Instruction:
All of the following conditions are associated with elevated levels of serum angiotensin conveing enzyme except:
A. Berylliosis
B. Silicosis
C. Sarcoidosis
D. Bronchogenic carcinoma

Response:
Angiotensin conveing enzyme is a dipeptidyl carboxypeptidase that conves angiotensin I to the vasopressor angiotensin II. It is normally present in the kidneys and other peripheral tissues. In granulomatous disease such as silicosis, sarcoidosis and berylliosis angiotensin conveing enzyme is derived from epithelioid cells within the granulomas, so its level is elevated in these diseases. Bronchogenic carcinoma is not associated with increased ACE levels. Ref: Pocket Guide to Diagnostic Tests, 5th Edition

So the answer to this question is D


Instruction:
Increased preload is seen in all of the following except: September 2011
A. Sympathetic stimulation
B. Rest
C. Aeriovenous fistula
D. Over transfusion of blood

Response:
Ans. B: RestPreloadIt is the end volumetric pressure that stretches the right or left ventricle of the hea to its greatest geometric dimensions under variable physiologic demand.Preload is theoretically most accurately described as the initial stretching of a single cardiomyocyte prior to contraction.The term end-diastolic volume is better suited to the clinic, although not exactly equivalent to the strict definition of preload.Atrial pressure is a surrogate for preload.Quantitatively, preload can be calculated as: LVEDP.LVEDR/ 2hWhere LVEDP = Left ventricular end diastolic pressure, LVEDR = Left ventricular end diastolic radius (at the ventricle's midpoint), and h = thickness of the ventricle.This calculation is based on the Law of Laplace.Preload is affected by venous blood pressure and the rate of venous return.These are affected by venous tone and volume of circulating blood.Preload is related to the ventricular end-diastolic volume; a higher end-diastolic volume implies a higher preload.Preload increases with exercise (slightly), increasing blood volume (over transfusion, polycythemia) and neuroendocrine excitement (sympathetic tone).An aeriovenous fistula can increase preload AfterloadIt is the tension or stress developed in the wall of the left ventricle during ejection.Following Laplace's law, the tension upon the muscle fibers in the hea wall is the product of the pressure within the ventricle, multiplied by the volume within the ventricle, divided by the wall thickness.Therefore, a dilated left ventricle has a higher afterload.Conversely, a hyperophied left ventricle has a lower afterload.When contractility becomes impaired and the ventricle dilates, the afterload rises and limits output.This may sta a vicious circle, in which cardiac output is reduced as oxygen requirements are increased.Afterload can also be described as the pressure that the chambers of the hea must generate in order to eject blood out of the hea and thus is a consequence of the aoic pressure (for the left ventricle) and pulmonic pressure or pulmonary aery pressure (for the right ventricle).The pressure in the ventricles must be greater than the systemic and pulmonary pressure to open the aoic and pulmonic valves, respectively.As afterload increases, cardiac output decreases. Preload best describes the maximum viscous blood volume of end diastole while afterload better describes the maximum tension of the myocardial muscle mass in end systole.

So the answer to this question is B


Instruction:
Vector of scrub typhus in man -
A. O. Tstsugamushi
B. Leptotrombidium deliense
C. Lice
D. Pediculous humanus

Response:
<p> scrub typhus:- Causative agent- Rickettsiae tsutsugamushi. Reservoir-Trombiculid mite.( Leptotrombidium delinese and L.akamushi). The infection is maintained in nature transovarially from one generation of mite to the next. The nymphal and adult stages of mite are free living in soil.they donot feed on veebrae host. Larva feed on veebrate host and picks up the Rickettsiae. Incubation period- 10-12 days. Clinical features- fever with chills, headache, malaise, prostration and maculopapular rash appearing around 5th day of illness. Eschar seen at bite site. Weil felix reaction strongly positive. Treatment- tetracycline Vector control Personal prophylaxis. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.300}</p>

So the answer to this question is B


Instruction:
C/F of cerebello pontine angle tumours
A. Tinitus
B. Deafness
C. Loss of cornea reflex
D. All

Response:
Most CPA tumors are benign, with over 85% being vestibular schwanommas (acoustic neuromas), lipomas, vascular malformations, and hemangiomas. Presenting symptoms of CPA tumors (including acoustic neuromas) include the following: Hearing loss - 95% Tinnitus - 80% Veigo/unsteadiness - 50-75% Headache - 25% Facial hypesthesia - 35-50% Diplopia - 10% Loss of corneal reflex Ref Harrison20th edition pg 2657

So the answer to this question is D


Instruction:
A 33-year-old woman complains of generalized, throbbing headache that is worse in the morning and with coughing. She occasionally feels dizzy and nauseated. Examination is significant only for obesity and bilateral papilledema. CT scan of the head is nominal. At lumbar puncture the opening pressure is 220 mm H2O; CSF is clear, with protein of 12 mg/100 mL (normal is 15 to 45), glucose of 68 mg/100 mL (normal is 45 to 80), an d no cells are seen. The most likely diagnosis is:
A. Migraine headache
B. Multiple Sclerosis
C. Malignant carcinomatosis
D. Pseudotumor cerebri

Response:
Pseudotumor cerebri is a disorder of increased intracranial pressure that has no obvious cause. The typical patient is an obese young woman who complains of headache and is found to have papilledema. Slight decrease in visual fields and enlargement of blind spots may also be observed. Neurologic examination is otherwise normal, and the patient appears to be healthy. CSF is under increased pressure and may have slightly low protein concentration but is otherwise normal. CT scan, aeriogram, and other x-ray studies are usually normal. The most serious complication is severe visual loss, which occurs in about 10% of affected persons. Treatment with coicosteroids and serial lumbar punctures usually leads to resolution in weeks to months. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 30. Disturbances of Cerebrospinal Fluid and Its Circulation, Including Hydrocephalus, Pseudotumor Cerebri, and Low-Pressure Syndromes. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.

So the answer to this question is D


Instruction:
Which of the following statements is false regarding Familial Mediterranean fever?
A. Form of hereditary amyloidosis
B. Excessive production of TNFa
C. Autosomal recessive
D. Mutation affecting pyrin protein

Response:
Familial Mediterranean Fever (FMF) Most common and best studied form of heredofamilial amyloidosis Autosomal recessive condition Autoinflammatory syndrome associated with excessive production of the cytokine IL-1 in response to inflammatory stimuli Attacks of fever accompanied by inflammation of serosal surfaces, including peritoneum, pleura, and synol membrane The gene for familial Mediterranean fever encodes a protein called pyrin (for its relation to fever) Disorder encountered largely in individuals of Armenian, Sephardic Jewish, and Arabic origins Sometimes associated with widespread amyloidosis The amyloid fibril proteins are made up of AA proteins, reflecting the increased production of SAA in response to excessive IL-1 secretion

So the answer to this question is B


Instruction:
POSCO act related to
A. Consumer protection
B. Child Protection
C. Women Protection
D. Cigarette Smoking

Response:
The Protection of Children from Sexual Offences (POCSO) Act, 2012 deals with sexual offences against persons below 18 years of age, who are deemed as children. The Act for the first time defines "penetrative sexual assault", "sexual assault" and "sexual harassment". The Act incorporates child-friendly procedures for repoing, recording, investigation and trial offences. The Act provides for stringent punishments which have been graded as per the gravity of the offence.

So the answer to this question is B


Instruction:
In acute anterior uveitis, the pupil is
A. Oval
B. Circular
C. Small, Irregular
D. Large, Irregular

Response:
Pupillary signs in acute iritis: 1. Narrow pupil: It occurs in an acute attack of iridocyclitis due to irritation of sphincter pupillae by toxins. Iris edema and engorged radial vessels of iris also contribute to making the pupils narrow. 2. Irregular pupil shape: It results from segmental posterior synechiae formation. Dilatation of pupils with atropine at this stage results in a festooned pupil. 3. Ectropion pupillae (eveion of pupillary margin).It may develop due to contraction of fibrinous exudateon the anterior surface of the iris. 4. Pupillary reaction becomes sluggish or may evenbe absent due to edema and hyperemia of iris which hamper its movements. 5. Occlusio pupillae results when the pupil iscompletely occluded due to an organization of the exudates across the entire pupillary area. Ref: Khurana; 4th edition; Pg.No.145

So the answer to this question is C


Instruction:
Which of the following is not a Contraindication of vaginal delivery after previous Caesarean?
A. Previous Classical C/S
B. No History of Vaginal Delivery in the past
C. Breech presentation in previous pregnancy
D. Puerperial infection in previous pregnancy

Response:
None

So the answer to this question is C


Instruction:
Which of the following method is most commonly used for sterilizing syringes and glassware?
A. Irradiation
B. Autoclave
C. Hot air oven
D. Glutaraldehyde

Response:
Hot air oven is the most widely used method of sterilisation by dry heat. It is the preferred method for sterilizing glassware. It is ued to sterilize glassware, glass syringe, forceps, scissors, scalpel, swabs, paraffin etc. Glasswares should be perfectly dry before placing into the oven. 2% gluteraldehyde is used to sterilize thermometer, cystoscope, bronchoscope, centrifuges and anaesthetic equipments.

So the answer to this question is C


Instruction:
Mitochondrial chromosomal abnormaity leads to ?
A. Lebers hereditary optic neuropathy
B. Angelman syndrome
C. Prader villi syndrome
D. Myotonic dystrophy

Response:
Ans. is 'a' i.e., Lebers hereditary optic neuropathy o Diseases associated with mitochondrial inheritance are rare and many of them affect the neuromuscular system. o Leber hereditary optic neuropathy is a prototype of this disorder. It is a neurodegenerative disease that manifests itself as progressive bilateral loss of central vision. Visual impairment is first noted between ages 15 and 35, and it leads to blindness. Cardiac conduction defects & minor neurologic manifestations have also been seen in some families.

So the answer to this question is A


Instruction:
Fats are stained by: CMC (Vellore) 14
A. Hematoxylin and eosin
B. Oil red O
C. Periodic Acid Schiff
D. GMS Silver Stain

Response:
Ans. Oil red O

So the answer to this question is B


Instruction:
A child is able to build blocks of 5 Cubes developmental age is –
A. 12 months
B. 15 months
C. 18 months
D. 24 months

Response:
None

So the answer to this question is C


Instruction:
What will be the BMI of a male whose weight is 89 kg and height is 172 cm?
A. 27
B. 33
C. 30
D. 36

Response:
BMI = 89/(1.72)2 = 30.08.

So the answer to this question is C


Instruction:
A 2-month-old infant is brought to the clinic because of poor feeding, sweating, and difficulty breathing. The parents state that she was doing very well, and has actually been a "very easy going baby", until about a week ago. They assumed that she was developing a "cold", but it has not passed, and the symptoms have been worsening. Cardiac examination reveals a loud, harsh systolic murmur with a thrill that is heard best at the left sternal border. The most likely underlying abnormality is
A. aoic stenosis
B. atrial septal defect
C. ventricular septal defect
D. patent ductus aeriosis

Response:
This patient most likely has a ventricular septal defect, which is the one of the most common acyanotic congenital cardiac anomalies. It is usually due to an opening in the membranous pa of the ventricular septum, and typically leads to symptoms a few weeks after bih, when the pulmonary vascular resistance decreases, and the left-to-right blood shunting increases. The signs and symptoms vary with the size of the defect, and include respiratory distress, failure to thrive, poor feeding, sweating, and a systolic murmur. An echocardiogram confirms the diagnosis. Some small defects close spontaneously, while larger defects may require surgery. Complications include pulmonary vascular obstruction, congestive hea failure, and endocarditis. Critical aoic stenosis (choice A), is more common in boys and is associated with congestive hea failure, and a low-pitched systolic ejection murmur that can be best heard at the second right intercostal space. This murmur is different than the murmur in this case. An atrial septal defect (choice B), is a common acyanotic, left-to-right shunting cardiac anomaly. Infants with this disorder are typically asymptomatic, and it is therefore, diagnosed during a routine examination. There is a systolic ejection murmur that is heard best at the left mid to upper sternal border. There is a wide, fixed split in the second hea sound. Complications include arrhythmias, pulmonary hypeension, and hea failure. The clinical history and findings in this case are inconsistent with this diagnosis. Patent ductus aeriosis (choice D) is usually asymptomatic if it is small. However, a wide pulse pressure, a continuous machinery murmur, apical heave, and a thrill may be present. The patent ductus allows blood to flow from the aoa directly to the pulmonary aery through the ductus aeriosis, (that should normally close by itself immediately after bih). It is typically acyanotic. Indomethacin or surgery is usually indicated to close the ductus.

So the answer to this question is C


Instruction:
Scala tympani is supplied by which of the following nerve:
A. Abducent nerve
B. Facial nerve
C. Vestibulocochlear nerve
D. Glossopharyngeal nerve

Response:
Vestibulo-cochlear nerve comprises of hearing and vestibular pasScala tympaniIt is one of the perilymph-filled cavities in the cochlear labyrinth of the ear.It is separated from the scala media by the basilar membrane, and it extends from the round window to the helicotrema, where it continues as scala vestibuli.The purpose of the perilymph-filled scala tympani and scala vestibuli is to transduce the movement of air that causes the tympanic membrane and the ossicles to vibrate, to movement of liquid and the basilar membrane.The movement of the basilar membrane compared to the tectorial membrane causes the sterocilia to bend.They then depolarise and send impulses to the brain the cochlear nerve.This produces the sensation of sound.

So the answer to this question is C


Instruction:
Mesosomes in bacteria are functional unit for ?
A. Lipid storage
B. Protein synthesis
C. Respiratory enzymes
D. None

Response:
Ans. is 'c' i.e., Respiratory enzymes Mesosomes (chondroids) . Mesosomes are formed by invagination of plasma membrane into the cytoplasm. . They are more prominent in gram positive bacteria. . They are the principle sites of respiratory enzymes in bacteria and are analogous to mitochondria of eukaryotes. . They coordinate nuclear and cytoplasmic division during binary fission.

So the answer to this question is C


Instruction:
Which does't cause hemolysis in G 6 PD deficiency-
A. Oestrogen
B. Salicylates
C. Primaquine
D. Nitrofurantoin

Response:
None

So the answer to this question is A


Instruction:
Familial Renal Cell carcinoma is associated with:
A. Turners syndrome
B. Alpos syndrome
C. Peutz-jeghers syndrome
D. Von Hippel Lindau syndrome

Response:
Von Hippel Lindau syndrome

So the answer to this question is D


Instruction:
Most severe manifestation of alcohol withdrawl syndrome: March 2010
A. Wernicke's encephalopathy
B. Delirium tremens
C. Seizures
D. Aloholic hallucinosis

Response:
Ans. B: Delirium Tremens Delirium tremens (DT) is the most severe form of ethanol withdrawal manifested by altered mental status and sympathetic overdrive, which can progress to cardiovascular collapse. Delirium tremens is a medical emergency with a high moality rate, making early recognition and treatment essential. Delirium tremens usually occurs 2-4 days after the last drink. It is differentiated from the less severe forms of withdrawal by altered sensorium and autonomic instability. Confusion, obtundation, and delirium are the hallmarks of delirium tremens. Other findings include severe agitation, hyperpyrexia, tachycardia, hypeension, and diaphoresis.

So the answer to this question is B


Instruction:
The ratio between the achievement of program activity and the desired level which, the planners had proposed would result from the program is called
A. Effectiveness
B. Efficiency
C. Appropriateness
D. Adequacy

Response:
None

So the answer to this question is A


Instruction:
"Orphan Annie eye nuclei" is characteristic histologic feature of which of the following thyroid malignancy ?
A. Papillary carcinoma of thyroid
B. Medullary carcinoma of thyroid
C. Anaplastic carcinoma of thyroid
D. Follicular carcinoma of thyroid

Response:
Orphan Annie nuclei is a characteristic intranuclear inclusion seen mainly in papillary carcinoma of thyroid. Ultrastructurally they are seen as membrane bound spheroidal masses of cytoplasm intruding into the nuclei. Intranuclear inclusions are less commonly seen in hyalinizing trabecular adenomas, medullary carcinoma, huhle cell carcinoma as well as anaplastic carcinoma.

So the answer to this question is A


Instruction:
A CKD patient had to undergo dialysis. His Hb was 5.2. So two blood transfusions were to be given. First bag was completed in 2 hours. Second was started and midway between he developed shortness of breath, hypertension. Vitals: BP 180/12- mm Hg and pulse rate 110/min. What is the cause?
A. Allergic
B. Transfusion related circulatory overload (TACO)
C. TRALI
D. FNHTR

Response:
Ans. (b) Transfusion related circulatory overload (TACO)Ref: Robbins and Cotran Pathologic Basis of Disease 9th Ed; Page No-666* The ISBT criteria for diagnosis of TACO states that it is characterized by any of the 4 of the following within 6 hours of transfusion:# Acute respiratory distress# Tachycardia# Raised blood pressure# Acute of worsening pulmonary oedema on CXR# Evidence of positive fluid balance.* This is usually due to rapid or massive transfusion of blood in patients with diminished cardiac reserve or chronic anemia. Patients over 60 years age, infants, and severely anemic patients are particularly susceptible.* Transfusion R elated Acute Lung Injury (TRALI):# It is most common cause of major morbidity and death after transfusion.# It is most commonly associated with FFP (Fresh Frozen Plasma) transfusion.# It presents as an acute respiratory distress syndrome (ARDS) within 6 hour of transfusion.# Transfusion-Related Acute Lung Injury (TRALI) is a severe, frequently fatal complication in which factors in a transfused blood product trigger the activation of neutrophils in the lung microvasculature.# Current models favor a "two hit" hypothesis for TRALI.# The priming event that leads to increased sequestration and sensitization of neutrophils in the microvasculature of the lung.# The most common antibodies associated with TRALI are those that bind major histocompatibility complex (MHC) antigens, particularly MHC class I antigens.# These antibodies are often found in multiparous women, who generate such antibodies in response to foreign MHC antigens expressed by the fetus.

So the answer to this question is B


Instruction:
Somatosensory area I largest representation is for
A. Arm
B. Leg
C. Back
D. Head

Response:
Coical areas for sensation from trunk and back are small, whereas large areas are concerned with impulses from hand and pas of mouth. And from the figure 11-4 it is evident that area for hand is more than face. Ref: Ganong&;s review of medical physiology; 23rd edition; pg:175

So the answer to this question is A


Instruction:
All the following is true about Kevorkian sign except.
A. Persist even after 3 years of death
B. Appear within minutes of death
C. Visualized using opthalmoscope
D. Cattle tracking sign

Response:
Kevorkian sign / cattle tracking sign

It is the earliest change in eye after death.
Blood in the retinal vessels appear fragmented, visualized in opthalmoscope.
It apppears with in few seconds to minutes after death and persists for an hour.

So the answer to this question is A


Instruction:
Which of the following is best suited for detection of calculi in the submandibular gland?
A. Lower true occlusal
B. Lower topographic occlusal
C. Lower oblique occlusal Vertex occlusal
D. Vertex occlusal

Response:
None

So the answer to this question is A


Instruction:
Which is the most common congenital cardiac defect?
A. TAPVC
B. Transposition of great arteries
C. Ventricular septal defect
D. Atrial septal defect

Response:
Ans. is 'c' i.e., Ventricular septal defect o VSD is the most common congenital heart diseaseo TOF is the commonest cyanotic congenital heart disease

So the answer to this question is C


Instruction:
Basal skull view X-ray is best to visualize
A. Ethmoid sinus
B. Frontal sinus
C. Sphenoid sinus
D. Maxillary sinus

Response:
submento veical view This view is taken with veex near the film and x-ray beam projected at right angles to the film from submental area. Structures seen are External auditory canal Middle ear cleft i.e. mastoid air cells, middle ear and eustachian tube Internal auditory canal Sphenoid sinus Foramen ovale Carotid canal (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 493)

So the answer to this question is C


Instruction:
Active form of Vitamin D is: March 2011, March 2013 (a, e, g)
A. Cholecalciferol
B. 24, 25 hydroxy Vitamin D
C. 1, 25 hydroxy Vitamin D (Calcitriol)
D. 25, hydroxyl Vitamin D

Response:
Ans. C: 1, 25 hydroxy Vitamin D (Calcitriol) Calcitriol (1, 25-DHCC) is the biologically active form of vitamin D Calcitriol/ 1, 25-dihydroxycholecalciferol/ 1,25-dihydroxyvitamin D3 It is the hormonally active form of vitamin D with three hydroxyl groups (abbreted 1,25-(OH)2D3 or simply 1, 25 (OH)2D). It increases the level of calcium (Ca2+) in the blood by (1) increasing the uptake of calcium from the gut into the blood, (2) decreasing the transfer of calcium from blood to the urine by the kidney, and (3) increasing the release of calcium into the blood from bone Calcitriol increases blood calcium levels () by promoting absorption of dietary calcium from the gastrointestinal tract and increasing renal tubular reabsorption of calcium thus reducing the loss of calcium in the urine. Calcitriol also stimulates release of calcium from bone by its action on the osteoblasts, causing them to release RANKL, which in turn activates osteoclasts. Calcitriol acts in conce with parathyroid hormone (PTH) in all three of these roles. For instance, PTH also stimulates osteoclasts. However, the main effect of PTH is to increase the rate at which the kidneys excrete inorganic phosphate (Pi), the counterion of Ca2+. The resulting decrease in serum phosphate causes Ca5 (PO4)30H to dissolve out of bone thus increasing serum calcium. PTH also stimulates the production of calcitriol. Many of the effects of calcitriol are mediated by its interaction with the calcitriol receptor, also called the vitamin D receptor or VDR.The maintenance of electroneutrality requires that the transpo of Ca2+ ions catalyzed by the intestinal epithelial cells be accompanied by counterions, primarily inorganic phosphate. Thus calcitriol also stimulates the intestinal absorption of phosphate.Calcitriol also inhibits the release of calcitonin, a hormone which reduces blood calcium primarily by inhibiting calcium release from bone. Calcitriol is produced in the cells of the proximal tubule of the nephron in the kidneys by the action of 25-hydroxyvitamin D3 1-alpha-hydroxylase, a mitochondrial oxygenase and an enzyme which catalyzes the hydroxylation of 25-hydroxycholecalciferol (calcifediol). The activity of the enzyme is stimulated by PTH. The reaction is an impoant control point in Ca2+ homeostasis. The production of calcitriol is also increased by prolactin, a hormone which stimulates lactogenesis, a process which requires large amounts of calcium.

So the answer to this question is C


Instruction:
A 67-year-old chronic heavy smoker presents with 2 weeks history of frank hematuria. USG pelvis shows a filling defect. Most probable diagnosis:
A. Bladder diverticula
B. Adenocarcinoma of bladder
C. Squamous cell carcinoma of bladder
D. Transitional cell carcinoma of bladder

Response:
Ans: (d) Transitional cell carcinoma of bladderRef: Bailey and Love's Short Practice of Surgery, 26th editionBladder CancerUrothelial/Transitional cell cancer - most common typeSquamous cell carcinoma (most prevalent form in Schistosomiasis endemic areas)Adenocarcinoma (usually arise in the fundus of the bladder at the site of urachal remnant)Risk FactorsTransitional ceil cancerSquamous cell cancer*. Smoking*. Chemical carcinogens: naphthylamine, benzidine, aniline*. Schistosomiasis (Bilharziasis)*. Long term use of analgesics*. Long time Cyclophosphamide exposure*. Pelvic irradiation*. Schistosomiasis (Bilharziasis)*. Chronic bladder infection*. Irradiation*. Bladder diverticulaCarcinoma in situ or Flat urothelial carcinoma - Pagetoid spread Staging and TreatmentSuperficial bladder cancers (does not invade the detrusor muscle)pTa - no lamina propria invasionpT1 - lamina propria invasionThe most common site of superficial tumors are the trigone and the lateral walls of bladder Clinical FeaturesPainless gross hematuria is the most common symptomFrequency, urgency and dysuria are common symptomsMetastasis: Most common primary to metastasize to penis - bladder cancerInvestigationsNew tests: Detection of antigens such as nuclear matrix proteins (NMP22) or mini-chromosome maintenance (MCM) in urine, which may be able to detect new or recurrent tumorsThe most common radiological sign is a filling defectFor staging contrast-CTMRI can demonstrate LN metastases and muscle invasionCystourethroscopy is the mainstay of diagnosisTreatmentSuperficial bladder cancersSolitary papillary lesions, no CIS: Endoscopic transurethral resection (TURT)CIS, recurrent disease, T1 disease, >40% bladder surface involvement: TURT followed by intravesical therapyStandard intravesical therapy: Bacille-Calmette-Guerin (BCG) 6 weeks instillations; followed by monthly instillations for 1 yearOther agents: Mitomycin C, interferon, gemcitabineFor persistent disease after BCG, immediate cystectomyMuscle invasion cancers (pT2-pT3): Radical cystectomy with pelvic lymphadenectomy; neo-adjuvant chemotherapy (M-VAC: Cisplatin, methotrexate, doxorubicin and vinblastine or GC: gemcitabine and cisplatin)

So the answer to this question is D


Instruction:
In ureotelic animals, carbamoyl group are transferred to:-
A. Urea
B. Uric acid
C. Ornithine
D. Creatine

Response:
The question is asking about the first step of the urea cycle in an indirect way (See Fig). Based on how nitrogen is excreted, animals are divided into 3 categories. Ammoniotelic animals - Animals that excrete ammonia. e.g. Fishes Ureotelic animals - Animals which excrete urea e.g. Mammals including man Uricotelic - Animals that excrete uric aciduric acid. e.g. Birds

So the answer to this question is C


Instruction:
1st reflex to recover after spinal shock:
A. Bulbocavernosus Reflex
B. Abdominal Reflex
C. Plantar Reflex
D. Ankle Reflex

Response:
1st reflex to recover form spinal shock is bulbocavernosus reflex(S2-S4) It refers to anal sphincter contraction in response to squeezing the glans penis or tugging on the Foley( see figure) During lumbar injury,- If all reflexes are gone, then its spinal shock- If there is symmetrical loss +/- bowel or bladder involvement (which occurs in saddle anaesthesia), it is conus medullaris syndrome- If there is asymmetrical loss, then it is cauda equina syndrome.

So the answer to this question is A


Instruction:
The working of an MRI machine is based on the propeies of which of the follwoing?
A. Protons
B. Electrons
C. CO2
D. O2

Response:
The patient is placed in a strong magnetic field. The protons (H-atoms) in the body align themselves in the body either in the same direction or in the opposite direction. A strong radio signal is sent at the level where an image needs to be taken. The vibration or spin of te atoms is used to record the tissue images. It is best suited for non-calcified tissue. It is contraindicated with pacemaker and chips. It has no ionising radiation. It is generally not useful for lung and bone pathology.

So the answer to this question is A


Instruction:
Underlying pathology of Nevus anemicus is:
A. Autoimmune destruction of melanocytes
B. Arrest of migration of melanocytes
C. Abnormal vasoconstriction
D. Defect in tyrosinase enzyme

Response:
Nevus anemicus presents as a localized area of skin blanching and hypopigmentation because of abnormal vasoconstriction due to increased sensitivity of blood vessels to catecholamines.

So the answer to this question is C


Instruction:
Students receive how much cereal /day in mid day meal prog -
A. 50 gm
B. 100 gm
C. 150gm
D. 75 gm

Response:
Ans. is 'd' i.e., 75 gm A mid-day school mealFoodstuffsg/day/childCereals and millets75Pulses30Oils and fats8Leafy vegetables30Non-leafy vegetables30Some suggestion for preparation of nutritious & economic! mid-day meals are as under-partial list.- Park 21st/612Food-grains must be stored in a place away from moisture, in air tight containers/bins to avoid infestation.Fermentation improves nutritive value. Preparation of idli, dosa. dhokla etc. may be encouraged.Sprouted pulses have more nutrients & should be incorporated in single dish meals.Cereal pulse combination is necessary to have good quality protein. The cereal pulse ratio could range from 3:1 to 5:1.Rice water if left after cooking should be mixed with dal if these are cooked separately & should never be thrown away.Use whole wheat or broken wheat (dalia) for preparing mid-day meals.Rice should preferably be parboiled or unpolished.Cooking must be done with lid to avoid loss of nutrients.Overcooking should be avoided.Only 'iodized salt' should be used for cooking mid-day meals.

So the answer to this question is D


Instruction:
Cobblestone appearance of the conjunctiva is typically seen with –
A. Phlyctenular conjunctivitis
B. Foreign body
C. Spring catarrh
D. Trachoma

Response:
Cobble-stone or pavement stone appearance is seen in spring catarrh.

So the answer to this question is C


Instruction:
Coronaryblood flow is increased by all of the following except
A. Beta adrenergic blockade
B. A decrease in aerial po2
C. An increase in aerial pCO2
D. Vagal stimulation

Response:
Beta adrenergic receptors causes karana vasodilation to increase CBF Blockage of these receptors causes decrease in the CBF Ref: page no 366 Textbook of physiology Volume 1 AK Jain 7th edition

So the answer to this question is A


Instruction:
In a population of 5000, incidence of disease is 100 in 1 year duration of disease studied for is 2 years calculate Prevalance -
A. 20/1000
B. 40/1000
C. 80/1000
D. 400/1000

Response:
Ans. is 'b' i.e., 40/1000

So the answer to this question is B


Instruction:
A 6 - year - old boy with lymphoreticular malignancy has come for a cycle of chemotherapy. Which of the following investigatins need to be done for next 4 hours to diagnose tumour lysis syndrome?
A. Urea, creatinine, chloride, Ca2+ and K+
B. Urea, creatinine, phosphate, Ca2+ and K+
C. Urea, creatinine, magnesium, Ca2+ and K+
D. Urea, creatinine, sodium and phosphate

Response:
Tumour lysis syndrome (TLS) - -Uric acid, phosphate and potassium are released in large quantities from death of tumour cells. -Hyperuricemia can lead to impairment of renal function, which fuher exacerbates the metabolic abnormalities. -Hypocalcaemia is a consequence of acute hyperphosphatemia with subsequent precipitation of calcium phosphate in soft tissues. 'TLS can occur before therapy in patients with a large tumour burden (e.g., Burkitt lymphoma, Hyperleukocytosis) It is usually seen within 12-48 hr of initiating chemotherapy.

So the answer to this question is B


Instruction:
Which is attached most anteriorly on the intercondylar areaof tibia intercondylararea of tibia (area b/w medial and lateral tibial plateau)-
A. Anterior cruciate ligament
B. Posterior cruciate ligament
C. Anterior horn of the lateral meniscus
D. Anterior horn of the medial meniscus

Response:
Ans. is'd' i.e, Anterior horn of the medial meniscusPROXIMAL END (upper end)Proximal (upper) end of tibia includes medial & lateral condyles, forming tibial plateau.It also includes tibial Tuberosity & intercondylar area.Attachments on proximal end are:Medial condyle:Semimembranous (posteriorly), capsule of knee joint, tibial (medial) collateral ligament (deep pa), medial patellar retinaculum (anteriorly).Lateral condyle: illiotibial tract (anteriorly), capsule of superior tibiofibular joint.Tibial Tuberosity:Ligamentum patellaeIntercondylar area (from anterior to posterior);Anterior horn of medial meniscusAnterior cruciate ligament (ACL)Anterior horn of lateral meniscusPosterior horn of lateral meniscusPosterior horn of medial meniscysPosterior cruciate ligament (PCL)

So the answer to this question is D


Instruction:
Platycephaly is:
A. Premature closure of unilateral occipitoparietal suture
B. Premature closure of bilateral coronal suture
C. Flat skull
D. Premature closure of unilateral coronal suture

Response:
None

So the answer to this question is A


Instruction:
Give the most probable diagnosis of a 1 year. old child of normal intelligence with features of hypotonia. On examination, there are tongue fasciculations and he keeps his body in a frog-like position –
A. Guillian Barre Syndrome
B. Limb girdle atrophy
C. Down's syndrome
D. Spinal muscular atrophy

Response:
Features of hypotonic and frog-like position suggest the diagnosis of Floppy infant syndrome.

Floppy infant syndrome

In FIS the baby is floppy i.e :
He cannot hold his head up, there will be marked head lag as the baby is pulled up from supine to sitting posture.
A normal infant, on ventral suspension (i.e. supporting the infant with a hand under the chest) keeps his back straight and head slightly up, arms abducted and knees partly flexed. A floppy infant droops, over the hand like an inverted U.

Typical features

Hypotonia and decreased muscular activity
Frog-like posture or other unusual position at rest
Delay in motor milestones

Causes of Floppy infant syndrome
Central nervous system

Perinatal asphyxia, neonatal encephalopathy, kernicterus, cerebral palsy (atonic type), intracranial haemorrhage, chromosomal anomalies including Down syndrome and inborn errors of metabolism e.g., aminoacidurias, mucopolysaccharidosis, and cerebral lipidosis.

Spinal cord lesions

Anterior horn cell disease: Werdnig Hoffman spinal muscular atrophy, poliomyelitis

Peripheral nerves

Acute polyneuropathy, familial dysautonomia, congenital sensory neuropathy

Myoneural junction

Neonatal myasthenia gravis, infantile botulism, following antibiotic therapy

Muscles

Muscular dystrophies, congenital myotonic dystrophies, congenital myopathies (including central core disease and Nemaline myopathy), polymyositis, glycogen storage disease (Pompe's), and arthrogryposis multiplex congenital

Miscellaneous

Protein-energy malnutrition, rickets, Prader-Willi syndrome, malabsorption syndromes, Ehler-Danlos syndrome, cutis laxa, cretinism

Coming back to question

There are many causes of floppy infant syndrome.
Out of the four option given in the question three of these can cause FIS -
Down’s syndrome

GB. syndrome
Spinal muscular atrophy

Spinal muscular atrophy

Features of normal intelligence and tongue fasciculation's strongly suggested spinal muscular atrophy.

 Down's syndrome

Can be easily ruled out as intelligence is impaired in Down's syndrome.

GB. syndrome

Can be ruled out as it presents as an acute case with a past history of fever or viral infections.
Majority of patients recover within a few days to 2 weeks.

So the answer to this question is D


Instruction:
A 3 yr old completely unimmunized child comes to an immunization clinic at PHC for the first time. He should receive -
A. BCG; Measles, Vitamin-A
B. DT-1, OPV-1, Measles, Vitamin-A
C. BCG; DPT-1, OPV-1, Measles, Vitamin-A
D. DPT-1, OPV-1, Measles, Vitamin-A

Response:
None

So the answer to this question is B


Instruction:
Most common inherited bleeding disorder:
A. Bernard soulier
B. Glanzmann thrombasthenia
C. ITP acute
D. Von wilebrand disease

Response:
Von Willebrand disease (VWD) is the most common inherited bleeding disorder.
It is autosomal dominant, and its prevalence is estimated to be as high as 1 case per 1000 population.

So the answer to this question is D


Instruction:
Positive End Expiratory Pressure is useful in: March 2009
A. Pneumonia
B. ARDS
C. Pulmonary edema
D. All of the above

Response:
Ans. D: All of the above Positive end-expiratory pressure (PEEP) is a term used in mechanical ventilation to denote the amount of pressure above atmospheric pressure present in the airway at the end of the expiratory cycle. It is indicated in Hypoxemia due to the following: ARDS Pneumonia Pulmonary edema Atelectasis

So the answer to this question is D


Instruction:
Oedipus complex is related to which phase of psychosexual development
A. Oral
B. Anal
C. Genital
D. Phallic

Response:
Phase: Phallic (Oedipal) phase Age Range: 3 to 5 years Normal Development: Major site of gratification is the genital area; genital masturbation is common at this stage. According to Freud, this development is different in both sexes. Male development-The boy develops castration anxiety (fear of castration at the hand of his father in retaliation for the boy's desire to replace his father in his mother's affections). This leads to the formation of the Oedipus complex (aggressive impulses directed towards the father; named after the Greek tragedy Oedipus Rex in which Oedipus unknowingly kills his father and marries his mother, unaware of their true identities). Oedipus complex is usually resolved by identification with father, attempting to adopt his characteristics. Female development- The girl develops penis envy (discontent with female genitalia following a fantasy that they result from loss of penis). This is theorised by Freud to lead to a wish to 'receive' the penis and to bear a child. Resolution occurs by identification with the mother. This phase has been called an Electra complex. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.211.

So the answer to this question is D


Instruction:
A 32 years old Bengali women had fever since 48 hours with history of irrelevant talk and 2 episodes of tonic clonic seizures on succession on the way to hospital. She was previously alright. Which of the following drug can be given while rest of the investigations were being carried out?
A. IV mannitol
B. IV amphotericin B
C. IV penicillin
D. IV acyclovir

Response:
Ans. d. IV acyclovir (Ref: Harrison 19/e p893. 18/e)A 32 years old Bengali women had fever since 48 hours with history of irrelevant talk and 2 episodes of tonic clonic seizures on succession on the way to hospital. She was previously alright. This patient is most probably suffering from viral encephalitis. Acyclovir is of benefit in the treatment of HSV and should be started empirically in patients with suspected viral encephalitis, especially if focal features are present, while awaiting viral diagnostic studies.Acyclovir is of benefit in the treatment of HSV and should be started empirically in patients with suspected viral encephalitis, especially if focal features are present, while awaiting viral diagnostic studies. Harrison 18/eViral EncephalitisIn encephalitis the brain parenchyma is involved.Many patients with encephalitis also have evidence of associated meningitis (meningoencephalitis) and, in some cases, involvement of the spinal cord or nerve roots (encephalomyelitis, encephalomyeloradiculitis).Clinical Features:In addition to the acute febrile illness with evidence of meningeal involvement, an altered level of consciousnessQ (confusion, behavioral abnormalities), or a depressed level of consciousness ranging from mild lethargy to coma, and evidence of either focal or diffuse neurologic signs and symptomsQ.Focal or generalized seizuresQ occur in many patients with encephalitis.MC encountered focal findings are aphasia, ataxia, upper or lower motor neuron patterns of weakness, involuntary movements (e.g., myoclonic jerks, tremor), and cranial nerve deficitsQ (e.g., ocular palsies, facial weakness).Diagnosis:CSF PCR has become the primary diagnostic test for CIVS infections caused by CMV, EBV. HHV-6. and enterovirusesQThe sensitivity (~ 96%) and specificity (~ 99%) of HSV CSF PCR is equivalent to or exceeds that of brain biopsyQ.Patients with suspected encephalitis almost invariably undergo neuroimaging studies and often EEGQ.Focal findings in a patient with encephalitis should always raise the possibility of HSV encephalitisQ.Treatment:Specific antiviral therapy should be initiated when appropriateQ.Basic management and supportive therapy should include careful monitoring of ICP, fluid restriction, avoidance of hypotonic intravenous solutions, and suppression of fever.Seizures should be treated with standard anticonvulsant regimensQ, and prophylactic therapy should be considered in view of the high frequency of seizures in severe cases of encephalitis.Acyclovir is of benefit in the treatment of HSV and should be started empirically in patients with suspected viral encephalitis, especially if focal features are present, while awaiting viral diagnostic studies.

So the answer to this question is D


Instruction:
All of the following pelvic structures suppo the vagina, except :
A. Perineal body
B. Pelvic diaphragm
C. Levator ani muscle
D. Infundibulopelvic ligament

Response:
Infundibulopelvic ligament Ans. is d i.e. Infundibulopelvic ligament Ref. Jeffcoate 7/e, p 46; CGDT 10/e, p 49 Vagina is strong canal of muscles (- 7.5 cm long) which extends from the uterus to the vestibule of the external genitalia, where it opens to the exterior. The cervix of the uterus projects into its upper pa and towards its lower end, vagina pierces the urogenital diaphragm and is surrounded by the 2 bulbocavernosus muscles which act as a sphincter (sphincter vaginae). Our question is related to the suppos of vagina. Before going into its details lets have a second look at the options. All the options given in the question are somehow related to vagina therefore may have a role in suppoing vagina except the infundibulopelvic ligaments. l7fundibulopelvic ligament attach the ovary to the lateral pevlic wall and suppoa the ovary, but has no connection to the vagina or uteriiinererore does not suppo either structures. So, by exclusion, our answer is infundibulopelvic ligament. Now, coming on to the details of suppos ol vaglna Vagina is suppoed in the lower pa as is evident lrom the diagram by: i. Bulbocavernosus muscle (at the level of introitus). ii. Urogenital diaphragm. iii. Perineal muscles iv. Levator ani muscles (known as pelwc dnphragm) suppo the lower 1/3 of vagina. ln its upper pa : vagina is suppoed by (see the ctiag) : Ca'dinal ligament (also called as lrarsverse cetvtcal hgament). The anterior wall of vagina, urethra and bladder base are suppoed by : PuboceNical fascia. The poster or wall of vagrna is suppoed by : Penneal body.

So the answer to this question is D


Instruction:
Bile acid uptake by hepatocytes is dependent on:
A. Calcium
B. Iron
C. Sodium
D. Potassium

Response:
Ans. C. SodiumThe uptake of bile acid by hepatocytes is sodium-dependent and is not dependent on calcium, iron, potassium, or chloride.

So the answer to this question is C


Instruction:
The active transport of 'Ca' is regulated by _______ which is synthesized in kidneys:
A. Cholecalciferol
B. Ergosterol
C. 25-OH cholecalciferol
D. 1, 25-di OH-Cholecalciferol

Response:
Ans. D. 1, 25-di OH-Cholecalciferol1,25-DHCC is Vitamin D. It is synthesized in the body. The reactions takes place in the liver and kidney. Vitamin D is also known as a prohormone. It helps in the transport of calcium against the electrochemical gradient to promote mineralization of bones.

So the answer to this question is D


Instruction:
A 42-year-old male was undergoing elective hernioplasty. End tidal carbon dioxide (ETC02) was found to be increased. Abdominal wall gradually showed rigidity, along with the presence of tachycardia and tachypnea. Blood gas analysis shows an increased mixed acidosis, along with a serum lactate of 3.4 mmol/L. Which of the following has most likely resulted in the present situation?
A. Neuroleptic malignant syndrome
B. Malignant hyperthermia
C. Serotonin syndrome
D. Pheochromocytoma

Response:
Answer: b) Malignant hyperthermiaMALIGNANT HYPERTHERMIADrug- or stress-induced hypermetabolic syndrome.Vigorous muscle contractions, an abrupt increase in temperature, subsequent cardiovascular collapseUncontrolled release of Ca2+ from the sarcoplasmic reticulum due to defect in the ryanodine receptor (RYR1) is the initiating eventInherited as autosomal dominant fashion, with variable penetrance & expressivity.Triggers: Stress, excitement, anoxia, viral infections, lymphoma, ischemia or hypoxia.Early signs: masseter muscle contracture, muscle rigidity, metabolic acidosis, sinus tachycardia, supraventricular tachyarrhythmias, mottling or cyanosis of the skin, increased CO2 production, and hypertension.Two signs helpful in making a prehyperthermic diagnosisIncreased end-tidal CO2Masseter spasmM/C with combination of depolarizing blocking agent and anesthetic.Drugs known to trigger malignant hyperthermiaDrugs safe in malignant hyperthermia* Halothane* Methoxyflurane* Enflurane, isoflurane* Succinylcholine* Decamethonium* Gallamine* Diethyl ether,* Ethylene, Ethyl chloride* Trichloroethylene* Ketamine* Phencyclidine* Cyclopropane* Nitrous oxide* Barbiturates* Diazepam* Tubocurarine* Pancuronium, vecuronium* OpiatesManagement of Malignant HyperthermiaDiscontinue volatile anesthetic and succinylcholine.Hyperventilate with 100% O2 at high flows.Administer sodium bicarbonate, 1-2 mEq/kg intravenously.Mix dantrolene sodium with sterile distilled water and administer 2.5 mg/kg ivInstitute cooling measures (lavage, cooling blanket, cold intravenous solutions).Administer additional doses of dantrolene if needed.Treat severe hyperkalemia with dextrose, 25-50 g IV, and regular insulin, 10-20 U intravenously (adult dose).

So the answer to this question is B


Instruction:
Anaesthetic having epileptogenic potential is:
A. Desflurane
B. Enflurane
C. Ether
D. Halothane

Response:
Enflurane may precipitate seizures in epileptic patients. Desflurane , ether and Halothane doesn&;t precipitate seizures and can be safely used in them. From padmaja 4th edition Page no 193

So the answer to this question is B


Instruction:
Alpha fetoproteins are not increased in :
A. Spina bifida
B. Post maturity
C. Esophageal atresia
D. Anencephaly

Response:
Post maturity

So the answer to this question is B


Instruction:
Agar is added to Broth medium:
A. To make the medium liquid
B. To make the medium solid
C. To provide extra nutrition to grow
D. None

Response:
Ans. B. To make the medium solida. Broth media can be made solid by adding agar, a gel like polysaccharide extracted from red algae,b. Broth with about 1.5% agar added will be liquid when heated, but solid at room temperature, making it easy to pour into a vessel, such as a Petri dish or test tube when hot.c. The solution then becomes solid once cooled.

So the answer to this question is B


Instruction:
Epidermolysis bullosa is due to defect in collagen type?
A. Type 1
B. Type 3
C. Type 4
D. Type 7

Response:
Ans. D. Type 7Diseases Caused by Mutations in Collagen Genes or by Deficiencies in the Activities of Posttranslational Enzymes Involved in the Biosynthesis of CollagenGene or EnzymeDisease 1COL1A1, COL1A2Osteogenesis imperfecta, type 12 (OMIM 166200)Osteoporosis 3 (OMIM 166710)Ehlers-Danlos syndrome type VII autosomal dominant (OMIM 130060)COL2A1Severe chondrodysplasias Osteoarthritis 3 (OMIM 165720)COL3A1Ehlers-Danlos syndrome type IV (OMIM 130050)COL4A3-COL4A6Alport syndrome (including both autosomal and X-linked forms) (OMIM 104200)COL7A1Epidermolysis bullosa, dystrophic (OMIM 131750)COL10A1Schmid metaphysial chondrodysplasia (OMIM 156500)Lysyl hydroxylaseEhlers-Danlos syndrome type VI (OMIM 225400)Procollagen N-proteinaseEhlers-Danlos syndrome type VII autosomal recessive (OMIM 225410)Lysyl hydroxylaseMenkes disease 4 (OMIM 309400)

So the answer to this question is D


Instruction:
Equatorial diameter of the lens is -
A. 7 mm
B. 8 mm
C. 9 mm
D. 10 mm

Response:
Circumferance of the lens is known as equator. its diameter varies from 8.8mm-9.2mm and the anteroposterior diameter varies with accommodation. REF IMG

So the answer to this question is C


Instruction:
Which of the following is not a criteria of screening test?
A. Reliability
B. Validity
C. Credibility
D. Yield

Response:
SCREENING TEST:

Less accurate, less expensive.

DIAGNOSTIC TEST:

More accurate, more expensive.

Criteria of screening test:

Reliability/repeatability – Test must give consistent result when repeated.
Validity – Refers to what extent the test accurately measures, which it is suppose to measure (same as in index).
Yield – It is the amount of previously unrecognized disease that is diagnosed as a result of screening.

So the answer to this question is C


Instruction:
First line of defence against tumour and virus?
A. NK cell
B. T cell
C. Histiocyte
D. Macrophage

Response:
NK cells Ability to kill virus-infected cells and tumor cells NK cells act as an early line of defense against viral infections and some tumors. Two cell surface molecules, CD16 and CD56, are commonly used to identify NK cells. CD16 is an Fc receptor for IgG, and it confers on NK cells the ability to lyse IgG-coated target cells. This phenomenon is known as antibody-dependent cell-mediated cytotoxicity (ADCC). The functional activity of NK cells is regulated by a balance between signals from activating and inhibitory receptors NK cell inhibitory receptors recognize self-class I MHC molecules, which are expressed on all healthy cells. The inhibitory receptors prevent NK cells from killing normal cells. Virus infection or neoplastic transformation often enhances expression of ligands for activating receptors and at the same time reduces the expression of class I MHC molecules.

So the answer to this question is A


Instruction:
Best imaging modality in bronchogenic carcinoma-
A. CT
B. MRI
C. Bronchoscopy
D. None

Response:
CT scan is the investigation of choice for pulmonary malignancy except for superior sulcus or pancoast tumor, where MRI is the investigation of choice.

So the answer to this question is A


Instruction:
Limiting amino acid in maize ?
A. Lysine
B. Threonine
C. Methionine
D. Arginine

Response:
Ans. is 'a' i.e., Lysine Food Limiting amino acidsWheat Lysine and threonineMaize Tryptophan and lysinePulses Methionine and to a lesser extent cystein

So the answer to this question is B


Instruction:
Poverty index does not include deprivation of
A. Long life
B. Knowledge
C. Income
D. Standard of living

Response:
None

So the answer to this question is C


Instruction:
Most sensitive non invasive test for diagnosis of H pylori?
A. Rapid urease test
B. Demonstration of organism in gastric biopsy
C. Breath urea test
D. ELISA

Response:
ELISA test has sensitivity of 80% and has been replaced by C-13 urea breath test and fecal antigen immunoassay. Both have sensitivity of >90%. Hence though rapid urease test is having a comparable sensitivity and higher specificity, it is an invasive test. Sensitivity of various diagnosis tests Test Sensitivity in % Rapid urease (INVASIVE) 80-95 Histology 80-90 Serology >80 Urea breath test (NON INVASIVE) >90 Stool antigen >90 In assessment of response to treatment, non-invasive tests are preferred. Breath urea test will be done but can be false negative if done within 4 weeks of antibiotic treatment. High levels of interleukin 1,2,6 & 8 and TNFa,IFN gamma in the gastric epithelium are found.

So the answer to this question is C


Instruction:
All are true of cerebral salt wasting except -
A. Increased urine output
B. Low intravascular volume
C. Low uric acid in serum
D. Decreased vasopressin levels

Response:
Cerebral salt-wasting syndrome (CSWS) is a rare endocrine condition featuring a low blood sodium concentration and dehydration in response to injury (trauma) or the presence of tumors in or surrounding the brain. In this condition, the kidney is functioning normally but excreting excessive sodium. Ref Davidson 23rd edition pg 745

So the answer to this question is C


Instruction:
All or none law refers to:
A. Action potential
B. Resting potential
C. Membrane potential
D. None

Response:
Action potential

So the answer to this question is A


Instruction:
High false positive cases in a community signify that disease has -
A. High prevalence & Low incidence
B. High incidence & Low prevalence
C. Low prevalence & Low incidence
D. High incidence & High prevalence

Response:
None

So the answer to this question is B


Instruction:
Characteristics of SIRS include all of the following EXCEPT: September 2012
A. Leukocytosis
B. Thrombocytopenia
C. Infectious or non-infectious cause
D. Oral temperature more than 380C

Response:
Ans. B i.e. Thrombocytopenia

So the answer to this question is B


Instruction:
Saturday night palsy is which type of nerve injury-
A. Neuropraxia
B. Axonotemesis
C. Neurotemesis
D. Complete section

Response:
Ans. is 'a' i.e., NeuropraxiaSeddon's classification of nerve injurieso Seddon identified three types of injuriesNeuropraxiaThere is contusion of the peripheral nerve which causes reversible physiological nerve conduction block. The axis cylinder (i.e., axon with its endoneurium) is preserved. Thus, there is physiological conduction block without anatomic disruption. The injury is temporary and recovery is complete. It is seen in crutchpalsy, tourniquet palsy, and Saturday night palsy.AxonotemesisThere is injury to axon but endoneurium is preserved. Spontaneous recovery is expected in some cases. This is seen in closed fractures and dislocations.NeurotemesisThere is complete anatomical section of nerve. No recovery possible. It is seen in open wound.

So the answer to this question is A


Instruction:
Polio virus is shed maximum in stool up to
A. 6 weeks
B. 12 weeks
C. 10 weeks
D. 8 weeks

Response:
None

So the answer to this question is B


Instruction:
The choroid plexus of the fouh ventricle is derived from the
A. alar plate
B. basal plate
C. floor plate
D. roof plate

Response:
Roof plate & its pial covering give rise to the choroid plexus. Alar plate gives rise to sensory neurons Basal plate gives rise to motor neurons Floor plate contains decussating fibers Rhombic lips give rise to the cerebellum.

So the answer to this question is D


Instruction:
The Ig found in exocrine secretions is:
A. IgG
B. IgD
C. IgM
D. IgA

Response:
None

So the answer to this question is D


Instruction:
The interincisal angle between deciduous incisors is:
A. 100 degrees
B. 120 degrees
C. 150 degrees
D. 170 degrees

Response:
Primary teeth are upright, but permanent teeth incline to the labial surface, thus decreasing the inter-incisal angle from about 150 degrees in the deciduous dentition to 123 degrees in the permanent dentition. This increases the arch perimeter.

Ref: Textbook of orthodontics Gurkeerat Singh 2nd ed pg no 46

So the answer to this question is C


Instruction:
A term, otherwise well neonate was found to have a total serum bilirubin of 17 mg/dl. So he was admitted in NICU and staed on some treatment. All of the following can be adverse effects of the treatment administered EXCEPT?
A. Bronze baby syndrome
B. Hypercalcemia
C. Dehydration
D. Retinal toxicity

Response:
Cut - off Levels (In an otherwise healthy neonate) Age Photo-Therapy Exchange Transfusion 24 - 48 hrs > 15 mg/dl > 20 mg/dl 48 - 72 hrs > 18 mg/dl > 25 mg/dl > 72 hrs > 20 mg/dl >25 mg/dl So, this baby must have been staed on Phototherapy. Adverse Effects Of Phototherapy - Bronze baby syndrome (in c/o conjugated hyperbilirubinemia) - Watery diarrhea - Dehydration - Hypocalcemia - Retinal toxicity - Gonadal toxicity

So the answer to this question is B


Instruction:
Pugilistic attitude in fireburns is due to: March 2010
A. Coagulation of blood in the vascular channels
B. Splitting of soft pas
C. Tight clothing
D. Coagulation of protein of the muscles

Response:
Ans. D: Coagulation of protein of the muscles The pugilistic attitude is an extremely typical post-moem body posture that is similar to a boxers position but is involuntary. The condition generally occurs several hours after death and is caused by a coagulation of muscle proteins when the body is exposed to extremely high temperatures. More simply put, it is caused by muscles contracting under intense heat It occurs whether the person was alive or dead at time of burning

So the answer to this question is D


Instruction:
Amino acid carrying ammonia from muscle to liver?
A. Alanine
B. Glutamine
C. Arginine
D. Lysine

Response:
Ans. is 'a' i.e., Alanine.DISPOSAL/DETOXIFICATION OF AMMONIA1. First line of Defense (Trapping of ammonia)Being highly toxic, ammonia should be eliminated or detoxified, as and when it is formed. Even very minute quantity of ammonia may produce toxicity in central nervous system.But, ammonia is always produced by almost all cells, including neurons.The intracellular ammonia is immediately trapped by glutamic acid to form glutamine, especially in brain cells .The glutamine is then transpoed to liver, where the reaction is reversed by the enzyme glutaminase .The ammonia thus generated is immediately detoxified into urea.Aspaic acid may also undergo similar reaction to form asparagine .2. Transpoation of AmmoniaInside the cells of almost all tissues, the transamination of amino acids produce glutamic acid.However, glutamate dehydrogenase is available only in the liver.Therefore, the final deamination and production of ammonia is taking place in the liver .Thus, glutamic acid acts as the link between amino groups of amino acids and ammonia.The concentration of glutamic acid in blood is 10 times more than other amino acids.Glutamine is the transpo forms of ammonia from brain and intestine to liver; while alanine is the transpo form from muscle.3. Final disposalThe ammonia from all over the body thus reaches liver. It is then detoxified to urea by liver cells, and then excreted through kidneys.Urea is the end product of protein metabolism.Transpo of alanine from muscle to liver (glucose-alanine cycle) has two functions :?i) Providing substrate for gluconeogenesisii) Transpo of ammonia (NH4-) to liver for urea synthesis.

So the answer to this question is A


Instruction:
The basis of combining Ritonavir with Lopinavir
A. Pharmaceutical compatability
B. CYP3A4 inhibiton NY Ritonavir
C. Long elimination half life of Ritonavir
D. Ability to counteract side effects of Lopinavir

Response:
Refer Katzung 10/e p810 Ritonavir is a microsomal enzyme inhibitor paicularly of CYP3A4 .it decreases the metabolism of other drugs and thus lower dose of Lopinavir can be used in treatment of HIV when combined with Ritonavir

So the answer to this question is B


Instruction:
Most common symptom of alcohol withdrawal is:
A. Bodyache
B. Tremor
C. Diarrhoea
D. Rhinorrheo

Response:
B ie. Tremor

So the answer to this question is B


Instruction:
Which is a safe muscle relaxant in renal failure -
A. Cisatracurium
B. Rocuronum
C. Vecuronium
D. Succinylcholine

Response:
Ans. is 'a' i.e., Cisatracurium o The unique feature of atracurium and cisatracurium is inactivation in plasma by spontaneous nonenzymatic degradation (Hofman elimination) in addition to that by alkaline ester hydrolysis,o Therefore both of these do not require hepatic or renal routes for elimination therefore can be used safely in hepatic and renal failure.o Moreover, cisatracurium does not provoke histamine release, therefore it is preferred over atracurium.

So the answer to this question is A


Instruction:
Manoeuvre carried out for diagnosing medial meniscus injury is: March 2010, March 2013 (c, d)
A. McMurray's test
B. Lachmann's test
C. Valgus stress test
D. Varus stress test

Response:
Ans. A: McMurray's Test McMurray's test is performed for meniscus injury For medial meniscus: Patient lying flat (non-weight bearing), the knee is completely flexed. The foot is rotated externally and the leg abducted. The joint is now slowly extended keeping the leg externally rotated and abducted. As the torn cailage gets caught during this manoeuvre, the patient will experience pain or a click may be heard and felt.

So the answer to this question is A


Instruction:
Investigation of choice for acute head injury
A. NCCT brain
B. MRI
C. X-ray
D. USG

Response:
Ans. A. NCCT brain* CT is the investigation of choice to identify acute intracranial bleed and hence is the preliminary investigation in acute head injury.* Investigation of choice for brain hemorrhage is NCCT brain* Investigation of choice for calcification is NCCT Brain* Other than above three pathology investigation of choice for neurological lesion is MRI.Investigation of choice in Neurology* Investigation of choice for optic neuritis is MRI* Investigation of choice for vestibular schwannoma is MRI* Investigation of choice for Multiple sclerosis is MRI* Investigation of choice for hippocampal volumetry is MRI* Investigation of choice for viral encephalitis is MRI* Investigation of choice for Pituitary adenoma is MRI* Investigation of choice for Spinal cord tumor is MRI* Investigation of choice for Neurofibroma is MRI* Investigation of choice for hemorrhagic stroke is NCCT brain* Investigation of choice for ischemic stroke is diffusion weighted MRI* Investigation of choice for Stroke is NCCT brain (since initially, we have to rule out hemorrhagic stroke).

So the answer to this question is A


Instruction:
Investigation of choice to diagnosis Hirschsprug's disease is:
A. Rectal manometry
B. Barium enema
C. Rectal biopsy
D. Laparotomy

Response:
Ans. is 'c' i.e. Rectal biopsy RepeatYou already know about the features of Hirschsprung's disease seen on contrast enema from the question asked earlierMore about the diagnosis of Hirschsprung's disease -Definitive diagnosis of Hirschsprung's disease is made by Rectal biopsy :It demonstrates following features-Absence of ganglion cells in Meissner's plexus, and myenteric plexusHypertrophy of nerve trunksManometric study - Manometric studies will show a failure of relaxation of internal sphincter following rectal distension.

So the answer to this question is C


Instruction:
Platelet adhesion to vessel wall is due to?
A. Factor IX
B. Fibrinogen
C. vWF
D. Fibronectin

Response:
Ans. (c) vWF(Ref: Robbins 9th/pg 660; 8th/pg 670)Platelet adhesion to vessel wall is due to vWF on endothelium and GpIb/IX receptors on the surface of platelets.

So the answer to this question is C


Instruction:
Hyperacute rejection occurs within:-
A. 12 hours
B. 2 weeks
C. 1 month
D. 3 month

Response:
Hyperacute rejection Takes place from few minutes to few hours Takes place because of presence of preformed antibodies Eg: multiparous female, blood recipients (WBC/platelets) are associated with Sensitization of immune system We have high degree of expression of HLA or MHC antigens on the surface of WBC/platelets, which are responsible for the formation of preformed antibodies Hyperacute transplant rejection is an example of Type II hypersensitivity reaction Cross matching reduces the risk of development of hyperacute transplant rejection significantly Hyper acute rejection: This form of rejection occurs within minutes or hours after transplantation. A hyperacutely rejecting kidney rapidly becomes cyanotic, mottled, and flaccid, and may excrete a mere few drops of bloody urine. Immunoglobulin and complement are deposited in the vessel wall, causing endothelial injury and fibrin-platelet thrombi. Neutrophils rapidly accumulate within aerioles, glomeruli, and peritubular capillaries. As these changes become diffuse and intense, the glomeruli undergo thrombotic occlusion of the capillaries, and fibrinoid necrosis occurs in aerial walls. The kidney coex then undergoes outright necrosis (infarction), and such nonfunctioning kidneys have to be removed. Hyperacute rejection, Hyperacute rejection of a kidney allograft showing platelet and fibrin thrombi, early neutrophil infiltration, and severe ischemic injury in a

So the answer to this question is A


Instruction:
Malignancy in a multinodular goiter is most often: September 2012
A. Follicular carcinoma
B. Papillary carcinoma
C. Anaplastic carcinoma
D. Medullary carcinoma

Response:
Ans. A i.e. Follicular carcinoma Thyroid carcinoma Rarest: Anaplastic Ca Worst prognosis: Anaplastic Ca Best prognosis: Papillary Ca Associated with MEN II: Medullary Ca Developing in thyroglossal cyst: Papillary Ca Least malignant: Papillary Ca Developing in Hashimoto's thyroiditis: Papillary Ca MC type: Papillary Ca Associated with psammoma bodies: Papillary Ca

So the answer to this question is A


Instruction:
Which of the following is not characteristic of Type I Schizophrenia
A. Positive symptoms
B. CT, MRT shows enlarged ventricles
C. Good Prognosis
D. None of the above

Response:
Type I
Type II

Positive symptoms
Negative symptoms

CT and MRI normal
CT and MRI shows enlarged ventricles

Good Prognosis
Bad Prognosis

So the answer to this question is B


Instruction:
Ethyl alcohol is effective (against spores)
A. 70%
B. 60%
C. 50%
D. 100%

Response:
None

So the answer to this question is A


Instruction:
A 9-month-old child is brought to the Health Depament to receive the second dose of oral polio vaccine, 2 weeks after the first vaccination. The child has mild diarrhea, so the decision is made to defer fuher immunizations. Bacteriologic examination of a stool culture is unremarkable; however, a small, single-stranded, positive RNA virus is isolated from the specimen. The viral isolate was not inactivated by ether. Which of the following viruses was most likely isolated?
A. Adenovirus
B. Hepatitis C
C. Parvovirus B19
D. Poliovirus

Response:
Poliovirus, which is a single-stranded +RNA virus, is naked (i.e., non-enveloped) and hence will not be inactivated by lipid solvents such as ether. The live virus vaccine had colonized the intestinal tract of the infant and was still being shed 2 weeks after the earlier oral dose. This same virus, the vaccine strain, is likely to be found in sewage, as all vaccinated infants will shed virus for a period of time after immunization with OPV. Adenoviruses and parvovirus B19 also may cause diarrheal disease and both are non-enveloped; however, they both have a DNA genome. Hepatitis C is an enveloped, single-stranded +RNA virus; its major target organ is the liver, not the intestinal tract. It is a fragile agent that does not survive well outside the body and would not be isolated from raw sewage effluent.

So the answer to this question is D


Instruction:
The strategy for therapy for dopamine deficiency in the substantia nigra of individuals with Parkinson's disease is indicated by which of the following?
A. Feedback inhibition of dopamine oxidation
B. Competitive inhibition of biosynthesis from histidine
C. Provision of metabolites in the tyrosine pathway
D. Stimulation of monoamine oxidase

Response:
Dopamine is produced from L-dopa, which in turn is made from tyrosine. Therapy with the L-dopa precursor increases dopamine concentrations and improves the rigidity and immobility that occur in Parkinsons disease. Dopamine is degraded in the synaptic cleft by monoamine oxidases A and B (MAO-A and MAO-B), producing 3,4- dihydroxyphenylacetaldehyde (DOPAC). DOPAC is in turn broken down to homovanilhic acid, which can be measured in spinal fluid to assess dopamine metabolism. Inhibitors of MAO-A and MAO-B have some use in treating Parkinson's disease. The metabolism of histidine or alanine is not related to that of dopamine. but phenylalanine is a precursor of tyrosine and L-dopa.

So the answer to this question is C


Instruction:
Which of the following methods is used for demonstrating old washed up blood-stains -
A. Infrared photography
B. Luminol spray
C. Ultraviolet light
D. Magnifying lens

Response:
Luminol (3-aminophthalhydrazide) spray is most common blood reagent used for visualizing/demonstrating weak/ faint blood stains i.e old washed up or cleaned up stains and blood stains in areas difficult to see such as outdoor vegetations etc.

So the answer to this question is B


Instruction:
Paragangliomas may show production of -
A. ACTH
B. Catecholamines
C. GH
D. ADH

Response:
When pheochromacytomas arise at extra-adrenal site, they are referred to as paraganglioma.
Paravertebral paragangliomas secrete catecholamines.
Note -chemodectomas usually do not secrete catecholamines.

So the answer to this question is B


Instruction:
Drug used in unstable angina to prevent Myocardial infarction is
A. Aspirin
B. GTN
C. Amlodipine
D. Fasudil

Response:
Aspirin is an antiplatelet agent used mostly in unstable angina to prevent MI. Ref: KD Tripathi 8th ed.

So the answer to this question is A


Instruction:
In flexor tendon graft repair, graft is taken from
A. Plantaris
B. Palmaris longus
C. Extensor digitorum
D. Extensor indicis

Response:
Secondary repair and reconstruction of flexor tendonsIf flexor tendons cannot be repaired within the first 10 to 14 days (delayed primary repair), the repair is considered to be secondary repairDonor tendons for grafting, in order of preference, are the Palmaris longus, the plantaris, and the long extensors of the toes. In rare cases, the index extensor digitorum communis, the extensor indicis proprius, and the flexor digitorum sublime are used.(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 497)

So the answer to this question is B


Instruction:
Resting membrane potential is mainly due to
A. Na+
B. K+
C. Cl-
D. Mg++

Response:
Resting membrane potential depends on the concentration of potassium ion. (REF: TEXTBOOK OF MEDICAL PHYSIOLOGY GEETHA N 2 EDITION, 23)

So the answer to this question is B


Instruction:
The antibiotic which acts on the cell membrane is?
A. Daptomycin
B. Bacitracin
C. Linezolid
D. Novobiocin

Response:
The antibiotics which acts on the cell membranes are: Polymyxins, Gramicidin, and daptomycin Ref: Harrisons, Edition-18, Page :1134.

So the answer to this question is A


Instruction:
A woman presents with chest pain and shoulder pain. On examination, she is found to have pericarditis with pericardial effusion. This shoulder pain is mediated by
A. Deep cardiac plexus
B. Superficial cardiac plexus
C. Phrenic nerve
D. Subcostal nerve

Response:
The pain of pericarditis is mediated by the phrenic nerve. The somatic sensation from the pericardium is carried by the somatic afferent fibers of the phrenic nerve. The pericardial pain may be referred to the supraclavicular region of the shoulder or lateral neck area (dermatomes C3, C4 and C5. Ref: Gray&;s Anatomy for students 3rd edition Pgno: 183

So the answer to this question is C


Instruction:
Chocolate agar is:
A. Basal medium
B. Enrichment medium
C. Enriched medium
D. Simple medium

Response:
Ans. (b) Enrichment medium

So the answer to this question is B


Instruction:
Erythema marginatum is seen in :
A. Drug reactions
B. Typhoid fever
C. Enteric fever
D. Rheumatic fever

Response:
D i.e. Rheumatic fever

So the answer to this question is D


Instruction:
A 27-year-old intravenous drug user presents with difficulty swallowing. Examination of the oropharynx reveals white plaques along the tongue and the oral mucosa. Which of the following best describes the microscopic appearance of the microorganism responsible for this patient's illness?
A. Budding yeast and pseudohyphae
B. Encapsulated yeast
C. Mold with nonseptate hyphae
D. Mold with septate hyphae

Response:
This patient has Candida esophagitis. Any time a patient presents with dysphagia or odynophagia and you note white plaques in the oropharynx (thrush), you can assume that the Candida is affecting the esophagus as well. The fact that the patient is an IV drug user makes an oppounistic infection such as Candida more likely. Candida appears as budding yeast with pseudohyphae in vivo. The other answer choices represent the morphology of other impoant oppounistic fungi: Cryptococcus are encapsulated yeast. You should think about Cryptococcus neoformans when you're presented with an immunocompromised patient with neurological symptoms. The classic clue is the presence of encapsulated organisms observable in an India ink preparation. Mucor and Rhizopus are molds with nonseptate hyphae. You should think about Mucor when you are presented with a diabetic (especially ketoacidosis) or a leukemic patient with a severe sinus infection. Aspergillus is a mold with septate hyphae. In immunocompromised patients, aspergillosis can present with acute pneumonia, often with cavitation (aspergillomas = fungus balls in the lungs). Ref: McQuaid K.R. (2013). Chapter 15. Gastrointestinal Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow (Eds), CURRENT Medical Diagnosis & Treatment 2013.

So the answer to this question is A


Instruction:
A person is able to abduct his arm, internally rotate it, place the back of hand on the lumbosacral joint, but is not able to lift it from back, What is the Etiology?
A. Subscapularis tendon tear
B. Teres major tendon tear
C. Long head of biceps tendon tear
D. Acromioclavicular jt. dislocation

Response:
The test described in the question is lift off test which is a test for subsacapularis muscle Internal rotation lag sign test The purpose of this test is to assess tears of the subscapularis muscle. 1. The patient is asked to bring the arm behind the back with the palm facing outwards. 2. The arm is held in near maximum internal rotation and with the hand away from the back by approximately 20deg of extension. 3. The patient is asked to hold the position while the examiner suppos the elbow but releases the wrist hold. 4. If the patient is unable to hold the position, the lag sign is positive. Refer Apleys Ohopedic 9th/e 345

So the answer to this question is A


Instruction:
First dose effect is shown by
A. Prazocin
B. Furosemide
C. Thyronorm
D. Ceftazidime

Response:
Ans. is 'a' i.e., Prazocin "First dose effect (postural hypotension) is now uncommon and occurs mainly with drugs having an action on veins (a-adrenoreceptor blockers like prazosin, ACE inhibitors) when baroreceptors reflex is impared e.g. old age or with contracted intravascular volume following diuretics" -- Lawrence 9th/ep. 489

So the answer to this question is A


Instruction:
MC valve involved in Rheumatic fever ?
A. Mitral
B. Aoic
C. Pulmonary
D. Tricuspid

Response:
Ans. is 'a' i.e., Mitral Mitral valve is involved most commonly. o RHD is the most common cause of mitral stenosis.

So the answer to this question is A


Instruction:
A female presented with long standing nasal obstruction. She also complaints about comments from her friends telling about foul smell coming from her nose which she could not recognise. On evaluation, atrophic rhinitis is diagnosed. What can be the etiology in this patient to develop secondary atrophic rhinitis?
A. Chronic sinusitis
B. Nasal trauma
C. Oropharyngeal cancer
D. Strong hereditary factors

Response:
Specific infections like syphilis, lupus, leprosy, and rhinoscleroma may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent sinusitis, radiotherapy to nose or excessive surgical removal of turbinates. Extreme detion of nasal septum may be accompanied by atrophic rhinitis on the wider side.

So the answer to this question is A


Instruction:
A 30 year old patient on digoxin therapy has developed digitalis toxicity. The plasma digoxin level is 4 ng/ml. Renal function is normal and the plasma t1/2 for digoxin in this patient is 1.6 days. How long should you withhold digoxin in order to reach a safer yet probably therapeutic level of 1 ng/ml?
A. 1.6 days
B. 2.4 days
C. 3.2 days
D. 4.8 days

Response:
* We want to decrease the plasma concentration of digoxin from 4 ng/ml to 1 ng/ml. * It will take two half lives (From 4 ng/ml to 2 ng/ml in one half life and from 2 ng/ml to 1 ng/ml in second half life). * Thus time required will be 2 x t 1/2 i.e. 2 x 1.6 = 3.2 days.

So the answer to this question is C


Instruction:
Donepezil has the following mechanism of action
A. Dopaminergic blockade
B. Cholinesterase inhibition
C. Serotonin blockade
D. Histaminergic action

Response:
Donepezil: cerebro selective and reversible anti-AchE produces improvement in several cognitive as well as non cognitive (activities of daily living) scores in Alzheimer's Dementia. The benefit is ascribed to elevation of Ach level in the coex, especially in the surviving neurons that project from basal forebrain to cerebral coex and hippocampus. Therapeutic doses produce only weak peripheral AchE inhibition: cholinergic side effects are mild. Because of long t 1/2 (~70 hr), donepezil is administered once daily at bedtime It is generally well tolerated and is not hepatotoxic.

So the answer to this question is B


Instruction:
Which of the following teeth are affected in Generalised periodontitis?
A. Incisors
B. Molars
C. Incisors, 1st molars and 3 other teeth.
D. None of the above

Response:
None

So the answer to this question is C


Instruction:
All are true about facial recess except:
A. Supra pyramical recess
B. Medially it is bounded by chorda tympani and laterally by facial nerve
C. Impoant in cochlear implant
D. Middle ear can be approached through it

Response:
None

So the answer to this question is B


Instruction:
Which of the following statements is not true for heparin
A. Acts by activating anti-thrombin III
B. Protamine sulphate antagonizes its action
C. Requires aPTT monitoring in patient
D. Has only in vivo anticoagulant action

Response:
None

So the answer to this question is D


Instruction:
Normal reduced hemoglobin in blood is ?
A. 3%
B. 10%
C. 20%
D. 30%

Response:
Ans. is 'a' i.e., 3%Normally 97% of hemoglobin is oxygenated.3% of hemoglobin is deoxygenated hemoglobin or reduced hemoglobin.

So the answer to this question is A


Instruction:
Blood supply of stomach is/are:
A. Left gastric aery
B. Sho gastric aery
C. Lt gastroepiploic aery
D. All

Response:
A. i.e. Left gastric aery; B. i.e. Sho gastric aery; C. i.e. Left gastroepiploic aery

So the answer to this question is D


Instruction:
All are true regarding endometriosis, except :
A. Hormone dependent condition
B. Can involve lung. pleura
C. Contains clear fluid
D. Ovary is the most common site

Response:
Ans. is c i.e. Contains clear fluid As already explained in previous question, endometriosis is occurence of functioning endometrial tissue (glands + stroma) outside the uterine cavity. Whatever the inital genesis of endometriosis its fuher development depends mainly on estrogen (Option "a) It can occur anywhere in body, Most common site being ovarydeg (Option "d"). Can also involve lungs and pleuradeg (Option "b"). - In endometriosis ovary contains tarry dark brown fluid (due to presence of blood pigments like hemosiderin) and cul de sac has yellow brown fluid. Clear fluid is not seen anywhere. So, Option "c" is incorrect. For more details about endometriosis, see answer 1

So the answer to this question is C


Instruction:
Herpes zoster infection can lead to
A. Frontal lobe infarction
B. Parietal lobe infarction
C. Temporal lobe infarction
D. Occipital neuralgia

Response:
Ans. is 'd' i.e., Occipital neuralgia Herpes simplex infection has a prediliction for the involvement of Temporal lobe. The lesions in HSV encephalitis are intense hemorrhagic necrosis of the inferior and medial temporal lobe and the mediorbital pa of frontal lobes. The temporal lobe lesions are usually b/L but not symmetrical. The distribution of the lesion is so characteristic that the diagnosis can be made by gross inspection or by their location and appearance on imaging studies. In the acute stages of the disease, intranuclear eosinophilic inclusions are found in neurons and glial cells in addition to the usual microscopic abnormalities of acute encephalitis and hemorrhagic necrosis C.S.F examination. Increased C.S.F pressure. Pleocytosis, cells are mostly lymphocytes. Red cells sometimes numbering in thousands and xantho chromia are found reflecting the hemorrhagic nature of the brain lesions. Protein content is increased in most cases. Slight reduction

So the answer to this question is D


Instruction:
Which of the following (in maternal serum) indicate open neural tube defect: March 2011
A. Increased folic acid levels
B. Increased Alpha fetoprotein levels
C. Decreased Alpha fetoprotein levels
D. Decreased beta-HCG

Response:
Ans. B: increased Alpha fetoprotein levels MSAFP level is elevated in 1) wrong gestational age, 2) open neural tube defect (NTD's), 3) multiple pregnancies, Rh isoimmunisation 4) IUFD, 5) anterior abdominal wall defects and 6) renal anomalies Risk factors for NTD: Family history of neural tube defects Maternal diabetes insufficient folic acid intake during pregnance Maternal intake of anti-epileptics

So the answer to this question is B


Instruction:
Which of the following structures are not involved in development of diaphragm?
A. Somatic body wall
B. Septum transversum
C. Pleuroperitoneal membrane
D. Pleuropericardial membrane

Response:
Ans: D. Pleuropericardial membranePleuropericardial membrane:Supradiaphragmatic structure.Not involved in formation of diaphragm.Development of Diaphragm:Septum transversum - Central tendon.Pleuroperitoneal membranes - Small intermediate muscular poione.Mesentery of esophagus - Crurae.Body wall - Peripheral muscular diaphragm.Cervical myotomes (muscular input).

So the answer to this question is D


Instruction:
Most Probable cause of food poisoning in a child who has eaten Ice Cream 16-18 hrs earlier is ?
A. Staph aureus
B. Clostridium perfringens
C. Clostridium botulinum
D. Salmonella typhimurium

Response:
Ans. is 'd' i.e., Salmonella typhimurium . Food poisoning 16-18 hrs after eating ice cream suggests S.typhimurium food poisoning. . Lets see each option - Staph aureus food poisoning has incubation period less than 6 hours. - Clostridium perfringens food poisoning has incubation period less than 16 hours. - Now two options are left - Cl. botulinum and salmonella typhimurium both can have incubation period > 16 hours. - Food sources responsible for botulism are home preserved foods such as home-canned vegetables, smoked or pickled fish, home-made cheese and similar home made food. - Salmonella typhimurium food poisoning occurs after eating contaminated meat, milk and milk products (ice cream), sausages, custards, eggs and egg products.

So the answer to this question is D


Instruction:
Why fetal cells continue to divide but terminally differentiated adult cells do not divide
A. There are many cyclin inhibitors which prevent cell to enter into S phase in adult
B. Phosphatase absent in fetal cells
C. Proteinase is absent in fetus
D. Absence of CD kinase

Response:
Ans. is 'a' i.e. There are many cyclin inhibitors which prevent cell to enter into S phase in adult * After a fixed number of divisions, normal cells become arrested in a terminally non dividing state known as replicative senescence.How does normal cell count their divisions ??It is not entirely clear, how normal cells count their divisions but it has been noted that with each cell division there is some shortening of specialized structures called telomers at the ends of chromosomes.Telomers are short repeated sequences of DNA present at the linear ends of chromosomes that are important for ensuring the complete replication of chromosomal ends and protecting chromosomal termini from fusion and degradation.When somatic cells replicate a small section of the telomere is not duplicated and telomeres become progressively shortened.As the telomers become shorter, the ends of chromosome cannot be protected and are seen as broken D.N.A., this signals cell cycle arrest.The loss of telomere function leads to activation of p 53 dependent cell cycle checkpoints causing proliferative arrest or apoptosis.Germ cells continue to divide because in these cells telomere shortening is prevented by sustained function of the enzyme Telomerase.Telomerase is an enzyme (specialized RNA-protein complex) that maintains the length of the Telomer by nucleotide addition.Telomerase activity is expressed in Germ cells and is present at low levels in stem cells but it is usually absent in most somatic tissues.Therefore as cells age their telomers become shorter and they exit the cell cycle, resulting in an inability to generate new cells to replace damaged ones.One more question which crops upIf loss of telomerase is the basis of the finite life span of cells, how do cancer cells continue to divide indefinitely ?In cancer cells telomerase is reactivated and thus the telomers are not shortened.

So the answer to this question is A


Instruction:
Macrophage activation syndrome is most commonly-1 seen in association with?
A. Systemic sclerosis
B. Sweet's syndrome
C. SLE
D. Juvenile Rheumatoid Ahritis

Response:
Answer is D (Juvenile Rheumatoid Ahritis): Macrophage Activation Syndrome is most commonly seen in association with Systemic Onset Juvenile Idiopathic Ahritides (Earlier termed JRA) and adult-onset Still's Disease. Amongst other autoimnnine diseases, MAS has also been repoed in patients with Juvenile SLE and Kawasaki Disease (Rare causes). Macrophage activation syndrome (MAS) is a life threatening complication of rheumatic diseases thought to be caused by the uncontrolled activation and proliferation of T lymphocytes and well-differentiated macrophages leading to widespread hemophagocytosis and cytokine overproduction. For unknown reasons, occurs much more frequently in systemic juvenile idiopathic ahritis (S-JIA) and in its adult equivalent, adult-onset Still disease. MAS has also been repoed in other systemic inflammatory disorders, including SLE and Kawasaki disease. The main clinical features of MAS include a high unremitting fever, hepatosplenomegaly, lymphadenopathy, bleeding, rash and central nervous system manifestations. Hyperferritinemia is an impoant laboratory hallmark of Macrophage Activation Syndrome MAS is regarded as a an acquired cause of Haemophagocytic Lymphohistiocytosis (HLH)

So the answer to this question is D


Instruction:
The following are precursors of endometrial carcinoma except:
A. Atypical adenomatous hyperplasia
B. Atrophic endometrium
C. Adenocarcinoma in situ
D. Cystic hyperplasia

Response:
Premaliginant Lesions of Endometrium are:-
Simple hyperplasia: Endometrium is thick. The glands are dilated and have outpouching and inva-ginations. They are crowded and have irregular outlines. The stroma is more dense and cellular.
Complex hyperplasia: Endometrium is thicker. The gland are crowded and arranged back to back with reduced stroma. Most glands have irregular outlines. There are papillary processes and intraluminal bridges within the glands. Epithelial pseudostratification is present.
Atypical hyperplasia: The endometrial glands have cytologic atypia. The gland outlines are of complex hyperplasia in type. The nuclei of the glands show enlargement, irregular size and shape, hyperchromasia and coarse chromatin. Carcinoma-in-situ: Commonly describes a lesion with severe cytologic as well as architectural abnormalities of the glands.

So the answer to this question is B


Instruction:
All are drugs causing cholestasis with inflammation of bile ducts: , EXCEPT:
A. Erythromycin
B. Amoxycillin clavulanic acid
C. Trimethoprim sulphamethoxazole
D. Trimethoprim sulphamethoxazole Astemizole

Response:
Drugs producing cholestasis with inflammation of the poal tracts: Erythromycin (paicularly the estolate salt), Trimethoprim-sulfamethoxazole Amoxicillin-clavulanic acid Terbinafine. Clinical features are ahralgias, rash, and peripheral eosinophilia cholestasis resolves within several months following discontinuation of the drug. Ref:Sleisenger and Fordtran's,E-9,P-329

So the answer to this question is D


Instruction:
What is deposited in Kyser-FIeischer ring -
A. Copper
B. Lead
C. Mercury
D. Heme

Response:
Ans. is 'a' i.e., CopperKayser-FLeischer (KF) ring - Copper deposition in Chalcosis or Wilson's diseaseFleischer ring - Deposition of iron and is a sign of keratoconus

So the answer to this question is A


Instruction:
Gene for Wilson's disease is located on chromonsome
A. 7
B. 10
C. 13
D. 17

Response:
Harshmohan textbook of pathology 7th edition. *Wilson's disease:the underlying defect in chromosome 13 is a mutation in ATP7B gene ,the normal hepatic copper exceeding gene. </p >

So the answer to this question is C


Instruction:
What is this teeth abnormality?
A. Mulberry molars
B. Natal teeth
C. Hutchinson's teeth
D. Supernumerary teeth

Response:
c. Hutchinson's teethNotched incisors, as seen in this image are known as Hutchinson's teeth. They are seen in congenital syphilis.

So the answer to this question is C


Instruction:
An eight month old child will be able to do which of the following:
A. Pincer grasp
B. Sitting stably
C. Stand without support
D. Says mama - baba

Response:
Ans: b

So the answer to this question is B


Instruction:
Suppositous child is?
A. Child bom out of wedlock
B. Child fictitiously claimed by a woman
C. Second bom of a twin pregnancy
D. None

Response:
Ans. is 'b' i.e., Child fictitiously claimed by a woman o Suppositious child: Child presented by the mother to have been delivered by her, though she has not delivered, i.e. fictious claim of child.

So the answer to this question is B


Instruction:
Tinel sign is seen in -
A. Nerve degeneration
B. Nerve regeneration
C. Muscle degeneration
D. Muscle regeneration

Response:
Ans. is 'b' i.e., Nerve regenerationPathological changes after nerve injuryo After nerve injury, nerve first degenerates and then tries to regenerate.Nerve degenerationo The part of the neurone distal to the point of injury undergoes secondary or Wallerian degeneration-, the proximal part undergoes primary or retrograde degeneration upto a single node.Nerve regenerationo As regeneration begins, the axonal stump from the proximal segment begins to growr distally. If the endoneural tube with its contained Schwrann cells is intact, the axonal sprout may readily pass along its primary course and reinnerv ate the end-organ. The rate of recovery of axon is 1 mm per day. The muscles nearest to the site of injury recovers first, followed by others as the nerve reinnervates muscles from proximal to distal, the so-called motor march.o When the skin over the nerve is percussed gently from distal to proximal, the patient gets a tingling sensation if the nerve is recovering. This is called Tinel's sign and is a sign of recovery.

So the answer to this question is B


Instruction:
Mizuo phenomenon is seen in:
A. Fundus albipunctatus
B. Oguchi's disease
C. Fundus amaculateus
D. Choroidermia

Response:
Ans. b. Oguchi's disease Mizuo phenomenon is seen in Oguchi \ disease."In Oguchis disease the characteristic golden yellowish metallic sheen (color) of posterior pole (fundus) in light adapted state reverts to normal after prolonged dark adaptation, a phenomenon described by and named after Japanese ophthalmologist Mizuo Re-exposure to light results in the return of golden yellow metallic sheen.** Female carriers of X-linked (XL) retinitis pigmentosa may have normal fundi or show a golden metallic (tapetal) reflex at macula and/or small peripheral patches of hone spicule pigmentation. The inverse Mizuo phenomenon seen in XL-RP is characterized by appearance of golden sheen in dark (hut no golden sheen in light)."Oguchi's Disease* Oguchi's disease is a rare autosomal recessive trait characterized by congenital stationary night blindness and a unique morphological and functional abnormality of the retina.* Show Mizuo phenomenon^* Mizuo phenomenon: Fundus is golden yellow in light adapted state which becomes normal after prolonged dark adaptation. Reexposure to light results in the return of the metallic y ellow sheeny.* Rod function is absent after 30-minutes of dark adaptation but recovers to a near normal level after a long period of dark adaptation (i.e. -- normal rod thresholds reached only after 4 hours or longer instead of normal 30 minutes).Etiopathogenesis:* A null allele in genes for each of rhodopsin kinase and arrestin (proteins responsible for terminating phototransduction cascade) is responsible for Oguchi's disease.* Therefore, the persistent low level of light may desensitize the rods continually.* Mizuo phenomenon suggest an abnormality in rod pigment, rhodopsin.* Cone function is normal because cone adaptation, final cone thresholds and photopicERG response are normal.* Rod function is abnormal with delayed dark adaptation and scotopic ERG showing only a small electronegative response, even when the rod threshold have reached normal.Clinical Features:* Patients have non-progressive night blindness since young childhood writh normal day vision, but they often claim improvement of light sensitivities w hen they remain long in the dark environment* The fundus oculi presents a most peculiar appearance.

So the answer to this question is B


Instruction:
A 6 year old boy presenting with palpable abdominal mass in the epigastrium. The clinical diagnosis is (There is no bile in vomitus)-
A. Duodenal Atresia
B. Choledochal cyst
C. Pyloric stenosis
D. Oesophageal Atresia

Response:
Ans. is 'c' i.e., Pyloric stenosisDiagnosis of congenital hyperophic pyloric stenosis o History of vomiting without bile (nonbilious vomiting).o Physical examination ?i) Palpable mass in the epigastriumii) After feeding, visible gastric peristatic wave that progresses across the abdomen.USG confirm the diagnosis Criteria --> Pyloric thickness > 4 mm or an overall pyloric length > 14 mm.o Contrast studies ?i) Shoulder sign A bulge of the pyloric muscle into the antrum.ii) Double tract sign -> Parallel streaks of barium in the narrowed channel.iii) Elongated pyloric channel.So the boy is having pyloric stenosis. The only problem is age of boy i.e 6 yrs. The hyperophic pyloric stenosis which we know of, makes its clinical presentation in early infancy (3rd to 6th weeks of life)o But the problem in solved once you know that there is a similar disease in adults - Hyperophic pyloric stenosis of adults. (Bailey & Love, 22th/e, p 675).

So the answer to this question is C


Instruction:
In which case cystometric study is indicated -
A. Neurogenic bladder
B. Stress incontinence
C. Fistula
D. Urge incontinence

Response:
Cystometric studies are urodynamic studies in which the pressure changes in the bladder is simultaneously measured with bladder filling and during micturition.
It helps in accurate assessment of detrusor and sphincter activity especially if a neurogenic abnormality is suspected.
Though it is also used in stress incontinence but the aim here is to rule out any neurogenic cause.

So the answer to this question is A


Instruction:
All are true about Prostatic venous plexus , except
A. Drains into vesicourethral plexus of veins
B. Dorsal vein of penis drains into it
C. Located beneath false capsule
D. Communicates with the pudendal and vesical plexuses

Response:
The prostatic veins form a well-marked prostatic plexus which lies paly in the fascial sheath of the prostate and paly between the sheath and the prostatic capsule. It communicates with the pudendal and vesical plexuses. The prostatic venous plexus drains into the internal iliac vein which connects with the veebral venous plexus, this is thought to be the route of bone metastasis of prostate cancer. Ref - BDC 6e vol2 pg403-406

So the answer to this question is A


Instruction:
"Incest' term used in sexual relationship with
A. A girl age less than 16 years
B. Divorced wife
C. Blood relationship
D. Sex with hijra

Response:
C. i.e. (Blood relationship) (5.46 Parikh 6th)INCEST - This is the act of sexual intercourse by a man with woman within a certain degree of blood relationship* In India incest per se is not a cognizable offence and police cannot take any notice of it unless the offence can be brought into any of the penalizing sections such as 376 and 497 IPC* Common example is the father and daughter, brother and sister* Medical examination is concerned with demonstrating evidence of habitual intercourse rather than of fresh defloration.Bestiality (bestio - sexuality) means sexual intercourse by a human being with a lower animal** either through the anus or the vagina (Punishible under the section 377. IPC)**Fetichism - is a perversion in which sexual gratification is associated with contact and sight of certain parts of the female body or even clothing or other articles known as fetish objects** (Corned - 08)Transvestism is a perversion in which the personality is dominated by the desire to be identified with opposite sex. The fantasy indulged in is clearly "being a women" if a male and 'being a man' if a female. It is also known as EONISM**Irresistible sexual desire in males is known as Satyriasis**

So the answer to this question is C


Instruction:
Which of the following has to be present for diagnosis of major depressive disorder
A. Loss of interest or pleasure
B. Recurrent suicidal tendency
C. Insomnia
D. Indecisiveness

Response:
In typical depressive episodes of all three varieties described below (mild, moderate, and severe), the individual usually suffers from depressed mood, loss of interest and enjoyment, and reduced energy leading to increased fatigability and diminished activity. Reference: International classification of diseases 10, page 119.

So the answer to this question is A