Instruction:
Which of the following inhalational agents, is the induction agent of choice in children?
A. Isoflurane
B. Desflurane
C. Sevoflurane
D. Methoxyflurane

Response:
Sevoflurane is considered to be the inhalational induction agent of choice in children, since it has a pleasant, faster, and smooth induction with no significant systemic toxicity. Other drugs which can be used in children are are a mixture of oxygen and nitrous oxide or halothane. Ref: Synopsis of Pediatric Emergency Medicine By Gary Robe Fleisher, 4th Edition, Page 34; Textbook of Anesthesia for Postgraduates By T. K. Agasti, Page 799.

So the answer to this question is C


Instruction:
In a 60 year old adult, which of the following diseases cause expansile maxillary lesions?
A. Paget's disease
B. Acromegaly
C. Fibrous Dysplasia
D. Rickets

Response:
None

So the answer to this question is A


Instruction:
Dysfunctional uterine bleeding (DUB) is seen in :
A. Polycystic ovarian disease
B. Endometrial tuberculosis
C. Metropathia haemorrhagica
D. Multiple fibroids

Response:
Metropathia haemorrhagica

So the answer to this question is C


Instruction:
Which feature would most likely be found in a patient with lepromatous leprosy?
A. No bacteremia
B. Macrophages with a foamy appearance in the dermis
C. A positive lepromin reaction
D. A high cell-mediated response against Mycobacterium leprae

Response:
The disease of leprosy is divided into two basic types: lepromatous and tuberculoid. The lepromatous form is an aggressive disease, whereas the tuberculoid form tends to be self-limiting. Individuals with lepromatous leprosy have an inflammatory skin infiltrate, which consists largely of macrophages that have a characteristic vacuolated or "foamy" appearance (caused by the accumulation of lipids within phagocytes) and intracellular acid-fast bacilli. In the lepromatous form, presence of organisms indicates impaired cellular immunity, unlike the tuberculoid type, which can effectively kill the bacteria.

So the answer to this question is B


Instruction:
Which of the following intravenous induction agent suppress steroidogenesis?
A. Thiopentone
B. Propofol
C. Ketamine
D. Etomidate

Response:
Etomidate causes adrenocoical suppression on long term use hence suppress steroidogenesis. All other drugs don&;t cause adrenocoical suppression. From padmaja 4th edition Page no 195

So the answer to this question is D


Instruction:
Erotomanic delusion is seen in
A. de Clerambault's syndrome
B. Cotard syndrome
C. Couvade syndrome
D. Othello syndrome

Response:
(A) de Clerambault's syndrome # EROTOMANIA is a type of delusion in which the affected person believes that another person, usually a stranger, high-stalus or famous person, is in love with him or her. The illness often occurs during psychosis, especially in patients with schizophrenia, delusional disorder or bipolar mania.During an erotomanic episode, the patient believes that a "secret admirer" is declaring his or her affection to the patient, often by special glances, signals, telepathy, or messages through the media. Usually the patient then returns the perceived affection by means of letters, phone calls, gifts, and visits to the unwitting recipient. Even though these advances are unexpected and unwanted, any denial of affection by the object of this delusional love is dismissed by the patent as a ploy to conceal the forbidden love from the rest of the world.> The term erotomania is often confused with "obsessive love", obsession with unrequited love, or hypersexuality. Obsessive love is not erotomania by definition. Erotomania is also called de Clerambault's syndrome, after the French psychiatrist Gaetan Gatian de Clerambault (1872-1934), who published a comprehensive review paper on the subject (Les Psychoses Passionelles) in 1921.

So the answer to this question is A


Instruction:
What is/are true about rat bite -a) Vaccinate with antirabies vaccineb) Give tetanus toxoidc) Rarely need rabies immunoglobulind) Wash with soape) Use antiseptic cream
A. abd
B. acd
C. cde
D. ade

Response:
None

So the answer to this question is C


Instruction:
Which one of the following phenomena is closely associated with slow wave sleep:
A. Dreaming
B. Atonia
C. Sleep walking
D. Irregular hea rate

Response:
C i.e. Sleep walking

So the answer to this question is C


Instruction:
True about pseudocyst of pancreas
A. Pancreatic fluid collection
B. May be asymptomatic
C. Amylase raised
D. All of the above.

Response:
None

So the answer to this question is D


Instruction:
A doctor injected syringe which was used before on a patient, who turned out to be HIV positive later. Under which of the following IPCs will the doctor be booked for medical negligence?
A. 166 B
B. 202
C. 203
D. 269

Response:
S. 269 IPC: Punishment for Negligent act likely to spread infection of disease dangerous to life. S. 270:- Malignant act likely to spread infection of disease dangerous to life.

So the answer to this question is D


Instruction:
False about viruses is -
A. Ribosomes absent
B. Mitochondria absent
C. Motility absent
D. Nucleic acid absent

Response:
Ans. is 'd' i.e., Nucleic acid absent o Viruses contain nucleic acid, either RNA or DNA.Properties of viruseso V iruses are obligate intracellular parasites.o They lack enzymes necessary for protein and nucleic acid synthesis and are dependent for replication on the synthetic machinery of host cells --> so, they cannot grow in cell free culture media.o They do not have cellular organization.o They are unaffected by antibacterial antibiotics.o They contain only one type of nucleic acid, either RNA or DNA, never both.o They multiply by a complex process and not by binary fission,o The extracellular infections virus particle is called the virion.o With few exceptions, viruses are very heat labile.

So the answer to this question is D


Instruction:
All of the following muscles have dual nerve supply, EXCEPT?
A. Brachialis
B. Pectineus
C. Flexor digitorum superficialis
D. Flexor digitorum profundus

Response:
Flexor digitorum superficialis muscle primarily produces flexion at the wrist and at the metacarpophalangeal and proximal interphalangeal joints. Innervation is provided by the median nerve (C8-T1).The brachialis muscle is supplied by musculocutaneous nerve (C5-C6) and radial nerve (C7).The femoral nerve (L2 and L3) innervates pectineus muscle, with occasional branches from the obturator nerve.The lateral half of the flexor digitorum profundus muscle is innervated by the anterior interosseous nerve from the median nerve (C8-T1), and the medial half of the muscle is innervated by the ulnar nerve (C8-T1).

So the answer to this question is C


Instruction:
All of the following regarding papillary carcinoma thyroid is true except -
A. Multicentric origin
B. Seocndaries to lymphnodes
C. Slowing growing
D. Bony metastasis in early stage

Response:
None

So the answer to this question is D


Instruction:
All of the following are true regarding congenital dislocation of hip except-
A. Assymetric Thigh folds may be seen
B. Galleazi sign and Ortolanis test may be positive
C. It may be bilateral
D. Polyhydramnios is a known risk factor

Response:
Ans. is 'd' i.e., Polyhydramnios is a known risk factor Risk factors for DDH/CDHo Femaleso First bomso FamilialDDH is found in familieso Faulty intrauterine position (Breech presentation)o Hormone induced laxityo OligohydramnionClinical features of DDHo Girls are affected six times as often as boys. In one third of cases, bilateral affection occurs. Unless it is specially looked for in infancy - as it always should be - abnormality may not be noticed until the child begins to walk. The clinical findings in older child arei) Limitation of abduction and external rotationii) Limb is in adduction, internal rotation & flexion.iii) Asymmetrical thigh foldiv) Higher buttock fold on the affected side.v) Galeazzi's sign : The level of the knees are compared in a child lying with hip flexed to 70deg and knees flexed. There is a lowering of the knee on the affected sidevi) Ortolani's test may be positive.vii) Trendelenbug's test is positive: This test is performed in an older child. The child is asked to stand on the affected side. The opposite ASIS (that of the normal side) dips down .viii) The limb is short and slightly externally rotated. There is lordosis of the lumbar spine.ix) Telescopy positive : In a case of a dislocated hip, it will be possible to produce an up and down piston- like movement at the hip. This can be appreciated by feeling the movement of the greater trochanter under the fingers.x) A child with unilateral dislocation exhibits a typical gait in which the body lurches to the affected side as the child bears weight on it (Trendelenburg'sgait)An a child with bilateral dislocation, there is alternate lurching on both side (waddling gait).xi) There is compensatory genu valgum as patient tries to keep the foot out (to compensate adduction at hip).

So the answer to this question is D


Instruction:
Which type of fear is the most usually difficult to
overcome?
A. Long standing objective fears
B. Long standing subjective fears
C. Short term objective fears
D. Short term subjective fears

Response:
None

So the answer to this question is B


Instruction:
Chances of veical transmission of Hepatitis B may be high as
A. 25%
B. 40%
C. 60%
D. 90%

Response:
Answer is D (90%) The rate of perinatal transmission of hepatitis B (HBV) essentially depends on the presence or absence of HBe Ag and viral replication. The rate of perinatal transmission of HBV may be as high as 90% in neonates born to mothers who are positive for HBe AG. 'The likelihood of perinatal transmission of HBV correlates with the presence of HBe Ag and high level viral replication. 90% of HBe Ag positive mothers but only 10-15% of Anti-HBe Ag negative mothers transmit HBV to their offspring' - Harrison 18th/2547 `Transmission of infection from an HBV carrier mother to her neonate accounts for the majority of new infections in the world today. Sixty to 90% of Hepatitis B surface antigen (HBs Ag) positive mothers who are Hepatitis B 'e' antigen (HBe Ag) positive transmit the disease to their offspring, whereas mothers who are positive for antibody to HBe Ag (Anti - HBe) do so less frequently (15-20%). -

So the answer to this question is D


Instruction:
A newborn has his leg inveed and the dorsum of his foot does not touch the front of tibia. What is the diagnosis of this condition?
A. Congenital veical talus
B. Congenital talipes equino varus
C. Cerebral palsy
D. Poliomyelitis

Response:
Congenital clubfoot (equinovarus foot; talipes equinovarus): It is characterized by fixed ankle plantar flexion (equinus), inversion and axial internal rotation of the subtalar (talocalcaneal) joint (varus), and medial subluxation of the talonavicular and calcaneocuboid joints (adductus). The typical radiographic findings of incompletely treated clubfoot include the following features: Presence of hind foot plantar flexion; Lack of the normal angular relationship between the talus and calcaneus (so-called parallelism of talus and calcaneus); and Residual medial subluxation or displacement of the navicular on the talus and the cuboid on the calcaneus. Ref: Rab G.T. (2006). Chapter 11. Pediatric Ohopedic Surgery. In H.B. Skinner (Ed), CURRENT Diagnosis & Treatment in Ohopedics, 4e.

So the answer to this question is B


Instruction:
'Heliotrope rash' over face is seen in
A. Systemic sclerosis
B. Dermatomyositis
C. Systemic lupus erythematosus
D. Rheumatoid ahritis

Response:
Dermatomyositis a. Heliotrope erythema and oedema of the periorbital skin are seen in dermatomyositis, b. Dermatomyositis is a well established cutaneous marker of interval malignancy. c. About 10% of all patients of dermatomyositis have an underlying malignancy. d. The most common malignancies associated with dermatomyositis are Lung, Ovary, breast, GIT and lymphoprol iterative disorders.

So the answer to this question is B


Instruction:
Contraindications for breast feeding are all except
A. Hepatitis - B infection of mother
B. Tetracycline treatment of mother
C. Acute bacterial mastitis
D. All

Response:
Ans. is a, b and c i.e. Hepatitis B infection of the mother; acute bacterial mastitis; and Tetracycline Breast feeding is not contraindicated in case of maternal hepatitis B infection as explained in previous question. Option '13' Lithium is contraindicated during pregnancy (see Answer 6) Option 'c' i.e. Acute bacterial mastitis. "In case of acute bacterial mastitis breast feeding should be continued as it is helpful in avoiding abscess formation. If the infected breast is too tender to allow suckling, gentle pumping until nursing can be resumed is recommended." Option `d' Tetracycline : according to KDT "Tetracycline is secreted in breast milk and can cause teeth discoloration and impaired growth in infants and children therefore is contraindicated during lactation." But all other books and extensive internet search (see Drug.com/Rxlist.com) says that tetracycline is not contraindicated during lactation but should be used cautiously in nursing mothers.

So the answer to this question is D


Instruction:
Beta blockers are indicated for all of the following conditions EXCEPT:
A. Hypothyroidism
B. Alcohol Withdrawal
C. Poal hypeention
D. Performance anxiety

Response:
Ref: KD Tripathi pharmacology 7th edition (page.no: 150) beta blockers used in thyrotoxicosis because Propranalol inhibit peripheral conversion of T4 to T3 Other uses are Hypeension, Phaeochromocytoma, Anxiety, Alcohol withdrawal ,Myocardial infarction, Angina pectoris, Poal hypeension etc

So the answer to this question is A


Instruction:
Refractive index of cornea is
A. 1.37
B. 1.33
C. 1.42
D. 1.45

Response:
Corneal refractive index is 1.376

So the answer to this question is A


Instruction:
All of the thyroid tumor arises from follicular epithelial cell except:
A. Papillary carcinoma
B. Follicular carcinoma
C. Medullary carcinoma
D. Anaplastic carcinoma

Response:
- Medullary Cancer arises from parafollicular cells or 'C' cells of thyroid associated with secretion of calcitonin. - Remaining all variants ; papillary, follicular, anaplastic thyroid cancers arise from follicular epithelial cells of thyroid

So the answer to this question is C


Instruction:
Which of the following structures contribute to development of Kidney?
A. Metanephros
B. Mesonephros
C. Blastema
D. All of the above

Response:
Kidney has two pas: The excretory system (true kidney) develops from the metanephric blastema. The collecting system develops from Mesonephric duct (ureteric bud). Ureteric bud penetrates metanephros to conve it into metanephric blastema, which later develops into true kidney. Sources for kidney development Source System Structure derived : Metanephric blastema Excretory system PCT, DCT, Bowman's capsule, Henle's loop Ureteric bud Collecting system Collecting ducts,major and minor calyces, renal pelvis.

So the answer to this question is D


Instruction:
A 4 1/2- year-old girl always had to wear warm socks even is summer season. On physical examination, it was noticed that she had high blood pressure and her femoral pulse was weak as compared to radial and carotid pulse, a chest radiograph showed remarkable notching of ribs along with their lower borders. This was due to:
A. Femoral artery thrombosis.
B. Coarctation of aorta.
C. Raynaud's disease.
D. Takayasu's arteritis.

Response:
Ans. is 'b' i.e. coarctation of Aorta. Cold extremities, high B.P. in upper extremity with marked diminution of pulsations and B.P. in lower extremity is characteristic of Coarctation of Aorta.More facts about Coarctation of AortaMost patients are asymptomatic.Symptomatic patients usually present with foilwing features.Headache dizziness *Epistaxis*Cold extremities and weakness in legs *Claudication with exercise. *Hypertension in upper extremities with marked diminution of pulsation in lower extremities.Mid systolic or continuous murmur over anterior part of chest and back.*Enlarged and pulsatile collateral vessels in intercostal spaces anteriorly in axilla or posteriorly in interscapular area.Upper extremity is more developed than the lower extremity. *Remember that the Cardiac output responds normally to exercise.*Most common site* of Coarctation of Aorta is just distal to origin of left subclavian artery.If it arises above subclavian artery, blood pressure elevation is evident only in right arm.Bicuspid aortic valve* is the most common abnormality associated with coarctation of Aorta.Radiographynotching of inferior surface of ribs*indentation of aorta at site of coarctation and '3' sign* on para mediastinal shadow.Complications:cerebral aneurysmleft ventricular failure*infective endocarditis

So the answer to this question is B


Instruction:
When a person has suspended himself by applying ligature around neck so that the point of suspension (knot) is situated in the region of the occiput. Such a hanging is called as:
A. Typical
B. Atypical
C. Paial
D. Incomplete

Response:
A i.e. Typical Hanging

So the answer to this question is A


Instruction:
A 65 year old retired accountant with a 60 pack year smoking history presents for his annual physical examination. He was last seen 3 years ago, when he presented with an episode of acute bronchitis. He repos that he has been coughing over the past several months with productive green sputum. He denies any dyspnea or limitation in his daily activities. On physical examination, his blood pressure is 126/62 mm Hg, pulse is 80/min, and respirations are 24/min. He has diffuse bilateral expiratory rhonchi with a markedly prolonged expiratory phase. His cardiac examination reveals a second hea sound that increases in intensity with inspiration. The liver edge is 14 cm into the midclavicular line and mildly tender to palpation. There is bilateral lower extremity edema to the knees. A chest x-ray film reveals hyperinflation of both lung fields, and pulmonary function tests reveal a diminished forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio. Routine laboratories are sent. Which of the following would most likely be expected?
A. A hemoglobin of 9 g/dL
B. A hemoglobin of 17 g/dL
C. A platelet count of 84,000
D. A platelet count of 102,000

Response:
A hemoglobin of 17 g/dL would be expected. The question describes a patient with chronic obstructive pulmonary disease (COPD) confirmed by his physical examination, which also suggests right-sided hea failure, loud P2, and hepatic congestion and peripheral edema due to right-sided hea failure. The pulmonary function tests are consistent with the diagnosis of obstructive airway disease. Given the long history of smoking, this patient most likely has COPD. Because of chronic hypoxia, these patients also develop erythrocytosis in an effo to increase the oxygen carrying capacity. The first choice would be seen in anemia. There is no reason for this patient to develop thrombocytopenia or leukopenia. Ref: Bates C.G., Cydulka R.K. (2011). Chapter 73. Chronic Obstructive Pulmonary Disease. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e.

So the answer to this question is B


Instruction:
Expansile lytic lesion with fluid-fluid levels within the metaphysis of fibula seen on CT and MRI in an early adolescent female is typical of –
A. Giant cell tumor
B. Aneurysmal bone cyst
C. Hemangioma
D. Fibrous dysplasia

Response:
Amongst given options, fluid-fluid levels are seen in GCT and ABC.
Lesion in question is metaphyseal:-

              ABC →  Metaphyseal
             GCT →  Epiphyseal

Age of the patient is early adolescent:-

             ABC →  Before the age of 20 years
            GCT →  20 - 40 years

So, the answer to the question is ABC.

So the answer to this question is B


Instruction:
Which of the following statements about 'Low' Radial nerve palsy is not true:
A. Loss of nerve supply to brachioradialis
B. Loss of nerve supply to extensor carpi radialis brevis
C. Loss of nerve supply to extensor pollicis brevis
D. Loss of sensation over first dorsal web space

Response:
A i.e. Loss of nerve supply to brachoradialis - Mnemonic - "TAB Long radial muscle" i.e. Triceps, Anconeus, Brachialis and Brachioradialis & Extensor carpi radialis longus muscles are spared in low radial nerve lesions (i.e. lesions below the level of elbow.) - Lateral & posterior cutaneous nerves of arm and posterior cutaneous nerve of forearm are also spared in low radial nerve lesions.

So the answer to this question is A


Instruction:
Vitamin A should be staed at the age of :-
A. 2 months
B. 9 months
C. 5-6 years
D. None of the above

Response:
- Accordong to NIS Vit A should be staed at the age of 9 months & from then, should be given for every 6 months till 5yrs of age. - Hence, totally 9 doses of Vit A is given; i.e 17 lakh IU.

So the answer to this question is B


Instruction:
Which of the following is not a rapidly growing atypical mycobacteria causing lung infections -
A. M. chelonae
B. M.fortuitum
C. M.abscessus
D. M.kansasii

Response:
None

So the answer to this question is D


Instruction:
What is minimum of amount of taper that should be maintained for an ideal tooth preparation?
A. 4 degree
B. 5 degree
C. 6 degree
D. 12 degree

Response:
None

So the answer to this question is C


Instruction:
Aminoacyl t-RNA is required for all except -
A. Hydroxyproline
B. Methionine
C. Cystine
D. Lysine

Response:
Hydroxyproline and hydroxylysine are not represented into genetic code, i.e. they to not have t-RNA capable of accepting them and inserting them into polypeptide chain. Therefore, they have to be synthesized post-translationally from proline and lysine residues in the polypeptides.

So the answer to this question is A


Instruction:
"Macropolycytes" in peripheral smear is a feature of which of the following red cell disorders?
A. Hereditary spherocytosis
B. Iron deficiency anemia
C. Sickle cell anemia
D. Megaloblastic anemia

Response:
Macropolycytes (large, hypersegmented polymorphonuclear cells/neutrophils) are a feature of megaloblastic anemia.

So the answer to this question is D


Instruction:
Which metabolic abnormality is seen in congenital hyperophic pyloric stenosis?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis

Response:
Repetitive vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria) Cause of paradoxical aciduria Initially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney stas retaining these ions in exchange of hydrogen ions, thus the urine becomes acidic and metabolic alkaline state is fuher aggravated. Reference: SRB edition: 5th page no:830

So the answer to this question is B


Instruction:
Physiological response to smoking, are all, except:
A. Decreased HDL
B. Increased hematocrit
C. Increased hea rate and increased catecholamine release
D. Decreased carboxyhemoglobin

Response:
Decreased carboxyhemoglobin Physiological effects of smoking The extent of the effects of smoking is related to the number of cigarettes smoked, smoking duration, the amount and type of smoke inhaled. Nicotine in tobacco and smoke stimulates the adrenal medulla, increasing plasma adrenaline and urinary catecholamines and their metabolites. Plasma glucose concentration is enhanced within min after the sta of smoking, often persisting for an hour or so after smoking ceases. Plasma insulin rises about an hour after smoking. Plasma growth hormone concentration may increase tenfold within 30 min after the smoking of one cigarette. Smoking increases the hea rate of smoker, both at rest and in exercise. There is an associated increase of both cardiac output and systemic blood pressure. These changes can be attributed to nicotine inducing release of the hormone noradrenaline. Cigarette smoking is associated with an increased risk and extent of advanced atherosclerotic vascular disease in peripheral as well as coronary aeries. The likelihood of claudication, amputation, stroke, abdominal aoic aneurysm, and failure of vascular reconstruction is higher in smokers than nonsmokers. Smoking exes its deleterious effects through many interactive mechanisms. Nicotine and carbon monoxide produce acute cardiovascular consequences, including altered myocardial performance, tachycardia, hypeension, and vasoconstriction. Smoking injures blood vessel walls by damaging endothelial cells, thus increasing permeability to lipids and other blood components. Among metabolic and biochemical changes induced by smoking are elevated plasma, free fatty acids, elevated vasopressin, and a thrombogcnic balance of prostacyclin and thromboxane A 2. Chronic smoking is associated with a tendency for increased serum cholesterol, reduced high density lipoprotein, and other lipid effects that contribute to atherosclerosis. Hematological changes from increased erythrocytes, leukocytes, and fibrinogen causes alterations in platelet aggregation and survival that produce thrombosis. Smokers have higher plasma beta-lipoprotein. cholesterol, and triglyceride concentrations than nonsmokers. Smoking increase total red blood cells, carboxyhemoglobin and leukocyes, but decreases blood paial pressure of oxygen in habitual smokers. The hematocrit is increased. Smoking affects the immune response, lowering serum IgA, IgG, and IgM but raising IgE.

So the answer to this question is D


Instruction:
ElekS Gel test is used in:(
A. Influenza
B. Diphtheria
C. Brucellosis
D. Cholera

Response:
Diphtheria

So the answer to this question is B


Instruction:
Which of the following prevents hyperextension of thigh
A. Ischiofemoral ligament
B. Iliofemoral ligament
C. Pectofemoral ligament
D. Puboischial ligament

Response:
B. i.e. Iliofemoral ligament

So the answer to this question is B


Instruction:
Which β1 selective blocker is used in glaucoma:
A. Levobunolol
B. Timolol
C. Betaxolol
D. Carteolol

Response:
None

So the answer to this question is C


Instruction:
Which of the following hospital waste must be discarded in Blue bag?
A. Plastic syringe
B. Catheter
C. Canula
D. Medicine Ampoules and Vials

Response:
Ans- D Medicine Ampoules and Vials Ref- BMW guidelines 2016

So the answer to this question is D


Instruction:
WhiCh of the following drugs is most likely to be effective against multi drug resistant strains big M. Tuberculosis including those resistant to Streptomycin
A. Amikacin
B. Claruthromycin
C. Gentamicin
D. Spectinomycin

Response:
Refer KDT 6/e p 744 Amikacin is an aminoglycoside that us most resistant to inactivating enzymes. It is used as a second line antitubercular drug It can be used in MDR tuberculosis management

So the answer to this question is A


Instruction:
Height of a newborn doubles at: September 2005, March 2010
A. 1 year
B. 2 year
C. 3 year
D. 4 year

Response:
Ans. D: 4 year In general, length in normal term infants increases about 30% by 5 months and > 50% by 12 months; infants grow 25 cm during the 1st yr; and height at 4 yr is about double bih length.

So the answer to this question is D


Instruction:
Angular conjunctivitis is caused by -
A. H. influenza
B. Adenovirus type 32
C. Moraxella axenfield bacillus
D. Brahnmella

Response:
Moraxella axenfeld (moraxella lacunata) is the most common causative organism for angular conjunctivitis. Ref: Parson's 21st/e p.168

So the answer to this question is C


Instruction:
The melting point of titanium is ____________ degree celsius
A. 1056
B. 1560
C. 1668
D. 1886

Response:
None

So the answer to this question is C


Instruction:
Most common cervical carcinoma: March 2007
A. Adenocarcinoma
B. Sarcoma
C. Squamous cell carcinoma
D. Small cell carcinoma

Response:
Ans. C: Squamous Cell Carcinoma Cervical cancer is typically composed of squamous cells. The most impoant risk factor in the development of cervical cancer is infection with a high-risk strain of Human papilloma virus. Women who have many sexual paners (or who have sex with men or women who had many paners) have a greater risk Risk factors for cervical cancer: HPV infection (16,18,31,33), HIV infection Smoking Chlamydia infection, Multiple pregnancies Exposure to the hormonal drug (DES) and a Family history of cervical cancer. Biopsy Procedures While the pap smear is an effective screening test, confirmation of the diagnosis of cervical cancer or pre-cancer requires a biopsy of the cervix. This is often done through colposcopy. Fuher diagnostic procedures are loop electrical excision procedure (LEEP) and conization. These are carried out if the biopsy confirms severe cervical intraepithelial neoplasia. Pathologic Types Cervical intraepithelial neoplasia, the precursor to cervical cancer, is often diagnosed on examiniation of cervical biopsies. Histologic subtypes of invasive cervical carcinoma include the following: Squamous cell carcinoma (about 80-85%) Adenocarcinoma (nearly 5%) Adenosquamous carcinoma Small cell carcinoma Neuroendocrine carcinoma Staging Cervical cancer is staged by the FIGO staging system Stage 0 - full-thickness involvement of the epithelium without invasion into the stroma (carcinoma in situ) Stage I - limited to the cervix - IA - diagnosed only by microscopy; no visible lesions IA1 - stromal invasion less than 3 mm in depth and 7 mm or less in horizontal spread IA2 stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less - IB - visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal spread of more than 7 mm IB1 - visible lesion 4 cm or less in greatest dimension IB2 - visible lesion more than 4 cm Stage II - invades beyond cervix - IIA - without parametrial invasion, but involve upper 2/3 of vagina - IIB - with parametrial invasion Stage III - extends to pelvic wall or lower third of the vagina - IIIA - involves lower third of vagina - IIIB - extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis IVB - distant metastasis Treatment Microinvasive cancer (stage IA) is usually treated by hysterectomy (removal of the whole uterus including pa of the vagina). For stage IA2, the lymph nodes are removed as well. Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or radiation therapy. Larger early stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy and cisplatin/ Paclitaxel+Ifosamide+Mesna based chemotherapy, hysterectomy (which then usually requires adjuvant radiation therapy), or cisplatin/ Paclitaxel+Ifosamide+Mesna chemotherapy followed by hysterectomy. Advanced stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy. The use of a combination of two chemotherapy drugs, hycamtin and cisplatin for women with late-stage (IVB) cervical cancer treatment is recommended. Combination treatment has significant risk of neutropenia, anemia, and thrombocytopenia side effects.

So the answer to this question is C


Instruction:
Most common histopathological variety of carcinoma vulva -
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Adenocarcinoma
D. Lymphoma

Response:
Ans. is 'a' i.e., Squamous cell carcinoma Vulval cancerso They account for 2-4% of all malignancies of female genital tract.o They are seen mostly in the sixth or seventh deacde of life.o Younger patients with vulval cancer have associated HPV/HIV infection.o Smoking is a risk factor for the development of vulval cancer.o Vulval cancer is associated with cervical and ovarian cancer in 20% of the cases.o Squamous cell carcinomas are the most common histological type accounting for 85% of all vulval cancers.

So the answer to this question is A


Instruction:
This permanent tooth is
A. Lower medial incisor
B. Upper medial incisor
C. First molar
D. First premolar

Response:
First molar is the first permanent tooth to appear, 6-7 yrs

So the answer to this question is C


Instruction:
ED50 is used for determining
A. Potency
B. Efficacy
C. Safety
D. Toxicity

Response:
Ed 50 measures potency Ld 50 measures safety or fatality ed50- dose required to produce 50% of the maximum effect LD50- The dose that causes death in 50 percent of the subjects tested Pgno-54 K D Tripathi Seventh edition

So the answer to this question is A


Instruction:
Lisch nodule and somatostatinoma in pancreas is seen in?
A. Neurofibromatosis
B. Multiple endocrine neoplasia 2A
C. Turcot syndrome
D. Familial adenomatous polyposis

Response:
Ans. (a) Neurofibromatosis* Neurofibromatosis type 1/von Recklinghausen disease caused by inherited gene, the NF1 gene codes for the protein neurofibromin.* Patients with neurofibromatosis develop cafe-au-lait spots, and benign and malignant tumors of the nervous system.* Benign nervous system involvement include neurofibromas, and the malignant include peripheral nerve sheath tumor.* They can also develop distinctive eye lesions called Lisch nodules, and a small percentage develop somatostatinomas of the pancreas/duodenum* The most common cause of death is CNS tumors.Also Know* Turcot syndrome is characterized by intestinal polyposis and CNS tumors: most commonly glioblastoma or medulloblastoma* MEN2A sipple consists of parathyroid adenoma, medullary carcinoma thyroid, phaeochromocytoma.

So the answer to this question is A


Instruction:
Taste loss due to radiation therapy is recovered in:
A. 2 weeks
B. 60 - 120 weeks
C. 60-120 days
D. Not reversible

Response:
Salivary Gland

60 mGy Xerostomia develops
Taste Loss – Reversible – recovery 60 to 120 days

So the answer to this question is C


Instruction:
Adverse effects of hypothermia are all except:
A. Cardiac arrhythmias
B. Renal failure
C. Decreased peripheral resistance
D. Reversible coagulopathy

Response:
C i.e. Decreased peripheral resistance

So the answer to this question is C


Instruction:
A 57-year-old woman presents to the hospital with a 2-hour history of retrosternal chest pain and dyspnea. Her electrocardiogram (ECG) reveals an acute myocardial infarction pattern. Which of the following ECG patterns is consistent with that interpretation?
A. tall P waves
B. prominent U waves
C. small QRS complex
D. elevated ST segments

Response:
Early ischemic changes are tall, peaked T waves that then develop into inverted T waves. Elevated ST segments and Q waves also occur early.

So the answer to this question is D


Instruction:
SOAP note refers to
A. Confidentiality of patient record
B. Classification of patient
C. Informed consent
D. Classification of problem

Response:
None

So the answer to this question is D


Instruction:
It is 1:00 A.M. and a hard-working second-year medical student is intent on finishing her pathology reading assignment. Soon she begins to note that her concentration is fading because 7 hours have passed since she had dinner, and she is feeling famished. Having studied the chapter on ischemic heart disease, she decides to be prudent and forgoes her favorite chocolate cookies, and instead devours two apples, gulping them down with a glass of low-fat milk. Of the following substances, which one was most likely to have increased rapidly when she became hungry and decreased promptly after she finished her healthy snack?
A. a-MSH
B. Corticotropin-releasing factor (CRF)
C. Ghrelin
D. Leptin

Response:
Appetite and satiety are controlled by a complex system of short-acting and long-acting signals. The levels of ghrelin produced in the stomach increase rapidly before every meal and decrease promptly after the stomach is filled. Leptin released from adipocytes exerts long-term control by activating catabolic circuits and by inhibiting anabolic circuits. a-MSH is an intermediate in leptin signaling. TRH and CRF are among the efferent mediators of leptin signaling, and they increase energy consumption.

So the answer to this question is C


Instruction:
A patient with Barrett's esophagus underwent chromoendoscopy. Dye used in this patient for detection of cancer is:
A. Gentian violet
B. Toluidine blue
C. Hematoxylin and eosin
D. Methylene blue

Response:
Methylene blue dye is taken up by the cytoplasm or absorptive cells such as the normal epithelial cells of the colon and small intestine and goblet cells, which are present in Barrett's epithelium. It will not stain nonabsorptive normal epithelium of the stomach as is found in the cardia and fundus, or normal squamous mucosa of the esophagus. Also know: Chromoendoscopy is a technique for enhancing mucosal detail by spraying a variety of colored solutions. Agents used for chromoendoscopy are; Vital dyes Methylene blue Lugol's solution Toluidine blue Contrast agents Indigo carmine Dilute acetic acid solution Ref: Endoscopic Oncology: Gastrointestinal Endoscopy and Cancer Management edited by Douglas O. Faigel, Michael L. Kochman, 2006, Page 20.

So the answer to this question is D


Instruction:
Which of the following is not a premalignant condition oral cancer?
A. Leukoplakia
B. Erythroplakia
C. Oral submucous fibrosis
D. Systemic Sclerosis

Response:
Lesions with an increased risk of malignancy on oral cancerPremalignant condition:- Leukoplakia, Erythroplakia, speckled erythroplakia, chronic hyperplastic candidiasisConditions increasing risk:- Oral submucous fibrosis, syphilitics glossitis, sideropenic dysphagia (Peterson Kelly syndrome)The risk is doubtful:- Oral lichen planus, DLE, Dyskeratosis congenital.Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 253

So the answer to this question is D


Instruction:
Cheiloscopy is the study of prints of -
A. Foot
B. Fingers
C. Palate
D. Lips

Response:
Cheiloscopy is study of lipprints which are divided into 8 patterns. The fissures and grooves are characteristic for an individual. There are 24 characteristics. If 7 to 9 characters tally identification is established. Cheiloscopy is derived from Greek words cheilos -- lips and eskopein - see Lips are unique to one person, except in monozygotic twins Lip grooves are permanent and unchangeable It is possible to identify lip patterns as early as the sixth week of intrauterine life Resist many afflictions, such as herpetic lesions Pathologies that damage the lip subtract like burns seem to rule out cheiloscopy Dr.K.S.Narayana Reddys Synopsis of Forensic Medicine & Toxicology 27th edition pg. 48.

So the answer to this question is D


Instruction:
In Video assisted thoracoscooic surgery for better vision the space in the operative field is created by?
A. Self retaining retractor
B. CO2 insufflations
C. Collapse of ipsilateral lung
D. Rib spacing

Response:
Ans is 'c' i.e. collapse of ipsilateral lung In contrast to most laparoscopic techniques, the working space for VATs is created not by adding an insuffalation gas but rather by removing air from the ipsilateral lung parenchyma causing collapse of the ipsilateral lung.

So the answer to this question is C


Instruction:
Aminoacyl t-RN A is required for all except :
A. Hydroxyproline
B. Methionine
C. Cystine
D. Lysine

Response:
A i.e. Hydroxyproline

So the answer to this question is A


Instruction:
Nicoladoni sign is also known as
A. Branham sign
B. Murray sign
C. Frei's sign
D. Darrier's sign

Response:
In medicine, the Nicoladoni sign, also Branham sign and Nicoladoni-Israel-Branham sign, is the slowing of the hea rate in response to (manual) compression of an aeriovenous fistula. Robbins 9 th edition page no. 365 onwards

So the answer to this question is A


Instruction:
The outcome following resuscitation of cardiac arrest is worsened if during resuscitation patient is given:
A. Ringer's lactate
B. Colloids
C. 5% Dextrose
D. Whole blood transfusion

Response:
C i.e. 5% Dextrose Glucose containing solutions should not be used in I.V. lines during treatment of shock or cardiac arrestQ because the amount needed to maintain B.P. would cause pulmonary edema and congestive hea failure d/t volume overload. In high risk patients, I.V. glucose solutions should be avoided Q or used judiciously and blood glucose concentration should be maintained within the normoglycemic range until the patients have passed the period of high risk for hemodynamic compromise.

So the answer to this question is C


Instruction:
In proteins the α-helix and β-pleated sheet are examples of:
A. Primary structure
B. Secondary structure
C. Tertiary structure
D. Quaternary structure

Response:
The term “secondary structure” denotes the configurational relationship between residues, which are about 3–4 amino acids apart in the linear sequence.
Reference: Vasudevan 7th  ed, pg 36

So the answer to this question is B


Instruction:
One unit of fresh blood raises Hb% ( Hemoglobin concentration ) by
A. 0.1gm%
B. 0.5 gm %
C. 1gm%
D. 2 gm%

Response:
Single unit of whole blood raises Hb by 1 gm% and Hematocrit by 3% More than 70% of transfused cells will be ble after 24 hours Ref: Harrison's 19th edition Pgno :138

So the answer to this question is C


Instruction:
Liver segment which is physiologically independent?
A. Segment I
B. Segment II
C. Segment III
D. Segment IV

Response:
Caudate lobe (segment I) is a physiological independent pa of liver, supplied by both right and left hepatic aeries; right and left branches of poal vein and drains bile into both right and left hepatic duct.

So the answer to this question is A


Instruction:
Rectal incontinence is due to involvement of :a) External anal sphincterb) Internal anal sphincterc) Ischiococcygeusd) Pubococcygeus
A. acd
B. bcd
C. abc
D. abd

Response:
Rectal continence depends solely on the anorectal ring and any damage to this ring results in rectal incontinence.
The anorectal ring is a muscular ring present at the anorectal junction, and formed by the fusion of -

Puborectalis (a part of pubococcygeus which in turn is a part of levator ani)
Deep external anal sphincter
Internal anal sphincter

The puborectalis muscle appears to be the most important muscle for maintaining fecal continence.

So the answer to this question is D


Instruction:
Which of the following lesions is NOT an infection from human papilloma virus?
A. Verruca vulgaris
B. Focal epithelial hyperplasia
C. Condyloma acuminatum
D. None of the above

Response:
None

So the answer to this question is D


Instruction:
An 18-year-old man is found to have metabolic alkalosis and hypokalemia. What could this be secondary to?For the above patient with a medical problem, select the most likely diagnosis or renal impairment.
A. polycystic kidney disease
B. medullary sponge kidney
C. medullary cystic disease
D. Bartter syndrome

Response:
Bartter syndrome and Liddle syndrome can be inherited in an autosomal dominant fashion. Patients with Liddle syndrome have hypertension, whereas those with Bartter syndrome do not. In both syndromes, hypokalemia is prominent.

So the answer to this question is D


Instruction:
True statements about DNA structure
A. All nucleotides are involved in linkage
B. Antiparallel
C. Parallel
D. Bases are perpendicular to DNA

Response:
Nucleotides polymerise by forming bonds between the carbon of the sugar and an oxygen atom of the phosphate. The bases do not take pa in the polymerisation, so the chain is held together by a sugar-phosphate backbone with the bases extending off it. This means that the nucleotides can join together in any order along the chain. Many nucleotides form a polynucleotide. A polynucleotide has a free phosphate group at one end and a free OH group at the other end.

So the answer to this question is A


Instruction:
Commonest causative organism of corneal ulcer is:
A. Pneumococci
B. Streptococci
C. Staphylococci
D. Fungal

Response:
Ans. Staphylococci

So the answer to this question is C


Instruction:
Parkland formula is: (Repeat)
A. %of burn area*body wt*4
B. %of burn area*body wt / 4
C. %of burn area*body surface area*4
D. %of burn area*body surface area / 4

Response:
Ans: A (% of burn area* body wt*4) Ref: Nelson's Textbook of Pediatrics. 19th EditionExplanation:Parkland's FormulaTotal percentage body surface area x weight (kg) x 4 = volume (ml)Half this volume is given in the first 8 hours, and the second half is given in the next 16 hours

So the answer to this question is A


Instruction:
The long term objective of national programme for prevention and control of deafness is:-
A. To reduce disease burden by 25% by end of XII five year plan
B. To reduce disease burden by 50% by end of XII five year plan
C. To reduce disease burden by 75% by end of XII five year plan
D. To reduce disease burden by 100% by end of XIIfive year plan

Response:
Long term objective: To reduce disease burden by 25% by end of XI five year plan. National programme for prevention and control of deafness: OBJECTIVES :1. To prevent avoidable hearing loss on account of disease or injury.2. Early identification, diagnosis and treatment of ear problems responsible for hearingloss and deafness.3. To medically rehabilitate persons of all age groups, suffering with deafness.4. To strengthen the existing inter-sectoral linkages for continuity of the rehabilitationprogramme, for persons with deafness.5. To develop institutional capacity for ear care services by providing suppo forequipment, material and training personnel. Long term objective: To prevent and control major causes of hearing impairment anddeafness, so as to reduce the total disease burden by 25% of the existing burden by the endof 12th Five Year Plan

So the answer to this question is A


Instruction:
Fat necrosis is common in -
A. Omentum
B. Breast
C. Retroperitoneal fat
D. All of the above

Response:
There are 2 Types of Fat Necrosis 1. Enzymatic fat necrosis This is due to action of lipase on adipose tissue. It occurs most frequently in acute pancreatitis due to leakage of lipase. Depending on the severity of acute pancreatitis, fat necrosis may occur in : Adipose tissue contiguous to pancrease, i.e., retroperitoneal fat. Adipose tissue in anterior mediastinum. Bone marrow Omental and abdominal fat 2. Nonenzymatic or Traumatic fat necrosis Occurs due to trauma Is seen in subcutaneous tissue of breast, thigh, and abdomen.

So the answer to this question is D


Instruction:
A 29-year-old woman was found to have Hb of 7.8mg/dl with a reticulocyte count of 0.8%. The peripheral blood smear showed microcytic hypochromic anemia. On HPLC, Hb A2 and Hb F was 2.4% and 1.3% respectively. The serum iron and TIBC were 15mg/dl and 420 micro g/dl respectively. The most likely cause of anemia is:
A. Iron deficiency anemia
B. Beta thalassemia minor
C. Sideroblastic anemia
D. Anemia due to chronic infection

Response:
Here seum iron is reduced and TIBC is on the higher side. These are the first major pointers towards iron deficiency anaemia. This rules out Beta thalassemia minor and anemia due to chronic infection. Second pointer towards iron deficiency anemia is reduced Hb A2, which should haven been in a range of 4-9% in case of beta thalassemia trait. Sideroblastic anemia can be ruled out as it reveals a dimorphic blood picture. Parameter Iron deficiency anaemia Anaemia of chronic disease b Thalassaemia 1. MCV | N or | Markedly |sed 2. RDW | | or N | or N 3. Red cell morphology Microcytic hypochromic, pencil cells, anisocytosis Normocytic normochromic or microcytic hypochromic Microcytic hypochromic, basophilic stippling, target cells, polychromasia 4. Red cell count | | N 5. Serum iron | | N 6. TIBC | | N 7.Transferrin saturation | |or N | or N 8. FEP | | N 9. Serum TfR | N | 10. Serum ferritin decreases Increased or normal Normal 11. Hb electrophoresis Normal Normal HbA2>3.5% 12. Marrow haemosiderin Low or absent Normal or increased Normal

So the answer to this question is A


Instruction:
The most common tumor of the minor salivary gland is -
A. Mucoepidermoid carcinoma
B. Acinic cell carcinoma
C. Adenoid cystic carcinoma
D. Pleomorphic adeno carcinoma

Response:
None

So the answer to this question is C


Instruction:
Drug of choice in Neonatal ITP is –
A. Platelet transfusion
B. Prednisolone
C. Dexamethasone
D. Gammaglobulin

Response:
Treatment of neonatal ITP

Prenatal administration of corticosteroids to mother.
IV immunoglobulin or sometimes corticosteroids to the infant after delivery.

Treatment of ITP in children

IV immunoglobulin is the treatment of choice.
Glucocorticoids are often used in combination.

So the answer to this question is D


Instruction:
Oogonia are derived from
A. Yolk sac
B. Germinal epithelium
C. Chorion
D. Mesoderm

Response:
Inderbir Singh&;s; Human Histology; Seventh edition; Pg 346The stem cells from which ova are derived are called Oogonia. These are large round cells present in the coex of the ovary. Oogonia are derived from the primordial germ cells that are formed in the region of the yolk sac and migrate into the developing ovary

So the answer to this question is A


Instruction:
All of the following are true about liver transplantation except:
A. MC indication of LT is alcoholic liver disease
B. Two recipients are benefitted in split liver transplantation
C. Choledocho-choledochostomy is preferred over choledochojejunostomy
D. Sequence of anastomosis: 1. Supra hepatic IVC 2. Infra hepatic IVC 3. Poal vein 4. Hepatic aery 5. Bile duct

Response:
Split Liver transplantation: Brain dead cadaver - transplant Right lobe for Adult and Left Lobe for child. i.e Two recipients are benefited. Sequence of anastomosis in liver transplant; Donor's Bile duct anastomosed with recipients bile duct: Choledococholedostomy (preferred) If recipient's bile duct is diseased or cannot be used donor bile duct is attached to the jejunum: choledochojejunostomy

So the answer to this question is A


Instruction:
All of the following are the criteria for weaning the patient from ventilation except :
A. Vital capacity: >10 mL/kg
B. Tidal volume: 4-6ml/kg
C. Minute ventilation: 10 L/min
D. Rapid shallow breathing index: <120

Response:
Mechanical criteria for weaning or extubation : Inspiratory pressure: -20-30cm H2O Tidal volume: 4-6ml/kg Vital capacity: >10 mL/kg Minute ventilation: 10L/min Rapid shallow breathing index: <100

So the answer to this question is D


Instruction:
School water fluoridation is considered as the primary preventive service provided by the
A. Community
B. Individual
C. Dental professional
D. None of the above

Response:
None

So the answer to this question is A


Instruction:
All of the following anticancer agents cause bone marrow depression except -
A. Chlorambucil
B. Daunorubicin
C. Doxarubucin
D. Flutamide

Response:
Ans. is 'd' i.e., Flutamine Flutamide is a non steroidal drug having specific antiandrogenic, but no other hormonal activity. o Daunarubicin, Doxorubicin and chlorambucil are all known agents for bone marrow depression.

So the answer to this question is D


Instruction:
How many doses of vitamin A are required to treat deficiency -
A. 1
B. 2
C. 3
D. 4

Response:
Ans. is 'c' i.e., 3 o Treatment schedule as recommended bv WHOAgeDay 0 (immediately)Day / (next day)After 2 week to 4 week> 1 year (except women of reproductive age)2 lakh IU orallyor1 lakh IU inti2 lakh IU orallyor1 lakh IU imi2 lakh IU orallyor1 lakh IU imi< 1 year or any age but < 8 kg50.000 IU orally50,000 IU orally50,000 IU orallyo Treatment schedule applies to all stages of active xeropthalmiao Oral administration is the recommended method of treatmento Intramuscular injection schould be preferred in presence of repeated vomiting and severe diarrhea

So the answer to this question is C


Instruction:
What is the diagnosis demonstrated in the barium esophagogram?
A. Achalasia
B. Schatzki's ring
C. Nut cracker esophagus
D. Carcinoma esophagus

Response:
Barium oesophagram demonstrating advanced carcinoma with abrupt, irregular narrowing of the distal oesophagus, with more proximal dilation and an air-fluid level . ref - harrisons internal medicine 20e pg566,567

So the answer to this question is D


Instruction:
In follow up of BPH, a most impoant indication of surgery is
A. Prostate size >75gm
B. Single episode of UTI requiring 3 day antibiotics
C. Cannot use medication due to hypeension
D. Bilateral hydronephrosis

Response:
Surgery should be recommended for patients who continue to be bothered by their symptoms or who experience urinary retention despite medical therapy. Surgery should also be recommended for patients with upper tract dilation, renal insufficiency secondary to BPH, or bladder stones."- Schwaz 8/e p1530 About other options: Prostate Size: Treatment of BPH is primarily dictated by patient's symptoms and not by the prostate size. However the size of prostate can decide whether to go for endoscopic method of treatment or open surgical procedure. Open surgery is more effective than endoscopic methods for prostates weighing >100gm UTI: Recurrent episodes of UTI (and not a single episode) are an absolute indication for surgery of prostate. Hypeension: Alpha blockers which are first line medical therapy for BPH lower the blood pressure and thus are helpful in hypeensive persons. Management of BPH Management is primarily directed by symptoms. Mild symptoms can be managed with watchful waiting. More severe symptomatic patients are treated with medicines (alpha blockers, 5-alpha reductase inhibitors or combination of both). Surgery is recommended if the patient is having problems despite medical therapy. Absolute indications for surgery as listed in Smith's Urology is given below. Absolute indications for surgical treatment of BPH Refractory urine retention (failing at least one attempt at catheter removal) Recurrent UTI from BPH Bladder stones d/t BPH Renal insufficiency d/t BPH Large bladder diveicula secondary to BPH Recurrent gross hematuria from BPH Upper tract dilatation is an indication for surgery according to Schwaz. Medical therapy Alpha-blockers (terazosin, doxazosin, and tamsulosin) Alpha-blockers help is reducing the symptoms of BPH by blocking the alpha 1 adrenoreceptors present in human prostate and bladder base. 5-Alpha-reductase inhibitors (Finasteride, Dutasteride) - 5-alpha-reductase inhibitors block the conversion of testosterone to dihydrotestosterone. This thus results in reduction in the size of the gland and improvement in symptoms (after several months of use). Surgery Surgery for BPH is most commonly performed endoscopically; however, if the prostate gland is quite large (approx >100 g), an open prostatectomy should be performed. The standard endoscopic procedure for BPH is a transurethral resection (TUR) of the prostate. Conventional surgical methods: Transurethral resection of the prostate (most commonly used method) Transurethral incision of the prostate (TUIP) Open simple prostatectomy (simple suprapubic prostatectomy, simple retropubic prostatectomy) - When the prostate is too large to be removed endoscopically, an open enucleation is necessary. What constitutes "too large" is subjective and varies depending upon the surgeon's experience with TURP. Glands >100 g are usually considered for open enucleation. Open prostatectomy may also be initiated when concomitant bladder diveiculum or a bladder stone is present or if dorsal lithotomy positioning is not possible. Open prostatectomies can be done with either a suprapubic or retropubic approach. A simple suprapubic prostatectomy is performed transvesically and is the operation of choice in dealing with concomitant bladder pathology. Minimally invasive methods: Laser therapy (Nd:YAG and holmium:YAG ) Transurethral electro vaporization of the prostate Microwave Hypehermia Transurethral needle ablation of the prostate- High-intensity focused ultrasound for thermal tissue ablation Intraurethral stents--stents are endoscopically placed in the prostatic fossa and are designed to keep the prostatic urethra patent. They are usually covered by urothelium within 4-6 months after inseion. These devices are typically used for patients with limited life expectancy who are not deemed to be appropriate candidates for surgery or anesthesia. Ref : Schwaz 8/e p1528-31

So the answer to this question is D


Instruction:
Which of the following clinical conditions is not an indication for induction of labor?
A. Intrauterine fetal demise
B. Severe preeclampsia at 36 weeks
C. Complete placenta pre
D. Chorioamnionitis

Response:
(Cunningham, 21/e, p 470.) Placenta pre is a contraindication to labor because the placenta is ahead of the presenting pa covering the cervix and vaginal delivery would result in hemorrhage. Intrauterine fetal demise, preeclampsia, chorioamnionitis, are all indications to induce labor.

So the answer to this question is C


Instruction:
Three point bony relationship around the elbow is not disturbed in which of the following -
A. Fracture supracondylar humerus
B. Fracture medial condyle of distal humerus
C. Fracture lateral condyle of distal humerus
D. Posterior dislocation of elbow

Response:
Ans. is 'a' i.e., Fracture supracondylar humerus * The three prominent bony points around elbow are medial epicondyle, lateral epicondyle and tip of the olecranon. The relationship of these three bony points is important in the diagnosis of injuries around the elbow. Normally, In 90deg flexed position of elbow, these three bony points form a near Isoceles triangle. In extension all three lies in a straight horizontal line.* In elbow injuries, following is seen in three bony relationship : -A) Maintained# Three point bony relationship is maintained in supracondylar fracture humerus. This is easy to understand, as the fracture is above all these three bony point, relationship in themselves is maintained. So, if fracture is above or below these 3 points, their relationship will be maintained.B) Disturbed# If injury involves a region at or in between these three bony point, their relationship will be disturbed. Such injuries are : -1) With increased intercondylar distance* The distance between two epicondyles (intercondylar distance) is increased.* Obviously, the injury is involving the region anywhere from lateral epicondyle to medial epicondyle: -i) Fracture medial epicondyle and/or condyle.ii) Fracture lateral epicondyle and/or condyleiii) Fracture intercondylar region2) With maintained intercondylar distance* The distance between two epicondyles is maintained as the intercondylar region is not involved : -i) Fracture olecranon (i.e., Upper ulna)ii) Dislocation of elbow

So the answer to this question is A


Instruction:
Vision 2020 - The Right to Sight do not include :-
A. Centres for Vision - 20
B. Training Centres - 200
C. Service Centres - 2000
D. Vision Centres - 20,000

Response:
VISION 2020: The Right to Sight- was launched in 1999 - Centres of excellence-20 - Training centres-200 - Service centres-2000 - Vision centres-20,000 - Main aim of vision-2020 is to eliminate all causes of avoidable blindness, i.e Preventable blindness - Vit A deficiency , trachoma Curable blindness - cataract

So the answer to this question is A


Instruction:
All are tests to check eustachian tube patency except -
A. Valsalva maneuver
B. Fistula test
C. Frenzel's maneuver
D. Toynbee's maneuver

Response:
This question can be solved even if we dont know all tests for eustachian tube patency, because we know fistula test is for assessing vestibular functions and not for Eustachian tube patency. Still it is worth while knowing tests for eustachian tube patency.

So the answer to this question is B


Instruction:
Anterior wall of axilla is formed by
A. Pectoralis major
B. Humerus
C. Latissimus dorsi
D. Teres major

Response:
Anterior wall of axilla is formed by pectoralis major in front, clavipectoral fascia, and pectoralis minor. Upper pa of shaft of humerus in the region of bicipital groove forms a pa of lateral wall of axilla.Posterior wall of axilla is formed by latissimus dorsi below along with subscapularis and teres major.B D Chaurasia 7th edition Page no: 49

So the answer to this question is A


Instruction:
A 45 - year old cirrhotic patient presented with severe haematemesis. The management of choice is -
A. Whole blood transfusion is the best
B. Colloids are preferred over crystalloids
C. Normal saline infusion
D. IV fluid with diuretics

Response:
None

So the answer to this question is A


Instruction:
Which of the following is the most significant risk factor for postoperative nausea and vomiting
A. Female gender
B. Smoking
C. Age over 60 years
D. Surgery on the breast

Response:
Postoperative nausea and vomiting is most common in women, young people, and patients who have received opioids during surgery. Surprisingly, perhaps the one advantage of smoking is that smokers tend to have less postoperative nausea and vomiting than nonsmokers. Similarly, the incidence of postoperative nausea and vomiting is lower in the geriatric population.

So the answer to this question is A


Instruction:
In uveitis, site of keratic precipitate is:
A. Corneal endothelium
B. Lens anterior pa
C. Lens posterior pa
D. Corneal stroma

Response:
Ant uveitis m/c - idiopathic 2n/m/c - ankylosing spondylitis Sign - 1. Circumciliary congestion 2. Cells - wbc, neutrophilic in a/c (earliest / hallmark) 3. Flare - protein deposition in aqueos humor 4. Keratic precipitate - neutrophils & lymphocytes in cornea 5. Iris nodules Koepp's - on pupillary margin Busaccas - surface of iris 6. Synechiae Ant - glaucoma Post - cataract Small pupil + low I.P Rx - topical steroid (D/O/C) Cycloplegic

So the answer to this question is A


Instruction:
All joints are involved in acute gout except:
A. MTP
B. Gleno-humeral joint
C. Ankle joint
D. Knee joint

Response:
Other than the great toe, the most common sites of gouty ahritis are the ankle, wrist, finger joints, and knee. In early gout, only 1 or 2 joints are usually involved. Consider the diagnosis in any patient with acute monoaicular ahritis of any peripheral joint except the glenohumeral joint of the shoulder.

So the answer to this question is B


Instruction:
A 50-year-old man has been having fainting "spells" for about 2 weeks. During the episodes, his ECG shows a ventricular rate of 25 beats/min and 100 P waves per minute. After about 30 seconds of fainting, a normal sinus rhythm recurs. What is his likely diagnosis?
A. First-degree A-V block
B. Second-degree A-V block
C. Third-degree A-V block
D. Stokes-Adams syndrome

Response:
Periodic fainting spells is known as Adams Stokes syndrome Reason: Fluctuating third degree AV block in heas with borderline ischemia of conductive system. Complete AV block -Brain cannot remain active for more than 4-7 sec without blood supply -fainting episode - ventricular escape from overdrive suppression occurs in 5-30 sec - rapid recovery from the faint and then to sustain the person. AV block types: 1. First degree block: prolonged P-Q or P-R interval >0.20, not actual blockage but delay of conduction. 2. Second degree block: a. Wenckebach or Mobitz type 1: progressive P-R prolongation followed by a dropped beat. Abnormality in AV node. b. Mobitz type 2: A fixed number of non-conducted P waves for every QRS complex. P-R interval constant. Ex: 3:1, 3:2, 2:1. Abnormality in bundle of His-Purkinje system. 3. Third degree hea block: Complete AV block. SA and AV node dissociation leading to idioventricular rhythm (ventricular escape as Purkinje fibres becomes new pacemaker, 15-40 beats/min).

So the answer to this question is D


Instruction:
Initial resuscitation of a trauma patient is best done by administration of which of the following?
A. D5W
B. D5W and 0.45% normal saline
C. Ringer's lactate solution
D. 5% plasma protein solution

Response:
- Initial resuscitation of a trauma patient is best done by administering Ringer's lactate, because it is isotonic, and it is similar to plasma in electrolyte composition. - There is no conclusive evidence that colloid solutions (albumin, plasma protein solution, or hydroxyethyl starch solution) improve the rate of resuscitation or eventual outcome. -D5W and 0.45% normal saline are hypotonic hence not used in this case. - Use of crystalloid solutions also aids in resuscitation of interstitial compament

So the answer to this question is C


Instruction:
Methanol toxicity causes blindness due to the formation of: March 2010
A. Formic acid
B. Formaldehyde
C. Lactic acid
D. Pyruvic acid

Response:
Ans. A: Formic Acid The initial step in the metabolism of methanol involves the enzyme alcohol dehydrogenase (ADH). First, methanol is slowly oxidized by ADH to yield formaldehyde. Next, formaldehyde is oxidized by formaldehyde dehydrogenase to yield formic acid (or formate, depending on the pH). This oxidation occurs rapidly so that little formaldehyde accumulates in the serum. Finally, formic acid is metabolized to carbon dioxide and water, which are excreted by the kidneys and lungs. The accumulation of formic acid is responsible for the presence of metabolic acidosis. Formic acid also inhibits cellular respiration leading to lactic acidosis. The ocular injury caused by methanol may be due to retinal injury, which results from intra-retinal metabolism of methanol and the accumulation of formic acid. Alternatively, it may be caused be the inhibition of normal metabolism in optic nerve calls.

So the answer to this question is A


Instruction:
Which of the following is not used in acute gout -
A. Allopurinol
B. NSAIDs
C. Corticosteroid
D. Colchicine

Response:
Ans. is 'a' i.e., Allopurinol o NSAIDs are the drug of choice for acute gout -They are prefered over colchicine because they are better toleratedo Indomethacin is often chosen because of its strong anti-inflammatory action and efficacy. - Laurence 9th/e 297Drugs used in acute gouti) NSAIDs - Drug of choiceii) Colchicineiii) Corticosteroidso Allopurinol and uricosuric drugs (sulfinpyrazone, probenacid) are not effective in acute gout because they will not relieve symptoms as they dont have antiinflammatory property.

So the answer to this question is A


Instruction:
Phacoemulsification includes
A. Hydrodissection
B. Hydrodeliniation
C. Continuous curvilinear capsulorrhexis
D. All of the above

Response:
PHACOEMULSIFICATION Steps: 1. Corneoscleral incision required is very small (3 mm). Therefore, sutureless surgery is possible with self-sealing scleral tunnel or clear corneal incision made with a 3 mm keratome. 2. Continuous curvilinear capsulorrhexis (CCC) of 4-6 mm. 3. Hydrodissection i.e., separation of capsule from the coex by injecting fluid exactly between the two is must for phacoemulsification in SICS. This procedure facilitates nucleus rotation and manipulation during phacoemulsification. Some surgeons also perform hydrodelineation 4. Nucleus is emulsified and aspirated by phacoemulsifier. Phacoemulsifier basically acts through a hollow 1-mm titanium needle which vibrates by piezoelectric crystal in its longitudinal axis at an ultrasonic speed of 40000 times a second and thus emulsifies the nucleus. 5. Remaining coical lens matter is aspirated with the help of an irrigation-aspiration technique. 6. Next steps i.e., IOL implantation, removal of viscoelastic substance and wound closure. Ref:- A K Khurana; pg num:-191,193

So the answer to this question is D


Instruction:
nerve of olfaction is ?
A. 1
B. 9
C. 5
D. all the above

Response:
nerves of olfaction = 1,7,9,5,10 OLFACTORY SYSTEM * Olfactory epithelium- receptor cells, suppoing cells and basal cells Receptor cells are bipolar neurons, distal process carries cilia that project into nasal cavity. Cilia have receptors for odoriferous molecules. Axons from the olfactory sensory neurons converge in the cy.. bulb to form clusters called glomeruli. These nerve fibers,are lacking in myelin sheaths. The glomerulus is a spherical structure located in the olfactory bulb of the brain where synapses form between the terminals of the tufted cell.and the dendrites of mitral, periglomerular and ref : guyton and hall

So the answer to this question is D


Instruction:
All of the following statements about Digoxin induced arrhythmia's are true, except:
A. Bi ventricular Tachycardia
B. Paroxysmal Atrial Tachycardia with variable AV block
C. Ventricular Bigeminy
D. May be used to treat Atrial Fibrillation

Response:
The most frequent disturbances of cardiac rhythm associated with digitalis intoxication are ventricular premature beats, bigeminy, ventricular tachycardia and rarely ventricular fibrillation. AV block and nonparoxysmal atrial tachycardia with variable AV block are characteristic of intoxication. Ref: Harrison's 16th Edition, Page 1375

So the answer to this question is A


Instruction:
which of the following is a tricyclic antidepressent
A. seraline
B. clomipramine
C. bupropion
D. fluvoxamine

Response:
TCA * MECHANISM This is an antidepressant with three rings. It acts by blocking the transpoers of neurotransmitters resulting in increased neurotransmitters in synapse DRUGS AMITRYPTILLINE IMIPRAMINE CLOMIPRAMINE DESIPRAMINE NORIPTILLINE DOXEPINE * USE AMITRYPTILLINE========PAIN WITH DEPRESSION IMIPRAMINE==========CHILDHOOD ENEURESIS CLOMIPRAMINE========OCD * SIDE EFFECTS ANTI HISTAMINERGIC==== sedation, weight gain ANTI MUSCURANIC=======dryness of mouth ANTI ADRENERGIC========hypotension, giddiness SWITCH TO MANIA when used in BIPOLAR DEPRESSION Ref. kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no 955

So the answer to this question is B


Instruction:
Nevirapine is -
A. NRTI
B. NNRTI
C. E-TI
D. FI

Response:
Ans is 'b' i.e., NNRTI o Nevirapine is NNRTIThese drugs inhibit reverse transcriptase by acting at a site (allosteric site) different from NRTIs.These are selective for HIV-1 and have no activity against HIV-2.Resistance to these drugs develops very rapidly.o NNRI drug groupEfavirenz, nevirapine, etravirtue and delavirdine,o Mechanism of action :These are nucleotide unrelated compounds which directly inhibit HIV reverse transcriptase without the need for intracellular phosphory-lation.Adverse effectsRashes (Steven Johnson Syndrome & Toxic epidermal necrolysis)NauseaHeadach, FeverRise in live enzyme (hepatotoxic)o Nevirapine is used in pregnancy to prevent vertical transmission.o It decrease transmission to 13% as compared to 21.5% by zidovudine.o NNRTI donot cause lipodystrophy like NRTIs and RTIs# Nevirapine and efavirenz are enzyme inducers and delaviridine is enzyme inhibitor.

So the answer to this question is B


Instruction:
Which of the following factors determines whether a patient develops acromegaly or gigantism?
A. Sex
B. Age at onset of the tumor
C. Amount of available calcium
D. Degree of function of the tumor

Response:
None

So the answer to this question is B


Instruction:
Glassgow Coma scale of a patient with head injury- He is confused, able to localize on right side and does flexion on left side and Opens eye for painful stimuli on Sternum.
A. 8 points
B. 9 points
C. 10 points
D. 11 points

Response:
Ref. Sabiston Textbook of Surgery. Pg. 411

So the answer to this question is D


Instruction:
Superimposition technique is used in -
A. Skull
B. Pelvis
C. Femur
D. Ribs

Response:
Superimposition technique determines whether the skull is that of a person in a photograph or not.

So the answer to this question is A


Instruction:
The frequency of a disease or characteristic expressed per unit size of the population or group in which it is observed is
A. Rate
B. Ratio
C. Proportion
D. Average

Response:
None

So the answer to this question is A


Instruction:
All are tests for stoppage of circulation EXCEPT:
A. Magnus test
B. Winslow's test
C. Icard's test
D. Diaphanous test

Response:
Tests of respiration: Winslow’s test- No movement of reflection of light shone on mirror, or surface of water in bowl, kept on the chest. Tests of circulation: (1) Magnus test (ligature test): Fingers fail to show congestion & swelling to a ligature applied at their base. (2) Diaphanous test (transillumination test):  Failure to show redness in the web-space between the fingers on transillumination from behind. (3) Icard’s test: Fluorescein dye on being injected at a given site in a dead body fail to produce yellowish-green discolouration in a dead body.)

So the answer to this question is B


Instruction:
Carotid sinus massage will terminate: March 2005
A. Atrial flutter
B. Atrial fibirillation
C. Supraventicular arrythmia
D. Suprventicular tachycardia

Response:
Ans. D: Suprventicular tachycardia Carotid sinus massage is a simple bedside maneuver that helps to clarify the type and sometimes also the mechanism of different rhythm disturbances. The major indication for carotid sinus massage is the diagnosis of tachyarrhythmias in which the atrial activity is either absent or intermittently present. Carotid sinus massage is also useful in altering conduction within the AV node. Vagal stimulation,such as occurs with the Vasalva maneuver or carotid sinus massage can slow conduction in the AV Node sufficiently to terminate AVN/ PSVT (aerioventricular nodal reentrant tachycardia). It is also helpful in some patients with normal hea rates; increased vagal tone may normalize a bundle branch block or localize the site of type I second-degree atrioventricular block and can be used for evaluation of the sensing function of permanent pacemakers. Carotid sinus massage is also an impoant diagnostic procedure in patients with suspected hypersensitivity of the carotid sinus. Massage of the carotid sinus is contraindicated in patients with diseased carotid aeries because of the risk of cerebrovascular accident. In rare instances, carotid sinus massage may initiate ventricular tachycardia.

So the answer to this question is D


Instruction:
Drug of choice for Acute Anterior Uveitis
A. Topical Steroids
B. Atropine
C. Systemic Steroids
D. NSAIDS

Response:
Atropine Is the Drug of choice for Acute Anterior Uveitis, due to

Relieves of Ciliary spasm
Preventing posterior synichae
Reduce candatis and reduces the signs

So the answer to this question is B


Instruction:
The embrasure areas in the following areas are continuous
A. Labial and Lingual
B. Lingual and Occlusal
C. Incisal and Occlusal
D. Labial and Occlusal

Response:
None

So the answer to this question is A


Instruction:
Drug of choice in Acute central anticholinergic syndrome is -
A. Neostigmine
B. Physostigmine
C. Tacrine
D. 4-amino pyridine

Response:
Ans. is 'b' i.e., Physostigmine Physostigmine penetrates blood-brain barrier and antagonizes both central and peripheral actions of anticholinergics in acute anticholinergic poisoning (belladonna poisoning). About other options o Neostigmine does not cross blood brain barrier. Thus it is ineffective for central anticholinergic actions. o Tacrine is used for chronic central anti-cholinergic syndrome (Alzhiemer's disease).

So the answer to this question is B


Instruction:
True about carbamoyl phosphate synthase ?
A. Mitochondria] enzyme
B. Cytosolic enzyme
C. Catalyzes condensation reaction
D. All are true

Response:
Ans. is 'd' i.e., All are true There are two types of carbamoyl phosphate synthase (CPS) :?CPS - I:- catalyzes the condensation of CO2 and ammonia to form carbomoyl phosphate in urea cycle. It is a mitochondrial enzyme.CPS - II:- It is a cytosolic enzyme and paicipates in pyrimidine synthesis.

So the answer to this question is D


Instruction:
Whole-body iodine scan after total thyroidectomy is not recommended for which thyroid cancer ?
A. Papillary thyroid cancer
B. Anaplastic thyroid cancer
C. Medullary thyroid cancer
D. Follicular thyroid cancer

Response:
Whole-body iodine scan is recommended for differentiated thyroid cancer , which fulfill following conditions : Tumors - between 1cm-4cm Confined to the thyroid Do not have nodal or distant metastasis, Adverse histologic subtype (tall cell) Vascular invasion. =Unlike differentiated thyroid cancer, Medullary thyroid carcinoma cells do not concentrate radioactive iodine and are not sensitive to manipulation of thyroid-stimulating hormone.

So the answer to this question is C


Instruction:
The youngest lens fibres are present in:
A. Central core of the lens nucleus
B. Outer layer of the nucleus
C. Deeper layer of the coex
D. Superficial layer of the coex

Response:
Ans. Superficial layer of the coex

So the answer to this question is D


Instruction:
Which of the following is true regarding nerve injury?
A. In all cases of open wound with clinical signs of nerve injury, nerve exploration should always be done.
B. Nerve conduction velocity is best predictor within 48 hours of injury.
C. Traction nerve injury should be repaired immediately.
D. Postive Tinel's sign indicates the accurate location of the lesion.

Response:
None

So the answer to this question is A


Instruction:
A 30 yrs woman 2+0, hypertension have menorrhagia. Which is the best treatment for her -
A. Combined pills
B. MIRENA
C. Hysterectomy
D. Transcervical resection of endometrium

Response:
Ans. is 'b' i.e., MIRENA * The question does not give any clue regarding the etiology of menorrhagia, so most probably the women are havingD.U.B. i.e., dysfunctional uterine bleeding. When a woman present with menorrhagia, consideration must first be given to diagnosis.This requires an appropriate history and clinical examination completed by the suitable investigation.Anemia should be detected by full blood count and iron studies.Ultrasonography, sonohysterography, and hysteroscopy are additional investigations that may diagnose a structural problem and should be utilized depending on their availability and the experience of the surgeon.Common causes of menorrhagia include local pathologies such as fibroids, polyps, adenomyosis or infection.Rarer, but important causes include genital malignancy (cervical, endometrial or myometrial) and systemic disorders such as thyroid disease and bleeding disorders.In over 50% cases no cause is found and the diagnosis of dysfunctional uterine bleeding is made.Dysfunctional uterine bleeding requires the following criteria: -Complaint of excessive menstrual blood loss (menorrhagia).Adequate exclusion of pathology that may otherwise cause menorrhagia.Dysfunctional uterine bleeding may be ovulatory or nonovulatory.Anovulatory cycles result in menorrhagia with regular cycles were asOvulatory cycles result in menorrhagia with irregular cycles.Most of the cases of dysfunctional uterine bleeding are secondary to anovulation.Without ovulation, the corpus luteum fails to form resulting in no progesterone secretion.In the absence of progesterone, there is no lateral phase or the secretory phase.The anovulatory woman is always in the follicular phase of the ovarian cycle and in the proliferative phase of the endometrial cycle.The only ovarian steroidal signal the endometrium receives is through estrogen.Continuous stimulation of endometrium by estrogen produces a proliferation of the endometrium to abnormal levels where it becomes fragile without the growth limiting and organizing effect of progesterone.The endometrium finally outgrows its blood supply and degenerates. The end result is an asynchronous breakdown of the endometrial lining at different levels.We can conclude that bleeding in anovulatory cycle occurs due to unopposed action of estrogen in the absence of progesterone.Anovulatory menstrual cycle gives rise to irregular bleeding.On the other hand, ovulatory cycles give rise to regular menstrual bleeding.These patients ovulate regularly. These patients have both the phases of menstrual cycle i.e., follicular phase and the secretory phase.Research has shown that several abnormalities can occur in the endometrium of women with DUB's ovulary cycles, for example, increased fibrinolytic activity and increased production of prostaglandins.These observations provide the rational basis for treatment in these women i.e.,Antifibrinolytic Tranexamic acidProstaglandin inhibitor acidManagement of dysfunctional uterine bleeding.In D.U.B's there is no specific abnormality present, therefore, the choice of t/t must be considered in relation to several factors: -Factors influencing t/tPresence of ovulatory or anovulatory cycles.Need for contraceptionPatient preferenceContraindication to t/tHeavy periods |Require contraceptionYes -Combined oral contraceptive or levonorgestrel-releasing intrauterine systemNo |Regular cyclesNo-Combined oral contraceptives or cyclical progestinsYes |Dysmenorrhea significant symptomsYes-Non-steroidal anti-inflammatory drugsNo | Tranexamic acid Medical treatment can be conveniently divided into hormonal and non hormonal: -As there is no hormonal defect the use of hormonal therapy does not correct an underlying disorder but merely imposes an external control of the cycle.The two main first-line t/t for menorrhagias associated with ovulatory cycles are nonhormonal as the ovulatory cycles usually have no defect in the menstrual cycle.They have normal menstruation and regular cycle the abnormality usually lies in increased fibrinolysis and increased production of prostaglandin.First line drugs in ovulatory cycles (menorrhagia with regular cycles)Antifibrinolytic Q (Tranexamic acid)NSAIDSTranexamic acid reduces menstrual loss by half and NSAID reduces it by one third.Both have the advantages of only being taken during menstruation, and aid to compliance and are particularly useful in those women who either do not require contraception or do not wish to use a hormonal therapy.They are also of value in treating excessive menstrual blood loss associated with the use of the nonhormonal intrauterine contraceptive device.Hormonal therapy Progesterone Traditionally hormonal therapy for menorrhagia has been progesterone given during luteal phase of the cycle.Normally progesterone therapy will control anovulatory bleeding once uterine pathology is excluded.In women who do not ovulate but are more frankly hypogonadal cyclic progesterone therapy restores the normal sequence of steroid hormone stimulation, estrogen followed by estrogen plus progesterone followed by withdrawal bleeding.Progestins are usually not effective.Despite this, they remain the first choice of many general practitioners and gynecologists.Progesterone's are effective when given for 21 days in each cycle but the side effects are such that patient may not choose to continue with the t/t.Although progestins have the contraceptive effect they are not the best choice when contraception required. Combined contraceptive pillThey are popular first-line drugs for women who desire contraception.OCP's suppress pituitary gonadotropin release preventing ovulation.Like cyclical progestins, they are useful for anovulatory bleeding as they impose a cycle.Levonorgestrel intrauterine system (MIRENA)It is a T shaped intrauterine device which releases levonorgestrel at the rate of 20 mcg daily.This low hormone minimizes the systemic progestin side effects and more patients will continue this therapy than cyclic progesterone's.It exerts its clinical effect by preventing endometrial proliferation and consequently reduces both the duration of bleeding and the amount of menstrual loss.The levonorgestrel-releasing system is also advocated as an alternative to surgery. Endometrial ablation Vs Levonorgestrel IVDFor women who wish to stop using chronic medical therapy or have contraindications to medications, minimally invasive options include the LNG-IUD or endometrial ablation.A systematic review of six randomized trials and a subsequent randomized trial found that women with menorrhagia who were treated with either the LNG-IUD or endometrial ablation had similar reductions in menstrual blood loss at 6, 12, and 24 months, as well as similar improvements in quality of life.A meta-analysis of four randomized trials found that rates of dissatisfaction were similar for women treated with the LNG-IUD (17 percent) compared with endometrial ablation (18 percent) (OR 0.9, 95% Cl 0.5-1.8).The decision to use the LNG-IUD or endometrial ablation depends upon a patient's preferences regarding treatment at 6, 12, and 24 months, as well as similar improvements in quality of life.factors such as plans for fertility and contraception, convenience, and risks of anesthesia.- The LNG-IUD is a reversible contraceptive. - Pregnancy is contraindicated after endometrial ablation. but the procedure does not prevent pregnancy: thus. women will need to continue to use contraception following ablation. The LNG-IUD can be placed in an office setting for all women and requires no or local anesthesia.Endometrial ablation can also be done in an office by surgeons who are appropriately equipped but is often performed in an operating room under general anesthesia.If successful, endometrial ablation is performed once, while the LNG-IUD needs to be replaced every five.

So the answer to this question is B


Instruction:
Recommended duration of surveillance after completion of treatment of multibacillary leprosy?
A. 6 months
B. 1 year
C. 2 years
D. 5 years

Response:
Ans. is 'd' i.e., 5 years

So the answer to this question is D


Instruction:
Cabana procedure is done in:
A. CA testis
B. RPLND
C. Sentinel LN biopsy in penile carcinoma
D. ca penis

Response:
1st SLM Biopsy was performed by CABANA & Procedure was known as CABANA Procedure Diagnosis- IOC - Biopsy- IOC for staging -MRI Treatment- Circumcision for CA Penis involving prepuce- C.A involving distal pa* Paial penectomy with is 2cm margin- CA Penis involving proximal Pa * Total penectomy + perineal urethrostomy

So the answer to this question is C


Instruction:
Which of the following belongs to antifibrinolytic drugs
A. Alteplase
B. Urokinase
C. Aprotinin
D. Reteplase

Response:
Antifibrinolytic drugs promote blood clotting by preventing blood clots from breaking down. Some examples of antifibrinolytic drugs are aprotinin, tranexamic acid (TXA), epsilon-aminocaproic acid and aminomethylbenzoic acid. Doctors sometimes give these drugs to patients having surgery to prevent blood loss. Ref: KD Tripathi 8th ed.

So the answer to this question is C


Instruction:
Gegenhalten (paratonia) indicates lesion in
A. Parietal lobe (dominant)
B. Temporal lobe (dominant)
C. Frontal lobe (dominant)
D. Parietal lobe (non-dominant)

Response:
Ans. c (Frontal lobe) (Ref. Harrison 18th/Fig 370-9).PARATONIA: | tone that varies irregularly in a manner that may seem related to a degree of relaxation, is present throughout the range of motion, affects flexors and extensors equally, usually results from lesion of bilateral frontal lobes or dominant frontal lobe.RIGIDITY: | Tone, affects flexors and extensors equally; seen in extrapyramidal lesionsSPASTICITY: | tone, affects mainly extensors and seen in pyramidal tract lesions.Signs and symptomsStructures involved# Paralysis of opposite foot and leg# A lesser degree of paresis of opposite arm# Cortical sensory loss over toes, foot, and legMotor leg areaArm area of cortex or fibers descending to corona radiateSensory area for foot and leg# Urinary incontinenceSensorimotor area in paracentral lobule# Contralateral grasp reflex, sucking reflex, gegenhaiten (paratonic rigidity)Medial surface of the posterior frontal lobe; likely supplemental motor area# Abulia (akinetic mutism), slowness, delay, intermittent interruption, lack of spontaneity, whispering, reflex distraction to sights and soundsUncertain localization--probably cingulate gyrus and medial inferior portion of frontal, parietaland temporal lobes# Impairment of gait and stance (gait apraxia)Frontal cortex near leg motor area# Dyspraxia of left limbs, tactile aphasia in left limbsCorpus callosumDeficit/feature of lesion of a particular area of brainLobesImportant regionsDeficit after lesionFrontalPrimary motor and premotorFrontal eye fieldsBroca speech area*Contralatera spastic paresis (region depends on area of homunculusEyes deviate to ipsilateral sideBroca aphasia (expressive, nonfluent aphasia): patient can understand written and spoken language, but speech and writing are slow and effortful; patients are aware of their problem; often associated with contralateral facial and arm weaknessPrefrontal cortexFrontal lobe syndrome: symptoms can include poor judgement, difficulty concentrating and problem solving, apathy, inappropriate social behaviorParietalPrimary somatosensory cortexSuperior parietal lobuleInfrerior parietal lobuleContralateral hemihypesthesia (region depends on area homunculus affected)Contralateral asteroegnosis and sensory neglect, apraxiaGerstmann syndrome (if dominant hemisphere): right/left: confusion, dyscalculia and dysgraphia, finger agnosia, contralateral hemianopia or lower quadrantanopiaTemporalPrimary auditory cortexBilateral damage deafnessUnilateral leads to slight hearing lossWernicke area*Wernicke aphasia (receptive, fluent aphasia); patient cannot understand any form of language; speech is fast and fluent, but not comprehensibleHippocampusAmygdalaOlfactory bulb, tract, primary cortexMeyer loop (visual radiations)Bilateral lesions lead to inability to consolidate short-term to long-termKluver-Bucy syndrome: hyperphagia, hypersexuality, visual agnosia Ipsilateral anosmiaContralateral upper quadrantanopia ("pie in the sky")OccipitalPrimary visual cortexBlindnessAlso Remember: Parietal lobe lesions | | | Dominant lobe Non dominant lobe | | Multinodal complex motor activities affected Multinodal complex sensory disabilities | | # Ideational# Ideomotor# Alexia}Apraxia Visuospatial disorders(Hemiattention) AnosognosiaDressing and constructionalApraxia# Gerstamann's syndrome

So the answer to this question is C


Instruction:
All are calculated by Coho study, except ?
A. Incidence
B. Relative risk
C. Odds ratio
D. Attributable risk

Response:
Ans. is 'c' i.e., Odds ratio Characteristics Coho Study Case control Study Cross Sectional Study Design Prospective Retrospective One point in time Incidence Estimated Not estimated Not estimated Prevalence Not estimated Not estimated Estimated Calculations Incidence rates Relative risk Attributable risk Odds ratio

So the answer to this question is C


Instruction:
Highest amount of saturated fatty acid is seen in ?
A. Soyabean oil
B. Groundnut oil
C. Palm oil
D. Sunflower oil

Response:
Ans. is 'c' i.e., Palm oil Fatty- acids On the basis of presence or absence of double bond fatty acids are divided into :- 1.Saturated fatty acids Have no double bond. Examples --* Palmitie acid, lauric acid, stearic acid 2. Unsaturated fatty acids Have one or more double bonds i) Monounsaturated (Have single double bond) Oleic acid ii) Polyunsaturated (Have more than one double bonds) --) Linoleic acid. Linolenic acid,,4rachidonic acid, Eicosapentaenoic acid, Docosahexaenoic acid. Coming to question o Polyunsaturated are mostly found in Vegetal* oils and the saturated fatty acids mainly in animal fats. Q However, there are exceptions, as jOr example, coconut and palm oils, although vegetable oils, have on extremly high percentage of saturated acids on the other hand, fish oils, although they are not vegetable oils, contain poly and mono-unsaturated fatty acids.

So the answer to this question is C


Instruction:
Requirement of Potassium in child is
A. 1-2 mEq/kg
B. 4-7 mEq/kg
C. 10-12 mEq/kg
D. 13-14 mEq/kg

Response:
Requirement of potassium in child is 1-2 mEq/kg . Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is A


Instruction:
CT Scan of head showing a 'Tram track5 appearance in
A. Neurofibroma
B. Tuberous sclerosis
C. Von Hippel Lindau disease
D. Sturge weber syndrome

Response:
Ans. is 'd' i.e.,. Sturge Weber Syndrome. Sturge-Weber syndrome is characterized by -A large unilateral cutaneous angioma* (.Port wine stain*) of the faceA cerebral angioma involving the ipsilateral* cerebral hemisphere and meninges.Adrenal pheochromocytoma*.Cerebral angioma leads to cortical atrophy and epilepsy*.Characteristic tram track calcification* is seen on x-ray and CT head.

So the answer to this question is D


Instruction:
Nutrient artery to Femur is a branch of
A. Inferior gluteal Artery
B. 1st perforating Branch of profunda femoris artery
C. 2nd perforating Branch of profunda femoris artery
D. Lateral circumflex femoral artery

Response:
Femur gets its nutrient artery from 2nd perforating Branch arising from profunda femoris artery.

So the answer to this question is C


Instruction:
All of the following signs may be appreciated in a patient with early papilloedema except
A. Mild hyperaemia of the disc
B. Obliteration of physiological cup of the optic disc
C. Obscuration of superior, inferior and nasal disc margins
D. Absence of spontaneous venous pulsation

Response:
PAPILLOEDEMA Clinical features: Early (incipient) papilloedema : Symptoms are usually absent and visual acvity is normal. Pupillary reactions are normal. Ophthalmoscopic features of early papilloedema are: (i) Obscuration of the disc margins (nasal margins are involved first followed by the superior, inferior and temporal). (ii) Blurring of peripapillary nerve fibre layer. (iii) Absence of spontaneous venous pulsation at the disc (appreciated in 80% of the normal individuals). (iv) Mild hyperaemia of the disc. (v) Splinter haemorrhages in the peripapillary region may be present. Visual fields are fairly normal. Ref:- A K KHURANA; pg num:-299

So the answer to this question is B


Instruction:
Chromosome 21 is -
A. Metacentric
B. Submetacentric
C. Acrocentric
D. None

Response:
Ans. is 'c' i.e., Acrocentrico Each chromosome has two armsi) p arm (the shorter of two)ii) q arm (longer one)o Depending on the position of there junction (centromere) they can be classified into :1. Metacentric# The centromere is in the middle so that the two arms of chromosomes are almost equal.# These chromosomes are : chromosomes 1,2, 3 and X-chromosome.2. Submetacentric# p arm is short and q arm is long.# These chromosomes are : 4, 5, 6, 7, 8 and 9.3. Acrocentric# p (short) arm is so short that it is hard to observe, but still present.# There are six acrocentric chromosomes : 13,14,15,21,22 and Y chromosomes.

So the answer to this question is C


Instruction:
Which of the following monoclonal antibodies is a humanized antibody?
A. Rituximab
B. Palivizumab
C. Infliximab
D. Basiliximab

Response:
Nomenclature of monoclonal antibodies: * Their name ends with mab. * Before mab the two letters tell the source: - XI means Chimeric - ZU means humanized - U means completely human

So the answer to this question is B


Instruction:
Which of the following is NOT an adverse effect of heparin ?
A. Bleeding
B. Thrombocytopenia
C. Hypokalemia
D. Osteoporosis

Response:
None

So the answer to this question is C


Instruction:
Fertilization occurs in -
A. uterine cavity
B. Ampulla of fallopian tube
C. Infundibulum of fallopian tube
D. Isthmus of tube

Response:
Ans. is 'b' i.e., Ampulla of fallopian tube * The uterine tubes, also known as oviducts or fallopian tubes, are the female structures that transport the ova from the ovary to the uterus each month. In the presence of sperm and fertilization, the uterine tubes transport the fertilized egg to the uterus for implantation.* The infundibulum gives rise to the fimbriae, fingerlike projections that are responsible for picking up the egg released by the ovary.* Fertilization takes place in the ampullary part of the fallopian tube.

So the answer to this question is B


Instruction:
Which of the following is associated with >20% risk of chromosomal anomalies?
A. Cleft lip
B. Gastroschisis
C. Omphalocele
D. Spina bifida

Response:
Omphalocele is a membrane-covered herniation of abdominal contents into the base of the umbilical cord; the incidence is 2 per 10,000 live bihs (0.02%). Over 50% of cases have either an abnormal karyotype or an associated syndrome. The sac may contain liver and spleen as well as intestine. Prognosis varies with the size of the lesion, with the presence of pulmonary hypoplasia and respiratory insufficiency, and with the presence of associated abnormalities. Ref: Thilo E.H., Rosenberg A.A. (2012). Chapter 2. The Newborn Infant. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.

So the answer to this question is C


Instruction:
Post - Vagotomy diarrhoea can be effectively managed by -
A. Steroids
B. Thyroxin
C. Somatostatin analogue
D. Parathormone

Response:
None

So the answer to this question is C


Instruction:
Picket fence fever is a feature of -
A. Acute mastoiditis
B. Lateral sinus thrombophlebitis
C. Bell's Palsy
D. Atticoantral CSOM

Response:
Ans. B. Lateral sinus thrombophlebitis Ref: Dhingra Sth/e p. 95] Hectic Picket-Fence fi:pe of fever with rigor,

So the answer to this question is B


Instruction:
Which category of ICD is associated with mood disorders
A. F0
B. F1
C. F2
D. F3

Response:
ICD ICD mentions International classification of mental and behavioural disorders this was given by WHO( World health Organisation) ICD is used all over the world except America latest edition of ICD is ICD11 ICD 11 was released in 2018 DSM DSM mentions Diagnostic and Statistical manual of mental disorders this was given by APA( American Psychiatric Assosiation) DSM is used in America latest edition of DSM is DSM 5 ICD 11 was released in 2018 categorisation ofmental disorders in ICD 10 is mentioned below F00-F09 Organic, including symptomatic, mental disorders F10-F19 Mental and behavioural disorders due to psychoactive substance use F20-F29 Schizophrenia, schizotypal and delusional disorders F30-F39 Mood disorders ICD-10 Classification of Mental and Behavioural Disorders, World Health Organization, Geneva, 1992

So the answer to this question is D


Instruction:
Fungus not cultivable usually is
A. Rhinosporidium
B. Cryptococcus
C. Dermatophytes
D. Histoplasma

Response:
Histoplasma- SDA or brain hea infusion agar. Cryptococcus- SDA and Niger seed agar media( Brown colonies). Dermatophytes - sabouraud glucose neopeptone agar, sabouraud agar. Reference: Textbook of Microbiology; Baveja; 4th edition

So the answer to this question is A


Instruction:
Urinary tract infection exists when the bacterial count in 1 ml. of midstream specimen of urine is ?
A. 100
B. 1000
C. 104
D. 105 or over

Response:
Ans. is 'd' i.e., 105 or over

So the answer to this question is D


Instruction:
Bone Density is best studied by –
A. CT scan
B. DEXA scan
C. MRI scan
D. Bone scan

Response:
DEXA scan is the gold standard test for screening of bone density (to rule out asteoporosis).

So the answer to this question is B