Instruction:
Which of the following is the most reliable method of identification of an individual?
A. Scars
B. Anthropometry
C. Dactylography
D. Handwriting

Response:
Dactylography - The finger print system is the most reliable method of identification of an individual. Fingerprints are impressions of pattern formed by papillary or epidermal ridges of the finger prints. The ridge pattern of fingers appear between 12 -16 weeks of intrauterine life and the formation is completed by 24 weeks. Finger print patterns are classified as loops, whorls, arches and composite. Commonly used powder for lifting fingerprints is grey powder (chalk+Hg) & white powder (French chalk + PbCO3). Ref:The Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, Pages 75-6

So the answer to this question is C


Instruction:
Koilocytes with perinuclear halo on pap smear is pathognomic of?
A. HPV infection
B. Metaplasia
C. Dysplasia
D. Bacterial vaginosis

Response:
ANSWER: (A) HPV infectionREF: Shaw's Gynecology 13th ed p- 78, The pap test by Richard M. DeMay page 49-50"Koilocytes, dyskeratocytes, macrocytes, etc. are some of the cytologic findings that are characteristic of condylomas (HPV). Koilocytes with perinuclear halo is pathognomonic of HPV infection"ConditionType of cellEstrogen dominated uterusNormal cornified cellsProgesterone dominated uterusIntermediate cellspregnancyIntermediate cells , Navicular cellsmenopausalBasal, parabasalHPVKoilocytes, dyskeratocytes, macrocytes with perinuclear halo.

So the answer to this question is A


Instruction:
According to American society of Anaesthelogists the physical status of a patient with severe incapacitating systemic disease that is a constant threat to life may be classified as:
A. ASA 1
B. ASA 2
C. ASA 3
D. ASA 4

Response:
None

So the answer to this question is D


Instruction:
Derivatives of HINDGUT are all except:
A. Urinary Bladder
B. Rectum
C. Uterus
D. Anal Canal

Response:
Ans. C. UterusDerivatives of the three parts of the primitive gutForegut* Floor of mouth* Tongue* Pharynx* Derivatives of pharyngeal pouches* Thyroid* Esophagus* Respiratory system* Stomach* Proximal (upper) half of the duodenumMidgut* Liver* Pancreas* Extrahepatic biliary system* Distal (lower) half of the duodenum* Jejunum* Ileum* Cecum and appendix* Ascending colon* Right two-third of transverse colonHindgut* Left one-third of transverse colon* Descending colon* Sigmoid (pelvic) colon* Rectum* Upper part of the anal canal

So the answer to this question is C


Instruction:
Pancytopenia with hypercellular marrow may be seen due to all of the following except:
A. Myelodysplasia
B. Paroxysmal Nocturnal Hemoglobinuria
C. Dyskeratosis congenita
D. Sarcoidosis

Response:
Answer is C (Dyskeratosis Congenita ) Dyskeratosis congenita (constitutional aplastic anemia) is associated with Pancytopenia and a Hypocellular bone marrow Myelodysplasia, PNH and Sarcoidosis may all be associated with Pancytopenia and a cellular bone marrow

So the answer to this question is C


Instruction:
A 15 year old child presents with falling school grades and development of abnormal posture. On examination dystonia and increase muscle tone is noted. Slit lamp examination shows presence of KF ring. Liver biopsy for copper will be stained by which of the following stain?
A. Perl stain
B. Rubeanic acid
C. Supravital stain
D. Schmorl's method

Response:
Rubeanic acid and Rhodamine stains are utilized to detect the cytoplasmic accumulation of copper in the liver. Schmorl's method is used for detecting melanin and uses the reducing propeies of melanin to stain granules blue-green. It is also used to detect lipofuscin.

So the answer to this question is B


Instruction:
A married middle aged female gives history of repeated aboions for the past 5 years. The given below is conceptions pre-natal karyogram. This karyogram suggests the following -
A. Klinefelter's syndrome
B. Turner's syndrome
C. Down's syndrome
D. Patau's syndrome

Response:
Ans. is 'c' i.e., Down's syndrome Most common chromosomal abnormalies causing aboion are chromosomal trisomy. Trisomy 21 is synonymous with down's syndrome and is the most common of the chromosomal disorders Trisomy 21 DOWN SYNDROME Trisomy 18 EDWARD SYNDROME Trisomy 13 PATAU SYNDROME

So the answer to this question is C


Instruction:
The normal P wave is inveed in lead :
A. LI
B. LII
C. aVF
D. aVR

Response:
Answer is D (aVR) The normal P wave is negative (inveed) in lead aVR. Characteristics of a Normal P Wave P wave results from spread of electrical activity through the atria (Atrial Depolarization) A normal p wave indicates that the electrical impulse responsible for the p wave originated in the sinus node and the normal depolarization of the right and left atria has occurred Normal P Wave is rounded, neither peaked nor notched. Width or duration of the P wave in time is 0.10 seconds or 2.5 small squares Height of the P wave is 2.5 mm (2.5 small squares) Sinus P waves are best seen in Lead II and V1 P wave is upright in most leads, mainly L1 L11 and aVF P Wave is inveed in aVR (and occasionally in aVL) P wave in VI may be biphasic with equal upward and downward deflection, notched and wide. Activation of right atrium produces positive component and activation of left atrium produces negative component. There should be one p wave preceding each QRS complex. More than one p wave before a QRS complex indicates a conduction disturbance.

So the answer to this question is D


Instruction:
Which of the following is associated with destruction of myenteric plexus?
A. Hirschsprung disease
B. Secondary Achalasia
C. HPSS
D. GIST

Response:
12 Ans. is 'b' i.e., Secondary achlasia * Secondary achalasia may arise in Chagas disease, in which Trypanosoma cruzi infection causes destruction of the myenteric plexus, failure of peristalsis, and esophageal dilatation.

So the answer to this question is B


Instruction:
A chronic alcoholic presenting with bleeding gums and petechiae is more likely to have deficiency of:
A. Vitamin B12
B. Vitamin C
C. Thiamine
D. Pyridoxine

Response:
Ans: B (Vitamin C) Ref: Harrison's Principles of Internal Medicine, 18th edExplanation:Principal Clinical Findings of Vitamin MalnutritionNutrientClinical FindingDietary Level per Day Associated with Overt Deficiency in AdultsContributing Factors to DeficiencyThiamine* Beriberi* Neuropathy* Muscle weakness* Wasting* Cardiomegaly* Edema* Ophthalmoplegia* Confabulation<0.3 mg/1000 kcalAlcoholism,chronic diuretic use hyperemesisRiboflavin* Magenta tongue* Angular stomatitis* Seborrhea* Cheilosis<0.6 mg Niacin* Pellagra* Pigmented rash of sun-exposed areas* Bright red tongue* Diarrhea* Apathy* Memory toss* Disorientation<9.0 niacin equivalentsAlcoholismVitamin B6 deficiency Riboflavin deficiency Tryptophan deficiencyVitaminB6* Seborrhea* Glossitis* Convulsions* Neuropathy* Depression* Confusion* Microcytic anemia: <0.2 mgAlcoholismIsoniazidFolate* Megaloblastic anemia* Atrophic glossitis* Depression* | Homocysteine<100 mcg/dAlcoholism.Sulfasalazine PyrimethamineTriamtereneVitaminB12* Megaloblastic anemia* Loss of vibratory and position sense* Abnormal gait* Dementia* Impotence* Loss of bladder and bowel control* | Homocysteine* |Methylmalonic acid<1.0 mcg/dGastric atrophy (pernicious anemia) terminal ileal disease, strict vegetarianism, acid- reducing drugs (e.g., H2. blockers)Vitami n C* Scurvy* Petechias* Ecchymosis* Coiled hairs* Inflamed and bleed, ng gums* Joint effusion* Poor wound healing<10 mg/dSmokingAlcoholismVitamin A* Xerophthalmia* Night blindness* Bitot's spots* Follicular hyperkeratosis* Impaired embryonic development* Immune dysfunction<300 mcg/dFat malabsorption.InfectionMeaslesAlcoholismProtein-energymalnutritionVitamin D* Rickets* Skeletal deformation* Rachitic rosary* Bowed legs* Osteomalacia<2 0 mcg/dAging, lack of sunlight exposure, fat malabsorption, deeply pigmented skinVitamin E* Peripheral neuropathy* Spinocerebellar ataxia* Skeletal muscle atrophy* RetinopathyNot described unless underlying contributing factor is presentOccurs only with fat malabsorption or genetic abnormalities of vitamin E metabolism/transportVitamin K* Elevated prothrombin time* Bleeding<10 mcg/dFat malabsorption, fiver disease, antibiotic use

So the answer to this question is B


Instruction:
A 5-year-old girl is admitted to your Paeds ward. The parents give the history that the child has had recurrent, intermittent episodes of fever and respiratory distress over the past 1.5 years, including cough, wheezing, and dyspnea lasting for 3-4 days. With every episode, hemoptysis is present. Now she is diagnosed with Right lower lobe pneumonia which improves upon treatment. On physical examination, the patient is pale, icteric with digital clubbing. Which of the following is the most appropriate next Investigation?
A. Modified barium swallow study to evaluate for aspiration
B. Bronchoalveolar lavage
C. Nasal swab for viral culture
D. Incentive spirometry

Response:
Above Findings are most likely suggestive of a diagnosis of Idiopathic Pulmonary Hemosiderosis. Clinical feature:- Hemoptysis with wheezing, cough, dyspnea (reflecting bronchospasm) and non-pulmonary symptoms such as failure to thrive or jaundice. During an acute exacerbation, children are frequently febrile. Examination of the chest may reveal retractions and differential or decreased aeration, with crackles or wheezes. Investigation Flexible bronchoscopy - Areas of active bleeding. Bronchoalveolar lavage - pulmonary secretions may be sent for pathologic review (which may show hemosiderin laden macrophages) and culture analysis Chest x-ray- Infiltrates are typically symmetric with apices spared Lung biopsy may be required. Treatment Suppoive therapy, including volume resuscitation, ventilatory suppo, supplemental oxygen, and transfusion of blood products Specific Treatment- Methylprednisolone

So the answer to this question is B


Instruction:
Classical phenylketonuria is caused by a deficiency of
A. Phenylalanine transaminase
B. Phenylalanine hydroxylase
C. Tyrosine transaminase
D. Tyrosine hydroxylase

Response:
Classical phenylketonuria (hyperphenylalaninemia type I) → Deficiency of phenylalanine hydroxylase.
Atypical phenylketonuria (hyperphenylalaninemia type II and III) → Defect in dihydrobiopterin reductase.
Hyperphenylalaninemia type IV and V → Defect in dihydrobiopterin synthesis.

So the answer to this question is B


Instruction:
In children below 5 years of age, most common cause of gingivitis is
A. local irritating factors
B. herpes
C. vitamin deficiency
D. malocclusion

Response:
None

So the answer to this question is A


Instruction:
The cause of homogenous opacity on X-ray is all except –
A. Pleural effusion
B. Diaphragmatic Hernia
C. Massive consolidation
D. Emphysema

Response:
Emphysema produces blackening (not opacity) due to increased air.
Homogeneous opacity is produced by consolidation, pleural effusion, hemothorax and diaphragmatic hernia.

So the answer to this question is D


Instruction:
An 80-year-old man is brought to dermatology OPD by his son for recently noticed skin lesion. A biopsy is carried out with HPE as shown. Which of the following option cannot be used as a management for the above clinical scenario?
A. Moh's micrographic surgery
B. Photodynamic therapy
C. Electrodessication
D. NONE

Response:
All of the given options are used in the management of the basal cell carcinoma. Skin lesion shows pearly rolled telangiectatic borders with central ulceration suggestive of BCC. HPE: shows lobulated nest of neoplastic cells with retraction and palisaded basal layer. Findings are suggestive of BASAL CELL CARCINOMA. Treatments options for Basal Cell Cancer include electrodesiccation and curettage (ED&C) excision cryosurgery radiation therapy () laser therapy Mohs micrographic surgery (MMS) topical 5-fluorouracil photodynamic therapy (PDT) topical immunomodulators such as imiquimod The choice of therapy depends on tumor characteristics depth location patient age, medical status patient preference.

So the answer to this question is D


Instruction:
Duputryens contracture commonly affects: September 2005
A. Little finger
B. Ring finger
C. Middle finger
D. Index finger

Response:
Ans. B: Ring Finger Dupuytren's contracture is more common among people with diabetes, alcoholism, or epilepsy. Dupuytren contracture, a disease of the palmar fascia, results in the thickening and shoening of fibrous bands in the hands and fingers. The ring finger is the one affected most commonly. It is usually limited to the medial three fingers. This disease entity belongs to the group of fibromatoses that include plantar fibromatosis (Ledderhose disease), penile fibromatosis (Peyronie disease), and fibromatosis of the dorsal proximal interphalangeal (PIP) joints (Garrod nodes or knuckle pads).

So the answer to this question is B


Instruction:
The contraceptive TODAY which has been recently introduced contains :
A. Prostaglandin F2
B. Norethisterol
C. 9 - Nonoxynol
D. Copper releasing mesh

Response:
9 - Nonoxynol

So the answer to this question is C


Instruction:
Howel-Jolly bodies may be seen after
A. Hepatectomy
B. Splenectomy
C. Pancreatectomy
D. Cholecystectomy

Response:
Howell-Jolly bodies are purple nuclear remnants, usually found singly, and are larger than basophilic stippling. They are present in megaloblastic anaemia and after splenectomy TEXTBOOK OF PATHOLOGY 6TH EDITION HARSH MOHAN PAGE NO:293 IMAGE REF:

So the answer to this question is B


Instruction:
Which of the following organisms is commonly implicated in spontaneous bacterial peritonitis in patients of Nephrotic syndrome?
A. Staphylococcus
B. Streptococcus pneumoniae
C. Hemophilus influenza
D. Salmonella

Response:
Ans. B. Streptococcus pneumoniaeSpontaneous bacterial peritonitis (SBP), an infection of ascitic fluid without a definitive intra-abdominal source that can be surgically treated. Polymorphonuclear neutrophilic leukocyte (PMN) counts, starting at 250cells/mL are considered valid markers for SBP. Streptococcus pneumoniae as the most common streptococcal organism. Other organisms implicated include Escherichia coli and Klebsiella spp, Enterococcus spp and S. aureus.

So the answer to this question is B


Instruction:
Malignant tumor associated with Waldenstrom macroglobulinemia includes -
A. Smoldering myeloma
B. Primary effusion lymphoma
C. Mycosis fungoides
D. Lymphoplasmacytic lymphoma

Response:
Waldenstrom macroglobulinemia is a syndrome in which high levels of IgM lead to symptoms related to hyperviscosity of the blood. It occurs in older adults , most commonly associated with lymphoplasmacytic lymphoma. Smoldering myelomas an uncommon variant of multiple myeloma defined by a lack of symptoms and a high plasma M component. Primary effusion lymphoma presents as a malignant pleural or ascitic effusion in patients with advanced HIV and older adults. Mycosis fungoides is a slowly evolving cutaneous T cell lymphoma occuring in middle aged adult males. Reference; Robbins and Cotran Pathologic basis of disease.South Asia Edition volume 1.page no. 596,598 Harsh Mohan textbook of pathology, 7th edition.Pg no.359

So the answer to this question is D


Instruction:
'Lucid Interval' may be seen in
A. Intracerebral haemorrhage
B. Insanity
C. Subdural haemorrhage
D. Alcohol

Response:
Lucid interval- This is a period occurring in insanity during which all the symptoms of insanity disappear completely. Lucid interval refers to a brief period during which an insane person regains sanity that is sufficient to regain the legal capacity to contract and to act on his/her own behalf. Ref ganong's review of medical physiology 25e

So the answer to this question is B


Instruction:
Prinzmetal angin a is-
A. Angina after extreme exertion
B. Caused due to atherosclerotic blockade
C. Caused due to spasm of artery
D. Calcium channel blockers not effective

Response:
Ans. is 'c' i.e., Caused due to spasm of artery o Variant angina (VA) which is also referred to as Prinzmetal angina, is a clinical entity characterized by episodes of anein a pectoris, usually at restand often between midnight and early morning, in association with ST-segment elevation on the electrocardiogram (ECG) Episodes are triggered by coronary artery vasospasm, which generally occurs in the absence of high grade coronary artery stenosis.o Variant angina has characteristics that allow it to be distinguished from stable angina pectoris, unstable angina, or microvascular angina.Pathogenesiso Variant angina (VA) is usually caused by focal spasm (of the smooth muscle layer of the arterial wall) of a major coronary artery, resulting in a high-grade obstruction.o Vascular smooth muscle hyper-reactivity is thought to be central to the pathogenesis of variant angina.o Spasm occurs in the absence of any preceding increase in myocardial oxygen demand (eg, exercise) and innormal or diseased vessels.Clinical presentationo Patients with variant angina typically present with a chronic pattern of recurrent episodes of chest pain,o The quality of the chest pain is indistinguishable from classical angina pectoris associated with obstructive coronary artery disease; however, the context in which it occurs differs.o In particular, patients with variant angina report that their episodes are predominantly at rest and that many occur from midnight to early morning.o Each episode of chest pain generally lasts 5 to 15 minutes.Diagnosiso The diagnosis of variant angina is made when a patient with recurrent episodes of anginal type chest pain, which generally occur at rest, is found to have transient ST-segment elevation on an electrocardiogram at the time ofan episode and subsequently found to not have high grade coronary stenoses at coronar\> arteriography.ManagementSmoking cessationo As smoking cessation removes one of the triggers for variant angina and leads to a significant decrease in the frequency of episodes, at least in the short term, smoking cessation should be encouraged.Nitrates and calcium channel blockerso Calcium channel blockers (nifedipine, diltiazem, and verapamil) and nitrates are effective as chronic therapies for variant angina.o Both present vasoconstriction and promote vasodilation in the coronary vasculature.o For patients who do not have acceptable improvement in symptoms on calcium channel blocker therapy, add a long-acting nitrate.Rho kinase inhibitorso Fasudil is a rho kinase inhibitor that has been shown to inhibit acetylcholine-induced spasm.Statinso Statins have been shown to be effective in preventing coronary# spasm and may exert their benefits via endothelial nitric oxide or direct effects on the vascular smooth muscle.

So the answer to this question is C


Instruction:
All are features of Wallenberg's syndrome, Except:
A. Ipsilateral loss of pain and temperature
B. Ipsilateral loss of taste sensation
C. Ipsilateral loss of posterior column sensations
D. Ipsilateral involvement of lower cranial nerves

Response:
Answer is A (Ipsilateral loss of pain and temperature): Pain and temperature sense are lost over opposite side of lesion due to involvement of spinothalamic tract. Symptom Pain numbness, impaired sensation over half the face Nystagmus, diplopia, oscillopsia, veigo, nausea vomiting Dysphagia hoarseness, paralysis of palate, paralysis of vocal cord (lower cranial nerve involvement) Ataxia, fall of side of lesion Loss of taste Homer's syndrome Numbness of ipsilateral arm, trunk & leg

So the answer to this question is A


Instruction:
True statement about unconjugated hyperbilirubinemia
A. 85% of the total should be indirect
B. Seen in hemolytic anemia
C. Seen in is hemoglobin destruction (T bilirubin production)
D. All

Response:
Answer is A, B, C (85% of the total should be indirect, Hemolytic anemia, Seen in | hemoglobin destruction (| bilirubin production) Unconjugated Hyperbilirubinemia is associated with > 85% indirect bilrubin or less than 15% of direct bilirubin. Hemolytic disorders and increased hemoglobin destruction cause unconjugated or indirect hyperbilirubinemia. Biliary atresia and neonatal hepatitis lead to conjugated hyperbilirubinemia.

So the answer to this question is D


Instruction:
The most sensitive and practical technique for detection of myocardial ischemia in die perioperative period is -
A. Magnetic Resonance Spectroscopy
B. Radio labeled lactate determination
C. Direct measurement of end diastolic pressure
D. Regional wall motion abnormality detected with the help of 2D transoesophagealechocardiography

Response:
Ans. is 'd' i.e., Regional wall motion abnormality detected with the help of 2D transesophageal echocardiography Two dimensional transesophageal echocardiography is the most sensitive method to detect myocardial ischemia in the perioperative period.But there are doubts, if it's a practical procedure too.Morgan states "Detection of regional wall motion abnormality is a rapid and more sensitive indicator of myocardial ischemia than is the E.C.G. but unfortunately TEE requires expensive equipment and considerable familiarity with the technique in order to make correct and rapid interpretations intraoperatively".Other methods available for intraoperative monitoring besides transesophageal echocardiography areElectrocardiography (E.C.G.) - The sensitivity of ECG in detecting ischemia is related to the number of leads monitored.Hemodynamic monitoring - It is done byCentral venous or pulmonary artery pressure monitoring.The most sensitive hemodynamic correlates are derived from pulmonary artery pressure monitoring - Ischemia is frequently but not always associated with an abrupt increase in pulmonary capillary wedge pressure.The most common hemodynamic abnormalities observed during ischemic episodes are hypertension and tachycardia.

So the answer to this question is D


Instruction:
A child was immunized at 6 months of age because of epidemic of measles. Now next step would be -
A. Administer vaccine as soon as he completes 9 months
B. Administer vaccine after 4 weeks
C. Administer along with DPT
D. Nothing to be done

Response:
MEASLES VACCINE:- Live attenuated vaccine Person to person transmission of measles vaccine strains has never been documented. Freeze dried product. Before use ,the lyophilised vaccine is reconstituted with sterile diluent. Diluent must be cooled before reconstitution but it should not be freezed.After reconstitution , vaccine must be stored in dark at 2-8 degree celcius and used within 4 hrs. Each dose if 0.5 ml contains > 1000 viral infective units of vaccine strain. Measles vaccine may also contain sorbitol and hydrolysed gelatin as stabilizers and neomycin but it doesn&;t have thiomersal. It is thermolabile. Age-before 9 months.The age can be lowered to 6 months if there is measles outbreak in community.For infants immunised between 6 and 9 months,second dose administered as soon as possible after the child reaches 9 months provided that at least 4 weeks have elapsed since the last dose. Route-subcutaneous/intramuscular. Immune response- both humoral and cellular. Contraindications- High fever,pregnancy, history of anaphylactic reaction to vaccine components, immunocompromised individuals, leukemia, lymphoma,severe HIV( early stage of HIV is not a contraindication), treatment with steroids, antimetabolites and serious malignancy. Adverse reactions:- TSS-toxic shock syndrome. Occurs when measles vaccine is contaminated or when the same l is used more than once on same day / next day. The vaccine should not be used after 4 hrs of reconstitution. Symptoms of TSS : severe watery diarrhoea, vomiting, high fever repoed within few hours after vaccination. TSS is totally preventable and reflects poor quality of immunisation. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.149}

So the answer to this question is A


Instruction:
A 45 year male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. On examination 6th cranial nerve shows weakness. What is he is most likely to be suffering from?
A. Delirium tremens
B. Korsakoff s psychosis
C. Wernicke encephalopathy
D. De Clerambault syndrome

Response:
Wernicke encephalopathy is an acute disorder which is a triad of ataxia, ophthalmoplegia and confusion. It is caused by thiamine deficiency and is most common in chronic alcoholics, it can also occur from malnutrition from any cause. The major sites of involvement are medial thalamic nuclei, mammillary bodies, periaqueductal and periventricular brainstem nuclei (especially oculomotor, abducens, and acoustic nerves), and superior cerebellar vermis. Cerebellar and vestibular involvement both contribute to the ataxia. Other classic findings includes an amnestic syndrome or global confusional state, horizontal or combined horizontal veical nystagmus, bilateral lateral rectus palsies, and absent ankle jerks. Ref: Clinical Neurology By Roger P. Simo, 7th Edition, Chapter 3; CURRENT Diagnosis & Treatment Emergency Medicine, 7th Edition, Chapter 37

So the answer to this question is C


Instruction:
FNAC is the least diagnostic in which thyroid carcinoma-
A. Anaplastic
B. Papillary
C. Follicular
D. Thyroiditis

Response:
FNAC is the best investigation for the diagnosis of all thyroid carcinomas except follicular carcinoma.
It cannot differentiate b/w follicular carcinoma and follicular adenoma. The definitive diagnosis of carcinoma is made when capsular and vascular invasion by the carcinoma is revealed.

Important features of follicular carcinoma

Second most common type of thyroid cancer.
Hurthle cells are seen.
Differentiated from follicular adenoma by capsular and/or vascular invasion.
Unlike in papillary carcinoma, lymphatic spread is rare, and vascular invasion is common in follicular cancers.

So the answer to this question is C


Instruction:
In peripheral tissues which of the following contains substance P:
A. Plasma cell
B. Mast cell
C. Nerve terminal
D. Vascular endothelium

Response:
None

So the answer to this question is C


Instruction:
Deformities present in colles fracture is/are:
A. Ventral tilt
B. Dorsalt tilt
C. Ventrl displacement
D. All

Response:
B i.e. Dorsal tilt

So the answer to this question is B


Instruction:
Which of the following statements best describes the mechanism of action of benzodiazepines ?
A. Benzodiazepines activate GABAB receptors in the spinal cord
B. Benzodiazepines block glutamate receptors in neuronal pathways in the brain
C. They increase the frequency of opening of chloride ion channels that are coupled to GABAA receptors
D. They are direct acting GABA receptor agonists in the CNS

Response:
None

So the answer to this question is C


Instruction:
The therapeutic efficacy of antihypertensive drugs is blunted by NSAIDs because they :
A. Cause sodium excretion
B. Increase the clearance of antihypertensive drugs
C. Decrease the absorption of antihypertensive drugs
D. Decrease the synthesis of vascular prostacyclin

Response:
None

So the answer to this question is D


Instruction:
Disulfiram like reaction is seen with
A. Phenformin
B. Chlorpropamide
C. Glibenclamide
D. Exenatide

Response:
Chlorpropamide is a sulphonyl urea that causes Disulfiram like reaction and also dilutional hyponatremia.

So the answer to this question is B


Instruction:
Iron in heme is linked to globin through
A. Histidine
B. Alanine
C. Glycine
D. Cysteine

Response:
Ans. a (Histidine) (Ref. Harper's biochemistry 27th ed., Chapter 6,12; Harrison's 17th/ pg. 635)Heme, an essentially planar, slightly puckered, cyclic tetrapyrrole, has a central Fe2+ linked to all four nitrogen atoms of the heme, to histidine F8, and, in oxyMb and oxyHb, also to O2.The Hemoglobin:# Heme synthesis:- Occurs in the liver and bone marrow.- Committed step is glycine + succinyl CoA -delta aminolevulinate (ALA Synthase required).- Lead inhibits ALA dehydratase and ferrochelatase, preventing incorporation of iron and causing anemia and porphyria.# Glutathione reductase requires NADPH for its action. In G6PD deficiency NADPH cannot be generated at the normal rate and hence oxidants cannot be destroyed, which in turn cause damage, both to hemoglobin and cell membrane cause hemolysis.# Solubility and reversible oxygen binding, both depend most on the hydrophilic surface amino acids, the hydrophobic amino acids lining the heme pocket, a key histidine in the F helix, and the amino acids forming the a1 b1, and a1 b2 contact points.# Hemoglobin is a tetramer composed of 4 globin molecules; 2 alpha globins and 2 beta globins. The alpha globin chain is composed of 141 amino acids and the beta globin chain is composed of 146 amino acids. Both alpha and beta globin proteins share similar secondary and tertiary structures, each with 8 helical segments (labeled helix A-G).# Each globin chain also contains one heme molecule. Heme, an essentially planar, slightly puckered, cyclic tetrapyrrole, has a central Fe2+ linked to all four nitrogen atoms of the heme, to histidine F8, and, in oxyMb and oxyHb, also to O2 The heme molecule is located between helix E and helix F of the globin protein. The alpha and beta subunits of the globin chains exist in two dimers, which are bonded together strongly. The four Pyrole rings are joined by Methylene or Methylidene bridge (-C = bridge).# In Heme synthesis, the two starting materials are succinyl-CoA and glycine. Pyridoxal phosphate is also necessary in this reaction to "activate" glycine.

So the answer to this question is A


Instruction:
Which of the following method is the best predictor for ovulation in a female infertility patient during a menstrual cycle
A. Basal body temperature
B. Hormonal Study
C. Endometrial biopsy
D. Fern study

Response:
In the anovulatory cycle, plasma progesterone reaches a peak of 15ng/ml at mid-luteal phase (22-23days).
Basal body temperature (BBT) falls at the time of ovulation by about 1/2degree. During the progestational half of cycle, the temperature is slightly raised above the preovulatory level. But it is now obsolete because:

Tedious daily recording
Not very accurate
Better modalities are available

In endometrial biopsy endometrium from the uterus is curetted preferably 1 or 2days prior to the onset of menstruation. Histological examination done for secreatory changes. Now a days endometrial biopsy is omitted as a routine investigation of infertility. Only used in suspected tubercular endometritis
Fern test: cervical mucus is examined under a low power microscope. During estrogenic phase, it shows a charecteristic fern patten which disappears after ovulation

So the answer to this question is B


Instruction:
In an Autosomal Recessive (AR) disorder, one parent is normal and the other is carrier and the child is also affected. What is the reason
A. Germ line mosaicism
B. Genomic imprinting
C. Penetration
D. Uniparental disomy

Response:
Uniparental disomy refers to the situation in which 2 copies of a chromosome come from the same parent, instead of 1 copy coming from the mother, and 1 copy coming from the father. Angelman syndrome (AS) and Prader-Willi syndrome (PWS) are examples of disorders that can be caused by uniparental disomy. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is D


Instruction:
All are true regarding sebaceous cyst except:
A. Is classified as an epidermoid cyst
B. Only occurs on the face and scalp
C. Can, if ulcerated, becomes a sebaceous horn
D. Characteristically displays a punctum

Response:
None

So the answer to this question is B


Instruction:
A 55-year-old woman is diagnosed with invasive cervical carcinoma by cone biopsy. Pelvic examination and rectal examination reveal the parametrium is free of disease but upper part of vagina is involved with tumor .IVP and sigmoidoscopy are negative but CT S can of abdomen and pelvis shows grossly enlarged pelvic and para aortic nodes. Thus patient is classified as stage.
A. IIa
B. IIb
C. IIIa
D. IIIb

Response:
Now here — in this patient
On examination — Parametrium is not involved and upper part of vagina is involved so stage will be IIa — clinically.
Remember cervical cancer is still staged clinically by using investigations recommended by FIGO.
CT scan results, while clinically useful are not useful to stage the disease.
No matter whatever finding are reported on CT scan it does not after the staging so Answer remains is Stage 11a.

So the answer to this question is A


Instruction:
A patient presented with headache and flushing. He has a family history of his relative having died of a Medullary ca of thyroid. . The investigation that would be required for this patient would be:
A. Chest X-ray
B. Measurement of 5 HIAA
C. Fractionated plasma metanephrines
D. Intravenous pyelography

Response:
Diagnosis is MEN-2 Syndrome Pt is having symptoms of Pheochromocytoma MEN-2- Aka MEN 2A / Sipple syndrome- Autosomal dominant- Characterized by* Medullary carcinoma thyroid* Pheochromocytoma* Parathyroid hyperplasia / Adenoma* Hirschsprung disease* Cutaneous lichen amyloidosis- Gene responsible* Mutation of RET oncogene located on chromosome 10* Mutated codon - Cysteine codon Investigations- Most sensitive Screening test - Urinary catecholamines & VMA level- Best test for diagnosis - Fractionated plasma metanephrines- Radiological IOC for Adrenal pheochromocytoma- Radiological IOC for Extra adrenal pheochromocytoma MRI- Radiological IOC for pheochromocytoma in pregnancy- MIBG scan - useful for diagnosis of extra adrenal pheochromocytoma- FNAC and biopsy - contraindicated in pheochromocytoma as they can lead to hypeensive crisis

So the answer to this question is C


Instruction:
Exudative retinopathy in hypeensive is due to
A. Co-arctation of aoa
B. Type I takaysu's aeritis
C. Renal aery stenosis
D. Diabetic atherosclerosis

Response:
C i.e. Renal aery stenosis Renal retinopathy describes the retinal changes seen in chronic renal failure. These may mimic a hypeensive retinopathy of grade III or IV but the tendency to exudates formation is marked paicularly at the macula.Q Severe hypeension in eclampsia may precipitate a florid retinopathy of grade IV often with exudative retinal detachment. This detachment clears rapidly with the termination of pregnancy when the hypeension is under control.

So the answer to this question is C


Instruction:
Squaregonial jaw with gonial angle will leads to:
A. Low mandibular plane angle
B. Increased mandibular plane angle
C. No change
D. Low or increased mandibular plane angle

Response:
In the horizontal growth pattern, there is a tendency for the mandible to rotate upward and forward. The lower anterior facial height is relatively short with a tendency for deep bite.
Such persons have a squarish face, a low mandibular plane angle, well-developed jaw elevators, increased biting force, and broad dental arches.
Ref: Orthodontics: Diagnosis and Management of Malocclusion and Dentofacial Deformities THIRD EDITION
Om P. Kharbanda, pdf no 670

So the answer to this question is A


Instruction:
Management of pancreatic abscess is -
A. Needle aspiration
B. Gastrocystostomy
C. External drainage
D. Jejunocystostomy

Response:
Pancreatic absecess is a complication of acute pancreatitis. It is a circumscribed intraabdominal collection of pus, usually in proximity to the pancreas containing little or no pancreatic necrosis.
Treatment-- antibiotics and external drainage (percutaneous catheter based method or surgical).

So the answer to this question is C


Instruction:
A person is obese if he has weight for height -
A. 1 SD from median weight for height
B. 2 SD from median weight for height
C. 3 SD from median weight for height
D. None

Response:
Park's textbook of preventive and social medicine 23rd edition In epidemiological studies it is conventional to accept +2SD from the median weight for height as a cutoff point for obesity.

So the answer to this question is B


Instruction:
One of the intestinal enzymes that is generally deficient in children following an attack of severe infectious enteritis is:
A. Lactase
B. Trypsin
C. Lipase
D. Amylase

Response:
Secondary lactose intolerence follows small bowel mucosal damage (celiac disease, infective diarrhea) and usually transient, improving with mucosal healing. Ref:Kligman, Behrman, Jenson, Stanton (2008), Chapter 335, "Disorders of Malabsorption", In the book, "Nelson's Textbook of Pediatrics", Volume 2, 18th Edition, New Delhi, Page 1598

So the answer to this question is A


Instruction:
True about H mole :
A. Thyrotoxicosis rare
B. Raised hCG
C. Hysterectomy in selected cases
D. All

Response:
Ans. is a, b and c i.e. Raised hCG; Hysterectomy in selected cases; and Thyrotoxicosis rare Lets have a look at each option separately ? Option 'a' Always asociated with raised uterine size for gestational age. This statement is incorrect as : "The size of the uterus is more than that expected for the period of amenorrhea in 70%, corresponds with the period of amenorrhea in 20% and smaller than the period of amenorrhea in 10%." Option : Raised hCG ? H. mole is characterised by raised levels of hCG (levels > 60,000m!U/ml as per Option 'c' Hysterectomy in selected cases : Management of H.mole * TOC in H.mole Suction evacuation followed by gentle but thorough currettage. * Hysterectomy It is indicated only in case of Female has completed her family Age of patient - >35 years (as chances of malignancy are more). * Hysterotomy Indicated in cases complicated by haemorrhage. So, option 'c' i.e. hysterectomy is done in selected cases is correct whereas option 'd' i.e. chemotherapy is the TOC is incorrect. As far as thyrotoxicosis is concerned : It is seen in only 2% cases of H.mole. It is rare (so, option 'e' is correct). "clinically apparent thyrotoxicosis is unusual."

So the answer to this question is D


Instruction:
Hasner valve is seen in:
A. Nasolacrimal duct
B. Gartner's duct
C. Stenson's duct
D. Wharton's duct

Response:
Ans: A (Nasolacrimal duct) VALVE OF HASNER BDC4th/Yolin230"The inferior meatus lies underneath the inferior concha, and is the largest of the three meatuses. The nasolacrimal duct opens into it at the junction of its anterior one-third and posterior two-thirds. The opening is guarded by the lacrimal fold or Hasner's valve"Table (Physiology by A.K. Jain 5th/207)GlandRoute of secretory' ductParotidStenson's ductSubmandibular or SubmaxillaryWharton's ductSublingualDuct of RivinusGARTNER'S DUCTIt is a potential embryologicai remnant in human female development of the mesonephric ducts in thedevelopment of the urinary and reproductive organs. It was discovered and described in 1822 by Hermann Treschow Gartner.The paired mesonephric ducts in the male, in contrast, go on to form the paired epididymis, ductus deferens, ejaculatory duct and seminal vesicle.In the female they may persist between the layer of the broad ligament of the uterus and in the wall of the vagina.These may give rise to Gartner's duct cysts

So the answer to this question is A


Instruction:
Fast breathing in a 6-year old infant is taken as
A. >60 breaths per minute
B. >50 breaths per minute
C. >40 breaths per minute
D. >30 breaths per minute

Response:
Fast Breathing in Children (New IMNCI Guidelines) Age group Respiratory rate Classification 12 months - 5 years >40/minute Pneumonia 2-12 months >50/minute Pneumonia <2 months >60/minute Very severe disease Ref: Park 25th edition &;Pgno: 183

So the answer to this question is B


Instruction:
Disinfecting action of chlorine is due to:
A. Hypochlorous acid
B. Hypochlorite ion
C. Hypochloric acid
D. Chloride radical

Response:
Hypochlorous acid

So the answer to this question is A


Instruction:
Anastomotic leaks are most commonly seen in
A. Billroth 1
B. Roux en y gastrojejunostomy
C. Polya gastrectomy
D. Antral gastrectomy

Response:
Since there is end to end gastroduodenal anastomosis in billroth 1 there are more chances of anastomotic leak

So the answer to this question is A


Instruction:
Heparin is the most widely used antithrombotic agent. It acts by activating -
A. Plasmin
B. Antithrombin III
C. Fibrinolysin
D. Factor X

Response:
Ans. is 'b' i.e., Antithrombin III

So the answer to this question is B


Instruction:
Great cardiac vein drains into -
A. Anterior cardiac vein
B. Coronary sinus
C. Thebesian vein
D. Venae cordis minimi

Response:
Ans. is 'b' i.e., Coronary sinus Veinous drainage of heart1. Coronary sinus: Opens into right atrium and has following tributries : (i) Great cardiac vein, (ii) Middle cardiac vein, (iii) Posterior vein of left ventricule, (iv) Small cardiac vein, (v) Oblique vein of left atrium and (vi) Sometimes right marginal vein.2. Anterior cardiac vein : Opens into right atrium.3. Venae cardis minimi (thebasian veins) : Open into right atrium.4. Right marginal vein : More often opens into right atrium but sometimes into coronary sinus.

So the answer to this question is B


Instruction:
EEG is used in the diagnosis of all except-
A. Intermittent expulsive disorder
B. Panic disorder
C. Anxiety disorder
D. Bipolar disorder

Response:
"EEG findings are frequently normal or show nonspecific changes in Intermittent expulsive disorder"

EEG may be used in Panic disorder, Catatonia, Generalized anxiety disorder, Schizophrenia, mood disorders (including bipolar disorder), Developmental disorders (ADHD, dyslexia, Autism), Alcoholism, Antisocial personality disorder, Borderline personality disorder and dementia.

So the answer to this question is A


Instruction:
All are ocular emergency except:
A. Eye injury
B. Sympathetic ophthalmitis
C. Retinal aery occlusion
D. CRVO

Response:
Answer- (D) CRVOComon ophthalmic emergencies are :-Acute congestive glaucomaRuptured globeUlcerative or traumatic corneal diseasesOptic neuritisHyphemaEndophthalmitisAcute blindnessOrbital cellulitisEyelid or conjunctival lacerationCentral retinal aerial occlusion (CRAG)Anterior lens subluxationRetinal detachment

So the answer to this question is D


Instruction:
Tetraethyl ammonium acts by blocking which of the following channels?
A. Na+
B. Cl-
C. K+
D. Ca

Response:
C i.e. K+Ref: 12th edition, page 272Explanation:TetraethylammoniumGanglionic blocker which blocks voltage-gated K+ channels.Tried previously for treatment of Phantom Limb.Marshall first described the "nicotine-paralyzing" action of Tetraethylammonium (TEA) on ganglia in 1913.TEA was largely overlooked until the effects of the ion on the cardiovascular system and autonomic ganglia were analyzed.It is of historical importance only.

So the answer to this question is C


Instruction:
Eale's disease is best treated with
A. Steroids
B. ATT drugs
C. Streptomycin
D. Benvacizumab

Response:
Best treatment is steroids.

So the answer to this question is A


Instruction:
All of the following are features of poliomyelitis except –
A. Acute onset
B. Progressive course
C. Intact sensation
D. Febrile onset

Response:
None

So the answer to this question is B


Instruction:
Single dose treatment for chlamydia is?
A. Doxycycline
B. Tetracycline
C. Azithromycin
D. Erythromycin

Response:
None

So the answer to this question is C


Instruction:
Cardiac output during pregnancy is maximal at :
A. 32nd week
B. 36th week
C. 24th week
D. 12th week

Response:
32nd week

So the answer to this question is A


Instruction:
Maxillary antrum dips in the region of?
A. Between 2nd premolar and 1 molar
B. Between buccal roots of furcation of 1st molar
C. Between 1 & 2 premolar
D. Between 1 & 2 molars

Response:
None

So the answer to this question is A


Instruction:
Which of the following is the characteristic pathologic feature of malignant hypeension?
A. Hyaline aeriosclerosis
B. Fibrinoid necrosis
C. Medial wall hyperplasia
D. Micro-aneurysm

Response:
Fibrinoid necrosis is a characteristic feature of malignant hypeension. In this, there is insudation and accumulation of plasma proteins which stain intensely with eosin. Aerial wall thickening and hyaline aeriosclerosis are found in benign hypeension.

So the answer to this question is B


Instruction:
Intrauterine insemination means placement of:
A. Semen
B. Washed Semen
C. Million of Sperms
D. Feilized Ova

Response:
Intrauterine insemination (IUI) : This procedure involves the placement of about 0.3-0.5 ml of washed, processed and concentrated sperm into the intrauterine cavity by means of fleixible polyethylene transcervical catheter around the time of ovulation. The Processed sperm count for insemination should be atleast 1million. For the best results sperm count should exceeds 10million. Common methods to extract spem from seminal plasma are: 1.Washing 2.Swim-up(BETTER METHOD) 3.Density gradient centrifugation. Sheila BalaKrishnan Text book of Gynaecology page no 135, Novak's Textbook of Gynaecology 15th edition page no 1145

So the answer to this question is B


Instruction:
Which of the following is used for improving long term prognosis in COPD with resting hypoxemia:March 2011
A. Oxygen
B. Beta-2 agonist
C. Inhaled steroids
D. Systemic steroids

Response:
Ans. A : OxygenLong term home oxygen therapy improves survival in selected patients with COPD complicated by severe hypoxemia (aerial Pa02 less than 8.0 kPa/ 55 mmHg)

So the answer to this question is A


Instruction:
Feature of hemorrhagic disease of new born is -
A. Prolonged prothrombin time
B. Defective platelet count
C. Prolonged bleeding time
D. Prolonged thrombin time

Response:
None

So the answer to this question is A


Instruction:
A neonate is born at term with multiple problems. He is small for gestational age and has cataract, hepatosplenomegaly and thrombocytopenia with purpura. Fuher studies demonstrate patent ductus aeriosus, bone lucency, pneumonia, and meningoencephalitis. The mother is a 17-year-old girl who had no prenatal care and had a mild maculopapular rash in mid-pregnancy. Which of the following is the most likely diagnosis?
A. Congenital cytomegalovirus infection
B. Congenital rubella
C. Congenital syphilis
D. Congenital toxoplasmosis

Response:
The rubella virus is one of the causes of devastating prenatal infection. In adults and older children, the virus can cause asymptomatic infection or a relatively mild febrile illness (German measles) with upper respiratory symptoms, lymphadenopathy, maculopapular rash, and sometimes joint symptoms. The effects on the fetus range from apparently asymptomatic infection to multiple anomalies to death in utero. Among the more common abnormalities are intrauterine growth retardation, involvement of the senses and nervous system (meningoencephalitis, cataracts, retinopathy, hearing loss), cardiac involvement (patent ductus aeriosus, pulmonary aerial hypoplasia), hepatosplenomegaly, purpura (due to thrombocytopenia), bluish red skin lesions (secondary to dermal erythropoiesis), and pneumonia. Apparently asymptomatic babies should be monitored for subsequent development of hearing loss, mental retardation, endocrinopathies, and (rarely) progressive encephalitis. Treatment is suppoive, as no specific antiviral therapy is available for this infection. The rubella vaccine should be given to women of childbearing age who are not pregnant at the time. Cytomegalovirus infections can cause asymptomatic to devastating disease in newborns; look for periventricular calcifications and mothers with a flu-like illness. Congenital syphilis can cause devastating disease in newborns and can occur in early forms (look for the rash of secondary syphilis) or late forms (look for bone and teeth abnormalities). Congenital toxoplasmosis can produce devastating infection in newborns; look for a maternal history of cleaning cat litter boxes.

So the answer to this question is B


Instruction:
Drug of choice in lithium induced polyuria is?
A. Amiloride
B. Demeclocycline
C. Thiazide diuretics
D. Indomethacin

Response:
Amiloride REF: Goodman & Gillman's 11th edition page 494, 505 "Lithium-induced polyuria is usually reversible. Amiloride is useful for lithium-induced nephrogenic diabetes insipidus because it blocks Li+ transpo into the cells of the collecting tubules" "Paradoxically, thiazide diuretics reduce the polyuria of patients with DI and often are used to treat non-lithium-induced nephrogenic DI" "While case repos describe the effectiveness of indomethacin in the treatment of nephrogenic DI, other cyclooxygenase inhibitors (e.g., ibuprofen) appear to be less effective"

So the answer to this question is A


Instruction:
When correlation between two variables is very strong, the correlation coefficients will be:-
A. >1
B. 1
C. 0.3
D. -1

Response:
CORRELATION: - Correlation is relationship between 2 quantitative or continuous variables. - Correlation is represented by: Scatter diagram/ Dot diagram. Correlation coefficient (r); Measures the degree or strength of relationship in a correlation Correlation coefficient (r) lies between : - 1 to + 1 (-1 < r < + 1) Positive correlation : 0 > r > +1 (+1 is perfectly positive/ strong correlation) Negative correlation: -1 < r < 0 (-1 is perfectly negative correlation) No correlation r = 0

So the answer to this question is B


Instruction:
Which of the following is associated with Antonie van Leeuwenhoek which became a cornerstone in microbiology?
A. Telescope
B. Microscope
C. Stains
D. Immunization

Response:
Antonie van Leeuwenhoek first observed and repoed bacteria. Using his handcrafted microscopes, he was the first to observe and describe single-celled organisms, which he originally referred to as animalcules, and which we now refer to as microorganisms. Ref: Textbook of Microbiology by Ananthanarayan, 6th edition, Page 1.

So the answer to this question is B


Instruction:
2nd generation sulfonylurea drugs are all except:
A. Glipizide
B. Gliclazide
C. Tolbutamide
D. Glibenclamide

Response:
None

So the answer to this question is C


Instruction:
The causes of systemic secondary insult to injured brain include all of the following except -
A. Hypercapnia
B. Hypoxemia
C. Hypotension
D. Hypothermia

Response:
Patients with primary brain injury whether due to any trauma or stroke are at significant risk for some secondary ischemic brain injury?

Causes of secondary brain injury are - Hypotension

Hypotension should be strictly avoided as significant hypotensive events as short as 10 minutes in duration have been shown to adversely influence the outcome after traumatic brain injury.
Even in patients with stroke or head trauma, who do not require I.C.P. monitoring, close attention to adequate cerebral perfusion is required.

Hypoxia

Hypoxia (percutaneous oxygen saturation < 90%) alone, or in combination with hypotension, also leads to secondary brain injury.

Fever

Fever can adversely affect the outcome of the patient.
So aggressive control of fever with a goal of normothermia is warranted and can usually be achieved with antipyretic medication and cooling blankets.

Hyperglycemia

This is also associated with worsened clinical outcome after stroke and trauma.
Intravenous insulin is encouraged for control of hyperglycemia as this allows better regulation of serum glucose level than subcutaneous insulin.
A reasonable goal is to maintain serum glucose level at < 160 mg/dl.

Also know,

Effect of hypothermia on secondary brain injury.

The drop in temperature inhibits the release of the excitatory neurotransmitter glutamate and attenuates the release of dopamine, in brain ischemia animal models, suggesting a protective effect of hypothermia in brain injury.

Secondary brain injury can be a major determinant in the outcome of the patient so strategies for minimizing secondary brain insults are an integral part of critical care of all patients.
Episodes of secondary brain insults are usually not associated with apparent neurological worsening, rather they lead to cumulative injury, which manifest as higher mortality or worsened long term functional outcome.
Thus clinical strategies to prevent secondary brain insults involve close monitoring of vital signs and risk factors to prevent secondary ischemia.

So the answer to this question is D


Instruction:
Which tooth in the permanent dentition is the most
susceptible to dental caries?
A. Maxillary 1st premolar
B. Maxillary 2nd molar
C. Mandibular 1st molar
D. Mandibular 2nd molar

Response:
None

So the answer to this question is C


Instruction:
The condition highlighted by the arrow in the occlusal radiograph in a 8 year old child could be due to:
A. Non-vital tooth
B. Impacted tooth
C. Ghost tooth
D. Mesiodens

Response:
None

So the answer to this question is D


Instruction:
Which of the following is not a feature of hypercalcemia?
A. Diarrhea
B. Polyuria
C. Depression
D. Vomiting

Response:
Hypercalcemia can be a manifestation of a serious illness such as malignancy or can be detected coincidentally by laboratory testing in a patient with no obvious illness. The number between detection of hypercalcemia and death, especially without vigorous treatment, is often <6 months. Accordingly, if an asymptomatic individual has had hypercalcemia or some manifestation of hypercalcemia such as kidney stones for >1 or 2 years, it is unlikely that malignancy is the cause.Hypercalcemia from any cause can result in fatigue, depression, mental confusion, anorexia, nausea, vomiting, constipation, reversible renal tubular defects, increased urination, a sho QT interval in the electrocardiogram, and, in some patients, cardiac arrhythmias. There is a variable relation from one patient to the next between the severity of hypercalcemia and the symptoms. Generally, symptoms are more common at calcium levels >2.9-3 mmol/L (11.5-12 mg/dL), but some patients, even at this level, are asymptomatic. When the calcium level is >3.2 mmol/L (13 mg/dL), calcification in kidneys, skin, vessels, lungs, hea, and stomach occurs and renal insufficiency may develop, paicularly if blood phosphate levels are normal or elevated due to impaired renal function. Severe hypercalcemia, usually defined as >=3.7-4.5 mmol/L (15-18 mg/dL), can be a medical emergency; coma and cardiac arrest can occur.(harrison 18 pg 3100)

So the answer to this question is A


Instruction:
Polygonal violaceous , well defined flat topped ,itchy papules are the primary lesions of
A. Lichen planus
B. Phemphigus vulgaris
C. Lupus erythematous
D. Psoriasis

Response:
Lichen planus lesions are classically violaceous well defined polygonal itchy papules.

So the answer to this question is A


Instruction:
Mesodermal in origin among the following is
A. Astrocytes
B. Oligodendrocytes
C. Ependymal cells
D. Microglial cells

Response:
There is a third type of neuroglial cell called microglia. This type doesn't develop from the cells of the neural tube but migrates into it along with blood vessels. These cells are believed to be of mesodermal in origin HUMAN EMBRYOLOGY-INDERBIR SINGH TENTH EDITION-PAGE NO:116

So the answer to this question is D


Instruction:
The diagnostic procedure not done in case of pheochromocytoma.
A. CT scan
B. MRI
C. FNAC
D. MIBGscan

Response:
Ans. is 'c' i.e. FNAC 1551 "Percutaneous fine-needle aspiration of chromaffin tumors is contraindicated; indeed, pheochromocytoma should be considered before adrenal lesions are aspirated." -Harrison"Catastrophic hypertensive crisis and fatal cardiac arrhythmias can occur spontaneously or may be triggered by intravenous contrast dye or glucagon injection, needle biopsy of the mass, anesthesia, and surgical procedures." -

So the answer to this question is C


Instruction:
Husband having a suspicion that his wife is having affair with another man, diagnosis is
A. Delusion
B. Illusion
C. Hallucination
D. Delirium

Response:
A delusion is false, firm (unshakeable) belief that is not accepted by other members of patient’s culture and society.
Above is an example of delusion of infidelity (morbid jealousy, Othello syndrome) i.e. False belief that one's lover has been unfaithful.
Persecutory delusions (paranoid) : The patient feels that he is being persecuted against.

There is a false belief that one is being harmed, threatened, cheated, poisoned, harassed or spied on or is a victim of a conspiracy to damage his reputation.
The supposed persecutor of the patient may be people in the environment (e.g., members of the family, neighbours, former friend) or may be political or religious groups.
These delusions occur in schizophrenia (especially paranoid), severe affective disorders (severe mania or severe depression) and organic brain syndrome.
This is the most common type of delusion. The delusion of persecution may occur in the context of primary delusional experiences, auditory hallucinations, bodily hallucinations or experiences of passivity

Grandiose delusion (expansive delusions) : False belief that one is exceptionally powerful, talented or important.

These delusions are seen most commonly in mania, However, can also occur in schizophrenia and organic states.

Delusions of reference : False belief that certain objects, people or events have intense personal significance and refer specifically to oneself,

e.g., Believing that a television newsreader is talking directly about oneself, or people walking on the road are talking about him.
These delusions are seen in schizophrenia, mania and organic states.

Religious delusions : False belief pertaining to a religious theme, often grandiose in nature, e.g. : believing that one is a special messenger from God.

These delusions are seen in schizophrenia.

Delusions of love (erotomania) : False belief that another person is in love with one (commoner in a woman).

In one form, termed de clerambault syndrome, a woman (usually) believes that a man, frequently older and of higher status, is in love with her.

The delusion of infidelity (morbid jealousy, Othello syndrome) : False belief that one’s lover has been unfaithful. These are seen in schizophrenia, alcohol-related psychosis, organic states.
The delusion of misidentification :

Capgras syndrome (Delusion of double) : Belief that a familiar person has been replaced by an exact double i.e. an impostor.
Fregoli syndrome : Belief that a complete stranger is actually a familiar person already known to one.

The delusion of self - accusation or guilt : False feeling of remorse of guilt.

It occurs in Depression.

Nihilistic delusions : False belief that oneself, others or the world is non - existent or about to end.

There are pessimistic ideas that the patient’s career is finished, he is about to die, the world is doomed.

These occur in severe depression :
If nihilistic delusions are accompanied by ideas concerning bodily function failure,
e.g., putrefaction of intestines, etc. the syndrome is called COTARD’s SYNDROME.
Hypochondriacal delusions :  False belief about one’s health, patient wrongly believes that he has a severe medical illness, contrary to the all medical evidence. It is seen in depression.
The delusion of infestations : False belief that one is infested with small but visible organisms.

As a monosymptomatic delusional disorder, this is called EKBOM SYNDROME.
It is seen in the acute confusional state (due to drugs or alcohol withdrawal), in schizophrenia, in dementing illness, and as a delusional elaboration of tactile hallucinatory experiences (secondary to fornication).

Delusion of control : Belief that his actions, impulses or thoughts are controlled by an outside agency and accordingly called as made action, made impulse or made an effect. Also called somatic passivity experiences (passivity phenomenon). Commonly seen in schizophrenia.
Delusions concerning possession of thoughts : Patients with delusions about possession of thoughts may lose the conviction that their thoughts are their own. Most commonly seen in schizophrenia.

So the answer to this question is A


Instruction:
Ground water has the following advantages except –
A. Likely to be free from pathogenic organisms
B. Usually requires no treatment
C. Supply is likely to be certain even during dry season
D. Likely to be hard

Response:
Ground water is hard, but it is a disadvantage (not advantage).
Ground water

Ground water is the cheapest and most practical means of providing water to small quantities.
Ground water is superior to surface water, because the ground itself provides an effective filtering medium.

Advantages

It is likely to be free from pathogenic agents.
Requires no treatment (disinfection).
The supply is likely to be certain even during dry season.
It is less subject to contamination than surface water.

Disadvantages

It is high in mineral content e.g., salts and magnesium which render the water hard.
It requires pumping or some arrangement to lift the water.

So the answer to this question is D


Instruction:
At 15 weeks of gestation, increased alpha fetoprotein in amniotic fluid is seen in :
A. Intrauterine death
B. Down syndrome
C. Turner syndrome
D. Normal pregnancy

Response:
Intrauterine death

So the answer to this question is A


Instruction:
Ocular bobbing?
A. Midbrain
B. Pons
C. Medulla
D. Coex

Response:
Ans. is 'b' i.e., Pons Square-wave erks Not localizing Macro square-wave erks Cerebellum Macrosaccadic oscillation Cerebellum Voluntary nystagmus Volitional Saccadic pulses Cerebellum, lower brainstem Ocular flutter Cerebellum, lower brainstem Opsoclonus Cerebellum, lower brainstem Ocular bobbing Pons

So the answer to this question is B


Instruction:
Appendices epiploicae is seen in all pa of large intestine except -
A. Sigmoid colon
B. Ascending colon
C. Caecum
D. Transverse colon

Response:
Ans. is 'c' i.e., CaecumSmall bags of peritoneum filled with fat, called appendices epiploicae are present over the surface of large intestine, except for appendix, caecum and rectum.

So the answer to this question is C


Instruction:
Severe pain which arise after injury to or sectioning of a peripheral sensory nerve is called as:
A. Temporal arteritis
B. Neuralgia
C. Neuritis
D. Causalgia

Response:
Complex Regional  Pain Syndrome (Causalgia, Reflex Sympathetic Dystrophy Syndrome)
Causalgia is a term applied to severe pain which arises after injury to or sectioning of a peripheral sensory nerve.
Although few reports of this condition exist in the dental literature, cases do occur after the extraction of teeth. It has readily identifiable signs and symptoms and is treatable if recognized early; however, the syndrome may become disabling if unrecognized.
Key Concept:
Causalgia manifests as severe pain after injury or sectioning of a peripheral sensory nerve following a diﬃcult extraction. The other names are complex regional pain syndrome and reﬂex sympathetic dystrophy syndrome.
Reference: Shafer’s Textbook of ORAL PATHOLOGY Eighth Edition page no 578

So the answer to this question is D


Instruction:
The model in which dental care is seen as privilege with the professional dominant in practitioner-patient relations is
A. Commercial model
B. Guild model
C. Interactive model
D. None of the above

Response:
None

So the answer to this question is B


Instruction:
A 17 year old with type 1 diabetes spends a weekend camping with friends. A day after returning, he is brought into the emergency depament because he is in diabetic ketoacidosis. In the emergency room, he is noted to be jaundiced. The laboratory calls the emergency depament physician because the plasma has a red color? Which of the following is a product of the enzyme for which the patient has a deficiency?
A. FADH2
B. NAD+
C. NADH
D. NADPH

Response:
Glucose-6-phosphate dehydrogenase is the committed step of the hexose monophosphate shunt pathway (pentose phosphate pathway). The enzymes of this pathway are present in the cytoplasm of all cells, but are especially prevalent in adipose and liver cells. The hexose monophosphate shunt pathway makes ribose-5-phosphate for nucleotide synthesis, interconves 6 carbon sugars and 5 carbon sugars, and produces NADPH. NADPH, the reduced form of nicotinamide adenine dinucleotide phosphate, is used in reductive biosynthetic reactions such as fatty acid synthesis, and in the regeneration of glutathione by glutathione reductase. Glutathione has three main roles in a cell: it keeps the protein sulfhydryl groups of cysteines reduced, it reduces peroxides, and it maintains hemoglobin in the reduced state. NADP+ is also involved in this reaction, but as a substrate, rather than a product. The various forms of NAD and FAD do not take pa. Ref: Bender D.A., Mayes P.A. (2011). Chapter 21. The Pentose Phosphate Pathway & Other Pathways of Hexose Metabolism. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.

So the answer to this question is D


Instruction:
One day after a casual sexual encounter with a bisexual man recently diagnosed as antibody-positive for HIV, a patient is concerned about whether she may have become infected. A negative antibody titer is obtained. To test for seroconversion, when is the earliest you should reschedule repeat antibody testing after this sexual encounter?
A. 1 to 2 weeks
B. 16 to 20 weeks
C. 6 to 12 weeks
D. 12 to 15 weeks

Response:
Persons at high risk for infection by human immunodeficiency virus (HIV) include homosexuals, bisexual males, women having sex with a bisexual or homosexual paner, intravenous drug users, and hemophiliacs. Antibody titer usually becomes positive 6 to 12 weeks after exposure, Because of occasional delayed appearance of the antibody after initial exposure, it is impoant to follow up patients for 1 year after exposure.

So the answer to this question is C


Instruction:
All of the following statements about nesiritide are true EXCEPT:
A. It is a BNP analogue
B. It can be used in decompensated CHF
C. It can be administered orally
D. It causes loss of Na+ in the urine

Response:
Nesiritide is a Natriuretic peptide useful in hea failure. It is administrated intravenously. It inhibits BNP degradation (REF. Essential of medical pharmacology KD TRIPATHI 8th Edition)

So the answer to this question is C


Instruction:
The drug available for the treatment of resistant cases of atrial fibrillation is?
A. Amiodarone
B. Quinidine
C. Propranolol
D. Digoxin

Response:
Ans. is 'a' i.e., Amiodarone o Amiodarone is used to maintain sinus rhythm when other drugs have failed.

So the answer to this question is A


Instruction:
The device is used for
A. Vertical dimension
B. Horizontal dimension
C. Orientation jaw relation
D. All of the above

Response:
Power point (maximum biting force):
Boos (1940) demonstrated that the maximum biting force in an  individual is registered at vertical dimension at rest.

The method involved attaching a pressure indicating gauge which displayed the biting pressure, to a central bearing plate and screw on the occlusal rims as previously described.
The device is called bimeter and the maximum biting point is termed as power point.
The screw is adjusted to increase or decrease the vertical dimension and the bite force is recorded with each insertion. Boos stated that the vertical dimension of  occlusion is the rest position or maximum force minus 2 mm.

So the answer to this question is A


Instruction:
Ketone body production occurs in?
A. Cytoplasm
B. Mitochondria
C. Golgi body
D. Nucleus

Response:
Ketogenesis Acetoacetate is the primary ketone body while beta-hydroxybutyrate and acetone are secondary ketone bodies. They are synthesised exclusivelyby the liver mitochondria.Ref: DM Vasudevan - Textbook of Biochemistry, 6th edition, page no: 143

So the answer to this question is B


Instruction:
In which type of abortion the gestational age corresponds to the uterine size?
A. Threatened
B. Inevitable
C. Complete
D. Mixed

Response:
Ans. is 'a' i.e., Threatened Type of Miscarriages and the Diagnostic FeaturesT>peSymptomsUterine SizeCervix (Ext. os)UltrasonographyThreatenedo Vaginal bleeding Presento Pelvic paino Corresponds to gestational ageo Closedo Fetus aliveo Retroplacental hemorrhage +Inevitableo Vaginal bleeding Presento Pelvic paino Same or smallero Open with palpable conceptuso Fetus often deado Retroplacental hemorrhage +Incompleteo Vaginal bleeding (may be heavy)o Smallero Openo Products of conception partly retainedCompleteo Vaginal bleeding- trace of absento Smallero Closedo Uterine cavity emptyMissedo Vaginal bleeding-trace brownish in coloro Smallero Closedo Blighted ovum or fetus without cardiac activitySeptico Vaginal discharge: Purulent, foul smelling with features of sepsis (see p. 192)o Variable, may be largero Openo Products of conception retained, presence of foreign body (1) fee fluid in the peritoneal cavity/PODThreatened Abortion:o Uterine size corresponds to the gestational age.o External os of cervix is closed.

So the answer to this question is A


Instruction:
Blue sclera is seen in-
A. Alkaptonuria
B. Osteogenesis imperfecta
C. Turners' syndrome
D. Kawasaki syndrome

Response:
It is an asymptomatic condition characterised by marked, generalised blue discolouration of sclera due to thinning (Fig. 6.7). It is a typical association of osteogenesis imperfecta. Its other causes are Marfan&;s syndrome, Ehlers-Danlos syndrome, pseudoxanthoma elasticum, buphthalmos, high myopia and healed scleritis.

So the answer to this question is B


Instruction:
Jefferson's is :
A. C1
B. C2
C. C2 C1
D. C2 C3

Response:
A i.e. C1

So the answer to this question is A


Instruction:
AA amyloid chain is found in-
A. Multiple myeloma
B. Rheumatoid ahritis
C. Gout
D. None

Response:
The AA (amyloid-associated) fibril is a unique nonimmunoglobulin protein derived from a larger (12-kDa)serum precursor called SAA (serum amyloid-associated) protein that is synthesized in the liver. SAA is synthesized by liver cells under the influence of cytokines such as IL-6 and IL-1 that are produced during inflammation; thus, long-standing inflammation leads to elevated SAA levels, and ultimately the AA form of amyloid deposits. However, increased production of SAA by itself is not sufficient for the deposition of amyloid. Elevation of serum SAA levels is common to inflammatory states but in most instances does not lead to amyloidosis. There are two possible explanations for this. According to one view, SAA normally is degraded to soluble end products by the action of monocyte-derived enzymes. Conceivably, people who develop amyloidosis have an enzyme defect that results in incomplete breakdown of SAA, thus generating insoluble AA molecules. Alternatively, a genetically determined structural abnormality in the SAA molecule itself renders it resistant to degradation by macrophages . Robbins 9 th edition page no. 153

So the answer to this question is D


Instruction:
Attack rate is:-
A. Incidence of the disease
B. Prevalence of the disease
C. Killing power of the disease
D. Incubation period of the disease

Response:
Attack Rate Is synonymous with disease incidence. Other synonyms include risk/ hazard. Incidence = x 1000 .

So the answer to this question is A


Instruction:
Gamma Gandy bodies contains hemosiderin and -
A. Na+
B. Ca++
C. Mg++
D. Cl-

Response:
Gamna gandy bodies in CVC spleen is characterised by calcific deposits admixed with hemosiderin on fibrous tissue. Gandy-Gamna nodules or Gandy-Gamna bodies, sometimes known as Gamna-Gandy bodies or Gamna-Gandy nodules, are small yellow-brown, brown, or rust-colored foci found in the spleen in patients with splenomegaly due to poal hypeension, as well as sickle cell disease. Ref: Harsh Mohan textbook of pathology,pg:35

So the answer to this question is B


Instruction:
Which structure marked below would be responsible for spreading infection into anterior pa of the middle nasal meatus through the frontonasal duct?
A. A
B. B
C. C
D. E

Response:
The frontal sinus drains into the anterior pa of the middle nasal meatus frontonasal duct or infundibulum. A.- Cerebrospinal fluid (CSF) is formed by vascular choroid plexus in the ventricles in the brain; the letter "A" indicates the lateral ventricle. C.- The maxillary sinus lies lateral to the lateral wall of the nasal cavity and inferior to the floor of the orbit. B.- Mastoid air cells communicate with the middle ear cavity through the antrum and aditus. D.- The ethmoid sinus has numerous small cavities and lies between the orbit and the nasal cavity.

So the answer to this question is D


Instruction:
River blindness is caused by -
A. Onchocerca
B. Loa loa
C. Ascaria
D. B. Malayi

Response:
pathogenesis and clinical features The infective larvae deposited in the skin by the bite of the vector develop at the site to adult worms .Adult worms are seen singly, in pairs , or in tangled masses in the subcutaneous tissues ocular manifestations range from photophobia to gradual blurring of vision , progressing to total blindness. Ref : panikers textbook of medical parasitology 8th edition page 222

So the answer to this question is A


Instruction:
Which of the following facts are false regarding Barrett's esophagus?
A. Premalignant
B. More common in men
C. Established metaplasia doesn't reverse
D. None

Response:
Barrett esophagus is well recognized as a complication of gastroesophageal reflux disease (GERD). Prolonged exposure of the esophagus to the refluxate of GERD can erode the esophageal mucosa, promote inflammatory cell infiltrate, and ultimately cause epithelial necrosis. This chronic damage is believed to promote the replacement of healthy esophageal epithelium with the metaplastic columnar cells of Barrett esophagus. The condition occurs in a 2:1 male-to-female ratio. The most significant morbidity associated with Barrett esophagus is the development of adenocarcinoma in the esophagus. Frequent esophagoscopy is needed in people with Barrett's esophagus as it doesn't regress.

So the answer to this question is D


Instruction:
Not related to hilum of right lung?
A. Azygous vein
B. Vagus nerve
C. SVC
D. Arch of aoa

Response:
Arch of aoa is related to left lung.

So the answer to this question is D


Instruction:
Which of the following drug does not affect GABAA gated chloride channel ?
A. Muscimol
B. Alcohol
C. Picrotoxin
D. Buspirone

Response:
None

So the answer to this question is D


Instruction:
All of the following statements about purification of water are true except
A. Sodium thiosulphate is used to neutralize certain contaminants
B. Coliforms must not be detectable in any 100 ml sample of drinking water
C. Presence of Clostridial spores indicates recent contamination of water
D. Coliforms may be detected by multiple tube method and indole production

Response:
None

So the answer to this question is C


Instruction:
"Prion" group of diseases include
A. Creutzfeldt-Jacob disease
B. Subacute sclerosing panencephalitis
C. Alzheimer's disease
D. Parkinson disease

Response:
(A) Creutzfeldt-Jacob disease # Prion Disease:> Prions are infectious proteins that cause degeneration of the Central Nervous System (CNS).> Prion diseases are disorders of protein conformation, the most common of which in humans is called Creutzfeldt-Jackob Disease (CJD).> CJD typically presents with dementia and myoclonus, is restlessly progressive, and generally cause death within a year of onset.> Most CJD patients are between 50 & 75 years of age; however, patients as young as 17 years and as old as 83 years have recorded. SLOW VIRUS DISEASESGroup A* Visna* Maedi (progressive pneumonia)Non-oncogenic retrovirus (Lentivirus), HIVGroup B* Affects in human* Creutzfeldt Jakob disease* Kuru* Fatal familial insomnia* Gerstmann-Straussler-Scheinker syndrome* Sub acute spongioform VE (SSVE)/Bovine* spongioform encephalopathy/(Mad cow disease)* Chronic wasting disease of deer & elk* Scarpie in sheep & goats* Mink transmissible encephalopathyPrion diseasesCorneal transplant may spread C-J diseaseGroup C* SSPE (delayed c/c of measles)* Progressive Multifocal LeukoencephalopathyDue to Papova virus

So the answer to this question is A


Instruction:
For a girl of 18 years, site for X-ray to determine her age is: PGI 07
A. Elbow
B. Wrist
C. Knee
D. Ankle Joint

Response:
Ans. Wrist

So the answer to this question is B


Instruction:
Post-tetanic potentiation is due to -
A. Hyperpolarization of muscle fibres
B. Rapid K+ efflux
C. Increased availability of Ca++
D. Rapid Na+ influx

Response:
Ans. is 'c' i.e., Increased availability of Ca++ "Repetitive stimulation enhances force development due to rise in intracellular Ca++, a phenomenon called posttetanic potentiation. It is due to increased phosphorylation of myosine light chain with increased number of cross bridges."

So the answer to this question is C


Instruction:
Who coined term anaesthesia -
A. Morton
B. Holmes
C. Morgan
D. Priestly

Response:
Ans. is 'b' i.e., Holmeso The term 'Anaesthesia' was coined by Oliver Wendell Holmes in 1846.o The term "Balanced Anaesthesia" was coined by John Lundy and Ralph Waters.

So the answer to this question is B


Instruction:
Spermatocoeles are most commonly found at -
A. The Head of epidydimis
B. Testis
C. Prostate
D. Seminal Vescicles

Response:
Ans. is 'a' i.e., The Head of epidydimis o A spermatocele is a benign cystic accumulation of sperm that arises from the head of the epididymis. Although often disconcerting to the patient when noticed, these lesions are benign. Spermatoceles can develop in varying locations, ranging from the testicle itself to locations along the course of the vas deferens. Nevertheless, in common usage, spermatoceles are intrascrotal, paratesticular cystic collections of sperm that arise from the epididymiso Usually smooth, soft, and well-circumscribed, spermatoceles are broadly described as scrotal masses. The differential diagnoses include hydrocele, varicocele, hernia, simple epididymal cyst, and neoplasm. History, examination, and ultrasonography can aid in the differentiation.o Spermatoceles typically arise from the caput (head) of the epididymis, which is located on the superior aspect of the testicle

So the answer to this question is A


Instruction:
All of the following are features of prematurity in a neonate, except
A. No creases on sole
B. Abundant lanugo
C. Thick ear cailage
D. Empty scrotum

Response:
Premature babies have soft and flat pinna with cailage not reaching up to periphery, lightly pigmented scrotum and not yet descended testis or prominent labia minora and clitoris, faint marks on sole and no deep creases, poorly developed breast bud, fuzzy scalp hair and abundant lanugo. Reference : page 139-40 Ghai Essential Pediatrics 8th edition

So the answer to this question is C


Instruction:
Dental anomaly of teeth associated with defective bone formation is seen in
A. amelogenesis imperfecta
B. dentinogenesis imperfecta
C. Odontodysplasia
D. Osteitis deformans

Response:
None

So the answer to this question is B


Instruction:
A female presented with loss of extension of little and ring finger, hypothenar atrophy and metacarpophalangeal joint hyperextension. The nerve injured is:
A. Post interosseous nerve
B. Radial trunk
C. Ulnar Nerve
D. Median nerve

Response:
When the ulnar nerve is injured in the hand, there is a loss of the interossei and lumbricals 3 and 4, and clawing of digits 4 and 5 may become apparent due to an imbalance of the extrinsic and intrinsic muscles. Because the extrinsic extensors of the hand are not opposed by the intrinsic flexors of the hand, the metacarpophalangeal joint hyperextends and is unable to extend the proximal and distal interphalangeal joints. The proximal and distal interphalangeal joints continue to flex because the extrinsic flexors are not opposed by the intrinsic extensors of the distal and proximal interphalangeal joints. The result is extension of the metacarpophalangeal joint and flexion of the proximal and distal interphalangeal joints. Hypothenar atrophy also seen. Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 33. Hand. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy.

So the answer to this question is C


Instruction:
Mousy odor of urine is seen in
A. Isovaleric acidemia
B. Phenyl ketonuria
C. MSUD
D. Tyrosinemia

Response:
Children with classic phenyl ketonuria have an unpleasant odour of urine due to presence of phenylacetic acid,which is often described as musty or mousey. Phenylketonuria is due to deficiency of enzyme phenylalanine hydroxylase or of its cofactor tetra hydro biopterin. Reference: Nelson TB of pediatrics pg 418 edit

So the answer to this question is B


Instruction:
Vitamin B12 and folic acid supplementation in megaloblastic anemia leads to the improvement of anemia due to
A. Increased DNA synthesis in bone marrow
B. Increased hemoglobin production
C. Erythroid hyperplasia
D. Increased iron absorption

Response:
Deficiency of folic acid Reduced DNA Synthesis because THF derivatives are involved in purine synthesis and thymidylate Synthesis Megaloblastic Anemia Vitamin B12 deficiency and Folate deficiency can lead to this condition In Vitamin B12 deficiency Megaloblastic anemia is due to folate trap ref DM Vasudevan 8th ed page 476

So the answer to this question is A


Instruction:
Calender method was described by -
A. Bitings
B. Ogino
C. Wallace
D. Ogive

Response:
None

So the answer to this question is B


Instruction:
Triad of Reiter's syndrome includes all except
A. Conjunctivitis
B. Ahritis
C. Urethritis
D. Uveitis

Response:
Conjunctivitis in eye

So the answer to this question is D


Instruction:
Most common site for thyroglossal cyst is ?
A. Suprahyoid
B. Subhyoid
C. Beneath the foramen ceacum
D. Floor of mouth

Response:
Ans. is 'b' i.e., Subhyoid

So the answer to this question is B


Instruction:
"Saw-tooth" appearance on barium enema is characteristic feature of
A. Crohn's disease
B. Carcinoma colon
C. Ulcerative colitis
D. Diverticulosis

Response:
(D) Diverticulosis # "Diverticulosis shows thickening of the circular muscle fibres of the intestine, which develops a concertina or saw-tooth appearance on barium enema".> X Ray Findings - Abdomen (Contrast) Barium:> Bird's Beak deformity of lower oesophagus - Achalasia cardia (Barium Swallow) Rat tail tapering of lower oesophagus - Carcinoma oesophagus (Barium Swallow) Cork screw oesophagus - Diffuse oesophageal spasm (Barium Swallow) Commonest radiological appearance of gastric carcinoma (in barium meal follow through) is - filling defect in antrum / body of stomach Trifoliate duodenum - Chronic duodenal ulcer with scarring (Barium Meal) Hour Glass stomach - Peptic ulcer Cup & Spill / Cascade stomach - Volvulus of stomach Constriction of transverse duodenum - superior mesenteric artery syndrome Bull's eye lesion (in barium meal) - Leiomyosarcoma Single-bubble appearance - pyloric stenosis Double-bubble sign - Duodenal atresia, duodenal stenosis, annular pancreas Triple-bubble sign - Jejunal atresia Coffee bean sign - Strangulation of incompletely obstructed loop of small intestine String of Beads - Small bowel obstruction Coiled spring appearance - Intussusception Pincer-shaped ending in barium enema - Intussusception Bird of Prey sign - Sigmoid volvulus Moulage sign (flocculation of barium, with mucosal thickening) - seen.in - malabsorption syndrome String sign of Cantor - Crohn's disease Pipe-stem appearance (Loss of Frustrations)- Ulcerative Colitis (Barium Enema) Saw-tooth appearance and / or diverticula - Diverticular disease / Diverticulosis (Barium Enema) Scalloping of edge of sigmoid colon on barium enema - Ulcerative colitis Napkin ring sign - Annular carcinoma of colon Porcelain gall bladder - Carcinoma of gall bladder Pad sign - Carcinoma pancreas (Barium Meal)> ERCP: Scrambled-egg appearance - Carcinoma of pancreas Chain of Lakes appearance - Chronic pancreatitis Double duct sign - Carcinoma of pancreas> PTC: Meniscus sign - Choledocholithiasis

So the answer to this question is D


Instruction:
Instrument which forms a blade angle of more than 125 is likely to be:
A. biangle chisel
B. Curette
C. chisel
D. Angle former

Response:
None

So the answer to this question is D


Instruction:
Cell surface molecules involved in peripheral tolerance induction are
A. B7 and CD28
B. CD40 and CD40L
C. CD34 and CD51
D. B7 and CD3

Response:
Immunological tolerance in peripheral lymphoid organs is called as peripheral tolerance. It requires signal to (interaction between CD28 and B7). CD28 molecules (co-stimulatory molecule) bind to their ligands-CD80 (B7-l) and/or CD86 (B7-2) and activates T-cell. If the antigen presented by cell do not bear CD28 ligand, a negative signal is delivered and cell become tolerant and anergic.

So the answer to this question is A


Instruction:
The size of ovum is :
A. 0.133 mm
B. 0.144 mm
C. 0.2 mm
D. None of the above

Response:
0.133 mm

So the answer to this question is A


Instruction:
Which arm of tRNA binds it to vibosomal surface
A. DHU arm
B. Pseudouridine arm
C. Acceptor arm
D. Anticodon arm

Response:
Pseudoridine arm of tRNA is involved in binding of aminoacyl tRNA to ribosomal surface.

So the answer to this question is B


Instruction:
Which of the following is the first treatment for an anesthetized patient experiencing bronchospasm
A. Administer inhalational beta-2 agonists
B. Administer intravenous epinephrine
C. Administer additional anesthetic
D. Administer neuromuscular blocking agent

Response:
Administer additional anesthetic(s) to deepen the level of anesthesia, is the first treatment for bronchospasm because it is quick to administer. Inhalational beta-2 agonists, volatile anesthetics, and intravenous drugs with beta-adrenergic activity (epinephrine) can all attenuate bronchospasm. Neuromuscular blocking agents, have no effect on bronchospasm. In fact, some neuromuscular blocking agents can precipitate a bronchospasm if they cause histamine release.

So the answer to this question is C


Instruction:
A 2 month old child has a respiratory rate of 45/ minute. He is not accepting feeds from last 4 days and shows sign of dehydration. Which type of pneumonia is this: March 2013 (c)
A. No pneumonia
B. Pneumonia
C. Severe pneumonia
D. Very severe pneumonia

Response:
Ans. C i.e. Severe pneumonia In children below 2 months of age, presence of any of the following indicates severe disease: Fever (38 degree C or more) Convulsions Abnormally sleepy or difficult to wake Not feeding Tachypnea Altered sensorium etc.

So the answer to this question is C


Instruction:
The amino acid which serves as a carrier of ammonia from skeletal muscle to liver is
A. Alanine
B. Methionine
C. Arginine
D. Glutamine

Response:
GLUCOSE-ALANINE CYCLE 1. Skeletal muscle transpos NH3 to the Liver in the form of the amino acid 'alanine'. The alanine is formed in the muscle tissue by a transamination reaction between pyruvate (PA) and glutamate. 2. The alanine is transpoed through the bloodstream to the liver, where it reacts with a-ketoglutarate to reform Pyruvate and glutamate. This reaction is catalysed by alanine transaminase. 3. The nitrogen originating from the glutamate is processed by the urea cycle. 4. When the blood glucose is low, the Pyruvate resulting from alanine transamination is used to make glucose the gluconeogenesis pathway. 5. The glucose can be returned to the skeletal muscle to supply quick energy. Thus, the transpo of alanine from muscle to Liver results in a reciprocal transfer of glucose to muscle. The entire cyclical process is referred to as the "glucose-alanine cycle" (Fig. 27.5). Its impoance is propoional to the muscular activity of the organism. It is to be noted that active muscle tissue operates anaerobically, producing large quantities of Pyruvate (PA) and consuming large quantities of glucoseRef: M.N. Chatterjea - Textbook of Biochemistry, 8th edition, page no: 483

So the answer to this question is A


Instruction:
Acanthamoeba keratitis is: March 2012
A. Allergic reaction to tuberculoprotein
B. Seen in contact lenses users
C. Lesion of herpes zoster
D. Seen in congenital syphilis

Response:
Ans: B i.e. Seen in contact lenses users Keratitis Phylctenular keratitis is an allergic reaction to an endogenous allergen, commonly tuberculoprotein Acanthamoebic keratitis occurrence is frequently associated with wearing of soft contact lenses. It has also been seen to occur in non-contact lens wearers & may be related to swimming or bathing in contaminated water Larger discoid lesions of herpes zoster are known as 'nummular' keratitis Interstitial keratitis due to inherited syphilis most commonly affects children between the ages of 5 & 15 years

So the answer to this question is B


Instruction:
On vigorous exercise, the respiratory function largely depends upon -
A. Available of ADP
B. Available of substrate
C. Glycogen stores
D. Increased IP

Response:
During intense, intermittent exercise and throughout prolonged physical activity, muscle glycogen paicles are broken down, freeing glucose molecules that muscle cells then oxidize through anaerobic and aerobic processes to produce the adenosine triphosphate (ATP) molecules required for muscle contraction.The rate at which muscle glycogen is degraded depends primarily upon the intensity of physical activity; the greater the exercise intensity, the greater the rate at which muscle glycogen is degraded. As a result, high-intensity activity, such as repeated sprinting, can quickly lower glycogen stores in active muscle cells, even though the total time of activity might be relatively brief (eg, 10 x 30-s sprints with sho recovery intervals). In comparison, an endurance athlete who trains for hours at a time will also experience a marked decline in muscle glycogen, although at a slower rate of degradation than the sprinter. Ref Davidson 23rd edition pg 730

So the answer to this question is C


Instruction:
Common fractures in children are all except -
A. Lacteral condyle humerus
B. Supracondylar humerus
C. Fracture of hand
D. Radius-ulna fracture

Response:
Ans. is 'c' i.e., Fracture of hand Common fractures in children1. Forearm bones fractures2. Supracondylar fracture of the humerus3. Fracture of lateral condyle of humerus4. Epiphyseal injuries5. Spiral fracture of tibial shaftUncommon injuries in childreno Dislocationo Communited fractureso Hands & feet fractur

So the answer to this question is C


Instruction:
Which among the following is not a feature of furious rabies?
A. Hydrophobia
B. Aerophobia
C. Constricted pupils
D. Seizure

Response:
Furious Rabies generally manifests as headache, fever, irritability, restlessness and anxiety. It is associated with dilated pupils, lacrimation, salivation and perspiration. Muscle pains, salivation and vomitting may follow. A few days following exposure the patient may experience a stage of excitement or muscle spasms initiated from the ingestion of of saliva or water. As a result these individuals have a tendency to drool and begin to fear water or hydrophobia. This excited phase continues for a few days until the patient lapses into a coma and dies. Dumb Rabies manifests itself in the opposite manner as Furious Rabies. Instead of demonstrating excitement the patient experiences depression and paralysis followed by a coma. Death eventually results from respiratory arrest. This form of the virus is often difficult to diagnose from a clinical perspective.

So the answer to this question is C


Instruction:
Which of the following pre-malignant condition is associated with the highest probability of progression to malignancy?
A. Dysplasia
B. Hyperplasia
C. Leucoplakia
D. Erythroplakia

Response:
Erythroplakia is a potentially malignant disorder, almost all lesions contain dysplastic cells and most contain severe dysplasia or are carcinoma in situ or carcinoma. Malignant potential of erythroplakia is 17 times higher than leukoplakia. It presents as a bright red velvety plaque which cannot be characterized clinically or pathologically as any other recognizable condition. Risk factors include tobacco, alcohol and betel. Most common sites are lower alveolar mucosa, gingivobuccal sulcus, and the floor of the mouth. Treatment: Erythroplakia should be excised and the patient should be advised to stop tobacco/alcohol/betel habits. Ref: Oral Medicine and Pathology at a Glance By Crispian Scull, Page 40; Tobacco Effects In The Mouth By Robe E. Mecklenburg, Page 5; The Nature Of Disease: Pathology for The Health Professions By Thomas H. McConnell, Page 94

So the answer to this question is D


Instruction:
All of the following are seen in oliguric phase of Acute Tubular necrosis, Except:
A. Hypernatremia
B. Hypermagnesemia
C. Hyper uricemia
D. Hyper phosphatemia

Response:
Answer is A (Aminoglycoside toxicity): Non-Oliguric Renal Failure is typically associated with Aminoglycoside toxicity. 'Aminoglycoside nephrotoxicity typically is associated with non-oliguric renal failure' - Management of Acute Kidney Problems 'Non-Oliguric renal failure is a common expression of aminoglycoside nephrotoxity and may reflect a direct inhibitory effect on solute transpo along the thick ascending loop of Hence or possibly tubulointerstitial cell injury. - Diseases of Kidney and Urinary Tract 81h/1035 'Non-Oliguric Acute Kidney Injury accompanies 10-30% of courses of aminoglvcosides even when plasm levels are in therapeutic range'- Harrison 18th/2298 'The Acute Kidney Injury of Aminoglycoside toxicity is characteristically non-oliguric and reversible with a low moality' - 'Renal and Electrolyte Disorders' by Sh -icy (Lippincott Williams) 2010/357-358 Non-Oliguric renal failure may also be associated with contrast induced nephropathy, however it is most typical /characteristic of Aminoglycoside toxity.

So the answer to this question is A


Instruction:
Von Herick angle grade '3' of anterior chamber denotes?
A. Wide open angle
B. Moderately open angle
C. Moderately narrow angle
D. Closed angle

Response:
Ans. is 'b' i.e., Moderately open ang Classification of anterior chamber angle based on van herick angleof the anterior chamber estimation method Angle grade Angle grade Cornea to angle ratio 4 Wide open angle incapabel of closure. Iris to cornea angular separation equals to 35-45 Anterior chamber depth (shadow) is equal to or greater than corneal thickness 3 Moderately open angle incapable of closure. Iris to corneal angular separation equals to 20-35deg Anterior chamber depth (shadow) is between 1/4 and 1/2 of the corneal thickness 2 Moderately narrow angle closure possible. Iris to corneal angular separation equals to 20deg Anterior chamber depth (shadow) is equal to 1/4 of the corneal thickness 1 Extremely narrow angle, closure chance high. Iris to corneal angular separation equals to 10deg Anterior chamber depth (shadow) is equal to less than 1/4 of the corneal thickness 0 Basically closed angle. Iris to corneal angular separation is 0 Anterior chamber depth (shadow) is nil or only a very narrow slit

So the answer to this question is B


Instruction:
Which of the following is not the function of smooth endoplasmic reticulum?
A. Lipid synthesis
B. Protein synthesis
C. Metabolism of drugs
D. Supply of calcium for cellular functions

Response:
None

So the answer to this question is B


Instruction:
Sickle cell anemia is associated with which type of RCC
A. Medullary
B. Papillary
C. Chromophobe
D. Colloid

Response:
Medullary ca is least common and it is associated with SCD

So the answer to this question is A


Instruction:
Commonest cause of lung abscess:
A. Aspiration
B. Hematogenous spread from distant site
C. Direct contact
D. Lymphatic spread

Response:
Lung Abscess Lung abscess refers to a microbial infection of the lung that results in necrosis of the pulmonary parenchyma MC cause of primary lung abscess: Anaerobic bacteria Etiology of anaerobic lung abscess: Aspiration

So the answer to this question is A


Instruction:
Friction burn on the skin indicates that
A. Person dragged on the road
B. Ligature crushing the epithelium
C. Cloth covering the skin
D. Pointed object passing across the skin

Response:
Friction burn: Extensive, superficial, reddened excoriated area minimal or no linear mark Occurs when the skin is covered by clothing or the person is dragged on smooth surface (eg. on a marble floor) Brush burn: Graze abrasion involving wider area such as the back, caused by violent rubbing against a surface, as in dragging along over the ground. In an abrasion caused by a tangential force, the direction of the force can be determined by epidermal tags.

So the answer to this question is C


Instruction:
Patient with hemophilia A have bleeding disorder because of:
A. Lack of platelet aggregation
B. Lack of reaction accelerator during activation of factor X in coagulation cascade
C. Neutralization of antithrombin III
D. Release of Thromboxane A2

Response:
Hemophilia A - X- linked disorder -90% cases- deficiency of factor 8 -10% cases - functional defect of factor 8 -Intrinsic Pathway affected -Factor VIIIa complex is the most impoant activator of factor X required for conversion of prothrombin to thrombin. -In symptomatic cases there is a tendency toward easy bruising and massive hemorrhage after trauma or operative procedures

So the answer to this question is B


Instruction:
A mother calls you on the telephone and says that her 4-year-old son bit the hand of her 2-year-old son 2 days ago. The area around the injury has become red, indurated, and tender, and he has a temperature of 39.4degC (103degF). Which of the following is the most appropriate response?
A. Arrange for a plastic surgery consultation at the next available appointment.
B. Admit the child to the hospital immediately for surgical debridement and antibiotic treatment.
C. Prescribe penicillin over the telephone and have the mother apply warm soaks for 15 minutes four times a day.
D. Suggest purchase of bacitracin ointment to apply to the lesion three times a day.

Response:
Human bites can pose a significant problem. They can become infected with oropharyngeal bacteria, including S aureus, Streptococcus viridans, Eikenella corrodens, and anaerobes. A patient with an infected human bite of the hand requires hospitalization for appropriate drainage procedures, Gram stain and culture of the exudate, vigorous cleaning, debridement, and appropriate antibiotics. The infected wound should be left open and allowed to heal by secondary intention (healing by granulation tissue rather than closure with sutures). Empiric antibiotic therapy for an infected bite should be penicillinase-resistant; amoxicillin-clavulanate orally, or ticarcillin-clavulanate or ampicillin-sulbactam IV are good choices. Antibiotic prophylaxis for noninfected bite wounds remains controversial, but some experts recommend prophylaxis for all significant human bites.

So the answer to this question is B


Instruction:
Distance of medial rectus from limbus -
A. 4.5 mm
B. 5.5 mm
C. 7.0 mm
D. 10 mm

Response:
Rectus muscles originate from a common tendinous ring- the annulus of Zinn, which is attached to the apex of the orbit. Different distances from limbus are - >>medial rectus : 5.5 mm >>inferior rectus: 6.5mm >>lateral rectus : 6.9mm >>superior rectus:7.7mm Ref;A.K.Khurana; 6th edition; Page no:336

So the answer to this question is B