong predilection for the aoic arch and its branches (thus also k/a aoic arch syndrome) Giant cell aeritis: - also k/a cranial aeritis or temporal aeritis is a systemic chronic inflammatory vascular disease with many characteristics similar to Takayasu disease involves medium and large sized aeries, characteristically one or more branches of the carotid aery, paicularly the temporal aery. Hypersensitivity angitis (Ref. Harrison 16/e, p 2011; Internet: emedicine) hypersensitivity angitis also k/a cutaneous vasculitis or leukocytoclastic vasculitis typically involves the small vessels of skin. Post capillary venules are most commonly involved vessels; capillaries and aerioles are involved less frequently. its the most commonly encountered vasculitis in clinical practice. the hallmark of idiopathic cutaneous vasculitis is the predominance of skin involvement. Skin lesions typically are palpable purpura.

So the answer to this question is D


Instruction:
Buerger's Disease is associated with -
A. Alcoholism
B. Smoking
C. Trauma
D. Cold environment

Response:
Thromboangiitis obliterans (Buerger disease)

Thromboangiitis obliterans is a distinctive disease that is characterized by segmental, thrombosing acute and chronic inflammation of medium-sized and small-sized arteries, and sometimes secondarily extending to veins and nerves.
Thromboangiitis obliterans occurs almost exclusively among heavy-cigarette-smoking persons.
It is more common in men but the incidence is increasing in women because of increasing smoking habit in women.
Buerger disease is associated with HLA -5 and HLA-A9.
In thromboangiitis obliterans there is acute and chronic segmental inflammation of vessels with accompanied thrombosis in the lumen.
Typically, the thrombus contains microabscesses with a central focus of neutrophils surrounded by granulomatous inflammation.
Later, the inflammatory process extends into contiguous veins and nerves and in time all three structures (arteries, veins and nerves) become encased in fibrous tissue, a characteristic that is very rare with another form of vasculitis.

Clinical manifestations

Thrombangiitis obliterans affects vessels of upper and lower extremities.
Symptoms are due to vascular insufficiency, i.e. Ischemia of toes, feet and fingers that can lead to ulcer and frank gangrene.
Due to neural involvement, there may be severe pain, even at rest.

Buerger disease Vs atherosclerosis

Buerger disease is almost exclusively associated with smoking. Atherosclerosis is also associated with smoking, but it has other predisposing conditions also, e.g. diabetes, hypertension, hypercholesterolemia etc.
Burger disease affects smaller arteries. Atherosclerosis involves larger and medium-sized arteries.
In Atherosclerosis, pain occurs on movement due to vascular insufficiency, while in Buerger disease, pain occurs at rest also due to neural involvement.

So the answer to this question is B


Instruction:
The pea-orbital view is carried out for -
A. Petrous apex
B. Mastoid process
C. Bilateral mastoid pathologies
D. Internal auditory meatus

Response:
None

So the answer to this question is D


Instruction:
SRY gene is located on -
A. Short arm of X chromosome
B. Long arm of X chromosome
C. Short arm of Y chromosome
D. Long arm of Y chromosome

Response:
Ans. is 'c' i.e., Short arm of Y chromosome o Y chromosome is necessary for development of Male :# The SRY gene present on the distal short arm of the Y chromosome is responsible for testicular development.

So the answer to this question is C


Instruction:
True about critical path method are all except
A. Network analysis
B. Longest path
C. Cannot be delayed
D. Shoest path

Response:
Ans. is 'd' i.e., Shoest path Network analysis A network analysis is a graphic of all events and activities to be completed in order to reach an end objective. It brings greater discipline in planning. The two common types of network technique are : a) Programme Evaluation and Review technique (PE) b) Critical Path method (CPM) Programme Evaluation and Review technique (PE) PE is a management technique which makes possible more detailed planing and more comprehensive supervision. PE is method to analyze the involved tasks in completing a given project, especially the time needed to complete each task, and identifying the minimum time needed to complete the total project. The essence of PE is to construct an arrow diagram, which represents the logical sequence in which events must take place. It is possible with such a diagram to calculate the time by which each activity must be completed, and to identify those activities that are critical. Critical path method (CPM) The longest path of the network is called the critical path. Critical path method determines the activities of a project which are critical and are given longest path. Other activities are total float, i.e. they can be delayed without making the project longer. Any delay in activity on the critical path results in delay of the project. o In the above figure, the longest path is from equipment ordered to equipment installed. That means, this is the critical path and installating of equiment is the most critical step (taking 10 months). o Other activities are total float, i.e. they can be delayed for sometimes without delaying the project.

So the answer to this question is D


Instruction:
A 64-year-old woman with a longstanding diagnosis of mixed connective tissue disorder and pulmonary fibrosis is admitted with symptoms of recent increase in postprandrial retrosternal distress, heaburn, and nocturnal cough. Her ECG shows nonspecific T-wave changes and she finds minimal relief of her symptoms with sublingual NTG. On examination, she is not in any acute distress and is afebrile. Chest exam reveals bilateral crackles. CXR is shown . The cause of this patient's acute symptoms may be
A. Large hiatal hernia
B. Mediastinal abscess
C. Pneumopericardium
D. Ileus

Response:
This chest x-ray shows a large, air-containing, hyperlucent opacity in the middle poion of the thorax representing a large hernia in the mediastinum. The lung parenchyma shows increased linear and reticular markings, predominantly in the lower zones, consistent with the diagnosis of interstitial disease. The symptoms described are due to an acid reflux disorder, and the chest x-ray shows a large hiatal hernia. Hiatal hernia represents herniation of the stomach through the esophageal hiatus and is frequently found in adults. It occurs as an oval retrocardiac mass, most often with an air-fluid level, and is due to laxity, stretching, and widening of the hiatus. Obesity and increased intraabdominal pressures are contributing factors. The majority of hernias spontaneously reduce and are called sliding hernias. A paraesophageal hernia occurs when the stomach herniates next to the distal esophagus. Patients may be asymptomatic or may have symptoms of reflux.

So the answer to this question is A


Instruction:
Defficiency of which element can lead to syndrome of growth failure, anaemia and hypogonadism –
A. Calcium
B. Copper
C. Zinc
D. Magnesium

Response:
None

So the answer to this question is C


Instruction:
Which amongst the following biological agents has the highest potential for use as a vector in bioterrorism
A. Plague (Yersinia pestis)
B. Small pox (variola major)
C. Botulism (Cl. Botulinum)
D. Brucellosis (Brucella sp)

Response:
Plague - this disease has a history of its use in biological warfare dating back many centuries and is considered a thread due to its ease of culture and ability to remain in circulation among local rodents for a long period of time. Ref: Baveja textbook of microbiology; 4th edition

So the answer to this question is A


Instruction:
Thermo philus sachari causes ?
A. Bagassosis
B. Siderosis
C. Byssinosis
D. Anthracosis

Response:
Ans. is 'a' i.e., Bagassosis Bagassosiso Bagassosis is the name given to an occupational disease of the lung caused by inhalation of bagasse or sugar- cane dust.o Bagassosis has been shown to be due to a termophilic actinomycete - Thermoactinomyces sacchari.Anthracosis-Coal dustSilicosis-SilicaSiderosis-ironByssinosis-Cotton dustFarmer's lung-Hay or grain dustSequousis-Moldy red wood saw dustSuberosis-Moldy cork dustDetergent worker's lung-Enzyme additivesBaggassosis-Sugarcane dust

So the answer to this question is A


Instruction:
A 26 year old female patient reports to the clinic with gummy smile. The complaint of this patient can be described best by which of the following?
A. Divergence
B. Roll
C. Pitch
D. Yaw

Response:
For this girl, who does not have anterior open bite despite her long-face skeletal pattern, the entire dentition is translated down, but a downward pitch posteriorly can be observed clinically. Note that the esthetic line of the dentition tilts down posteriorly relative to the intercommissure line and that there is greater exposure of gingiva posteriorly than anteriorly.
An excessive upward/downward rotation of the dentition relative to the lips and cheeks would be noted as pitch (up or down, in front or back). Pitch of the dentition relative to the facial soft tissues must be evaluated on clinical examination.
Pitch is revealed as the orientation of the palatal, occlusal and mandibular planes relative to the true horizontal.
Roll, which is analogous to the banking of an airplane, is described as rotation up or down on one side or the other.
Rotation of the jaw or dentition to one side or the other, around a vertical axis, produces a skeletal or dental midline discrepancy that is best described as yaw.

So the answer to this question is C


Instruction:
The amount of sewage flowing in a system in 24 hours is called:
A. Sewage rate
B. Dry weather flow
C. RCA index
D. Sludge

Response:
Sewage is wastewater from a community, containing solid and liquid excreta, derived from houses, street and yard washings, factories and industries. It resembles dirty water with an unpleasant smell. The term "sullage" is applied to wastewater which does not contain human excreta, e.g., wastewater from kitchens and bathrooms.
The amount of sewage that flows in the sewers depends upon:

Habits of the people: If people use more water, there will be more sewage.
Time of day: Sewage does not flow uniformly throughout the day.

The average amount of sewage which flows through the sewerage system in 24 hours is called the "dry weather flow."
Park's textbook of preventive and social medicine 23rd edition
Page.no.762

So the answer to this question is B


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

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

So the answer to this question is C


Instruction:
True regarding anaemia of chronic ds. are A/E -
A. Decreased TIBC
B. Increased macrophage iron in marrow
C. Decrease serum ferritin level
D. Decreased serum iron levels

Response:
None

So the answer to this question is C


Instruction:
Marked deformity is due to
A. Radial nerve
B. Posterior interosseous nerve
C. Ulnar nerve
D. Median nerve

Response:
Given action - wrist drop Due to radial nerve injury PIN palsy causes - finger drop not wrist drop

So the answer to this question is A


Instruction:
Preauricular lymphadenopathy not seen in
A. Chlamydial conjunctivitis
B. Herpes simplex keratoconjunctivitis
C. Atopic conjunctivitis
D. Staphylococcal conjunctivitis

Response:
Ans. is 'c' i.e., Atopic conjunctivitiso Preauricular lymphadenopathy is seen in -Bacteral conjunctivitis (staphylococcal, gonococcal, pneumococcal).Viral conjunctivitis (Herpes simplex, epidemic keratoconjunctivitis).Chlamydial conjunctivitiso It is not seen in allergic (atopic) conjunctivitis.

So the answer to this question is C


Instruction:
Which of the following is true about parasympathetic nervous system?
A. Ach is transmitter at both pre & post synaptic junction
B. It causes dilatation of skeletal muscles
C. Post-ganglionic fibres are longer than pre ganglionic fibres
D. Noradrenalin is the neurotransmitter at post ganglionic junction

Response:
None

So the answer to this question is A


Instruction:
All of the following statement are true about Staphylococci except :
A. A majority of infection caused by coagulase (-) ve Staph. are due to staph epidermidis
B. β -Lactmase production is under plasmid control
C. Expression of methicillin resistance in Staphylococcus aureus increases when it is incubated at 37 degree C on blood agar
D. Methicillin resistance in Staph. aureus is independent of b-Lactmase production

Response:
“Methicillin resistance is expressed more when Staph. is incubated at 30 0 C than at 37 0 C.”
Penicillin resistance in Staphylococcus is by following ways :
1. Production of β lactmase :

Plasmid mediated inducible enzyme which is transmitted by transduction (more commonly) or conjugation.

Now only <5% of strains of staph are sensitive to penicillin.

Hospital strains mostly form type A penicillinase.
Same plasmid carry genes for resistance to tetracycline, Erythromycin, Aminolgycoside too.

2.  Altered penicillin binding protein :

Due to production of novel penicillin binding protein PBP2a. The protein is synthesized by mecAgene.
Chromosomally mediated expressed more at 30 0 C than at 37 0 C.
Responsible for resistance against penicillinase resistant penicillin such as methicilin, cloxacillin. Strains are called MRSA (Methicillin resistant Staph. aureus).

3. Tolerance to pencillin :

Bacteria only inhibited not killed.

So the answer to this question is C


Instruction:
True about consensual light reflex is -
A. Decussation of some fibres at optic chiasma is responsible for the consensual light reflex
B. Oculomotor nerve carries afferent signals
C. Decussation occurs at ciliary ganglion
D. All are true

Response:
Ans. is 'a' i.e., Decussation of some fibres at optic chiasma is responsible for the consensual light reflex Pupillary light reflex (Light reflex)* Pupillary light reflex refers to constriction of pupil in response to light. When a sudden light is thrown into the eye, the pupil of that eye constricts (direct light reflex). The pupil of other eye also constricts (Consensual or indirect light reflex). The pathway for pupillary reflex involve (sequentialy): -i) Afferent: - Retina - Optic nerve- Optic chiasma - Optic tract - Pretectal nucleus - Internuncial neurons - EWN (Edinger westphal nucleus).ii) Efferent: - Edinger westphal nucleus- Occulomotor (3rd) nerve- Ciliary ganglion - Short ciliary nerve - Sphinctor pupillae.* Some fibres decussate at optic chiasma and go to contralateral side which is responsible for consensual or indirect light reflex. From retina upto the Pretectal nucleus is afferent pathway and from EWN of third nerve to sphincter pupillae is efferent pathway.

So the answer to this question is A


Instruction:
HLA-I is present on ?
A. All nucleated cells
B. Only on cells of immune system
C. Only on B-cells
D. Only on T-cells

Response:
Ans. is 'a' i.e., All nucleated cells

So the answer to this question is A


Instruction:
A person has an injury in the forefinger with glass and it is suspected that he has a retained piece of glass in his finger. What is the first investigation you will do?
A. MRI
B. CT scan
C. Plain radiograph
D. Ultrasonography

Response:
Ans. c. Plain radiograph 'Plain films can be clinically beneficial in locating glass foreign bodies in deep wounds with or without exploration.' Glass Foreign Body Patients with glass embedded in a wound are more likely to repo the sensation of foreign bodies. In patients with sensation of foreign body, superficial wounds that have been adequately explored do not require radiography. Plain films can be clinically beneficial in locating glass foreign bodies in deep wounds with or without explorationQ In patients without sensation, the history can guide the decision for fuher investigation. All glass is radiopaque; however, there is limited ability for radiography to detect glass fragments smaller than 2 mm. Glass is ine and can be left in place if it is difficult to locate or remove.

So the answer to this question is C


Instruction:
Na/K pump which enzyme is used -
A. ATPase
B. GTPase
C. Acetyl CoA
D. None of these

Response:
Sodium-potassium pump is the most important pump for primary active transport Q in the body.
Na + -K + pump is an electrogenic pump Q that is responsible for maintaining the Na + and K + concentration difference across the cell membrane.
Na + - K + pump extrudes 3 Na + out from the cell and at the same time pump 2K + into the cell Q , i.e., Coupling ratio of Na + K + pump is 3 : 2 Q . Na + and K + transport by Na + - K + pump is primary active transport Q and both Na + and K + are transported against concentration gradient Q
(intracellular fluid has high concentration of K + and ECF has high concentration of Na - ).
Na + K + pump uses energy by hydrolysing ATP; this pump contains ATPase activity Q.

Na + - K + pump is a carrier protein which is a heterodimer 0 made up of two separate globular proteins: a larger one called α-subunit with a molecular weight of 100,000 and a smaller one called β-subunit, with a molecular weight of about 55,000. Both α- and β- subunits span across the membrane with intracellular and extracellular sites.
Na + and K + transport occurs through a-subunits.

Intracellular portion of a-subunit has three Na + binding sites (three receptor sites for Na + ), an ATP binding site, a phosphorylating site and ATPase activity Q.
Extracellular portion Q has two K + binding sites (two receptor sites for K + ), and an ouabain binding site Q.
The β- subunit has three extracellular glycosylation sites Q, all of which appear to have attached carbohydrate residue.

The Na + - K + pump is an electrogenic pump Q since it produces a net movement of positive charge out of the cell.

Thus, besides maintaining the ionic composition of the intracellular fluid, the Na + - K + pump helps to maintain the electrochemical potential difference across the cell membrane.
However, Na + - K + pump contributes only 4 millivolts to the total resting membrane potential of 90 volts which is almost negligible Q.

Active transport of Na+ and K+ - is one of the major energy-using processes in the body.

On average, it accounts for about 24% of the energy utilized by cell and in neurons, it accounts for 70%. o Activity of Na+ - K+ pump is stimulated by the increased intracellular concentration of Na +,
thyroid hormones, aldosterone and insulin. Pump activity is inhibited by CHF, CRF, digoxin toxicity and dopamine.

So the answer to this question is A


Instruction:
In microangiopathic hemolytic anemia, cells seen are -a)  Fragmented RBC'sb)  Schistocytesc)  Spherocytesd)  Anisocytes
A. ac
B. ab
C. ad
D. bc

Response:
None

So the answer to this question is B


Instruction:
Which of the following causes the majority of UTIs in hospitalized patients?
A. Lack of fluid intake
B. Inadequate perineal care
C. Invasive procedures
D. Immunosuppression

Response:
Invasive procedures such as catheterization can introduce bacteria into the urinary tract.
A lack of fluid intake could cause the concentration of urine, but wouldn’t necessarily cause infection.

So the answer to this question is C


Instruction:
Egg shell calcification is seen in all except:
A. Silicosis
B. Sarcoidosis
C. Coal worker's pneumoconiosis
D. Osteogenic sarcoma

Response:
Ans: d (Osteogenic sarcoma)Egg shell calcification of lymph node in chest X-ray seen in:* Silicosis* Sarcoidosis* Coal worker's pneumoconiosis* Lymphoma following radiotherapy* Histoplasmosis* Amyloidosis* Scleroderma

So the answer to this question is D


Instruction:
Least common site for lung abcess is
A. Right upper lobe
B. Right lower lobe
C. Left lower lobe
D. Left upper lobe

Response:
About the site of lung abscess associated with aspiration . "Because of the effect of gravity, foci of infection tend to develop in the subpleural regions of the superior segments of the lower lobes and in the posterior segments of the upper lobes. The right lung is involved more frequently, presumably because of the less acute angle of the right main bronhus. thus the right upper and lower lobes are the most commonly affected, followed by the left lower lobe and right middle lobe." Ref : Schwaz 9/e p.549

So the answer to this question is D


Instruction:
As per CEAP classification healed venous ulcer is
A. C2
B. C3
C. C4
D. C5

Response:
CEAP (Clinical-aEtiology-Anatomy-Pathophysiology) classification for chronic venous disorders Clinical classificationC0: no signs of venous disease;C1: telangectasia or reticular veins;C2: varicose veins;C3: oedema;C4a: pigmentation or eczema (some include malleolar flare in this category);C4b: lipodermatosclerosis or atrophie blanche;C5: healed venous ulcer;C6: active venous ulcer.Etiological classificationEc: congenitalEp: primaryEs: secondary (post-thrombotic)En: no venous cause identified.Anatomical classificationAs: superficial veinsAp: perforator veinsAd: deep veinsAn: no venous location identified.Pathophysiological classificationPr: refluxPo: obstructionPr,o: reflux and obstructionPn: no venous pathophysiology identifiable.Ref: Bailey and love pg: 974

So the answer to this question is D


Instruction:
Hiatus semilunaris is present in?
A. Superior meatus
B. Middle meatus
C. Inferior meatus
D. Spheno-ethmoidal recess

Response:
Middle meatus: Uncinate process is a hook-like structure running in from anterosuperior to the posteroinferior direction in the middle meatus. It&;s postero superior border is sharp and runs parallel to the anterior border of bulla ethmoidalis. This gap between the two is called hiatus semilunaris .it is two-dimensional space of 1-2 mm width. (Ref: Diseases of Ear, Nose and Throat and head and neck surgery, Dhingra 7th edition, Pg no. 150)

So the answer to this question is B


Instruction:
Best parameter by USG to assess fetal maturity:
A. Crown rump length at 16 weeks
B. Head circumference at 36 weeks
C. Biparietel diameter at 12 weeks
D. Femur length at 12 weeks

Response:
Ans. Biparietel diameter at 12 weeks

So the answer to this question is C


Instruction:
Which is not a feature of MCA blockage?
A. Anosognosia
B. Apraxia
C. Dysahria
D. Abulia

Response:
Abulia is a feature of ACA territory stroke Features of entire MCA blockage at the origin: Acalculia, Agraphia, Finger agnosia, & Global aphasia is present due to the involvement of dominant lobe. Anosognosia, constructional apraxia, and neglect are found due to the involvement of non-dominant lobe. Contralateral hemiplegia Hemi-anesthesia Homonymous hemianopia Dysahria due to facial weakness.

So the answer to this question is D


Instruction:
Coxsackie virus is implicated in
A. Herpes zoster
B. Measles
C. Small pox
D. Hand, Mouth & foot disease

Response:
None

So the answer to this question is D


Instruction:
An 18-year-old man, of Italian extraction, is found to have a hypochromic microcytic anemia of 10 g/dL. In addition, there are a fair number of anisocytosis, poikilocytosis, and target cells seen on the blood film. The WBC is 9500/mL, the platelet count is 240,000/mL, and the reticulocyte count is 7%. The spleen is palpated 5 cm below the left costal margin. Which of the following is the most likely diagnosis?
A. sickle cell trait
B. thalassemia minor
C. HbS-C disease
D. sideroblastic anemia

Response:
Thalassemia minor usually represents a heterozygous state and is often asymptomatic. Symptoms may develop during periods of stress such as pregnancy or severe infection. Hemoglobin values are usually in the 9-11 g/dL range. The red cells are small and poorly hemoglobinized.

So the answer to this question is B


Instruction:
Immunoglobulin secreted by fetus as primary response
A. IgA
B. IgM
C. IgG
D. IgD

Response:
Ans. is 'b' i.e., IgM IgM is the first immunoglobulin class produced in a primary response to an antigen. IgM antibodies are relatively sho lived, disappearing earlier than IgG. IgM is the earliest immunoglobulin to be synthesized by the fetus beginning by about 20 weeks of age. IgM can not cross the placenta. The presence of IgM in the fetus or newborn indicates intrauterine infection and its detection is useful in the diagnosis of congenital infections such as Toxoplasmosis, syphilis, rubella, cytomegalovirus infection and HIV infection.

So the answer to this question is B


Instruction:
Intracellular calcification begins in
A. Mitochondria
B. Golgi body
C. Nucleus
D. ER

Response:
None

So the answer to this question is A


Instruction:
Upper Lid Retractors include ?
A. Muller muscle and superior rectus
B. Levator palpabrae superioris and superior oblique
C. Superior oblique and superior rectus
D. Levator palpabrae superioris & muller muscle

Response:
Ans. is 'd' i.e., Levator palpabrae superioris & muller muscleo The levator palpebrae superioris is the important upper eye lid retractor. Injury or weakness to this muscle leads to ptosis.o This muscle is supplied by occulomotor (3rd) nerve.o Deep part of the elevator muscle is the Muller's muscle, which is sympathetically innvervated.o In hyperthyroidism, sensitization of the Muller muscle leads to upper eyelid retraction and pseudoproptosis,o On the other hand, in Horner's syndrome loss of this muscle action leads to ptosis.o The capsulopalpebral fascia assists in lower eyelid retraction and coordinates with eyeball movement. It arises as an extension of the inferior rectus and inserts into the lower edge of the lower tarsus and the adjacent orbital septum.

So the answer to this question is D


Instruction:
Massive bleeding per rectum in a 70 yr old patient is due to :
A. Diveiculosis
B. Carcinoma colon
C. Colitis
D. Polyps

Response:
Answer is A (Diveiculosis) Although anorectal disease is the most commonm cause of bleeding per rectum in the elderly, these lesions usually cause small amount of 'bright red' blood on the surface of stool and toilet tissue (small bleeds). Diveiculosis may give rise to massive colonic bleed. The usual presentation of diveicular hemorrhage is that of brisk painless passage of a maroon coloured stool. It is the most common cause of massive bleeding per rectum in those above 55 years of aze and hence the answer here. Angiodysplasias and diveiculosis were the most common reasons for LGIB Common causes of Acute Lower G.I. bleeding over 55 years of age are : Anorectal disease : Haemorrhoids and fissures Diveiculosis Angiodysplasia Polyps and Cancer Enterocolitis

So the answer to this question is A


Instruction:
A patient on amphotericin B has weakness and cramps. Serum potassium = 2.3 mEq/dl. Calculate the total parenteral potassium supplementation to be given to the patient over the next 24 hous?
A. 40mEq
B. 80mEq
C. 100mEq
D. 140mEq

Response:
Ans. is 'd' i.e., 140 mEq o For causing a rise of potassium in blood by ImEq/dl, 200 mEq of potassium supplementation is required.o Since symptoms develop with serum potassium less than 3 mEq/dl, the clinician should give sufficient potassium to rise upto 3 mEq/dl via intravenous route. Following this oral potassium supplement will sufficeo Hence mathematically speaking this patient requires approximately 0.7 mEq/dl of potassium to rise in the blood leading to a requirement of0.7 * 200 = 140 mEq over 24 hours

So the answer to this question is D


Instruction:
Which is seen in nephrotic syndrome-
A. Low serum calcium
B. Raised AT-III in serum
C. LOw serum lipids
D. Decreased Platelet activation

Response:
Nephrotic syndrome Results in Hyperlipidemia Urine loss of antithrombin III increased platelet aggregation Hypocalcemia is seen in severe NS Ref:Harrison 20 th edition, pg no. 293

So the answer to this question is A


Instruction:
Cellular immunity is induced by-
A. NK-cells
B. Dendritic-cells
C. TH1-cells
D. TH2-cells

Response:
Cell mediated immunity (cellular immunity) is induced by TH-1 cells.

So the answer to this question is C


Instruction:
Contraceptive efficacy expressed as
A. 100 women months
B. 1000 women years
C. 100 women years
D. 10 women years

Response:
Contraceptive efficacy is assessed by measuring the number of unplanned pregnancies that occur during a specified period of exposure and use of contraceptive methods.Contraceptive efficacy is measured using Pearl index and life table analysis. Pearl index is number of failure per 100 woman-years of exposure (HWY) HWY=total accidental pregnancies/total months of exposure.*1200 Life table analysis measure failure rate per month of exposure. Park&;s textbook of preventive and social medicine.K Park. Edition 23.Pg no: 510

So the answer to this question is C


Instruction:
IPC 193 is for -
A. Perjury
B. Punishment for perjury
C. Issuing false certificate
D. Causing disappearance of evidence

Response:
Ans. is 'b' i.e., Punishment for perjury Perjury, Hostile witness and false certificate* 191 IPC: (i) Giving false evidence (perjury) under oath and (ii) hostile witness.* 192 IPC: Fabricating false evidence (perjury).* 193 IPC: Punishment for false evidence (punishment for perjury): imprisonment upto 7 years + fine.* 194 IPC: Giving or fabricating false evidence to procure conviction of capital offence.* 195 IPC: Giving or fabricating false evidence to procure conviction of offence punishable with imprisonment for life.* 197 IPC: Issuing or signing (attesting) false certificate by a doctor is a criminal offence.* 201 IPC: Causing disappearance of evidence.

So the answer to this question is B


Instruction:
Which among the following is the commonest malignancy of childhood?
A. ALL
B. Brain tumor
C. Lymphoma
D. Neuroblastoma

Response:
The most common childhood malignancies are acute lymphoblastic leukemia, central nervous system (CNS) tumors and lymphomas. Together, these cancers account for 63 percent of cases. The frequency is ALL > Brain tumor > Lynphoma > Neuroblastoma. Neuroblastoma, retinoblastoma and Wilms' tumor most commonly occur in children between bih and four years of age, whereas osteosarcoma, Ewing's sarcoma and Hodgkin's disease tend to occur in children more than 10 years of age. Acute lymphoblastic leukemia is the most common type of leukemia in children. Acute lymphoblastic leukemia typically develops in children between one and 10 years of age. This leukemia is more common in males and in whites.

So the answer to this question is A


Instruction:
Bird of prey sign is seen in
A. Gastric volvulus
B. Intussusception
C. Sigmoid volvulus
D. Caecal volvulus

Response:
Sigmoid volvulus is a cause of large bowel obstruction and occurs when the sigmoid colon twists on the sigmoid mesocolon. Imaging signs areRadiograph:coffee bean signFrimann Dahl&;s sign - three dense lines converge towards the site of obstructionabsent rectal gas water-soluble contrast enema - the beak sign (or bird beak sign). CTlarge gas-filled loop without haustral markings, forming a closed-loop obstructionwhirl sign: twisting of the mesentery and mesenteric vesselsbeak sign: if rectal contrast has been administered (Ref: Grainger and Allison&;s diagnostic radiology 6th edition, chapter 25)

So the answer to this question is C


Instruction:
Definition and Detail Describes:
A. Image sharpness.
B. Increases as focal spot size reduce
C. Reduces as focal spot size increases.
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
Post dural puncture headache is
A. Retro-orbital
B. Frontal
C. Occipital
D. Temporal

Response:
Post dural puncture headache is occipital > frontal > retroorbital.

So the answer to this question is C


Instruction:
When a person stands suddenly from lying down posture, there is
A. Increased tone of capacitance vessels.
B. Increase efferent discharge from IX cranial nerve
C. Decreased heart rate
D. All of the above

Response:
(A) Increased tone of capacitance vessels. > It occurs due to noradrenergic impulses causing venoconstriction via their action on a1 and a2 - adrenergic receptors on systo veins.

So the answer to this question is A


Instruction:
Sphincter of Oddi consists of
A. 2 sphincters
B. 3 sphincters
C. 4 sphincters
D. 5 sphincters

Response:
The sphincter of Oddi is a muscular valve that controls the flow of digestive juices through the ampulla of vater into the second pa of the duodenum. It is named after ruggero oddi. Ref - BDC 6e vol2 pg259 , britannica.com

So the answer to this question is B


Instruction:
Metastatic calcification is most commonly seen in
A. Cornea
B. Extensor tendons
C. Brain
D. Renal tubules

Response:
Metastatic calcification may occur in normal tissues whenever there is hypercalcemia. Metastatic calcification may occur widely throughout the body but principally affects the interstitial tissues of the gastric mucosa, kidneys, lungs, systemic aeries, and pulmonary veinsReference: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 2; Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death

So the answer to this question is D


Instruction:
Reversion of Neisseriagonorrhoeae from a fimbriated (fim 1) to a non-fimbriated (fim 2) state would result in which one of the following phenomena?
A. Inability of N. gonorrhoeae to colonize the mucosal epithelium
B. Reversion to a Gram-positive stain
C. Death of the organism
D. Loss of serologic specificity

Response:
Bacteria may shift rapidly between the fimbriated (fim +) and the non-fimbriated (fim -) states. Fimbriae function as adhesions to specific surfaces and consequently play a major role in pathogenesis. Lack of fimbriae prevents colonization of the mucosal surface by the bacterium.

So the answer to this question is A


Instruction:
IUCD is made up of -
A. Nickel
B. Strontium
C. Copper
D. Polyethylane

Response:
park's textbook of preventive and social medicine 23rd edition. *The 1st generation IUD comprises the ine or non medicated devices usually made up of poly ethylene or other polymer.They appear in different shapes loops ,spirals,coils and rings .lippes loop is most commonly used.2nd generation IUDs are made by adding copper to the IUDs.

So the answer to this question is D


Instruction:
Which is not involved in Ankylosing spondylitis :
A. Knee & Ankle
B. Sacroiliac joint
C. Wrist & elbow
D. Spine

Response:
Ans. is 'c' ie Wrist & elbow Ankylosing spondylitis also k/a Marie-Strumpell ds is a chronic ds characterized by progressive inflammatory stiffening of the joints with a predilection for the joints of axial skeleton. MC involved joint - Sacro iliac joint* , next is spine Also Remember Sex ratio : M>F (10:1)* Age gp : young (15-30 yr) X-ray appearance Bamboo spine* Squaring of vertebrae Ankylosing spondylitis is a very imp topic and a good look at it will definitely help you.

So the answer to this question is C


Instruction:
Which is found in DiGeorge&;s syndrome -
A. Tetany
B. Eczema
C. Total absence of T cells
D. Absent B and T cells

Response:
Digeorge syndrome Digeorge syndrome is an example of a T cell deficiency that results from failure of development of the third and fouh pharyngeal pouches. * Clinical features * Enhanced susceptibility to viral, fungal (mucocutaneous candidiasis) and bacterial infections. * Facial abnormalities : Hypeelorism, abnormal ears, sho philtrum and micrognathia. Hypocalcemic tetany due to failure of parathyroid development. Congenital hea diseases eg fallot&;s tetralogy. * Absence of a normal thymus. * Serum immunoglobulin concentration are frequently normal, but antibody responses, paicularly of IgG and IgA isotypes, are usually impaired. * T cell levels are reduced (not total absence). * B cell levels are normal. REF: Harrison book of internal medicine 21ST EDITION

So the answer to this question is A


Instruction:
Non specific esterase in present in –
A. Megakaryocytic leukaemia
B. Lymphocytic leukaemia
C. Erythroleukaemia
D. AML

Response:
Acute Myelogenous leukemia (AML)

AML is a cancer of myeloid line of WBCs, characterized by the rapid proliferation of abnormal cells which accumulate in the bone marrow and interfere with the production of normal blood cells.
AML is the most common acute leukemia affecting adults.
The diagnosis of AML is based on finding that myeloid blasts make up more than 20% of the cells in the marrow.

Mveloblasts are inyeloperoxidase (peroxidase) positive.

Auer rods (Represent abnormal azurophilic granule) are also present in myeloblasts and their presence is taken to be definite evedence of myeloid differentiation.
In some AMLs, blast cells exhibit differentiation of other myeloid stem cell line (other than myeloblast), e.g.,

i)  Monoblast → Lack aver rods, peroxides negative, but nonspecific esterase positive.
ii). Megakaryocytic differentiation
iii) Erythroblast

So the answer to this question is D


Instruction:
Which of the following condition is associated with limitation of both adduction and abduction of the affected eye?
A. Duane retraction syndrome Type 1
B. Duane retraction syndrome Type 2
C. Duane retraction syndrome Type 3
D. Double elevator palsy

Response:
Weakness of both adduction and abduction of the eye is a feature of Duane retraction syndrome type 3. Duane retraction syndrome is a congenital, incomitant ocular motility disorder characterized by abnormal function of lateral rectus muscle in the affected eye together with retraction of the globe and narrowing of the palpabrel fissure on attempted adduction. Retraction of the globe and narrowing of the palpabrel fissure occur due to simultaneous contraction of medial and lateral rectus muscles on attempted adduction. There are of 3 types: DRS type 1 - limited abduction, normal adduction DRS type 2 - limited adduction, normal abduction DRS type 3 - limited adduction and abduction

So the answer to this question is C


Instruction:
The normal time required to culture mycobacterium TB is :
A. 4-8 weeks
B. 2-3 weeks
C. 6-10 weeks
D. 21 days

Response:
M. tuberculosis 4-8 weeks is required before growth is detected. New methods have decreased the time required for bacteriologic confirmation of TB to 2-3 weeks. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 1350

So the answer to this question is A


Instruction:
All are indications of lithium except
A. Neutropenia
B. Major Depression
C. Vasculogenic Headache
D. Generalized anxiety disorder

Response:
Lithium is a drug of its own kind to suppress mania and to exe a prophylactic effect in bipolar manic depressive illness (MDI) at doses which have no ove CNS effects. Ref KD T ripati 8th ed.

So the answer to this question is D


Instruction:
Pandemic are caused by -a)  Hepatitis Bb)  Influenza-Ac)  Influenza-Bd)  Influenza-Ce) Cholera
A. bd
B. be
C. bcd
D. da

Response:
None

So the answer to this question is B


Instruction:
Which of the following is used for prostatic carcinoma-
A. Danazole
B. Clomiphene
C. Finasteride
D. None

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

So the answer to this question is C


Instruction:
All of the following statements are true about repair of groin hernias except:
A. Lichtenstein tension free repair has a low recurrence rate
B. TEP repair is an extraperitoneal approach to laparoscopic repair of groin hernia
C. In Shouldice repair, non-absorbable mesh is used
D. The surgery can be done under local anesthesia in selected cases

Response:
Ans. (c) In shouldice repair, non absorbable mesh is usedRef: Sabiston 19/e p1120-1126* Lichtenstein uses Tension free prolene mesh (procedure of choice for Inguinal hernia)* TEP repair - Total Extra Peritoneal repair* Shouldice- Anatomical repair- Double breasting of Fascia transversalis done* Hernia Surgeries are done by Local Anesthesia Infiltration

So the answer to this question is C


Instruction:
Intermittent dysphagia is caused by -a) Strictureb) Reflux esophagitisc) Achalasia cardiad) Pharyngeal diverticulme) Diffuse esophageal spasm
A. ab
B. bc
C. cd
D. de

Response:
None

So the answer to this question is D


Instruction:
All of the following are true about Arnold-Chiari malformation except:
A. Type I Chiari malformation is displacement of cerebellar tonsil into cervical canal
B. Type II Chiari malformation is associated with syringomyelia of cervical canal
C. Type II Chiari malformation is characterized by elongation of the 4th ventricle and kinking of the brainstem, with displacement of the inferior vermis, pons, and medulla into the cervical canal
D. Type I Chiari malformation is not associated with hydrocephalus

Response:
Arnold-Chiari Malformation Type I Chiari malformation Type II Chiari malformation - Displacement of cerebellar tonsil into cervical canal - Associated with syringomyelia of cervical canal - Typically produces symptoms during adolescence or adult life - Not associated withhydrocephalus - Patients complain of recurrent headache, neck pain, urinary frequency, and progressive lower extremity spasticity - Lesion represents an anomaly of the hindbrain - Characterized by elongation of the 4th ventricle and kinking of the brainstem, with displacement of the inferior vermis, pons and medulla into the cervical canal. - Type II Chiari malformation is characterized by progressive hydrocephalus with a myelomeningocele. - Plain skull radiographs show a small posterior fossa and a widened cervical canalQ. - CT scanning with contrast and MRI display the cerebellar tonsils protruding downward into the cervical canal and the hindbrain abnormalities. - The anomaly is treated by surgical Decompression

So the answer to this question is B


Instruction:
What is the major role of 2, 3 bisphosphoglycerate in RBCs?
A. Acid-base balance
B. Reversal of glycolysis
C. Release of oxygen
D. Binding of oxygen

Response:
2,3 BPG is responsible for significantly lowering the oxygen affinity of hemoglobin and and allowing the hemoglobin to more efficiently release oxygen at the typical Po2 of tissues. Only one molecule of 2,3 BPG interact with each hemoglobin tetramer. Rise in 2,3 BPG in RBCs promotes the shift of hemoglobin to the T form and subsequently release oxygen. In rbcs 2, 3 BPG rise as they adapt to conditions of tissue hypoxia ( from anemia, high altitude, pulmonary dysfunction).

So the answer to this question is C


Instruction:
Dumbell tumour is seen in
A. Meningioma
B. Neurofibroma
C. Ependymoma
D. Thymoma

Response:
None

So the answer to this question is B


Instruction:
Most common cause of persistent hypeension in child with Intrinsic Renal disease is
A. CGN
B. Chronic pyelonephritis
C. Obstructive uropathy
D. Renal tumor

Response:
ACEIs or ARBs, appropriate diuretic therapy, and dietary salt restriction make up the foundation for the treatment of HTN in CKD. Bedtime dosing of at least one antihypeensive medication improves BP control in patients with CKD. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is B


Instruction:
Most common Organism causing Bronchiolitis
A. Respiratory syncytial Virus
B. Parainfluenza virus
C. Hemophilius Influenza A
D. Hemophilius Influenza B

Response:
Most common Organism causing Bronchiolitis Respiratory Syncytial Virus.

So the answer to this question is A


Instruction:
27. Topical steriods are not recommended post surgery for:
A. allergic fungal sinusitis
B. Chronic rhinosinusitis
C. Antrochoanal polyp
D. Ethmoidal polyp

Response:
For antrochoanal polyps cause is infection and not the allergy. antrochoanal polyps are single,unilateral and rarely recur. Topical steriods are rarely recommend ref Scott Brown 7/e,p 1553

So the answer to this question is C


Instruction:
A 31-year-old man has an infertility work-up. He has aspermia. He also has chronic diarrhea with elevated quantitative stool fat. He has had recurrent, severe respiratory tract infections since early childhood. As a neonate, he had bowel obstruction from meconium ileus. He is most likely to have an abnormality involving mutation in which of the following genes?
A. CFTR
B. FGFR
C. G6PD
D. HFE

Response:
Cystic fibrosis can be accompanied by agenesis of the vas deferens, a common finding that leads to infertility. With good medical care, patients with cystic fibrosis are living longer, and childbearing becomes an issue. Disorders of fibroblast growth factor receptor (FGFR) can include dwarfism. Glucose-6-phosphate dehydrogenase (G6PD) deficiency results in hemolysis on exposure to oxidants such as antimalarial drugs (e.g., primaquine). The HFE gene is abnormal in hereditary hemochromatosis; however, the patient is young for the onset of this disease. NF1 (neurofibromatosis) is associated with the appearance of various neoplasms, including neurofibromas, pheochromocytomas, and gliomas. p53 is a tumor suppressor gene, and loss of both alleles can promote the appearance of various malignancies, mainly carcinomas.

So the answer to this question is A


Instruction:
False statement about plague is -
A. It is a gram-negative coccobacillus responding to streptomycin
B. Bubonic plague is the most common form
C. Pneumonic plague develops most rapidly and is most frequently fatal
D. The bubo of plague is characterised by intense cellulitis

Response:
None

So the answer to this question is D


Instruction:
Renal papillary necrosis is almost always associated with one of the following conditions: March 2004
A. Diabetes mellitus
B. Analgesic nephropathy
C. Chronic pyelonephritis
D. Post streptococcal glomerulonephritis

Response:
Ans. A i.e. Diabetes mellitus

So the answer to this question is A


Instruction:
Which one of the following is an emerging viral disease?
A. SARS
B. Chicken pox
C. Measles
D. Rabies

Response:
Virus discovery in particular has been greatly facilitated by new nucleic acid technology. These frontiers were first notably explored with high-density microarrays containing spatially arrayed sequences from a phylogenetically diverse collection of viruses. Although biased toward those with homology to known viruses, novel viruses in clinical samples were successfully identified on the basis of their ability to hybridize to these prespecified sequences. This methodology famously contributed to identification of the corona virus causing severe acute respiratory syndrome (SARS). Once discovered, this SARS corona-virus was rapidly sequenced: the full genome was assembled in April 2003, less than 6 months after recognition of the first case. This accomplishment illustrated the advancing power and speed of new diagnostic technologies.

Harrisson Principle of Internal Medicine Ed 19th Pg772

So the answer to this question is A


Instruction:
Ethmoid bone forms A/E -
A. Superior turbinate
B. Middle turbinate
C. Inferior turbinate
D. Uncinate process

Response:
"The inferior turbinate is a separate bone, while rest of the turbinates are a part of ethmoidal bone". —Tuli 1st/e p. 135

So the answer to this question is C


Instruction:
Which one of the following drugs is not used in the treatment of mycobacterium avium intercellulare infection ?
A. Clarithromycin
B. Eflornithine
C. Ethambutol
D. Rifabutin

Response:
None

So the answer to this question is B


Instruction:
Chronic use of which of the following medications is most likely to cause osteoporosis?
A. Lovastatin
B. Propanolol
C. Warfarin
D. Prednisone

Response:
(Ref: KDT 6/e p286) * Steroids result in osteoporosis on long term use.

So the answer to this question is D


Instruction:
In a coho study nonsmokers were found to have carcinoma lung. This indicates-
A. Smoking does not cause lung cancer
B. Etiology for lung Ca is multi factorial
C. Smoking is the only cause of lung cancer
D. Passive smoking also increase lung cancer

Response:
Coho study is also known as incidence study. The cohos are identified prior to the appearance of disease under investigation. The study group so defined are observed over a period of time to determine the frequency of disease among them. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 83

So the answer to this question is B


Instruction:
A child has staed mouthing objects, shows likes and dislikes, but has not yet developed stranger anxiety. The age of child is:
A. 3 months
B. 5 months
C. 7 months
D. 9 months

Response:
Stranger anxiety, that develops at around 7 months has not yet appeared. So, the age of the child is 5 months. Child stas mouthing object: 5-6 months.

So the answer to this question is B


Instruction:
Normal corneal endothelial count in a young adult is
A. 500/mm2
B. 2500/mm2
C. 4500/mm2
D. 6500/mm2

Response:
Ans. (b) 2500/mm2Ref Parson's 21/e, p. 120* The cell density of endothelium is around 2800cells/mm2(2400-3000cells/mm2) in young adults, which decreases with the advancing age.

So the answer to this question is B


Instruction:
Superior pancreaticoduodenal artery is a branch of
A. Splenic artery
B. Gastroduodenal artery
C. Right gastric artery
D. Superior mesenteric artery

Response:
(Gastroduodenal artery) (263-BDC-2 4th) (261-Snell 7th)* Superior pancreatico duodenal artery is a branch of Gastroduodenal artery* Inferior pancreatico duodenal artery is a branch of superior mesenteric arteryHEPATIC ARTERY - branchesSUPERIOR MESENTERIC ARTERY branches* Right gastric artery* Gastroduodenal artery-*Right gastroepiploic-*Superior pancreatico duodenal* Right and left hepatic arteries (Right hepatic artery gives off cystic artery)* *Left gastroepiploic artery is branch of splenic artery* *Inferior pancreatico duodenal artery* Middle colic artery* Iliocolic artery (Appendicular artery is a branch of the posterior cecal artery)* Jejunal and Ileal branches

So the answer to this question is B


Instruction:
Best investigation for ureteric stones is:
A. CT
B. CECT
C. USG
D. IVP

Response:
Helical CT without oral or intravenous contrast is the preferred imaging modality for patients with renal colic or suspected urolithiasis" -- Smith's Urology Ref : Smith's Urology 17/e p81, 261

So the answer to this question is A


Instruction:
All of the following modalites can be used for in situ ablation of liver secondaries, except:
A. Ultrasonic waves
B. Cryotherapy
C. Alcohol
D. Radiofrequency

Response:
Ans. Alcohol

So the answer to this question is C


Instruction:
A 10 year old child develops hematuria after 2 days of diarhoea. Blood film shows fragmented RBCs. Which of the following is likely diagnosis-
A. Acute pyelonephritis
B. Disseminated intravascular coagulopathy
C. Haemolytic uremic syndrome
D. Haemolytic crises

Response:
None

So the answer to this question is C


Instruction:
Name the pathology seen in scalp
A. Dermoid
B. Sebaceous cyst
C. Hemangioma
D. Metastasis

Response:
Ans. (b) Sebaceous cyst* MC site of Sebaceous cyst is scalp.* Never seen in palms, soles, mucosa.* Ulcerated Sebaceous cyst of scalp is Cock's peculiar tumor.

So the answer to this question is B


Instruction:
A patient has been diagnosed as having "long QT syndrome." The patient is experiencing significant pain following a bout with shingles. What would be an appropriate drug for his pain?
A. Amitriptyline
B. Fentanyl
C. Acyclovir
D. Gabapentin

Response:
It's a case of post-herpetic neuralgia. Gabapentin is the drug of choice. Amitriptyline can also be used for pain but it can also cause arrhythmia.

So the answer to this question is D


Instruction:
A number of enzymes take role in the formation of DNA synthesis. Unwinding of DNA is done by:
A. Helicase
B. DNA polymerase
C. Primase
D. Topoisomerases

Response:
A replication fork consists of four components that form in the following sequence: The DNA helicase unwinds a sho segment of the parental duplex DNA; A primase initiates synthesis of an RNA molecule that is essential for priming DNA synthesis; The DNA polymerase initiates nascent, daughter-strand synthesis; and Single-stranded DNA-binding proteins (SSBs) bind to ssDNA and prevent premature reannealing of ssDNA to dsDNA. Topoisomerases relieve torsional strain that results from helicase-induced unwinding. Must know: DNA ligase seals the single strand nick between the nascent chain and Okazaki fragments on lagging strand. Ref: Weil P. (2011). Chapter 35. DNA Organization, Replication, & Repair. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.

So the answer to this question is A


Instruction:
A 22-year-old man sustains severe blunt trauma to the back. He notes that he cannot move his lower extremities. He is hypotensive and bradycardic. Which of the following is the best initial management of the patient?
A. Administration of phenylephrine
B. Administration of dopamine
C. Administration of epinephrine
D. Intravenous fluid bolus

Response:
The patient is in neurogenic shock as a result of a spinal cord injury. Neurogenic shock is characterized by loss of sympathetic tone peripherally as well as bradycardia owing to loss of the reflexive increase in hea rate in response to hypotension. Initial treatment is with fluid resuscitation followed by initiation of vasoconstrictors such as dopamine or phenylephrine. Hypovolemia caused by hemorrhage should also be ruled out in trauma patients

So the answer to this question is D


Instruction:
A 22-year-old man has symptoms of low back pain and stiffness. After several months of mild symptoms, he notes more severe stiffness at night and hip pain. On physical examination, there is paravertebral muscle tenderness and limited flexion of the lumbar spine. Figure shows an x-ray of the lumbar spine. Which of the following is the most likely diagnosis?
A. Reiter syndrome
B. Marfan syndrome
C. ankylosing spondylitis (AS)
D. RA

Response:
(c) Source: (Kasper, p. 1993) AS occurs in 1-6% of adults inheriting human lymphocyte antigen B27 (HLA-B27). However, the prevalence in B27-positive relatives of patients with AS is up to 30%. Men are three times more likely to be affected.

So the answer to this question is C


Instruction:
Articulation of pisiform bone is with:
A. Triquetral
B. Lunate
C. Scaphoid
D. Trapezoid

Response:
Ans. A TriquetralRef: BDC, 6th ed. vol. I pg. 25; Snell's 8th ed. pg. 402PISIFORM* It is a sesamoid bone in the tendon of flexor carpi uinaris.* Its dorsal surface presents a smooth, oval facet, for articulation with the triquetral* The palmar surface is rounded and rough, and gives attachment to the transverse carpal ligament, and to the Flexor carpi uinaris and Abductor digiti quinti.

So the answer to this question is A


Instruction:
Vit B1 is a cofactor for
A. Transketolase
B. Transaldolase
C. Aldolase A
D. Aldolase B

Response:
Vit B1 is a cofactor for Transketolase. Transketolase: The second group of enzymes that use TPP as co-enzyme are the transketolases, in the hexose monophosphate shunt pathway of glucose the main role is in carbohydrate metabolism Ref: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 467

So the answer to this question is A


Instruction:
Periventricular calcification is often due to:
A. Toxoplasmosis
B. Cytomegalic infection
C. Congenital syphilis
D. All of the above

Response:
B i.e. Cytomegalovirus

So the answer to this question is B


Instruction:
The supraoptic nucleus of the hypothalamus is believed to control secretion of which of the following hormones?
A. Antidiuretic hormone
B. Oxytocin
C. Growth hormone
D. Adrenocoiocotrophic hormone

Response:
The supraoptic nucleus (SON) is a nucleus of magnocellular neurosecretory cells in the hypothalamus of the mammalian brain. The nucleus is situated at the base of the brain, adjacent to the optic chiasma. In humans, it contains about 3,000 neurons.Function; The cell bodies produce a peptide hormone: anti-diuretic hormone.Ref: Ganong&;s review of medical physiology; 24th edition; page no; 311

So the answer to this question is A


Instruction:
Perikymata are the external surface manifestations of
A. Enamel rods
B. Incremental lines of retzius
C. Nasmyth's membrane
D. Pellicle

Response:
The number of perikymata gradually decreases form cervical region to occlusal or incisal region because of undisturbed development of enamel prior to birth. Perikymata are usually absent in prenatally developed occlusal parts of deciduous teeth, whereas they are present in postnatal cervical parts.

So the answer to this question is B


Instruction:
A 17 year old unmarried girl presents with fever, nausea, vomiting, pallor and pain abdomen. She is having foul smelling blood stained discharge per vaginum. Your most likely diagnosis of this case is
A. Twisted ovarian cyst
B. Typhoid with enteric perforation
C. Pelvic abscess with septic peritonitis
D. Ruptured ectopic pregnancy

Response:
It is a case of septic aboion complicated by septic peritonitis and pelvic abscess. As the patient is unmarried she had some procedure as criminal aboion to terminate unwanted pregnancy. In case of twisted ovarian cyst, fever and vaginal discharge are absent. In ruptured ectopic pregnancy, same findings are there but fever is usually absent and vaginal discharge is not foul smelling, there is only slight bleeding

So the answer to this question is C


Instruction:
Kiesselbach's area does not involve:
A. Superior labial artery
B. Anterior ethmoidal artery
C. Greater palatine artery
D. Posterior ethmoidal artery

Response:
Ans: D Posterior ethmoidal artery* Kiesselbach's area aka Kiesselbach;s plexus and Little's area, is an area on the nasal septum located on the antero inferior part of the septum* in this area four arteries anastomose to form a vascular plexus called Kiesselbach's plexus.* The arteries are# Sphenopalatine artery (from the maxillary artery): Main artery of plexus# Greater palatine artery (from the maxillary artery)# Anterior ethmoidal artery (from the ophthalmic artery)# Septal branch of the superior labial artery (from the facial artery)

So the answer to this question is D


Instruction:
Which of the following is a feature of gram-positive bacteria rather than gram-negative bacteria?
A. Lipid A-containing lipopolysaccharide
B. Lipoprotein in periplasmic space
C. Outer membrane
D. Thick peptidoglycan cell wall

Response:
Most of the features listed are those of gram-negative bacteria, which have a complex cell envelope consisting of a cytoplasmic (inner) membrane, a periplasmic space containing peptidoglycan and lipoprotein, an outer membrane, and sometimes a capsule. The outer membrane contains lipopolysaccharide which is a major component of endotoxin. The peptidoglycan cell wall of the gram-negative bacteria is thin, while that of the gram-positive bacteria is thick. Other features of gram- positive bacteria include a fairly simple surface with cytoplasmic membrane, peptidoglycan, cell wall, and sometimes, an outer capsule. The cell wall contains lipoteichoic acids.

So the answer to this question is D


Instruction:
All are true regarding transforming growth factor? p except-
A. Proliferation for fibroblast
B. Proliferation of endothelial cells
C. Chemotaxis of fibroblasts
D. Activation of macrophages

Response:
Ans. is `d' i.e., Activation of macrophagesAlso see above explanation.Growth factors and cytokines involved in regeneration and wound healingGrowth factor Epidermal growth aTransforming growth factor aHeparin-binding EGFHepatocyte growth factor/scatter factorVascular endothelial cell growth factor (isoforms A,B,C,D)Platelet-derived growth factor (isoforms A,B,C,D)Fibroblast growth factor 1 (acidic), 2 (basic), and familyTransforming growth factor 13 (isoforms 1,2, 3); other members of the family are BMPs and activinFunctionsMitogenic keratinocytes and fibroblasts; stimulates keratinocyte migration and granulation tissue formationSimilar to EGF; stimulates replication of hepatocytes and most epithelial cellsKeratinocyte replicationEnhances proliferation of hepatocytes, epithelial cells, and endothelial cells; increases cell motility, keratinocyte replicationIncreases vascular permeability; mitogenic for endothelial cells; angiogenesisChemotactic for PMNs, macrophages, fibroblasts, and smooth muscle cells; activates PMNs, macrophages and fibroblasts; mitogenic for fibroblasts, endothelial cells, and smooth muscle cells; stimulates production of MMPs, fibronectin, and HA; stimulates angiogenesis and wound contractionChemotactic for fibroblasts; mitogenic for fibroblasts and keratinocytes; stimulates keratinocyte migration, angiogenesis, wound contraction and matrix depositionChemotactic for PMNs, macrophages, lymphocytes fibroblasts and smooth muscle cells; stimulates TIMP synthesis, angiogenesis and fibroplasia; inhibits production of MMPs and keratinocyte proliferationKeratinocyte growth Ka Fibroblasts Stimulates keratinocyte migration, proliferationfactor (also called and differentiationFGF-7)Tumor necrosis factor TNF Macrophages mast cells, Activates macrophages; regulates otherT lymphocytes cytokines, multiple functions

So the answer to this question is D


Instruction:
Investigation using dye to find out stone in salivary gland
A. Sialography
B. Mammography
C. MR angiography
D. USG

Response:
Dye used is lipiodol or sodium diatrizoate(Hypaque).24-gauge cannula is passed into either Stenson's duct or Whaon's duct and one ml of the dye is injected into the duct and X-ray is taken. SRB,5th,406.

So the answer to this question is A


Instruction:
What is the diagnosis in this patient with abdominal pain?
A. Amyloidosis
B. Familial Mediterranean fever
C. Lead poisoning
D. Leukemia

Response:
Answer C. Lead poisoningThe blue lines evident on the gums are Burton's lines, which can be present in patients with lead poisoning. The diagnosis of occupational lead poisoning was confirmed by an elevated serum lead level. The patient recovered following chelation therapy.

So the answer to this question is C


Instruction:
In Nephrotic syndrome hypercoaguability occurs due to-
A. Urinary loss of Antithrombin III
B. Increase in serum protiens-c,s
C. Decrease in serum Fibrinogen
D. Factor vIII

Response:
Hypercoaguble state in nephrotic syndrome is due to Urine loss of Anithrombin III Hyperfibrinogenemia Decrease in serum protiens c, s Increase in platelet aggregation. Venous complications can occur due to Hypercoaguble state in nephrotic syndrome ,so anticoagulants are given to all patients Ref Harrison 20th edition pg. No. 2142,293

So the answer to this question is A


Instruction:
Ecbolics are the drugs which
A. Cause uterine contraction
B. Increase menstrual blood flow
C. Increases sweating
D. Causes vomitting

Response:
Ecbolics: They increase uterine contractions, e.g. ergot preparations, synthetic estrogens, pituitary extract, strychnine or quinine. Ref - Krishan Vij textbook of forensic medicine and toxicology 5e pg - 383

So the answer to this question is A


Instruction:
Advantage of newer liposomal preparation of amphotericin B
A. Similar in efficacy and antifungal spectrum as conventional preparations
B. Fewer chances of nephrotoxicity
C. Lesser uptake in the tissues like the kidney
D. All of the above

Response:
Newer liposomal preparations of amphotericin B have the following features:

Fewer chances of nephrotoxicity and infusion-related reactions
Lesser uptake in the tissues like kidney
More expensive
Similar in efficacy and antifungal spectrum as conventional preparations

So the answer to this question is D


Instruction:
Which of the following is the constituent of mini pill?
A. Only progesterone
B. Only estrogen
C. Estrogen + progesterone
D. Norethisterone + estradiol

Response:
Ans: a (Only progesterone) Ref: Shaw, 13th ed, p. 228The constituent of minipill is only progesterone. It does not contain estrogen. It is also known as progesterone only pill.OCP(a) Combined- Monophasic- Multiphasic -Sequential pill (only estrogen in 1st 14 days and estrogen + progesterone in next 14)(b) Minipill -Progesterone only pillMechanism of action of OCPCombined OC pills suppress pituitary hormones FSH and LH and through their suppression prevents ovulation. At the same time, progesterone causes atrophic changes in the endometrium and prevents nidation.Benefits of OCP(1) Contraceptive - Prevention of pregnancy(2) Non contraceptive(a) Cycle stabilization(b) Cure of menstrual disorder (c) Protection against cancer- Ovarian- Endometrial(d) Benign tumour- Benign breast disease- Ovarian functional cyst- Fibromyoma uterus(e) Protects against- P1D-Anaemia- Endometriosis- Acne, hirsuitism- Rheumatoid arthritis- OsteoporosisOCP reduces the incidence of ectopic pregnancy is due to suppression of ovlulation, and reduction inPIDSide effects of OCPI. MinorNausea, vomiting, lack of appetite, break- through bleedingBreast tendernessVaginal dischargeHeadache, migraineChloasmaWeight gainAcne, Oily skinII. Major(a) Cardiovascular disease- Stroke- Venous Thromboembolism- HT- Coagulation abnonnalities(b) Cancer - Breast Ca, Ca cervix, Liver Ca(c) Diabetes(d) Gall stones(e) Affects lactation

So the answer to this question is A


Instruction:
An infant with failure to thrive, hypertension, metabolic alkalosis and hyperkalemia presents to a clinician. Most probable cause is
A. Liddle's syndrome
B. Bartter's syndrome
C. Gittelman's syndrome
D. Gordon syndrome

Response:
d. Gordon syndrome(Ref: Nelson 20/e p 2535)Out of the given causes, hyperkalemia is seen only in Gordon syndromeGordon syndrome or familial hyperkalemic hypertension, is due to gain-of-function mutations in WNK1 & ioss-of-funotion mutations in WNK4 in distal convoluted tubule, leading to excessive NCCT-mediated salt reabsorption with the clinical picture of pseudohypoaldosteronism type 2Liddle syndrome is due to gain-of-function mutations of the gene that encodes the epithelial sodium channel in the collecting duct, leading to hypertension, hypokalemia & suppressed aldosterone

So the answer to this question is D


Instruction:
All are effect of parasympathetic system on hea except -
A. Negative chronotropic
B. Negative ionotrophic
C. Negative dromotropic
D. All are seen

Response:
Ans. is 'b' i.e., Negative inotropic

So the answer to this question is B


Instruction:
Following drugs are used in the treatment of ADHD:
A. Amphetamine
B. Modafinil
C. Methylphenidate
D. All of the above

Response:
Pharmacotherapy: Stimulants Non stimulants Methylphenidate, dexmethylphenidate Atomoxetine Amphetamines Bupropion Modafinil Clonidine, Guanfacine Venlafaxine - Stimulants are the preferred group of drugs in children with ADHD - Methylphenidate is the drug of choice for ADHD children * Atomoxetine is efficacious for ADHD and has modest antidepressant activity. * Similarly, many studies have shown efficacy for depressive and ADHD symptoms with the use of bupropion. However, it is known to lower the seizure threshold and as such would not be a recommended drug of choice in a patient with a history of seizure disorder.

So the answer to this question is D


Instruction:
Which of the drug Does not have active metabolite
A. Diazepam
B. Propanonol
C. Allupurinol
D. Lisnopril

Response:
(Ref KDT 6e p485). Captopril and lisinopril are ACE inhibitors that are not prodrugs. Diazepam produce many active metabolites like.oxazepam. Propranolol can produce 4-hydroxypropanolol .which has b-antagonist activity. Allopurinol gives rise to oxypurinol which can inhibit xanthine oxidase.

So the answer to this question is D


Instruction:
Systemic Millary TB spreads
A. Aery
B. Vein
C. Bronchus
D. Lymphatic

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

So the answer to this question is A


Instruction:
The classification proposed by the International Lymphoma Study Group for non Hodgkin&;s lymphoma is know as -
A. Kiel classification
B. REAL classification
C. WHO classification
D. Rappapo classification

Response:
International Lymphoma Study Group proposed a classification called revised European -American classification of lymphoid neoplasm abbrevated as REAL classification. This was based on the hypothesis that all forms of lymphoid malignancies represent malignant counterpa of normal population of immune cell present in lymph node and bone marrow . Kiel classification is an immunologic classification of NHL.It is a modification of Lukes- Collins classification. Divided all malignant lymphomas in to B cell or T cell origin WHO classification is an international classification of all lymphoid neoplasms together as a unified group under the ageis of WHO. Rappapo is a morphological classification based on low power and high power microscopy Ref: Harsh Mohan textbook of pathology, 7th edition.Pg no.344-346

So the answer to this question is B


Instruction:
As a pa of space-research program, a physiologist was asked to investigate the effect of flight-induced stress on blood pressure. Accordingly, the blood pressure of the cosmonauts were to be measured twice: once before the takeoff and once after the spacecraft entered the designated orbit around the eah. For a proper comparison, the preflight blood pressure should be recorded in:
A. The lying down position
B. The sitting position
C. The standing position
D. Any position, as long as the post-flight recording is made in the same position

Response:
A i.e. The lying down position For two values to be comparable (to remove any bias) we must remove as many confounding variables as possible. The confounding variable in this question is gravity. Gravity is present on eah but is not present in space. The best position in which the effect of gravity is nullified is lying down.

So the answer to this question is A


Instruction:
If stage Ib cervical cancer is diagnosed in a young woman, while performing radical hysterectomy which structure would you not remove:
A. Uterosacral and uterovesical ligament
B. Pelvic LN
C. Both ovaries
D. Upper third of vagina

Response:
Ans. is c, i.e. Both ovariesRef: Textbook of Gynecology sheila Balakrishnan 1st/ed, p255Cancer cervix rarely involves the ovaries.When radical/modified radical hysterectomy are being performed in young females, ovaries should not be removed.

So the answer to this question is C


Instruction:
An 8 year old child diagnosed with Langerhans cell histiocytosis. Bone involvement is seen. All of the following are true about Langerhans cell histiocytosis, EXCEPT:
A. Peak incidence less than 3 years of age
B. Radiosensitive
C. Diffuse form is known as litter-sewe-disease
D. Enophthalmos present

Response:
Exophthalmos is present in only 10% to 30% of cases of Langerhans cell histiocytosis. It may be unilateral or bilateral and is due to retroocular bone infiltration by Langerhans cells. Langerhans cell histiocytosis is a disease of childhood. Letterer-Siwe disease is the prototype of the acute, disseminated, multisystemic form that usually appears in infants or newborns. The disease can occur in individuals of any age and can also be congenital, but is most common in children aged 1-3 years. Ref: Gelmetti C. (2012). Chapter 147. Cutaneous Langerhans Cell Histiocytosis. In L.A. Goldsmith, S.I. Katz, B.A. Gilchrest, A.S. Paller, D.J. Leffell, N.A. Dallas (Eds), Fitzpatrick's Dermatology in General Medicine, 8e.

So the answer to this question is D


Instruction:
Filgrastim is a.
A. T-cell stimulating factor
B. GnRH analogue
C. G-CSF
D. GM-CSF

Response:
Filgrastim is a recombinant G-CSF. From medical pharmacology padmaja 4th edition Page no 333

So the answer to this question is C


Instruction:
A thyroid nodule is found on a 40-year-old woman on routine evaluation. She has no prior history of thyroid disease and clinically feels well. There is a 15-mm nontender nodule on the right lobe of the thyroid with no associated lymphadenopathy. Thyroid function tests are normal. Which of the following is the most appropriate next step in management?
A. thyroid scan
B. fine needle aspiration (FNA) biopsy
C. repeat assessment in 6 months
D. partial thyroidectomy

Response:
Needle biopsy can be used in numerous diseases, but the main rationale is to differentiate benign from malignant nodules. A thyroid scan is appropriate if the TSH is suppressed suggesting a possible "hot" nodule (hyperfunctioning nodules are very rarely malignant). The specimen must be read by an experienced cytologist. It is difficult to diagnose differentiated follicular carcinoma or to differentiate lymphoma from Hashimoto's thyroiditis. Papillary carcinoma is the easiest diagnosis to make by needle biopsy.

So the answer to this question is B


Instruction:
Which of the following is true about METFORMIN
A. Hypoglycemia is very common
B. Increases hepatic Gluconeogeneis
C. Reduces the lipogeneis in adipose tissue
D. Increases the secretion of Insulin

Response:
None

So the answer to this question is C


Instruction:
According to PALS, which of the following is not included in initial impression?
A. Consciousness
B. Color
C. Airway
D. Breathing

Response:
Initial impression includes: Consciousness Breathing Color. Airway is included in Primary assessment. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is C


Instruction:
false regarding neoplasms of the ovary are:
A. Stromal invasion is commonly present in ovarian tumours of borderline malignancy
B. Lymphocytic infiltration is characteristic to dysgerminoma
C. Presence of ascites and pleural effusion in Brenner tumour indicates poor prognosis
D. Endometrioid carcinoma of the ovary may coexist with endometrial adenocarcinoma

Response:
Borderline ovarian tumours grade 0 tumors may demonstrate papillary tufting,stratification,epithelial atypia,exfoliation of cellular clusters,minimal mitotic activity No stromal invasion Patients have a high survival rate. runs a typical indolent course spontaneous regression of peritonial implants multiple sections examined to exclude invasion SHAW&;S TEXTBOOK OF GYNECOLOGY,Pg no:373,374,15th edition

So the answer to this question is A


Instruction:
Anterior cardiac vein opens into -
A. Right atrium
B. Coronary sinus
C. Thebesian veins
D. Middle cardiac vein

Response:
Ans. is 'a' i.e., Right atrium Veinous drainage of heart1. Coronary sinus: Opens into right atrium and has following tributries : (i) Great cardiac vein, (ii) Middle cardiac vein, (iii) Posterior vein of left ventricule, (iv) Small cardiac vein, (v) Oblique vein of left atrium and (vi) Sometimes right marginal vein.2. Anterior cardiac vein: Opens into right atrium.3. Venae cordis minimi (thebasian veins): Open into right atrium.4. Right marginal vein: More often opens into right atrium but sometimes into coronary sinus.

So the answer to this question is A


Instruction:
A patient is receiving insulin and acarbose for diabetes mellitus and developed hypoglycemia. Which of the following should be used for the treatment of hypoglycemia in this patient?
A. Sucrose
B. Galactose
C. Glucose
D. Starch

Response:
Complex carbohydrates (polysaccharides and sucrose) are absorbed after conversion to simple carbohydrates by alpha-glucosidase. Inhibitors of this enzyme (acarbose and miglitol) decrease carbohydrate absorption from the GIT. Although these drugs themselves do not cause hypoglycemia blood sugar may decrease if these are combined with insulin or other drugs releasing insulin. In such a case of hypoglycemia, simple carbohydrates like glucose (not sucrose or other complex carbohydrates) should be used.

So the answer to this question is C


Instruction:
Protein synthesis takes place in:
A. Stratum basale.
B. Stratum spinosum.
C. Stratum granulosum.
D. Stratum corneum.

Response:
None

So the answer to this question is B


Instruction:
Dermatophytes primarily involves _______:
A. Stratum corneum
B. Stratum granulosum
C. Stratum basale
D. Stratum spinosum

Response:
Ans. A. Stratum corneumDermatophytes infect and survive only in the dead keratin layers of skin (stratum corneum), hair and nails as they are keratinophilic.

So the answer to this question is A


Instruction:
Greater petrosal nerve is formed from ?
A. Geniculate ganglion
B. Plexus around ICA
C. Plexus around middle meningeal aery
D. None of the above

Response:
Ans. is 'a' i.e., Geniculate ganglion Petrosal nervesGreater petorsal nerveFirst branch of facial nerveArises from geniculate ganglionIn foramen lacerum it joins deep petorsal nerve and forms the nerve to pterygoid canalSupplies lacrimal glands, nose, mucosal glands of pharynx, palate.Lesser petorsal nerveBranch of 9th cranial nerve through tympanic plexus (passes otic ganglion)It suplies parotid gland.Deep petorsal nerveIt is a branch of sympathetic plexus around internal carotid aery.It contains cervical sympathetic fibers.External petorsal nerveIt is an inconsistant branch of sympathetic plexus around middle meningeal aery.

So the answer to this question is A


Instruction:
Simian crease is not seen in -
A. Down
B. Trisomy 13
C. Atopic dermatitis
D. Noonan syndrome

Response:
Ans. is 'c' i.e., Atopic dermatitisSimian creaseo Single transverse palmer creaseo Resembles non-human-simian so K/a simian crease,o It is seen inDown syndromeFetal alcohol syndromeCri-du chat syndrome (Chr. 5)Klinefelter (XXY)Noonan (Chr. 12)Patau (Chr. 13)Edward (Chr. 18)

So the answer to this question is C


Instruction:
All of the following are centrally acting antihypeensive drugs except:-
A. Alpha methyl dopa
B. Clonidine
C. Guanabenz
D. Trimethoprim

Response:
Stimulation of a2 receptors in CNS leads to decrease in sympathetic outflow Therefore, a2 agonists can decrease the sympathetic activity and are useful for the treatment of hypeension. These include: Clonidine a-methyl dopa Guanafacine Guanabenz

So the answer to this question is D


Instruction:
Most impoant pathophysiological cause of GERD is
A. Hiatus hernia
B. Transient LES relaxation
C. LES hypotension
D. Inadequate esophageal clearance

Response:
"Transient LES relaxations account for at least 90% of reflux in normal subjects or GERD patients without a hiatus hernia"- Harrison Transient lower oesophagal sphincter relaxations account for essentially all reflux events in individuals with a normal LES pressure at the time of reflux. Pathogenesis of gastroesophageal reflux disease (GERD) The primary event in the pathogenesis of gastroesophageal reflux disease (GERD) is a movement of gastric juice from the stomach into the oesophagus. The three dominant pathophysiologic mechanisms causing gastroesophageal junction incompetence are: Transient lower esophageal sphincter relaxations (tLESRs) A hypotensive lower oesophagal sphincter (LES) Anatomic disruption of the gastroesophageal junction, often associated with a hiatal hernia The latest concept is that the dominant mechanism varies as a function of disease severity with tLESRs predominating with mild disease and mechanisms associated with a hiatus hernia and/or a weak sphincter predominating with more severe disease Transient LES relaxations are different from swallow-induced LES relaxation: tLESRs occur without an associated pharyngeal contraction, are unaccompanied by oesophagal peristalsis, and persist for longer periods (>10 sec) than do swallow-induced LES relaxations. tLESRs are the physiological mechanism of belching. Ref : Harrison 18/e p2433

So the answer to this question is B


Instruction:
Extensive surgical debridement, decompression or amputation may be indicated in the following clinical setting except -
A. Progressive synergistic gangrene
B. Acute thrombophlebitis
C. Acute haemolytic streptococcal cellulitis
D. Acute rhabdomyolysis

Response:
Ans. is 'b' i.e., Acute thrombophlebitis

So the answer to this question is B


Instruction:
Which of the following is phase -2 reaction -
A. Oxidation
B. Reduction
C. Cyclination
D. Glucuronidation

Response:
Ans. is 'd' i.e., Glucuronidation o Phase I reactions: - Oxidation, reduction, hydrolysis, cyclization, decyclization.o Phase II reactions: - Acetylation, glutathione conjugation, glucoronide conjugation (glucuranization), glycine conjugation, methylation, sulfate conjugation (sulfuranation), nucleotide synthesis.

So the answer to this question is D


Instruction:
On the articulator the incisal guidance is the
A. Horizontal guidance
B. Same as condylar guidance
C. Mechanical equivalent of curve of space
D. Mechanical equivalent of horizontal and vertical over lap

Response:
None

So the answer to this question is D


Instruction:
All are clinical features of pheochromocytoma, except :
A. Increased hematocrit
B. Ohostatic hypotension
C. Low coisol level
D. Impaired glucose tolerance

Response:
Answer is C (Low coisol level) Pheochromocytoma is not associated with low coisol levels. Pheochromocytoma is unique in presentation as it may present both with, Hypeension and hypotension. Hypeension occurs in paroxysms and is the most common manifestation - Hypotension occurs as `ohostatic hypotension' and it occurs as a consequence of diminished plasma volume and blunted sympathetic reflexes. Carbohydrate intolerance: Over half of patients have impaired carbohydrate tolerance due to suppression of insulin and stimulation of hepatic glucose output. Hematocrit: An elevated hematocrit may be secondary to diminished plasma volume.

So the answer to this question is C


Instruction:
Anemic hypoxia is due to :
A. 113O2 in aerial blood
B. TPO2 in aerial blood
C. TPCO2 in aerial blood
D. L O2 content in aerial blood

Response:
D i.e. L O2 content in aerial blood

So the answer to this question is D


Instruction:
Inflation of lungs induces fuher inflation is called
A. Hering-Breuer inflation reflex
B. Heads paradoxical reflex
C. Frank-starling law
D. J reflex

Response:
Definition. The Head's paradoxical reflex occurs in case of cold block (or in general irritation) of the vagus nerve. The inflation inhibition explained by Hering-Breuer inflation reflex is annulled and a deep breath occurs Ref: guyton and hall textbook of medical physiology 12 edition page number: 334,335

So the answer to this question is B


Instruction:
NOT true about co-relation is-
A. Doesn't tell about causation
B. Tells about risk of the disease
C. -1.0 correlation shows linear relationship
D. Tells association between two variables

Response:
Ref:Parks 23rd edition pg 852 In order to find out whether there is significant association or not between the two variables , coefficient or Corelation is calculated . r lies between -1 and +1 r near -1 : indicates strong negative correlation . r = 0 : indicates no association r near +1: indicates strong positive correlation. Note: correlation does not necessarily prove causation .

So the answer to this question is B


Instruction:
The typical 'Orphan-Annie eye' nucleus is described in -
A. Serous cystadenocarcinoma of ovary
B. Renal cell carcinoma
C. Papillary carcinoma of thyroid
D. Seminoma

Response:
Papillary carcinoma: Accounts for 85% of thyroid malignancy in iodine-deficient areas Most common thyroid cancer in children and in persons exposed to external radiation Most often in women between 30-40 years Excellent prognosis Characteristic nuclear features: Ground glass (Orphan Annie) nuclei pseudoinclusions Nuclear grooves. Nuclear features are used as diagnostic criteria even in the absence of papillae. Papillary carcinoma: Most commonly spreads through lymphatics. Papillary carcinoma: Metastasize through lymphatics and have an excellent prognosis.

So the answer to this question is C


Instruction:
Drug of choice in MDP is:
A. Lithium
B. Amphetamine
C. Diazepam
D. Alprazolam

Response:
Lithium

So the answer to this question is A


Instruction:
Exposure of left subclan aery by supraclavicular approach does not require cutting of ?
A. Sternocleidomastoid
B. Scalenus anterior
C. Scalenus medius
D. Omohyoid

Response:
Scalenus medius lies posterior to the subclan aery and thus need not be divided to expose the aery. Whereas, sternocleidomastoid & scalenus anterior lie anteriorly and omohyoid lies superiorly and thus are cut during exposure of the subclan aery.

So the answer to this question is C


Instruction:
Weakness of both Adduction and abduction is seen in
A. Duane's retraction syndrome type 1
B. Duane's retraction syndrome type 2
C. Duane's retraction syndrome type 3
D. Double elevator palsy

Response:
Ans. c. Duane's retraction syndrome type 3 Weakness of both adduction and abduction is seen in Duane c retraction syndrome type 3. Duane's Retraction Syndrome Congenital strabismus that is usually caused by failure of normal development of the abducens nerve. Absence of the abducens nerve and fascicle with anomalous innervation of the lateral rectus muscle by the oculomotor nerve Patients may have esotropia or exotropia Mostly unilateral, commonly affecting the left eye more than right Characteristic feature of Duane's Retraction Syndrome Retraction of the globe and narrowing of the palpebral fissure during attempted adductionQ. This feature is caused by the simultaneous contraction of the medial and lateral rectus muscle that occurs during attempted adductionQ Duane's Retraction Syndrome Type I (Esotropic Duane's Syndrome) Most common typeQ Absence or limitation of abduction and normal adductionQ Type II (Exotropic Duane's Syndrome) Least common typeQ Limited adduction with normal abductionQ Type III Limitation of both adduction and abductionQ Double Elevator Palsy All horizontal gaze movements are normal. Double elevator palsy (mono ocular elevator palsy) is caused by tight oblique contracted inferior rectus muscle or hypoplastic/ineffective superior rectus muscle

So the answer to this question is C


Instruction:
A gardener was accidentally poisoned by a weed killer that inhibits acetylcholinesterase. Which of the following alterations in neurochemical transmission at brain cholinergic synapses is the most likely result of this poisoning?
A. Blockade of cholinergic receptors
B. A pileup of choline outside the cholinergic neuron (in the synaptic cleft)
C. A pileup of acetylcholine outside the cholinergic neuron (in the synaptic cleft)
D. Up-regulation of postsynaptic cholinergic receptors

Response:
Ans. C. A pileup of acetylcholine outside the cholinergic neuron (in the synaptic cleft)Acetylcholinesterase is the enzyme that breaks acetylcholine down into acetate and choline. The acetate diffuses away, and choline is taken back up into the presynaptic nerve terminal for the synthesis of more ACh. Blocking the function of acetylcholinesterase would prevent the breakdown of ACh, which would accumulate in the cleft because there is no uptake mechanism for ACh and it diffuses away more slowly than acetate.

So the answer to this question is C


Instruction:
Foramen spinosum transmits the following
A. Meningeal branch of the mandibular nerve , middle meningeal aery
B. Superior ophthalmic vein from the cavernous sinus
C. Both of the above
D. None of the above

Response:
Foramen spinosum transmits Middle meningeal aery & vein Emissary vein Nervosus spinosus - Meningeal branch of the mandibular nerve

So the answer to this question is A


Instruction:
Corneal sensation is lost in –
A. Herpes simplex
B. Conjunctivitis
C. Fungal infection
D. Trachoma

Response:
There is marked diminution of corneal sensations in herpetic dendritic ulcer.

So the answer to this question is A


Instruction:
Which of the following cells predominate on vaginal cytology in menopausal women
A. Intermediate cells
B. Superficial cells
C. Parabasal cells
D. Superficial cells and intermediate cells

Response:
Predominance of parabasal cells is seen in menopausal patients.

So the answer to this question is C


Instruction:
All of the followings are true about Narcolepsy; except:
A. Strong association with HLA class II
B. Sudden loss of voluntary muscle tone
C. NREM abnormality
D. Irresistible desire to sleep

Response:
NARCOLEPSY Narcolepsy is a condition characterized by excessive sleepiness, as well as auxiliary symptoms that represent the intrusion of aspects of REM sleep into the waking state . The sleep attacks of narcolepsy represent episodes of irresistible sleepiness, leading to perhaps 10 to 20 minutes of sleep. They can occur at inappropriate times (e.g., while eating, talking, or driving and during sex). The REM sleep includes hypnagogic and hypnopompic hallucinations, cataplexy, and sleep paralysis. Diagnosis-* polysomnographic - reveals a characteristic sleep-onset REM period * HLA ASSOCIATION - HLA - DR2

So the answer to this question is C


Instruction:
A 20-year-old female presents with excess facial hair and oligomenorrhea, increased levels of free testosterone, and normal ovaries on USG. Most likely diagnosis is:
A. PCOD
B. Adrenal hyperplasia
C. Idiopathic hirsutism
D. Testosterone-secreting tumor

Response:
Ans. A. PCODa. PCOS/PCOD is a disorder of chronically abnormal ovarian function (oligo/anovulation) and hyperandrogenism frequently a/w hyperinsulinemia and insulin resistance, resulting in menstrual irregularity, infertility, and hirsutism.b. Rotterdam 2003 criteria for diagnosis of PCOS/PCOD:c. At least 2 of 3 should be present:i. Oligo/anovulation (causes oligomenorrhea, amenorrhea, and infertility)ii. Hyperandrogenism: Biochemical or clinical (increased serum androgens or acne, hirsutism)iii. 12 or more than 12 follicles 2-9mm in size present within or both ovaries on USG and/or ovarian volume >10mL (necklace-of pearl pattern).* As the patient in the question satisfies first 2 criteria, she is a case of PCOS.

So the answer to this question is A


Instruction:
Red or brown discoloration of teeth is seen in
A. Porphyra
B. Internal resorption
C. Nasmynth membrane
D. Silver

Response:
None

So the answer to this question is A


Instruction:
False positive rheumatoid factor can be associated with all except -
A. Inflammatory bowel disease
B. HbsAg
C. VDRL
D. Coombs test

Response:
None

So the answer to this question is A


Instruction:
Hypomagnesemia is associated with which of the following-
A. Alcoholism
B. Hypothyroidism
C. Both
D. None

Response:
A rising blood concentration of ethanol directly impairs tubular magnesium reabsorption, thus leading to hypomagnesemia. Hypehyroidism is a cause for hypomagnesemia and hypothyroidism causes hypermagnesemia. Reference : page 2462-63 Harrison's Principles of Internal Medicine 19th edition

So the answer to this question is A


Instruction:
The best skin graft for open wound is
A. Isograft
B. Homograft
C. Allograft
D. Autograft

Response:
Autograft or autologous graft means skin grafts from one site of body to another. They are the best skin grafts.

So the answer to this question is D


Instruction:
Zero order kinetics is followed by all of the following drugs EXCEPT:
A. Phenytoin
B. Barbiturates
C. Alcohol
D. Theophylline

Response:
None

So the answer to this question is B


Instruction:
A patient on warfarin sodium following myocardial infarction reports for an oral surgical procedure. Which one of the following Laboratory tests should be preferred to ascertain the fitness
A. Prothrornbin time
B. Tourniquet time
C. Clotting time
D. Bleeding time

Response:
None

So the answer to this question is A


Instruction:
In acute exacerbations of COPD, noninvasive positive pressure ventilation (NIPPV) is initiated when
A. Paco2 >45 mmHg
B. PaO2 <80 mmHg
C. FEV1 <30
D. FEV1/FVC <0.7

Response:
In acute exacerbations of COPD, noninvasive positive pressure ventilation (NIPPV) is initiated in patients with respiratory failure, which is defined as Paco2 > 45 mmHg, This results in a significant reduction in moality rate, need for intubation, complications of therapy, and hospital length of stay.Ref: Harrison 19e pg: 1707

So the answer to this question is A


Instruction:
Which test differentiate maternal and fetal blood CellaEUR'
A. Apt test
B. Kleihauer-Betke test
C. Bubblin test
D. Osmotic fragility test

Response:
Apt test Both Apt test and Kleihaur-betke test can be used to detect the presence of fetal blood within a sample. Apt Test -Is used to detect the presence or absence of fetal blood (qualitative) in a vaginal discharge to rule out vasa pre late in pregnancy or to detect the origin of a neonatal bloody, vomiting whether it's a genuine upper GI hemorrhage/hemoptysis or simply a swallowed maternal blood during delivery or from cracked nipple. Kleihauer-Betke Test -The sample is maternal peripheral smear and is used to see how much of fetal blood (quantitative) has been transfused into the maternal serum in order to assess the risk of isoimmunization and then the risk of hemolytic disease of the newborn. Both of them relies on the fact that HbF is resistant to alkali (Apt) and acids (Kleihauer) and so the HbA containing RBCs (maternal) will be hemolyzed but not the fetal RBCs as they contain the HbF. In simple words When fetal blood needs to be differentiated from adult (maternal) blood Apt test is used --> (qualitative estimation). When the amount of fetal bleeding needs to estimated Kleihauer Betke test is used --4 (quantitative estimation). The question has asked about the test used to differentiate between maternal and *fetal blood therefore the answer should he Apt test. Apt test Kleihaur Betke test Source of sample Maternal or neonatal Maternal How it works Adding 1% NaOH destroys adult HbA but not fetal HbF Adding acid destroys adult HbA but not fetal HbF Assessement type Qualitative Quantitative Result Positive means blood is of fetal origin Repoed in estimated 'inr s of fetal blood

So the answer to this question is A


Instruction:
A 40 year old farmer with history of recurrenmt attack of porphyria complains of itching when exposed to the sun and maculopapular rashes on sun exposed area. His symptoms are exaggerated in summer. The diagnosis is :
A. Seborrheic dermatitis
B. Contact dermatitis
C. Psoriasis
D. Porphyrea Cutanea tarda

Response:
D i.e. Porphyria cutanea tarda Two types of porphyria are photosensitive Porphyria cutanea tarda Is most common type of porphyria and is caused by decreased activity of enzyme uroporphyrinogen decorboxylase. - Two types of PCT are: (1) Sporadic or acquired type, seen in individuals ingesting ethanol or estrogens; (2) inherited type. Both forms are associated with increased hepatic iron stores. Predominant clinical feature is a chronic photosensitivity characterized by increased fragality of sun exposed skin, paicularly areas subject to repeated trauma such as dorsum of hands, forearms, face and ears. The predominant skin lesions are vesicles and bullae, that rupture, producing moist erosion, often with a hemorrhagic base, that heal slowly with crusting and purplish discolouration of the affected skin. Hyperichosis, mottled pigmentary change, and scleroderma like induration are associated features. - Confirmation of diagnosis is done by measurement of urinary porphyrin excretion, plasma porphyrin assay and by assay of erythrocyte and/or hepatic uroporphyrinogen decorboxylase. Erythropoietic porphyria - Erythropoietic porphyria originate in the bone marrow and is d/t decrease in mitochondrial enzyme ferrochelatase; congenital type is d/t deficiency of URO synthetase. - Clinical features include an acute photosensitivity, characterized by subjective burning and stinging of exposed skin that often develops during or just after sun exposure. These may be skin swelling, and after repeated episodes, wax like scarring. - Diagnosis is confirmed by demonstration of elevated levels of free erythrocytes protoporphyrins Detection of increased plasma protoporphyrin helps to differentiate lead poisoning & iron deficiency anemia; in both of which elevated erythrocyte protoporphyrin levels occur in the absence of cutaneous photosensitivity & of elevated plasma protoporphyrin levels. * Seborrhic Dermatitis: presents with greasy scales & severe dandruff. Cradle cap is seborrhic dermatitis of scalp, face & groin in infant. But infant cradle cap is found in ptyriasis capititis complicated by seborrheic dermatitis.

So the answer to this question is D