Instruction:
Characteristic Direct immunofluorescence findings in Herpes gestationis is
A. Epidermal cell-surface deposits of IgG and C3
B. Linear, homogeneous deposits of IgGand C3 at the dermal-epidermal junction
C. Linear homogeneous deposits of C3 at the dermal-epidermal junction
D. Focal granular deposits of IgA at the papillary tips

Response:
DIRECT IMMUNOFLUORESCENCE FINDINGS IN AUTOIMMUNE BLISTERING DISEASE. Disease Pattern and nature of immunoreactants Pemphigus Epidermal cell-surface deposits of IgG and C3 giving fishnet appearance Bullous pemphigoid Linear, homogeneous deposits of IgG (epidermal side on salt-split skin) and C3 at the dermal-epidermal junction. Linear IgA dermatosis Linear homogeneous deposits of IgA at the dermal-epidermal junction Herpes gestationis Linear homogeneous deposits of C3 at the dermal-epidermal junction Epidermolysis bullosa acquisita Linear homogeneous deposits of IgG (dermal side on the salt-split skin) and C3 at the dermal-epidermal junction. Cicatricial pemphigoid Linear homogeneous deposits of IgG and C3 at the dermal-epidermal junction Dermatitis herpetiformis Focal granular deposits of IgA at the papillary tips The bullous eruption of lupus erythematosus Linear homogeneous, or non-homogeneous, deposits of multiple immunoglobulins, C3 and fibrin at the dermal-epidermal junction. (Ref. Harrison's Table 7.9) Ref Harrison 20th edition pg 1256

So the answer to this question is C


Instruction:
In extra amniotic 2nd trimester medicolegal termination of pregnancy, which of the following is used?
A. Ethacrydine lactate
B. Prostaglandin
C. Hypertonic saline
D. Glucose

Response:
Ans. is a, i.e. Ethacrydine lactateRef. Dutta Obs. 7/e, p 173Ethacridine lactate is drug of choice for extra-amniotic instillationAvailable as injection Emcredil (0.1%)Foleys catheter is introduced into extra-amniotic or extraovular space and bulb is inflated by 10-20 ml of Ethacridine solution.Dose is calculated as 10 ml/week of gestation upto maximum of 150 mlCatheter is left for 6 hours.Uterine action begins in 16-18 hours.In 30% cases abortion is incomplete and requires oxytocin drip or supplementation with prostaglandin.

So the answer to this question is A


Instruction:
Corpus striatum includes all except
A. Caudate nucleus
B. Putamen
C. Globus pallidus
D. Amygdala

Response:
The corpus striatum, which is paially divided by the internal capsule into two nuclei: (a) The caudate nucleus; and (b) the lentiform nucleus. These two nuclei are interconnected by a few bands of grey matter below the anterior limb of the internal capsule. The bands give it a striped appearance, hence the name.The lentiform nucleus is divided into a lateral pa, the putamen, and a medial pa, the globus pallidus. The caudate nucleus and putamen (neostriatum) are often grouped as the striatum, whereas the globus pallidus (paleostriatum) is the pallidum.The amygdaloid body forms a pa of the limbic system.Ref: BD Chaurasia; Volume 3; 6th edition; Brain; Page no: 358

So the answer to this question is D


Instruction:
The characteristic of the pulmonary circulation:
A. High resistance, high compliance
B. Low resistance, low compliance
C. High resistance, low compliance
D. Low resistance, high compliance

Response:
Pulmonary aery pressures are reflective of RV pressures .Pulmonary circulation is low pressure, low resistance circulation as compared to systemic circulation. Pulmonary vessels are about 24 times more compliant compared to their systemic counterpas. Pulmonary circulation, in a sho route, has to accommodate large quantities of blood. Due to their high compliance and large amounts of blood accommodated within them, lungs are called 'reservoir of blood'. At any given time, lungs accommodate about 15% of the total blood volume.

So the answer to this question is D


Instruction:
Causes of localized hypopigmented macule or patch are all except
A. Vitiligo
B. Piebaldism
C. Pityr i as is alba
D. Freckle

Response:
Freckles - multiple, ill-defined brown macules, which darken on sun exposure. Individual macules may show variation in skin color. All the other three condition produces localized hypopigmented macules or patch.

So the answer to this question is D


Instruction:
The earliest muscle to be involved in dermatomyositis is
A. Deltoid
B. Gluteal
C. Lumbricals
D. Quadriceps

Response:
Dermatomyositis (DM) is a long-term inflammatory disorder which affects muscles. Its symptoms are generally a skin rash and worsening muscle weakness over time.These may occur suddenly or develop over months.Other symptoms may include weight loss, fever, lung inflammation, or light sensitivity.Complications may include calcium deposits in muscles or skin. People with DM experience progressively worsening muscle weakness in the proximal muscles (for example, the shoulders and thighs).Tasks that use these muscles: standing from sitting, lifting, and climbing stairs, can become increasingly difficult for people with dermatomyositis .(quadriceps are first effected) Ref Robbins 9/e pg 172

So the answer to this question is D


Instruction:
Which of the following is most specific and sensitive screening test in a case of renovascular hypeension
A. HRCT
B. CT guided angiography
C. Captopril induced radionuclide scan
D. MRl

Response:
A number of investigations may be abnormal in patients with renovascular disease. Renal function may be impaired and plasma renin activity may be elevated, sometimes with hypokalaemia due to hyperaldosteronism. Ultrasound may reveal a discrepancy in size between the two kidneys. Unfounately, these simple non-invasive tests are insufficiently sensitive for screening in hypeensive patients and vascular imaging is required to diagnose renovascular disease. Such imaging is usually undeaken only in patients in whom intervention to improve renal perfusion would be contemplated; this is usually limited to young patients and those in whom blood pressure cannot be controlled with antihypeensive agents ('resistant hypeension'), those who have a history of 'flash' pulmonary oedema or accelerated phase ('malignant') hypeension, or those in whom renal function is deteriorating. CT and MRI angiographic techniques have largely replaced Doppler ultrasound or renal isotope scanning (including 'captopril renography') in diagnosing renal aery stenosis. Conventional renal aery cannulation and aeriography is now usually undeaken for therapeutic rather than diagnostic purposes. CT angiography entails large intravenously administered doses of contrast medium which may be nephrotoxic. ref:Harrison&;s principles of internal medicine,ed 18,pg no 3045

So the answer to this question is D


Instruction:
Organic content of Dentin is
A. 15%
B. 35%
C. 65%
D. 5%

Response:
Dentin forms bulk of the tooth tissues and occupies both the crown and the root. It is surrounded by the enamel in the crown and cementum in the root. Physically and chemically it resembles bone. Dentin consists of 65% inorganic and 35% organic material. The organic substance consists mainly of type I collagen fibers embedded in ground substance of mucopolysaccharides. The inorganic component consists of plate shaped hydroxyapatite crystals.

So the answer to this question is B


Instruction:
True about MHC
A. Transplantation reaction
B. Autoimmune disease
C. Immunosuppression
D. Involved in T cell function

Response:
Ref Harrison 16/e p1930; Robbins 7/e p204_ 205 Also involved in autoimmune disease, involved T cell function MHC class II molecules are a class of major histocompatibility complex (MHC) molecules normally found only on professional antigen-presenting cells such as dendritic cells, mononuclear phagocytes, some endothelial cells, thymic epithelial cells, and B cells. Thesecells are impoant in initiating immune responses.

So the answer to this question is A


Instruction:
Neurological complications of meningitis include all of the following, except:
A. Seizures.
B. Increased intra-cranial pressure.
C. Cerebral hamartoma.
D. Subdural effusions.

Response:
Ans. is 'c' i.e. Cerebral hamartoma Cerebral hamartoma is a benign, neoplastic condition and is not associated with meningitis.Complications of MeningitisHydrocephalusCranial nerve involvementSeizuresSubdural effusionsSubdural empyemaCerebral herniation d/t increased ICT.

So the answer to this question is C


Instruction:
The following statements are true of patent ductus arteriosus(PDA) except – a) Spontaneous closure occurs in some term infantsb) Pulmonary hypertension developsc) Bacterial endocarditis is more frequent with small PDAd) Recurrent chest infection and congestive failure may develope) Anatomic existence of PDA is an indication for surgery
A. a
B. b
C. ae
D. ad

Response:
Spontaneous closure of PDA
1) In premature infants

In premature infants, spontaneous closure of PDA may occur because in these infants PDA is due to unresponsiveness to oxygen and there is no structural abnormality.

2) In Full-term infants

Unlike that in premature infants, spontaneous closure of a PDA does not usually occur in full-term infants.
This is because the PDA in term infants results from a structural abnormality of the ductal smooth muscle.

Clinical manifestations of PIA

Patient may be asymptomatic
Symptoms develop early and CHF may develop at 6 to 8th weeks of age.
Common symptoms → Dysnea on exertion, palpitation and frequent chest infections.

Signs

Tachypnea & Tachycardia
Bounding pulse with wide pulse pressure (with elevated systolic and lower diastolic pressure).
Hyperkinetic cardiac impulse
Systolic or continuous thrill.
Accentuated S1
The narrow or paradoxical split of S2 (But it may be masked by continuous murmur since the maximum intensity of continuous murmur occurs at S2).
Continuous (machinery) murmur → Murmur starts after S and reaches the peak at S2. It then diminishes and is audible only during a part of the diastole. Murmur is best heard at second left intercostal space and is also heard below left clavicle.
S3 may occur at apex followed by a delayed diastolic murmur.

So the answer to this question is C


Instruction:
A 52-year-old female, Rukmini presents at the outpatient clinic with pain in the groin. Physical examination reveals a bulge in the groin area immediately inferior to the inguinal canal. The physician suspects that the patient has a femoral hernia containing a loop of small intestine. Which of the following structures is located immediately medial to the hernia sac?
A. Femoral aery
B. Femoral nerve
C. Femoral vein
D. Lacunar ligament

Response:
A femoral hernia exits the abdominal cavity through the femoral ring to enter the femoral canal. The femoral ring is bounded medially by the lacunar ligament. Compression of the herniated intestine against the sharp edge of the lacunar ligament may cause strangulation of the intestine. The other borders of the femoral ring are the inguinal ligament anteriorly, the pubis posteriorly, and the femoral vein laterally. The femoral aery is within the femoral sheath along with the femoral hernia, but is lateral to the femoral vein, which separates the aery from the hernia. The femoral nerve is not inside of the femoral sheath, but is lateral to the sheath. The femoral vein is lateral to the femoral canal within the femoral sheath.

So the answer to this question is D


Instruction:
All are true regarding DDT, Except
A. It acts as neurotoxin
B. It is primarily a contact poison
C. It does not cause immediate death, but it takes several hours to kill
D. It has repellent action on insects

Response:
DDT (Dichloro diphenyl trichloroethane)It was first synthesized by a German chemist, Ziedler.Its insecticidal action was described by Paul Muller.It is primarily a contact poison.It acts on the nervous system of insects.It takes several hours to kill the insect.The residual action of DDT may last as long as 18 months.It has no repellent action on insects.As a residual spray, DDT is applied at a dosage of 100-200 mg/ sq. foot area.The formulation of choice is a 5 % suspension, 5-10 % strength for the control of lice, fleas, ticks, and bugs.

So the answer to this question is D


Instruction:
Replacement of columnar epithelium in respiratory tract to squamous epithelium is -
A. Hyperplasia
B. Hypoplasia
C. None of the above
D. Metaplasia

Response:
Metaplasia
o Metaplasia is a reversible change in which one differenated cell type is replaced by another differenated cell type.
o Metaplasia represents an adapve substuon of cells that are sensive to stress by cell types beer able to withstand the adverse environment,
o Metaplasia may be of two types

So the answer to this question is D


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

Response:
Ans. is 'a' Whole Blood transfusion "Patients with significant hemorrhage, Anaemia or Intravascular volume depletion require Blood transfusion or colloid containing solutions (albumin, Dextran) but whole blood transfusion is the t/t of choice because colloidal solutions are expensive and they have some adverse effect"T/T of hypovolemia :The therapeutic goals are to restore normovolemia with fluid similar in composition to that lost and to replace ongoing losses.Mild volume contraction can usually be corrected via oral route. More severe hypovolemia requires intravenous therapy. Normonatremic or Mildly - Isotonic or normal saline (0.9% NaCl) and should be hyponatremic individuals administered initially in pts with hypotension or shock.Severe Hyponatremia - Hypertonic Saline (3.0% NaCl)Hypernatremia - Half Normal Saline(0.5% NaCl)If Hypokalemia also occurs - Add appropriate amount of KC1 to replacement solution.Significant haemorrhage, - Whole blood transfusion.Anaemia or IntravascularVolume depletion

So the answer to this question is A


Instruction:
Which of the following is a feature of temporal aeries
A. Giant cells aeries
B. Granulomatous vasculitis
C. Necrotizing vasculitis
D. Leukocytoclastic vasculitis

Response:
Refer robbins 9/e p506 Temporal aeritis is a condition in which the temporal aeries, which supply blood to the head and brain, become inflamed or damaged. It is also known as cranial aeritis or giant cell aeritis. Although this condition usually occurs in the temporal aeries, it can occur in almost any medium to large aery in the body

So the answer to this question is A


Instruction:
What psychopathology does the term 'perseveration' describe?
A. Patient feeling very distressed
B. Characteristic feature of schizophrenia
C. Characteristic of obsessive compulsive disorder (OCD)
D. Persistent and inappropriate repetition of the same thoughts

Response:
Perseveration refers to inappropriate recurrence or continuance of a paicular behavior (in sucession). E.g. talk the same sentence many times and not able to move away from it. It is unintentional and the patient may or may not be aware of this disorder. Perseveration usually indicates an organic pathology like a brain injury, stroke etc. Ref: Linguistic Disorders and Pathologies: An International Handbook By Gerhard Blanken, page 230.; Medical-Legal and Forensic Aspects of Communication Disorders, By Dennis C. Tanner page 80.

So the answer to this question is D


Instruction:
All of the following are true about bacillus anthracis except -
A. Plasmid is responsible for toxin production
B. Cutaneous anthrax generally resolve spontaneously
C. Capsular polypeptide aids virulence by inhibiting phagocytosis
D. Toxin is a complex of two fractions

Response:
None

So the answer to this question is D


Instruction:
This is known as ?
A. Falanga
B. Bansdola
C. Telefono
D. Jack knife Toure

Response:
FALANGA/ BASTINADO It is a type of toure method in which the soles of the feet of the victim are beaten by stick or blunt object Findings : Hematoma on the sole of the feet TELEFONO :Repeated slapping on the ears DRY SUBMARINE :Plastic bag asphyxiation WET SUBMARINE : Forced immersion of head under water. PICANA :Electric shock toure. PLANTON :Prolonged standing

So the answer to this question is A


Instruction:
A 60 year old male suffering from auditory hallucination says that people staying upwards are talking about him and conspiring against him. He dropped police complaint against them but the allegations were proved to be wrong. The diagnosis is -
A. Depression
B. Dementia
C. Delusional disorder
D. Schizophrenia

Response:
This patient has third person hallucination (voices are talking about the patient) which is characteristic of schizophrenia, and only one characteristic symptom is required for diagnosis if third person hallucination is present.

So the answer to this question is D


Instruction:
True about polio vaccination is all EXCEPT -
A. Follow up of AFP for 30 dyas
B. Salk contains three types of polio virus
C. Pulse polio doses are extra and supplemental
D. Oral polio vaccine provides intestinal immunity also

Response:
<p> Follow up in 60 days. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:203. <\p>

So the answer to this question is A


Instruction:
All the following are features of Guillain-Barre syndrome except:
A. Predominant motor involvement
B. Facial nerve involvement
C. Absence of pleocytosis in CSF
D. Bladder bowel involvement

Response:
Answer is D (Bladder bowel involvement): Bladder bowel involvement is rare in G. B. syndrome. Bladder dysfunction may occur in severe cases but is usually transient. 'If bladder dysfunction is prominent and comes early possibilities other than GBS should be considered'.- Harrison Guillain Barre syndrome (GBS) is an autoimmune disease characterized by acute demyelinating polyneuropathy. It has several distinctive features, which are so often asked. These include : Aetiology Preceding evidence of a viral infection such as that with - Herpes group : CMV / EBV Campylobacter jejuni gastroenteritis Lymphoma / Lupus Erythematosus Clinical manifestation Predominant motor involvement Sensory disturbance Autonomic * Paraplegia / Quadriplegia * Sensory disturbance may or may not be * Autonomic involvement * Proximal muscles affected more than the present : Cutaneous sensory deficits (eg. characterized by Postural distal ones loss of pain and temperature sensation) hypotension. episodes of * Ascending pattern of paralysis when present are usually mild. hypotension or hypeension * Cranial nerve involvement 9 : The * Bladder & Bowel rarely involved deg : and tachycardia. commonest involvement is bilateral Facial Bladder dysfunction may occur in severe and then Bulbar muscles. The patient has cases but is usually transient difficulty in swallowing, speech, etc. - If bladder dysfunction is a prominent * Areflexia Q .-Deep tendon reflexes usually feature and comes early, possibilities disappear within the first few days of onset. other than GBS should be considered. CSF Findings Nerve Conduction Studies - CSF shows albumino-cytological dissociation Q.i.e. Increased proteins with normal cells - CSF Pleocytosis with cells above 50/mm3 is against the diagnosis of.GBS. - API / 35 Nerve conduction studies show demyelination i.e. slow conduction velocity, distal latency, conduction block Prognosis - Recovery is usually remarkable in GBS, although all patients may not recover fully. - Approximately 85% of patients with GBS achieve a full functional recovery within several months to a year.-Harrison 15`72509

So the answer to this question is D


Instruction:
Enzyme of Pathway common to Glu- coneogenesis
A. Pyruvate kinase
B. PFK
C. Hexokinase
D. Phosphoglycerate kinase

Response:
Phosphoglycerate kinase (Pathway shown: Glycolysis)

So the answer to this question is D


Instruction:
Texas Statewide Preventive Dentistry program is also known as:
A. Sharp Program
B. Tattle Tooth Program
C. Smile Train Program
D. Theta Program

Response:
"TATTLETOOTH PROGRAM" - TEXAS STATEWIDE PREVENTIVE DENTISTRY PROGRAM
The Tattle tooth Program was developed in 1974-1976 as a cooperative effort between Texas Dental health professional organizations, the Texas Department Health and the Texas Education Agency through a grant from the Department of Health and Human Services to the Bureau of Dental Health. The program was pilot tested in 1975 and field-tested in spring 1976 in schools within the state of Texas.
Essentials of preventive and community dentistry
Soben Peter
5th edition
page no. 229

So the answer to this question is B


Instruction:
Left recurrent laryngeal nerve has a longer course because of which arch aery:
A. 1st arch
B. 2nd arch
C. 4th arch
D. 6th arch

Response:
The Left recurrent laryngeal nerve has a longer course to the neck than the right side. This is because it hooks under the left sixth arch aery which persists in extra-uterine life as the ductus aeriosus, a fibrous remnant. On the right side, neither the sixth nor fifth arch aeries persist and so the recurrent laryngeal nerve is restrained by the next most superior structure which is the fouh branchial arch aery (Right Subclan Aery). Rarely, the right fouh branchial arch aery does not develop in the adult and instead, the right dorsal aoa of the fetus persists to supply the same territories. Hence, the right recurrent laryngeal nerve is no longer restrained by a subclan aery and so it divides from the vagus more superiorly to run inferiorly on the larynx. This anomalous nerve (Non Recurrent Laryngeal nerve) may be transected during thyroid surgery. * The recurrent laryngeal nerve has differing courses oneach side. On the right, it loops under the subclanaery and on the left under the aoic arch. On bothsides it then ascends on the side of the trachea.

So the answer to this question is D


Instruction:
Most common symptom in buphthalmos is-
A. Lacrimation
B. Pain
C. Photophobia
D. Itching

Response:
Ans. is 'a' i.e., Lamination "Commonest symptom is watering" -- MukherjeeIn Buphthalmoso Most common symptom - Watering (lacrimation)o 2nd most common symptom - Photophobiao Most troublesome symptom - Photophobia (Child avoids light)o First sign - Corneal edema with wateringo Haab striaeo Large corneao Deep anterior chambero Lens antero-posteriorly flat

So the answer to this question is A


Instruction:
A newborn developed respiratory distress. Which of the following ors Respiratory distress syndrome?
A. Onset of distress after 6 hrs of bih
B. Air bronchogram on chest x-ray
C. History of receiving antenatal coicosteroids
D. Term bih

Response:
The chest x-ray of an infant with RDS is characterized by atelectasis, air bronchograms, and a diffuse reticular granular pattern commonly referred to as "ground glass". The chest x-ray may progress to a complete "white out" with severe disease. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is B


Instruction:
Which is not a type HI hypersensitivity reaction
A. TB
B. Rheumatoid ahritis
C. SIF
D. Ahus reaction

Response:
Ans. is 'a' i.e., Tuberculosis Tuberculosis is a delayed hypersensitivity or type IV hypersensitivity reaction.

So the answer to this question is A


Instruction:
Which of the following antiglaucoma medications can Cause drowsiness?
A. Latanoprost
B. Timolol
C. Brimonidine
D. Dorzolamide

Response:
The most commonly repoed ADRs are oral dryness, ocular hyperaemia and burning/stinging, all occurring in 22 to 25% of patients. They are usually transient and not commonly of a nature serious enough to require discontinuation of treatment. Symptoms of ocular allergic reactions have been repoed to have occurred in 12.7% of subjects in clinical trials (causing withdrawal in 11.5% of subjects), with onset being between 3 and 9 months in the majority of patients. The following convention has been used for classification of frequency of undesirable effects: Very common : >=1 in 10. Common : >=1 in 100 and <1 in 10. Uncommon : >=1 in 1,000 and <1 in 100. Rare : >=1 in 10,000 and <1 in 1,000. Very rare : < 1 in 10,000. Not known (cannot be estimated from the available data) Within each frequency grouping, undesired effects are presented in order of decreasing seriousness. Cardiac disorders: Uncommon: Palpitations/arrhythmias (including bradycardia and tachycardia). Nervous system disorders: Very common: Headache, drowsiness. Common: Dizziness, abnormal taste. Very rare: Syncope Eye disorders: Very common : Ocular irritation including allergic reactions (hyperaemia, burning, stinging, pruritis, foreign body sensation, conjunctival follicles); blurred vision, allergic blepharitis, allergic blepharoconjuctivitis, allergic conjunctivitis, ocular allergic reaction and follicular conjunctivitis. Common: Local irritation (eyelid hyperaemia and oedema, blepharitis, conjunctival oedema and discharge, ocular pain and tearing); photophobia; corneal erosion and staining; ocular dryness; conjunctival blanching; abnormal vision; conjunctivitis. Very rare : Iritis (anterior uveitis); miosis. Respiratory, thoracic and mediastinal disorders: Common: Upper respiratory symptoms. Uncommon: Nasal dryness. Rare: Dyspnoea Gastrointestinal disorders: Very common: Oral dryness. Common: Gastrointestinal symptoms. Vascular disorders: Very rare: Hypeension, hypotension. General disorders and administration site conditions: Very common: Fatigue. Common: Asthenia. Immune system disorders: Uncommon: Systemic allergic reactions. Psychiatric disorders: Uncommon: Depression. Very rare: Insomnia. The following adverse reactions have been identified during post-marketing use of Brimonidine eye drops in clinical practice. Because they are repoed voluntarily from a population of unknown size, estimates of frequency cannot be made. Not known: Eye disorders Iridocyclitis (anterior uveitis) Eyelid pruritus Skin and subcutaneous tissue disorders Skin reaction including erythema, face oedema, pruritus, rash and vasodilation

So the answer to this question is C


Instruction:
Position of mid-inguinal point is ?
A. Midpoint of Anterior Superior Iliac Spine (ASIS) and pubic tubercle
B. Mid point of ASIS and pubic symphysis
C. Mid point of both ASIS
D. Mid-point of inguinal ligament

Response:
Ans-B

So the answer to this question is B


Instruction:
Which of the following statement is TRUE about spinocerebellar tract?
A. Equilibrium
B. Smoothes and coordinates movement
C. Learning induced by change in vestibulo ocular reflex
D. Planning and programming

Response:
The spinocerebellar pathway is organised into the ventral and dorsal tracts. Both these tracts transmits proprioceptive and exteroceptive impulses from the body. They occupy the periphery of the lateral aspect of the spinal white matter and carry proprioceptive and cutaneous information to the cerebellum for the coordination of movement and maintenance of posture. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 8. Somatosensory Neurotransmission: Touch, Pain, and Temperature. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.

So the answer to this question is B


Instruction:
Which of the following cranial structures are insensitive to pain:
A. Dural sheath surrounding vascular sinuses
B. Choroid Plexus
C. Falx cerebri
D. Middle meningeal Aery

Response:
Answer is B (Choroid plexus): Choroid plexus is a pain insensitive cranial structure. The ventricular ependyma, choroids plexus, pial veins and much of brain parenchyma are not pain producing'- Harrison's Pain Sensitive Intracranial Cranial venous sinuses with afferent veins Aeries at base of brain and aeries of dura including middle meningeal aery Dura around venous sinuses and vessels Falx Cerebri Extracranial Skin Scalp Appendages Periostium Muscles Aeries Mucosa Nerves Trigeminal (Vth) Facial (VIII) Vagal (X) Glossopharyngeal(IX) Second (II) & Third (IIIrd) C.N. Pain Insensitive Intracranial Brain parenchyma Ependyma Choroid plexus Piamater Arachnoid Dura over convexity of skull (Dura around vascular sinuses and vessels is sensitive to pain)

So the answer to this question is B


Instruction:
Acoustic shadow on USG is due to:
A. Reflection
B. Refraction
C. Aefact
D. Absorption of waves

Response:
Ans. Reflection

So the answer to this question is A


Instruction:
After splenectomy, the most common infection:
A. Pneumococci
B. E. coli
C. Klebsiella
D. Streptococcus

Response:
Splenectomy increases the risk of following infections:

Bacterial:
Pneumococcal
H. influenzae
Some Gram -ve enteric organism
Parasitic – Babesia
Viral – No ↑ in risk of viral infection

So the answer to this question is A


Instruction:
Which is the most frequent cause for Budd chiari syndrome?
A. Hepatic vein thrombosis
B. Poal vein thrombosis
C. Malignancy
D. Valves in hepatic veins

Response:
The Budd-Chiari syndrome results from the thrombosis of one or more major hepatic veins and is characterized by hepatomegaly ascites, and abdominal pain. All hypercoagulable states cause an increased risk of Budd chain's syndrome. Hepatic vein thrombosis is associated with myeloproliferative disorders (especially polycythemia vera), pregnancy, the postpaum state, the use of OCPs, paroxysmal nocturnal hemoglobinuria, and intra-abdominal cancers, paicularly hepatocellular carcinoma.

So the answer to this question is A


Instruction:
In Testicular Feminization syndrome Gonadectomy is indicated :
A. As soon as it is diagnosed
B. At pubey
C. Only when Malignancy develops in it
D. When hirsutism is evident

Response:
At pubey Patients of Testicular Feminization syndrome (Androgen insensitivity) are genotypically males (Karyotype 46XY) but phenotypically females (i.e. male pseudo hermaphroditism). Due to the presence of Y chromosome gonads are testis which remain intraabdominal and have a malignant potential (Most common = Gonadoblastoma, Dysgerminoma). Therefore testis should be removed in such patients. B/L Laparoscopic Gonadectomy is the preferred proceduredeg. As far as timing of Gonadectomy is concerned ? "In patient with complete androgen insensitivity, the testis should be removed 'ter Pubeal developmen is complete to prevent malignant degeneration.

So the answer to this question is B


Instruction:
Hemodialysis can be performed for long periods from the same site due to
A. Aeriovenous fistula reduces bacterial contamination of site
B. Aeriovenous fistula results in aerialization of vein
C. Aeriovenous fistula reduces chances of graft failure
D. Aretiovenous fistula facilitates small bore needles for high flow rates

Response:
Ans. is 'b' i.e., Aeriovenous fistula results in aerialization of vein The tstu/a graft, or catheter hemodialvsis is often referred to as a dialysis access. A native fistula created by the anastomosis of an aery to a vein (e.g. the Bresica-Cimino fistula, in which the cephalic vein is anastomosed end-to-side to the radial aery) results in aerialization of the vein. This facilitates its subsequent use in the placement of large needles (typically 15 Gauge) to access the circulation. Fistulas have the highest long-term patency rate of all dialysis access options. The most impoant complication of aeriovenous grafts is thrombosis of the graft and graft failure, due principally to intimal hyperplasia at the anastomosis between the graft and recipient vein. Many patients undergo placement of an aeriovenous graft (i.e., the interposition of prosthetic material, usually polytetrafluoroethylene, between an aery and a vein) or a tunneled dialysis catheter.

So the answer to this question is B


Instruction:
Maximum endo-capillary proliferation is seen in :
A. Membranous glomerulonephritis
B. Mesangio-proliferative glomerulonephritis
C. Focal segmental glomerulonephritis
D. Post streptococcal GN

Response:
Ans. (d) Post streptococcal GNRef: Robbiris pathology 9th ed. /909-910* PSGN is characterized by enlarged hyper-cellular glomeruli.* There is also swelling of endothelial cells & combination of proliferation, swelling, leukocyte infiltration obliterates capillary lumen.* Endo-capillary proliferation is also seen in MPGN

So the answer to this question is D


Instruction:
Most common bony tumour of middle ear is:
A. Adeno carcinoma
B. Squamous cell carcinoma
C. Glomus tumour
D. Acoustic neuroma

Response:
(Squamous cell carcinoma) (107-8-D) (213-14-LT) (98- Maqbool 11th)* Squamous carcinoma is the commonest tumour of the middle earIt causes extensive bone destruction involving the facial nerve, labyrinth, the middle cranial fossa, temporomandibular joint and the base of the skull. It also involves the IXth, Xth, XIth, and XIIth cranial nerves and can extend along the eustachian tube into the nasopharynx (213-LT)* Glomustumour - is the most common benign neoplasm of middle ear, because its origin from glomus bodies.

So the answer to this question is B


Instruction:
Narrowest part of larynx in children-
A. Supraglottic
B. Subglottic
C. Glottic region
D. None

Response:
Ans. is 'b' i.e., Subglottico Narrowest part of larynx in children - Subglottic region,o Narrowest part of larynx in adults - Rima glottidis (glottis)

So the answer to this question is B


Instruction:
Prenatal diagnosis of Down Syndrome is by -
A. Karyo typing
B. Triple test
C. Fetal ultrasonography
D. All of above

Response:
Ans. is 'D' i.e., All of above o Screening for Down syndrome in pregnancy can be done by number of option like - Karyotyping by - Chorionic villus sampling at 10-12 weeks. Amniocentesis at 16-18 wreeks. Cordocentasis after 18 weeks. Maternal serum marker - PAPP-A and free ji HCG in first trimester. a-feto protein, HCG and estradiol (Triple test) in second trimester. Fetal USG - done in 2nd trimester to look for - Increased nuchal fold thickness. Short femur and humerus. Duodenal atresia.

So the answer to this question is D


Instruction:
Prophylactic iron and folic acid content according to RCH program during pregnancy:
A. 500mg iron + 100 meg folic acid
B. 100mg iron + 500mcg folic acid
C. 100 mg iron + 100 meg folic acid
D. 20 mg iron +100 meg folic acid

Response:
Ans. (b) 100mg iron + 500mcg folic acidRef: K. Park 23rded. /527* Adult iron+folic acid tablet given in pregnancy: 1 tab/ day x 100 days* Kids iron+folic acid tablet given: 1 tab/day x 100 days per year- 0 to 5 years of age.Iron and Folic acid tablet content IronFolic acidAdult tab100 mg500 megKids tab (l/5th)20 mg100 meg

So the answer to this question is B


Instruction:
Unilateral clubbing seen in -a) Samilial clubbingb) Pancoast tumorc) Pulmonary A-V fistula  d) Aortic aneurysm (arch)e) Congenital cyanotic heart ds.
A. bcd
B. acd
C. ac
D. bd

Response:
None

So the answer to this question is A


Instruction:
Inherited hyperammonemia is a result of deficiency of which enzyme of Krebs-Henseleit urea cycle?
A. Malate dehydrogenase
B. Isocitrate dehydrogenase
C. N-acetyl glutamate synthetase
D. Succinate dehydrogenase

Response:
Inherited hyperammonemias are a group of six diseases caused by inborn deficiencies of the enzymes of the Krebs-Henseleit urea cycle. The enzymes involved are: 1. N-acetyl glutamate synthetase 2. Arbamyl phosphate synthetase (CPS) 3. Ornithine transcarbamylase (OTC) 4. Argininosuccinic acid synthetase (citrullinemia) 5. Argininosuccinase deficiency 6. Arginase deficiency Most Severe Cases: In the most severe forms of the hyperammonemic disorders, the infants are asymptomatic at bih and during the first day or two of life, after which they refuse their feedings, vomit, and rapidly become inactive and lethargic, soon lapsing into an irreversible coma. Profuse sweating, focal or generalized seizures, rigidity with opisthotonos, hypothermia, and hyperventilation have been observed in the course of the illness. These symptoms constitute a medical emergency, but even with measures to reduce serum ammonia, the disease is usually fatal. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 37. Inherited Metabolic Diseases of the Nervous System. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.

So the answer to this question is C


Instruction:
Lipoprotein-associated with carrying cholesterol from periphery tissues to liver is
A. HDL
B. LDL
C. VLDL
D. IDL

Response:
METABOLISM OF HDL Synthesis: HDL is synthesized in Liver cells and also in intestinal mucosal cells. (a) Hepatic HDL * Apo-A and apo-C are synthesized by polysomes on the rough endoplasmic reticulum (ER). * They are assembled with lipids to form the nascent HDL which is released in the circulation. (b) Intestinal HDL * In a similar manner, apo-A is synthesized by polysomes on the rough endoplasmic reticulum (ER). * It is assembled with lipids to form the "nascent"- HDL which is released in circulation from intestinal mucosal cells. Difference of nascent intestinal HDL from "nascent" hepatic HDL * "Nascent" intestinal HDL contains only apo-A when it circulates, it acquires apo-C and apo-E. * "Nascent"-Hepatic HDL, on the other hand, contains both apo-A and apo-C. Note: Apo-C and apo-E are only synthesized in liver and not in intestinal mucosal cells. Scavenging action of HDL: Glomset (1968) has suggested that HDL plays a major role in the removal of cholesterol from peripheral extrahepatic tissues and transpo of this cholesterol to the liver where it is fuher metabolized. This has been called as scavenging action of HDL (reverse cholesterol transpo). METABOLISM OF HDL HDL Receptor Proteins and HDL Cycle Two types of HDL receptor proteins haven been described involved in HDL metabolism. They are: 1. HDL receptor protein--SR-B1 2. ATP-binding cassette transpoer A1 Protein (ABCA1) 1. HDL receptor protein SR-B1 The class B scavenger receptor B1 (SR-B1) has been identified recently as HDL receptor with a dual role in HDL metabolism. * In the liver, and steroidogenic tissues, it binds HDL apo-A1 and cholesteryl ester is selectively delivered to the cells, although the paicle itself, including apo-A1, is not taken up. * In the tissues: On the other hands, SR-B1 mediates the acceptance of cholesterol from the cells by HDL, which then transpos it to the liver for excretion the bile (either as cholesterol or after conversion to bile acids), the process known as reverse cholesterol transpo. Nascent HDL: Nascent HDL is made up of a bilayer of PL and free cholesterol arranged in disc-like form called as discoid HDL containing apoproteins. Formation of HDL3 by LCAT: Lecithin-cholesterol acyltransferase of plasma binds with nascent HDL discs and gets activated by A-1 and C-II apoproteins of HDL itself and transfers acyl groups from HDL-PL to the free cholesterol thus producing Lysophospholipids and cholesteryl-esters. Lysophospholipids thus formed are released from HDL to plasma where they bind to albumin and cholesteryl esters and transferred into the 'central core' of the HDL paicles. Thus by the above reactions 'Discoid HDL' is conveed to 'spherical' HDL which is called as HDL-3 paicle, which is bounded by a lipid layer with apoproteins and cholesteryl esters embedded in its core. Nascent HDL (discoidal) --- HDL-3 paicle (spherical)Ref: Textbook of Medical Biochemistry, Eighth Edition, Dr (Brig) MN Chatterjea, page no: 449

So the answer to this question is A


Instruction:
“Anhedonia” seen in schizophrenia is linked to which of the following neurotransmitter abnormality?
A. Serotonin
B. Norepinephrine
C. Glutamate
D. GABA

Response:
Norepinephrine
(Ref : Kaplan Psychiatry Pg 290)

So the answer to this question is B


Instruction:
Pneumatosis cystoids intestinalis is
A. Gas filled cysts in the subserosa or submucosa of the small intestine
B. Gas filled cysts in the subserosa or submucosa of the duodenum
C. An external fistula communicating with the caecum following operation of gangrenous appendicitis
D. Fibrotic thickening of the intestinal walls with narrow lumen

Response:
(Gas-filled cysts are found in the subserosa or submucosa of the small intestine) (1182-LB)Pneumatosis cvstoids intestinalis - in which gas-filled cysts are found in the subserosa or submucosa of the intestine or colon.* Majority of cases are associated with COPD or the immunocompromised state (eg. AIDS, post transplantation; in association with leukemia, lymphoma, vasculitis, or collagen vascular disease, and in those patients taking chemotherapy or corticosteroids) other associated conditions include inflammatory, obstructive or infectious conditions of the intestine: iatrogenic conditions such as endoscopy and jejunstomy placement; ischemia and extra-intestinal disease such as diabetes.

So the answer to this question is A


Instruction:
Foster's test is used in the diagnosis of-
A. Spastic type of cerebral palsy
B. Hypotonic CP
C. Choreo athetotic CP
D. Myasthenia gravis

Response:
None

So the answer to this question is A


Instruction:
Acyclovir is used for the following viral infection :
A. Rabies virus
B. Cytomegalovirus
C. Herpes simplex virus
D. Human immunodeficiency virus

Response:
None

So the answer to this question is C


Instruction:
Disease which shows cyclical trend:-
A. Malaria
B. Diarrhea
C. Measles
D. Tuberculosis

Response:
Time Distribution of Disease: - Periodic fluctuations: 1. Cyclical Trend - Fluctuations in every few years Ex - Measles, Rubella, Influenza Measles every 2-3 years Rubella every 5-8 years Influenza show maximum cyclical trends d/t antigenic shift/drift 2. Seasonal Trend - Disease that increases every paicular season Ex - Malaria/Dengue in Rainy Season, I in winter Season 3. Epidemic Trend - Sho term fluctuations Ex-Food poisoning, Bhopal Gas tragedy 4. Secular Trend - Long term fluctuations Ex - Non-communicable disease ( CHD, HTN etc)

So the answer to this question is C


Instruction:
Bile acids consist of all EXCEPT
A. Lithocholic acid
B. Taurocholic acid
C. Deoxycholic acid
D. Chendeoxycholic acid

Response:
Taurocholic acidREF: Ganong 22' ed chapter26* The bile salts are sodium and potassium salts of bile acids, and all those secreted into the bile are conjugated to glycine or taurine, a derivative of cysteine. The bile acids are synthesized from cholesterolThe two principal (primary) bile acids formed in the liver are cholic acid and chenodeoxycholic acid.In the colon, bacteria conve cholic acid to deoxycholic acid and chenodeoxycholic acid to lithocholic acid. Since they are formed by bacterial action, deoxycholic acid and lithocholic acid are called secondary bile acids.

So the answer to this question is B


Instruction:
Which of the following is terminal group of axillary lymph node?
A. Pectoral
B. Apical
C. Lateral
D. Central

Response:
It receives lymphatic drainage from all other axillary nodes . The nodes of the apical or infraclaaicular group lie deep to the clavipectoral fascia, along the axillary vessels. They receive lymph from the central group, from the upper pa of the breast, and from the thumb and its web. The lymphatics from the thumb accompany the cephalic vein REF - BDchaurasia 6e p53

So the answer to this question is B


Instruction:
26 year old female patient wanted epidural for labor analgesia. She was given 12ml of 0.25% bupivacaine immediately after this she developed hypotension, bradycardia, respiratory difficulty. Which of the following explains condition of the patient.
A. Vasovagal attack
B. Systemic toxicity
C. Total spinal anaesthesia
D. Drug allergy

Response:
Total spinal is one of the dreaded complication of epidural anaesthesia. Accidental puncture of dura, while giving epidural will cause whole volume (10-20ml) of drug to enter subarachnoid space.
This can reach upto cranium producing total spinal block.

So the answer to this question is C


Instruction:
All of the following are true about the papovavirus except -
A. They are non-enevloped icosahedral viruses
B. Produce papilloma and was in human
C. RNA virus
D. SV - 40 is oncogenic

Response:
Popova viruses are small non enveloped icosahedral DNA virus REF:ANANTHANARYANAN TEXTBOOK OF MICROBIOLOGY 9EDITION PGNO.553

So the answer to this question is C


Instruction:
Arterial supply of tonsil is mainly:
A. Tonsillar branch of facial artery
B. Maxillary artery
C. Middle meningeal artery
D. Internal carotid artery

Response:
(a) Tonsillar branch of facial artery(Ref. Scott Brown, 8th ed., Vol 3; 742)The arterial supply to tonsil is by external carotid artery branches.Maxillary artery also supplies the tonsil but the main artery supplying is the tonsillar branch of facial.Middle meningeal artery, a branch of maxillary artery, does not supply the tonsil.

So the answer to this question is A


Instruction:
Abroviral infection(s) include -a) Chikungunya feverb) West nile feverc)  JEd)  Sandfly fevere) Malaria
A. abcd
B. acd
C. bcd
D. abd

Response:
None

So the answer to this question is A


Instruction:
A 7-year-old child from West Bengal presented with high grade fever with chills and rigor. Peripheral smear examination revealed Plasmodium vivax. He was given treatment for the same. But he again presented with jaundice, and a repeat peripheral smear showed following. What is your diagnosis?
A. Viral Hepatitis
B. Sickle cell Anemia
C. Hemolytic uremic syndrome
D. Glucose 6 Phosphate dehydrogenase deficiency

Response:
- Peripheral smear showing 'bite cells' after treatment with anti-malarials - suggests G6PD deficiency. G6PD deficiency: X-linked recessive disorder. Most common red cell enzyme deficiency. Hemolysis is seen d/t raised oxidative stress. FEATURES: Pallor, icterus, hemoglobinemia, hemoglobinuria, splenomegaly etc are seen Heinz bodies are seen DRUGS CAUSING OXIDATIVE STRESS IN THESE PATIENTS: Sulfonamides - sulfamethoxazole Anti-malarials - Primaquine, quinine Analgesics - Aspirin, NSAIDS, phenazopyridine (pyridium) Others - Nitrofurantoin, Dapsone, Methylene blue, Rasburicase, Toluidine blue, Nalidixic acid, Furazolidine, quinidine

So the answer to this question is D


Instruction:
Most common presentation of peutz jegher syndrome is
A. Pancreatic Ca
B. Melanoma
C. Intussusception
D. Malabsorption

Response:
Most common presentation of peutz jegher syndrome is intussusception. Mutation is STK 11 mutation.

So the answer to this question is C


Instruction:
Which is the precursor amino acid for selenocysteine
A. Cysteine
B. Cystine
C. Serine
D. Glycine

Response:
None

So the answer to this question is C


Instruction:
Causative organism of rheumatic fever ?
A. Group A Streptococci
B. Staphylococci
C. Group B Streptococci
D. Group D Streptococci

Response:
Ans. is 'a' i.e., Group A StreptococciRheumatic fever :?Rheumatic fever (RF) is an acute, immunologically mediated, multisystem inflammatory disease classically occurring a few weeks after an episode of group A streptococcal pharyngitis; occasionally, RF can follow streptococcal infections at other sites, such as the skin.

So the answer to this question is A


Instruction:
Le Forte fracture having craniofacial dysjunction is
A. Type-I
B. Type-II
C. Type-III
D. None

Response:
(C) Type-III # They are classified into 3 types:> Le Fort I (transverse) fracture runs above and parallel to the palate. It crosses lower part of nasal septum, maxillary antra and the pterygoid plates.> Le Fort II (pyramidal) fracture passes through the root of nose, lacrimal bone, floor of orbit, upper part of maxillary sinus and pterygoid plates. This fracture has some features common with the zygomatic fractures.> Le Fort III (craniofacial dysjunction). There is complete separation of facial bones from the cranial bones. The fracture line passes through root of nose, ethmofrontal junction, superior orbital fissure, lateral wall of orbit, frontozygomatic and temporozygomatic sutures and the upper part of pterygoid plates.

So the answer to this question is C


Instruction:
4-year-old male child had febrile seizures, best prophylaxis –
A. Paracetamol 6 hourly
B. Paracetamol & diazepam
C. Diazepam
D. Phenobarbitone

Response:
Prophylaxis in febrile seizures
Prophylactic anticonvulsants are not given routinely in febrile seizures. They are required when -

A febrile seizure is prolonged or complicated
Medical reassurance fails to relieve family anxiety.
	Prophylaxis may be continuous or intermittent

Intermittent prophylaxis

It is currently the desirable form of therapy
It is used during episodes of fever
Indicated during first three days of fever:
Drugs that are used are - Diazepam and other benzodiazepines (these drugs are used because they attain desired levels quickly) Diazepam is given oral or rectal.

Continuous prophylaxis -

It is used when
Intermittent therapy has failed
Central nervous system disease
Drugs used are → Sodium valproate or phenobarbitone.
Recurrent atypical seizures
The family history of epilepsy

Note - Carbamazepine and phenytoin are ineffective for prevention of recurrence.

So the answer to this question is C


Instruction:
Doppler ultrasonography in IUGR & Preeclampsia shows notch in which aery :
A. Umbilical aery
B. Uterine aery
C. Internal iliac aery
D. Vitiline aery

Response:
Uterine aery

So the answer to this question is B


Instruction:
Enterotest is used for diagnosis of
A. E. histolytica
B. N. fowleri
C. T. Cruzi
D. Giardia lambia

Response:
Stringtest / enterotest is done in Giardia lambia in which bile stained mucus is collected for examination of Trophozoites.

So the answer to this question is D


Instruction:
Paralysisof 3rd, 4th, 6th nerves with involvement of ophthalmicdivisionof5thnerve, localizes the lesion to
A. Apex of orbit
B. Brainstem
C. Cavernous sinus
D. Base of skull

Response:
Ipsilateral ophthalmoplegia  causing diplopia occur due to 3rd, 4th  & 6th cranial nerves.
6th nerve passes through cavernous sinus and others are related to the lateral wall of cavernous sinuses.

So the answer to this question is C


Instruction:
In Hypertrophic pyloric stenosis which electrolyte should be replenished?
A. Na+
B. K+
C. C1--
D. HCO3--

Response:
ANSWER: (B) K+REF: With textHypertrophic pyloric stenosis presents with hyponatremic, hypokalemic, hypochloremic metabolic alkalosis with paradoxical aciduriaSchwartz 9th ed chapter 3, 39: Treatment includes replacement of the volume deficit with isotonic saline and then potassium replacement once adequate urine output is achieved. Fluid resuscitation with correction of electrolyte abnormalities and metabolic alkalosis is essential before induction of general anesthesia for operation. For most infants, administration of fluid containing 5% dextrose and 0.45% saline with 2 to 4 mEq/kg of added potassium at a rate of approximately 150 to 175 mL/kg for 24 hours will correct the underlying deficit. After resuscitation, a Fredet-Ramstedt pyloromyotomy is performedSabiston 18tk ed ch 71 states: The definitive treatment of choice is pyloromyotomy. But Before surgery, it is important that the infant is hydrated with IV fluids to establish a normal urine output. It is important that the underlying metabolic alkalosis is slowly corrected with normal saline. Potassium is not given until the intravascular volume has been restored and normal urine output has resumed.Nelson 's 18th ed ch:326.1 states that: The preoperative treatment is directed toward correcting the fluid, add-base, and electrolyte losses. Intravenous fluid therapy is begun with 0.45- 0.9% saline, in 5-10% dextrose, with the addition of potassium chloride in concentrations of 30-50 mEq/L. Fluid therapy should be continued until the infant is rehydrated and the serum bicarbonate concentration is <30 mEq/dL, which implies that the alkalosis has been corrected.

So the answer to this question is B


Instruction:
Partial agonist of opioid is -
A. Pethidine
B. Buprenorphine
C. Morphine
D. Butorphenol

Response:
Ans. is 'b > d' i.e., Buprenorphine > Butorphenol o An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and GIT.o So, opioids can be divided into:-1. Opioid agonists# These have only agonistic action on opioid receptors. Drugs are:1. Natural:- Morphine, codeine.2. Semisynthetic:- diacetylmorphine (Heroin), pholcodeine, hydromorphone, oxymorphone, hydrocodone, oxycodone.3. Synthetic:- Pethidine (mepridine), fentanyl, methadone, dextropropoxyphene, tramadol, sulfentanil, alfentanil, remifentanil, levorphenol, dextromoramide, dipipanone.2. Complex action opioid and opioid antagonists.# Relatively minor changes in the structure of an opioid can convert a drug that is primarily an agonist into one with antagonistic actions at one or more types of opioid receptors. Drugs are:1. Agonist-antagonists (k analgesics) - Nalorphine, Pentazocine, Butorphenol.2. Partial/weak p agonist + k antagonist - Buprenorphine.3. Pure antagonists - Naloxone, Naltrexone, Nalmefene.Nature of interaction of opioid ligands with the three major typesof opioid receptors, along with equivalent analgesic dosesLigandm (mu)k (kappa)d (delta)Analgesic dose (mg)1. MorphineAgo. (St)Ago. (W)Ago. (W)102. NalorphineAnta. (St)Ago. (M)--3. PentazocineP. Ago., Anta. (W)Ago. (M)-30-604. ButorphanolP. Ago. (W)Ago. (St)-1-35. BuprenorphineP. Ago.Anta. (M)-0-3-0-46. NaloxoneAnta. (St)Anta. (M)Anta. (W)-7. NaltrexoneAnta. (St)Anta. (M)Anta. (W)-8. Met/Leu enkephalinAgo. (M)-Ago. (St)-9. b-EndorphinAgo. (St)-Ago. (St)-10. Dynorphin A, BAgo. (W)Ago. (St)Ago. (W)-

So the answer to this question is B


Instruction:
Which among the following is a depolarizing muscle relaxant
A. Decamethonium
B. D tubocurarine
C. Doxacurium
D. Atracurium

Response:
(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.219)

So the answer to this question is A


Instruction:
Broncholithiasis means -
A. Calcified lymphnodes eroding into bronchus
B. Foreign body calcified in bronchus
C. Lithium deposition in bronchial wall
D. A hamartoma

Response:
Broncholithiasis is defined as a condition in which calcified or ossified material is present within the bronchial lumen. The most common cause of broncholithiasis is erosion by and extrusion of a calcified adjacent lymph node into the bronchial lumen, a finding usually associated with tuberculosis or histoplasmosis. Other causes of broncholithiasis include
(a) aspiration of bone tissue or in situ calcification of aspirated foreign material and
(b) erosion by an extrusion of calcified or ossified bronchial cartilage plates.

So the answer to this question is A


Instruction:
The person is disoriented to time and space in
A. Hallucinations
B. Illusion
C. Delusion
D. Delirium

Response:
Delirium It is the disturbance of consciousness in which the person is disoriented in time and space. It is a disorder of cognition. This occurs in clinical conditions eg, high fevers like typhoid or meningitis or datura poisoning. Another example is delirium tremens that occurs in chronic alcoholism. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 360

So the answer to this question is D


Instruction:
a married women died in unnatural conditions within 5yrs of marriage,her parents complained of frequent demand of dowry .her autopsy will be conducted under ?
A. 174 crpc
B. 176 crpc
C. 302 ipc
D. 304B ipc

Response:
dowry death is 304B ipc autopsy is under 176 crpc = magistrate inquest ref : narayanareddy 9th ed

So the answer to this question is B


Instruction:
Cause for renal vein thrombosis could be -a) Membranous nephropathyb) Lupus nephritisc) Membranoproliferative glomerulonephritisd) Post streptococcal glomerulonephritise) Renal amyloidosis
A. acd
B. ace
C. cde
D. ade

Response:
None

So the answer to this question is B


Instruction:
A 4-day-old baby boy has not defecated since coming home from the hospital even though feeding has been normal without any excessive vomiting. Rectal examination reveals a normal anus, anal canal and rectum. However, a large fecal mass is found in the colon and a large release of flatus and feces followsthe rectal examination. Which of the following conditions would be suspected?
A. Imperforate anus
B. Anal agenesis
C. Anorectal agenesis
D. Colonic aganglionosis

Response:
This baby boy suffers from colonic aganglionosis, or Hirschsprung disease, which results in the retention of fecal material, causing the normal colon to enlarge. The retention of fecal material results from a lack of peristalsis in the narrow segment of colon distal to the enlarged colon. A biopsy of the narrow segment of colon would reveal the absence of parasympathetic ganglion cells in the myenteric plexus caused by failure of neural crest migration.

So the answer to this question is D


Instruction:
All are true about warfarin except
A. It inhibits the activation of vitamin K dependent clotting factors
B. It's half life is 36hrs
C. It can cross placenta
D. It's dose is increased in liver disease

Response:
Refer Katzung 11/e p595 Warfarin is an oral anticoagulant that acts by inhibiting the gamma carboxylation of glutamate residues in vitamin K dependent clotting factors It has a long half life It readily crosses the placenta Liver disease reduces the synthesis of clotting factors thus increases the effect of warfarin

So the answer to this question is D


Instruction:
Which of the following is not used as a topical LA?
A. Procaine
B. Tetracaine
C. Lidocaine
D. Benzocaine

Response:
None

So the answer to this question is A


Instruction:
The pearl index indicates teh number of accidental pregnancies per -
A. 1000 population
B. 100 live bihs
C. 100 women in the age group of 15 to 44 years
D. 100 women years

Response:
park's textbook of preventive and social medicine 23rd edition. *pearl index is defined as the no of failure per 100 women year of exposure.

So the answer to this question is D


Instruction:
Visual hallucinations are most commonly seen in: PGI 09; FMGE 11
A. Delusional syndrome
B. Delirium
C. Mania
D. OCD

Response:
Ans. Delirium

So the answer to this question is B


Instruction:
Thaliomide is used in all except ?
A. ENL
B. HIV neuropathy
C. HIV associated ulcer
D. Behcet's syndrome

Response:
Ans. is 'b' i.e., HIV neuropathy

So the answer to this question is B


Instruction:
Antral puncture is done through-
A. Superior meatus
B. Inferior meatus
C. Middle meatus
D. All

Response:
Proof puncture (Antral puncture)

This procedure involves puncturing the medial wall of the maxillary sinus in the region of the inferior meatus and irrigating the sinus.

Indications
1)   Chronic and subacute maxillary sinusitis with the dual purpose of :

Confirming the diagnosis and
Washing out the pus

2)   To collect the specimen of the antral contents for culture and sensitivity, or cytological examination to exclude early malignancy.
Contraindications

Children less than 12 years of age.
Acute maxillary sinusitis as it may lead to osteomyelitis
Fracture of maxilla as fluid may pass through fracture line.
Diabetes

So the answer to this question is B


Instruction:
Organelle that plays a pivotal role in apoptosis:
A. Endoplasmic reticulum
B. Golgi complex
C. Mitochondria
D. Nucleus

Response:
Mitochondrion must be recognized not only as an organelle with vital roles in intermediary metabolism and oxidative phosphorylation, but also as a central regulatory structure of apoptosis.

So the answer to this question is C


Instruction:
Erythromycin acts by interfering with:
A. Translocation of 50S ribosome
B. Translocation of 50S ribosome
C. Transcription of 50S ribosome
D. Signal transduction of 50S ribosome

Response:
ERYTHROMYCIN It was isolated from Streptomyces erythreus in 1952. Since then it has been widely employed, mainly as alternative to penicillin. Water solubility of erythromycin is limited, and the solution remains stable only when kept in cold. Mechanism of action Erythromycin is bacteriostatic at low but cidal (for ceain bacteria) at high concentrations. Cidal action depends on the organism concerned and its rate of multiplication. Sensitive gram-positive bacteria accumulate erythromycin intracellularly by active transpo which is responsible for their high susceptibility to this antibiotic. It is several fold more active in alkaline medium, because the nonionized (penetrable) form of the drug is oured at higher pH. Erythromycin acts by inhibiting bacterial protein synthesis. It combines with 50S ribosomes subunits and interferes with 'translocation' . After peptide bond formation between the newly attached amino acid and the nacent peptide chain at the acceptor (A) site the elongated peptide is translocated back to the peptidyl (P) site, making the A site available for next aminoacyl tRNA attachment. This is prevented by erythromycin and the ribosome fails to move along the mRNA to expose the next codon. As an indirect consequence, peptide chain may be prematurely terminated: synthesis of larger proteins is especifically suppressed. Essentials of medical pharmacology K D Tripathi Sixth edition Pg no 727

So the answer to this question is A


Instruction:
Nail patella syndrome is characterized by -a) Iliac hornb) Sacral hornc) Absent patellad) Knee deformitye) Dislocation of patella
A. bce
B. bde
C. acde
D. abde

Response:
The disease is characterized by :-

Unduly small or absent patella
Nail dysplasia (nail dystrophy) most commonly in thumbnail
Recurrent dislocation of patella
Postero-lateral subluxation of radial head
Bony excrescences on lateral aspect of the ileum, i.e. iliac horns.
Genu valgum
Congenital nephropathy

So the answer to this question is C


Instruction:
A patient is passing stones recurrently in urine for past few years. All are due to be restricted in diet except
A. Protein restriction
B. Calcium restriction
C. Salt restricted diet
D. Phosphate restriction

Response:
Calcium restriction Calcium intake in stone Higher urine calcium is a common finding in stone formers, but restricting dietary calcium intake is not recommended unless it is excessive (more than 2000 mg/d). Although urine calcium excretion may decrease with restriction, the decrease in free intestinal calcium can lead to increased absorption of dietary oxalate and enhanced oxalate excretion, due to decreased binding of oxalate by calcium in the intestinal lumen. The net effect may be increased supersaturation of the urine with respect to calcium oxalate and an enhanced tendency to stone formation. Prevention of recurrent calcium stones (which are usually composed primarily of calcium oxalate) is aimed at decreasing the concentrations of the lithogenic factors (calcium and oxalate) and at increasing the concentrations of inhibitors of stone formation, such as citrate. - Achieving these goals may require both dietary modification and the administration of appropriate medications. Medical therapy (and metabolic evaluation) is usually undeaken in individuals who have formed more than one stone. Reduce animal protein intake Adverse changes in urinary calcium and citrate excretion can be induced by a high protein diet, since the metabolism of sulfur- containing amino acids increases the daily acid load by generating sulfuric acid. Animal protein is much more likely to induce this effect than vegetable protein, since it has a higher sulfur content and therefore generates more acid. Thus, lowering animal protein intake will produce ,orable changes in the urine. However, it has not been proven that this will reduce the incidence of stone .formation. In observational studies, a high animal protein diet was a risk factor.for renal stones in men, but not in women. In a randomized trial, reduced animal protein in association with higher dietary calcium and lower dietary sodium was associated with a reduced risk of stone recurrence, but the individual impact of animal protein could not be determined. Based on the available data, it would be prudent to avoid excessive animal protein intake. Increase fruit and vegetable intake Foods that are rich in potassium, paicularly fruits and vegetables, may be beneficial. Increasing intake of fruits and vegetables may reduce the risk of calcium oxalate stone formation, paicularly in patients who self-select a diet that is low in fruits and vegetables. This benefit is primarily the result of increasing citrate excretion. Limit dietary oxalate intake Some .foods contain very large amounts of oxalate and those should be avoided (eg spinach, rhubarb). In addition, some nuts and legumes are also high in oxalate and the intake should be limited (eg, peanuts, cashews, and almonds). However, there is scant evidence that low oxalate diets reduce the risk of stone formation. In prospective observational studies of individuals who had never had a stone, higher dietary oxalate only slightly increased the risk of incident stone formation in men and older women; there was no association in younger women. Because of the documented health benefits of many .foods that are traditionally considered high in oxalate (but still 10 mg or less per serving), strict oxalate restriction does not seem to be suppoed. As noted above, some foods traditionally believed to be high in oxalate, such as tea, do not increase the risk of stone formation. If a low oxalate diet is recommended, it should only be continued if there is documented evidence that the urine oxalate excretion has fallen. Limit sodium intake Calcium is reabsorbed passively in the proximal tubule down the .orable concentration gradient created by the reabsorption of sodium and water. Thus, a low sodium diet (to 80 to 100 meq/day) can enhance proximal sodium and calcium reabsorption, leading to a reduction in calcium excretion. In one study, for example, lowering sodium intake from 200 to 80 meq/day diminished calcium excretion by as much as 100 mg/day (2.5 mmol/day). Although the independent contribution of lowering dietary sodium intake on actual stone formation is unknown and higher sodium intake may be associated with higher urine volume, it is likely an impoant component of a regimen that has been demonstrated to reduce recurrent stone .formation. Limit sucrose and fructose intake Sucrose intake increases urine calcium independent of calcium intake and has been associated with an increased risk of stones. Fructose intake also increases the risk of stone .formation. Calcium intake Higher urine calcium is a common finding in stone forrners, but restricting dietary calcium intake is not recommended unless it is excessive (more than 2000 rued). Although urine calcium excretion may decrease with restriction, the decrease in .free intestinal calcium can lead to increased absorption of dietary oxalate and enhanced oxalate excretion, due to decreased binding of oxalate by calcium in the intestinal lumen. The net effect may be increased supersaturation of the urine with respect to calcium oxalate and an enhanced tendency to stone .formation. The ability to help prevent new stone formation with a normal calcium intake was shown in pa by a five year study that compared two diets among men with idiopathic hypercalciuria and recurrent calcium oxalate stones. - In this trial, 120 such men were randomly assigned to either a diet consisting of a normal amount of calcium (1200 mg/day ) and low amounts of animal protein (52 g/day) and salt (2900 mg/day of sodium chloride) or a diet containing a low amount of calcium (400 mg/day ). At .five years, a significantly lower risk of stone recurrence was observed among the group assigned to the normal calcium, low animal-protein, low-salt diet. - This selective benefit likely arose because of a decrease in urinary oxalate excretion compared to an increase with the low calcium diet; the urine calcium actually decreased in both treatment arms. However, the independent effect of calcium is unclear given that the amounts of animal protein and salt ingested among those in the low calcium diet differed from that of patients in the normal calcium diet group. Nonetheless, the low calcium intervention was not beneficial and is not recommended. -In addition to increasing stone formation, a low calcium diet may have a second deleterious effect in patients with idiopathic hypercalciuria: development of negative calcium balance. This extra loss of calcium can exacerbate the already diminished hone density in some of these patients, a complication that may be due to enhanced bone resorption. It should be noted that calcium supplements do not appear to be effective in preventing recurrent stones and may even slightly increase risk. - Ira patients with a history of stones who require calcium supplements (eg, .for the treatment of osteoporosis), a suggested approach is to measure urinary calcium excretion before and approximately one month after staing the calcium supplement. If there is a clinically impoant increase in urinary calcium excretion, then the addition of a thiazide diuretic may be useful to reduce urinary calcium excretion (and to help maintain bone density). Other factors High dose vitamin C appears to increases urine oxalate excretion in ceain individuals and the risk of stone .formation; thus, high dose supplements should be avoided in those with higher urine oxalate excretion. Phytate appears to decrease the risk of stones in women. Although not simply a matter of dietary intake, higher body mass index increases the risk of stone .formation, paicularly in women. Therefore, weight control may be helpful in preventing stone recurrence. Nothing has been mentioned about dietary phosphate restriction. - Most of the urinary phosphate is derived from dietary protein. - Dietary protein restriction results in decrease in phosphate in urine. Increase intake offluid - To reach this goal, the best strategy is to reconmzend how much additional fluid the patient should drink based on his or her 24 hour urine volume. As an example, if the total urine volume is 1.5 liters, then we recommend two additional 8 ounce (240 mL) glasses of .fluid each day to reach the goal of at least 2 liters of urine output per day. Limiting animal protein in the diet - Although it has not been proven that a low protein diet will reduce the incidence of stone formation, a high animal protein diet is a risk factor for renal stones in men, but not in women. Limiting dietary sodium to 100 meq/day - A low sodium diet can enhance proximal sodium and calcium reabsorption, leading to a reduction in calcium excretion. Increasing dietary potassium intake - As this substantially decreases risk in men and older women. Limiting dietary sucrose and fructose Limiting dietary oxalate and vitamin C in patients with calcium oxalate stones. - However, excessive limitation is not likely to be helpful; patients should continue to consume a wide variety of fruits and vegetables.

So the answer to this question is B


Instruction:
Submucosal plexus is -
A. Myenteric plexus
B. Auerbach's plexus
C. Meissner's plexus
D. Tympanic plexus

Response:
Ans. is 'c' i.e., Meissner's plexusInnervation of GITo The gastrointestinal tract has a nervous system all its own called the enteric nervous system. It lies entirely in the wall of the gut, beginning in the esophagus and extending all the way to the anus. The enteric nervous system is composed mainly of two plexus : -i) Myenteric plexus or Auerbach's plexusIt is an outer plexus lying between the longitudinal and circular muscle layer. The myenteric plexus controls mainly gastrointestinal motility, therefore, peristalsis requires an active myenteric plexus.ii) Meissner's plexus or submucosal plexusIt is an inner plexus that lies in the submucosa. The submucosal plexus controls mainly gastrointestinal secretion and local blood flow.o Extrinsic nerves (Parasympathetic and sympathetic) are connected to both myenteric and submucosal plexuses. The enteric nervous system can function independently of these extrinsic nerves and these extrinsic nerves only modify the activity of the enteric nervous system,\o Therefore, peristalsis is present even if the intestine is deprived of extrinsic innervation.o Parasympathetic stimulation enhances GI motility and secretion whereas sympathetic stimulation inhibits motility and secretions.

So the answer to this question is C


Instruction:
Most characteristic Feature of lichen planus is:
A. Thinning of nail plate is most common
B. Non scarring alopecia
C. Violaceous lesions on skin and mucous membrane
D. Wickham striae

Response:
D i.e. Wickham Striae

So the answer to this question is D


Instruction:
All of the following take part in the pathogenesis of macular edema in diabetic retinopathy except:
A. Retinal pigment epithelium dysfunction
B. Oxidative stress
C. VEGF
D. Increased protein kinase-C

Response:
Ans. is 'a' i.e. Retinal pigment epithelium dysfunction [Ref: Harrison 17/e, p 2286-2287; Yanoff & Duker 2/e, p 877-880, Khurana 3/e, p 256-258; Parson's 20/e, p 294-298; http://care.diabetesjoumals.org/cgi/content/full/26/912653JDiabetic retinopathy (DR) & diabetic macular edema (DME) are one of the microvascular complications of diabetes mellitus (DM)DR & DM are leading causes of blindness in most of the developed countries.Chronic hyperglycemia is an important etiological factor leading to complications of DM & following is the proposed mechanism So retinal vascular pathology is behind DR. Retinal layers are not primarily involved in pathogenesis of DRJDME. Diabetic retinopathyDR is a progressive disease that has following stages:Non apparent DRNon proliferative DR Proliferative DR Pathogenesis of DR: * International clinical diabetic retinopathy disease severity scale Proposed disease severity levelDilated ophthalmoscopy findings* No apparent retinopathyNo abnormalities* Mild nonproliferative DRMicroaneurysms only* Moderate nonproliferative DRMore than just microaneurysm, but less than severe NPDR* Severe nonproliferative DRNo signs of PDR, with any of the following: More than 20 intraretinal hemorrhages in each of four quadrantsDefinite venous beading in two or more quadrantsProminent intraretinal microvascular anomalies in one or more quadrants* PDROne or more of the following:NeovascularizationVitreous or preretinal hemorrhageDiabetic macular oedema:DME can develop any time during progression of DR & involves retinal thickening in the macular area.DME occurs after breakdown of the blood-retinal barrier because of leakage of dilated hyperpermeable capillaries and micro aneurysms. Leakage can be diffuse or focal resulting in focal or diffuse macular edema. * Clinically significant macular edema (CSME) occurs when only NPDR is present.Definition of CSME: CSME is when any one of 3 criterias is present -Retinal thickening involving macula or area within 500 pm of it orHard exudates at or within 500 pm of macula with thickening of adjacent retina orA zone of retinal thickening one disc area or larger in size, any part of which is within one disc diameter of macula.Also know -Circinate retinopathy is due to chronic edema involving a considerable area of retina at and around macula with massive changes in retina itself.

So the answer to this question is A


Instruction:
A healthy 22-year-old female medical student with normal kidneys decreases her sodium intake by 50% for a period of 2 months. Which of the following parameters is expected to increase in response to the reduction in sodium intake?
A. Aerial pressure
B. Atrial natriuretic peptide release
C. Extracellular fluid volume
D. Renin release

Response:
A reduction in sodium intake leads to a decrease in extracellular fluid volume and therefore a decrease in aerial pressure. The decrease in aerial pressure stimulates renin release, which in turn leads to an increase in the formation of angiotensin II. The angiotensin II increases the renal retention of salt and water (ie, decreases sodium excretion, which returns the extracellular fluid volume nearly back to normal. Atrial natriuretic peptide is released from the two atria of the hea as a result of an increase in the extracellular fluid volume. Therefore, a decrease in sodium intake would tend to decrease the release of atrial natriuretic peptide.

So the answer to this question is D


Instruction:
During disaster management the following condition would be classified under international code green signal
A. High priority treatment
B. Medium priority treatment
C. Ambulatory patient
D. Dead patients

Response:
None

So the answer to this question is C


Instruction:
Acute severe lung injury is characterised by-
A. Hypotension
B. Shunting
C. Cardiac tamponade
D. Cardiac irregularities

Response:
None

So the answer to this question is B


Instruction:
Umami taste is due to:
A. Glutamate
B. B. Sodium
C. H+
D. K+

Response:
Ans. A. Glutamatea. Umami is one of the five basic tastes, together with sweet, sour, bitter and salty. The human tongue has receptors for L-glutamate, which is the source of umami flavor.b. Saltiness is a taste produced primarily by the presence of sodium ionsc. Sourness is the taste that detects acidity.d. Sweetness is produced by the presence of sugars and a few other substances. Sweetness is often connected to aldehydes and ketones, which contain a carbonyl group. Sweetness is detected by a variety of G protein coupled receptors coupled to the G protein gustducin found on the taste buds.

So the answer to this question is A


Instruction:
A 48-year-old female nurse is seen with complaints of cough. She has been treated for "bronchitis" without much improvement. On exam, she is afebrile and has crackles in the upper zones of the lung field. PPD is negative and sputum for AFB is negative. CXR is shown.All of the following findings may be seen in this patient except
A. Uveitis
B. Skin lesion
C. Bony cysts
D. Hypocalcemia

Response:
A bilateral upper zone interstitial pattern is seen with hilar and paratracheal adenopathy. Lung volumes are normal. Cardiac size is normal. The physical signs are inconsistent with an infectious process. The CXR shows hilar, paratracheal LN, and parenchymal disease. Sarcoidosis may be associated with uveitis, skin lesions, bony cysts, and hypercalcemia, which is due to abnormal vitamin D metabolism. Sarcoidosis is a systemic disease of unknown etiology characterized pathologically by widespread development of noncaseating epithelioid cell granulomas, which may resolve or conve to fibrous tissue. The disease most commonly affects hilar lymph nodes and lungs, but uveitis and involvement of other organs such as the liver, spleen, skin, bone, and salivary glands are not rare. Lab studies may show anemia, leukopoenia, elevated SED rates, blood eosinophilia, hypercalcemia, hypercalciuria, and elevated levels of serum angiotensin-conveing enzymes. Half of the cases are detected incidentally on chest radiograph. Patients with adenopathy alone are usually asymptomatic, althoughpatients with pulmonary involvement may experience weight loss, fatigue, fever, cough, or shoness of breath. Hemoptysis is rare unless it is associated with end-stage sarcoidosis and a superimposed mycetoma. The disease is most common in African Americans, Pueo Ricans, and West Indians. Women are more susceptible than men. Diagnosis is usually confirmed by transbronchial biopsy, which can demonstrate granulomas despite the absence of radiographic evidence of this peribronchial disease. Adenopathy is the most common manifestation. Symmetrical, hilar, and classically right paratracheal involvement is seen. Unilateral hilar adenopathy is seen in less than 5% of cases. Peripheral "eggshell" lymph node calcification is occasionally seen. Pleural effusion is rare. Radiographic staging of sarcoid is as follows: Stage 0: normal finding, 10% at presentation, with the primary problem being nonpulmonary Stage 1: adenopathy without pulmonary disease, 50% at presentation Stage 2: adenopathy with pulmonary disease, 30% at presentation Stage 3: pulmonary disease without adenopathy, 10% at presentation Stage 4: pulmonary fibrosis, usually as a sequel to stage 3, rare at presentation Stage 1 disease resolves within a few years in most patients, and less than one-third of patients with stage I disease develop lung disease. Adenopathy is usually present when there is pulmonary disease. The lung involvement results from deposition of noncaseating granulomas along the lymphatic lining of the bronchial vascular bundles and interlobular septa. Findings include small, irregular interstitial and subpleural nodules throughout the lungs. Confluent interstitial infiltrates may be asymmetric, and cavitation is rare. The midzone and upper zone are most commonly involved, whereas the lung periphery and the bases are generally spared. Pulmonary involvement usually resolves but does progress to fibrosis in less than 20% of the cases, with architectural distoion, traction, and pleural thickening. The distribution is often patchy, in contrast to the peripheral lower lobe distribution of IPF. Occasionally, pulmonary sarcoidosis may appear as ground-glass opacities, patchy consolidation, or rounded "cannonball" infiltrates described as alveolar sarcoid.

So the answer to this question is D


Instruction:
In traumatic myostis ossificans, following are true except:
A. Hydroxyapatite deposition
B. Common in elbow injury
C. Periosteal hematoma & leakage
D. All

Response:
A i.e. Hydroxypatite deposition

So the answer to this question is A


Instruction:
Content of Na' in ringer lactate is meq/1-
A. 154
B. 12
C. 130
D. 144

Response:
Ans. is 'c' i.e., 130

So the answer to this question is C


Instruction:
FESS means
A. Factual endoscopic sinus surgery
B. Functional endonasal sinus surgery
C. Factual endonasal sinus surgery
D. Functional endoscopic sinus surgery

Response:
Ans. d (Functional endoscopic sinus surgery), (Ref. Scott Brown, Otolaryngology, 6th ed., 12, 29)Functional Endoscopic Sinus Surgery (FESS) is based on the philosophical concept that function can be restored to the paranasal sinuses and normal structures can be preserved through removal of minimal amounts of tissue. This concept embodies a new understanding of the pathophysiology and development of sinus disease and requires a more delicate, minirealist approach to sinus surgery than the extirpative procedures of the past. These techniques were developed by Walter Messerklinger of Graz, Austria. Uncinectomy is 1st step of FESS.

So the answer to this question is D


Instruction:
All are pas of anterior segment of eye except?
A. Lens
B. Cornea
C. Vitreous
D. None

Response:
Ans. is 'c' i.e., Vitreous The eyeball is divided into two segments : ? Anterior segment Pa of eyeball anterior to posterior border of lens is called anterior segment. It consists of lens, and structures anterior to it, i.e., cornea, iris and two aqueous humor-filled spaces, i.e., anterior and posterior chambers. Anterior chambers : - It is bounded anteriorly by back of cornea and posteriorly by the iris & pa of ciliary body. It contains aqueous humor. Posterior chamber : - This triangular chamber is bounded anteriorly by the posterior surface of the iris & ciliary body and posteriorly by the lens and it zonules. It also contains aqueous humor. Thus, both anterior and posterior chambers are pa of anterior segment and both contain aqueous humor. Posterior segment Pa of eye ball posterior to lens is called posterior segment. It consists of vitreous humor, retina, choroid and optic disc.

So the answer to this question is C


Instruction:
The karyotype of a patient with Androgen Insensitivity Syndrome is:
A. 46XX
B. 46XY
C. 47XXY
D. 45X0

Response:
Androgen Insensitivity Syndrome is the largest single entity that leads to 46, XY undermasculinization. AIS is divided into three categories that are differentiated by the degree of genital masculinization: Complete Androgen Insensitivity Syndrome (CAIS) is indicated when the external genitalia is that of a normal female, Mild Androgen Insensitivity Syndrome (MAIS) is indicated when the external genitalia is that of a normal male, and Paial Androgen Insensitivity Syndrome (PAIS) is indicated when the external genitalia is paially, but not fully masculinized. Ref:Kligman, Behrman, Jenson, Stanton (2008), Chapter 589, "Disorders of Sex Development", In the book, "Nelson's Textbook of Pediatrics", Volume 2, 18th Edition, New Delhi, Page 1164

So the answer to this question is B


Instruction:
acute and chronic renal failure can be differentiated by?
A. anemia in CRF
B. hyperphosphatemia in CRF
C. peripheral neuropathy in CRF
D. d)

Response:
Ans c (peripheral neuropathy in CRF) ref: Harrison 17th ed 1755Findings that suggest chronic kidney disease include anemia, evidence of renal osteodystrophy (radiologic or laboratory), and small scarred kidneys, anemia may also complicate ARF ARF with hyperphosphatemia:rhabdomyolysisUrate nephropathytumor lysis syndromeNormal renal size with chronic renal disease-diabetic nephropathy, amy-loidosis, polycystic kidney disease, HIV associated nephropathy. Periph-eral neuropathy is unlikely in ARF.

So the answer to this question is C


Instruction:
All of the following statements about Emphysema are true. Except:
A. Breathlessness is the charachteristic presenting symptom
B. Diffusion rate of carbon monoxide is reduced
C. Restrictive pattern on pulmonary function test is seen
D. Long term bronchadilater therapy does not improve lung function

Response:
Answer is C (Restrictive pattern on pulmonary function test is seen): The hallmark of Emphysema is air flow obstruction and pulmonary function tests show an obstructive pattern Breathlessness (Dyspnea) is a charachteristic presenting symptom The three most common symptoms in COPD (emphysema) are cough, sputum production and exeional dyspnea Obstructive (and not Restrictive) pattern is seen on PFT The hallmark of Emphysema (COPD) is airflow obstruction. PFT shows airflow obstruction with a reduction in FEV i/FVC (< 0.7) Diffusion of carbon monoxide is Reduced (4DLCO) Three main categories of disease with Reduced DLCO are: Interstial Lung disease Emphysema Pulmonary vascular Disease Long term bronchodilater therapy does not improve lung; function `Bronchodilators do not alter the inexorable decline in lung function that is a hallmark of the disease' -CMDT 2008/219 The only drug therapy that is documented to improve the natural history (lung function) of COPD patients is supplemental oxygen in those patients with resting hypoxemia -CMDT 09/230 The only three interventions that influence the natural history of COPD patients Smoking cessation Oxygen therapy in chronically hypoxemic patients Lung volume reduction surgery in selected patients with emphysema

So the answer to this question is C


Instruction:
Enophthalmos is due to plasy of-
A. Levator palpebrae superioris
B. Superior tarsal muscle
C. Orbitalis muscle
D. Tenon's Capsule instability

Response:
*Tenon's capsule instability is a major cause of enophthalmos, as it forms all the major ligament of the orbit which suppo the globe in the orbit. Ref: Duane's Clinical ophthalmology, vol.2, chapter 48, p.5

So the answer to this question is D


Instruction:
Which of the following condition is associated with a loss of attenuation reflex?
A. Stapedial palsy
B. Glomus tumor
C. Internal ear pathology
D. Malingerers

Response:
In stapedial palsy, damage to the nerve result in a reduction in sound attenuation reflex resulting in sound being heard excessively loud in the affected ear (hyperacusis). Attenuation reflex: When very loud sound is transmitted through the ossicular system to CNS a reflex is initiated with a latent period of 40 to 80ms. This reflex causes contraction of tensor tympani and stapedius muscle. Contraction of these two muscles make the ossicular system rigid and therefore it fails to vibrate with the sound wave. Thus sound is not allowed to enter inner ear or its intensity is reduced by 30 to 40 decibels.

So the answer to this question is A


Instruction:
Shingles caused by infection with:
A. Varicella zoster virus
B. Herpes simplex virus
C. Human papilloma virus
D. Epstein-Barr virus

Response:
Ref. Robbins Pathology. 9th edition. Page. 358

So the answer to this question is A


Instruction:
The recommended level of fluorides in drinking water in this Country is accepted as
A. 0.5 to 0.8 mg per litre
B. 1 to 2 mg per litre
C. 3 to 6 mg per litre
D. 7 to 12 mg per litre

Response:
None

So the answer to this question is A


Instruction:
Mitral valve vegetations do not embolise usually to
A. Brain
B. Liver
C. Spleen
D. Lungs

Response:
Ans. is 'd' i.e., Lungs o It is very simple question, vegetations from left side (mitral valve) embolize to systemic vasculatures as blood of from left side of hea goes to systemic circulation (not pulmonary circulation) o On the other hand, vegetations from right side (tricuspid valve) embolize to pulmonary vasculatures.

So the answer to this question is D


Instruction:
A 54-year-old man undergoes laparoscopic hernia repair. In spite of the small size of the incisions, he has poor wound healing. Further history reveals that his usual diet has poor nutritional value and is deficient in vitamin C. Synthesis of which of the following extracellular matrix components is most affected by this deficiency?
A. Collagen
B. Elastin
C. Fibronectin
D. Integrin

Response:
Vitamin C deficiency leads to scurvy, with reduced lysyl oxidase enzyme activity that helps cross-link fibrillar collagens to provide tensile strength. Though elastin is a fibrillar protein, it tends to regenerate poorly in scar tissue, even with the best of nutrition, explaining why a scar does not stretch like the skin around it. The other listed choices are glycoproteins that have an adhesive quality and are not vitamin C dependent.

So the answer to this question is A


Instruction:
Rotting fish urine odour is seen in?
A. Hawkinsuria
B. Phenylketonuria
C. MSUD
D. Trimethylaminuria

Response:
Maple syrup urine disease Maple syrup/Burnt sugar Hypermethioninemia Boiled cabbage Multiple carboxylase deficiency Tomcat urine Oasthouse urine disease Hopslike Phenylketonuria Mousy or musty Trimethyl aminuria Rotting fish Tyrosinemia Boiled cabbage, rancid butter

So the answer to this question is D


Instruction:
Dew drops on rose petal appearance is seen infection with -
A. Varicella zoster virus
B. Herpes genitalis
C. Candida
D. T. rubrum

Response:
Ans. is 'a' i.e., Varicella zoster virus Chickenpox - Varicella Zoster virus infectiono Etiology : Varicella-zoster virus,o Prodrome : Fever and malaise.o Morphology : Crops of papules with erythematous halo; rapidly become vesicular (dew drops on rose petal appearance), then pustular. Eruption at different stages present. Heal with minimal scarring unless complicated by secondary' infection or hemorrhagic lesions (as seen in immunocompromised). Adults usually have a more severe eruption.o Site : Centripetal distribution.o Prophylaxis : Live attenuated vaccine.o Treatment : Specific antiviral therapy (acyclovir 800 mg, five times daily x 7-10 days) in adults and in immunocompromised individuals. None needed in children.

So the answer to this question is A


Instruction:
Which of the following is not true about testicular tumor?
A. About 95% are embryonal tumors
B. 10% are bilateral
C. Pulmonary metastases suggest that the tumor is teratoma
D. Lymphatic spread is to retroperitoneal and intrathoracic lymph nodes

Response:
About 95% of testicular tumours are Germ cell tumours. Embryonal carcinoma is a type of non seminomatous germ cell tumour. Pure embryonal carcinoma constitutes 30% of germ cell tumours but areas of embryonal carcinoma are present in about 40% of germ cell tumours. Teratomas spreads mainly through blood ( to lungs, liver, brain etc) , less commonly through lymphatics.Lymphatic spread occurs to retroperitoneal, para-aoic, mediastinal and left supraclavicular nodes.Reference : page 1083 SRB's manual of surgery 5th edition and page 708 textbook of pathology Harshmohan 6th edition

So the answer to this question is A


Instruction:
A male patient 59 year old complains of multiple swellings in the neck, fever, and weight loss. He gives a history of hypertension treatment. General examination reveals painless lymph nodal enlargement in the neck and on blood investigation, anaemia is revealed. Lymph node biopsy shows typical owl eye-shaped appearance cells.
What can be the most probable diagnosis for this patient?
A. Multiple myeloma
B. Hodgkin’s lymphoma
C. Non-hodgkin’s lymphoma
D. Burkitt’s lymphoma

Response:
Hodgkin lymphoma, like NHL, usually manifests  as  painless  lymphadenopathy.  Although  a definitive  distinction  from  NHL  can  be  made  only  by examination  of  a  tissue  biopsy,  several  clinical  features favor  the  diagnosis  of  Hodgkin  lymphoma.   After the diagnosis is established, staging is used to guide therapy  and  determine  prognosis.
Younger patients with more favorable subtypes tend to present with stage I or stage II disease and usually are free of so-called “B symptoms” (fever, weight loss, night sweats). Patients with advanced disease (stages III and IV) are more likely to  exhibit  B symptoms  as  well  as  pruritus  and  anemia.
The sine qua non of Hodgkin lymphoma is the Reed-Sternberg (RS) cell, a very large cell (15 to 45 µm in diameter) with an enormous multilobate nucleus, exceptionally prominent nucleoli, and abundant, usually slightly eosinophilic cytoplasm. Particularly characteristic are cells with two mirror-image  nuclei  or  nuclear  lobes,  each  containing  a  large (inclusion-like)  acidophilic  nucleolus  surrounded  by  a clear zone, features that impart an owl-eye appearance.

Difference between Hodgkin Lymphoma and Non-Hodgkin Lymphoma

So the answer to this question is B


Instruction:
All of the following drugs are used in hypertensive crisis except:
A. Labetalol
B. Pindolol
C. Nitroprusside
D. Nifedipine

Response:
Ans. B. PindololLabetalol is used as hypertensive emergency in pregnancy, nitroprusside is given in patients with aortic dissection. Nifedipine though rarely used, can be given as sublingual therapy for rapid control of blood pressure.

So the answer to this question is B


Instruction:
A 50 year old male presents with malignant hypeension. the drug of choices
A. Sodium nitroprusside
B. Sublingual nifedipine
C. Furosemide
D. Enalapril

Response:
It is a first choice drug for malignant hypeension Refer kDT 11e p185

So the answer to this question is A


Instruction:
Most common inherited thrombotic disorder is -
A. Protein C deficiency
B. Protein S deficiency
C. Factor V leiden mutation
D. tPA deficiency

Response:
None

So the answer to this question is C


Instruction:
Epidemic typhus causes & vector
A. R. typhi & mite
B. Rickettessia prowazki & louse
C. R. conori & tick
D. R. akari & mite

Response:
None

So the answer to this question is B


Instruction:
Sun ray appearance is seen in – a) Osteosarcomab) Ewing sarcomac) Osteoclastomad) Multiple myeloma
A. ac
B. ab
C. ad
D. bc

Response:
Sunray appearance is classically seen in osteosarcoma. It may also occur in metastases, Ewings sarcoma, Haemangioma, Meningioma and tuberculosis.

So the answer to this question is B


Instruction:
SAFE strategy for Trachoma includes all of the following except:
A. Screening
B. Antibiotic
C. Face wash
D. Environmental improvement

Response:
A i.e. Screening

So the answer to this question is A


Instruction:
Ring scotoma is seen in: September 2012
A. Glaucoma
B. Retinitis pigmentosa
C. Sympathetic ophthalmia
D. Vitreous hemorrhage

Response:
Ans. B i.e. Retinitis pigmentosa

So the answer to this question is B


Instruction:
A young female has the following lab values : MCV-70 Hb 10 gm% serum iron 60, serum feritin 100,the diagnosis is -
A. Thalassemia trait
B. Chronic iron deficiency anemia
C. Megaloblastic anemia
D. Anaemia of chronic infection

Response:
None

So the answer to this question is D


Instruction:
All arc atypical antipsychotic drugs except
A. Clozapine
B. Risperidone
C. Olanzapine
D. Loxapine

Response:
Atypical antipsychotic Clozapine Risperidone Olanzapine Quetiapine Aripiprazole Ziprasidone Other hetrocyclics Pimozide, Loxapine Ref: K D Tripathi 8th edition

So the answer to this question is D


Instruction:
Which of the following is not expected in a case of Microcytic Hypochromic anemia -
A. Reduced serum Iron
B. Reduced total RBC distribution width
C. Normal Ferritin levels
D. Increased TIBC

Response:
Ans. is 'b' i.e., Reduced total RBC distribution width o Microcytic hypochromic anemias are typically associated with a normal or High Red Cell distrubution width.MCV||||LowNormalHigh|||RDWRDWRDW|||||||||IncreasedNormalIncreasedNormalIncreasedNormalo Iron deficiencyo Thalassemiao Red cell fragmentationo Hemoglobin Ho Chronic diseaseo Heterogenous thalassemiao Myelofibrosis o Sideroblustic anemiao Chronic diseaseo Hemorrhageo Hemolysiso Transfusiono HbAc, Aso Hereditary spherocytosiso Folate or B12 deficiencyo Immunehemolytic anemiao WBC leukemiao Aplastic anemiao Preleukemia

So the answer to this question is B


Instruction:
Flaccid Bullae lesions with oral mucosal lesion. The finding in immunofluoscence is aEUR'
A. Fish net IgG in epidermis
B. Linear IgG in dermo epidermal junction
C. Granular IgA in dermal papillae
D. Linear IgA in reticular dennis

Response:
Fish net IgG in epidermis Child with multiple flaccid bullae along with oral mucosal lesions suggests pemphigus. All patients suspected of having pemphigus should be evaluated inzmunopathologically. Immunofluorescene findings in common billions disorders Direct immunotlorescence Indirect immunoflorescence * Petriphigig IgG intercellular depositsQ Circulating IgG to cell in epidermis "(fish net pattern)" surface of epidermal cells These titres correlate with disease activity. * MMus C3 and IgG linear hand at Circulating IgG (in 70% pemphigoid Dermoepidermal junction2 patients that hind to base? ment inenthrone. * Chronic hull ous IgA, linear band at denno- Low titre of circulating disease of child- epidennaljunctionQ IgA hood (Linear IgA dermatosis of childhood) * Dermatitis IgA (-1- 0), granular deposit Circulating immune herpetiformis at dermal papillary tipsdeg complexes in less than 50%

So the answer to this question is A


Instruction:
A child presents with lid lag and an enlarged cornea with a diameter of 13 mm. Examination of the eye reveals double contoured opacities concentric to the limbus. Which of the following is the most likely diagnosis?
A. Superficial keratitis
B. Deep keratitis
C. Thyroid Endocrinopathy
D. Congenital Glaucoma

Response:
Ans. (d) Congenital GlaucomaRef: Kanski 7/e, p. 374; Parson's 22/e, p. 304; Shields 6/e, p. 210, 223An enlarged globe with an enlarged corneal diameter > 13 mm along with characteristic Haabs striae (double contoured opacities concentric to limbus) suggests the diagnosis of congenital glaucoma.

So the answer to this question is D


Instruction:
During surgical exploration for hydatid cyst of the liver, any of the following agents can be used as scolicidal agent except -
A. Hypeonic sodium chloride
B. Formalin
C. Cetrimide
D. Povidone Iodine

Response:
Ans. is 'd' i.e., Povidone Iodine

So the answer to this question is D