Instruction:
Which of the following is TRUE about leiomyosarcoma of breast?
A. Well encapsulated
B. Radical mastectomy is treatment of choice
C. Metastasize by lymphatic channel
D. Axillary lymph node dissection is mandatory

Response:
Leiomyosarcoma: These primary soft tissue sarcomas of the breast represent less than 1% of all breasts malignancies. It includes malignant fibrous histiocytoma and angiosarcoma. Leiomyosarcoma are malignant tumors composed of cells showing smooth features. These tumors behave as sarcoma behave elsewhere in the body. They are locally aggressive tumors & when they metastasize, it is through a hematogenous route. Palpable axillary lymphadenitis is uncommon and when encountered usually represents reactive lymph nodes univolved by metastatic disease. A clinically negative axilla in presence of large tumors may be indicative of breast sarcoma. Tumor is well circumscribed or encapsulated. Simple mastectomy is gold standard of treatment. Axillary lymph node dissection is not indicated. Postoperative radiation may be used in patient undergoing mastectomy because chest wall recurrence are observed. Ref: Breast Carcinoma By Roses, 2/e, Page 707-08

So the answer to this question is A


Instruction:
Clinical manifestation of Schizophrenia are all of the following EXCEPT:
A. Delusion
B. Altered sensorium
C. Auditory hallucinations
D. Catatonia

Response:
Ans. (b) Altered sensoriumRef : Harrison 19th ed. / 2270-71* Schizophrenia is a formal thought disorder, characterized by third person hallucination & inappropriate emotion (affect)* Altered consciousness (sensorium) is a characteristic feature seen in delirium (not in szchizophrenia)Characteristics* Only 3rd person hallucinations are characteristic of schizophrenia.* Third person hallucination means: Two or more voices talking to one another, discussing about the patient; and giving a running commentary on his actions or thoughts.* Auditory hallucination is most characteristic of Schizophrenia.

So the answer to this question is B


Instruction:
Thoracotomy is indicated in all the following except
A. Penetrating chest injuries
B. Rapidly accumulating haemothorax
C. Massive air leak
D. Pulmonary contusion

Response:
Ans. d (Pulmonary contusion). (Ref. Bailey & Love, Short Practice of Surgery, 25th/pg. 341)CHEST INJURIES# Directly or indirectly involved in 50% of trauma deaths in the USA# About 80% of chest injuries can be managed closed# A chest radiograph is the investigation of first choice# A spiral CT scan provides rapid diagnosis in the chest and abdomen# A chest drain can be diagnostic as well as therapeutic# If there is an open wound insert a chest drain# Do not close a sucking chest wound until a drain is in place# If bleeding persists, the chest will need to be opened.# One of the most vital parts of management of patient with chest trauma is to identify any threat to life mentioned below. These are surgical emergencies & operative treatment required.Immediately life threatening injuriesPotentially life threatening injuries# Airway obstruction# Aortic injuries# Tension pneumothorax# Tracheobronchial injuries# Pericardial tamponade# Myocardial contusion# Open pneumothorax# Rupture of diaphragm# Massive haemothorax# Oesophageal injuries# Flail chest# Pulmonary contusion

So the answer to this question is D


Instruction:
Xanthurenic acid is produced in
A. Tyrosine metabolism
B. Tryptophan metabolism
C. Cysteine metabolism
D. Valine metabolism

Response:
In the metabolism of Tryptophan, Kynurenin is an intermediate step. The accumulated Kynurenine is shunted to Xanthurenic acid. So, in pyridoxal deficiency, Xanthurenic acid is excreted in the urine.Ref: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 240

So the answer to this question is B


Instruction:
a patient was brought to psychiatry casuality with contraction of the neck , the patient told that it was painul. this symptom staed after the injection given at the psychiatry hospital for his psychosis. the type of side effect caused by the drug is
A. dystonia
B. neuroleptic malignant syndrome
C. akathisa
D. tardive dyskinesia

Response:
Acute dystonia * <48 hours of staing antipsychotics * M.C in======Younger black males * If a patient develops dystonia he is more prone for eps Patient considers this as an Allergic reaction , thereby may stop drugs Layryngeal dystonia is a Psychiatric emergency, should be treated with IV lorazepam TREATMENT * Diphenhydramine * Benztropine mesylate * Prophylactic anticholinergics helps Ref. Kaplonand sadock, synopsis of psychiatry, 11 th edition, page no. 925

So the answer to this question is A


Instruction:
For a survey a village is divided into 5 lanes then each lane is sampled randomly is an example is ?
A. Simple random sampling
B. Stratified random sampling
C. Systemic random sampling
D. All of the above

Response:
Ans. is 'c' i.e., Stratified random sampling Simple random sampling has been explained (See above explanation). Systematic random sampling In order to do systematic random sampling, the individuals in a population are arranged in a ceain way (for example, alphabetically). o A random staing point is selected and then every nth (for example 10th or 15th) individual is selected for the sample. o That is, after arranging the individuals in ceain pattern (e.g., alpabetically) a staing point is chosen at random, and choices thereafter at regular intervals. For example, suppose you want to sample 8 houses from a street of 120 houses. 120/8 = 15, So every 15th house is chosen after a random staing point between 1 and 15. If the random staing point is 11, then the houses selected are -4 11, 26, 41, 56, 71, 86, 101, and 116. o In contrast to simple random sampling, some houses have a larger selection probabily e.g., in this question 11, 26, 41, 56, 71, 86, 100 and 116. While the remaining number can not be selected. Stratified random sampling When sub-populations vary considerably, it is advantageous to sample each subpopulation (stratum) independently. o Stratification is the process of grouping members of the population into relative hemogenous subgroups before sampling. o The strata should be mutually exclusive, every element in the population must be assigned to only one stratum. o Then systematic random sampling method is applied within each stratum. Population Stratification -4 Systematic random sampling -4 Sample. o This often improves the representativeness of the sample by reducing sampling error. o For example, suppose in a population of 1000, sample of 100 is to be drawn for Hb estimation, first conve the population into homogenous striata (e.g., 700 males and 300 females), then draw 70 males and 30 females by doing systematic random sampling. Now see the question o First the village has been stratified into five lanes. o Then random sampling is done on each lane. o It is stratified random sampling. Multistage random sampling: o Is done in successive stages; each successive sampling unit is nested in the previous sampling unit o Advantage: Introduces flexibility in sampling. o For example, in large country surveys, states are chosen, then districts, then villages, then every 10th person in village as final sampling unit. Multiphase random sampling: Is done in successive phase; pa of information is obtained from whole sample and pa from the sub-sample. o For example, in a TB survey, Mantourx test done in first phase, then X-ray done in all Mantoux positive, then sputum examined in all those with positive X-ary findings.

So the answer to this question is C


Instruction:
Umbilical cord has -
A. 1 vein and 2 aeries
B. 2 vein and 2 aeries
C. 1 vein and 1 aery
D. 2 veins and 1 aery

Response:
Ans. is 'a' i.e., 1 Vein and 2 aeries

So the answer to this question is A


Instruction:
The overdrive mechanism observed during hyperventilation is due to
A. image_question
B. image_question
C. image_question
D. image_question

Response:
The ventral respiratory group contributes to the extra respiratory drive (overdrive mechanism) During quiet breathing: Expiration is a passive process and the neurons from the ventral respiratory group remain almost totally inactive during quiet respiration. Unlike the dorsal respiratory group (DRG; dorsal group of neurons), VRG (the ventral group of neurons) doesnot appear to paicipate in the basic rhythmic oscillations that control respiration. Extra-respiratory drive(overdrive mechanism) : When the reapiratory drive for increased pulmonary ventilation becomes greater than normal, for example, during exercise, respiratory signals spill over to VRG from DRG. So, VRG contributes to the extra respiratory drive (overdrive mechanism). The neurons of VRG contribute to both inspiration and expiration; especially, they are impoant in providing powerful expiratory signals to the abdominal muscles during very heavy expiration. Dorsal Respiratory group Ventral Respiratory group Location Nucleus Tractus Solitarius in medulla Nucleus Retro Ambigualis in medulla Function Inspiratory ramp signals- stimulates inspiration Inactive during quiet breathing; Active during forced expiration. Ref: Ganong&;s Review of Medical Physiology 26th edition Pgno: 645-657

So the answer to this question is D


Instruction:
The partial pressure of CO2 is lowest in:
A. Arterial blood
B. End tidal air
C. Expired air
D. Venous blood

Response:
Ref: Multiple sources, Guyton, 12th edition, Pages 487- 488. 502-503: Khurana, W F Ganong, Review of Medical Physiology, 23rd edition Explanation: Normal PO2 and PCO2 at various sites Atmosphere (sea level) (inspired air Alveoli Pulmonary vein Arterial blood Tissue Venous Pulmonary artery Etpurid Air pO2 160 149-160 100-105 95-100 100 40 40 40 120 pCO2 0.3 (Negligible) 0.3 (Negligible) 40 4O 40 46 45 45 27 *A11 values in 'mm Hg' Note: Expired air pCO2 - 27 (Ref: Guyton Table 39-1) Expired air pCO2 - 32 (Ref: Ganong Figure 34-15. Page 635. 24th edition)

So the answer to this question is B


Instruction:
Which of the following suppress the activity of osteoblasts?
A. Vitamin D3
B. T3 and T4
C. Coicosterone
D. Parathormone

Response:
Steroid causes inhibition of osteoblast function and potential increase in osteoblast apoptosis, resulting in impaired synthesis of new boneStimulation of bone resorption, probably as a secondary effectImpairment of the absorption of calcium across the intestine, probably by a vitamin D-independent effectIncrease of urinary calcium loss and induction of some degree of secondary hyperparathyroidismReduction of adrenal androgens and suppression of ovarian and testicular secretion of estrogens and androgensPotential induction of glucocoicoid myopathy, which may exacerbate effects on skeletal and calcium homeostasis, as well as increase the risk of falls.

So the answer to this question is C


Instruction:
Anaplastic cells often display the following morphologic features except  --------.
A. Nuclear-to-cytoplasmic ratio 1:1
B. Retention of polarity
C. Formation of tumor giant cells
D. Quadripolar mitotic figures

Response:
Anaplastic cells often display the following morphologic features:

Pleomorphism (i.e., variation in size and shape).
Nuclear abnormalities, consisting of extreme hyperchromatism  (dark-staining), variation in nuclear size and shape, or unusually prominent single or multiple nucleoli. Enlargement of nuclei may  result in an increased nuclear-to-cytoplasmic ratio that approaches 1:1 instead of the normal 1:4 or 1:6. Nucleoli may attain astounding  sizes, sometimes approaching the diameter of normal lymphocytes.
Tumor giant cells may be formed.
Atypical  mitoses, which may be numerous. Anarchic multiple spindles may produce tripolar or quadripolar mitotic figures.
Loss of polarity.

Reference-Robbins BASIC PATHOLOGY 10th edition pg-193

So the answer to this question is B


Instruction:
Midgut is supplied by which artery -
A. Superior mesenteric artery
B. Middle colic artery
C. Celiac trunk
D. Inferior mesenteric artery

Response:
Ans. is 'a' i.e., Superior mesenteric artery Part of gutDerivativesArteryForegutPharynxLower respiratory tractEsophagusStomachDuodenum upto the opening of the main pancreatic ductLiverPancreasCeliac trunkMidgutDuodenum distal to the opening of the main pancreatic ductSmall intestineAppendixCecumAscending colonTransverse colon upto th junction of right 2/3 and left 1/3SupermesentericarteryHindgutLeft 1/3 of transverse colonDescending colonSigmoid colonRectumUpper part of anal canalInferior mesentericartery

So the answer to this question is A


Instruction:
Use of shakirs tape for measuring arm circumference is -
A. Equitable distributin
B. Community participation
C. Intersectoral coordination
D. Appropriate technology

Response:
Ans. is 'd' i.e., Appropriate technology * Appropriate technology is defined as 'technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principles of self reliance with the resources the community and country can afford.'* Examples of appropriate technology -i) Use of coloured tapes (e.g. shakir tape) for measuring mid arm circumferenceii) Use of ORSiii) Growth chart maintenance for under-5 children

So the answer to this question is D


Instruction:
Collagen found in hyaline cailage is ?
A. Type I
B. Type II
C. Type IV
D. Type v

Response:
Ans. is 'b' i.e., Type II

So the answer to this question is B


Instruction:
Pinta is caused by:
A. Treponema peenue
B. Treponema carateum
C. Treponema pallidum
D. Treponema endemicum

Response:
Pinta Non-sexually transmitted spircohetal infection caused by Treponema carateum. Three sub-species of T. pallidum are known: T. pallidum, which causes syphilis T. endemicum, which causes bejel or endemic syphilis T. peenue, which causes venereal syphilis or yaws

So the answer to this question is B


Instruction:
Underdeveloped maxilla is seen in all except:
A. Cleidocranial dysplasia.
B. Treacher collins syndrome.
C. Osteogenesis imperfecta.
D. Achondroplasia.

Response:
None

So the answer to this question is B


Instruction:
Golgi tendon is innervated by which nerve fibre?
A. Ia
B. Ib
C. II
D. III

Response:
Ans. B IbGOLGI TENDON ORGAN is embedded within the musculotendinous junction (90%) and in the tendon itself (10%).* They are stimulated by: Increased tension at muscle tendon* Afferent: Ib fiber (myelinated).* Mediates inverse stretch reflexExtra MileReflexAfferent fiberStimulusResponseGolgi tendon reflexIbMuscle contractionRelaxation of the muscleStretch reflexIaMuscle is stretchedContraction of the muscleFlexor - withdrawal reflexII, III, and IVPain, touchIpsilateral flexion, contralateral extension* Group III/IV afferent fibers are afferent arm of cardiovascular ventilatory reflex responses which are mediated in nucleus tractus solitarius and ventrolateral medulla. They facilitate central fatigue and are important in endurance sports.

So the answer to this question is B


Instruction:
A toddler has few drops of blood coining out of rectum. Probable diagnosis is:(AIIMS May 2013, May 2012)
A. Juvenile rectal polyp
B. Adenomatous Polyposis Coli
C. Rectal ulcer
D. Piles

Response:
Ans. a. Juvenile rectal polyp (Ref: Sabiston 19/e p1342; Schwartz 9/e p1043: Bailey 25/e p1228; Schackelford 7/e p2030; Harrison 19/e p537, 18/e p313, 352; 17/e p250)Most common cause of passage of few drops of blood per rectum in a toddler is Juvenile rectal polyp.Juvenile polypsJuvenile polyps are the MC type of colorectal hamartomasQOccur most commonly in children <5 years of ageQ.Up to 80% of juvenile polyps occur as a single lesion of the rectumQTypical symptoms are rectal bleeding, mucus discharge, diarrhea, and abdominal painQ.Also called retention polyps due to the inflammatory obstruction of the crypt necks that leads to cystic dilation of the mucus-filled glands.No increased risk of cancerQ

So the answer to this question is A


Instruction:
The following phase diagram (in which Liquid + Beta solid solution -----------→ Alpha solid solution) shows:
A. Eutectic alloy
B. Peritectic alloy
C. Both
D. None

Response:
The peritectic reaction is an invariant reaction that occurs at a particular composition and temperature. The reaction during the cooling process can be written as:
Liquid + β solid solution → α solid solution
Figure is the phase diagram for the Ag-Pt alloy system.  The α phase is silver-rich, the β phase is platinum-rich, and the two-phase (α-plus-β) region results from the limited solid solubility of less than approximately 12% Ag in Pt at 700°C (point F) of silver in platinum. Figure shows that the equilibrium solid solubility of Pt in Ag is approximately 56% at 700°C. The peritectic transformation occurs at point P, where the liquid composition at B and the platinum-rich β phase  (composition at point D) transform into the silver-rich α phase (composition at point P).

So the answer to this question is B


Instruction:
Disease spread by hard tick is: September 2007
A. Rocky mountain spotted fever
B. Epidemic typhus
C. Murine typhus
D. Scrub typhus

Response:
Ans. A: Rocky mountain spotted fever Hard Tick-borne diseases of concern include: Human Babesiosis is a protozoan infection that occurs infrequently. Babesiosis also have Lyme disease from the same deer tick bite. Rocky Mountain spotted fever. Tularemia is a potentially serious illness. It is caused by the bacterium rodents, rabbits, and hares). Viral hemorrhagic fever Tick paralysis Colarado tick fever Viral encephalitis

So the answer to this question is A


Instruction:
A female, Lalita, aged 26 yrs accidentally takes 100 tablets of paracetamol. What is treatment of choice:
A. Lavage with charcoal
B. Dialysis
C. Alkaline diuresis
D. Acetyl cystein

Response:
D i.e. Acetyl cysteine In cases of moderate to severe poisoning of paracetamol, N? acetyl cysteine (mucomyst) should be givenQ orally within 24 hours of overdose to prevent hepatic damage. Treatment of Paracetamol poisoning 1. Gastric lavage - useful in < 4 hours. 2. < 2.5 lit fluid daily, as pcm 1/t fluid retention 3. N-acetyl cysteineQ (Treatment of choice) 4. Hemodialysis for ARF

So the answer to this question is D


Instruction:
Which one is non-ionising radiation –
A. MRI
B. CT Scan
C. X–ray
D. Position emission scintigraphy

Response:
MRI is non-ionizing radiation.

So the answer to this question is A


Instruction:
Which of these is FALSE of vulvar carcinoma?
A. Most common type is squamous cell carcinoma
B. In situ vulvar cancer occurs more commonly in older females
C. Basaloid or way type is associated with HPV
D. Keratinising type is associated with lichen sclerois and occurs in older females

Response:
Most common histological type of ca vulva is squamous cell carcinoma In situ vulval cancer occurs more commonly in young females due to rising incidence of HPV infection. Basaloid or way types Keratinizing 40% of squamous 60 % of squamous Multifocal Unifocal Younger patients Older patients Related to HPV Not related to HPV, related to lichen sclerosis Usual VIN, immunosuppression, smoking related Differentiated VIN, chronic inflammatory dermatosis

So the answer to this question is B


Instruction:
RULE OF HALVES RELATED TO-
A. OBESITY
B. BURNS
C. BLINDNESS
D. HYPEENSION

Response:
REF:-PARK 25TH EDITION PGNO:-404. RULEOF HALVES:- HYPEENSION IS AN &;ICEBERG DISEASE&;.ONLY ABOUT HALF OF HYPEENSIVE SUBJECTS IN GENERAL POPULATION OF MOST OF THE DEVELOPED COUNTRIES ARE AWARE OF THE PROBLEM WERE BEING TREATED AND ONLY HALF OF THOSE TREATED WERE CONSIDERED ADEQUATELY TREATED. 1. The whole community 2. Normotensive subjects 3. Hypeensive subjects 4. Undiagnosed hypeension 5. Diagnosed hypeension 6. Diagnosed but untreated 7. Diagnosed and treated 8. Inadequately treated 9. Adequately treated.

So the answer to this question is D


Instruction:
If the coefficient of correlation between height and weight is 2.6, TRUE is -
A. Positive correlation
B. No association
C. Negative correlation
D. Calculation of the coefficient is wrong

Response:
None

So the answer to this question is D


Instruction:
A patient of rheumatic hea disease with mitral stenosis and atrial fibrillation is on oral warfarin. On one OPD visit, his INR is found to be 6. What is the action to be taken?
A. Stop warfarin, and review
B. Stop wairfarin, and administer fresh frozen plasma
C. Stop wairfarin, and administer fresh frozen plasma
D. Stop warfarin, and administer intramuscular vitamin K

Response:
People living with RHD need to be on medication to reduce the risk of blood clots which can cause stroke. Medication may be needed if you have a hea valve replacement operation or an abnormal hea rhythm (atrial fibrillation). The most common anticoagulation medicine is called warfarin An INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin for disorders such as atrial fibrillation or a blood clot in the leg or lung. If InR increases stop anti coagulation Medication and review the patient Ref Davidson 23rd edition pg 435

So the answer to this question is A


Instruction:
In which type of Schizophrenia is grimacing a feature of:
A. Juvenile
B. Hebephrenic
C. paranoid
D. Catatonic

Response:
D. i.e. Catatonic

So the answer to this question is D


Instruction:
Which of these is not a tributary of cavernous sinus -
A. Sphenoparietal sinus
B. Superior petrosal sinus
C. Superficial middle cerebral vein
D. Inferior ophthalmic vein

Response:
Superior petrosal sinus is a draining channel (not a tributary) of the cavernous sinus.
Tributaries (incoming channels) of the cavernous sinus

Superior ophthalmic vein
A branch of an inferior ophthalmic vein or sometimes vein itself
Central vein of the retina (it may also drain into a superior ophthalmic vein)
Superficial middle cerebral vein
Inferior cerebral vein
Sphenoparietal sinus
Frontal trunk of middle meningeal vein (it may also drain into pterygoid plexus or into sphenoparietal sinus)

So the answer to this question is B


Instruction:
Mondor's disease is:
A. Thrombophlebitis of the superficial veins of breast
B. Carcinoma of the breast
C. Premalignant condition of the breast
D. Filariasis of the breast

Response:
Mondor's disease is thrombophlebitis of the superficial veins of the breast and anterior chest wall, although it may also occur in the arm. Frequently involved veins: Lateral thoracic vein, thoracoepigastric vein, superficial epigastric vein. Benign, self-limited disorder. TREATMENT NSAIDs & application of warm compresses

So the answer to this question is A


Instruction:
Which of the following is a stimulant?
A. Cocaine
B. Alcohol
C. Nicotine
D. Cannabis

Response:
Stimulants Non stimulants Methylphenidate, dexmethylphenidate Atomoxetine Amphetamines Bupropion Modafinil Clonidine, Guanfacine Cocaine Venlafaxine Nicotine has dual action to stimulate or depress neural activity.

So the answer to this question is A


Instruction:
In b-thalassemia there is:
A. Excess a-chain
B. Reduced a-chain
C. Excess b-chain
D. Reduced b-chain

Response:
d. Reduced p-chain(Ref: Ne/sosn's 20/e p 2349, Ghai 8/e p 341)In beta-thalassemia there is reduced b chain and relatively excess chain.

So the answer to this question is D


Instruction:
In an adult man weighing 70 Kgs, the Total body water volume will be about -
A. 42L
B. 25L
C. 15L
D. 12L

Response:
Ans. A. 42L60% of body weight is composed of water. Therefore, total body water in a 70 Kg man would be 60% of 70 Kg, ie, 42 Kg, which is equivalent to 42 L.

So the answer to this question is A


Instruction:
Minimum number of sputums require to confirm diagnosis TB according to RNTCP guidelines:
A. One
B. Two
C. Three
D. Four

Response:
Ans. b. TwoAFB SPUTUMS SMEARS (SS) FOR DIAGNOSIS OF CASE OF TB (NEW GUIDELINES)TB suspect A person with productive cough >2 weeks with or without hemoptysis, fever for >2 weeks, chest pain, weight loss, night sweats, and loss of appetite is subjected to 2 SS examinationsNumber of specimens required for diagnosis of smear positive pulmonary Tuberculosis: TwoChances of detecting smear positive cases:With 1 sample: 80%With 2 sample: 93%

So the answer to this question is B


Instruction:
Drug of choice for diabetic diarrhea:
A. Duloxetine
B. Clonidine
C. Domperidone
D. Alosetron

Response:
(Ref: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, Volume 1; P 575)Diabetic diarrhea is seen in middle aged type 1 poorly controlled diabetic patients and is characterized by intermittent, brown, watery and voluminous stools which is occasionally accompanied by tenesmus.In these patients, GI adrenergic function is impaired in autonomic neuropathy. Therefore, any adrenergic agonist may further stimulate the intestinal absorption of fluid and electrolytes.Drugs used areAlpha 2 adrenergic agonist: Clonidine. Acts as adrenergic antagonist which acts by reversing the peripheral adrenergic resorptive abnormalities.# Because of autonomic neuropathies, these patients will not experience postural hypotension.# Moreover, clonidine doesn't alter diabetic control or renal function.Somatostatin analogue: Octreotide. Useful in refractory diabetic diarrheaCodeine, Diphenoxylate with atropine, Loperamide:Used for symptomatic treatment.Anti-diarrheal agentsDrugsMain uses ;Tryptophan hydroxylaseinhibitor: Telotristat ethylSevere diarrhea due tocarcinoid tumorsEnkephalinase inhibitor-RacecadotrilAcute diarrheaSafe in childrenOctreotide* Severe secretory diarrhea due to GI tumors* Postgastrectomy dumping syndromeCrofelemer (plant derived)HIV/AIDS diarrheaAlosetron* Diarrhea-predominant IBS in womenBile acid sequestrants:Cholestyramine, Colesevelam, ColestipiolBile salt induced diarrheaClonidineDiabetic diarrheaMOR agonists* Diphenoxylate, difenoxin, LoperamideAcute diarrheaChronic diarrheaTraveler's diarrheaAntibiotics--empiric therapy* Fluoroquinolone* Ciprofloxacin* Levofloxacin* Norfloxacin* OfloxacinAlternative antibiotics* Azithromycin* Rifaximin* Acute diarrhea* Traveler's diarrhea* Azithromycin: Preferred treatment for children with traveler's diarrhea* Rifaxamin: Preferred for diarrhea predominant IBS

So the answer to this question is B


Instruction:
Cultivation of virus in all of the following media are used for isolation of viruses from clinical samples, EXCEPT:
A. Tissue culture
B. Embryonated eggs
C. Animals
D. Chemically defined media

Response:
Demonstration of virus in appropriate clinical specimens by culture is used in establishing the diagnosis of viral diseases. Isolation of virus is considered as the gold standard for establishing viral etiology of a disease. Most of the viruses can be cultivated in experimental animals, embryonated eggs or tissue culture. Chemically defined media is not used for viral isolation. Ref: Textbook of Microbiology and Immunology By Parija, pages 471-3

So the answer to this question is D


Instruction:
All the following are the risk factors for cervical cancer except
A. Young age at first intercourse
B. Multiple sexual paners
C. Low parity
D. Low socioeconomic status

Response:
There are numerous risk factors for cervical cancer: Young age at first intercourse (younger than 16 years), Multiple sexual paners, Cigarette smoking, race, High parity, Low socioeconomic status, and Chronic immune suppression. Reference: Novak's gynaecology; 14th edition; Chapter 35; Uterine cancer

So the answer to this question is C


Instruction:
Most common infection of the hand is - (PGI 88)
A. Acute paronychia
B. Felon
C. Web space infection
D. Palmar abscess

Response:
Ans- A Hand Infections Arrangement of fascia and fascial septa in the hand is such that many spaces are formed. These spaces are of surgical important because they may become infected and distended with pus. Spaces are as follows: Palmar spaces - Pulp space of the fingers - Midpalmar space - Thenar space Dorsal spaces - Dorsal subcutaneous space - Dorsal subaponeurotic space The forearm space of Parona Pulp Space of Finger Fig: The digital pulp space. Tips of finger and thumb contain subcutaneous fat arranged and tight compartments formed by fibrous septa which pass from skin to the periosteum of the terminal phalanx. Infection of Pulp Spaces Infection of pulp spaces also known as FELON or WHITLOW. Caused by penetrating injury from a foreign body or from fingersticks: for medical reasons (e.g. hematocrit and blood sugar determination). Staph aureus is the commonest organism to cause this infection. Swelling redness, pain, typical of cellulitis initially are presented. The pulp abscess (felon) can extend into the periosteum, around the nail bed, or proximally through the periosteum, around the nail bed, or proximally through the fibrous curtain or through the skin to the exterior over the pulp. Treatment: Incision and Drainage Web Space Infection (Collar Button Abscess) Web space infection localizes in one of the three fat filled interdigital spaces just proximal to the superficial transverse ligament at the level of metacarpophalangeal joints. Infection begins beneath palmar calluses in labourers. It may begin near the palmer surface but because skin and fascia here are less yielding it may localize to drain dorsally. Mid Palmer and Thenar Space Infection Fig: Fascial Spaces of Hand iMid palmer abscess can cause severe systemic reaction local pain and tenderness inability to move long and ring fingers because of pain and generalized swelling of hand and fingers which resemble and INFLATED GLOVE. iThenar abscess causes similar symptoms but thumb web is more swollen. The index finger is held flexed and active motion of both the index finger and thumb is impaired because of pain. Space of Parona This space is border by pronator quadratus dorsally, flexor pollicis longus laterally, flexor carpi ulnaris medially and flexor tendons on palmar aspect. Abscess of these spaces usually result from spread of infection from other parts of hand typically from purulent flexor tenosynovial infections.

So the answer to this question is A


Instruction:
Glomerulonephritis is NOT a feature of:
A. Granulomatosis with polyangiitis (Wegener's)
B. Churg-Strauss syndrome
C. Microscopic polyangiitis
D. Polyaeritis nodosa

Response:
In Polyaeritis nodosa the pathology in the kidney is that of aeritis without glomerulonephritis. In patients with significant hypeension, typical pathologic features of glomerulosclerosis may be seen. Ref: Harrisons principles of internal medicine, 18th edition, Page: 2794.

So the answer to this question is D


Instruction:
Myosin and actin filaments are kept in place by ?
A. Tropomyosin
B. Troponin
C. Actinin
D. Titin

Response:
Ans. is 'd' i.e., TitinThe side-by-side relationship between the myosin and actin filaments is difficult to maintain.This is achieved by a large number of filamentous molecules of a protein called titin.Titin molecules act as a framework that holds the myosin and actin filaments in place so that the contractile machinery of the sarcomere will work.Impoant muscle proteins Myosin :- Myosin is the protein that constitutes the thick filaments. Myosin of skeletal muscle is myosin-IL Myosin paicipates in the contractile mechanism and also acts as an ATPase.Actin :- Actin is the major protein of thin filament. It is the actin which slides over myosin during contraction.Tropomyosin : - It is the other protein of thin .filament. It covers the active sites (myosin binding sites) on actin. When Ca+2 concentration of cytoplasm (sarcoplasm) is raised, it uncovers the active sites of actin and allow the contraction So, the 'cross-bridge cycling' is switched off or on by the tropomyosin molecule which slides on the actin molecule to cover or uncover the active sites on it.

So the answer to this question is D


Instruction:
An 8-month-old female child presented to emergency with a hea rate of 220/minute and features of congestive hea failure. Her hea rate comes down to normal after administering intravenous adenosine. What is the most likely diagnosis?
A. Atrial fibrillation
B. Atrial flutter
C. Paroxysmal supraventricular tachycardia
D. Ventricular tachycardia

Response:
Ans. is 'c' i.e., Paroxysmal supraventricular tachycardia o Adenosine is the DOS for PSVT.

So the answer to this question is C


Instruction:
Mutation of which of the following gene is most impoant in Paroxysmal Nocturnal Hemoglobinuria
A. Decay accelerating factor (DAF)
B. Membrane inhibitor of reactive lysis (MIRL)
C. Glycosyl phosphatidyl inositol (GPI)
D. CD8 binding protein

Response:
.

So the answer to this question is C


Instruction:
Renal biopsy demonstrates concentric, laminated thickening of aeriolar walls due to proliferation of smooth muscle cells. This process is BEST described by which of the following terms?
A. Atherosclerosis
B. Hyaline aeriolosclerosis
C. Hyperplastic aeriolosclerosis
D. Monckeberg's aeriosclerosis

Response:
The "onion skinning" morphology of these aerioles is a feature of hyperplastic aeriolosclerosis. Affected vessels may also show necrotizing aeriolitis with acute vessel wall necrosis accompanied by fibrin deposition. This type of vessel change is a hallmark of severe (malignant) hypeension, and can damage aerioles throughout the body, notably in the kidneys, intestine, and gall bladder.Atherosclerosis would produce luminal narrowing by plaques.Hyaline aeriolosclerosis would produce paial replacement of aerial walls by homogeneous, pink material.Monckeberg's aeriosclerosis is characterized by medial calcification of smaller aeries. Ref: Chandrasoma P., Taylor C.R. (1998). Chapter 20. The Blood Vessels. In P. Chandrasoma, C.R. Taylor (Eds), Concise Pathology, 3e.

So the answer to this question is C


Instruction:
Which of the following prevent lens opacity by free radical scavenging?
A. Glutathione
B. Catalase
C. Vitamin A
D. Vitamin E

Response:
Rediced glutathione is the most impoant anti-oxidant mechanism in lens. Ref: Yanoff ch.501; Biochemistry of Lens p.330; Parson 22nd/e p.261&20th/e p.248; Alder's Physiology 10th/e p.130.

So the answer to this question is A


Instruction:
Which of the following fluoroquinolones does not require dose adjustment in a patient with creatinine clearance of < 50mg/min -
A. Ciprofloxacin
B. Trovafloxacin
C. Lomefloxacin
D. Sparfloxacin

Response:
Ans. is 'b' i.e., Trovofloxacin Fluoroquinolones that are excreted primarily by non renal mechanism and for which adjustment is not needed in renal pathology include : Nalidixic acid 3. Trovafloxacin 5. Moxifloxacin Grepofloxacin 4. Pefloxacin Fluroquinolones that are primarily excreted by renal mechanisms and for which dose adjustment is needed include: 1. Ciprofloxacin 3. Gatifloxacin 5. Lomefloxacilin 7. Ofloxacin 2. Cinafloxacin 4. Levofloxacilin 6. Norfloxacin Sparfloxacin has 50% renal and 50% faecal route of excretion and hence dose adjustment may be required in renal pathology.

So the answer to this question is B


Instruction:
Culture media of leptospirosis -
A. Korthof
B. Perkin
C. Tinsdale
D. Baker's

Response:
None

So the answer to this question is A


Instruction:
Transfusing blood after prolonged storage could lead to:
A. Citrate intoxication
B. Potassium toxicity
C. Circulatory overload
D. Haemorrhagic diathesis

Response:
Prolonged storage of blood can lead to hyperkalemia due to lysis of RBC. Citrate intoxication, circulatory overload & haemorrhagic diathesis results from massive blood trasfusion. Citrate intoxication - Hypocalcemia, manifested by circumoral numbness and/or tingling sensation of the fingers and toes. Circulatory overload - Transfusion-associated circulatory overload (TACO). Dyspnea, bilateral infiltrates on CXR with systolic hypeension and elevated levels of Brain natriuretic peptide (BNP). Haemorrhagic diathesis - Dilutional thrombocytopenia

So the answer to this question is B


Instruction:
The best diagnostic procedure of M.tuberculosis
A. PCR
B. Auramin rhodamin stain
C. Sputum culture
D. ESR

Response:
Ans. is 'c' i.e., Sputum culture "Definitive diagnosis depends on isolation (culture) and identification of M. tuberculosis from a diagnostic sepcimen (most common specimen in sputum)".

So the answer to this question is C


Instruction:
Regarding stapedial reflex, which of the following is true:
A. It helps to enhance the sound conduction in middle ear
B. It is a protective reflex against loud sound
C. It helps in masking the sound waves
D. It is unilateral reflex

Response:
Ans. is b i.e. It is a protective reflex against loud sounds Stapedius muscle helps to dampen very loud sound and thus prevents noise trauma to the inner ear. It is supplied by VII nerve (facial nerve). Lesions of facial nerve lead to loss of stapedial reflex and hyperacusis or phonophobia i.e. intolerance to loud sounds. For more details see chapter - physiology of hearing and assessment of hearing loss of the guide Stapedial reflex = Acoustic reflex

So the answer to this question is B


Instruction:
Cephalometrics was introduced by:
A. Margolis and William Wilson in 1925
B. Tweed and Mills in 1940
C. Bjork and sassouni in 1995
D. Broadbent and Hoftath in 1932

Response:
None

So the answer to this question is D


Instruction:
Venoocclusive disease of the liver is caused by:
A. Cyclophosphamide
B. Melphalan
C. Both
D. None

Response:
Potential target for sinusoidal lining cells; when these are injured, such as by high-dose chemotherapeutic agents (e.g., cyclophosphamide, melphalan, busulfan) administered prior to bone marrow transplantation, venoocclusive disease can result. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 2560

So the answer to this question is C


Instruction:
Taper present in 20 number GT file is
A. 0.06, 0.08, 0.10, 0.12
B. 0.006, 0.008, 0.01, 0.012
C. 0.6, 0.8, 1.0, 1.2
D. 0.03, 0.04, 0.05, 0.06

Response:
None

So the answer to this question is A


Instruction:
Ascorbic acid is a potent enhancer of iron absorption because it
A. Enhances the absorption of heme iron
B. Enhances the activity of heme oxygenase
C. Is a reducing agent, thereby helping to keep iron in the ferrous state
D. Decreases the production of ferritin by enterocytes

Response:
Ascorbic acid enhances iron absorption mostly by its reducing capacity, keeping iron in the ferrous state. Ascorbic acid does not enhance heme iron absorption, nor does it affect heme oxygenase activity or the produc on of ferritin or transferrin.

So the answer to this question is C


Instruction:
A child with a small head, minor anomalies of the face including a thin upper lip, growth delay, and developmental disability can have all of the following,except –
A. A chromosomal syndrome
B. A teratogenic syndrome
C. A mendelian syndrome
D. A polygenic syndrome

Response:
A syndrome with facial anomalies including a thin upper lip, growth delay and developmental disabilities is likely to result from either a teratogenic congenital malformation, a single gene defect (Mendelian) or a chromosomal disorder. A trait is called polygenic if multiple genes are thought to contribute to the phenotype and includes conditions like diabetes and hypertension. A polygenic disorder is the least likely diagnosis amongst the options provided and the single best answer of exclusion.

So the answer to this question is D


Instruction:
All are contents of the Femoral traingle except
A. Femoral nerve
B. Femoral vein
C. Superficial inguinal lymphatics
D. Nerve to pectineus

Response:
Femoral triangle : Lateral - Saorius Medial - Adductor longus Base - Inguinal ligament Contents - Femoral nerve, Femoral aery, Femoral vein,deep inguinal lymphatics, nerve to pectineus. Ref : Gray's Anatomy The Anatomical Basics of Clinical Practice 41 e pg 1362.

So the answer to this question is C


Instruction:
Patient with fixed dilated pupil, with iris atrophy and secondary glaucoma after penetrating keratoplasty is suggestive of:
A. Benedict's syndrome
B. Posner-Shlossman syndrome
C. Kaufmann's syndrome
D. Urrets Zavalia syndrome

Response:
Ans. d. Urrets Zavalia syndrome (Ref: style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif">icles/PMC1770988)A fixed dilated pupil following penetrating keratoplasty is a well recognized if rare postoperative complication.The mydriasis following penetrating keratoplasty was first described by Castroviejo but it was Urrets-Zavalia who first published his observations on a series of six cases and suggested an association of fixed dilated pupil, iris atrophy, and secondary glaucoma.The pupil can become abnormally dilated following penetrating keratoplasty for keratoconus, particularly if dilating drops are used.In addition to the pupil and iris abnormalities, Urrets-Zavalia also described other features--iris ectropion, pigment dispersion, anterior subcapsular cataract and posterior synechiae.Urrets Zavalia SyndromeUrrets Zavalia Syndrome is characterized by triad of: Secondary glaucoma + Iris atrophy + Fixed dilated pupilQUrrets-Zavalia syndrome (UZS) consists of a fixed dilated pupil associated with iris atrophy.It is a poorly understood complication following penetrating keratoplasty for keratoconus.Posner Shlossman syndromeIt is also called as glaucomatocyclitic crisis.Episodic unilateral mild anterior uveitis, photophobia, reduced vision and colored rings around lights (from secondary corneal edema)Benedict's SyndromeIf red nucleus is involved, tremors and jerky movements occur in contralateral side of the body.This condition combined with ipsilateral 3rd nerve paralysis is called as Benedict's syndrome.McKusick-Kaufmann SyndromeMcKusick-Kaufman syndrome: A rare genetic disorder characterized by hydrometrocolpos (fluid buildup in vagina and uterus), extra fingers and congenital heart defects.

So the answer to this question is D


Instruction:
Relaxation volume of lung is documented as ?
A. Functional residual capacity
B. Residual volume
C. Vital capasity
D. Closing volume

Response:
Ans. is 'a' i.e., Functional residual capacity Relaxation volume The relaxation volume is the volume of the relaxed respiratory system, i.e., the volume at which net elastic recoil of he total respiratory system is zero (the elastic recoil of chest wall is equal and opposite to that of lungs). In healthy subjects, this occurs at the end of quiet expiration, i.e., at functional residual capacity. Therefore, in healthy adults at rest FRC is essentially equal to relaxation volume of respiratory system and FRC is usually treated as synonymous with relaxation volume. However, in real sense FRC and relaxation volume are not synonymous terms and, while the two volumes are some times equal, more often they are not, i.e., active or passive mechanisms often operate to make FRC different from relaxation volume. For example, neonates have a more compliant (less stiff) chest wall. The chest wall thus has less elastic recoil to balance that of lung, thus decreasing the relaxation volume of lung. FRC then is often maintained above relaxation volume by active mechanisms like inspiratory muscle activity and slowing of expiration. Another example where FRC and relaxation volume may differ is in obstructive lung disease where FRC is dynamically determined and may be considerably above relaxation volume.

So the answer to this question is A


Instruction:
Circumvallate papillae are associated with:
A. Sweet taste.
B. Sour taste.
C. Bitter taste.
D. All of the following.

Response:
None

So the answer to this question is C


Instruction:
Most probable cause of red congested painful eye with mild dilated veically oval pupil is:
A. Acute primary angle closure glaucoma
B. Anterior uveitis
C. Keratoconjunctivitis
D. Eale's disease

Response:
Signs of acute primary angle closure glaucoma: Lids appears edematous Conjunctiva is chemosed and congested Cornea becomes oedematous and insensitive Anterior chamber is very shallow Angle of anterior chamber is completely closed as seen on gonioscopy Iris may be discoloured Pupil is semi dilated, veically oval and fixed. It is non-reactive to both light and accommodation. IOP is markedly elevated, usually between 40 and 70 mm of Hg Optic disc is oedematous and hyperemic Fellow eye shows shallow anterior and a narrow angle (latent angle closure glaucoma) Ref: Comprehensive Ophthalmology by A K Khurana, 4th edition, Page 229.

So the answer to this question is A


Instruction:
A 55 year old male presented with angina. Coronary angiography revealed a block in the right coronary aery. The condition is likely to cause a decrease in blood supply through all of the following blood vessels except
A. Acute Marginal
B. Posterior interventricular aery
C. Aery to SA node
D. Circumflex aery

Response:
Circumflex aery is not a branch of the right coronary aery. It is the branch of the left coronary aery. The branches of the right coronary aery are: Right coronary aery-It is the first branch of the right coronary aery. Aery of the SA node. Acute right marginal aery. Posterior interventricular aery (in 65% population) Atrial and anterior and posterior ventricular branches. Ref: Gray&;s Anatomy 41st edition Pgno: 1016

So the answer to this question is D


Instruction:
Which of the following muscle is blocked first by neuromuscular blocker:-
A. Face
B. Proximal limb
C. Diaphragms and vocal cords
D. Distal limb

Response:
Neuromuscular blockade usually sooner occur at well perfused centrally located muscles (diaphragm or vocal cords ) than at peripheral locations (hand or foot). Recovery occurs also in same sequence thus diaphragm and vocal cords , face, proximal limbs and distal limbs. Sequence of NM paralysis and recovery from paralysis is sameDiaphragm & vocal cords - Head & Neck - Upper Limb - Trunk - Lower Limb

So the answer to this question is C


Instruction:
Commonest variety of carcinoma stomach is:(1991)
A. Squamous carcinoma
B. Adenocarcinoma
C. Colloid carcinoma
D. None

Response:
Ans: b

So the answer to this question is B


Instruction:
True about anopheles mosquito-
A. Larvae have siphon tube
B. Larvae are surface feeder
C. Larvae are bottom feeder
D. Larvae tie at an angle to water surface

Response:
Anopheles mosquito: Eggs are laid singly, boat-shaped with lateral floaters Larvae rest parallel to the surface and are thus surface feeders, have no siphon tube, palmate hairs are present Adults at rest are inclined at an angle to the surface, wings are spotted, palpi are long in both sexes. Only option 2 is correct. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 831.

So the answer to this question is B


Instruction:
All are features of A-type 1 Except
A. Renal stones
B. Fanconi syndrome
C. No anion gap
D. Decreased potassium

Response:
The typical findings in acquired or inherited forms of classic distal A (type 1 A) include hypokalemia, non-AG metabolic acidosis, low urinary NH4+ excretion (positive UAG, low urine ), and inappropriately high urine pH (pH > 5.5). Most patients have hypocitraturia and hypercalciuria, so nephrolithiasis, nephrocalcinosis, and bone disease are commonReference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 66; Acidosis and Alkalosis

So the answer to this question is B


Instruction:
A patient with glaucoma is being treated with systemic beta blocker. All of the following can be given to the patient except?
A. Brimonidine
B. Dorzolamide
C. Levobunolol
D. Prostaglandin

Response:
Ans. c. Levobunolol (Ref: KDT 7/e p154, 6/e p144: 5/e p85)Brimonidine, dorzolamide and prostaglandin are topical anti-glaucoma drugs. These drugs do not have systemic side effects, while levobunolol (beta-blocker) is systemic anti-glaucoma drug given orally, having systemic side effects. That is why in patients with glaucoma treated with systemic beta blockers, levobunolol may add on the side effects of beta-blockers, hence, avoided in the above mentioned patient.Topical Anti-glaucoma DrugsAdrenergic agonistNon-selective: Epinephrine, DipivefrineAlpha2-selective: Apraclonidine, BrimonidineAdrenergic antagonistBeta-blocker (Non-selective): Timolol, Levobunolol, Carteolol, Metipranolol, AdapralolBeta 1-blocker: BetaxololMiotics (direct parasympatomimetics)Pilocarpine, PhysostigmineEcothiophate. Carbachol, DemacariumProstaglandin analoguesLatanoprostCarbonic anhydrase inhibitorsDorzolamideSystemic Antiglaucoma DrugsCarbonic anhydrase inhibitorsHyperosmotic agents* Acetazolamide* Dichlorphenamide* Methazolamide* Mannitol* Glycerol

So the answer to this question is C


Instruction:
Acute hemorrhagic conjunctivitis is caused by ?
A. Enterovirus 70
B. Adenovirus
C. Poliovirus
D. Hepadnavirus

Response:
Ans. is 'a' i.e., Enterovirus 70 Acute hemorrhagic conjunctivitis (AHC) may be caused by adenoviruses, but two enteroviruses, enterovirus 70 and coxsackie A24 variant, are the major causes.

So the answer to this question is A


Instruction:
Lambda phage true ist:
A. Cause mad cow disease
B. Lytic and lysogenic interconversion can't occur
C. Lytic form incorporated within host DNA and multiply causing rupture of cell membrane
D. Lysogenic form incorporates with host DNA and remains dormant

Response:
Ans. (a) Transduction Transmission of genetic material = gene transfer = acquisition of characteristic occur by four process. a. Transformation: - Transfer of genetic information (about 10-50 genes) through the free DNA. Seen mainly in pneumococci; bacillus species and Hemophilus influenza. Any characteristic may be transferred by transformation. b. Transduction: - Transfer of poion of DNA from one to other bacteria by agency of bacteriophage (acts only as vehicle). It may be generalised (when it involves any segment of donor DNA) or restricted (when specific bacteriophage transduces only a paicular genetic trait). It is most widespread mechanism of gene transfer among prokaryotes. Episomes and plasmids (e.g. plasmid determining Pn resistance in staphylococci) may also transduced. It is used in genetic engineering in the treatment of some inborn errors of metabolism. c. Conjugation Bacterial equivalent of sexual mating Described by Lederberg and Tatum in strain of E. coli (K12), e.g. Transfer of episomes and plasmids of drug resistance. d. Lysogenic conversion: - Phage DNA becomes integrated with bacterial chromosome as the prophage which codes for new characteristic, e.g. toxin production in C. diptheriae.

So the answer to this question is A


Instruction:
Which of the following is true of Wilson's disease all except -
A. Autosomal recessive
B. Serum ceruloplasmin level < 20 mg/d1
C. Urinary coppor excretion < 100 microgram/c11
D. Zinc acetate is used as maintence therapy

Response:
Urinary copper excretion <100 microgram/di Symptomatic pts. of Wilson disease invariably have urine copper levels > 100 pg per day. Wilson disease is an autosomal recessive disorder caused by mutation in the ATP 7B gene (a copper transpoing ATPase) Diagnosis - The gold standard for diagnosis is Liver biopsy with quantitative copper assayQ. Other diagnostic tests used are ? - Serum ceruloplasmin levelQ - KF rings(2 - Urine copper excretiono - DNA Helpful-ye analysisQ Serum copper values have no diagnostic value, since they may be low, normal or elevated depending upon the stage of evolution of disease. Table : Useful Diagnostic Tests for Wilson Disease Test Normal Value Wilson Disease Serum 180-350 mg/L ceruloplasmin (18-35 mg/d1) * Low in 85% * Present in 99% KF rings Absent - If neurologic or psychiatric symptoms present. * Present in 30-50% - in hepatic presentation and presymptomatic state * Urinary copper excretion is increased 24-h urine Cu 0.3-0.8 mmol - >1.6intn ol(>100mg) in symptomatic patients * 0.9 to > mmol (60 to > 100 mg) - in presymptomatic patients Liver Cu 0.3 -- 0.8 mmol/g * Liver copper is increased (20-50 mg) tissue * > 3.1 mmol (200 mg) Haplotype analysis 0 Matches 2 Matches Treatment Zinc is the treatment of choice for Wilson diseaseQ. It produces a negative copper balance - By blocking intestinal absorption of copper - By inducing hepatic metallothionein synthesis which sequesters additional toxic copper. Table : Recommended Anticopper Treatments for Wilson Disease Disease Status First Choice Second Choice Initial hepatic manifestations Zinc Trientine and zinc Trientine and zinc Hepatic transplantation Trientine Penicillainine and zinc Hepatic transplantation Trientine and zinc * Hepatitis or cirrhosis without decompensation * Hepatitis or Cirrhosis with decompensation - Mild - Moderate - Severe Initial neurologic/psychiatric Tetraioinolybdate and zinc Trientine and zinc Maintenance therapy Zinc Trientine Presymptomatic therapy Zinc Trientine Pediatric Zinc Trientine Pregnant Zinc Trientine

So the answer to this question is C


Instruction:
All of the following are known complication of pancreatitis except?
A. Pancreatic abscess
B. Colonic necrosis
C. Pancreatic malignancy
D. Pancreatic fistula

Response:
Pancreatic malignancy is not a complication of acute pancreatitis. The other complications of acute pancreatitis are pancreatic pseudocyst, intraperitoneal haemorrhage, pleural effusion, atelectasis, pneumonia, ARDS, DIC, peptic ulcer disease, erosive gastritis, poal vein thrombosis, oliguria, azotaemia, acute tubular necrosis, hyperglycaemia, hypocalcaemia, fat emboli, Puscher's retinopathy, hyperiglyceridaemia etc.

So the answer to this question is C


Instruction:
CURB 65 criteria include all except
A. Age more than or equal to 65
B. RR more than 30/min
C. Systolic BP more than 90mmHg
D. BUN level more than 7mmol/L

Response:
Image ref Davidsons 23e p563

So the answer to this question is C


Instruction:
BCR ABL gene mutation is seen in?
A. CML
B. AML
C. CLL
D. ALL

Response:
CML is distinguished from other myeloproliferative disorders by the presence of a chimeric BCR-ABL gene derived from the poions of BCR gene on chromosome 22 and ABL gene on chromosome 9.It directs the synthesis of a constitutively active BCR-ABL tyrosine kinase. Reference; Robbins and Cotran Pathologic basis of disease.South Asia Edition volume 1.page no. 616

So the answer to this question is A


Instruction:
Fasciotomy -all of the following are cut except:
A. Skin
B. Superficial fascia
C. Deep fascia
D. Muscles

Response:
Fasciotomy must release skin, superficial fascia and deep fascia. Fig. Forearm fasciotomy Fasciotomy is an emergency procedure used to release pressure in compament syndrome either due to trauma or infections.

So the answer to this question is D


Instruction:
One of them is NOT a principle of health education:
A. Credibility
B. Feedback
C. Setting an example
D. Utilization

Response:
None

So the answer to this question is D


Instruction:
Pleomorphic adenoma is usually arise from
A. Parotid gland
B. Sub mandibular gland
C. Minor salivary gland
D. Superficial lobe

Response:
(Parotid gland) (546-HM) (584-Basic pathology 8th)Pleomorphic adenoma (Mixed salivary tumour) is the commonest tumour in the parotid gland and occurs less often in other major and minor salivary gland, common in females.

So the answer to this question is A


Instruction:
Ductus arteriosus closes in response to –
A. Decrease in peripheral oxygen saturation
B. Indomethacin therapy
C. Prostaglandin E1
D. Increase in pulmonary vascular resistance

Response:
None

So the answer to this question is B


Instruction:
Gustafson's method used for age estimation of the tooth includes all except -
A. Primary dentition
B. Root resorption
C. Root transparency
D. Attrition

Response:
Gustafson's method includes :

(i) Attrition,
(ii) Paradentosis,
(iii) Secondary dentin formation,
(iv) Cementum apposition,
(v) Root resorption and
(iv) Transparency of the root.

So the answer to this question is A


Instruction:
Lesion of ventrolateral spinal cord will show:
A. Loss of proprioception on the same side
B. Loss of proprioception on the contralateral side
C. Loss of pain and temperature on same side
D. Loss of pain and temperature on contralateral side

Response:
None

So the answer to this question is D


Instruction:
The Kennedy classification that is more suitable for an
internal attachment is
A. Class 1
B. Class 2
C. Class 3
D. Class 4

Response:
None

So the answer to this question is C


Instruction:
Regarding ribosome all is true except
A. 16 S ribosome identifies shine- dalgamo sequence
B. Cytosolic ribosomes synthesize proteins of peroxisome
C. Large subunit catalyzes peptide bond formation
D. Binding of aminoacyl tRNA uses 2ATP

Response:
D i.e. Binding of aminoacyl tRNA uses 2ATP- Component of 50s subunit are 23s & 5s; and components of 60s subunit are 28s, 5.8s and 5s.Ribosome is a highly conserved natural machine for protein synthesis that brings m-RNA & t-RNA togetherQ. It has 2 subunits the large subunit catalzes peptide bond formation whereas small subunit is responsibl for accuracy. 16s rRNA component of 30s subunit identifies & binds shine Dalgarno sequence. Binding of aminoacyl tRNA to A site uses 1 GTP. Free cytosolic ribosomes synthesize proteins required in cytosol, nucleus, mitochondria & peroxisomes. Whereas RER bound ribosome form proteins for various plasma membranes.

So the answer to this question is D


Instruction:
All of the following are taken into consideration in Kuppuswamy scale EXCEPT-
A. Education status
B. Occupational status
C. Living/Housing conditions
D. Per capita Income

Response:
Ans. is 'c' i.e., Living/Housing conditions

So the answer to this question is C


Instruction:
All are features of hemolytic uremic syndrome, EXCEPT:
A. Thrombocytopenia
B. Anemia
C. Renal dysfunction
D. Neuro-psychiatric disturbances

Response:
Neuro-psychiatric disturbances are not a feature of hemolytic uremic syndrome, but may be seen in TTP. HUS: Hemolytic-uremic syndrome (HUS) is a common cause of community acquired acute kidney injury in young children characterised by a triad of Microangiopathic Hemolytic anemia Thrombocytopenia Renal dysfunction In HUS, capillary and aerial endothelial injury in kidney leads to localized thrombosis. The entrapment of platelets in micro-thrombi formed in small blood vessels leads to thrombocytopenia. The consumption of clotting factors due to initiation of coagulation cascade leads to hypofibrinogenemia. Microangiopathic hemolytic anemia results from mechanical damage to red blood cells as they through the damaged and thrombotic microvasculature.

So the answer to this question is D


Instruction:
The following are indications for assisted ventilation in acute severe asthma EXCEPT?
A. PEFR 50-60% of predicted value
B. Rising PaCO2> 6kPa (45 mm Hg)
C. Diminishing level of consciousness
D. Falling PaO2< 8kPa (60 mm Hg)

Response:
PEFR of 50-60% indicates moderate asthma. Indication for intubation in asthma exacerbation is a poor response to oxygen with salbutamol nebulisation and oral steroids. The definition of poor response is: 1. FEV1< 40%. 2. PaCO2> 45mmHg. 3. Features of carbon dioxide narcosis. 4. Hypoxia defined as PaO2<60 mm Hg.

So the answer to this question is A


Instruction:
All of the following are true about Ewing's sarcoma, EXCEPT
A. Responds well to radiotherapy
B. Grows in diaphysis of long bones
C. Common in 4th decade
D. Has onion peel appearance on radiograph

Response:
(C) Common in 4th decade # Ewing sarcoma, a highly malignant primary bone tumor.> The tumor is derived from red bone marrow.> Most frequently, it is observed in children and adolescents aged 4-15 years and rarely develops in adults older than 30 years.> Ewing sarcoma is the second most common malignant bone tumor in young patients, and it is the most lethal bone tumor.> Typically, the periosteal reaction and new bone formation with an onionskin appearance may suggest the diagnosis of E wing sarcoma.> It is highly radiosensitive and it melts like ice but only to recur at a later date.

So the answer to this question is C


Instruction:
'Tram-track' calcification on skull radiograph is characteristic of
A. Congenital CMV infection
B. Congenital toxoplasmosis
C. Sturge Weber syndrome
D. Craniopharyngioma

Response:
.

So the answer to this question is C


Instruction:
Regarding HIV transmission to foetus all are true except –a) > 50% risk of transmission to foetusb) Can present as failure to thrivec) Greatest risk of transmission of in perinatal periodd) Cannot be diagnosed
A. b
B. ad
C. ac
D. ab

Response:
None

So the answer to this question is B


Instruction:
Giving Benzathine penicillin in RHD is a type of -
A. Primary prevention
B. Secondary prevention
C. Teiary prevention
D. Primordial prevention

Response:
park's textbook of preventive and social medicine 23rd edition. *in children :Im injection of benzyl pencillin 600000 units. *in adult :1.2 million units. *this must be continued for 5 years or until the child reaches 18 years.

So the answer to this question is B


Instruction:
Which of the following is the LEAST likely physiological change in pregnancy?
A. Increase in intravascular volume
B. Increase in cardiac output
C. Increase in stroke volume
D. Increase in peripheral vascular resistance

Response:
Blood volume expansion begins early in the first trimester, increases rapidly in the second trimester, and plateaus at about the 30th week. Cardiac output increases approximately 40% during pregnancy, with maximum values achieved at 20-24 weeks' gestation. Stroke volume increases 25-30% during pregnancy, reaching peak values at 12-24 weeks' gestation. Vascular resistance decreases in the first trimester, reaching a nadir of approximately 34% below nonpregnancy levels by 14 to 0 weeks of gestation with a slight increase toward term. Ref: Flick A.A., Kahn D.A. (2013). Chapter 8. Maternal Physiology during Pregnancy & Fetal & Early Neonatal Physiology. In DeCherney A.H., Nathan L, Laufer N, Roman A.S. (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.

So the answer to this question is D


Instruction:
Nasal intubation is contra indicated in –
A. CSF Rhinorrhea
B. Fracture cervical spine
C. Fracture inaudible
D. Short neck

Response:
Nasal intubation is contraindicated in : Basal skull fracture, CSF rhinorrhea, coagulopathy, nasal polyp / abscess / foreign body and adenoid.

So the answer to this question is A


Instruction:
Which of the following favours filtration at the arteriolar end of the capillary bed
A. Decrease in hydrostatic pressure of capillaries
B. Increase in hydrostatic pressure of capillaries
C. Increase in oncotic pressure of capillaries
D. Decrease in oncotic pressure of interstitium

Response:
For filtration to take place at the capillaries, the hydrostatic pressure should be more in capillaries than the interstitium, or the oncotic pressure in capillaries should be less than that in the interstitium.

So the answer to this question is B


Instruction:
Residual auditory defect is a common complication in meningitis caused by -
A. Staphylococcus
B. Meningococcus
C. Escherichia coli
D. Hemophilus influenza

Response:
Ans. is 'd' i.e., Hemophilus influenzae

So the answer to this question is D


Instruction:
Magnesium sulphate potentiates the hypotensive action of -
A. Methyldopa
B. Nifedipine
C. Enalapril
D. Hydralazine

Response:
ans-B

So the answer to this question is B


Instruction:
Following is given with iron to increase its absorption ?
A. Milk
B. Antacids
C. Citrus fruits
D. Alkalies

Response:
Ans. is 'c' i.e., Citrus fruits Citrus fruits are good sources of vitamin C (ascorbic acid) which increases intestinal absorption of iron.

So the answer to this question is C


Instruction:
Thick ascending limb of loop of Henle has-
A. Na+ K+ cotransporter
B. Na+Cl- cotronsporter
C. Na+ H+ cotronsporter
D. Na+ K+ 2C1- transporter

Response:
Ans. is 'd' i.e., Na+ K+ 2C1- transporter Na+ reabsorptiono 60-70% in proximal tubule - by Na" - H+ exchange, Na+ - Glucose contransport, Na+ - aminoacid cotransport, Na+ unitransport.o 30% in thick ascending limb of loop of Henle by Na+ - 2C1- - K+ cotransport.o 7% in early distal tubule - Na+ Cl- cotransporto 3% in late distal tubule and collecting duct - via ENaC channelso Na+ is reabsorbed in all segments of nephron except for thin descending limb of loop of Henle.

So the answer to this question is D


Instruction:
Most common affected by Blunt trauma abdomen?
A. Spleen
B. Intestine
C. Liver
D. Mesentery

Response:
Ans. (a) SpleenRef: Bailey & Love 26th ed./1087* The spleen is the most commonly injured viscus in blunt abdominal trauma and can result from the most trivial of traumas.* The classical presentation is that of a hemodynamically unstable patient with a history of trauma, with severe abdominal pain and signs of peritonitis.* The classic physical'findings of splenic rupture are left shoulder pain, left upper quadrant pain and tenderness, and Kehrs sign (left shoulder pain from irritation of inferior border of left diaphragm by hematoma).* Absence of one or more or even all of these signs does not rule out splenic injury. Diagnosis is based on a thorough physical examination and confirmed with the FAST examination

So the answer to this question is A


Instruction:
A 30 year old manic patient was prescribed haloperidol one week back. For the last two days, he has become restless and kept pacing in the room for a day. On examination, he was found to have tremors of hand. He is most likely suffering from -
A. Anhedonia
B. Dystonia
C. Restless leg syndrome
D. Akathisia

Response:
Restlessness and pacing in room within 1 week of antipsychotic (haloperidol) therapy suggest the diagnosis of Akathisia.

So the answer to this question is D


Instruction:
Lymphocyte phenotype test done for?
A. Agammaglobinemia
B. SCID
C. Sepsis
D. Acute leukemia

Response:
Ans. (b) SCID(Ref: HENRY'S Clinical Diagnosis and Management by Laboratory Methods; 22ned ed/ pg 944-945)Lymphocyte phenotyping for assessing immune deficiency includes CD3 (pan T cell), CD4 (T helper subset), CD8 (T cytotoxic/suppressor subset), CD 19 (pan B cell), CD 16/56 (pan NK cell) and other cell surface markers as required based on clinical data. This analysis is indicated in diagnosis and monitoring of immunodeficiencies and immunotherapy in children and adults

So the answer to this question is B


Instruction:
Eosinophilic pustular folliculitis a rare form of folliculitis that is seen with increased frequency in patients with ?
A. ABPA
B. Asthma
C. Leukemia cutis
D. HIV infection

Response:
Eosinophilic pustular Folliculitis is most prevalent in HIV infection and is seen in ~20% of patients. m/c in patients with CD4+ T cell counts <200 cells/mL Presents as multiple, uicarial perifollicular papules that may coalesce into plaque like lesions. Skin biopsy reveals an eosinophilic infiltrate of the hair follicle, which in ceain cases has been associated with the presence of a mite. Patients have an elevated serum IgE levels and may respond to treatment with topical antihelminthics.

So the answer to this question is D


Instruction:
Which of the following is the only reversible cataract:
A. Senile cataract
B. Cataract in galactosemia
C. Congenital cataract
D. None

Response:
Ans. Cataract in galactosemia

So the answer to this question is B


Instruction:
Uses of estrogen are all except -
A. Senile vaginitis
B. Carcinoma prostate
C. Breast cancer
D. Delayed pubey

Response:
Ans. is 'c' i.e., Breast cancer Antiestrogens (not estrogen) are used in breast cancer.

So the answer to this question is C


Instruction:
Which of the following is true in case of AIDS patient?
A. Acute pain
B. Diffuse red lesion of the attached gingiva
C. Gingiva covered with pseudomembrane
D. Gingival itching

Response:
None

So the answer to this question is B


Instruction:
Thalidomide was once used for treating emesis of pregnancy. Later it was withdrawn from market due to side effects. But it was reintroduced for certain indications like multiple myeloma. All of the following are side effects of thalidomide except :
A. Hypothyroidism
B. Diarrhea
C. Teratogenicity
D. Deep Vein Thrombosis

Response:
None

So the answer to this question is B


Instruction:
M/C ovarian cancer associated with endometriosis:
A. Endometroid tumor
B. Clear cell tumor
C. Germ cell tumor
D. Brenner tumor

Response:
Ans. is b, i.e. Clear cell tumorM/C ovarian cancer associated with endometrial cancer: Endometrioid tumorM/C ovarian cancer associated with endometriosis: Clear cell carcinoma

So the answer to this question is B


Instruction:
The most common termination of lobar pneumonia is-
A. Consolidation
B. Resolution
C. Abscess formation
D. Empyema

Response:
In the usual course of pneumonia, the final stage is a resolution.
However, in some neglected cases following complications may develop -

(i) Abscess formation
(ii) Organization
(iii) Empyema
(iv) Pleural effusion, pleuritis
(v) Bacteremic dissemination → Brain abscess, endocarditis, meningitis, suppurrative arthritis.

So the answer to this question is B


Instruction:
True about Myeloma is all, EXCEPT
A. Plasma cell clonal proliferation
B. Common after 50 yrs of age
C. Amyloidosis can occur
D. Protein casts in urine are made up of complete Ig chains

Response:
Ans. is 'd' i.e., protein casts in urine are made up of complete Ig chains Protein casts in urine are made up of light chains only Complete Ig chain comprises of both heavy chain & light chain but in Multiple myeloma there is excess production of light chains over heavy chains. These light chains are eliminated in urine as Bence Jones Protein *.

So the answer to this question is D


Instruction:
All can take split thickness graft except -
A. Fat
B. Muscle
C. Skull bone
D. Deep fascia

Response:
"The skin graft must be applied to a well-vascularized recipient wound bed. It will not adhere to exposed bone, cartilage, or tendon devoid of periosteum, perichendrium or peritenon, respectively, or devoid of its vascularized perimembranous envelope." - Sabiston 17/e p 2185

So the answer to this question is C


Instruction:
The appearance of this foot is most consistent with which one of the following diagnoses?
A. Buruli ulcer
B. Chromoblastomycosis
C. Leishmaniasis
D. Madura foot

Response:
Answer B. ChromoblastomycosisThe patient lived in a rural area and had walked barefoot for most of his life. Several nodular and verrucous lesions were seen in the distal region of the foot. Analysis of a skin-biopsy specimen revealed findings diagnostic for chromoblastomycosis. Chromoblastomycosis is a chronic, soft-tissue fungal infection commonly caused by Fonsecaea pedrosoi, Phialophora verrucosa, Cladosporium carrionii, or F. compacta. The infection occurs in tropical or subtropical climates and often in rural areas.

So the answer to this question is B


Instruction:
Which is not secreted by placenta ?
A. HPL
B. HCG
C. Prolactin
D. Progesterone

Response:
Prolactin

So the answer to this question is C


Instruction:
All are true about cartilage, hair hypoplasia syndrome except –
A. Neutropenia
B. Depigmentd hair
C. Non functioning T cells
D. None of the above

Response:
Cartilage-hair hypoplasia syndrome

Cartilage-hair hypoplasia is an unusual form of short-limbed dwarfism with frequent and severe infections.
It is an autosomal recessive condition.

Feature of CHH

Short limb dwarfism.
Very fine thin light hairs and eyebrows.
Hyperextensible joints of hands and feet but an inability to extend.
Abnormalities of the spine.
Neutropenia
Defective antibody-mediated immunity.
Severe combined immunodeficiency and combined immunodeficiency.
Decreased number of T cells and defective T cell proliferation, cell-mediated immunity is also decreased.
Nothing is written about the function of T cell, only their number is decreased.

So the answer to this question is C


Instruction:
Only drug used in pregnancy with syphilis ?
A. Penicillin
B. Clinadmycin
C. Azithromycin
D. Erythromycin

Response:
Ans. is'a'i.e., Penicillin[Ref: Harrisons 18th/e p. 1j871Management of Syphilis in Pregnancy:Penicillin is the only recommended agent for the treatment of syphilis in pregnancy.If the patient has a documented penicillin allergy, desensitization and penicillin therapy should be undeaken according to the CDC's 2010 guidelines.

So the answer to this question is A


Instruction:
A 44-year-old man with a stab wound was brought to the emergency depament and a physician found that the patient was suffering from a laceration of his right phrenic nerve. Which of the following conditions has likely occurred?
A. Injury to only general somatic efferent fibers
B. Difficulty in expiration
C. Loss of sensation in the pericardium and mediastinal pleura
D. Normal function of the diaphragm

Response:
Loss of sensation in the pericardium and mediastinal pleura because Phrenic nerve supply (sensory) central pa of diaphragm, pain from pericardium, mediastinal and diaphragmatic pleurae and peritoneum in the undersurface of diaphragm. Difficulty in inspiration on injury to phrenic nerve.

So the answer to this question is C


Instruction:
To achieve a NRR of 1, Couple protection rate should be: March 2005
A. More than 30%
B. More than 40%
C. More than 50%
D. More than 60%

Response:
Ans. D: More than 60% Couple protection rate is an indicator of the prevalence of contraceptive practice in the community. It is defined as the percent of eligible couples effectively protected against childbih by one or the other approved methods of family planning. CPR is based on the observation that 50-60% of bihs in a year are of bih order 3 or more. Thus attaining a 60% CPR will be equivalent to cutting off almost all third or higher order bihs, leaving 2 or less surviving children per couple So demographic goal of NRR=1 can only be achieved only if the CPR exceeds 60%.

So the answer to this question is D


Instruction:
Intraosseous line is placed in which bone in children?
A. Femur
B. Tibia
C. ASIS
D. Iliac crest

Response:
Ans. (b) TibiaRef.: Nelson's 18" ed./ch. 66* If venous access is not available in an arrest situation within 1 min, an intraosseous line should be placed in the anterior tibia (with care taken to avoid traversing the epiphyseal plate)* The needle should penetrate the anterior layer of compact bone, with its tip advanced into the spongy interior of the bone.* Intraosseous needles are special rigid, large-bore needles that resemble those used for marrow aspiration. Current recommendations urge the use of intraosseous cannulation in patients for whom intravenous access proves difficult or unattainable, even in older children.* Once the patient has received initial drug and fluid therapy through the IO line, every effort should be made to obtain more conventional central venous access and remove the 10 line as soon as possible.* Alternative sites for intraosseous (IO) insertion include the distal tibia, distal femur, sternum, and humerusComplications of 10 Infusion* Extravasation of fluid is the most common complication and occurs when a needle is misplaced* Compartment syndrome is a risk with IO insertion.* Extravasation of hypertonic or caustic medications, such as sodium bicarbonate, dopamine, or calcium chloride, can result in necrosis of the muscle.* Infection and osteomyelitis are relatively rare complications and occur most commonly if aseptic technique is not followed during insertion.* Other possible complications include local hematoma, pain, fracture and growth plate injuries (with incorrect placement), and fat microemboli (not clinically significant) and compartment syndrome

So the answer to this question is B


Instruction:
Barr body was first detected in: DNB 08
A. Buccal mucosa
B. Brain
C. Liver
D. Skin

Response:
Ans. Brain

So the answer to this question is B


Instruction:
Microscopic Hematuria is defined as:
A. >5 RBCs/high power field
B. >10 RBCs/high power field
C. >15RBcs/high power field
D. >20RBCs/high power field

Response:
Ans. A. >5 RBCs/high power fieldPresence of blood in urine imparts it a colour, which includes various shades of deep red, smoky brown, cola colored and faint pink. Parents may even confuse very concentrated urine with hematuria. Hematuria can then be confirmed by presence of RBC in urine analysis. Presence of >5RBCs/HPF suggests hematuria.

So the answer to this question is A


Instruction:
Which of the following expectorant causes gastric irritation & reflex increase in bronchial gland secretions
A. Ambroxol
B. Guaifenesin
C. Sodium cromoglycate
D. Fosaprepitant

Response:
Guaifenesin, hypertonic saline & ammonium cloride are the expectorants that cause gastric irritation and also reflexly increase bronchial gland secretions.

So the answer to this question is B


Instruction:
LEAST diagnostic test for breast tumours: March 2013
A. Chest X-ray
B. Biopsy
C. USG
D. Mammography

Response:
Ans. A i.e. Chest X-ray

So the answer to this question is A


Instruction:
Commonest cause of intestinal obstruction in children is -
A. Intussusception
B. Volvulus
C. Hernia
D. Adhesions

Response:
Ans. is 'a' i.e., IntussusceptionIntussusceptiono Intussusception occurs when a poion of the alimentary tract is telescoped into an adjacent segment.o It is the most common cause of intestinal obstruction between 3 months and 6 year of age. o It is more common in males.o Intusssception may be --> i) Ileocolic (most common) ii) Cecocolic iii) Ileoilealo The upper poion of bowel that invaginates into lower poion is called intussusceptum. o Lower poion which recieves telescoped upper poion is called intussuscipiens.

So the answer to this question is A


Instruction:
True about hyperacute rejection in renal transplant:
A. Occur within few days of transplant
B. T cell involvement
C. Blood vessel thrombosis
D. Eosinophilic infiltration

Response:
Ans: C (Vessel thrombosis) HYPERACUTE REJECTION Harshmohan 7th/50Appears within minutes to hours of placing the transplantSt is mediated by preformed humoral antibodyThere are numerous neu trophils around dilated & obstructed capillaries which are blocked by fibrin & platelet thrombiIn acute rejection there is infiltration ofT&B cell"- Harshmohan 7th/ 50HYPERACUTE REJECTION; Robbins9th/233This form of rejection occurs within minutes or hours after transplantation and can sometimes be recognized by the surgeon just after the graft vasculature is anastomosed to the recipient's.In contrast to the nonrejecting kidney graft, wrhich rapidly regains a normal pink coloration and normal tissue turgor and promptly excretes urine, a hyperacutely rejecting kidney rapidly becomes cyanotic, mottled, and flaccid and may excrete a mere few drops of bloody urine.Immunoglobulin and complement are deposited in the vessel wrall, and electron microscopy discloses early endothelial injury together with fibrin-platelet thrombi.There is also a rapid accumulation of neutrophils within arterioles, glomeruli, and peritubular capillaries. These early lesions point to an antigen-antibody reaction at the level of vascular endothelium.Subsequently, these changes become diffuse and intense, the glomeruli undergo thrombotic occlusion of the capillaries, and fibrinoid necrosis occurs in arterial walls.ACUTE REJECTION. Robbins 9th/233# This may occur within days of transplantation in the untreated recipient or may appear suddenly months or even years later, after immunosuppression has been employed and terminated. As suggested earlier, acute graft rejection is a combined process in wrhicb both cellular and humoral tissue injuries contribute. In any one patient, one or the other mechanism may predominate.Histologically, humoral rejection is associated with vasculitis, whereas cellular rejection is marked by an interstitial mononuclear cell infiltrate.Mechanisms of Recognition and Rejection ofAlografts Robbins 9th/231-32# Rejection is a process in wrhsch T lymphocytes and antibodies produced against graft antigens react against and destroy tissue grafts# Recognition of Graft Alloantigens by T and 8 Lymphocytes: The major antigenic differences between a donor and recipient that result in rejection of transplants are differences in HLA alleles.T CELL-MEDIATED REACTIONS Robbins 9th/233Acute cellular rejection, also called acute T cell-mediated rejection, is most commonly seen within the initial months after transplantation and is heralded by clinical and biochemical signs of organ failure.T cells also contribute to chronic rejection, ANTIBODY-MEDIATED REACTIONS Robbins9th/233Although T cells are pivotal in the rejection of organ transplants, antibodies produced againstalloantigens in the graft are also important mediators of rejection. Antibody mediated reactions can take three forms.Hyperacute rejection occurs when preformed antidonor antibodies are present in the circulation of the recipient. Such antibodies may be present in a recipient who has previously rejected a transplant.Acute antibody-mediated rejection is caused by antidonor antibodies produced after transplantation.Chronic antibody-mediated rejection usually develops insidiously, without preceding acute rejection, and primarily affects vascular components.

So the answer to this question is C


Instruction:
Paessure difference of 5 mm Hg between the two up per limbs occurs in which congenital heart disease
A. TOF
B. TGA
C. HOCM
D. Supra-valvular aortic stenosis

Response:
None

So the answer to this question is D


Instruction:
Froment's sign is due to which nerve injury
A. Intercostobrachial
B. Radial
C. Ulnar
D. Median

Response:
froment's sign / book test : tests adductor pollicis muscle it is innervated by ulnar nerve. in ulnar nerve injury, when pt is asked to grasp a book firmly b/w thumb & other fingers of both hands, the terminal phalanx of thumb on paralysed side becomes flexed at interphalangeal joint (by flexor pollicis longus supplied by median nerve). The signs indicative of ulnar nerve palsy are as follows: Froment's sign: Jeanne's sign:

So the answer to this question is C


Instruction:
Major site for absorption of iron in GIT-
A. Duodenum
B. Ileum
C. Jejunum
D. Colon

Response:
Ans. is 'a' i.e., Duodenum * Iron is absorbed from upper small intestine mainly duodenum. In diet iron occurs in two forms, haeme iron and inorganic (non-haeme) iron. Flaem iron is better absorbed than inorganic iron, but the major fraction of diet is inorganic iron. Inorganic iron is mostly in ferric form; needs to be reduced to ferrous form because iron is absorbed in ferrous form.* After absorption ferrous form is once again oxidized to ferric form inside enterocytes. A fraction of absorbed iron is rapidly delivered to plasma transferrin. However, most of the iron is deposited in the enterocytes as ferritin, some to be transferred more slowly to plasma transferrin, and some to be lost when senescent mucosal cells (enterocytes) are sloughed into the intestine.* Iron absorption is regulated according to the demand, e.g., when there is iron deficiency, absorption increases. This regulation is mediated by uiron metabolism regulatory hormone", i.e., hepcidin that inhibit iron absorption. When there is iron deficiency, concentration of hepacidin falls and there is increase iron absorption. Hepacidin also decreases release of iron from storage sites. Factors affecting iron absorptioni)Decreasing absorption* By complexing (forming chelate) with iron: Phytate, phosphate, milk, EDTA, tetracycline.* By opposing reduction of ferric to ferrous form : Antacids, alkalies, pancreatic secretions.2)Increasing absorption* By enhancing reduction of ferric to ferrous form : Ascorbic acid, HCL, gastric secretions, citric acid.

So the answer to this question is A


Instruction:
The histological features of the celiac disease include all of the following Except -
A. Crypt hyperplasia
B. Increase in thickness of the mucosa
C. Increase in intraepithelial lymphocytes
D. Increase in inflammatory cells in lamina propria

Response:
Pathological features

In celiac disease, the proximal intestine is commonly involved while in tropical sprue whole of the intestine is involved.
Biopsy of the intestine in celiac sprue demonstrates.

- Villous atrophy, loss of microvilli brush border
- The crypts are hyperplastic and become elongated.
- Presence of following cells on lamina propria → Plasma cells, Lymphocytes, Macrophages, Eosinophils, Mast cells
- Remember that overall mucosal thickness remains same in celiac sprue

Celiac disease is associated with dermatitis herpetiformis.
Individuals with celiac disease have a higher incidence of malignancy → enteropathy-associated T-cell lymphoma (most common), small intestine adenocarcinoma.

So the answer to this question is B


Instruction:
What is normal average IQ -
A. 100
B. 90
C. 80
D. 70

Response:
Ans. is 'a' i.e., 100 o An average normal IQ is considered to be 100. However, the range actually extends from 90-109.

So the answer to this question is A


Instruction:
One of the following diuretics does not require its presence in the tubular lumen for its pharmacological effects :
A. Thiazide diuretics
B. Loop diuretics
C. Carbonic anhydrase inhibitors
D. Aldosterone antagonists

Response:
Most of the diuretics act from the luminal side of the membrane in the nephron.
Thiazides, loop diuretics, carbonic anhydrase inhibitors and epithelial Na+channel blockers (e.g. amiloride and triamterene) are secreted in the proximal tubules through organic anion/cation transport process.
Osmotic diuretics reach the lumen of proximal tubules via glomerular filtration.
Aldosterone antagonists like spironolactone do not act through luminal side rather they act from basolateral side of the membrane. Therefore, these agents do not require access to the tubular lumen.

So the answer to this question is D


Instruction:
Lamivudine belongs to which type of anti retroviral group of drugs ?
A. Nucleotide reverse transcriptase inhibitor
B. Non Nucleoside reverse transcriptase inhibitor
C. Nucleoside reverse transcriptase inhibitor
D. Non Nucleotide reverse transcriptase inhibitor

Response:
Ans. is 'c' i.e., Nucleoside reverse transcriptase inhibitor

So the answer to this question is C


Instruction:
Erythema nodosum is seen in all of the following except –
A. Pregnancy
B. Tuberculosis
C. SLE
D. Chronic pancreatitis

Response:
None

So the answer to this question is D


Instruction:
The electronic probing system "Foster Miller Probe" detects:
A. Only the pocket depth
B. Only the CEJ
C. CEJ and pocket depth
D. Furcation involvement

Response:
None

So the answer to this question is C


Instruction:
The Iron requirement in pregnant and non-pregnant women respectively:
A. 40-50mg; 20-25mg
B. 20-25mg; 15-20mg
C. 15-20mg; 40-50mg
D. 10-15mg; 15-20mg

Response:
The total content of iron in an adult body is 3-5 g.
About 70% of this occurs in the erythrocytes of blood as a constituent of hemoglobin.
At least 5% of body iron is present in myoglobin of muscle.
Heme is the most predominant iron-containing substance.
lt is a constituent of several proteins/enzymes (hemoproteins, hemoglobin, myoglobin, cytochromes, xanthine oxidase, catalase, tryptophan pyrrolase, peroxidase).
Certain other proteins contain non-heme iron e.g. transferrin, ferritin, hemosiderin.

Dietary requirements:
Adult man - 10 mg/day
Menstruating woman - 18 mg/day
Pregnant and lactating woman - 40 mg/day
Key Concept:
Iron requirement for pregnant woman is around 40mg/day and in menstruating woman is around 18mg/day
Ref : Textbook of Biochemistry, Satyanarayana

So the answer to this question is A


Instruction:
Which is not true regarding superantigen?
A. Bind T cells irrespective of antigen specificity of TCR
B. Bind directly to both MHC II and T cell receptor causing T cell activation
C. Bind to cleft (antigen binding groove) in the MHC II molecule
D. Binds directly to lateral aspect of T cell receptor

Response:
.

So the answer to this question is C


Instruction:
Cell that can form the maximum number of other cells in the body is called?
A. Totipotent
B. Multipotent
C. Pluripotent
D. Lineage stem cells

Response:
Totipotent cells- can form maximum no of other cells in body e.g. cells of zygote Note: Totipotent cells gives rise to teratoma B - multipotent - gives rise to different types of cells, except cells of placental tissue. C - pluripotent: gives rise to cell belonging to more than one lineage e.g. hematopoietic stem cells

So the answer to this question is A


Instruction:
Chance of affected child to Autosomal recessive carrier parents is ?
A. 10%
B. 15%
C. 25%
D. 50%

Response:
ANSWER: (C) 25%REF: BRS Genetics by Ronald W. Dude page 31-33In autosomal recessive condition the risk of having an affected child when both parents are carriers is 25%, and the chance of having a child who is a carrier is 50%.GENETIC RISK ASSESSMENT IN AUTOSOMAL RECESSIVE INHERITANCE:The genetic risk associated with Autosomal recessive disorder is as followsAffected mother, normal fatherMother -AA| FatheraAaAaaAaAaConclusion: 100% carrier childCarrier mother, normal fatherMother -Aa| FatheraAaaaaAaaaConclusion: 50% carrier, 50% normal childCarrier mother, Carrier fatherMother -Aa| FatherAAAAaaAaaaConclusion: 25% affected, 50% carrier, 25% normal childCarrier mother, affected fatherMother -Aa| FatherAAAAaAAAAaConclusion: 50% affected, 50% carrier childNormal mother, affected fatherMother -aa| FatherAAaAaAAaAaConclusion: 100% carrier childAffected mother, affected fatherMother -AA| FatherAAAAAAAAAAConclusion: 100% affected child

So the answer to this question is C


Instruction:
Off label use of topiramate -
A. Alcohol withdrawal
B. Extrapyramidal symptoms on anti-psychotic use
C. Opioid withdrawal
D. Sedative agent

Response:
Ans. is 'a' i.e.. Alcohol withdrawalo Drugs used for alcohol dependence to prevent relapse are:NaltrexaneAcamprosateOndansetronNalmefeneDisulfiramTopiramateo Topiramate is an antiepileptic drug.o Mechanism of action in alcohol dependence is not well understood but is distinct from that of other drug used for dependence, suggesting it may provide a new and unique approach to pharmacotherapy of alcoholism.

So the answer to this question is A


Instruction:
Major basic proteins are produced by?
A. Lymphocyte
B. Eosinophil
C. Neutrophil
D. Basophil

Response:
Eosinophils have a granule that contains major basic protein (MBP)
Proteoglycan 2, (natural killer cell activator, eosinophil granule major basic protein), also known as PRG2, is a protein which in humans is encoded by the PRG2 gene.
It is a potent enzyme against helminths. The eosinophil major basic protein also causes the release of histamine from mast cells and basophils and activates neutrophils and alveolar macrophages.

So the answer to this question is B


Instruction:
Amiloride can cause hyperkalemia due to its action on:
A. Potassium channel
B. Sodium channel
C. Na+ Cl- symporter
D. H+K+ATP ase

Response:
Ans. B. Sodium channelAmiloride and triamterene are K+ sparing diuretic, they act by inhibiting epithelial Na+ channel. When they inhibit the sodium channel, there is no generation of electrical gradient and thus potassium and hydrogen are not excreted. They may be responsible for hyperkalemia.

So the answer to this question is B


Instruction:
Inflammation in the airways can be reduced by:
A. Fluticasone
B. Budesonide
C. Theophylline
D. Salbutamol

Response:
fluticasone an example of inhaled steroid coicosteroids suppress bronchial inflammation by stimulating lipocoin production and inhibiting phospholipase A2 after binding to intracellular receptors ESSENTIALS OF MEDICAL PHARMACOLOGY SEVENTH EDITION KD TRIPATHI PG NO.230

So the answer to this question is A


Instruction:
Standard detion is defined as: March 2009, March 2013 (a, c, f h)
A. Value of middle observation when data is arranged in ascending order.
B. Arithmetic mean
C. Dispersion of values about the mean
D. Most frequently occurring value

Response:
Ans. C: Dispersion of values about the mean The steps are: Compute the mean for the data set. Compute the detion by subtracting the mean from each value. Square each individual detion. Add up the squared detions. Divide by one less than the sample size. Take the square root. Standard detion gives us an idea of the spread of the dispersion; that the larger the standard detion, the greater the dispersion of values about the mean.

So the answer to this question is C


Instruction:
all of these are cluster A personality disorders except
A. anakastic
B. schizoid
C. schizotypal
D. paranoid

Response:
his is the most repeated question personality disorder are divided into several types and the knowledge of the classification of these disorders helps in answering a lot of questions CLUSTER A=== schizoid, paranoid, schizotypal CLUSTER B====histirionic, narcisstic, borderline, anti social CLUSTER C====anxious, anakastic, dependent Ref.Kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no.742

So the answer to this question is A


Instruction:
Night blindness may be caused by all except
A. Vitamin A deficiency
B. Retinitis pigmentosa
C. Syphilis
D. Lattice degeneration

Response:
Ans. Lattice degeneration

So the answer to this question is D


Instruction:
Extrachorial placentation increases risk of
A. Abruptio placenta
B. Stillbirth
C. Intra-partum fetal acidosis
D. None of the above

Response:
Most cases with extra chorial placenta have normal outcome. Pre - term birth and antepartum hemorrhage is seen with circumvallate placenta.

So the answer to this question is D


Instruction:
Carcinosarcoma occurs in
A. Uterus
B. Liver
C. Breast
D. Lungs

Response:
Carcinosarcoma is the rare combination of malignant tumour of the epithelium (carcinoma) and of mesenchymal tissue (sarcoma) such as in thyroid, lung, and uterus. Refer robbins 9/e

So the answer to this question is A


Instruction:
Beta phage is seen in
A. Bacillus anthracis
B. Corynebacterium diptheriae
C. Clostridium botulinum
D. Peptostreptococcus

Response:
The toxigenicity of the diphtheria bacillus depends on the intracellular presence of corynephages (tox+), which acts as genetic controlling toxin production. Non-toxigenic strains are rendered toxigenic by infecting them with the beta or some other phages This is known as lysogenic or phage conversion. REF:Textbook of microbiology; Ananthanarayan and paniker's; 10th Edition; Pg: 240

So the answer to this question is B


Instruction:
Which of the following diseases needs not to be screened for, in workers to be employed in a dye industry in gujarat?
A. Anemia
B. Bronchial asthma
C. Bladder cancer
D. Precancerous lesion

Response:
Prepalcement examination in dye industries include asthma,skin and bladder,kidney diseases,precancerous lesion.Anemia comes under lead.(Ref.PARK'S textbook of preventive and social medicine 21st edition page no.753)

So the answer to this question is A


Instruction:
Uncontrolled flailing of an arm is a symptom of?
A. Amyotrophic lateral sclerosis
B. Lower motor neuron syndrome
C. Dysdiadochokinesias
D. Hemiballismus

Response:
Hemiballismus is associated with a lesion of the sub thalamic nucleus of the motor system. Lesions in this nucleus produce uncontrolled flailing and involuntary movement, especially of the upper extremity. Amyotrophic lateral sclerosis, a disease of the lower motor neurons, produces weakness in skeletal muscles, which may eventually lead to paralysis and muscle atrophy. Athetosis refers to slow writhing movements of the limbs. This finding is characteristic of lesions in areas of the basal ganglia that are not subthalamic.

So the answer to this question is D


Instruction:
Hypeension is associated with all of the following except: March 2010
A. Excess salt
B. Excess exercise
C. Phaeochromocytoma
D. Obesity

Response:
Ans. B: Excess exercise Modifiable risk factors: - Obesity - Excess salt intake Saturated fat in the diet - Environmental stress - Reduced physical activity Renovascular hypeension: It has two main causes: fibromuscular dysplasia and atheromatous stenosis. Hypeension secondary to other renal disorders: - Chronic renal failure - Kidney disease/renal aery stenosis: the normal physiological response to low blood pressure in the renal aeries is to increase cardiac output (CO) to maintain the pressure needed for glomerular filtration. - Renal segmental hypoplasia Hypeension secondary to endocrine disorders - Pheochromocytoma - caused by an excessive secretion of norepinephrine and epinephrine which promotes vasoconstriction - Hyperaldosteronism (Conn's syndrome) - Cushing's syndrome - an excessive secretion of glucocoicoids causes the hypeension Hyperparathyroidism - Acromegaly - Hypehyroidism -- Hypothyroidism Other causes: - Hormonal contraceptives - Atherosclerosis Liquorice (when consumed in excessive amounts) - Scieroderma - Neurofibromatosis - Drugs: In paicular, alcohol, nasal decongestants with adrenergic effects, NSAIDs, MAOIs, adrenoceptor stimulants, and combined methods of hormonal contraception (those containing ethinyl-estradiol) can cause hypeension while in use. - Malformed aoa, slow pulse, ischemia: these cause reduced blood flow to the renal aeries, with physiological responses as already outlined. - Coarcation of the aoa

So the answer to this question is B


Instruction:
Transverse myelitis usually presents
A. 1 – 2 weeks
B. 1 – 2 months
C. 4 – 6 months
D. 1 year

Response:
Usual time of onset of symptoms of post-radiation transverse myelitis is 12-24 months but can occur as early as 6 months after radiation.

So the answer to this question is D


Instruction:
Term Juvenile periodontitis was given by:
A. Wearbaug
B. Glickman
C. Chaput and Buttler
D. Gottlib

Response:
None

So the answer to this question is C


Instruction:
Which of the following is not associated with peripheral neuropathy
A. Uicaria pigmentosa
B. Diabetes mellitus
C. Nitrofurantion
D. Infectious mononucleosis

Response:
Uicaria pigmentosa (also known as generalized eruption of cutaneous mastocytosis (childhood type) ) is the most common form of cutaneous mastocytosis. It is a rare disease caused by excessive numbers of mast cells in the skin that produce hives or lesions on the skin when irritated.not associated with peripheral neuropathy Ref Harrison20th edition pg 2478

So the answer to this question is A


Instruction:
Treatment of choice of 28 weeks size H mole In 40 years parous woman is :
A. Vacuum extraction
B. Hysterectomy
C. Hysterotomy
D. Vaginal delivery

Response:
Hysterectomy

So the answer to this question is B


Instruction:
Etiopathogenesis of diabetic foot include the following except -
A. Myelopathy
B. Osteoarthropathy
C. Microangiopathy
D. Infection

Response:
None

So the answer to this question is A


Instruction:
Foot process effacement is seen on EM in -
A. Minimal change disease
B. Focal segmental Glomerulosclerosis
C. IgA nephropathy
D. Mesangial proliferative GN

Response:
Disease Pathogenesis Light Microscopy Fluorescence microscopy Electron microscopy Minimal-change disease podocyte injury Normal Negative Effacement of foot processes; no deposits Focal segmental glomerulosclerosis Unknown: reaction to the loss of renal mass. Focal and segmental sclerosis and hyalinosis Usually negative; IgM and C3 may be present in areas of scarring Effacement of foot processes; epithelial denudation Ref: ROBBINS BASIC PATHOLOGY 10th ed Pg no: 556

So the answer to this question is B