Instruction:
An infant presents with cardiac failure. Examination reveals a weaker femoral pulse when compared to the radial pulse. What is the probable diagnosis?
A. PDA
B. COA
C. Aorto-illiac vasculitis
D. VSD

Response:
Ref: Nelson's Textbook of Pediatrics. 19th Edition.Explanation:Weak femoral pulse is indicative of Coarctation of aorta. Normally, the femoral pulse occurs slightly before the radial pulse. Weak femoral pulse or femoral pulse felt after radial pulse is a characteristic feature of COACoarctation of aorta (COA)Constrictions of the aorta of varying degrees may occur at any point from the transverse arch to the iliac bifurcation, hut 98% occur just below the origin of the left subclavian artery at the origin of the ductus arteriosus i juxtaductal coarctation).The anomaly occurs twice as often in males as in females.Coarctation of the aorta may be a feature of Turner syndrome and is associated with a bicuspid aortic valve in more than 70% of patients.Mitral valve abnormalities (a supravalvular mitral ring or parachute mitral valve) and subaortic stenosis are potential associated lesions.When this group of left-sided obstructive lesions occurs together, they are referred to as the Shone complex.Clinical ManifestationsMostly asymptomaticSome children or adolescents complain about weakness or pain in the legs after exerciseSilent hypertension diagnosed on routine physical examination.Disparity in pulsation and blood pressure in the arms and legs.The femoral, popliteal, posterior tibia], and dorsalis pedis pulses are weak (or absent in up to 40%' of patients), in contrast to the bounding pulses of the arms and carotid vessels.The radial and femoral pulses should always be palpated simultaneously for the presence of a radial-femora] delay.Normally, the femoral pulse occurs slightly before the radial pulse. A radial-femoral delay occurs when blood flow to the descending aorta is dependent on collaterals, in which case the femora] pulse is felt after the radial pulse.In normal persons, systolic blood pressure in the legs obtained by the cuff method is 10-20 mm Hg higher than that in the arms.In coarctation of the aorta, blood pressure in the legs is lower than that in the arms.The precordial impulse and heart sounds are usually normal.The presence of a systolic ejection click or thrill in the suprasternal notch suggests a bicuspid aortic valve (present in 709c of cases).A short systolic murmur is often heard along the left sternal border at the 3rd and 4th intercostal spaces.In older patients with well-developed collateral blood flow, systolic or continuous murmurs may be heard over the left and right sides of the chest laterally and posteriorly. (SUZMAN SIGN)In these patients, a palpable thri 11 can occasionally be appreciated in the intercostal spaces on the back.DiagnosisCardiac enlargement and pulmonary congestion are noted in infants with severe coarctation.The enlarged left subclavian artery commonly produces a prominent shadow in the left superior mediastinum.Notching of the inferior border of the ribs from pressure erosion by enlarged collateral vessels is common by late childhood.In most instances, the descending aorta has an area of poststenotic dilatation.

So the answer to this question is B


Instruction:
Causes of virilization at puberty is all except
A. PCOD
B. 5α - Reductase deficiency
C. All of the above
D. None of the above

Response:
None

So the answer to this question is D


Instruction:
ADAMTS 13 is associated with:
A. TTP
B. Churg Strauss
C. Wegener
D. Membranous nephropathy

Response:
Ans. a. TTPThrombotic thrombocytopenic purpura (TTP) is a rare disorder of hemostasis in which there is widespread intravascular formation of fibrin-platelet thrombi.It is sometimes associated with an acquired or inherited deficiency of the enzyme ADAMTS 13, responsible for cleaving large multimers of von Willebrand factor.Clinically, TTP most often affects adult women.The inclusion criteria are microangiopathic hemolytic anemia and thrombocytopenia, with or without renal failure or neurologic abnormalities.Pathology includes widespread formation of platelet thrombi with fibrin (hyaline thrombi) leading to intravascular hemolysis (thrombotic microangiopathy).

So the answer to this question is A


Instruction:
Treatment of choice in Wegner's granulomatosis is
A. Cyclosporine
B. Cyclophosphamide
C. Steroids
D. Radiotherapy

Response:
Answer- B. CyclophosphamideCyclophosphamide alongwith glucocoicoids is the treatment of choice, For selected patients whose disease is not immediately life threatening or in those patients who have experienced significant cyclophosphamide toxicity, methotrexate together with glucocoicoids may be considered as an alternative

So the answer to this question is B


Instruction:
Drug contraindicated in bilateral renal artery stenosis is:
A. Propranolol
B. Guanethidine
C. Captopril
D. Amlodipine

Response:
None

So the answer to this question is C


Instruction:
Sho stature, secondary to growth hormone deficiency is associated with all of the following EXCEPT?
A. Normal body propoion
B. Normal bone age
C. Delayed dentition
D. Delayed pubey

Response:
Sho stature due to human growth hormone deficiency is characterized by: Normal body propoion Delayed dentition Bone age delayed Delay in sexual development

So the answer to this question is B


Instruction:
Which one of the following is the primary treatment of pubey menorrhagia in a 16 years old girl with 3 gm% Hb ?
A. Dilatation and curettage with blood transfusion
B. Danazol with blood transfusion
C. Progestogen with blood transfusion
D. A combination of estrogen and progesterone with blood transfusion

Response:
Ans. is d i.e. A combination of estrogen and progesterone with blood transfusion Management of Pubey Menorrhagia Since, it is not mentioned in the question, whether the girl is having severe bleeding / moderate bleeding and I.V. conjugated estrogen with blood transfusion is not given in the options, combination of Estrogen and Progesterone is the next best option. The girl has Hb = 3 gm%. So, blood transfusion should be done.

So the answer to this question is D


Instruction:
Commonest cause of pyogenic liver abscess
A. Aspiration
B. Hematogenous spread from a distant site
C. Direct contact
D. Lymphatic spread

Response:
Hematogenous spread is most common among given option

So the answer to this question is B


Instruction:
Type 1 thyroplasty is true
A. Lateralisation of vocal cord
B. Medialisation of vocal cord
C. Vocal cord shortening
D. Vocal cord Lenhtheninh.

Response:
Medialisation of vocal cord, used in unilateral complete vocal palsy.
4 types of Thyroplaty.

p - Type 1 - Proximalisation / medialise of VC in u/c complete palsy.
La - Type 2 - Lateralisation of VC.
S - type 3 - shortening of UC / relaxing of UC, used in puberophonia .
Ty - type 4 - Tightening of VC used in androphonia[Female with low pitch voice.

So the answer to this question is B


Instruction:
Unilateral elevation of diaphragm is commonly due to – a) Obesityb) Large liverc) Scoliosisd) Congenital causes
A. a
B. c
C. bc
D. ad

Response:
Scoliosis can cause unilateral elevation of hemidiaphragm.
Obesity and hepatomegaly cause bilateral elevation of hemidiaphragm.

Option 'b' requires specific mention here :-
Hepatomegaly (large liver) causes bilateral elevation of hemidiaphragm because normal liver is under both the dome of diaphragms. Therefore, enlargment of whole liver (hepatomegaly) causes bilateral elevation of hemidiaphragm. However, involvement of a part of liver (e.g. liver abscess) causes unilateral elevation of hemidiaphragm.

So the answer to this question is C


Instruction:
During a fire accident a man got blisters on his hand. Which of the following classes of burns does have blister formation?
A. Superficial first degree burn
B. Superficial second degree burn
C. Third degree burn
D. Deep first degree burn

Response:
Burns are classified by two different systems: paial thickness or full thickness burns, and first, second, or third degree burns. First-degree burns show superficial erythema with no blistering. Second-degree burns may be either superficial or deep. Superficial second-degree burns show erythema with blister formation, and they may be painful for days. Deep second-degree burns show more extensive loss of epidermis with blistering, and the skin may be dry, wet, anaesthetic, or painful and it may appear mottled. Third degree burns show full-thickness destruction of the skin and all its appendages . These burns are anaesthetic, leathery, and discolored. Ref: Color Atlas of Foot & Ankle Dermatology By Gary L. Dockery, Gary L. Dockery Mary Elizabeth Crawford, 1999, Page 280; Schwaz's Principles of Surgery, 9th edition, Chapter 8. Burns.

So the answer to this question is B


Instruction:
Emergence delirium are seen with:
A. Midazolam
B. Ketamine
C. Thiopentone
D. Opoids

Response:
Ketamine

So the answer to this question is B


Instruction:
Which of the following is not an example of Direct transmission in communicable disease?
A. Transplacental
B. Soil contact
C. Droplet nuclei
D. Skin contact

Response:
Direct transmission includes the following modes of transmission: 1. Direct Contact 2. Droplet infection 3. Contact with soil 4. Inoculation into skin/mucosa 5. Trans-placental (veical) Indirect transmission: 1. Vehicle-borne 2. Vector-borne Mechanical Biological 3. Air-borne Droplet nuclei Dust 4. Fomite-borne 5. Unclean hands and fingers

So the answer to this question is C


Instruction:
Best test to detect benign form malignant thyroid is
A. FNAC
B. CT scan
C. Excision
D. MRI

Response:
Robbins basic pathology 9th edition page no, 729, Answer is option 3,excision Ultimately it is the morphological evaluation of a given thyroid nodule by fine needle aspiration, combined with histological study of surgically resected thyroid parenchyma, that provides the most defenitive information about its nature.

So the answer to this question is C


Instruction:
HDN is seen due to deficiency of vitamin
A. A
B. C
C. K
D. E

Response:
Vit k is necessary for coagulation. Factors dependent on Vit k are synthesised on the liver as inactive zymogen. They undergo gamma carboxylation, which requires Vit k as a cofactor. Clinical Manifestations of Deficiency i. Hemorrhagic disease of the newborn is attributed to vitamin K deficiency. The newborns, especially premature infants have relative vitamin K deficiency. This is due to lack of hepatic stores, limited oral intake (breast milk has very low levels, 15 mg/litre) and absence of intestinal bacterial flora. ii. It is often advised that pre-term infants be given prophylactic doses of vitamin K (1 mg Menadione iii. In children and adults, Vitamin K deficiency may be manifested as bruising tendency, ecchymotic patches, mucous membrane haemorrhage, post-traumatic bleeding Ref: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 462

So the answer to this question is C


Instruction:
True regarding barret's oesophagus is -
A. Benign course
B. Premalignant condition
C. Sq. metaplasia of lower oesophagus
D. Medical T/t is not usefull

Response:
Barrett's esophagus is an Intestinal metaplasia (not squamous metaplasia) which follows the metaplasia - dysplasia - cancer course (a premalignant condition for adenocarcinoma of esophagus) Now about the medical t/t Though medical treatment does not reve back the metaplastic changes, it can be used to treat the underlying reflux disorder and prevent fuher damage. Ref : Bailey & Love 25/e p1023

So the answer to this question is B


Instruction:
The unalloyed form of titanium used to form dental implants is in the
A. beta form
B. alpha form
C. gamma form
D. delta form

Response:
None

So the answer to this question is B


Instruction:
Validity of an indicator means -
A. It should actually measure what it is supposed to measure
B. The answer should be same if measured by different persons in similar circumstances
C. Indicators should reflect changes in the situation concerned -
D. Indicators should have ability to obtain data needed

Response:
None

So the answer to this question is A


Instruction:
Oral iron chelating agent -
A. Penicillamine
B. Desferrioxamine
C. Deferiprone
D. Ca Na EDTA

Response:
Ans. is 'c' i.e., Deferiprone Deferiprone* It is an orally active iron chelator which has simplified the treatment of transfusion siderosis in thalassemia patients.* Excessive haemolysis occurs in these patients, and they have to be given repeated blood transfusions.* An iron chelator has to be used to clear the resulting iron overload.* Oral deferiprone is a somewhat less effective alternative to injected desferrioxamine.* Side effects and cost of treatment are reduced.* Deferiprone has also been indicated for acute iron poisoning (less effective than desferrioxamine) and for iron load in liver cirrhosis.* Side effects are anorexia, vomiting, altered taste, joint pain, reversible neutropenia, rarely agranulocytosis. However, long-term safety is not yet known.

So the answer to this question is C


Instruction:
The primary gutta-percha cone must fill the canal wall tightly in the:
A. apical third
B. middle third
C. cervical third
D. entire canal

Response:
None

So the answer to this question is A


Instruction:
Harmone associated with satiety is
A. α-MSH
B. Orexin
C. Ghrelin
D. Neuropeptide-Y

Response:
α-MSH (α- Melanocyte Stimulating Harmone) is associated with satiety.
Orexin, Ghrelin, Neuropeptide-Y is associated with increased appetite.

So the answer to this question is A


Instruction:
During endotracheal intubation, unilateral breath sounds, no air heard entering the stomach and no gastric distension is suggestive of entry of the endotracheal tube into -
A. Right main bronchus
B. Oesophagus
C. Mid-trachea
D. Left main bronchus

Response:
Ans. is 'a' i.e., Right main bronchus

So the answer to this question is A


Instruction:
Carpal tunnel syndrome can be caused by the following except -
A. Diabetes Mellitus
B. Amyloidosis
C. Addison's Disease
D. Hypothyroidism

Response:
Causes of carpal tunnel syndrome

There are many causes of carpal tunnel syndrome : -

idiopathic: - This is the most common cause.
Pregnancy and menopause
Metabolic : - Gout, Diabetes mellitus
Endocrine : - Hypothyroidism, Myxedema, Acromegaly, Hyperparathyroidism.
Deposition disorder : - Amyloidosis, Sarcoidosis, Rheumatid arthritis, Leukemia, CRF, Mucopolysaccharoidosis.
Alcoholism
Local causes: - Malunited Colle's fracture, osteoarthritis of the carpal bones, synovitis of flexor tendon sheath, hematoma.

So the answer to this question is C


Instruction:
Ovarian cause of hirsutism:
A. PCOD
B. Ovarian carcinoma
C. Dysgerminoma
D. Endometriotic cyst

Response:
Ref: Shaw's textbook of gynaecology, 15th ed. Pg 115Explanation:Ovarian causes of hirsutism:PCODHypeerthecosisMasculinising ovarian tumorArrhenoblastomaHilus cell tumorCauses of HirsutismGenetic and ethnic.Excess androgen or increased sensitivity of the pilosebaceous unit to testosterone.Liver disease when the level of SHBG level drops.Ovarian.PCOD (polycystic ovarian disease)HyperthecosisMasculinizing ovarian tumours, e.g. arrhenoblastoma,Hilus cell tumourAdrenalCongenital adrenal hyperplasiaCushing's syndromeAdrenal tumour (1-2% cases).DrugsAndrogensProgestogens with androgenic effectLevonorgestrelAnabolic steroidsPhenytoin.DanazolMinoxidilOthersObesityHypothyroidism Anovulatory hypo-oestrogenismIdiopathic-15%,Hyperprolactinaemia.Hirsutism occurs early in CAS, around puberty in PCOD and at menopause.

So the answer to this question is A


Instruction:
After starting your patient on imipramine, his heart rate rises to 120/min and he has blurred vision. These effects can be explained by the fact imipramine:
A. Is a muscarinic antagonist
B. Potentiates epinephrine
C. Is a ganglionic blocker
D. Is a potent a-adrenergic blocker

Response:
None

So the answer to this question is A


Instruction:
A typical child presents with an epigastric aura, followed by a quiet period of unresponsiveness with staring, lip- smacking, picking at sheets or clothes, contralateral dystonic posturing, and postictal confusion and lethargy. The probable diagnosis is
A. Psychogenic seizures
B. Temporal lobe epilepsy
C. Panic disorder
D. Occipital lobe epilepsy

Response:
(B) Temporal lobe epilepsy # Temporal Lobe Epilepsy: Clinical manifestation of a seizure (seizure semiology) is also of localizing value.> For example, a typical patient with TLE may have an epigastric aura, followed by a quiet period of unresponsiveness with staring, lip-smacking (oral automatisms), picking at sheets or clothes (manual automatism), contralateral dystonic posturing, and postictal confusion and lethargy. If from the dominant hemisphere, there is usually delayed recovery of language, often with transient aphasia on testing. A typical frontal lobe seizure will occur from sleep with no warning, may show restlessness and/or prominent bilateral limb movements (such as bicycling or asymmetric tonic posturing), and will end quickly with immediate recovery; this may recur several times in one night. Occipital lobe seizures often have a visual aura, and may progress (due to electrical spread) into a temporal lobe or frontal lobe type of seizure. Parietal lobe seizures are the least common, may have a sensory aura, and tend to mimic frontal lobe seizures.> Differential Diagnoses: Absence Seizures; Frontal Lobe Epilepsy; Narcolepsy; Periodic Limb Movement Disorder; Tardive Dyskinesia.

So the answer to this question is B


Instruction:
When treating hypeension chronically, ohostatic hypotension is maximum with:
A. Clonidine
B. Guanethidine
C. Prazosin
D. Propanolol

Response:
Postural hypotension cause by a-blockers is called first dose hypotension because tolerance occurs to this adverse effect on chronic use. On the other hand, adrenergic neuron blockers continue to produce ohostatic hypeension even on chronic use.

So the answer to this question is B


Instruction:
Aseptic necrosis is common in: March 2007, September 2010
A. Scaphoid
B. Calcaneum
C. Cuboid
D. Trapezium

Response:
Ans. A: Scaphoid Fracture through the waist of the scaphoid may lead to avascular necrosis of the proximal pole of scaphoid.

So the answer to this question is A


Instruction:
A 41 year old man presented with swelling over parotid area. He has only mild pain. Which is the commonest tumor of the parotid?
A. Pleomorphic adenoma
B. Monomorphic adenoma
C. Wahin's tumor
D. Adenocarcinoma

Response:
Pleomorphic adenomas or benign mixed tumors, are the most common neoplasms of the salivary glands. They represent approximately 60-70% of all parotid tumors and 90% of submandibular benign tumors. These neoplasms affect females more than males and are commonly seen in the third to sixth decades of life. Histologically, pleomorphic adenomas arise from the distal poions of the salivary ducts, including the intercalated ducts and acini.

So the answer to this question is A


Instruction:
The criteria for diagnosing GTN are all
A. Persistently increasing p-hCG for 3 weeks
B. Plateau levels of p-hCG for 4 weeks
C. Theca lutein cyst > 6 cm
D. Histological criteria for choriocarcinoma

Response:
Theca lutein cysts may be felt in the ovaries in about 50%.These cysts are due to over stimulation of luteal elements by large amount of circulating hCG secreted by the proliferating trophoblast.Larger moles are more likely to be associated with cysts.Persistent trophoblastic disease is more likely in women with Theca lutein cysts.(refer pgno:170 sheila textbook of obstetrics 2 nd edition)

So the answer to this question is C


Instruction:
Most common cause of proptosis in adults is ?
A. Orbital cellulitis
B. Thyroid Ophthalmopathy
C. Carotico - cavernous fistula
D. Trauma

Response:
Ans. is 'b' i.e., Thyroid Ophthalmopathy The most common cause of unilateral proptosis in children is orbital cellulitis. The most common cause of unilateral proptosis in adults is thyroid ophthalmopathy.

So the answer to this question is B


Instruction:
Non invasive test for H.pylori -a) Rapid urease testb) Urease breath testc) Stool antigen assayd) Stomach aspiration culturee) Biopsy
A. a
B. c
C. bc
D. ad

Response:
None

So the answer to this question is C


Instruction:
Prions. True statement is:
A. Defect in protein folding
B. Cleave proteins
C. Scarpie is a human disease
D. Are non infectious

Response:
Defect in protein folding

So the answer to this question is A


Instruction:
The average diameter of coronal dentinal tubules near the pulp is:
A. 0.2-0.5 microns
B. 2-3 microns
C. 0.2-0.3 microns
D. 7 microns

Response:
None

So the answer to this question is B


Instruction:
The commonest type of renal lesion in children is :
A. Lipoid nephrosis
B. Membrano proliferative glomerulonephritis
C. Focal glomerulonephritis
D. Diffuse glomerulosclerosis

Response:
Minimal change GN is also referred to as lipoid nephrosis.

So the answer to this question is A


Instruction:
50 years old man present complaints of painful tender mass situated one third of the way between xiphisternum and umbilicus what is the likely diagnosis
A. Omphalocoele
B. Epigastric hernia
C. Spigelian hernia
D. Fibrosarcoma of abdominal walk

Response:
None

So the answer to this question is B


Instruction:
What is the net gain of ATPs when Palmitic acid undergoes complete oxidation?
A. 106 ATPs
B. 100 ATPs
C. 28 ATPs
D. 128 ATPs

Response:
Refer the byte "Beta Oxidation"

So the answer to this question is A


Instruction:
Naeglers reaction is shown by
A. Cl. Tetani
B. Cl. Botulinum
C. Cl. Perfringenes
D. Cl. Septicum

Response:
Naeglers reaction is due to α toxin = lecithinase C = Phospholipidase
So, given by Cl. perfiringes.

So the answer to this question is C


Instruction:
Conjunctival xerosis is seen in -
A. Vitamin A deficiency
B. Herpetic keratitis
C. Glaucoma
D. None

Response:
Ans. is 'a' i.e., Vitamin A deficiencyo Xerosis of conjunctiva refers to a condition where the conjunctiva becomes dry and lusterless. Depending upon the etiology', conjunctival xerosis can be divided into two groups : -A) Parenchymatous xerosis : - It occurs following cicatricial disorganization of conjunctiva due to local causes which can be : -TrachomaDiphtheric membranous conjunctivitisStevens - Johnson syndromePemphigusThermal, chemical or radiational burnLagophthalmos due to symblepheron.B) Epithelial xerosis : - It occurs due to vitamin 'A'deficiency (Xerophthalmia).

So the answer to this question is A


Instruction:
Vertical crest in fundus of the internal auditary canal is k/a:
A. Bill's bar
B. Ponticulus
C. Cog
D. Falciform crest

Response:
Ans is 'a' i.e. Bill's Bar The internal acoustic canal is divided by transverse crest (or falciform crest) into a superior and inferior Part. The superior part is divided by vertical crest or Bill's bar into anterior and posterior parts. Antero-superior part transmits-facial nerve and nervus intermediusPostero-superior part transmits-superior vestibular nerveInferior part transmits-- cochlear nerve lying antero- inferiorly - inferior vestibular nerve postero-inferiorly Bill's bar is used as a surgical landmark for facial nerve identification during Tran's labyrinthine surgery.

So the answer to this question is A


Instruction:
All are recognised tumour markers except ?
A. Beta HCG
B. Beta 2 microglobulin
C. Alpha fetoprotein
D. None

Response:
Answer is None Tumor Markers Cancer Non-Neoplastic Conditons HORMONES Human chorionic gonadotropin Gestational trophoblastic disease, gonadal germ cell tumor Pregnancy Calcitonin Medullary cancer of the thyroid Catecholamines Pheochromocytoma ONCOFETAL ANTIGENS Alphafetoprotein Heptaocellular carcinoma, gonadal germ cell tumor Cirrhosis, hepatitis Carcinoembryonic antigen Adenocarcinomas of the colon, pancreas, lung, breast, ovary Pancreatitis, hepatitis, inflammatory bowel disease, smoking ENZYMES Prostatc acid phosphatase Prostate cancer Prostatitis, prostatic hyperophy Neuron -specific enolase Small cell cancer of the lung, Neuroblastoma Lactate dehydrogenase Lymphoma, Ewing's sarcoma Hepatitis, hemolytic anemia many others TUMOR-ASSOCIATED PROTEINS Prostate -specific antigen Prostate Cancer Prostatitis, Prostatic hyperophy Monoclonal Myeloma Infection, MGUS Immunoglobulin (132 microglobulin) CA-125 Ovarian cancer, some lymphomas Menstruation, peritonitis, pregnancy CA 19-9 Colon, pancreatic, breast cancer Pancreatitis, ulcerative colitis CD30 Hodgkin's disease, anaplastic large cell lymphoma CD25 Hairy cell leukemia, adult T cell leukemia/lymphoma

So the answer to this question is D


Instruction:
Delusions are seen in all of the following, except
A. Schizophrenia
B. Depression
C. Dementia
D. Conversion disorder

Response:
Conversation disorder is characterised by the presence of symptoms or deficits affecting motor or neurological disorders.development of symptoms usually in the presence of significant psychosocial stress. (Ref: A sho textbook of psychiatry, Niraj Ahuja,7th edition, page no.99)

So the answer to this question is D


Instruction:
Which of the following enzyme uses zinc as a cofactor for its biochemical functions?
A. Pyruvate dehydrogenase
B. Pyruvate decarboxylase
C. a-ketoglutarate dehydrogenase
D. Alcohol dehydrogenase

Response:
Zinc containing enzymes are: Alcohol dehydrogenase Carbonic anhydrase Retinine reductase Alkaline phosphatase Glutamate dehydrogenase Lactate dehydrogenase DNA and RNA polymerase d-ALA dehydratase Ref: Medical Biochemistry By Chatterjea, 2011, Page 627.

So the answer to this question is D


Instruction:
All statement about Plummer Winson Syndrome are true except -
A. Commonly leads to carcinoma in lower third of esophagus
B. Common with iron deficiency
C. Common in females
D. Premalignant

Response:
Ans. is 'a' i.e., Commonly leads to carcinoma in lower third of esophagusPlummer-Vinson syndromeo Plummer-Vinson syndrome, also known as Brown-Kelly-Paterson syndrome or sederopenic dysphagia, seen in middle aged edentulous women.o The plummer Vinsion Paterson Brown Kelly Syndrome is characterized by: -DysphagiaChronic iron deficiency anemiaAtrophic oral mucosa and glossitisBrittle, spoon-shaped fingernails (Koilonychia)o The cause of dysphagia is usually a cervical esophageal web, but abnormal pharyngeal and esophageal motility may play a role.o The syndrome eharactersticallv occurs in middle aged edentulous (without teeth) women,o It is a premalignant lesion. Approximately 10% of patient develop squamous cell Ca of esophagus, oral cavity or the hypopharynx.o As iron-deficiency anemia is a common finding, it is also known as sideropenic dysphagia.o Carcinoma develops in post-cricoid region (not in lower third esophagus).

So the answer to this question is A


Instruction:
Coxsackie virus can be isolated by inoculating into:
A. Rabbit
B. Guinea pig
C. Suckling mice
D. Foot pad of mice

Response:
Coxsackie virus is isolated from the lesion or from the feces, made by inoculation into suckling mice. Identification is by studying the histopathology in infected mice and by neutralization tests. Serodiagnosis is not as possible. Ref: Textbook of microbiology, Anathanaraya and Panicker's, 8th Edition, Page 489

So the answer to this question is C


Instruction:
Probing and irrigation is not done in -
A. Lacrimal fistula
B. Acute dacryocystitis
C. Congenital dacryocystitis
D. Trauma to eye

Response:
Main treatment consist of topical and systemic antibiotics and anti inflamatory analgesics . Ref :ak khurana 6th edition pg no:395

So the answer to this question is B


Instruction:
In a chronic alcoholic, Wernicke's encephalopathy can be prevented by: March 2013 (g)
A. I/V saline
B. Large amount of glucose
C. Imipramine
D. Thiamine supplement

Response:
Ans. D i.e. Thiamine supplement

So the answer to this question is D


Instruction:
Glutamate entering into the brain along with ammonia transforms into the following amino acid:
A. Glutamine
B. Arginine
C. Glyceride
D. Glycine

Response:
The brain's uptake of glutamate is approximately balanced by its output of glutamine. Glutamate entering the brain associates with ammonia and leaves as glutamine. The glutamate--glutamine conversion in the brain--the opposite of the reaction in the kidney that produces some of the ammonia entering the tubules--serves as a detoxifying mechanism to keep the brain free of ammonia. Ammonia is very toxic to nerve cells, and ammonia intoxication is believed to be a major cause of the bizarre neurologic symptoms in hepatic coma. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 33. Circulation through Special Regions. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.

So the answer to this question is A


Instruction:
In hemoglobin, the innate affinity of heme for carbon monoxide is diminished by the presence of :
A. His F8
B. His E7
C. Gly B6
D. Thr C4

Response:
The heme has high affinity for carbon monoxide (about 25000 more than for 02). But when heme molecule is associated with Histidine E 7 (as occurs in myoglobin), its affinity for CO is drastically reduced because His E 7 creates a hindered environment for CO by disturbing the orientation of atoms in heme molecules.

So the answer to this question is B


Instruction:
The Waldeyer's group of lymph nodes do not include:
A. Submandibular lymph nodes
B. Tonsils
C. Lingual tonsils
D. Adenoids

Response:
(a) Submandibular lymph nodes(Ref. Scott Brown, Vol 3; 741)Waldeyer's ring componentsAlso calledLocationAdenoidsLushka's or nasopharyngeal tonsilNasopharynx (in the midline at the junction of the roof and posterior wall)Tubal tonsilsGerlach's tonsilsNasopharynx (on the lateral wall behind the Eustachian tube opening)PalatineFaucial tonsilsOropharynx (in between the anterior and posterior pillars)Lingual tonsils-Posterior 1/3rd , i.e. base of tongueLateral pharyngeal bands and nodules-Posterior pharyngeal wall

So the answer to this question is A


Instruction:
A 3-month-old infant has suffered recurrent episodes of fever, skin pustules, and pneumonia since the first week of life. Repeated blood counts have shown absolute neutrophil count (ANC) to be less than 500/mm3, whereas hemoglobin and platelet count are normal. The most likely diagnosis is
A. Aplastic anemia
B. Congenital leukemia
C. Kostmann disease
D. cyclic neutropenia

Response:
The patient has a severe congenital cytopenia that is limited to the neutrophil lineage; thus, aplastic anemia and acute leukemia, which affect all hemic lineages, are very unlikely. Cyclic neutropenia is characterized by a periodicity in absolute neutrophil count (ANC) rather than a constant lowering of ANC. The use of granulocyte colony-stimulating factor to stimulate neutrophil production has markedly improved the prognosis for patients with both Kostmann agranulocytosis and cyclic neutropenia.

So the answer to this question is C


Instruction:
The first cell to migrate into a wound due to chemotaxis to start the process of wound healing is -
A. Lymphocyte
B. Macrophage
C. Platelet
D. Neutrophil

Response:
Ans-D

So the answer to this question is D


Instruction:
Treatment of recently sputum positive case of pulmonary TB is
A. RMP + INH + PZM
B. RMP + INH + PZM + SMC
C. RMP + INH + PZM + ETM
D. RMP + INH + ETM

Response:
Ans. c (RMP + INH + PZM + ETM); (Ref. Park PSM 22nd/pg. 175)Treatment categories and sputum examination schedule in DOTS chemotherapy in IndiaTREATMENT REGIMENSPUTUM EXAMINATIONS FOR PULMONARY TBCategory of treatmentType of patientRegimenPret- reat- ment sputumTest at monthIF: result is-----THEN:New cases Category I Red BoxNew sputum smear-positiveNew sputum smear-negativeNew extra-pulmonary**New others2(HRZEE)3+4(HR)3+2-Start continuation phase, test sputum again at 4 and 6 months +Continue intensive phase for one more monthComplete the treatment in 7 monthsPreviouslyTreatedCategory IIBlue BoxSputum smear positiveRelapse***Sputum smear-positiveFailure***Sputum smear-positive treatment after default others2(HRZES)3+1(HRZE)3+5(HRE)3+3-Start continuation phase, test sputum again at 5 months 6 months, completion of treatment + + Continue intensive phase for one more month, test sputum again at 4 months if sputum is positive send sputum for culture and drug sensitivity as it might be a case of MDR-TB* The number before the laetters refers to the number of months of treatment. The subcript after the letters refers to the number of doses per week. H; Isoniazid (600 mg), R: Rifampi (450 mg), Z: pyrazinamide (1500 mg), E: Ethambutol (1200 mg), S: Streptomycin (750 mg).Patients who weigh more than 60 kg receilve additional Rifampicin 150 mg. Patients more than 50 years old receive streptomycin 500 mg.Patients in categories I and II, who have a positive sputum smear at the end of the initial intensive phase, receive an additional month of intensive phase treatment.** Examples of seriously ill extra-pulmonary TB cases are meningitis, disseminated TB, tuberculous pericarditis, peritonitis, bilateral or extensive pleurisy, spinal TB with neurological complications and intestinal and genito-urinary TB.*** In rare and exceptional cases, patients who are sputum smear-negative or who have extra-pulmonary disease can have relapse or failure. This diagnosis in all such cases should always be made by an MO and should be supported by culture or histological evidence of current, active tuberculosis. In these cases, the patient should be categorized as 'Other' and given Category II treatment. Any patient treated with Category I who has a positsive smear at 5 months of treatment should be considered a failure and started onCategory II treatment, afresh. If category I sputum smear-ve case fails to improve or if patient develops pulmonary signs and positive smear at the end of intensive phase, it is considered treatment failure. Start category II treatment and confirm failure by culture and perform DST.

So the answer to this question is C


Instruction:
Sudden cardiac death may occur in all of the following, except:
A. Dilated cardiomyopathy
B. Hyperophic cardiomyopathy
C. Eisenmenger's syndrome
D. Ventricular septal defect

Response:
Among the options provided VSD has the least chance of causing sudden cardiac death. All other conditions are associated with increased risk of sudden cardiac death. Ref: Harrison's Principles of Internal Medicine, 16th Edition, Page 1619.

So the answer to this question is D


Instruction:
All of the following features can differentiate between ventricular tachycardia and supraventricular tachycardia except-
A. QRs < 0.14 seconds
B. Ventricular rate >160/min
C. Variable first hea sound
D. Relieved by carotid sinus massage

Response:
In SVT, AV-node drugs would work in normalizing the dysrhythmias. However, in VT, it won't work as it would worsen the condition of the patient. SVT relieved by carotid sinus massage VT has variying PR intervals so variying first hea sound In VT, Brugada sign, Josephson's sign, etc. are evident while SVT, narrow QRS complexes < 140 msec , a PR interval of less than 120 ms, etc. can be seen on the screen. Ref Harrison 20th edition pg 1556

So the answer to this question is B


Instruction:
An example of a two-way discussion is:
A. A seminar
B. Role playing
C. Symposium
D. Group discussion

Response:
Group discussion

So the answer to this question is D


Instruction:
True about coarctation of aorta –
A. Most common site is distal to the origin of the left subclavian artery
B. Most common age of presentation is at 15–20 years
C. Upper rib notching is due to erosion by dilated collateral vessels
D. Right ventricular hypertrophy

Response:
Most common site of COA is distal to the origin of left subclavian artery.
Hemodynamics of COA during fetal life

In fetal life, blood from right ventricle passes to pulmonary artery and then to descending aorta through ductus arteriosus.
Blood from left ventricle passes to Aorta and then to innominate, left carotid and left subclavian artery.
If constriction (coarctation) is proximal to ductus arteriosus (preductal or infantile coarctation), there is no obstruction to flow because constriction is not obstructing the flow of upper limb and lower limb --> Collaterals are not formed.
If the constriction is distal to ductus arteriosus (post ductal or adult type coarctation of aorta), it causes obstruction of flow of desending aorta, and parts of body that are supplied by descending aorta, have impaired circulation —> This stimulates formation of collaterals in fetal life.

Hemodynamics after birth

After birth, ductus arteriosus closes, so that blood flow to descending aorta from right ventricle does not occur and descending aorta must receive its total supply from left ventricle via ascending aorta.
But there is obstruction due to coarctation.
In preductal coarctation, there are no collaterals Neonates become symptomatic immediatly --> Hypertension results in CHF.
In postductal coarctation, due to presence of collaterals neonates are spared from developing hypertension & CHF.
Due to obstruction, there is pressure overload to left ventricle -4 Left ventricular hypertrophy.

So the answer to this question is A


Instruction:
Atropine is not used in the poisoning of
A. Parathion
B. Endrin
C. Tik 20
D. Baygon

Response:
Atropine is used ar antidote in argaphosphones and orgarocholorine poisnonings.
Through endrin does not have a specific antidote,atropine is particulorly contraindicated in pyrethroid poisonings.
The major component of baygon is pynethroids(Cyfleathrin ,Thansfluthrin,Prallithrin).
Atropine and oximes both are contraindicated in pyrethroid poisonings.
Atropine should not be used beacuse it could exacerbate the CNS stimulatory effects and tachycardia in there cases.

So the answer to this question is D


Instruction:
All are B-cell marker except:
A. CD15
B. CD19
C. CD21
D. CD24

Response:
Direct lines from Wintrobes hematology..CD-15 is expressed on neutrophils, esinophils and monocytes but not on on platelets,lymphocytes and erythrocytes.About option (d)CD24 is expressed on B cell activation and differentiation and is lost at the plasma cell stage. It is also present ion granulocytes and thymocytes but not on mature T cells.data shows its increased levels are associated with colon/breast and pancreatic cancer.( ref Robbins 7th/670,9/e590)

So the answer to this question is A


Instruction:
Which of the following cause Teratogenecity -
A. Vit. C
B. Vit. E
C. Vit. A
D. Vit. D

Response:
Vit A is teratogenic and can cause craniofacial CVS and CNS defects.

So the answer to this question is C


Instruction:
Angioid streaks occur in -
A. Sturge-Weber's syndrome
B. Sickle cell disease (SS)
C. Pseudoexfoliation syndrome
D. Septo-optic dysplasia

Response:
None

So the answer to this question is B


Instruction:
A new systolic murmur after Acute myocardial infarction may be due to all of the following Except:
A. Complete hea block
B. Rupture of Interventricular septum
C. Papillary muscle dysfunction
D. Ischemic cardiomyopathy

Response:
Answer is A (Complete hea block) Complete hea block iv not a cause for new onset systolic murmur after Acute _Myocardial Infarction. Cause of new systolic murmur after Acute Myocardial infarction Papillary muscle dysfunction/rupture (causing severe mitral regurgitation) Rupture of interventricular septum Right ventricular infarction and tricuspid regurgitation Free wall rupture Left ventricular outflow tract obstruction Note: Ischemic cardiomyopathy is defined as dilated cardiomyopathy in a subject with history of MI. This may lead to papillary muscle dysfunction and hence produce a new onset systolic murmur.

So the answer to this question is A


Instruction:
A 59 yr old man with severe myxomatous mitral regurgitation is asymptomatic,wi wia left ventricular ejection fraction of 45% and an endsystollic diameter index of 2.9cm/m2 . The most appropriate treatment is
A. Mitral valve repair or replacement
B. No treatment
C. ACE inhibitor therapy
D. Digoxin and diuretic therapy

Response:
Ref Harrison 19 th ed pg 1545 Valve repair for ischemic MR is associated with lower periopera- tive moality rates but higher rates of recurrent MR over time. In patients with ischemic MR and significantly impaired LV systolic function (EF <30%), the risk of surgery is higher, recovery of LV per- formance is incomplete, and long-term survival is reduced.

So the answer to this question is A


Instruction:
A scatter diagram was plotted as shown below to study the relationship between two variables. This is an example of:
A. High positive correlation
B. High negative correlation
C. Low positive correlation
D. Low negative correlation

Response:
None

So the answer to this question is D


Instruction:
Common causes of infeility are :
A. Chlamydia
B. Gonorrohea
C. Mycoplasma
D. All

Response:
Ans. is a, b and c i.e. Chlamydia; Gonorrhea; and Mycoplasma PID resulting in salpingitis is an impoant cause of infeility. Infeility from PID can occur due to following organisms : Chlamydia Gonorrhea Tuberculosis Mycoplasma (Specifically ureoplasma) Ceain Infections cause Intrauterine synechiae or ashermann syndrome thus leading to infeility like : Schistosoma Mycobacter

So the answer to this question is D


Instruction:
FEV1 / FEVC ratio is decreased in all, except
A. Bronchiectasis
B. Emphysema
C. Chronic bronchitis
D. Tuberculosis

Response:
ParameterObstructive lung diseaseRestrictive lung diseaseTotal lung capacityNormal to increaseDecreaseResidual volumeIncreaseDecreaseVital capacityDecreaseDecreaseFEV1/ FVC (FEV1%)DecreaseNormal to increaseFEF 25-75% (Forced expiratory flow rate)Decrease NormalDiffusion capacityNormal (| in emphysema)DecreasedRefer: Harrison's Principles of Internal Medicine, 18th edition, pg no: 2163-2165

So the answer to this question is D


Instruction:
All of the following are dimorphic fungi, except:
A. Sporotricum
B. Blastomycetes
C. Histoplasma
D. Cryptococcus

Response:
Ans. d. Cryptococcus

So the answer to this question is D


Instruction:
One year old baby exclusively breast fed has a 1cm. hepatomegaly severe pallor and no spleen.The most important investigation is –
A. B12 estimation
B. Serum iron estimation
C. Folic and estimation
D. Fetal hemoglobin estimation

Response:
By the age of 6 months the breast-fed infant's diet should be supplemented with iron fortified complementary foods because iron in breast milk is sufficient upto the age of 6 months.
The baby in question has been exclusively breast fed upto 1 year, so he has developed iron deficiency anemia.

So the answer to this question is B


Instruction:
Testis lies in deep inguinal ring upto
A. 4th month
B. 5th month
C. 7th month
D. 9th month

Response:
Descent of testis The testes develop in relation to the developing mesonephros, at the level of segments T10 to T12. Subsequently, they descend to reach the scrotum. Each testis begins to descend during the second month of intrauterine life. It reaches the iliac fossa by the 3rd month Rests at the deep inguinal ring from the 4th to the 6th month, Traverses the inguinal canal during the 7th month, Reaches the superficial inguinal ring by the 8th month and the bottom of the scrotum by the 9th month. An extension of peritoneal cavity called the processus vaginalis precedes the descent of testis into the scrotum, into which the testis invaginates. The processus vaginalis closes above the testis. Descent does not occur after one year of age. Ref - BDC 6th edition vol2 pg 227

So the answer to this question is C


Instruction:
who gave the concept of self esteem as the heirachy of motivation
A. maslow
B. lorenz
C. freud
D. seligman

Response:
ABRAHAM MASLOW Gave the hierarchy of needs It is also called as hierarchy of motivation According to Maslow the basic needs should be met to move on to the next stage Once the basic step is attained, we work on to the higher stage The final stage is self-actualization, that is acceptance of your positives, negatives, sho comings, doing things that you are good at and working with satisfaction. Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 845

So the answer to this question is A


Instruction:
Calculate the loading dose of a drug whose systemic bioavailability will be 20%, Vd-200L and target concentration is 5gm/L
A. 1g
B. 5g
C. 12.5g
D. 25g

Response:
In pharmacokinetics, a loading dose is an initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose Loading dose-= 1000/20=5 Ref: KD tripathi 8th ed

So the answer to this question is B


Instruction:
HLA antigen is located at?
A. Short arm of chr-6
B. Long arm of chr-6
C. Short arm of chr-8
D. Long arm of chr-8

Response:
Ans. is 'a' i.e., Short arm of chr-6 o HLA complex (MHC) gene is located on the short arm of chromosome 6.

So the answer to this question is A


Instruction:
Anchovy Sauce pus/chocolate brown pus is the clinical feature of:
A. Amoebic liver abscess
B. Pyogenic liver abscess
C. Peritoneal abscess
D. Hydatid liver

Response:
Ans. (a) Amoebic liver abscessRef : Microbiology by Ananthanarayan and Paniker 8th ed. /595, 625AMOEBIC LIVER ABSCESS* It is a liver abscess caused by Entamoeba histolytica* It is common in tropical countries.* It exists in vegetative form outside the body and is spread by the faeco-oral route.* Presents with Pain in the right hypochondrium, fever, Profuse sweating and rigors, loss of weight etc.* Diagnostic of choice: ultrasound* DOC: Metronidazole

So the answer to this question is A


Instruction:
In fatty acid synthesis CO2 loss occurs in which step
A. Hydration
B. Dehydration
C. Condensation reaction
D. Reduction

Response:
C i.e. Condensation reaction

So the answer to this question is C


Instruction:
Which of the following metabolic disorders is associated with hypokalemia?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Mixed acidosis

Response:
Metabolic alkalosis Metabolic alkalosis is characterised by an increase in the plasma bicarbonate concentration and the plasma pH (see Box 14.18). There is a compensatory rise in PCO2 due to hypoventilation but this is limited by the need to avoid hypoxia. Classical causes include primary hyperaldosteronism (Conn's syndrome, p. 674), Cushing's syndrome (p. 666) and glucocoicoid therapy (p. 670). Occasionally, overuse of antacid salts for treatment of dyspepsia produces a similar pattern. Pathophysiology Metabolic alkalosis is best classified according to the accompanying changes in ECF volume. Hypovolaemic metabolic alkalosis is the most common pattern. This can be caused by sustained vomiting, in which acid-rich fluid is lost directly from the body, or by treatment with loop diuretics or thiazides. In the case of sustained vomiting, loss of gastric acid is the immediate cause of the alkalosis, but several factors act to sustain or amplify this in the context of volume depletion (Fig. 14.11). Loss of sodium and fluid leads to hypovolaemia and secondary hyperaldosteronism, triggering proximal sodium bicarbonate reabsorption and additional acid secretion by the distal tubule. Hypokalaemia occurs due to potassium loss in the vomitus and by the kidney as the result of secondary hyperaldosteronism, and itself is a stimulus to acid secretion. Additionally, the compensatory rise in PCO2 fuher enhances tubular acid secretion. The net result is sustained metabolic alkalosis with an inappropriately acid urine, which cannot be corrected until the deficit in circulating volume has been replaced. Normovolaemic (or hypervolaemic) metabolic alkalosis occurs when bicarbonate retention and volume expansion occur simultaneously. Clinical features Clinically, apa from manifestations of the underlying cause, there may be few symptoms or signs related to alkalosis itself. When the rise in systemic pH is abrupt, however, plasma ionised calcium falls and signs of increased neuromuscular irritability, such as tetany, may develop (p. 663). Investigations The diagnosis can be confirmed by measurement of electrolytes and aerial blood gases Ref Davidson 23rd edition pg 366

So the answer to this question is B


Instruction:
Part of eukaryotic DNA contributing to polypetide synthesisa) Exonb) Enhancerc) Leader sequenced) tRNAe) ncRNA
A. ac
B. a
C. ad
D. ab

Response:
Exon (coding protein) : Sequence of a gene that is represented as m-RNA.
Enhancer: Are special cis-acting DNA sequences that increase the rate of initiation of transcription of eukaryotic genes by RNA polymerase II.
Leader sequence: Sequence at the 5' end of a mRNA that is not translated into protein.
Non-coding RNA (nc RNA): Functional RNA that is not translated into a protein. Non-coding RNAs include tRNA, rRNA, Sno RNA, mi-RNA, si-RNA, pi-RNA and long nc RNA like Xist & HOT AIR.

So the answer to this question is D


Instruction:
Features of Horner's syndrome include all of the following except-
A. Miosis
B. Ptosis
C. Anhydrosis
D. Exopthalmos

Response:
There is enophthalmos (not exophthalmos).

So the answer to this question is D


Instruction:
Autoimmune hemolytic anaemia is seen in:
A. All
B. AML
C. CML
D. CLL

Response:
About 15% of patients develop autoantibodies ( IgG )against their own red cells or platelets which leads to autoimmune hemolytic anemia.

So the answer to this question is D


Instruction:
AML causing Gum hyperophy -
A. M1
B. M2
C. M3
D. M4

Response:
Gum hyperophy due to leukaemic infiltration of the gingivae is a frequent finding in myelomonocytic(M4) and monocytic (M5) leukaemias. Reference textbook of Pathology 6th edition author Harsha Mohan page number 363

So the answer to this question is D


Instruction:
All except one is continued prior to elective caesarean section in an hypertensive diabetic term gestation, obese female who is a case of chronic aorto iliac obstruction.
A. Labetalol
B. Statins
C. Magnesium sulphate
D. Heparin

Response:
Heparin is stopped 6 hours priorly. Rest all drugs need to be continued till day of surgery.

So the answer to this question is D


Instruction:
What is acceptable angulation after reducing the fracture tibia - a) 5  b) 10  c) 15  d) 20
A. ab
B. bc
C. ad
D. ac

Response:
Criteria of acceptable reduction

Acceptable varus or valgus angulation is 5°.
Acceptable anterior or posterior angulation is 10°.
Acceptable rotational malalignment is 5°.
Acceptable shortening is 10 mm
Ankle and knee joint surfaces should be parallel

So the answer to this question is A


Instruction:
A patient develops hepatosplenomegaly, lymphadenopathy following sexual contact, 3 weeks back. The best test to rule out HIV infection is :
A. ELISA
B. Western blot
C. P24Ag
D. Lymph node biopsy

Response:
Ans. is 'c' P24 Ag. "Antibodies to HIV usually appear within 6 weeks and almost invariably within 12 weeks of primary infection." - Harrison,15/eDetection of these Antibodies forms the basis of most diagnostic screening tests for HIV infection. Such as ELISA & Western blot test.In the question the patient is giving H/O sexual contact just 3 weeks back. So there is strong probability of that Antibodies might not have developed against HIV. Now the diagnosis of HIV in this patient depends upon the direct detection of HIV or one of its components.The simplest of the direct detection test is the p24 Antigen Capture Assay.

So the answer to this question is C


Instruction:
Asymptomatic hyper - calcemia in a 30 year old young male is due to-
A. Occult primary malignancy
B. Primary Hyperparathyroidism
C. Familial hypocalciuria
D. Hyper-nephroma

Response:
Primary hyperparathyroidism is a generalized disorder of calcium, phosphate, and bone metabolism due to an increased secretion of PTH. The elevation of circulating hormone usually leads to hypercalcemia and hypophosphatemia. There is great variation in the manifestations. Patients may present with multiple signs and symptoms, including recurrent nephrolithiasis, peptic ulcers, mental changes, and, less frequently, extensive bone resorption. However, with greater awareness of the disease and wider use of multiphasic screening tests, including measurements of blood calcium, the diagnosis is frequently made in patients who have no symptoms and minimal, if any, signs of the disease other than hypercalcemia and elevated levels of PTH. The manifestations may be subtle, and the disease may have a benign course for many years or a lifetime. This milder form of the disease is usually termed asymptomatic HPT . Rarely, hyperparathyroidism develops or worsens abruptly and causes severe complications such as marked dehydration and coma, so-called hypercalcemic parathyroid crisis. The annual incidence of the disease is calculated to be as high as 0.2% in patients >60, with an estimated prevalence, including undiscovered asymptomatic patients, of >=1%; some repos suggest the incidence may be declining. If confirmed, these changing estimates may reflect less frequent routine testing of serum calcium in recent years, earlier overestimates in incidence, or unknown factors. The disease has a peak incidence between the third and fifth decades but occurs in young children and in the elderly.(harrison 18 pg 3100)

So the answer to this question is B


Instruction:
Glycine is used in the synthesis of all EXCEPT-
A. Purines
B. Creatine
C. Heme
D. Pyrimidines

Response:
Glycine as Precursor of Many Compounds WITH REGARD TO OTHER OPTIONS For pyrimidines, two amino acids are required i.e. Aspaate and Glutamine.

So the answer to this question is D


Instruction:
Bacteria implicated in dental caries is
A. Streptococcus mutans
B. Pneumococci
C. Streptococcus pyogenes
D. Streptococcus aureus

Response:
Streptococcus mutans is an alpha Hemolytic streptococcus which is a pa of the normal flora of the oral cavity. This gram-positive coccus is commonly found in the mouth from where it can spread to cause dental caries or endocarditis in individuals with risk factors(dental extraction in individuals with damaged hea valves). The bacterium has a polysaccharide coat that allows it to stick to teeth and also to the damaged hea valves. It produces acid from sugar in saliva and this promotes erosion of tooth enamel. Normal body defenses are usually adequate to prevent disease. Disease due to this bacterium can be prevented by mainataince of good oral hygeine and by regular dental checkup Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 221

So the answer to this question is A


Instruction:
The basis of Korotkoff sound is
A. Aoic valve closure
B. Production of hea sound
C. Aerial turbulence
D. Aerial valve expansion

Response:
The sounds of Korotkoff are produced by turbulent flow in the brachial aery. When the aery is narrowed by the cuff, the velocity of flow through the constriction exceeds the critical velocity and turbulent flow results.

So the answer to this question is C


Instruction:
Mediators of inflammation are all except aEUR'
A. TNF
B. IFN
C. Prostaglandins/Interleukins
D. Myeloperoxidase

Response:
Myeloperoxidase [Ref: Robbin's 8/e p. 57 (7/e p. 63, 74, 75)1 Mediators of inflammation :- The vascular and cellular reactions of both acute and chronic inflammation are mediated by chemical factors known as mediator of inflammation. Mediators originate either: - 1. From plasma Complement proteins, Bradykinin 2. From cells Cells derived mediators may he preformed and are stored in secretory granules or they may be synthesized denovo in response to a stimulus. Preformed mediators Histamine, Serotonin, Lysosornal enzymes. Newly synthesized --> Prostaglandins, Leukotrienes, platelet activating factors, nitric oxide, reactive oxygen species,cytokines (TNF, IL-I). Myeloperoxidase is not an inflammatory mediator. It is an enzyme of neutrophil which catalyzes the conversion of CI-, Br. and and SCN to the corresponding acids (HOC1, HOBr etc.). These acids are potent oxidants and help in destroying the invading organisms. Mediator Source Vascular Vascu leakage Chemotaxis Other Histamine & serotonin Mast cell, platelets + - Bradykinin Plasma substrate + - * Pain C3,, Plasma protein Liver + * Opsonic fragment C5, + + * Leucocyte adhesion Prostaglandins Mast cells from membrane phospholipid Potentiate other mediators - * Vasodilation, * Pain, * Fever Leukotriene BP Leucocytes - + * Leucocyte adhesion activation LenkotrieneQ C4, 1)4, E4 Leucocyte Mast cells + * Bronchocuntriction, * Vasoconstriction Oxygen Metabolites Leucocytes / - * Endothelial damage, * Tissue damage PM' Leucocytes mast cells + + * Bronchoconstriction * Leucocyte priming IL-le and TNF Q Macrophages, others - + * Acute phase reactions, * Endothelial activation Chentokines Leucocytes, others - + * Leucocyte activation Nitric oxide Macrophages + + * Vasodilation cytotoxicity endothelium

So the answer to this question is D


Instruction:
Which of the following is the greatest contributor to global warmig as a consequence of human activities and life style: September 2012
A. CO2
B. Chlorofluorocarbons
C. Methane
D. Ozone

Response:
Ans: A i.e. CO2 Global warming It is the rise in the average temperature of Eah's atmosphere and oceans since the late 19th century and its projected continuation. Since the early 20th century, Eah's mean surface temperature has increased by about 0.8 degC(1.4 degF), with about two-thirds of the increase occurring since 1980. Warming of the climate system is unequivocal, and scientists are more than 90% ceain that it is primarily caused by increasing concentrations of greenhouse gases produced by human activities such as the burning of fossil fuels and deforestation. The major greenhouse gases are water vapor, which causes about 36-70% of the greenhouse effect; carbon dioxide (CO2), which causes 9-26%;methane (CH4), which causes 4-9%; and ozone(03), which causes 3-7%

So the answer to this question is A


Instruction:
A patient lalita present with dry mouth, pupillary dilation and warm skin, the likely drug toxicity is:
A. Organo-phosphorus
B. Carbamazepine
C. Lithium
D. Amytriptyline 1:1

Response:
D i.e. Amitryptiline Most tricyclic anti depressants eg. imipramine, amitryptiline have potent anticholinergic side effects. So atropine is not used in treatment of amitryptiline poisoningQ

So the answer to this question is D


Instruction:
You have noticed ape like thumb in a 30 years young man from bihar who is a known patient of leprosy? Which of the following test is not done to show the nerve involved in this condition?
A. Card test
B. Pen test
C. Benediction sign (pointing index deformity)
D. Oschner clasp sign

Response:
Common in leprosy-The involvement of the: median nerve at the wrist ulnar nerve at the elbow common peroneal nerve at the fibular head Here median nerve (C5-T1) is involved all other tests done for median nerve palsy Card test is done for ulnar nerve A high/proximal lesion of the median nerve manifests in the hand of benediction

So the answer to this question is A


Instruction:
Excessive O2 concentration in Neonates causing
A. Retrolental fibroplasias
B. Respiratory distress syndrome
C. Hyaline membrane disease
D. Anaemic retinopathy

Response:
(Retrolental fibroplasia) (264-KH)Retinopathy of prematurity term coined for the disease "retrolental fibroplasia"* It is a bilateral proliferative retinopathy, occurring in premature infants (weighting less than 1300 gm) exposed to high concentration of oxygen during the first 10 days of life.* Premature infants should not be placed in incubator with an O2 concentration of more than 30% and efforts should be made to avoid infection and attacks of apnoea.

So the answer to this question is A


Instruction:
The Haversian system is found in -
A. Diaphysis of long bones
B. Cancellous bone
C. Epiphysis
D. Spongy bones of children

Response:
Shaft (diaphysis) of a long bone is made up of cortical (compact) bone which consists of Haversian system.

So the answer to this question is A


Instruction:
Most commonly used nerve for neuromuscular monitoring under anesthesia is
A. Radial
B. Ulnar
C. Glossopharyngeal
D. Vagus

Response:
Monitoring of Neuromuscular block Done by nerve stimulator Different stimulation - Single Twitch Tetanus Train of four stimulus (most common) Double burst stimulation Post - tetanic count Nerves used - ulnar nerve (most common) (Adductor pollicis muscle ) Facial nerve Posterior tibial nerve External peroneal nerve Response of stimulation

So the answer to this question is B


Instruction:
Which antifungal drug is an anti-metabolite?
A. Ketoconazole
B. Flucytosine
C. Terbinafine
D. Griseofulvin

Response:
Flucytosine

So the answer to this question is B


Instruction:
Adrenaline acts on which enzyme in glycogenolysis?
A. Glucokinase
B. Hexokinase
C. Phosphorylase
D. Gluc diphosphatase

Response:
C i.e. Phosphorylase

So the answer to this question is C


Instruction:
Vicarious responsibility peains to: Delhi 06; NIMHAS 14
A. Patient's, contribution towards negligence
B. Hospitals contribution towards patient's damage
C. Responsibility for actions of a colleague
D. Responsibility of senior for actions of junior

Response:
Ans. Responsibility of senior for actions of junior

So the answer to this question is D


Instruction:
A 50 year old lady presented with history of pain upper abdomen, nausea, and decreased appetite for 5 days. She had undergone cholecystectomy 2 years back. Her bilirubin was 10 mg/dl, SGOT 900 IU/I SGPT 700 IU/I and serum alkaline phosphatase was 280 IU/I. What is the most likely diagnosis -
A. Acute pancreatitis
B. Acute cholangitis
C. Acute viral hepatitis
D. Posterior penetration of peptic ulcer

Response:
Ans. is 'c' i.e., Acute viral hepatitis The serum abnormalities and the symptoms of the patient matches with those of acute viral hepatitis.Liver test pattern in alcoholic hepatitis.* Bilirubin-Both fractions may be elevated. Peak usually follows aminotransferases Bilirubinemia* Aminotransferases-Elevated ALT > AST* Alkaline-Normal to < 3 timesphosphatase normal elevation* Albumin-Normal* Prothrombin time-Usually normalSymptoms of acute viral hepatitisProdromal symptoms include - Anorexia, nausea, vomiting, fatigue, malaise, arthralgia, myelalgia, headacheThese symptoms precede the onset of Jaundice by 1-2 weeks About other options -Acute pancreatitisAcute pancreatitis does not present with these serum abnormalities.Diagnosis of acute pancreatitis is highly unlikely in the absence of elevated serum amylase.Acute cholangitisAcute cholangitis can present with the above mentioned laboratory abnormalities.Diagnosis of acute cholangitis is highly unlikely in the absence of classical clinical presentation of - pain, fever and jaundice (Charcot's triad).

So the answer to this question is C


Instruction:
Subtelomeric rearrangement of genes is frequently associated with mental retardation. All of the following techniques can be used to diagnose them, EXCEPT:
A. FISH
B. MAPH
C. CGHarray
D. MALDI

Response:
MALDI: It is a technique used to assess the molecule, based on their mass only. Most commonly employed methods for dispersing peptides, proteins, and other large biomolecules into the vapor phase for mass spectrometric analysis are electrospray ionization and matrix-assisted laser desorption and ionization, aka MALDI. In electrospray ionization, the molecules to be analyzed are dissolved in a volatile solvent and introduced into the sample chamber in a minute stream through a capillary . As the droplet of liquid emerges into the sample chamber, the solvent rapidly disperses leaving the macromolecule suspended in the gaseous phase. The charged probe serves to ionize the sample. Electrospray ionization is frequently used to analyze peptides and proteins as they elute from an HPLC or other chromatography column already dissolved in a volatile solvent. In MALDI, the sample is mixed with a liquid matrix containing a light-absorbing dye and a source of protons. In the sample chamber, the mixture is excited using a laser, causing the surrounding matrix to disperse into the vapor phase so rapidly as to avoid heating embedded peptides or proteins. Ref: Kennelly P.J., Rodwell V.W. (2011). Chapter 4. Proteins: Determination of Primary Structure. 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 D


Instruction:
Transcutaneous electrical nerve stimulation is based on
A. Allodynia
B. Referred pain
C. Central Pain.
D. Gate control theory of pain

Response:
Ans. (d) Gate control theory of pain(Ref: Ganong, 25th ed/p.172)Gate control theory of pain:#Proposed by Melzack and Wall#Dorsal horn neuron receives collaterals from both the touch receptors and pain receptors. Simultaneous activation of innocuous touch receptors reduces the responsiveness of dorsal horn neurons to their input from pain receptor afferents#It is also the basis behind transcutaneous electrical nerve stimulation (TENS) where in electrodes are used to activate Aa and Ab fibers near the site of injury to relieve pain

So the answer to this question is D


Instruction:
QT interval is shortened in -
A. Hypocalcaemia
B. Hypokalemia
C. Hypercalcemia
D. Hyperkalemia

Response:
None

So the answer to this question is C


Instruction:
False statement about dermatophytes is
A. Trichophyton - macroconidia are pencil shaped
B. Epidermophyton - macroconidia are club shaped
C. Trichophyton - microconidia are absent
D. Epidermophyton - microconidia are absent

Response:
In Trichophyton - microconidia are abundant

So the answer to this question is C


Instruction:
A 42-year-old man has had a constant bad taste in his mouth for the past month. On physical examination there are white fluffy patches on the sides of his tongue. These cannot be scraped off. A biopsy is taken and on microscopic examination shows squamous epithelial hyperkeratosis, parakeratosis, and koilocytosis. Immunohistochemical staining for Epstein- Barr virus (EBV) is positive. Which of the following is the most likely risk factor for his oral lesions?
A. Chronic alcohol abuse
B. Diabetes mellitus
C. HIV infection
D. Pernicious anemia

Response:
Oral hairy leukoplakia is seen in immunocompromised persons. It presages AIDS in persons who are HIV positive. Chronic alcohol and/or tobacco use are associated with oral squamous cell carcinomas. Type 1 diabetes mellitus with ketoacidosis is associated with fungal sinusitis, particularly with mucormycosis. Pernicious anemia from vitamin B12 deficiency is associated with glossitis that is mainly atrophic. Sjogren syndrome leads to inflammation and atrophy of salivary glands leading to xerostomia with atrophy, fissuring, and ulcerations in the oral cavity mucosa.

So the answer to this question is C


Instruction:
All of the following nutritional assessment methods indicate inadequate nutrition except –
A. Hb < 11.5 g/dl during 3rd trimester of pregnancy
B. Increased 1–4 year mortality rate
C. Birth weight < 2500 gm
D. Decreased weight for height

Response:
None

So the answer to this question is A


Instruction:
Axial proptosis is produced by tumors lying in ?
A. Retrobulbar space
B. Subperiosteal space
C. Tenon space
D. Peripheral space

Response:
Ans. is 'a' i.e., Retrobulbar space SURGICAL SPACES IN THE ORBIT These are of impoance as most orbital pathologies tend to remain in the space in which they are formed. Therefore, their knowledge helps the surgeon in choosing the most direct surgical approach. Each orbit is divisible into four surgical spaces. 1. The subperiosteal space This is a potential space between the bone and the periorbita (periosteum). 2. The peripheral space It is bounded peripherally by the periorbita and internally by the four recti with thin intermuscular septa. Tumours present here produce eccentric proptosis and can usually be palpated. For peribulbar anaesthesia, injection is made in this space. 3. The central space It is also called muscular cone or retrobulbar space. It is bounded anteriorly by the Tenon's capsule lining back of the eyeball and peripherally by the four recti muscles and their intermuscular septa in the anterior pa. In the posterior pa, it becomes continuous with the peripheral space. Tumours lying here usually produce axial proptosis. Retrobulbar injections are made in this space. 4. Tenon's space It is a potential space around the eyeball between the sclera and the tenons capsule.

So the answer to this question is A


Instruction:
Metastasis to neck lymph nodes is from?
A. Breast cancer
B. Lung cancer
C. Adrenal carcinoma
D. Stomach cancer

Response:
Ans. (B) Lung cancerRef: Schwartz 10th ed. / 583; Harrison 18th ed/ Ch 99Metastasis to Cervical lymph NodesSquamous cell carcinoma (SCC) is the most common histotype, followed by adenocarcinoma, undifferentiated carcinoma and other malignancies (for example, lymphoma and melanoma)Common site for metastasis to neck nodes - Head and Neck (M.C.), Lungs (2nd M.C.), esophagus, stomatch, ovary, pancreas. Approximately ten percent of patients with abnormal cervical nodes present without obvious primary. Most common sites for unknown primary:* Nasal Pharynx.* Pyriform Sinus.* Tongue Base* Tonsillar Crypts.* Thyroid* Lung.DRAINAGE Sites for Cervical Lymph NodesThe left supraclavicular node is called Virchow's node since it is on the left side of the neck where the lymphatic drainage of most of the body (from the thoracic duct) enters the venous circulation via the left subclavian vein. The metastasis blocks the thoracic duct leading to regurgitation into the surrounding nodes i.e. virchow's node.RememberProbable Source of Nodal Metastasis* Level 1: Oral cavity, submandibular gland.* Level 2: Nasal pharynx, oral pharynx, parotid, superglottic larynx.* Level 3: Oral pharynx, hypopharynx, superglottic larynx.* Level 4: Subglottic larynx, hypopharynx, esophagus, thyroid.* Level 5: Nasal pharynx, oral pharynx.* Level 6 & 7: Thyroid, larynx, lung.* Note: Bilateral nodes are common with cancers of soft pallet, tongue, epiglottis, and nasal pharynx.

So the answer to this question is B


Instruction:
Treatment for common bile duct stone is by all except
A. ESWL
B. Exploration of bile duct and recovery of stones
C. Bile duct stenting
D. TIPSS

Response:
Choledocholithiasis :Treatment options ERCP stone extraction is successfull 80-90% of the time using the techniques of sphincterectomy and Balloon catheter or Dormia basket stone retrieval. The addition of mechanical, electro hydraulic, laser or extracorporeal shock wave lithotripsy for large stones increases the success rate to over 95% The placement of pancreatic stents has been found to reduce the incidence of post biliary sphincterectomy pancreatitis in patients suspected of sphincter of oddi dysfunction In patients for whom ERCP is not available, not possible secondary to anatomic consideration, or not successful, an alternative method of cholangiography and nonsurgical therapy is percutaneous transhepatic cholangiography (PTC) followed by transhepatic methods of stone removal Ref: Shackelford 7th edition Pgno : 1326-1331

So the answer to this question is D


Instruction:
A 65 year old elderly male has history of sweating and chest pain for last 24 hrs with the following ECG. Which of the following is not given in managing the patient?
A. Aspirin
B. Statin
C. Thrombolytic therapy
D. Morphine

Response:
Ans. C. Thrombolytic therapyFirst let us diagnose the ECG; we need to know the following points:E.C.G changes in acute infarctionEarly acute phase (with - in hours)Fully evolved phaseOld infarction (resolution phase)Elevation of ST segmentPathological Q warePathogical Q waveTall wide (peaked) T waveElevated ST segment being to resolveT wave inverts.ST segment and T wave may be normalST segment elevation, unlike depression, will localize to the ECG lead of the affected myocardium. Note that 1mm of ST elevation in 2 contiguous leads is required to diagnose STEMI, however there are two major exceptions.a. Anterior STEMI requires 2mm of ST elevation in V2 and V3 in men > 40 years old or 1.5mm in women according to the ACC/AHA definition.b. Posterior STEMI frequently has ST depression in V1-V3 instead of elevation since the vectors are completely reversed. Hence, this is an ECG of anterior STEMI.In STEMI, thrombolysis or PCI (primary PCI) are effective methods to restore coronary blood flow and salvage myocardium within the first 12 h after onset of chest pain.ST elevation MI (STEMI) Immediate management:a. Nitratesb. Morphinec. Oxygend. AspirinStart adjunctive treatmenta. Beta blockers (IV)b. Nitroglycerine (IV)c. Heparin (IV)Reperfusion therapy is the definitive treatment of choice if patient present < 12 hours.a. Thrombolysis (Streptokinase)b. Early primary PCI

So the answer to this question is C


Instruction:
Which among the following is false regarding rheumatic hea disease?
A. May cause CHF
B. Pulmonary valve is most commonly affected
C. Affects young people
D. Varying degree of pancarditis observed

Response:
Rheumatic fever is principally a disease of childhood, with a median age of 10 years. Acute rheumatic fever may develop varying degrees of pancarditis with associated valve insufficiency, hea failure, pericarditis, and even death. With chronic rheumatic hea disease, patients develop valve stenosis with varying degrees of regurgitation, atrial dilation, arrhythmias, and ventricular dysfunction. Chronic rheumatic hea disease remains the leading cause of mitral valve stenosis and valve replacement in adults. The mitral valve is most commonly and severely affected (65-70% of patients), and the aoic valve is second in frequency (25%). The tricuspid valve is deformed in only 10% of patients and is almost always associated with mitral and aoic lesions. The pulmonary valve is rarely affected.

So the answer to this question is B


Instruction:
Primary Amenorrhea with Absent uterus, Normal breasts and Scanty pubic hair is seen in
A. Mayer Rokitansky Kuster hauser Syndrome
B. Turner Syndrome
C. Noonan Syndrome
D. Testicular Feminizing Syndrome

Response:
Testicular Feminising Syndrome Complete AIS (testicular feminization) is a form of male pseudohermaphroditism Gonadal sex (male) and the Contrasting phenotype (female) Normal male karyotype (46,XY) and testes that produce both testosterone and AMH An inactivating mutation in the gene encoding the intracellular androgen receptor (located on the long arm of the X chromosome, Xq) results in an end organ insensitivity to androgen actions that prevents normal masculinization of the internal and external genitalia during embryonic development Consequently, the external genitalia are those of a female (absent androgen action), the cervix and uterus are absent (due to normal AMH action), and the vagina is sho and ends blindly (derived only from the urogenital sinus) Reference: Clinical Endocrinologic Gynecology and Infeility; Eigth Edition; Chapter 11

So the answer to this question is D


Instruction:
Omenn syndrome represents which of the following immunological condition?
A. Human Leukocyte antigen (HLA) Class II Deficiency
B. HLA Class I Deficiency
C. Purine Metabolism Deficiency
D. Subset of T cell deficiency

Response:
Omenn syndrome consists of a subset of T cell deficiencies that present with early-onset erythroderma, alopecia, hepatosplenomegaly, and failure to thrive. This peculiar syndrome is due to the hypomorphic mutations in genes usually associated with SCID, i.e., RAG-1, RAG-2,. The patients are very fragile, requiring simultaneous anti-infective therapy, nutritional suppo, and immunosuppression. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2701.

So the answer to this question is D


Instruction:
All of the following drugs reduce afterload ,except
A. Enalapril
B. Propranolol
C. Hydralizine
D. Sodium nitroprusside

Response:
Afterload is reduced by the drugs having aeriolar dialting propey. Propranolol is a non selective beta blockers. It can cause Vasoconstriction by antagonizing beta 2 mediated vasodilatation. It, therfore do not cause afterload Refer kDT 6/e 504

So the answer to this question is B


Instruction:
Undescended testis increases the risk of which cancer
A. Teratoma
B. Seminoma
C. Yolk sac tumor
D. Lymphoma

Response:
Seminoma risk is increased by 8-9 times by undescended testis.

So the answer to this question is B


Instruction:
Centrally acting sympatholytic agent used as anti hypeensive agent is:
A. Propanolol
B. Moxonidine
C. Prazosin
D. Phenoxybenzamine

Response:
Clonidine, moxonidine,relminidine are centrally acting antihypeensives They cross the blood-brain barrier and stimulates alpha2A receptors in vasomotor Centre and decreases sympathetic outflow from VMC. This lead to a decrease in blood pressure. (REF: ESSENTIALs OF MEDICAL PHARMACOLOGY-K.D TRIPATHI 8th Edition)

So the answer to this question is B


Instruction:
One of the important defence mechanism is -
A. Alienation
B. Confabulation
C. Repression
D. Suppression

Response:
Repression is the most basic mechanism, therefore it is referred to as primary defence mechanism.
Suppression (option d) is also is a defence mechanism, but repression is the most important defence mechanism.

So the answer to this question is C


Instruction:
Deficiency of which of the following causes perioral rash, gonadal atrophy, neuritis and pigmentation of skin crease ?
A. Zinc
B. Copper
C. Selenium
D. Magnesium

Response:
The condition described is acrodermatitis enteropathica.

So the answer to this question is A


Instruction:
At autopsy, the spleen of a patient is noted to have a thickened capsule and many small, scarred areas. Microscopic examination of the scarred areas reveals fibrosis with hemosiderin and calcium deposition. This type of spleen is usually seen in conjunction with which of the following disorders?
A. Hepatic cirrhosis
B. Hodgkin’s disease
C. Rheumatoid arthritis
D. Sickle cell anemia

Response:
The spleen shows the changes of chronic congestive splenomegaly, typically associated with hepatic cirrhosis. The described small scars are called Gandy-Gamma nodules which are due to the result of organization of old hemorrhages.

Hodgkin’s disease (choice B) produces large splenic nodules in which Reed-Sternberg cells can be found surrounded by mature lymphocytes, eosinophils, and neutrophils.
Rheumatoid arthritis (choice C) and many other chronic inflammatory disorders induce reactive hyperplasia of the spleen with formation of many large germinal centers in the splenic follicles.
Sickle cell anemia (choice D) produces many small (often triangularly shaped) infarctions in the spleen.

So the answer to this question is A


Instruction:
Best Test for intestinal malabsorption
A. D-xylose test
B. NBT-PABA TEST
C. Fecal fatestimation
D. Schilling test

Response:
None

So the answer to this question is A


Instruction:
Prenatal ultrasound at 20 weeks revealed a midline mass that appeared to contain intestines and was membrane bound. Probable diagnosis is:
A. Omphalocele
B. Gstrochisis
C. Diaphragmatic hernia
D. None of the above

Response:
The most likely diagnosis is an omphalocele resulting from a failure of herniated bowel to return to the abdominal cavity at 10 to 12 weeks of gestation. Because the bowel normally herniates into the umbilical cord, it is covered by amnion. This situation is in contrast to gastroschisis, in which loops of bowel herniate through an abdominal wall defect and are not covered by amnion. Ref: Langman's embryology 11th edition Chapter 14.

So the answer to this question is A


Instruction:
Which is not true for therapeutic drug monitoring (TDM)?
A. Done when clinical response can be easily measured
B. Done for narrow therapeutic index drugs
C. Digoxin is an example of a drug for which TDM is done
D. TDM can be done if drug has erratic pharmacokinetics

Response:
Criteria for doing TDM Low therapeutic index When therapeutic response cannot be easily measured Inconsistent pharmacokinetics of the drug TDM is done for A Aminoglycosides Drug Digoxin Possessing Phenytoin Very Valproate Low Lithium Therapeutic Tricyclic Antidepressants Index Immunosuppressants

So the answer to this question is A


Instruction:
Methadone is used in the management of opioid addiction because:
A. Its analgesic activity is less than that of morphine
B. It is an opioid receptor antagonist
C. It is not addictive
D. It is longer acting and causes milder withdrawal symptoms

Response:
None

So the answer to this question is D


Instruction:
Which is the ideal position to insert the below tube
A. Sitting with neck extended
B. Supine with neck flexed
C. Supine with neck extended
D. Sitting with neck flexed

Response:
Ans. (d) Sitting with neck flexedRef Clinical Practical Procedures for Doctors, pg. 123-128; Medscape (Nasogastric tube placement)* Ideal position to insert the Ryles Tube is sitting with Neck flexed or Fowler position.

So the answer to this question is D


Instruction:
All are true about Na-K pump except
A. It needs ATP for its functioning
B. It is located on basolateral membrane of cell
C. It is electrogenic
D. It is needed for generation of action potential

Response:
Na-K pump is responsible for maintaining resting membrane potential and not action potential generation.

So the answer to this question is D


Instruction:
After the age of six the increase in the size of mandible
occurs at:
A. Symphysis
B. Between canines
C. Along the lower border
D. Distal to 1st molars

Response:
None

So the answer to this question is D


Instruction:
Most common cause of viral pneumonia in infant is ?
A. Rhinovirus
B. RSV
C. Reovirus
D. CMV

Response:
Ans. is 'b' i.e., RSV RSV is the most common cause of pneumonia and bronchilis in infants. In adults, influenza is the most common cause of viral pneumonia.

So the answer to this question is B


Instruction:
A 65-year-old chronic smoker presented with a central lung mass with distal bronchiectasis and recurrent pneumonia. A greyish white tumor was resected. Which of the following histopathological finding is most likely to be seen?
A. Small cells with scant cytoplasm, ill-defined borders and hyperchromatic nuclei with nuclear moulding
B. Derivatives of all three germ layers are seen
C. Tall columnar cells with cytoplasmic and intraalveolar mucin
D. Palisading or rosette-like arrangement of cells separated by abundant fibrovascular stroma

Response:
Ans. a. Small cells with scant cytoplasm, ill-defined borders and hyperchromatic nuclei with nuclear moulding

So the answer to this question is A


Instruction:
Left anterior descending aery is a branch of
A. Ascending aoa
B. Right coronary aery
C. Left coronary aery
D. Circumflex aery

Response:
Ascending aoa Right coronary aery Left coronary aery SA Nodal aery AV Nodal Aery Posterior Interventricular Aery (PIVA) Anterior Interventricular Aery (AIVA) OR Left anterior descending aery Circumflex Aery AIVA supplies the anterior 2/3rd of interventricular septum PIVA supplies the posterior 1/3rd of interventricular septum

So the answer to this question is C


Instruction:
Trimetazine is used for -
A. Hypeension
B. Angina
C. CHF
D. Arrhythmia

Response:
Ans. is 'b' i.e, Angina o The drug that inhibit fatty acid oxidation is Trimetazine. o These drugs are paial inhibitors of FA oxidation o These drugs also inhibit lipid peroxidation ---> Reduce the generation of free radicals o These drugs are indicated for the treatment of chronic angina pectoris who failed to respond to standard antianginal therapy.

So the answer to this question is B


Instruction:
False positive tuberculin test indicates:
A. Atypical mycobacteria infection
B. Miliary tuberculosis
C. Immunosuppression
D. Extrapulmonary tuberculosis

Response:
A false-positive result may be caused by non tuberculous mycobacteria or previous administration of BCG vaccine.

So the answer to this question is A


Instruction:
Ciprofloxacin acts on
A. DNA histone proteins
B. DNA gyrase
C. Camp
D. mRNA polymerase

Response:
Ans. is 'b' i.e., DNA gyrase Major mechanism of action of fluoroquinolone is inhibition of bacterial enzyme DNA gyrase.Recent evidence indicates that in gram positive bacterias, the major target is topoisomerase IV.So greater affinity for topoisomerase IV may confer higher potency against gram positive bacteria.

So the answer to this question is B


Instruction:
Lungs develop from:
A. Foregut
B. Midgut
C. Hindgut
D. None of the above

Response:
When the embryo is approximately 4 weeks old, the respiratory diveiculum (lung bud) appears as an outgrowth from the ventral wall of the foregut

So the answer to this question is A


Instruction:
Most potent analgesic agent among following
A. Nitrous oxide
B. Nitric oxide
C. CO2
D. Oxygen

Response:
Ans. a. Nitrous oxide above options, most potent analgesic agent is Nitrous oxide. "Nitrous oxide- 50:50 nitrous oxide and oxygen has revolutionized it as analgesic agent; it has been used as an analgesic agent in obstetric surgeries; dental procedures; in acute trauma; burn dressings and cardiac pain as well."- Wiley and Churchill-Davidson A Practice of Anesthesia 7/e p536 Miller says "Nitrous oxide produce analgesia that is in pa because of release of proenkephalin derived family of endogenous opioids Physical propeies of N20 It is colourless, non-irritating and sweet smelling Boiling point is -89degC. Critical temperature is 36.5degCdeg which is a.bove room temperature, therefore it can be kept in liquefied state. Stored as liquid in blue color cylindersQ 35 times more soluble than nitrogen Remember: Anesthesia with No analgesia HalothaneQ Only analgesia N20Q Profound analgesia KetamineQ Best/maximum analgesia TrileneQ

So the answer to this question is A


Instruction:
Imaging investigation of choice to Diagnose Mullerian duct Abnormalities?
A. USG
B. HSG
C. MRI
D. CT

Response:
MRI is the investigation of choice for Mullerian Duct Anomalies Newer modality - 3D USG also has high sensitivity and specificity and accuracy comparable to MRI

So the answer to this question is C


Instruction:
An old man's autopsy shows brown atrophy of the liver. Microscopic morphology shows finely granular, yellow-brown pigment which often surrounded the nucleus. Brown atrophy is due to accumulation of:
A. Melanin
B. Hemosiderin
C. Hematin
D. Lipofuscin

Response:
Lipofuscin is a "wear and tear" pigment. It is a product of lipid peroxidation, which accumulates in lysosomes as the cell ages. The cell cannot get rid itself of these lipofuscin-laden lysosomes. Lipofuscin accumulation can impa brown discoloration to organ. Such organs may also be atrophic, giving rise to the term 'brown atrophy'. The most common organs where lipofuscin accumulates are the hea and liver.Ref: Pathology: The Big Picture By William Kemp, 2007, Page 8 ; Pathology by Edward R Goljan, Page 7

So the answer to this question is D


Instruction:
A patient admitted with abdominal mass underwent MRI. and it revealed B/L adrenal calcification. Diagnosis?
A. Pheochromocytoma
B. Adrenal incidentalma
C. Neuroblastoma
D. Medullary thyroid cancer

Response:
Neuroblastoma is characterized by abdomonal mass that often crosses midline and it shows stippled calcification on MRI.

So the answer to this question is C


Instruction:
Most common cause of low birth wt baby is
A. Anemia
B. Infection
C. Prematurity
D. Diabetes

Response:
None

So the answer to this question is C


Instruction:
Chapter-14 in International classification of disease is related to -
A. Disease of CVS
B. Disease of urinary system
C. Disease of eye
D. Disease of ear

Response:
Ans. is 'b' i.e., Disease of urinary system 21 Chapters and their contents* Chapter Iincludes'Infectious and parasitic diseases'* Chapter IIincludes'Neoplams'* Chapter IIIincludesDiseases of blood & immune system '* Chapter IVincludes'Endocrine, nutritional and metabolic disorders'* Chapter Vincludes'Mental & behavioral disorders'* Chapter VIincludesDiseases of nervous system '* Chapter VIIincludesDiseases of eye'* Chapter VIIIincludesDiseases of ear and mastoid'* Chapter IXincludesDiseases of CVS'* Chapter XincludesDiseases of respiratory system'* Chapter XIincludesDiseases of digestive system'* Chapter XIIincludesDiseases of skin & subcutaneous tissue'* Chapter XIIIincludesDiseases of musculoskeletal system'* Chapter XIVincludesDiseases of genitourinary system'* Chapter XVincludesPregnancy childbirth andperperium'* Chapter XVIincludes'Conditions of perinatal period'* Chapter XVIIincludes'Congenital malformation and genetic disorders'* Chapter XVIIIincludes'Clinical and laboratory findings not included elsewhere'* Chapter XIXincludesInjury, poisoning and other consequences of external causes.* Chapter XXincludes'External causes of morbidity and mortility'* Chapter XXI (21)includesfactors influencing health status and contact with health services. These area) Problem of lifestyleb) Alcohol usec) Tobacco used) Drug usee) Lack of physical exercisef) Inappropriate diet & eating habitsg) High risk sexual behavior

So the answer to this question is B


Instruction:
A 6-year-old child has been drinking more water, with more frequent urination, for the past 7 months. On physical examination, dehydration is noted. Urinalysis findings include a pH of 6.5; specific gravity, 1.010; and no protein, blood, glucose, or ketones. There are no WBCs, RBCs, or casts. Serum electrolytes show Na+, 152 mmol/L; K+, 4.6 mmol/L; Cl-, 120 mmol/L; HCO3-, 21 mmol/L; urea nitrogen, 29 mg/dL; and creatinine, 3.2 mg/dL. An ultrasound scan shows bilaterally small kidneys with barely visible medullary cysts concentrated at the corticomedullary junction. Which of the following genes is most likely mutated in this child?
A. MCKD1
B. NPHP1
C. PKD1
D. PKHD1

Response:
The child has nephronophthisis, the most common genetic cause for end-stage renal disease in children and adolescents, and transmitted in autosomal recessive pattern. The NPHP1 to NPHP11 genes encode for proteins found in the primary cilia, attached ciliary basal bodies, or the centrosome organelle, from which the basal bodies originate. There is a loss of concentrating ability and renal tubular acidosis. MCKD1 mutations are associated with the adult medullary cystic disease with the autosomal dominant transmission. PKD1 encodes for polycystin-1, associated with autosomal dominant polycystic kidney disease (ADPKD). PKHD1 mutations encode for fibrocystin and is associated with autosomal recessive polycystic kidney disease (ARPKD).

So the answer to this question is B


Instruction:
The following fatty acid does not belong to W6 series
A. Linoleic acid
B. Arachidonc acid
C. Gamma linolenic acid
D. Alpha linolenic acid

Response:
D i.e. Alpha linolenic acidAlpha linolenic acid belongs to W3 seriesQ. Rest others belong to W6 series.Carbon atoms are numbered from the carboxyl carbon (carbon no. 1). The carbon atoms adjacent to carboxyl carbon are also called. a, 13, Y respectively. The terminal methyl carbon is K/as W or n- carbonW3 Family ,MILW6 FamilyW7 FamilyW9- Alpha linolenic Q- Gamma linolenicQPalmitoleic- 0 leicQ- Timnodonic- ArchidonicQ - Elaidic- Cervonic- LinolicQ - The first double bond introduced into a saturated fatty acid (to make it unsaturated) is nearly always in 49 position. The reaction is catalyzed by 49 desaturase in presence of 02, NADH and cytochrome b5.Since animals have 49 desaturase, they are able to synthesize W9 (oleic) family.- Linoleic (W6) or a - linolenic (W3) acids required for the synthesis of other members of W6 or W3 family must be supplied in diet.

So the answer to this question is D


Instruction:
If division of feilized egg takes place in between 5-8 days. It would give rise to which kind of twin pregnancy: March 2009, March 2013 (c)
A. Monochorionic/monoamniotic
B. Monochorionic/diamniotic
C. Dichorionic/ monoamniotic
D. Siamese twins

Response:
Ans. B: Monochorionic/diamniotic Approximately 70% of monozygotic twins are monochorionic /diamniotic. If splitting occurs later (ie, 9-12 d after feilization), monochorionic/ monoamniotic placentation occurs. Monochorionic/monoamniotic twins are rare; only 1% of monozygotic twins have this form of placentation. twins have a common placenta, with vascular communications between the 2 circulations. These twins can develop twin-to-twin transfusion syndrome (TTTS). If twinning occurs more than 12 days after feilization, then the monozygotic feilized ovum only paially splits resulting in conjoined twins.

So the answer to this question is B


Instruction:
The PHP index describes:
A. Performance of hygiene by patient after brushing self evaluation
B. Measures oral hygiene and gingival bleeding
C. Score the plaque surface after treatment
D. Measures the oral flora and plaque index

Response:
None

So the answer to this question is A


Instruction:
All are true about otosclerosis excepta) Increased incidence in femaleb) Sensorineural deafnessc) Irreversible loss of hearingd) Carhart's notch at 2000 Hze) Family history positive
A. a
B. c
C. ac
D. bc

Response:
In otosclerosis—50% cases have positive family history.
Females are affected more than males.
Bilateral conductive deafness seen in otosclerosis is not irreversible as it can be successfully treated by stapedectomy / Stapedotomy.
Sensorineural hearing loss occurs when later in the course of time osteosclerotic focus reaches the cochlear endosteum but actually most common hearing loss seen is conductive type.Q
Carharts notch is seen in bone conduction curve at 2000 Hz.

So the answer to this question is D


Instruction:
Renal Calculi associated with Proteus infection is
A. Uric Acid
B. Triple Phosphate
C. Calcium oxalate
D. Xanthine

Response:
Phosphate calculus Phosphate calculus is smooth and diy whiteIt tends to grow in alkaline urine, especially when urea-splitting Proteus organisms are present; As a result, the calculus may enlarge to fill most of the collecting system, forming a staghorn calculusStaghorn calculus may be clinically silent for years and may present with haematuria, urinary infection or renal failure(Ref: Harrison's 18/e p2387; Bailey 26/e p1293)

So the answer to this question is B


Instruction:
Selection bias occurs mainly in
A. Coho study
B. Case control study
C. RCT
D. All the above

Response:
It's usually unwise to choose a control group of patients with one disease. This is because hospital controls are often a source of 'selection bias'. Many hospitals may have diseases that are also influenced by factors under study. In selection bias, cases and controls may not be representative of actual cases and controls in the general population. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 79, 81

So the answer to this question is B


Instruction:
Xeroderma pigmentosum is caused due to:
A. DNA synthesis defect
B. Ectodermal cell migration defect
C. Abnormal nucleotide excision repair
D. Melanocyte proliferation

Response:
Xeroderma pigmentosum (XP) is a rare autosomal recessive disease characterized by photosensitivity, pigmentary changes, premature skin ageing, neoplasia and abnormal Nucleotide excision repair. Ref: Rook's textbook of dermatology, 8th edition, Pg15.71.

So the answer to this question is C


Instruction:
Breast Ca most important prognostic factor
A. Lymph node status
B. Size of tumor
C. Skin involvement
D. Peude orange

Response:
"Metastasis to ipsilateral axillary nodes predicts outcome are surgery more powerfully than tumor size does”.
“The single most important predictor of 10 and 20-year survival rates in breast cancer is the number of axillary lymph nodes involved with metastatic disease”.

So the answer to this question is A


Instruction:
Which of the following valvular hea diseases is most commonly associated with sudden death:
A. Aoic Stenosis
B. Mitral Stenosis
C. Mitral Regurgitation
D. Aoic Regurgitation

Response:
Answer is A (Aoic Stenosis) Aoic Stenosis is the most common valvular disease associated with sudden death. The most common valve disease causing sudden death is aoic stenosis. In children subvalvular and supravalvular aoic stenosis may cause sudden death whereas in adults both congenitally bicuspid and trileaflet valves are the cause. Aoic stenosis accounts for approximately 2 percent of sudden death in adults' The classic symptoms of the valvular type of aoic stenosis (regardless of type) include external dyspnoea, syncope, angina, and sudden cardiac death. The onset of symptoms is an ominous sign. The presence of angina does not necessarily indicate coexisting coronary disease; rather, it is related to increased left ventricular filling pressure causing subendocardial ischemia.

So the answer to this question is A


Instruction:
Treatment of patient with Infeility and Endometriotic cyst of 8 cms is:
A. IUI as early as possible, to utilize the remaining feility potential
B. Surgery first & then infeility treatment
C. Danazol first and then IUI/IVF
D. Ovulation induction and follow feile period

Response:
An infeile patient with endometriotic cyst is best treated by excision of the cyst followed by medical treatment of infeility including ovulation induction, IUI or assisted reproduction. Surgical management of endometriosis broadly includes: 1. Patients with infeility: Laparoscopic ovarian cystectomy, adhesiolysis, and electrocoagulation of endometriotic implants 2. If the Family is complete and the patient has severe pain or menstrual complaints: Hysterectomy with bilateral salpingo-oophorectomy.

So the answer to this question is B


Instruction:
A young patient presented with HTN and VMA 14 mg/24, the causes is/are -
A. Medullary carcinoma thyroid
B. VonHippelLindau syndrome
C. Grave's disease
D. Pseudohypoparathyroidism

Response:
Answers are options 1and 2 i.e. Medullary Ca of thyroid and Von Hippel Lindau syndrome Familial syndrome associated with pheochromocytoma are MEN type 2A MEN type 2B Von Hippel Lindau disease Von Reclinghausen&;s neurofibromatosis Sturge weber syndrome Ref Harrison 17/e p2358

So the answer to this question is A


Instruction:
Which carries more weight in a cou of law :
A. Dying declaration
B. Dying deposition
C. Both carry the same weight
D. Both are not significant

Response:
B i.e. Dying deposition

So the answer to this question is B


Instruction:
Rhinophyma complicates –
A. Acne vulgaris
B. Acne rosacea
C. Psoriasis
D. Pemphigus

Response:
Rhinophyma is slowly progressive condition due to hypertrophy of the sebaceous gland of the tip of nose often seen in cases of long standing acne rosacea.

So the answer to this question is B


Instruction:
Which of the following is the characteristic of irreversible injury on electron microscopy?
A. Disruption of ribosomes
B. Amorphous densities in mitochondria
C. Swelling of Endoplasmic reticulum
D. Cell swelling

Response:
One of the characteristic features of irreversible injury on electron microscopy is marked dilation of mitochondria with the appearance of large amorphous densities.

So the answer to this question is B


Instruction:
Late onset endophthalmitis after cataract surgery is most often caused by:
A. Staphylococcus Epidermidis
B. Pseudomonas
C. Streptococcus Pyogenes
D. Propionobacterium Acnes

Response:
Propionobacterium Acnes - most frequent isolate in chronic postoperative endophthalmitis followed by S.epidermidis, aerobic streptococci and Actinomyces species. Most frequent repoed organism is Propionobacterium Acnes. Ref: Clinical Eye Atlas - Page 700; Complications in Phacoemulsification: Avoidance, Recognition, and Management - Page 304.

So the answer to this question is D