Instruction:
A 45-year-old woman is undergoing chemotherapy for breast cancer. She presents 10 days after her last chemotherapy with fever (temperature >38.5), but no other symptoms except a sore throat and mouth. On examination, she looks well, there is oral mucositis, ears are normal, lungs are clear, and the central line site is clean. The CXR, urinalysis, and biochemistry are normal. Her WBC is 800/mL and the absolute neutrophil count is low (<500). Which of the following is the most appropriate next step in management?
A. start empiric bacterial antibiotics
B. start empiric antifungal and bacterial antibiotics
C. acetaminophen alone until culture results are available
D. start antiviral medications for HSV-1

Response:
Several antibiotic combinations could be used and may vary with the indigenous organisms. Aminoglycoside and cephalosporin are commonly used in combination. The antibiotic combination must cover both Gram-positive and Gram-negative organisms. Antifungal or viral agents are not empirically started unless there is an appropriate clinical fungal or viral infection. In some centers, empiric antifungal agents are started if the patient remains febrile on antibiotics after 5 days. Observation alone is not an option, since these individuals usually have some form of bacteremia causing the fever.

So the answer to this question is A


Instruction:
Hemodialysis related complications are all of the following except: September 2008
A. Altered cardiovascular dynamics
B. Anaphylactoid reaction
C. Hypeension
D. Muscle cramps

Response:
Ans. C: Hypeension Complication of hemodialysis: Fever- Bacteremia, water-borne pyrogens, overheated dialysate Hypotension - Excessive ultrafiltration, cardiac arrhythmia, air embolus, pericardial tamponade; hemorrhage (gastrointestinal, intracranial, retroperitoneal); anaphylactoid reaction Hemolysis- Inadequate removal of chloramine from dialysate, failure of dialysis concentrate delivery system Dementia- Incomplete removal of aluminum from dialysate water, prescription of aluminum antacids Seizure- Excessive urea clearance (first treatment), failure of dialysis concentrate delivery system Bleeding- Excessive heparin or other anticoagulant Muscle cramps- Excessive ultrafiltration

So the answer to this question is C


Instruction:
A 55-year-old man felt a lump near his shoulder 1 week ago. On physical examination, there is an enlarged, nontender, supraclavicular lymph node and enlargement of the Waldeyer ring of oropharyngeal lymphoid tissue. There is no hepato- splenomegaly. CBC is normal except for findings of mild anemia. A lymph node biopsy specimen shows replacement by a monomorphous population of lymphoid cells that are twice the size of normal lymphocytes, with enlarged nuclei and prominent nucleoli. Immunohistochemical staining and flow cytometry of the node indicates that most lymphoid cells are CD19+, CD10+, CD3-, CD15-, and terminal deoxynucleotidyl transferase negative (TdT-). A BCL6 gene mutation is present. Which of the following is the most likely diagnosis?
A. Acute lymphoblastic lymphoma
B. Chronic lymphadenitis
C. Diffuse large B-cell lymphoma
D. Hodgkin lymphoma

Response:
Diffuse large B-cell lymphoma occurs in older individuals and frequently manifests as localized disease with extranodal involvement, particularly of the Waldeyer ring. A third of cases have BCL6 rearrangements or mutations. The staining pattern indicates a B-cell proliferation (CD19+, CD10+). T-cell (CD3) and monocytic (CD15) markers are absent. TdT can be expressed in B lineage cells at an earlier stage of maturation. Lymphoblastic lymphoma is a T-cell neoplasm that occurs typically in the mediastinum of children. In chronic lymphadenitis, the lymph node has many cell types-macrophages, lymphocytes, and plasma cells. A monomorphous infiltrate is typical of non-Hodgkin lymphomas. Reed-Sternberg cells characterize Hodgkin lymphoma. Small lymphocytic lymphoma also is a B-cell neoplasm, but it manifests with widespread lymphadenopathy, liver and spleen enlargement, and lymphocytosis.

So the answer to this question is C


Instruction:
Most common nerve involvement in fracture surgical neck humerus:
A. Axillary nerve
B. Radial nerve
C. Ulnar nerve
D. Median nerve

Response:
A i.e. Axillary nerve Injury Common Nerve Involvement Anterior shoulder dislocation Fracture surgical neck humerus Axillary (circumflex humeral) nerveQ Axillary nerveQ Fracture shaft humerus Fracture supracondylar humerus Medial condyle humerus Radial nerveQ Radial or median nerve Ulnar nerve Monteggia fracture dislocation Posterior interosseous nerve Vockman's ischemic contracture Lunate dislocation Median nerve Median nerveQ Hip dislocation Sciatic nerve Knee dislocation Peroneal nerve

So the answer to this question is A


Instruction:
First line Treatment of Abnormal Uterine bleeding is
A. Versapoint
B. Novasure
C. Medical mangement
D. Surgical management

Response:
Managment of Abnormal uterine bleeding Medical management is the first line treatment, If medical therapy fails or is contraindicated, consider Mirena IUCD. If Mirena fails or side effects develop, go for ablative techniques. When the above methods fail, consider hysterectomy Versapoint- Bipolar electrosurgical system works in normal saline, is cheap, has excellent haemostasis NovaSure Impedance-controlled endometrial ablation is the latest and most safe procedure, taking just 90 sec. It uses bipolar radiofrequency and vaporizes endometrium upto myometrium.

So the answer to this question is C


Instruction:
In NREM stage 4, the EEG waves are
A. d
B. b
C. K-spindles
D. a

Response:
(A) 5 # There are two different kinds of sleep: rapid eye movement (REM) sleep and non-REM (NREM), or slow-wave sleep.> NREM sleep is divided into four stages. A person falling asleep first enters Stage 1, which is characterized by low-amplitude, high-frequency EEG activity. Stage 2 is marked by the appearance of sleep spindles. These are bursts of alpha-like, 10-14 Hz, 50 uV waves. In stage 3, the pattern is one of lower frequency and increased amplitude of the EEG waves. Maximum slowing with large waves is seen in Stage 4. Thus, the characteristic of deep sleep is a pattern of rhythmic slow waves, indicating marked synchronization.

So the answer to this question is A


Instruction:
Oculomotor nerve supplies all muscles of the eye except
A. Inferior oblique
B. Superior oblique
C. Superior rectus
D. Inferior rectus

Response:
(B) Superior oblique > Lateral rectus is supplies by the 6th cranial (abducent) nerve.> Oculomotor nerve supplies all extra ocular muscles of the eye except:> Superior oblique supplied by IV cranial nerve (SO IV).> Lateral rectus supplied by VI cranial nerve (LR VI).

So the answer to this question is B


Instruction:
All of these drugs are used in treatment of acute gout except:
A. Allopurinol
B. Steroids
C. Colchicine
D. Naproxen

Response:
Naproxen is used in acute gout . Steroids are used in case of NSAID hypersensitivity. Colchicine can also be used but not allopurinol which is used in chronic gout.

So the answer to this question is A


Instruction:
Clinical features of complicated cataract are all, EXCEPT –
A. Polychromatic lusture
B. Axial spread of opacity
C. Opacity along sutures
D. Posterior subcapsular opacity

Response:
Typically opacification starts in the posterior part of the cortex in the axial region (Posterior cortical cataract or posterior subcapsular cataract).
Opacity along the suture lines is seen sutural cataract.

So the answer to this question is C


Instruction:
The activity of which of the following enzymes is increased in Diabetes Mellitus?
A. CPT-1
B. Phosphoenol Pyruvate carboxykinase (PEPCK)
C. Glucose-6-Phosphatase
D. All

Response:
Diabetic situation is same like fasting or starvation i.e. catabolic situation in the body. So, in Diabetes Mellitus, the activity of Catabolic enzymes is increased. Carnitine Palmitoyl Transferase-I (CPT-I) is an enzyme of b-Oxidation which is a Catabolic pathway. Therefore, it is increased in Diabetes. Option b & c - Phosphoenol Pyruvate Carboxykinase (PEPCK) and Glucose -6-Phosphatase are enzymes of Gluconeogenesis which is a Catabolic pathway and hence increased in Diabetes. So, answer is all.

So the answer to this question is D


Instruction:
Normal GFR is ?
A. 125 ml/min
B. 90 ml/min
C. 60 ml/min
D. 150 ml/min

Response:
Ans. is 'a' i.e., 125 ml/min In man, resting glomerular filtration rate is about 125 ml/min (180L/day), the renal plasma flow being about 600 ml/min. Thus about one-fifth (20%) of plasma passing through kidney is filtered, i.e., fraction of renal plasma flow that is filtered (filtration fraction) is 0-2.

So the answer to this question is A


Instruction:
Most common cause of neonatal diarrhea worldwide is:
A. Rotavirus
B. Adenovirus
C. Norwalk virus
D. Cholera

Response:
a. Rotavirus(Ref: Nelson's 20/e p 1616)In early childhood, the single most important cause of severe dehydrating diarrhea is rotavirus infection.

So the answer to this question is A


Instruction:
A patient is said to have chronic diarrhea if it is occurring for more than ...... weeks?
A. 3
B. 4
C. 5
D. 6

Response:
Ans. B. 4DiarrheaDefinition-It is defined according to symptoms as increase in liquidity, frequency and volume of stools; and according to sign as increase in stool weight of more than 200gm/day.Pseudo diarrhea-it is the frequent passage of small volume of stools. It is seen in irritable bowel syndrome and proctitis.Classification-It is classified according to duration asa. Acute-Duration less than 2 weeks.b. Persistent-Duration of 2-4 weeks.c. Chronic-Duration of more than 4 weeks.

So the answer to this question is B


Instruction:
All the following are features of achondroplasia EXCEPT:
A. Diminished trunk length
B. Brachycephaly
C. Exaggerated lumbar lordosis
D. Trident hand

Response:
Ans. A. Diminished trunk lengthAlthough the limbs are short in achondroplasia, trunk length (crown to pubis) is normal. The skull is brachycephalic, the face broad, and the bridge of the nose flattened, there is exaggeration of the normal lordotic curve of the lumbar spine. The digits of the hand are of equal length with the long and ring fingers spread forming a trident hand. Tibial and, less commonly, femoral bowing are also seen.

So the answer to this question is A


Instruction:
Vitamin A deficiency leads to metaplasia of?
A. Squamous epithelium
B. Columnar epithelium
C. Both
D. None

Response:
Ans. is 'a' i.e., Squamous epithelium Metaplasia* Metaplasia is a reversible change in which one differentiated cell type is replaced by another differentiated cell type.Metaplasia represents an adaptive substitution of cells that are sensitive to stress by cell types better able to withstand the adverse environment. Metaplasia may be of two types1. Epithelial metaplasia* Here one type of adult epithelium is replaced by another type of adult epithelium. It may be :-a) Squamous metaplasia# It occurs most frequently in respiratory tract as a result of chronic irritation by cigarette smoking. The columnar epithelium is replaced by squamous epithelium. This squamous metaplasia represents an attempt by the host to repair or prepare an epithelial tissue that has been damaged by environmental toxicants with a more resistant tissue.# Squamous metaplasia is also encountered in other location such as pancreatic duct (Vit A deficiency, stones in pancreatic duct), gall bladder (gall stones), urinary bladder (bladder calculi, Schistosomiasis), and in endocervix.# Though the metaplasia is reversible, if the influences that predispose to metaplasia is persistent, malignant transformation may occur in metaplastic epithelium.b) Glandular metaplasia# It is a change of the squamous epithelium to glandular (columnar) epithelium e.g. development of Barrett's esophagus, i.e., Stratified squamous epithelium of the esophagus is replaced by gastric columnar epithelium. It is due to reflux of acid contents of stomach into esophagus. This necessitates the replacement of susceptible squamous epithelium of the lower third of esophagus with gastric acid resistant glandular epithelium.2. Connective tissue metaplasia* This transformation occurs between the mesodermally derived tissues i.e., one type of connective tissue is replaced by another type of connective tissue. This is characterized by conversion of fibroblast-derived soft tissue into muscle, Cartilage or bone. Example-Bone formation in muscle i.e., myositis ossificans.

So the answer to this question is A


Instruction:
Transfusion of stored blood causes: (Repeat)
A. Hyperkalemia
B. Hyponatremia
C. Hypercalcemia
D. Hypokalemia

Response:
Ref: Harrison's 18th editionExplanation:The two important electrolyte disturbances caused by transfusion of stored blood areHyperkalemiaHypocalcemia.RBC leakage during storage increases the concentration of potassium in the unit.Neonates and patients in renal failure are at risk for hyperkalemia.Preventive measures, such as using fresh or washed RBCs. are warranted for neonatal transfusions because this complication can be fatal.Citrate, commonly used to anticoagulate blood components, chelates calcium and thereby inhibits the coagulation cascade.Hypocalcemia, manifested by circumoral numbness and tingling sensation of the fingers and toes, may result from multiple rapid transfusions.Because citrate is quickly metabolized to bicarbonate, calcium infusion is seldom required in this setting.If calcium or any other intravenous infusion is necessary, it must be given through a separate tine.

So the answer to this question is A


Instruction:
The following chemical mediator is a product of arachidonic add metabolite by cyclo oxygenase pathway
A. LxA4
B. LxB4
C. 5-HETE
D. PGH2

Response:
None

So the answer to this question is D


Instruction:
A young male presents with central scotoma in left eye. His right vision showed 6/6 vision. On examination, in the left eye, there was focal foveal detachment in fundoscopy. What would be the next step?
A. Examine retrolental cells
B. Inquire about the use of steroids
C. Ask for history of tranuma in the other eye
D. Examination under slit lamp

Response:
Using of steroids may cause detachment of focal fovea. Ref khurana 6/e

So the answer to this question is B


Instruction:
1 curie is equivalent to:
A. 1.7 x 1010 disintegration/second
B. 2.7 x 1010 disintegration/second
C. 3.7 x 1010 disintegration/second
D. 4.7 x 1010 disintegration/second

Response:
Ans. (C) 3.7 x 1010 disintegration/secondRadiology by S. Bhadury 2ndl197:Writes:1 Bq= 1 disintegration/second1 Curie (Ci)= 3.7 x 10 (10) disintegration/second1 Ci is equal to 37 gigabecquerel1 gray (Gy) = 100 rads 10 mGy = 1 rad 1 mGy = 100 mrad Gray (Gy) is the SI unit of absorbed dose.One gray is equal to an absorbed dose of 1 foule/kilogram (100 rads).

So the answer to this question is C


Instruction:
True about Ca cervix
A. 90% associated with HPV
B. Immunocompromised patients
C. OCP
D. All

Response:
Ans. is a, b and c i.e. 90% associated with HPV; OCP; and Immunocompromised Patients Risk factors for development of Ca cervix : Coitus before the age of 18 years.deg Multiple sex paners.deg Delivery of V baby before 20 years of age.deg Poor personal hygiene.deg Poor socioeconomic status. Smokingdeg, Alcohol, Drug abuse. Women with STDdeg, HIV infectiondeg, HSV-20, HPV infectiondeg or condyloma Immunocompromised individualsdeg Women with H/O Preinvasive lesionsdeg OCPdeg and progesterone use over long periods.deg "HPV is central to the development of cervical neoplasia. HPV - DNA is found in 95% of all squamous cell carcinoma & 90% of all adenocarcinomas."

So the answer to this question is D


Instruction:
True regarding cardio pulmonary resuscitation is -
A. Most common presentation in ECG is asystole
B. Compression to ventilation ratio is 5:1
C. Adrenaline is given if cardioversion fails.
D. Calcuim gluconate is given immediately.

Response:
200 joules are given every 2 minutes after each cycle of cardiopulmonary resuscitation (CPR). During resuscitation, adrenaline(epinephrine, 1 mg i.v.) should be given every 3-5 minutes and consideration given to the use of intravenous amiodarone, especially if ventricular fibrillation or ventricular tachycardia reinitiates after successful defibrillation. Ventricular fibrillation of low amplitude, or 'fine VF', may mimic asystole. If asystole cannot be confidently diagnosed, the patient should be regarded as having 'fineVF' and defibrillated. If an electrical rhythm is present that would be expected to produce a cardiac output, 'pulseless electrical activity' is present. There are several potentially reversible causes that can be easily remembered as a list of four Hs and four Ts. Pulseless electrical activity is treated by continuing CPR and adrenaline (epinephrine) administration whilst seeking such causes. Asystole is treated similarly, with the additional suppo of atropine and sometimes external or transvenous pacing in an attempt to generate an electrical rhythm. ref:harrison&;s principles of internal medicine,ed 18,pg no 2231

So the answer to this question is C


Instruction:
Superficial inguinal ring in the female transmits:
A. Broad ligament of uterus
B. Round ligament of the uterus
C. Cardinal ligament
D. None of the above

Response:
The superficial inguinal ring is a triangular apeure in the aponeurosis of the external oblique muscle and is situated above and medial to the pubic tubercle. In the female, the superficial inguinal ring is smaller and difficult to palpate; it transmits the round ligament of the uterus.

So the answer to this question is B


Instruction:
Features of congenital syphilis are-
a) Snuffles is late manifestation
b) Perforation in cartilaginous part of nose
c) Mulberry molar
d) Saddle nose deformity
A. abc
B. bcd
C. acd
D. abd

Response:
None

So the answer to this question is B


Instruction:
Rubor in inflammation is due to - rpt Q24
A. Dilation of aerioles
B. Increased vascular permeability
C. Increased viscocity of blood
D. Edema

Response:
Harshmohan textbook of pathology 7th edition. persistent progressive vasodilatation seen in acute inflammatory response due to dilatation of aerioles but to a lesser extend affect other components of micro circulation like venules and capillaries. Vasodilatation result in increased blood volume in the microvascular bed of the area which is responsible for redness/ rubor and warmth at the site of acute inflammation. .

So the answer to this question is A


Instruction:
Physical examination of a 45 year old man who looks much older than his stated age demonstrates thin arms and legs, a swollen abdomen, red tongue, dry, thin, and slightly yellow skin, gynecomastia, testicular atrophy, multiple spider angiomas, tremor, yellow discoloration of sclera, and sho term memory loss. Which of the following conditions is most strongly suggested by these findings?
A. Bronchogenic carcinoma
B. Colon carcinoma
C. Congestive hea failure
D. Hepatic cirrhosis

Response:
The physical examination is typical for an advanced alcoholic with hepatic cirrhosis. It is impoant to recognize these symptoms, as these patients are notorious for "underestimating" and even denying their alcohol use. Bronchogenic carcinoma typically presents with cough and/or respiratory changes, but can present with mass effects in the chest or involvement of mediastinal nerves or vessels. Colon cancer typically presents with changes in the stool or bowel habits. Congestive hea failure is typically heralded by shoness of breath or peripheral edema, or both. Ref: Khalili M., Liao C.E., Nquyen T. (2010). Chapter 14. Liver Disease. In S.J. McPhee, G.D. Hammer (Eds), Pathophysiology of Disease, 6e.

So the answer to this question is D


Instruction:
Diabetes mellitus is present in all except-
A. Fanconis anemia
B. Noonans syndrome
C. Ataxia telangiectasia
D. Myotonic dystrophy

Response:
Type 1 diabetes *Immune-mediated *Idiopathic. Type 2 diabetes Other specific types *Geneticdefectsofb-cellfunction(seeBox21.6) *Geneticdefectsofinsulinaction(e.g.leprechaunism, lipodystrophies) *Pancreaticdisease(e.g.pancreatitis,pancreatectomy, neoplasticdisease,cysticfibrosis,haemochromatosis, f ibrocalculouspancreatopathy) *Excessendogenousproductionofhormonalantagoniststo insulin,e.g. Growthhormone-acromegaly Glucocoicoids-Cushing'ssyndrome Glucagon-glucagonoma Catecholamines-phaeochromocytoma Thyroidhormones-thyrotoxicosis *Drug-induced(e.g.coicosteroids,thiazidediuretics, phenytoin) *Uncommonformsofimmune-mediateddiabetes(e.g.IPEX (immunodysregulationpolyendocrinopathyX)syndrome) *Associatedwithgeneticsyndromes(e.g.Down'ssyndrome; Klinefelter'ssyndrome;Turner'ssyndrome;DIDMOAD (Wolfram'ssyndrome)-diabetesinsipidus,diabetesmellitus, opticatrophy,nervedeafness;Friedreich'sataxia;myotonic dystrophy). Gestational diabetes. DAVIDSON'S PRINCIPLES AND PRACTICE OF MEDICINE 22ND EDITION PAGE NO-807

So the answer to this question is A


Instruction:
Hemodialysis is used in poisoning with all except-
A. Salicylates
B. Methyl alcohol
C. Diazepam
D. Barbiturates

Response:
Hemodialysis is not useful in benzodiazepine (e.g. diazepam) poisoning.

So the answer to this question is C


Instruction:
True regarding vascularity of lung is
A. Hypoxia causes vasodilation
B. Pulmonary resistance is half of the systemic vascular resistance
C. Perfusion is more in the apical lobe than in base
D. Distended pulmonary veins in the lower lobe

Response:
In lungs, the lower lobes get perfused more due to the effect of gravity. So the lower lobe vessels are more distended.

So the answer to this question is D


Instruction:
A 60-year old female presented with decreased movements for the last 2 years with rigidity and vertical large square wave jerks. The most likely diagnosis is -
A. Parkinson's disease
B. Lewy body dementia
C. Multisystem atrophy
D. Progressive supranuclear palsy

Response:
None

So the answer to this question is D


Instruction:
APGAR stands for
A. Appearance, Pulse rate, Growth, Activity, Respiratory rate
B. Appearance, Pulse rate, Grimace, Activity, Respiratory rate
C. Appearance, Pulse rate, Grimace, Activity, Respiratory  effort.
D. Activity, Pulse rate, Grimace, Activity, Respiratory effort.

Response:
None

So the answer to this question is C


Instruction:
Which of the following is Tensor of the vocal cord
A. Cricothyroid
B. Inter arytenoid
C. Posterior cricoarytenoid
D. Lateral cricoarytenoid

Response:
Intrinsic muscles of larynx They may act on vocal cords or laryngeal inlet. (a) Acting on vocal cords:- * Abductors:- Posterior cricoarytenoid * Adductors:- Lateral cricoarytenoid , Interarytenoid (transverse arytenoid), Thyroarytenoid (external pa) * Tensors:- Cricothyroid , Vocalis (internal pa of thyroarytenoid). Ref:- Dhingra; pg num:-283

So the answer to this question is A


Instruction:
The most sensitive indicator of depletion of intravascular volume in an infant is –
A. Cardiac output
B. Stroke volume
C. Heart rate
D. Blood pressure

Response:
An increase in heart rate is the earliest and the most sensitive indicator to any reduction in intravascular volume.
Cardiac output and blood pressure are preserved initially because of compensatory mechanisms such as increase in heart rate and peripheral vasoconstriction.
Stroke volume is usually preserved in infants and compensatory increased in cardiac output is primarily achieved by increasing heart rate.

So the answer to this question is C


Instruction:
MELD score includes?
A. Serum creatinine
B. Transaminase
C. Albumin
D. Alkaline phosphatase

Response:
Model for End stage liver disease (MELD): Done to calculate the requirement of liver transplantation in case of Fulminant hepatic failure. If MELD sore > 14 Ohoptic liver Treatment Bilirubin INR Severe creatinine Child Pugh classification: Cirrhosis grading (helpful to know if shunt surgery required or not) NAZERS index: Used to determine the severity of damage and need for treatment of liver is WILSON'S disease.

So the answer to this question is A


Instruction:
Profuse watery diarrhea in an immune compromised child is due to
A. Cryptococcus
B. Amoeba
C. Giardia
D. Lactose intolerance

Response:
.Giardiasis caused by Giardia lamblia is a major cause of diarrhoea in children and travellers Individuals with malnutrition,humoral immunodefeciencies,and cystic fibrosis are paicularly susceptible. Features:acute diarrhoea with sudden onset of explosive,watery foul smelling stools, along with nausea and anorexia,abdominal distension,flatulence,epigastric camps and mild fever. ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:244,7th edition

So the answer to this question is C


Instruction:
A patient when asked about a paicular topic, stas speaking irrelevant details that is totally needed and finally reaches the goal. this type of formal thought disorder is called as
A. loosening of assosiation
B. circumstantiality
C. flight of ideas
D. clang assosiation

Response:
In normal individual when asked a question they will have a staing point and add some relevant details and then reach the goal. In circumstantial speech individual stas about a topic, adds minute irrelevant details , beats around the bush and finally reaches the goal. This is seen in ORGANIC BRAIN CONDITIONS In flight of ideas, the individual stas at a point, shifts the topic , subsequent thoughts will have some association but they will not reach goal. This is classical of MANIA In loosening of association, patient comes with random thoughts that is not connected to each other and the goal is not reached. This is classical of schizophrenia * Neologism= they will introduce new words that are not present in one's dictionary , seen in SCHIZOPHRENIA clang, ====subsequent words will have rhyming seen in MANIA Ref. Kaplon and sadock, synopsis of psychiatry, 11th edition, pg No.195

So the answer to this question is B


Instruction:
Auenbrugger's sign is seen in -
A. Pericardial Effusion
B. Constrictive pericarditis
C. Aortic Regurgitation
D. Mitral Stenosis

Response:
Ans. is 'a' i.e., Pericardial Effusion o Auenbruger 's sign is an epicardial bulging due to massive pericardial effusion.Auenbrugeer frsieno It represents bulging of the epigastrium that may be seen in case of severe pericardial effusion.o The auenbrugger s sign is seen in large pericardial effusion.o During a large pericardial effusion an epigastric bulge is present,o This represents large pericardial effusion extending subxiphoid.o Compression of this bulge may cause hemodynamic compromise and cardiac tamponade.Signs in pericardial effusion : -Sign PresentationFriedreich's sign-Sudden collapse inthe distended neck veins with diastole suggests pericardial tamponade.Pitres's sign-Anterior bidging of the lower sternum suggests pericardial effusion.Auenbrugger's sign-Protuberance/Bulging of the epigastrium suggests massive pericardial effusion (Sign on inspection).Sansom s sign-Percussible dullness in the left third intercostal space suggests large pericardial effusion.Greene's sign -Lateral displacement of the percussed cardiac border with expiration suggests a large pericardial effusions.Ebstein's sign A large pericardial effusion can blunt the percussible righ cardiomyopathic angle producing dullness along the lower right sternal border.Rotch's sign-Dullness at the right lower sternal border suggests large pericardial effusion.Moschcowitz s sign-In pericardial effusion, the transition on percussion from the lungs in the right heart border is abrupt.Ewart's sign-A large pericardial effusion produces egophony and bronchial breathing at the lower border of the left scapula.Ewart's second sign-A large pericardial effusion makes the first rib seen more prominent along the sternal border.Dressier 's sign-Is dullness to percussion of the lower one half of the sternum.The Dressier sound is aflat sound on percussion the lower half or two third of the sternum. In the absence of mitral stenosis, this finding 'should at once arouse suspicion of pericardial effusion '.Bamberger's sign-Dullness at the angle of the scapula that disappears when the patient leans forward is Bamberger s sign of pericardial effusion.Dullness at the left lower lung field is Ewart s sign ofpericardial effusion, while right-sided dullness is Conner s sign. Disappearance of Ewart s or Conner s signs when the patient sits up and leans forward is Bambeiger s sign of pericardial effusion.

So the answer to this question is A


Instruction:
Which of the following statements regarding the treatment of radiation accident victims is false?
A. At doses less than 4 to 5 Gy, the patient is only treated in response to specific symptoms
B. At doses 5-8 Gy, infection, bleeding and physical trauma are to be avoided during the period in which the circulating blood elements have a low concentration
C. At doses 8-10 Gy, a bone-marrow transplant can be administrated
D. At doses above 10 Gy, a bone-marrow transplant must always be administrated

Response:
If the radiation exposure is known to be less than 4 to 5 Gy (400-500 rad), most expes recommend that the patient is watched carefully but only treated in response to specific symptoms, such as antibiotics for an infection, fresh platelets for local haemorrhage, and so on. If the dose is known to have exceeded about 5 Gy (500 rad), then death from the hematopoietic syndrome 3 to 4 weeks later is a real possibility. In some countries, isolation and barrier nursing--that is, isolation from others so that they do not come in contact with possible infections while their blood count is low--is recommended. It has been shown in animals that the LD50 can be raised by a factor of about 2 by the use of antibiotics, and there is no reason to suppose that the same is not true in humans. The impoant things are to avoid infection, bleeding, and physical trauma during the period in which the circulating blood elements reach a nadir and to give the bone marrow a chance to regenerate. Below about 8 Gy (800 rad), an exposed person is likely to survive with careful nursing and an antibiotic screen because the LD50 can be approximately doubled by such conservative measures. In such cases, therefore, a transplant is not necessary. Above about 10 Gy (1,000 rad) death from the gastrointestinal syndrome is inevitable, and so a bone-marrow transplant is of no use. Reference: Eric J Hall Textbook of Radiobiology for Radiologist; 5th edition

So the answer to this question is D


Instruction:
Mitochondria gene (True statement)a) Paternal transmissionb) Maternal transmissionc) Mendelian inheritanced) Mitochondrial myopathy
A. c
B. bd
C. ab
D. ac

Response:
Mitochondrial DNA is always maternally inherited.
Important mitochondrial diseases are mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS), Leber hereditary optic neuropathy, myoclonic epilepsy with ragged-red fibers, Leigh syndrome, Pearson syndrome, keams-sajre syndrome, chronic progressive external ophthalmoplegia and NARP (neurogenic weakness with ataxia & retinitis pigmentosa).

So the answer to this question is B


Instruction:
NRHM involves
A. VHG
B. ASHA
C. ANM
D. HWM

Response:
Ans) b (ASHA) Ref park 20th ed pg 379-381The main aim of the national rural health mission (NRHM) is to provide accessible, affordable, accountable, effective and reliable primary health care and bridging the gap of rural health care through creation of a cadre of Accredited social health activist (ASHA)VHG is village health guide.ANM is Auxiliary nurse midwife.HWM is health worker male.

So the answer to this question is B


Instruction:
On exposure to cold, all are seen EXCEPT:March 2013
A. Increased adrenaline
B. Shivering
C. Increased thyroxine
D. Cutaneous vasodilation

Response:
Ans. D i.e. Cutaneous vasodilationHypothermiaIt is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as 35.0 degC (95.0 degF).Symptoms may be sympathetic nervous system excitation:- Shivering,Hypeension,- Tachycardia,- Tachypnea, and- VasoconstrictionThese are all physiological responses to preserve heat. Cold diuresis, mental confusion, as well as hepatic dysfunction may also be present.

So the answer to this question is D


Instruction:
All of the following are Vitamin B6 dependent syndromes, EXCEPT:
A. Pyridoxine dependent seizures
B. Xanthurenic aciduria
C. Cystanthioninuria
D. Darier disease

Response:
Darier disease- autosomal dominant, characterized by greasy hyperkeratotic papules in seborrheic regions, nail abnormalities, and mucous membrane changes. Vitamin B6 dependence syndromes syndromes : pyridoxine-dependent epilepsy, a vitamin B6-responsive anemia, xanthurenic aciduria, cystathioninuria, and homocystinuria.

So the answer to this question is D


Instruction:
Leprosy is not targeted for global eradication because
A. No effective vaccine
B. Highly infectious but low pathogenicity
C. Only humans are reservoir
D. Long incubation period

Response:
Ans. d. Long incubation period

So the answer to this question is D


Instruction:
Which is not true about high copper amalgam alloys:
A. Low tensile and compressive strength
B. Low Hg: Alloy ratio
C. High tensile strength
D. Low creep

Response:
None

So the answer to this question is A


Instruction:
True regarding pre-exposure tetanus immunization are all except: September 2005
A. If already immunized, a booster in the last trimester is advocated
B. Vaccine is given intramuscularly
C. Tetanus immunoglobulin is injected to the mother
D. 2 doses are recommended

Response:
Ans. C: Tetanus Immunoglobulin is Injected to the Mother Administration of attenuated virus vaccines are contraindicated during pregnancy, this includes vaccines against measles, mumps, poliomyelitis, rubella, yellow fever, and varicella. MMR vaccination can be given during lactation and does not affect the baby. The CDC recommends that non-pregnant women who receive the MMR vaccine or varicella vaccination should wait four weeks before getting pregnant. In situations where inactivated virus or pas of a virus are administered, in general, there is no contraindication to immunization during pregnancy. Thus influenza vaccination is given to pregnant women at risk, as are vaccinations against hepatitis A and B. HPV vaccine was introduced in 2006. It is not to be used during pregnancy. BCG(Live attenuated bacterial) vaccine is used against tuberculosis and is contraindicated in pregnancy Inactivated bacterial vaccine is used during pregnancy for women who have a specific risk of exposure and disease. Vaccination against pneumococcus or meningococcus infections, or typhoid fever show no confirmed side effects regarding the fetus. Tetanus toxoids appear safe during pregnancy and are administered intramuscularly. 0.5 ml tetanus toxoid is given at 6 weeks interval for 2 such,the first one to be given between 16-24 weeks.. Immune globulins are used for post exposure prophylaxis. Such agents are considered in pregnant women exposed to hepatitis B, rabies, tetanus, varicella, and hepatitis A

So the answer to this question is C


Instruction:
A 47-year old woman was referred for bone pain and abnormal findings on radiography. The patient repoed that for the past 17 years, she has habitually consumed water from that area. She repoed a 5-years history ofpain in the lower back, arms, legs and hips, Because of brittleness, all her teeth had been extracted. Radiography ofthe forearm revealed interosseous membrane calcification and radiography ofthe spine revealed a rugger-jersey appearance (striated pattern of increased density in the upper and lower zones of the veebrae). The probable diagnosis is
A. Silicosis
B. Fluorosis
C. Vitamin B toxicity
D. Hypercalcinosis

Response:
Skeletal fluorosis is a bone disease caused by excessive accumulation of fluoride in the bones. In advanced cases, skeletal fluorosis causes painful damage to bones and joints. Symptoms are mainly promoted in the bone structure. Due to a high fluoride concentration in the body, the bone is hardened and thus less elastic, resulting in an increased frequency of fractures. Other symptoms include thickening of the bone structure and accumulation of bone tissue, which both contribute to impaired joint mobility. Ligaments and cailage can become ossified. Most patients suffering from skeletal fluorosis show side effects from the high fluoride dose such as ruptures of the stomach lining and nausea. Fluoride can also damage the parathyroid glands, leading to hyperparathyroidism, the uncontrolled secretion of parathyroid hormones. These hormones regulate calcium concentration in the body. An elevated parathyroid hormone concentration results in a depletion of calcium in bone structures and thus a higher calcium concentration in the blood. As a result, bone flexibility decreases making the bone more susceptible to fractures Mechanism of action The best way to view the mechanism of action by which fluorine breaks down bones and causes skeletal fluorosis is in a stepwise fashion. Fluoride enters the body by two paths: Ingestion or respiration. Both paths lead to corrosion of exposed tissue in high concentrations. Since the most likely form of fluoride to enter the body is hydrogen fluoride (HF) gas, this is what stas the process. Exposed tissues will be utilized by HF in neutralization reactions. This will leave F- free to pass fuher into the body. It reacts with the concentrated HCl in the stomach to form the weak acid, HF. This compound is then absorbed by the gastro-intestinal tract and passes into the liver the poal vein. Since elemental F is one of the strongest oxidizers currently known, the anion F- is immune to phase 1 metabolic reactions, which are generally oxidation reactions, in the liver. These reactions are the body's first line of defense to biotransform harmful compounds into something more hydrophilic and more easily excreted. The HF is now free to pass into the blood stream and be distributed to all tissues including bones. Bones are largely composed of Ca compounds, paicularly carbonated hydroxyapatite (Ca 5(PO 4) 3(OH)); the reaction of Ca2+ ions and HF forms an insoluble salt, CaF 2. This salt must be cleared by the body, which concomitantly leaches out some of the calcium that would be pa of the bone matrix. This process results in increased density, but decreased strength in bones As of now, there are no established treatments for skeletal fluorosis patients. However, it is reversible in some cases, depending on the progression of the disease. If fluorine intake is stopped, the amount in bone will decrease and be excreted urine. However, it is a very slow process to eliminate the fluorine from the body completely. Minimal results are seen in patients. Treatment of side effects is also very difficult. For example, a patient with a bone fracture cannot be treated according to standard procedures, because the bone is very brittle. In this case, recovery will take a very long time and a pristine healing cannot be guaranteed. However, fuher fluorosis can be prevented by drinking defluoridated water. It is recently suggested that drinking of defluoridated water from the ''calcium amended-hydroxyapatite'' defluoridation method may help in the fluorosis reversal. Defluoridated water from this suggested method provides calcium-enriched alkaline drinking water as generally fluoride contaminated water has a low amount of calcium mineral and drinking alkaline water helps in eliminating the toxic fluoride from the body Ref Davidson 23rd edition pg 715

So the answer to this question is B


Instruction:
A 15-year-old girl with short stature, neck webbing, and sexual infantilism is found to have coarctation of the aorta. A chromosomal analysis likely would demonstrate which of the following?
A. Mutation at chromosome 15q21.1
B. Trisomy 21
C. XO karyotype
D. Defect at chromosome 4p 16

Response:
Short stature, neck webbing, sexual infantilism, and a shield like chest with widely spaced nipples are signs of Turner syndrome, which is usually associated with an XO karyotype. Aortic coarctation occurs in about 15% to 20% of those with this disorder. Down syndrome is most commonly associated with endocardial cushion defects or VSD. Marfan syndrome (mutation 15q21.1) is associated with dilatation of the aorta and mitral and aortic regurgitation. Ellis-van Creveld syndrome (defect 4p16) is associated with ASD.

So the answer to this question is C


Instruction:
class III malocclusions can be seen in all except:
A. Cleidocranial dysplasia.
B. Craniofacial dysostosis.
C. Pierre Robin syndrome.
D. Achondroplasia.

Response:
None

So the answer to this question is C


Instruction:
The enzyme pseudocholinesterase acts on
A. Decamethonium
B. Tubocurarine
C. Gallamine
D. Suxamethonium

Response:
Refer Katzung 11/e p454 Suxamethonium is the other name of succinylcholine It is the shoest acting muscle relaxant due to metabolism by pseudocholinesterase

So the answer to this question is D


Instruction:
Which among the following is TRUE about Clomiphene?
A. Anti-gonadotrophin
B. Anti-progesterone
C. Anti-oestrogen
D. Anti-androgenic

Response:
Clomiphene is an antiestrogen. These compounds are distinguished from the Selective estrogen receptor modulators(SERMs) in that they are pure antagonists in all tissues studied. Clomiphene citrate is a potent anti-estrogen that primarily is used for treatment of anovulation in the setting of an intact hypothalamic--pituitary axis and adequate estrogen production (e.g., PCOS). By inhibiting the negative feedback effects of estrogen at hypothalamic and pituitary levels, clomiphene increases follicle-stimulating hormone (FSH) levels--typically by ~50%--and thereby enhances follicular maturation. Clomiphene s approved for the treatment of infeility in anovulatory women. Clomiphene increases gonadotropin secretion and stimulates ovulation. It increases the amplitude of LH and FSH pulses without changing pulse frequency. This suggests that the drug is acting largely at the pituitary level to block inhibitory actions of estrogen on gonadotropin release from the gland and/or is somehow causing the hypothalamus to release larger amounts of GnRH per pulse. Ref: Levin E.R., Hammes S.R. (2011). Chapter 40. Estrogens and Progestins. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.

So the answer to this question is C


Instruction:
The staging for pelvic inflammatory is described by-
A. Jonathan
B. Florence
C. Gainesville
D. Sartonini

Response:
Ans. is 'c' i.e., Gainesville Gainesville staging of pelvic inflammatory disease:o Acute salpingitis without peritonitiso Acute salingitis with peritonitiso Acute salpingitis with superimposed tubal occlusion or tube-ovarian complexo Ruptured tubo - ovarian abscesso Tubercular salpingitis

So the answer to this question is C


Instruction:
Neurocardiagenic syncope, the least useful investigation is :
A. Tilt table
B. Carotid sinus massage
C. Carotid duplex scan
D. Ohostatic blood pressure recording

Response:
Carotid duplex scan Neurocardiogenic syncope is also called vasovagal syncope or vasodepressor syncope. It is considered to be an abnormality in the complex neurocardiovascular interactions responsible for maintaining systemic and cerebral perfusion. Under normal circumstances, upright posture causes venoul polling and a transient decrease in aerial pressure, resulting in unloading of baroreceptors. Reflex augumentation of sympathetic activity and parasympathetic withdrawl results in peripheral aerial vasoconstriction, venoconstriction and an increase in hea rate and contractility. These adaptive mechanisms serve to maintain normal systemic and cerebral perfusion. Individuals susceptible to neurocardiogenic syncope are unable to maintain the adaptive neurocardiovascular response to upright posture for prolonged periods. In these patients due to incompletely understood mechanisms the cardiopulmonary mechanoreceptors are stimulated resulting in increased neural stimulus to vasomotor centre. This results in reflex paradoxical vasodilation and bradycardia. The final result is hypotension, cerebral hypopeifusion, cerebral hypoxia and syncope. Diagnosis of neurocardiogenic syncope : Tilt table study It is used to evaluate patients with neurocardiogenic syncope. In a tilt table study the patient is strapped to a table which is then mechanically tilted to an upright position. While monitoring the pulse, blood pressure, electrocardiogram and sometimes blood oxygen saturation, the patient is left in a 'motionless standing position' for 20 to 30 minutes. When the patient's syncope is reproduced during the test a "positive" tilt table study is said to have occurred. During an upright tilt, a patient's cardiovascular system has to adjust itself in order to prevent a significant poion of the blood volume from pooling in the legs. These adjustments consists of a mild increase in hea rate and a constriction of blood vessels in the legs. When a normal individual is placed in an upright tilt, these cardiovascular adjustments occur very quickly, and there is no significant drop in the blood pressure. However, in patients with neurocardiogenic syncope, these adjustments do not occur. Carotid sinus massage In patients with neurocardiogenic syncope, the symptoms can be elicited by carotid sinus massage. Ohostatic blood pressure recording Supine and upright blood pressure monitoring should be done in all patients with neurocardiogenic syncope. Carotid duplex scan Carotid duplex scan is a non-invasive study to estimate the presence and severity of carotid narrowing due to atherosclerosis. In neurocardiogenic syncope, no organic cause is present, so carotid duplex scan has no role.

So the answer to this question is C


Instruction:
General feility rate is a better measure of feility than the crude bih rate because the denominator includes
A. 15 - 45 years of aged females
B. Midyear population
C. Total women population
D. Married women population

Response:
General feility rate is the number of live bihs per 1000 women in the reproductive are group ( 15-44 or 49 years) in a given year GFR = number of live bih in an area during the year X 1000/ mid year female population age group 15-44 (or 49) in the same area in same year General feility rate is a better measure of feility than the crude bih rate because the denominator includes the number of women in the child bearing age rather than the whole population Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 488

So the answer to this question is A


Instruction:
Which of the following is false about Hemolytic Anemias
A. Jaundice is the main clinical sign
B. Shortend red cell life span
C. Increased Recticulocyte count
D. Decreased erythropoietin levels

Response:
Elevated erythropoietin leves are seen in Hemolytic anemias.

So the answer to this question is D


Instruction:
Wrong statement is –
A. Mees line in arsenic poisoning
B. Pterygium of nails in Lichen planus
C. Onycholysis in Psoriasis
D. Koilonychia in Megaloblastic Anemia (B12 def)

Response:
Koilonychia is seen in iron deficiency anemia (not in megaloblastic anemia).
Mees line is seen in Arsenic poisoning.
Pterygium is diagnostic for lichen planus.
Psoriasis can cause onycholysis

So the answer to this question is D


Instruction:
Nutrient artery arises to fibula from -
A. Peroneal artery
B. Anterior tibial artery
C. Dorsalis pedis
D. Popliteal artery

Response:
Nutrient artery to fibula is peroneal artery branch of posterior tibial artery.

So the answer to this question is A


Instruction:
Which of the following is used for functional reline method of complete dentures?
A. Short term denture liners
B. Long term denture liners
C. Lab processed denture liners
D. None of the above

Response:
Short term denture liners also called as tissue conditioners, are highly plasticized acrylic resins, that are used for treatment of abused tissues. Functional reline method employs use of tissue conditioners.

So the answer to this question is A


Instruction:
L1 L2 L3 serovar of chlamydia trachomatis cause ?
A. Trachoma
B. Inclusion conjuctivitis
C. NGU
D. LGV

Response:
Ans. is 'd' i.e., LGV

So the answer to this question is D


Instruction:
Food with maximum cholesterol content
A. Egg
B. Coconut Oil
C. Hydrogenated Fats
D. Ghee (Hydrogenated)

Response:
Ans. a. Egg Food with maximum cholesterol content is egg. "The yolks of eggs have the most cholesterol of any food with 1234 mg pr 100 gram serving or 411% of the DV. A single egg yolk will provide 210 mg (70% DV) of cholesterol, while a whole egg provides slightly more with 212 mg Impoant points about Egg All the cholesterol in egg is found in the yolkQ Egg white does not have any cholesteroldeg Egg contains all the nutrients except carbohydrates and vitamin CQ. Egg protein is considered the best among food proteins and is the standard against which the quality of other proteins is comparee. NPU of egg protein is 100Q

So the answer to this question is A


Instruction:
A Female patient aged 40 years comes for routine general examination. Full mouth radiographs are taken. Oval shaped radiolucent areas are seen in the root canals of maxillary central incisors Teeth are asymptomatic and show feeble response to vitality tests.

What is your choice of medicament?
A. Formocresol
B. Calcium hydroxide
C. CMCP
D. MTA

Response:
None

So the answer to this question is B


Instruction:
Besides its properties of decreasing intraocular pressure, timolol is preferred in the treatment of glaucoma because it:
A. Produces no miosis
B. Possess membrane stabilizing activity
C. Increases outflow of aqueous humor
D. Is a selective beta–adrenoceptor blocker

Response:
None

So the answer to this question is A


Instruction:
In DNA transfer the vectors used from smallest to largest is -
A. Cosmids, Plasmids, Bacteriophage
B. Plasmids, Bacteriophage, Cosmids
C. Bacteriophage, Cosmides, Plasmids
D. Cosmids, Bacteriophage, Plasmids

Response:
None

So the answer to this question is B


Instruction:
Addison's disease is characterized by all except
A. Hyperglycemia
B. Hypotension
C. Hyperkalemia
D. hyponatremia

Response:
Ref - Davidson's medicine20e p672 ( Harrison 17 pg 2263)

So the answer to this question is A


Instruction:
Long term complication of live kidney donors are
A. Hypeension
B. HPV Infection
C. Renal Carcinoma
D. Pyelonephritis

Response:
Answer- A. HypeensionHypeentionCardiovascular risksPreoteinuriaEnd stage renal disease

So the answer to this question is A


Instruction:
Daily regularment of Vit A in children is -
A. 40
B. 400
C. 1500
D. 5000

Response:
Daily requirement in children is 400mcg. (1-6yrs) Ref : Park 25th edition Pgno : 653

So the answer to this question is B


Instruction:
All are lysosomal storage disorders except -
A. I cell disease
B. Hunter's disease
C. Me Ardle's Disease
D. Farber's disease

Response:
Ans. is 'c' i.e., Me Ardle's Disease* Lysosomal storage disorders is a group of metabolic disorders caused by a defect of lysosome. Lysosomes are sacs concerned with metabolising unwanted lipids, glycoproteins and mucopolysaccharides.* They are classified as# Lipid storage disorders* E.g., sphingolipidosis like Gml gangliosidosis caused by b galactosidase defect, GM2 gangliosidoses caused by hexosaminidase A defect, Fabry's disease caused by a galactosidase defect, Gaucher's disease caused by b glucosidase defect, Farber's disease caused by ceramidase defect (It is a granulomatous condition and it presents with painful subcutaneous nodules, hepatosplenomegaly and pulmonary involvement)# Mucopolysaccharidoses* E.g., Hurler syndrome caused by a defect of L-iduronidase, Hunter syndrome caused by a defect of L-iduronate sulfatase.# Glycoprotein storage disorders* E.g., Fucosidosis, Mannosidosis# Mucolipidosis* E.g., I cell disease - caused by a defect of GlcNAC phosphotransferase. Because of this defect, the lysosomal enzymes are not labelled with mannose 6 phosphate. Mannose 6 phosphate is required as a label for targeting lysosomal enzymes to lysosomes. In this condition, lysosomal enzymes do not reach lysosomes. They are secreted out. Lysosomes are empty bags. Hence all undigested glycoproteins and lipids accumulate within all cells as Inclusions, that is why the name I cell disease or Inclusion cell disease. This condition resembles hurler syndrome# Apart from this classification, there is also lysosomal transporter defects like cystinosis caused by a defect of efflux of cysteine from lysosomes. It is characterised by fanconi's syndrome, photophobia and characteristic cysteine crystals can be observed in cornea on slit lamp examination# All these disorders are autosomal recessive disorders except Hunter syndrome and Fabry's disease, both of which are X linked recessive disorders.# All lysosomal storage disorders present as hepatosplenomegaly, mental retardation, seizures with or without deafness and blindness.# Me Ardle's disease is not a lysosomal storage disorder. It is Glycogen Storage Disorder Type V (GSDIV). It is caused by Muscle Glycogen phosphorylase defect. It presents as exercise intolerance, intolerance to anaerobic exercises. Glycogen phosphorylase is not a lysosomal enzyme, it is a cytoplasmic enzyme.# The only Glycogen storage disorder which is also a Lysosomal Storage disorder is Type IIGSD or Pompe's disease, caused by alpha glucosidase defect.

So the answer to this question is C


Instruction:
Retinoblastoma is associated with-
A. Osteosarcoma
B. Hepatocellular
C. SCC
D. Osteoclastoma

Response:
Robbins basic pathology 9th edition page no 777 Pathogenesis Several mutations are associated with the devolopmeny of osteosarcoma. The patients with hereditory retinoblastomas have a thousand fold greater risk for devolopment of osteosarcoma.

So the answer to this question is A


Instruction:
A 60 year man had undergone cardiac bypass surgery 2 days back. Now he staed forgetting things and was not able to recall names and phone numbers of his relatives. What is the probable diagnosis?
A. Depression
B. Post traumatic psychosis
C. Cognitive dysfunction
D. Alzheimer's disease

Response:
C i.e. Cognitive dysfunction Post cardiac surgery delirium (similar to ICU syndrome) is fairly common disorder typically occurring after 24-48 hours of surgeryQ in fearful patients. It presents as cognitive dysfunction affecting information processin intellect, concentration retention, visuo-spatial organization and memoryQ.

So the answer to this question is C


Instruction:
An inhaled foreign body is likely to lodge in the right lung due to all of the following features except:
A. Right lung is shoer & wider than left lung
B. Right principal bronchus is more veical than the left bronchus
C. Tracheal bifurcation directs the foreign body to the right lung
D. Right inferior lobar bronchus is in continuation with the principal bronchus

Response:
A. i.e. Right lung is shoer and wider than left lung

So the answer to this question is A


Instruction:
The term catatonia is coined by -
A. Kahlbaum
B. Freud
C. Maxwell jones
D. Adler

Response:
None

So the answer to this question is A


Instruction:
Which of the following immunosuppressant drugs is nephrotoxic?
A. Azathioprine
B. Cyclophosphamide
C. Mycophenolate mofetil
D. Tacrolimus

Response:
Tacrolimus and cyclosporine toxicity include nephrotoxicity, neurotoxicity, hyperglycemia, hypertension, hyperkalemia and GI complaints. Cyclosporine also cause hirsutism, which is not seen with tacrolimus use.

So the answer to this question is D


Instruction:
Recent influenza pandemic was due to which strain?
A. H1N1
B. H5N1
C. H7N7
D. H3N2

Response:
Influenza us cause by Ohomyxovirus 3 types: A, B, C - Type A:MC cause of outbreaks/ epidemics; only cause of pandemics Examples: H1 N1 (Type A) - Cause of Swine flu -Recent influenza pandemic H2 N2 (Type A) H5 N1 (Type A) -Cause of An influenza (Bird flu)

So the answer to this question is A


Instruction:
If TFR in a population is 4, then GRR would be (approx.)
A. 2
B. 4
C. 8
D. 16

Response:
- GRR or NRR= 1/2 TFR (approx.) - In given question, TFR is 4; hence GRR is half of 4 = 2

So the answer to this question is A


Instruction:
"Founder effect" describes the distribution of diseases on the basis of
A. Occupation
B. Environment
C. Genetics
D. All of the above

Response:
Ans. c (Genetics) (Ref. Park PSM 22nd/, p 680)GENETIC DRIFT AND FOUNDER PSEEE&# Founder effect refers to loss of genetic variation when a new colony is established by a very small number of individuals from a large population like antigenic drifting.# When people migrate to new regions, they may develop "new" disease or express "old" disease at higher frequencies.# This phenomenon reflects either new experiences or old genes expressed at altered frequencies in the settlers and the number of susceptible persons in the newly resident population after migration of "founder" depends on number of incoming mutant genes borne by the founders and the factors that favor their spread through the population.HARD Y-WEINBERG LAW# Concerns with population genetics.# It states that "the relative frequency of each gene allele tends to remain constant from generation to generation" in the absence of forces that change the gene frequencies.# Thus it assumes that human population is static.# But in reality, human population and gene pool is never static due to mutation, natural selection, population movements, breeding structures and public health measures.CHANGING GENE FREQUENCIESA rise in frequency of a particular phenotype (due to changing gene frequncies), may be cuased by one or more following5 factors, which disturb the Hardy-Weinberg equilibrium:# Non-random mating# Selection# Mutation# Heterozygote advantage# Genetic drift and "founder" effect.

So the answer to this question is C


Instruction:
which of the following is immediate anterior relation to uterus ?
A. A) Urinary bladder
B. B) Uterovesicle pouch
C. C) Pubic symphysis
D. D) Urogenital diaphragm

Response:
The anterior or vesical surface is flat and related to the urinary bladder. It is covered with peritoneum and forms the posterior or superior wall of the uterovesical pouch. SO, the immidiate anterior relation is uterovesical pouch. Ref : B D Chaurasia's Human Anatomy , Seventh Edition , Volume 2, pg. no., 420 ( figs.31.11a )

So the answer to this question is B


Instruction:
Fibrin is degraded by
A. Plasminogen
B. Plasmin
C. Thromboplastin
D. FD

Response:
Clotting also sets into motion a fibrinolytic cascade that moderates the ultimate size of the clot. Fibrinolysis is largely carried out by plasmin, which breaks down fibrin and interferes with its polymerization. The resulting fibrin split products (FSPs or fibrin degradation products) also can act as weak anticoagulants.
Elevated levels of FSPs (most notably fibrin-derived D-dimers) can be used for diagnosing abnormal thrombotic states including disseminated intravascular coagulation (DIC), deep venous thrombosis, or pulmonary thromboembolism.
Plasmin is generated by proteolysis of plasminogen, an inactive plasma precursor, either by factor XII or by plasminogen activators. The most important of the plasminogen activators is tissue-type plasminogen activator (t-PA); t-PA is synthesized principally by endothelial cells and is most active when attached to fibrin.

So the answer to this question is B


Instruction:
In maple syrup urine disease FeCl3 test with urine gives ____ color –
A. Green
B. Blue
C. Black
D. Red

Response:
Diagnosis

Is usually suspected because of the peculiar odour of maple syrup found in the body fluids - urine, sweat, cerumen etc.
Diagnosis is continued by amino acid analysis showing marked elevation in plasma level of leucine, isoleucine, valine and alloisoleucine (a stereoisomer of isoleucine not normally found in blood) and depression of alanine. Leucine levels are usually higher than those of other three amino acids.
Urine contains high levels of leucine, isoleucine and valine and their respective ketoacids.
The keto acids may be detected by adding a few drops 2-4 dinitrophenylhydrazine (DNPH) reagent which produces a yellow precipitate in a positive test.
Ferric chloride gives navy blue colour with the patient's urine.

So the answer to this question is B


Instruction:
All are true regarding folliculogenesis and ovulation except
A. Follicular development and differentiation takes about 85 days
B. AMH suppos monofollicular development
C. First phase of follicular growth is gonadotropin insensitive
D. Elevated and static level of estradiol is essential for ovulation

Response:
Ovulation The LH surge initiates the continuation of meiosis in the oocyte, luteinization of the granulosa, and synthesis of progesterone and prostaglandins within the follicle Progesterone enhances the activity of proteolytic enzymes responsible, together with prostaglandins, for digestion and rupture of the follicular wall The progesterone influenced midcycle rise in FSH serves to free the oocyte from follicular attachments, to conve plasminogen to the proteolytic enzyme, plasmin, and to ensure that sufficient LH receptors are present to allow an adequate normal luteal phase The onset of the LH surge appears to be the most reliable indicator of impending ovulation, occurring 34-36 hours prior to follicle rupture A reasonable and accurate estimate places ovulation approximately 10-12 hours after the LH peak and 24-36 hours after peak estradiol levels are attained Reference: Clinical Endocrinologic Gynecology and Infeility, Eighth edition; Chapter 6

So the answer to this question is D


Instruction:
Hassall's corpuscles are found in:
A. Liver
B. Spleen
C. Kidney
D. Thymus

Response:
Ans. (d) ThymusRef: Gray's 41st ed. / 619* CORPUSCLE means any small body.* Hassall's corpuscles are spherical or ovoid bodies found in the medulla of the thymus, composed of concentric arrays of epithelial cells which contain keratohyalin and bundles of cytoplasmic filaments.Also KnowSome other known corpuscles* Lamellated corpuscle a type of large encapsulated nerve ending found throughout the body, concerned with perception of sensations.* Malpighian corpuscles : Found in Nephrons (kidney) and in spleen (white pulp)* Meissner's corpuscle: A type of mediumsized I encapsulated nerve ending in the skin, chiefly in the palms and soles.* Paciniform corpuscles a type of rapidly adapting lamellated corpuscles responding to muscle stretch and light pressure.* Red corpuscle: Red Blood Cells* White corpuscle: White Blood Cells

So the answer to this question is D


Instruction:
Metabolically active layer of cornea is –a) Endotheliumb) Stromac) Descemet membrane d) Epithelium
A. b
B. c
C. ad
D. ab

Response:
The most actively metabolizing layers of the cornea are epithelium and endothelium.

So the answer to this question is C


Instruction:
Which of these are true of Gilbe's syndrome ?
A. Increased liver transaminases
B. Unconjugated hyperbilirubinemia
C. Bleeding tendency
D. Presence of auto-antibodies

Response:
Ans. is 'b' i.e., Unconjugated hyperbilirubinemia

So the answer to this question is B


Instruction:
All are true about neuropeptide 'Y’ excepta) Consist of 36 amino acidsb) Decreases thermogenesisc) Decreased in starvationd) Same effect like melanocorticotropin
A. ab
B. bc
C. bd
D. cd

Response:
Neuropeptide Y has 36 aminoacid residues. It stimulates appetite, reduces thermogenesis by decreasing the energy expenditure and also decreases the activity of MSH. During starvation it is secreted at increased levels.

So the answer to this question is D


Instruction:
Earliest change in atherosclerosis is
A. Fatty streaks
B. Fibrofatty plaque
C. Calcification
D. Gelatinous lesions

Response:
A. i.e. (Fatty streaks) (385- 86 - Harsh Mohan 5th) (349 - Basic pathology 8th)ATHEROSCLEROSIS - is an intima- based lesion organized into a fibrous cap and an atheromatous (gruel- like) core and composed by smooth muscle cells, endothelial cells inflammatory cells, lipids and necrotic debris* Atherosclerosis is a slowly evolving lesion usually requiring many decades to become significant. However acute plaque changes {eg rupture, thrombosis or hematoma formation) can rapidly precipitate clinical sequalae (so-called - Clinical Horizon)* Early lesions in the form of diffusal internal thickening, fatty streaks and gelatinous lesions*** Earliest light microscopic changesin MI is- Waviness of the fibres***Morphological features, pathogenic events and clinical complications* Most common cause of aortic aneurysm is - Athero sclerosis*** Most common site for MI is - Anterior wall of left ventricles*** Granulation tissue appears in acute MI - At 1 weeks*** Calcification of the aortic valve is seen in - Aortic stenosis** Me - Collum's patch is diagnostic of - Rheumatic endocarditis*** Osier's node, Janueway and Roth spot seen in Subacute Bacterial endocarditis*** Most common change in atherosclerotic vessel is - Dystrophic calcification* Atherosclerosis LDL is present in LDL monocytes**

So the answer to this question is A


Instruction:
The maximum sterilizing action is shown with which of the following anti-TB drug?
A. Rifampicin
B. Streptomycin
C. INH
D. Pyrazinamide

Response:
Pyrazinamide acts on slow-growing bacteria inside the macrophages causing maximum sterilization.Ref: katzung 13th edition; Pg: 819

So the answer to this question is D


Instruction:
10% Tumour is
A. Pheochromocytoma
B. Papillary Thyroid Carcinoma
C. Follicular Thyroid Carcinoma
D. Brown’s Tumor

Response:
Pheochromocytomas normally obey the “rule of 10”. Hence, they are also called the “10% tumor”. i.e. 10% of pheochromocytomas are:

Familial.
Malignant.
Bilateral.
Extra-adrenal.
Seen in children

So the answer to this question is A


Instruction:
Not a criteria of a solitary benign pulmonary nodule on chest X-ray
A. Less than 5cm size
B. Peripheral Location
C. Cavitation
D. Concentric Calcification.

Response:
Ans. is 'c' ie Cavitation (Ref Sutton, 6/e, p 316; Harrison, 16/e, p 512, 516 (15/e, p 568))Even looking in a large no. of books including radiology books, I could not get a satisfactory explanation. But still I could give some help on a repeatedly asked topic - Solitary Pulmonary nodule (SPN)"When apt: presents with an asymptomatic SPN (defined as an X-ray density of any shape usually 1 to 6 cm in greatest diameter) a decision to resect or to follow the nodule must be made.Approximately 35% of all such lesion in adults are malignant, most being primary lung cancer; while < 1% are malignant in nonsmokers under 35 years of age.If no diagnosis is immediately apparent the following risk factors would all argue strongly in favour of proceeding with resection to establish a histological diagnosis -a h/o Cigarette smokingage 35 year or oldera relatively large lesionlack of calcificationchest symptomsassociated atelectasis, pneumonitis or adenopathyAt present, only 2 radiographic criteria are reliable predictors of the benign nature of a solitary pulmonary noduleLack of growth over a period of 2 yrs.Certain characteristic pattern of calcification (calcification alone does not exclude malignancy). Calcification patterns which are highly suggestive of a benign lesion -a dense central nidusmultiple punctate focibulls eye (granuloma)popcorn calcification (hamartoma)When old X-ray are not available and the characteristic calcification patterns are absent the following approach is reasonable -Non smoking patients younger than 35 yrs can be followed and any significant growth should lead to its resection."For pts older than 35 yrs and all pts with smoking history, a histological diagnosis must be made." - Harrison 15/e, Size - Masses larger than 4 cm are predominantly primary malignancies. -Sutton, 6/eCavitation - common cavitating lesion are tuberculosis, staphylococcal inf & carcinoma.Peripheral location - The maximum I could get is that Metastasis have predilection for the periphery but they are usually multiple nodules (75%)So much of B.C., but still we are not certain of the answer, but this text will certainly help you for future questions on this imp. topic.Cavitation was the answer of consensus in my circle.

So the answer to this question is C


Instruction:
HSV-2 (Herpes simplex) causes -
A. Oral ulcers
B. Genital ulcers
C. U.T.I.
D. Pharyngitis

Response:
Ans. is 'b' i.e., Genital ulcerHERPES SIMPLEX VIRUS (HSV)HSV Type 1HSV Type 2o Cause lesion in and around mouthCause lesion around genital areao Transmitted by direct contact or droplet spreadUsually transmitted sexuallyo Replicate poorly in chick embryo fibroblast cellReplicate wello Relatively sensitive to antiviral agentsResistanto Less neurovirulentMore neurovirulento Infectivity is less temperature sensitiveMore temperature sensitiveo Site of latency-trigeminal gangliaSacral gangliao On chick embryo CAM. form smaller pockForm larger pock

So the answer to this question is B


Instruction:
The most common mediastinal tumor is-
A. Neurogenic tumor
B. Pericardial cyst
C. Hernia
D. Teratoma

Response:
Overall most common mediastinal masses are neurogenic tumors (20%) followed by thymomas (19%), primary cysts (18%), lymphomas (13%) and germ cell tumors (10%).
Most of the mediastinal masses are located in the anterior mediastinum followed by the posterior (25%) and middle (19%).

So the answer to this question is A


Instruction:
"Rain drop'skull is seen in -
A. Burkitfs lymphoma
B. Hodgkin's lymphoma
C. Multiple myeloma
D. Haemophilia

Response:
Ans. is 'c' i.e., Multipie Myeloma Pain film on chest x-ray in multiple mvelomaDiffused unexplained osteoporosis, especially in spineo Diffuse loss of densityo Thinning of corticeso Lower thoracic and lumbar regions most commonly involvedo Pathological vertebral collapse inevitable single or multiple# Vertebral plana# Wrinkled vertebra of myelomao Sharply circumscribed osteolytic defects (radiological hallmark of myeloma)# Punched out lesions (multiple round purely lytic)# Most common in skull, pelvis, long bones, clavicles, ribs in long bones diaphysis most commonly involved# Humerus andfermur most common sites# Widespread lesions of skull (rain drop skull)# Size of lesions tend to be fairly uniform : round or oval# No reactive sclerosis

So the answer to this question is C


Instruction:
Posterior styphayloma is a feature of ?
A. Congenital myopia
B. Simple myopia
C. Pathological myopia
D. Hypermetropia

Response:
Ans. is 'c' i.e., Pathological myopia Staphyloma Staphyloma is an abnormal protrusion of uveal tissue through a weak and thin poion of cornea or sclera. So, a staphyloma is lined internally by uveal tissue and externally by weak cornea or sclera. Staphyloma is divided anatomically into : ? 1) Anterior staphyloma : - Protrusion and adhesion of iris to ectatic cornea. The most common cause is a sloughing corneal ulcer which perforates and heals with the formation ofpseudocornea by the organization of exudates and laying down of fibrous tissue. It is lined internally by iris. 2) Intercalary staphyloma : - It occurs at the limbus. It is lined internally by the root of iris and the anterior most poion of the ciliary body. The causes are perforating injuries to limbus, marginal corneal ulcer, anterior scleritis, Scleromalacia perforans, Complicated cataract surgery, secondary angle closure glaucoma. 3) Ciliary staphyloma : - This affects the ciliary zone that includes the region upto 8 mm behind the limbus. The ciliary body is incarcerated in the region of scleral ectasia. Causes are Developmental glaucoma, Primary or secondary glaucoma end stage, scleritis, trauma to ciliary region. 4) Equatorial staphyloma : - This occurs at the equatorial region of the eye with incarceration of the choroid. Causes are scleritis, degenerative myopia and chronic uncontrolled glaucoma. Posterior staphyloma : - Occurs at posterior pole and is lined internally by choroid. Degenerative high axial myopia is the most common cause.

So the answer to this question is C


Instruction:
A 5-year-old girl is brought to the physician after her parents noticed red blood in her stool. Physical examination reveals mucocutaneous pigmentation. Small bowel radiography discloses multiple, small- to medium-sized polyps that are diagnosed pathologically as hamartomas. Which of the following is the most likely diagnosis?
A. Congenital teratoma
B. Hyperplastic polyp
C. Peutz-Jeghers polyp
D. Tubular adenoma

Response:
Peutz-Jeghers syndrome is an autosomal dominant, hereditary disorder characterized by intestinal hamartomatous polyps and mucocutaneous melanin pigmentation, which is particularly evident on the face, buccal mucosa, hands, feet, and perianal and genital regions. The polyps seen in Peutz-Jeghers syndrome are hamartomatous, characterized by a branching network of smooth muscle fibers continuous with the muscularis mucosa that support the glandular epithelium of the polyp. Congenital teratoma (choice A) does not involve the intestine. The other choices are principally colonic polyps that derive from the luminal epithelium.Diagnosis: Gastrointestinal polyp, Peutz-Jeghers polyp

So the answer to this question is C


Instruction:
High resolution is obtained with:
A. Intraoral films with direct exposure
B. Extraoral films with intensifying screen
C. OPG
D. All of the above

Response:
Intraoral dental X-ray film is made as a double-emulsion film—that is, both sides of the base are coated with an emulsion. With a double layer of emulsion, less radiation is required to produce an image.  Direct exposure film is used for intraoral examinations, because it provides higher resolution images than screen-film combinations. Some diagnostic tasks, such as detection of incipient caries or early periapical disease, require this higher resolution.
Reference: White and Pharoah's Oral Radiology Principles and Interpretation 7th edition page no 64

So the answer to this question is A


Instruction:
Localised juvenile periodontitis is ________ type of disease
A. Atrophic
B. Inflammatory
C. Degenerative
D. None of the above

Response:
None

So the answer to this question is C


Instruction:
Somatic efferent does not include
A. Facial nerve
B. Oculomotor nerve
C. Abducent nerve
D. Trochlear nerve

Response:
Somatic efferent nerves, also called as general somatic efferent (GSE) nerves, supply skeletal muscle of somatic origin ( muscles of eye and tongue).
Somatic efferent nerves include,

Oculomotor nerve - 3rd nerve
Trochlear nerve - 4th nerve
Abducent nerve - 6th nerve
Hypoglossal nerve - 12th nerve

So the answer to this question is A


Instruction:
All of the features of Wilson's disease, EXCEPT:
A. Haemolytic anaemia
B. Testicular atrophy
C. Chorea
D. Chronic active hepatitis

Response:
Ans. is 'b' Testicular atrophy Basic defect in Wilson's disease is|Reduced biliary exception of copper*|Cu accumulates in hepatocytes resulting in liver damage (Manifest almost all types of hepatitis* including fulminant hepatitis)|Liver cells get saturated with Cu|Cu spilled in plasma|Gets deposited in following organsBasal ganglia - Spasticity, Rigidity, Chorea (dysphagia, dysarthria, positive Babinski, abdominal reflex absent).Eye - Kayser Fleischer ring* present in descemet's membrane* of cornea.Some frequently asked facts about Wilson's diseaseAssociated with Coombs (-ve) hemolytic anemia*Sensory symptoms are characteristically absent*Testis never involved*Ceruloplasmin deficiency is important marker of disease*

So the answer to this question is B


Instruction:
Commonest site of extramedullary relapse of ALL
A. CNS
B. Lung
C. Liver
D. Testis

Response:
Despite success of modern treatment,20-30% of children with ALL relapse.The main cause of treatment failure in leukemia is relapse of the disease.Common sites of relapse are the bone marrow(20%),central nervous system(5%),and testis(3%).Relapse in extramedullary sites,paicularly testes,is more ourable in terms of survival. Reference:Essential pediatrics-Ghai,8th edition,page no:604

So the answer to this question is A


Instruction:
The most common presentation of congenital CMV infection is -
A. Hepatosplenomegaly
B. Microcephaly
C. Cerebarl calcification
D. Chorioretinitis

Response:
This is a genaralised infection associated with Hepatosplenomegaly REF:ANANTHANARYANAN TEXT BOOK OF MICROBIOLOGY 9EDITION PGNO.473

So the answer to this question is A


Instruction:
Primary objective of use of atropine in anterior uveitis
A. Rest to the ciliary muscle
B. Increase supply of antibody
C. Increase blood flow
D. Prevents posterior synechia formation

Response:
A i.e. Rest to the ciliary muscle In inflamatory glaucoma (glaucoma with uveitis) pilocarpine (miotic) & prostaglandin analogue e.g. latanoprost are contraindicated Q because - Pilocarpine 1/t development of posterior synechiae - Prostaglandin analogue enhance breakdown of aqueous barrier and exacerbate cystoid macular edema.

So the answer to this question is A


Instruction:
Wrong about Mother and Child Health programme is – a) Useful for children upto 12 years of ageb) It's objective is to prevent against chronic diseasesc) 100% immunization to be done by 200 A.D. against six vaccine preventable diseasesd) To decrease acute respiratory infections
A. ac
B. ab
C. ad
D. bc

Response:
None

So the answer to this question is B


Instruction:
Tissue suturing glue contains:-
A. Cyanoacrylate
B. Ethanolamine oleate
C. Methacrylate
D. Polychloroprene

Response:
Tissue glue Tissue glue is also available based upon a solution of n-butyl-2-cyanoacrylate monomer. When it is applied to a wound, it polymerizes to form a firm adhesive bond Wound does need to be clean, dry, with near perfect hemostasis and under no tension Specific uses: - closing a laceration on the forehead of a fraction child in accident and emergency thus dispensing with local anesthetic and sutures. Relatively expensive, it is quick to use, does not delay wound healing and is associated with an allegedly low infection rate

So the answer to this question is A


Instruction:
Nerve of Latarjet is seen in ?
A. Thorax
B. Neck
C. Stomach
D. Hea

Response:
Ans. is 'c' i.e., Stomach Nerve supply of stomach The stomach is supplied by sympathetic and parasympathetic system.The sympathetic nerves are derived from T6-T9 spinal nerve segments greater splanchnic nerves, and coeliac and hepatic plexus.Pain sensations from stomach are carried along sympathetic fibers.The parasympathetic nerves are derived from right vagus and left vagus which enter the abdomen as anterior vagal trunk (anterior gastric nerve) from left vagus and osterior vagal trunk (posterior gastric nerve) from right vagus. u Anterior vagal trunk gives : (i) Main gastric nerve of laterjet, (ii) Pyloric branch and (iii) Hepatic branch. u Posterior vagal trunk gives : (i) Nerve of Grassi to fundus, (ii) Coeliac branches, and (iii) Main gastric nerve of laterjet.

So the answer to this question is C


Instruction:
Sho 4th metacarpal is a feature of
A. Hyperparathyroidism
B. Hyperparathyroidism
C. Pseudohypoparathyroidism
D. Scleroderma

Response:
Ans. is `c' i.e., Pseudohypoparathyroidism Sho 41kmetacarpal/metatassal (metacarpal sign) Post - traumatic Post infection (from sickle cell anemia) Turner's syndrome Pseudohypoparathyroidism Pseudopseudohypoparathyroidism Hereditary multiple exostosis Chondroectodermal dysplasia (Ellis-vanCreveld syndrome)

So the answer to this question is C


Instruction:
Safest treatment of hyperthyroidism in pregnant women is:
A. Radioactive iodine
B. Methimazole
C. Carbimazole
D. Propylthiouracil

Response:
None

So the answer to this question is D


Instruction:
One virus particles prevents multiplication of 2nd virus. This phenomena is:
A. Viral interference
B. Mutation
C. Supervision
D. Permutation

Response:
Viral interference
Interference in which infectionof a cell by one virus inhibits simultaneous or subsequent infection by another virus.
Most important mediator of interference is interferon.
Interference produced by destruction of cell receptors is seen with myxoviruses and enterovirus.
It is applied in the field in controlling poliomyelitis outbreaks by in controlling poliomyelitis outbreaks by introducing into the population, the live attenuated poliovirus vaccine.

So the answer to this question is A


Instruction:
Brighton's criteria is used for:
A. Guillain Barre Syndrome
B. Myasthenia Gravis
C. Polymyositis
D. Muscular dystrophy

Response:
(A) GBS# 'Brighton criteria also account for the level of diagnostic certainty based on the presenting findings at clinical and additional examinations, ranging from level 1 (highest level of diagnostic certainty) to level 4 (reported as Guillain-Barre syndrome, possibly due to insufficient data for further classification) as shown in below table.KEY BRIGHTON DIAGNOSTIC CRITERIA FOR GUILLAIN-BARRE SYNDROMEDiagnostic criteriaLevel of diagnostic certainty I1234Bilateral and flaccid weakness of limbs++++/-Decreased or absent deep tendon reflexes in weak limbs++++/-Monophasic course and time between onset-nadir 12 h to 28 days++++/-CSF cell count <50/ml++*-+/-CSF protein concentration > normal value++/-*-+/-Nerve conduction studies findings consistent with subtypes of GBS++/--+/-Absence of alternative diagnosis for weakness+++++ = Present; - = Absent; +/- = present or absent;*When CSF is not available, nerve electrophysiology results must be consistent with the diagnosis of Guillain-Barre syndrome. Level 1 is the highest level of diagnostic certainty, whereas Level 4 is the lowest level of diagnostic certainty

So the answer to this question is A


Instruction:
Differential diagnosis of Meniere's disease are all expect -
A. Acoustic neuroma
B. CNS disease
C. Labyrinthitis
D. Suppurative otitis media

Response:
Differential Diagnosis of Vertigo + Tinnitus + SNHL Deafness – Includes:

Meniere’s disease (Endolymphatic hydrops)
Syphilis
Labyrinthitis
Labyrinthine trauma due to fracture of temporal bone, postoperatively after stapedectomy
Cogan syndrome
Labyrinthine hemorrhage due to blood dyscrasia
Acoustic neuroma/meningioma (CP angle lesion),
Multiple sclerosis,
Hypothyroidism/Hyperlipidemia

NOTE
In serous otitis media these symptoms may be seen but then hearing loss will be of conductive variety and not SNHL.

So the answer to this question is D


Instruction:
Enzyme deficient in occulocutaneous albinism type 1 is ?
A. Tyrosinase
B. Pink protein
C. Tyrosinase related protein 1
D. Membrane associated transpo protein (MATP)

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

So the answer to this question is A


Instruction:
Blood platelets in stored blood do not remain functional after ...... hrs. -
A. 24
B. 48
C. 72
D. 96

Response:
Ans. is 'a' i.e., 24

So the answer to this question is A


Instruction:
Primary osteoahritis affect all except:
A. Hip Joint
B. Knee joint
C. Distal interphalangeal joint
D. Matacarpophalangeal joint

Response:
Osteoahritis involves DIP and PIP with sparing of MCP. Rheumatoid ahritis involves PIP and MCP with sparing of DIP. Osteoahritis commonly involves knee joint in India. Hip joint is rarely involved in osteoahritis.

So the answer to this question is D


Instruction:
The vitamin present in the fatty acid synthase complex is
A. Thiamine
B. Folate
C. Pantothenate
D. Pyridoxine

Response:
Fatty acid synthase: In yeast, mammals, and birds, the synthetase enzyme system is called the fatty acid synthase complex--it is a multienzyme complex. It is made up of an ellipsoid dimer of two identical polypeptide monomeric units (monomer I and II), arranged in a "head to tail" fashion. Each monomeric unit contains six enzymes and an ACP molecule (Acyl carrier protein). Active Site * The ACP has an -SH group in the 4-phosphopantetheine moiety, referred as Pantothenic-SH (Pan-SH) * Another active -SH group present in the cysteine moiety of the enzyme ketoacyl synthase (condensing enzyme), referred as cysteinyl-SH (Cys-SH). The "Pan-SH" of one monomeric unit is in close proximity to the "Cys-SH" group of other monomeric unit and vice-versa.Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th edition, page no: 414

So the answer to this question is C


Instruction:
Which one of the following insecticides is not used as a larvicides ?
A. Abate
B. Paris green
C. Fenthion
D. Dichloros

Response:
None

So the answer to this question is D


Instruction:
Which of the following local anaesthetics belongs to the ester group?
A. Procaine
B. Bupivacaine
C. Lignocaine
D. Mepivacaine

Response:
Procaine belongs to ester group. Since Ester links are more prone for hydrolysis than amide links generally esters have a shoer duration of action. Other three are amide group. From padmaja 4th edition Page no 199

So the answer to this question is A


Instruction:
What does Gettlers test detects ?
A. Diatoms in drowning
B. Chloride content of blood in drowning
C. Weight in drowning
D. None

Response:
Ans. is 'b' i.e., Chloride content of blood in drowning Gettler test estimates chloride content of blood from both sides of hea. It is done for drowning. Normally the chloride content is equal in the right and left chambers of the hea (600 mg/100 m1). In fresh water drowning due to hemodilution the chloride content is decreased and in salt water drowning due to hemoconcentration the chloride content is increased in left side of hea. A 25% difference in chloride is significant but the test is of doubtful value.

So the answer to this question is B


Instruction:
MAO inhibitors are contra-indicated in all the following conditions EXCEPT:
A. With tricyclic antidepressants
B. With indirectly acting sympathomimetics
C. Cheese
D. Aspirin

Response:
(Ref: KDT 6/e p458, 459) In first three conditions mentioned in the question, MAO inhibitors will lead to hypeensive crisis but these drugs do not interact with aspirin.

So the answer to this question is D


Instruction:
Brown atrophy is due to
A. Fatty necrosis
B. Lipofuscin
C. Haemosiderin
D. Ceruloplasmin

Response:
Ref, Robbins 8/e p10,532,7/e10,9/ep64

So the answer to this question is B


Instruction:
Agent which on addition to a colony inhibits its growth and on removal the colony regrows is -
A. Bacteriostatic
B. Bactericidal
C. Antibiotic
D. Antiseptic

Response:
They prevent the multiplication of bacteria but however they remain alive. Few antibiotics such as tetracycline,sulphomethoxazole REF:Textbook of microbiology, Ananthanarayan and Paniker. Page no.: 28 Tara textbook of pharmacology

So the answer to this question is A


Instruction:
Kiesselbach's plexus is formed by -a) Greater palatine arteryb) Septal branch of sphenopalatine arteryc) Posterior ethmoidal arteryd) Septal branch of superior labial arterye) Anterior ethmoidal artery
A. abcd
B. bcde
C. abde
D. ade

Response:
None

So the answer to this question is C


Instruction:
Postmoem caloricity is seen in -
A. Strychning poisoning
B. Organophosphorus poisoning
C. Dhatura poisoning
D. Ergot poisoning

Response:
Postmoem caloricity is the condition in which temperature of body remains raised for first two hours after death. It can be due to breakdown of heat regulation as in sunstroke or increased heat production due to convulsion of muscles as in strychnine poisoning or excess bacteria as in cholera. Dr.Narayana Reddys Synopsis of Forensic Medicine and Toxicology 27th edition pg. 76.

So the answer to this question is A


Instruction:
Treatment of human brucellosis include following EXCEPT-
A. Rifampicin
B. Azithromycin
C. Streptomycin/gentamicin
D. Doxycycline

Response:
Drugs used in the treatment of brucellosis include doxycycline 100mg twice daily or orally for 6 weeks plus gentamicin 5mg/kg iv once daily for 7 days or doxycycline 100mg twice daily plus rifampicin 600-900mg orally once daily for 6 weeks. Aminoglycosides show synergistic activity with tetracyclines against brucellosis. Reference Harrison20th edition 1079

So the answer to this question is B


Instruction:
A female of 35 years old that has completed her family is having asymptomatic 10 weeks size f 1- broid. The most appropriate management is :
A. Observation only
B. Hysterectomy with bilateral salping000phorectomy
C. Hysteroscopic myomectomy
D. Myomectomy

Response:
Observation only

So the answer to this question is A


Instruction:
True about lateral corticospinal tract
A. Crossed
B. Uncrossed
C. Stops in midthoracic region
D. Crossed at midspinal level

Response:
Pyramids of medulla are made by crossing fibers of the lateral corticospinal tract. About 80% of lateral corticospinal tract cross.

So the answer to this question is A


Instruction:
Aniridia is associated with:
A. Retinoblastoma
B. Hepatoblastoma
C. Nephroblastoma
D. Medulloblastoma

Response:
Aniridia and Wilm's tumor (nephroblastoma) are components of a rare genetic syndrome - WAGR syndrome W - Wilm's tumor A - Aniridia G - Genitourinary problems R - Mental Retardation Aniridia is a condition of complete or paial iris hypoplasia and foveal hypoplasia, resulting in reduced visual acuity and nystagmus. It may be found in isolation or in association with other syndromes. PAX6 is present on band p13 of chromosome 11, and its mutation results in aniridia. Syndromes associated with Aniridia: Miller syndrome Aniridia associated wilm's tumor WAGR syndrome Wilm's tumor, aniridia, genital abnormalities and mental retardation Gillespie's syndrome Aniridia, mental retardation and cerebellar ataxia Axenfeld-Rieger syndrome Iris hypoplasia, corectopia and polycoria. Ref: Yanoff & Duker's Opthalmology, 3rd Edition, Page 1208.

So the answer to this question is C


Instruction:
Growth is generally completed
A. First in head and last in depth of face
B. First in head and last in width of face
C. First in head and Last in height of face
D. First in depth and Last in width of face

Response:
None

So the answer to this question is C


Instruction:
What are fly belts?
A. Insecticide impregnated belts to ward off tse tse flies
B. Regions infested with tse tse flies
C. Sticky paper strips to catch flies
D. None of the above

Response:
Regions of Africa are ravaged by tse tse flies. Such regions infested with flies are known as fly belts. Chapter: Environment and health Ref: Park 21st edition page: 716

So the answer to this question is B


Instruction:
Finish line prepared in full veneer crown is
A. Buccal shoulder & lingually chamfer
B. Lingually shoulder & buccally chamfer
C. All shoulder
D. All chamfer

Response:
None

So the answer to this question is A


Instruction:
Elaboration of inactivating enzymes are the important mechanism of drug resistance among all of these antibiotics EXCEPT :
A. Quinolones
B. Penicillin
C. Chloramphenicol
D. Aminoglycosides

Response:
Resistance to fluoroquinolones is mediated by mutation in DNA gyrase.

So the answer to this question is A


Instruction:
A 4 year old child presented with a painful eruption affecting the flexures. Patient was hospitalised and O/E, there was erythema with peeling and blistering of the skin around the lips, eyelid, groin and natal cleft. A few small flaccid blisters were present at the margins of affected areas. The skin of the trunk showed faint erythema. Histological features were not conclusive. Immunofluorescence studies were awaited. What protein family is most likely to be affected by this disease?
A. Desmocollins
B. Desmogleins
C. BPAg1
D. BPAg2

Response:
Dx: Blistering Disorder- Linear IgA Disease MC protein involvement BPAg2 > BPAg1 Characteristic C/F: String of pearl appearance/cluster of jewel appearance Linear IgA diseaseIt is chronic, acquired sub-epidermal disease of children & adults with cutaneous & mucosal involvement. Two clinical syndromes seen1. Chronic bullous disease of childhood2. Adult linear IgA disease Auto antibodies are IgA (usually IgA1) Chronic Bullous disease of childhood. Linear IgA disease of Adults

So the answer to this question is D


Instruction:
Commonly used long bone for identification -
A. Femur
B. Radius
C. Ulna
D. Humerus

Response:
The best long bone for identification is femur. Ref: K.S.Narayan Reddy's synopsis of Forensic Medicine and Toxicology 29 th edition Chapter 4 page,43,45.

So the answer to this question is A


Instruction:
Fogarty’s catheteris used for:
A. Drainage of urinary bladder
B. Parenteral hyperalimentation
C. Removal of embolus from blood vessels
D. Ureteric catheterization

Response:
Fogarty catheter is like a ureteric catheter, with a balloon tip and is introduced until it is deemed to have passed the limit of the thrombus.
The balloon is inflated and the catheter is withdrawn slowly with the clot.
Ref.:Bailey and love’s sort practice of surgery- 934

So the answer to this question is C


Instruction:
Hoffman's elimination is feature of
A. Pancuronium
B. Thiopentone
C. Vecuronium
D. Atracurium

Response:
Ans. d (Atracurium) (Ref KDT 6th !345; Anaesthesia by Ajay yadav, 2nd ed., p. 90)The unique feature of atracurium is inactivation in plasma by spontaneous nonenzymatic degradation (Hofmann elimination) in addition to that by cholinesterases. Consequently its duration of action is not altered in patients with hepatic/renal insufficiency or hypodynamic circulation. It is the preferred muscle relaxant for such patients as well as for neonates and the elderly. Hypotension may occur due to histamine release.Cisatracurium, R-Cis, R-Cis enantiomer of atracurium is nearly 4 times more potent, slower in onset, but similar in duration of action. Like atracurium it undergoes Hofmann elimination, but in contrast it is not hydrolysed by plasma cholinesterase. Most importantly, it does not provoke histamine release.ATRACURIUM BESYLATE# Long acting and non-depolarising muscle relaxant.# Muscle relaxant of choice in renal failure or anephric patients.# pH of solution is 3.5.; Stored at 4degC.; Duration of action doubled at 25degC.# Metabolism mainly by Hofmann elimination (chemical degradation) and hydrolysis in plasma and elsewhere in body.# Major metabolite is laudanosine, which is CNS stimulant.# Cisatracurium is one of the ten isomers of atracurium and its active metabolites contain less laudanosine which causeless hypotension, central nervous system excitement, and seizures than that of atracurium.# It is considered an intermediate-acting agent in terms of duration of action.Notable features of Few muscle relaxantsPropertyMuscle relaxant (MR)Rapid onset of ActionShortest ActingLongest ActingSch (overall); Rocuronium (non-depolarising)Sch (overall); Mivacurium (non-depolarising)DoxacuriumExcreted in LiverRocuronium; VecuroniumNo placenta crossingd -TCHistamine released-TC (maximum) Atracuronium Mivacuronium SchLeast Histamine releaseVecuroniumMost CardiostableVecuroniumM.R. used to decrease BPd -TCM.R. Used to maintain BPPancuroniumM.R. Safe in asthmaVecronium; CisatracuroniumM.R. Causing epilepsyAtracurium; secondary LaunodocinM.R. Causing epilepsyCisatracurium; Atracurium

So the answer to this question is D


Instruction:
Which of the following is most common among all psychiatric disorders?
A. Depression
B. Anxiety disorder
C. OCD
D. Delusional disorder

Response:
Anxiety disorder are the most common among all psychiatric disorders and among the group of anxiety disorders, Phobias are the most common.

So the answer to this question is B


Instruction:
Injury to the superficial peroneal nerve will result in motor loss of which muscle?
A. Extensor digitorum brevis
B. Extensor hallucis longus
C. Extensor digitorum longus
D. Peroneus longus

Response:
The superficial peroneal nerve supplies the peroneus longus and brevis and sensation to the lateral aspect of the lower pa of the leg and the dorsum of the foot. Foot drop does not occur but eversion of the foot is lost. The deep peroneal nerve supplies the tibialis anterior, extensor hallucis longus, extensor digitorum longus, the peroneus teius, and sensation to the adjacent sides of the first and second toes. Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 37. Leg. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy.

So the answer to this question is D


Instruction:
All tracts passed through superior cerebellar peduncles except
A. Tectocerebellar
B. Ceruleocerebellar
C. Olivo cerebellar
D. Cerebellorubral

Response:
The olivocerebellar fibres pass through inferior cerebellar peduncle.The tracts passing through superior cerebellar peduncle are:AFFERENTAnterior spinocerebellarTectocerebellarTrigeminocerebellarCeruleocerebellarHypothalamocerebellarEFFERENT:CerebellorubralDentatorubral, dentatothalamicCerebello-olivaryCerebelloreticular(Ref: vishram singh textbook of clinical neuroanatomy second edition pg 118)

So the answer to this question is C


Instruction:
Which of the following is NOT an indication for surgical interventation in acute pancreatitis
A. Acute fluid collection
B. Pancreatic necrosis
C. Pancreatic abscess
D. Diagnostic dilemma

Response:
.Treatment of acute pancreatitis * Conservative, 70-90% * Surgical treatment when indicated, 10-30% * Management of complications like acute pseudocyst, abscess, fistula, haemorrhage; systemic complications like ARDS, renal failure, MODS Indications for Surgical Intervention (10% cases) -1. If condition of patient deteriorates in spite of good conservative treatment. 2. If there is formation of pancreatic abscess, or infected necrosis. 3. When diagnosis is in doubt. 4. In severe necrotising pancreatitis as a trial to save the life of the patient which has got very high moality. ref:SRB&;S manual of surgery,ed 3,pg no 618

So the answer to this question is D


Instruction:
Which of the following represent the commonest mode of inheritance of congenital hea disease?
A. Autosomal dominant
B. Autosomal recessive
C. Sex linked dominant
D. Multifactorial

Response:
Cardiovascular defects are the most common among all the bih defects. These malformations occur due to complex multifactorial genetic and environmental causes. In Ref: Harrison's Principle of Internal Medicine, 16th Edition, Page 1920

So the answer to this question is D


Instruction:
Which of the following is FALSE regarding a normal pregnancy?
A. Fall in free T4/T3 in 3rd trimester
B. TSH falls in the first and second trimester but increases in the third trimester
C. TSH rises in the first and second trimester but falls in the third trimester
D. There is an increase in Thyroid binding globulin

Response:
In pregnancy there is a relative iodine deficiency and increased renal excretion. Ref: Karla Philip, 33rd Edition, Page 304

So the answer to this question is C


Instruction:
Life span of mosquito is?
A. 1 week
B. 2 weeks
C. 1 month
D. 1 year

Response:
Under orable conditions of temperature and food supply, the life cycle from the egg to adult is complete in 7-10 days. Normally the adult mosquito lives for about 2 weeks. The males are generally sho-lived Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg

So the answer to this question is B


Instruction:
Reduced enamel epithelium is
A. Thin layer laid by ameloblasts on tooth surface after they finish formation of enamel matrix
B. Reduced epithelial enamel organ to a few layers of cells
C. Once the tip of crown emerge, the reduced enamel cuticle
D. All of the above

Response:
None

So the answer to this question is B


Instruction:
Ptosis is due to damage of :
A. Occulomotor nerve
B. Abducens nerve
C. Trochlear nerve
D. Facial nerve

Response:
None

So the answer to this question is A