Instruction:
Good pasture's syndrome is characterised by -
A. Necrotisting hemorrhagic interstitial pneumonitis
B. Alveolitis
C. Patchy consolidation
D. Pulmonary edema

Response:
Ans. is 'a' i.e., Necrotizing hemorrhagic interstitial pneumonitis Goodpasture syndromeo Goodpasture syndrome is a rare condition characterized by rapid destruction of the kidney and diffuse pulmonary hemorrhage.o It is an autoimmune disease characterized by presence of circulating autoantibodies targeted against basement membrane of lung and kidney.o These antibodies are directed against the noncollagenous domain of the a-3 chain of type IV collegen (collegen of basement membrane).o The antibodies initiate an inflammatory destruction of the basement membrane in kidney glomeruli and lung alveoli.o In Goodpasture syndrome, immune reaction is type II hypersensitivity.Morphological changes1. Lungo The lungs are heavy, with areas of red brown consolidation.o There is focal necrosis of alveolar walls associated with intraalveolar hemorrhages.o Alveoli contain hemosiderin-laden macrophages.o Linear deposits of immunoglobulins along the basement membranes of the septal walls.2. Kidneyo Diffuse proliferative rapidly progressive glomerulonephritis,o Focal necrotizing lesion and crescents in >50% of glomeruli.o Linear deposits of immunoglobulins and complement along glomerular basement membrane.Clinical manifestationso Occur typically in young males.o Most cases begin clinically with respiratory symptoms, principally hemoptysis.o Soon, manifestations of glomerulonephritis appear and typically present as nephritic syndrome - hematuria, nephritic urinary sediment, subnephrotic proteinuria, rapidly progressive renal failure,o The common cause of death is renal failure.

So the answer to this question is A


Instruction:
Most common site of sub ependymal astrocytoma (giant cell)
A. Trigone of lateral ventricle
B. Foramen of munro
C. Temporal horn of lateral ventricle
D. 4th ventricle

Response:
Subependymal giant cell astrocytoma (SEGA, SGCA, or SGCT) is a low-grade astrocytic brain tumor (astrocytoma) that arises within the ventricles of the brain. It is most commonly associated with tuberous sclerosis complex (TSC). Although it is a low-grade tumor, its location can potentially obstruct the ventricles and lead to hydrocephalus Subependymal giant cell astrocytoma (SEGA) is a slowly growing tumor of unknown histogenesis mainly arising in the periventricular regions adjacent to the foramen of Monro which causes increased intracranial pressure, seizures, and focal neurologic signs Ref Harrison20th edition pg 2456

So the answer to this question is B


Instruction:
Mechanism of action of terbinafine is?
A. Binds to ergosterol
B. Prevents formation of purine
C. Inhition of microtubule formation
D. Inhibition of ergosterol synthesis

Response:
Antifungal Drugs: CLASS IFICATION 1. Antibiotics A. Polyenes:AmphotericinB (AMB),Nystatin, Hamycin, Natamycin (Pimaricin) B. Heterocyclic benzofuran: Griseofulvin 2. Antimetabolite Flucytosine (5-FC) 3 Azofes A. lmidazoles (topical): Clotrimazole, Econazole, Miconazole, Oxiconazole (systemic): Ketoconazole B. Triazoles (systemic): Fluconazole, Itraconazole, Voriconazole 4. Allylamine: Terbinafine 5. Other topical agents Tolnaftate, Undecylenic acid, Benzoic acid, Quiniodochlor, Ciclopirox olamine, Butenafine, Sod. thiosulfate. TERBINAFI N E This orally and topically active drug against dermatophytes and Candida belongs to a new allylamine class of antifungals. In contrast to azoles which are primarily fungistatic, terbinafine is fungicidal: shoer courses of therapy are required and relapse rates are low. It acts as a non-competitive inhibitor of &;squalene epoxidase&;, an early step enzyme in ergosterol biosynthesis by fungi. Accumulation of squalene within fungal cells appears to be responsible for the fungicidal action. The mammalian enzyme is inhibited only by 1000-fold higher concentration of terbinafine. Approximately 75% of oral terbinafine is absorbed, but only 5% or less from unbroken skin. First pass metabolism fuher reduces oral bioavailability. lt is lipophilic, widely distributed in the body, strongly plasma protein bound and concentrated in sebum, stratum corneum and nail plates. It is inactivated by metabolism and excreted in urine (80%) and faeces (20%); elimination :plasma half life of l l-16 hr is prolonged to 10 days after repeated dosing. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:757,765

So the answer to this question is D


Instruction:
2.IDDM patient presents with septal perforation of nose with brownish black discharge probable diagnosis is:
A. Rbinosporidiosis
B. Aspergillus
C. Leprosy
D. Mucormycosis

Response:
Mucormycosis is a fungal infection of nose and paranasal sinuses which may prove rapidly fatal if untreated.It is seen in uncontrolled diabetes or those taking immunosuppressive drugs.It presents as black necrotic mass filling the nasal cavity and eroding the septum and hard palate. Treatment is by amphotericib B and surgical debridement. Ref Dhingra 6/e p 159.

So the answer to this question is D


Instruction:
The' 1/2 life of 1131 is:
A. 8 hours
B. 2 days
C. 5.2 days
D. 8 days

Response:
Ans. 8 days

So the answer to this question is D


Instruction:
The impoant symptom of radiation proctitis is:
A. Bleeding PR
B. Weight loss
C. Loss of weight
D. Colicky abdominal pain

Response:
Radiation proctitis can lead to persistent rectal bleeding and iron deficiency anemia. Other symptoms include diarrhea, mucoid discharge, urgency, tenesmus, rectal pain and fecal incontinence. Ref: World J Gastroenterol 2011 November 7; 17(41): 4554-4562.

So the answer to this question is A


Instruction:
Which one of the following is true of hyaline membrane disease of the newborn -
A. Prematurity provides relative protection of the occurrence
B. Maternal steroid exposure increase severity of the disease
C. Phosphatidyl glycerol estimation is a reliable method of diagnosis
D. Surfactant increases the surface tension of a lveoli

Response:
Ans. is 'c' i.e., Phosphatidyl glycerol estimation is a reliable method of diagnosis o In HMD surfactant is reduced and its measurement can be used for diagnosis e.g. in shake test. o Constituent of surfactant are - dipalmitoyl phosphatidylcholine (lecithin), phosphatidylglycerol, apoproteins (surfactant proteins ----> SPA, SPB, SPC, SPD) and cholesterol.

So the answer to this question is C


Instruction:
Colonic diverticulosis is best diagnosed by
A. Colonoscopy
B. Nuclear scan
C. Barium enema
D. CT scan

Response:
"Diverticula are best seen on barium enema. Colonoscopy is a less sensitive means of detecting diverticula." - CMDT 2007

Diverticulosis refers to the presence of multiple diverticula
Diverticulitis refers to inflammation and infection associated with a diverticulum.

Best investigation for
Diverticulosis - Barium enema
Diverticulitis - CT scan

On barium, enema diverticulosis shows characteristic 'sawtooth' appearance

So the answer to this question is C


Instruction:
A PATIENT OF SCHIZOPHRENIA TREATED FOR 5 YEARS DEVELOPE PERIORAL MOVEMENTS. LIKELY DIAGNOSIS IS:
A. Tardive dyskinesia
B. Muscular dystonia
C. Akathisia
D. Malignant neuroleptic syndrome

Response:
* TARDIVE DYSKINESIA IS THE MOST COMMON DELAYED ( LATE) COMPLICATION OF ANTIPSYCHOTIC MEDICATION * IT IS CHARACTERISED BY PURPOSELESS, INVOLUNTARY FACIAL AND LIMB MOVEMENTS TARDIVE DYSKENYSIS * MUSCULAR DYSTONIA : - IS CHARACTERISED BY BIZZARE MUSCLE SPASMS SPECIALLY AFFECTING LINGUOFASCIAL MUSCLES - GRIMACING ETC.OCCURS WITHIN FEW HOURS OF A SINGLE DOSE AT MOST MOST WITHIN A WEEK. MUSCULAR DYSTONIA THUS W HILE FACIAL MOVEMENTS CAN BE A FEATURE OF BOTH TARDIVE DYSKINESIA AND MUSCULAR DYSTONIA, THOSE DEVELOPING AS LATE AS 5 YEARS AFTER INSTITUTION OF TREATMENT ARE LIKELY TO BE DUE TO BE DUE TO TARDIVE DYSKINESIA. * AKATHASIA : REFERS TO REST LESSNESS / F EELING OF DISCOMFO / APPARENT AGITATION FACIAL MOVEMENTS ARE NOT A FEATURE. AKATHASIA * MALIGNANT NEUROLEPTIC SYNDROME : IS CHARACTRISED BY RIGIDITY, IMMOBILITY, FEVER, FLUCTUATING BP AND HEA RATE. FACIAL MOVEMENTS ARE NOT A FEATURE REF : HARRISONS 20TH ED

So the answer to this question is A


Instruction:
Type of seizures in Eclampsia
A. Focal seizures
B. Absence seizures
C. Generalised Tonic-Clonic Seizures
D. Myoclonic seizures

Response:
Eclampsia is an extremely severe form of preeclampsia characterized by the sudden onset of generalized tonic-clonic seizures.Reference: Reference: Practical guide to High-risk pregnancy and delivery; Chapter 16; Hypeensive DIsorders of Pregnancy

So the answer to this question is C


Instruction:
A 6-year-old child has a DQ of 50. Which of the following can the child do?
A. Identify colors
B. Read a sentence
C. Ride a bicycle
D. Copy a triangle

Response:
a. Identify colors(Ref: Nelson's 20/e p 65-77, Ghai 8/e p 52-53)DQ=Developmentalagex100/actualage.In the given question, a 6 year old child has a DQ of 50; so his developmental age is 3 years.So, he can do milestones corresponding to 3 years age only; At 3 years, a child can name 2 colors and at 5 years, 4 colors.

So the answer to this question is A


Instruction:
The investigation of choice for renal scarring defect in kidney:
A. DMSA scan
B. DTPA scan.
C. Dexa scan
D. MCU

Response:
Ans. (a) DMSA scanRef: Bailey 26th Edition, Pages 1276-1277* IOC for Renal Structure scarring - DMSA* IOC for Congenital PUJ obstruction - DTPA

So the answer to this question is A


Instruction:
A diabetic patient presents with fungal infection of sinuses and peri–orbital region with significant visual impairment. The best drug for treatment of this patient is :
A. Amphotericin B
B. Itraconazole
C. Ketoconazole
D. Broad spectrum antibiotics

Response:
None

So the answer to this question is A


Instruction:
Stapes develop from -
A. 1st arch
B. 2nd arch
C. 3rd arch
D. 4th arch

Response:
Ans. is 'b' i.e., 2nd archo External auditary canal - First branchial cleft.o Auricle (pinna) - First & second branchial (pharyngeal) arch.o Middle ear cleft (Eustachian tube, tympanic cavity, attic, antrum, mastoid air cells) - 1st & 2nd arch,o Malleus, incus - 1st arch,o Stapes (except footplate) - 2nd arch,o Footplate of stapes and annular ligament - Otic capsule.

So the answer to this question is B


Instruction:
Maximum weight for skin traction -
A. 1-2 kg
B. 4-5 kg
C. 10-15 kg
D. 15-20 kg

Response:
Ans. is 'b' i.e.. 4-5 kg o Skin traction- 4-5 kgo Skeletal traction- 20 kgTractiono Traction is defined as a pulling force to treat muscle or skeletal disorders (jfractures, dislocation). There are two major types of tractions : skin & skeletal traction.A) Skin tractionHere the traction is applied to the skin (using adhesive or nonadhesive tape or straps) which is indirectly- transmitted to the bone.Skin traction can sustain a pull of no more than 4 to 5 kgs.Skin traction is given by adhesive tape & bandage. Buck's appratus. Gallow's'BryantVRussel traction are examples of skin traction.B) Skeletal tractionSkeletal traction is an invasive procedure in which pins, screws, wires or tongs (e.g., Seinmann pin, Denham 'spin, Kirschner's wire, ice tong, Crutchfield's tong, Bohler stirrup, Ilizarov's wire) are placed into the bones so that the weight is directly applied to the bone.Skeletal traction is used.In cases when the pulling force needed is more than the skin traction can bear,When longer durations of traction is required.iii) When the part of the body needing traction is positioned so that the skin traction is impossible.Upto 20 kg weight is permitted.

So the answer to this question is B


Instruction:
Activation of which receptor causes pulmonary vasoconstriction?
A. Alpha 2 adrenergic
B. H2 histamine
C. M3 cholinergic
D. ETA epithelial receptor

Response:
Activation of ETA receptor causes pulmonary vasoconstriction. These are endothelin receptors.Ref: Ganong review of medical physiology, 23rd edition Page no: 609

So the answer to this question is D


Instruction:
Warfarin skin necrosis is caused by-
A. Protein C/Protein S deficiency
B. APLA
C. Vitamin K deficiency
D. Fibrinogen deficiency

Response:
Ans. (a) Protein C/Protein S deficiency(Ref: Wintrobe's 12th/pg 1490)Warfarin skin necrosisDue to warfarin-induced rapid reduction in protein C levels in patients with a pre-existing inherited protein C deficiency that results in a hypercoagulable state and thrombosis.Not all heterozygous protein C-deficient patients receiving warfarin experience this complication, and not all patients with this complication have protein C deficiency.

So the answer to this question is A


Instruction:
Which drug is not used for acute bronchial asthma ?
A. Salmeterol
B. Formeterol
C. Salbutamol
D. Coicosteroids

Response:
Ans. is 'a' i.e., Salmeterol Bambuterol is a prodrug of terbutaline. It is slowly hydrolysed by pseudocholineterase. Sho acting 132-agonists produce bronchodilatation within 5 min and action lasts for 2-6 hrs --> are used to abo and terminate acute asthma, but are not suitable for prophylaxis. Salmeterol is delayed acting, can be used for prophylaxis only, while formoterol is fast acting and long acting can be used for both prophylaxis and acute attack.

So the answer to this question is A


Instruction:
Pseudo obstruction of intestine is also known as?
A. Hamann's syndrome
B. Ozili's syndrome
C. Ogilive's syndrome
D. Merizzi syndrome

Response:
This condition describes an obstruction, usually of the colon, that occurs in the absence of a mechanical cause or acute intraabdominal disease. It is associated with a variety of syndromes in which there is an underlying neuropathy and/or myopathy and a range of other factors Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1202

So the answer to this question is C


Instruction:
Red infarction is seen in -
A. Kidney
B. Brain
C. Small instestine
D. Hea

Response:
Ans. is 'c' i.e., Small intestine

So the answer to this question is C


Instruction:
The success of oral rehydration therapy of diarrhea depends upon which of the following processes in the intestinal mucosa ?
A. Sodium pump mediated Na+ absorption
B. Glucose coupled Na+  absorption
C. Bicarbonate coupled Na+  absorption
D. Passive Na+ diffusion secondary to nutrient absorption

Response:
None

So the answer to this question is B


Instruction:
Muller muscle is supplied by which nerve:
A. Facial nerve
B. Sympathetic nerve
C. Trigeminal nerve
D. Vagus nerve

Response:
Ans. (b) Sympathetic nerveRef.-.BDC 6th ed. Vol-III/74* Ptosis is drooping of eyelid.* Eyelid is comprised of 4 muscles:Muscles, their innervation and functionMuscleCN innervationFunction* LPSIIIOpens the eyelid* Muller's muscleT1 (NOT a CN; sympathetic nerve)Opens eyelid when LPS tired* FrontalisVIICloses the eyelid* Orbicularis oculiVIICloses the eyelid* CN III palsy leads to drooping of eyelid (Ptosis).* CN VII palsy may also cause ptosis.Also Know*All the extraocular muscles are supplied by CN III except lateral rectus and superior oblique.* Lateral rectus supplied by- CN VI* Superior oblique supplied by- CN IVRemember- LR6; So4

So the answer to this question is B


Instruction:
Water hammer pulse seen in
A. >Aoic stenosis
B. >Aoic regurgitation
C. >Aoic stenosis and Aoic regurgitation
D. >Mitral regurgitation

Response:
Aoic regurgitation Water hammer pulse It is a large bounding pulse, associated with increased stroke volume of the left ventricle and decrease in the peripheral resistance, leading to a wide pulse pressure. The pulse strikes the palpating finger with a rapid, forcefid jerk and quickly disappears. It is best felt in the radial aery with the patients arm elevated. It is seen in Aoic regurgitation. Pathophysiology of water hammer pulse In Aoic regurgitation the stroke volume is high, so the systolic pressure is high and this is responsible for sharp rise in the pulse. The stroke volume is high because the left ventricle gets blood from two sources during the diastole i.e. blood leaking from the Aoa and the blood it receives from left atria. The collapse occurs because Diastolic leak of blood into the left ventricle from the Aoa Rapid run off to the periphery as a result of low systemic vascular resistance (the increased cardiac output stimulates the baroreceptors in the aoic arch and the result is reflex vasodilatation of the peripheral vessels into which the blood flows rapidly). Wiry are arms elevated in the examination ? When the arm is raised there is fall of blood column resulting in vasodilation and thus helps to reduce the diastolic pressure more, so the pulse pressure widens. It may be so that the aery palpated becomes more in the line of Aoa after elevation of the arm and thus allows the direct systolic ejection and diastolic backward flow.

So the answer to this question is B


Instruction:
Primary action of superior oblique is -
A. Intorsion
B. Depression
C. Adduction
D. Abduction

Response:
Ans. is 'a' i.e., Intorsion There are six extraocular muscles in each eye.MusclePrimary ActionSecondary ActionSuperior rectusElevationAdduction and intorsionInferior rectusDepressionAdduction and extorsionMedial rectusAdduction Lateral rectusAbduction Superior obliqueIntorsionAbduction and depressionInferior obliqueExtorsionAbduction and elevationo All the extra ocular muscles are supplied by the occulomotor nerve except for the superior oblique which is supplied by the trochlear nerve and the lateral rectus which is supplied by the abducens nerve.o The occulomotor nerve also supplies the levator palpebrae superioris, sphincter papillae and the ciliary muscle.

So the answer to this question is A


Instruction:
Chikungunya is caused by ?
A. Mosquito-borne Alphavirus
B. Mosquito-borne Beta virus
C. Mosquito-borne Gamma virus
D. Mosquito-borne Deltavirus

Response:
Chikungunya caused by a mosquito-borne alphavirus.Previous outbreaks had been confined to the tropics, and some have attributed this expansion to global warming. Ref: Harrison's Principles of Internal Medicine, 18e, Chapter 119.Introduction to Infectious Diseases.

So the answer to this question is A


Instruction:
Increased risk of cancer is seen in
A. Fibroadenoma of breast
B. Bronchial asthma
C. Chronic ulcerative colitis
D. Leiomyoma of the uterus

Response:
Ref Robbins 8/e p276; 9/e p279 Ceain non neoplastic disorders _ the chronic atrophic gastric of pernicious Anemia, solar keratosis of skin, chronic ulcerative colitis and leukoplakia of the oral cavity, vulva and penis, have such a well defined association with cancer that they have been termed precancerous condition

So the answer to this question is C


Instruction:
A drug used in estrogen-dependent breast cancer
A. Clomiphene citrate
B. Tamoxifen
C. Estrogen
D. Adriamycin

Response:
Hormonal drug therapy for breast cancer targets estrogen receptor-positive breast cancer. It aims at blocking the action of estrogen on estrogen receptor-positive breast cells. The hormonal therapy of choice for breast cancer in premenopausal women is Tamoxifen. Tamoxifen belongs to a class of drugs known as Selective Estrogen Receptor Modulator". Tamoxifen binds to the estrogen receptors on tumours and blocks the effect of estrogen on these cells. Tamoxifen is only effective in treating estrogen receptor-positive breast cancers. Therefore the tumour's hormone receptor status should be determined before deciding on a treatment option for breast cancer. Tamoxifen is used to treat patients with early sta2e breast cancer as well as those with metastatic breast cancer Adjuvant therapy with Tamoxifen Chemotherapy after primary t/t to increase the chance of cure. It helps in preventing the recurrence and also helps to prevent the development of new cancers in the other breast When used as adjuvant chemotherapy it is usually taken for 5 years. When taken for 5 years if reduces the chance of the original breast cancer coming back in the same breast or elsewhere. It also reduces the risk of developing secondary primary cancer. Metastatic cancer therapy with Tamoxifen As a treatment for metastatic breast cancer, the drug slows or stops the growth of cancer cells that are present in the body. Patient with metastatic breast cancer may have to take tamoxifen for varying lengths of time. ref - srb's manual of surgery 5e p530,551

So the answer to this question is B


Instruction:
Organism which is CAMP test positive and Bacitracin resistant is
A. S.Aureus
B. S.pyogenes
C. S.Agalactiae
D. Enterococcus

Response:
S.Agalactiae which is a group B Streptococcus shows

CAMP test positive
HHT positive
BACITRACIN RESISTANT

So the answer to this question is C


Instruction:
Apnea of prematurity is defined as sudden stoppage of breathing that lasts for
A. 10 sec
B. 15 sec
C. 20 sec
D. 30 sec

Response:
Apnea of prematurity defined as sudden stoppage of breathing that lasts for 20 sec or is associated with bradycardia or cyanosisApnea of prematurity should be different from periodic breathing which is normal phenomenon is preterm neonate.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 832, 849 - 850)

So the answer to this question is C


Instruction:
Pinhole can reduce refractive error up to -
A. 3 D
B. 1 D
C. 5 D
D. 10 D

Response:
Pin-hole test: It helps in confirming whether the optical correction in the trial frame is correct or not.
An improvement in visual acuity while looking through a pinhole indicates that optical correction in the trial frame is incorrect.
PPinholecan reduce refractive error upto 3 D.

So the answer to this question is A


Instruction:
Regarding oncogenesis: All are true except:
A. Topoisomerase II causes breaks in strands
B. p53 is the most common oncogene mutation causing malignancy in humans
C. At G2-M phase there is loss of inhibitors controlling cell-cycle
D. Decrease in telomerase activity causes anti-tumor effects

Response:
None

So the answer to this question is B


Instruction:
Base of femoral triangle is formed by
A. Inguinal ligament
B. Medial border of saorius
C. Medial borer of adductor longus
D. Iliacus

Response:
Base of femoral triangle is inguinal ligament which is aponeurosis of external oblique muscle. Medial border of adductor longus forms the medial boundary. Medial border of Saorius forms the lateral boundary. Floor is formed by adductor longus,pectineus and iliacus. Femoral aery, femoral vein and lymphatics are involved in femoral sheath.

So the answer to this question is A


Instruction:
Cataract in newborn is:
A. Zonular
B. Coronary
C. Snowflake
D. Coical

Response:
Ans. Zonular

So the answer to this question is A


Instruction:
Myocarditis is caused bya) Pertussisb) Measlesc) Diptheriad) Scorpion sting
A. bc
B. c
C. ac
D. ad

Response:
None

So the answer to this question is A


Instruction:
Bence Jones proteinuria is not seen in
A. Multiple myeloma
B. Chronic interstitial nephritis
C. Macroglobulinemia
D. Non-Hodgkins lymphoma

Response:
Ans: b (Chronic interstitial nephritis)Ref: Henry's clinical diagnosis and management by laboratory methods, 21st ed Pg. 399Bence Jones proteinuria:1. Refers to urinary excretion of monoclonal light chains.1. It occurs due to exclusive production of one light chain, being in excess.2. Free light chain - diffuse freely to extracellular compartment - filtered through glomeruli - reabsorbed in PCT by receptor mediated endocytosis - appear in urine when the metabolising capacity of the nephron is exceeded.3. BJP - low molecular weight protein- Screening - sulphosalicylic acid test- Not detected by dip stick test- Alpha 2 mobility on electrophorectic techniques.BJP is produced in:1. Multiple myeloma2. AL amyloidosis3. Waldenstrom's macroglobulinaemia4. Chronic lymphocytic leukaemia5. Papular mucinosis.Electrophoresis and immunofixation electrophoresis methods are the best detection and quantification methods respectively.

So the answer to this question is B


Instruction:
Primary Resistance form is that shape of cavity which:
A. Prevents displacement of restoration
B. Permits the restoration to withstand occlusal forces
C. Allows adequate instrumentation
D. Allows the restoration to withstand occlusal forces and prevent displacement

Response:
None

So the answer to this question is B


Instruction:
A 40-week-old infant can do all the following except:
A. Waves bye bye
B. Transfer object from one hand to another
C. Sits without support
D. Makes a tower of 3-4 cubes

Response:
d. Makes a tower of 3--4 cubes(Ref: Nelson's 20/e p 65-77, Ghai 8/e p 52-54)40 week old infant is around 10 months old; Tower of 3-4 cubes comes by around 18 months age.

So the answer to this question is D


Instruction:
Stage of falciparum not seen in peripheral smear is -
A. Schizont
B. Gametocyte
C. Ring form
D. Double ring

Response:
None

So the answer to this question is A


Instruction:
EPA and NEERI, which of the element is used?
A. ALF3
B. CaF2
C. NaF
D. SnF2

Response:
None

So the answer to this question is A


Instruction:
About Achalasia Cardia: 1. Dysphagia is a presenting symptom 2. The cause is the absence of Auerbach's plexus 3. Esophagectomy is the treatment 4. Motility improving agents are used in treatment 5. Barium swallow shows irregular filling defects in lower esophagus
A. 1,2,3 False & 4,5 True
B. 1,2,4 True & 3,5 False
C. 2,3,4 True &1,5 False
D. 1,3,5 True & 2,4 False

Response:
Achalasia is a rare disease caused by loss of ganglion cells within the esophageal myentric plexus. Patients mostly presents with dysphagia, regurgitation, chest pain and weight loss. It is diagnosed by barium swallow and esophageal manometry. Barium swallow shows a beak like appearence. Esophageal manometry shows impaired lower esophageal sphincter relaxation and absent peristalsis. Most common surgical procedure for achalasia is Heller's myotomy performed in conjunction with paial fundoplication.

So the answer to this question is B


Instruction:
Most common type of anterior shoulder dislocation?
A. Subglenoid
B. Subcoracoid
C. Posterior
D. Complete

Response:
Ans. b (Subcoracoid) (Ref. Bailey & Love surgery, 24th/pg. 499)SHOULDER DISLOCATIONTypes:# About 95%-- anterior dislocation.# In < 5% -- posterior dislocation.- Posterior dislocations are unusual, and seen after injuries such as electrocution or after a seizure.- Recurrent traumatic instability. This is predominately in one direction, most commonly anteroinferiorly.- Atraumatic instability. Although there may be an initiating event, this is often less traumatic, for example a fall climbing stairs rather than a sporting injury.Causes of Recurrent shoulder dislocation:- Hill-Sachs lesion (injury to the posterolateral aspect of the humeral head)- Lax joint capsule- Bankart's lesion (detachment of the anteroinferior segment of glenoid labrum)Test for recurrent shoulder dislocation- "Apprehension test". Q- Sulcus testQ:# The shoulder can often be subluxed inferiorly to produce a sulcus sign, with a lateral sulcus appearing beneath the acromion as the arm is pulled down.X-ray- A sign of posterior shoulder dislocation =>"Light-bulb" sign.Comparison of Posterior and Anterior shoulder dislocationsClassified According to Displacement of the Humeral HeadType of DislocationFeaturesOther Clinical cluesRadiographsPosterior# 95% subacromial# 5% subglenoid and subspinous# Humeral head posterior to the glenoid# Arm held in the sling position with adduction and internal rotation# Attempts at abduction and external rotation cause extreme pain# Coracoid process prominent, glenoid fossa empty anteriorly, and humeral head bulging posteriorly# On AP view; vacant glenoid sign, 6-mm sign, light bulb sign# On lateral view or Y view: humeral head appears posterior to the glenoid fossaAnterior# 99% subcoracoid and subglenoid# Humeral head anterior to the glenoid# Arm held in abduction and slight external rotation (abduction more prominent with subglenoid dislocation)# The patient cannot adduct or internally rotate the shoulder# Seen from the front, the shoulder appears "squared off"# Distal acromion prominent on a side view# On AP view: obvious dislocation On lateral view: humeral head appears anterior to the glenoid fossaReprinted with permission. Roberts JR, Hedges JR. Clinical Procedures in EmergencyMedicine, 6th edition, Philadelphia: Saunders/ Elsevier, 2014, 0. 958Rx# Physiotherapy should be tried first in these patients.# As well as muscle strengthening, re-education of the patient and shoulder is necessary, and specific muscle groups may need to be targeted.# Approximately half of the patients will require surgery and a capsular tightening procedure is carried out through an anterior approach.- This is a successful procedure but there is a higher failure rate than with patients found to have a Bankart defect.- Arthroscopic shrinkage of the capsule may have a place in these patients, and this is currently being evaluated.DISLOCATION OF THE GLENOHUMERAL JOINT# Approximately 45 per cent of all joint dislocations in adults occur at the glenohumeral joint.# Rx:- The dislocation should be reduced as early as possible and this can usually be accomplished under sedation.- There are three common methods of reduction dislocations:# Hippocratic method.# Hanging-arm method.# Kocher's method.

So the answer to this question is B


Instruction:
The site of action of vasopressin antagonist in kidney
A. Medullary Collecting duct
B. Coical collecting duct
C. Proximal convoluted tubule
D. Distal convoluted tubule

Response:
V2 receptors are located on medullary collecting ducts. drugs acting on V2 receptor antagonists are vaptans like convivaptan and tolvaptan Ref: Goodman Gillman 12th ed pg 707

So the answer to this question is A


Instruction:
The earliest manifestation of increased intracranial pressure following head injury is
A. Ipsilateral pupillary dilatation
B. Contralateral pupillary dilation
C. Altered mental status
D. Hemiparesis

Response:
• Early signs of elevated ICP includes drowsiness and a diminished level of consciousness.
• Coma and unilateral papillary changes are late signs and require immediate intervention.

So the answer to this question is C


Instruction:
Formation of excessive amounts of granulation tissue, which protrudes above the level of the surrounding skin and blocks re-epithelialization is called:
A. Proud flesh
B. Keloid
C. Desmoids
D. Hypertrophic scar

Response:
The accumulation of excessive amounts of collagen may result in a raised scar known as a hypertrophic scar and they tend to regress over several months.
If  the scar tissue grows beyond the boundaries of the original wound and does not regress, it is called a keloid.
Exuberant granulation is another deviation in wound healing characterized by the formation of excessive amounts of granulation tissue, which protrudes above the level of the surrounding skin and blocks reepithelialization, this process has been called, proud flesh.
Rarely, incisional scars or traumatic injuries may be followed by exuberant proliferation of fibroblasts and other connective tissue elements that may, in fact, recur after excision called desmoids, or aggressive fibromatoses.

Robin’s Textbook of pathology 10th ed Page 93-94

So the answer to this question is A


Instruction:
MC Type of female pelvis
A. Gynaecoid
B. Anthropoid
C. Android
D. Platy pelloid

Response:
Ans. (a) Gynaecoid

So the answer to this question is A


Instruction:
What is Saturation index?
A. Used to assess the Air quality by measuring concentration of pollutants.
B. Used to assess the water quality by estimating hardness, total dissolved solids, alkalinity and pH.
C. Used to assess the Soil quality that whether it is good for growing crops.
D. Used to assess the Milk quality by estimating the bacterial count in it.

Response:
Langlier saturation index indicates degree of saturation of CaCO3 in water Used in industry to stabilize water. LSI is based on 1) pH of water 2) Total dissolved solids 3) Alkalinity 4) Calcium concentration 5) water temperature - LI positive - it leads to deposition & scaling - LI negative - it leads to corrosion - LI should be kept zero - to avoid corrosion & scaling

So the answer to this question is B


Instruction:
G.P. is plasticized (softened) by
A. Alcohol
B. Chloroform
C. Eugenol
D. EDTA

Response:
None

So the answer to this question is B


Instruction:
Increased plasma concentration of calcium is associated with: March 2009
A. Rickets
B. Osteomalacia
C. Primary hyperparathyroidism
D. Pseudohypoparathyroidism

Response:
Ans. C: Primary hyperparathyroidism The most common cause of high calcium levels (hypercalcemia) is an overproduction of parathyroid hormone, or hyperparathyroidism. Hyperparathyroidism tends to be more common in women, and occurs in 25 out of every 100,000 individuals. Hyperparathyroidism can be the result of all four parathyroid glands producing an excessive amount of parathyroid hyperplasia (PTH), or the result of just one gland specifically producing an excessive amount of PTH (usually the result of a parathyroid adenoma or benign tumor). Other conditions associated with hypercalcemia include: Cancers, paicularly multiple myeloma, breast cancer and lung cancer; Excessive levels of vitamin D from vitamins, excessive dietary calcium, or from diseases that may result in excess vitamin D production; Immobilization over a long period of time; Kidney failure; Overactive thyroid (hypehyroidism) or excessive thyroid hormone intake; and Use of ceain medications such as thiazide diuretics. Endocrine disorders like adrenal insufficiency, pheochromocytoma Calcitonin is a hypocalcemic hormone.

So the answer to this question is C


Instruction:
AB blood group antigen are known as....factor ?
A. Duffy
B. Landsteiner
C. Rhesus
D. Lutheran

Response:
Ans. is 'b' i.e., Landsteiner . Human ABO blood group system was discovered by Landsteiner.

So the answer to this question is B


Instruction:
Barium meal contrast radiography is better than endoscopy for diagnosing the following Except
A. Large hiatus hernia (rolling type)
B. Linitus plastica
C. Chronic gastric volvulus
D. All of the above

Response:
Barium meal contrast study is better than endoscopy in diagnosing a number of conditions such as chronic gastric volvulus,linitus plastica, and rolling type of large hiatus hernia .in linitus plastica, there is irregular filling defect is noted in barium contrast study, Ref: SRB&;s manual of surgery,ed5, pg 842

So the answer to this question is D


Instruction:
A patient receives a toxic dose of lignocaine i.v., the patient is likely to exhibit?
A. Excessive salivation
B. Mydriasis and diarrhea
C. Respiratory paralysis
D. Seizures and coma

Response:
* If LA reaches the blood stream, most prominent adverse effects are related to CNS and CVS. * In CNS :-stimulation (convulsions) followed by depression (coma) is seen. - Initial stimulation is due to inhibition of the inhibitory neurons.

So the answer to this question is D


Instruction:
True about acoustic neuroma:
A. Malignant tumour
B. Arises from vestibular nerve
C. Upper pole compresses IX,X,XI nerves
D. Lower pole compresses trigeminal cranial nerve

Response:
(b) Arises from vestibular nerve(Ref. Shambaugh, 6th ed., 645)The most common site of origin of acoustic neuroma is from the Schwann cells of the inferior vestibular nerve followed by superior vestibular nerve.Acoustic neuroma is the most common benign tumour of the CP angle.When the tumour invades CP angle its upper pole compresses trigeminal nerve which is situated at the upper pole of CP angle.9th, 10th and 11th cranial nerves present at the base of CP angle are compressed by the lower pole of Acoustic neuroma.

So the answer to this question is B


Instruction:
All are steps of PCR EXCEPT:
A. Denaturation
B. Annealing
C. Extension
D. Transformation

Response:
ANSWER: (D) TransformationREF: Harper's 28 ed chapter 39The polymerase chain reaction (PCR) is a method of amplifying a target sequence of DNA. PCR provides a sensitive, selective, and extremely rapid means of amplifying any desired sequence of DNA. Specificity is based on the use of two oligonucleotide primers that hybridize to complementary sequences on opposite strands of DNA and flank the target sequence. The DNA sample is first heated to separate the two strands of the template DNA containing the target sequence; the primers, added in vast excess, are allowed to anneal to the DNA; and each strand is copied by a DNA polymerase, starting at the primer sites in the presence of all 4 dXTPs. The two DNA strands each serve as a template for the synthesis of new DNA from the two primers. Repeated cycles of heat denaturation, annealing of the primers to their complementary sequences, and extension of the annealed primers withDNA polymerase result in the exponential amplification of DNA segments of defined length (a doubling at each cycle). Early PCR reactions used an E coli DNA polymerase that was destroyed by each heat denaturation cycle. Substitution of a heat-stable DNA polymerase from Thermusaquaticus (or the corresponding DNA polymerase from other thermophilic bacteria), an organism that lives and replicates at 70-80degC, obviates this problem and has made possible automation of the reaction, since the polymerase reactions can be run at 70degC. This has also improved the specificity and the yield of DNA.

So the answer to this question is D


Instruction:
PAS positive are all the following except -
A. Glycogen
B. Lipids
C. Fungal cell wall
D. Basement membrane of bacteria

Response:
Ans-DThe basement membrane of bacteria

So the answer to this question is D


Instruction:
A 16-year-old girl presents with a painfully enlarged lymph node in her right axilla and low grade fever. Peripheral blood counts are within normal limits. The lymph node is biopsied, and numerous granulomas filled with neutrophils and necrotic debris are observed. Which of the following organisms could produce this disease?
A. Baonella henselae
B. Borrelia burgdorferi
C. Chlamydia psittaci
D. Coxiella burnetii

Response:
Baonella henselae is the infective agent of cat scratch disease, which generally presents as regional lymphadenopathy with or without low fevers and headaches. Baonella is a gram-variable pleomorphic rickettsial organism that is introduced to the skin in a cat bite or scratch. It produces a self-limited granulomatous response in the draining lymph nodes. Borrelia burgdorferi is a spirochetal organism that is transmitted by a tick bite (Ixodes spp.), producing Lyme disease. Lyme disease progresses from a skin rash to fevers, headache and pain over about one month. It may produce lymphadenopathy, but is not associated with granuloma formation. Chlamydia psittaci infection occurs after contact with infected bird droppings and produces an atypical pneumonia. The central nervous system may also be involved, but lymph nodes are spared. Chlamydia trachomatis is the chlamydial species that typically produces suppurative nodal granulomas (lymphogranuloma venereum). Coxiella burnetii infection is transmitted by inhaling dusts or drinking milk from infected mammals, especially sheep and cows. The disease in humans, Q fever, is marked by mild nonspecific symptoms or pneumonia, and may progress to myocarditis or hepatitis.

So the answer to this question is A


Instruction:
A child is presenting with erythmatous follicular papules on trunk. There are areas of normal skin within the lesions. There is thickening of Palms & soles. This child is suffering from –
A. Pityriasis rosea
B. Pityriasis rubra pilaris
C. Psoriasis
D. Seborrheic dermatitis

Response:
Clues are :-

Erythmatous follicular papules
Involvement of trunk
Thickening of Palm and soles (Palmo-Planter keratoderma)
The most important one is presence of normal skin within the lesions

Diagnosis is nothing other than pityriasis rubra pylaris.

So the answer to this question is B


Instruction:
Treatment of complete rupture of tendo calcaneum is
A. Can be left as it is
B. Physiotherapy
C. Arthrodesis
D. Surgical repair

Response:
Ans. d (Surgical repair). (Ref. Essential Orthopedics by Maheshwari, 2nd/pg.101)Tendoachillas (tendo calcaneum) is the strongest and biggest tendon in body. Achilles tendon rupture is the most common injury involving a break in a tendon. Although tear may occur in it, complete rupure is not very common, but when occurs it needs surgical repair.Additional Educational points:# A proximal biceps tendon rupture is the most common type of biceps tendon injury and its most common cause is overuse/ over-exercise.# Supraspinatus is the most common muscle involved in Rotator cuff Tears/ Injuries.# Fracture of the radius is the most common single cause of EPL rupture.# The most commonly injured ligament at ankle is the anterior talofibular ligament

So the answer to this question is D


Instruction:
Which of the following correlates well to overcoming of limiting amino acids in diet: March 2013
A. Rancidity
B. Teiary structure of
C. Biological value
D. Complementary action of proteins

Response:
Ans. D i.e. Complementary action of proteins A varied diet that includes different types of food will contain all the amino acids that an individual needs. If a food lacking in an amino acid is eaten with another food which contains it, then the second food compensates for the first and vice versa. This is called the complementary action of proteins

So the answer to this question is D


Instruction:
The most common hormone other than gastrin contained in the gastric secreting islet cell tumour is:
A. ACTH
B. Glucagon
C. Melanocyte stimulating hormone
D. Growth hormone releasing factor

Response:
Ans: aRef: Harrison, 14th ed, p. 1613

So the answer to this question is A


Instruction:
Disturbance of affect is not seen in
A. Drowsiness
B. Obsessions
C. Hallucinations
D. Delusions

Response:
(B) Obsessions # Obsessive-Compulsive Disorder:> An obsession is defined as an idea, impulse or image which intrudes into conscious awareness repeatedly. It is recognized as one's own idea, impulse or image but is ego-alien (foreign to one's personality). It is recognized as irrational and absurd (insight is present) Patient tries to resist against it but is unable to Failure to resist leads to marked distress.> Differentiation has to be made from delusion and thought insertion.> A delusion is recognized as one's own idea but is not recognized as ego-alien. It is strongly believed, hence it is never thought to be irrational and is never resisted.> Thought inertion is not thought of as one's own idea, but somebody else's thought being forcibly inerted into one's mind.> An obsession is usually associated with a compulsion form of behaviour which usually follows obsessions.

So the answer to this question is B


Instruction:
The disease process that best accounts for this problem:
A. Ethylene glycol poisoning
B. Chronic obstructive pulmonary disease
C. Congestive hea failure
D. Vomiting

Response:
Vomiting

So the answer to this question is D


Instruction:
Earliest Sign/Symptom of Compartment Syndrome of Leg is
A. Tingling Numbness
B. Pain on passive flexion of fingers
C. Skin Changes
D. Absent Pulses

Response:
Ans. (B) Pain on Passive flexion of FingersRef: Surgery Sixer 3rd Edition Page 103Repeated question so many times,Compartment syndrome of Lower leg is associated with* Early Sign- Pain on Passive stretching* Late Sign- Absent Pulses* Fasciotomy done Longitudinally at 2 sides of Tibia, at pressure >30mmHg.* Delayed Fasciotomy may result in Myoglobinuria and Renal Failure.

So the answer to this question is B


Instruction:
Buon's agammaglobulinemia is due to?
A. B-cell defect
B. IgA deficiency
C. Ig M deficiency
D. Ig G deficiency313

Response:
Ans is 'a' i.e. B-cell defect X-Linked agammaglobulinemia of buonThere is defective humoral immunity with normal cell mediated immunity. It is characterized by the failure of B cell precursors (Pro-B cells and pre B cells) to mature into B cells. There is mutation in cytoplasmic tyrosine kinase called B - cell tyrosine kinase (BtK).The disease usually does not become apparent until about age 6 months, when maternal immunoglobulins are depleted.B cells are absent or markedly decreased in the circulation, and the serum levels of all classes of immunoglobulin.There is depletions of B cell area of lymphnode (Coical follicles and medullary cord) and spleen (perifollicular region, germinal centre and mantle layer). Tonsil and adenoids are atrophic.T-cell collection areas are normal i.e. (i) Paracoical area in lymph nodes, and (ii) Periaerial lymphoid region & malpighian corpuscle in white pulp of spleen.The disease is seen almost entirely in males. There is recurrent bacterial infections of respiratory tract by H. influenzae, str. pneumoniae or staph. aureus. There is increased susceptibity to infection with enterovirus (echo, coxsackievirus, poliovirus), giardia lamblia, and ahritis by mycoplasma.As there is agammaglobulinemia, Opsonization is defective (Immunoglobulins are the major opsonins in body).

So the answer to this question is A


Instruction:
Funneling in cervicogram is seen in -
A. In labour
B. Cervical incompetence
C. Cervical ectopic
D. During TVS

Response:
Ans. is 'b' i.e., Cervical incompetence o Cervicogram is done for diagnosis of cervical incompetence. In other conditions, cervicogram is not done.Diagnosis of cervical incompetence:o Diagnosis in pregnant state:1) History : Painless second trimester abortion in previous gestation.2) Shirodkar's digital palpation test:# In suspected cases (those with a previous abortion), do a weekly per vaginal examination. A finger introduced upto the internal os and if found open pass it a little beyond and withdraw the finger. While withdrawing feel for the sphincter - like tone of the internal os; if the os tends to close down with sphincter like or snapping action, the os is considered competent and no cerclage is necessary. This is a highly subjective test.3) Cervical sonography:# Funelling of the cervix with changes in the form of Y, V, U.# Cervical length < 2.5 cm.# Funnelling of the internal os > 1 cm# Speculum examination: Detection of dilatation of internal os with herniation of the membranes.# Cervical index = (Funnel length + 1) / (endocervical length).# The "+1" allows an index to be calculated when funelling is absent.o Predictors of preterm birth:# Cervical index >0.52.# Cervical length < 18 mm# Funnel length > 9 mm.# Funnel width > 6 mm.o Diagnosis in non - pregnant state:1) Passage without resistance and pain of No. 8 Hegarrs dilator.2) Cervicogram : shows funnel shaped cervix.3) Intracervical balloon studies: Pass a balloon (e.g. Foley's) into cervical canal and inflate it with a radio - opaque dye and then take x - rays after applying due traction. Pear shaped shadow of balloon due to funneling of cervical canal indicates incompetent os.4) Traction studies : Pass foley's catheter through internal os of cervix and inflate it with 5 - 10 ml and apply traction. If traction of 600 gm or less is enough to pull out the bulb through the os, then the diagnosis is certain.5) Bromen papaine test : This dye selectively dilates the cervico - uterine junction. After injecting the dye (locally into the cervix and intramuscularly.

So the answer to this question is B


Instruction:
Most common nephropathy in world is?
A. IgA nephropathy
B. FSGS
C. Minimal Change ds
D. Adult PSGN

Response:
a. IgA nephropathy(Ref: Nelson's 20/e p 2496)High Yield Points:IgA nephropathy is the most common type of glomerulonephritis worldwideIgA nephropathy is the most common cause of gross hematuria

So the answer to this question is A


Instruction:
Example of IgA nephropathy is -
A. Henoch Schonlein purpura
B. Minimal Change Glomerulonephritis
C. Good Pasture's syndrome
D. Wegener's granulomatosis

Response:
Ans. is 'a' i.e., Henoch Schonlein purpura o There is deposion of IgA, sometimes with IgG and C3, in the mesangial region in HSP.o IgA is deposited in the glomerular mesangium in a distribution similar to that of IgA nephropathy. This has led to the concept that IgA nephropathy and Henoch-Schonlein purpura are spectra of the same disease.

So the answer to this question is A


Instruction:
Earliest feature of pulmonary venous hypeension is -
A. Upper lobar vessel dilatation
B. Kerley B Lines
C. Left atrial enlargement
D. Pleural effusion

Response:
Upper lobe venous diversion is the 1st radiological sign of pulmonary venous hypeension.Kerley B Lines , perihilar haze ,peribronchial cuffing,pumonary ossicles ,fine punctuate calcification and perihilar batwing pattern are the other features seen in PVH.

So the answer to this question is A


Instruction:
Granulation tissue is replaced by connective tissue in?
A. 7 days
B. 14 days
C. 21 days
D. 1 month

Response:
None

So the answer to this question is C


Instruction:
Albumin-cytological dissociation is seen in all of the following Except
A. Lead encephalopathy
B. Acute poliomyelitis
C. Infective polyneuritis
D. Tumors of spinal cord

Response:
Conditions that produce albumin cytological dissociation are:Guillain Barre syndromeInfective polyneuritisTumors of the spinal cordLead encephalopathyIn acute poliomyelitis, there is pleocytosis with moderate elevation of protein

So the answer to this question is B


Instruction:
A 15 year old female patient presents with pain in the calf muscles on exercise. Routine investigation reveals burgundy-colored urine (sample obtained after exercise). Histopathology of muscle shows deposits of glycogen in an excess amount. What is the diagnosis?
A. Von Gierke's disease
B. Pompe's disease
C. McArdle's disease
D. Cori's disease

Response:
Type V Glycogen Storage Disease (McArdle Disease)

Type V GSD is an autosomal recessive disorder.

Biochemical Defect:

Muscle Phosphorylase Defect.
The gene for muscle phosphorylase (PYGM) has been mapped to chromosome 11q13.
Lack of this enzyme limits muscle ATP generation by  glycogenolysis, resulting in muscle glycogen accumulation, and is the prototype of muscle energy disorders.

Clinical Manifestations:

Symptoms usually 1st develop in late childhood or as an adult and are characterized by exercise intolerance with muscle cramps and pain.
Many patients experience a characteristic ‘second wind’ phenomenon. If  they slow down or pause briefly at the 1st appearance of muscle pain, they can resume exercise with more ease.
About 50% of patients report burgundy-colored urine after exercise, which is the consequence of exercise-induced myoglobinuria, secondary to rhabdomyolysis.

Key Concept:
Burgundy-colored urine after exercise is the consequence of exercise-induced myoglobinuria, secondary to rhabdomyolysis. It occurs in Type V Glycogen Storage Disease (McArdle Disease).
Reference- Harper’s illustrated biochemistry. 30th edition page no: 179

So the answer to this question is C


Instruction:
Which one of the following is not a Pervasive Developmental Disorder
A. Autistic disorder
B. Conduct disorder
C. Asperger's disorder
D. Rett's disorder

Response:
Pervasive Developmental Disorder- group of neurodevelopmental disorder. It includes- Autism (i.e. marked impairment in reciprocal social and interpersonal interaction) Asperger's syndrome is characterized by autism without any significant delay in language or cognitive development (including intelligence). Rett's syndrome is a disorder which is only repoed in girls so far. Heller's syndrome

So the answer to this question is B


Instruction:
Which of the following is helpful in determining the amount of osseous respective surgery that should be done:
A. Radiograph.
B. Probing depth.
C. Sounding.
D. All of the above.

Response:
None

So the answer to this question is D


Instruction:
Hypercalcemia is caused by all except:
A. Thyrotoxicosis
B. Vit. D intoxication
C. Sarcoidosis
D. Furosemide

Response:
Answer is D (Furosemide): Thiazide diuretics cause hypercalcemia while loop diuretics (furosemide) cause hypocalcemia. Furosemide is a loop diuretic that is characteristically associated with hypocalcemia and not hypercalcemia.

So the answer to this question is D


Instruction:
The topical use of following local anesthetic is not recommended ?
A. Ligocaine
B. Bupivacaine
C. Cocaine
D. Dibucaine

Response:
Topical (surface) anesthetics :- Tetracaine (amethocaine), Cocaine, Benzocaine, Lidocaine, Dibucaine, Benoxinate, Oxethazane, Butamben.

So the answer to this question is B


Instruction:
Combination of pilocarpine and epinephrine use in glaucoma treatment may inhibit:
A. Pigmented pupillary cyst
B. Retinal detachment
C. Vitreous haemorrhage
D. Iridocyclitis

Response:
Ans. Pigmented pupillary cyst

So the answer to this question is A


Instruction:
Increasing difficulty in swallowing both for solids and liquids in a woman with bird's beak appearance in X-ray seen in
A. Reflux esophatitis
B. Carcinoma
C. Achalasia cardia
D. Barret's esophagus

Response:
ACHALASIA CARDIA is the failure of relaxation of oesophagogastric junction due to disorganised oesophageal peristalsis.
aetiological factors include stress, vitamin b1 deficiency, Chagas's disease.it is a precancerous lesion chance to transform into squamous cell carcinoma.common in females of 20-40 yrs, presents with progressive dysphagia, more to liquids than solids, regurgitation and recurrent pneumonia, heartburn, and lung abscess.
a barium swallow is diagnostic and shows pencil like smooth narrowing of the lower oesophagus (bird beak appearance) and dilatation of proximal oesophagus (cucumber oesophagus). chest x-ray shows patches of pneumonia, manometry reveals unrelaxed lower oesophagal sphincter. differential diagnosis includes *carcinoma oesophagus   *scleroderma  *stricture oesophagus. treatment includes

*modified heller's operation
*POEM(peroral endoscopic myotomy
*forcible dilatation

So the answer to this question is C


Instruction:
Cell drinking is also known as:
A. Phagocytosis
B. Pinocytosis
C. Endocytosis
D. None of the above

Response:
Pinocytosis ("cell drinking") is a similar process with the vesicles much smaller in size and the substances ingested are in solution. Ref: Ganong's Review of Medical Physiology 23rd edition, Chapter 2.

So the answer to this question is B


Instruction:
A 29 yr old unmarried female presents with dyspnea. Her chest X-ray is normal, FVC is 92%, FEV1/ FVC is 89% and DLCO is 59% of normal. On exercise her oxygen saturation drops from 92% to 86%. What is the likely diagnosis ?
A. Alveolar hypoventilation
B. Primary pulmonary hypeension
C. Interstitial lung disease
D. Anxiety

Response:
In primary pulmonary hypeension: Pulmonary function tests shows Non restrictive Non obstructive FVC,FEV1,FEV1/FVC Are normal where as DLCO is characteristically decreased

So the answer to this question is B


Instruction:
Which of the following is the most characteristic ultrastructural feature of paraganglioma on electron microscopy?
A. Shrunken mitochondria
B. Large Golgi apparatus
C. Frequent mitoses
D. Dense core neuroendocrine granules

Response:
Electron microscopy examination of paragangliomas show membrane bound electron dense neurosecretory granules in the cytoplasm of tumor cells. Ref: Head and Neck Surgical Pathology By Ben Z. Pilch, Page 68; Dail and Hammar's Pulmonary Pathology: Neoplastic Lung Disease By Joseph F. Tomashefski, Page 533; Salivary Gland Diseases: Surgical and Medical Management By Robe Lee Witt.

So the answer to this question is D


Instruction:
What is the Goal of Prudent diet for prevention of Coronary hea disease?
A. Cholesterol: HDL ratio <3.5
B. Cholesterol; HDL ratio <6.5
C. Cholesterol: HDL ratio >3.5
D. Cholesterol: HDL ratio >6.5

Response:
Goal of WHO Prudent diet is to Reduce Cholesterol: HDL ratio <3.5 Prudent diet: Dietary modification is the principle preventive strategy in the prevention of CHD. WHO recommended changes: Reduction of fat intake to <20-30% of total energy intake Consumption of saturated fats <7% of total energy intake Reduction in cholesterol intake to <200 mg/day Increase in complex carbohydrate consumption Reduction of salt intake to < 5 gms per day Avoidance of alcohol consumption. Extra edge: Balanced diet contain: Proteins -10-15 % of daily energy intake Fats - 15-30 % Carbohydrates - constitute remaining energy.

So the answer to this question is A


Instruction:
All of the following statements regarding total anomalous pulmonary connection are true except –
A. The total pulmonary venous blood reaches the right atrium
B. Always associated with a VSD
C. The oxygen saturation of the blood in the pulmonary artery is higher than that in the aorta
D. Infracardiac type is always obstructive

Response:
Hemodynamics of TAPVC

TAPVC results in the pulmonary venous blood reaching the right atrium which also receives the systemic venous blood.
This results in volume overload to right atrium -p Right atrial enlargement.
Larger volume of blood reaches the right ventricle --> Right ventricle enlargement.
The blood flow to the left atrium is through patent foramen ovale or ASD.
Because there is mixing of unoxygenated blood from systemic circulation and oxygenated blood from pulmonary circulation in the right atrium —> The oxygen saturation of blood in pulmonary artery is higher or identical to that in Aorta.
TAPVC can be divided into : -

i) TAPVC with pulmonary venous obstruction

Pulmonary venous obstruction results in pulmonary arterial hypertension. Pulmonary obstruction —> T back pressure —> 1' Pulmonary capillary pressure

T Pulmonary artery pressure
u Because of pulmonary venous obstruction oxygenated blood cannot reach heart —> Cyanosis and CHF during first week of life.
ii) TAPVC without obstruction (more common)

In TAPVC without obstruction, pulmonary blood flow is high.
Patients develops CHF at around 6-8 weeks when the fetal pulmonary resistance falls maximally and pulmonary circulation reaches the maximum.
Infracardiac type of TAPVC is always obstructive whereas cardiac and supracardiac type may be obstructive or nonobstructive.

So the answer to this question is B


Instruction:
A child presents with seborrheic dermatitis, sinusitis and chronically draining ears. On examination child has failure to thrive with hepatosplenomegaly and exophthalmos. Probable diagnosis is
A. Histiocytosis-X
B. Wegener's granulomatosis
C. Chronic granulomatous disease
D. Chediak-Higashi syndrome

Response:
Ans. a. Histiocytosis-X

So the answer to this question is A


Instruction:
Which of the following drug is a common and classical example producing reverse tolerance?
A. LSD
B. Cannabis
C. Alcohol
D. Nicotine

Response:
Reverse tolerance is seen with alcohol. Reverse tolerance is also called sensitization or hypersensitization. It involves the exaggerated effect of taking in a small amount of substance, in genetically susceptible individuals.

So the answer to this question is C


Instruction:
The following cereals should be avoided in patients with celiac diseases, except -
A. Wheat
B. Barely
C. Maize
D. Rye

Response:
Celiac disease (celiac sprue / gluten-sensitive enteropathy)

Celiac disease is a chronic disease, in which there is a characteristic mucosal lesion of the small intestine and impaired nutrient absorption, which improves on withdrawal of wheat gliadins and related grain proteins from the diet.
The fundamental disorder in celiac sprue is sensitivity to gluten which is alcohol soluble, water-insoluble protein component. It is found in wheat and closely related grains such as oat, barley and rye.
Celiac disease presents with features of malabsorption and the characteristic is that withdrawal of gluten-containing substances from the diet i.e. (wheat, oat, barley and rye) produces a dramatic improvement in the disease.

So the answer to this question is C


Instruction:
According to the Enneking system, not true regarding an active benign tumour is -
A. Intracapsular
B. Margin of reactive bone
C. Thick rim of reactive bone
D. Extended curettage is treatment

Response:
Enneking active stage of benign tumors is stage 2 in which tumor is actively growing and can cause symptoms of pathological fracture.
Radiograph shows well defined margins with a thin rim of reactive bone. Tumor may expand and thin the cortex.
Treatment usually consists of extended curettage, e.g. in ABC.

So the answer to this question is C


Instruction:
A 28 year old female presents with recurrent aboions and pain the calves. She is most likely suffering from a deficiency of which of the following -
A. Protein C
B. Thrombin
C. Factor XIII
D. Plasmin

Response:
. Protein C

So the answer to this question is A


Instruction:
Capacitance of sperms takes place in
A. Seminiferous tubules
B. Epididymis
C. Vas deference
D. Uterus

Response:
Sperm is the male reproductive cell in the sexual reproduction. Capacitation is the penultimate step in the maturation of mammalian spermatozoa and is required to render them competent to feilize an oocyte. This step is a biochemical event; the sperm moves normally and looks mature prior to capacitation. In vivo, this step typically occurs after ejaculation, in the female reproductive tract. Ref: Ganong&;s review of medical physiology; 24th edition; page no:-422

So the answer to this question is D


Instruction:
Best prognosis in liver transplantation is observed, if indication for transplant was?
A. Acute liver failure
B. Chronic liver failure
C. Malignancy
D. Metabolic liver disease

Response:
Acute liver injury may present with non-specific symptoms of fatigue and abnormal LFTs, or with jaundice and acute liver failure. * Chronic liver injury is defined as hepatic injury, inflammation and/or fibrosis occurring in the liver for more than 6 months. In the early stages, patients can be asymptomatic with fluctuating abnormal LFTs. With more severe liver damage, however, the presentation can be with jaundice, poal hypeension or other signs of cirrhosis and hepatic decompensation . Patients with clinically silent chronic liver disease frequently present when abnormalities in liver function are observed on routine blood testing, or when clinical events, such as an intercurrent infection or surgical intervention, cause the liver to decompensate. Patients with compensated cirrhosis can undergo most forms of surgery without significantly increased risk, whereas decompensation can be a complication in all cases and the presence of poal hypeension with intra-abdominal varices can make abdominal surgery more hazardous. The possibility of undiagnosed liver disease should be borne in mind in all patients in at-risk groups undergoing significant surgery. Ref Davidson edition23rd pg856

So the answer to this question is B


Instruction:
Best investigation for pulmonary embolism ___:
A. MRI
B. V/Q scan
C. Plain CT
D. CT angiography

Response:
Ans. D. CT angiographyPulmonary CT angiography /MDCT is the best investigation for pulmonary embolism. The dye is injected through the intravenous route.* V/Q scan is done in pregnant females.* Investigation of choice for an aortic aneurysm is CT angiography.

So the answer to this question is D


Instruction:
The benefits of the technique shown below are all of the following except:
A. Protects from neonatal jaundice
B. Protects from hypothermia
C. Decreases duration of hospital stay
D. Promotes exclusive breastfeeding

Response:
a. Protects from neonatal jaundiceThe neonate is kept in skin to skin contact with mother, in between the breasts, inside clothing of mother. This is Kangaroo Mother Care (KMC)

So the answer to this question is A


Instruction:
Hassall's corpuscles are found in-
A. Lymph nodes
B. Spleen
C. Liver
D. Thymus

Response:
Ans. is 'd' i.e., Thymus o The dominant feature of medulla of thymus is its epithelial components, which are onion like structures called Hassall's Corpuscles, which have an intensely eosinophilic core of dead material,

So the answer to this question is D


Instruction:
A young child, who has had abnormal development of the membranous bones has a broad skull with associated facial and dental anomalies. Which other bones is most likely to be also affected?
A. Clavicles
B. Femurs
C. Metatarsals
D. Phalanges

Response:
In a syndrome called cleidocranial dysostosis, absence of pa of the clavicles accompanies a broad skull, and facial and dental anomalies. Note that you could also have answered this question by noting that of the bones listed, only the clavicles form by intramembranous ossification. The femurs, metatarsals, phalanges, and tibias are cailaginous (formed by endochondral ossification) rather than membranous bones.

So the answer to this question is A


Instruction:
Charcot's joint includes all of the following Except:
A. Syrimgomyelia
B. Leprosy
C. Diabetes
D. Ahrogryposis multiple congenital

Response:
Answer is D (Ahrogryposis multiple congenita): Ahrogryposis multiplex congenital is not associated with charcot's joint. Charcot foot occurs in patients with peripheral neuropathy resulting from diverse conditions including diabetes mellitus, leprosy, syphilis, poliomyelitis, chronic alcoholism or syringomyelia. Repetitive microtrauma that exceeds the rate of healing may cause fractures and dislocations. Changes in circulation may cause resorption of bone, weakening the bone and increasing susceptibility to fracture and dislocation.

So the answer to this question is D


Instruction:
Not seen in Korsakoff's syndrome
A. Clear consciousness
B. Inability to learn new things
C. Hallucinations
D. Confabulation

Response:
As Korsakoff's psychosis often follows Wernicke's encephalopathy; these are together referred to as Wernicke-Korsakoff syndrome. Clinically, Korsakoff's psychosis presents as an organic amnestic syndrome, characterised by gross memory disturbances, with confabulation. Insight is often impaired. The neuropathological lesion isusually wide-spread, but the most consistent changes are seen in bilateral dorsomedial nuclei of thalamus and mammillary bodies. The changes are also seen in periventricular and periaqueductal grey matter, cerebellum and pas of the brainstem. The underlying cause is believed to be usually severe untreated thiamine deficiency secondary to chronic alcohol use. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.38

So the answer to this question is C


Instruction:
Which of the following childhood tumors show extracranial metastasis?
A. Glioblastoma multiforme
B. Medulloblastoma
C. Choroid plexus carcinoma
D. Ependymoblastoma

Response:
b. Medulloblastoma(Ref: Nelson's 20/e p 2453-2460, Ghai 8/e 612-613)Among the given options, Medulloblastoma is the most malignant brain tumor seen in children. Up to 30% of patients with medulloblastoma present with neuroimaging evidence of leptomeningeal spread.

So the answer to this question is B


Instruction:
A 63-year-old woman fell while crossing the street after her Thursday afternoon bridge game. Attempts at resuscitation for cardiac arrest by the emergency medical service (EMS) team were unsuccessful. The woman had previously been diagnosed as having aortic stenosis and left ventricular hypertrophy. In addition to these factors, which of the following predisposes to sudden cardiac death?
A. Split first heart sound
B. Hypokalemia
C. Soft murmur at left of sternum that varies with inspiration
D. Failure of the central venous pressure (CVP) to rise more than 1 cm H2O with 30-second pressure on the liver (hepato-jugular reflux)

Response:
Sudden cardiac death is defined as an unexpected death occurring within 1 hour after the beginning of symptoms in a patient who was previously hemodynamically stable. In asymptomatic patients presenting initially with cardiac disease, 20% will die within the first hour of symptoms. Electrolyte imbalance, hypoxia, and conduction system defect are additional factors that increase the risk of sudden death syndrome. Split first heart sound accentuated on inspiration occurs in normal individuals. In CHF, the CVP changes more than 1 cm when pressure is applied below the right costal margin to the liver (hepatojugular reflex) for a 30-second period.New York Classification of Functional changes in Heart DiseaseClassLimitation of Physical ActivityINoneIISlightIIIMarkedIVComplete (even at rest)

So the answer to this question is B


Instruction:
Erythropoiesis is promoted by all of the following except:
A. ACTII
B. Thyroxine
C. Oestrogen
D. Prolactin

Response:
C i.e. Oestrogen

So the answer to this question is C


Instruction:
Medial border of triangle of auscultation is
A. Trapezius
B. Scapula
C. Lattismus dorsi
D. Rhomboids major

Response:
Triangle Of Auscultation It is a small triangular interval interval bounded medially by the lateral border of the trapezius, laterally by the medial border of the scapula,and inferiorly by the upper border of the latissimus dorsi.The floor of the triangle is formed by the seventh rib,sixth and seventh intercostal spaces,and the rhomboideus major. Ref.B D Chaurasia's human anatomy vol.1.

So the answer to this question is B


Instruction:
Which of the following vaccine can be given to AIDS positive child:
A. DPT
B. BCG
C. Measles
D. OPV

Response:
Ans. (a) DPTRef : OP Ghai 8th ed./193* Since all live vaccines are contraindicated in immune- compromised patients hence only DPT can be given. Please note that the question mentions an AIDS positive patient and "not a child born to HIV positive mother".* If a child is born to HIV positive mother, the child may or may-not be acquire HIV infection from the mother. Hence WHO recommends BCG should be given to a baby born to HIV positive lady. Textbook clearly mentions that if baby has documented AIDS then live vaccines are contraindicated. In such cases I.P. V. can be given in place of O.P.V.

So the answer to this question is A


Instruction:
Drug of choice for Digoxin induced Ventricular Tachycardia:-
A. Propranolol
B. Dilitiazem
C. Verapamil
D. Lignocaine

Response:
Lignocaine:- DOC in Digoxin Induced Ventricular Tachycardia. DOC in post Mi Ventricular Tachycardia. It is class IB Ant arrythmia drug. Propranolol:- Non selective antagonist, having both negative inotropic and chronotropic effect It doesnot reduce blood pressure in people with (N) Blood pressure. It lower BP in Hypeension. Verapamil and diltiazem should be avoided in patient with hea failure or with AV block due to their negative inotropic and dromotropic

So the answer to this question is D


Instruction:
All of the following drugs can be administered in acute hypeension during labour,except
A. IV Labetalol
B. IV Nitroprusside
C. IV Hydralazine
D. IV Esmolol

Response:
Sodium nitroprusside is contraindicated in eclampsia. Contraindications. Sodium nitroprusside should not be used for compensatory hypeension (e.g. due to an anteriovenous stent or coarctation of the aoa). It should not be used in patients with inadequate cerebral circulation or in patients who are near death. Refer kDT 7/e p732

So the answer to this question is B


Instruction:
Arcuate field defect akin to glaucoma is seen in-
A. Pituitary tumor
B. Occipital lobe infarct
C. Optic nerve lesion
D. None of the above

Response:
Arcuate field defect akin to glaucoma seen in conditions which cause optic nerve compressions

So the answer to this question is C


Instruction:
FALSE statement about Ulcerative colitis is
A. Smoking may prevent the disease
B. 58% concordance with monozygotic twins
C. 0% concordance with dizygotic twins
D. Appendectomy is protective for the disease

Response:
Patients with quiescent UC and CD have normal feility rates. The fallopian tubes can be scarred by the inflammatory process of CD, especially on the right side Ulcerative colitis Crohn's disease Male / female ratio 1:1 1.1 - 8.1 Smoking May prevent disease May cause disease Oral contraceptives No increased risk Odds ratio 1.4 Appendectomy Protective Not protective Monozygotic twins 6% concordance 58% concordance Dizygotic twins 0% concordance 4% concordance

So the answer to this question is B


Instruction:
Breast milk at room temperature is stored for
A. 4 hrs
B. 8 hrs
C. 12 hrs
D. 24 hrs

Response:
Expressed Breast milk (EBM) can be stored at room temperature for 6-8 hrs. Ref: Page 155, Ghai essential pediatrics; 8th edition

So the answer to this question is A


Instruction:
The paraneoplastic syndrome associated with Hodgkin's disease is :
A. Nephrotic syndrome
B. Retinopathy
C. Cerebellar degenerative disease
D. Acanthosis nigricans

Response:
Answer is C (Cerebellar degenerative disease): Horlf,kin's I vloohonta is associated with prominent or purr paraneoplastic cerebellar deg=eneration. Cancer Syndrome Antibody Hodgkins Lymphoma Paraneoplastic cerebellar degeneration (PCD) Anti Tr. Paraneoplastic Cerebellar degeneration Pure crebellar degeneration Subacute Cerebellar degeneration Breast and Gynaecological cancers * Small cell carcinoma lung (Anti Yo Antibodies) * Thymoma Hodgkins Lymphoma (Anti Tr Antibodies) * Neuroblastoma

So the answer to this question is C


Instruction:
Gluten sensitive enteropathy is most strongly associated with;
A. HLA-DQ2
B. HLA-DR4
C. HLA-DQ3
D. None

Response:
Answer is A (HLA-DQ2): "About 95% of patients with coeliac sprite express HLA-DQ2 allele" - Harrisons Gluten sensitive Enteropathv (coeliac disease) HLA-DQ genes are the primary bases for disease association HLA - DQ gene present on both DR3Q & DR7 haplotypes appear to account for HLA genetic contribution to disease susceptibility

So the answer to this question is A


Instruction:
Cytokine causing fever
A. IL-6
B. IFN-y
C. IL-18
D. IL-4

Response:
Ans. is 'a' i.e., IL-6

So the answer to this question is A


Instruction:
Intra epidermal splitting is found in –
A. Bullous pemphigoid
B. Pemphigus foliaceous
C. Dermatitis herpetiformis
D. Burns

Response:
In pemphigus group of lesions, intraepidermal splitting is seen.
Pemphigus group includes, P. vulgaris, P. vegetans, P foliaceous, P. erythematosus.

So the answer to this question is B


Instruction:
True about Von Willebrand's disease is all except :
A. Increased bleeding time
B. Factor VIII c levels are decreased in circulation
C. Defect in VWF is detected by ristocetin
D. None

Response:
Answer is D None (All statements are true) Von Willebrand disease is associated with decreased levels of VWF and factor VIII in circulation. Bleeding time and APTT are prolonged. Platelet aggregation in response to ristocetin is abnormal which indicates a deficit in VWF or Ristocetin cofactor. Von Willebrand Von Willebrand disease is caused by a defect of deficiency of VWF factor and presents as bleeding and coagulation disorder. VWF factor is required fir normal platelet adhesion and aggregation. VWF factor is the plasma carrier for factor VIII which is required for intrinsic pathway of the coagulation cascade. VWF disease by demonstrating decreased aggregation.

So the answer to this question is D


Instruction:
True about thermal burn injury
A. Outermost layer is zone of stasis
B. Middle layer is zone of hypermia
C. Inner layer is zone of coagulation
D. Hypermia is due to vasodilation

Response:
Outermost area is zone of hyperaemia and Middle layer is zone of stasis and Innermost layer is the zone of coagulation according to JACKSON'S burn zones. ref:SRB;s manual of surgery,ed 5,pg no 130

So the answer to this question is C


Instruction:
Prophylactic intracranial irradiations is indicated in all the following, EXCEPT:
A. Small cell Carcinoma of lung
B. Acute Leukemic Leukemia
C. Hodgkin's Lymphoma
D. Non-Hodgkin's lymphoma

Response:
Ans. C. Hodgkin's LymphomaLung cancer, breast cancer, leukemias, NHL, gastrointestinal malignancies and melanoma are common tumors that metastasize to brain. By contrast, prostate and ovarian cancer and Hodgkin's disease (HD) rarely metastasize to brain.Radiation is the primary treatment for brain metastases. Thus, prophylactic craniospinal irradiation is useful in lung cancer, ALL and NHL but not in HO.

So the answer to this question is C


Instruction:
Pressure of Nitrous oxide cylinder at 100% and 40% volume respectively measured by pressure gauge is:
A. 750 Psi and 500 Psi
B. 750 Psi and 750 Psi
C. 750 Psi and 375 Psi
D. 750 Psi and 275 Psi

Response:
In cases of gases which are in liquid form in cylinder ( N2O) , pressure gauze shows always full till it becomes Zero Thus in case of N2O , whether cylinder has 100% or 40% volume , pressure gauze will always show 750 Psi.

So the answer to this question is B


Instruction:
Initial treatment for perforated corneal ulcer is: March 2009
A. Conjuctival flap grafting
B. Tissue adhesive glue
C. Contact lens
D. Local anesthetics drops instillation

Response:
Ans. B: Tissue adhesive glue Bacterial corneal ulcer requires intensive foified antibiotic therapy to treat the infection. Fungal corneal ulcers require intensive application of topical anti-fungal agents. Viral corneal ulceration caused by herpes virus may respond to antivirals like topical acyclovir ointment instilled at least five times a day. Alongside, suppoive therapy like pain medications are given, including topical cycloplegics like atropine or homatropine to dilate the pupil and thereby stop spasms of the ciliary muscle. All forced expiration like blowing the nose, coughing etc. must be avoided. Proper nutrition, including protein intake and Vitamin C are usually advised. In cases of Keratomalacia, where the corneal ulceration is due to a deficiency of Vitamin A, supplementation of the Vitamin A by oral or intramuscular route is given. Drugs that are usually contraindicated in corneal ulcer are topical coicosteroids and anesthetics - these should not be used on any type of corneal ulcer because they prevent healing, may lead to superinfection with fungi and other bacteria Fuher option is the use of a tissue adhesive such as N-butyl 2-ethyl cyanoacrylate monomer which is applied to the area of perforation after careful debridement. Drying of the adhesive may take few minutes after which anterior chamber may reform. Following this, a continuous-wear soft contact lens can be applied or a definite surgical procedure such as therapeutic penetrating keratoplasty or conjunctival flap undeaken. Superficial ulcers may heal in less than a week.

So the answer to this question is B


Instruction:
The Predominant source of blood supply to the organ whose histological slide is shown in:
A. Hepatic aery
B. Hepatic Vein
C. Poal vein
D. Cystic aery

Response:
Poal Vein

So the answer to this question is C


Instruction:
All of the following are true regarding Screening of disease except
A. Done on apparently healthy people
B. Time consuming
C. Generally never a basis to sta treatment
D. Arbitrary and final

Response:
Screening test Diagnostic test Done on apparently healthy Done on those with indications or sick Applied to groups Applied to single patients, all diseases are considered Test results are arbitrary and final Diagnosis is not final but modified in light of new evidence, diagnosis is the sum of all evidence Based on one criterion or cut-off point Based on evaluation of a number of symptoms, signs (e.g. diabetes) and laboratory findings. Less accurate More accurate Less expensive More expensive Not a basis for treatment Used as a basis for treatment The initiative comes from the investigator or agency providing care. The initiative comes from a patient with a complaint

So the answer to this question is B


Instruction:
The term physical half life is applicable to
A. Respiratory preparation
B. Prodrugs
C. Radioactive isotopes
D. Alkylating agents

Response:
Physical half-life is defined as the period of time required to reduce the radioactivity level of a source to exactly one half its original value due solely to radioactive decay. The physical half-life is designated tphys or more commonly t1/2 . Refer 6/e p252

So the answer to this question is C


Instruction:
The minor connector for a mandibular distal extension base should extend posteriorly about _____.
A. Two-third the length of the edentulous ridge
B. Half the length of the edentulous ridge
C. One-third the length of the edentulous ridge
D. As long as possible

Response:
The minor connector for the mandibular distal extension base should extend posteriorly about two thirds the length of the edentulous ridge; this adds strength to the denture base.

So the answer to this question is A


Instruction:
Marfan's syndrome associated with?
A. Retinal detachment
B. Vitreous hemorrhage
C. Ectopia lentis
D. Roth spots

Response:
Ectopia lentis REF: Khurana 4th ed p. 422, Pediatric ophthalmology: A clinical guide by Pamela Gallin Table 8-7 "Marfan's syndrome is the most common cause of subluxated lens of childhood" Differential diagnosis of dislocated/subluxated lens: Trauma Ectopia lentis et pupillae Aniridia Syphilis Megalocornea (X linked recessive) Marfan's syndrome Homocystinuria Hyperlysinemia Sulfite oxidase deficiency Weill- Marchesani

So the answer to this question is C


Instruction:
Most common genentic enzyme defect in urea cycle is
A. Arginase
B. Arginosuccunate lyase
C. Ornithine transcarbomylase
D. Carbomoyl phosphate synthase I

Response:
OTC combines carbamyl phosphate with ornithine to make citrulline which is subsequently processed tourea (see: cycle diagram). Along with CPSI and NAGS deficiency, OTCdeficiency is the most severe of theurea cycle disorders. Patients with complete OTC deficiency rapidly develop hyperammonemia in the newborn period Ref-Harpers illustrated biochemistry 30/e p583

So the answer to this question is A


Instruction:
Winging of scapula is due to which of these conditions?
A. Long thoracic nerve palsy
B. Thoraco-dorsal nerve palsy
C. Erb's palsy
D. Klumpke's palsy

Response:
Winging of scapula is due to the paralysis of Serratus anterior muscle which is supplied by long thoracic nerve . Long thoraic nerve damage causes paralysis of Serratus muscle. FEATURES: 1)Medial border of the bone becomes unduly prominent 2)Arm cannot be abducted 90 degrees. REF:B D Chaurasia 7th edition Page no: 45. Figure :3.9,page no:38-Vishram Singh - upper limb& thorax, 2nd edition

So the answer to this question is A


Instruction:
1st evidence of calcification of Maxillary deciduous Lateral incisor occurs
A. 14 wk IU
B. 16 wk IU
C. 17 wk IU
D. 15 wk IU

Response:
None

So the answer to this question is B


Instruction:
The process of complete fluorination in Desflurane produces all the following effects except:
A. Decreases blood and tissue solubility
B. High vapor pressure
C. High potency
D. Requirement of special vaporiser

Response:
The process of complete fluorination of the ether molecule has several effects. It decreases blood: tissue solubility which results in loss of potency. It also results in a high vapour pressure owing to decreased intermolecular alteration requiring new heated pressurized vaporizer.

So the answer to this question is C


Instruction:
Viral enterotoxin is detected as a possible of mechanism pathogenesis in -
A. Adenovirus
B. Rotavirus
C. Calcivirus
D. Astrovirus

Response:
Ans. is b i.e., Rotavirus Pathogenesis Three different mechanisms have recognized 1. Destruction of mature enterocytes (Major pathogenic mechanism) Enterotoxin - A non-structural `rotavirus protein, NSP4, functions as an enterotoxin and contributes to secretory diarrhea. Activation of enteric nervous system - Rotavirus may evoke fluid secretion through activation of enteric nervous system in the intestinal wall.

So the answer to this question is B


Instruction:
HTV pt with malabsotion, fever, chronic diarrhoea, with acid fast positive organism. What is the causative agent ?
A. Giardia
B. Microsporidia
C. Isospora
D. E. histolytica

Response:
Ans. is 'c' i.e., Isospora Common parasitic infections causing diarrhoea in HIV patientIsospora belliCryptosporidiumMicrosporidiaNow the list of Acid fast parasitesOocyst of CryptosporidiumOocyst of CyclosporaOocyst of IsosporaEggs of Taenia saginataAlso knowOther acid fast organisms BacteriaMycobacteriumNocardiaRhodococcusSmegma bacilliLegionella micdadei OthersBacterial sporesSpermatic head

So the answer to this question is C


Instruction:
All of the following statements regarding Rheumatoid ahritis are true, except?
A. IgM antibody directed against Fc pa of IgG
B. Morning stiffness
C. Raised ESR
D. C - Reactive protein suggests a good prognosis

Response:
High ESR and CRP are associated with poor prognosis in rheumatoid ahritis. Rheumatoid factor (IgM antibody directed against Fc poion of IgG) and anti CCP antibody are present in 70-80% of cases. Anti CCP antibody are the most specific blood test for rheumatoid ahritis.

So the answer to this question is D


Instruction:
HLA III gene codes for -
A. Immunological reaction in graft rejection
B. Complement
C. Graft versus host reaction
D. Immunoglobulins

Response:
HLAs corresponding to MHC class III encode components of the complement system. Ref: Ananthanarayanan & Panikers textbook of microbiology 9th edition pig: 140

So the answer to this question is B


Instruction:
Comparison of efficacy of a new drug B with an existing drug A is done in which phase of clinical trials ?
A. Phase I
B. Phase II
C. Phase III
D. Phase IV

Response:
"The purpose of phase III trials is to obtain adequate data about the efficacy and safety of drugs in a larger number of patients of either sex in multiple centres usually in comparison with the standard drug."

So the answer to this question is C


Instruction:
Small pox belongs to which class of poxviruses -
A. Parapoxvirus
B. Capripoxvirus
C. Leporipox virus
D. Ohopovirus

Response:
Variola virus causes smallpox. It belongs to ohopoxvirus REF:ANANTHA ANARAYANAN MICROBIOLOGYNINTH EDITION PAGE.461&465(RECAP)

So the answer to this question is D


Instruction:
Phossy jaw is seen in which poisoning?
A. Mercury
B. Yellow phosphorous
C. Red phosphorous
D. Tetanus

Response:
ANSWER: (B) Yellow phosphorousREF: Textbook of Forensic Medicine and Toxicology by Nagesh Kumar Rao - Page 371Phossy jaw is a type of osteomyelitis of jaws observed in chronic cases of phosphorus poisoning. Incidence is common among the workers of phosphorus industries linked to "yellow phosphorous," the key ingredient in "strike-anywhere" matches, who are exposed to phosphorus fumes. The process starts in a carious tooth and then spreads, causing severe necrosis of the lower jawNote: Yellow phosphorous is also known as white phosphorous

So the answer to this question is B


Instruction:
The vein formed by union of posterior division of retromandibular vein and posterior auricular vein is
A. Common facial vein
B. Anterior jugular vein
C. External jugular vein
D. Interior jugular vein

Response:
External jugular vein is formed by posterior auricular vein and posterior division of retromandibular vein.

So the answer to this question is C


Instruction:
Object permanence milestone develop at?
A. 6 months
B. 9 months
C. 12 months
D. 15 months

Response:
Ans. is 'b' i.e., 9 month

So the answer to this question is B


Instruction:
All of the following are features of an intraepidermal bullae, EXCEPT:
A. Flaccidity
B. Contains serous/turbid fluid
C. Have thick roof and less likely to rupture
D. Leaves hyperpigmentation on healing

Response:
Intraepidermal bullae has thin roof and rupture less readily. Where as subcorneal bullae has very thin roof so rupture very easily, and bullae at dermoepidermal junction has thick roof and rupture least readily. Characteristics of different bullae: Subcorneal Intraepidermal Dermoepidermal Level of split Below stratum corneum In epidermis At dermoepidermal junction Ease of rupture very thin roof, rupture very easily thin roof rupture less readily thick roof, rupture least readily Flaccidity Very flaccid Usually flaccid Usually tense Contents Scanty fluid Serous/turbid fluid Serous/turbid often hemorrhagic fluid On rupturing Form areas of scale crust, no erosions Form erosions covered with crusts Form erosions or ulcers covered with crusts, often hemorrhagic On healing Normal skin Hyperpigmentation Milia and scarring Examples Pemphigus foliaceus Bullous impetigo Pemphigus vulgaris Bullous pemphigoid Ref: Illustrated Synopsis Of Dermatology & Sexually Transmitted Diseases By Khanna page 7

So the answer to this question is C


Instruction:
Contraindications to MRgFUS uterine fibroid are all except
A. Myoma size >10cm
B. Vascular myomas
C. Uterine size > 24 weeks
D. Abdominal wall scars

Response:
Myomas with poor perfusion is contraindication to MRgFUS.

So the answer to this question is B


Instruction:
Pus formation in lacerated wound occurs in:
A. 12-24 hours
B. 24-48 hours
C. 48-72 hours
D. 1 week

Response:
Normally, pus formation occurs in about 48 hours, but in a lacerated wound it occurs slightly earlier.

So the answer to this question is B


Instruction:
Not true regarding Prune belly syndrome is?
A. Macroglossia
B. Hydroureteronephrosis
C. Anterior abdominal wall defect
D. Cryptorchidism

Response:
Prune Belly Syndrome Aka Triad Syndrome Or Eagle Barrett Syndrome C/f: deficient abdominal muscles, undescended testis, cryptorchidism, urinary tract abnormalities eg. large bladder

So the answer to this question is A


Instruction:
The second most common skull radiograph used in dentistry is:
A. Lateral Cephalometric Projection
B. PA Cephalometric Projection
C. Both
D. None

Response:
Lateral Cephalometric Projection is the most common extraoral skull radiograph.

So the answer to this question is B


Instruction:
A large for gestational age baby delivered at 40 weeks was observed to be lethargic. The blood sugar was measured to be 35 mg/di. The management is-
A. Foified Breast Milk
B. 10% IV Dextrose
C. Oral Glucose Solution
D. Normal Saline

Response:
Ans. is `b' i.e., 10% IV Dextrose o Symtomatic (Lethargy) Hypoglycemia (<40mg/d1) should be managed with 10% IV Dextrose. Treatment of neonatal hypoglycemia (1) Asymptomatic with blood glucose between 20-40 mg/dl Direct breast feeding is staed. If neonate is unable to suck, expressed breast milk is given. Expressed breast milk should be foified by 5g sugar per 100 ml of milk. (2) Symptomatic or asymptomatic with blood glucose Bolus 10% dextrose 2m1/kg is given IV. Followed by continuous infusion of 6 mg/kg/minute. If normoglycemia is not achieved within 24 hours, glucocoicoids (prednisone or hydrocoisone) should he administered. For intractable hypoglycemia, glucagon, epinephrine or diazoxide can be given.

So the answer to this question is B


Instruction:
Occlusal guards are given to
A. Prevent bruxism
B. To guard the dentition
C. To alter the muscle forces
D. None

Response:
None

So the answer to this question is C


Instruction:
Therapeutic index is an assessment of:
A. Potency of a drug
B. Onset of action
C. Duration of action
D. Margin of safety

Response:
None

So the answer to this question is D


Instruction:
Necrosis of Proximal convoluted tubules is caused by -a) Arsenicb) Phenolc) Alcohold) Amanita phalloides
A. ac
B. ab
C. ad
D. bc

Response:
Poisons causing proximal tubular necrosis : Lead, mercury, arsenic, cadmium, bismuth, phenol (carbolic acid), oxalic acid (oxalate), and ethylene glycol.

So the answer to this question is B


Instruction:
Physiological uncoupler is
A. Thyroxine
B. Free fatty acids
C. Thermogenin
D. All of the above

Response:
Uncouplers will allow oxidation to proceed, but the energy instead of being trapped by phosphorylation Fig. 19.18. Impoant mitochondrial membrane transpoers. 1 = PYT (pyruvate transpoer); 2 = TCT (tricarboxylate transpoer); 3 = ANT (adenine nucleotide transpoer) is dissipated as heat. This is achieved by removal of the proton gradient. (Table 19.5; Fig. 19.17). The uncoupling of oxidative phosphorylation is useful biologically. In hibernating animals and in newborn human infants, the liberation of heat energy is required to maintain body temperature. In Brown adipose tissue, thermogenesis is achieved by this process. Thermogenin, a protein present in the inner mitochondrial membrane of adipocytes, provides an alternate pathway for protons. It is one of the uncoupling proteins (UCP). Thyroxine is also known to act as a physiological uncoupler.Ref: DM Vasudevan Textbook of Medical Biochemistry, 6th edition, page no: 234

So the answer to this question is D


Instruction:
Familial hypercholesterolemia is due to defect in
A. Apo A
B. Lipoprotein lipase
C. Apo C
D. Apo B 100

Response:
Name Defect Remarks Familial hypercholesterolemia (type IIa) Defective LDL receptors or mutation in the ligand region of apo B-100 Elevated LDL levels and hypercholesterolemia, resulting in atherosclerosis and coronary disease Reference: Harper; 30th edition; Page no: 275

So the answer to this question is D


Instruction:
The most common facial abnormality in Gardener's syndrome
A. Ectodermal dysplasia
B. Odontome
C. Multiple osteomas
D. Dental cysts

Response:
Ans. is 'c' i.e. Multiple osteomas Osteomas is mandible and skull are the most common facial lesions in Gardner syndrome. Gardner syndrome is a variant of FAP characterized by: - Colorectal polyposis - Epidermoid cysts - Desmoid tumors - Osteomas - Thyroid neoplasms, and - Congenital hyperophy of the retinal pigment epithelium

So the answer to this question is C


Instruction:
Amphotericin B treatment mandates the monitoring of which of the following electrolytes:-
A. Ca2+
B. Na+
C. K+
D. Cl-

Response:
Hypokalemia is a serious adverse effect of Amphotericin B hence treatment mandates the monitoring of serum K+levels. ADVERSE EFFECTS OF AMPHOTERICIN B: Infusion related reactions are most common adverse effects and require premedication with antihistaminics or glucocoicoids. Dose limiting toxicity is nephrotoxicity manifested by renal tubular acidosis, hypokalemia and hypomagnesemia. It is most common dose dependent adverse effect. It may also result in anemia (due to decreased erythropoietin). * Intrathecal administration may cause seizures and neurological damage. Liposomal AMB, colloidal dispersion (ABCD) and lipid complex (ABLC) are lipid preparations of amphotericin B. These formulations result in decreased accumulation of the drug in tissues like kidney, thus nephrotoxicity is decreased. Some formulations also show decreased incidence of infusion related reactions. However, these new preparations have similar efficacy and antifungal spectrum as possessed by conventional preparations.

So the answer to this question is C


Instruction:
The most common benign tumor of the lung is ?
A. Hamaoma
B. Alveolar adenoma
C. Teratoma
D. Fibroma

Response:
Ans. is 'a' i.e., Hamaoma

So the answer to this question is A


Instruction:
A patient with sore throat has a positive Paul Bunnell test. The causative organism is:
A. EBV
B. Herpes virus
C. Adenovirus
D. Cytomegalovirus

Response:
None

So the answer to this question is A


Instruction:
Rectal adenoma is associated with -
A. Familial polyposis coli
B. Hypokalemia
C. Intussusception
D. Hemorrhoids

Response:
None

So the answer to this question is B


Instruction:
Non-septate hyphae with a tendency to branch at 90 degree angle is characteristic of:
A. Mucormycosis
B. Aspergillosis
C. Cryptococcus neoformans
D. Coccidioides immitis

Response:
The organisms appear as large, nonseptate hyphae with branching at obtuse angles. Round or ovoid sporangia are also frequently seen in the tissue section.
Histopathologically, mucormycosis should be differentiated from aspergillosis in which the former has an acute angulating branched hyphae of smaller width and latter has septate branched hyphae.
Reference: Shafer’s Textbook of ORAL PATHOLOGY Eighth Edition page no 349

So the answer to this question is A


Instruction:
Haemolytic disease of newborn is an example of
A. Type 3 hypersensitivity reaction
B. Type2 hypersensitivity reaction
C. Ahur reaction
D. Type 4 hypersensitivity reactions

Response:
Ref Robbins 7/e p211,9/e p206 Autoimmune hemolytic Anemia Red cell membrane proteins (Rh blood group antigens, I antigen) Opsonization and phagocytosis of erythrocytes Hemolysis, anemia Autoimmune thrombocytopenic purpura thrombocytopenic Platelet membrane proteins (GpIIb/IIIa integrin) Opsonization and phagocytosis of platelets..leads to bleeding..type 2 hypersensitivity reaction

So the answer to this question is B


Instruction:
Impaired "anticipatory posture" is seen in
A. Erb's palsy
B. Autism
C. ADHD
D. Oppositional defiant disorder

Response:
Posture that a child assumes when he wants to get picked up is termed as anticipatory posture. Autism is characterized by poor parental attachment ,eye contact and absence of anticipatory posture.

So the answer to this question is B


Instruction:
Reading and writing skills of a moderately mental retarded child
A. Reasonable
B. Basic
C. Minimal
D. None

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

So the answer to this question is B


Instruction:
CSF findings shows protein - 60%, sugar - 40%; and neutrophils - predominant. The diagnosis is
A. Viral meningitis
B. Bacterial meningitis
C. Tuberculous meningitis
D. Fungal meningitis

Response:
(B) Bacterial meningitis TYPICAL LUMBAR CSF FINDINGS IN MENINGITISTestBacterialViralFungalTuberculousOpening PressureElevatedUsually normalVariableVariableLeukocyte count>1000/pL<100/pLVariableVariableCell differentialMainly neutrophilsMainly lymphocytesMainly lymphocytesMainly lymphocytesProteinMild-marked increaseNomral-mild increaseIncreasedIncreasedGlucoseUsually < 40 mg/dLNormalDecrasedDecreased: may be < 40 mg/dLCSF-to-serum glucose ratioNormal-marked decreaseUsually normalLowLowLactic acidMild-marked increaseNormal-mild increaseMild-moderate increaseMild-moderate increase

So the answer to this question is B


Instruction:
Longest muscle in the body
A. Biceps
B. Triceps
C. Saorius
D. Quadriceps

Response:
REF BD CHAURASIAS HUMAN ANATOMY SIXTH EDITION VOLUME 2 PAGE 53 Saorius is long narrow and ribbon like it run downwards and medially across the front of thigh .it is the longest muscle in the body. It orgin :anterior superior iliac spine Ipper half of notch below spine Inseion: medial surface of shaft of tibia upper pa

So the answer to this question is C


Instruction:
Pin point pupil is seen in all except
A. Pontine hemorrhage
B. Organophosphorus poisoning
C. Opium poisoning
D. Barbiturates poisoning

Response:
Pin point pupil can be caused by : Opioids (morphine), organophosphates, phenothiazines, clonidine, mushroom poisoning, chloral hydrate, carbolic acid and pontine hemorrhage.

So the answer to this question is D