Instruction:
Scales used for assessing soeio-economie status of populations are the following except?
A. Modified udai Pareek scale
B. Modiefied Kuppuswamy scale
C. Like scale
D. BG Prasad scale

Response:
Ans. is 'c' i.e., Like scale

So the answer to this question is C


Instruction:
What term is used to describe this finding?
A. Arc eye
B. Asthenopia
C. Choroideremia
D. Coloboma

Response:
Answer D. ColobomaColobomas are the result of abnormal closure of the optic fissure. They may occur anywhere along the optic fissure and can affect the iris, choroid, or macula. Isolated iris colobomas are asymptomatic, but those involving the macula or the optic disk can result in severe visual impairment. Typical iris colobomas occur in the inferonasal quadrant.

So the answer to this question is D


Instruction:
Calcific hepatic metastases are seen in –
A. Adenocarcinoma of the colon
B. Carcinoid tumours
C. Renal cell carcinoma
D. Lymphoma

Response:
A calcified pattern in hepatic metastasis is commonly due to mutinous adenocarcinoina of colon or ovary.

So the answer to this question is A


Instruction:
CT skull giving tram track appearance is diagnostic of-
A. Neurofibroma
B. Tuberous sclerosis
C. Von Hippel Lindau disease
D. Sturge Weber syndrome

Response:
Ans is 'd' i.e. Sturge Weber syndrome * CT scans in Sturge Weber syndrome show the tramline gyriform calcification of apposing gyri that underlies the contrast-enhancing leptomeningeal vascular malformation.Other CT scan findings Sturge Weber syndrome* Cortical atrophy* Abnormal draining veins* Enlarged choroid plexus* Blood-brain barrier breakdown (during seizures)* Contrast enhancement

So the answer to this question is D


Instruction:
The length of tongue spike in tongue thrusting habit breaking appliance should be upto the
A. Incisal edges of maxillary incisors
B. Incisal edges of mandibular incisors
C. Cingulum of mandibular incisors
D. Cervical margin of mandibular incisors

Response:
None

So the answer to this question is C


Instruction:
Which among the following is used as yardstick for the assessment of standards of therapy
A. Proportional mortality rate
B. Survival rate
C. Case fatality rate
D. Crude death rate

Response:
None

So the answer to this question is B


Instruction:
Tertiary syphilis most frequently involves the
A. CNS
B. Liver
C. Testes
D. Aorta

Response:
None

So the answer to this question is A


Instruction:
Cause of False positive D-xylose test include all of the following, Except
A. Bacterial overgrowth
B. Renal failure
C. Ascitis
D. Celiac sprue

Response:
Answer is D (Celiac sprue) Celiac sprue is associated with a positive D- xylose and not a False positive Dxylose test. D-xylose Test Positive test ecreased (4) D- Xylose excretion in urine due to malabsorption from gastrointestinal mucosal disease Causes Include Celiac disease Tropical sprue Whipple's disease Other mucosal diseases

So the answer to this question is D


Instruction:
Nitrates in excess of ----mg/L may cause infantile methaemoglobinemia
A. 15
B. 25
C. 35
D. 45

Response:
Nitrates level >50 increases the risk of infantile methaemoglobinaemia. Ref: Park's textbook of PSM 25th edition, pg 783

So the answer to this question is D


Instruction:
Tension band wiring is done in following except?
A. Fracture patella
B. Fracture olecranon
C. Colie's Fracture
D. Fracture medial malleolus

Response:
Ans. C. Colle's Fracture. (Ref Maheshwari orthopaedics 3rd/pg. 24 & 139)Maheshwari orthopaedics 3rd/pg. 24 mentions........................|||Tension-band wiringTension-band plateTension-band fixation|||iUsed for producing dynamic compression in Patella, Olecranon & transverse malleolus .Used for Humerus & Tibia .Used for Tibia .RECENT ADVANCES IN Rx OF FRACTURES:# A.O. method# Cast (functional) bracing# Ilizarov's techniqueA.O. method:In this method the following principles are used to achieve stable fixation:# A. Inter-fragmentary compression i.e., achieving compression between different fragments.# B. Splinting (splinting fracture fragments internally or extrenally)# C. Combination of A and B.A. Inter-fragmentary compression i.e., achieving compression between different fragments.a. Static compressionb. Dynamic compression# Methods of producing static compression:- a). Lag screw- b). Compression plating- c). External fixator# Methods of producing dynamic compression:- a). Tension-band wiring e.g. Patella & Olecranon - b). Tension-band plate e.g. Humerus & Tibia - c). Tension-band fixation e.g. Tibia .B. Splinting.a. IM splinting: e.g. Kuntscher's nailing for+shaft of femur.b. EM splinting: e.g. plating without compression (neutralising plate), or plate supporting the without fixing it (buttress plate) sometimes used for tibial condyle .c. Outside the body e.g. external fixators used merely to hold the fragments.C. Combination of A and B.e.g. for Spiral of shaft of femur.Cast (functional) bracing# Popularized by Sarmiento (1973)# Done if fracture reduction is satisfactory, and once the swelling subsides - usually 2-3 weeks after injury.# Most commonly used for of the shaft tibia. It is also used for femoral/humerus shaft, and other fractures.Ilizarov's technique# * Infected non-union of long bones is a problem in the developing countries.# * Persistent infection, deformity, shortening, bone loss, joint stiffness and disability complicate the non-union.# * Secondary procedures are often required for correction of bone defects and deformity.# * Ilizarov method deals with all the above problems simultaneously and offers a kind of universal remedy for infected non-unions.# *The stability of the fixation and provision for bone transport allows bridging of bone defects, limb lengthening, early weight bearing ambulation and joint mobilization.# The basic principle of Ilizarov's technique is that Osteogenesis requires dynamic state, which causes dormant mesenchymal cells at the non-union gap to differentiate into functioning osteoblasts.# Distraction or compression is carried out at lmm/day.# This is done is four settings i.e. l/4th mm four times a day.# It is useful in management of:- Limb lengthening- Non-union especially resistant to conventional methods of Rx or those associated with deformity or shortening.- Deformity correction, which may be congenital or acquired.- Osteomyelitis can be treated as this technique offers possibility of excision of necrotic bone - creating a gap, which can be made up by transporting a segment of bone from either end.- Arthrodesis can be performed by crushing articular surfaces against each other, and thus stimulating union between opposite bones.# Advantages:- Immediate load bearing- Healthy viable bone in place of de-vascularized bone- Correction of more than one problems by one-stage operation.# Disadvantages:- Inconvenience- Long duration Rx- Pin-tract infection- Nerve palsy by pin insertion or traction- Joint stiffness of the soft tissues by external fixator.

So the answer to this question is C


Instruction:
Uterus reaches up to umbilical level at: September 2009
A. 16 weeks
B. 20 weeks
C. 24 weeks
D. 28 weeks

Response:
Ans. C: 24 weeks The height of the uterus is midway between symphysis pubis and umbilicus at 16th week; at the level of umbilicus at 24th week and at the junction of the lower third and upper two-third of the distance between the umbilicus and ensiform cailage at 28th week.

So the answer to this question is C


Instruction:
Most permissible capillaries are seen in
A. Kidney
B. Liver
C. Brain
D. Skin

Response:
Capillaries are classified in toContinuous or non fenestrated capillaries - Endothelial cells are arranged without any gap in between them. Eg. Skin, BBB. Allows only very small molecules to pass through. Fenestrated capillaries - Gaps in between endothelial cells ranging from 70-100nm in diameter which are lined by basement membrane. Eg. Capillaries of intestinal villi, renal glomeruli, choroid plexus of the ventricles of the brain, ciliary process of eyes and endocrine glandsDiscontinuous type- Very wide cleft are present in between endothelial cells. The basement membrane is incomplete or absent. Almost all substance in plasma can cross this gap. Seen in liver sinusoids, sinusoids of spleen, anterior pituitary and parathyroid gland Ref: Textbook of medical physiology by N Geetha, 2nd edition, page no. 194

So the answer to this question is B


Instruction:
Precocious pubey is seen in -
A. Hypothyroidism
B. CNS irridation
C. Mc cune-Albright syndrome
D. All

Response:
Ans. is 'a' i.e., Hypothyroidism; 'b' i.e., CNS irradiation; 'c' i.e., Mc Cune Albright syndrome Precocious pubey o Pubey before the age of 8 years in girls or 9 years in boys is considered precocious pubey. o Menarche before the age of 10 years in girls is also considered as precocious. o Precocious pubey is of two types 1. Central or true precocious pubey Results from excessive GnRH, gonadotropins and target sex hormone elaborated by premature activation of hypothlamic pituitary-gonadal (HPG) axis. 2. Peripheral or pseudo-precocious pubey Due to increased sex steroid secretion from either the adrenal gland or the gonads. It is independent of HPG axis activation Causes of Precocious pubey A. Central precocious pubey 1. Idiopathic : Sporadic or familial. 2. Central nervous system abnormalities i) Congenital anomalies of CNS: Hypothalamic hamaoma, hydrocephalus, porencephaly, arachnoid cysts. ii) Acquired lesions of CNS : Inflammation, granuloma, trauma, surgery, radiation, chemotherapy. iii) Tumors of CNS : Pineal tumors, optic glioma, ependymoma, camiopharyngioma. iv) Hypothyroidism B. Peripheral precocious pubey : Isosexual Girls 1. Ovarian causes : McCune-Albright syndrome, benign follicular cysts, granulosa-theca cell tumors; Gonadoblastoma 2. Adrenal causes : Feminizing adrenal neoplasia 3. Exogenous estrogen administration Boys 1. Testis : Leydig cell tumor, adrenal rest tumor, testotoxicosis. 2. Adrenal: CAH (21 or 11-(3 hydroxylase deficiency), virilizing tumors. 3. hCG secreting tumors : Hepatoma, hepatoblastoma, choriocarcinoma, chorionepithelioma, teratoma, dysgerminoma. Exogenous testosterone C. Heterosexual precocity 1. Girls : Virilization in girls due to virilizing CAH, ovarian or adrenal neoplasia, polycystic ovarian disease. 2. Boys : Feminization due to estogen producing adrenal tumors, exogenous estrogen, marijuana smoking. Note - Hypothyroidism usually causes delayed pubey, but juvenile hypothyroidism some times can cause precocious pubey.

So the answer to this question is D


Instruction:
Most common metabolic complication of gastrectomy is
A. Iron deficiency anemia
B. Megaloblastic anemia
C. Hypocalcemia
D. Osteoporosis

Response:
Nutritional disorders are common after gastrectomy. Weight loss is common after gastrectomyAnaemia may be due toeither iron or vitamin B12 deficiency.Iron-deficiency anaemia occurs after both gastrectomy and vagotomy and drainage. Reduced iron absorption is probably the most impoant factor, although the loss of blood from the gastric mucosa may also be impoant. Vitamin B12 deficiency is prone to occur after total gastrectomy. However, because of the very large vitamin B12 stores that most patients have, this maybe very late in occurring.Bone disease is seen principally after gastrectomy and mainly in women. The condition is essentially indistinguishable from the osteoporosis commonly seen in post-menopausal women.Bailey and love pg: 1127

So the answer to this question is A


Instruction:
Cavernous sinus thrombosis can occur due to spread of odontogenic infection via:
A. Tissue spaces
B. Lymphatic route
C. Hematogenous route
D. All of the above

Response:
None

So the answer to this question is C


Instruction:
Which one of the following statements is false regarding vincristine -
A. It is an alkaloid
B. Its use is associated with neurotoxicity
C. It does not cause alopecia
D. It is a useful drug for induction of remission in acute lymphoblastic leukaemia

Response:
Ans. is 'c' i.e., It does not cause alopecia o Vincristine belongs to the plant alkaloid group of anticancer. o Useful for inducing remission in childhood ALL (not useful in maintenance therapy) o It can also be used for pediatric solid tumors (Wilm's tumor, neuroblastoma, rhabdomyosarcoma) and lymphomas. o Prominent adverse effects? o Peripheral neuropathy Alopecia SIADH

So the answer to this question is C


Instruction:
Angiotensin II causes all of the following except:
A. Stimulation of thirst
B. Aldosterone secretion
C. Increased ADH secretion
D. Vasodilation

Response:
. Ans. d. VasodilationAngiotensin II causes vasoconstriction (most potent or - 4-S times more than noradrenaline on weight basis)."Cotonic motility is minimal in fasting period. Eating stimulates colonic contractions. Fat component of meal is major stimulus to colonic contractions. Protein ingestion inhibits colonic contraction. Maximum postprandial increase in motility is seen in sigmoid colon > descending colon > transverse colon"Actions of Angiotensin IIBlood Vessels(AT1A receptors)Brain(AT1a receptors)Adrenal Cortex(AT1B receptors)Others* Potent arteriolar (Vaso) constrictor causing:-Rise in systolic and diastolic BP-Rise in total peripheral resistance* Its pressor activity is decreased in cirrhosis and in Na* depleted individuals. Because circulating angiotensin II is increased in those conditions, which down regulates angiotensin receptors in vascular smooth muscle* It does not penetrate blood brain barrier, but triggers responses by acting on circum ventricular organs (out side BBB)* Area postrema is primarily responsible for pressure potentiation. Angiotensin II acts here to decrease the sensitivity of baroreflex* Dipsogenic effect (i.e. Increase thirst or water intake) is due to action of subfornical organ and organum vasculosum of lamina terminalis.* | Antidiuretic hormone(ADH) or vasopressin) from posterior pituitary* | ACTH* Increase secretion of aldosterone which:- Promotes Na and water reabsorption0- Expands ECF (leading to CO)- Facilitates K+ excretion* Direct effect on PCT to increase Na+ reabsorption by increasing Na+ - H+ exchange* Contraction of mesangial cells with resultant decrease in GFR* Direct action on post ganglionic sympathetic neurons facilitates release of norepinephrine

So the answer to this question is D


Instruction:
A child with congenital hearing loss is brought for cochlear implantation. For the implantation, the following structure should be intact:
A. Outer hair cell
B. Inner hair cell
C. Spiral ganglion cell
D. Auditory nerve

Response:
Cochlear implants are neural prostheses that conve sound energy to electrical signals and can be used to stimulate the auditory division of the eighth nerve directly. Successful cochlear implantation requires an intact and functional auditory processing pathway, from spiral ganglion cells to the auditory coex.

So the answer to this question is D


Instruction:
A 40 year old man was admitted to the hospital emergency with sudden onset of the symptoms and signs of severe left ventricular failure. Calculate the atrial rate of the patient.
A. 100/min
B. 150/min
C. 200/min
D. 300/min

Response:
Ventricular rate : 1500/10 = 150 ECG shows HR of 150/min with normal axis. Saw tooth waves are noted with 2:1 AV block. Ventricular rate is 150/min therefore the atrial rate would be 300/min.

So the answer to this question is D


Instruction:
Kala-azar is not responding to primary treatment. The treatment should now consist of-
A. Double dose of antimony
B. Amphotericin - B
C. Ketoconazole
D. Splenectorny

Response:
None

So the answer to this question is B


Instruction:
A 4-year child presents with a history of hoarseness, croupy cough and aphonia, the child has dyspnoea with wheezing. The most probable diagnosis is ?
A. Asthmatic bronchitis
B. Laryngeal foreign body
C. Bronchopneumonia
D. Retropharyngeal abscess

Response:
Ans. is 'b' i.e., Laryngeal foreign body

So the answer to this question is B


Instruction:
Which is not a 2nd generation antihistaminic ?
A. Loraudine
B. Acrivastatine
C. Cyclizine
D. None of the above

Response:
Cyclizine Histamine is a naturally occuring amine. It is found in most body tissues but is predominantly secreted by mast cells. Histamine acts as a local hormone (autacoid) i.e. it acts within the immediate vicinity of its release. It main physiological effects are on: Blood vessels ? - Aerioles are dilated - Capillary permeability is increased Smooth muscles -- Cause contraction of the smooth muscles G.I.T. -- Increase gastric acid secretion Histamine acts through two receptors - H1 --> mediates edema and vascular effects of Histamine - H2 --> mediates effect on gastic secretion. Hi receptor antagonists : T- hey are classified in two types (i) First generation antihistamines (ii) Second generation antihistamines The term antihistamine is unsatisfactory for the first generation or older generation antihistamine because besides blocking histamine receptors, they also show considerable blocking activity against - muscarinins receptors - serotonin receptors - a adrenergic receptors They also enter the brain readily and cause sedation. Because of their non-specificity and their highly sedative action, they have a great tendency to cause serious adverse effect. Because of these disadvantages, second generation antihistamines were developed which are more selective for H1 receptor and largely free of antimuscarinic and antiadrenergic activity. The newer second generation antihistamines penetrate the blood-brain barrier poorly and are largely devoid of sedative effects.

So the answer to this question is C


Instruction:
Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the
A. Contralateral side in a simple pneumothorax
B. Affected side in a hemothorax
C. Affected side in a tension pneumothorax
D. Contralateral side in hemothorax

Response:
The trachea will shift according to the pressure gradients within the thoracic cavity.
In tension pneumothorax and hemothorax, accumulation of air or fluid causes a shift away from the injured side.
If there is no significant air or fluid accumulation, the trachea will not shift.
Tracheal deviation toward the contralateral side in simple pneumothorax is seen when the thoracic contents shift in response to the
release of normal thoracic pressure gradients on the injured side.

So the answer to this question is D


Instruction:
Sub acute - Sclerosing pan - encephalitis (SSPE) is caused by
A. Measles
B. Mumps
C. Rubella
D. Small pox

Response:
(Measles) (137-Park 20th)* Subacute sclerosing pan-encephalitis (SSPE) is a rare complication which develops many years after the initial measles infections. It is characterized by progessive mental deterioration leading to paralysis, probably due to persistence of the virus in the brain.* Measles vaccination definitely constitutes a protection against the neurological and other complications by preventing natural measles from occurring* **A11 cases of severe measles and all cases of measles in areas with high case fatality rates should be treated with vitamin A

So the answer to this question is A


Instruction:
A 34 weeks pregnant female presented with intense itching over vulvar area and a white, cheesy vaginal discharge. On examination, vulvar erythema is noted. Which among the following is the causative organism in this patient?
A. Epidermophyton
B. Aspergillus
C. Candida albicans
D. Tinea

Response:
Candida albicans, the most common Candida species, causes symptomatic vulvovaginitis in approximately 90% of the cases. Clinical infection is associated with a systemic disorder (diabetes mellitus, HIV, obesity), pregnancy, medication (antibiotics, coicosteroids, oral contraceptives), and chronic debilitation. Vulvovaginal candidiasis presents with intense vulvar pruritus; a white, cheesy vaginal discharge; and vulvar erythema. A burning sensation may follow urination, paicularly if there is excoriation of the skin from scratching. The current medical treatment of candidal infection is by imidazoles. Ref: Bornstein J. (2013). Chapter 39. Benign Disorders of the Vulva & Vagina. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.

So the answer to this question is C


Instruction:
Which is not the action of TGF?
A. Anti-inflammatory
B. Proliferation of fibrous tissue
C. Inhibition of metalloproteinases
D. Anaphylaxis

Response:
.

So the answer to this question is D


Instruction:
Following age pyramid denotes
A. Developing country
B. Developed country
C. Underdeveloped country
D. Poor country

Response:
The pyramid of developing country (e.g. India) has a broad base and a tapering top.
In developed countries, the pyramid generally shows a bulge in the middle and has a narrower base (as in figure given in the question).

So the answer to this question is B


Instruction:
Drug of choice for Neutropenia due to cancer chemotherapy is
A. Vitamin B-12
B. IL 11
C. Filgrastim
D. Erythropoietin

Response:
ANSWER: (C) FilgrastimREF: KDT 6TH edition, page 833, internet resourcesSee APPENDIX-37 below "ANTICANCER DRUGS TOXIC AMELIORATION" APPENDIX - 37Classification of Cancer Chemotherapy Agents:GroupSubgroups & AgentsAcute ToxicityDelayed ToxicityUsesAlkylatingAgentsNitrogen Mustard Alkylation of DNA at N7 &06 position of Guanine -DNA crosslinking I; b/n 2 strands - prevents duplication(1) Mechiorethamine(First anticancer drug)CINV-chemo induced nausea vomiting (4hr- 48hrs)MyelosuppressionMyelosuppression (delayed type-onset = 7d, Nadir = 10-14d, reco%rerv = 21-28d)AlopeciaMOPP-HodgkinslymphomaAA are commonly used in chronic leukemia(2) Cyclophosphamide1CP - 4hydroxyCP -aldophosphamide- Acrolein (toxic) & phosphamide mustard (active)]CINVMyelosuppression(CP>Ifo)Myelosuppression (CP>Ifo) Alopecia, SIADHHemorrhagic cystitis (Ifo>CP)Sec cancer-transitional cell cancer of bladderWagner'sgranulomatosis DOC CMF-Breast, small cell lung ca Broad spectrumAA are nonphase specific(3) Ifosfamide 4hydroxy ifosfamide (active)CINVMyelosuppression(CP>Ifo)Myelosuppression(CP>Ifo)AlopeciaHemorrhagic cystitis (Ifo>CP)Broad spectrum Lung, breast, ovary, sarcoma, testis, germ cell tumorAA causes secondary leukemia in 4-5 years(4) Melphanamino acid derivative ofmechloretamineCINVMyelosuppressionMyelosuppression No alopeciaMultiple myeloma DOCCan replace C in CMF (5) ChlorambucilMyelosuppression CINV is rareMyelosuppression No alopeciaCLL, Hodgkin's Nitrosoureas(lipophilic-crosses BBB) Nitrosoureas causes delayedMyelosuppression (onset-15d, Nadir-4wks, recovery-6wks) (1) Carmustine (BCNU- bis chloro nitroso urea)CINV (severe-2hrs)Myelosuppression, male infertility,Pulmonary fibrosisBrain tumors DOC(Glioblastomamultiforme.Astrocytoma,Medulloblastoma) (2) Lomustine (CCNU)CINV (severe-2hrs)Myelosuppression Interstitial lung diseasedo (3) Semustine (methyl CCNU)CINV (severe-2hrs)Myelosuppressiondo (4) Streptozocin (methylation of protein & nucleic acid)CINV (severe-2 hrs)No MyelosuppressionPancreatic islet cell tumorCarcinoid tumor Alkyl Sulfonates(Intra strand cross linking of DNA by 2 N7 Guanine) BUSULFAN {Dealkylating agent)Hyperuricemia(MC)Sterility, gynecomastia, seizures, Skin pigmentation, Adrenal insufficiency Pulmonary fibrosis (specific)CM L-DOC until imatinibConditioning of BM transplant Ethyl Enimines Thiotepa(Organophosphorous)CINVMyelosuppressionSeldom used nowNon ClassicalAlkylatingAgentsTriazenes Acts on RNA &Protein synthesis not/ mild DNADacarbazine (Active- methyl carbonium ion)CINV-severePermanent sterility Myelos uppre ssion (early/classical)MAID-sarcoma, ABVD-Hodgkins Malignant melanoma (most active agent) Procarbazine (autoxidize spontaneously, Active- Azoprocarbazine, crosses BBB)CINV, MAO inhibitor Disulfiram like reactionMyelosuppression,DermatitisLeukenogenic,teratogenicMOPP-Hodgkin'sPCV-Glioblastoma AltretamineCINV-severe HypotensionNeuro toxic NephrotoxicRefractory ovarian cancerAlkylating Like AgentsPlatinum Compounds 1st gen platinum Inactivated by aluminumCisplatinCINV (most emitogenic)Hypo Mg, K, Ca sec to hypo Mg)Myelosuppression N ephrotoxicity, Ototoxicity Secondary leukemiaCMF-Solidmalignancies2nc generation platinum, Cross resistance- cisplatinCarboplatinCINV (cis>carbo)Myelosuppression(carbo>ds)No nephrotoxicityLess potent than cisplatin (1:4) GemCarco-Iung cancer3rd generation platinum No cross resistanceOxaliplatinPSN pathy (reversible hand & foot, temp loss)Neurotoxicity (dose limiting)No nephrotoxicity PSN pathyflrreversible, hand, foot, leg, arm, temp loss, propio loss)FOLFOX- colon cancerCis/carboplatin resistance AntimetabolitesFolate Antagonists S phase specificMethotrexate HepatotoxicityMyelosuppressionMucositisChoriocarcinoma DOC, ALL, Osteosarcoma. RA, ectopic Myasthenia, psoriasis, meningeal leukemia (intrathecal route)Inhibits DMA syn thesisPemetrexed : Mesothelioma, nonsmall cell lungNo acute toxicidesPurine Analogue Commonly used in acute leukemias6 THIO Guanine MyelosuppressionHepatotoxicityAdult acute leukemia 6 Mercapto Purine Myelosupp ression, hepatotoxicityChildhood acute leukemia Fludrabine Myelosuppression, Flu like symptom (fever, myalgia, arthralgia) Cladribine Myelosuppression, Nephrotoxic, ClXVHairy cell leukemia Pentostatin NephrotoxicHairy cell leukemia Pyrimidine Analogue 5 Fluorouracil (5-FU) GI upset-diarrhea (MC) Hand foot syndrome, CINVMyelosuppression, neurotoxicity Cerebellar ataxia Cytrabine Stomatitis, CINV, Cerebellar ataxia MyelosuppressionAML Capecitabine CINV, Diarrhea, Hand foot syndrome Myelosupp ression (<5FU)Metastatic breast cancer, Metastatic colorectal cancer Gamecitabine CINV, Myelosuppression (dose limiting)Pancreatic cancer DOC Bladder & Nonsmall cell lung CaAntibioticsAnthracyclinsTopoisomerase 2 inhibitor (me)Quinone Free radical injury & intercalation b/n DNA strandsMembrane binding (responsible for cardiotoxicity) Doxorubicin (Adriamycin)CINV, AlopeciaMyelosuppression (dose limiting, neutropenia >th rombocytopenia) Cardiotoxicity(cardiomy opathy, CHF)Radiation recall Hand foot syndromeBroad spectrum Solid tumors & sarcomas (rhabdo/ leiomyosarcoma, Kaposi sarcoma) DaunorubcinCl MV, AlopeciaMyelosuppression, cardiotoxicity, radiation recallNarrow spectrum AML Idarubcin (synthetic Daunorubicin analogue)CINV, Alopecia, Red urine (not hematuria)Myelosuppression, cardiotoxicity, radiation recallAML (more efficacious than daunorubicin) MitoxantroneCINV, Bluish discoloration of nailsMyelosuppression (dose limiting)Lower cardiotoxicity? Other Antibiotics Bleomycin(Glyco peptide Antibiotic) Free radical injury - ds- ss DMA breaks, have both DNA & Fe binding domainAllergic reaction HypotensionPulmonary fibrosis (dose limiting)Mucocutaneous toxicity? Marrow sparingHL, NHL, SCC Malignant pleural effusionAscitis (sclerosing agent) Mitomycin- CActs as alkylating agentCINVHemolytic uremic syndrome. Pulmonary- fibrosis, 8th nerve damageRadiosensitizer- DOC, SCC Dactinomycin Inhibits all forms of DMA dependent RMA synthesis, r-RNA most sensitiveCINVMyelosupp ression Alopecia Radiation recallPediatric tumors (Ewing's, witm's, Rhabdomyosarcoma) Radiosensitizer ActinomycinCINVDesquamationMyelosuppressionAlopeciaPediatric tumors (Ewing's, wilm's, Rhab domyosarcoma) Radiosensitizer PlicamycinCINV EnzymeL-ASPARGINASE (inhibits protein synthesis of tumor cell by depletion of L-Aspargine)Anaphylaxis/ hyper sensitivity- fever, chills, rash, urticaria (brochospasm, hypotension if severe)Hypercoagulable state Pancreatitis, Hepatotoxicity Marrow sparing, no alopeciaALLIneffective in solid tumors(normal cells spared)Plant DerivedVinca AlkaloidsM phase specificInhibits tubulin polymerizationMitotic inhibitors VincristineAlopeciaPSNpathySIADH, Marrow sparingLymphosarcoma, wilm's, Ewing's Remission of childhood acute leukemia. VinblastineAlopecia (Vc >Vb)PSNpathy (Vc >Vb) MyelosuppressionHodgkin s, testicular carcinoma EpipodophylotoxinsTopoisomerase 2 inhibitor Etopside (VP-16)CINV, HypotensionMyelosuppression, early onset secondary leukemia (1-3 years) alopecia Teniposide (VP-26) TaxansM phase specificEnhance tubulin polymerizationSpindle poison PaclitaxelHypersensitivityPSNpathy (stocking glove type) Myelosuppression,Cisplatin resistance Relapse &resistant breast/ovary ca Docetaxel (more potent)HypersensitivityMyelosuppression, PSNpathy (is less frequent)Cisplatin resistance, Relapse-resistant br/ovary ca CamptothecinTopoisomerase 1 inhibitorss DNA breaks TopothecanCINVMyelosuppression (dose limiting) Irinothecan (active = SN-38)CINV, Cholinergic syndrome (SLUDGE) including early diarrhea-24hrsMyelosuppression, cholinergic syndrome (SLUDGE) including late diarrhea 3-10d (dose limiting)Advanced colorectal ca- DOCMiscellaneousArsenic Trioxide (degradation of PM LI & RARa protein)Headache, lightheadednessCINVCardiotoxicity (QT prolongation, arrhythmias), Myelosuppression Syndrome-fever, fluid retention, wt gain, rashAPL-induction in tretinoin relapse and refractoryHydroxyurea has 100% oral bioavailabilityHydroxyurea (inhibits ribonucleotide reductase - inhibits DMA synthesis)CINVMyelosuppression (dose limiting)HyperpigmentationCMLAML-blast crisis Imatinib (Bcr-Abl Tyrosine kinase inhibitor)CINVFluid retention, Ankle & perioral edemaCML-chronic phase GIST with Ckit tyrosine kinase Dasatinib & Nilotinib (novel agents- TK inhibitors) CML- imatinibresistance/intoleranceAnticancer Drug Toxicities:MYELOSUPPRESSIONAll except Asparginase, Vincristine, BleomycinCARDIOTONICAnthracyclins, arsenic trioxideNEPHROTOXICPlatinum compounds (cisplatin>carboplatin>oxaliplatin)PULMONARY FIBROSISBleomycin. Busulfan, CarmustinePERIPHERAL NEUROPATHYGxaliplatin, vincristine Taxans (stoking & glove type)HAEMORRHAGIC CYSTITISCyclophosphamide, IfosfamideHAND FOOT SYNDROME5FU, Capecitabine, DoxorubicinCEREBELLAR ATAXIAPyrimidine analogs like Cytrabine & 5FUSIADHCyclophosphamide, VincristineSECONDARY LEUKEMIAAll alkylating agents & alkylating like agents (in 4-5 years) E topside (in 1-3 years)STERLITYAlkylating agentsDISULFIRAM LIKE REACTIONProcarbazineCHOLINERGIC SYNDROMEIrinitecanRADIATION RECALL SYNDROMEAnthracydinsAnticancer Drugs Toxic Amelioration:ToxicityMeasuresMethotrexateFolinic acidAlkalization of urine (Mtz is weak acid & reabsorbed in acidic urine)Hemorrhagic cystitis (cyclophosphamide, ifosfamide)ME SNA (2 mercapto ethyl sulfonyl sodium) systemic ACETYLCYSTEINE irrigation of bladderHigh fluid intakeFrequent voidingCINV (Cytotoxic drug induced nausea Stvomiting )Ondansetron (5HT3 Antagonist)Cytotoxic drug induced MucositisPabfermin (human recombinant keratinocyte growth factor)TUMOR LYSIS SYNDROME (hyperkalemia, hypophosphatemia, hyperuricemia, hypemricosuria, hypocalcaemia, acute renal failure)prophylactic ALLOPURINOL (xanthine oxidase inhibitor)alternatively RASBURICASE (urkase)Aggressive hydrationHigh urine outputAlkalization of urine not recommended/controversialDiuresis is reserved for well hydrated patientsHEMODIALYSIS (if above fails) MYE LOS OPPRESSIONFor AnemiaERYTHROPOIETIN (recombinant)For NeutropeniaFILGRASTIM- Granulocyte colony-stimulating factor (G-CSF) analogSARGRAMOSTTM - Recombinant granulocyte macrophage colony stimulating factor (GM-CSF)For ThrombocytopeniaOPRELVEKIN (IL-11)BONE MARROW TRANSPLANT (for extreme suppression)CANCER CACHEXIATHALIDOMIDECYTOPROTECTION of normal tissueAMIFOSTINE= WTR-2721=prodrug(active = free thiol=WR-1065. activation normal tissue)USES=cispIatin based chemotherapy & radiation therapyAnthracyclins induced CARDIOTOXICITYDEXRAZOXAXE (ICRF-187) Iron chelating agent Cardio protective agent, derivative of EDTA

So the answer to this question is C


Instruction:
Antihypertensive drug of choice in a diabetic patient is:
A. Methyldopa
B. Beta blocker
C. ACE inhibitor
D. Thiazides

Response:
None

So the answer to this question is C


Instruction:
Fructose is not used in IV infusion as it cause -
A. Irritability
B. Mental retardation
C. Increased erythrocyte protoporphyrin
D. None

Response:
Ans. is 'None' Fructose causes lactic acidosis & hepatocellular dysfunction.

So the answer to this question is D


Instruction:
Which is not transmitted by arthropod :
A. Rickettsia prowazaki
B. Coxiella burneti
C. Rickettsia akasi
D. Rickettsia rickettsi

Response:
Ans. is 'b' i.e. Coxiella Burnetti "Rickettsia is a small obligate intracellular parasite and except for Q fever (caused by Coxiella burnetti) are transmitted to human by Arthropod"Human Diseases Caused By RickettsiaOrganism Disease Vector* Rickettsia prowazekii Epidemic Typhus* louse** Rickettsia typhi Endemic Typhus* Flea** Orientia Tsutsugamushi Scrub Typhus* Mite** Rickettsia Ricketsei Rocky mountain* spotted fever* Tick** Rickettsia Akari Rickettsialpox* Mite** Coxiella Burnetti Q fever * Airborne fomites*

So the answer to this question is B


Instruction:
All are elevators of mandible except -
A. Temporalis
B. Medial pterygoid
C. Masseter
D. Digastric

Response:
Depressors of mandible are :-

Muscle of mastication : Lateral pterygoid (major depressor).
Suprahyoid muscles : Digastric, mylohyoid, geniohyoid.

Elevators of mandible are :-

Muscles of mastication : Masseter, temporalis, medial pterygoid.

So the answer to this question is D


Instruction:
Postmoem blood is collected from which vessel ?
A. Femoral aery
B. Femoral vein
C. Cephalic vein
D. Brachial aery

Response:
Ans. is 'b' i.e., Femoral vein Before autopsy 10 - 20 ml of blood is collected from the femoral vein in groin. Jugular/ subclan vein can also be used.

So the answer to this question is B


Instruction:
&;Take in&; of split skin graft occurs when
A. Tight dressing is applied
B. Excessive discharge from wound
C. ss hemolytic streptococcus infection is present
D. Wound bed not vascularised

Response:
.take in occurs if there is close contact of graft with recepient bed and decreased when there is infection or pus draining or wound bed not vascularized

So the answer to this question is A


Instruction:
All are metabolic causes of liver disease except
A. Histiocytosis
B. Hemochromatosis
C. Gaucher's disease
D. Wilson disease

Response:
Ans. is 'a' i.e., HistiocytosisMetabolic liver diseases can be classified into 3 categories:Manifestations due to hepatocellular necrosis: Galactosemia, hereditary fructose intolerance, tyrosinemia type I, Wilson disease, Hemochromatosis and al -antitrypsin deficiency.Cholestatic jaundice :Al -antitrypsin deficiency, Byler's disease, cystic fibrosis, Niemann-Pick disease and some disorders of peroxisome biogenesis.Hepatomegaly (disorders with liver damage & storage diseases ): Glycogen storage diseases, cholesteryl ester storage disease and, when associated with splenomegaly, lysosomal storage diseases (eg:- Gaucher disease).

So the answer to this question is A


Instruction:
Megaloblastic anaemia may be caused by all of the following except
A. Phenytoin
B. Methotrexate
C. Pyrimethamine
D. Amoxicillin

Response:
Phenytoin decreases folate absorption & increases its excretion causing megaloblastic anaemia.

Methotrexate is folate antagonist

Pyrimethamine in high doses causes megaloblastic anaemia,especially in those with marginal folate stores.

Reference :Tripathi essentials of medical pharmacology 7th edition

So the answer to this question is D


Instruction:
Which anti-cancer drug affects DNA as well as RNA?
A. 5-FU
B. Methotrexate
C. Actinomycin-D
D. Etoposide

Response:
Actinomycin-D is one of the anti-tumor antibiotic. It has two mechanisms of action: - It blocks RNA transcription by interfering with template function of DNA. - It causes single strand breaks in the DNA. It is used in the treatment of Wilm's tumor and rhabdomyosarcoma.

So the answer to this question is C


Instruction:
Lumbar hemivertebra results due to the abnormal development of -
A. Dorsal sclerotome
B. Intermediate cell mass
C. Notochord
D. Ventral sclerotome

Response:
None

So the answer to this question is D


Instruction:
Thin spiral interdental brushes are used in which type of embrasures?
A. Type 1
B. Type 2
C. Type 5
D. Type 4

Response:
None

So the answer to this question is B


Instruction:
A patients of iron deficiency anaemia have been put on iron therapy. What should be the rate of rising in haemoglobin level of blood so that response is considered adequate
A. 0.05-0.1g/dl per week
B. O.1-0.2g/dl per week
C. O.5-1.0g/dl per week
D. More than 1.0g/dl per week

Response:
Medicinal iron. A rise in Hb level by 0.5-1 g/dl per week is an optimum response to iron therapy. Treatment should be continued till normal Hb level is attained (generally takes 1-3 months depending on the severity) and 2-4 months thereafter to replenish the stores because after correction of anaemia, iron absorption is slow.

So the answer to this question is C


Instruction:
Which one of the following is not a principle followed in the management of missile injures?
A. Excision of all dead muscles
B. Removal of foreign bodies
C. Removal of fragments of bone
D. Leaving the wound open

Response:
Ans. (c) Removal of fragments of bone Missile injury management*Wound excision and leave wound opened* Foreign materials to be removed.* Excise the skin edge around the entry and exit point* Unhealthy dead muscle must be removed.* Bone shattered by high energy transfer may still have attachment to periosteum or muscle. Such fragments must not be discarded as it may result in mal union or non-union.

So the answer to this question is C


Instruction:
Enlarged and pale placenta, is due to infection by _______
A. Parvovirus
B. Measles
C. Syphilis
D. Toxoplasmosis

Response:
Enlarged and pale placenta is due to infection by syphilis. Other clinical manifestations and complications include: Spontaneous aboion Stillbih Non-immune hydrops intrauterine Growth restriction Perinatal death Ref: Williams Obstetrics 25th edition Pgno: 1237

So the answer to this question is C


Instruction:
Drug used in the treatment of resistant gonorrhoea is:
A. Penicillin
B. Cotrimoxazole
C. Spectinomycin
D. Erythromycin

Response:
Spectinomycin

So the answer to this question is C


Instruction:
Which muscle divides the axillary artery into three parts?
A. Pectoralis Minor
B. Pectoralis Major
C. Serratus Anterior
D. Scalenus Anticus

Response:
Ans. is 'a' i.e., Pectoralis Minor Axillary artery* It is the main artery of upper limb. It begins at the level of outer border of first rib as a continuation of subclavian artery.It ends at the level of lower border of teres major to continue as brachial artery.* The axillary artery is covered anteriorly by pectoralis minor, which divides it into three parts:-1) First part# This part is proximal to upper border of pectoralis minor, i.e. extends from outer border of first rib to upper border of pectoralis minor.# The branch of first part is Superior thoracic artery.2) Second part# This part is behind pectoralis minor.# It gives following branches.a) Thoracoacromial artery:- It pierces clavipectoral foscia and gives following branches (i) Acromial (ii) Pectoral, (iii) Clavicular and deltoid.b) Lateral thoracic artery3) Third part:-# This part is distal to lower border of pectoralis minor, i.e. extends from pectoralis minor (lower border) to teres major (lower border).# It gives following branches -a) Subscapular artery: - It gives off circumflex scapular artery and then continues us thoracodorsal artery.b) Anterior circumflex humeral artery.c) Posterior circumflex humeral artery.

So the answer to this question is A


Instruction:
Sertoli cell feedback mechanism involves
A. Decreased LH
B. Decreased FSH
C. Decreased TRH
D. Decreased CRH

Response:
Ans (b) Decreased FSH(Ref: Ganong, 25th ed/p.417)Sertoli cells produce the hormone inhibin which inhibits pituitary FSH (negative feedback)LH acts on the Leydig cells of testis to increase the production and secretion of testosterone which inhibits LH (negative feedback).

So the answer to this question is B


Instruction:
Duroziez's sign is seen in?
A. Aoic Regurgitation
B. Aoic Stenosis
C. Mitral Stenosis
D. Mitral Regurgitation

Response:
Duroziez's sign is seen in severe aoic regurgitation 1. Duroziez Sign - Gently press the femoral aery using stethoscope | Murmur in hea d/t turbulence | To and fro murmur Aerial pulse seen with aoic regurgitation : 2. Corrigan's pulse -Water hammer pulse 3. Quincke's sign - Flushing and blanching at distal pa of nail 4. Traube Sign - Pistol shot sounds heard at femoral aery

So the answer to this question is A


Instruction:
Most common translocation in acute promyelocytic leukemia (APML) is
A. t (8:14)
B. t (9:22)
C. t (15:17)
D. t (8:21)

Response:
Answer- C, t (15:17)Acute promyelocytic leukemia (M3 by the FAB classification) is associated with a t(15;17) (q22;q11) translocation.Disseminated intravascular coagulation can occur in this disorder due to the release of procoagulant substances from the leukemic cells, especially during treatment.The t(4;11)(q21;q23) translocation is associated with acute lymphocytic leukemia (ALL) and undifferentiated leukemia.The t(6;9)(p23;q34) translocation is found in subtypes of AML with basophilia (M1, M2, M4).Burkitt's leukemia, which is related to Burkitt's lymphoma, is associated with t(8;14) (q 24;q32).The t(8;21) (q22;q22) translocation (choice D) is seen in M2 leukemia, also known as acute myeloid leukemia (AML) with maturation

So the answer to this question is C


Instruction:
Condyloma acuminatum is caused by HPV types of -
A. 18, 31
B. 17, 12
C. 6, 11
D. 16, 18

Response:
HPV6&11 causes condyloma accuminata or genital was REF:ANATHANARAYANAN MICROBIOLOGY NINTH EDITION PAGE.553

So the answer to this question is C


Instruction:
Principal of using Robeson cooked meat broth:
A. Meat kills other bacteria
B. Meat is utilized by anaerobes
C. Content of meat extract utilize 02
D. All of the above

Response:
Ans. is. 'c' i. e., Content of meat extract utilize 02

So the answer to this question is C


Instruction:
What is the value of poisons ratio for ideal isotropic material:
A. 0.3
B. 0.4
C. 0.5
D. 0.6

Response:
For most engineering materials poisons ratio is 0.3

So the answer to this question is C


Instruction:
Epiphyseal enlargement is seen in
A. Rickets
B. Scurvy
C. Spondo-epiphyseal dysgenesis
D. Juvenile Rheumatoid Ahritis

Response:
D i.e. Juvenile Rheumatoid

So the answer to this question is D


Instruction:
Ramu is 60 year old male with CA Descending colon presents with acute intestinal obstruction. In emergency depament tit of choice is -
A. Defunctioning colostomy
B. Haman's procedure
C. Total colectomy
D. Lt hemicolectomy

Response:
Ans is 'b' ie Haman's procedure As already explained above, a variety of operations can be done in the obstructing lesion of left colon depending on a variety of factors, but Haman's procedure is the most commonly preferred operation.

So the answer to this question is B


Instruction:
Le dance sign is seen in
A. Appendicitis
B. Intussusception
C. Meconium ileus
D. Large bowel obstruction

Response:
Le dance sign is empty right iliac fossa, seen in Intussusception.

So the answer to this question is B


Instruction:
A child presented at 10 weeks with recurrent episode of pneumonia and failure to thrive. X-ray show cardiomegaly & pulmonary plethora diagnosis?
A. VSD
B. ASD
C. TOF
D. Patent foramen ovale

Response:
- Features given in the question are suggestive of VSD VENTRICULAR SEPTAL DEFECT : - Communication b/w 2 ventricles of hea - 90% are located in membranous pa of ventricular septum with variable extension into muscular septum. - Clinical features: Usually presents at 6-10 weeks of age Recurrent episodes of pneumonia Hea failure Failure to thrive X-ray showing cardiomegaly & pulmonary plethora -->MC congenital hea disease in children--> VSD -->MC congenital acyanotic hea disease in children--> VSD -->MC congenital hea diseases affected by infective endocarditis in children--> VSD

So the answer to this question is A


Instruction:
Systemic lupus erythromatosus with anti-SSA/SSAb positivity is associated with ________
A. Poor prognosis
B. Increased risk of nephritis and vasculitis
C. Congenital hea block
D. All of the above

Response:
The correct association is congenital hea block. Systemic lupus erythematosus (SLE) with anti-SSA/SSB (Ro/La) is associated with: Good prognosis Less risk of developing nephritis and vasculitis Congenital hea block in neonatal lupus Subacute cutaneous lupus. Ref: Nelson textbbook of pediatrics 21st edition Pgno: 1279

So the answer to this question is C


Instruction:
3rd hea sound is d/t
A. Closure of av valve
B. Closure of aoic valve
C. Mid diastolic flow in the ventricle
D. Atrial contraction

Response:
A soft, low-pitched third sound is heard about one-third of the way through diastole in many normal young individuals. It coincides with the period of rapid ventricular filling and is probably due to vibrations set up by the inrush of blood. Ref: Ganong's Review of medical physiology 25th edition. Page:542 first sound-beginning of systole- Causes- sudden closure of av valves. Rapid increase in tension in the ventricular muscles during isometric contraction acting on filled ventricles. Turbulence created in the blood due to ventricular contraction. second sound-end of clinical systole - closure of semilunar valves. Rush of blood into the ventricles due to opening of AV valves contributes. Third sound- vibration setup in the ventricle during the early period of rapid ventricular filling. fouh sound- causes-atrial contraction. Vibration setup within the ventricle due to inflow of blood produced by atrial systole.

So the answer to this question is C


Instruction:
Not used in the treatment of Juvenile Larynegeal papillomatosis
A. INF α
B. INF β
C. Bevacizumab
D. Cedofovir

Response:
None

So the answer to this question is B


Instruction:
Maximum refractive index -
A. Cornea
B. Air
C. Lens
D. Vitreous

Response:
Ans. is 'c' i.e., Lens o Lens has maximum refractive index among the refractive structures of eye. The refractive indices of the successive layers of lens increase from the periphery towards the nucleus. Thereforey Anterior lens cortexy Posterior lens cortex- Refractive index is 1.386.- Refractive index is 1.386. Refractive indexMediumAirCorneaAqueous humourLensVitreous humorRefractive index1-0001 3761-3361-386 - 1-4061-336

So the answer to this question is C


Instruction:
All are true about electrocochleography except
A. the electrode must be kept close to source of amplitude
B. actionpotentional is produced by inner hair cells and positive waves
C. cochlearmicrophonic is produced from the outer hair cells of the cochlea
D. mostly used in monitoring the meniers disease

Response:
Electrodes can be kept over the promontory,EAC or outside,the signals are better as much it is kept close to source. Different waves are cochlear microphonic:produced from outer hair cells action potential is produced by all the nerve fibers Used in diagnosis and monitoring the meiners disease and endolymphatic hydrops

So the answer to this question is B


Instruction:
Patients with axonal neuropathy, unexplained abdominal pain along with history of psychiatric illness may be suffering from:
A. Porphyria
B. PNH
C. Arsenic toxicity
D. Hypothyroidism

Response:
In patients with an axonal GBS, unexplained abdominal pain, psychiatric illness should be screened for porphyria. MUST KNOW: In GBS in CSF study if cells are present should suspect HIV infection, Lyme disease, sarcoidosis, or lymphomatous or leukemic infiltration of nerve roots. PNH patients may present with abdominal pain but peripheral neuropathy and psychiatric illness are not seen. Ref: Harrison, Edition-18, Page-3450

So the answer to this question is A


Instruction:
Artery usually torn in temporal bone fracture is:
A. Middle meningeal artery
B. Posterior auricular artery
C. Transverse facial artery
D. Deep temporal artery

Response:
Ans. (A). Middle meningeal arteryType of haemorrhageCommonest sourceExtradural haemorrhageMiddle meningeal arterySub dural haemorrhageBridging veinsSub arachnoid haemorrhageAneurysm - Circle of willisIntracerebral haemorrhageLenticulo-striate artery

So the answer to this question is A


Instruction:
What is the treatment for Benign Positional vertigo -
A. Vestibular exercises
B. Vestibular sedatives
C. Anthistamines
D. Diuretics

Response:
None

So the answer to this question is A


Instruction:
The pupil of a newborn is:
A. Dilated
B. Mid-dilated
C. Constricted
D. Normal

Response:
c. Constricted(Ref: Nelson's 20/e p 3016)Pupils of a newborn are small & difficult to dilate, due to immature iris dilator muscle.Lens of a newborn infant is more spherical than that of an adult.Fundus of a newborn's eye is less pigmented than that of an adult.

So the answer to this question is C


Instruction:
A young child presented with history of passage of dark colored with urine with reduced urine output. He has a past history of abdominal pain, fever, and bloody diarrhea for 4 days which resolved on its own. There is absence of peripheral edema or rashes. Investigations show anemia, thrombocytopenia, and elevated blood urea nitrogen and serum creatinine. Which of the following findings is most expected finding in this patient?
A. Elevated haptoglobin level
B. Elevated serum indirect bilirubin
C. Elevated thrombin and prothrombin time
D. Low fibrinogen and elevated D-dimer level

Response:
- Child given is presenting with classical history of hemolytic uremic syndrome In HUS, there is initial history of diarrhea caused d/t E-coli which causes damage to endothelial cells resulting in thrombotic microangiopathy affecting kidney. Typical Causative agent: Escherichia coli strain O157:H7 infection; Endothelial damage by Shiga-like toxin Characterized by triad of Renal failure, Anemia, Thrombocytopenia Peripheral findings - Presence of Schistocytes. As it causes hemolytic anemia, | in haptoglobin level & | in serum indirect bilirubin is seen Low fibrinogen and elevated D-dimer level is usually seen in DIC

So the answer to this question is B


Instruction:
A 6-year-old boy has been complaining of a headache, ignoring to see the objects on the sides for four months. On examination, he is not mentally retarded, his grades at school are good, and visual acuity is diminished in both the eyes. Visual charting showed significant field defect.CT scan of the head showed suprasellar mass calcification. Which of the following is the most probable diagnosis
A. Astrocytoma
B. Craniopharyngioma
C. Pituitary adenoma
D. Meningiona

Response:
None

So the answer to this question is B


Instruction:
All of the following drugs acts by blocking calcium channels except
A. Dantrolene
B. Nicardipine
C. Diltiazem
D. Verapamil

Response:
Dantrolene is a directly acting skeletal muscle relaxant. It is used for treating malignant hypehermia. It is available as an injection All others are calcium channel blockers used in HTN REF.Essentials of Pharmacology KD Tripathi 8th ed.

So the answer to this question is A


Instruction:
DOTS chemotherapy is given for -
A. TB
B. Leprosy
C. AIDS
D. Tetanus

Response:
Ans. is 'a' i.e., TB Directly observed treatment sho course (DOTS) In the Revised National Tuberculosis Control Programme (RNTCP), patients are provided sho course chemotherapy as DOTS. o All patients are provided sho-course chemotherapy free of charge. o During the intensive phase of treatment a health worker watches as the patient swallows the drug in his presence. o During continuation phase, the patient is issued medicine for one week in a multiblister combipack of which the first dose is swallowed by the patient in the presence of health worker. o The consumption of medicine in the continuation phase is also checked by return of empty multiblister combipack when the patient comes to collect medicine for the next week. In this programme, alternate day treatment is given. o Under RNTCP, active case finding is no longer pursued. Case finding is passive. Patients presenting themselves with symptoms suspicious of tuberculosis are treated with DOTS therapy. o The colour of boxes (containing the drugs for full course of treatment) is according to the category of regimen : - i) Category I patients ---> Red Category II patients --> Blue iii) Category III patients --> Green

So the answer to this question is A


Instruction:
Negative pressure wound therapy (NPWT) is used in:
A. Bedsore in sacrum after debridement
B. After amputation negative suction
C. Osteomyelitis
D. Unexplored fistulas

Response:
VACCUM ASSISTED CLOSURE/ NEGATIVE PRESSURE WOUND THERAPY (NPWT) NPWT Promotes wound healing by applying a vacuum through a special sealed dressing. Continued vacuum draws out the fluid from wound & increases blood flow to the area. Vaccum may be applied continuosly or intermittently, depending upon the types of wound being treated & clinical objectives. Negative pressure of -125 mm Hg is used Dressing should be changed 2-3 times/week Primary Effects of NPWT on Wound Healing Macrodeformation Drawing the wound edges together leading to contraction Stablization of wound environment Wound protected from outside micro- organisms in a warm & moist envirnoment Reduced edema With removal of soft tissue exudates Microdeformation Leading to cellular proliferation on the wound surface Contraindications for NPWT Use Malignancy in the wound Untreated osteomyelitis Non-enteric & unexplored fistula Necrotic tissue with eschar

So the answer to this question is A


Instruction:
Spur cell is seen in -
A. Uremia
B. Hepatocellular carcinoma
C. Gastric carcinoma
D. None

Response:
Ans. is 'None' Spur cells-They are irregularly distoed red cells containing several irregularly distributed thornlike projections. Cells with this morphologic abnormality are also called acanthocytes.They are seen in Splenectomised patients and patients with liver disease.

So the answer to this question is D


Instruction:
In cell membrane, following are true except:
A. Lipids are regularly arranged
B. Lipids are symmetrical
C. Protein displaced laterally
D. None

Response:
B i.e. Lipids are symmetricalPropeies of Cell MembraneMembranes are asymmetricalQ sheet like enclosed structure with distinct out and inner surfaces. This asymmetry is attributed to irregular distribution of protein with in the cell membranes external location of carbohydrate attached to membrane protein. (inside - outside asymmetry) specific enzymes are located exclusively on the outside or inside of membranes, (inside - outside asymmetry) gap junction synapses and tight junctions occupy only smaller regions of membrane and generate local (regional) asymmetry there is inside - outside (transverse) asymmetry of the phospholipidsThe choline- containing phospholipids (phosphotidylcholine or lecithin & sphingomyelin) are located mainly in the outer molecular layer; the aminophospholipids (phosphotidyl serine & phosphotidylethanolamine) are preferentially located in inner leaflet. There must be limited transverse mobility (flip- flop) of the membrane phospholipid to maintain this transverse asymmetry. Phospholipids exhibit an extraordinarily slow rate of flip flop. When ceain membrane proteins such as erythrocyte protein glycoplwrin are inseed aificially into synthetic bilayers, the frequency of phospholipid fillip -flop increases as much as 100 folds.Membranes are composed of - lipids, proteins and carbohydrates and membranes are dyanic structure- Major lipids in mammalian membranes are phospholipids (phosphoglycerides > sphingomyelin), glycolipids & cholesterol.Membrane lipids are amphipathetic i.e. contain both hydrophobic & hydrophilic regionsQ.- Membrane lipids are bilayer- Proteins are associated with lipid bilayer (+- covalent linkage) and may be integral or peripheral in location. Ion channels are transmembrane proteins that allow selective entry of various ions; ionophores are molecules that act as membrane shuttle for various ions and aquaporins are proteins that form water channels in ceain molecules.Oleic acid is most abundant unsaturated fatty acid in animal membrane lipids. Sphingolipids are found in membranes specifically in tissues of nervous system. Degree of unsaturation determines fluidity of membrane and cholesterol helps to regulate it.

So the answer to this question is B


Instruction:
What should be the target INR in a patient on warfarin therapy?
A. 1.5
B. 2.5
C. 3.5
D. 4.5

Response:
For most indications, warfarin is administered in doses that produce a target INR of 2.0- 3.0. An exception is patients with mechanical hea valves, where a target INR of 2.5-3.5 is recommended. Studies in atrial fibrillation demonstrate an increased risk of cardio embolic stroke when the INR falls to 4. Warfarin interferes with the synthesis of the vitamin K-dependent clotting proteins, which include prothrombin (factor II) and factors VII, IX, and X. Like all anticoagulants, the major side effect of warfarin is bleeding. A rare complication is skin necrosis. Warfarin crosses the placenta and can cause fetal abnormalities. Consequently, warfarin should not be used during pregnancy. Dabigatran etexilate, an oral thrombin inhibitor, and rivaroxaban, an oral factor Xa inhibitor are new oral anticoagulants.

So the answer to this question is B


Instruction:
Which among the following doesn't cause an elevated serum alkaline phosphatase?
A. Paget's disease
B. Multiple myeloma
C. Ostiomalacia
D. Hypehyroidsm

Response:
Serum ALP is normal in multiple myeloma. It's an impoant point. The most common cause of hypercalcemia in patients with hypercalcemia, decreased GFR, and anemia is multiple myeloma. Alkaline phosphatase is generally normal because there is only a limited osteoblastic response to myelomatous infiltrate in the marrow Calcium is elevated. Phosphate is elevated Alkaline phosphatase is normal PTH is suppressed PTHrP is normal or low Serum protein immunoelectrophoresis is abnormal

So the answer to this question is B


Instruction:
Calymmatobacterium granulomatosis causes ?
A. Lymphogranuloma venerum
B. Granuloma venerum
C. Syphilis
D. None

Response:
Ans. is 'b' i.e., Granuloma venerum Granuloma inguinale or Granuloma venerum or Donovanosis Caused by Calymmatobecterium granulomatis, a gram negative intracellular bacteria. IP is 1- 4 weeks. Begins as one or more subcutaneous nodules that erode through skin to produce ulcer. Ulcer has following characterstics. Painless Bleeding withred granulation tissue Indurated Subcutaneous granulomas of inguinal region in Donovenosis look like enlarged lymph nodes but these are not enlarged lymph nodes. Therefore, these are known as Pseudobubos. Sites of the lesions are genitalia (90%), inguinal (10%), and anal regions. Complications are pseudoelephentiasis, phimosis, paraphymosis. Diagnosis Preferred method is demonstration of typical intracellular Donavan Bodies within large mononuclear cells visualised in smear prepared from lesion or biopsy specimen. It shows safety pin appearance. Treatment Azithromycin is the DOC. Alternatives are doxycycline (2nd choice) and chloremphenicol. Streptomycin, once used, is not used now. Lymphogranuloma venerum (LGV) is caused by - Chlamydia trachomatic Granuloma venerum (Donovanosis) is caused by --> Calymmatobacterium granulomatosis

So the answer to this question is B


Instruction:
Which one of the following insecticides is commonly used for ultra low volume fogging –
A. Abate
B. DDT
C. Paris green
D. Malathion

Response:
None

So the answer to this question is D


Instruction:
Which of following is content of anterior part of jugular foramen?
A. Vagus nerve
B. Superior petrosal sinus
C. Inferior petrosal sinus
D. Internal jugular vein

Response:
Ans. c (Inferior petrosal sinus) (Ref. BDC Vol. III 4th/pg. 16-19)JUGULAR FORAMEN# Behind the carotid canal is the jugular foramen, a large aperture, formed in front by the petrous portion of the temporal, and behind by the occipital; it is generally larger on the right than on the left side, and subdivided into 3 compartments.# CONTENTS:1Anterior compartment transmits# Inferior petrosal sinus.21 ntermediate transmits# Glossopharyngeal, Vagus, and Accessory nerves.3Posterior transmits# Transverse sinus and# Some meningeal branches from the occipital and ascending pharyngeal arteries. Also Know:Cranial nerve and vessel pathwaysCribriform plate(CN 1) Middle cranial fossa(CN II--VI)-- through sphenoid bone1.Optic canal (CN II, ophthalmic artery, central retinal vein).2.Superior orbital fissure (CN III, IV, VI, VI, ophthalmic vein).3.Foramen Rotundum (CN V2).4.Foramen Ovale (CN V3).5.Foramen spinosum (middle meningeal artery).Posterior cranial fossa(CN VII-XII)--through temporal or occipital bone1.Internal auditory meatus (CN VII, VIII)2.Jugular foramen (CN IX, X, XI, jugular vein)3.Hypoglossal canal (CN XII)4.Foramen magnum (spinal roots of CN XI, brain stem, vertebral arteries)

So the answer to this question is C


Instruction:
The virus which causes aplastic anemia in chronic hemolytic diseases is
A. Adenovirus
B. Hepatitis virus
C. EB virus
D. Parvovirus

Response:
None

So the answer to this question is D


Instruction:
False regarding NK cells:
A. NK cell activity is augmented by interferons
B. Initial response in viral infection
C. Active against tumour cells
D. MHC restricted

Response:
ans-DRef: Ananthanarayan, Paniker CJ. Textbook of Microbiology. 8th Edition. London: John Wiley & Sons: 2009. Pg. 131Explianation:Natural killer cellsNatural killer cells possess spontaneous cytotoxicity towards various target cells such as malignant and virus infected cells.Their cytotoxicity is NOT antibody dependent or MHC restricted.NK cell activity is 'natural" or 'nonimmune' as it does not require sensitisation by prior antigenic contact.NK cells form part of the innate immune setup.They belong to a different lineage from T and B cells.They have CD16 and CD56 on their surface.NK cell activity is augmented by interferons.

So the answer to this question is D


Instruction:
Limiting amino acid in legumes ?
A. Lysine
B. Methionine
C. Alanine
D. Tryptophan

Response:
Ans. is b, i.e., MethionineFood itemlimiting amino acidLegumesMethionine (also leucine & threonine)CerealsThreonine (also lysine)PulsesMethionine (also cysteine)MaizeTryptophan (also lysine)

So the answer to this question is B


Instruction:
Hypehermia-
A. Temperature >41.5
B. > 40 with autonomic dysfunctuion
C. No change in hypothalamic thermostat
D. One which normalises with anti pyretic

Response:
Hypehermia. Hypehermia (HT) is the use of elevated temperature for the treatment of cancer, in this case, typically using temperatures in the range of 41deg C to 45deg C for 1 hour or more Ref Davidson 23rd edition pg 1145b

So the answer to this question is A


Instruction:
Interstitial keratitis is caused by all except -
A. TB
B. HSV
C. EBV
D. Peussis

Response:
INTERSTITIAL KERATITISInterstitial keratitis denotes an inflammation of thecorneal stroma without primary involvement of theepithelium or endothelium.Causes. Its common causes are:  Congenital syphilis  Tuberculosis  Cogan's syndrome  Acquired syphilis  Trypanosomiasis  Malaria  Leprosy  Sarcoidosis REF:Comprehensive ophthalmology,4th edition,pg no.120

So the answer to this question is D


Instruction:
On stomach washing which poison turns to black on exposure to silver nitrate:
A. Tik 20
B. Celphos
C. Malathion
D. Arsenic

Response:
B i.e. Celphos

So the answer to this question is B


Instruction:
A female has episodic, recurrent headache in left hemicranium with nausea and parasthesia on right upper and lower limbs is most probably suffering from :
A. Migraine
B. Glossopharyngeal neuralgia
C. Herpes zoster infection of trigeminal Nerve
D. Brain tumour

Response:
Answer is A (Migraine) Migraine is a syndrome of episodic recurrent throbbing headache, more often unilateral, which is associated with nausea vomiting, photophobia or phonophobia. Parastheasis with tingling and numbness and focal neurological deficits are often associated. Aura may or may not be present.

So the answer to this question is A


Instruction:
Traveller&;s diarrhoea is caused by
A. Shigella
B. E. Coli
C. E. histolytica
D. Giardiasis

Response:
Enterotoxigenic E. Coli causes traveller&;s diarrhoea. Persons travelling from developed countries visiting endemic areas often suffer from ETEC diarrhoea. Ref: Ananthanarayan and Paniker&;s Textbook of Microbiology, 9th edition; pg no: 279

So the answer to this question is B


Instruction:
Which of the following is defective in renal glucosuria?
A. GLUT-1
B. GLUT-2
C. SGLT-1
D. SGLT-2

Response:
SGLT-2 is defective in Renal glucosuria.

So the answer to this question is D


Instruction:
Heme is which porphyrin?
A. Type I
B. Type II
C. Type III
D. Type IV

Response:
The protoporphyrinogen-III is oxidized by the enzyme protoporphyrinogen oxidase to protoporphyrin-III in the mitochondria. The xidation requires oxygen.The methylene bridges (-CH2) are oxidized to methenyl bridges ( -CH=) and colored porphyrins are formed.Protoporphyrins -9 is thus formed. The last step in the formation of heme is the attachment of ferrous iron to the protoporphyrin. The enzyme is heme synthase or ferrochelatase, which is also located in the mitochondria. REFERENCE : DM VASUDEVAN TEXTBOOK SEVENTH EDITION ; PAGE NO : 273.

So the answer to this question is C


Instruction:
Forbe’s disease is caused due to absence of
A. Alpha Galactosidase
B. Ceramidase
C. Debranching enzyme
D. None of the above

Response:
None

So the answer to this question is C


Instruction:
Pulsus parvus et tardus is seen in ?
A. Severe AS
B. Severe MS
C. Severe AR
D. Severe MR

Response:
Answer- A. Severe ASPulsus tardus or pulsus parvus-et-tardus is a slow rising pulse with delayed systolic peak. It is seen in severe AS.

So the answer to this question is A


Instruction:
The main muscle of opposition is?
A. Abductor pollicis brevis
B. Flexor pollicis brevis
C. Opponens pollicis
D. Adductor pollicis

Response:
Opponens pollicis - Origin-flexor retinaculum crest of trapezium Inseion- lateral border and adjoining lateral half of planar surface of the 1 St metacarpal bone Actions- Opposition of thumb & deepens the hollow of palm Abductor pollicis Brevis(APB)-abducts the thumb Flexor pollicis brevis(FPB)-flexes the thumb Adductor pollicis adducts the thumb APB, FPB and opponens pollicis are the 3 thenar muscles. Reference: Textbook of anatomy upper limb and thorax, Vishram Singh,2nd edition, page no.144 Figure 11.2,page no:145- Textbook of anatomy- upper limb & thorax - vishram singh

So the answer to this question is C


Instruction:
Which passive movement causes pain in deep posterior compament syndrome ?
A. Foot abduction
B. Dorsi flexion of foot
C. Plantar flexion of foot
D. Foot adduction

Response:
Passive stretching of the muscles produce pain in compament syndrome and hence, dorsiflexion of foot (a) causes pain. Posterior compament of leg is concerned with plantar flexion of foot, and is supplied by the tibial nerve and posterior tibial vessels. Compament syndrome is caused by increased pressure in an enclosed space that leads to compromise of circulation and function of tissues in that space. a. There is elevation of interstitial pressure in closed fascial compament that results in microvascular compromise. b. As duration & magnitude of interstitial pressure increase, myoneural function is impaired & necrosis of soft tissues eventually develops. Pain with passive stretching is the most sensitive early sign of compament syndrome. a. Patient will usually hold injured pa in a position of plantar-flexion to maximally relax the fascia/muscles and reduce pain. b. For e.g., Clawing of the toes is a common sequela of post-traumatic compament syndrome within the deep posterior compament following a distal third tibia fracture. Fasciotomy is one of the definitive treatments of the syndrome. Ref - CSDT 12th e p1123

So the answer to this question is B


Instruction:
False positive nontreponemal serological test for syphilis are seen in -a) HIV infectionb) Collagen disordersc) Paediatric age groupd) Tuberculosise) Chronic liver disease
A. ac
B. a
C. ab
D. bc

Response:
None

So the answer to this question is C


Instruction:
Dose of anti D in ectopic pregnancy -
A. 50 mg
B. 100 mg
C. 150 mg
D. 300 mg

Response:
Ans. is 'a' i.e., 50 mg o In Rh - negative women not yet sensitized to Rh antigen, anti - D gamma globulin - 50 microgram (if gestation < 12 weeks) or 300 microgram (if> 12 weeks) i.m. is administered soon following operation to prevent isoimmunization.Anti - Do It is an IgG antibody that is given by i.m. route.o It binds to fetal RBCs so that they cannot stimulate the maternal immune system.o It should be given at 28 weeks to all unsensitized Rh - negative mother and postpartum within 72 hours if the baby's blood group is Rh positive.o It should also be given after abortion, MTP, and ectopic pregnancyo Indications and Recommended Dose of Anti - D:IndicationsRecommended Dose (pg)First trimester abortion/MTP50First trimester ectopic pregnancy50Second trimester abortion/MTP300Second trimester amniocentesis300Prophylaxis at 28 weeks gestation300After delivery300

So the answer to this question is A


Instruction:
People living in developing countries -
A. 90%
B. 80%
C. 70%
D. 60%

Response:
About three fourths of world's population lives in the developing countries.
95% of growth of population is occurring in developing countries.
China is most populous country in the world.
India is 2nd most populous country in the world (17.5% of world's population).

So the answer to this question is B


Instruction:
Chadwick sign is seen in :
A. Cervix
B. Vagina
C. Uterus
D. Ovary

Response:
During pregnancy, due to increased vascularity and hyperemia there is bluish discoloration of vagina called as Chadwick sign. Ref: Datta Obs 9e pg 42.

So the answer to this question is B


Instruction:
In twin pregnancy, Vaginal delivery is contraindicated in
A. Monochorionic monoamniotic
B. First twin veex, 2nd breech
C. Second twin transverse
D. First twin Mentoanterior

Response:
Monoamniotic twins are at a great risk of developing cord accidents like entanglement which can lead to sudden fetal death. Therefore all monoamniotic twins have to be delivered by a Cesarean sections between 32-34 weeks , after ensuring lung maturation

So the answer to this question is A


Instruction:
As a general rule in borderline crowding cases of a broad facial type:
A. An expansion treatment should be carried out
B. Extraction therapy, should be considered
C. No treatment required
D. Only surgical treatment required

Response:
Key comment:
In broad face type(brachycephalic) patient with mild crowding, if expansion is possible, it is the first line of treatment of choice rather than extraction.

So the answer to this question is A


Instruction:
All of the following statements about Pulse deficit in Atrial Fibrillation are true , except:
A. Usually more than 10/minute
B. Increases with faster ventricular rates
C. May be absent in digitalis intoxication
D. Radial pulse rate may be more than ventricular pulse rate

Response:
Answer is D (Radial pulse rate may be more than ventricular pulse rate) The radial pulse rate is always lower than the ventricular pulse rate. Pulse deficit refers to the difference between the radial pulse rate and the hea rate counted by auscultation (Apical Ventricular Rate). Pulse deficit is produced when ventricular contractions are preceded by sho diastoles such that poor ventricular filling results in insufficient stroke volume to transmit the pressure wave out to the radial pulse. The radial pulse rate is always lower than the ventricular pulse rate. Pulse Deficit in Atrial Fibrillation Atrial fibrillation is the most common cause of pulse deficit (Pulse deficit has traditionally been believed to be a classical bedside sign for diagnosis of atrial fibrillation) Pulse deficit in Atrial Fibrillation is often more than 10 per minute. Pulse deficit in atrial fibrillation is greater when the ventricular rate is high Pulse deficit in atrial fibrillation may be absent in patients with slow ventricular rate (<50) If a digitalized patient with a prior diagnosis of chronic atrial fibrillation presents with a perfectly regular pulse, one should suspect digitalis intoxication with a regular nodal rhythm and atrioventricular dissociation. (Note that in this form of 'regularized' atrial fibrillation, the apical- radial pulse deficit also disappears.)

So the answer to this question is D


Instruction:
A pilot in Sukhoi aircraft is experiencing negative G. Which of the following physiological events will manifest in such situation?
A. The hydrostatic pressure in veins of lower limb increases
B. The cardiac output decreases
C. Black out occurs
D. The cerebral arterial pressure rises

Response:
In negative gravity, the blood will no longer be held onto lower limbs. So lower limb venous pressure decrease and the venous return increases. This will cause the cardiac output to increase. Since no gravity, blood rushes to the head, and cause increased cerebral arterial pressure and red outs (mental confusion).

So the answer to this question is D


Instruction:
Most common type of tracheo-oesophageal fistula is
A. Type A
B. Type B
C. Type C
D. Type D

Response:
Most common type of tracheo- oesophageal is type C, Atresia with distal Tracheo - oesophageal constituting 85%. Reference: SRB's Manual of Surgery, 6th Edition, page no= 794.

So the answer to this question is C


Instruction:
Nucleus pulposus is derived from -
A. Sclerotome
B. Myotome
C. Notochord
D. None

Response:
Ans. is 'c' i.e., Notochord Development of vertebral column o The human nervous system develops from neuroectoderm. o During development, behind the neuroectoderm lies the mesoderm (paraxial mesoderm) that encloses the notochord (a derivative of endoderm). o This paraxial mesoderm give rise to somites, o Somites further differentiated into i) Dermatomyotome:- Give rise to skeletal muscles and dermis. ii) Sclerotomes:- Give rise to the vertebral column. o Sclerotomes which surround notochord starts projecting posteriorly (dorsally) to surround neural tube and forms. Ventral sclerotomes :- Give rise to the vertebral body and annulus Jibrosus. Lateral sclerotomes :-Give rise to vertebral arch (pedicle and lamina). Dorsal sclerotomes :-Give rise to the spinous process. o The notochord forms the nucleus pulposus.

So the answer to this question is C


Instruction:
Oxidation of a fatty acid with an odd number of carbon atoms yields:
A. Acetyl-CoA plus a molecule of Propionyl-CoA
B. Two molecules of Acetyl CoA
C. Two molecules of Propionyl CoA
D. Acetyl CoA only

Response:
Fatty acids with an odd number of carbon atoms are oxidized by  the  pathway  of  β xidation  described  above  producing acetyl  CoA  until  a  three-carbon  (propionyl-CoA)  residue remains. This compound is converted to succinyl-CoA, a constituent of the citric acid cycle. Hence, the propionyl residue from an odd-chain fatty acid is the only part of a fatty acid that is glucogenic.
HARPERS ILLUSTRATED BIOCHEMISTRY30th ed, Page No:225

So the answer to this question is A


Instruction:
Which of the following antibiotics acts by inhibiting cell wall synthesis :
A. Cefepime
B. Aminoglycosides
C. Erythromycin
D. Doxycycline

Response:
Cefepime is a beta lactam antibiotic, which acts by inhibiting cell wall synthesis.

So the answer to this question is A


Instruction:
Two litres of normal saline in 4 hours will stimulate secretion of -
A. Atrial natriuretic peptide
B. IL - 2
C. TNF - alpha
D. Prostaglandins

Response:
None

So the answer to this question is A


Instruction:
Which of the following statements concerning alveolar macrophages is true?
A. They secrete a1-antitrypsin.
B. They secrete elastase.
C. They originate from blood neutrophils
D. They may play a role in causing hyaline membrane disease

Response:
Alveolar macrophages secrete elastase. Normally, a1-antitrypsin, a serum protein, interacts with elastase, thereby protecting the lung against damage that may lead to emphysema.

So the answer to this question is B


Instruction:
Anti cancer drug causing nephrotoxicity
A. Cyclophosphamide
B. Busulfan
C. Cisplatin
D. Procarbazine

Response:
None

So the answer to this question is C


Instruction:
All of the following are indicators of adequacy of preoperative resuscitation except -
A. C-reactive protein level
B. Consciousness level
C. Urine output
D. Hematocrit level

Response:
Ans. is 'a' i.e., C-reactive protein level

So the answer to this question is A


Instruction:
Enzyme replacement therapy is available for the treatment of the following disorder-
A. Gaucher' disease
B. Niemann-Pick disease
C. Hunter syndrome
D. Phenylketonuria

Response:
Ans. is 'a' i.e. Gaucher's diseaseRef: Harrison 17th/Ep 2455 & 16th/Ep 2319 (15th/e p2280)The t/t of choice for Gaucher's disease is enzyme replacement therapy. A recombinantly produced mannose terminated enzyme called Cerezyme is used in the t/t of Gaucher's diseaseAbout the t/t of other options.Treatment of Niemann Pick disease -There is no specific treatment of Niemann pick disease.The efficacy of hepatic or bone marrow transplantation has not been proven. Clinical trials using enzyme therapy are anticipated to begin soon.Treatment of Phenylketonuria -T/T of phenylketonuria is to limit dietary intake of phenylalanine to amounts that permit normal growth and development.We could not get the t/t for - Hunter syndromeImp, points about Gaucher's diseaseIt's an autosomal recessive disorder *It results from the defective activity of b-glucosidase*b-glucosidase cleaves glucosylceramide. the parent compound of many glycosphingolipids and glucolipid.Diagnosis is established by demonstrating decreased acid b-glucosidase activity (0 to 20% of normal) in nucleated cells.

So the answer to this question is A


Instruction:
Incubation period of LGV:
A. 3-12 days
B. 15-45 days
C. 1 month
D. 6 months

Response:
Ans. (a) 3-12 days Ref. Ananthanarayan 9/2/e 421 Incubation period of Lymphogranuloma venereum range from 3 days to 5 weeks. Incubation period of common Sexually transmitted disease Chancroid (Hemophilus ducreyi) 1-14 days Gonorrhea 2-30 days Syphilis 10-90 days Lymphogranuloma venereum (Chlamydia) 3-35 days HIV 14 days to years Genital herpes 2-14 days Scabies 3-60 days Granuloma inguinale 10-40 days

So the answer to this question is A


Instruction:
Rickettsial pox is transmitted by a house mice mite. The symtoms similar to chicken pox is caused by which of the following?
A. Rickettsia ricketsiae
B. Rickettsia akari
C. R. typhi
D. Rickettsia conori

Response:
Rickettsial pox, caused by Rickettsia akari, is transmitted to humans by the house mouse mite Liponyssoides sanguineus. It is also known as vesicular rickettsiosis, a disease similar to chicken pox. The disorder begins with the bite of an infected mite, which results in a black eschar. The classic triad of rickettsialpox consists of fever, eschar, and rash. It is endemic in US. It is self-limited over 7-10 days. Rickettsia rickettsia is the cause of the tick-borne Rocky Mountain spotted fever. R. typhi is the flea-borne cause of endemic typhus. Rickettsia conori causes Mediterranean spotted fever, also known as African tick typhus.

So the answer to this question is B


Instruction:
True about veebral aery :
A. Enter skull through condylar canal
B. Branch of Internal carotid aery
C. Branch of subclan aery
D. All

Response:
C i.e. Branch of subclan aery

So the answer to this question is C


Instruction:
Which of the following drug is a hallucinogen: September 2011
A. Quinidine
B. Disulfiram
C. Cocaine
D. Steroids

Response:
Ans. C: Cocaine The complications of chronic cocaine use include acute anxiety reaction, uncontrolled compulsive behaviour, psychotic episodes (with persecutory delusions, and tactile and other hallucinations), delirium and delusional disorder. Hallucination: It is a disorder of perception (false perception without external stimulus) It is viewed as sensory perceptions and occurs in inner subjective space Not dependent on the will of the observer Formed visual hallucinations are seen in: Temporal lobe lesion

So the answer to this question is C


Instruction:
Crepitus will be seen in the tissues surrounding an
infection by:
A. Staphylococcus
B. Streptococcus
C. Clostridium tetani
D. C. perfringens

Response:
CLOSTRIDIAL SKIN AND SOFT-TISSUE INFECTIONS
Histotoxic clostridial species such as C. perfringens, C. histolyticum, C. septicum, C. novyi, and C. sordellii cause aggressive necrotizing infections of the skin and soft tissues. These infections are attributable in part to the elaboration of bacterial proteases, phospholipases, and cytotoxins. Necrotizing clostridial soft-tissue infections are rapidly progressive and are characterized by marked tissue destruction, gas in the tissues, and shock; they frequently end in death. Severe pain, crepitus, brawny induration with rapid progression to skin sloughing, violaceous bullae, and marked tachycardia are characteristics found in the majority of patients.

So the answer to this question is D


Instruction:
A child has phocomelia. This is due to drug taken by mother -
A. Tetracycline
B. Thalidomide
C. Warfarin
D. Chloroquine

Response:
Ans. is 'b' i.e., Thalidomide Thalidomide is the worst teratogen known in the history of medicine.It was widely used as sedative and hypnotic.It was also believed to reduce vomiting in pregnancy.It was a routine hypnotics in hospitals, was even recommended to help children adapt themselves to a convalescent home atmosphere. The indiscrete use of these drugs in pregnant women resulted in an outbreak of Phocomelia. Phocomelia means "seal extremities", it is a congenital deformity in which the long bones of the limbs are defective and substantially normal or rudimentary hands and feet arise on or nearly on the trunk like the flippers of seal. Thalidomide was subsequently banned.Now, decades later thalidomide has received approval from the food and drug administration in certain conditions.According to Indian Journal of pharmacology Clinical uses of thalidomideAIDS related aphthous ulcers(r)AIDS related wasting syndrome^Multiple myeloma and other solid tumoursQPrevention of graft versus host disease after transplantationQRheumatoid arthritisQAnkylosing spondylitisQCrohn's disease and Bechet's syndromErythema nodosum leprosumQ

So the answer to this question is B


Instruction:
Which of the following is the most impoant pa of brain involved in Narcolepsy
A. Neocoex
B. Hypothalamus
C. Hippocampus
D. Pons

Response:
Answer is B (Hypothalamus): Narcolepsy in humans is caused by deficiency of hypocretin (Orexin) a neurotransmitter produced in the Hypothalamus. Recently several convergent lines of evidence suggest that the hypothalamic neuropeptide hypocretin (orexin) is involved in the pathogenesis of Narcolepsy'- Harrison's 181h/220 Narcolepsy Narcolepsy is a common sleep disorder charachterized by excessive daytime sleepiness, cataplexy (episodes of muscle weakness triggered by emotions), hypnagogic hallucinations and sleep paralysis. Narcolepsy (classic Tetrad) Excessive day Time somnolence Sudden weakness or loss of muscle tone without loss of consciousness often elicited by emotion (cataptexy) Hallucination at sleep onset (Hypnagogic Hallucination) or upon awakening (Hypnopompic Hallucination) Muscle Paralysis upon awakening Pathology /Pathogenesis Most impoant cause of narcolepsy is believed to be deficiency of neuropeptide Hypocretin (orexin) produced in Hypothalamus Autoimmune All narcoleptics with cataplexy are positive for HLA DQBI (0602)

So the answer to this question is B


Instruction:
A decrease in which of the following is the most likely cause of peripheral edema in a patient with long-term alcoholism and liver disease?
A. Capillary hydrostatic pressure
B. Interstitial colloid osmotic pressure
C. Interstitial hydrostatic pressure
D. Plasma colloid osmotic pressure

Response:
- Osmotic pressure of a solution is an indicator of the force of water movement resulting from its solute concentration. The higher the solute concentration of a solution, the greater its osmotic pressure. The plasma colloid osmotic pressure is often low in alcoholics with chronic liver disease (cirrhosis). The diseased liver cannot produce adequate amounts of albumin, which leads to a decrease in the concentration of albumin in the plasma (i.e., hypoalbuminemia).
- Because approximately 75% of the plasma colloid osmotic pressure can be attributed to the presence of albumin in the plasma, the decrease in plasma albumin concentration that occurs in the latter stages of cirrhosis often leads to peripheral edema. Cirrhosis also causes excess fluid to accumulate in the peritoneal cavity as ascites.
- In the case of ascites, the edema results not only from hypoalbuminemia, but also from portal vein obstruction (which increases capillary hydrostatic pressure) and the obstruction of lymphatic drainage of the liver. In fact, ascites is observed more often than peripheral edema in liver disease.

So the answer to this question is D


Instruction:
Looking at the serum protein electrophoresis above, which of the following is the likely diagnosis of the patient?
A. Tuberculosis
B. Multiple myeloma
C. Nephrotic syndrome
D. Liver cirrhosis

Response:
In the given graph , there is | albumin,| alpha-2 globulin, |in gamma globulin. Tuberculosis -gamma globulins increase. Multiple myeloma -M-spike due to rise in gamma globulins. Liver cirrhosis- Decrease in function of liver due to which all proteinswill decrease. Nephrotic syndrome Albumin appears in urine, thus albumin decrease in blood. alpha2 globulin is a larger protein which can not cross glomerular membrane. alpha2 globulin increases in serum.

So the answer to this question is C


Instruction:
Which of the following is most Likely to occur after trauma in primary dentition?
A. Intrusion
B. Extrusion
C. Complicated Crown fracture
D. Subluxation

Response:
None

So the answer to this question is D


Instruction:
Compared to plasma, the CSF has a higher concentration of:
A. Ca++
B. Na+
C. Chloride
D. Glucose

Response:
Substance CSF concentration CSF: plasma ratio Na+ K+ Ca++ Chloride Mg++ Bicarbonate Protein Glucose 147 meq/L 2.9 meq/L 2.3 meq/L 113 meq/L 2.2 meq/L 25.1 meq/L 20 mg% 64 mg% 0.98 0.62 0.49 1.14 1.39 1.01 0.003 0.64

So the answer to this question is C


Instruction:
FSH is secreted by
A. Chrompphobes
B. Basophils
C. Acidophils
D. Theca interna Cells

Response:
Gonadotropic cells are endocrine cells in the anterior pituitary that produce the gonadotropins, such as the follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Release of FSH and LH by gonadotropes is regulated by gonadotropin-releasing hormone (GnRH) from the hypothalamus.Gonadotropes appear basophilic in histological preparations.Ref: Ganong&;s review of medical physiology; 24th edition; page no:-333

So the answer to this question is B


Instruction:
In a hypeensive patient with glaucoma which of the following is not used:
A. Dipivefrine
B. Alpha blocker
C. Alpha agonist
D. Laser trabeculoplasty

Response:
Ans. Dipivefrine

So the answer to this question is A


Instruction:
Anti -carcinogens are:
A. Carotenoids
B. Flavenoids
C. Curcumoids
D. Benzene

Response:
A i.e. CarotenoidsProtooncogenes are normal cell genes that paicipate in cellular functions related to growth and proliferationQ. Proteins encoded by protooncogenes may function as growth factor, ligands and receptors, signal transducers, transcription factors and cell cycle regulatorsQ.Protooncogenes on activation become oncogenes that induce cancerQ. The process of activation include gene amplification, point mutation, inseion mutation, retroviral transduction (integration), chromosomal translocation and protein- protein interaction.Onchoproteins encoded by oncogenes have similar functions as their normal counterpas but they are constitutively expressed and endow the cell with self sufficiency in growth. Carotinoids are anticarcinogensQ.

So the answer to this question is A


Instruction:
Hot teeth refers to:
A. Temperature of the tooth increases due to pulpitis.
B. Difficult to anasthesize.
C. Both of the above
D. Periapical abscess increases the temperature of the involved tooth.

Response:
None

So the answer to this question is B


Instruction:
Which of the following drug causes malignant hyperthermia:
A. Mivacurium
B. Pancronium
C. Succinylcholine
D. Atracurium

Response:
Ans: (c) SuccinylcholineRef: Miller's Anaesthesia Th ed. / 866* Malignant hyperthermia is a condition that is usually triggered by exposure to certain drugs used for general anesthesia, specifically the volatile anesthetic agents and the neuromuscular blocking agent succinylcholine.* Succinylcholine is depolarizing / non competitive M.R. with shortest duration of action (3-5 min) due to rapid hydrolysis by pseudo cholinesterase.* It causes dual/biphasic block. It causes hyperkalemia, increased intraocular & intragastric pressure and temperature which leads to malignant Hyperthermia.* Susceptibility to MH is often inherited as an autosomal dominant disorder, for which there are at least 6 genetic loci of interest, most prominently the Ryanodine receptor gene (RYR1).* DOC for malignant hyperthermia: Dantrolene

So the answer to this question is C


Instruction:
Sumatriptan is used in :
A. Mania
B. Depression
C. Schizophrenia
D. Migraine

Response:
None

So the answer to this question is D


Instruction:
Which of the following is the auto antibody associated with Rheumatoid arthritis -
A. Anti DLE
B. Anti CCP
C. Antids DNA
D. Antihistone

Response:
Anti CCP

So the answer to this question is B


Instruction:
Which of the following enzyme does not catalyse reversible step in glycolysis?
A. PFK
B. Enolase
C. Phosphoglyceromutase
D. Glyceraldehyde-3-phosphate dehydrogenase

Response:
Enzymes of glycolysis - a process which converts 6 carbon glucose to 3 carbon unit pyruvate & lactate - are present in cytoplasm. Whereas, complete oxidation of glucose (to CO2 & H2O) requires mitochondrial enzymes (of TCA cycle).
Out of total 9 enzymes used in glycolysis,
3 enzymes - hexokinase, phosphofructokinase (PFK-1) and pyruvate kinase are used in  irreversible steps.
6 enzymes - phosphohexose isomerase, aldolase,  glyceraldehyde-3-phosphate dehydrogenase, 1, 3-bisphosphoglycerate kinase, phosphoglyceromutase and enolase are used in reversible steps.
2 enzymes used in energy utilizing steps are - hexokinase (using 1 ATP) and phosphofructokinase / PFK-1 (using 1 ATP). This energy consumption is for 1 molecule of glucose.
3 enzymes used in energy producing steps are - glyceraldehyde-3-phosphate dehydrogenase (producing 2 NADH = 5 ATP), 1, 3-bisphosphoglycerate kinase (producing 2 ATP) and pyruvate kinase (producing 2 ATP). This energy production is for 1 molecule of glucose or 2 molecules of glyceraldehyde-3-phosphate.

So the answer to this question is A


Instruction:
Sudden loss of vision in patient with diabetic retinopathy is due to:
A. Cataract
B. Glaucoma
C. Vitreous defects
D. Papilloedema

Response:
Ans. Vitreous defects

So the answer to this question is C


Instruction:
Filigree burns are
A. Lightening bums
B. Thermal bums
C. Chemical bums
D. Radiation bums

Response:
(A) Liahtnina burns FN. Reddv26 - 293: N. Reddv25- 292: Parikh5- 2071# Arborescent or Filigree Burns (Lichtenberg's flowers):> Burns are superficial, thin, irregular and tortuous markings on the skin.> These markings have a general pattern resembling the branches of a tree.> Fern-like pattern of erythema in the skin is usually found over the shoulder or the flanks.> These are seen in lightning stroke.

So the answer to this question is A


Instruction:
Function of Health worker female -
A. Perform 50% of deliveries
B. Trains dais
C. Enlist dais of the subcentre
D. Chlorination of water

Response:
Functions maternal and child health Family planning Medical termination of pregnancy Nutrition Dai training Communicable diseases Vital events Record keeping Treatment of minor ailments Team activities (refer pgno:910 park 23rd edition)

So the answer to this question is B


Instruction:
In patients who present with a penetrating chest injury, injury to the heart is most likely when the following physical sign(s) is/are present:
A. Hypotension
B. Distended neck veins.
C. Decreased heart sound.
D. Decreased venous pressure

Response:
Hypotension, increased venous pressure (distended neck veins), and decreased heart sounds make up the classic Beck's triad associated with cardiac tamponade. If these three findings are present in a person who has a penetrating chest wound, intracardiac injury is almost certain and operative intervention is mandatory.

So the answer to this question is D


Instruction:
A patient is brought to the emergency depament following carbon monoxide poisoning. Hyperbaric oxygen was given, following which patient developed oxygen toxicity. What is the likely mechanism of the toxicity?
A. Direct DNA damage
B. Apoptosis
C. Nuclear fragmentation
D. Mediated by free radicals

Response:
The free radical theory of oxygen toxicity explains the mechanism of oxygen toxicity. According to the theory, various highly reactive and potentially cytotoxic free-radical products of oxygen are generated metabolically in the cell. These sho-lived oxygen metabolites, including superoxide anion, hydroxyl radical, hydrogen peroxide, and singlet oxygen, have been shown to be capable of effects such as inactivation of sulfhydryl enzymes, interaction with and disruption of DNA, and peroxidation of unsaturated membrane lipids with resultant loss of membrane integrity. The cell is also equipped with an array of antioxidant defenses, including the enzymes superoxide dismutase, catalase, glutathione peroxidase, vitamin E, and ascorbate. Under hypoxia, the intracellular generation and influx of free radicals is believed to increase markedly and may overwhelm the detoxifying capacity of the normal complement of antioxidant defenses, with resultant cytotoxicity. The pathology of oxygen toxicity in the lungs is non-specific and consists of atelectasis, edema, alveolar hemorrhage, inflammation, fibrin deposition, and thickening and hyalinization of alveolar membranes. Ref: Yao & Ausio's Anesthesiology: Problem-Oriented Patient Management By Fun-Sun F. Yao, Vinod Malhotra, M.D., 2012, Page 67 ; Pulmonary physiology by Michael G. Levitzkypage, 2007, Page 245

So the answer to this question is D


Instruction:
All the following assess the water-quality-criteria for water pollution are all EXCEPT:
A. Solid particles
B. Dissolved oxygen
C. Dissolved chloride
D. Dissolved nitrogen

Response:
(Dissolved nitrogen): Ref: (629-30-Park 20th)CHEMICAL CRITERIA FOR WATER - QUALITY(a) Nitrites - should be zero in potable waters, their presence indicates pollution of RECENT origins.(b) Nitrates - There presence indicates one OLD contamination, Nitrates in water should not exceed 1 mg/L(c) DISSOLVED OXYGEN - This should not be less than 5 mg/L(d) Free and saline ammonia - This is an excellent indicator of sewage contamination of RECENT origin.Free and saline aminonia should not exceed 0.05 mg/L in drinking water(e) Chloride - The standard prescribed for chloride is 200 mg/L, The maximum level is 600 mg/L(f) Hardness - The total hardness should not exceed 0.1 mg/L(g) Albuminoid ammonia - In potable water should not exceed 0.1 mg/L(h) Oxygen absorbed - The oxygen absorbed at 37degC in 3 hours should not be more than 1 mg/L* Water with concentration of total dissolved solids below 1000 m/glitre is usually acceptable to the consumers (> 1200 mg/L unpalatable)

So the answer to this question is D


Instruction:
True is all except about lung circulation
A. V/P ratio at rest is 0.8
B. In apex ventilation is less than at base
C. Decreased vital capacity in supine position
D. All

Response:
C i.e. Decreased vital capacity in supine position

So the answer to this question is C


Instruction:
Angular vein communicates with
A. Cavernous sinus
B. Superior sagittal sinus
C. Inferior sagittal sinus
D. Straight Sinus

Response:
Angular Vein is the upper most segment of the Facial Vein, formed by the union of the Supratrochlear Vein and Supraorbital Vein. It runs obliquely downward by the side of the nose, is linked with the cavernous sinus by the superior and inferior ophthalmic veins which are devoid of valves. fig:-Angular vein communication with cavernous sinus

So the answer to this question is A


Instruction:
Which of the following drugs does not activate opioid receptors, has been proposed as a drug in the management of opioid addiction and with just a single dose blocks the action of injected heroin for up to 48 hours ?
A. Amphetamine
B. Buspirone
C. Methadone
D. Naltrexone

Response:
None

So the answer to this question is D


Instruction:
Infedelity & jealousy involving spouse is the thought content of which disorder:
A. Capgras syndrome
B. Othello syndrome
C. Hypochondrial paranomia
D. Declerambault's syndrome

Response:
B i.e. Othello syndromeIt is characterized by nonbizzare delusion of atleast one month duration with overall well preserved personality (except in the area of delusion) and absence of significant hallucinations.

So the answer to this question is B


Instruction:
Which of the following is/are X ray feature/s of perthes disease?
A. Increased medial joint space
B. Metaphyseal cysts and rarefaction
C. Lateral extrusion of femur head
D. All the above

Response:
Ans. is 'd' i.e., All the above * Radiological findings in perthe's disease arei) Increased medial joint spaceii) Widening of femoral neckiii) Lateral extrusion (lateral subluxation)iv) Metaphyseal cysts and rarefaction ofmetaphysisv) Horizontal physis with speckled calcification lateral to itvi) Fragmentation of femoral head with increased density (irregular densities in the epiphysis)

So the answer to this question is D


Instruction:
Ulcerative colitis what is seen -
A. Cryptitis
B. Crypt loss
C. Crypt branching
D. Proliferating mucosa

Response:
The Pathology in ulcerative colitis typically involves distortion of crypt architecture, inflammation of Crypts (Cryptitis), frank crypt abscess, and hemorrhage or inflammatory Cell in the lamina propria.

So the answer to this question is A


Instruction:
Best way to measure the working length of 21, with open apex is
A. Radiograph
B. Apex locator
C. Tactile method
D. Paper point

Response:
When RCT is indicated in an immature tooth with wide open apex, a relatively reliable means of determining working length is by gently passing the blunt end of a paper point into the canal after profound anaesthesia has been achieved, the moisture or blood on the portion of the paper point that passes beyond the apex may be an estimation of working length or the junction between the root apex and the bone.

So the answer to this question is D