Instruction:
Which of the following drugs is both anti-receptive and bone formative?
A. Strontium ranelate
B. Calcitonin
C. Ibadronate
D. Teriperatide

Response:
Ans. is 'a' i.e., Strontium Ranelate Osteoporosis is an abnormal decrease in amount of bone, but whatever left, is of normal quality. It results from bone loss due to age related changes in bone remodelling.In adult bones, remodelling is the principal metabolic skeletal process.During remodelling the bone is first resorbed by osteoclasts and is then replaced by an equal amount of bone tissue due to action of osteoblasts.This process of bone resorption and formation goes on throughout the adult life, and it serves two purposes.To repair the micro damage within the skeleton.To supply calcium from the skeleton to maintain serum calcium.In young adult the resorbed bone is replaced by an equal amount of new bone tissue. Thus the mass of skeleton remains constant after peak bone mass in achieved in adulthood.However after the age of 35-40 the resorption and formation processes becomes imbalanced and resorption exceeds formation.Excessive bone loss can be due to an increase in osteoclastic activity and or decrease in osteoblastic activity. Mechanism of action of Strontium Ranelate in the t/t of osteoporosis.Strontium Ranelate increases bone mass throughout the skeleton. It appears to be modestly anti resorptive while at the same time not causing much decrease in bone formation.Strontium is incorporated into hydroxyapatite replacing calcium, a feature that might explain some of its fracture benefit.* It is approved in several European countries for the t/t of osteoporosis.Pharmacological agents used to manage osteoporosis either act byDecreasing the rate of bone resorption (anti resorptive therapy.)Promoting bone formation (anabolic therapy).Since bone remodelling is a coupled process, anti resorptive drugs ultimately decrease the rate of bone formation and therefore do not promote substantial gains in BMD."Thus, Strontium ranelate is unique because it decreases osteoblastosis as well as promote bone formation. "More on t/t of osteoporosisPharmacological treatment of osteoporosis is generally aimed at restoring bone strength and preventing fractures.The long standing centrepiece of this approach has been anti resorptive drugs such as: -BiphosphonateEstrogenSelective estrogen receptor modulator, RaloxifeneCalcitoninUntil recently, anti resorptive drugs were the only drugs approved in the United States for treating osteoporosis.This situation changed in 2002 when FDA approved Teriparatide (the biologically active PTH fragment). Teriparatide acts by increasing the bone massBecause teriparatide stimulates bone formation whereas biphosphonates reduce bone resorption, it was predicted that therapy combining the two would enhance the effect on bone marrow density more than treatment with either one alone.However addition of teriparatide to alendronate provided no additional benefit for bone mass density.Before the advent of strontium Ranelate there wasn't any drug which combined the two processes i.e., increasing bone formation and at the same time, decreasing bone resorption.Strontium Ranelate has a novel mechanism of action for an osteoporotic drug as it acts on bone resorption to reduce the rate of bone growth but also acts on bone formation promoting the growth of new bone.More on anti resorptive therapies for osteoporosis:BisphosphonatesAlendronate, PamidronateMost effective drugs currently approved for prevention and t/t of osteoporosis.They suppress bone resorption at doses that do not inhibit mineralization.Thiazide diureticsThey are not strictly anti resorptive but they reduce urinary Ca2+ excretion and constrain bone loss in patients with hypercalciuria.EstrogenThere is an unambiguous relationship between estrogen deficiency and osteoporosis. Post-menopausal status or estrogen deficiency at any stage significantly increases patient's risk for osteoporosis.Selective Estrogen receptor modulator (SERM)These are estrogenic compounds with tissue selective activities.Raloxifene (SERM) acts as an estrogen agonist on bone and liver and is inactive on the uterus.CalcitoninCalcitonin inhibits osteoclastic bone resorption.

So the answer to this question is A


Instruction:
Gram positive, catalase negative cocci ?
A. Staph aureus
B. Staph epidermidis
C. Staph saprophyticus
D. Pneumococcus

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

So the answer to this question is D


Instruction:
Not a radiological feature of Ankylosing spondylitis
A. Dagger sign
B. Trolley track sign
C. Romanus sign
D. Fish mouth vertebrae

Response:
None

So the answer to this question is D


Instruction:
The regression between height and age follows y = a + bx. The curve is -
A. Hyperbola
B. Sigmoid
C. Straight line
D. Parabola

Response:
None

So the answer to this question is C


Instruction:
Adipocure occurs in
A. Arsenic poison
B. Lying in water
C. Body inside car locked doors
D. Inside shallow soil

Response:
Warm, moist climate essential.
Clostridium - lecithinase.
Intrinsic lipase.

So the answer to this question is B


Instruction:
Drug causing cataract-
A. Amikacin
B. Dexamethasone
C. Chloramphenicol
D. Penicillin

Response:
Ans. is ;b' i.e., Dexamethasone o Corticosteroids (dexamethasone) can cause cataract.Types of CataractCausesPosterior subcapsularMyotoic dystrophy, wilson's disease, DM, Atopic dermatitis, Down's syndrome, Corticosteroids, Busulfan, Chloroquine, Trauma, Ionizing radiation, Galactosemia, Senile cataract, Infrared/heat cataract (glass-blower's or glass worker).Anterior subcapsularWilson's disease, DM, Down's syndrome, Trauma, Electric shock, Anticholinesterase, Amiodarone, Senile cataract, Galactosemia.Anterior capsularVoissious ring (Blunt trauma), Gold, Chlorpramazine,NuclearCigarette smoking, Congenital rubella, Ichthyosis, Galactosemia, Senile cataract, DM.CorticalStickler syndrome, Senile cataract, DMAnterior capsular (Polar)Penetration of cornea (Penetrating injury, ophthalmia neonatorum), Congenital cataractPosterior capsular (Polar)Congenital cataract

So the answer to this question is B


Instruction:
All of the following are affected in low radial nerve palsy except
A. Extensor carpi radialis longus
B. Extensor carpi radialis brevis
C. Finger extensors
D. Sensation on dorsum of hand

Response:
A i.e. Extensor carpi radialis longus Extensor carpi radialis longus muscle is supplied by main trunk of radial nerve above the level of elbow joint; whereas extensor carpi radialis brevis, finger extensors (extensor indics, extensor digitorum, extensor digits minimi) are supplied by its posterior interosseous branch and sensation on dorsum of hand by superficial radial branch below the level of elbow joint.

So the answer to this question is A


Instruction:
Lymphoid tissue is the site of latent infection for which of the following herpes viruses?
A. Cytomegalovirus
B. Epstein barr virus
C. Herpes simplex virus type 1
D. Herpes simplex virus type 2

Response:
Epstein barr virus is a human herpes virus type 4, belonging to the gamma family. Its latent infection is in the lymphoid tissues. While that of Herpes simplex virus type 1 and 2 is in neurons and that of cytomegalovirus is in secretary glands and kidneys. Ref: Textbook of Microbiology, Anathanaraya and panicker's, 8th Edition, Page 468

So the answer to this question is B


Instruction:
All of the following are increased in isometric exercise, EXCEPT:
A. Hea rate
B. Cardiac output
C. Mean aerial pressure
D. Systemic vascular resistance

Response:
As a result of vasodilation in the vascular bed in the active muscles, the peripheral resistance to blood flow is reduced during exercise, but the elevation in cardiac output causes the blood pressure to rise. The increase in cardiac output results principally from an increase in hea rate. When the cardiac output increases, mean aerial pressure also increases. Some increase in stroke volume also takes place. Ref: Abdulla C., Nixon J.I. (2009). Chapter 34. The Athlete's Hea. In M.H. Crawford (Ed), CURRENT Diagnosis & Treatment: Cardiology, 3e.

So the answer to this question is D


Instruction:
Which of the following biomedical wastes can be incinerated?
A. Pressurized gas containers
B. Radiographic wastes
C. PVC
D. Human anatomical wastes

Response:
None

So the answer to this question is D


Instruction:
You have treated the simple and undisplaced fracture of shaft of right tibia in a nine year girl with above knee plaster cast. Parents want to know the prognosis of union of the fractured limb which was affected by polimoyelitis four years age. What is the bet possible advice will you offer to the parents ?
A. Fracture will unite slowly
B. Fracture will not unite
C. Fracture will unite normally
D. Fracture will unite on attaining puberty

Response:
"There is no significant delay in the rate of fracture healing in poliomyelitis".  — Skeletal injury in children

So the answer to this question is C


Instruction:
A School based dental health education programme that emphasizes home activities for skill development
A. Health-way arcade
B. Head Start
C. Tattle tooth
D. Natural Noshers

Response:
None

So the answer to this question is D


Instruction:
In Von willebrand disease, there is -
A. Factor VII deficiency
B. Factor VIII C deficiency
C. Factor X deficiency
D. Defects in vWF

Response:
Von willebrand disease is the most common hereditary coagulation disorder due to qualitative or quantitative defect in vWF. von Willebrand Disease von Willebrand disease is transmitted as an autosomal dominant disorder. It usually presents as spontaneous bleed- ing from mucous membranes, excessive bleeding from wounds, and menorrhagia. It is underrecognized, as the diagnosis requires sophisticated tests and the clinical manifestations often are quite mild. Actually, this disease is surprisingly prevalent, paicularly in persons of European descent. It is estimated that approximately 1% of people in the United States have von Willebrand disease, making it the most common inher- ited bleeding disorder. People with von Willebrand disease have compound defects in platelet function and coagulation, but in most cases only the platelet defect produces clinical findings. The exceptions are rare patients with homozygous von Willebrand disease, in whom there is a concomitant defi- ciency of factor VIII severe enough to produce features resembling those of hemophilia (described later on). The classic and most common variant of von Willebrand disease (type I) is an autosomal dominant disorder in which the quantity of circulating vWF is reduced. There is also a measur- able but clinically insignificant decrease in factor VIII levels. The other, less common varieties of von Willebrand disease are caused by mutations that produce both qualita- tive and quantitative defects in vWF. Type II is divided into several subtypes characterized by the selective loss of high- molecular-weight multimers of vWF. Because these large mul- timers are the most active form, there is a functional deficiency of vWF. In type IIA, the high-molecular-weight multimers are not synthesized, leading to a true deficiency. In type IIB, abnormal "hyperfunctional" high-molecular- weight multimers are synthesized that are rapidly removed from the circulation. These high-molecular-weight multiA mers cause spontaneous platelet aggregation (a situation reminiscent of the very-high-molecular-weight multimer aggregates seen in TTP); indeed, some people with type IIB von Willebrand disease have mild chronic thrombocytope- nia, presumably due to platelet consumption. Reference : Harsh Mohan textbook pathology, 7th edition.Pg no.314 Ref Robbins 9/e pg 455

So the answer to this question is D


Instruction:
Glottic chink, in cadaveric positions of vocal cords is
A. 3 mm
B. 3.5 mm
C. 7 mm
D. 19 mm

Response:
Glottic chink It is the distance between the vocal cords. In cadaveric position--the vocal cords are 3.5 mm away from midline, so the distance between them i.e glottic chink is 7 mm. Similary in full abduction it is about 19 mm. Ref:- Mohan Bansal; pg num:- 374

So the answer to this question is C


Instruction:
In intracellular fluid, which of the following has least concentration?
A. Calcium
B. Magnesium
C. Potassium
D. Protein

Response:
- Calcium is kept very LOW in cytoplasm, hence intracellular fluid doesn't contain much Ca+2 - Calcium is mostly stored in organelles inside cell - E.g. In sarcoplasmic reticulum of muscle cell etc.

So the answer to this question is A


Instruction:
Snow storm appearance is seen in:
A. Hydatid cyst
B. Choriocarcinoma
C. Hydatidiform mole
D. Twin pregnancy

Response:
Ans: c (Hydatidiform mole)Ref: William's Obstetrics, 23rd ed. Chapter 11Some women will present early with spontaneous passage of molar tissue.ln most cases, however, there are varying durations ofamenorrhoea, usually followed by irregular bleeding. Thesealmost always prompt pregnancy testing and sonography.If left untreated, spontaneous expulsion usually occurs around 16 weeks.The characteristic sonographic appearance of a complete mole includes a complex, echogenic uterine mass with numerous cystic spaces and no fetus or amnionic sac- "snow-storm".Sonographic features of a partial mole include a thickened, hydropic placenta with foetal tissue. Importantly, in early pregnancy, sonography willdemonstrate the characteristic appearance in as few as athird of women with a partial mole.Occasionally, molar pregnancy may be confused for auterine leiomyoma or multi fetal pregnancy.

So the answer to this question is C


Instruction:
Which is the best prognosticator of survival from nasopharyngeal carcinoma?
A. High angiogenesis in the tumor
B. WHO type III histology
C. Lung metastases
D. WHO type I histology

Response:
WHO type PATHOLOGY Risk factor Other factors Survival/ Recurrence I 25% Keratinizing Squamous cell differentiated carcinoma Smoking Low risk population Older age Non familial factors 10% Survival II 12% Non keratinizing Squamous cell differentiated carcinoma EBV Preserved foods Familial factors 50% Survival III 60% Non keratinizing Squamous cell undifferentiated carcinoma EBV High risk population, Children Preserved foods Familial factors 60% Survival Best prognosis Type 3 NPC- Poorly differentiated, EBV Associated & Best prognosis The undifferentiated NPC havea higher local tumour control rate with therapy although theincidence of distant metastasis is also higher.

So the answer to this question is B


Instruction:
Linitis plastica is a type of ?
A. Plastic like lining of stomach
B. Diffuse carcinoma of stomach
C. Benign ulcer
D. GIST

Response:
Ans. is `b' i.e., Diffuse carcinoma of stomach Linitis plastica Involvement of a broad region of the gastric wall or entire stomach by diffuse stomach cancer cause linitis plastica. It is also known as Brinton's disease. The appearance of stomach is like leather bottle. The other cause of linitis plastica are Lye ingestion Metastatic infiltration of stomach Syphilis Sarcoidosis Non -hodgkin lymphoma of stomach

So the answer to this question is B


Instruction:
A baby can follows an object with 180deg, can hold neck, can sit with suppo but can not sit without suppo. The age of the baby is -
A. 1 month
B. 3 months
C. 5 months
D. All

Response:
Ans. is 'c' i.e., 5 months o A child follows object upto 180deg by 3 months, o Neck holding develops by 3 months. o A child can sit with suppo by 5 months and can sit without suppo by 8 months. o So, the age of this child is between 5-8 months, which may be 5 months (option c) or 6 months (option d) or 7 months.

So the answer to this question is C


Instruction:
Vitamin deficiency causing circumcorneal vascularization is:
A. Biotin
B. Riboflavin
C. Thiamine
D. Vitamin D

Response:
Ans. B. RiboflavinPrincipal Clinical Findings of Vitamin MalnutritionNutrientClinical findingThiaminePeripheral nerve damage (beriberi) or central nervous system lesions (Wernicke-Korsakoff syndrome)RiboflavinMagenta tongue, angular stomatitis, cheilosis, seborrheic dermatitis, circumcorneal VascularisationNiacinPellagra: pigmented rash of sun-exposed areas (photosensitive dermatitis), bright red tongue, diarrhea, apathy, memory loss, disorientation, depressive psychosisVitamin B6 Seborrhea, glossitis, convulsions, neuropathy, depression, confusion, microcytic anemiaFolateMegaloblastic anemia, atrophic glossitis, depression, homocysteineVitamin B12 Pernicious anemia = megaloblastic anemia with degeneration of the spinal cord, loss of vibratory and position sense, abnormal gait, dementiaQ, impotence, loss of bladder and bowel control, homocysteine, methyl malonic acidPantothenic AcidPeripheral nerve damage (nutritional melalgia or "burning foot syndrome")Vitamin CScurvy: petechiae, ecchymosis, coiled hairs, inflamed and bleeding gums, joint effusion, poor wound healing, fatigueVitamin AXerophthalmia, night blindness, Bitot's spots, follicular hyperkeratosis, impaired embryonic development, immune dysfunctionVitamin DRickets: skeletal deformation, rachitic rosary, bowed legs; osteomalaciaVitamin EPeripheral neuropathy, spinocerebellar ataxia, skeletal muscle atrophy, retinopathyVitamin KElevated prothrombin time, bleeding

So the answer to this question is B


Instruction:
A paicular genetic disorder appears in three consecutive generations of a family without any sex predilection. It was also noticed that phenotypically normal family members were having healthy offspring . What is the pattern of inheritance in this disorder?
A. Autosomal recessive
B. Autosomal dominant
C. Mitochondrial inheritance
D. Uniparenteral disomy

Response:
The pattern of inheritance in this disorder is autosomal dominant. Points in our: Autosomal dominant disorders have a veical mode of transmission (individuals of two generations are affected-Parent and children affected) Genetic disorder has appeared in three consecutive generations of a family without any sex predilection, and normal family members have healthy offspring. An affected individual has 50% chance of passing on the deleterious gene in each pregnancy Males and females are equally affected. Unaffected individuals donot pass on the disorder to their children Autosomal Dominant Ref: Nelson textbook of pediatrics 21st edition Pgno: 640

So the answer to this question is B


Instruction:
Transport medium most commonly used for vibrio cholera is?
A. TCBS medium
B. Venkatraman Ramakrishna medium
C. Sodium taurocholate medium
D. Thayer martin medium

Response:
Ans. (b) Venkatraman Ramakrishna mediumRef: Textbook of microbiology- Ananthanarayan & Paniker 7th ed /306, textbook of microbiology and immunology-parija / 308

So the answer to this question is B


Instruction:
Which of the following organ is most severely affected in Kala azar?
A. Spleen
B. Liver
C. Kidney
D. Bone Marrow

Response:
A disease caused by infection with leishmania parasites.
Visceral leishmaniasis / Black fever is spread by sandfly bites.
This type of leishmaniasis affects the internal organs, usually the spleen, liver and bone marrow.
Some people have no symptoms.
For others, symptoms may include fever, weight loss and swelling of the spleen or liver.
If left untreated, severe cases are typically fatal, by affecting spleen.

So the answer to this question is A


Instruction:
All of the following are biomarkers of kidney function except
A. NGAL
B. Cystatin - C
C. KIM - 2
D. IL - 18

Response:
Biomarkers of kidney function :
Cystatin - C.
NGAL ⇒ Neutrophil Gelatinase associated lipocalcin.
KIM - 1 ⇒ Kidney injury molecule - 1.
IL - 18 ⇒ Interleukin - 18.

So the answer to this question is C


Instruction:
Which of the following is true about degenerative myopia?(AIIMS Nov 2013, May 2013)
A. More common in males as compared to females
B. Myopic degeneration can lead to retinal detachment
C. It is seen in <-6 Diopters myopia
D. Optic dis swelling is seen

Response:
Ans. b. Myopic degeneration can lead to retinal detachment (Ref: Khurana 4th/34)Myopic degeneration can lead to retinal detachment.Pathological Myopia/Degenerative/Progressive myopiaPathological Myopia/Degenerative /Progressive myopia is a rapidly progressive error which starts in childhood at 5-10 years of ageResults in high myopiaQ (> -6 D) during early adult lifeLess common, seen in 2% of populationEtiology:Results from rapid axial growth of eyeballEtiological hypothesis:Genetic Factors (Major role) and General Growth Process (Minor role)|More growth of retinaStretching of sclera* Increased axial lengthQ* Degeneration of choroidQ* Degeneration of retinaQ* Degeneration of vitreousQClinical Features:SymptomsSigns* Defective visionQ* Muscae volitantes* Night blindness* Prominent eye balls* Large cornea* Deep anterior chamber* Slightly large pupils, react slugguishly to lightFundus Examination:Myopic crescentsQ (on temporal edge of optic disc)Foster fuch's spotQ (dark red patch at macula due to retinal neovascularization and Choroidal hemorrhage)Cystoid degenerationQPeripheral retinal degeneration (lattice and snail track degeneration)QPosterior staphylomaQComplications of Pathological Myopia* Retinal detachmentQ* Complicated cataractQ* Vitreous hemorrhageQ* Choroidal hemorrhageQTreatment:Optical treatment of myopia by concave lensesSurgical treatment

So the answer to this question is B


Instruction:
A 60- year - old patient presented with several bullous lesions for the last 3 days; each bulla was surrounded by an erythematous halo. There were multiple target lesions. Patient also had oral erosions. The most likely diagnosis is:
A. Chicken pox
B. Herpes simplex
C. Herpes zoster
D. Steven- Johnson syndrome

Response:
D. i.e. Steven Johnson syndrome

So the answer to this question is D


Instruction:
A pregnant lady presented with 32 weeks of gestation with abdominal pain, elevated BP (160/110 mmHg), with proteinuria and retinal haemorrhage. Next step of management is:
A. Ritodrine
B. Nifedipine
C. Magnesium sulphates
D. Termination of pregnancy

Response:
HELLP syndrome is a form of severe preeclampsia. HELLP develops in 10-20% of women with preeclampsia/eclampsia. Signs and symptoms include abdominal pain, commonly occurring in the right upper quadrant or epigastrium, nausea, vomiting, and elevated blood pressure. Proteinuria less commonly accompanies symptoms. HELLP is an indication for delivery to avoid hepatic complications, such as rupture, infarct, and hemorrhage. Ref: Anantharaman P., Schmidt R.J., Holley J.L. (2009). Chapter 55. Pregnancy & Renal Disease. In E.V. Lerma, J.S. Berns, A.R. Nissenson (Eds), CURRENT Diagnosis & Treatment: Nephrology & Hypeension.

So the answer to this question is D


Instruction:
Pregnancy which continues 'following threatened abortion is likely to have increased incidence of:
A. Preterm laber
B. Fetal malformation
C. IUGR
D. All of the above

Response:
Prognosis of threatened abortion
In about two-third, the pregnancy continues beyond 28 weeks. In the rest, it terminates either as inevitable or missed miscarriage. If the pregnancy continues, there is increased frequency of preterm labor, placenta previa, intrauterine growth restriction of the fetus and fetal anomalies.

So the answer to this question is D


Instruction:
Dye which is NOT used in fluorescent microscopy:
A. Thioflavin
B. Lissamine
C. Rhodamine
D. Auramine

Response:
Thioflavin is not used as a dye for fluorescent microscopy Fluorescent microscopy - Based on the principle that the specimens stained with fluorescent dye when exposed to ultraviolet light result in emission of longer wavelength of light (i.e. visible light). The bacteria stained with fluorescent dye appear as a brightly glowing object against a dark background *(F)-Fluorescent dye used commonly are -( FAL Rapid Fire) *(A)-Auramine *(L)-Lissamine *(Rapid)-Rhodamine *(Fire)-Fluoresceine isothiocynate =Congo red , Thioflavin T and Thioflavin S is used for staining in Amyloidosis =Brilliant Blue - used as a biological stain to stain cell walls, bacteria, and fungal cells.

So the answer to this question is A


Instruction:
Reinke crystalloids can be seen in which of the following sex cord-stromal tumours?
A. Leydig cell tumour
B. Granulosa cell tumour
C. Gonadoblastoma
D. Thecoma

Response:
Hilus cell tumours (pure Leydig cell tumours) are rare, unilateral tumors comprised of large lipid-laden Leydig cells with distinct borders and characteristic cytoplasmic structures called Reinke crystalloids.

So the answer to this question is A


Instruction:
Hypoglycemia is a recognized feature of all of the following conditions, except -
A. Uieinia
B. Acromegaly
C. Addison's disease
D. Hepatocellular failure

Response:
None

So the answer to this question is B


Instruction:
Most common histological type of renal cell carcinoma
A. Clear cell
B. Medullary
C. Papillary
D. Mixed type

Response:
Refer Robbins 9/e p953 Clear cell carcinoma. This is the most common type, accounting for 70% to 80% of renal cell cancers. The tumors are made up of cells with clear or granular cytoplasm and are nonpapillary. They can be familial, but in most cases (95%) are sporadic. In 98% of these tumors, whether familial, sporadic, or associated with VHL syndrome, there is loss of sequences on the sho arm of chromosome 3. The deleted region harbors the VHL gene (3p25.3). A second nondeleted allele of the VHL gene shows somatic mutations or hypermethylation-induced inactivation in up to 80% of clear cell cancers, indicating that the VHL gene acts as a tumor suppressor gene in both sporadic and familial cancers (Chapter 7). The VHL gene encodes a protein that is pa of a ubiquitin ligase complex involved in targeting other proteins for degradation. Impoant among the targets of the VHL protein is the transcription factor hypoxia- inducible factor-1 (HIF-1). When VHL is inactive, HIF-1 levels remain high, even under normoxic conditions, causing inappropriate expression of a number of genes that are turned on by HIF. These include genes that promote angiogenesis, such as VEGF, and genes that stimulate cell growth, such as insulin-like growth factor-1 (IGF-1). In addition, HIF collaborates in complex ways with the oncogenic factor MYC to "reprogram" cellular metabolism in a way that ors growth. D

So the answer to this question is A


Instruction:
Prostaglandin used in the management of glaucoma: September 2009
A. Bimatoprost 0.03%
B. Travoprost 0.004%
C. Travoprost 0.004%
D. All of the above

Response:
Ans. D: All of the above Contraindiactions to their use: Ocular infection/inflammation Systemic side-effects: Headache Symptoms of upper respiratory tract infection Ocular side -effects: iris pigmentation Punctate keratitis

So the answer to this question is D


Instruction:
Drug of choice for nephrogenic diabetes insipidus is:-
A. Mannitol
B. Spironolactone
C. Thiazides
D. Demeclocycline

Response:
Diabetes insipidus Central Nephrogenic Desmopressin (DOC) Thiazides (DOC) (As endogenous ADH is already present that is not able to work, so there is no point in giving ADH(desmopressin))

So the answer to this question is C


Instruction:
All are features of hypernephroma except:
A. May invade renal vein
B. Lower pole involvement
C. More common in males
D. Cannon ball secondaries are seen

Response:
RENAL CELL CARCINOMA (AKA gravitz tumor, hypernephroma, internist's tumor, radiologist's tumor) - More common in males, in 6th and 7th decade - Tumor usually involve upper pole Most common site of distant metastasis are lungs (cannon ball deposits and pulsatile osteolytic secondaries in bone>liver>brain) Characteristic feature of RCC is tendency to invade renal vein

So the answer to this question is B


Instruction:
Bertillon System is for
A. Anthropometry
B. Dactylography
C. Dentition
D. Nuclear Sexing

Response:
Bertillon's System : After 21 years

Anthropometric system based on physical measurement of specified parts of the body

Ref - Naryana Reddy, pg. 85.

So the answer to this question is A


Instruction:
Commonly used in narcoanalysis
A. Atropine
B. Scopolamine
C. Opium
D. Thiopentone

Response:
D i.e. Thiopentone

So the answer to this question is D


Instruction:
Neuroparalytic keratitis is due to which cranial nerve?
A. 3rd nerve
B. 5th
C. 6th
D. 7th

Response:
5th nerve REF: Khurana 4th ed p. 107 "Neuroparalytic keratitis is due to paralysis of sensory supply to cornea which is by trigeminal nerve')

So the answer to this question is B


Instruction:
Trismus in CA of temporal bone occurs due to involvement of-
A. Dura
B. Temporo mandibular joint
C. Mastoid
D. Eustachian tube

Response:
Ans. is 'b' i.e., Temporo mandibular joint Clinical Assessment of Temporal bone Tumorso A long history of ear discharge suggests cancer associated with inflammatory ear disease (Maijolins ulcer)o Pulsatile tinnitus suggests tumor of vascular origin such as glomus tumor or a middle ear vascular anamoly; or a duralarteriovenous abnormality.o Deep headache raises the suspicion of dural involvement.o Facial weakness indicates invasion of the facial nerveo Onset of vertigo and sensineuronal hearing loss indicates involvement of the labyrinth and the development of speech and swallowing problems heralds involvement of the lower cranial nerves in the jugular foramen.o The onset of trismus due to the involvement of temporomandibular joint, pterygoid muscles or mandible suggests advanced disease that has spread anteriorly. Also the appearance of perauricular and parotid swelling is a grave sign.

So the answer to this question is B


Instruction:
A 5 month-old-baby (exclusively cow milk fed) presented to pediatrics OPD with history of crying on touch. Cause may be:
A. Scurvy
B. Rickets
C. JRA
D. Osteogenesis imperfecta

Response:
Deficiency of Vitamin C Sub periosteal hemorrhage involving long bones- crying on touch

So the answer to this question is A


Instruction:
All are markers of Wilms' tumor except:
A. Desmin
B. Vimentin
C. TTF 1
D. Cytokeratin

Response:
Wilms tumor Marker of Triphasic tumor. 3 components d/t abnormal mesenchymal differentiation : Blastemal Epithelial Stromal Various markers: Desmin - Muscle cell tumor Vimentin - Mesenchymal cell tumor marker Cytokeratin - Epithelial cell tumor marker TTF-1 (thyroid transcription factor): Lung cancer Thyroid cancer. Adenocarcinoma Small cell Ca of lung.

So the answer to this question is C


Instruction:
Which of the following arteries is a direct branch of the gastroduodenal artery -
A. Right gastric artery
B. Left gastric artery
C. Inferior pancreaticoduodenal artery
D. Right gastroepiploic artery

Response:
Gastroduodenal artery divides into right gastroepiploic and superior pancreaticoduodenal arteries.

So the answer to this question is D


Instruction:
The deficiency of thiamine can be identified by measuring the red cell:
A. Transketolase
B. Transaldolase
C. Alpha ketoglutarate dehydrogenase
D. Pyruvate dehydrogenase

Response:
None

So the answer to this question is A


Instruction:
Watson Jones operation is done for which condition ?
A. Polio
B. Muscle paralysis
C. Neglected clubfoot
D. Chronic ankle instability

Response:
ref : maheswari 9th ed

So the answer to this question is D


Instruction:
A pt of BPD on lithilhium for 6months after fasting for a day presents with seizure coarse tremors confusion and weakness of limbs Whats the most accurate to diagnosis her condition
A. Serum Electrolyte
B. s.Lithium
C. S .creatinine
D. ECG

Response:
ref : harissons 21st ed

So the answer to this question is B


Instruction:
Overweight BMI ?
A. 25 to 29.99
B. 15-18
C. 18-20
D. None

Response:
Ans. is 'a' i.e., 25 - 29.99 Classification of adults according to BMIClassificationBMIRisk of comorbiditiesUnderweight<18.50Low (but risk of other clinical problems increased)Normal range18.50-24.99AverageOverweight:>25.00 Pre-obese25.00-29.99IncreasedObese class I30.00-34.99ModerateObese class II35.00-39.99SevereObese class III>40.00Very severe

So the answer to this question is A


Instruction:
Neutrophil count below which there is increased risk of nosocomial invasive pulmonary aspergillosis -
A. < 4000/4
B. < 3000/4
C. < 2000/4
D. < 1000-500/RL

Response:
Ans. is 'd' i.e., < 1000-500/RL Invasive aspergillosis is a severe respiratory infection with a moality rate of over 90% in neutropenic patients.It is most often encountered in patients with absolute neutrophil counts of <500/4 from leukemia or chemotherapy.Patients undergoing bone marrow transplantation are susceptible to a greater extent than patients with hea, kidney, or liver transplants.

So the answer to this question is D


Instruction:
The monoclonal antibody useful in the treatment of PNH is:
A. Rituximab
B. Eculizumab
C. Infliximab
D. Adalimumab

Response:
By blocking the complement cascade downstream of C5, eculizumab abolishes complement-dependent intravascular hemolysis in all PNH patients, and significantly improves their quality of life. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 884

So the answer to this question is B


Instruction:
Dose of streptokinase to be used in MI is
A. 0.15 million units
B. 1.5 million units
C. 15 millions units
D. 150 million units

Response:
Ref Harrison 19 th ed pg 758 The adult dose of streptokinase for acute myocardial infraction is 1.5 million units IV over 60 minutes .

So the answer to this question is B


Instruction:
Which of the following conditions typically has rickets with normal or low calcium, elevated phosphorus, elevated parathormone, and elevated alkaline phosphatase?
A. Vitamin D deficiency
B. Fanconi syndrome
C. Dent's disease
D. Chronic kidney disease

Response:
All of the above conditions are causes of Rickets, so elevated alkaline phosphatase is seen in all the above. Chronic kidney disease is the only condition out of the above, where Phosphate is elevated.

So the answer to this question is D


Instruction:
Treatment of neurogenic diabetes insipidus is?
A. Vasopressin
B. Desmopressin
C. Terlipressin
D. Amiodarone

Response:
ANSWER: (B) DesmopressinREF: Harrison s Internal Medicine 17th ed chapter 334The signs and symptoms of uncomplicated pituitary DI can be eliminated completely by treatment with Desmopressin (DDAVP), a synthetic analogue of AVP. It acts selectively at V2 receptors to increase urine concentration and decrease urine flow in a dose-dependent manner. It is also more resistant to degradation than AVP and has a three-to four fold longer duration of action. Desmopressin (DDAVP) can be given by IV or SC injection, nasal inhalation, or oral tablet.

So the answer to this question is B


Instruction:
Panic attack is characterized by all of the following except:
A. Felling of impending doom
B. Auditory hallucinations
C. Trembling
D. Shortness of breath

Response:
Ans. B. Auditory hallucinationsDiagnostic criteria for panic attack - A discrete period of intense fear or discomfort, in which four or more of the following symptoms developed abruptly and reached a peak within 10 min.1. Palpitations, pounding heart or accelerated heart rate.2. Sweating.3. Trembling or shaking.4. Sensations of shortness of breath of smothering.5. Feeling of choking.6. Chest pain or discomfort.7. Nausea or abdominal distress.8. Feeling dizzy, unsteady, lightheaded or faint.9. Derealization (feeling of unreality) or depersonalization (being detached from oneself)10. Fear of losing control or going crazy.11. Fear of dying.12. Parenthesis (numbness or tingling sensations).13. Chills or hot flushes.

So the answer to this question is B


Instruction:
Narrowest part of male urethra -
A. Prostatic
B. Membranous
C. Spongy
D. Penil

Response:
Ans. is 'b' i.e., Membranous o Narrowest and least dilatable part of male urethra - membranous urethra.o Widest and most dilatable part of male urethra - Prostatic urethra.o Shortest part of male urethra - Membranous urethra.o Longest part of male urethra - Penile urethra.

So the answer to this question is B


Instruction:
Which of the following statement is true regarding gastrulation?
A. Establishes all the three germ layers
B. Usually occurs at 4 weeks of gestation
C. Involves the hypoblastic cells of inner cell mass
D. Occurs at the caudal end of the embryo prior to its cephalic end

Response:
Gastrulation is the formation process by which the 3 germ layers and axial skeleton are established in the embryo. It is the beginning of morphogenesis. It occurs during the third week of gestation. 3 germ layers which are formed includes ectoderm, endoderm and mesoderm.Ref: The Developing Human, Keith L. Moore, 7th Edition, Page 60 ; Langman's Medical Embryology, 8th Edition, Page 61

So the answer to this question is A


Instruction:
Most common site of March fracture is?
A. Shaft of 2nd and 3rd metatarsals
B. Avulsion fracture of fifth metatarsal
C. Calcaneus
D. Olecranon

Response:
ANSWER: (A) Shaft of 2nd and 3rd metatarsalsREF: Apley's 8th ed p. 757See APPENDIX-68 below for "ALPHABETICAL LIST OF EPONYMOUS FRACTURES"March fracture: stress fracture of second metatarsal APPENDIX - 68Alphabetical List of Eponymous FracturesFractureDescriptionMechanism of injuryAviators fractureFracture neck of talusDorsiflexionBumper fracturecompression fracture of lateral condyle of tibial (always intra articular)Forced valgus of knee when struck from side by car bumperBoxer's fractureFracture of distal 5th metacarpalPunching solid objectBos worth fractureFracture of distal fibula with posterior dislocation of the proximal fibula behind the tibiaSevere external rotation of the footBennett's fractureIntra-articular fracture of base of first metacarpalAxial load along metacarpal in a partially flexed thumb (Abductor pollids longus pull)Barton's fractureIntra articular distal radius fracture invoking the articular surface with dislocation of the radio carpal jointFall on outstretched handBankart's fractureFracture of anterior glenoid associated with anterior shoulder dislocationExternal rotation and abduction of shoulderColies' fractureDistal radius fracture with dorsal angulation, impaction and radial driftFall on outstretched handCotton's fractureTrimalleolar fracture of ankle Clay shoveller's fractureStress avulsion fracture of Spinous process of C6, C7 or T1Forced hyper flexion of neckCh opart's fracture- dislocationFoot dislocation through talonavicular and calcaneocuboid joints with associated fractures, usually after ankle twisting. Treated in a non-weight bearing cast for 6-8 weeks Chauffeur's fractureIntra-articular fracture of radial styloidForced ulnar deviation of the wrist causing avulsion of the radial styloidChance fractureHorizontal fracture of vertebral bodyHyper flexion of spine, seen in car accidents when lap belts xvere usedDuverney fractureIsolated fracture of the iliac wingDirect traumaEssex-LoprestifractureComminuted radial head fracture xvith interosseous membrane disruption and distal radioulnar joint subluxationFall from heightGosselin fractureV-shaped distal tibia fracture extending into the tibial plafond Galeazzi fractureRadius shaft fracture with dislocation of distal radioulnar jointBlow to forearmHolds worth fractureUnstable spinal fracture-dislocation at the thoracolumbar junction Hume fractureOlecranon fracture with anterior dislocation of radial head Hill-Sachs fractureImpacted posterior humeral head fracture occurring during anterior shoulder dislocation Hangman s fractureFracture of both pedicles of C2Distraction and extension of neck (judicial hanging)Jones fractureFracture of base of 5th metatarsal extending into intermetatarsal jointInversion of ankle (pronator brevis pull)Jefferson fractureBurst fracture of 1st cervical vertebraCompression of neckLisfranc fractureFracture dislocation of midfootForced plantar flexion of foot or dropping heavy weight on footLe Forts fracture of the ankleVertical fracture of distal fibula with avulsion of medial malleolus Le Fort fracturesSeries of facial fracturesDirect trauma to faceMoores fractureDistal radius fracture with ulnar dislocation and entrapment of styloid process under annular ligament Monteggia fractureProximal ulna fracture with dislocation of radial headBlow to forearmMarch fractureStress fracture of 2n<1 /3rd metatarsal shaftHeavy or unaccustomed exerciseMalgaignesfractureVertical pelvic fracture through both pubic rami and the ilium or sacroiliac joint with vertical displacementHigh energy impact to pelvis (front to back)MaisonneuvefractureSpiral fracture of proximal fibulaExternal rotation of anklePipkin fracture- dislocationPosterior dislocation of hip with avulsion fracture of fragment of femoral head by the ligamentum teresImpact to the knee with the hip flexed (dashboard injury)Pilon fractureComminuted fracture of distal articular fracture with fibular fracture Pott's fractureBimalleolar fracture of the ankleEversion of ankleRolando fractureIntra articular T or Y shaped Comminuted fracture of base of V metacarpalAxial load along the metacarpal causing splitting of the proximal articular surfaceRunner's fractureStress fracture of distal fibula 3-8 cm above the lateral malleolusRepeated axial stress on fibulaStieda fractureAvulsion fracture of the medial femoral condyle at the origin of the medial collateral ligament Smith's fractureDistal radius fracture with volar displacementFall on outstretched hand with wrist in flexed positionShepherd s fractureFracture of the lateral tubercle of the posterior process of the talus Segond fractureLateral tibial plateau avulsion fracture with anterior cruciate ligament tear| Internal rotation of the kneeSalter-HarrisfracturesFractures involving a growth platevariousTitlaux fractureSalter-Harris III fracture of the tibiaForced lateral rotation of footToddlers fractureUndisplaced spiral fracture of distal tibia in children under 8 years oldLow-energy trauma t often rotational

So the answer to this question is A


Instruction:
True about ACELLULAR PERTUSSIS VACCINE include the following EXCEPT
A. It is a toxoid
B. Superior to wP (whole cell pertussis vaccine)
C. Acellular component has same immunity as cellular one
D. Can be given as both primary and booster immunization

Response:
Ans. b (Ref. OP Ghai 6th/pg.l94; Nelson paeds 17th /pg.908)PERTUSSISPreventionUniversal immunization of children <7 yr of age with pertussis vaccine, beginning in infancy, is central to the control ofpertussis. Current goals of immunization are protection of the individual from a significant coughing illness and controlof endemic and epidemic disease.ACELLULAR VACCINE# Multiple diphtheria and tetanus toxoids combined with acellular pertussis (DTaP) vaccines currently are preferred over those containing whole-cell pertussis (DTP) vaccines because of fewer adverse reactions.# Recommendations for use of DTaP are similar to recommendations for use of DTP, which continues to be given to infants and children in many other countries. Acellular pertussis vaccines all contain inactivated PT and may contain one or more other bacterial components (FHA, Pn, Fim 2 and 3).# Mild local and systemic adverse events as well as more serious events occur significantly less frequently among infants who receive DTaP compared with DTP vaccine.# DTaP containing vaccines can be administered simultaneously with any other vaccines used in standard schedules for children. Combination of vaccines that include DTaP in place of DTP can affect immunogenicity of products. Local reactions increase in rate and severity with successive doses of DTaP.# The same special considerations, precautions, contraindications, and reporting requirements for serious adverse events that exist for DTP vaccination apply to DTaP as well. Acellular pertussis vaccines are now licensed for use only among children through 6 yr of age.# Live virus vaccines should be avoided in immunocompromised patients. For patients without chronic GVHD, diphtheria and tetanus toxoids, acellular pertussis (in children <7 yr of age), inactivated polio, hepatitis B, Haemophilus influenzae type b, and Streptococcus pneumoniae immunizations may be given 12 mo after transplant, and measles- mumps-rubella immunizations after 24 mo. Influenza vaccines should be given every fall.# Currently available combinations are PRP-OMP combined with hepatitis B vaccine (Comvax) and a DtaP vaccine that can be combined with PRP-T for the fourth dose only.

So the answer to this question is B


Instruction:
Lactating women with painful breast, 1st investigation to be done should be NOT RELATED-SURGERY
A. USG
B. Mammography
C. CT
D. MRI

Response:
.

So the answer to this question is A


Instruction:
Following nutritional consequences are possible following peptic ulcer surgeries other than vagotomy
A. Iron deficiency
B. Weight loss
C. Vitamin B12 deficiency
D. Folic acid deficiency

Response:
.COMPLICATIONS OF GASTRIC SURGERY * Haemorrhage. * Stomal obstruction. * Biliary fistula. * Injury to CBD. * Duodenal blow out--on 4th postoperative day. * Pancreatitis.* Recurrent ulcer stomal ulcer. * Gastrojejunocolic fistula. * Dumping syndrome (Postcibal syndrome). * Nutritional disturbances, diarrhoea. * Pulmonary tuberculosis. * Carcinoma in gastric remnant (after 10-15 years). * Gallstone formation. * Alkaline gastritis. * Afferent and efferent loop syndrome. * Afferent loop obstruction--common. * Efferent loop obstruction. Nutritional deficiencies following gastrectomy Iron deficiency anaemia 40% * Megaloblastic anaemia (after 5 years) 25% (100mg B12 is given IM weekly, later monthly) *Vit. B deficiency 10% *Calcium deficiency 40% *Calcium deficiency with bone changes (after 5 years) 5% ref:SRB&;s manual of surgery,ed 3,pg no 770

So the answer to this question is D


Instruction:
Causative agent of Trench fever
A. Coxiella burnetii
B. Bartonella Quintana
C. R. tsusugamushi
D. R. prowazekii

Response:
Q fever - Coxiella burnetii.
Trench fever - Bartonella Quintana.

So the answer to this question is B


Instruction:
True regarding atrial fibrillation -
A. | Thromboembolism
B. adrenaline treatment
C. Anticoagulant not required
D. Aspirin given

Response:
thromboembolism is a feature of atrial fibrilation anticoagulant is given but aspirin is not used adrenaline is contraindicated Ref Harrison 20th edition pg 1443

So the answer to this question is A


Instruction:
Mean aerial pressure depends upon
A. Cardiac output
B. Cardiac output & peripheral resistance
C. Aerial complaince
D. Peripheral resistance

Response:
Cardiac output and peripheral resistance. As blood is pumped out of the left ventricle into the aoa and distributing aeries, pressure is generated. The mean aerial pressure (MAP) is determined by the cardiac output (CO), systemic vascular resistance (SVR), and central venous pressure (CVP).

So the answer to this question is B


Instruction:
Cytosolic Cytochrome C mediates
A. Apoptosis
B. Electron transpo
C. Krebs cycle
D. Glycolysis

Response:
A i.e. Apoptosis Cytochrome C has two very opposite roles. Within the mitochondrial membrane it serves as electron carrier in oxidative phosphorylation. But when it leaks out into cytosol it combines with Apaf I and activates caspase-9 to mediate apoptosisQ. This dual functioning is known as moonlighting.

So the answer to this question is A


Instruction:
Non-pathogenic amoebae is/are -
A. E. histolytica
B. E.coli
C. Acanthanmoeba
D. All

Response:
Ans. is 'b' i.e., E. coli Non-pathogenic amaebae are E.hamanni, E.coli, E.polecki, Endolimax nana, lodamoeba botschlii, and Dientamoeba fragilis.

So the answer to this question is B


Instruction:
Lingua nigra is :
A. Familial dysautonomia.
B. Hairy tongue.
C. Migratory glossitis.
D. Median rhomboid glossitis.

Response:
None

So the answer to this question is B


Instruction:
Early onset sepsis in a neonate occurs within
A. 12 hours
B. 24 hours
C. 48 hours
D. 72 hours

Response:
Early-onset sepsis (EOS) (less than 72 hr) infections are caused by organisms prevalent in the maternal genital tract or in the delivery area.Late-onset sepsis (LOS) (72 hr or later) infections are caused by the organisms thriving in the external environment of the home or the hospital. The infection is often transmitted through the hands of the care providers.Ref: Paediatrics; O.P. Ghai; 8th edition; Page no: 163

So the answer to this question is D


Instruction:
True regarding presentation of Primary TB is:
A. Bilateral pleural effusion with negative tuberculin test
B. Unilateral hilar lymphadenopathy
C. Sustained chronic pyrexia
D. B/L pleural effusion with positive tuberculin test

Response:
TB in young children is almost invariably accompanied by hilar or paratracheal lymphadenopathy due to the spread of bacilli from the lung parenchyma through lymphatic vessels.

So the answer to this question is B


Instruction:
Testes completely descend in the scrotum by the age of?
A. End of 7th month of intrauterine life
B. End of 8th month of intrauterine life
C. End of 9th month of intrauterine life
D. After bih

Response:
End of 9th month of intrauterine life PhaseIntrauterine agePosition of testisTransabdominal phaseUp to the sta of 3rd monthEntrance of future inguinal canal (internalinguinal ring)Transinguinal phaseBetween 4 to 5 monthsNo descent7th to 9th monthPasses through inguinal canalBefore bihInto the scrotum

So the answer to this question is C


Instruction:
Kleptomania is:
A. Delusion disorder
B. Obsession
C. Impulse disorder
D. Compulsion Seclusion

Response:
Ans. C (Impulse...) Habbit & Impulse Disorders are:Pathological gamblingPyromaniaKelptomaniaTrichotillomniaIntermittent explosive disorderDefinition: The defining behavior of kleptomania is the repetitive theft of items that are usually of little monetary' value and are not realistically needed. Increasing tension is experienced before stealing. Feelings of relief and gratification during and after the act eventually give way to guilt, remorse, and self- loathing, compounded by the fear of arrest. Kleptomania is profoundly repugnantTable: DSM-IV-TR Diagnostic Criteria for Kleptomania Kaplan & Sadock'sRecurrent failure to resist impulses to steal objects that are no t needed for personal use or for their monetary value.Increasing sense of tension immediately before committing the theft.Pleasure, gratification, or relief at the time of committing the theft.The steaiing is not committed to express anger or vengeance and is not in response to a delusion or a hallucination.The stealing is not better accounted for by conduct disorder, a manic episode, or antisocial personality1 disorder.

So the answer to this question is C


Instruction:
A 9 year old girl was admited for dialysis. On laboratory examination her potassium levels were 7.8 mEq/L. Which of the following would quickly lower her increased potassium levels -
A. IV calcium gluconate
B. IV Glucose and insulin
C. Oral kayexalate in sorbitol
D. IV NaHCO3

Response:
None

So the answer to this question is B


Instruction:
Derivative of third pharyngeal pouch is:
A. Thymus
B. Inferior parathyroid gland
C. Both of the above
D. None of the above

Response:
In the fifth week, epithelium of the dorsal region of the third pouch differentiates into the inferior parathyroid gland, while the ventral region forms the thymus. Ref: Langman's embryology 11th edition Chapter 16.

So the answer to this question is C


Instruction:
The center of ossification used as medico-legal evidence for fetal bility: COMEDK 07; Punjab 08
A. Head of femur
B. Distal end of femur
C. Talus
D. Calcaneum

Response:
Ans. Talus

So the answer to this question is C


Instruction:
MC cause of morbidity and moality late in the course of mitral stenosis: March 2013
A. Infective endocarditis
B. Pulmonary edema
C. Recurrent pulmonary emboli
D. Pulmonary infections

Response:
Ans. C i.e. Recurrent pulmonary infections Mitral stenosis/ MS Features: - Atrial fibrillation - Hemoptysis - Pulmonary hypeension, - Hoarseness of voice Most impoant differential diagnosis: Left atrial myxoma Investigation of choice for MS: Echocardiography Mitral valve area less than 0.6 cm2 is incompatible with life

So the answer to this question is C


Instruction:
Carrier stage seen in -
A. Polio
B. Cholera
C. Peusis
D. All

Response:
Ans is d All of the above

So the answer to this question is D


Instruction:
Serum Creatine PhosphoKinase-3 (CPK-3) is elevated in-
A. Muscular dystrophy
B. Myocardial infarction
C. Alcoholic cirrhosis
D. Brain tumours

Response:
Musculardystrophy CreatineKinase(CK)or CreatinePhosphokinase(CPK)catalysestheinterconversionof phosphocreatineto creatine. CPKexistsasthreeisoenzymes.Eachisoenzymeisa dimercomposedoftwosubunits- M(muscle)orB (Brain)orboth Isoenzyme SubUnit Tissueoforigin CPK1 BB Brain CPK2 MB Hea CPK3 MM SkeletalMuscle

So the answer to this question is A


Instruction:
Double aoa develops from
A. 1st arch aery
B. 2nd arch aery
C. Right dorsal aoa
D. Left dorsal aoa

Response:
Inderbir Singh&;s Human embryology Tenth edition Pg 257Double aoa occurs due to the persistence of distal poion of the right dorsal aoa

So the answer to this question is C


Instruction:
Metastasis of carcinoma buccal mucosa goes to
A. Regional lymph node
B. Liver
C. Heart
D. Brain

Response:
The spread of carcinoma of buccal mucosa

Buccal carcinoma spread locally and to regional lymph nodes.

1) Local spread: - From its site of origin, the lesion may spread deeply involving submucosa → muscle → Subcutaneous fat → skin. Involvement of buccinator muscle or anterior masseter causes trismus.
2) Lymphatic spread: - Nodal involvement occurs in about 50% of cases. Submandibular and later the upper jugular nodes may get involved. Upper jugular nodes may also be involved, directly skipping the submandibular group.

So the answer to this question is A


Instruction:
Most common salivary gland tumor -
A. Mucoepidermoid carcinoma
B. Pleomorphic adenoma
C. Warthims tumor
D. Oncocytoma

Response:
None

So the answer to this question is B


Instruction:
According to Strasberg classification. Lateral CBD injuries are classified as:
A. Type B
B. Type C
C. Type D
D. Type E

Response:
Strasberg Classification of Laparoscopic Biliary Injuries Type A Bile leaks from minor ducts still in continuity with CBD Includes leakage from cystic duct stump and from a subvesical duct of Luschka MC causes of biliary leaks seen after laparoscopic cholecystectomy Type B Occlusion of a pa of the biliary tree, almost always an aberrant right sectoral duct Type C Transection without ligation of an aberrant right sectoral duct Type D A lateral injury to an extrahepatic duct Type E Includes biliary strictures, divided into E1 to E5 as classified by Bismuth

So the answer to this question is C


Instruction:
Imaging study of choice for para nasal sinuses is?
A. USG
B. CT Scan
C. XrayPNS
D. FDG PET scan

Response:
Ans. (b) CT ScanRef: Scott-Brown's Otorhinolaryngology: Head and Neck Surgery7ed p-1086

So the answer to this question is B


Instruction:
Crumbled egg shell calcification of liver is seen in:
A. Hemangioma
B. Hepatoma
C. Hydatid cyst
D. Liver abscess

Response:
Ans: c (Hydatid cyst) Ref: David Sutton, 7thed, p. 740; Harrison, 16th ed, p. 1275Egg shell or mural calcification in CT liver is indicative of E. granulosus infection, and helps to distinguish the cyst from carcinomas, bacterial or amoebic liver abscess or hemangiomas.The appearance is pathognomonic and is due to the presence of daughter cysts within the larger cyst.Calcification patterns seen in radiology1. Stippled calcification in plain X-ray abdomen- Neuroblastoma2. Curvilinear calcification in plain X-ray abdomen- Wilm's tumor3. Tram track /rail road calcification in skull X-ray- Sturge Weber syndrome4. Pop com calcification- Pulmonary hamartoma5. Suprasellar calcification- Craniopharyngioma6. Ochronosis/ calcification of intervertebral disc.- Alkaptonuria7. Pericardial calcification- Constrictive pericarditis8. Calcification in heart wall- Carcinoid syndrome9. Rice grain calcification- Cysticercosis10. Basal ganglia calcification- Hyperparathyroidism11. Urinary bladder calcification- Schistosomiasis12. Calcification of meniscal cartilage- Pseudogout13. Calcification of interspinous ligament- Ankylosing spondylitis.14. Intraocular calcification- Retinoblastoma15. Bracket calcification- Lipoma of corpus callosumEgg shell calcification of lymph node in chest x ray seen in:* Silicosis* Sarcoidosis* Coal worker's pneumoconiosis* Lymphoma following radiotherapy* Histoplasmosis* Amyloidosis* Scleroderma

So the answer to this question is C


Instruction:
The drug of choice for treatment of cholera in pregnant women is -
A. Tetracycline
B. Doxycycline
C. Furazolidone
D. Contrimoxazole

Response:
<p> NOW azythromycin, earlier Furazolidone. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:233. <\p>

So the answer to this question is C


Instruction:
Acute phase reactant include all except -
A. C reactive protein
B. Ferritin
C. Ceruloplasmin
D. Hemoglobin

Response:
Hemoglobin is the O2 carrying pigment in RBCs. Acute phase proteins are those proteins that are raised in response to acute inflammation. Basic Pathology, Robbins. Page no.: 57

So the answer to this question is D


Instruction:
Lucid interval is classically seen in -
A. Intracerebral haematoma
B. Acute subdural haematoma
C. Chronic subdural haematoma
D. Extradural haematoma

Response:
None

So the answer to this question is D


Instruction:
35-year-old c/o fever, severe abdominal pain in epigastrium radiating to the back with a h/o binge drinking. Pulse is 120 bpm, BP is 90/60 mm Hg. CT Abdomen (P+C) was done. Most likely diagnosis is(AIIMS 2016)
A. Peptic ulcer
B. Acute pancreatitis
C. Chronic calcific pancreatitis
D. Acute cholecystitis

Response:
Ans. B Acute pancreatitisObserve a bulky pancreas with fuzzy margins and adjacent fat stranding - s/o Acute pancreatitis. CE-CT scan is IOC. Balthazar grading systemQ and CT Severity Index (CTSI)Q are used for prognosis.

So the answer to this question is B


Instruction:
Regarding the established risk factors for breast cancer, all are true, EXCEPT:
A. Occurrence in Indian women is about a decade earlier than in western women
B. Breast cancer is common in higher socioeconomic groups
C. Prior breast biopsy of benign breast disease is associated with a decreased risk of Ca breast
D. 40 or more years of menstruation doubles the risk of Ca breast as compared with 30 years

Response:
Prior breast biopsy for benign breast disease is associated with an increased risk of Ca breast. History of Ca breast in 1st degree relative, nulliparity, high fat diet, OCP and radiation are also associated with increased risk of Ca breast. The rest of the statements regarding breast cancer given in the question are true. Ref: Park, Edition 21, Page 359

So the answer to this question is C


Instruction:
which of th efollowing tyrosine kinase inhibitor is used in carcinoma of lung ?
A. afatinib
B. ceritinib
C. erlotinib
D. all of the above

Response:
tyrosine kinase inhibitors : stop the cell division of cancer cells . as tyrosine kinase is a insulin growth factor that promotes the cellular divison drugs used in lung carcinoma : afatinib erlotinib ceritinib gefitinib ref : kd tripati 8th ed

So the answer to this question is D


Instruction:
Best view to seen pneumoperitoneum is
A. Chest X-ray in erect position
B. X-ray abdomen
C. USG abdomen
D. FAST

Response:
Best view to seen pneumoperitoneum - Chest x-ray in erect position.
If unable to stand - Left lateral decubitus View.

So the answer to this question is A


Instruction:
A baby on examination shows unilateral Moro's reflex with positive palmar grasp reflex. The site of lesion is –
A. C3–C4
B. C5–C6
C. C8–T1
D. C1–C2

Response:
Moro's reflex is a neonatal reflex which develops by 28th wk of gestation and disappears by 3-6 months of age.
Moro reflex is obtained by placing the infant in a semi-upright position. then the head is momentarily allowed to fall backwards with immediate re-support by the examiner's hand.
The child symmetrically abducts and extends the arms and flexes the thumbs, followed by flexion and adduction of upper extremities.

Unilateral Moro's reflex is seen in :

Erb's palsy (C5-C6) damage
Spastic hemiplegia
Fracture of humerus or clavicle.
Shoulder dislocation
Exaggerated Moro's reflex is seen in - cerebral damage.

So the answer to this question is B


Instruction:
Which of the following opioid analgesics is most likely to cause central nervous system (CNS) disturbance?
A. heroin
B. morphine
C. meperidine
D. fentanyl

Response:
Meperidine has a half-life of 3 hours, but it has an active metabolite, normeperidine, which has a half-life of 15-20 hours. Therefore, accumulation of normeperidine with toxicity is common. The drug should not be used for prolonged periods (over 48 hours), and probably should not be used at all in those susceptible to delirium (e.g., the elderly).

So the answer to this question is C


Instruction:
Which of the following may be seen in children with Vitamin C excess?
A. Alopecia
B. Oxaluria
C. Peripheral neuropathy
D. Benign intracranial hypeension

Response:
Vitamin C is a precursor of oxalate, liable to produce hyperoxaluria . ... In malabsorption, Ca chelates with fatty acids, generating enteric hyperoxaluria Ref ganong's review of medical physiology 25e p436

So the answer to this question is B


Instruction:
If a patient with a suspected fracture of the pelvis has some bleeding from the urethra and is unable to pass urine. What should be the next appropriate step in the management?
A. He should be encouraged to pass urine after being given antibiotics and analgesics
B. He should be immediately catheterized in the ward
C. A hot water bottle should be given followed by injection of carbachol
D. He should be prepared for surgery and catheterization attempted in the O.T.

Response:
Urogenital injuries are common in pelvic fractures (5-10%), especially in men. These injuries should be suspected in conscious patients Who is unable to void or who has gross hematuria Bloody urethral discharge Swelling or ecchymosis of the penis or perineum High riding or floating prostate on rectal examination Management No attempt should be made to pass a catheter, as this could conve a paial to a complete tear of urethra. A retrogram should be obtained before attempting to introduce a foley's catheter. Retrograde urethrogram positive: When a paial or complete urethral disruption is diagnosed on retrograde urethrogram then suprapubic cystotomy should be performed. Retrograde urethrogram negative: Catheterization can be safely undeaken Ref: Current Diagnosis & Treatment in Ohopedics 3/e, page 151; Apley's 8/e, page 672-73; Rockwood & Green's fracture in Adults 6/e, Page 1618-1; Watson Jones: Fracture & Joint Injuries 6/e, Page 867.

So the answer to this question is D


Instruction:
Helper cells belong to
A. T cells
B. Macrophages
C. B cells
D. Monocytes

Response:
1. CD4+ T cells: CD4 cells are also known as helper T (Th) cells. They constitute about 65% of peripheral T cells and are found mainly in the thymic medulla, tonsils, and blood. CD4 displayed on the surfaces of these T cells recognize a nonpeptide-binding poion of MHC class II molecules. Hence, CD4+ T cells are restricted to the recognition of MHC class II complexes. Helper T lymphocytes are involved in the induction and regulation of immune responses. 2. Main function of helper T cells: 1. Help in the antigen-specific activation of B cells and effector T cells. 2. Th-1 cytokines activate cytotoxic inflammatory and delayed hypersensitivity reactions. 3. Th-2 cells help in the production of interleukins which encourage production of antibodies especially IgE. 4. Th-2 cytokines are associated with regulation of strong antibody and allergic responses.

So the answer to this question is A


Instruction:
Period of onset in tetanus refers to the time between-
A. First injury to spasm
B. First symptom to spasm
C. First spasm to death
D. Trismus to laryngeal spasm

Response:
None

So the answer to this question is B


Instruction:
Mummification refers to:
A. Hardening of muscle following death
B. Colliquative putrifaction
C. Saponification of subcuatenous fat
D. Desiccation of dead body

Response:
Ans: D (Desiccation of dead body) Ref: The Essentials of Forensic Medicine ami Toxicology by KS Narayan Reddy. 29th edition. 2010Explanation:MummificationIt is dessication/dehydration or drying and shriveling of body tissue and viscera after deathCommon in infants (neonates and still births)ideal conditions for its formation are:High temperatureDevoid of moistureFree circulation of air around the bodyChronic arsenic or antimony poisoning favour mummificationFirst involves exposed body parts like lips. nose. Fingers, toes etcThe natural appearances and body features are preserved, but face is grossly distorted due to shrinkage of skin.The skin is contracted, shruken and dry (rusty brown in colour)The body is odourless and helps in estimation of time since death

So the answer to this question is D


Instruction:
The following physical appearance is seen in which of the following condition
A. Nephroblastoma
B. Retinoblastoma
C. Neuroblastoma
D. Osteoblastoma

Response:
This is Raccoon eyes seen in Neuroblastoma.

So the answer to this question is C


Instruction:
Mark true in following?
A. Hanta virus pulmonary syndrome is caused by inhalation of rodent urine and faeces
B. Kyasanur forest disease is caused by bite of wild animal
C. Lyssavirus is transmitted by ticks
D. None

Response:
None

So the answer to this question is A


Instruction:
Pneumothorax could be a complication of:
A. Staphylococcal pneumonia
B. Pneumococcal pneumonia
C. Klebsiella pneumonia
D. Viral pneumonia

Response:
a. Staphylococcal pneumonia(Ref: Nelson's 20/e p 2088-2093, Ghai 8/e p 379-381)Pneumothorax could be a complication of Staphylococcal pneumonia, due to rupture of pneumatoceles.

So the answer to this question is A


Instruction:
Most common cause of breech presentation:
A. Contrcted pelvis
B. Hydramnios
C. Prematurity
D. Oligohydramnios

Response:
Prematurity

So the answer to this question is C


Instruction:
The minimum mesiodistal space required for placement of two standard diameter implants (4.0 mm diameter) between teeth is
A. 8 mm
B. 20 mm
C. 10 mm
D. 14 mm

Response:
None

So the answer to this question is D


Instruction:
Antihypeensive drug which is beneficial or neutral in the lipid metabolism is
A. Prazosin
B. Propanolol
C. Fursemide
D. Chlohiazide

Response:
Refer kDT 6/e p488_545 drugs-lipid metabolism 1.Prazosin and clonidine-ourable effect 2.ARB and ACE inhibitor -no significant effect in plasma lipid profile 3.beta blockers-unourable effect 4.diuretics- dyslipideamia 5.CCBs- no effect

So the answer to this question is A


Instruction:
N.K cell and cytotoxic cells are differentiated by -
A. Interferons reduce N.K cell activity
B. Antibody specificity
C. Receptor fo IgG
D. Presence in spleen

Response:
NK cells are unique, however, as they have the ability to recognize stressed cells in the absence of antibodies and MHC, allowing for a much faster immune reaction. They were named "natural killers" because of the initial notion that they do not require activation to kill cells that are missing "self" markers of MHC class 1.Cytotoxic Tells are antibody specific. Reff: Ananthanarayanan & Panikers textbook of microbiology 9th edition pg:137

So the answer to this question is B


Instruction:
Subodontoblastic zone is
A. Cell rich zone
B. Cell free zone
C. Odontoblastic zone
D. Core

Response:
None

So the answer to this question is B


Instruction:
Contraindication of Enteral nutrition :a) Intestinal obstructionb) Severe Pancreatitisc) Severe diarrhoead) IBDe) Intestinal fistula
A. abce
B. abc
C. acd
D. ace

Response:
None

So the answer to this question is A


Instruction:
Most common malignant tumour of thyroid:
A. Papillary
B. Folliclar
C. Medullary
D. Anaplastic

Response:
Ans: a (Papillary) Ref: Schwartz, 8th ed, p. 1417; Harrison, 16th ed, p. 2122TYPE OF THYROID CARCINOMAAPPROXIMATE PREVALENCEPapillary CA80-90 %Follicular CA5-10%Medullary CA10%Anaplastic CARareLymphoma1-2%Histological features of Papillary CA1. Papillary projections - PTC contains branching papillae of cuboidal epithelial cells.2. Orphan annie nulei - Nucleus of PTC contain finely dispersed chromatin which imparts an optically clear or empty appearance giving rise to term ground glass or orphan annie nuclei. In addition invagination of cytoplasm in cross sections give the appearance of intranuclear inclusions or grooves - Diagnosis of papillary Ca is is based on these nuclear characteristics.3. Psammoma bodies - These are concentrically calcified structures.

So the answer to this question is A


Instruction:
Aerial supply of tonsil is mainly by?
A. Tonsillar branch of facial aery
B. Maxillary aery
C. Middle meningeal aery
D. External carotid aery

Response:
The tonsil is supplied by five aeries : 1. Tonsillar branch of the facial aery. This is the main aery. 2. Ascending pharyngeal aery from external carotid. 3. Ascending palatine, a branch of the facial aery. 4. Dorsal lingual branches of the lingual aery. 5. Descending palatine branch of the maxillary aery. (Ref: Diseases of ear, nose and throat and head and neck surgery, PL Dhingra 7th edition, Pg no. 291)

So the answer to this question is A


Instruction:
All are true about streptococcus preumoniae except:
A. Capsule aids in infection
B. Commonent infection is otitis media
C. Respiratory tract of carriers is most impoant source of infection
D. Meningitis caused by S. pneumoniae is milder than others

Response:
Ans. (d) i.e. Meningitis caused by S. pneumoniae is milder than others Moality in Bacterial Meningitis Cause 3-7% H. I nfluenzae, Meningococci, Group B streptococci 3-7% Listeria meningitis 15% S. pneumococci 20% E. coli > 20% Others options have already been explained. Note: Pneumococci is the most common cause of pneumonia, meningitis, otitis media. Otitis media is the most common infection of Pneumococci.

So the answer to this question is D


Instruction:
The uterus becomes pelvic organ after delivery in:
A. 10-12 days
B. 12-14 days
C. 14-16 days
D. 16-18 days

Response:
Uterus begins to shrink in size 2 days following delivery and it becomes a pelvic organ after 2 weeks. By 6 weeks uterus regains its nonpregnant size. During involution of uterus there is no loss of myometrial cells. It occurs due to diminution of size of myometrial cells as a result of enzymatic autolysis of cytoplasm. There is augmentation of protease activity. Each myometrial cell measuring about 500-800ml in late pregnancy shrinks to less than 100ml. Ref: Donald School Manual of Practical Problems in Obstetrics edited by Narendra Malhotra page 581.

So the answer to this question is B


Instruction:
White gold alloy predominantly is:
A. Gold added with palladium
B. Gold added with calcium
C. Gold with much of chromium
D. Gold with silver

Response:
These alloys were introduced as a cheaper alternative to gold alloys.
It is predominantly silver in composition. Palladium (at least 25%) is added to provide nobility and resistance to tarnish. They may or may not contain copper and gold. They are white in color.
The current trend is to avoid the display of metal. At the same time, increase in the platinum, palladium and silver content of modern alloys have resulted in whiter colored gold alloys. Thus, there are ‘yellow gold alloys’ and ‘white gold alloys’. The rise in gold prices has also led to the availability of alloys with low gold content. These are the ‘low golds’.
Ref: Mannapalli 3 ed page no 273

So the answer to this question is A


Instruction:
Commonest cause of uniocular diplopia
A. Cataract
B. Subluxated lens
C. Third nerve palsy
D. Astigmatism

Response:
In Unilocular diplopia an object appears double from the affected eye even when the normal eye is closed. CAUSES Subluxated clear lens. Subluxated intraocular lens. Keratoconus (irregular refraction from corneal surface) Double pupil (congenital / large iridectomy / iridodialysis) Incipient cataract (this usually causes polyopia - due to irregular refraction due to multiple water clefts within the lens) Ref;A.K.Khurana; 6th edition; Page no:344

So the answer to this question is B


Instruction:
DT 104 strain is belongs to which of the following bacteria-
A. Salmonella Gallinarum
B. Salmonella Typhi
C. Salmonella Enteritidis
D. Salmonella Typhimurium

Response:
Ans. is `e' i.e., Salmonella Typhimurium DT 104 is a strain of Salmonella Typhimurium which emerged in early 1990s. It is multidrug resistant strain & associated with an increased risk of bloodstream infection and hospitalization. Acquisition is associated with exposure to ill farm animals and to various meat products, including uncooked or undercooked ground beef.

So the answer to this question is D


Instruction:
A previously healthy 20-year-old man is admitted to a hospital with acute onset of left-sided chest pain. The electrocardiographic findings are normal but chest x-ray shows a 40% left pneumothorax. Treatment consists of which of the following procedures?
A. Observation
B. Barium swallow
C. Thoracotomy
D. Tube thoracostomy

Response:
Spontaneous pneumothorax usually results from the rupture of subpleural blebs in young men (age 20-40), which is often signaled by a sudden onset of chest and shoulder pain. Pneumothorax of more than 25% requires placement of a chest tube; thoracotomy with bleb excision and pleural abrasion is generally recommended if spontaneous pneumothorax is recurrent. Small pneumothoraxes in patients with minimal symptoms usually resolve and therefore can be observed. A spontaneous perforation of the esophagus (Boerhaave syndrome) can result in hydropneumothorax as well as the more usual pneumomediastinum but would not present with an isolated 40% pneumothorax. Barium swallow is an appropriate diagnostic test for evaluation of a suspected leaking esophagus.

So the answer to this question is D


Instruction:
The first scientist to observe bacteria and other microscopic organisms was: September 2004
A. Syndenham
B. Virchow
C. Harvey
D. Van Leeuwenhoek

Response:
Ans. D i.e. Van Leeuwenhoek Leeuwenhoek October 24, 1632 - August 26, 1723 He was a Dutch tradesman and scientist from Delft, Netherlands. He is best known for his work on the improvement of the microscope and for his contributions towards the establishment of microbiology. Using his handcrafted microscopes, he was the first to observe and describe single-celled organisms, which he originally referred to as animalcules, and which are now referred to as microorganisms.

So the answer to this question is D


Instruction:
Froments sign is seen -
A. Ulnar nerve palsy
B. Median nerve palsy
C. Anterior interosseous nerve palsy
D. Radial nerve palsy

Response:
Ans. is 'a' i.e., Ulnar nerve palsy [Ref: BDC 5th/e Volume 1 p. 136}NERVESRELEVANT TESTSUlnar Nerve PalsyBook test (Froment sign)Card testEgawa's testMusician's NerveMedian Nerve PalsyPointing index fingerPen testBenediction testOschner clasp testApe thumbLabourer's NerveRadial Nerve PalsyWrist dropFinger drop

So the answer to this question is A


Instruction:
Most common mode of treatment for laryngomalacia is -
A. Reassurance
B. Medical
C. Surgery
D. Wait & Watch

Response:
In most patients laryngomalacia is a self-limiting condition.
Treatment of laryngomalacia is reassurance to the parents and early antibiotic therapy for upper respiratory tract infections.
Tracheostomy is required only in severe respiratory obstruction.
Surgical intervention (supraglottoplasty i.e. reduction of redundant laryngeal mucosa) is indicated for 10% of patients. Main indications for surgery are:

Severe stridor
Apnea
Failure to thrive
Pulmonary hypertension
Cor pulmonale.

So the answer to this question is A


Instruction:
True about pearl index:
A. Population study
B. Family planning
C. Contraceptive methods
D. Contraceptive failure

Response:
Ans. (d) Contraceptive failureRef: Park's PSM 21sted. 1472* Pearl index is used to measure the contraceptive efficacy/ contraceptive failure.* It is defined as the number of failures per 100 women- years (HWY) of exposure.P/ =Total accidental pregnancies------------------------Total months of exposurex 1200* Another method used to measure contraceptive failure/ efficacy is life table analysis.* Life table analysis: calculates failure rates for each month of use.

So the answer to this question is D


Instruction:
Devi, a 28 year female, has diarrhoea, confusion, high grade fever with bilateral pneumonitis. The diagnosis is :
A. Legionella
B. Neisseria meningitis
C. Streptococcus pneumoniae
D. H. influenza

Response:
Answer is A (Legionella): Pneumonia in association with clinical clues in the form of high grade fever, confusion and diarrhea suggests a diagnosis of Legionnaire's pneumonia Legionnaire's disease : Legionnaires disease presents as an 'atypical pneumoniaQ where a gram stained smear of sputum does not show organisms (Caused by Legionella). Legionella Legionella is a gram negative Q,motile Q,non-encapsulated bacilli Q,classified under a miscellaneous group Man to Man transmission does not occur with Legionella. Q. No animal reservoirs occur. Q Disease is limited to humans. Q Legionella survive and multiply inside free living amoeba and protozoa, distributed in natural reservoirs such as stagnant waters Q,mud and hot spring. Human infection is typically acquired by inhalation of aerosols, which form the only source of infection.2 Smoking and immunocompromised status.are known risk factors. The disease occurs with unusual frequency among patients with hairy cell leukemia but not among patients with other types of leukemia Common Risk factors for Legionnaires disease Advancing age Immunocompromised patients: - Transplant recipients, HIV, Glucocoicoid recipients - Hairy cell leukaemia (monocyte deficiency and dysfunction) Chronic lung disease Smokers Diabetes mellitus (Javetz) Presents as mild cough slightly productive sputum, sometimes streaked with blood, along with high fever and nonspecific symptoms such as malaise, fatigue, anorexia & headache. Think about the diagnosis as Legionaire's disease whenever the question talks about a pneumonia like picture along with any of the these : Occurrence of illness in immunocompromised e,smokers Q or those with chronic lung disease Q,or Occurance of illness in an environment where potable water supply is known to be contaminated with Legionella Onset of symptoms within 10 days of discharge from a hospital (1.P. 2 to 10 day), or High fever, Q or Gastrointestinal difficulties like diarrhea, Q or Neurological abnormalities like confusion or altered Sensorium, Q or Numerous neutrophils but no organisms revealed by gram staining of respiratory secretions, or Hyponatremia Q is more common in Legionnaire's, than in any other form of pneumonia, or Failure to respond to p-lactam drugs e (penicillin or cephalosporins) and aminoglycosids antibiotics.

So the answer to this question is A


Instruction:
A 50-year-old female patient presented with swelling of the right jaw. The swelling was painless and covered with exudate. She also gave a history of trauma to the same area. The pus was sent for culture. On macroscopic examination, a Sulphur granule was found in the exudate. The gram stain of the exudate is given below. What is the drug of choice of the above condition: -
A. Penicillin
B. Azithromycin
C. Doxycycline
D. Streptomycin

Response:
This is a case of cervicofacial actinomycosis. The image shows a discharging sinus, a characteristic feature of actinomycosis. Gram stain shows branching gram-positive bacilli, characteristic of actinomyces. Actinomycosis occurs most frequently at an oral, cervical, or facial site. It usually occurs as a soft tissue swelling, abscess, mass, or ulcerative lesion. It is often mistaken for a neoplasm. Dental diseases or procedures are common precipitating factors. The angle of the jaw is generally involved. The Drug of choice for the above condition is penicillin.

So the answer to this question is A


Instruction:
High FMA angle indicates
A. Good prognosis
B. Bad prognosis
C. Good bone growth
D. Class III relation

Response:
None

So the answer to this question is B


Instruction:
Glomus tumor arises from
A. Modified smooth muscle cells
B. Modified skeletal muscle cells
C. Merkel discs
D. Melanocytes

Response:
Ans. is 'a' i.e., Modified smooth muscle cells Glomus tumors (Glomangioma)* Glomus tumors are benign but exquisitely painful tumors arising from modified smooth muscle cells of the glomus bodies, arteriovenous structures involved in thermoregulation.* Although they may superficially resemble hemangiomas, glomangiomas arise from smooth muscle cells rather than endothelial cells.* They are most commonly found in the distal portion of the digits, especially under the fingernails.* Excision is curative.

So the answer to this question is A


Instruction:
Which antibodies in mother with SLE is responsible for congenital heart disease in child-
A. Anti-histone
B. Anti-Ro & Anti-LA
C. Anti ds DNA
D. Anti-centromere

Response:
Most sensitive → Antinuclear antibody (ANA)
Most specific → Anti-double stranded antibody and the antibody against Smith (Sm)
Associated with neonatal lupus and congenital heart block → Anti Ro, Anti LA antibody
Associated with lupus psychosis → Anti P antibody

So the answer to this question is B


Instruction:
Most common nerve used for monitoring during anesthesia :
A. A. Ulnar nerve
B. B. Facial nerve
C. C. Radial nerve
D. D. Median nerve

Response:
Most common nerve used in neuromuscular monitoring is Ulnar nerve stimulation (recording contractile responses of thumb muscle, adductor pollicis) Second most common nerve used for monitoring is facial nerve (orbicularis oculi)

So the answer to this question is A


Instruction:
Stocker's line is seen a  –
A. Pinguecula
B. Pterygium
C. Congenital Ocular Melanosis
D. Conjunctival epithelial melanosis

Response:
Stocker's line is a line of iron deposition in the corneal epithelium seen adjacent to the head of the pterygium.

So the answer to this question is B


Instruction:
Topical antifungal used in corneal fungal infection -
A. Silver sulfadiazine
B. Neomycin
C. Natamycin
D. Griseofulvin

Response:
Topical antifungal eyedrops should be used for long period(6-8 weeks),these include:Natamycin,Amphotericin B and either fluconazole or miconazole. Reference:Comprehensive ophthalmology,AK Khurana,6th edition,page no.107

So the answer to this question is C


Instruction:
Gleason's staging is used in:
A. Ca prostate
B. Ca bladder
C. Ca pancreas
D. Ca colon

Response:
Ans: A (Ca prostate) Ref: Bailey & Love s Short Practice of Surgery, 25th Edition & Internet SourcesExplanation:The Gleason Grading SystemIt is used to help evaluate the prognosis of men with prostate cancer.It also predicts prognosis and helps guide therapy.Scoring based upon its microscopic appearance on histopathology.Cancers with a higher Gleason score are more aggressive and have a worse prognosis.The pathologist assigns a Gleason score based on the sum ot' two numbers:The first number is the grade of the most common tumor pattern.The second number is the grade of the second most common pattern.If there are three patterns the first number is the most common and the second is the one with the highest grade.

So the answer to this question is A


Instruction:
Emergency operation done in cases of
A. Volvulus
B. Obstructed hernia
C. Appendicular perforation with paralytic ileus
D. Toxic megacolon

Response:
Surgery is required to prevent or relieve ischaemia.When a removable lesion is found in the caecum, ascending colon, hepatic flexure or proximal transverse colon, an emergency right hemicolectomy should be performed. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1191,1200

So the answer to this question is A


Instruction:
All are used in treatment of endometriosis except:
A. Medroxyprogesterone acetate
B. Tibolone
C. OCP
D. Danazol

Response:
None

So the answer to this question is B


Instruction:
False positive fistula test is associated with -
A. Perilymph fistula
B. Malignant sclerosis
C. Congenital syphilis
D. Cholesteatoma

Response:
False Positive Fistula Test–Hennebert Sign

Fistula test is positive without the presence of fistula.
It is seen in case of congenital syphilis and Meniere’s disease
In congenital syphilis, stapes foot plate is hypermobile while in meniere’s disease there is a fibrous band connecting utricular macula to the stapes footplate.
In both these conditions, movements of stapes result in stimulation of utricular macula which will cause nystagmus and vertigo leading to false positive fistula test. This is called as Hennebert sign.

Ref. Dhingra 5/e, p 47

So the answer to this question is C


Instruction:
Fulminant Amoebic meningoencephalitis caused by-
A. Acanthamoeba
B. N.fowleri
C. E.Histolytica
D. E. Coli

Response:
None

So the answer to this question is B


Instruction:
A Scatter diagram is drawn to study
A. Trend of a variable over a period of time
B. Frequency of occurrence of events
C. Relationship between two given variables
D. Mean & median values of the given data

Response:
SCATTER DIAGRAM
• Also known as ‘Correlation diagram’ or ‘Dot diagram’
• Is used to depict ‘correlation (relationship) between 2 quantitative variables’
• The vertical axis in the scatter diagram: should be the dependent or the outcome variable
• In a scatter diagram, 2 imaginary lines are drawn along the distribution of dots/scatter

So the answer to this question is C


Instruction:
A 50-year-old male patient gives history of STD acquired 20 years back, now complaints of headache, seizures, confusion and numbness in extremities. Which of the following will be true about the pupillary response of the above patient?
A. Light reflex and accomodation reflex absent
B. Light reflex and accomodation reflex present
C. Light reflex absent and accommodation reflex present
D. Light reflex present and accommodation reflex absent

Response:
Ans. (c) Light reflex absent and accommodation reflex presentRef: Kanski 7/e, p. 815STD with neurpsychiatric symptoms hints towards patient having Neurosyphilis.Argyll Robertson pupil is seen in Neurosyphilis, which presents withIrregular, small pupil in dim lightIn bright light, neither pupil constricts (Light reflex absent)On accommodation both pupil constrict (Accomodation reflex absent)

So the answer to this question is C


Instruction:
Receptor for inverse stretch reflex?
A. Golgi tendon organ
B. Ruffines end organ
C. Neuromuscular junction
D. Muscle spindle

Response:
Ans. a (Golgi tendon organ). (Ref. Ganong, Physiology, 21st ed. 133)The harder a muscle is stretched, the stronger is reflex contraction however, when tension becomes great enough contraction suddenly ceases & muscle relaxes. This relaxation in response to stronger stretch is inverse stretch reflex or autogenic inhibition.REFLEXES:.Sr. no.MonosynapticDisynapticPolysynaptic1.Stretch reflexInverse stretch reflexWithdrawal reflex (crossed extensor); all superficial reflexes2.Receptors in intrafusal fibresReceptors in golgi tendon organ-3.Afferent thro lalphaAfferent thro lb-4.NT-glutamateNT-glutamate-(Note -- Intrafusal fibres are nuclear bag and nuclear chain fibres)

So the answer to this question is A


Instruction:
BCR-ABL fusion gene is detected by?
A. Flow cytometry
B. FISH
C. Karyotyping
D. RT-PCR

Response:
Ans. (b) FISH(Ref: Robbins 9th/pg 616-618)Flow cytometry: is used for immunophenotyping in Leukemias & LymphomasFISH- used for detecting submicroscopic chromosomal aberrations of BCR-ABL fusionKaryotyping: Used for detecting chromosomal defects of at least 5 mb size (low sensitivity)RT-PCR: used for quantitative DNA estimation

So the answer to this question is B


Instruction:
A 50 year old diabetic female presents with intense pruritis and discharge from vagina. Smear of the discharge shows budding yeast cells. What is the most likely causative agent?
A. Candida albicans
B. Trichomonas vaginalis
C. Mobilincus
D. Chlamydia trachomatis

Response:
For mucocutaneous candidiasis, a wet mount, scrapings or smears obtained from skin, nails, or oral or vaginal mucosa are examined under the microscope for hyphae, pseudohyphae, or budding yeast cells. Trophozoites of Trichomonas vaginalis are pyriform and 7-30 um long. They have five flagella. The large nucleus is usually located at the wider, anterior end and contains many chromatin granules and a small karyosome. The cytoplasm also contains many granules, but these are often not seen in Giemsa-stained specimens. Mobiluncus is a genus of gram-positive, anaerobic, rod-shaped bacteria. C. trachomatisis a Gram-negative bacteria, therefore its cell wall components retain the counter-stain safranin and appear pink under a light microscope.

So the answer to this question is A


Instruction:
A female child with virilization, hypertension with low plasma renin diagnosis is :
A. 21α hydroxylase deficiency
B. 11 β hydroxylase deficiency
C. 3β hydroxylase deficiency
D. Conn’s syndrome

Response:
9] Congenital adrenal hyperplasia represents a group of autosomal recessive inherited, metabolic errors,
each characterized by decency or total lack of a particular enzyme involved in the biosynthesis of cortical steroids,
Steroidogenesis is then channelled into other pathways leading to increased production of androgens,
which accounts for virilization.
Simultaneously, the decency of cortisol results in increased secretion of ACTH resulting in adrenal hyperplasia.
Following enzymes are implicated in the congenital adrenal hyperplasia 21 α hydroxylase decency (partial or complete) 17 α hydroxylase deficiency 11β hydroxylase
deficiency 21 α hydroxylase deficiency
• Two forms of this deficiency include -
A. Salt-wasting adrenogenital ism
B. Simple Virilizing adrenogenital ism
A) Salt-wasting syndrome (complete lack) The salt wasting syndrome results from complete lack of 21 hydroxylases.
There is no synthesis of mineralocorticoids and glucocorticoids in the adrenal cortex.
Decreased mineralocorticoids causes marked sodium loss in the urine, resulting in hyponatremia, hyperkalemia, acidosis and hypotension.
Because of the enzyme block, there is increased formation of 17 - hydroxyprogesterone, which is then shunted into the production of testosterone.
This may cause virilism (pseudo-hermaphroditism) in female infants.
That is (XX) Female with 21 hydroxylase deficiency develops ovaries,
female ductal structures and external male genitalia. But in the male child, the effect of increased testosterone will not be manifested at the time of birth.
The complete21 hydroxylase deficiency or salt wasting syndrome usually comes to light only after the birth because in utero the electrolytes and uids
can be maintained by maternal kidneys. Males with this disorder comes to clinical attention 5 to 15 days later because of salt losing crisis while
females come to attention soon after the birth because of the virilization.
B) Simple Virilizing adrenogenital syndrome (Partial deficiency) Occurs in individuals
with partial deficiency of 21 hydroxylases Less severe deficiency of mineralocorticoid, is sufficient for salt reabsorption, but the lowered glucocorticoid fails to cause
feedback inhibition of ACTH secretion.
Thus level of aldosterone is mildly reduced, testosterone is increased and ACTH elevated with resultant adrenal hyperplasia.
11B hydroxylase deficiency-. Rare Leads to decreased cortisol and increased ACTH.
This, in turn, leads to the accumulation of DOC (deoxycorticosterone) and 11 deoxycortisol
both of which are strong mineralocorticoids. This results in increased sodium retention by the kidneys and hypertension, hypokalemia.
Patients also develop virilization due to androgen excess. 17 α hydroxylase deficiency - Patients with deficiency of 17 hydroxylases also have impaired cortisol production,
increased ACTH and secondary increased DOC.
These patients, however, cannot synthesize normal amount of androgens and estrogens.
This is because the gene that codes for 17 α hydroxylase is the same for the enzyme in the adrenal cortex and the gonads and the decency is same in both organs.
Because of decreased sex hormones, genotypic females develop primary amenorrhoea and fail to develop secondary sex characteristics while genotypic
males will present as pseudohermaphrodite.
3 β hydroxylase deficiency 3-β hydroxylase deficiency is a rare genetic disorder of steroid biosynthesis that results
in decreased production of all three groups of adrenal steroids which include mineralocorticoid, glucocorticoid and sex steroids.
Decreased mineralocorticoid secretion
results in varying degrees of salt wasting in both males and females.
Decent androgen production results in ambiguous genitalia in males
The usual presentation is a male child with ambiguous genitalia and severe salt wasting. Sometimes it may also occur in females

So the answer to this question is B


Instruction:
Reservoir of hookworm
A. Human being
B. Soil
C. Faces
D. Monkeys

Response:
.man is the only impoant reservoir of human hookworm infection.faeces containing the ova of hookworms is the infective material.as long a sthe person harbours the parasite ,the infectivity of the disease continues. ref:park&;s textbook,ed 22,pg no 221

So the answer to this question is A


Instruction:
Which of the following is not a pox virus -
A. Cow pox
B. Molluscum contagiosum
C. Small pox
D. Chicken pox

Response:
Chickenpox caused by varicella come under Herpesviruses. Other 3 come under poxviruses. REF:ANATHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:471 and 461

So the answer to this question is D


Instruction:
Radioisotope used systemically in Polycythemia rubra vera.
A. 32p
B. 131I
C. Strontium-89
D. Rhenium-186

Response:
32p - Polycythemia rubra vera.
Rhenium -186; Painful bone metastasis.

So the answer to this question is A


Instruction:
Most common type of intracranial haemorrhage in boxers -
A. Intra ventricular
B. Extradural
C. Subdural
D. Cerebellar

Response:
None

So the answer to this question is C


Instruction:
A contraindication to the use of ciprofloxacin is a history of :
A. Epilepsy
B. Deep vein thrombosis
C. Gout
D. G–6 PD deficiency

Response:
None

So the answer to this question is A


Instruction:
Other than the spleen, occlusion of the splenic aery at its origin will most likely affect the blood supply to
A. Jejunum
B. Head of the pancreas
C. Fundus of the stomach
D. Duodenum distal to the entrance of the common bile duct

Response:
The sho gastric aeries arise from the Splenic aery at the hilum of the spleen and pass forward in the gastrosplenic omentum (ligament) to supply the fundus of the stomach.

So the answer to this question is C


Instruction:
Which of the following occurs in Charcot's triad ?
A. Pain abdomen
B. Fever and chills
C. Jaundice
D. All

Response:
Ans. (a) Pain abdomen (b) Fever and chills; (c) Jaundice

So the answer to this question is D


Instruction:
Childhood osteopetrosis is characterized by – a) B/L frontal bossingb) Multiple # (fracture)c) Hepatosplenomegalyd) Cataracte) Mental retardation
A. bc
B. c
C. ac
D. ad

Response:
Osteopetrosis

Osteopetrosis is an autosomal recessive heredofamilial disorder in which partly calcified cartilaginous intercellular ground substance is not regularly reabsorbed & replaced by regular osteoid tissue & bone.
Manifested by :
Increased bone density masking the distinction between cortex & medulla, bone within bone appearance (Marble's bone).
Brittle bone & easily fracturability
Fracture healing satisfactory resulting in skeletal deformities.
Myelophthisic anemia
Hepatosplenomegaly & presence of immature leukocytes & normoblasts in the peripheral blood.
Growth retardation,Macrocephaly.
Thickening of cranial foramina & thus causing pressure on optic nerve & optic atrophy.
Deafness & blindness
Dental problems & osteomyelitis of the mandible.
Learning disorder but may have normal intelligence despite hearing & visual loss.

So the answer to this question is A


Instruction:
Ectopic mucosa of Meckel's diveiculum is diagnosed by:
A. Tc-99 radionuclide scan
B. Angiography
C. CT
D. Endoscopy

Response:
MECKEL'S DIVEICULUM Diagnosis Most accurate diagnostic test in children: Scintigraphy with sodium 99m Tc-peechnetate. The 99mTc-peechnetate is preferentially taken up by the mucus-secreting cells of gastric mucosa and ectopic gastric tissue in the diveiculum. (sensitivity-85%, specificity-95% and an accuracy-90 in the pediatric age group) Pentagastrin, H2 blockers and glucagon- enhance detection of ectopic gastric mucosa in Meckel's diveiculum by Tc-peechnate scan. Glucagon- relaxes the smooth muscles of GIT and decreases peristalsis. Pentagastrin- potent stimulator of gastric secretions, increases uptake and secretion of peechnetate by the gastric mucosa and stimulates gastrointestinal motility. Histamine H2 blockers (Cimetidine) block secretion from the cells and increase gastric mucosa uptake Less accurate in adults because of the reduced prevalence of ectopic gastric mucosa. In adult with normal nuclear medicine findings, barium studies should be performed.

So the answer to this question is A


Instruction:
Common age for otosclerosis is
A. 5-10 years
B. 10-20 years
C. 20-30 years
D. 30-45 years

Response:
Hearing loss usually stas between 20 to 30 years of age and is rare before 10 and after 40 years. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 95)

So the answer to this question is C


Instruction:
True/false statements about inflammatory bowel disease- pending Mucosal granularity is earliest finding seen in ulcerative colitis Coomb sign is seen in UC. Lead pipe colon is seen in UC. Fibrosis and strictures are more common in UC. Apthous ulcers are earliest finding seen in CD.
A. T,F,T,F,T
B. T,F,F,T,F
C. F,T,T,F,T
D. T,F,F,F,F

Response:
Inflammatory bowel Disease: Crohn's disease Ulcerative colitis - Terminal ileitis - Rectum - Skip areas - Continuous - Backwash ileitis - has transmural involvement - has superficial involvement - Signs seen Target sign / halo sign Comb sign Rose thorning sign Creeping fat sign String sign of kantor - Sign Seenv Mucosal granularityv Lead pipe appearance Collar button signv Loss of haustration - Earliest finding Aphthous ulcer - gives cobblestone Appearance in bowel Note: Cobblestone appearance in oesophagus-Candida - Earliest finding Mucosal granularity - Has Pseudo sacculation - Has rectal sparing / fibrosis / strictures / Gut shoening - Has Pseudo polyps & crypt abscesses

So the answer to this question is A


Instruction:
The bacterial drug resistance in tuberculosis results from :
A. Transduction
B. Transformation
C. Plasmid mediated
D. Mutation

Response:
Resistance to INH occurs due to point mutation in inhA or katG genes.
Resistance to rifampicin occurs due to point mutation in rpoB genes.
Resistance to ethambutol is due to mutations resulting in overexpression of the embB gene.

So the answer to this question is D


Instruction:
Hepatitis E infection spreads by:
A. Feco-oral route
B. Parenteral
C. Blood transfusion
D. Rectal

Response:
None

So the answer to this question is A


Instruction:
As absolute contraindication of MRI is:
A. Pacemaker
B. Prosthetic cardiac valves
C. Insulin pump
D. Cochlear implants

Response:
Pacemaker

So the answer to this question is A