Instruction:
Which of the following inhalational agent is contraindicated in a patient with history of epilepsy;
A. lsoflurance
B. Enflurane
C. Halothane
D. Sevoflurane

Response:
B i.e. Enflurane

So the answer to this question is B


Instruction:
Regarding nitric oxide false is
A. Derived from endothelium
B. Acts by increasing c–AMP levels
C. Vasodilator
D. Derived from arginine

Response:
Nitric oxide is formed from Arginine, released from endothelial cells and acts through cGMP to cause vasodilation.

So the answer to this question is B


Instruction:
The number of symphyseal cartilages appearing during the development of mandible
A. Two
B. Three
C. Four
D. One

Response:
None

So the answer to this question is A


Instruction:
Pond's fractures are common in: AP 09
A. Children
B. Adolescent
C. Adult
D. Old age

Response:
Ans. Children

So the answer to this question is A


Instruction:
Drug most commonly implicated in causing pseudo membranous colitis is :
A. Clindamycin
B. Streptomycin
C. Amoxicillin
D. Metronidazole

Response:
None

So the answer to this question is A


Instruction:
The tilting of a cast during surveying in a RPD changes the
A. Position of undercuts
B. Path of insertion
C. Amount of undercut
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
Eradication of polio type 2 done on
A. 12-May-14
B. 20-Sep-15
C. 14-Jul-16
D. 22-Feb-03

Response:
None

So the answer to this question is B


Instruction:
Which ion is added in OPV vaccine acts as stabilizer
A. Sodium
B. Magnesium
C. Chloride
D. Potassium

Response:
None

So the answer to this question is B


Instruction:
Fetal anemia is detected on Doppler of:
A. Uterine artery
B. Umbilical artery
C. Middle cerebral artery
D. Any of the above

Response:
Ans. is c, i.e. Middle cerebral arteryRef. Williams 23/e, p 362, 363As discussed in the text:Doppler of Middle cerebral artery is used to detect.(i). Fetal anemia as in Rh isoimmunization, vasa previa and TTTS(ii). IUGR

So the answer to this question is C


Instruction:
The cofactor involved in sulphur containing amino acid metabolism is which of the following?
A. Folic acid
B. Biotin
C. Vitamin B1
D. Vitamin B12

Response:
While both folic acid and vitamin B12 are involved in sulphur containing amino acid metabolism, vitamin B12 acts as cofactor and folate acts as substrate.

So the answer to this question is D


Instruction:
Myelin sheath in the central nervous system is formed by
A. Schwann cell
B. Microglia
C. Oligodendrocytes
D. Protoplasmic astrocytes

Response:
Oligodendrocytes are responsible for myelination in the CNS. In the PNS, Schwann cells form the myelin sheath. The process of myelination begins before bih and is not complete until a year or more after bih. (Ref: Vishram Singh textbook of neuroanatomy, second edition, pg- 19)

So the answer to this question is C


Instruction:
CARE is associated with -
A. ICDS
B. CRY
C. Ford Foundation
D. RCH scheme

Response:
Cooperative for Assistance and Relief Everywhere was founded in Noh america.Its world largest independent ,non-profit ,non secretarian international relief and devolopment organization.CARE provides emergency aid and long term devolopment assistance. CARE India focused its food suppo in the ICDS programme and in devolopment of programmes in areas of health and income supplementation.Parks textbook of preventive and social medicine.K Park. Edition 23.Pg no: 924

So the answer to this question is A


Instruction:
A patient with acute urinary tract infection (UTI) usually presents with:
A. Chills and fever.
B. Flank pain.
C. Nausea and vomiting.
D. Painful urination.

Response:
Cystitis or infection of the bladder is the most common UTI. Lower UTI, or cystitis, is an infection in the bladder. Painful urination and frequency are the most common presenting complaints. Hematuria may occur, but is associated with painful urination and frequency. Flank pain, fever, chills, nausea, and vomiting usually occur only when the infection involves the kidney. An acute UTI is identified in unspun urine only when there are more than 10 leukocytes per hpf in the unspun urine. The normal urine may have as many as 10 WBC/per hpf without being infected.

So the answer to this question is D


Instruction:
Pain during inflammation is mediated by
A. Nitric oxide
B. Leukotriene B4
C. Bradykinin
D. Chemokines

Response:
Ans. (c) Bradykinin(Ref: Robbins 9th/pg 65, 89)Functions of bradykinin:Increases vascular permeability, vasodilationSmooth muscle contraction and pain when injected into the skin.

So the answer to this question is C


Instruction:
Which of the following has highest electrophoretic mobility and least lipid content
A. Chylomicrons
B. HDL
C. LDL
D. VLDL

Response:
HDL

HDL:- Has maximum electrophoretic mobility, has maximum density, has minimum lipid content, has maximum protein (apoprotein) content, are smallest in size, has maximum phospholipid, has minimum triglycerides.
Chylomicrons:- Have no electrophoretic mobility, have minimum density, have maximum lipid content, have minimum protein content, are largest in size, have minimum phospholipids, have maximum triglycerides.

So the answer to this question is B


Instruction:
Pupillary dilatation is seen in which of the following drug abuse ?
A. Organophosphorus compounds
B. Belladona
C. Heroin
D. Morphine

Response:
ATROPA BELLADONNA AND HYOSCYAMUS NIGER: Atropa belladonna/ deadly nightshade is a plant of Europe and Asia. All pas are toxic The active principle is - hyoscyamine. This group of compounds acts by inhibiting the muscarine effects of acetylcholine. Mydriatic Test: A drop of the solution to be tested is put into the eyes of a cat. The pupils dilate within half hour if datura is present, due to the presence of atropine. Drugs causing dilatation of pupils: Datura, Atropine, Belladonna, Cannabis, Cocaine, Alcohol

So the answer to this question is B


Instruction:
Best index of contraceptive efficacy is-
A. Pearl index
B. Chandelers index
C. Quetlet index
D. Broca index

Response:
Ans. is 'a' i.e., Pearl index o For contraceptive efficacy two method are used Pearl index Life table analysis (Better measure than Pearl index)

So the answer to this question is A


Instruction:
Red keratin precipitates are seen in -
A. Granulomatous uveits
B. Hemorrhagic uveitis
C. Old healed uveitis
D. Acute anterior uveitis

Response:
Ans. is 'b' i.e., Hemorrhagic uveitisKeratic precipitates (KPs)o KPs are proteinaceous cellular deposits occurring at the back of cornea (corneal endothelial deposits). Keratic precipitates are formed by the aggregation of polymorphonuclear cells, lymphocytes, and epithelioid cells. In the setting of uveitis, the microscopic appearance of KP may yield important diagnostic clues for the identification of the underlying inflammatory disorderMutton fat KP:- Large, yellowish KPs, are characteristic of granulomatous uveitis. These are composed of epithelioid cells and macrophages. They are large, thick fluffy, lardaceous KPs, having a greasy or waxy appearance.Small or medium KPs (granular KPs):- These are composed of lymphocytes and are characteristic of non-granulomatous uveitis. These are small, round and whitish precipitatesRed KPs:- Composed of RBCs and inflammatory cells. These are seen in hemorrhagic uveitis.Old KPs:- In healed uveitis. The above described KPs shrink, fade, become pigmented and irregular in shape with crenate margins.

So the answer to this question is B


Instruction:
Engagement of foetal head is with reference to :
A. Biparietal diameter
B. Bitemporal diameter
C. Occipito frontal diameter
D. Suboccipito frontal diameter

Response:
Biparietal diameter

So the answer to this question is A


Instruction:
A 70 year old patient with benign prostatic hyperplasia underwent transuretheral resection of prostate under spinal anaesthesia. One hour later, he developed vomiting and altered sensorium. The most probable cause is -
A. Over dosage of spinal anaesthetic agent
B. Rupture of bladder
C. Hyperkalemia
D. Water intoxication

Response:
None

So the answer to this question is D


Instruction:
The risk of having a baby with Down syndrome for a 30-year-old woman increases
A. If her pregnancy has been achieved by induction of ovulation by menotropins
B. If she has had a previous baby with Turner syndrome (45,X)
C. If she has had a previous baby with triploidy
D. If she has had three first-trimester spontaneous aboions

Response:
The risk of aneuploidy is increased with multiple miscarriages not attributable to other causes such as endocrine abnormalities or cervical incompetence.A 45, X karyotype results from loss of chromosome material and does not involve increased risks for nondisjunction errors.Similarly, induced ovulation does not result in increased nondisjunction, and hyper model conceptions (triploidy) do not increase the risk for future pregnancies.

So the answer to this question is D


Instruction:
Chandu, a 45 yrs male shows calcification on the Rt side of his abdomen in an AP view. In lateral view the calcification is seen to overlie the spine. Most likely diagnosis is -
A. Gallstones
B. Calcified mesenteric nodes
C. Renal stones
D. Calcified rib

Response:
Ans. is 'c' i.e., Renal stone

So the answer to this question is C


Instruction:
Lyophilised (Freeze dried) vaccine do not include:-
A. BCG
B. OPV
C. Measles
D. JE Live vaccine

Response:
Lyophilized ( freezed dried ) vaccine:- Available in Powder form Examples:- BCG Yellow Fever Japanese Encephalitis HiB Require Saline Measles MMR Distilled water / saline water - Reconstructed vaccines should be used before 4hrs other wise they may case Toxic shock syndrome.

So the answer to this question is B


Instruction:
A standing person lies down. Which of the following physiological change occurs immediately? (D. REPEAT Feb 2014)
A. Increased heart rate
B. Decreased blood flow to the apices of the lung
C. Immediate increase in venous return
D. Increase in blood pressure

Response:
Ans: C (Immediate increase in venous return) Ref: Guyton 12th edition and A Textbook of Practical Physiology By C. L. Ghai, pg 243ExplanationStanding to Lying PositionDecreased peripheral vascular resistance.Increased venous return to heart.Rise in HR followed by slowing of heart.The rise and fall in HR is due to changes in vagal tone.Sudden Standing from Supine PositionSudden standing - Pooling of blood in lower parts of body - Fall in venous return - Decrease in Cardiac output and Blood pressure - Decreased baroreceptor activity - Increase in sympathetic tone and decrease in parasympathetic activity - Reflex increase in heart rate and peripheral vasoconstriction - Heart rate falls.Heart rate rises immediately on standing and continues to rise for next 15-20 seconds, after which it slows down to a maximum degree as a result of variations in vagal tone.

So the answer to this question is C


Instruction:
Which of the following does not contribute to the development of diaphragm?
A. Septum transversum
B. Pleuroperitoneal folds
C. Body wall
D. Septum primum

Response:
Diaphragm develops from the following sources. 1.Septum transversum forms the central tendon. 2.Pleuroperitoneal membranes form the dorsal paired poion. 3. Lateral thoracic wall contributes to the circumferential poion of the diaphragm. 4. Dorsal mesentry of esophagus forms the dorsal unpaired poion. Ref.B D Chaurasia's human anatomy vol.2

So the answer to this question is D


Instruction:
Which of the following is an absolute indication for BPH
A. Prostatitis
B. Voiding bladder pressures>70 cm of water
C. Episode of hematuria
D. Bilateral hydronephrosis

Response:
Indications of prostate surgery in BPH - Acute or Chronic urine retension
Multiple UTI
B/L hydronephrosis
> 1 episode of hematuria
Bladder divertuli.

So the answer to this question is D


Instruction:
Goldenhar syndrome is?
A. Facial deformity, auricular abnormalities and vertebral deformity
B. Facial deformity, auricular abnormalities, vertebral deformity and genital lesion
C. Facial and auricular abnormalities only
D. Auricular abnormalities only

Response:
None

So the answer to this question is A


Instruction:
A 65 years old patient of coronary aery disease was on Aspirin for 2 years. He now complains of black stools. Abdominal examination is normal. What is the most probable diagnosis?
A. Ileocecal TB
B. Ca colon
C. Esophageal varices
D. Duodenal ulcer

Response:
Duodenal ulcer Peptic ulcers are the most common cause of upper CI bleed of which NSAIDs is an impoant cause. So here in this patient on long duration NSAIDs and no other clinical abnormality the most likely cause is peptic ulcer disease.

So the answer to this question is D


Instruction:
Which of the following gas is most commonly used in laproscopy?
A. CO2
B. N2O
C. O2
D. Helium

Response:
CO2 is used in laproscopy because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is impoant because electrosurgical devices are commonly used in laparoscopic procedures.

So the answer to this question is A


Instruction:
Most common site of gastric cancer is:
A. Lesser curvature of stomach
B. Greater curvature of stomach
C. Fundus
D. Antrum

Response:
Ans: D (Antrum) Ref: Robbins Pathologic Basis of Disease, 8th edition.Explanation:"Most gastric adenocarcinomas involve the gastric antrum; the lesser curvature is involved more often than the greater curvature" (Ref: Robbins)Gastric AdenocarcinomaAdenocarcinoma is the most common malignancy of the stomach, comprising over 90% of all gastric cancers.Early symptoms are non-specific and resemble those of chronic gastritis, including dyspepsia, dysphagia, and nausea.Weight loss, anorexia, altered bowel habits, anemia, and hemorrhage manifests in advanced stagesAs a result, these tumors are often discovered at advanced stagesMorphologyMost gastric adenocarcinomas involve the gastric antrumThe lesser curvature is involved more often than the greater curvatureGastric tumors are divided into two major types based on morphologyIntestinal typeDiffusi ve tnfil trative typeTumors with intestinal morphology tend to form bulky tumors composed of glandular structures while cancers with a diffuse infiltrative growth pattern are more often composed of signet-ring cells Intestinal-type adenocarcinomas typically grow along broad cohesive fronts to form either an exophytic mass or an ulcerated tumor.The neoplastic cells often contain apical mucin vacuoles, and abundant mucin may be present in gland lumens.Diffuse gastric cancer is generally composed of discohesive cells that do not form glands but instead have large mucin vacuoles that expand the cytoplasm and push the nucleus to the periphery, creating a signet-ring cell morphology.Extracellular mucin release in either type of gastric cancer can result in formation of large mucin lakes that dissect tissue planes.A mass may be difficult to appreciate in diffuse gastric cancer, but these infiltrative tumors often evoke a desmoplastic reaction that stiffens the gastric wallWhen there are large areas of in titration, diffuse rugal flattening and a rigid, thickened wall may impart a leather bottle appearance termed linitis plasticaBreast and lung cancers that metastasize to the stomach may also create a linitis plastica- like appearance.Clinical CharacteristicsThe depth of invasion and the extent of nodal and distant metastasis at the time of diagnosis remain the most powerful prognostic indicators for gastric cancerIn advanced cases gastric carcinoma may first he detected as metastases to the supraclavicular sentinel lymph node, also called Virchow's node.Gastric tumors can also metastasize to the periumbilical region to form a subcutaneous nodule, termed a Sister Mary Joseph nodule.Local invasion into the duodenum, pancreas, and retroperitoneum is also characteristic.

So the answer to this question is D


Instruction:
WHich of the following proton pump inhibitor has enzyme inhibitory activity?
A. Rabeprazole
B. Lansoprazole
C. Pantoprazole
D. Omeprazole

Response:
Omeprazole and esomoprazole are microsomal anzymes inhibitors .these may decrease the metabolism of diazepam. Lansoprazole enhances the metabolism of theophyllin .(katzung 11/e p1075)

So the answer to this question is D


Instruction:
Incidence of malignancy is maximum in -
A. Villous adenoma
B. Juvenile polyps
C. Hyperplastic polyps
D. Tubular adenoma

Response:
Incidence of malignancy is maximum in villous adenoma ie upto 30-70% in comparison to Tubular adenoma (1-3%)
Juvenile polyp (hamartomatous polyp) and Hyperplastic polyp are non-neoplastic epithelial tumors of intestine. There is no increased risk of malignancy.
Tubular adenoma & villous adenoma are benign neoplastic lesion, but have propensity to become malignant.
Tubular adenoma  (also k/a Adenomatous polyp)
account for over 90% of colonic adenomas
1-3% incidence of carcinoma
Although the risk of cancer is small, the high frequency of these polyps in the population makes them the most important precancerous colonic lesions.

Villous adenoma

are uncommon, comprising less than 10% of colonic adenomas
have a 30-70% incidence of carcinoma

So the answer to this question is A


Instruction:
The function of oligodendrocyte is -
A. Myelinates the CNS
B. Nutrition of nervous tissue
C. Lining the cavities of the CVS
D. Behave like macrophages

Response:
The principal function of oligodendrocytes is the production and maintenance of myelin in CNS - Robbins

Myelination in Central nervous system → Oligodendrocytes
Myelination in Peripheral nervous system → Schwann cells

So the answer to this question is A


Instruction:
A person who laughs one minute and cries the next without any clear stimulus is said to have -
A. Incongruent effect
B. Euphoria
C. Labile affect
D. Split personality

Response:
Lability (labile affect)

Sudden and short - lived changes in emotional response, i.e. emotional changes are very rapid, e.g. from sorrow to joy.

So the answer to this question is C


Instruction:
Which of the following statement is false about extended-spectrum beta-lactamases (ESBL)?
A. These can hydrolyze penicillins, cephalosporins as well as monobactams
B. Carbapenems are sensitive to ESBL
C. Amber classification of ESBL is based on structural differences
D. Third and fourth generation cephalosporins are used for detection of ESBL.

Response:
ESBL producing bacteria are sensitive to carbapenems whereas these drugs are resistant to breakdown by ESBL.

So the answer to this question is B


Instruction:
Prior to discharge of a patient of H. influenza meningitis the essential investigation to be done is –
A. ABER
B. EEG
C. Developmental screening test
D. BOG

Response:
After H. influenza meningitis sensor neural hearing loss occurs in 5-10% of patients during long term follow up.
Therefore Auditory rain Stem Evoked Response is done to check the peripheral auditory system.

So the answer to this question is A


Instruction:
Structure preserved in Radical Neck Node dissection:
A. Vagus nerve
B. Spinal Accessory Nerve
C. Internal Jugular Vein
D. Sterno cleido mastoid muscle

Response:
Ans. (a) Vagus nerve(Ref Sabiston 20th Edition Page 794)* Standard RND (CRILE operation) removes nodal levels I through V and the sternocleidomastoid muscle, internal jugular vein, cranial nerve XI, cervical plexus, and submandibular gland.* Modified RND (Bocca Operation) preserves one or more of the three structures - SCM, IJV and Spinal Accessory nerve.

So the answer to this question is A


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

Response:
Ans. d (All of the above) (Ref. Bailey and Love 25th/1024; 1050)Bailey and Love 25th/p. 1024; 1050...Upper gastrointestinal radiology is not used as much as in previous years as endoscopy is a more sensitive investigation for most gastric problems. There is, however, a number of circumstances where the barium meal is of great value and augments the value of endoscopy. These include large hiatus hernias of the rolling type and chronic gastric volvulus where it may be difficult for the endoscopists to determine exactly the anatomy or, indeed, negotiate the deformity to see the distal stomach. Linitus plastica may be missed by even relatively experienced endoscopists as the mucosal aspect of the stomach may not look particularly abnormal. This condition may be diagnosed more easily by using contrast radiology, although this is of limited value to the patient as the outlook is so poor.Paraoesophageal ('rolling') hiatus hernias are dangerous and always require surgical repair. They may be visible on a plain X-ray of the chest as a gas bubble, often with a fluid level behind the heart. Fluid levels are not seen in sliding hernias. A barium meal is the best method of diagnosis.0 The endoscopic appearances may be confusing, especially in large hernias when the endoscopist feels as if they have lost their sense of direction.Radiology studyClinical utilityKey commentsAbdominal radiograph(X-ray abdomen)# Pneumoperitoneum# Bowel obstruction# Calcification and calculi# Chest X-ray is the most sensitive X-ray for detecting minimum pneumoperitoneum.# CT is the most sensitive method to detect air as well as calcification.Barium studies# Indirectly assess GI pathologies.# Initial test of choice to evaluate case of dysphagia is Barium swallow. Barium swallow and meal examinations give the best appreciation of gastro esophageal anatomy. This may be important to the surgeon planning an operation that may be complicated by esophageal shortening or a rolling hiatus hernia, but it is not important for the diagnosis of GORD.# Barium meal study may even be better than endoscopy for diagnosing:- Chronic gastric volvulus- Large hiatus hernia- Linitus plastica# Enteroclysis (a special study better than BMFT for small bowel) is excellent study for many non-neoplastic lesions small bowel (e.g. malabsorption, intestinal strictures, CD, TB, etc). Jejunum has typical 'feathery' pattern, while ileus is 'featureless'.# Barium enema is one of the best studies for diagnosing and evaluating colorectal pathologies like UC, CD, Diverticulosis, Hirschprung's disease, colonic polyps, volvulus, etcBarium sulphate is contrast media used. CT and MR Enteroclysis now possible.Water-soluble contrast study# Bowel perforation# TO fistulaBarium is relatively contraindicated if we suspect bowel perforation.Chest X-ray with coiled Rubber catheter is highly suggestive of TO fistula with esophageal atresia.Ultrasonography# Initial test of choice for any case of obstructive jaundice.# Initial tests of choice for acute abdomen.# Initial test of choice for abdominal trauma (Protocol = FAST)# Excellent for detecting gallstones and other conditions like adeno- myomatosis of gall bladder, CHPS, Intussusception, minimal ascites, etcAir and bone obscure imaging with USG as they produce "post-acoustic" shadow.Probe of frequency 3.5-7 MHz is used. EUS/ endoluminal sonography due to its high sensitivity is mainly used for Ca esophagus & stomach staging, insulinoma, periampullary tumours and terminal bile duct calculi detection.CT# Blunt abdominal trauma# Subdiaphragmatic abscess# Mesenteric ischemia# Complicated appendicitis# Diverticulitis and diverticular abscessMultislice spiral CT is best machine.No "tissue overlap" and rapid diagnosis are key advantages.Air and bone do not create hindrance in CT imaging. It is the "triple-phase" CECT usuallyRadiology studyClinical utilityKey comments# Small bowel tumors# Staging of Ca colon# Mesenteric cysts/tumors# Pancreatic diseases# Focal liver lesions# Adrenal lesions (e.g., adenoma)# Epiploic appendicitis# Bezoars# Extraintesinal abdominal TB (Ba study is better for intestinal IC TB)# Parietal wall lesionsdone for hepatic and pancreatic lesions. Virtual endoviewing is now possible.MRI# Liver hemangiomas of size < 2.5 cm, especially when triple phase CECT is equivocal.# MRCP is screening tool of choice for primary sclerosing cholangitis, bile duct anomalies, cholangiocarcinomas and dital intrahepatic bile duct lesions.# MRI with ER coil is supposed to be better than CT or TRUS for assessing the locoregional spread of carcinoma rectum.# It is tool of choice for preoperative staging of cervical, endometrial and prostatic cancer.# It is excellent tool for anorectal region pathologies.Due to abdominal wall motion and bowel peristalsis, overall for abdominal pathologiesMRI has not achieved the popularity compared to CT. However, due to high field strength MRI machines, Intraoperative MRI, newer and faster MRI pulse sequences (e.g., HASTE) MRI is gaining its own importance.MRI can be supposed to be better than CT for many vessels in abdomen, for some liver lesions, rectal cancer staging, pelvic pathologies (especially the female pelvis) and screening of the biliary tract with MRCP.

So the answer to this question is D


Instruction:
The portion of the antigen molecule which is recognized by antibody is known as:
A. Hapten
B. Epitope
C. Complement
D. Variable region

Response:
Ans. B. EpitopeEpitope is a localized region on the surface of an antigen that is capable of eliciting an immune response and of combining with a specific antibody to counter that response. Hapten is a small molecule that reacts with a specific antibody but cannot induce the formation of antibodies unless bound to a carrier protein or other large antigenic molecule. A complement is a complex system of proteins found in normal blood plasma that combines with antibodies to destroy pathogenic bacteria and other foreign cells. Also called alexin. A variable region is present in the antibody that shows many sequence differences between antibodies of different specificities; the part of the antibody that binds to the antigen.

So the answer to this question is B


Instruction:
True about Nocardia is all except
A. Most commonly causes pneumonia
B. Is aerobic
C. Acid fast propeies
D. Pencillin is the drug of choice

Response:
Pencillin is the drug of choice

So the answer to this question is D


Instruction:
In non pregnant uterus cervical incompetence is treated by ?
A. Counselling
B. Shirodkars cerclage suture
C. McDonalds cerclage suture
D. Abdominal cerclage

Response:
Ans. is 'a' i.e., Counselling Cervical incompetence treatment in INTERCONCEPTIONAL PERIOD (non pregnant uterus):To allete anxiety and to improve the psychology - couple should be counselled that even after three consecutive miscarriages, the chance of a successful pregnancy is high (70%). However, the success rate depends on the underlying etiology as well as the age of the woman.

So the answer to this question is A


Instruction:
3 point symmetry is not disturbed in which fracture?
A. Fracture ulna only
B. Fracture radius only
C. Fracture of radius and ulna both bones of forearm
D. Weak posterior capsule

Response:
Weak posterior capsule may disrupt three point bony relation by promoting subluxation or dislocation of elbow. Fracture ulna on the upper end i.e. involving olecranon also disturb three point symmetry, but the radius has nothing to do with three point bony relationship and so it will not disturb three point bony symmetry. Ref: Apley's 8/e, Page 596-609.

So the answer to this question is B


Instruction:
A 40-year-old women presented with a CT scan of the head showing an enlarged sella tursica. Neurological and endocrine work up in detail were found to be normal. The most likely diagnosis is -
A. Prolactinoma
B. Chromophobe adenoma
C. Craniophobe
D. Empty sella syndrome

Response:
None

So the answer to this question is D


Instruction:
A young boy came to OPD with the complaints of difficulty in breathing. On examination, bilateral polyps were found. On aspiration, bleeding was seen. What will be the initial management?
A. I and D
B. Antihistaminic
C. Conservative
D. Septoplasty

Response:
1. Early polypoidal changes with oedematous mucosa may reve to normal with antihistaminic and control of allergy. 2. A sho course of steroids may prove useful in case of people who cannot tolerate antihistaminic and/or in those with asthma and polypoidal nasal mucosa. 3. Contraindications to use of steroids, e.g. hypeension, peptic ulcer, diabetes, pregnancy and tuberculosis should be excluded. 4. Surgical: Endoscopic sinus surgery.

So the answer to this question is B


Instruction:
Radioprotector among the following is
A. Amifostine
B. Mesna
C. Paraffin wax
D. Leucovorin

Response:
Amifostine is an organic thiophosphate cytoprotective agent indicated to reduce the cumulative renal toxicity associated with repeated administration of cisplatin in patients with advanced ovarian cancer or non-small cell lung cancer and also to reduce the incidence of moderate to severe xerostomia in patients undergoing post-operative radiation treatment for head and neck cancer. Amifostine is a prodrug that is dephosphorylated by alkaline phosphatase in tissues to a pharmacologically active free thiol metabolite, believed to be responsible for the reduction of the cumulative renal toxicity of cisplatin and for the reduction of the toxic effects of radiation on normal oral tissues. Healthy cells are preferentially protected because amifostine and metabolites are present in healthy cells at 100-fold greater concentrations than in tumour cells.Reference: Eric J Hall Textbook of Radiobiology for Radiologist; 5th edition

So the answer to this question is A


Instruction:
Upper covering layer of cochlear duct is
A. Basilar membrane
B. Tectorial membrane
C. Stria vascularis
D. Vestibular membrane

Response:
Reissner's membrane - between Scala vestibuli & Scala media. Basilar membrane - between scala media & Scala tympani Tectorial membrane - covers the hair cells. Stria vascularis gives the endolymph which is ultrafiltrate of blood.

So the answer to this question is D


Instruction:
Treatment of choice for carrier of diphtheria ?
A. Tetracycline
B. Erythromycin
C. Cotrimoxazole
D. Sulfonamide

Response:
Ans. is 'b' i.e., Erythromycin Control of diphtheria Control diphtheria requires :? Control in cases and carrier Control for contacts (prophylaxis for contact) Prophylaxis for community - by vaccination Control in cases and carrier Early diagnosis - By nose & throat examination and culture. Isolation - For at least 14 days or until proved free of infection, i.e. at least 2 consecutive nose and throat swabs, taken 24 hours apa, should be negative before terminating isolation. Treatment Cases - Diphtheria antitoxin plus penicillin or erythromycin. Carrier - Erythromycin Prophylaxis for contacts a. Where primary immunization or booster dose was received within the previous 2 years : No fuher action b. Where primary course or booster dose was received more than 2 yrs before Only a booster dose of toxoid c. Non-immunized closed contact Prophylactic penicillin or erythromycin Diphtheria antitoxin Active immunization against diphtheria.

So the answer to this question is B


Instruction:
What is mirabegron?
A. Alpha 2 agonist
B. Beta 3 agonist
C. Beta 1 agonist
D. Beta 2 agonist

Response:
Mirabegron used in overactive bladder which is a selective b3 agonist.

So the answer to this question is B


Instruction:
The immediate treatment of 10 kg weight infants presented with tetany -
A. IV Diazepam
B. IV calcium gluconate with cardiac monitoring
C. IV slow phenobarbitone
D. Wait and watch

Response:
Ans. is 'b' i.e., IV calcium gluconate with cardiac monitory

So the answer to this question is B


Instruction:
All of the following statements about sodium fluoride in otosclerosis are true, except:
A. Acts by inhibiting Proteolytic enzymes in cochlea
B. Acts by inhibiting osteoblastic activity
C. Is contraindicated in chronic nephritis
D. Is indicated in patients with a positive Schwaze sign

Response:
In active cases i.e. when Schwaze sign is present, medical management with sodium fluoride (Na F) is done. Na F accelerates the maturation of the focus by increasing osteoblastic and decreasing osteoclastic activity. It also inhibits the proteolytic enzymes that release cytotoxic chemicals to cochlea.

So the answer to this question is B


Instruction:
Cerebral infarction is caused by
A. Toxoplasma
B. Mucor
C. Aspergillosis
D. All of the above

Response:
Refer Robbins page no 1363 Causes of cerebral infarction. Syphilis Tuberculosis Toxoplasmosis Aspergillosis Mucormycosis CMV encephalitis

So the answer to this question is D


Instruction:
Exudation of plasma and Leucocytes in acute inflamation is from the -
A. Venules
B. Capillaries
C. Aerioles
D. Aerioles and capillaries

Response:
Ans. is 'a' i.e., Venules Post capillary venules are an impoant point of interchange between the Lumen of the vessels and the surrounding tissue. Moreover both vascular leakage and Leucocyte exudation occur preferrentially in venules in many types of inflammation. Note - In lung the Leucocyte diapedesis also occur in Capillaries.

So the answer to this question is A


Instruction:
Which of the following is lanceolate -
A. Cl. tetani
B. Donovania
C. Pneumococci
D. Meningococci

Response:
Ans. is 'c' i.e., Pneumococci Pneumococci are typically small, slightly elongated cocci, with one end broad or rounded and other pointed, presenting a flame shaped or lanceolate appearance.

So the answer to this question is C


Instruction:
Which of the following statements is true about thermoreceptor?
A. They are activated only by severe cold or severe heat
B. They are located on superficial layers of the skin
C. They are on dendritic endings of A fibers and C fibers
D. All of the above

Response:
Pain and temperature sensations arise from unmyelinated dendrites of sensory neurons located around hair follicles throughout the glabrous and hairy skin as well as deep tissue.

So the answer to this question is D


Instruction:
Which of the following nerve carries taste sensations from the posterior 1/3rd of tongue?
A. Glossopharyngeal
B. Lingual
C. Chorda tympani
D. Vagus

Response:
The sensory nerve fibers from the taste buds on the anterior two-thirds of the tongue travel in the chorda tympani branch of the facial nerve, and those from the posterior third of the tongue reach the brainstem the glossopharyngeal nerve. The fibers from areas other than the tongue (eg, pharynx) reach the brain stem the vagus nerve.On each side, these nerves unite in the gustatory poion of the nucleus of the solitary tract (NTS) in the medulla oblongata. From there, axons of second-order neurons ascend in the ipsilateral medial lemniscus and project directly to the ventral posteromedial nucleus of the thalamus.From the thalamus, the axons of the third-order neurons pass to neurons in the anterior insula and the frontal operculum in the ipsilateral cerebral coex.

So the answer to this question is A


Instruction:
All of the following is true about dashboard injury except:
A. It is associated with posterior dislocation of the hip
B. Sciatic nerve may be involved leading to foot drop
C. Avascular necrosis of the hip could be a late complication
D. The point of impact is on the greater trochanter

Response:
Posterior Dislocation and Fracture-Dislocation-Dashboard injury Dashboard Injury is associated with Post. dislocation > PCL avulsion Present with a shoened, internally rotated, adducted limb in slight flexion. It is associated with a fracture of the femoral head or acetabulum. The sciatic nerve lies behind the posterior wall of the acetabulum- may be damaged in a posterior dislocation of the hip resulting in foot drop and other symptom. The force is transmitted up the femoral shaft NOT the greater trochanter.

So the answer to this question is D


Instruction:
Anaesthetic of choice for day care srgery is-
A. Thiopentone
B. Nitrous oxide
C. Propofol
D. Halothane

Response:
Ans. is 'c' i.e., Propofol "Propofol is particularly suitable for day care surgery' because residual impairment is less marked and shorter lastingPropofolo Propofol is a milky white powder that is preservative free; therefore, it must be used within 6 hours. It is an oil based preparation, therefore injection is painful.o Propofol is the most frequently used intravenous anaesthetic today. -- Miller 6th/e-3l8o It can be used for both induction as well as maintenace.o It does not possess anticonvulsive action (unlike thiopentone),o It causes fall in BP and bradycardia,o Like thiopental it does not possess muscle relaxant action.o Propofol possess significant antiemetic and antipruritic action. -- Miller 6th/e - 324o Propofol decreases polymorphonuclear leukocyte chemotoxis but not aherence, phagocytosis and killing (Thiopentone blocks all these) increased life threatning infections.o Propofol is particularly suitable for outpatient surgery.o Intermittent injection or continuous infusion of propofol is frequently used for total iv. anaesthesia (TIVA) when supplemented by fentanyl.o It is anaesthetics of choice for intubation in ICU and for patients with malignant hyperthermia.o Side effects - pain on injection, myoclonus, apnea, X BP and rarely thrombophlebitis,o Propofol infusion syndromeA lethal syndrome, associated with infusion of propofol for 48 hours or longer.Occurs in children and critically illIt occurs as a result of failure of free fatty acid metabolism and failure of the mitochondrial respiratory chain.Features are - cardiomyopathy with acute cardiac failure, metabolic acidosis, skeletal myopathy, hyperkalemia, hepatomegaly and lipemia.

So the answer to this question is C


Instruction:
Which of the following nerves transmits impulses originating from the vestibular apparatus?
A. Cranial nerve ll
B. Cranial nerve VII
C. Cranial nerve VIII
D. Cranial nerve XI

Response:
The vestibular poion of cranial nerve VIII (vestibulocochlear nerve) carries impulses from the vestibular apparatus to the vestibular ganglion, which then conveys the impulses to the vestibular nuclei of the brainstem.

So the answer to this question is C


Instruction:
Symptomatic Neonatal CNS involvement is most commonly seen in which group of congenital intrauterine infections?
A. CMV and Toxoplasmosis
B. Rubella and Toxoplasmosis
C. Rubella and HSV
D. CMV and Syphillis

Response:
CNS involvement is a common feature of "TORCH infection". The newborn is asymptomatic at bih. The baby develops symptoms characteristic of the infection in the late neonatal period. Symptomatic CNS manifestations are most common with herpes and rubella infections. Ref: O P Ghai 6th Edition, Page 165; Vope's Neurology of the born 3rd Edition, Page 675

So the answer to this question is C


Instruction:
A patient with angle closure glaucoma is posted for laser iridotomy. Which of the following laser is used for iridotomy?
A. Nd-Yag laser
B. Argon
C. Helium-Neon
D. Krypton

Response:
Pupillary block in angle-closure glaucoma is most satisfactorily overcome by forming a direct communication between the anterior and posterior chambers that removes the pressure difference between them. Laser peripheral iridotomy is best done with the neodymium: YAG laser, although the argon laser may be necessary in dark irides. Surgical peripheral iridectomy is performed if YAG laser iridotomy is ineffective. YAG laser iridotomy is preventive when used in patients with narrow angles before closure attacks occur. Ref: Salmon J.F. (2011). Chapter 11. Glaucoma. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.

So the answer to this question is A


Instruction:
Cystosarcoma phylloides is treated by ?
A. Simple mastectomy
B. Radical mastectomy
C. Modified radical mastectomy
D. Antibiotic with conservative treatment

Response:
Ans. is 'a' i.e., Simple mastectomy Treatment of cystosarcoma phyllodes ? a) T/T of small phyllodes tumour ---> It should be locally excised with an obvious lcm of normal breast tissue After excision, when the diagnosis of a phyllodes tumor with suspicious malignant elements is made, re-excision of the biopsy site to ensure complete excision of a tumour with a 1 cm margin of normal-appearing breast-tissue is indicated. b) T/T of large phyllodes tumour --> simple mastectomy Remember, cystosarcoma phyllodes does not metastasize by lymphatic route, so axillary dissection is not needed. Cystosarcoma phyllodes metastasize exclusively by blood borne route. Other questions on cystosarcoma phyllodes Pathologically it is similar to fibroadenoma i.e., proliferation of both duct and stroma is seen. - The tumor displays a range of behaviour from benign like fibroadenoma to frankly malignant Mammographic evidence of calcifications and morphologic evidence of necrosis do not distinguish between benign, borderline, and malignant phyllodes tumors. Consequently, it is difficult to differentiate benign phyllodes tumors from the malignant variant and from fibroadenomas. Peak incidence is in the fifth decade, exceedingly rare in adolescents. The excised specimen is firm and rubbery and may separate into leaflike structures therefore the term (phyllodes means leaf like) They usually present as a large growth which is mobile and commonly there is a history of rapid growth.

So the answer to this question is A


Instruction:
All of the following are functions of estrogen, EXCEPT:
A. Secretory function on endometrium
B. Synthetic function on endometrium
C. Causes secondary sexual characters in female
D. Breast enlargement during pubey

Response:
Estrogen is found to induce proliferation of endometrial glands and stroma including vascular endothelium. Progestin is responsible for the secretory differentiation in endometrial glands and decidual type changes in the stroma. Other effects of estrogen are: Estrogen facilitate the growth of ovarian follicles and increase the motility of uterine tubes. Estrogen increases the growth of ducts in breasts and is responsible for breast enlargement at pubey in girls. It is also associated with the development of secondary sexual characters in females. It increases libido in humans, by exeing a direct effect on ceain neurons in hypothalamus.

So the answer to this question is A


Instruction:
Lipid in tissue is detected by-
A. Oil Red
B. Muciramine
C. PAS
D. Myeloperoxidase

Response:
Special stains for fat: Frozen sections stained with Sudan IV or Oil Red-O give an orange-red color to the fat. Osmic acid gives a black color Oil Red O is a lysochrome diazo dye used for staining of neutral triglycerides and lipids on frozen sections and some lipoproteins on paraffin sections. It has the appearance of a red powder with maximum absorption at 518 nm

So the answer to this question is A


Instruction:
Most common salivary gland tumor a -
A. Mucoepidermoid carcinoma
B. Pleomorphic adenoma
C. Wahims tumor
D. Oncocytoma

Response:
Pleomorphic Adenoma (Mixed Salivary Tumour)This is the most common tumour of major (60-75%) andminor (50%) salivary glands. Pleomorphic adenoma is thecommonest tumour in the parotid gland and occurs less oftenin other major and minor salivary glands. The tumour iscommoner in women and is seen more frequently in 3rd to5th decades of life. The tumour is solitary, smooth-surfacedbut sometimes nodular, painless and slow-growing. It is oftenlocated below and in front of the ear TEXTBOOK OF PATHOLOGY 6th edition pg no 534

So the answer to this question is B


Instruction:
A 3rd gravida with normal previous 2 pregnancies. Best test to diagnose Rh sensitization in Rh -ve mother is
A. Direct Coombs' test
B. 'C' Antigen
C. Indirect Coombs' test
D. 'O 'Antigen

Response:
In all cases of Rh-negative women irrespective of blood grouping and parity, albumin antibody is detected by indirect Coombs' test.

So the answer to this question is C


Instruction:
Prozone phenomenon is due to:-
A. Antigen excess
B. Antibody excess
C. Excessive immune complex
D. Acute phase reactants

Response:
Most of the antigen antibody reactions occurs in three phases. Zone of antibody access- Prozone phenomenon Zone of equivalence- Lattice formation and visible reactions are enhanced. Zone of antigen excess- Post zone phenomenon

So the answer to this question is B


Instruction:
Acoustic dip occurs at:
A. 2000 Hz
B. 4000 Hz
C. 500 Hz
D. 1500 Hz

Response:
Acoustic dip is dip seen in pure tone audiometry due to noise trauma, which is seen typically at 4 kHz i.e. 4000 Hz.

So the answer to this question is B


Instruction:
A child has got a congenital cataract in one eye involving the visual axis. When should the child be operated ?
A. Immediately
B. At 2 months of age
C. At 1 year of age when the globe becomes normal sized
D. After 4 years when entire ocular and orbital growth becomes normal

Response:
Presence of dense cataract present at bih is an indication for urgent surgical management to prevent amblyopia. Ref: CURRENT Diagnosis and Treatment: Surgery, 13th Edition, Chapter 37; Comprehensive Ophthalmology By AK Khurana, 4th Edition, Page 174.

So the answer to this question is A


Instruction:
Which one of the following aeries pierces the oblique popliteal ligament of the knee joint?
A. Medial superior genicular aery
B. Lateral superior genicular aery
C. Middle genicular aery
D. Posterior tibial recurrent aery

Response:
OBLIQUE POPLITEAL LIGAMENT:- Expansion from the tendon of semimembranosus. Runs upwards and laterally, blends with the posterior surface of the capsule, and is attached to the intercondylar line and lateral condyle of femur. Related to politeal aery. Structures piercing the ligament:-1. Middle Genicular vessels.2. Posterior division of obturator nerve. {Reference BDC 9E }

So the answer to this question is C


Instruction:
A neonate was found to have periventricular calcifications on CT brain. The best method for the diagnosis of this etiological agent is ______
A. Urine examination
B. Liver Biopsy
C. Blood examination
D. CSF examination

Response:
Urine examination is one of the best methods to diagnose congenital cytomegalovirus infection, in which periventricular calcification is seen For diagnosis of congenital CMV infection, urine and saliva are the best specimens for culture and saliva and cord blood are the best specimens for polymerase chain reaction (PCR). Among the given options, the best option would be urine. Congenital CMV infection: Clinical features: Characteristics signs and symptoms of clinically manifested infections: Intrauterine growth retardation(IUGR), prematurity, hepatosplenomegaly, jaundice, blue-berry muffin-like rash, thrombocytopenia, purpura, microcephaly and intracranial calcification, Other nuerological problems: Chorioretinitis, Sensineural hearing loss (SNHL), and mild increases in cerebrospinal fluid (CSF) protein. Asymptomatic congenital CMV infection is possibly a leading cause of SNHL, which occurs in 7-10% of all infants with congenital CMV infection, whether symptomatic at bih or not. Diagnosis: Definitive diagnosis: By virus isolation or demonstration of CMV DNA by PCR (performed first 2 weeks of life) Treatment: Ganciclovir treatment can limit hearing loss and improve the developmental outcome in symptomatically infected infants. Ref: Nelson 21st edition Pgno: 1721

So the answer to this question is A


Instruction:
Which of the following is renin inhibitor -
A. Losartan
B. Benazepril
C. Remikiren
D. Imidapril

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

So the answer to this question is C


Instruction:
The cross-bridges of the sarcomere in skeletal muscle are components of:
A. Myosin
B. Actin
C. Troponin
D. Tropomyosin

Response:
The cross-bridges of the sarcomere in skeletal muscle are components of myosin. The myosin heads contain enzymes and ATP that will cause attachment to active sites on actin filaments when they are uncovered. Tropomyosin covers these active sites until troponin binds with Ca++ and causes the tropomyosin to move off these sites. Myelin is the sheath on ceain axons that is created by Schwann cells. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 5. Excitable Tissue: Muscle. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds),Ganong's Review of Medical Physiology, 24e.

So the answer to this question is A


Instruction:
Leprosy is not yet eradicated because
A. No effective vaccine
B. Highly Infectious but low pathogenicity
C. Only humans are reservoir
D. Long incubation period

Response:
Ans is 'a' i.e. No effective vaccine Both "No Effective Vaccine" and "Long incubation period" are the reason behind not being able to fully control Leprosy. But when it comes to eradication, "No Effective Vaccine" is correct answer because only disease eradicated (small pox) was because of effective vaccine.About leprosy Park writes- "Although significant progress has been made in controlling the disease and reducing the disease burden, much remains to be done in order to sustain the gains and further reduce the impact of the disease...One of the long-term needs is to develop reliable diagnostic tests for early diagnosis and an effective vaccine for the prevention of leprosy."The only disease which has been eradicated till now is smallpox. There were many advantageous features of the disease coupled with a highly effective, heat stable vaccine which led to its eradication.The other disease which is a very potential candidate for eradication is Polio. It does not have advantageous features like those possessed by Small pox, still it has a very effective vaccine.Small pox was eradicated and Polio is likely to be eradicated because of the massive global immunization programs launched by WHO.This suggests that most probable reason for non-eradication of leprosy could be absence of an effective vaccine. Other reasons which are also culprits are - long incubation period, highly infectious, large number of infective subclinical cases, difficult to diagnose and animal reservoir.Various definitions:Control:The reduction of disease incidence, prevalence, morbidity or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction.Example: diarrhoeal diseases.Elimination:Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts; continued intervention measures are required.Example: neonatal tetanus, measles, poliomyelitis.Eradication:Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed.Example: smallpox.Extinction:The specific infectious agent no longer exists in nature or in the laboratory.Example: none. Factors associated with potential for eradication of a communicable disease:There are many factors but the three factors considered to be of primary importance are:An effective intervention is available to interrupt transmission of the agent;Practical diagnostic tools with sufficient sensitivity and specificity are available to detect levels of infection that can lead to transmission; andHumans are essential for the life-cycle of the agent, which has no other vertebrate reservoir and does not amplify in the environment.Factors Associated with Potential for Eradication of a Communicable Disease Factors Associated with the DiseaseEase of diagnosis and treatment Low prevalence of subclinical disease High disease burden and economic impact Immunity is long term or lifelong Disease cannot be reactivated Disease has predictable seasonalityFactors Associated with the Etiologic AgentLack of an animal reservoir or vectorOnly one causative agent or serotypeShort incubation periodFactors Associated with the Host or Target PopulationCorrelates or protection can be demonstratedHost cannot be reinfected with the agentHost cannot shed the organism once infection is resolvedPublic acceptance of the vaccine and other control measures is highFactors Associated with the VaccineCan confer long-lasting protection in a few injectionsMinimal handling and storage requirements (e.g., cold chain)Simple administrationCan be administered simultaneously with other vaccines or adapted to schedules and timing of the national childhood immunization programsFew short- or long-term adverse effectsLow cost to produce and purchase vaccine Epidemiological factors which led to the eradication of smallpox are:No known animal reservoir.No long-term carrier of the virus.Life-long immunity, after recovery from the disease.The detection of the cases was relatively simple as the rashes were characteristic.Persons with subclinical infection did not transmit the diseaseHighly effective, heat stable vaccine, easily administrable and provides long term protection.International cooperation

So the answer to this question is A


Instruction:
Demographic divided is due to -
A. Increase fertility
B. Decrease fertility
C. Decrease in death rate
D. None

Response:
Demographic window

The period of time in a nation's demographic evolution when the proportion of population of working age group (15-55 years) is particularly prominent people < 15 years of age are less than 30% and > 65 years of age are less than 15%.
The demographic window opportunity lasts for 30-40 years (i.e. from the age of 15 to age of 55).
Demographic window of India is expected from 2010 to 2050

Demographic dividend

A rise in the rate of economic growth due to a rising share of working age people in a population.
It occurs when fertility rate falls. Lets see why :-

Because of mechanical link between fertility levels and age structure, when the birth rate (fertility) falls, the age pyramid first shrinks with gradual lower proportion of young population (under 15 years) and proportion of population in working age group increases. This has following effects -
i)  The respective nation has demographic window.
Output per capita rises as population in working age group is prominent and dependency ratio (child dependency ratio) is decreased.
In other words, decrease fertility rate is responsible for demographic dividend and demographic window.
Demographic gift

This the gift due to decreased fertility rate.
That means favorable effects (demographic dividend) of decrease in fertility rate.

Demographic transition

A model used to explain the process of transition from high birth rate & death rate to low birth rate & death rate.

Demographic trap

This trap is the population growth due to high birth rate and low death rate.

Demography bonus

The term demography bonus connotes the period when the dependency ratio in a population declines because of decline in fertility, until it starts to rise again because of increasing longevity.

Demographic burden

It is the increase in the total dependency ratio during any period of time, mostly caused by increased old age dependency ratio.

So the answer to this question is B


Instruction:
Simple method to evaluate the plaque after a thorough brushing can be done by ?
A. Snyder Test
B. Sand Paper Strips
C. Disclosing Solution
D. Unwaxed Floss

Response:
None

So the answer to this question is C


Instruction:
Medical therapy can be tried in gallstone patients with:
A. Contracted and small non functioning gallbladder
B. Radiolucent gallstones
C. Gallstones of size < 30 mm in diameter
D. Gallstone pancreatitis

Response:
Ursodeoxycholic acid (UDCA) decreases cholesterol saturation of bile. In carefully selected patients with functioning gallbladder and with radiolucent stones <10 mm in diameter, complete dissolution with UDCA can be achieved in 50% of patients within 6 months to 2 years. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 2621

So the answer to this question is B


Instruction:
Which of the following is major concern for overdenture fabrication
A. Reduced interarch space
B. Increased cost due to endodontic treatment and coping fabrication
C. Patient’s oral hygiene habits
D. More number of visits as compared to complete denture patients

Response:
Scrupulous hygiene accompanied by biannual professional monitoring is mandatory to ensure continued abutment health. Substantial part of it depends on patient's oral hygiene procedures and compliance.

So the answer to this question is C


Instruction:
Difference between ectopic pregnancy and threatened aboion is
A. Minimal vaginal bleeding
B. Pain follows bleeding
C. Uterine size corresponds to gestational age
D. Manifests at an early age

Response:
In Threatened aboion , uterus corresponds to the period of amenorrhea In ectopic pregnancy, uterus is normal or slightly bulky. Ref: Dutta Obs 9e pg171.

So the answer to this question is C


Instruction:
Anticraving drug given in alcohol dependence:
A. Buprenorphine
B. Acamprosate
C. Disulfiram
D. Diazepam

Response:
Ans. b. Acamprosate (Ref: Niraj Ahuja 6th/39-40; Kaplan Synopsis 10th/396)Anticraving drug given in alcohol dependence is Acamprosate.Treatment of Alcohol Dependence1. Aversion therapy: ApomorphineQ, sub-threshold electric shock2. Psychotherapy3. Group therapy4. Deterrent agents: ( Alcohol sensitizing drugs)Q- DisulfiramQ- Citraied calcium carbimide (CCC)- MetronidazoleQ, NitrafezoleQ- Methyltetrazolethiol- Sulfonylureas (specially ChlorpropamideQ)- Cephalosporins (cefoperazoneQ, moxalactamQ, cefamandoleQ)5. Anticraving agents: (FAN)- FluoxetineQ- AcamprosateQ- NaltrexoneQ

So the answer to this question is B


Instruction:
“Eugenics” is
A. A feeling of well-being or elation, may be drug related
B. the humane destruction of an animal accomplished by a method that produces rapid unconsciousness and subsequent death without evidence of pain or distress, or a method that utilizes anaesthesia produced by an agent that causes painless loss of consciousness and subsequent death
C. the study of hereditary improvement of the human race by controlled selective breeding
D. A state of being carried away by overwhelming emotion

Response:
None

So the answer to this question is C


Instruction:
Which of the following describes humoral hypercalcemia of malignancy (HHM)?
A. The rise in calcium levels due to PTH-rP
B. Paraneoplastic Calcitonin Production
C. Vitamin D Hypervitaminosis
D. Parafollicular C-cell proliferation of Thyroid Gland

Response:
The rise in calcium levels due to PTH-rP is termed humoral hypercalcemia of malignancy (HHM). A common consequence of some cancers can be increased levels of calcium (hypercalcemia) with secretion of PTH-related peptide (PTH-rP). PTH-rP has significant homology with PTH, but only in the amino-terminal 13 amino acids, which make up the receptor-binding region. Because PTH-rP is not secreted by the parathyroid glands, hypercalcemia produces no feedback regulation of its production. Cancers usually associated with HHM include breast and lung cancers and multiple myeloma. Ref: Kerr J. (2012). Chapter 13. Connective Tissue and Bone. In L.W. Janson, M.E. Tischler (Eds), The Big Picture: Medical Biochemistry.

So the answer to this question is A


Instruction:
MAC stands for
A. Minimum alveolar concentration
B. Minimal analgesic concentration
C. Minimal anaesthetic concentration
D. Maximum alveolar concentration

Response:
Minimum alveolar concentration is defined as the alveolar concentration of an inhaled anesthetic agent that prevents movement in 50% of patients in response to a standardized surgical stimulus. Low MAC - High potency MAC values of adult Halothane: 0.75 Sevoflurane: 2.0 Isoflurane: 1.2 Desflurane: 6.0 Enflurane: 1.7 Xenon: 70 N2O: 104 Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e

So the answer to this question is A


Instruction:
True about the following tongue lesion :
A. Geographic tongue associated with vitamin B deficiency
B. Mucosal silvery plauqe associated with mucosal psoriasis
C. Candidiasis associated with diabetes
D. Oral hairy leukoplakia associated Epstein-Barr virus infection

Response:
Oral hairy leukoplakia presents as white plaques on the lateral tongue and is associated with Epstein-Barr virus infection. Geographic tongue : Multiple red patches with irregular yellow-white border, dorsal lateral tongue, lesions migrate, usually asymptomatic Candidiasis :Surface debris with pain/ burning which rubs off associated submucosal erythema A/W H/O Antibiotic use/ Immunosuppresive Rx/ Nail/ vaginal/ oesophageal lesions Psoriasis involves multiple sites and lesions will be associated with scales

So the answer to this question is D


Instruction:
Indication for relining of complete denture include alt, expect
A. Immediate denture at 3-6 months after their original construction
B. Patient cannot afford new denture
C. Abuse soft tissues are present
D. When the construction of new dentures with the multiple appointment cause physical and mental stress

Response:
None

So the answer to this question is C


Instruction:
Expired medicines must be put in ____colored biomedical waste management bag:-
A. White
B. Yellow
C. Red
D. Black

Response:
Expired medicines must be put in yellow colored biomedical waste management bag. Treatment and disposal is done by; Incineration/ plasma pyrolysis/ encapsulation. Dry Heat - Temp > 185deg C. Plasma Pyrolysis - > 1200 deg C. Extra edge: - No healthcare system would establish on-site treatment & disposal facility if a Common Biomedical Treatment facility is available within 75kms.

So the answer to this question is B


Instruction:
True about subarachnoid block (spinalnesthesia)
A. Cannot be used in infant & children
B. Can be given by unskilled doctor
C. May be used when I.V access is not possible for intravenous drugs
D. Hypotension is most common side-effect

Response:
Ans: D (Hypotension...) Note:Due to associated serious complicationsfmany are life threa tening), ft must not be given by unskilled doctorsPreparation for Subarachnoid block(spinal anesthesia) Lee 13th/479# Obtaining venous accessCommencing intravenous infusionf to minimize post spinal hypotension)SUBARACHNOID BLOCKfSPINAL ANESTHESIA) Ajay Yadav 5 th/155-61It is most commonly used anaesthetic technique 3 In adult /eve/ is usually L3-4Indications: orthopaedics surgery, general surgeryfpelvic & perineal), gynecological & obstetrical surgery, urological surgeries etcMost commonly drugs used in India are-xylocaine(lignocaine) & Sensoricaine(bupivacine)Hypotension is most common side-effect. It is managed by preloading & intraoperative fluids & vasopressors. For this good i.v acess is very important Other side-effects & complications are- bradycardia, apnoea, nausea & vomiting, cardiac arrest, high spinal, post spinal headach, meningitis, spinal cord ischemia etcSubarachnoid block(spina! anesthesia) in children Ajay Yadav 5th/161In children it should be given in lower space(L4-5)As children are usually free of haemodynamic side effects therefore preloading is not required till the age of 8 yearsDue to more CSF volume, dose of local anaesthetics required is more & duration of block is less

So the answer to this question is D


Instruction:
Glomular filtration rate increases if: September 2005
A. Increased plasma oncotic pressure
B. Decreased glomerular hydrostatic pressure
C. Increased renal blood flow
D. Increased tubular hydrostatic pressure

Response:
Ans. C: Increased renal blood flow GFR = Kf x Net filtration pressure Net filtration pressure represents the sum of the hydrostatic and colloid osmotic forces that either our/oppose filtration across glomerular capillaries Hydrostatic pressure inside the glomerular capillaries (PGC) - Promotes filtration Hydrostatic pressure in the bowman's capsule outside the capillaries (PB)-opposes filtration Colloid osmotic pressure of glomerular capillary plasma proteins-Opposes filtration Colloid osmotic pressure of Bowman's capsule proteins-promotes filtration - Afferent aeriolar constriction will reduce renal blood flow and reduce PGC, causing a reduction in GFR. - Efferent aeriolar constriction will reduce renal blood flow but increase PGC; these changes act in opposite directions with respect to GFR and the net effect on GFR is minimal. - A reduction in Kf will reduce GFR (contraction of mesangial cells and reducing the area available for filtration) - Any given vasoactive agent may have a spectrum of effects (on afferent/efferent aeriolar tone or Kf), making the net effect on GFR difficult to predict. Thus, angiotensin II, a major regulator of glomerular function, causes constriction of both afferent and efferent aerioles, as well as reducing Kf. The overall outcome for GFR depends on the relative magnitudes of these actions, which vary in different pathophysiological conditions. A high protein intake increase renal blood flow and GFR - Large increase in blood glucose levels in uncontrolled D increase renal blood flow and GFR. Kf: Glomerular ultrafiltration coefficient, PGC: mean hydrostatic pressure in glomerular capillaries

So the answer to this question is C


Instruction:
A 4 year old boy, with three days history of upper respiratory tract infection presents with stridor, which decreases on lying down. What is the most probable diagnosis?
A. Acute Epiglottitis
B. Laryngotracheobronchitis
C. Foreign body Aspiration
D. Retropharyngeal Abscess

Response:
Prodromal symptoms of upper respiratory tract infection preceding sings of respiratory tract obstruction is characteristic of croup. Ref: Nelson 17th Edition, Page 1405;1406,14; Respiratory Care: Principles And Practice By Dean Hess, Neil MacIntyre, Shelley Mishoe, William Galvin, 2011, Page 1019.

So the answer to this question is B


Instruction:
Nontoxic form of storage and transpoation of ammonia:
A. Aspaic acid
B. Glutamate
C. Glutamine
D. Glutamic acid

Response:
Catabolism of amino acid give rise to ammonia which get transferred to glutamate. From glutamate, NH3 is ultimately taken up by glutamine which is Non-toxic form of storage and transpoation of ammonia in blood (see fig below). Glutamine is neutral in nature and can readily move across cell membrane by facilitative diffusion. Glutamine is formed from glutamate by following reaction:

So the answer to this question is C


Instruction:
In Cushing syndrome, which of the following are seen -
A. |Aldosterone
B. |Aldosterone
C. |Epinephrine
D. |norEpinephrine

Response:
Cushing syndrome is a disorder resulting from increased adrenocoical secretion of coisol, due to any one of several sources: ACTH-dependent adrenocoical hyperplasia or tumor, ectopic ACTH-secreting tumor, or excessive administrations of steroids; characterized by truncal obesity, moon face, acne, abdominal striae, hypeension, decreased carbohydrate tolerance, protein catabolism, psychiatric disturbances, and osteoporosis, amenorrhea, and hirsutism in females; when associated with an ACTH-producing adenoma, called Cushing disease.Ref: Ganong&;s review of medical physiology;24th edition; page no-366

So the answer to this question is A


Instruction:
True about pseudohypoparathyroidism:
A. Dystrophic calcification
B. |ed Ca2+
C. |ed PO4
D. |ed PTH

Response:
Answer is D ( |ed PTH): Pseudohypoparathyroidism is associated with elevated PTH and signs of ineffective PTH action The response of urinary cAMP to PTH is decreased/normal and Heterotopic ossification may be characteristically seen.

So the answer to this question is D


Instruction:
Drug used treatment of Acute promyelocytic leukemia-
A. Arsenic trioxide
B. Tretinoin
C. Gefitinib
D. Dasatinib

Response:
Arsenic trioxide is effective and approved for treatment of relapsed or refractory acute promyelocytic leukemia (APL) cases resistant to all-trans retinoic acid (ATRA), but its effect on new cases of APL is not clear. Ref Davidson 23rd edition pg 789

So the answer to this question is A


Instruction:
Dose of Oseltamavir (Tamiflu) for Chemoprophylaxis against H1N1 Influenza is:-
A. 75mg OD for 5 days
B. 75 mg OD for 7 days
C. 75 mg OD for 10 days
D. 75 mg OD for 6 weeks

Response:
H1N1 Risk factors : Child < 2yrs ; pregnancy ; old aged > 65yrs ; COPD; Chronic hea/ hepatic/ kidney disease; Pts on Aspirin therapy; Morbid obesity Lab diagnosis : -PCR Sample used : Nasopharyngeal swabs Chemoprophlaxis for H1N1 Swine flue: Oseltamivir 75 mg OD X 10 days Therapy/DOC for H1N1 Swine Flu : Oseltamivir 75mg BD X 5 Days

So the answer to this question is C


Instruction:
Which IUCD acts for 10 yrs
A. Cu-T 200 B
B. Nova-T
C. Cu-T 380A
D. Multi load-250

Response:
Cu-T 380A There are two types of IUD's Nonmedicated or ine e.g. Lippe's loop Medicated - Copper releasing - Hormone releasing Intra uterine devices can be categorised according to their evolution into IUDs Life span First generation: Lippe's loop (obsolete) ? Second generation Copper-T - CuT-200-B 4 yr CuT-200 3 yr CuT-220C - Nova-T 5 yr Multiload-250 375 3 yr 5 yr CuT-380A 10 yr Third generation Progestase 1 yr LNG-20 (Mirena) 5 yr(Ref Novak p263: Note that Park mentions the life span of mirena to be 7 to 10 yrs) So it is the CuT-380A which has the longest life span In India under the National Family Welfare Programmes, CuT-200B is being used. From the year 2002, CuT 380A has been introduced

So the answer to this question is C


Instruction:
The following interleukin is characteristically produced in a TH1 response -
A. IL-2
B. IL-4
C. IL-5
D. DL-10

Response:
Ans. is 'a' i.e., IL-2 A. T helper - 1 {TH1) secretes-IL-2 and interferon - gB. T helper - 2 (T[f2) secretes-IL-4,IL-5, IL-6, EL-13 T-cellso T cells are amongst the two important cells of adaptive immune system (others are B-cells).o T cell precursors arise in bone marrow (also in yolk sac & liver before birth) and migrate to the thymus,o Maturity ofT-cells takes place in the thymus (So, T cells arise in bone marrow and mature in thymus),o T-cells constitutes 60%-70% of the circulating peripheral lymphocytes.o Based on their surface markers. target cells and functions the following T cell category have been identified:1. Helper/Inducer T cellsThese cells have CD4 surface marker and are MHC class II restricted.These are further subdivided into : -A. Effector CD4 helper T cellso These cells secrete cytokines and other products that perform all major functions,o These cells are of following types.TH, cellsThese cells are activated by IFN-gThese cells produce IL-2, IFNyand IL-12.These cells facilitate delayed hypersensitivity, cell mediated immunity. Macrophage activation,killing of intracellular microbes e.g., tuberculosis & leprosy.These cells also induce destruction of target cell by : -Activating CD8 T cells to become cytotoxic cells; andActivating NK cells.TH, cellsThese cells are activated by IL-4.These cells secrete IL-4,1L-5, IL-6 and IL-13.hese cells facilitates the synthesis of antibodies particularly IgE and cause activation of mast cells and eosinophils - Therefore, provide defence against Helminthic parasites.TH17 cellsA third subset of CD4 T-cells (besides TH1 and TH2) has been discovered recently and is called the TH17 cells.If the antigen producing cells produce inflammatory cytokines such as IL-1, IL-6 and IL-23, these work in collaboration with TGF-(3 to stimulate differentiation of T-cells to the TH 17 cells.TH17 cells are powerful recruiters of neutrophils and monocytes, and thus play major roles in severe inflammatoiy diseases.They may also be important for defense against some bacterial and fungal infections in which neutrophilic inflammation is a prominent feature.TH 17 cells are activated by some microbial antigens and by self antigens in autoimmune diseases. Activated TH17 cells secret IL-17, IL-22 and chemokines. Collectively, these cytokines recruit neutrophils and monocytes.TH17 cells produce IL-21, which amplifies the TH17 (self) response.B. Memory CD4 helper T cellso Provide memory, i.e., retain the antigenic affinity of the originally activated T cells and are used to act aslater effector cells during a second immune response.Cytolytk/cytotoik T cellsThese cells have CD8 surface marker and are MHC class I restricted.They kill and lyse target cells including tumor cells, virus infected cells and allograft; and participate in type II Hypersensitivity.Suppressor T-cellsThese cells have CDg surface marker and are MHC class I restricted.These cells down regulate immune response.o Helper T cell (CD4 T cell) is known as the master regulator of the immune system.o The ratio of CD4 and CD8 T cell is normally 2 :1.

So the answer to this question is A


Instruction:
Which of the following is the most likely inheritance pattern in the pedigree given below-
A. Autosomal dominant
B. Mitochondrial
C. Autosomal recessive
D. X-linked dominant

Response:
It is an X-linked dominant pattern of inheritance.
The features which suggest the X-linked dominant pattern of inheritance are-
A single abnormal X chromosome is sufficient to express the disease.
All of the female offspring’s of a diseased male XY will receive the abnormal X chromosome and express the disease, whereas none of the male offspring to the diseased father will have the disease (as sons don't receive X chromosome from their father).
A diseased mother can transmit the abnormal X chromosome to both daughter and sons equally.

Important facts

If a female is transmitting the disease to all offspring’s (both males and females) and a male is not transmitting the disease to any child, it is mitochondrial inheritance.
If a male is transmitting the disease only to daughters (all daughters) and not to the sons whereas female transmit the disease to half daughters and half of the sons, it is X-linked dominant.
If only males are affected in a pedigree, it is likely to be an X-linked recessive disease (females act as carriers; only transmit the disease and themselves remain unaffected).
If there is no sex-predilection and affected individuals transmit the disease to half of the offspring’s, it is an autosomal dominant disorder.
If there is no sex-predilection and affected individuals transmit the disease to one-fourth of the offspring’s, it is likely to be an autosomal recessive disorder.

So the answer to this question is D


Instruction:
A 10 years old child with recurrent epistaxis, likely cause -
A. Hypertension
B. Arteriosclerosis
C. Angiofibroma
D. Surgery

Response:
Ans. is 'C' i.e., Angiofibroma Causes of Recurrent epistaxis in children o Retained nasal foreign body o Use of nasal sprays as intranasal steroid sprays o Haemorrhagic disease as in ITP, von willebrand disease o Angiofibroma (suspect in adolescent boys) o Nasal parasitosis/Nasal myiasis

So the answer to this question is C


Instruction:
Which is not a test for diabetes mellitus -
A. Fasting blood sampling
B. Random blood sampling
C. D-xylose
D. Oral glucose tolerance test

Response:
D-xylose absorption is a laboratory test to determine how well the intestines absorb a simple sugar (D-xylose). The test helps determine if nutrients are being properly absorbed. It is done in : persistent diarrhea, signs of malnutrition, unexplained weight loss. Rest of the options are the tests done in diabetes mellitus. Ref - Harrisons internal medicine 20e topic diabetes

So the answer to this question is C


Instruction:
"Phantom calyx/ Amputed calyx" on IVU is feature of
A. Tuberculosis
B. Hydronephrosis
C. Bilharziasis
D. UPJ obstruction

Response:
.

So the answer to this question is A


Instruction:
Most common cause of acute bacterial endocarditis is:September 2009
A. Staphylococcus aureus
B. Streptococcus viridans
C. Streptococcus intermedius
D. Candida albicans

Response:
Ans. A: Staphylococcus aureusOverall, S aureus infection is the most common cause of Infective Endocarditis (IE), including acute IE, and Intravenous drug abusers IE.More than half the cases are not associated with underlying valvular disease.Streptococcus viridans accounts for approximately 50-60% of cases of subacute disease.Most clinical signs and symptoms are mediated immunologically.Streptococcus intermedius group infections may be acute or subacute.S intermedius infection accounts for 15% of streptococcal IE cases.S intermedius is unique among the streptococci; it can actively invade tissue and can cause abscesses.

So the answer to this question is A


Instruction:
Incretin like function is seen in -
A. Exenatide
B. Miglital
C. Poiglitazone
D. Repaglinide

Response:
Ans. is 'a' i.e., Exenatide o Exenatide is a synthetic glucagon-like peptide - 1 (GLP-l) analogue,o GLP-l is an important incretin that is released from gut in response to oral glucose.o But GLP-I can not be used clinically as it is degraded rapidly by enzyme dipeptidly peptidase - 4 (DPP-4).o Exenatide is resistant to DPP-4.o It acts similar to GLP-l -Enhancement of postprandial insulin release, suppression of glucagon release and appetite as well as slowing of gastric emptying,o It is given by subcutaneous route & used in type 2 DMo Nausea is most important side effect.

So the answer to this question is A


Instruction:
Proliferation of cells which are not native to that place is known as:
A. Hemartoma.
B. Choriostoma.
C. Fordyce's granule
D. Both BC

Response:
None

So the answer to this question is D


Instruction:
Endoscopic biopsy from a case of H.pylori related duodenal ulcer is most likely to reveal -
A. Antral predominant gastritis
B. Multifocal atrophic gastritis
C. Acute erosive gastritis
D. Gastric atrophy

Response:
H. pylori gastritis typically affects the antrum and is associated with increased gastric acid production. The induced mucosa-associated lymphoid tissue (MALT) can transform TEXT BOOK OF ROBBINS BASIC PATHOLOGY NINTH EDITION PAGE.569 IMAGE REF:

So the answer to this question is A


Instruction:
A 30 yrs old female has Sputum positive TB. Her child is 3 yrs old. What is the recommended chemoprophylaxis:
A. INH 3mg/kg for 3 months '
B. INH 5mg/kg for 3 months
C. INH 3mg/kg for 6 months
D. INH 5 mg/kg for 6 months

Response:
Ans is 'd' i.e. INH 5 mg/kg for 6 months [Ref: http://health.gov.bz/www/attachments/569_TUBERCULOSIS%20GUIDELINE.pdf; WHO guidelines for Treatment of Tuberculosis at website style="font-size: 1.04761904761905em; color: rgba(0, 102, 204, 1); font-family: Times New Roman, Times, serif">1547833_eng.pdfWHO guidelines for treating child contacts to infectious pulmonary tuberculosis is isoniazid at a dose of 5mg/kg bodyweight for a total of 6 months."Among household contacts, people living with HIV (and children, regardless of their HIV status) who do not have active TB are candidates for isoniazid treatment to prevent the development of active TB WHO guidelines for Treatment of Tuberculosis "The currently WHO guidelines for treating child contacts to infectious PTB is isoniazid at a dose of 5mg/kg bodyweight for a total of 6 months " -http://health.gov.bz/www/attachments/569_TUBERCULOSIS%20GUIDELINE.pdf

So the answer to this question is D


Instruction:
All of the following are true about phrenic nerve, except
A. It is purely motor nerve
B. It arise from C4 spinal nerve
C. It is formed at the lateral order of scalenus anterior
D. Accessory phrenic is commonly a branch from the nerve of subcalvirus

Response:
The phrenic nerves contain motor, sensory, and sympathetic nerve fibers. The phrenic nerve originates mainly from the 4th cervical nerve, but also receives contributions from the 5th and 3rd cervical nerves Both phrenic nerves run from C3, C4, and C5 along the anterior scalene muscle deep to the carotid sheath. The accessory phrenic nerve is a branch of the nerve to the subclavius Ref: BD Chaurasia; 7th edition

So the answer to this question is A


Instruction:
Which is not an inflammatory stage in pneumonia -
A. Organisation
B. Congestion
C. Resolution
D. Hepatisation

Response:
None

So the answer to this question is A


Instruction:
A women delivered a baby of 2.2 kg weight. Her LMP is not known. To know the maturity of baby, following are used -
A. Sole Crease
B. Ear Cailage
C. Breast nodule
D. All

Response:
Ans. is 'a' i.e., Sole creases; 'b' i.e., Ear Cailage; 'c' i.e., Breast nodules

So the answer to this question is D


Instruction:
Anticarcinogenic vitamins are:
A. Vitamin A, E, D.
B. Vitamin K, E, D
C. Vitamin K, E, A.
D. All of the above.

Response:
None

So the answer to this question is A


Instruction:
In humans, end product of purine metabolism
A. Allantoin
B. Uric acid
C. CO2
D. None

Response:
Question repeated

So the answer to this question is B


Instruction:
A 20 yr female come with a mass in the cavernous sinus & 6th cranial nerve palsy. In T2W MRI Hyperintense shadow is present which shows homogenous contrast enhancement. Diagnosis is:
A. Schwannoma
B. Meningioma
C. Astrocytoma
D. Cavernous sinus hemangioma

Response:
B i.e. Meningioma Tumors or lesions (like infection, thrombosis, aneurysm, fistula) of cavernous sinus can cause neuropathy/involvment of 3rd, 4th 6th and 5th (V1 >>112.) cranial nerves because of their anatomical proximity to the lateral wall of cavernous sinus. So for pin pointing the diagnosis we have to focus on other features like sex, age, incidence and MR findings. Now lets focus on differential diagnosis of cavernous sinus masses which indicates that Schwannoma & meningioma are common; cavernous sinus hemangioma is very rare and astrocytoma is almost not a cause cavernous sinus masses. Unilateral Mass Common Uncommon - SchwannomaQ - Chordoma - MeningiomaQ - Lymphoma - Metastasis Very Rare - Aneurysm (cavernous- - Lipoma internal carotid aery) - Carotid cavernous - Epidermoid fistula - Cavernous hemangiome - Osteo cailagenous tumors - Plexiform neurofibroma (NF1) Bilateral Mass Common Uncommon - Invasive pituitary adenoma - Meningioma - Metastases - Lymphoma - Cavernous sinus thrombosis Lets focus on astrocytoma to see wheter it can be completely ruled out or not - Astrocytomas either do not/mildly enhance (low grade astrocytoma) or strongly enhance (anaplastic/malignant astrocytoma, glioblastoma multiformae, PA, PXA, SEGA) but when they enhance they characteristically enhance inhomogenously (heterogenously) mostlyQ (except in PXA >PA). Now we are left with cavernous hemangioma, meningioma and schwannoma Cavernous sinus hemangioma is a rare benign tumor seen in young or middle aged (4th & 5th decade) predominantly females (F:M = 9:1 to 3:1). It presents as homogenous hypointense on T1 and highly hyperintense on T2 weighted images. Contrast enhancement is homogenousQ, which distinguish them from other lesions. So it seems a probable answer but lets rule out other options. Trigeminal Schwannoma (neuroma) is a common cause of cavernous sinus mass. It presents predominantly in females (F:M=2:1) of 35 to 60 years ageQ. But it is characterized by high chances (3040%) of heterogeniety of both density and contrast enhancementQ (b/o tumor necrosis & cyst formation in larger > 1 mm tumors). So schwannoma can be easilyruled out. Meningiomas are common cause of cavernous sinus mass. It presents predominantly in females (F:M=4:1 to 2:1) of 35 to 70 years and even in younger patients in Wzv NF2Q. Meningiomas are characteristically homogenous hyperdense mass (with broad dural base) on CT and characteristically show homogenous (uniform) intense contrast enhancementQ. So this is the answer because it is far more common than CSH. Dont get confused that ----book mention, meningioma may be heterogenous without understanding the logic behind it. Brodly speaking any tumor may give any appearance but we are concerned about its typical / characteristic/ most common pattern of appearance. This and most of PGME question about CNS tumors are very broad concept based. Now let me rephrase this question to make it more clear : What would be your first diagnosis of cavernous sinus mass which appears hyper intense on T2 WI and shows homogenous contrast enhancement in a 20 yr old female.

So the answer to this question is B


Instruction:
Diagnostic power of the test is reflected by:
A. Sensitivity
B. Specificity
C. Predictive value
D. Population attributable risk

Response:
Diagnostic power of a screening test: Predictive accuracy (it tells the actual no. of people having the disease or not having the disease out of those shown positive or negative by a screening test) Diagnostic power of a screening test to correctly identify disease: positive predictive value (PPV) Diagnostic power of a screening test to correctly exclude a disease: negative predictive value (NPV)

So the answer to this question is C


Instruction:
MC cause of abortion in first trimester is :
A. Trisomy
B. Triplody
C. Cervical incompetence
D. APLA syndrome

Response:
Ans. is 'a' i.e., Trisomy [Ref: Williams 24th/e p. 351* Abortion occurring without medical or mechanical means to empty the uterus is referred to as spontaneous.* More than 80% of abortions occur in the first 12 weeks of pregnancy, and at least half result from chromosomal anomalies.* After the first trimester, both the abortion rate and the incidence of chromosomal anomalies decrease.* Trisomy 16 is the most common abnormal karyotype found in the abortus.* Monosomy X (45 X), the second most frequent chromosomal abnormality (after trisomy), usually results in abortion and much less frequently in live born female infants (Turner syndrome).* Trisomies have been identified in abortus for all except chromosome 1

So the answer to this question is A


Instruction:
A 35 yr female with ductal ca in situ of breast. What is best possible management
A. Breast conservative surgery
B. Simple mastectomy
C. Modified radical mastectomy
D. Radical mastectomy

Response:
Rx: Breast conservative surgery with to breast and axillary dissection after sentinel LNB(if +&;ve) Ref : SRB&;s 4thE pg:566

So the answer to this question is A


Instruction:
Metronidazole is a:
A. Luminal amoebicide
B. Tissue amoebicide
C. Both
D. None

Response:
Ans: b (Tissue amoebicide) Ref: Tripathi, 6th ed, p, 7981. Tissue amoebicidesa) For both intestinal and extraintestinal amoebiasisNitroimidazoles:Metronidazole, tinidazole. secnidazole,Omidazole, satranidazoleAlkaloids-. Emetine, dehydroemetineb) For extraintestinal amoebiasis only: Chloroquine2. Luminal amoebicidesa) Amide-. Diloxanide furoate, nitzoxanideb) 8-Hydroquinolines-. Quindochlor, diiodohydroxyquin (Iodoquinol)c) Antibiotics: TetracyclinesMetronidazoleTHERAPEUTIC USESMetronidazole cures genital infections with T. vaginalis in > 90% of cases. The preferred regimen is 2 g metronidazole as a single oral dose for both males and females.Metronidazole is the agent of choice for all symptomatic forms of amebiasis, including colitis and liver abscess. The recommended dose is 500-750 mg metronidazole taken orally three tiniesdaily for 7-10 days. The daily dose for children is 35-50 mg/kg, given in three divided doses, for 7-10 days.. E. histolytica persist in most patients who recover from acute amebiasis after metronidazole therapy, so it is recommended that all such individuals also be treated with a luminal amebicide.Metronidazole is used for treatment of giardiasis.Metronidazole is used for the treatment of serious infections owing to susceptible anaerobic bacteria, including bacteroides, Clostridium, fusobacterium, peptococcus. peptostreptococcus. eubacterium. And helicobacter.Metronidazole achieves clinically effective levels in bones, joints, and the CNS and can be given intravenously when oral administration is not possible..Metronidazole is used as a component of prophylaxis of postoperative mixed bacterial infections and is used as a single agent to treat bacterial vaginosis.Metronidazole is used increasingly as primary therapy for pseudomembranous colitis due to Clostridium difficile infection. At doses of250-500 mg orally three times daily for 7-14 days, metronidazole is effective and less expensive than oral vancomycin. Metronidazole also is used in patients with Crohn disease who have perianal fistulas or significant colonic diseaseMILTEFOSINEMiltefosine is the first orally available therapy for leishmaniasis.It is safe and effective treatment for visceral leishmaniasis and has also shown >95% efficacy against cutaneous leishmaniasisNIFURTIMOXNifurtimox and benznidazole are trypanocidal against both the trypomastigote and amastigote forms of T. cruzi. Nifurtimox also has activity against T. brucei and can cure early- and late-stage disease.NITAZOXANIDENitazoxanide and its active metabolite tizoxanide inhibit the growth of sporozoites and oocytes of C. parvum and inhibit the growth of the trophozoites of G intestinalis. E. histolytica, and T. vaginalis in vitro.

So the answer to this question is B


Instruction:
Rupture of the skin and subcutaneous tissue is called: September 2010
A. Incised wound
B. Abrasions
C. Lacerated wound
D. Contusion

Response:
Ans. C: Lacerated wound

So the answer to this question is C


Instruction:
A false-negative response to the pulp tester may occur
A. primarily in anterior teeth.
B. in a patient heavily premedicated  with analgesics, narcotics,  alcohol,  or tranquilizers.
C. most often in  teenagers.
D. in the  presence of periodontal  disease.

Response:
Responses Obtained from Electric Pulp Testing
False-Positive Responses
Partial pulp necrosis
Patient’s high anxiety
Ineffective tooth isolation
Contact with metal restorations
False-Negative Responses
Calcific obliterations in the root canals
Recently traumatized teeth
Immature apex
Drugs that increase patient’s threshold for pain
Poor contact of pulp tester to tooth
Cohen's Pathway of the Pulp ed: 11th Pg18

So the answer to this question is B


Instruction:
A farmer presents to the emergency department with painful inguinal lymphadenopathy and history of fever and flu like symptom. Clinical examination reveals an ulcer in the leg. Which of the following stains ahould be used to detect suspected bipolar stained organisms -
A. Albert's stain
B. Wayson's stain
C. Ziehl Nelson stain
D. Mc Fayden's stain

Response:
None

So the answer to this question is B


Instruction:
Amount of gastric juice secreted per day ?
A. 500-1000 ml
B. 1000-1500 ml
C. 2000-2500 ml
D. 3000-3500 ml

Response:
Ans. is 'c' i.e., 2000-2500 ml

So the answer to this question is C


Instruction:
Which of the following murmur increases on standing?
A. HOCM
B. MR
C. MS
D. VSD

Response:
On standing: The venous return is going be reduced & there is decrease blood coming to the hea, therefore intensity of murmurs get reduced. E.g.: Valsalva, Amyl nitrate (Except HOCM: louder murmur; MVP: longer murmur) Note: All murmurs increase on doing sit ups, hand grip or exercise as there is increase of peripheral resistance HOCM: soften MVP: shoer Therefore, HOCM and MVP behave opposite of normal LVOT dynamic/ Sub valvular Aoic stenosis: Volume of blood in left Ventricle is directly propoional to left ventricular output tract obstruction (LVOT) i.e. if more amount of blood coming in then aoic gap separated so less intensity of murmur. But in case of standing, volume of blood in LV is less, so the LVOTO will also be lesser and thus the intensity of murmur increases.

So the answer to this question is A


Instruction:
Most common complication of lateral condyle humerus fracture
A. Malunion
B. Nonunion
C. VIC
D. Median nerve injury

Response:
Among the given options, non union is the most common complication Refer Rock wood and Wilkins 7th/e p 547

So the answer to this question is B


Instruction:
In CRP, the C stands for
A. Canavallin A
B. Cellular
C. Chondoitin sulfate
D. C polysaccharide of streptococcus

Response:
C-reactive protein (CRP) was originally identified as binding to the phosphocholine attachment site of capsular polysaccharide (C-polysaccharide) from Streptococcus pneumoniae

So the answer to this question is D


Instruction:
Which of the following is antitubercular drugs bus assoasiated with hypothyroidism
A. Rifamipicini
B. Pyrazinamide
C. Ethionamide
D. Streptomycin

Response:
Refer KDT 7th/771 Ethionamide PAS They are two antitubercular drugs assoasiated with hypothyroidism and goitre

So the answer to this question is C


Instruction:
The relative risk of 1 indicates that
A. There is no cause effect relationship
B. Effect may be due to type 1 error
C. Strong correlation
D. Effect may be due to type 2 error

Response:
Relative risk is the ratio of the incidence of the disease (or death) among exposed and the incidence among non-exposed. A relative risk of 1 means the incidence in exposed and non-exposed is same. So there is no relation between disease and cause (exposure). Park, pg: 79

So the answer to this question is A


Instruction:
True about Todani's modification of Alonso-Lej classification include the following except
A. TypeI - Saccular dilation of common bile duct
B. Type II - Diveiculum of Supra duodenal bile duct
C. Type IVA--Choledochocele
D. Type IVB- Multiple Saccular dilation of extrahepatic ducts only

Response:
Todani Modification of Alonso-Lej classification Type I - Dilation of extrahepatic biliary tree Type Ia- cystic dilation Type Ib - focal segmental dilation Type Ic- fusiform dilation Type II - Diveicular dilation of extrahepatic biliary tree Type III - Cystic dilation of intra duodenal poion of common bile ducts (choledochocele) Type IVA- Dilation of the extrahepatic and intrahepatic biliary tree Type IVB- Dilation of multiple secretion of extrahepatic bile ducts Type V - Dilation confined to intrahepatic bile ducts (caroli's disease) Type VI - Cystic dilation of cystic duct (not included in Todani's modification) Ref: Sabiston 20th edition Pgno :1510-1511

So the answer to this question is C


Instruction:
Earliest response to iron supplementation in iron deficiency anemia is denoted by?
A. Increase in serum ferritin
B. Increase in reticulocyte count
C. Increase in iron binding capacity
D. Increase in hemoglobin

Response:
Response to iron therapy: Rapid subjective improvement, with disappearance or marked reduction of fatigue, lassitude, and other nonspecific symptoms, before any improvement in anemia is observed. Earliest hematologic evidence of response to treatment is an increase in reticulocytes on 5th to 10th day after sta of supplementation therapy & thereafter returns to normal. There is steady improvement in Hb and normalization of red cell indices. RETICULOCYTE IN BLUE LINE

So the answer to this question is B


Instruction:
Flaying is seen in which type of lacerated wound.
A. Split
B. Stretch
C. Avulsion
D. Cut

Response:
Incised looking laceration

Laceration looking like an incised wound (Margins appears to be regular and clean cut).
Sites : Skin, scalp, eyebrows, cheek bones, iliac crust, knee and perineum.
Can be differentiated from incised wound by careful examination with magnifying lens.

Avulsion laceration:

Also called as shearing laceration.
Run over injuries Eg: lorry wheel passes over a limb.
Flapping / Flaying: A flap pf tissues is tripped off from the underlying bone.
Direction of flop - direction of force.

So the answer to this question is C


Instruction:
Kussmaul's sign is not seen in: September 2010
A. Right Ventricular infarction
B. Constrictive pericarditis
C. Restrictive cardiomyopathy
D. Cardiac tamponade

Response:
Ans. D: Cardiac tamponade Possible causes of Kussmaul's sign include: Constrictive pericarditis Restrictive cardiomyopathy Pericardial effusion Right ventricular infarction Right hea failure Cardiac tumours Tricuspid stenosis With Cardiac tamponade, KS is absent (lack of inspiratory decline in jugular venous pressure), yet jugular veins are distended and typically show a prominent x descent and an absent y descent as opposed to patients with constrictive pericarditis).

So the answer to this question is D


Instruction:
Which of the following is associated with maximum bile secretion?
A. Secretion of CCK
B. Secretion of secretin
C. Secretion of gastrin
D. Presence of fat in food

Response:
Ans: b (Secretion of secretin) Ref: Ganong 22nd ed/p.503Secretin is a choleretic so it is associated with bile secretion Substances that increase the secretion of bile (Choleretics)SecretinBile salts (most potent stimulus)Vagal stimulationSubstances that cause contraction of gall bladder (Cholagogues) Cholecystokinin (most potent stimulus)Fatty acidsBy increasing CCK-PZ Amino acidsCCK-PZ: -Released from mucosa of jejunum (from I cells)Stimuli for secretion are presence of peptides and amino acids in small intestine and fatty acids having more than 10 carbon atoms, in the duode num.Secretes pancreatic juice rich in enzymeContracts gall bladder and release bileInhibits gastric emptying by augmenting contraction of pyloric sphincter Enhances small intestine and colonic motility Augments action of secretin in producing alkaline pancreatic juice Increases secretion of glucagon and insulinSecretin:-Released from S cells of duodenal mucosa. It is structurally similar to glucagon, GIP, VIP and GLI.Stimuli for secretion are acidity of chyme and products of protein digestionStimulates bicarbonate rich pancreatic secretion.Responsible for adding water and alkaline component to pancreatic juiceInhibits gastric acid secretion and gastric emptying by causing contraction of pyloric sphincterAugments action of CCK-PZ in producing pancreatic secretion of digestive enzymes.Stimulates bile secretion (cholerectics)Bile acids have detergent action on the lipids due to their amphipathic nature. They make the lipids soluble by forming micelles, lgm of haemoglobin yields 35 mg of bilirubin.Gastrin:-Hormone produced by G cells in the lateral wall of glands in the antral portion of gastric mucosa.Also found in pancreatic islets in fetal life, gastrinomas of pancreas and pituitary gland.Stimulates gastric acid and pepsin secretionStimulates growth of mucosa of stomach, small and large intestine.Promotes gastric emptyingStimulation of insulin secretionStimuli that increase gastrin and HC1 secretion:-Oligopeptides and amino acids in gastric lumenDistention Ca2+Epinephrine Increased vagal dischargeStimuli that decrease gastrin secretion Somatostatin Acid Secretin GIP VIPGlucagon Calcitonin

So the answer to this question is B


Instruction:
Otomycosis is caused by -
A. Candida
B. Aspergillus
C. Both
D. None

Response:
None

So the answer to this question is C


Instruction:
Arrange the following ECG changes of hyperkalemia with increasing potassium levels:- a. Prolonged PR interval b. Peaked T waves c. Sine wave pattern d. Absent P waves
A. b - a - d - c
B. c - a - d - b
C. b - c - d - a
D. d - a - b - c

Response:
--> --> ECG changes appear progressively with rising potassium levels HYPERKALEMIA: Serum potassium levels > 5.5 mEq /L Potassium levels ECG changes Line of treatment 5.5 - 6.5 mEq /L (mild) Tall,peaked T-waves Stop K+ intake offending drugs 6.5 - 8 mEq / L (Moderate) Prolonged PR interval, Flat P waves, Wide QRS complex Inj. Sodium Bicarbonate Insulin-glucose infusion > 8mEq / L (Severe) Absent P waves, Bundle branch block SINE WAVES Inj. Ca gluconate Rx of moderate Hyperkalemia Long term K+ binding resin Refractory hyperkalemia Dialysis.

So the answer to this question is A


Instruction:
The most important channel of elimination of digoxin is:
A. Glomerular filtration
B. Tubular secretion
C. Hepatic metabolism
D. Excretion in bile

Response:
Digoxin is primarily eliminated unchanged by glomerular filtration whereas digitoxin is eliminated by hepatic metabolism.

So the answer to this question is A


Instruction:
Klinefelter no of chromosomes-
A. 47
B. 46
C. 45
D. 44

Response:
Ans. is 'a' i.e., 47 o In Klinefelter's syndrome there is extra X or Y chromosome to a male karyoty pe. Thus there are 47 chromosome.

So the answer to this question is A