Instruction:
Working formulation in staging of non-hodgkins lymphoma is based on: March 2010
A. Morphology of cells
B. Cell surface markers
C. Survival characteristic of cells
D. Cellular genetics

Response:
Ans. A: Morphology of cells The 1982 Working formulation is a classification of non-hodgkin lymphoma. It excluded the Hodgkin lymphomas and divided the remaining lymphomas into four grades (Low, Intermediate, High, and Miscellaneous) related to prognosis, with some fuher subdivisions based on the size and shape of affected cells. This purely histological classification included no information about cell surface markers, or genetics, and it made no distinction between T-cell lymphomas or B-cell lymphomas. The working formulation was widely accepted at the time of its publication but is now obsolete. It was superseded by subsequent classifications but it is still used by cancer agencies for compilation of lymphoma statistics and historical comparisons.

So the answer to this question is A


Instruction:
A 20 year - old male has features of acute renal failure. Blood examination shows thrombocytopenia and Hb-10 gm%. Likely cause is -
A. Haemolytic uremic syndrome
B. Hereditary spherocytosis
C. Haemolytic crises
D. Chronic glomerulonephritis

Response:
None

So the answer to this question is A


Instruction:
Zoster recurrance occur after infection with?
A. HSV 1
B. HSV 2
C. Varicella
D. Small pox

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

So the answer to this question is C


Instruction:
A 50 year old man with aoic stenosis is doing exercise for 11 minutes according to bruce protocol. Exercise stopped due to fatigue, Regional pressure gradient is 60 mm Hg between the two sides of the aoic valve. What is the best management -
A. Angiogram
B. Aoic valve replacement
C. Aoic ballooning to prevent fuher derangement
D. Observation

Response:
Aoic stenosis (AS or AoS) is the narrowing of the exit of the left ventricle of the hea (where the aoa begins), such that problems result.It may occur at the aoic valve as well as above and below this level. It typically gets worse over time. Symptoms often come on gradually with a decreased ability to exercise often occurring first. If hea failure, loss of consciousness, or hea related chest pain occur due to AS the outcomes are worse. Loss of consciousness typically occurs with standing or exercise. Signs of hea failure include shoness of breath especially when lying down, at night, or with exercise, and swelling of the legs.Thickening of the valve without narrowing is known as aoic sclerosis Treatment is generally not necessary in people without symptoms. In moderate cases echocardiography is performed every 1-2 years to monitor the progression, possibly complemented with a cardiac stress test.In severe cases, echocardiography is performed every 3-6 months.In both moderate and mild cases, the person should immediately make a revisit or be admitted for inpatient care if any new related symptoms appear.There are no therapeutic options currently available to treat people with aoic valve stenosis; however, studies have indicated that the disease occurs as a result of active cellular processes, suggesting that targeting these processes may lead to ble therapeutic approaches Ref Davidson 23rd edition pg 453

So the answer to this question is D


Instruction:
Personality chages is seen in lesions of-
A. Temporal lobe lesions
B. Parietal lobe
C. Frontal lobe
D. Occipital lobe

Response:
None

So the answer to this question is C


Instruction:
Duct of Bartholins gland opens
A. On outer side of Labium minus
B. On inner side of Labium majus
C. On outer side of Labium majus
D. On inner side of Labium minus

Response:
Duct of Bartholins gland opens on the inner side of Labium minus external of hymen.

So the answer to this question is D


Instruction:
All of the following statements about lignocaine are true EXCEPT :
A. It blocks active sodium channels with more affinity than resting sodium channels
B. It can cause cardiotoxicity
C. It is given orally for treatment of cardiac arrhythmias
D. Adrenaline increases the duration of action of lignocaine when used for infiltration anaesthesia.

Response:
None

So the answer to this question is C


Instruction:
Taste fibres from anterior two third of tongue is carried by?
A. Trigeminal nerve
B. Facial nerve
C. Hypoglossal nerve
D. Glossopharyngeal nerve

Response:
Sensory innervation of tongue: General sensation of the anterior two third of tongue is supplied by the lingual nerve and the taste senastions runs in the chorda tympani branch of facial nerve. While the glossopharyngeal nerve carries the general sensation and the taste fibres of the posterior third of tongue including the vallate papillae.

So the answer to this question is B


Instruction:
Which of the following is not true regarding development of inferior vena cava?
A. Hepatic poion is formed by right vitelline vein
B. Infra renal poion by supra cardinal vein
C. Renal & supra renal poion by sub cardinal vein
D. Beginning of IVC by anterior cardinal vein

Response:
DEVELOPMENT OF VENOUS DRAINAGE : Beginning of IVC is by posterior cardinal vein. Renal & supra renal poion formed by sub cardinal vein Infra renal poion formed by supra cardinal vein Hepatic poion is formed by right vitelline vein Anterior cardinal vein forms SVC

So the answer to this question is D


Instruction:
A patient is suspected to have vestibular schwannoma the investigation of choice for its diagnosis is:
A. Contrast enhanced CT scan
B. Gadolinium enhanced MRI
C. SPECT
D. PET scan

Response:
Ans. B (Gadolinium enhanced MRI) Vestibular schwannoma (VS) - arise from inferior vestibular division of eight nerve as from the auditory division a. MRI with gadolinium is the current standard for screening for suspected vestibular schwannomas because of the high false negative rate associated with BSERA Treatment Under 65 years - small intracranial tumors (within the internal auditory canal) may be surgically removed through the transmastoid labyrinthine route a. Larges tumors (> 3 cm) are associated with increased incidence of hearing loss, dysequilibrium, headache facial numbness, and diplopia are removed a suboccipital craniotomy b. Huge ones can only be removed combined suboccipital and translabyrinthine approach Over age 65 with slowly growing tumors, observation is the proffered treatment.

So the answer to this question is B


Instruction:
When suture are removed from an incisional surgical wound at the end of one week, the wound strength of the wounded skin when compared to unwounded skin approximately?
A. 50%
B. 80%
C. 1%
D. 10%

Response:
When sutures are removed, usually at 1 week, wound strength is approximately 10% of that of unwounded skin, but this increases rapidly over the next 4 weeks. Wound strength reaches approximately 70% to 80% of normal by 3 months but usually does not substantially improve beyond that point.

So the answer to this question is D


Instruction:
A patient comes to emergency opd with feeling of impending doom, intense anxeity and palpitations. All of the following investigations should be done in emergency except?
A. T3, T4, TSH
B. Glucose levels
C. Hemoglobin
D. ECG

Response:
The symptoms of impending doom and palpitations are suggestive of a panic attack and it is important to rule out hyperthyroidism, hypoglycemia and myocardial infarction. Hence T3, T4, TSH, Glucose levels and ECG has to be done.

So the answer to this question is C


Instruction:
A diabetic patient with hypertension, which drug is preferred:
A. ACE Inhibitor
B. Beta blockers
C. CCB
D. Diuretics

Response:
Ans. (a) ACE InhibitorRef Harrison's 18th ed. Ch 344* In a diabetic patient, hypertension can accelerate compli- cations of DM, particularly cardiovascular disease and nephropathy. In these patients ACE inhibitor is preferred. It slows down the progression of diabetic nephropathy.* American Diabetic Association recommends that all patients with diabetes and hypertension be treated with an ACE inhibitor or an ARB.* Subsequently, agents that reduce cardiovascular risk (beta blockers, thiazide diuretics, and calcium channel blockers) should be incorporated into the regimen.* While ACE inhibitors and ARBs are likely equivalent in most patients with diabetes and renal disease, the ADA notes:# In patients with type 1 diabetes, hypertension, and micro- or macroalbuminuria, an ACE inhibitor slowed progression of nephropathy# An ACE inhibitor or an ARB slowed the progression to macroalbuminuria in patients with type 2 diabetes, hypertension, and microalbumin-uria; and# ARB slowed the decline in GFR in patients with type 2 diabetes, hypertension, macroalbuminuria, and renal insufficiency.

So the answer to this question is A


Instruction:
Who gave the basic concepts of "Analytical Psychology"?
A. Sigmond Freud
B. Erik erikson
C. Anna Freud
D. Carl Jung

Response:
Psychoanalysis : Sigmond Freud
Child psychoanalysis: Anna Freud
Analytical psychology: Carl Jung.

So the answer to this question is D


Instruction:
The worldwide point prevalence of schizophrenia is best estimated as?
A. 1%
B. 2.50%
C. 5%
D. 10%.

Response:
The worldwide point prevalence of schizophrenia is 1%.

So the answer to this question is A


Instruction:
All are useful for management of severe Clostridium difficle treatment except -
A. Intravenous metronidazole
B. Neomycin enema
C. Fecal transplant
D. Tigecycline

Response:
Ans. is 'b' i.e., Neomycin enema Treatment of nonsevere Clostridium diffid-assodateddiarrhea in adultsInitial episodeo Mild diseaseo Severe diseaseo Severe complicated or fulminant- metronidazole- vancomycin- vancomycinFirst relapseo Confirm diagnosis.o If symptoms are mild, conservative management may be appropriate,o If antibiotics are needed, repeat treatment as in initial episode above,o Alternative: ftdaxomicin 200 mg orally twice daily for 10 days.Second relapseo Confirm diagnosis# Repeat vancomycin taper/pulseMultiple recurrences# Repeat vancomycin taperv'pulse# Vancomycin# Nitazoxanide# Fecal microbiota transplantation# IV immunoglobulin

So the answer to this question is B


Instruction:
Rinsing of eye with water causes blurring of vision. Which of the following is the TRUE cause of blurring?
A. Elimination of refraction through cornea
B. Extra refraction through water
C. Impurities of water
D. Speed of light is more through water

Response:
Corneal refractive power is substantial in air but viually eliminated when the eye is under water. Under water, the divergent refraction by the cornea is small since the media on its both sides (water outside and anterior chamber liquid inside) have refractive indices not greatly different from that of the cornea itself. Ref: The Sensory Physiology of Aquatic Mammals By Alexander Ya, Page 232

So the answer to this question is A


Instruction:
An 86 yr old male complains of cough and blood in his sputum for the past two days. On admission, his temperature is 103deg F. physical examination reveals rales in his right lung, and x- ray examination shows increased density in the right middle lobe. A sputum smear shows many Gram positive coci, confirmed by sputum culture as penicillinase producing staphylococcus aureus. Which of the following agents should be given?
A. Ampicillin
B. Oxacillin
C. Carbenicillin
D. Ticarcillin

Response:
Unlike the other listed drugs, oxacillin is resistant to penicillinase. The other four agents are broad-spectrum penicillins, while oxacillin is generally specific for Gram-positive microorganisms. Use of penicillinase resistant penicillins should be reserved for infections caused by penicillinase producing staphylococci.

So the answer to this question is B


Instruction:
Commonest cause of ectopic pregnancy is :
A. Endometriosis
B. Previous salpingitis
C. Anemia
D. Cervicitis

Response:
Previous salpingitis

So the answer to this question is B


Instruction:
All are true about estrogen EXCEPT:
A. Causes cholestasis
B. Used in treatment of gynecomastia
C. Used in HRT
D. Increased risk of breast cancer

Response:
ANSWER: (B) Used in treatment of gynecomastiaREF: Harrison's 18th ed chapter 346, KDT 3d1 edition page 276Estrogen receptor antagonists are used in the treatment of gynecomastia not estrogenAdverse effects of Estrogen:Suppression of libido and gynecomastiaFusion of epiphysesEndometrial carcinomaIncreased incidence of breast cancerIncreased incidence of cholestasis and gall stonesIncreased chances of thromboembolism

So the answer to this question is B


Instruction:
Where do primordial germ cells initially develop
A. In the gonads at week 4 of embryonic development
B. In the yolk sac at week 4 of embryonic development
C. In the gonads at month 5 of embryonic development
D. In the yolk sac at month 5 of embryonic development

Response:
Primordial germ cells, the predecessors to gametes, are first seen in the wall of the yolk sac at week 4 of embryonic development They migrate into the gonads at week 6.

So the answer to this question is B


Instruction:
Which organ is NOT affected by Plasmodium falciparum?
A. Hea
B. Liver
C. Lungs
D. Kidney

Response:
The trophozoites of Plasmodium falciparum disappears from peripheral circulation after about 24 hrs. By then a strain specific high molecular weight antigen appears on the surface of infected red cells, associated with knob like projections on the erythrocyte membrane. Such red cells disappear from peripheral circulation and adhere to the walls of venules and capillaries in the internal organs like brain, hea, kidney, lungs, spleen, intestine, bone marrow and placenta. Ref: Paniker's textbook of parasitology, 6th ed page 80.

So the answer to this question is B


Instruction:
Which of the following is the earliest symptom of acoustic neuroma?
A. Deafness
B. Tinnitus
C. Veigo
D. Facial weakness

Response:
The earliest symptom of many patients with acoustic neuroma is mild unilateral sensorineural hearing loss. Tinnitus is common, veigo may or may not be present. Acoustic neuromas arise predominantly from the superior half of the vestibular poion of the vestibulocochlear nerve. Very large tumors may cause brain stem compression and obstructive hydrocephalus.

So the answer to this question is A


Instruction:
Steroids hormones exe their effects by binding to
A. Cell surface receptors
B. G proteins
C. Transcription factors
D. Cyclic adenosine monophophate (AMP)

Response:
Steroid hormones cross the cell membrane and bind to specific receptors within the cell. These receptors are transcription factors that are active only in the presence of paicular hormones. The hormone-transcription factor complex binds to steroid hormone responsive elements in DNA to influence transcription from steroid-sensitive genes. Thyroid hormone, retinoic acid, and 1,25-dihydroxycholecalciferol exe their effects in a similar way.

So the answer to this question is C


Instruction:
Thalidomide is used in -
A. Mutilple myeloma
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Masopharyngeal carcinoma

Response:
Ans. is 'a' i.e., Multiple myeloma Clinical uses of thalidomideo AIDS related aphthous ulcerso AIDS related wasting syndromeo Multiple myeloma and other solid tumourso Prevention of graft versus host disease after transplantationo Rheumatoid arthritiso Ankylosing spondylitiso Crohn's disease and Bechet's syndromeo Erythema Nodusum Leprosum

So the answer to this question is A


Instruction:
After ovulation the discharged oocytes and surrounding layer of granulosa cells are known as
A. Corpus luteum
B. Corona radiata
C. Stigma
D. Zona pellucida

Response:
The corona radiata is the innermost layer of the cells of the cumulus oophorus and is directly adjacent to the zona pellucida, the inner protective glycoprotein layer of the ovum . Its main purpose in many animals is to supply vital proteins to the cell. It is formed by follicle cells adhering to the oocyte before it leaves the ovarian follicle, and originates from the squamous granulosa cells present at the primordial stage of follicular development. The corona radiata is formed when the granulosa cells enlarge and become cuboidal, which occurs during the transition from the primordia to primary stage . These cuboidal granulosa cells, also known as the granulosa radiata, form more layers throughout the maturation process, and remain attached to the zona pellucida after the ovulation of the graafian follicle . For feilization to occur, sperm cells rely on hyaluronidase (an enzyme found in the acrosome of spermatozoa) to disperse the corona radiata from the zona pellucida of the secondary (ovulated) oocyte, thus permitting entry into the perivitelline space and allowing contact between the sperm cell and the nucleus of the oocyte. Ref - Wikipedia.org

So the answer to this question is B


Instruction:
ALL are true about Colles fracture except -
A. In old age
B. Dorsal shift
C. At cortico-cancellous junction
D. Garden spade deformity

Response:
Ans. is 'd' i.e., Garden spade deformity' COLLES FRACTUREo Colles fracture is an extra-articular fracture at the distal end of radius, at its corticocancellous junction. It is the most common fracture in person over 40 years of age and especially in women after menopause (Postmenopausal females). The association of the fracture with osteoporosis is now well established and it is one of the fragility fracture, seen in osteoporosis. The fracture nearly always caused by fall on outstretched hand.Displacement in Colles fractureo The fracture line runs transversely at the corticocancellous junction.o In the majority of the cases, one or more displacements of the distal fragment occuri) Dorsal displacement (Dorsal shift)ii) Dorsal tilt (Dorsal angulation)iii) Lateral displacement (lateral shift)iv) Lateral tilt (lateral angulation)v) Supination (external rotation)vi) Impaction (proximal migration)Clinical features of Colles fractureo Pain and swelling at the wrist.o Typical deformity : There is a dorsal hollow or depression just proximal to the fracture and immediately distal to this there is a marked prominence caused by lower fragment being displaced backwards, carrying with it the whole of the carpus and hand. This gives appearance of a fork, So named dinner fork/ silver fork / spoon shaped deformity.o There is local tenderness.Treatment of colles fractureo Treatment of code's fracture is essentially conservative,o For undisplaced fracture below-elbow cast is given in-situ.o For displaced fractures, the standard method of treatment is to undertake manipulative reduction under local or general anaesthesia.o Technique of closed manipulation involves reversing the typical deformities of Colle's fracture (in following sequence)Disimpaction (by traction) to correct impaction.Palmar flexion & ulnar deviation to correct dorsal tilt / shift and radial tilt / shift.Pronation (internal rotation) :- to correct supination (external rotation),o After reduction below elbow cast is given.

So the answer to this question is D


Instruction:
Permanent mandibular first molar is a common site for all the lesions EXCEPT
A. Pulp polyp
B. Condensing osteitis
C. Lateral periodontal cyst
D. Benign cementohlastoma

Response:
None

So the answer to this question is C


Instruction:
All of the following statements are true about regulation of cholesterol synthesis, EXCEPT?
A. HMG-CoA reductase is inhibited by mevalonate
B. HMG-CoA reductase is inhibited by cholesterol
C. SREBP increases the transcription of HMG-CoA reductase
D. Thyroid hormone decreases the HMG-CoA reductase activity

Response:
Cholesterol Metabolism Mevalonate and cholesterol both allosterically inhibit HMG-CoA reductase (option a and b are correct) Transcription of HMG-CoA reductase gene is regulated by a transcription factor known as SREBP (sterol regulatory element binding protein) Binding of this SREBP protein to DNA sequences known as SRE (sterol regulatory element) which is located 5' to the HMG-CoA reductase gene | the transcription. So SREBP increases the HMG-CoA transcription (option c is correct) Insulin or thyroid hormone | HMG-CoA reductase activity (option d is false and hence is the answer) Glucagon or glucocoicoids | it

So the answer to this question is D


Instruction:
Rivastigmine and Donepezil are drugs used predominantly in the management of
A. Depression
B. Dissociation
C. Delusion
D. Dementia

Response:
In dementia, specific drug treatment such as cholinesterase inhibitors (e.g. donepezil, rivastigmine, galantamine) in moderate Alzheimer&;s disease, or memantine (NMDA antagonist) in moderate to severe Alzheimer's disease, can be helpful. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 26

So the answer to this question is D


Instruction:
All of the following are true about antrochoanal polyp except:
A. Single
B. Unilateral
C. Premalignant
D. Arises from maxillary antrum

Response:
(c) Premalignant(Ref. Scott Brown, 6th ed., 4/10/14)Nasal polyps arise due to edema of the nasal mucosa. They are not premalignant.

So the answer to this question is C


Instruction:
Commonest bone malignancy is:
A. Osteosarcoma
B. Chondrosarcoma
C. Ewing sarcoma
D. Secondaries

Response:
Ans: D (Secondaries) "Metastatic deposits in the bone are commoner than primary tumor. Of the primary bone malignancies, multiple myeloma is the commonest. Osteochondroma is the commonest benign tumor"- Maheswari 3rd/214METASTATIC BONE TUMORSCarcinomas often metastasize to the skeleton, and metastatic lesions are much more common than primary' bone lesions in general orthopaedic practice.The five primary cancers with a strong propensity to metastasize to bone are those originating in the breast, prostate, lung., kidney, and thyroid.The axial skeleton^, including the skull, thoracic spine, ribs, lumbar spine, and pelvis, is most commonly involved. The proximal long bones, particularly the humerus and femur, also are affected frequently. Acral (distal) metastases are uncommon0 and are almost always secondary to lung carcinoma when they do occur.The predilection of particular tumors for bone, and forparticular regions of specific bones, is thought to be caused by cytokines, local growth factors, or matrix components that attract and support growth of these lesions in spedfic areas. Lesions can be blastic (breast, prostate), lytic (breast, lung, myeloma, kidney, thyroid), or mixed (breast, lung) in radiographic appearance. Blastic or sclerotic lesions are less prone to pathologic fractures. Age predilection || |TumorAge range (yrs) AgeBenignMalignantOther 0-5 yrs (child)- Eosinophilic granuloma- Unicameral bone cyst (rare)- Leukemia- Metastatic neuroblastoma- Osteomyelitis- Stress fractureEosinophilic granuloma Ewing's tumor1-155-15 6-18 yrs(youngadolescent)- Unicameral bone cyst- Aneurysmal bone cyst- Eosinophilic granuloma- Enchondroma- Chondroblastoma- Chondromyxoid fibroma- Ewing's sarcoma- Osteo sarcoma Non ossifying fibroma Fibrous cortical defect Simple (unicameral) bone cyst2-20 Aneurysmal hone cyst5-20 Osteogenic sarcoma5-20 Chondroblastoma Chondromyxoid fibroma5-2510-30 19-40 yrs (adult)- Osteoblastoma- Osteoclastoma- Eosnophilie granuloma- Ewing's sarcoma Osteoid osteoma Osteoblastoma10-35 > 40 yrs (middle aged old) - Metastasis (breast, lung), prostate, renal, thyroid, colon- Multiple myeloma- Lymphoma- Paget's disease- Hyperpara thyroidism- OsteomyelitisEnchondroma15-40 Osteoclastoma (GCC)20-40q ChondrosarcomaFibrosarcoma30-60q Lymphoma Multiple myelomaMetastasis>50q

So the answer to this question is D


Instruction:
Choledochotomy is indicated in all of the following except
A. Palpable CBD stones
B. History of jaundice or cholangitis
C. Abnormal alkaline phosphatase
D. Abnormal gamma glutamyl transferase

Response:
Choledochotomy Absolute indications(High Suspicion of CBD calculi) Palpable CBD stones Jaundice with cholangitis Demonstration of stone on intra operative cholangiography CBD diameter >12 mm Relative indications (Low Suspicion of CBD calculi) Jaundice without cholangitis History of pancreatitis Dilated CBD White bile on aspiration Dilated cystic duct Ref: Shackelford 7th edition Pgno : 1326-1331

So the answer to this question is D


Instruction:
Which of the following nutritional factors is required for proper collagen assembly in the scar tissue of the 25-year-old woman who sustains a deep, open laceration over her right forearm in a motorcycle accident.
A. Folic acid
B. Thiamine
C. Vitamin A
D. Vitamin C

Response:
Vitamin C (ascorbic acid) is a powerful, biologic reducing agent that is necessary for the hydroxylation of proline residues in collagen. Vitamin C deficiency (scurvy) causes formation of an abnormal collagen that lacks tensile strength. Patients with vitamin C deficiency exhibit poor wound healing. Dehiscence (bursting open) of previously healed wounds may also occur. None of the other choices are required for collagen assembly.

So the answer to this question is D


Instruction:
Long term use of nitrates lead to decreased effect because of -
A. Development of resistance
B. SH group in the enzyme
C. Decreased oral absorption
D. Increased resistance

Response:
Ans. is 'b' i.e., SH groups in the enzyme o Tolerance develops to hemodynamic and antiischaemic effects of nitrates if they are continuously present in the body. No significant tolerance develops when nitrates are used intermittently. However; significant tolerance develops when nitrates are used continuously. This mechanism of nitrate tolerance is not well understood. The mechanism proposed is --> "Reduced ability to generate NO due to depletion of cellular SH radicals".

So the answer to this question is B


Instruction:
Maximum loss of DALY occurs in which psychiatric disorder?
A. Depression
B. Schizophrenia
C. Alcohol dependence
D. Bipolar disorder

Response:
Unipolar depressive disorders - DALY lost: 64963.

So the answer to this question is A


Instruction:
Which of the following statement is true about Bacteroides
A. It is gram positive bacilli
B. It is strictly aerobic
C. It may cause peritonitis
D. Presence in stool culture indicates need for treatment

Response:
It is a Gram-negative strictly anaerobic bacilli and is a common inhabitant of the intestinal tract. They may cause peritonitis. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 264

So the answer to this question is C


Instruction:
Which of the following is primordial prevention -
A. Avoiding nicotine
B. Chemoprophylaxis
C. Vaccination
D. Screening

Response:
Ans. is 'a' Level of prevention Examples o Primordial prevention o Discouragement from adapting a harmful lifestyle, e.g. smoking o Primary prevention o Immunization (vaccination) o Chemoprophylaxis o Nutritional supplementation programmes o Chlorination of water o Using a mosquito net o Health education o Secondary prevention o Screening test o Case finding programmes o Early diagnosis & treatment o Tertiary prevention o Disability limitation # Resting the affected limb in neutral position in PRPP to prevent deformity o Rehabilitation # Estabilishing schools for blind # Provision of aids for crippled # Reconstructive surgery in leprosy # Muscle re-education and graded exercise in neurological disorder like polio # Changing profession for a more suitable one

So the answer to this question is A


Instruction:
Which of the following Local anaesthetic will be suitable for a hypertensive patient suffering from a heart disease?
A. Lignocaine without adrenaline
B. Prilocaine
C. Lignocaine with adrenaline 1:1000
D. Prilocaine and felypressin

Response:
None

So the answer to this question is D


Instruction:
Which of the following is used in management of diabetes?
A. Bromocriptine
B. Octreotide
C. Prednisolone
D. Pegvisomant

Response:
Answer- A. BromocriptineBromocriptine is recently included as antidiabetic.

So the answer to this question is A


Instruction:
Keoppe nodules are present on -
A. Cornea
B. Conjunctiva
C. Iris
D. Retina

Response:
The pathological reaction in granulomatous uveitis is characterised by infiltration with lymphocytes, plasma cells, with mobilization and proliferation of large mononuclear cells which eventually become epithelioid and giant cells and aggregate into nodules. Iris nodules are usually formed near pupillary border (Koeppe's nodules). and sometimes near collarette (Busacca nodule).

So the answer to this question is C


Instruction:
A 30-year-old G2P1 is undergoing an elective repeat caesarean section at term. The infant is delivered without any dificulties, but the placenta cannot be removed easily because a clear plane between the placenta and uterine wall cannot be identified. The placenta is removed in pieces. This is followed by uterine atony and haemorrhage. All of the following are true regarding the condition except
A. Previous LSCS is a predisposing factor
B. Absence of Nitabuch's membrane
C. May require obstetric hysterectomy
D. If Placenta invades muscle and reaches serosa it is known as placenta increta

Response:
With placenta accreta a cesarean hysterectomy may be required. This is because there is uncontrollable bleeding often when placental delivery is attempted. Hysterectomy is frequently required since regular methods of reducing bleeding with suturing mostly don't work. Nitabuch's layer limits invasion of the decidua by the trophoblast. The membrane is absent in the placenta accreta. It causes morbid adhered placenta Placenta accreta:- Paial or complete absence of decidua with adherence of placenta directly to the superficial myometrium Placenta increta :- Villi invade into but not through the myometrium Placenta percreta :- Villi invade through the full thickness of myometrium to the serosa

So the answer to this question is D


Instruction:
A3 year old girl has problems with writing and spelling. Other intelligence is normal
A. Specific writing disorder
B. Mental retardation
C. Dyslexia
D. Dysphonia

Response:
Dyslexia

Dyslexia - problem in reading, spelling and written expression
Intelligence is normal
Dyslexia is the most common type of learning disability.
Children with dyslexia have problem in reading, spelling and written expression.
The important clues to dyslexia in school age children include delayed language, trouble rhymic words, mispronunciation, hesitation,
work-finding difficulties and poor spellings with presence of letter reversal. Reading is slow, inaccurated and labored.

So the answer to this question is C


Instruction:
Tooth is removed before radiotherapy to avoid all except:
A. Radiation pulpitis
B. Radiation caries
C. Osteoradionecrosis
D. None

Response:
Tooth in the line of fire: (Radiotherapy)
Radiation Beam
Tooth removed Prophylactically,

To avoid radiation Pulpitis
Radiation caries
Osteoradionecrosis

So the answer to this question is D


Instruction:
End of ameloblast represents
A. Pits
B. Enamel Caps
C. Enamel brocks
D. None of the above

Response:
None

So the answer to this question is A


Instruction:
All of the following agents are antidepressants, except
A. Trazodone
B. Amitryptiline
C. Fluoxetine
D. Pimozide

Response:
Trazodone, Amitryptiline and fluoxetine are antidepressants.
Pimozide is an antipsychotic.

So the answer to this question is D


Instruction:
Isolation period, false is -
A. Chicken pox - 6 days after onset of rash
B. Herpes zoster - 6 days after onset of rash
C. Measles - up to 3 days after onset of rash
D. German measles - 7 days after onset of rash

Response:
Ans. is 'd' i.e., German measles - 7 days after onset of rash

So the answer to this question is D


Instruction:
You are on board a plane and mid way through the flight. A person sitting near you became excited, restless, very talkative and maniacal following this he became very dull and pale. On examination his pupils were dilated and his body temperature elevated. On fuher examination he had ulceration of the nasal septum also. He later had convulsion. The onboard emergency kit with glucometer relieved his blood sugar to be 150 mg/dl. He also had arrhythmia. Despite resuscitative and suppoive measures he died before the plane landed. What is your diagnosis?
A. Body stuffer syndrome
B. Acute Dystonia
C. Delirium tremens
D. Meningitis

Response:
This is a case of body stuffer syndrome. Here the illegal drugs are packed in plastic bags and swallowed. Occasionally the bags burst in to GIT leading to massive absorption of the drug (most likely cocaine in this case) resulting in toxicity and death. The nasal septal ulcer provides the clue that he may be a cocaine user. The low pressure in the plane may also have contributed to the bursting of the plastic bag. Ref: The Essentials of Forensic Medicine and Toxicology by Narayana Reddy, Edition 21, Page 525 to 530

So the answer to this question is A


Instruction:
Lord's and Jaboulay's operation is indicated for
A. Hydrocele
B. Varicocele
C. Seminoma
D. Teratoma

Response:
(Hydrocele) (1408-LB 24th) (1382-B & L 25th)Treatment of Hydrocele - Lord's operation is suitable when the sac is reasonably thin walled. There is minimal dissection and the risk of haematoma is reduced.Eversion of the sac with placement of the testis in a pouch prepared by blunt dissection in the facial planes of the serotum is an alternative (Jabouley's procedure)Varicocele - Embolisation of the testicular vein under radiographic control is probably the treatment of choice (1407-LB)* Simplest surgical procedure is ligation of the testicular vein above the inguinal ligaments where the pempiniform plexus has coalesced into one or two vessels

So the answer to this question is A


Instruction:
Which of the following is false about somatization syndrome
A. Involves 2 sexual disturbance systems
B. Two GI symptoms
C. Four pain symptoms
D. Multiple recurrent symptoms

Response:
Somatization disorder: (somatic symptom disorder DSM-5*) A history of at least 2 years c/o multiple and variable physical symptoms that cannot be explained by any detectable physical disorders. . Preoccupation leads to distress and seek repeated consultations & investigations persistent self-medication or multiple consultations must be present. Refusal to accept medical advice and reassurances. 4 pain symptoms +2 gastrointestinal symptoms +1 sexual symptom+ 1 pseudoneurological symptom(DSMIV-TR) 6 symptoms from >2 groups GIT/CVS/ Genito-urinary system/ Skin/pain symptoms .(ICD-10) Reference: (Kaplan & Sadock's Synopsis of Psychiatry 10th Edition) chap-17.Somatoform Disorders P.636

So the answer to this question is A


Instruction:
A child died soon after birth. On examination, there was hepatosplenomegaly and oedema all over the body. Most probable diagnosis in –
A. β–thalassemia
B. α–thalassemia
C. Hereditary spherocytosis
D. ABO incompatibility/sickle cell anemia

Response:
Out of the given 4 types of hemolytic anemias only alpha thalassemia is able to give rise to such severe presentation at birth. In all other conditions the newborn is either normal or has mild jaundice.

So the answer to this question is B


Instruction:
Maximum density of goblet cells is seen in:
A. Superior conjunctiva
B. Inferior conjunctiva
C. Nasal conjunctiva
D. Temporal conjunctiva

Response:
C i.e. Nasal conjunctiva Goblet cells are the chief source of tear mucus Q. These occur throughout the conjunctiva, especially the plica semilunaris.

So the answer to this question is C


Instruction:
Which is the most laterally located deep cerebellar nucleus?
A. Emboliform nucleus
B. Dentate nucleus
C. Globose nucleus
D. Fastigial nucleus

Response:
Dentate nucleus is the largest, most laterally placed and most conspicuous of the deep cerebellar nuclei. From lateral to medial, the four deep cerebellar nuclei are the Dentate, Emboliform, Globose, and Fastigial. An easy mnemonic device to remember their names and positions relative to the midline is the phrase "Don't Eat Greasy Food"

So the answer to this question is B


Instruction:
An Example of a tumour suppressor gene is:
A. myc
B. fos
C. ras
D. RB

Response:
RB

So the answer to this question is D


Instruction:
Hung up ankle reflex seen in -
A. Hypothyroidism
B. Thyrotoxicosis
C. Sipple syndrome
D. Wermer syndrome

Response:
Hung up reflex is a deep tendon reflex in which, after a stimulus is given and the reflex action takes place, the limb slowly returns to its neutral position. This prolonged relaxation phase is characteristic of reflexes in persons with hypothyroidism. It is also known as Woltman sign. In unaffected patients, the relaxation time for deep tendon reflexes is 240-320 ms. Delays in relaxation time in patients with hypothyroidism appears to be propoional to the level of thyroid-hormone deficiency.

So the answer to this question is A


Instruction:
A patient aged 65 years, is diagnosed to have severe aplastic anemia. HLA compatible sibling is available. The best option of treatment is -
A. Anti-thymocyte globulin followed by cyclosporine
B. A conventional bone marrow transplantation from the HLA identical sibling
C. A non-myeloablative bone marrow transplantation from the HLA identical sibling
D. Cyclosporine

Response:
None

So the answer to this question is A


Instruction:
Uterinesouffle is defined as :
A. Is a soft blowing murmur synchronous with foetal heart sounds.
B. Is due to increase in blood flow through the dilated uterine vessels
C. Is due to the active foetal movements
D. Indicates the underlying foetal distress.

Response:
The uterine souffle is a soft, blowing sound that is synchronous with the maternal pulse.
It is usually heard most distinctly near the lower portion of the uterus.
This sound is produced by the passage of blood through the dilated uterinevessels.
It also may be heard with any condition in which uterine blood flow is greatly increased, for example, with large uterine myomas or ovarian tumors.

So the answer to this question is B


Instruction:
A 24-year-old female graduate student repos increasing shoness of breath with exercise and has recently noticed dyspnea on mild activity. One day before presenting at the office, she experienced sudden loss of consciousness while shopping at a grocery store. On physical examination, vital signs are: pulse 88 bpm; temperature 97.8degF; respirations 18/min; blood pressure 100/70 mm Hg. BMI is 34. ABGs on RA: pH 7.43; PCO2 36 mm Hg; PO2 87 mm Hg. Chest x-rays are shown in.The clinical and chest radiographic diagnosis may be commonly associated with
A. A loud A2 on cardiac auscultation
B. Right arm swelling
C. Rib notching
D. A loud P2 on cardiac auscultation

Response:
The lateral view shows that the anterior clear space behind the sternum is occupied above a poion of the lower one-third of the cardiac shadow. The truncus of the right pulmonary aery seen in front of the trachea is very large and the left main pulmonary aery coursing over the left upper lobe bronchus is greater than 16 mm. These findings are consistent with pulmonary aerial hypeension. The chest x-ray shows large pulmonary aeries, and this, coupled with the clinical scenario, is consistent with primary pulmonary hypeension (PPH). As mentioned in the general discussion, this entity is due to an unknown cause. The physical sign most likely to be present would be a loud P2, and right hea catheterization would confirm the high pulmonary aery (PA) pressures. Patients with PPH may give a history of syncopal episodes. A loud A2 is heard in systemic hypeension, and rib notching is classically seen on the x-ray in coarctation of the aoa. Right arm swelling is seen with either a localized vascular or lymphatic obstruction such as postradiation, malignancy, or superior vena cava syndrome. This patient does not exhibit any of these signs. Since the hilar shadows are of vascular nature, mediastinoscopy or bronchoscopy would not be indicated and in fact may be dangerous if PA pressures are very high.

So the answer to this question is A


Instruction:
HIV prevalence can be assessed by
A. Sentinel surveillance
B. Active surveillance
C. Passive surveillance
D. Register

Response:
HIV Surveillance: 1) HIV Sentinel surveillance 2) HIV Sero-surveillance 3) AIDS case surveillance 4) STD Surveillance 5) Behavioral surveillance and 6) Integration with surveillance of other diseases like tuberculosis, etc. Ref: Park&;s Textbook of Preventive and Social Medicine, 24th edition, Page no. 452

So the answer to this question is A


Instruction:
Vaccine which requires most stringent condition for storage-
A. DPT
B. OPV
C. BCG
D. TT

Response:
.oral polio vaccine is highly sensitive to varying temperatures.the cold chain temperature for storage of OPV are, routine storage at 2 to 8 degrees long term storage at -20 to-40 degrees ref:park&;s textbook,ed 22,pg no 138

So the answer to this question is B


Instruction:
A 42 yearold female has palpable purpura with rash over buttocks, pain in abdomen, and ahropathy diagnosis is -
A. Sweet syndrome
B. HSP
C. Purpura fulminans
D. Meningococcernia

Response:
HSP a small vessel vasculitis is commonly seen in young males characterized by palpable purpura of dependent areas. It is associated with ahritis, gut vasculitis and glomerulonephritis. Page 309. Reference IADVL's concise textbook of dermatology

So the answer to this question is B


Instruction:
Acute and recurrent pancreatitis is reported to occur in -
A. Homocystinuria
B. Maple syrup urine disorder
C. Methyl malonic acidemia
D. Tyrosinemia

Response:
None

So the answer to this question is C


Instruction:
Consequence of maternal use of cocaine is :
A. Hydrops
B. Sacral agenesis
C. Cerebral infarction
D. Hyperichosis

Response:
One of the consequence of maternal use of cocaine is cerebral infarction. Ref: Williams Obstetrics, 20th Edition, Page 960 and 21st Edition, Page 206 ; Clinical Obstetrics: The Fetus and Mother By E. Albe Reece, John C. Hobbins, 2008, Page 245

So the answer to this question is C


Instruction:
A 50-year-old man complains of swelling of the neck and shoness of breath for 7 days. He has noticed some nasal stuffiness with hoarseness of his voice for about 4 weeks and had attributed these symptoms to an upper respiratory infection. He denies the use of alcohol but has smoked two packs of cigarettes per day for 35 years. Lately, he feels as though something is pushing against his throat. On physical examination, the patient's face appears ruddy and swollen. The jugular veins are distended. Following sign is observed in the patient. Chest x ray was done with the following findings. What is the most likely diagnosis?
A. Retrosternal goiter
B. Thymoma
C. SVC syndrome
D. Congestive cardiac failure

Response:
1st image shows the classical Pembeon sign. 2nd image shows a mass in the right mediastinum-s/o CA lung causing compression of SVC. The SVC receives venous drainage from the head, neck, upper limb, and thorax. Located in the upper mediastinum, this thin-walled vessel is susceptible to pressure from external sources. The most common cause of such external compression is malignancy, usually from a right-side bronchogenic carcinoma. Presents with dyspnea, hoarseness and Horner syndrome. The development of SVC syndrome is often an emergency because the trachea may be obstructed, leading to respiratory compromise.

So the answer to this question is C


Instruction:
A 5-year-old child with recurrent sinusitis, cause is:
A. Adenoids
B. Angiofibroma
C. Nasal carcinoma
D. All of the above

Response:
(a) Adenoids(Ref. Scott Brown, Vol 2; 286)Because of nasal obstruction the child can have recurrent sinusitis. Angiofibroma and nasopharyngeal carcinoma are not seen at this age.

So the answer to this question is A


Instruction:
Blood bags after blood transfusion are disposed in
A. Red bag
B. Yellow bag
C. White container
D. Blue bag

Response:
None

So the answer to this question is B


Instruction:
Meig's syndrome is associated with:
A. Teratoma
B. Brenner tumor
C. Theca cell tumor
D. Fibroma

Response:
Ans. is d, i.e. FibromaRef: Comprehensive Gynecology by Arthur L Herbst 2nd/ed, p533; Jeffcoate 7th/ed, p543Meig's syndrome:* Ascites and right sided hydrothorax in association with fibroma of ovary is called as Meig's syndrome.* It can also be seen in Brenner's tumor and Granulosa cell tumor where it is called as Pseudomeig's syndrome.* True meig's syndrome is rare, occurring in <5 per cent of fibromas.* Hydrothorax can be bilateral also.* Ascites is caused by transudation of fluid from the ovarian fibroma. Hydrothorax develops secondary to flow of ascitic fluid into the pleural space via lymphatics of the diaphragm.* Ascites occurs (in 50% cases) when tumor size is >6cms.* Tumors producing Meig's syndrome manifest in the late childbearing period i.e., 30-40 years.* Both ascites and hydrothorax resolve spontaneously after removal of the tumor.Criteria for diagnosis of Meig's syndrome:* Tumor must be ovarian, solid and benign.* Both hydrothorax and ascites must be present.* Removal of the tumor must result in their spontaneous and permanent cure.Pseudomeig syndrome:* Can be seen in association with either benign or malignant tumor.* Hydrothorax could be a manifestation of pulmonary metastasis.* Syndrome can result from overstimulation of the ovaries with gonadotropins but, in such cases, the peritoneal exudate is more likely to be caused by an electrolyte imbalance rather than by ovarian tumor.

So the answer to this question is D


Instruction:
Physiological effects of emphysema may include all of the following, except
A. Increased vital capacity
B. Irregular ventilation
C. Impaired gas diffuse
D. Pulmonary hypeension

Response:
Emphysema is a pathological condition of the lungs marked by an abnormal increase in the size of the air spaces, resulting in labored breathing and an increased susceptibility to infection. It can be caused by irreversible expansion of the alveoli or by the destruction of alveolar walls.Ref: Ganong&;s review of medical physiology, 23ed edition page no: 595

So the answer to this question is C


Instruction:
A Child presents with complaints of abdominal colic and hematuria USG showed a renal stone 2.5cm in diameter in renal pelvis the next step in management of this case ?
A. ESWL
B. PCNL
C. Nephroureterostomy
D. Conservative

Response:
Ans is 'b' i.e. PCNL Also know Steinstrasse - literally means 'stone street' - it is condition which follows the use of ESWL. - small pieces of fragmented calculi collect and obstruct in the distal ureter, like sand occluding a straw.

So the answer to this question is B


Instruction:
A most common cause of death due to burns in the early period is?
A. Sepsis
B. Hypovolemic shock
C. Both
D. None

Response:
Srb's manual of surgery,4th edition Pathophysiology of burns:
1.Burns,
2.Loss of fluid,
3.Severe hypovolemia,
4.Reduced cardiac output,
a.Decreased myocardial function.
b.altered pulmonary resistance causing pulmonary edema,
5.Infection,
6.Systemic inflammatory response syndrome-SIRS,
7.Multiorgan dysfunction syndrome-MODS
8. Ultimately leading to death.

So the answer to this question is B


Instruction:
Superior angle of scapula lies at which level ?
A. T7
B. T12
C. T2
D. C5

Response:
Ans. is 'c' i.e., T2

So the answer to this question is C


Instruction:
In Potters syndrome - primary pathology is:
A. Oligohydramnios
B. Renal agenesis
C. Dysmorphism
D. Limb defects

Response:
b. Renal agenesis(Ref: Nelson 20/e 2513)Components of oligohydramnios complex (Potter syndrome), including low-set ears, micrognathia, flattened nose, limb positioning defects, intrauterine growth restriction & death may result from pulmonary hypoplasia.Bilateral renal agenesis is incompatible with extrauterine life & produces the Potter syndrome.

So the answer to this question is B


Instruction:
Keratomalacia ;s associated with:
A. Measles
B. Mumps
C. Rubella
D. Chicken pox

Response:
Ans. Measles

So the answer to this question is A


Instruction:
During which orthodontic tooth movement center of rotation is at the bracket slot:
A. Controlled movement
B. Torque
C. Rotation
D. Translation

Response:
None

So the answer to this question is B


Instruction:
Which is not a finding in viral encephalitis-
A. Astroglial proliferation
B. Perivascular mononuclear infiltrate
C. Inclusion bodies intranuclear and intracytoplasmic
D. None of the above

Response:
The pathologic Changes in viral encephalitis are :

Parenchymal infiltrate chiefly in perivascular location, of mononuclear cells consisting of lymphocytes, plasma cells, macrophages.
Microscopic clusters of MICROGLIAL cells and presence of Neuronophagia.
Viral infection can lead to : -

Intranuclear inclusions → Herpes infection (Cowdry body 'A')
Cytoplasmic inclusions → Rabies (Negri body)
Both intranuclear & cytoplasmic inclusions  → Cytomegalovirus.

So the answer to this question is A


Instruction:
Japanese encephalitis is transmitted by?
A. Culex
B. Aedes
C. Anopheles
D. Hard tick

Response:
ANSWER: (A) CulexREF: Park 20th ed p. 676Also asked in June 2011See APPENDIX-43 below for list of medically important "Mosquitos" APPENDIX - 43Mosquito AnophelesCulexAedesMansoniaA.K.A Nuisance mosquitoTiger mosquito Egg layingSingly on waterIn small dusters of 200-300 on waterSingly on damp soilIn star shaped clusters/Rafts on under surface of aquatic plantsEgg shapeBoat shaped2 Lateral floats +Trabeculated surface +Raft shape No lateral floatsCigar shapedNo lateral floatsStar shapedNo lateral floatsDesiccationCannot surviveCannot surviveCan surviveCannot surviveLarva (Wrigglers) 5-7 daysHorizontal floating Surface feeders.Mo siphon tubeHead down at an angle of 45deg parallel to the surface of 'water.Bottom feeders. Siphon tube 8th segment of abdomenHead down at an angle of 45deg parallel to the surface of water.Bottom feeders. Siphon tube 8th segment of abdomenHead down at an angle of 45'' parallel to the surface of water. Bottom feeders. Siphon tube 8th segment of abdomenPupa/T umblers 1-2 daysTrumpet/siphon tube broad & shortTrumpet/ siphon tube long & narrowTrumpet/ siphon tube long & narrowTrumpet/ siphon tube long & narrowAdult (2 weeks)Body inclined with surface at rest. Wings spotted Long palpi in both sexes.Body parallel to surface at rest. Wings not spotted. Short palpi in females.Body parallel to surface at rest. Wings not spotted. Short palpi in females.Body parallel to surface at rest.Wings not spotted. Short palpi in females.Feeding habitNight bitersNight biters Biting peak at MidnightDay time bitersNight bitersBreeding habitClean waterDirty and polluted waterArtificial collection of waterAquatic vegetationVector ofMalariaFilaria (not in India)Bancroftianfllariasis, Japanese encephalitis, west Nile feverYellow fever (not in India), Dengue, Chikungunya, Rift valley fever, Filaria (not in India)Malayan (Brugianfllariasis),ChikungunyaEggs hatch in 48 hoursPupa is resting stage, moves actively but do not feed Eggs to adult = 7-10 daysDuring growth, the larva molts (sheds its skin) four times. The stages between molts are called instars Life span of mosquito varies from 8-34 days (2 weeks average), males are short lived.Males never bite (feed on nectar). Females need blood meals every 2-3 days for development of eggs

So the answer to this question is A


Instruction:
A malignant tumor of childhood, that metastasizes to bones most often, is –
A. Wilm's tumor
B. Neuroblastoma
C. Adrenal gland tumors
D. Granulosa cell tumor of ovary

Response:
Metastasis present in 60-70% of children at time of diagnosis are usually to the skeleton, characteristically to the facial bones and the skull and to the bone marrow and nodes'

So the answer to this question is B


Instruction:
Laryngeal prominence is formed by-
A. Cricoid cartilage
B. Hyoid bone
C. Anterior margin of thyroid
D. Angle of the thyroid cartilage

Response:
The lower part of anterior borders of right and left laminae of thyroid fuse and form a median projection called laryngeal prominence.

So the answer to this question is D


Instruction:
Effects of hypokalemia-
A. Acidosis
B. Arrhythmia
C. Ileus of intestine
D. Polyuria

Response:
* The functional effects of hypokalemia on the kidney can include Na+-Cl- and HCO3- retention, polyuria, phosphaturia, hypocitraturia, and an activation of renal ammoniagenesis. Bicarbonate retention and other acid-base effects of hypokalemia can contribute to the generation of metabolic alkalosis * Hypokalemia is a major risk factor for both ventricular and atrial arrhythmias * Hypokalemia also results in hyperpolarization of skeletal muscle ,thus impairing the capacity to depolarize and contract; weakness and even paralysis may ensue. It also causes a skeletal myopathy and predisposes to rhabdomyolysis. Finally, the paralytic effects of hypokalemia on intestinal smooth muscle may cause intestinal ileus. (REF : harrisons principles of internal medicine, 19E, pg 308)

So the answer to this question is A


Instruction:
A 45-year-old man presents with a history of frequent falls. He has difficulty in looking down also. What is the most probable diagnosis -
A. Normal pressure hydro-cephalus
B. Parkinson's disease
C. Alzheimer's disease
D. Progressive supranuclear palsy

Response:
None

So the answer to this question is D


Instruction:
Which of the following is referred to as Luxatio erecta?
A. Tear of the glenoid labrum
B. Inferior dislocation of shoulder
C. Anterior dislocation of shoulder
D. Defect in the humeral head

Response:
"Inferior (downward/subglenoid) dislocation of shoulder is known as luxatio erecta". Inferior dislocation of shoulder It is caused by severe hyper abduction force. With the humerus as the lever and acromion as fulcrum, the humeral head is lifted across the inferior rim of the glenoid socket and pokes into axilla (subglenoid position). It is rare and also called luxatio erecta because the humeral head is subluxated (dislocated anteriorly and humerus shaft points upwards (erected). The staing picture of a patient with his/her arm locked in almost full abduction/ elevation, should make the diagnosis quite easy. The patient comes with his/her arm fixed almost by the side of the head. Potentially serious consequences e.g. neurovascular damage is quite common. It is reduced by pulling upward in the line of abducted arm with counteraction downwards. Ref: Rockwood and Green's Fractures in Adult 6/e, Page 1287.

So the answer to this question is B


Instruction:
Fohergill's repair is also known as :
A. Khanna's sling operation
B. Manchester operation
C. Le Fo's repair
D. Shirodkar's abdominal sling operation

Response:
Manchester operation

So the answer to this question is B


Instruction:
Which of the following is true statement for pramipexole:
A. Act on dopamine receptors
B. First line treatment for parkinsonism
C. Not an ergot alkaloid
D. All of the above

Response:
Ans. D. All of the abovePramipexole and ropinirole are dopamine agonist. They non-ergot derivatives which are used as first line treatment in parkinsonism. It is also used in restless leg syndrome.

So the answer to this question is D


Instruction:
In a patient with multiple injuries, first thing is to be done is
A. Patency of airway
B. Maintenance of B.P.
C. Immobilize cervical spine
D. Lateral position with mouth gas

Response:
None

So the answer to this question is A


Instruction:
Classical markers for Hodgkin's disease is -
A. CD 15 and CD 30
B. CD 15 and CD 22
C. CD 15 and CD 20
D. CD 20 and CD 30

Response:
None

So the answer to this question is A


Instruction:
A driver wearing seat belt applied brake suddenly to avoid accident. Most common organ injured in seat belt injury
A. Liver
B. Spleen
C. Mesentery
D. Abdominal aorta

Response:
Most common seat belt injury is mesentery

So the answer to this question is C


Instruction:
Frequency of woods lamp is ?
A. 365 nm
B. 400 nm
C. 320 nm
D. 200 nm

Response:
Ans. is `a' i.e., 360 nm Wood's lamp Wood's lamp has an ultraviolet light lamp (365 nm) with a filter containing nickle oxide and barium silicate. The UV light, when absorbed by ceain substances, fluorescences in dark and the color of fluorescence is useful in diagnosis of the condition. Condition Fluorescent colours Tinea capitis Bright yellow green Erythrasma Coral red or pink Vitiligo Milky white Albinism Blue white Leprosy Blue white Tuberous sclerosis Blue white Pseudomonas infection Greenish white Porphyria Pinklorange Tinea versicolor Golden yellow

So the answer to this question is A


Instruction:
Chemotherapeutic agents in the EMA-CO regimen include all EXCEPT which of the following?
A. Etoposide
B. Mithramycin
C. Actinomycin-D
D. Cyclophosphamide

Response:
EMA-CO regimen: * Etoposide * Methotrexate * Actinomycin D * Cyclophosphamide * Oncovin (vincristine).

So the answer to this question is B


Instruction:
Prophylactic Cholecystectomy is done in
A. Calcified GB
B. Diabetes
C. Asymptomatic gallstones
D. Family history of gallstones

Response:
Indications of prophylactic Cholecystectomy Cardiac transplant recepients Lung transplant recipients Chronic TPN requirements Recepients of biliopancreatic diversion (bariatric patient) Children with hemoglobinopathy (sickle cell, thalassemia and spherocytosis) Asymptomatic gallstone >=3cm Stone associated with the polyp Family history of GB cancer and asymptomatic stones Cholelithiasis encountered during elective abdominal procedures Non functioning GB Typhoid carrier with positive bile culture Trauma to GB Procelain GB Ref: Sabiston 20th edition Pgno :1494

So the answer to this question is A


Instruction:
Infection of CNS spreads in inner ear through
A. Cochlear aqueduct
B. Endolymphatic sac
C. Vestibular aqueduct
D. Hyle fissure

Response:
Ans. A Cochlear aqueductAs we know that cochlear aqueduct (Aqueduct of Cochlea) is a connection between scala tympani (containing perilymph) and the subarachnoid space (containing CSF). On occassions, paicularly in young children, the Cochlear aqueduct is large and open.Infection can spread to the inner ear from the infected CSF or vice versa, the cochlear aqueduct resulting in severe profound hearing loss (meningitic labyrinthitis).

So the answer to this question is A


Instruction:
Common fungus causing corneal ulcer is
A. Aspergillus
B. Mucor
C. Fusarium
D. Sprothrix

Response:
Aspergillus causes respiratory diseases, disseminated aspergillosis in brain, kidney and hea, and superficial infection like sinusitis, otomycosis and mycotic keratitis. Sporothrix causes sporotrichosis - nodular ulcerative disease of the skin and subcutaneous tissue. Mucor causes pulmonary and gastrointestinal mucormycosis. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition

So the answer to this question is A


Instruction:
The roof of the olfactory region is formed by
A. Nasal bone
B. Cribriform plate of ethmoid
C. Sphenoid
D. Temporal bone

Response:
The bony pa of the olfactory region is formed by: The vomer and The perpendicular plate of ethmoid.It's margins receive contributions from nasal spine of the frontal bone, the rostrum of the sphenoid and the nasal crests of the nasal palatine and maxillary bones. The cailaginous pa is formed by: The septal cailage and The septal processes of the inferior nasal cailages. The cuticular pa or lower end is formed by fibrofatty tissue covered by skin. Ref BDC volume 3,sixth edition

So the answer to this question is B


Instruction:
Phagocytic cells in brain -
A. Oligodendrocytes
B. Macrophages
C. Microglia
D. Astrocytes

Response:
Ans. is 'c' i.e., MicrogliaMicroglia are the major phagocytic cells in the brain.Phagocvtosis Phagocytosis and release of enzymes by neutrophils and macrophages are responsible for eliminating injurious agents.o Phagocytosis involves the following three steps.1. Recognition and attachmentPhagocytosis of microbes and dead cells is initiated by recognition of paicles by receptors expressed on leukocyte surface.These receptors are Mannose receptors and scavenger receptors.These receptors bind a variety of microbes.2. EnglulfmentBinding of a paicle to phagocytic leukocyte receptors initiates the process of active phagocytosis of the paicles.During engulment, extension of the cytoplasm, i.e., pseudopods flow around the paicle to be engulfed. Eventually, this results in complete enclosure of the paicle within a phagosome created by the plasma membrane.Membrane of this phagocytic vacuole (Phagosome) fuses with the membrane of lysosome to form phagolysosome resulting in discharge of lysosomal granule's content into phagosome.During this process neutrophils and macrophages become progressively degranulated.Phagocytosis is dependent on polymerization of actin (similar to chemotoxis that is also dependent on polymerisation of actin).3. Killing and degradationKillingMicrobial killing is accomplished largely by oxygen-depending mechanism, i.e., due to generation of reactive oxygen species.The generation of reactive oxygen species is due to rapid activation on an oxidase - NADPH oxidase. Reactive oxygen species cause membrane damage, cytoskeletal damage and DNA damage.Bacterial killing can also occur by oxygen-independent mechanisms, through action of substances in leukocyte granules -3 Bacterial permeability increasign protein (BPI), lysozyme, lactoferrin, major basic protein and defensin.DegradationAfter killing, acid hydrolases, which are normally stored in lysosomes, degrade the microbes within phagolysosome.

So the answer to this question is C


Instruction:
All of the following are poor prognostic factors of vitiligo except:
A. Long standing skin lesion
B. Underlying thyroid disease
C. Vitiligo on bony prominence
D. Black hair

Response:
Black hair follicle has melanocyte precursors which is a good prognostic sign.
White hair or leucotrichia is a poor prognostic sign.

So the answer to this question is D


Instruction:
Radiological findings in meningioma are all except:
A. Calcification
B. Vascular markings
C. Vascular markings
D. None of the above

Response:
Ans. None of the above

So the answer to this question is D


Instruction:
Congenital pseudo ahrosis is seen in which of the following:
A. Hip joint
B. Femur
C. Radius - ulna
D. Tibia

Response:
Tibia is the commonest affected bone in pseudoahrosis. Congenital pseudahrosis A pseudoahrosis is a bone fracture that fails to heal properly on its own Anterolateral bowing of the tibia Associated with neurofibromatosis Treatment is mainly surgical

So the answer to this question is D


Instruction:
Indications of urgent delivery of the second baby in twin are all except
A. Abruptio placentae
B. Cord prolapse of the second baby
C. Inadveent use of IV ergometrine with the delivery of the anterior shoulder of the first baby
D. Breech presentation of the second baby

Response:
Sometimes rapid delivery is indicated as in cord prolapse,abruption of the second twin or fetal distress.In such cases,the second baby is delivered by vaccum or forceps if it is in a veex presentation and by breech extraction in case of breech. Refer page no 188,189 of Text book of obsteics,sheila balakrishnan,2 nd edition

So the answer to this question is D


Instruction:
Tuberculin test is reaction of:
A. Anaphyxis mediated
B. Cell mediated
C. Antibody mediated
D. Immuno complex mediated

Response:
(Cell mediated): Ref: 196- CP, 160-AN 7thTypes of hypersensitivity reaction and their featuresType of reactionClinical syndromesType I (Anaphylactic IgE or region dependant)Antibodies (cytotropic IgE) dependent(I) Anaphylaxis(II) Atopy1. Theobald Smith phenomenon in animals (Guinea pigs) 2. Prausnitz - Kustner (PK) reaction (GI allergy to certain cooked fish)3. Casoni's test (skin test)Type II (cytotoxic or cell stimulating)Antibody mediated damage - Thrombocytopenia, agranulocytosis, hemolytic anemiaType III (Immune complex or toxic complex disease)1. Arthrus reactions2. Serum sicknessType IV (Delayed or Cell mediated hypersensitivity1. Tuberculin (Lepromin, Frie's test, Histoplamsin and toxoplasmin test,2. Granulomatous type (Mitsuda reaction to leprosy Ag)3. Contact dermatitis (patch test)4. Graft rejection (chronic)5. Jones - Mole reaction (cutaneous basophil hypersensitivity)Type V stimulating type reaction: It is a modification of type II hypersensitivity reaction eg Grave's disease - in which thyroid hormones are produced in excess amountThyroid stimulating antibody (LATs) is a specific thyroid auto antibody to thyroid membrane antigens, LATs can cross placenta which may lead to hyperthyroidism in neonates.Antibody - Dependent Cell Mediated Cytotoxicity (ADCO Type VI hyper sensitivity reaction - While most workers prefer include the entity under immediate type (Type I hypersensitivity reaction) because of involvement of circulating Ig. ADCC is mediated through NK cells and the cytoplasmic mechanism is independent of compliment (206-C)

So the answer to this question is B


Instruction:
Appendix the  persent -
A. Appendix
B. Caecum
C. Rectum
D. Sigmoid colon

Response:
Small bags of peritoneum filled with fat, called appendices epiploicae are present over the surface of the large intestine, except for appendix, coecum and rectum.

So the answer to this question is D


Instruction:
Hemiplegia is most often caused by thrombosis of -
A. Anteiror cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Basiliar artery

Response:
Ans. is 'b' i.e., Middle cerebral artery Middle Cerebral Arteryo Deep branches of the middle cerebral artery on the lenticulostriate branches supply the internal capsule (posterior limb).o Motor tracts are densely packed in this region and hence occlusion of deep branches or lenticulostrials branches leads to Densse Hemiplegia/ Pure motor Hemiplegia.o Anterior choroidal artery supplies the posterior limb of internal capsule (and not anterior limb of internal capsule).o Anterior chorodial artery arises from the internal carotid artery and supplies the posterior limb of internal capsule. The complete syndrome of anterior choroidal artery occlusion consists of contralateral hemiplegia hemianesthesia (hypoesthesia) and homonymous hemianopiaPosterior Cerebral Arteryo The posterior cerebral artery supplies the midbrain, thalamus lateral geniculate bodies, posterior of chroid plexus, occipital lobes, inferior and medial aspect of the temporal lobe and posterior inferior areas of the parietal lobe.Occlusion of the Posterior Cerebral Artery usually results in two common clinical svndrome dcncndimi on the areas involved|||PI SyndromeP2 Syndromeo Occlusion of the proximal segment of PCA from its origin to its union with the posterior communicating artery.o PI syndrome present primarily with the following signs:# Midbrain signs# Thalamic signs# Subthalamic signso Occlusion of the distalsegment of PCA distal to the junction of PCA with the posterior communicating arteryo P2 syndrome presents primarily with the following signs:# Temporal lobe signs# Occipital lobe signs

So the answer to this question is B


Instruction:
Tacrolimus acts by inhibiting :
A. DNA and RNA synthesis
B. Anti–lymphocyte antibody formation
C. T–Cell proliferation
D. All of the above

Response:
None

So the answer to this question is C


Instruction:
Most common mechanism of transfer resistance in Staphylococcus aureus is:
A. Conjugation
B. Transduction
C. Transformation
D. Mutation

Response:
Ans.is. b i.e.' Transduction

So the answer to this question is B


Instruction:
Which is the most common cause of acquired aeriovenous fistula?
A. Blunt trauma
B. Fungal infection
C. Bacterial infection
D. Penetrating trauma

Response:
Acquired aeriovenous fistulas are caused by aificial connections between adjacent aeries and veins. Penetrating injuries are the most common cause of acquired aeriovenous fistula. Other causes includes creating vascular access for hemodialysis, as complications of aerial catheterization or surgical dissection and rarely it can be caused by rupture of an aerial aneurysm into a vein. Ref: Bailey and Love Sho Practice of Surgery, 25th Edition, Page 596; Harrison's Principles of Internal Medicine, 18th Edition, Chapter 249.

So the answer to this question is D


Instruction:
Which of the following aery is not a terminal branch of coeliac trunk ?
A. common hepatic aery
B. left gastric aery
C. splenic aery
D. gastroduodenal aery

Response:
The coeliac trunk arises from the front of the abdominal aoa just below the aoic opening of the diaphragm at the level of the disc between veebrae thoracic twelve and first lumbar. The trunk is only about 1.25 cm long. It ends by dividing into its three terminal branches, namely the left gastric, hepatic and splenic aeries. Ref : B D Chaurasia's Human Anatomy ,seventh edition , volume 2 , pg. no., 302 ( fig. 21.3 to 21.5 ).

So the answer to this question is D


Instruction:
Most common cause of repeated 2nd-trimester foetal loss is
A. Chromosomal anomaly
B. Intrauterine infection
C. Abnormality of cervix and uterus
D. Hormonal imbalance

Response:
Common known causes of aboion: First trimester: defective germ cells, hormonal deficiency, trauma, acute infection. Second trimester: Cervical incompetence, uterine malformations, uterine fibroid, low implantation of placenta, twins and hydramnios

So the answer to this question is C


Instruction:
Treatment of atropine toxicity -
A. 2-pralidoxime
B. Naloxone
C. Flumazenil
D. Physostigmine

Response:
Ans. is 'd' i.e., Physostigmine o Atropine blocks cholinergic receptors. So, for atropine overdose, we require a drug that increases cholinergic action. o Physostigmine increases the concentration of Ach. Physostigmine counteracts central (because it crosses BBB) as well as peripheral symptoms of atropine toxicity (other anticholinesterases like neostigmine and pyridostigmine counteract only peripheral symptoms as they cannot cross BBB) --> Physostigmine is the DOC.

So the answer to this question is D


Instruction:
Lymph nodes draining the breast and lying behind the pectoralis minor are labelled as:
A. Level 1
B. Level 2
C. Level 3
D. None of the above

Response:
Axillary nodes receive more than 75% of the lymph from the breast. There are 20-40 nodes, grouped aificially as pectoral (anterior), subscapular (posterior), central and apical. Surgically, the nodes are described in relation to pectoralis minor. Those lying below pectoralis minor are the low nodes (level 1), those behind the muscle are the middle group (level 2), while the nodes between the upper border of pectoralis minor and the lower border of the clavicle are the upper or apical nodes (level 3). Ref: Gray's anatomy 40th edition, Chapter 58.

So the answer to this question is B


Instruction:
In a clinical trial, blood pressure was measured between in a group of patients before and after treatment, which of the following test will be suitable as at test of significance?
A. Paired t-test
B. Mann Whitney U test
C. Student test
D. ANOVA

Response:
Ans. A. Paired t-test

So the answer to this question is A


Instruction:
Basophilic stippling is seen which of the following cells
A. Eosinophils
B. RBC's
C. Basophils
D. Neutrophils

Response:
LEAD Chronic Poisoning (plumbism; saturnism) Signs and Symptoms :- (1) Facial Pallor : The facial pallor paicularly about the mouth is one of the earliest and most consistent sign. It seems to be due to vasospasm. (2) Anaemia : There may be polycythaemia with polychromatophilia in early stages, but later there is anaemia which is associated with polychromasia, punctate basophilia, reticulocytosis, poikilocytosis, anisocytosis, nucleated red cells (sideroblasts) and an increase in mononuclear cells, whereas polymorphonuclear cells and platelets are decreased. The anaemia is probably due to decreased survival time of red blood cells and inhibition of haeme synthesis by interference with the incorporation of iron into protoporphyrin. Punctate basophilia or basophilic stippling means the presence of many dark blue-coloured pinhead- sized spots in the cytoplasm of red blood cells, due to toxic action of lead on porphyrin metabolism. Reticulocytes and basophilic stippled cells result from the inhibition of 5 pyrimidine nucleotidase, an impaired ability to rid the cell of RNA degradation products and the aggregation of ribosome. (3) Line : A stippled blue line, called Buonian line, is seen on the gums. It appears due to subepithelial deposit of granules at the junction with teeth, only near diy or carious teeth, within a week of exposure, especially on upper jaw. It is due to formation of lead sulphide by the action of hydrogen sulphide formed by decomposed food in the mouth. (4) Colic and Constipation : It is usually later symptom. Colic of intestines, ureters, uterus and blood vessels occur in 85% of cases. The colic occurs at night and the pain may be very severe. Constipation is usual but diarrhoea or vomiting may occur. (5) Lead Palsy: It usually occurs late, and is seen in less than 10% of cases. There may be tremors, numbness, hyperaesthesia, and cramps before the actual muscle weakness. It is commoner in adults than in children, and men are paicularly affected. The muscle groups affected are those most prone to fatigue. Usually the extensor muscles of the wrist (wrist drop; radial nerve is affected) are affected, but the deltoid, biceps, anterior tibial (foot drop), and rarely muscles of eye or intrinsic muscles of hand or foot are affected. The paralysis is associated with degeneration of the nerve and atrophy of the muscles. Recovery may be complete but is usually slow. ( 6) Encephalopathy : It is common in children often associated with tetraethyl lead. The symptoms are vomiting, headache, insomnia, visual disturbances, irritability, restlessness, delirium, hallucinations, convulsions, coma and death. Lead encephalopathy is usually irreversible and about 85% have permanent brain damage. Death occurs in about 25% cases. Ref:- k s narayan reddy; pg num:-544,545

So the answer to this question is B


Instruction:
Following is associated with maximum risk of invasive cervical cancer:-
A. LGSIL
B. HPV associated koilocytosis
C. High grade squamous intraepithelial lesion (HGSIL)
D. HSV related changes

Response:
HSV & HIV predisposes more to pre invasive cervical cancer than invasive disease. Severity of dysplasia is directly propoional to malignancy. HPV 16 is the most common association, HPV 18 is this most malignant association with ca cervix LSIL (CIN I) , HSIL (CIN II and CIN III) and carcinoma in situ (CIS) are degrees of cervical dysplasia noted on a paps smear and confirmed on a colposcopic biopsy. Their risk of transforming into invasive cancer are CIS>HSIL>LSIL

So the answer to this question is C


Instruction:
All of the following drugs are useful in destrussor instability EXCEPT:
A. Solefenacin
B. Tolterodine
C. Flavoxate
D. Duloxetine

Response:
Ref:KD Tripathi pharmacology 7th edition (page.no: 117,118, 462) Vesicoselective drugs are used for detrusor instability resulting in urinary frequency and urge incontinence. It selectively blocks M1/M3 subtypes. Example are Oxybutynin, Tolterodine, Flavoxate, Darifenacin, Drotaverine, Solifenacin. Duloxetine is an SNRI. it is neither sedative nor anticholinergic, nor antihistaminic, nor a blocker

So the answer to this question is D


Instruction:
Gallstones do not contain:
A. Oxalate
B. Cholesterol
C. Phosphate
D. Carbonate

Response:
Gallstones In the USA and Europe, 80% are cholesterol or mixed stones, whereas in Asia, 80% are pigment stones Cholesterol or mixed stones - 51-99% pure cholesterol Pigment stone contains <30% cholesterol Black stones - Insoluble bilirubin polymer + calcium phosphate + calcium bicarbonate Brown pigment stones- calcium bilirubinate+ calcium palmitate + calcium stearate+ cholesterol

So the answer to this question is A


Instruction:
Bochdaleck hernia location:
A. Posterolateral
B. Anteroposterior
C. Anterolateral
D. Posteromedial

Response:
Ans. (a) PosterolateralRef.: Bailey & Love 26th ed. / 871-72* Bochdaleks hernia is the most common form of diaphragmatic hernia, occurring in approximately 1 in 2500 births and twice as often in males as in females.* Bochdaleks hernia results from failure of normal development of the posterolateral diaphragm during embryogenesis.* Separation of the developing thoracic and abdominal cavities occurs during the eighth week of gestation, when the opening between the chest and abdomen (the pleuroperitoneal canal) closes. A congenital diaphragmatic hernia results when the pleuroperitoneal membrane fails to form.* Most Bochdaleks hernias occur on the left side, allowing protrusion of the abdominal viscera into the chest. The herniated bowel passes through the defect, filling the chest cavity and causing hypoplasia of the left lung and a shift of mediastinal structures to the right side. It is not uncommon for other abnormalities to be associated with Bochdaleks hernia; these may include neural tube defects and cardiovascular abnormalities* The left-sided Bochdalek hernia occurs in approximately 85% of cases. Left-sided hernias allow herniation of both the small and large bowel and intraabdominal solid organs into the thoracic cavity.* In right-sided hernias (13% of cases), only the liver and a portion of the large bowel tend to herniate. Bilateral hernias are uncommon and are usually fatalRemember* The 3 basic types of congenital diaphragmatic hernia include the posterolateral Bochdalek hernia (occurring at approximately 6 weeks' gestation), the Anterior Morgagni hernia, and the hiatus hernia.

So the answer to this question is A


Instruction:
In neonate, intra muscular injection given at -
A. Deltoid
B. Gluteal
C. Thigh
D. Abdomen

Response:
Ans. is 'c' i.e., Thigho Anterolateral aspect of thigh because of leaking of important blood vessel & nerve,o This is preferred site upto 12 month of age.

So the answer to this question is C


Instruction:
All lysosomal storage diseases are autosomal recessive, EXCEPT?
A. Fabry's disease
B. Hurler disease
C. Morquio disease
D. Gaucher disease

Response:
All lysosomal storage diseases are autosomal recessive, EXCEPT Fabry disease & Hunter disease. Fabry disease: X-linked recessive inheritance. Hunter disease: X-linked recessive inheritance.

So the answer to this question is A


Instruction:
“Tophus” is the pathognomonic lesion of which of the following condition
A. Multiple myeloma
B. Gout
C. Cystinosis
D. Eales disease

Response:
Tophi are pathognomonic of gout. They are formed by large aggregations of urate crystals. The urate crystals are surrounded by
a. Macrophages
b. Lymphocytes
c. Large foreign body giant cells
They are seen in them.
Articular cartilages of joints *
b. Periarticular ligaments*
c. Tendons and soft tissues*
d. Achilles tendon*
e. Earlobes*
Also, remember these very important points related to Gout-
Hyperuricemia is present in approximately 5% of individuals. Most of them are asymptomatic with regard to their hyperuricemia and are at no clinical risk.
The most recognized complication of Hyperuricemia is Gouty arthritis. The higher the serum level of urate the more likely an individual is to develop Gout.
An acute attack of gout occurs without any precipitating cause or may occur following rapid

So the answer to this question is B


Instruction:
Which of the following drug should not be used to treat Klebisella infection?
A. Ampicillin
B. Amikacin
C. Imipenem
D. Tigecycline

Response:
Ans. is 'a' i.e. Ampicillin Treatment of Klebsiella infection o Klebsiella pneumoniae and K.oxytoca are intrinsically resistant to ampicillin and ticarcillin, and nitrofurantoin is only poorly active against them. o Empirical treatment of serious or health care-associated Klebsiella infections include amikacin, or Carbapenem (Imipenem). (According to 17th/e of Harrison, Tigecyclin was also used as empirical treatment). o Treatment of infections due to strain that possess carbapenemases includes Tigecyclin, Polymyxin B, and poly? myxin E (Colistin) (This information has been added in 18th/e of Harrison)

So the answer to this question is A


Instruction:
Which part of DNA is most susceptible to radiation?
A. Nucleotides
B. Nucleosides
C. Histones
D. Double helix

Response:
(D) Double helix > Relatively flexible areas of the DNA double helix are most susceptible to damage.> Radiation can damage the DNA "double helix" - a two-stranded, twisting molecule - in a variety of ways: 1) by knocking off one or more of the DNA "bases" known by the letters A, T, G, and C, which form the bonds between the two strands of the double helix; 2) by oxidizing these bases; or 3) by breaking through one or both strands. All can result ir a failure of the molecule to perform its main task - telling cells which proteins to make. That can lead to out-of-control cell growth (cancer) or death.

So the answer to this question is D


Instruction:
Which of the following has maximum density?
A. VLDL
B. LDL
C. HDL
D. Chylomicrons

Response:
Ref: M.N. Chatterjea - Textbook of Biochemistry, 8th edition, page no: 446

So the answer to this question is C


Instruction:
Most common carcinoma after burns is
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Melanoma
D. Mucoid carcinoma

Response:
None

So the answer to this question is A


Instruction:
True about tonsils area) Develops from 4th pharyngeal archb) Lymph nodes drains to jugulodigastric nodec) It is endodermal derivatived) Rest on superior constrictor of the pharynxe) Long axis of tonsil is forward and medially
A. abc
B. bcd
C. ac
D. bd

Response:
Palatine tonsil develops from 2nd pharyngeal pouch from endodermal lining.
Lymphatics drain into jugulodigastric nodes (upper deep cervical nodes).
Superior constrictor forms the bed of tonsil, i.e. tonsil rests on superior constrictor.
Long axis of tonsil is directed from above downward and backward.

So the answer to this question is B


Instruction:
In hand surgery which area is called no man's land
A. Proximal phalanx
B. Distal phalanx
C. Between distal phalanx crease and proximal phalanx
D. Wrist

Response:
C i.e. Between the distal phalanx crease and proximal phalanx

So the answer to this question is C


Instruction:
"Spongy appearance" with central sunburst calcification is seen in
A. >Pancreatic adenocarcinoma
B. Mucinous cyst adenocarcinoma
C. Somato statinoma
D. Serous cyst adenoma

Response:
Serous cyst adenoma (Ref: Sutton Radiology, 7/e, p 793] "The serous cyst adenoma, or inicrocystic adenoma, is a benign tumor of elderly women, presenting with vague abdominal symptoms. A large calcified mass is often seen, with the calcification having a characteristic sunburst pattern within a central fibrotic scar". - Sutton Splenocolic ligament Small and large bowel mesentry Left broad ligament in women Left spermatic cord in men

So the answer to this question is D


Instruction:
Which of the following is seen in Seropositive Rheumatoid Arthritis?
A. Multiple joints affected
B. Symmetrical joint symptoms
C. Morning stiffness, joint pain and swelling
D. All of the above

Response:
(D) All of the above[?]Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology marked by a symmetric, peripheral polyarthritis.It is the most common form of chronic inflammatory arthritis & often results in joint damage and physical disability.Because it is a systemic disease, RA may result in a variety of extraarticular manifestations, including fatigue, subcutaneous nodules, lung involvement, pericarditis, peripheral neuropathy, vasculitis & hematologic abnormalities. Rheumatoid Arthritis Criteria (1987 revision, American Rheumatism Association):Morning stiffness (in/around joints, >1 hr before maximal improvement)Arthritis (swelling) of 3 or more joint areas (observed by physician)Symmetric arthritis (swelling, NOT bony overgrowth)Arthritis of Hand joints (wrists, MCPs or PIPs)Rheumatoid nodulesRheumatoid factor (serum)Radiographic changes (erosions and/or peri-articular osteopenia in hand/wrist joints)Requirements: >4 of the above 7 criteria. Criteria 1-4 must have been present for at least 6 weeks.Characteristic hand signs:Z-thumbs, Boutonniere, swan-necking, ulnar deviation, muscle wasting, subluxation of MCP, sometimes Carpal tunnel syndrome, Atlantoaxial subluxationExtra-articular features; Sjogren 'ds syndrome, Reynaud's, vasculitis. Nodules (firm but usually painless)Pathology: Auto-antibody production (70%IgM,30%IgG) against joint tissues.Investigations:Blood: RA factor positive. Rheumatoid factor is not diagnostic. Present in 70%, but also in general population. Rheumatoid positive disease has worse prognosis and more extensive deformity. Anti-CCP antibodies test similar to rheumatoid factor, | ESR + | CRP, normochromic-normocytic anaemia common.X-ray: look for nodules, soft-tissue swelling, osteopaenia, deformity, erosions.Treatment:Aim to reduce long-term deformity & LoF. Steroids induce remission, beware SE's long termDMARDs are mainstay. All can cause myelosuppression and rash plus: Sulfasalzine: hepatic impairment, oligospermia, methotrexate; GI disturbance (give folic acid to reduce), mouth ulcers, hepatic impairment gold; medical emergency rash, photosensitivity, nephrotic syndrome; leflunomide, chloroquine: retinitis, tinnitus, infliximab; anti TNF- a agent: can cause reactivation of latent diseases (e.g. TB).

So the answer to this question is D


Instruction:
Which is not a side effect of POP (Progestin only pill)-
A. Ovarian cysts
B. Venous thromboembolism
C. Increased risk of diabetes mellitus
D. Ectopic pregnancy

Response:
Ans. is 'b' i.e., Venous thromboembolism o POP have no significant metabolic effects (lipid levels, carbohydrate metabolism, and coagulation factors remain unchanged), and thus no increased risk of venous thromboembolism.Progestin only pill (MinipilBo Mechanism of action :# Because of the small amount of progestin in the circulation (25% of that in Combined oral contraceptives), it has significant effect only on those tissues very sensitive to the female sex steroids.# Thus it acts primarily on endometrium and cervical mucus.# It does not have a feedback inhibition effect on FSH secretion, thus patients on POP ovulate normallyo Pill taking# Because of the low dose, the minipill must be taken every day at the same time of day.# The change in the cervical mucus requires 2-4 hours to take effect, and, most importantly, the impermeability diminishes 22 hours after administration, and by 24 hours some sperm penetration occurs. Midday administration is recommended.# If more than 3 hours delay in taking a pill, a back up method should be used for contraceptiono Side effects:a) Increased risk of non - insulin dependent diabetes mellitus in lactating women with recent gestational diabetes.b) Acne:# Mechanism of acne development: Androgenic activity of levonorgestrel decreases the circulating levels of sex-hormone binding globulin (SHBG). Therefore, free steroid levels (levonorgestrel and testosterone) will be increased despite the low dose.# This is contrast to the action of combined oral contraception where the effect of the progestin is countered by the estrogen - induced increase in SHBG.c) Ectopic pregnancy - Not prevented as effectively as intrauterine pregnancy.# Although a previous ectopic pregnancy is not regarded as a contraindication to the minipill.

So the answer to this question is B


Instruction:
A 30-year-old lady who is always very talkative, even to strangers. She always compare herself to other colleagues in company. She remains agitated and move from one task to another (hyperactive): March 2013 (f)
A. Mania
B. Depression
C. Schizophrenia
D. Psychosis

Response:
Ans. A i.e. Mania

So the answer to this question is A


Instruction:
The most frequent cataract type seen in adult retinitis pigmentosa patient is
A. PSC
B. Anterior polar
C. Cortical
D. Mixed

Response:
Ans. (a) PSCRef: Yanoff and Duker 2/e, p. 818; Kanski 7/e, p. 654* Retinitis pigmentosa is associated with posterior subcapsular cataract (PSC)Retinal pigment degeneration such as retinitis pigmentosa, Usher's syndrome and gyrate atrophy are associated with cataract, which are usually subscapular opacities.

So the answer to this question is A


Instruction:
Characteristic histological finding in benign hypertension
A. Proliferative end arteritis
B. Necrotizing arteriolitis
C. Hyaline arteriosclerosis
D. Cystic medial necrosis

Response:
Ans. (c) Hyaline arteriosclerosis(Ref: Robbins 9th/pg 490, 938-939; 8th/pg 495)a. Also called obliterative endarteritis seen in syphilis/TB/radiation, poisoning, etcb. Malignant MTc. Benign HTd. MC in marfan syndrome

So the answer to this question is C


Instruction:
Infantile autism is characterized by – a) Impaired visionb) Impaired Neurobehavioural developmentc) Impaired folate leveld) A socio–economic hazarde) Parenting
A. bd
B. d
C. ab
D. ac

Response:
Autism is a neurological disorder.
It is more common in low socio-economic groups.

So the answer to this question is A


Instruction:
Best method of condensation
A. Lateral condensation
B. Thermoplasticized
C. Vertical condensation
D. None of above

Response:
None

So the answer to this question is A


Instruction:
The following are the common features of acute idiopathic thrombocytopenic purpura except-
A. Epistaxis
B. Cutaneous ecchymoses
C. Massive splenomegaly
D. Thrombocytopenia

Response:
Acute ITP is a self limiting disorder seen mor frequently in children following recovery from a viral illness or an upper respiratory illness.The clinical manifestations develop abruptly with petechial hemorrhages,easy bruising ,menorrhagia,nasal bleeding ,bledding from gums,melaena & hematuria.In ITP, platelet count is markedly reduced. Splenomegaly & hepatomegaly may occur in cases with chronic ITP ,but not in acute ITP.Reference :Harsh mohan textbook of pathology 6th edition pg no 333.

So the answer to this question is C


Instruction:
A reluctant child forced to bring sugar from a shop spills half of it in the way. This is an example of:
A. Hysteria
B. Passive aggression
C. Disobedience
D. Active aggression

Response:
Passive - aggressive behavior -Indirectly expressing the anger towards others.It is an immature defense mechanism. For example, a young boy was forced to bring a glass of water for the father, While bringing the water, the child accidentally tripped and dropped the glass. Here, the child was able to express his anger indirectly by dropping the glass. Other immature defense mechanism- Acting out - Acting on an unconscious desire without becoming aware of it Regression - Return to an earlier stage of development. Involved in neurosis Projective identification - Intolerable aspects of self are projected on to another person , that person is induced to play the projected pa and two persons act in unison.

So the answer to this question is B


Instruction:
Anti-D immune globulin is administered to Rh-negative women antenatally at
A. 20weeks
B. 24weeks
C. 28weeks
D. 30weeks

Response:
The antepaum administration of anti-D immune globulin at 28weeks to Rh-negative women decreases the incidence of third-trimester alloimmunization from 18 to 20/1000 to 2/1000 patients.Reference: Practical guide to High-risk pregnancy and delivery; Chapter 14; Rh Alloimmunization

So the answer to this question is C


Instruction:
According to Glasgow coma scale (GCS), a verbal scare of 1 indicates:
A. No response
B. Inappropriate words
C. Incomprehensible sounds
D. Disoriented response

Response:
Ans. is 'a' i.e., No response

So the answer to this question is A


Instruction:
PDS is absorbed within?
A. 7 days
B. 21 days
C. 100 days
D. 180 days

Response:
Polydioxanone (PDS): A synthetic smooth suture that is delayed absorbable, monofilament and lasts longer than dexon. It is absorbed in 6 months; other propeies are the same as dexon.

So the answer to this question is D


Instruction:
Which of the following is false regarding blood supply of dura mater?
A. Meningeal branch of ICA in posterior cranial fossa
B. Accessory meningeal artery
C. Meningeal branch of anterior and posterior ethmoidal artery
D. Middle meningeal artery

Response:
(a) Meningeal branch of ICA in posterior cranial fossaRef: Grays Anatomy, 41st ed., pg, 439 and Snell's neuroanatomy, 7th ed., pg. 475-477In the anterior cranial fossa, the dura is supplied by the anterior meningeal branches of the anterior and posterior ethmoidal and internal carotid arteries and a branch of the middle meningeal artery.In the middle cranial fossa, it is supplied by the middle and accessory meningeal branches of the maxillary artery, a branch of the ascending pharyngeal artery (entering via the foramen lacerum), branches of the internal carotid and a recurrent branch of the lacrimal artery.In the posterior fossa, the dura is supplied by the meningeal branches of the occipital artery (one enters the skull by the jugular foramen and another by the mastoid foramen), the posterior meningeal branches of the vertebral artery, occasional small branches of the ascending pharyngeal artery, which enter by the jugular foramen and hypoglossal canal, and the dorsal meningeal and tentorial arteries arising from the meningohypophysial trunk.

So the answer to this question is A


Instruction:
A mother comes with her 3 year old female child with complain of that child is not eating anything. Her weight is 11 kg (50th percentile) and height is 88 cm. (75th percentile). What should be done next?
A. Vitamin rich tonic to be given
B. Forceful eating
C. Nothing should be done actively and assure the parent
D. Complete investigation for UTI

Response:
Ans. is 'c' i.e., Nothing should be done actively and assure the parent "Allowable normal range of variation in observation, is conventionally taken between 3' and 97" percentile curves" - Ghai o This female child has weight (50 th percentile) and height (75th percentile) in normal range of variation (3rd-97th percentile). o So, nothing should be done actively and the parent should be assured that weight and height of the child are within normal range

So the answer to this question is C


Instruction:
In autopsy, which organ is removed with liver?
A. Kidney
B. Stomach
C. Brain
D. Spleen

Response:
LIVER is removed by itself or attached to the stomach and the duodenum when bile ducts are to be examined.

So the answer to this question is B


Instruction:
All these are techniques to decrease scarring except
A. Late removal of sutures
B. Tension free suturing
C. Finer suture materials
D. Debridment

Response:
Principles of wound managementCleansingDebridementRepair of structuresReplacement of lost tissues where indicatedSkin cover if requiredSkin closure without tensionCareful tissue handling and meticulous techniqueSuture marks may be minimised by using monofilament sutures that are removed early (3-5 days).Fine sutures (6/0or smaller) placed close to the wound margins tend to leave less scarring.Bailey and Love 27e pg: 32

So the answer to this question is A


Instruction:
Koenen's periungal fibroma is seen in
A. Tuberous sclerosis
B. Neurofibromatosis
C. Psoriasis
D. Alopecia aerata

Response:
A i.e. Tuberous sclerosis

So the answer to this question is A


Instruction:
Data of happy, moderately happy and very happy is-
A. Nominal
B. Ratio
C. Ordinal
D. Interval

Response:
Scales can be: Qualitative: Categorical scales: Nominal : eg: names of countries . Dichotomous : eg: yes/no, presence/absence. Ordinal : severity of disease: mild/moderate/severe.eg: staging of cancer, kuppusamy socioeconomic class. Quantitative: Metric scales: Interval Ratio

So the answer to this question is C


Instruction:
DNA fingerprinting was discovered by
A. Crick
B. Galton
C. Jeffery
D. Southern

Response:
DNA FINGERPRINTING DNA fingerprinting (DNA typing, DNA identification, or genetic typing) is a technique involving chemically dividing the DNA into fragments which form a unique pattern and then matching that "identity profile" with the pattern obtained from similarly testing a suspect&;s blood specimen. If the two patterns match, the possibility of error, i.e. the chance that they do not belong to the same individual may be less than one in 30 billion. Dr. Alec Jeffreys in 1985, developed DNA fingerprinting. Ref:- k s narayan reddy; pg num:- 459

So the answer to this question is C


Instruction:
Yellow Fatty liver is characteristic of poisoning with:
A. Arsenic
B. Mercury
C. Phosphorus
D. Oxalic Acid

Response:
Yellow fatty liver is characteristic of poisoning with Phosphorus. Mercury and arsenic may have fatty liver, but is most characteristic with the poisoning of phosphorus. Ref: The Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Page 474, 484, 485; Harrison's Principles of Internal Medicine, 16th Edition, Page 1870

So the answer to this question is C


Instruction:
Most common defect in hereditary spherocytos is in ?
A. Spectrin
B. Ankyrin
C. Band 3
D. Band 4.2

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

So the answer to this question is B


Instruction:
Herbert\'s pits are seen in –
A. Trachoma
B. Spring catarrh
C. Phlyctenular conjunctivitis
D. Sarcoidosis

Response:
Herbert pits are the oval or circular pitted scar, left after healing of herbert follicles in the limbal area.

So the answer to this question is A


Instruction:
Boundaries of Koch's triangle is not formed by:
A. Tricuspid Valve Ring
B. Coronary Sinus
C. Limbus fossa ovalis
D. Tendon of Todaro

Response:
Ans. C. Limbus fossa ovalisKoch's triangle, named after the German pathologist and cardiologist Walter Karl Koch, is an anatomical area located in the superficial paraseptal endocardium of the right atrium, which its boundaries are the coronary sinus orifice, tendon of Todaro, and septal leaflet of the right atrioventricular valve. It is anatomically significant because the atrioventricular node is located at the apex of the triangle.

So the answer to this question is C


Instruction:
In Cone Beam Radiography, raw digital data for reconstruction is obtained from:
A. 120 exposures / projections
B. 240 exposures / projections
C. 360 exposures / projections
D. 480 exposures / projections

Response:
All computed tomographic (CT) scanners consist of an X-ray source and detector mounted on a rotating gantry. During rotation of the gantry, the X-ray source produces radiation, while the receptor records the residual X-rays after attenuation by the patient’s  tissues. These recordings constitute the “raw data” that is reconstructed by a computer algorithm to generate cross-sectional images. The basic component of these grayscale images is the picture element (pixel) values. The grayscale value or intensity of each pixel is related to the intensity of the photons incident on the detector. Although providing similar images, CBCT imaging represents a separate evolutionary arm to CT imaging employing multidetector computed tomographic (MDCT) imaging equipment.
 Reference: White and Pharoah's Oral Radiology Principles and Interpretation 7th edition page no 184

So the answer to this question is C


Instruction:
When does the Implantation occur?
A. On day 4 after feilization
B. After the endometrium undergoes a decidual reaction
C. When the embryo is at the morula stage
D. Only after priming of the uterine endometrium by progesterone and estrogen

Response:
.

So the answer to this question is D


Instruction:
Which of the follow ing is the disorder of purine -
A. Hyperammonemia
B. Gout
C. Orotic acduria
D. Hartnup disease

Response:
Ans. is 'b' i.e., Gout Disorders of purine metabolism Disorders of pyrimidine metabolismo Gout o Orotic aciduriao Lesch-Nyhan syndrome o b-hydroxybutyric aciduriao Adenosine-deaminase dificiency o Uraciluria-thyminuriao Purine uncleoside phosphorylase dificiency

So the answer to this question is B