Instruction:
A lady on long term hemodialysis developed carpel tunnel syndrome. The cause was diagnosed to be amyloidosis by using a biopsy. What is the type of amyloid that is seen?
A. Beta 2 microglobulin
B. Amyloid light chain
C. ATTR
D. Serum amyloid associated protein

Response:
Ans. is 'a' i.e. Beta 2 microglobulin Dialysis-related amyloidosis (DRA) is a disorder caused by tissue deposition of beta2 microglobulin as amyloid fibrils.The clearance of beta2 microglobulin, a component of the major histocompatibility complex that is present on cell surfaces, normally occurs by glomerular filtration with subsequent reabsorption and catabolism in proximal tubules. Clearance therefore declines in patients with reduced kidney function, leading to plasma accumulation and slow tissue deposition.The tissue deposition of amyloid detected histologically occurs much earlier than any clinical or radiographic manifestations of the illness.In contrast to fragments of immunoglobulin light chains in primary amyloidosis and serum amyloid A in secondary amyloidosis, the amyloid protein in DRA is composed primarily of beta2- microglobulin.The amyloid found in the bone cysts and synovial tissue in patients with DRA is similar to other forms of amyloid in its staining properties with Congo red and in exhibiting apple-green birefringence under polarized light. It has been proposed that beta2- microglobulin has a high affinity for collagen, an effect that could explain the predominance of joint and bone diseaseClearance of beta2-microslobulinUnderlying the tissue deposition of beta2-microglobulin among patients with end-stage renal disease is the inability to adequately clear this substance, even with modem high flux hemodialysis and/or convective therapies. Bones and diseasesLess tendency to deposit in gastrointestinal organsRarely involvesp2 amyloid has preference for deposition in bones joints and synoviump2 amyloid has affinity for collagenCarpal tunnel syndromeScapulohumeral periarthritisEffusive arthropathySpondyloarthropathyBone diseasesColonStomachEsophagusSmall intestineCardiacPulmonarycutaneousTissue histologyIn contrast to fragments of immunoglobulin light chains in primary amyloidosis and serum amyloid A in secondary amyloidosis, the amyloid protein in DRA is composed primary of beta2-microglobulinThe amyloid found in the bone cysts and synovial tissue is similar to other forms of amyloid in its staining properties with Congo red and in exhibiting apple-green birefringence under polarized light - Biopsy remains the "gold standard" for the diagnosis of beta2- microglobulin amyloidosis. Despite this, the diagnosis of DRA is usually clinical and relies upon the combination of typical clinical features plus characteristic radiographic findings. Abdominal fat pad aspirates are not useful for the diagnosis of DRA.Type of AmyloidosisMajor Fibril proteinPrecursor proteinSystemic Amyloidosis Primary amyloidosisSecondary amyloidosisHemodialysis associated amyloidosisALAAAb2 microglobulinImmunoglobulin light chainSSAb2 microglobulinHereditary amyloidosis Familial Mediterranean feverFamilial amyloidotic neuropathiesSystemic senile amyloidosisAAATTRATTRSAATransthyretinTransthyretinLocalized amyloidosis Senile cerebral(Alzheimer's)Medullary ca thyroidIslet of LangerhansIsolated atrial amyloidosisAbAcalAIAPPAANIAPPCalcitoninIslet amyloid peptideAtrial natriuretic factor

So the answer to this question is A


Instruction:
Greenish discolouration at putrefaction is due to-
A. MetHb
B. Sulph-meth Hb
C. Deoxy Hb
D. Carboxy Hb

Response:
Ans. is 'b' i.e., Sulph-meth Hb Signs of putrefactiono The signs and effects of putrefaction are as followsColour changesThe earliest sign of decomposition is greenish discoloration of body, seen in right iliac fossa externally and under liver internally. This is due to involvement of caecum. Which contains more liquid and is full of bacteria. In these areas, it appears in 12-18 hours and slowly spreads to whole body in 24-48 hours. Greenish discoloration is due to formation of sulph-meth-haemoglobin,Morbling occurs when Hb dissociates from RBCs and the colour of Hb is taken up by vessels, which are seen as prominent lines having purple or green or brown colour. Marbling occurs in 24-48 hours.Formation of foul smelling gasesDue to action of bacteria, foul smelling gases are formed, e.g. SO., H^S, ammonia, methane and CO,.Effects of gasesBloating up of body occurs in 34-48 hours. At the same time following changes occurs :i) Appearance of stomach contents and froth on nose and mouth.ii) Degloving and destocking with appearance of putrifactive blisters,iii) Emptying of heart due to pressure of gas.In 48-72 hours prolapse of rectum and uterus occur and postmortem delivery may occur if the dead woman is pregnant. Color of postmortem staining also changes to brown and finally to black. False rigidity (putrefactive rigidity ) may occur at this time.Appearance of maggotsFlies lay their eggs in wrounds, exposed natural orifices and exposed moist parts of the body and folds of skin, e.g. neck, axilla, nostrils, mouth etc. Flies lay eggs in 6-12 hours after death and these eggs change in larva (maggot) in 1 -2 days. Thus maggots appear in 2-3 days after the death. After further 4-5 days, the maggots change into pupa, which convert into adult flies in next 3-5 days. Thus adult flies will be coming out of the body after total 8-12 days of death. Thus appearance of maggot determine the time since death.Other late changesIn 3-5 days : Nails and teeth become loose and can be pulled out, sutures of skull may separate.In 7-12 days: Liquefaction of body (colliquative putrefaction) occurs.In 1-3 months : Skeletonization of dead body occurs.Finally: Bones also decompose : Exposed bones in 1-5 years and deep burried bone (> 2 meters) in 25-100 years.Internal changesLiver becomes spongy and is called as foamy or Swiss cheese or honeycombed liver.In 7-12 days lequefaction of internal organs occur.Floatation of body (if body is in water)Floatation of body occurs due to accumulation of sufficient putrefactive gases. Abdomen is above (due to gases) and spine is below during floatation. Time required for floatation is ordinarily 24 hours after death in summers and 2-3 days in winter. Factors affecting floatation are :-i) Causing early floatation : Newborn mature infant, females, in summer, clothed body, obese, in sea water and in still pond wrater.ii) Causing delayed floatation : Still birth/i immature newrbom, male, in winter, naked body, thin built, in fresh water and in running stream water.o inspiration and expiration before death has no effect on floatation as floatation is due to putrefactive gases (not due to respiratory air).

So the answer to this question is B


Instruction:
On giving a patient insulin, which of the following is expected to occur first?
A. Increased transpo of K+ into adipocytes
B. Stimulation of protein synthesis
C. Activation of glycolysis
D. Increase in mRNA for lipolysis

Response:
Increased transpo of K+ into adipocytes will occur first onn giving an injection of insulin. Based onn time on onset, actions of insulin are classified as: Rapid(seconds): Increased permeability, leading to : Increased transpo of glucose, aminoacids, and K+ into insulin sensitive cells. Intermediate(minutes): Changes in activity levels of intracellular enzymes, leading to: Stimulation of protein synthesis Inhibition of proteinn degradation Activation of glycolytic enzymes and glycogen synthase Innhibition of phophorylase and glucogenic enzymes. Delayed (Hours to days): Changed rates of transcription for DNA, leading to: Increased in mRNAs for lipogenic and other enzymes. Ref: Guyton and Hall 13th edition Pgno: 985

So the answer to this question is A


Instruction:
Rupture of extensor pollicis longus occurs four weeks after:
A. Colles' fracture
B. Radial styloid fracture
C. Smith's fracture
D. Scaphoid fracture

Response:
A i.e. Colle's fracture

So the answer to this question is A


Instruction:
Fluconazole is more effective than itraconazole in the following systemic fungal disease
A. Pulmonary histoplasmosis
B. Cryptococcal meningitis
C. Non-meningeal blastomycosis
D. Disseminated sporotrichosis

Response:
Ref-KDT 6/e p763,764 Fluconazole has maximum CNS penetration whereas itraconazole has limited entry in the brain. Therefore fluconazole is preferred over itraconazole for the treatment of cryptococcal meningitis. For all other conditions listed in the question, itraconazole is first choice drug.

So the answer to this question is B


Instruction:
ICD 10
A. Revised every 5 years
B. Consists of 10 chaptors
C. Arranged in 3 volumes
D. Produced by UNICEF

Response:
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) Medical classification list by the World Health Organization (WHO); Revised every 10years Consists of 21chapters The ICD-10 consists of: Tabular lists containing cause-of-death titles and codes (Volume 1) Inclusion and exclusion terms for cause-of-death titles (Volume 1) Description, guidelines, and coding rules (Volume 2) and An alphabetical index to diseases and nature of injury, external causes of injury, table of drugs and chemicals (Volume 3) Ref : Park's textbook of preventive and social medicine; 23rd edition

So the answer to this question is C


Instruction:
What is glomerular filtration rate?
A. 100 ml/min
B. 125 ml/min
C. 150 ml/min
D. 175 ml/min

Response:
(B) 125 ml/min # GFR in a healthy person of average size is approximately 125 mL/min. Its magnitude correlates fairly well with surface area, but values in women are 10% lower than those in men even after correction for surface area.> A rate of 125 mL/min is 7.5 L/h, or 180 L/d, whereas the normal urine volume is about 1 L/d. Thus, 99% or more of the filtrate is normally reabsorbed.> At the rate of 125 mL/min, in 1 day the kidneys filter an amount of fluid equal to 4 times the total body water, 15 times the ECF volume, and 60 times the plasma volume.

So the answer to this question is B


Instruction:
Which of the following is not gram-positive?
A. Listeria
B. Moraxella
C. Nocardia
D. Actinomycetes

Response:
Cocci are mostly gram positive except Bacilli are mostly gram negative except -meningococci -gonococci -veilonella -MORAXELLA M- Mycobacrerium A-Anthracis bacillus C-Clostridium species D-Diptheriae cornybacterium o N Nocardia A Actinomycetes L -Listeria D -Diptherioids s

So the answer to this question is B


Instruction:
Which of the following is aldosterone antagonist?
A. Eplerenone
B. Deoxicorticosterone
C. Fenoldopam
D. Frusemide

Response:
Ans. a (Eplerenone) (Ref. KDT 5th/pg. 534; Katzung 9th/pg. Chapter 11)Eplerenone is a new, selective mineralocorticoid receptor antagonist without clinically significant androgen receptorblocking or progesterone receptor stimulating activities, which translates into absence of gynecomastia and impotence inmen and of menstrual irregularity in women. It is approved in treatment of hypertension.Mineralocorticoid receptors are expressed in many tissues, including:# Kidney,# Colon,# Heart,# Central nervous system (hippocampus),# Brown adipose tissue and# Sweat glands (not in liver).Educational points:# Lithium & demeclocyline are ADH antagonists.

So the answer to this question is A


Instruction:
Serum ACE may be raised in all of the following except;
A. Sarcoidosis
B. Silicosis
C. Berylliosis
D. Bronchogenic carcinoma

Response:
Answer is D (Bronchogenic carcinoma) : CE levels are not elevated in Bronchogenh. carcinoma.

So the answer to this question is D


Instruction:
Bicarbonate is absorbed -
A. Activity in PCT
B. Actively in DCT
C. Indirectly in PCT
D. Actively in DCT

Response:
Ans. is 'c' i.e., Indrectly in PCT o About 80-90 of filtered HCO2, is absorbed in PCT.o Absorption of HCO,' is indirect, which is due to secretion H+, i.e., secretion of H+ is coupled with absorption of HCO3-o Filtered HCO3' reacts with H+ to form H2CO, which then is dissociated into H2Oand CO2,.o CO. diffuses into epithelial cell and generate HCO2 which is then reabsorbed. In early tubular segmentso In proximal tubule, thick ascending limb of loop of Henle and early distal tubule, the H+ is secreted into tubular fluid by "Na+ - H+ exchanger", i.e., by 'sodium and hydrogen countertransport'o The energy is derived from Na+ Kf ATPase locate on the basolateral membrane. Therefore, it is a secondary active transport.o Filtered HCO3 is reabsorbed by interaction with these secreted H+ . Filtered HCO3- react with H' to form H2CO3o This H,CO. dissociates into CO. and H,0 by carbonic anhydrase, which is present in the brush border of proximal tubules, thick ascending limb and early distal tubules.o The CO, rapidly diffuses into the tubular cell where it reacts with water to form H2C03 under the influence of intracellular carbonic anhydrase.o This H,CO. in turn dissociates to form HCO. and H+; the HCO. then diffuses across the basolateral membrane into the interstitial fluid and is taken up by peritubular capillaries.Distal nephrono In the late distal tubule and collecting ducts, H+ ions are secreted by primary active transport, i.e., H+ ions are directly transported by hydrogen - transporting ATPase.o Primary active secretion of H+ occurs in special type of cell called the intercalated (I) cellsQ.o Hydrogen ion secretion in these cells is accomplished in two steps : (1) The dissolved CO2 in the cells combine withH2O to form H2CO3, and (2) The H2CO3. then dissociates into HCO3' which is reabsorbed into the blood, plus H-, which is secreted into the tubule.o For each H+ secreted, an HCO3 is reabsorbed similar to the process in the early segments.o The main difference is that H+ moves across the luminal membrane by primary active transport instead of by counter-transport as occurs in the early parts of the nephron.

So the answer to this question is C


Instruction:
DIENES phenomenon s used for
A. Mycoplasma
B. Chlamydiae
C. Plague
D. Diptheria

Response:
None

So the answer to this question is A


Instruction:
Dimension of HDI which is measured to check good standard of living ?
A. Income
B. Knowledge
C. Lingevity
D. Housing

Response:
Ans. is 'a' i.e., Income HDI is a composite index combining indicators representing three dimensions ? Longevity (life expectancy at bih) Knowledge (Adult literacy rate and mean years of schooling, i.e. Gross enrolement ratio) Income (real GDP per capita in purchasing power parity in US dollars) Among these three, income is included in standard of living. Standard of living It refers to the usual scale of our expenditure, goods we consume and services we enjoy. It includes :? Income & occupation Standards of housing, sanitation & nutrition Level of provision of health, educational, recreational and other services. Standard of living depends on per capita GNP

So the answer to this question is A


Instruction:
Shape of the arterial pulse is influenced by:
A. Viscosity of blood
B. Velocity of blood
C. Cross sectional area of artery
D. Arterial wall expansion

Response:
The blood forced into the aorta during systole not only moves the blood in the vessels forward but also sets up a pressure wave that travels along the arteries. The pressure wave expands the arterial walls as it travels, and the expansion is palpable as the pulse. The rate at which the wave travels, which is independent of and much higher than the velocity of blood flow, is about 4 m/s in the aorta, 8 m/s in the large arteries, and 16 m/s in the small arteries of young adults. Consequently, the pulse is felt in the radial artery at the wrist about 0.1 s after the peak of systolic ejection into the aorta. With advancing age, the arteries become more rigid, and the pulse wave moves faster.
Reference: Ganong’s Review of Medical Physiology T W E N T Y - F I F T H   E D I T I O N page no 540

So the answer to this question is D


Instruction:
Cornea drives its nutrition chiefly from:
A. Aqueous humour
B. Mucous layer
C. Corneal vessels
D. Perilimbal vessels

Response:
Cornea is avascular and dehydrated structure Gets glucose from aqueous humour Gets oxygen from 3 different source. Air Tear film Aqueous The innermost layer of the tear film is the mucous layer, which consists of secreted mucins, electrolytes and water produced by conjunctival goblet cells Mucin stabilizes the tear film

So the answer to this question is A


Instruction:
All are true about Typhoid except -
A. Incubation period 10-14 years
B. Most common among males
C. Carrier are treated by ampicillin
D. Highest incidence occur in 30-40 years age group

Response:
<p> Typhoid fever:- Typical continuous fever for 3-4 weeks,relative bradycardia with involvement of lymphoid tissue. Without effective treatment, typhoid kills over 10% of those infected. Causative agent- Salmonella typhi. S.paraA and S.paraB are infrequent. Reservoir- man Case - a case is infectious as long as bacilli appear in stools /urine. Carriers:- 1. Convalescent carriers-excrete bacilli for 6-8 weeks,after which their number dimnishes rapidly. 2. Chronic carriers- persons who excrete bacilli for more than a year after a clinical attack. In most chronic carriers,the organism persists in gall bladder and in biliary tract. Source of infection- faeces and urine of cases/carriers. Age group involved mostly is 5-19 yrs old. Males affected more than females. Incubation period- 10-14 days. Mode of transmission: faecal oral route/ urine oral routes. Treatment of carriers:- Intensive course of ampicillin/ amoxycillin (4-6g/day) together with probenecid for 6 weeks. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.235}</p>

So the answer to this question is D


Instruction:
Which one of the following feature is NOT associated with primary hyperparathyroidism
A. Giant cell tumour
B. Sharply defined radiolucencies of maxilla and mandible
C. Partial loss of lamina dura
D. Hypercementosis

Response:
None

So the answer to this question is D


Instruction:
Which group of streptococcus grow at > 60degC -
A. A
B. B
C. C
D. D

Response:
Option 1, 2, 3 Heat tolerance test (60oC) is negative for Group A, B, C Streptococci. Option 4 Enterococcus is heat resistant. Enterococcus grows in presence of 6.5% NaCl, pH 9.6 and temperature >55oC which differentiate it from Group D streptococci.

So the answer to this question is D


Instruction:
Which of the following type of leukemia is associated with autoimmune haemolytic anemia?
A. ALL
B. AML
C. CLL
D. CML

Response:
Autoimmune hemolytic Anemia is frequently seen in patients with CLL treated with fludarabine or 2-chlorodeoxyadenosine (cladribine). Secondary Autoimmune Hemolytic Anemia is seen in diseases such as lymphoma, CLL, SLE, primary agammaglobulinemia or hyper-IgM immunodeficiency syndrome. In these diseases, warm-antibody autoimmune hemolytic anemia most likely arises through an underlying defect in immune regulation and also due to an aberrant immune response to self-antigen. Ref: Williams Hematology, 8th Edition, Chapter 53 ; Current Medical Diagnosis and Treatment, 2012, Chapter 13

So the answer to this question is C


Instruction:
Most common complication after ERCP is
A. Acute Pancreatitis
B. Acute cholangitis
C. Acute cholecystitis
D. Duodenal perforation

Response:
Complication perforation(1.3%)/hemorrhage (1.4%),pancreatitis (4.3%) and sepsis (3-30%). Bailey & Love 26th, 208

So the answer to this question is A


Instruction:
Which of the following is not an indication for keratoplasty
A. Pseudophakic bullous keratopathy
B. Keratoconus
C. Corneal dystrophies
D. None

Response:
Common indications for keratoplasty are aphakic or pseudophakic bullous keratopathy, Fuchs dystrophy, corneal scar, keratoconus, and corneal dystrophies. Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue. When the entire cornea is replaced it is known as penetrating keratoplasty and when only pa of the cornea is replaced it is known as lamellar keratoplasty. Reference: Aravind FAQS in Ophthalmology; First Edition; Page no: 125

So the answer to this question is D


Instruction:
CRAO may be seen in
A. Diabetes mellitus
B. CMV retinitis
C. Panophthalmitis
D. Orbital mucormycosis

Response:
D i.e. Orbital mucormycosis - Most of central retinal aery obstruction (CRAO) are caused by atherosclerotic thrombus formation at or just proximal to the lamina cribrosaQ (-80%) followed by emboli (20%). Inflammation in form of vasculitis (eg varicella infection), optic neuritis or even orbital disease (eg mucormycosis)Q, local trauma and radiation may also cause CRAO. Vascular tropism/ invasion is the hallmark of orbital mucomycosis. This along with thrombosis b/o inflammatory process results in CRAO. In CRAOQ, when obstruction to blood flow is not complete, the flow may be paially restored in the course of a few days in which case gentle pressure upon the globe may break up the column of venous blood (in retinal veins)Q into red beads separated by clear interspaces. The beads move in jerky fashion sometimes in normal direction of blood flow & sometimes in the opposite direction - The "Cattle Truck Appearance". Central retinal aery occlusion characteristically presents with sudden (not gradual) painless loss of vision, cherry red spotQ and cattle truck appearanceQ of retinal veins (usually).

So the answer to this question is D


Instruction:
Which of the following is the best to compare vital statistics of countries?
A. Crude death and bih rates
B. Propoional moality rate
C. Age standardized death rate
D. Age specific death rate

Response:
If we want to compare the death rates of two populations with different age-composition, the crude death rate is not the right yardstick This is because rates are only comparable if the populations upon which they are based ae comparable.It is cumbersome to use a series of age-specific death rates, hence &;age standardization&; is used to remove the confounding effect of different age groups.Park 23epg: 59

So the answer to this question is C


Instruction:
Following are true regarding chlorination except ?
A. Residual chlorine is 0.5 mg/lit.
B. Contact period - 30 minute
C. Water should not be turbid
D. Chlorine demand should be estimated

Response:
Ans. is 'b' i.e., Contact period - 30 minute Contact period of 1 hour is recommended.

So the answer to this question is B


Instruction:
McArdle's disease is due to deficiency of -
A. Branching enzyme
B. Glucose 6 phosphatase
C. Acid maltase deficiency
D. Muscle phosphorylase

Response:
Ans. is 'd' i.e., Muscle phosphorylase Type Enzyme deficiencyOrgan (s) affected1von Gierke's diseaseGlucose 6-phosphataseLiver, kidney11Pompe's diseasea (1 - 4) Glucosidase (acid maltase)All organsIIICori's disease/Forbe's diseaseDebranching enzymeMuscle, liverIVAndersen's diseaseBranching enzymeLiver, myocardiumVMcArdle's diseaseMuscle PhosphorylaseMuscleVIHers' diseasePhosphorylaseLiverVIITarui's diseasePhosphofructokinaseMuscle, RBCsVIII Phosphorylase kinaseLivero There is also on X-ltnked form of phosphorylase kinase deficiency. This is sole exception as all other glycogen storage diseases are inherited as autosomal recessive trait.

So the answer to this question is D


Instruction:
Deglutition peristalsis of oesophagus:
A. Primary
B. Secondary
C. Tertiary
D. Quaternary

Response:
Ans. A. Primarya. Esophageal peristalsis can be initiated by deglutition ("primary" peristalsis) or local distention ("secondary" peristalsis).b. Deglutition is one of the most complex reflex neural activities.c. The initial phase is voluntary when food is chewed, mixed with saliva and formed into a bolus before being pushed to the posterior pharynx by the tongue. Receptors in the posterior pharynx are then activated to initiate the involuntary phase of deglutition, which involves carefully sequenced contraction of numerous head and neck muscles.d. Secondary peristalsis refers to peristalsis activated by esophageal distention.e. This can occur physiologically by food left behind after the primary peristaltic wave has passed, or by refluxed contents from the stomach.f. Unlike primary peristalsis, secondary peristalsis is not accompanied by deglutition with associated pharyngeal and upper esophageal sphincter motor function.

So the answer to this question is A


Instruction:
Calories provided by a cup of tea with the usual amount of sugar is around:
A. 50
B. 80
C. 130
D. 200

Response:
Composition of a 150 ml cup: Coffee tea cocoa Protein in g 1.2 0.9 7.2 Fat in g 7.8 1.1 8.8 Carbohydrate in g 17.8 16.4 26.2 Kcal 98 79 213 Ref: Park, 22nd edition pg: 585

So the answer to this question is B


Instruction:
A patient presented with complaints of ipsilateral flushing and sweating with eating and salivation. He had a parotid gland surgery few weeks ago. Frey's syndrome is diagnosed. Frey's syndrome is related to:
A. Auriculotemporal nerve
B. Facial nerve
C. Abducens nerve
D. Glossopharyngeal nerve

Response:
Frey syndrome: Aberrant nerve regeneration after parotid gland injury or surgery may result in ipsilateral flushing and sweating with eating and salivation. Sweating occurs in the distribution of the auriculotemporal nerve after an injury, abscess, or surgery in the parotid region. Freys syndrome can be seen in infants and children, often following bih trauma with forcep delivery.

So the answer to this question is A


Instruction:
In normal delivery, breast feeding should be started –
A. 1/2 hour after delivary
B. 2 hour after delivary
C. 4 hour after delivary
D. 6 hour after delivary

Response:
Breast feeding should be initiated within 30 min. of a normal vaginal delivery.
Breast feeding should be initiated within 4 hrs of delivery by caesarian section.

So the answer to this question is A


Instruction:
The occurrence of hypehyroidism following administration of supplemental iodine to subjects with endemic iodine deficiency goiter is known as:
A. Jod-Basedow effect
B. Wolff-Chaokoff effect
C. Thyrotoxicosis factitia
D. De Quervain's thyroiditis

Response:
Answer is A (Jod-Basedow effect) Contrast agents and other iodine containing substance should be avoided because of risk of inducing the Vod -Basedow effect' characterized by enhanced production of thyroid hormone by autonomous nodules'- Harrison Jad Basedow disease is synonymous with iodine induced hypehyroidism and may occur in patients with multinodular goitre after intake of large amount of iodine. - in the diet in the form of radiographic contrast material - in the form of drugs especially amiadarone Thyrotoxicosis factitia : Thyrotoxicosis produced due to ingestion of excessive amount of exogenous thyroid hormone is called Thyrotoxicosis factitia. Epidemics of thyrotoxicosis have been caused by consumption of ground beef contaminated with bovine thyroid gland. Presentation is one of thyrotoxicosis with low or absent thyroid nucleotide uptake. Wolff - Chaikoff effect: Harrison 15th / 2062, 2073, 2076; Harrison 16th/2117, 2106 Excess iodine transiently inhibits thyroid iodide organification. This phenomenon of iodine dependent transient supression of thyroid is called Wolff-Chaikoff effect. De Quervon's thyroiditis is same as subacute thyroiditis, granulomatosus thyroiditis or viral thyroiditis.

So the answer to this question is A


Instruction:
Colposcopy can visualize the all structures EXCEPT
A. Vulva
B. Vagina
C. Cervix
D. Endometrium

Response:
(Endometrium) (447-49-Shaw's Nth)COLPOSCOPY - uses in integrated screening programme of cervical cancer world overINDICATIONS - Diagnostic screening procedures are* Abnormal pap smear of cervix* Abnormal areas on the vagina and preoperative assessment in early stages of cancer cervix* Abnormal vulval area* Locate the abnormal areas and biopsyApplications of colposcopy in clinical practice

So the answer to this question is D


Instruction:
Climbing fiber inputs in the cerebellum stimulate
A. Granule cells
B. Golgi cells
C. Purkinje cells
D. Basket cells

Response:
Climbing fibers from contralateral inferior olive terminate on Purkinje cells, and also send a collateral innervation to the corresponding deep cerebellar nuclei RELAYS OF CEREBELLAR CIRCUIT Basket cells - Inhibits - Purkinje cell Stellate cells - Inhibits - Purkinje cell Climbing fibres - Stimulate - Purkinje cell Purkinje cells- Inhibits - Deep cerebellar nuclei Mossy fibres - Stimulate - Granule cells Granule cells - Stimulate - Stellate, basket, Purkinje, Golgi cells Golgi cells - Inhibitory - Interneuron NEURONS IN CEREBELLUM Granular cells > EXCITATORY NEURONS

So the answer to this question is C


Instruction:
Trident hand is seen in:
A. Achondroplasia
B. Mucopolysacchoroidosis
C. Diphyseal achlasia
D. Cleidocranial dystosis

Response:
A i.e. Achondroplasia

So the answer to this question is A


Instruction:
The greatest amount of fluoride recharge is seen with:
A. Composites
B. Resin modified glass ionomers
C. Resin composites
D. Polycarboxylates

Response:
The ability of a restorative material to be recharged and serve as a fluoride reservoir depends on the type and permeability of the material, the frequency of fluoride exposure, and the concentration of the fluoridating agent.
Glass ionomers and compomers are significantly better for recharging than resin-based composite materials, but this depends on the composition of the materials. Hybrid ionomers are often reported to have the highest capacity for recharging. It has also been reported that as the specimens age, their efficiencies of fluoride recharging decrease.
Water soluble methacrylate-based monomers have been used to replace part of liquid component of conventional GIC resulting in a group of materials called resin-modified glass ionomer cements, also known as hybrid ionomer cement.
Ref: Phillip’s Science of Dental Materials ed 12 pg 334

So the answer to this question is B


Instruction:
Zero Incidence is not seen in
A. Elimination of disease
B. Eradication of disease
C. Elimination of infection
D. Control of infection

Response:
Control of infection: The reduction of disease incidence, prevalence, morbidity or moality to a locally acceptable level as a result of deliberate effos; continued intervention measures are required to maintain the reduction. Example: diarrhoeal diseases.Elimination of disease: Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate effos; continued intervention measures are required. Example: neonatal tetanusElimination of infections: Reduction to zero of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate effos; continued measures to prevent re-establishment of transmission are required. Example: measles, poliomyelitis.Eradication: Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate effos; intervention measures are no longer needed. Example: smallpox.

So the answer to this question is D


Instruction:
Lowest projection of ligamentum denticulatum lies at which level of spinal nerves
A. T9,10
B. T12,L1
C. S2,3
D. S4,5

Response:
First tooth of ligamentum denticulatum is at the level of foramen magnum, last between T12-L1 Ref: Gray's39e/p227

So the answer to this question is B


Instruction:
A 55-ycar-old woman presents with progressively deepening jaundicc, uncontrollable pruritus, pain in the abdomen (right upper quadrant) and yellow coloured urine. Investigations revealed -
A. Viral hepatitis
B. Cirrhosis of liver
C. Carcinoma of head of the pancreas
D. Hepatocellular carcinoma

Response:
DAVIDSON&;S principles and practice of medicine 22nd edition. #around 60% of tumours arising from head of pancreas and involvement of common bile duct result in the development of obstructive jaundice, often with severe pruritis.Advanced stage present with central abdominal pain ,weight loss,pain radiates from upper abdomen from back.

So the answer to this question is C


Instruction:
A 5-year-old girl came with history of progressively increasing pallor since bih and hepatosplenomegaly. Which is the most relevant test for achieving diagnosis?
A. Hb electrophoresis
B. Peripheral smear examination
C. Osmo c fragility test
D. Bone marrow examination

Response:
Progressive increasing pallor along with hepatosplenomegaly in a five-year-old girl is consistent with a diagnosis of thalassemia. (Thalassemia intermedia) 'Hemoglobin electrophoresis' is the test of choice of diagnosing this condition and hence is the option of choice here.

So the answer to this question is A


Instruction:
"Maidon Teeth" is due to:
A. Lead
B. Fluoride
C. Calcium
D. Phosphorus

Response:
Fluoride

So the answer to this question is B


Instruction:
Reflux oesophagitis is common in which type of Hiatus Hernia
A. Sliding type of Hiatus Hernia
B. Paraoesophageal type of Hiatus Hernia
C. Both
D. None

Response:
HIATUS HERNIA It is displacement of stomach into the chest through oesophageal opening of the diaphragm. Most patients are elderly, past 40 years. This disorder is of two types: 1. Sliding:- Stomach is pushed into the thorax, in line with the oesophagus. Reflux oesophagitis is common and may give rise to ulceration and stenosis. Haematemesis may occur. It is caused by raised intra-abdominal pressure. 2. Paraoesophageal: A pa of the stomach along with its peritoneal covering passes up into the thorax by the side of oesophagus. The gastro-oesophageal junction still remains below the diaphragm and the angle between oesophagus and stomach is maintained. There is no reflux oesophagitis in this type of hernia. The main symptom is dyspnoea on exeion due to position of stomach in the thorax and sometimes bleeding. Ref:- Dhingra; pg num:-343

So the answer to this question is A


Instruction:
All the following are used in the treatment of Pneumocystis carinii except:
A. Pentamidine
B. Dapsone
C. Cotrimoxazole
D. Fluoroquinolones

Response:
Answer is D (Fluoroquinolones): Fluoroquinolones are not used in the treatment (. P. carinii infection. Drugs used for treatment of Pneumocystis carinii infection include: Agent Disease First choice drug Second choice Third choice Pneumocystis carinii Mild to moderate pneumonia Trimethoprim Sulfamethoxazole Trimethoprim -- Dapsone Clindamycin -- Primaquine Atovaquone Sever pneumonia Trimethoprim Sulfamethoxazole Pentamidene Clindamycin-Primaquine Trimetroxate Drug of choice for all forms of pneumocystosis: Trimethoprim-Sulfamethoxazole (Cotrimoxazole)

So the answer to this question is D


Instruction:
Sunray appearance on X - ray is seen in -
A. Osteosarcoma
B. Osteochondroma
C. Osteoclastoma
D. Chondroblastoma

Response:
Ans. is 'a' i.e., Osteosarcoma o Codman's triangle and sun ray appearance are typical of osteosarcoma.o However, you should keep in your mind following very important facts : -Sunray (sunburst) appearance and codman's triangle indicates periosteal reaction (periosteal new bone formation).Both these are typical of osteosarcoma but may also occur in other rapidly growing bone tumors (Ewing's sarcoma), and infection (osteomyelitis).Similarly, onion peei appearance indicates periosteal new bone-formation and is typical for Ewing's sarcoma. But this can also occur in oseosarcoma and osteomyelitis.The crux is that, aggresively growing tumors and infection stimulate the periosteum which then react by forming new bone, (therefore it is called periosteal reaction) which may take any of the above form.

So the answer to this question is A


Instruction:
All of the following cause panuveitis except ?
A. Ankylosing spondylitis
B. Toxoplasmosis
C. Sarcoidosis
D. Sympathetic ophthalmitis

Response:
Panuveitis. It is inflammation of all pas of the uveal tract - i.e. iris, ciliary body and choroid, manifestations of which can be seen in both the anterior (anterior chamber + posterior chamber) and posterior (vitreous cavity) segment of the eye. Cause of Panuveitis Sarcodiosis Tuberculosis Syphils Onchocerciasis Leptospirosis Brucelliosis Sympthetic Opthalmia Bechets's diseas Multiple Sclerosis Cysticercosis Vogt-Koyanagi-Harada Syndrome Retinal itraneuclear foreign body Masquerade syndrome:retinoblastoma , leukemia Ankylosing spondylitis causes anterior uveitis.(Seronegative ahropathy)

So the answer to this question is A


Instruction:
Hereditary spherocytosis is characterized by: March 2004
A. Anemia
B. Splenomegaly
C. Jaundice
D. All of the above

Response:
Ans. D i.e. All of the above

So the answer to this question is D


Instruction:
All of the following statements about carcinoid syndrome are true except:
A. Midgut carcinoids produce typical carcinoid syndrome
B. Plasma serotonin levels may be normal in atypical carcinoid syndrome
C. Metastasis to bone is common in Midgut Carcinoids
D. Carcinoid Syndrome is rare in Hindgut Carcinoids

Response:
Answer is C (Metastasis to bone is common in Midgut Carcinoids): Palliative Care (Oxford University Press, 2009)/ 452; Multiple references Metastasis to bone is rare in Midgut Carcinoids and is Common in Foregut Carcinoids. Features Foregut Midgut Hindgut Site Esophagus Jejunum Transverse Colon(Distal) Stomach Ileum Descending Colon Duodenum (Proximal) Appendix Rectum Liver; Gallbladder Meckel's Diveiculum Pancreas Ascending Colon Respiratory tract Transverse Colon (Proximal) Argentaffin Stain Negative Positive +/? Carcinoid Syndrome Atypical Typical Syndrome is Rare (Prolonged purple flush; (Sho pink red flushes; Headache; , lacrimation; Diarrhoea; Wheezing; Bronchoconstriction) Dyspnea; Cardiac Fibrosis; Pallegra) Metastasis to Bone Common Rare Common Plasma Serotonin Normal Elevated +/? Typical Urinary 5-HTP 5-HIAA, 5HT Rarely 5HT Metabolite

So the answer to this question is C


Instruction:
Village Health Nutrition Day is observed -
A. Every week
B. Every month
C. Every 6 month
D. Every year

Response:
Ans. is 'b' i.e., Every month * The Village-Health and Nutrition day (VHND) is to be organised once in every month on a fixed day (such as second Saturday).* The day can be decided by the VHWSC (village health and water sanitation committe) in each village at anyone of the Anganwadi centres (AWCs) in that village, preferably, all the AWCs should be covered by rotation.* On that day, Anganwadi worker and other VHWSC members will mobilize villagers to assemble in AWC.* Services to be provided during VNHDs are -# All pregnant women are to be registered on that day if they have not been previously registered.# Ensure all registered pregnant women are given ANC.# Dropout pregnant women for ANC are traced and services provided# Ensure Registration of all newborns# Ensure all eligible children below one year are given vaccine against six vaccine preventable diseases.# All drop out children who have not received vaccines as per schedule are to be vaccinated in the presence of mobile medical unit in the remote villages visited by Mobile Medical Unit. In other areas the unimmunized children are to be motivated to attend the catch up session at PHC.# Vitamin A solution to be administered.# Ensure all children are weighed, weight plotted on card and managed appropriately for taking care of malnutrition.# Ensure TB patients are taking drugs as per schedule and trace the defaulters and take necessary action.# IUD insertion# Ensure Depot holders have sufficient quantity of Condoms and Oral Contraceptives (OCPs)# Supplementary nutrition advice to be provided to under weight children.# Distribution of IFA tablets to AN mothers, adolescent girls and children.

So the answer to this question is B


Instruction:
Spermatozoa gets its nutrition from
A. Glucose
B. Fructose
C. Galactose
D. Starch

Response:
Ans: B. Fructose(Ref KS Sanoop 3'd/e p.171)Nutrition to sperms is mainly provided by fructose.Fructose (f .5-6.5 mg/ml).

So the answer to this question is B


Instruction:
Serological pattern observed for Acute Hepatitis B, with active viral replication is:
A. HBsAg, HBeAg, IgM Anti-HBc
B. HBsAg, IgG Anti-HBc
C. HBeAg
D. HBsAg

Response:
Hepatitis B virus expresses three antigens, viz. Corresponding antibodies produced on stimulation of immune system are: 1. HBsAg (Australia antigen) - surface antigen - 1st antigen to appear 2. HBcAg - core antigen - Rarely appears alone 3. HBeAg - Marker of infectivity, indicate active viral replication 1. Anti-HBs - Marker of end of period of communicability 2. Anti-HBc - 1st Ab to appear 3. Anti-HBe - Marker of good prognosis Serological patterns seen in Hepatitis B infection are: Condition Serological Pattern Acute Hepatitis B HBsAg, HBeAg, IgM Anti-HBc Chronic Hepatitis B, with active viral replication HbsAg, HBeAg, IgG Anti-HBc Chronic Hepatitis B, with low viral replication HbsAg, IgG Anti-HBc, Anti-HBe Recovery from Hepatitis B infection Anti-HBs, IgG Anti-HBc Post Vaccination Anti-HBs

So the answer to this question is A


Instruction:
During bilateral adrenalectomy, intraoperative dose of hydrocoisone should be given after -
A. Opening the abdomen
B. Ligation of left adrenal vein
C. Ligation of right adrenal vein
D. Excision of both adrenal glands

Response:
Ans. is 'd' i.e., Excision of both adrenal galnds About coicosteroids given in adrenalectomy, the maximum we could get is mentioned below. The answer has been confirmed by a good knowledgeable Prof. in Surgery. Schwaz 9/e p1397 writes? "Patients undergoing surgery for a primary adrenal adenoma secreting glucocoicoids require preoperative and postoperative steroids due to suppression of the contralateral adrenal gland. Duration of steroid therapy is determined by the ACTH stimulation test. Exogenous steroids may be needed for up to 2 years but are needed indefinitely in patients who have undergone bilateral adrenalectomy. This latter group of patients also may require mineralocoicoid replacement therapy." Sabiston 18/e p1013 writes? "Perioperative and postoperative glucocoicoid administration is obviously essential in the care of patients with Cushing's syndrome. For patients undergoing adrenalectomy for Cushing's syndrome, perioperative "stress dose" steroids (hydrocoisone, 100 mg IV every 8 hours for 24 hours) are recommended." Note that Bailey (25/e p811) & CSDT (13/e p749) differ from Schwaz and Sabiston. According to them only post operative steroids are given.

So the answer to this question is D


Instruction:
Black colour code is used in four colour code system of triage management in disaster for: March 2011
A. Ambulatory patients
B. Low priority patients
C. Dead patients
D. High priority patients

Response:
Ans. C: Dead patients Black colour in triage indicates dead/ moribund persons Triage After disasters such as eahquakes, hurricanes and train wrecks, triage often includes a system of color coding. The code changes in different countries and regions but four colors are almost universal: Black indicates dead, Red indicates that the patient needs immediate attention, Green indicates that a patient has only minor injuries. Yellow signals medium priority Sometimes the coding medium is as simple as rolls of colored tape. A person with some medical training--and a checklist--goes among the injured and wraps a strip of tape around the leg of an injured person. The checklists for disaster situations tend to be simple and omit injuries that might be hidden by clothing. Most ambulances are required to carry disaster triage checklists and color coding material

So the answer to this question is C


Instruction:
Tibial Fracture with > 1 cm wound, slight comminution and moderate crushing is
A. Grade I
B. Grade II
C. Grade III A
D. Grade III B

Response:
B i.e. Grade II

So the answer to this question is B


Instruction:
Injury to cervical sympathetic trunk produces Horner's syndrome, that includes all, except
A. Anhydrosis
B. Enopthalmos
C. Ptosis
D. Mydriasis

Response:
Injury to cervical Symphathetic trunk (which are formed by T1 to T4 fibres of spinal cord) produces Horner's syndrome. It is characterized by
• ptosis (dropping of the upper eyelid)
• miosis (constriction of pupil)
• anhydrosis (loss of sweating)
• enophthalmos (retraction of eye ball)

So the answer to this question is D


Instruction:
The hertwig's epithelial root sheath is essential to development of the root because it
A. Gives rise to cementoblasts that produce cementum of the root
B. Moulds the shape of roots and stimulates differentiation of odontoblasts
C. Given rise to odontoblasts that lay down dentin of the root
D. Remains as an essential constituent of the periodontal ligament

Response:
None

So the answer to this question is B


Instruction:
An 18-year-old-female patient with swelling and pain in the mandibular third molar area will most likely to have:
A. juvenile periodontitis
B. pericoronitis
C. pregnancy epulis
D. plasma cell gingivitis

Response:
None

So the answer to this question is B


Instruction:
A 60-year-old man came to emergency with sudden-onset cough with yellow sputum production and dyspnea.He is taking amlodipine for hypeension. Chest X-ray shows a left upper lobe alveolar infiltrate and investigations shows Hb of 6g/dL, BUN of 60 mg/dL, Creatinine of 2.8 mg/dL, Calcium of 12.3 mg/dL, total protein of 9 g/dL and albumin of 4.2 g/dL.On Echocardiogram dilated hea is seen and peripheral neuropathy is also present. Most common cause of death in the above described disease is:
A. Infection
B. Bleeding
C. CHF
D. Kidney failure

Response:
Patient is having multisystem illness pointing to the diagnosis of Multiple myeloma which is causing amyloidosis leading to above clinical manifestation Components of end organ damage in multiple myeloma:C - Hypercalcemia > 11 mg%R - Renal failure: Uremia (Creatinine > 2 mg%)A - AnemiaB - Bony Lytic lesions and not bleeding manifestations. Most frequent cause of death in multiple myeloma is infection (24 to 52% patients) and renal failure (20% of patients). Most common organism involved: Gram negative bacilli > Staph. aureus > Capsulated organisms. Note: Extra edge Cytokines involved in pathogenesis of Multiple myeloma : IL-6 Cause of renal failure in multiple myeloma : Hypercalcaemia > Amyloidosis MC infection in M.M. : Pneumomia Anion gap is reduced in multiple myeloma. Bone marrow biopsy- allow evaluation of the percentage of plasma cells in bone marrow and aid in diagnosis of multiple myeloma Multiple myeloma is associated with amyloid AL. Light chains most commonly deposit in the hea, kidneys, liver, and nervous system, causing organ dysfunction. Biopsy- shows classic eosinophilic material that, when exposed to Congo red stain, has a characteristic apple-green birefringence. Best test for prognosis of multiple myeloma : serum Beta 2 microglobulin Inclusion bodies seen in plasma cells in multiple myeloma : Dutcher bodies : Intranuclear Russell bodies : Intracytoplasmic

So the answer to this question is A


Instruction:
Drugs used in CHF -
A. Nesiritide
B. Digoxin
C. Spironolactone
D. All

Response:
Ans. is 'a' i.e., Nesiritide; 'b' i.e., Digoxin; 'c' i.e., Spironolactone

So the answer to this question is D


Instruction:
Preload measures?
A. End systolic volume
B. End diastolic volume
C. Peripheral resistance
D. Stroke volume

Response:
ANSWER: (B) End diastolic volumeREF: Guytons physiology 22nd edition page 111, http://en.wikipedia.org/wiki/Preload_% 28cardiology%29"For cardiac contraction, the preload is usually considered to be the end-diastolic pressure when the ventricle has become filled"Quantitatively, preload can be calculated asLV EDT . LV EDR2hWhere LVEDP = Left ventricular end diastolic pressure, LVEDR = Left ventricular end diastolic radius (at the ventricle s midpoint), and h = thickness of the ventricle. This calculation is based on the Law of Laplace.

So the answer to this question is B


Instruction:
Which of the following is not a free radical scavenger -
A. Glutathione peroxidase
B. Superoxide dismutase
C. Catalase
D. Xanthine oxidase

Response:
Ans. is 'd' i.e., Xanthine oxidase o Glutathione peroxidase is primarily a scavanger of free radicals and catalyzes free radical breakdown (does not generates free radicals).o Superoxide dismutase is also a scavenger of free radical and converts superoxide into H,Ov Howrever, it is indirectly involved in generation of free radicals (see previous explanation). So, you keep in mind that SOD is primarily an antioxidant (free radical scavenger). But for this question, we can consider SOD to be involved in generation of free radicals (indirectly)as we have better option for our answer (glutathione peroxidase).Free radicalsGeneration of free radicalso H.O. - MPO - Halide system#NADPH oxidase#Myeloperoxidaseo Heber- Weiss reactiono Fenton's reactiono Xanthine oxidaseFree radical scavenging enzymeso Catalaseo Superoxide dismutaseo Glutathione peroxidase

So the answer to this question is D


Instruction:
What is the drug of choice for treating angle closure glaucoma?
A. Pilocarpine
B. Timolol
C. Dipiveffine
D. Apraclonidine

Response:
Ans. is 'a' i.e., Pilocarpine o Has been explained in previous sessions.

So the answer to this question is A


Instruction:
Folinic acid used in:
A. Methotrexate toxicity
B. Cisplatin toxicity
C. Vincristine toxicity
D. 5FU toxicity

Response:
Ref: Goodman & Gillman's 13th ed. P 1177* Folic acid is an essential dietary factor which is converted to FH4 by DHFR enzyme and provide methyl groups for the synthesis of precursors of DNA.* Folic acid analogues such as MTX interfere with FH4 metabolism, thereby inhibiting DNA replication.* Adverse effects: Myelosuppression, GI toxicity.* Folinic acid (Leucovorin) can reverse toxic effects; used as "rescue" in high-dose therapy.* Glucarpidase, a methotrexate-cleaving enzyme, is approved to treat toxicity.

So the answer to this question is A


Instruction:
Choose the appropriate lettered structure in this CT scan of the abdomen at the level of the 12th thoracic vertebra. Which structure is divided into the proper hepatic and gastroduodenal arteries?
A. A
B. B
C. C
D. D

Response:
(a) The common hepatic artery is divided into the proper hepatic and gastroduodenal arteries.

So the answer to this question is A


Instruction:
Delusion of infidelity of pa of the sexual paner is known as:
A. De Clerambault's syndrome
B. Couvade syndrome
C. Othello syndrome
D. Ekbim's syndrome

Response:
C. i.e. Othello syndrome

So the answer to this question is C


Instruction:
In a slow sand filter, the element responsible for yielding bacteria-free water is the -
A. Valve
B. Vital layer
C. Supernatant water
D. Under-drainage system

Response:
Ans. is 'b' i.e., Vital layer

So the answer to this question is B


Instruction:
Prefabricated pontics are commercially available as:
A. Metal pontics.
B. Ceramic pontics.
C. Porcelain pontics.
D. Any of the above.

Response:
None

So the answer to this question is C


Instruction:
Immediate treatment of hypercalcemia of malignancy is
A. IV Fluids
B. Bisphosphonates
C. Calcitonin
D. Glucocorticoids

Response:
Drug of choice for hypercalcemia of malignancy is Bisphosphanates but immediate treatment involves administration of IV fluids.

So the answer to this question is A


Instruction:
For the following medical conditions, select the associated acid base disturbances.Sepsis.
A. metabolic acidosis and respiratory acidosis
B. metabolic acidosis and respiratory alkalosis
C. metabolic alkalosis and respiratory acidosis
D. metabolic alkalosis and respiratory alkalosis

Response:
Sepsis can cause cardiovascular insufficiency with lactic acidosis, whereas fever and endotoxemia stimulate the respiratory center, causing respiratory alkalosis.

So the answer to this question is B


Instruction:
A health assistant (male) covers a population of -
A. 1,000
B. 5,000
C. 30,000
D. 1,00,000

Response:
- the suggested norm of health assistant male is 1 per 30,000 population in plain area and 20,000 population in tribal or hilly areas. - he provide suppoive supervision to 6 health workers. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:900 <\p>

So the answer to this question is C


Instruction:
The most common cause of class II malocclusion:
A. Sleeping habits
B. Growth discrepancy
C. Thumb and tongue thrusting
D. Tooth to jaw size discrepancy

Response:
The class II division 2 pattern is known to have a strong familial occurrence. Peck and Peck called it a heritable entity of small teeth in well-developed jaws. According to their findings, the pattern of strong vertical posterior development of the mandible with upward and forward rotation and skeletal-facial hypo-divergence anteroposteriorly, smaller mesio-distal tooth diameters for the maxillary and mandibular incisors are characteristic pattern of heritable skeletal and tooth-size features in class II division 2 malocclusion. These findings indicate the presence of strong genetic influences in the formation of Angle’s class II division 2 overbite discrepancies.
Orthodontics: Diagnosis and Management of Malocclusion and Dentofacial Deformities
THIRD EDITION Om P. Kharbanda P: e 2874

So the answer to this question is B


Instruction:
Which of the following is weakest antigen
A. Nucleic acids
B. Proteins
C. Carbohydrates
D. Lipids

Response:
Proteins are stronger immunogens followed by carbohydrates, Lipids, Nucleic acids.

So the answer to this question is A


Instruction:
Tumbling motility is shown by:
A. Proteus vulgaris
B. Proteus mirabilis
C. Vibrio
D. Listeria

Response:
Listeria

So the answer to this question is D


Instruction:
Plaster mix:
A. Rapid spatulation results in decreased setting time
B. 2% potassium sulphate is accelerator
C. Citrates are retarders
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
Boundries of foramen of Winslow is formed by all except ?
A. IVC
B. Liver
C. 2nd pa of duodenum
D. Suprarenal gland

Response:
Ans. is 'c' i.e., 2nd pa of duodenum

So the answer to this question is C


Instruction:
Most common agent responsible for Bronchiolitis is -
A. RSV
B. Adenovirus
C. Herpesvirus
D. Influenza virus

Response:
In 25-30 %to lower respiratory involvement, including tracheobronchitis, bronchiolitis, and one monia are due to respiratory syncytial virus REF:ANANTHANARYANAN TEXTBOOK OF MICROBIOLOGY 9EDITION PGNO.511

So the answer to this question is A


Instruction:
When used in the management of inflammatory disorders, glucocorticoids are likely to cause
A. hypoglycemia
B. decreases in blood pressure
C. anabolic actions in wound healing
D. increase in intraocular pressure

Response:
Ocular side effects of glucocorticoids include the development of cataracts and glaucoma through increases in IOP. All of the other effects listed are "opposites," so anticipate possible hyperglycemia, hypertension, decreased wound healing, and CNS excitatory effects that have been interpreted as psychosis.

So the answer to this question is D


Instruction:
Schuffner's dots are seen in infection due to
A. Plasmodium falciparum
B. Plasmodium vivax
C. Plasmodium malariae
D. Plasmodium ovale

Response:
Plasmodium vivax induces morphologic alterations in infected host erythrocytes that are visible by light microscopy in Romanowsky-stained blood smears as multiple brick-red dots.
These morphologic changes, referred to as Schüffner's dots, are important in the identification of this species of malarial parasite and have been associated by electron microscopy with caveolae vesicle complexes along the erythrocyte plasmalemma.

Ref :https://en.wikipedia.org/wiki/Sch%C3%BCffner%27s_dots#:~:text=Sch%C3%BCffner's%20dots%20refers%20to%20a,Plasmodium%20ovale%20or%20Plasmodium%20vivax

So the answer to this question is B


Instruction:
Defect in Gluteus Maximus lead to all of the following, EXCEPT:
A. Positive Trendelenburg's sign
B. Extension defect
C. Difficulty in straightening from the bending position
D. Difficulty rising from the sitting position

Response:
Positive trendelenburg's sign is seen in superior gluteal nerve (Gluteus mediusminimus) injury and not in Inferior gluteal nerve injury (Gluteus maximus). The gluteus maximus is the most powerful hip extensor and is crucial for movements requiring large forces. It functions primarily between the flexed and the standing positions, as when rising from the sitting position, straightening from the bending position, walking uphill and upstairs, running and jumping.

So the answer to this question is A


Instruction:
The clot formed after coagulation cascade is not stable unless extensive cross linking occurs. This is done by -
A. Plasmin
B. Factor XIII
C. Thrombin
D. High molecular weight kininogen

Response:
. Factor XIII

So the answer to this question is B


Instruction:
Life span of LNGIUD is -
A. 2 years
B. 5 years
C. 10 years
D. 12 years

Response:
Ans. is 'b' i.e., 5 years IUDsLife spanFirst generation:Lippe's loop (obsolete)--Second generationCopper-T--CuT-200-B4 yrCuT-2003yrCuT-220C--Nova-T5 yrMultiload - 2503 yr3755 yrCuT-3 80A10 yrThird generationProgestasert1 yrLNG-20 (Mirena)5 yr (Ref: Novak p263; Note that Park mentions the life span of mirena to be 10 yrs)

So the answer to this question is B


Instruction:
About CSF following statement (s) is/ are true:
A. Specific gravity is 1.003 - 1.0008
B. Daily production is 550 ml/day
C. Total volume of CSF is 150 ml
D. All

Response:
A, C, & B i.e. Specific gravity is 1.003 - 1.0008, Total volume of CSF is 150 ml , & Daily production is 550 ml/day

So the answer to this question is D


Instruction:
The structure that passes between middle cerebellar peduncle and pons is
A. Trigeminal nerve
B. Vagus nerve
C. Olfactory nerve
D. Optic nerve

Response:
Trigeminal nerve exits the brain by a large sensory root and a smaller motor root coming out of the pons at its junction with the middle cerebellar peduncle.(Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg-81, fig 8.9)

So the answer to this question is A


Instruction:
Which of the following is seen in intrauterine death?
A. Hypertension
B. DIC
C. Increase in fundal height of uterus
D. Increased uterine tone

Response:
Ans: b (DIC) Ref: Dutta, 6th ed, p. 325If the fetus is retained for more than 4 weeks there is possibility of silent DIC. It is due to gradual absorption of thromboplastin liberated from dead placenta and decidua, into the maternal circulation.Intrauterine deathSymptoms - Absence of fetal movementSigns - Egg shell cracking feel of fetal head- FHS absent- Uterine tone diminished- Gradual retrogression of the height of fundus- Appearance of gas shadow (Robert sign) in large vessel - Earliest sign (12 hrs)- Blistering and peeling of skin - 12-24 hrs- Spalding sign- Hyperflexion of spine- Crowding of ribs

So the answer to this question is B


Instruction:
Kehr&;s sign is seen in-
A. Splenic trauma
B. Hepatic trauma
C. Renal trauma
D. Paccreatic trauma

Response:
Ans. is 'a' i.e., Splenic trauma o In splenic rupture the pain may be referred to the tip of the left shoulder. o This is known as Kehr's sign. o It occurs due to irritation of the undersurface of the diaphragm with blood and the pain is referred to the shoulder through the affected fibres of phrenic nerve (C4 and C5). o Kehr's sign can be elicited by bimanual compression of the left upper quadrant after the patient has been in Trendelenburg's position for about 10 minutes prior to the maneuver.

So the answer to this question is A


Instruction:
Trachoma is characterized by A/E :
A. Epithelial Keratitis
B. The corneal lesion is pannus
C. Pits in limbus in late stage
D. Follicle formation is a late stage

Response:
Ans. is 'd' ie Follicle formation is a late stage Entropion of upper eyelids is seen in trachoma (not ectropion) Trachoma is a specific type of contagious Kerato conjunctivitis caused by chlamydia trachomatis*. Characteristic features: Conjunctiva: follicles*, diffuse papillary hyperplasia * Follicles appear in the palpebral conjunctiva and occasionally on bulbar conjunctiva. Follicles on bulbar conjunctiva in pathognomic of ds* Cornea : Pannus* Herbert's pits at limbus* Me Callan's staging Tr O - Trachoma free (no sign of trachoma)* Tr D - Trachoma dubium (trachoma cannot be distinguished from nontrachomatous conjunctivitis)* Tr I - Stage I (Incipient trachoma) - earliest stage of ds* Tr II - Stage II (Manifest trachoma)* Tr IIl- Stage III (Healing trachoma) cicatrization and scarring* Tr IV- Stage IV (Healed trachoma)*

So the answer to this question is D


Instruction:
Which of the following has no Tm value ?
A. Albumin, arginine
B. Betahydroxybutyrate, glucose
C. Glucose haemoglobin, phosphate
D. Urea

Response:
D i.e. Urea

So the answer to this question is D


Instruction:
Which of the following protein binds to free heme?
A. Ceruloplasmin
B. Haptoglobin
C. Hemopexin
D. Hemosiderin

Response:
Ans: c) Hemopexin Option analysis: Binding protein Ceruloplasmin is a copper containing protein Haptoglobin Free Haemoglobin Hemosiderin Denatured ferritin Hemopexin is a b1-globulin that binds free heme

So the answer to this question is C


Instruction:
Swine flu is caused most commonly by
A. HIN,
B. H5N,
C. H3N2
D. B virus

Response:
Ans. is 'a' i.e., HiNi Swine flu Swine flu, also called swine influenza, or pig influenza, is caused by influenza virus. It is mainly occurs in swines (pigs) and occasionally transmitted to human. It is usually caused by influenza virus type A (Hi-NI). Incubation period is about 1-3 days and the symptoms of swine flu in humans are similar to most influenza infections, e.g. fever, cough, rhinorrhea, fatigue and headache. Other influenza virus causing swine flu, occasionally, are H,N2, H2N,, 1-13N2 and H2N3

So the answer to this question is A


Instruction:
A 25 year old male presents to emergency dept. following a road traffic accident. On examination there is pelvic fracture and blood at urethral meatus. Following are true about pt except -
A. Anterior urethra is the most likely site of injury
B. Retrograde urethrography should be done after the pt is stabilized.
C. Foley catheter may be carefully passed if the RGU is normal
D. Rectal examination may reveal a large pelvic hematoma with the prostate displaced superiorly

Response:
Ans is (a) anterior urethra is most likely the site of injury The pa of urethra most likely injured in pelvic fracture is membranous urethra (a pa of post. urethra) - Post. Urethra includes -- Prostatic + membranous urethra - Anterior urethra includes -- Bulbar + penile urethra The anterior urethra (paiularly bulbar urethra) is injured due to direct blow to the perineum (straddle injuries*) About other options ? (d) Prostate is displaced superiorly (high lying prostate) in membranous urethral injury due to rupture of puboprostatic fascia. Pelvic hematoma is seen in membranous urethral injuries (Perineal hematoma is seen in bulbar urethral injury) (b) Once an urethral injury is suspected the pt. is instructed not to pass urine and a RGU or ascending urethrogram is performed to assess the injury. (c) Catheterisation is contraindicated and is passed only if the RGU is normal.

So the answer to this question is A


Instruction:
The most common location of hypeensive intracranial haemorrhage is:
A. Subarachnoid space
B. Basal ganglia
C. Cerebellum
D. Brainstem

Response:
Ans. Basal ganglia

So the answer to this question is B


Instruction:
Which of the follow ing drugs is contraindicated in a patient with raised intracranial pressure ?
A. Thiopentone
B. Propofol
C. Midazolam
D. Ketamine

Response:
Ans. is 'd' i.e., Ketamine o Cerebral blood flow, metabolism, oxygen consumption and ICT all are increased by ketamine - ketamine is contraindicated in raised ICT.o Ketamine increases cerebral blood flow, metabolism, oxygen consumption and intracranial tension, unlike thiopentone, propofol&etomidate, which have cerebroprotectiveeffect, therefore ketamine is contraindicated in head injury, intracranial space-occupying lesions and for neuroanaesthesia.Ketamineo The primary site of action is in the cortex and subcortical areas; not in the reticular activating system (site of action of barbiturates),o It acts on NMD A receptors.o Short duration of action (10-15 minutes) is due to redistribution from brain and blood to other tissues of the body,o Ketamine is different from most other anaesthetic induction agents in that it has significant analgesic action.o Ketamine increases IOT and cerebral metabolism - contraindicated in head injury.o It causes sympathetic stimulation with elevation of HR, CO & BP - contraindicated in hypertension and ischemic heart disease.o It also raises IOT - contraindicated in glaucoma.o It relieves bronchospasm - intravenous anaesthetic of choice in asthmatics (inhalation anaesthetic of choice in asthmatic is halothane).o Injection is not painful (All other inducing agents cause pain on injection),o It is i.v. anaesthetic of choice in child ren (Sevoflurane is inhalation agent of choice).o Because it causes sympathetic stimulation it is intravenous anesthetic of choice in patients with shock and hypovolemia.o It has no muscle relaxant property rather muscle tone is increased.o Airway reflexes (pharyngeal and laryngeal) are not depressed - intravenous anaesthetic of choice for emergency anaesthesia (no starvation is required).o Ketamine produces emergence reaction during awakening from anesthesia - vivid dreaming, illusions, extracorporeal experiences, excitement, confusion, fear and euphoria - contraindicated in psychiatric illness like schizophrenia.

So the answer to this question is D


Instruction:
True about pugilistic attitude: MP 09; PGI 10
A. Indicate antemoem burns
B. Indicate postmoem burns
C. Cannot differentiate between ante- or postmoem
D. Indicate defense by victim

Response:
Ans. Cannot differentiate between ante- or postmoem

So the answer to this question is C


Instruction:
Which thyroid carcinoma is most commonly associated with cervical lymphadenopathy
A. Follicular carcinoma
B. Anaplastic carcinoma
C. Medullary carcinoma
D. Papillary carcinoma

Response:
None

So the answer to this question is D


Instruction:
Action of quadratus femoris is -
A. Extension
B. Flexion
C. Lateral rotation
D. Medial rotation

Response:
Ans-C

So the answer to this question is C


Instruction:
Acute complication of PEM -
A. Hypothermia
B. Hypoglycemia
C. Hypokalemia
D. All

Response:
Ans. is 'a' i.e., Hypothermia; 'b' i.e., Hypoglycemia; 'c' i.e., Hypokalemia Acute complications of malnutrition (Mnemonic - SHIELDED) S --> Sugar deficiency, i.e. Hypoglycemia H --> Hypothermia I --> Infection and septic shock FL --> Electrolyte imbalance ---> reduced intracellular sodium, hypokalemia & hypomagnesemia. FE --> Dehydration --> Deficiency of iron, vitamins and other micronutrients.

So the answer to this question is D


Instruction:
A client is prescribed with Pentamidine (Pentam) IV for the treatment of Pneumocystis carinii pneumonia. Suddenly, the client develops a temperature of 101.5°F. The nurse in charge knows that this sign would mostly indicate on which of the following?
A. An overdosage of the medication.
B. The need for an additional dosage.
C. The client has developed another infection.
D. The client is experiencing the therapeutic effect of the medication.

Response:
Pentamidine can cause low white blood cells or low platelets in your blood, so the client is most likely developed another infection brought about these side effects.

Options A, B, and D are inappropriate interpretation.

So the answer to this question is C


Instruction:
Long term side effect of glucocorticosteroids:
A. Hepatotoxicity
B. Osteoporosis
C. Precocious puberty
D. Lupus like syndrome

Response:
Ans. B. OsteoporosisGlucocorticosteroid have many side effects like Cushing syndrome hyperglycemia, osteoporosis, delay in wound healing, increase in infection and many other.

So the answer to this question is B


Instruction:
False statement regarding Lithium is:
A. Maximum plasma concentration is avoided due to low therapeutic index
B. Contraindicated in pregnancy
C. No individual variation in the rate of excretion
D. 80% reabsorbed in the proximal convoluted tubule

Response:
There is marked individual variation in the rate of lithium excretion. Thus, with the same daily dose, different individuals attain widely different Antimanic Drugs 435 plasma concentrations. However, in an individual the clearance remains fairly constant. Since the margin of safety is narrow, monitoring of serum lithium concentration is essential for optimal therapy. Serum lithium level is measured 12 hours after the last dose to reflect the steadystate concentration; 0.5-0.8 mEq/L is considered optimum for maintenance therapy in bipolar disorder, while 0.8-1.1 mEq/L is required for episodes of mania. Toxicity symptoms occur frequently when serum levels exceed 1.5 mEq/L. Ref: KD Tripati 8th ed.

So the answer to this question is C


Instruction:
An 18-month old developed acute gastroenteritis with fever and watery diarrhea that lasted 10 days. She had been vaccinated against rotavirus at 2 and 4 months of age as recommended. Eight days later, both of her brothers, ages 3 and 6, developed acute gastroenteritis. Which of the following tests would most likely reveal the etiologic agent of their gastroenteritis?
A. Culture for Norovirus
B. DFA for enterovirus on intestinal biopsy
C. EIA for adenovirus 40/41
D. EM examination of stool for astrovirus

Response:
The lack of vomiting, duration of her symptoms, and timing of onset of her brothers' symptoms described in the clinical vignette, and her up-to-date immunization against rotavirus strongly suggest that adenovirus is the etiologic agent. Therefore, an EIA for adenovirus types 40/41 (c) is the best test. Rotavirus and Norovirus infections can also be diagnosed by EIA; however, culture for Norovirus (a) is not available and serology for Rotavirus (e) would be expected to be positive due to her immunizations. An EM examination of stool for astrovirus (d) would not likely be available in most clinical settings, although EM can also reveal Rotavirus, Norovirus and other caliciviruses, and adenovirus. Enteroviruses, although they infect cells of the intestinal tract, do not usually cause acute gastroenteritis. A DFA for enterovirus on intestinal biopsy (b) would not likely be helpful in establishing the etiologic agent. See the table in the answer to question 114 for additional information.

So the answer to this question is C


Instruction:
The usual site of stress fracture includes
A. Tibia
B. First metacarpal bone
C. Second metacarpal bone
D. Second metatarsal bone

Response:
D. i.e. Second metatarsal bone

So the answer to this question is D


Instruction:
Auer rods are seen in which AML
A. M0
B. M3
C. M5
D. M7

Response:
None

So the answer to this question is B


Instruction:
Most common malignancy in children is-
A. Acute Myeloid Leukemia
B. Acute Lymphoblastic leukemia
C. Neuroblastoma
D. Medulloblastoma

Response:
Ans. is 'b' i.e., Acute Lymphoblastic leukemiao Repeat from previous sessions.

So the answer to this question is B


Instruction:
Treatment of choice of Kawasaki disease:
A. Intravenous immunoglobulin
B. Prednisolone
C. Dapsone
D. Methotrexate

Response:
Ans. a. Intravenous immunoglobulin (Ref: Nelson 19/e p863; Harrison 19/e p2192, 18/e p2800; Fitzpatrick7/e p1626-1632)Treatment of choice of Kawasaki disease is intravenous immunoglobulin."Intravenous immunoglobulin (IV Ig) is given in Kawasaki disease, GBS and Myasthenia gravis."Kawasaki disease is generally common in children, not in adults.DiseaseAffected Age GroupTakayasu arteritisYounger than 50 yearsSusac syndromeAdults, 20-40 yearsHenoch-Scbonlein purpuraChildren and young adultsKawasaki diseaseChildren'Susac's syndrome (Retinocochleocerebral Vasculopathy) is a microangiopathy characterized by encephalopathy, branch retinal artery occlusions and hearing loss. The cause is unknown but the current thinking is that antibodies are cproduced against endothelial cells in tiny arteries, which leads to damage and the symptoms related to the illness. The syndrome usually affects women around the age of 18 years old, with female to male ratio of cases of 2:1.' Immune-Mediated VascuiitidesTypeExamplesDescriptionLarge vessel VasculitisGiant-cell(temporal)arteritisQ* Granulomatous inflammation: frequently involves the temporal arteryQ.* Usually occurs in patients older than age 50* Associated with polymyalgia rheumatica.Aorta and large branches to extremities, head and neckTakayasuarteritisQ* Granulomatous inflammation* Usually occurring in patients younger than age 50Medium vessel VasculitisPolyarteritisnodosaQ* Necrotizing inflammation* Typically involving renal arteries but sparing pulmonary vesselsQMain visceral arteries and their branchesKawasakidiseaseQ* Arteritis with mucocutaneous lymph node syndromeQ: usually occurs in childrenQ.* Coronary arteries can be involved with aneurysm formation and/or thrombosisQ.Small vessel VasculitisWegenergranulomatosis* Granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small vessels, including glomerular vessels.* Associated with PR3-ANCAsQ.Arterioles, venules, capillaries, and occasionally small arteriesChurg-Strausssyndrome* Eosinophil-rich granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small vesselsQ.* Associated with asthma and blood eosinophilia. Associated with MPO-ANCAsQ Microscopicpolyangitis* Necrotizing small-vessel vasculitis with few or no immune deposits; necrotizing arteritis of small and medium-sized arteries can occurQ.* Necrotizing glomerulonephritis and pulmonary capiliaritis are common.* Associated with MPO-ANCAsQ.Kawasaki (Mucocutaneous-Lymph Node) SyndromeAcute multisystem vasculitis of unknown etiologyAssociated with marked activation of T cells and monocyte or macrophages.Primarily an illness of young children ranging from 7 weeks- 12 years, with - 80% being younger than 5 years of ageQ.Male: female = 1.5: 1.Three Clinical phases of Kawasaki SyndromeAcute febrile phase:Ends with resolution of fever in 7-14 daysQIt has conjunctival injection, mouth and lip changes, erythema of hand and feet, rash and cervical lymphadenopathyQ.Subacute phase:From end of fever to 25 daysIt has desquamation, arthralgia, arthritis and thrombocytosisConvalescent phase:From disappearance of clinical sign to normalcy of ESR (usually 6- 8 weeks after onset of illness).Associated features/Complications:Cardiovascular manifestations are leading cause of morbidity and mortalityQ and include myocarditis, arterial aneurysm, pericarditis, MR, AR. ventricular arrhythmias.Arthralgia and arthritisUrethritis with sterile pyuriaAseptic meningitisHydrops of gall bladderDiarrhea, vomiting or abdominal painSensorineural hearing lossUveitisHepatic dysfunctionDiagnostic Criteria of Kawasaki SyndromeSymptomOccurrence (%)Fever lasting > 5 days (with spikes) plus at least 4 of the following:1001. Bilateral painless bulbar non exudative conjunctival injectionQ922. Oro-pharyngeal mucous membrane changes (> 1)- Cherry red (injected) or fissured LipsQ (+-drying, cracking and fissuring)- Injected (red) pharynx- Strawberry tongueQ (i.e. hypertrophic tongue papillae with hyperemia)1008472323. Extremity changes (>1)- Erythema of palms or soles- Edema (non pitting) of hands or feetQ(tenderness may limit walking and hand use)- Desquamation (perigenital and perineal followed by periungual, starting at the tips of finger)Q.724856Diagnostic Criteria of Kawasaki Syndrome SymptomOccurrence (%)4. Rash: polymorphous erythematous exanthema1005. Acute non-suppurative cervical lymphadenopathy (>1 node, > 1.5 cm in diameter)72Treatment:Treatment of choice in KS in first 10 days of fever is intravenous gamma-globulin/ immunoglobulin (IVGG or IVIG) as a large single dose of 2gm/kg given over 10-12 hours plus high dose aspirin (80-100 mg/kg/ day in four doses)Q.It reduces risk of coronary artery disease from 20% to <5%.Aspirin is reduced to antithrombotic (3-5 mg/kg/day as single dose) in 14 days when fever has resolved and can be discontinued after 6-8 weeks if Echo shows no evidence of coronary artery disease. And if abnormality is detected, low dose aspirin is continued indefinitelyQ

So the answer to this question is A


Instruction:
Staphylococcus is localised in which of the following infections
A. SSSS
B. TSS
C. Scarlatina
D. Carbuncle

Response:
Staphylococcal infections are characteristically localised pyogenic lesions. The common localised pyogenic staphylococcal infections are: Skin and soft tissue infections: Folliculitis, furuncle, abscess, wound infection, carbuncle, impetigo, paronychia and less often cellulitis. Musculoskeletal: Osteomyelitis, ahritis, bursitis and pyomyositis Respiratory: Tonsillitis, pharyngitis, sinusitis, otitis, bronchopneumonia, lung abscess, empyema and rarely pneumonia CNS: Abscess, meningitis and intracranial thrombophlebitis Endovascular: Bacteremia, septicemia, pyemia and endocarditis Urinary: UTI Ref: Textbook of Microbiology; Ananthanarayanan and Panicker; 10th Edition page 204

So the answer to this question is D


Instruction:
All of the following is used as accelerator in zinc oxide eugenol cement except
A. Acetic acid
B. Zinc acetate dehydrate
C. Calcium chloride
D. Bromoglycerine

Response:
None

So the answer to this question is D


Instruction:
Drug of choice for the treatment of hyperthyroidism in pregnancy is:
A. Propylthiouracil
B. Radio iodine
C. Carbimazole
D. Iodides

Response:
None

So the answer to this question is A


Instruction:
Which of the following drug can be used for closure of patent ductus aeriosus?
A. Paracetamol
B. Alprostadil
C. Indomethacin
D. Celecoxib

Response:
PGE2 and PGI2 keeps ductus aeriosus patent. If ductus aeriosus fails to close (patent ductus aeriosus) at bih, NSAIDs like aspirin and indomethacin are given to close it. In some congenital hea diseases (like transposition of great vessels), it becomes essential to keep ductus aeriosus patent before surgery. For this indication, alprostadil (PGE1) and epoprostenol (PGI2) can be given intravenously.

So the answer to this question is C


Instruction:
In assessing LUTS in men, which of the following statements are false?
A. Chaing patient's symptoms according to the International Prostate Symptom Score (IPSS) is routinely used.
B. Flow rate measurement studies and pressure-flow urodynamic studies are done.
C. Thorough nervous system examination is mandatory.
D. Cystourethroscopy is a good guide as an indication for surgery.

Response:
Cystourethroscopy does not give any guide as to the degree of BOO and the need for surgery. Causes of male lower urinary tract symptoms (LUTS) Obstruction: - Benign Prostatic Obstruction - Foreign Body - Urethral Stricture Primary Bladder Pathology: - Overactive Bladder - Detrusor Underactivity Infectious: - Urinary Tract infection - Prostatitis Malignant: - Bladder tumor - Prostate Cancer Neurogenic bladder dysfunction Diuretic causes:- - Diabtes - Noctumal Polyuria Extra-vesicle cause: - Distal Ureteric Stone

So the answer to this question is D


Instruction:
"Inverted beer bottle appearance" is seen in
A. Lipodermatosclerosis
B. Sporotrichosis
C. Actinomycosis
D. Filariasis

Response:
Lipodermatosclerosis or venous eczema is characterized by increased venous pressure (as in DVT, varicose veins) which allows escape of RBCs,WBCs and fibrinogen outside the vessels causing inflammatory changes over the skin.
This is seen typically over the ankle region giving "Inverted beer bottle appearance".

So the answer to this question is A


Instruction:
"Bone within a Bone" appearance is
A. Osteogenesis imperfecta
B. Osteopetrosis
C. Scurvy
D. Rickets

Response:
Osteopetrosis

So the answer to this question is B


Instruction:
Billing's method of contraception refers to:
A. Monitoring BBT
B. Cervical mucus method
C. Rhythm method
D. Coitus interruptus method

Response:
None

So the answer to this question is B


Instruction:
Casoni test is:
A. Type I Hypersensitivity reactions
B. Type II Hypersensitivity reactions
C. Type III Hypersensitivity reactions
D. Type IV Hypersensitivity reactions

Response:
Type I Hypersensitivity reactions

So the answer to this question is A


Instruction:
BRCA- 1 gene is associated with -
A. Lobular carcinoma
B. Mucinous carcinoma
C. Tubular carcinoma
D. Papillary carcinoma

Response:
Answer- B. Mucinous carcinomaFamilial cancers (or around 3% of all breast cancer) can be attributed to two highly penetrant autosomal dominant genes BRCA-1 on chromosome 17 (52%) and BRCA-2 on chromosoine 13.

So the answer to this question is B


Instruction:
Not a histological feature of lichen planus is -
A. Acanthosis
B. Hyperkeratosis
C. Neutrophils in stratum corneum
D. Pigment incontinence

Response:
LICHEN PLANUS:-Inflammatory T cell mediated auto immune disorder affecting skin, hair,nails and mucous membranes.Histology:-1. Irregular acanthosis of the epidermis.2. Hypergranulosis- wedge shaped3. Compact hyperkeratosis.4. Basal cell degeneration5. Colloid bodies6. Pigment incontinence.7. Band like lympho histiocytic infiltrate obscuring the dermoepidermal interface.{Reference: IADVL textbook of dermatology,page 1070 neutrophils in stratum corneum - munro micro abcess seen in psoriasis

So the answer to this question is C


Instruction:
Buspirone is used as a/an
A. Anxiolytic
B. Sedative
C. Muscle relaxant
D. Anticonvulsant

Response:
Busiprinone, is a medication primarily used to treat anxiety disorders, paicularly generalized anxiety disorder. Benefits suppo its sho term use. It is not useful for psychosis. It is taken by mouth, and it may take up to four weeks for an effect Ref KD Tripati 8th ed.

So the answer to this question is A


Instruction:
Treatment of choice for secondary hyperaldosteronism is:
A. Drug management
B. Unilateral adrenalectomy
C. Both
D. None

Response:
→ Primary hyperaldosteronism – Unilateral adrenalectomy.
→ Bilateral hyperplasia – Diuretics (water pills).
→ Secondary hyperaldosteronism – Drug management.

So the answer to this question is A


Instruction:
The regeneration of endometrial surface of uterus is completed - weeks after labour :
A. 1
B. 2
C. 3
D. 4

Response:
3

So the answer to this question is C


Instruction:
Carpopedal spasm with normal serum ionic calcium level is due to:
A. Hypomagnesemia
B. Hyponatremia
C. Hypokalemia
D. Acidosis

Response:
(A) Hypomagnesemia # Hypomagnesemia is an electrolyte disturbance in which there is an abnormally low level of magnesium in the blood.> Usually a serum level less than 0.7 mmol/l is used as reference. Hypomagnesemia is not equal to magnesium deficiency.> Causes: It may result from a number of conditions including inadequate intake of magnesium, chronic diarrhea, malabsorption, alcoholism, chronic stress, diuretic use and other disorders> Clinical Features: Deficiency of magnesium causes weakness, muscle cramps, cardiac arrhythmia, increased irritability of the nervous system with tremors, athetosis, jerking, nystagmus and an extensor plantar reflex. In addition, there may be confusion, disorientation, hallucinations, depression, epileptic fits, hypertension, tachycardia and tetany.

So the answer to this question is A


Instruction:
Fournier's gangrene affects
A. Cheek area
B. Perineal area
C. Abdominal wall
D. Toes

Response:
Ref:Bailey and love 27th edition Pg no :419

So the answer to this question is B


Instruction:
Hydatidiform - mole is characterized histologically by:
A. Hyaline membrane degeneration
B. Hydropic degeneration of the villous stroma
C. Non proliferation of cytotrophoblast
D. Non proliferation of syncytiotrophoblast

Response:
None

So the answer to this question is B


Instruction:
Concious proprioception is carried by :
A. Dorsal column fibres
B. Anterior spinothalamic tract
C. Anterior spinothalamic tract
D. Vestibular tract

Response:
A i.e. Dorsal column fibers

So the answer to this question is A


Instruction:
In Muller's maneuver to predict cephalopelvic disproportion (CPD)
A. The vaginal finger is at ischial spine
B. The vaginal finger is at sacral promontory and thumb at the pubic symphysis
C. The vaginal finger is at tip of sacrum
D. None of the above

Response:
Ans. a (The vaginal finger is at ischial spine) (Ref. Dutta Obst 6th/353)Muller introduced the abdominovaginal method of diagnosing CPD at the brim by placing the vaginal finger at the level of ischial spine to note the descent of the fetal head.Munro-Kerr added placement of the thumb over the synmphysis pubis to note the degree of overlapping.

So the answer to this question is A


Instruction:
Osteoporosis is characterized by-
A. Increased serum alkaline phosphatase
B. Decreased bone density
C. Wasting of muscles
D. Looser's zone seen

Response:
*Osteoporosis is characterized by an abnormally low bone mass and defects in bone structure, a combination of which renders the bone unusually fragile and at greater than normal risk of fracture. * Osteoporosis means "porous bones," causes bones to become weak and brittle -- so brittle - that even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture. * In most cases, bones weaken when low levels of calcium, phosphorus and other minerals in the bones and results as low bone density. * A common result of osteoporosis is fractures of the spine, hip or wrist. * Although it&;s often thought of as a women&;s disease, osteoporosis also affects many men. SYMPTOMS * Back pain, which can be severe if fractured or collapsed veebra_ # Loss of height over time, with an accompanying stooped posture # Fracture of the veebrae, wrists, hips or other bones Ref: Maheshwari 9thth/e p.308

So the answer to this question is B


Instruction:
A country has a population of 1000 million; bih rate is 23 and death rate is 6. In which phase of the demographic cycle does this country lie?
A. Early expanding
B. Late expanding
C. Plateau
D. Declining

Response:
This country has a high growth rate (Crude Bih Rate-Crude Death Rate) and therefore lies in an expanding phase. The stages of a demographic cycle whether 'early' or 'late' are based on relative terms like decreasing or increasing crude bih and death rates. The question here provides us only with absolute values, as given in this question (CBR=23 & CDR=6) are insufficient data to comment on the stage of demographic cycle, this country is in. A country with a 1000 million population like India, a bih rate of 23 is a declining rate, and a death rate of 6 is a decline fuher. Thus, this case can be placed in the late expanding phase, in which India currently is. Ref: Park's Textbook of Preventive and Social Medicine By K. Park, 19th Edition, Page 379.

So the answer to this question is B


Instruction:
All of the	following	are	dental	characteristics of a
skeletal class III malocclusion, except:
A. Anterior cross bite
B. Distocclusion
C. Linguoversion of the mandibular molars
D. Posterior cross bite

Response:
None

So the answer to this question is B


Instruction:
MC tumors of kidney in children?
A. Wilms tumor
B. Neuroblastoma
C. PCKD
D. Angioliposarcoma

Response:
Ans. (a) Wilms tumor(Ref: Nelson 20th ed/ pg 2466-68)Wilms tumor (WT), also known as nephroblastoma, is the most common primary malignant renal tumor of childhood; It is the second most common malignant abdominal tumor in childhood. The most common sites of metastases are the lungs, regional lymph nodes, and liver.

So the answer to this question is A


Instruction:
False regarding larvae of anopheles ?
A. Long siphon tube
B. Parallel to water
C. Palmate hairs
D. None of the above

Response:
Ans. is 'a' i.e., Long siphon tube

So the answer to this question is A


Instruction:
Diabetes mellitus diagnosed when?
A. Fasting blood glucose is 100 and post prandial 140
B. Fasting blood sugar 125 and 2 hour postprandial blood sugar is 199
C. Insulin level
D. Hb A1c > 6.5%

Response:
Ans. is 'd' i.e., Hba1c > 6.5%

So the answer to this question is D


Instruction:
Extradural haematoma is associated with what % of severe trauma -
A. 36%
B. 10%
C. 77%
D. 96%

Response:
"Epidural hematoma occur in upto 10% of severe head injury cases and are less often associated with underlying cortical damage than are subdural hematomas." - Harrison

So the answer to this question is B


Instruction:
All the following are TRUE about HCG except
A. Has luteotrophic action
B. Acts on the same receptors as LH
C. Secreted by cytotrophoblast
D. It is a glycoprotein

Response:
hCG is produced by syncytiotrophoblast of the placenta and secreted into the blood of both mother and fetus

So the answer to this question is C


Instruction:
Patient of juvenile myoclonic epilepsy on valproate comes to you at 5 months of pregnancy with level H scan normal what will you advise?
A. Change the drug
B. Continue the drug in same dose
C. Decrease the dose of drug
D. Increase the dose of drug

Response:
Ans. is 'b' i.e., Continue the drug in same dose Valproic acid has the risk of fetal malformations during the first trimester of pregnancy. This patient has normal level II scan at 5 months of pregnancy so the risk period of valproate is already over and valproate is the drug of choice in juvenile myoclonic epilepsy. Thus the drug shoud be continued in the same doses.

So the answer to this question is B


Instruction:
Receptor for BDNF -
A. TrK - A
B. TrK - B
C. TrK - C
D. None

Response:
Ans. (b) TrK-B(Ref: Ganong, 25th ed/p.95)NeurotrophinReceptorNerve growth factorTrk ABrain derived neurotrophic factorTrk BNeurotrophin 3Trk C, Trk BNeurotrophin 4/5Trk B

So the answer to this question is B


Instruction:
A 56-year-old woman with diabetes, hypertension, and hyperlipidemia is found to have an A1C of 11 despite her best attempts at diet and faithfully taking her metformin and glyburide. The patient mentions that she has been unable to exercise much, partially due to severe fatigue and sleepiness in the daytime. On examination she is obese, has a full appearing posterior pharynx, clear lungs, a normal heart examination, and trace bilateral edema. Reflexes and skin are normal. Her TSH is 2.0 m/L (normal). The patient asks if there is anything else that can be done before adding another oral agent or switching to insulin. What is the best next step?
A. Educate the patient on sleep hygiene to ensure better rest and more energy.
B. Prescribe zolpidem as a sleep aid to help her sleep and increase her energy to exercise during the day.
C. Explore for possible depression as a contributor to the fatigue which is keeping her from exercising.
D. Arrange for a sleep study to check the patient for obstructive sleep apnea.

Response:
Obstructive sleep apnea (OSA) that has gone untreated contributes to increased insulin resistance. This appears to have an additional effect even beyond the common cooccurrence of obesity as in this patient. Treatment of OSA can lead to improvement in glucose control. This patient is obese, has a crowded oropharynx on examination, and has daytime somnolence. Although overnight oxygen saturation monitor may be performed at home as screening, this patient is at high risk of complications of OSA should proceed directly to formal overnight polysomnography. Sleep hygiene is important for patients with sleep disturbance but is not likely to help in this patient with probable severe OSA. Similarly, sedative hypnotic agents such as zolpidem are widely prescribed for sleep but could exacerbate the OSA. Depression should always be explored but there are no clues beyond fatigue to suggest this diagnosis. Low vitamin D levels are generally asymptomatic unless the condition is severe and prolonged and would not affect sleep apnea or glucose control specifically.

So the answer to this question is D


Instruction:
The most definitive method of diagnosing pulmonary embolism is :
A. Pulmonary aeriography
B. Radioisotope perfusion pulmonary scintigraphy
C. EKG
D. Venography

Response:
Answer is A (Pulmonary aeriography): `Selective pulmonary angiography is the most specific examination available for establishing the definitive diagnosis of PE.'-Harriosn 16th/1563 Most definitive investigation :Pulmonary angiography is an invasive procedure, and it is the most definitive procedure. It is however ceainly not the initial investigation of choice. The initial investigation of choice in a case of suspected pulmonary embolism is either a lung ventilation perfusion scan or a CT of the chest with intravenous contrast. `CT scanning of the chest with intravenous contrast is the principal imaging test for diagnosis of PE.' - Harrison `Lung scanning (V/Q scan) is now a second line diagnostic test for PE' Most definitive / specific test for PE Q Best initial imaging test for diagnosis of PEdeg Pulmonary angiographyQ CT scan with intravenous contrast Q (Preferred choice, against a lung V-Q scan)

So the answer to this question is A


Instruction:
Which of the following is the investigation of choice for diagnosing carcinoma colon: September 2005
A. X-ray abdomen
B. CT scan
C. Colonoscopy
D. Barium enema

Response:
Ans. C: Colonoscopy Laboratory studies are done with a goal of assessing patients organ function (liver, kidneys) in anticipation of diagnostic and therapeutic procedures (imaging, biopsy, surgery, chemotherapy) and also to estimate tumor burden (CEA level). - Complete blood cell count - Chemistries and liver function tests - Serum carcinoembryonic antigen (CEA) should be obtained preoperatively as it carries prognostic value and when highly elevated may indicate more advanced, disseminated disease Adequate imaging of the chest and abdomen should be obtained for staging purposes, ideally preoperatively. - Chest radiograph or chest CT scan - Abdominal barium study to better delineate primary lesion preoperatively - Abdominal/ pelvic computerized tomography (CT scan), contrast ultrasound of the abdomen/liver, and abdominal/pelvic MRI are appropriate for imaging abdomen and liver, for the purpose of staging. - Positron emission tomography (PET) scans are emerging as a very useful modality for staging and assessment of colorectal cancers. The newest addition, a fusion PET-CT scan, allows for detection of metastatic deposits and has added tissue-based resolution of CT scan. A suspicion of colorectal cancer diagnosis warrants rectal examination and colonoscopy with a biopsy of suspicious lesion. Colonoscopy is the investigation of choice if colorectal cancer is suspected provided the patient is fit enough to undergo bowel preparation. - Sigmoidoscopy - Double contrast barium enema is indicated when colonoscopy is contraindicated.

So the answer to this question is C


Instruction:
The adenocarcinoma of esophagus-develops in
A. Barret's esophagus
B. Long standing achalasia
C. Corrosive structure
D. Alcohol abuse

Response:
In barrett's esophagus there is a metaplastic change in the esophageal mucus membrane. The resulting columnar epithelium is susceptible to the development of the adenocurcinoma. The risk of developing adenocarcinoma inBarret's esophagus is 50-100 time, that of general population. If 100 patients with Barrett's esophagus are followed prospectively for one year, one adenocarcionom can be expected in that group.Alcohol abuse, achalasia, lye stricture and smoking are all risk factors for the development of squamous carcinoma of the esophagus.

So the answer to this question is A


Instruction:
Alzheimer's disease is associated with:September 2012
A. Delerium
B. Delusion
C. Dementia
D. All of the above

Response:
Ans. C i.e. DementiaAlzheimer's dementiaCoical (NOT subcoical) dementia,Progressive,Associated with Apo E gene,Neurofibrillary tangles are seen andDonepezil is used in management

So the answer to this question is C


Instruction:
What is the rationale for combining levodopa with carbidopa
A. Carbidopa stimulates dopamine receptors
B. Carbidopa increases levodopa entry into CNS by inhibiting peripheral dopa decarboxylase
C. Carbidopa enhances levodopa absorption
D. Carbidopa blocks peripheral COMT

Response:
PERIPHERAL DECARBOXYLASE INHIBITORS Carbidopa and benserazide are extracerebral dopa decarboxylase inhibitors; they do not penetrate blood-brain barrier and do not inhibit conversion of levodopa to DA in the brain. Administered along with levodopa, they increase its t 1/2 in the periphery and make more of it available to cross blood-brain barrier and reach its site of action. Benefits of the combination are-- 1. The plasma t 1/2 of levodopa is prolonged and its dose is reduced to approximately 1/4th. 2. Systemic concentration of DA is reduced, nausea and vomiting are not prominent therapeutic doses of levodopa can be attained quickly. 3. Cardiac complications are minimized. 4. Pyridoxine reversal of levodopa effect does not occur. 5. 'On-off' effect is minimized since cerebral DA levels are more sustained. 6. Degree of improvement may be higher; some , patients not responding adequately to levodopa alone, also improve. Ref:- kd tripathi; pg num:-429,430

So the answer to this question is B


Instruction:
CPITN:
A. Was observed for the first time by ADA in 1992
B. Scored by a special periodontal probe of length 3 to 5 mm backward for easy visibility
C. Measure 6 representative teeth in young people
D. Score of '3' means the treatment involves oral hygiene instructions, scaling and curettage

Response:
None

So the answer to this question is C


Instruction:
Brush fire appearance of fundus is seen in
A. Toxoplasmosis
B. CMV retinitis
C. Chloroquine toxicity
D. Bacterial endocarditis

Response:
Ans. is 'b' i.e., CMV retinitis

So the answer to this question is B


Instruction:
Atropine should never be staed when the patient is cyanosed due to danger of :
A. Cerbral edema
B. Respiratory arrest
C. Ventricular fibrillation
D. None of the above

Response:
B i.e. Respiratory arrest

So the answer to this question is B


Instruction:
Narrow, high arches palate, prolonged retention of decidous teeth and failure in the eruption of permanent teeth are characteristic of:
A. Cherubim.
B. Cleidocranial dysplasia.
C. Paget's disease.
D. Marfan syndrome.

Response:
None

So the answer to this question is B


Instruction:
Calcium channel blockers are used in all, except -
A. Angina
B. Supraventricular tachycardia
C. Sick sinus syndrome
D. Hypeension

Response:
Ans. is 'c' i.e., Sick sinus syndrome o Calcium channel blockers suppress SA node automaticity --> can cause cardiac arrest in sick sinus syndrome.

So the answer to this question is C


Instruction:
All of the following are features of apoptosis, except
A. Inflammation is present
B. Chromosomal breakage
C. Clumping of chromatin
D. Cell shrinkage

Response:
In apoptosis chromosomal condensation, clumping, fragmentation, cell shrinkage, followed by cytoplasmic budding and phagocytosis of extruded apoptotic bodies occur.Since any products are not released directly rather than in apoptotic bodies an inflammatory reaction is not initiated in apoptosis. so option 1 is the answer.Robbins basic pathology 6th edition page.no:18

So the answer to this question is A


Instruction:
Alagile syndrome is characterized by
A. Bile duct paucity
B. IHBR dilation
C. PBC
D. PSC

Response:
Ans. (a) Bile duct paucityRef: Internet sources* Alagille syndrome is an autosomal dominant genetic disorder affecting liver and heart commonly.* Bile duct paucity is the common manifestation which results in Cirrhosis and Liver failure

So the answer to this question is A