Instruction:
The renal biopsy of a 6–year–old boy with recurrent gross hematuria shows IgA nephropathy. The urinary protein excretion is 130 mg/day. Which of the following is the most appropriate next step in the management –
A. Administer corticosteroids
B. Give Azathiopiine
C. Start Cyclosporine
D. Urinary bag sample

Response:
T/T of IgA nephropathy

There is no proven tit for IgA nephropathy.
The primary t/t is proper blood pressure control.

The drugs which have been proved useful are:-
i)  Fish oil (It contains omega - 3 fatty acids).

It is an anti-inflammatory agent and it prevents the rate of renal progression.

ii)   Immunosuppressive therapy -

It is done with corticosteroids with or without cytotoxic therapy.

iii) ACE inhibitors and Angiotensin II receptor antagonists -

Their role in reducing proteinuria and retarding the rate of renal progression is still to be determined.

iv) Prophylactic antibiotics and tonsillectomy -

It may reduce the frequency of gross hematuria but they have no effect on the progression of renal disease.

So the answer to this question is A


Instruction:
Quinsy is characterized by all except -
A. Peritonsillar abscess
B. Indication for tonsillectomy
C. Should be drained
D. Affects nasal mucosa

Response:
Ans-D

So the answer to this question is D


Instruction:
Most common malignancy in marjolin's ulcer
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Malignant fibrous histiocytoma

Response:
(B) Squamous cell carcinoma) (29, 548- Bailey & Love)A squamous cell carcinoma known as Marjolin's ulcer being the most common (Leg ulcers)Most frequently associated with * Chronic venous ulcer* Long standing burn scar* Squamous cell carcinoma developing in long standing scar/ulcers* Adenocarcinomas are the most common histological subtype of stomach cancer * *** Gastric carcinomas are often associated with hypochlorhydria /achlorhydria* Gastric carcinomas are relatively radioresistant* Maleny's ulcer (Burro wing ulcer) is caused by synergistic infection by Microerophilic Nonhaemolytic streptococci and Aerobic, Hemolytic staphylococci

So the answer to this question is B


Instruction:
The greater omentum is derived from which of the following embryonic structures?
A. Dorsal mesoduodenum
B. Dorsal mesogastrium
C. Pericardioperitoneal canal
D. Pleuropericardial membranes

Response:
Both the omental bursa and the greater omentum are derived from the dorsal mesogastrium, which is the mesentery of the stomach region.Must know:The dorsal mesoduodenum is the mesentery of the developing duodenum, which later disappears so that the duodenum and pancreas come to lie retroperitoneally.The pericardioperitoneal canal embryologically connects the thoracic and peritoneal canals. The pleuropericardial membranes become the pericardium and contribute to the diaphragm. Ref: Gray's Basic Anatomy: With Student Consult Online Access - Page 151

So the answer to this question is B


Instruction:
Which of following is not seen in nephritic syndrome -
A. Edema
B. Hematuria
C. HTN
D. Hypocholestremia

Response:
Ans. is `d' i.e., Hypocholestremia

So the answer to this question is D


Instruction:
Metachromatic Granules are stained by -
A. Ponder's stain
B. Negative stain
C. Gram's stain
D. Leishman stain

Response:
The granules are often situated at the poles of the bacilli and are called Polar bodies they are more strongly Gram positive than the rest of the bacterial cell stained with Loefflers methyelene blue the granules take up a bluish purple colur and are hence called Metachromatic Granules . They are also called Volutin or Babes Ernest Granules . These granules composed of polymetaphosphate and serve as storage granules . Special stains such as Albes , Neissers and Ponders have been devised for demonstrating the granules clearly Ref :Ananthanarayan & paniker's Textbook of microbiology 9th edition pg no 237

So the answer to this question is A


Instruction:
Syringes and glass ware are sterilized by:
A. Irradiation
B. Autoclave
C. Hot air owen
D. Cidex

Response:
Hot air owen

So the answer to this question is C


Instruction:
All changes occur in fibroid uterus except :
A. Atrophy
B. Squamous metaplasia
C. Calcification
D. Hyaline dogeneration

Response:
Ans. is b i.e. Squamous metaplasia Fibromyoma can have following complications and r4----,:ative changes. Complication Changes / Degenerations Torsiondeg Haemorrhagedeg Infectiondeg Ascites; Pseudo-Meig's Syndromedeg (Produced by pedunculated deg subserous fibroid) deg Maliy iant changedeg (rarest) - Avoid = Atrophy - Red = Red degeneration - Hot = Hyaline degeneration (MC) - Fatty = Fatty degeneration or calcification -Meat = Myxomatous degeneration - chicken = Cystic degeneration (Mnemonic : Avoid Red hot fatty meat of chicken) Also know : Most common degeneration : Hyaline degeneration.deg Degeneration stas from the central pa.deg Calcification stas in periphery (Womb stone).deg Most uncommon (Rarest) change in fibroid is malignant change / sarcomatous change.deg It occurs in 0.5%deg cases of fibroid.

So the answer to this question is B


Instruction:
ABO antigens are not found in:
A. Semen
B. Plasma
C. Sweat
D. CSF

Response:
Ans: D (CSF) Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy. 29th edition. 2010Explanation:ABO antigensABO antigens are found in high concentration in saliva, semen, vaginal and gastric secretions.They are found in low titres in sweat, tears and urine.Totally absent in nerve tissue, epithelium, skin appendages, bone and cartilage.

So the answer to this question is D


Instruction:
True about MHCAI-
A. Present on chromosome 4
B. Class III has complement
C. Class II comprises A, B, C loci
D. Class I is involved in mixed leucocyte reaction

Response:
MHC gene is present on the short arm of chromosome 6.
Class II comprises DR, DQ, DP regions (A, B, C loci are present on class I).
Class III consists of complement components,
Mixed leukocyte reaction involves class II MHC.
The histocompatibility antigens (human leukocyte antigens - HLA) are cell surface antigens that induce an immune response leading to the rejection of allografts.
The principal physiologic function of the cell surface histocompatibility molecules is to bind peptide fragments of foreign proteins for the presentation of antigen-specific T cells.
The histocompatibility antigens are encoded by a closely linked multiallelic cluster of genes -» Major histocompatibility complex (MHC) or Human leukocyte antigens complex (HLA complex).
HLA complex of genes is located on the short arm of chromosome 6.

So the answer to this question is B


Instruction:
In dacryocystorhinostomy operation the communication of the sac is established with:
A. Middle meatus
B. Superior meatus
C. Inferior meatus
D. All of the above

Response:
Ans. Middle meatus

So the answer to this question is A


Instruction:
In a positively shewed curve, true statement is?
A. Mean = median
B. Mean < Mode
C. Mean > Mode
D. Mean = Mode

Response:
.

So the answer to this question is C


Instruction:
The drugs used in the treatment of idiopathic hypercalcemia except is -
A. Allopurinol
B. Furosemide
C. Acetazolamide
D. Thiazide

Response:
Thiazide type diuretics cause Hypercalcemia by retaining calcium from excretion whereas loop diuretic increase calcium excretion . Steroids are also used in treatment of Hypercalcemia Ref - pubmed.com

So the answer to this question is D


Instruction:
Laparoscopic uterine nerve ablation (LUNA) is used most commonly in the treatment of-
A. Mild to mod Endometriotic lesions
B. Severe Vasomotor symptoms of menopause
C. Conservative management of Fibroids
D. Pain relief in Ca Ovary

Response:
Ablation of endometriotic lesions along with laparoscopic uterine nerve ablation (LUNA) in minimal to moderate disease reduces pain associated with endometriosis Ablation of endometriotic lesions plus adhesiolysis in minimal to mild endometriosis is more effective than diagnostic laparoscopy alone in improving feility LUNA: involves the destruction of the uterine nerve fibres that exit the uterus through the uterosacral ligament. Impoant complication is devervation of pelvis and uterine prolapse PSN: Pre Sacral Neurectomy: interruption of sympathetic innervation of the uterus at the level of superior hypogastric plexus

So the answer to this question is A


Instruction:
The protective factors of breast milk are known to be associated with:
A. IgM antibodies
B. Lysozyme
C. IgA antibodies
D. Mast Cells

Response:
Breastmilk contains mainly secretory IgA, which has a specific antigen-targeted anti-infective action. Other protective factors include macrophages, lymphocytes, lactoferrin, lysozyme, Bifidus factor, and interferon. But, as IgA plays a major role, it is the best answer here. Components Of breast milk and diseases they protect against: Components of breast milk Protection against Lysozyme Escherichia coli, Salmonella Entamoeba histolytica Lactoferrin E.coli, Shigella, Salmonella E.histolytica, Giardia lamblia Plasmodium falciparum Rotavirus Bifidus factor E.coli, Shigella, Salmonella Low levels of para-amino benzoic acid Plasmodium Ref: Ghai Essential Pediatrics 9th edition Pgno: 145

So the answer to this question is C


Instruction:
A 12 year old, Aswin, presents with a severely damaged nail on his index finger, after accidentally crushing the finger while closing a door. A decision is made to excise the injured nail. In preparation for the procedure, the physician would most likely anesthetize a branch of which of the following nerves?
A. Anterior interosseous nerve
B. Median nerve
C. Musculocutaneous nerve
D. Radial nerve

Response:
The median nerve supplies the surface of the lateral palm, the palmar surface of the first three digits and the distal dorsal surface of the index and middle fingers (including the nail beds). Therefore, prior to performing surgery in this area, it is essential to anesthetize a branch of this nerve (possibly a proper digital branch) to eliminate pain sensation around the nail bed of the index finger.Neither the anterior interosseous nor the musculocutaneous nerves supplies the hand. The anterior interosseous nerve supplies the flexor pollicis longus, the lateral half of flexor digitorum profundus, and pronator quadratus. The musculocutaneous nerve supplies the coracobrachialis, biceps, and most of the brachialis muscle, then becomes the lateral cutaneous nerve of the forearm. The radial nerve supplies skin on the radial side of the dorsal surface of the hand, but not the fingeips.

So the answer to this question is B


Instruction:
Antibody dependent killing:
A. NK cell
B. NK cell only
C. Macrophage
D. NK cells, neutrophils & macrophage

Response:
Antibodies coat the target cell and target cell will be attacked by phagocytic cells such as:- Neutrophils Macrophages The NK cells. It forms the basis for type II Hypersensitivity reaction

So the answer to this question is D


Instruction:
In which of the following virus is shed in stool:
A. Herpangina
B. Influenza
C. Varicella
D. Smallpox

Response:
Ans. a. Herpangina

So the answer to this question is A


Instruction:
Lamina papyracea separates nose from
A. Sphenoid bone
B. Orbit
C. Frontal bone
D. Maxillary sinus

Response:
Ref: Henry Gray. Anatomy of the Human Body. The lateral surface is formed of a thin, smooth, oblong plate, the lamina papyracea (os planum), which covers in the middle and posterior ethmoidal cells and forms a large pa of the medial wall of the orbit; it aiculates above with the orbital plate of the frontal bone, below with the maxilla and orbital process of the palatine, in front with the lacrimal, and behind with the sphenoid.

So the answer to this question is B


Instruction:
Nephrotic syndrome may be caused by the following except -
A. Renal cell carcinoma
B. Minimal change nephropathy
C. Diabetes mellitus
D. Rheumatoid ahritis

Response:
Diabetes, which is the most common secondary cause of nephrotic syndrome in adults. It can cause kidney damage, known as diabetic nephropathy. Lupus (systemic lupus erythematosus), a chronic disease of the immune system, can seriously damage the kidneys. This can damage your kidneys Minimal Change Disease (MCD for sho) is a kidney disease in which large amounts of protein is lost in the urine. It is one of the most common causes of the Nephrotic Syndrome (see below) worldwide. When the kidney filters are damaged, however, protein sometimes "slips through" into the urine Renal cell carcinoma presenting as nephrotic syndrome. Nephrotic syndrome is a rare complication of renal cell carcinomas, and it is paicularly uncommon for minimal change nephropathy to be associated with solid tumours Ref Harrison20th edition pg 278

So the answer to this question is D


Instruction:
A patient present with lower gastrointestinal bleed. Sigmoidoscopy shows ulcers in the sigmoid. Biopsy from this area shows flask-shaped ulcers. Which of the following is the most appropriate treatment -
A. Intravenous ceftriaxone
B. Intravenous metronidazole
C. Intravenous steroids and sulphasalazine
D. Hydrocoisone enemas

Response:
Typical flask shaped ulcers are seen in amoebiasis. Intestinal & early hepatic amoebiasis responds quickly to oral metronidazole (800mg 3times daily for 5-10 days) or other long acting nitroimidazoles like tinidazole or ornidazole. In severe cases of amoebic dysentery or liver abscess 500mg may be infused i.v. slowly every 6-8 hrs for 7-10 days or till oral therapy is instituted . Reference: Harrison20th edition pg 1207

So the answer to this question is B


Instruction:
What complication commonly occurs in anterior duodenal ulcer -
A. Bleeding
B. Penetration
C. Perforation
D. Stricture formation

Response:
None

So the answer to this question is C


Instruction:
Necrosis of cells is due to -
A. Ca' efflux in cell
B. Fat deposition in cells
C. Water imbibition in cells
D. Enzymatic digestion

Response:
Ans. is 'd i.e., Enzymatic digestion o Cell injury is reversible upto a ceain point, but if the stimulus persists, irreversible injury and ultimate cell death occur. o There are two principal patterns of cell death : ? a Necrosis q Apoptosis Necrosis o Necrosis refers to a spectrum of morphological changes that follow cell death in living tissue. o Remember this fact Cell death is not due to necrosis rather necrosis (i.e., morphological changes) occurs after cell death cells placed immediately in fixative are dead but not necrotic. Necrosis only represents the morphological changes that occur after cell death. o These morphological changes (necrosis) is the result of 2 concurrent processes : ? 1. Enzymatic digestion of the cell q Enzymes used in the process are derived from two sources :? (a) From the lysosomes of the dead cells themselves (Autolysis) (b) From the lysosomes of the immigrant leukocytes (Heterolysis) 2. Denaturation of intracellular proteins o These processes require hours to develop, So immediatly after cell death there are no detectable necrotic changes. o Necrosis usually effects a group of contigous cells (in contrast to apoptosis that involves death of a single cells), but it can effect single cell also. o In necrosis, there is diruption of membrane integrity --3 Intracellular contents leak out and elicit inflammation --> Inflammatory changes in the surrounding tissue (By contrast, in apoptosis there is no inflammatory reaction in the tissue). Morphological changes o As necrosis follows irreversible injury, the morphological changes are same that have been described in irreversible injury. These are ? 1.Membrane damage 2.Large flocculent amorphous densities in mitochondria. 3.Intracytoplasmic myelin figures 4.Decreased basophilia and increased eosinophilia due to decreased RNP. 5.Nuclear changes : Karyolysis --> Basophilia of chromatin Pyknosis --> Nuclear shrinkage Karyorrhexis --> Fragmentation of Pyknotic nucleus.

So the answer to this question is D


Instruction:
Pupil is small in all of the following except:
A. During sleep
B. Adie's pupil
C. Argyll Robeson pupil
D. Pontine haemorrhage

Response:
Ans. Adie's pupil

So the answer to this question is B


Instruction:
The most radio sensitive tumor amongst the following is:
A. Small cell lung cancer
B. Seminoma
C. Soft tissue sarcoma
D. Osteosarcoma

Response:
Ans. (b) SeminomaRef: Devita Th/1907* Most radiosensitive tumor: HL > Ewings* Most radiosensitive tumor of head and Neck: Nasopharyngeal CA > Glottic CARadiosensitivity of tumorsHighly sensitiveModerate sensitiveRelatively ResistantHighly Resistant# Ewing's sarcoma# Lymphoma# Wilms tumor# Multiple Myeloma# Seminoma# Nasopharyngeal CA# Dysgerminoma# Medulloblastoma# Small Cell Cancer lung# Breast Cancer# Ovarian Cancer# Basal cell cancer# Nasopharyngeal Cancer# Dysgerminoma# Small Cell Cancer lung# Breast Cancer# Ovarian Cancer# Basal cell cancer# Renal cell CA# Rectal/ colon cancer# Bladder Carcinoma# Soft tissue sarcoma Squamous cell carcinoma of lung# Cervix cancer# Hepatoma# Melanoma# Pancreatic cancer# Osteosarcoma

So the answer to this question is B


Instruction:
Which is not seen in Polycythemia Vera?
A. Ocular congestion
B. Increase RBC count
C. Increase erythropoietin level
D. Increased Vit B12 binding capacity

Response:
Polycythemia vera is characterized by an increase in red cell mass without any increase in level of erythropoietin. In fact erythropoietin level is decreased due to feedback by increased erythrocytes. The plasma erythropoetin level is a useful diagnostic test in patients with isolated erythrocytosis, because an elevated level excludes polycythemia vera as the cause for erythrocytosis.

So the answer to this question is C


Instruction:
Which one of the following is not a characteristic feature of rheumatoid ahritis ?
A. Sacroiliitis
B. Metacarpophalangeal joint involvement
C. Symmetrical ahritis
D. Positive rheumatoid factor

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

So the answer to this question is A


Instruction:
Which of the following evaluation methods is most sensitive in diagnosing pregnancy early?
A. Serum pregnancy test
B. Detection of fetal heart tones by Doppler equipment
C. Abdominal ultrasound
D. Bimanual exam to assess uterine size

Response:
A Doppler instrument will detect fetal cardiac action usually no sooner than 10 weeks.
A sensitive serum pregnancy test can detect placental HCG levels by 8 to 9 days post-ovulation, and it is therefore the most sensitive modality for detecting and diagnosing pregnancy.

So the answer to this question is A


Instruction:
Sequestrated lung is most commonly supplied by:
A. Bronchial artery
B. Subclavian artery
C. Pulmonary artery
D. Ascending aorta

Response:
Ans. d (Ascending aorta). (Ref. Sutton Radiology 7th ed. 253)Pulmonary sequestration# Sequestrated lung is "a congenital mass of aberrant pulmonary tissue that has no normal connection with the bronchial tree or with the pulmonary arteries, and usually supplied separately by a anomalous branch from ascending aorta directly.# It is usually located in one of the basal segments of lower lobe. In 98% cases intralobar sequestration involves medial parts of left lower lobe. 98% of extralobar sequestrations are left sided.# Two varieties of pulmonary sequestration are known:A. Extralobar: it is most common variety in neonates and infants, is located between the lower lobe and diaphragm, has its own pleural covering, and other anomalies are common (65%), (like pulmonary hypoplasia, horseshoe lung, CCAM, bronchogenic cysts, diaphragmatic hernia and cardiac anomalies).B. Intralobar sequestration: diagnosed after adolescence, contained within lung with no separate pleural covering, and is intimately connected to adjacent lung.

So the answer to this question is D


Instruction:
Most probable diagnosis in a newborn baby with regurgitation of feeds and continuous drooling of saliva is:
A. Esophageal atresia
B. Diffuse esophageal spasm
C. Achalasia cardia
D. Zenker's diveiculum

Response:
Continuous drooling of saliva indicates no communication of Esophagus distally - esophageal atresia. Type E is also known as H shaped Fistula Least Common- Type D Classification of TEF Type A: Atresia only (6%) Type B: Atresia with proximal TEF (2%) Type C: Atresia with distal TEF (85%): Most common Type D: Atresia with both proximal and distal TEF (rare) Type E: TEF only (1%) Clinical Features The diagnosis of EA is enteained in an infant with excessive salivation along with coughing or choking during the first oral feeding. A maternal history of polyhydramnios is often present. The newborn baby with atresia regurgitates all of its first and subsequent feeds0. Saliva pours continuously from its mouth . Repeated episodes of coughing, choking and cyanosis occur on feeding in TEF. Associated Anomalies MC anomaly associated with TEF is CVS (VSD). Esophageal atresia may occur as pa of VACTERL group of anomalies: -V: Veebral body segmentation defects0 -A: Anal atresia0 -C: Cardiovascular (PDA, VSD) -TE: Tracheoesophageal fistula -R: Renal (unilateral renal agenesis) -L: Limb anomalies (radial ray hyplasia)

So the answer to this question is A


Instruction:
In a case of chest pain with pericarditis and pericardial effusion, pain is referred by?
A. Superficial cardiac plexus
B. Phrenic nerve
C. Deep cardiac plexus
D. Vagus nerve

Response:
The phrenic nerve arises from the ventral rami of cervical spinal nerves C3-5 and courses down in the preveebral fascia, in front of the anterior scalene muscle, into the thorax between the subclan aery and vein. It provides motor innervation to the diaphragm. The fibrous and parietal pericardial are supplied by the phrenic nerve (C3-C5). They are sensitive to pain. The visceral pericardium or epicardium is supplied by autonomic nerves, not sensitive to pain.

So the answer to this question is B


Instruction:
True about cholera -
A. Gram negative rod
B. Associated with fever
C. Causes painful watery diarrhea
D. All

Response:
Ans. is `a' i.e., Gram negative rod Vibrio cholerae is a gram negative rod (bacillus). It causes painless watery diarrhea, without associated fever. Vibrios are highly susceptible to acids and gastric acidity provides an effective barrier against small dose of V. cholerae. Therefore, achlorhydria predisposes for infection by V cholerae.

So the answer to this question is A


Instruction:
Cold caloric test stimulates -
A. Cochlea
B. Lateral semi circular canal
C. Posterior semicircular canal
D. All

Response:
Caloric Tests: Important points

Principle: to induce nystagmus by thermal stimulation of vestibular system.
Lateral semicircular canalQ is commonly tested by all these tests
There are 3 methods of performing these tests:

So the answer to this question is B


Instruction:
A 25-year-old woman presents to the emergency room with new symptoms of decreased urine output, leg edema, and facial swelling. She was previously well and has no significant past medical history. Laboratory investigations reveal acute kidney injury and a renal biopsy is performed. Immunofluorescence of the biopsy specimen reveals a granular pattern of immune complex-mediated glomerulonephritis. (See Figure below) Which of the following conditions is most likely to cause this pattern of renal injury?
A. acute tubular necrosis (ATN)
B. Wegener granulomatosis
C. postinfectious glomerulonephritis
D. hemolytic uremic syndrome (HUS)

Response:
Immune complexes with low complement levels can be seen in idiopathic and postinfectious glomerulonephritis, lupus, cryoglobulinemia, shunt nephritis, and bacterial endocarditis. Immune complexes are not detected in ATN, Wegener's, HUS, or Goodpasture syndrome. Immune complexes with normal complement levels are found in IgA nephropathy and Henoch-Schonlein purpura.

So the answer to this question is C


Instruction:
Novy-McNeal-Nicolle INNN] medium is used for:
A. Giardia lamblia
B. Leishmania donovani
C. Echinococus
D. Toxoplasma gondii

Response:
Ans. B: Leishmania donovani A variety of media have been used for the culture of leishmanias. These can be divided into three main categories: semisolid, biphasic, and liquid. While biphasic and semisolid culture media need blood, an impoant factor for the reproduction of parasites, most liquid media require fetal calf serum (FCS) or erythrocyte lysate. NNN medium is a solid medium with a little water of condensation on the top of the slant. The organisms crowd together in this water of condensation. Biphasic Novy-MacNeal-Nicolle (NNN) culture medium, which has been used for a long time, is preferred because it is far cheaper than commercial media. Although it is quite suitable for the isolation of parasites, in this medium samples taken from leishmaniosis patients fail to produce a great number of promastigotes in a sho time.

So the answer to this question is B


Instruction:
Infection by which of the following agents leads to wart formation-
A. Herpes simplex virus
B. HPV
C. Molluscum contagiousum virus
D. Varicella zoster virus

Response:
Ans. is 'b' i.e., HPV o Human papilloma virus (HPV) is the causative agent of all type of warts.Type of wartSite of involvementHPV types1. Verruca vulgaris (common wart)Most common type wart On Hands and fingers2 (most common), 4, 272. Verruca Plana (Flat wart)Face, hands3, 103. Verruca plantaris (Palmoplantar warts)Palms & soles1,2,4, 57i) Superficial palmoplantar wart (Mosaic wart) 2 (most common)ii) Deep palmoplantar wart (Myrmecia wart) 1 (most common)4. Condyloma acuminata (anogenital wart)Genital, perianal, perineum,Most common - 6,11, (low risk)Other - 16, 18, 31, 33, 45 (High risk)5. Laryngeal papillomatosisLarynx, respiratory tract6, 116. Bowenoid papulosisGenitalia167. Epidermodysplasia verruciformisExtensive5, 8

So the answer to this question is B


Instruction:
Dwarf tapeworm is the common name of which of the following
A. Echinococcus multilocularis
B. Hymenolepis nana
C. Taenia saginata
D. Taenia solium

Response:
Hymenolepis nana is commonly known as dwarf tapeworm The name hymenolepis refers to the thin membrane covering the egg(greek: hymen -membrane,lepis-covering,nana (nanus) -dwarf) Ref: panikers textbook of Medical parasitology 8th edition page :136

So the answer to this question is B


Instruction:
Dryness of eye is caused by injury to the facial nerve at-
A. Chorda tympani
B. Cerebellopontine angle
C. Tympanic canal
D. Geniculate ganglion

Response:
Dryness in the eye (loss of lacrimation) occurs if the injury is at or proximal to geniculate ganglion.
First, see the major symptoms of facial nerve palsy : -
Loss of lacrimation: - Due to the involvement of greater superficial petrosal nerve.
Loss of stapedial reflex: - Due to the involvement of nerve to stapedius.
Lack of salivation: - Due to chorda tympani.
Loss of taste sensation from Anterior 2/3 of the tongue: - due to chorda tympani.
Paralysis of the muscle of facial expression: - Due to terminal (peripheral) branches.
Now you can make out the site of injury : -
All the 5 symptoms (i to v) are present → Injury is at or proximal to geniculate ganglion (as all the branches of the facial nerve are involved).
There is no loss of lacrimation (greater superficial petrosal nerve is spared) but symptoms (ii) to (v) occur → Injury is distal to geniculate ganglion but proximal to or at the level of the second genu from where the nerve to stapedius arises.
Only symptoms (iii) to (v) are present (greater petrosal and nerve to stapedius are spared) → Injury is distal to the second genu but proximal to the origin of chorda tympani, i.e., Injury is between Second genu and mid portion of verticle segment.
Only (Vth) symptom is present → Injury is distal to the origin of chorda tympani, which may be at the level of the stylomastoid foramen.

So the answer to this question is D


Instruction:
A fifty-year-old man presents to his practitioner complaining that he often feels as if the room is spinning when he gets up from a recumbent position or turns his head. He has not lost consciousness and has had no chest pain. He has no cardiac history and a recent treadmill test showed no abnormalities. On examination, the sensation can be produced by rapidly turning the head. It can be reproduced many times, but it eventually ceases. Nystagmus is elicited. Hearing is normal. Which of the following is the most likely diagnosis?
A. Benign paroxysmal positional veigo
B. Brain stem tumor
C. Meniere's disease
D. Syncope

Response:
Benign paroxysmal positional veigo (BPPV) is veigo that is precipitated by head position. It can be precipitated by trauma, but often no precipitating factor is identified. It generally abates after weeks to months. On exam, patients display nystagmus and the symptoms can be reproduced by head movement. In addition, the symptoms show latency, fatigability and habituation. Brain stem tumor and veebrobasilar TIA are causes of central causes of veigo, but would often be associated with other neurologic findings. Meniere disease displays the classic triad of unilateral tinnitus, unilateral deafness, and paroxysmal veigo. Since the patient has normal hearing, this is unlikely to be Meniere syndrome, although hearing loss may not manifest until later stages of the disease. Syncope is defined as transient loss of consciousness of cardiovascular origin. Thus since the patient has a lack of other cardiovascular symptoms and has not lost consciousness, this is not syncope.

So the answer to this question is A


Instruction:
All are true about Pthisis bulbi except
A. Size of eye decreases
B. Calcification occurs in Bowman's layer of cornea
C. IOP increases in later stages
D. Treatment is enucleation operation

Response:
IOP will not increase in Pthisis bulbi.

So the answer to this question is C


Instruction:
Hysterosalphingography is clone during?
A. During menstruation
B. Luteal phase
C. Follicular phase
D. Secretory phase

Response:
Follicular phase REF: Shaw's Gynecology 13th ed p.- 210 "Hysterosalphingography is performed between the end of the menstrual period and ovulation at around 10th day. This is the phase of follicular development"

So the answer to this question is C


Instruction:
Which of the following drugs is not recommended in septic shock:
A. Normal saline
B. Activated protein C
C. Steroids
D. Rituximab

Response:
Essentials of medical pharmacology, seventh edition, page no 872 Answer is option 4, rituximab It is not recommended in septic shock since it will adverse the condition. The major adverse effects are chills, fever, uicarial rashes, pruritus, dyspnoea, and hypotension. Pretreatment with antihistamines dampens the reaction.

So the answer to this question is D


Instruction:
False about p53 is-
A. It is present on chromosomes 17
B. It causes cell cylce arrest in G1
C. 53 KDa
D. Non mutated wild p53 is associated with neoplasm in childhood

Response:
p53 is the protein produced by TP53, guardian of human genome. It stimulates cells for DNA repair and in anti onco genic.Basic Pathology, Robbins. Page no.:185

So the answer to this question is D


Instruction:
Infraorbital anesthesia involves which nerve:
A. Anterior superior alveolar nerve
B. Posterior superior alveolar nerve
C. Facial nerve
D. Mandibular nerve

Response:
None

So the answer to this question is A


Instruction:
Long and peaked a waves are seen in all except-
A. Tricuspid atresia
B. Ebsteins anomaly
C. Hyperkelamia
D. Right atrial enlargement

Response:
ECG : left axis detion in tricuspid atresia The common ECG findings in Ebstein anomaly include tall and broad P waves, prolonged PR interval, right bundle branch block pattern, fragmented QRS complex, and tachyarrhythmias due to accessory pathways usually present around the malformed TV. ECG Criteria of Right Atrial Enlargement Right atrial enlargement produces a peaked P wave (P pulmonale) with amplitude: > 2.5 mm in the inferior leads (II, III and AVF) > 1.5 mm in V1 and V2 Ref Harrison 20th edition pg 1476

So the answer to this question is C


Instruction:
CRF shows all except
A. Hyperphosphatemia
B. Hyperuricaemia
C. Decreased 11/2 of insulin
D. Decreased serum vitamin D3

Response:
Ans. is 'c' i.e., Decreased of insulin

So the answer to this question is C


Instruction:
Viability of fetus is beyond ?
A. 25 weeks
B. 28 weeks
C. 30 weeks
D. 32 weeks

Response:
Ans. is 'b' i.e.,28 weeksViability means the physical ability of a fetus to lead a separate existence after bih apa from its mother, by viue of a ceain degree of development. A child is ble after 210 days (7 months) of intrauterine life, and in some cases after 180 days (6 months) but in most of these cases fetus is immature.

So the answer to this question is B


Instruction:
Typical feature of thoracic veebrae ?
A. Hea shaped
B. Large body
C. Triangular veebral foramen
D. None

Response:
Ans. is 'a' i.e., Hea shaped Thoracic veebrae There are 12 thoracic veebrae. T2-T9 are typical thoracic veebrae and Tl, TIO, Tl 1, T12 are atypical thoracic veebrae. Characteristic features of typical thoracic veebra : -Body is medium sized and hea shaped.Spinous process is long and inclined downward.Veebral foramen is small and circular.Transverse process possess costal facets for rib aiculation (last two veebrae lack these facets). Costal facets are also present on the sides of body for aiculation of heads of ribs.Superior aicular facet is directed backwards and laterally, and inferior aicular facet faces forward and medially. Aicular procesess are veically placed and interlocked; So dislocation can only occur if they are fractured.

So the answer to this question is A


Instruction:
Inspissation is ?
A. Heating at 160degC for 15 minutes
B. Heating at 160degC for 30 seconds
C. Heating at 80degC for 30 minutes
D. Heating at 120degC for 15 seconds

Response:
Ans. is 'c' i.e., Heating at 80degC for 30 minutes Inspissation: It is heat exposure method that is employed with high protein material, like egg containing media, that cannot withstand the high temperature used in autoclaving. The medium is exposed to 80degC for 30 minutes for three successive days in inspissator. It can be used for LI medium and loeffler serum slop.

So the answer to this question is C


Instruction:
Antisperm antibody testing is not needed if the sperm are to be used for-
A. ICSI
B. GIFT
C. ZIFT
D. IVF

Response:
Antisperm antibody testing is not needed if the sperm are to be used for Intracytoplasmic sperm injection (ICSI). Antisperm antibody testing Using the immunobead test, washed spermatozoa are exposed and assessed for binding to labeled beads. In the mixed agglutination reaction, human red blood cells sensitized with human immunoglobulin G (IgG) are mixed with the paner's semen. Spermatozoa that are coated with antibodies form mixed agglutinates with the red blood cells Anti sperm antibodies cause agglutination of sperms and hence the sperms are'nt free to move and feilise the oocyte. This test is therfore impoant before A procedures except ICSI because here the sperm is directly injected into the oocyte cytoplasm.

So the answer to this question is A


Instruction:
Prolonged treatment with INH leads to deficiency of?
A. Pyridoxine
B. Thiamine
C. Pantothenic acid
D. Niacin

Response:
Pyridoxine: Chemistry and source: Pyridoxine, Pyriodoxal and Pyridoxamine are related naturally occurring pyridine compounds that have vit B6 activity. Dietary sources are-liver, meat, egg, soybean, vegetables and whole grain . Absorption and fate: All three forms of the vitamin are well absorbed from the intestine. They are oxidized in the body and excreted as pyridoxic acid. little is stored. Physiological role and actions: Pyridoxine and pyridoxamine are readily oxidized to pyridoxal, which is then phosphorylated to pyridoxal phosphate. Isoniazid reacts with pyridoxal to form a hydrazone, and thus inhibits generation of pyridoxal phosphate. Isoniazid also combines with pyridoxal phosphate to interfere with its coenzyme function. Due to formation of hydrazones, the renal excretion of pyridoxine compounds is increased. Thus, isoniazid therapy produces a pyridoxine deficiency state.

So the answer to this question is A


Instruction:
In leprosy nerves commonly involved?
A. High ulnar, low median
B. High median, low ulnar
C. Triple nerve palsy
D. High radial, low median

Response:
Involvement is high ulnar (at or above elbow) and low median (at wrist). The sensory component is commonly the first and most severely affected, but occasionally there is a pure motor lesion. Autonomic dysfunction is always present in severe nerve damage. MC cranial nerve involved: Facial MC peripheral nerve involved: Ulnar>Posterior Tibial

So the answer to this question is A


Instruction:
Blunt injury abdomen, patient was hemodynamically stable, next investigation:
A. X-ray abdomen
B. Barium swallow
C. FAST
D. DPL

Response:
None

So the answer to this question is C


Instruction:
Paneth cells contain -
A. Zinc
B. Copper
C. Molybdenum
D. Selenium

Response:
Paneth cells are zinc-containing cells widely distributed in Lieberkuhn's crypts of the intestine in a variety of species.
These cells have atypically oriented bright eosinophilic granules containing a variety of antimicrobial proteins and play a role in mucosal immunity (and not mucin secretion).
The principal defence molecule secreted by Paneth cells are alpha-defensins.
In addition to defensins, Paneth cells secrete lysozyme, TNF- α, and phospholipase-A2.

So the answer to this question is A


Instruction:
Effects of estrogen are all of the following except ?
A. Reduces HDL
B. Reduces LDL
C. Increases triglyceride
D. Reduces bone resorption

Response:
Ans. is 'a' i.e., Reduces HDL o Estrogens decrease LDL while increase HDL and triglyceride -4 atherosclerosis is rare before menopause.

So the answer to this question is A


Instruction:
True about conversion of 20C fatty acid conversion to prostaglandin synthase
A. First PG synthesized is PGI I2
B. It is rate limiting enzyme
C. It convees PGI H2 to PGI E2
D. The primary prostaglandin is PG H2

Response:
Biosynthesis of Prostaglandins Prostaglandins are derived from the PUFA, the three series being derived from the following fatty acids. 1 series (1 double bond) -from Linoleic acid 2 series (2 double bonds)-from Arachidonic acid 3 series (3 double bonds)-Eicosa Penta-enoic Naturally occurring PGs belong to the 2 series. i. PGs are not stored as such; the precursor fatty acids are stored in membrane as phospholipids. The arachidonic acid is released by the action of phospholipase A2 on phospholipids (Fig. 13.3). ii. Synthesis is catalyzed by Prostaglandin H synthase (PGHS). It contains two separate enzyme activities, cyclo-oxygenase, and peroxidase. iii. PGG2 and PGH2 are formed as intermediates during the synthesis of other PGs. Specific enzymes conve PGH2 to other prostaglandinsRef: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 164

So the answer to this question is D


Instruction:
A 22-year-old man is admitted to the hospital after a car collision. Radiographic examination reveals an oblique fracture of his humerus. Upon physical examination the patient is unable to extend his forearm. The damaged nerve was most likely composed of fibers from which of the following spinal levels?
A. C5, C6
B. C5, C6, C7
C. C5, C6, C7, C8, T1
D. C6, C7, C8, T1

Response:
The radial nerve acts to extend the forearm at the elbow. This nerve is derived from all the roots of the brachial plexus C5 to T1. None of the other answers include all the roots and are therefore incorrect.

So the answer to this question is C


Instruction:
The frequent mechanism in perforation of appendix is?
A. Impacted faecolith
B. Tension gangrene due to the accumulating secretions
C. Necrosis of lymphoid patch
D. Retrocaecal function

Response:
Ans. is 'b' i.e., Tension gangrene due to the accumulating secretions

So the answer to this question is B


Instruction:
A 36-year-old G2P1 woman at 24 weeks gestation is noted to have fatigue of 4 weeks duration. Her hemoglobin level is 8.0 g/ dL, leukocyte count is 2.0 cells/ uL, and platelet count is 20,000/ uL. Which of the following is the most likely diagnosis
A. H ELLP syndrome
B. Preeclampsia with severe features
C. Acute leukemia
D. Iron deficiency anemia

Response:
Pancytopenia, a reduction in the number of RBCs, WBCs, and platelets circulating throughout the body, suggests a bone marrow process. None of the other answer choices involve low leukocyte counts (leucopenia). Low platelets (thrombocytopenia) may also be a manifestation of severe preeclampsia, and is pa of the criteria for HELLP syndrome as well. Iron deficiency anemia involves low hemoglobin levels and is common in pregnancy due to decreased iron stored prior to pregnancy, and increased demands for iron during pregnancy. Since this patient's blood work showed low WBCs, a bone marrow biopsy should be done. A pregnant woman with leukemia may require chemotherapy, which poses a risk of intrauterine growth retardation to the developing fetus. Acute leukemia itself carries a risk for preterm labor, spontaneous aboion, and stillbih.

So the answer to this question is C


Instruction:
Onion skin spleen is seen in -
A. ITP
B. Thalassemia
C. SLE
D. Scleroderma

Response:
In spleen the central peniciliary arteries show thickening and perivascular fibrosis, producing so called Onion Skin lesions.

So the answer to this question is C


Instruction:
Lyedig cells secrete ?
A. Testosterone
B. Inhibin
C. Mullerian inhibiting substance (MIS)
D. ABP

Response:
Ans. is 'a' i.e., TestosteroneThe hormone-secreting cells in the testes are the leydig cells and seoli cells. Leydig cells have receptors for LH and secrete all the androgens, i.e., testosterone (major androgen), dihydrotestosterone (DHT), androstendione and dehydroepiandrosterone (DHEA). All of theme have 19 carbon atoms.Seoli cells are under the control of FSH, i.e., have receptors for FSH. When stimulated by FSH, these cells secrete androgen binding protein (ABP), in hibin and MIS (mullerian inhibiting substance). Seoli cells also contain aromatase; the enzyme that conves androgens to estrogens. Beside these hormonal function, junction between adjacent seoli cells forms blood-testis barrier which does not allow harmful substances to enter the area where spermatogenesis is going on. Seoli cells also have receptors for androgens (testosterone) which stimulates spermatogenesis.

So the answer to this question is A


Instruction:
Triple deformity of the knee is a complication of: September 2012
A. Tuberculosis
B. Osteoahritis
C. Septic ahritis
D. All of the above

Response:
Ans. A i.e. Tuberculosis Skeletal TB MC site of skeletal TB: Veebrae In Spine, TB stas in: Veebral body MC region involved in spinal TB: T9-L1 Earliest symptom of spinal TB: Pain Earliest X-ray sign in Pott's disease: Narrowing of disc space

So the answer to this question is A


Instruction:
A patient who is on LMWH, suddenly develops hemorrhage, next step is
A. Level of factor X
B. APTT
C. Platelet count
D. PT

Response:
LMWH is monitored by factor Xa assay.(Refer: Harrison's Principles of Internal Medicine, 18th edition, pg no: 996)

So the answer to this question is A


Instruction:
Parathyroid autotransplantation is done in which of the following muscle?
A. Brachioradials
B. Biceps
C. Triceps
D. Saorius

Response:
Parathyroid auto transplantation is done in 2 muscles Sternocleidomastoid muscle Brachioradialis of non-dominant hand SCM Brachioradialis Indication: Accidental removal of PT gland while performing a thyroidectomy. | A small amount of the PT gland is auto-transplanted into SCM muscle. Indication: Hyperparathyroidism due to parathyroid adenoma (or) Parathyroid hyperplasia. | A sub-total parathyroidectomy is performed and a small amount of PT gland is implanted into brachioradialis muscle of non-dominated hand. Transplanted site is marked with silk suture or clip for easy identification

So the answer to this question is A


Instruction:
Hypercalcemia is seen in all EXCEPT:
A. Bone metastasis
B. Sarcoidosis
C. Pseudohypoparathyroidism
D. Hyperparathyroidism

Response:
Ans. C i.e. Pseudohypoparathyroidism Pseudohypoparathyroidism presents with hypocalcemia, normal to raised PTH, normal 25-(OH)D, and decreased 1,25-(OH),D

So the answer to this question is C


Instruction:
A 35 year old female with a previous history of bih of a child with Down's syndrome, presents with 18 weeks Amenorrhoea. The Investigation of choice rule out Down's syndrome in the present pregnancy is:
A. Triple test
B. Amniocentesis
C. Cordocentesis
D. Chorionic villous biopsy

Response:
The Answer is B (Amniocentesis) : At 18 weeks of pregnancy the best confirmatory test available is amniocentesis 'Triple test only gives a risk ratio. For confirmation of diagnosis, amniocentesis has to be done' - Dutta

So the answer to this question is B


Instruction:
Production of fructose in seminal fluid is by following steps
A. Glucose-6-phosphate > fructose-6-phosphate > fructose
B. Glucose-6-phosphate > sorbitol phosphate > fructose phosphate > fructose
C. Glucose-6-phosphate > glucose > sorbitol > fructose
D. Glucose-6-phosphate > fructose- 1 -phosphate > fructose

Response:
Glucose-6-phosphate>glucose>Sorbitol>Fructose

Fructose can be synthesis from glucose or glycogen. The pathway is :-

So the answer to this question is C


Instruction:
Oral vancomycin is indicated in the following condition
A. Bacillary dysentery
B. Campylobacter diarrhoea
C. Appendicitis
D. Antibiotic associated pseudomembranous enterocolitis

Response:
GLYCOPEPTIDE ANTIBIOTICS Vancomycin Mech of action:- Vancomycin acts by inhibiting bacterial cell wall synthesis. It binds to the terminal dipeptide 'D-ala-D-ala' sequence of peptidoglycan units-- prevents its release from the bactoprenol lipid carrier so that assembly of the units at the cell membrane and their cross linking to form the cell wall cannot take place. pharmacokinetics:- Vancomycin is not absorbed orally. After i.v. administration, it is widely distributed, penetrates serous cavities, inflamed meninges and is excreted mainly unchanged by glomerular filtration with a t 1/2 of 6 hours. Dose reduction is needed in renal insufficiency. Toxicity:- Systemic toxicity of vancomycin is high. It can cause plasma concentration dependent nerve deafness which may be permanent. Kidney damage is also dose-related. Other oto- and nephrotoxic drugs like aminoglycosides must be very carefully administered when vancomycin is being used. Skin allergy and fall in BP during i.v. injection can occur. Vancomycin has the potential to release histamine by direct action on mast cells. Rapid i.v. injection has caused chills, fever, uicaria and intense flushing-- called 'Red man syndrome'. Uses:- Given orally (125-500 mg 6 hourly), it is the second choice drug to metronidazole for antibiotic associated pseudomembranous enterocolitis caused by C. difficile. Staphylococcal enterocolitis is another indication of oral vancomycin. Ref:- kd tripathi; pg num:-757

So the answer to this question is D


Instruction:
A pt present with clinical features of veigo nystagmus the following condition is dft to thrombosis in which aery?
A. Posterior cerebral Aery
B. middle cerebral Aery
C. Superior cerebellar aery
D. Internal candid Aery

Response:
ref : BD CHAURASIA

So the answer to this question is C


Instruction:
All are true about staing of b-Blocker therapy in a case of CHF except aEUR'
A. They should be staed with optimal doses
B. They should be gradually increased over weeks
C. Special precautions should be taken in cases of NYHA class III and IV
D. Carvedilol and Metoprolol are the preferred drugs

Response:
They should be staed with optimal dose Beta blocker therapy represents a major advance in the treatment of patients with depressed ejection fraction. - Although the negative inotropic effect of beta blocker resulted in their contraindication in left ventricular dysfunction until very recently, there is now evidence that, not only are they tolerated, but they greatly improves prognosis. How does blockade of fi receptors help in hea failure?? Left ventricular dysfunction results in neurohormonal activation (renin angiotensin aldosterone system, sympathetic system, cytokine release) which, although beneficial in acute cases is reponsible for gradual deterioration in myocardial function. For instance , in response to decrease in cardiac output, an increase in circulating norepinephrine (NE) can be seen which acts on the sympathetic myocardial receptors paicularly beta-1 thus increasing tnyocardial contractility. In addition, by stimulating peripheral alpha receptor, NE induces peripheral vasoconstriction, which helps to maintain blood pressure - This effect is counter balanced by peripheral *to-2 stimulation and consequent vasodilation. Prolonged exposure of hea to alpha and beta receptor stimulation unfounately, promotes left ventricular modelling, cell death due to necrosis or apoptosis and water/ salt retention. 8 blockers interfere with the harmful effect of sustained activation of the adrenergic nervous system by competitively antagonizing one or more adrenergic receptors. When given along with ACE inhibitors beta blockers reverse the process of RV remodelling, improve patient symptoms, prevents hospitalisation and prolongs life. Therefore II blockers are indicated for patients with symptomatic or asymptomatic HF and depressed Ejection Fraction < 40%. There are three beta blockers that have been shown to be effective in reducing the risk of death in patients with chronic HE : - Bisoprolol - Metoprolol - Carvedilol Current recommendation are to consider the addition of fl blockers in the case of patients presenting with functional class II or Ill congestive hea failure if caused by systolic function. Dose of 13eta blockers First of all, treatment should be staed at extremely low doses:? - This dosage should be maintained for at least two to .four weeks and is increased only if the patient has tolerated it well. - if the patient does not tolerate the increased dosage the medication should not be considered a failure and treatment should be maintained at the tolerated dose. - The dose of beta blocker should he increased, until, the dose, used are similar to those that have been repoed to be effective in clinical trials. Administering ,8 blockers may lead to worsening fluid retention consequent to the withdrawl of adrenergic suppo to the hea and the circulation. - Thus it is impoant to optimize the dose of diuretic before staing therapy with beta blockers. - The increased, fluid retention can usually be managed by increasing the dose of diuretics. Beta blockers in NYHA class IV :? Since most of the clinical trials of Beta blocking agents have been conducted in patients with hea failure NYHA .functional class 11/ HI, until recently, there was limited information regarding safety and efficacy of Beta blockers in patients with hea failure NYHA functional class IV. Carvedilol prospective Randomized cumulative survival (COPER- NICUS) - The COPERNICUS TRIAL was designed as multicentric multinational trial in patients with severe hea failure randomized to Carvedilol vs Placebo. -The result of COPERNICUS demonstrates that even in patients with advanced hea .failure, Carvedilol exes a beneficial effect.

So the answer to this question is A


Instruction:
A 45-year-old woman presents with a 4-month history of severe headaches and pain, and blanching of the hands upon exposure to cold. She is a nonsmoker. Over the past 6 months, she has noticed progressive difficulty in swallowing solid food. Physical examination reveals smooth and tight skin over the face and fingers. The serologic test for anti-Scl-70 (antitopoi-somerase) is positive. Painful hands in this patient are best described using which of the following terms?
A. Chilblains
B. Homans' sign
C. Intermittent claudication
D. Raynaud phenomenon

Response:
This patient suffers from scleroderma complicated by Raynaud phenomenon. The latter refers to intermittent, bilateral attacks of vasospasm of the fingers or toes (sometimes affecting the ears or nose), resulting in pallor, paresthesias, and pain from ischemia. The symptoms are precipitated by cold or emotional stimuli and relieved by heat. Raynaud phenomenon may occur as an isolated disorder or as a feature of a number of systemic diseases, including systemic lupus erythematosus and scleroderma. Intermittent claudication (choice C) is associated with peripheral vascular disease (atherosclerosis). Chilblains (choice A) represent itchy or tender red or purple bumps that occur as a reaction to cold.Diagnosis: Scleroderma

So the answer to this question is D


Instruction:
Major end product of beta oxidation of odd chain fatty acids:
A. Propionyl CoA
B. Succinyl CoA
C. Acetyl CoA
D. Malonyl CoA

Response:
Odd chain fatty acid on beta-oxidation Give many Acetyl CoA (released at every step) and only 1 Propionyl CoA. In 17 C fatty acid ( odd chain ) , when it's broken down , 7 molecules of acetyl CoA ( 14 C)and 1 molecule of propionyl CoA (3C) are obtained So, major end product is Acetyl CoA whereas Propionyl CoA is a minor end product.

So the answer to this question is C


Instruction:
Most important component of level of living-
A. Health
B. Education
C. Food
D. Clothes

Response:
Health is the most important component because its impairment always means impairment of level of living.

So the answer to this question is A


Instruction:
An OPV vial shows this symbol on it. What does it indicate?
A. The vaccine has reached its expiry date
B. The vaccine has not been stored properly
C. The vaccine vial is empty
D. Use the vaccine if expiry date not reached

Response:
d. Use the vaccine if expiry date not reachedThis is a vaccine vial monitor (VVM) showing white inner square & blue outer circle; VVM provides an indication of the cumulative heat to which the vial has been exposed

So the answer to this question is D


Instruction:
As per POCSO act, child was brought for age estimation. Xray wrist taken. The maximum age of the wrist joint is:
A. 4 years
B. 7 years
C. 10 years
D. 13 years

Response:
The POCSO Act defines a child as any person below the age of 18 years and provides protection to all children (both males and females) under the age of 18 years from sexual abuse. Ossification Centres of Carpal Bones: Capitate: 1-3 months Hamate: 2-4 months Triquetrum: 2-3 years Lunate: 2-4 years Scaphoid: 4-6 years Trapezium: 4-6 years Trapezoid: 4-6 years Pisiform: 8-12 years Capitate is the first one andPisiformis the last one to ossify. Base of 1stmetacarpel is not fused with the shaft which means age is <15 years. Pisiform has not apppeared so the age is less than 12 years.

So the answer to this question is C


Instruction:
Sperm acquires motility in
A. Seminal vesicle
B. Testes
C. Epididymis
D. Ejaculatory duct

Response:
The seminiferous tubules of the testes are the staing point for the process, where spermatogonial stem cells adjacent to the inner tubule wall divide in a centripetal direction--beginning at the walls and proceeding into the innermost pa, or lumen--to produce immature sperm. Maturation occurs in the epididymis Ref: guyton and hall textbook of medical physiology 12 edition page number:625,626,627

So the answer to this question is C


Instruction:
Pernicious anaemia is associated with the deficiency of:
A. Folic acid
B. Vitamin B1
C. Vitamin B6
D. Vitamin B12

Response:
None

So the answer to this question is D


Instruction:
Which of the following is the inheritance pattern of Familial Hypercholesterolemia?
A. Autosomal dominant
B. Autosomal recessive
C. X Linked dominant
D. X Linked recessive

Response:
Familial hypercholesterolemia (FH) is an autosomal dominant disorder that causes severe elevations in total cholesterol and low-density lipoprotein cholesterol (LDLc). The LDL receptor gene is located on the sho arm of chromosome 19. It is the primary determinant of hepatic LDL uptake, which normally processes approximately 70% of circulating LDL.

So the answer to this question is A


Instruction:
A patient with diarrhea has a fecal smear that is negative for leukocytes. The patient's diarrhea is most likely caused by
A. Campylobacter enteritis
B. Shigellosis
C. Typhoid fever
D. Enterotoxigenic Escherichia coli

Response:
The enterotoxigenic strain of Escherichia coli secretes a heat-labile toxin that stimulates adenylate cyclase, producing a cholera-like syndrome that is responsible for the majority of cases of traveler's diarrhea. Because the bowel mucosa is not invaded and there is no toxin-induced damage, the fecal smear is negative for leukocytes. Campylobacter enteritis, shigellosis, typhoid fever, and amebiasis are all invasive, and infected individuals have stools with inflammatory cells. Typhoid fever is unique because the inflammatory cells are not neutrophils, but mononuclear cells.

So the answer to this question is D


Instruction:
Neurofibromatosis true all, except aEUR'
A. Autosomal recessive
B. Associated with cataract
C. Scoliosis
D. Multiple fibroma

Response:
Autosomal recessive Neurofibromatosis is an inherited disorder It is of two types: ? Neurofibromatosis - Neurofibromatois II Genetics of Neurofibromatosis Both the neurofibromas are inherited in an autosomal dominant pattern. The genes for them are located on different chromosome - NF-1--) Neurofibrin gene on chromosome 17 - NF-2 --) Merlin gene on chromosome 22 NEUROFIBROMATOSIS TYPE I ? Neurofibromatosis is a comparatively common hereditary disorder in which the skin, nevous system, bone, endocrine glands and sometimes other organs are at the sites of a variety of congenital abnormalities often taking the fonn of benign tumours. . The main feature of neurofibromatosis I is - (i) Spots of hyperpigmentation and (ii) Cutaneous and subcutaneous neurofibromatous tumours'. Hyperpigmentation in Neurofibromatosis I takes two forms :? a) Cafe - au - lait spots' . These are patches of pigmentation and they appear sholy after bih' and occur anywhere on the body. . They are light brown in colour (cafe - au - lait) and do not change in number as the patient ages but they increase in size during pubey. . Presence of more than six cafe - au - lait spots > 1.5 cm in size is considered diagnostic of Neurofibromatosis. b) Freckles' . Neurofibromatosis I is also characterized by the presence of Freckles like or diffuse pigmentation of the axillae and other interiginous areas (groin, under breast) and small round whitish spots. When coupled with cafe au lait patches they are viually pathogtzomonice of the disease. ii) Neurofibromas a) Cutaneous tumours . They are situated in the dermis and form discrete soft or, firm papules. . They are ,flesh coloured or violaceous and often topped with comedo. When pressed, the soft tumours tend to invaginate through a small opening in the skin giving the feeling of a seedless raisin or a scrotum without a testicle. This phenomenon is spoken of as "button holding". b) Subcutaneous tumours . They take two forms ? a) Firm discrete nodules attached to a nerve. b) Plexiform neuromase (overgrowth of subcutaneous tissue sometimes reaching enormous size and occur most often in the face, scalp, neck and chest and may cause hideous disfigurement). Lisch Nodule'? This is another unique .finding of neurofibromatosiso. . It is a small whitish spote present in the iris. Tumours associated with Neurofibromatosis I are 1) Tumours of the CNS a) Optic Nerve Gliomao b) Non-optic Gliomas (usually low grade astrocytomas) c) Nonneoplastic ' hamaomatous" lesion Osborn writes - "The common CNS tumor in NF-1 is optic nerve glioma occuring in 5 to 15% of casese" 2) Other tumours associated with NF-1 a) Pheochromocytoma b) Rhabdomyosarcoma c) leukemia (myeloid leukemia) d) Wilms tumour e) Juvenile Xanthogranuloma

So the answer to this question is A


Instruction:
Population covered by a community health centre?
A. 5000
B. 30,000
C. 100,000
D. None

Response:
Ans. is 'c' i.e., 100,000

So the answer to this question is C


Instruction:
Which of the following interactions does not cause film fog?
A. Coherent scattering
B. Transient scattering
C. Photoelectric absorption
D. Compton scattering

Response:
None

So the answer to this question is C


Instruction:
2, 3 DPG binds to __________ site of Hb and __________ release of O2
A. One, increase
B. Four, increase
C. One, decrease
D. Four, decrease

Response:
Fate of 2,3 - DPG2, 3-DPG is synthesized within RBCs from 3 phospho glyceraldehyde, which is a product of glycolysis the Embden-Meyerhof pathway.It is a highly charged anion that binds to the P chains of deoxy-hemoglobin. One mole of deoxyhemoglobin binds 1 mol of 2,3-DPG.HbO2 + 2,3-DPG = Hb - 2,3-DPG + O2In this equilibrium, an increase in the concentration of 2,3-DPGshifts the reaction to the right, causing more 02 to be liberated.Factors affecting 2,3-DPG concentration and affinity for hemoglobinIncreasing 2,3-DPGDecreasing 2,3-DPGChronic hypoxia egObstructive pulmonary emphysemaHigh altitudeCyanotic congenital hea diseaseAnaemiaeg.sickle cell HbAcidosisExerciseHormonesThyroid hormoneGrowth hormoneAndrogensPregnancyInosineDihydroxyacetonePyruvatePhosphateStored bloodFetal hemoglobinAlkalosis

So the answer to this question is A


Instruction:
A 43-year-old man presents with signs and symptoms of peritonitis in the right lower quadrant. The clinical impression and supportive data suggest acute appendicitis. At exploration, however, a tumor is found; frozen section suggests carcinoid features. For each tumor described, choose the most appropriate surgical procedure. A 2. 5-cm tumor at the base of the appendix (SELECT 1 PROCEDURE)
A. Appendectomy
B. Segmental ileal resection
C. Cecectomy
D. Right hemicolectomy

Response:
Carcinoid tumors are most commonly found in the appendix and small bowel, where they may be multiple. They have a tendency to metastasize, which varies with the size of the tumor. Tumors <1 cm uncommonly metastasize. Tumors >2.0 cm are more often found to be metastatic. Metastasis to the liver and beyond may give rise to the carcinoid syndrome. The tumors cause an intense desmoplastic reaction. Spread into the serosal lymphatics does not imply metastatic disease; local resection is potentially curative. When metastatic lesions are found in the liver, they should be resected when technically feasible to limit the symptoms of the carcinoid syndrome. When extensive hepatic metastases are found, the disease is not curable. Resection of the appendix and cecum may be performed to prevent an early intestinal obstruction by locally encroaching tumor.

So the answer to this question is D


Instruction:
A patient presents with the clinical features of interstitial lung disease. How will you confirm the diagnosis: September 2007, 2010
A. CT scan
B. X - Ray
C. Bronchoscopy
D. MRI

Response:
Ans. A: CT Scan CT scans are often the first diagnostic step for interstitial lung disease and may also help rule out other conditions that may cause similar symptoms. Pulmonary function tests (PFTs) are noninvasive tests that measure the function of the lungs. Spirometer can measure the volume of the lungs as well as the air flow into and out of the lungs. Biopsies or washings may be taken of the lungs and airways during bronchoscopy.

So the answer to this question is A


Instruction:
Which is not a feature of pilonidal sinus:
A. Branching tracts are common
B. Recurrence is uncommon
C. Bony involvement is uncommon
D. Seen in Drivers

Response:
"Recurrence is common, even though adequate excision of the track is carried out." - Bailey & Love "Once an acute episode has resolved, recurrence is common"- Schwartz 9/e p1067
Pilonidal disease
Pilonidal disease consists of a hair-containing abscess or chronic sinus, occurring in the intergluteal cleft.
It is an acquired disease
Although earlier it was thought to be a congenital disease, it is now considered to be an acquired infection of natal cleft hair follicles. The hair follicles become infected and rupture into the subcutaneous tissues to form a pilonidal abscess. Hair from surrounding skin is pulled into the abscess cavity by the friction generated by the gluteal muscles during walking.
More common in males
The incidence of pilonidal disease is more common in males (3:1 male: female ratio) between ages 15 & 40 with peak incidence between 16 & 20 yrs.
Pilonidal ds is more common in people with more body hair (hirsute). The ds. is almost rare in persons with less body hair.
Treatment of choice is surgery
Pilonidal sinus should be excised along with the secondary openings. (But only after controlling acute infection).
Acute pilonidal abscesses and sinus ds can be managed by simple incision and drainage (under local anesthesia).

So the answer to this question is B


Instruction:
Breast conservation surgery is contraindicated in-
A. Pregnancy
B. Axillary node involvement
C. Subareolar lump tnt
D. Large pendulous breast

Response:
Ans. is 'a' i.e., Pregnancy Conservative breast cancer managementAbsolute ContraindicationsPregnancy is an absolute contraindication to the use of breast irradiation. However, in many cases, it may be possible to perform breast-conserving surgery in the third trimester and treat the patient with irradiation after delivery.Women with tw o or more primary tumors in separate quadrants of the breast or with diffuse malignant- appearing microcalcifications are not considered candidate for breast conservation treatment.A history of prior therapeutic irradiation to the breast region that would require retreatment to an excessively high total-radiation dose to a significant volume is another absolute contraindication.Persistent positive margins after reasonable surgical attempts.Relative ContraindicationsA history of collagen vascular disease is a relative contraindication to breast conservation treatment because published reports indicate that such patients tolerate irradiation poorly. Most radiation oncologists will not treat patients with scleroderma or active lupus erythematosus, considering it an absolute contraindication. In contrast, rheumatoid arthritis is not a relative or an absolute contraindication.The presence of multiple gross tumors in the same quadrant and indeterminate calcifications must be carefully assessed for suitability because studies in this area are not definitive.Tumor size is not an absolute contraindication to breast conservation treatment, although there is little published experience in treating patients with tumor sizes greater than four to five cm. However, a relative contraindication is the presence of a large tumor in a small breast in which an adequate resection would result in significant cosmetic alteration. In this circumstance, preoperative chemotherapy should be considered.Breast size can be a relative contraindication. Large pendulous breast is a relative contraindication, as it presents difficulty in delivering a uniform radiation dose.Centrally located tumor for which removal of the nipple areola complex is required to obtain a tumor free margin is a relative contraindication. It depends on patient acceptability. The nipple and areola can now be reconstructed.

So the answer to this question is A


Instruction:
A 3 year old boy with normal developmental milestones with delayed speech and difficulty in communication and concentration is not making friends. Most probable diagnosis is:
A. Autism
B. ADHD
C. Mental retardation
D. Specific learning disability

Response:
Autism is a neurologic disorder characterized by, Qualitative impairments in social interaction Qualitative impairments in communication Restricted repetitive and stereotyped patterns of behavior, interests, and activities Ref: Goldson E., Reynolds A. (2012). Chapter 3. Child Development & Behavior. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.

So the answer to this question is A


Instruction:
A patient presents with a severe form of atopic asthma. Which of the following changes would most likely be found in this patient's blood?
A. Basophilic leukocytosis
B. Eosinophilic leukocytosis
C. Lymphocytosis
D. Monocytosis

Response:
An increased number of eosinophils (AKA eosinophilia) occurs in association with several conditions, the most frequent of which are immune-mediated diseases (e.g., asthma, hay fever, and pemphigus vulgaris) and parasitic infestations. This is due to an absolute increase in the number of circulating eosinophils, brought about by IL-5, which stimulates differentiation of eosinophilic precursor cells in the bone marrow.Basophilic leukocytosis is a rare event that is sometimes observed in association with chronic myelogenous leukemia. It is not seen in patients with asthma. Lymphocytosis may result from a vast array of conditions, but it is not typical of asthma or other allergic diseases. Lymphocytosis may develop in response to a number of infections (e.g., brucellosis, whooping cough, hepatitis, infectious mononucleosis, and tuberculosis) or manifest as pa of chronic lymphocytic leukemia. Monocytosis refers to an increase in number of monocytes, which are circulating macrophages. Chronic infections (e.g., tuberculosis, rickettsiosis, and malaria) and chronic inflammatory conditions (e.g., collagen vascular diseases and inflammatory bowel disease) are the most common underlying causes.

So the answer to this question is B


Instruction:
Cause of bladder cancer are all except: March 2011
A. Alcohol
B. Naphthylamine exposure
C. Cigarette smoking
D. Schistosoma hematobium

Response:
Ans. A: Alcohol Cigarette smoking is the main aetiological factor for bladder carcinoma 2-naphthylamine may be carcinogenic Urothelial cell carcinoma may be strongly associated with Schistosoma haematobium infection (bilharzial bladder cancer) Carcinoma urinary bladder: Over 90% are transitional cell Ca Carcinogenic compounds: - 2 - Naphthylamine - Methylene dianiline - Benzidine - 0-toluidine Occupations at risk of bladder Ca: - Textile workers - Dye workers - Tyre workers Squamous cell Ca may be seen with: - Schistosomiasis - Stones - Irradiation - Smoking Primary adenoCa may be seen with: - From urachal remnants - From area of glandular metaplasia MC site: Trigone and posterior wall MC symptom: Painless hematuria Cystoscopy is main stay of evaluation Filling defect on IVU is the MC sign Intravesical BCG vaccine may be used in initial stages Other terms: Kiss cancer: Benign bladder tumour Tear drop bladder: Pelvic hematoma

So the answer to this question is A


Instruction:
Marker for pancreatic non-functional neuro-endocrine tumor is
A. Chromogranin-A
B. CD100
C. CEA
D. PSA

Response:
Ans is 'a' i.e. Chromogranin-A Chromogranin-A (CgA) is a glycoprotein used commonly as a tumor marker in histopathology but also has elevated circulating levels in patients with both functional and non-functional PNETs.Other markers for PNETs - pancreatic polypeptide (PPP), pancreastatin, and neuron-specific enolase (NSE).

So the answer to this question is A


Instruction:
Mission Indradhanush is for
A. non communicable disease
B. universal immunization
C. Family planning
D. safe water and sanitization

Response:
ref : park 21st ed

So the answer to this question is B


Instruction:
Efficacy of Measles vaccine after second dose:-
A. 90%
B. 95%
C. 99%
D. 100%

Response:
Efficacy of Measles Vaccine:- >90% with 1 dose. >99% with 2 doses. (AMMRS Strategy)

So the answer to this question is C


Instruction:
Most effective HDL raising drug is:
A. Omega three fatty acids
B. Niacin
C. Fenofibrate
D. Rosuvastatin

Response:
Niacin is the most effective HDL raising drug currently available. Niacin is the only drug currently available that lowers Lipoproteinp(a), and can be considered as an addition to a statin in patient with elevated Lp(a). Statins have a modest HDL-raising effect (5-10%). Fibrates are the most effective drugs available for reducing triglyceride levels and also raise HDL-C levels modestly. Omega three fatty acids are also effective in raise HDL level. Ref: Harrisons principles of internal medicine, 18th edition, Page: 3161

So the answer to this question is B


Instruction:
GnRH agonist is used in all EXCEPT
A. Delaying puberty in individuals with precocious puberty
B. Endometriosis
C. Hypoestrogenism
D. Congenital adrenal hyperplasia

Response:
(C) Hypoestrogenism# Gonadotropin-Releasing Hormone Agonist (GnRH agonist, GnRH-A) is a synthetic peptide modeled after the hypothalamic neurohormone GnRH that interacts with the gonadotropin-releasing hormone receptor to elicit its biologic response, the release of the pituitary hormones FSH and LH.# H agonists are useful in:> Suppression of spontaneous ovulation as part of controlled ovarian hyperstimulation, which is an essential component in in vitro fertilisation (IVF).> Typically, after GnRH agonists have induced a state of hypoestrogenism, exogenous FSH is given to stimulate ovarian follicle, followed by human chorionic gonadotropins (hCG) to trigger oocyte release.> GnRH agonists routinely used for this purpose are: buserelin, leuprorelin, nafarelin, and triptorelin.> Final maturation induction after having performed controlled ovarian hyperstimulation.> Usage of GnRH agonist for this purpose necessitates using a GnRH antagonist instead of a GnRH agonist for suppression of spontaneous ovulation, because using GnRH agonist for that purpose as well inactivates the axis for which it is intended to work for final maturation induction.> Treatment of cancers that are hormonally sensitive and where a hypogonadal state decreases the chances of a recurrence. Thus they are commonly employed in the medical management of prostate cancer and have been used in patients with breast cancer.> Treatment of delaying puberty in individuals with precocious puberty.> Delaying puberty pending treatment decisions in children with gender incongruency> Management of female disorders that are dependent on estrogen productions.> Women with menorrhagia, endometriosis, adenomyosis, or uterine fibroids may receive GnRH agonists to suppress ovarian activity and induce a hypoestrogenic state.> Suppressing hormone levels in transsexual people, especially trans women.> Severe cases of congenital adrenal hyperplasia> Side effects of the GnRH agonists are signs and symptoms of Hypoestrogenism, including hot flushes, headaches, and osteoporosis.

So the answer to this question is C


Instruction:
The following are true of vibrio cholerae excepta) Produces indole and reduces nitratesb) Synthesises neuraminidasec) Dies rapidly at low temperatured) Vaccine confers long immunity
A. ab
B. bc
C. cd
D. ac

Response:
None

So the answer to this question is C


Instruction:
Warm autoinumne hemolytic anaemia may be seen in all of the following conditions except :
A. Systemic lupus erythematous
B. a-Methyl dopa therapy
C. Non hodgkin's lymphoma
D. Mycoplasma pneumonia

Response:
Answer is D (Mycoplasma Pneumonia) Mycoplasma pneumoniae infections are associated with a cold antibody haemolytic anemia Autoimmune hemolytic anemias are characterized by formation of autoantibodies against patient's own red cells. Depending upon reactivity of autoantibodies these are fuher divided into two types. Warm Antibody Hemolytic Anemia Cold Antibody Hemolytic Anemia * Antibodies here bind with antigens (on RBC) at * Antibodies here bind with antiens (on RBC) better at body temperature (37degC) temperatures lower than 37degC * These antibodies are called warm antibodies and are * These antibodies are called cold reactive antibodies and are nearly IgG (Rarely IgM or IgA) usually IgM Q Causes Causes 1. Idiopathic 1. Acute: Mycoplasma infection Q Infectious mononucleosis e 2. Lymphomas: CLL Q,Non-Hodgkins, etc 2. Chronic : IdiopathicQ 3. SLE deg and other Collagen Vascular Diseases 3. Paroxysmal cold hemoglobinuria e 4. Drugs: eg. a MethyldopaQ Mechanism of Hemolysis Mechanism of Hemolysis Human red cells cooled with IgG are trapped by splenic Antibodies of IgM type bind on Red cell surface and cause macrophages - red cell destruction agglutination. Hemolytic effect is mediated through fixation of C3 to RBC surface.Q Diagnosis Diagnosis Positive direct Coomb's test, at 37degC for presence of Positive direct Coomb's test for detection of C3 on the red cell warm antibodies on surface of Red cellQ surface but 1gM responsible for coating on red cells is not Positive Indirect Coomb's test at 37degC for presence of large quantities of warm antibodies in serum. Q found. Q

So the answer to this question is D


Instruction:
Which of the following is used to compare two data sets taken on two different scales of measurement?
A. Variance
B. Coefficient of variation
C. Standard error of mean
D. Standard deviation

Response:
Ans. b. Coefficient of variation (Ref: http://en.wikipedia.org/wiki/Coefficient_of_yariation)Coefficient of variation is used to compare two data sets taken on two different scales of measurement.'For comparison between data sets with different units or widely different means, one should use the coefficient of variation instead of the standard deviation. - http://en.wikipedia.org/wiki/Coefficient_of_variationCoefficient of variation (CV)Coefficient of variation (CV) is a normalized measure of dispersion of a probability distribution or frequency distribution.It is defined as the ratio of the standard deviation to the mean.The absolute value of the CV is sometimes known as relative standard deviation (RSD). which is expressed as a percentage.AdvantagesDisadvantages* The coefficient of variation is useful because the standard deviation of data must always be understood in the context of the mean of the data.* In contrast, the actual value of the CV is independent of the unit in which the measurement has been taken, so it is a dimensionless number.* For comparison between data sets with different units or widely different means, one should use the coefficient of variation instead of the standard deviationQ.* When the mean value is close to zero, the coefficient of variation will approach infinity and is therefore sensitive to small changes in the mean. This is often the case if the values do not originate from a ratio scale.* Unlike the standard deviation, it cannot be used directly to construct confidence intervals for the mean.

So the answer to this question is B


Instruction:
The best indicator for the measurement of "completed family size", that is, the number of children a woman would have through her reproductive years is -
A. General feility rate
B. Total feility rate
C. Gross reproduction rate
D. Net reproduction rate

Response:
Total feility Rate Is standardised Index for feility level Average no of children a woman would bear in her reproductive life span ; Also known as 'Period Total Feility Rate' Gives magnitude of approximately 'Completed family size' - No of alive children in a family Obtained by summing single year age-specific rates at a given time TFR is a synthetic rate : Is not actually counted, as thus would involve waiting until women compelete child bearing TFR (India) : 2.2 (2017) Replacement level of feility : (TFR=2.1): TFR at which new born girls would have an average of exactly 1 daughter over their lifetimes (women have just enough babies to replace themselves) Replacement TFR (industrialised countries) =2.1 Replacement TFR (developing countries) =2.5-3.3 Reolacemnet TFR (globally) = 2.33 Ref: Park 25th edition Pgno : 540

So the answer to this question is B


Instruction:
What is/are effect on the membrane when extracellular concentration of K+ decreased?
A. | magnitude of RMP
B. | negativity of the membrane
C. | magnitude of RMP
D. | negativity of membrane

Response:
While K+ is positively charged and more abundant on the inside, there exists a great amount of negatively charged paicles (the anions), accounting for the negative charge inside the membrane. The cell membraneforms the border of a neuron and acts to control the movement of substances into and out of the cell. Ref guyton and hall textbook of medical physiology 12/e pg 58

So the answer to this question is B


Instruction:
Following statements are true about Afrezza except
A. Used for both Type I and Type II diabetes
B. Substitute for long acting insulin
C. It is a rapid acting insulin
D. Used as inhaled insulin formulation and techno-sphere technology

Response:
Afrezza Approved in 2014 For both Type I and Type II diabetes Available as single-use caridges of 4 and 8 units Is rapid acting inhaled insulin, administered at the beginning of each meal * Inhaled insulin formulation (2.5mm) and technosphere technology Remember: Afrezza Not a substitute for long acting insulin Must be used in combination with long acting insulin in Type I diabetes Not recommended for treatment of Diabetic Ketoacidosis or in patient who smoke. Use restricted in Asthma Active lung cancer Chronic Obstructive Pulmonary Disease

So the answer to this question is B


Instruction:
Which of the following drugs have narrow therapeutic index
A. Phenytoin
B. Lithium
C. Digoxin
D. All of the above

Response:
Therapeutic index measures the safety of the drug. Wider therapeutic index safer is the drug. Hence, drugs like lithium, Phenytoin, Digoxin which have narrow therapeutic index can become either ineffective or toxic with small variations in the dosage.

So the answer to this question is D


Instruction:
Which of the following is most useful for sex determination?
A. Skull
B. Femur
C. Pelvis
D. Tibia

Response:
Ans: C (Pelvis) Ref: The Essentials of Forensic Medicine and Toxicology by KS Moray an Reddy. 29th edition. 2010. Pg. 57-6/Explanation:According to Krogman theory, the degree of accuracy in sexing adult skeletal remains is:Entire Skeleton100 %Pelvis alone95 %Skull alone90 %Pelvis + Skull98 %Long bones alone80 %Some Important Difference Between Male and FemalePelvis (See Table-5)

So the answer to this question is C


Instruction:
All of these are the adverse effects of naloxone in the treatment of opioid poisoning except.
A. Hypeension
B. Pulmonary edema
C. Seizures
D. Ventricular dysrrythmia

Response:
Adverse effects of naloxone are uncommon, may include rise in BP , pulmonary edema,ventricular dysrrythmia. Ref: KD Tripati 8th ed.

So the answer to this question is C


Instruction:
What is TRUE about antinuclear antibody (ANA) -
A. Anti-RNA antibody is specific for SLE
B. Double stranded Anti-DNA is specific for SLE
C. ANA normally present in 80%
D. None of the above

Response:
Ans. is 'b i.e., Double stranded Anti-DNA is specific for SLE "Antibodies to double - stranded DNA and the Smith (Sm) antigen are viually diagnostic of SLE". -- Robbins Antibodies in SLE SLE is an autoimmune disease and the fundamental defect is a failure of mechanism that mantain self tolerance. o Failure of tolerance results in formation of autoantibodies and autoimmunity. o Amongst these antibodies, most impoant are antinuclear antibodies (ANA). ANAs are directed against several nuclear antigens and can be of following types. 1. Generic antinuclear antibody o Most common (between 95 to 100% of the patients). o Against DNA, RNA and proteins. o Most sensitive antibodies for SLE --> best screening test. o But, not specific because patients with other autoimmune diseases also show positive test. 2. Anti ds DNA antibody o Most specific for SLE o Not sensitive 3. Anti Smith (Sm) antibody o Along with anti ds DNA antibody, most specific for SLE. o Not sensitive 4. Antihistone antibody Paicularly seen in drug induced SLE. 5. Anti RNP- SS - A (Ro), SS-B (La) Seen in neonatal lupus with congenital hea block and in subacute cutaneous lupus. o Associated with decreased risk of lupus nephritis. o More common in sjogren syndrome (Sicca syndrome). 6. Anti Ui RNP Seen in patients that have overlap feature of several rheumatic syndromes including SLE Mixed connective tissue disease. 7. Anti DNA topoisonerase (Scl - 70) o In less than 5% of patients of SLE. o More common in patients with systemic sclerosis. 8. Anticentromere In less than 5% of patients of SLE. More common in patiens with localized form of systemic sclerosis, i.e. scleroderma. 9. Anti-histidyl t-RNA systhatase In less than 5% of SLE patiens. o More common in patiens with inflammatory myopathies. Besides antinuclear antibodies following antibodies are also seen in SLE ? 1. Antiphospholipid (lupus anticoagulant) 2. Antierythrocyte ---> causes hemolytic anemia 3. Antiplatelet --> Causes thrombocytopenia 4. Antiribosomal P 5. Antineuronal

So the answer to this question is B


Instruction:
Not true about Glossopharyngeal neuralgia
A. Eagle's syndrome
B. Reichert syndrome
C. Syncope is not seen
D. Tonsillectomy has to be done to approach and treat glossoharyngeal neuralgia

Response:
None

So the answer to this question is C


Instruction:
Which is not a complication of PUVA therapy:
A. Premature aging of skin
B. Cataracts
C. Skin cancers
D. Exfoliative

Response:
D. i.e. Exfoliation

So the answer to this question is D


Instruction:
Diencephalon represents
A. Lateral ventricle
B. 3rd ventricle
C. 4th ventricle
D. Aquedct

Response:
The diencephalon is the pa of brain between the cerebrum and brainstem.The cavity within it is called third ventricleThe pas of diencephalon are:ThalamusMetathalamusEpithalamusSubthalamusHypothalamus(Ref: Vishram Singh textbook of clinical neuroanatomy Second Edition pg -123)

So the answer to this question is B


Instruction:
Which of the following is not targeted in Millenium Development Goals (MDGs)?
A. Eradicating extreme povey
B. Fostering global panership for development
C. Reducing child moality
D. Improving health care delivery

Response:
Governments have set a date of 2015 by which they would meet the MDGs I.e, eradicate extreme povey and hunger;achieve universal primary education;promotes gender equality;improve maternal health,ensure environmental sustainability and develop a global panership for development (refer pgno:893 park 23rd edition)

So the answer to this question is D


Instruction:
All of the following are causes of primary amenorrhea, EXCEPT:
A. Rokitansky syndrome
B. Sheehan syndrome
C. Kollman syndrome
D. Turner syndrome

Response:
Sheehan's syndrome, characterized by postpaum amenorrhea, results from postpaum pituitary necrosis secondary to severe hemorrhage and hypotension and is a rare cause of secondary amenorrhea. Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome) is the second most common cause of primary amenorrhea. Kallmann syndrome results from defective hypothalamic gonadotropin-releasing hormone (GnRH) synthesis and is associated with anosmia or hyposmia due to olfactory bulb agenesis or hypoplasia. It is a cause of primary amenorrhea. Patients with Turner's syndrome usually present with primary amenorrhea. Must know: Causes of Secondary Amenorrhea: Common: Pregnancy Hypothalamic amenorrhea Pituitary amenorrhea Androgen disorders: polycystic ovarian syndrome, adult-onset adrenal hyperplasia Galactorrhea-amenorrhea syndrome Less Common: Premature ovarian failure Asherman's syndrome Sheehan's syndrome Drug-induced amenorrhea Rare: Diabetes Hypehyroidism or hypothyroidism Cushing's syndrome or Addison's disease Cirrhosis Infection Malnutrition Irradiation or chemotherapy Hemosiderosis Ref: Simon A., Chang W.Y., DeCherney A.H. (2013). Chapter 54. Amenorrhea. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.

So the answer to this question is B


Instruction:
Fournier's gangrene is seen in: September 2008
A. Scrotum
B. Shaft of penis
C. Base of penis
D. Glans penis

Response:
Ans. A: Scrotum Idiopathic scrotal gangrene/Fournier's gangrene is an uncommon condition of the scrotum. Hemolytic streptococci are associated with other organisms (Staph., E.coli etc.) in a fulminating inflammation of the subcutaneous tissues, which results in obliterative aeritis of the aerioles to the scrotal skin.

So the answer to this question is A


Instruction:
Caustic poison erodes mucosa because
A. Glue like action
B. Hygroscopic in nature
C. High affinity for mucosa
D. Being programmed to stick

Response:
B i.e. Hygroscopic in nature Caustic alkalis are the commonest cause of chemical burns. The hydroxyl ion produces a saponification of fat, soluble alkaline proteinases, cellular dehydration hygroscopic excrating water from tissues)Q, exothermic reaction, coagulation of cellular proteins and conversion of hemoglobin into haematin. Mainly in the local tissues of alimentary tract (or rarely respiratory) mucosa.

So the answer to this question is B


Instruction:
Smallest unit of antigenicity
A. Epitope
B. Paratope
C. Idiotype
D. Hapten

Response:
Epitope of antigenic determinant is the smallest unit of antigenicity.

So the answer to this question is A


Instruction:
"Guidance to eruption" is another term for
A. Frankel's appliance
B. Activator
C. Serial extraction
D. Bionator

Response:
None

So the answer to this question is C


Instruction:
alder-Reilley bodies are seen in -
A. Mucopolysacharidosis
B. Langerhans Histiocytosis
C. Alport's syndrome
D. Chediak-Higashi syndrome

Response:
Ans. is 'a' i.e., Mucopolysacharidosis Hypersegmentationo The presence of abnormally increased nuclear lobulation, is one of the first hematologic abnormalities seen in megaloblastic anemia.o Normal mature circulating neutrophils have an average of 3 lobes and always fewer than 5 lobes. Eosinophils have fewer than 4 lobes and basophils have fewer than 3 lobes.o More than 3 cells having 5 lobes or a single cell with 6 lobes found in the course of a 100 cell differential is evidence of hypersegementation.o Hypersegmentation is sometimes referred to as a myeloid "right shift". Hypersegmentation may accompany other disorders in which there is a disturbance of maturation, such as iron defiency.Pelger-Huet anomalyo A congenital autosomal dominant disorder in which granulocyte nuclei fail to segment normally, o In the homozygote state the nucleus is round. In heterozygotes most granulocytes have bilobed nuclei ("pince- nez" cells) resembling bands.o The trait is benign and occurs in 1 in 6,000 people. Cell function is normal.o An acquired or pseudo-Pelger-Huet anomaly is seen in myelodysplastic disorders and following drug therapy and may accompany leukemia and certain infections.Toxic granulationo Toxic granulation is found severe inflammatory states.o The toxic granules are azurophilic, usually found in the promyelocyte, metamyelocyte, band and segmented stages.o The toxic granulation is thought to be due to impaired cytoplasmic maturation, in the effort to rapidly generate large numbers of granulocytes.L Dohie bodieso L Dohie bodies are single or multiple blue cytoplasmic inclusions.o They represent remnants of rough endoplasmic reticulum from earlier maturational stages.o They are associated with myeloid "left shifts" and are seen in conjuction with toxic granulation.May-Hegglin anomalyo May-Hegglin anomaly is a rare autosomal dominant abnormality characterized by large pale basophilic inclusions resembling Dohie bodies and appear to be altered RNA.o Giant platelets and sometimes thrombocytopenia are associated with this. The anomaly is usually but may be associated with bleeding.The chedlak-Hagashi syndromeo The chedlak-Hagashi syndrome is a rare autosomal recessive condition associated with abnormally large leukocyte granules resulting from fusion of lysozymes.o This disorder may affect granulocytes, leukocytes and monocytes. Chemotaxis and phagocytosis is defective.o Platelets lack dense granules and platelet function is abnormal.o Giant melanosomes in occular and skin tissues result in hypopigmentation.The alder-reillv anomalyo The alder-reilly anomaly is associated with the genetic mucopoly-saccharidoses.o Patients with mucopolysaccharidoses lack the lysozymal enzymes necessary to break down mucopolysaccharides.o Dense azurophilic granules, resembling toxic granulation in neutrophils, are seen in all leukocytes.o Most characteristic of these disorders are the metachromatic granules surrounded by a clear zone seen in lymphocytes.Alder Reiilv granuleso Alder Reilly granules are larger than normal azurophilic and basophilic granules (Alder-Reilley bodies) in the cytoplasm of granulocytes, monocytes and lymphocytes seen in patients with mucopolysaccharodosis, mucopolysulfatidosis and lipofuscinosis.o Alder reilley granules stain iliac with wright giemsa and are metachromatic with toluidene blue. They are evenly distributed throughout the cytoplasm and at times may be so dense as to partially obscure the nuclear.

So the answer to this question is A


Instruction:
Actinomycosis is commonly seen in -
A. Tibia
B. Mandible
C. Scapula
D. Femur

Response:
None

So the answer to this question is B


Instruction:
Glycosylated hemoglobin in a normal pregnant lady should be less than:
A. 4.50%
B. 5.50%
C. 6.50%
D. 7.50%

Response:
The cut off for glycosylated hemoglobin in a pregnant lady is less than 6.5 %.

So the answer to this question is C


Instruction:
The substrate depleted earliest in the postoperative period is
A. Branched-chain amino acids
B. Non-branched-chain amino acids
C. Glycogen
D. Glucose

Response:
The metabolic response to surgery (and other trauma) is a result of neuroendocrine stimulation that sharply accelerates protein breakdown, stimulates gluconeogenesis, and produces glucose intolerance. The glycogen stores are rapidly depleted because of a fall in insulin and a rise in glucagon levels in the plasma. The peripheral effects of the neuroendocrine secretion result in an increase in plasma levels of amino acids, free fatty acids, lactate, glucose, and glycerol. In the liver, the coisol and glucagon stimulate glycogenolysis, gluconeogenesis, and increased substrate uptake.

So the answer to this question is D


Instruction:
Radiation dose monitoring in occupational personal is done by
A. TLD Badge
B. Linear accelerator
C. Collimators
D. Grid

Response:
ref : david sutton

So the answer to this question is A


Instruction:
All of the following are suggestive of low lesion in Anorectal malformation except ?
A. Bucket handle deformity
B. Midline raphe fistula
C. Meconuria
D. Perineal fistula

Response:
Clinical clues suggestive of low lesion 1. Bucket handle deformity - Prominent midline skin tag stem tag below which one can pass an instrument 2. Midline Raphe fistula 3. Perineal fistula - Presence of meconium coming out through a small opening anterior to anal dimple 4. Anal stenosis - Narrow anal canal 5. Anal membrane - Very thin epithelial membrane through which one can see meconium Meconuria and Flat bottom are signs suggestive of High lesion .

So the answer to this question is C


Instruction:
Sho structured primi gravida has height less then
A. 140 cm
B. 145 cm
C. 150 cm
D. 135 cm

Response:
140 cm

So the answer to this question is A


Instruction:
Delivery of stimulus above threshold intensity leads to a constant amplitude of AP and is known as:
A. All or none law
B. Electronic potential
C. Absolute refractory period
D. Relative refractory period

Response:
All or none principle - - Once AP, is elicited at any point on membrane of normal fiber, depolarization process travels over entire membrane if conditions are right, but it doesn't travel at all if conditions are not right. This is all or none principle. Relative refractory period: - It is the time, at which muscle is difficult to excite than normal but can be excited by very strong excitatory signal. Absolute refractory period: - Period during which 2nd action potential cannot be elicited, even with strong stimulus . Electronic potential: - Work per unit of charge required to move a charge from reference point to specified point is called electric potential.

So the answer to this question is A


Instruction:
Peribulbar injection is given in:
A. Subtenon space
B. Muscle case
C. Periorbital space
D. Subperiorbital space

Response:
C i.e. Periorbital space Peribulbar injection is given in peripheral orbital space Q

So the answer to this question is C


Instruction:
Following is not true about adipocere formation
A. It's a modification of putrefaction
B. Its developed in the presence of moist air
C. It occurs in dead bodies lying in water
D. Body has rotten & foul smell

Response:
Adipocere has rancid butter/ ammonical smell Mummification is odourless Decomposition is foul smelling Factors Influencing Adipocere Formation : A warm, moist and anaerobic environment ors adipocere formation. i. Environmental temperature: Heat accelerates, and cold retards adipocere formation in a body. ii. Moisture: Moisture is essential for chemical reactions to occur. It occurs rapidly in bodies submerged in water than in damp soil. iii. Bacterial infection: Early activity by anerobes such as Clostridium perfringens assist in the reaction, as the bacteria produce lecithinase which facilitates hydrolysis and hydrogenation. iv. Built: In obese people and mature newborn, it is formed quickly. v. Age: Fetuses < 7 months do not show adipocere formation. vi. Air current: It retards adipocere formation by evaporation of the body fluid, and by reducing the body temperature. vii.Running water: Adipocere formation is retarded as the electrolytes are washed away from the surface of the body which is necessary for the change.

So the answer to this question is D


Instruction:
All statements are true about Paget-Schroetter syndrome except
A. Also known as Venous thoracic outlet syndrome
B. Associated with Jugular-subclan venous thrombosis(JSVT)
C. H/O performing prolonged activities
D. Results in damage to the subclan vein

Response:
Paget-Schroetter syndrome Also k/a Venous thoracic outlet syndrome or Effo thrombosis Associated with Axillary-subclan venous thrombosis (ASVT) C/F : H/O performing prolonged activities ,Repetitive motion activities, Results in damage to the subclan vein, where it passes between head of clavicle and first rib in association with the subclavius muscle.

So the answer to this question is B


Instruction:
Bankart's lesion is seen at
A. Post surface of glenoid labrum
B. Ant surface of glenoid labrum
C. Ant part of head of humerus
D. Post part of head of humerus

Response:
Ans. is 'b' i.e Ant. Surface of glenoid labrum In anterior dislocation of shoulder following pathological changes are seen*.Bankart's lesion :Ant. Dislocation causes stripping of the glenoid labrum along with the periosteum from the anterior surface of the glenoid and scapular neck.The head thus comes to lie in front of the scapular neck, in the pouch thereby created.Hill Sach's lesion :This is a depression on the humeral head in its postero-lateral quadrant*. Caused by impingement by the interior edge of the glenoid on the head as it dislocates.Roundening of the anterior glenoid rim occurs as the head dislocated over it.There may be associated fractures of the greater tuberosity of the humerus or of the rim of the glenoid.

So the answer to this question is B