Instruction:
Maximal deaths in MI occurs within
A. 0-24 hrs
B. 24-48 hrs
C. 48-72 hrs
D. > 72 hrs

Response:
(A) 0-24 hrs > The vast majority of deaths due to ventricular fibrillation occur within the first 24 h of the onset of symptoms, and of these, over half occur in the first hour.> Therefore, the major elements of prehospital care of patients with suspected STEM I include Recognition of symptoms by the patient and prompt seeking of medical attention Rapid deployment of an emergency medical team capable of performing resuscitative maneuvers, including defibrillation Expeditious transportation of the patient to a hospital facility that is continuously staffed by physicians and nurses skilled in managing arrhythmias and providing advanced cardiac life support Expeditious implementation of reperfusion therapy

So the answer to this question is A


Instruction:
Delayed hypersensitivity in skin tests, is assessed by
A. Erythema
B. Bulla
C. Necrosis
D. Induration

Response:
Intradermal test for delayed hypersensitivity - Usually employed for infectious diseases. - Antigen is prepared from the respective infective agents and injected intradermally. - Significantly indurated nodule after 48 hrs is considered to indicate delayed hypersensitivity to the antigen. - Test continues to remain positive even after the infection has subsided, though active infections usually produce more severe reactions. -In overwhelming infections the test can completely become negative because of the suppression of delayed hypersensitivity. Erythema- redness of the skin or mucous membranes due to increased flow in superfiial cappillaries Bulla- clear fluid filled lession with size mor tha 0.5 cm Necrosis-irreversibe cell injury leading to cell death due to denaturation of proteins / enzymatic digestion of cells. it is always pathological and associated with inflamation

So the answer to this question is D


Instruction:
A 29-years-old male taking oral hypoglycemic drug never had ketonuria in his life. His BMI is 20.5. His grandfather had diabetes and his father who is the only son of his grandfather too had the disease. Which type of DM this person will be most likely -
A. Pancreatic
B. MODY
C. Type I
D. Type II

Response:
None

So the answer to this question is B


Instruction:
T helper cells recognizes -
A. MHC class I
B. MHC class II
C. Processed peptides
D. Surface Ig

Response:
MHC restriction

T cells (in contrast to B cells) cannot be activated by soluble antigens.
Therefore, presentation of processed antigen by antigen presenting cells is required for induction of cell mediated immunity.
T cell receptors recognizes peptide antigens that are displayed by major histo compatibility complex (MHC) molecules on the surface of antigen presenting cells.
T cells develop MHC restriction so that :-

Helper (CD4) T cells respond only to foreign antigens presented along with HLA class II (MHC class II).
CD8 T cells respond to antigens presented along with HLA class I (MHC class I).
MHC restriction refers to the fact that a given T cell will recognize a peptide antigen only when it is bound to a particular MHC molecule.

So the answer to this question is B


Instruction:
All the following are true regarding Dracunculiasis, EXCEPT:
A. The parasites reach adulthood by 6 months
B. Control of cyclops help in the spread of the disease
C. Mebendazole and niridazole are effective in preventing the transmission of the disease
D. No effective vaccines are available to prevent the disease

Response:
Dracunculiasis has no diagnostic test for preclinical detection, no vaccine to immune at risk community and no drug to kill any stage of the parasite. The parasites reach adulthood by about 9 - 12 months. Ref: Park, Edition 21, Page - 223

So the answer to this question is C


Instruction:
Which of the following diuretics will continue to induce significant diuresis after return of blood volume to normal levels?
A. hydrochlorothiazide
B. spironolactone
C. triamterene
D. furosemide

Response:
The loop diuretics inhibit tubular reabsorption of sodium, potassium, and chloride in the loop of Henle and can continue to cause diuresis even during volume contraction. The likely site of action of furosemide is in the thick ascending limb of the loop of Henle.

So the answer to this question is D


Instruction:
NOT a content of carpal tunnel
A. Flexor pollicis longus
B. Flexor digitorum profundus
C. Ulnar nerve
D. Median nerve

Response:
Carpal tunnel Contents - 1. 4 tendons of Flexor Digitorum Profundus (FDP) 2. 4 tendons of Flexor Digitorum Superficialis (FDS) 3. 4 tendons of Flexor Pollicis Longus (FPL) 4. Median nerve Structure passing anterior to carpal tunnel: 1. Ulnar nerve 2. Ulnar aery 3. Palmaris longus tendon. Structure embedded into flexor retinaculum Flexor carpi radialis tendon.

So the answer to this question is C


Instruction:
Anterior end of the spleen is held up by -
A. Lienorenal ligament
B. Phrenicocolic ligament
C. Gastrosplenic ligament
D. Gastrocolic ligament

Response:
Phrenicocolic ligament is not attached to the spleen but supports its anterior end.

So the answer to this question is B


Instruction:
Left border of heart on chest X–ray is formed by -a) Aortic archb) Left Pulmonary arteryc) Right atriumd) Left ventriclee) Right ventricle
A. b
B. c
C. ac
D. ad

Response:
Amongst the given options, left heart border is formed by Aortic knuckle (formed by aortic arch) and left ventricle.
Some guides have included left pulmonary artery in the answer. But, it is pulmonary trunk which forms left heart border (not left pulmonary artery).

So the answer to this question is D


Instruction:
Light radiographic film is due to:
A. Overdeveloping
B. Overfixing
C. Directly putting in fixer
D. Exposure to sunlight

Response:
LIGHT RADIOGRAPHS
Processing Errors
Underdevelopment (temperature too low; time too short; thermometer inaccurate) Depleted developer solution
Diluted or contaminated developer
Excessive fixation
Underexposure
Insufficient mA
Insufficient kVp
Insufficient time
Film-source distance too great
Film packet reversed in mouth
DARK RADIOGRAPHS
Processing Errors
Overdevelopment (temperature too high; time too long)
Developer concentration too high
Inadequate time in fixer
Accidental exposure to light
Improper safelighting
Storage of films without shielding, at too high a temperature, or past expiration date
Reference: White and Pharoah's Oral Radiology Principles and Interpretation 7th edition page no 80

So the answer to this question is B


Instruction:
Most common cause of aortic dissection:
A. Syphilis
B. Hypertension
C. Marfan syndrome
D. Cystic medial necrosis

Response:
Ans. (b) HypertensionRef: Harrison 19th ed. /1640* 70% cases of aortic dissection occur due to hypertension. The tear occurs in tunica media and causes a tearing pain in the chest with maximum intensity in inter-scapular area. The IOC for aortic dissection is trans-esophageal echocardiography.* Marfan syndrome also can present with aortic dissection, which in fact is the leading cause of death in these patients. Syphilis involves the arch of aorta and causes an aneurysm that can rupture anyday.

So the answer to this question is B


Instruction:
Blastomycosis may involve any of the following organs except(NOT RELATED)
A. Skin
B. Lungs
C. Lymphatics
D. Intestinal tract

Response:
Blastomycosis does not involve intestinal tract

So the answer to this question is D


Instruction:
Immunity by vaccination is
A. Active natural
B. Passive natural
C. Active acquired
D. Passive acquired

Response:
Active immunity occurs as a result of infection or by specific immunization and is usually associated with the presence of antibodies or cells having a specific action on the microorganism or on its toxin. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 109

So the answer to this question is C


Instruction:
In the human body, which of the following trace elements is next to iron:
A. Ca2+
B. Zn2+
C. Cu2+
D. Selenium

Response:
After Iron (18mg/day), zinc (11mg/day) comes next in total requirement among trace elements.Followed by manganese and copper.** NA, K, Ca, Cl, Ph, Mg are not trace elements.(ref: OP Ghai 8/e p123)

So the answer to this question is B


Instruction:
WEBER'S test in otitis media will be
A. Not lateralized
B. Lateralised to poorer ear
C. Lateralised to better ear
D. Inconclusive

Response:
Otitis media causes conductive hearing lossWeber's testLateralized to poorer ear-conductive hearing lossLateralized to better ear-SNHLNo lateralization - NormalRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 24

So the answer to this question is B


Instruction:
Watery diarrhea in children is caused by
A. ETEC
B. EPEC
C. EIEC
D. EAEC

Response:
Enteropathogenic E.coli: associated mainly with diarrhea in children and infants usually occurring as an institutional outbreak. The pathogenesis of EPEC diarrhea is not fully understood. EPEC is non-invasive and does not produce enterotoxin. Another mechanism is by adherence to the enterocyte membrane. This activity is regulated by the chromosomally coded locus of enterocyte effacement (LEE). This is a pathogenicity island by an intimin protein coded for by the eae gene. This results in the disruption of the brush border microvilli. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 285

So the answer to this question is B


Instruction:
Which of the following is a feature of marasmus and not kwarshiorkor?
A. Vorac ious appe ti te
B. Fatty change in liver
C. Hypoalbuminemia
D. Edema

Response:
Ref: Nelson's Textbook of Pediatrics. 19th Edition. Robbins Pathologic basis of disease, 8th edition. Page: & Vishnu Shot's Protein Energy Malnutrition. 1st ed.Peepee. Page: 121 135.Explanation:MARASMUS (Xonedeniatous malnutrition)It is characterized by failure to gain weight and irritability. followed by weight loss and listlessness until emaciation results.The skin loses turgor and becomes wrinkled and loose as subcutaneous fat disappears.Loss of fat from the sucking pads of the cheeks often occurs lateInfants are often constipated, but they can have starvation diarrhea, with frequent small stools containing mucus.The abdomen may be distended or flat. with the intestinal pattern readily visible.There is muscle atrophy and re su Itant hypotonia.Children often have Voracious appetiteAs the condition progresses, the temperature usually becomes subnormal (Hypothermia) and the pulse slowsKWASHIORKOR (Edematous malnutrition)It can occur initially as vague manifestations that include lethargy, apathy, and irritability.When kwashiorkor Is advanced, there is lack of growth. lack of stamina, loss of muscle tissue, increased susceptibility to infections, vomiting, diarrhea, anorexia, flabby subcutaneous tissues, and edema.Psychological changesThe edema usually develops early secondary to hypoalbum in emia.It is often present in internal organs before it is recognized in the face and limbs.Liver enlargement due to fatty liver can occur early or late in the course of disease.Dermatitis is common, with darkening of the skin in irritated areas, but in contrast to pellagra not in areas exposed to sunlight.Depigmentation can occur after desquamation in these areas, or it may be generalizedThe hair is sparse and thin, and in dark-haired children, it can become streaky red or gray.Eventually, there is stupor, coma and death

So the answer to this question is A


Instruction:
All are true about extra lobar pulmonary sequestration except:
A. More common in males
B. Surrounded by seperate pleural covering
C. Associated with multiple other anomalies
D. Removed by either segmentectomy or lobectomy

Response:
There is less risk of infection in extralobar pulmonary sequestration as there is no bronchial communication in most of the cases.

So the answer to this question is D


Instruction:
The infectious disease among following which closely resemble vasculitis is:
A. Lyme disease
B. Rubella
C. Tuberculosis
D. Leprosy

Response:
Infectious diseases that mimic vasculitis are: Bacterial endocarditis Disseminated gonococcal infection Pulmonary histoplasmosis Coccidioidomycosis Syphilis Lyme disease Rocky Mountain spotted fever Whipple's disease Ref: Harrison, E-18, P-2787.

So the answer to this question is A


Instruction:
What is deficient in exclusively breast fed baby ?
A. Vitamin B
B. Vitamin A
C. Vitamin C
D. Proteins

Response:
Ans. is 'a' i.e., Vitamin B o Deficiency of Vitamin B12 may occur in exclusive breastfed infants of mother who is on strict vegetarian diet. Remember following impoant facts ? o Milks from the mother whose diet is sufficient and properly balanced will supply all the necessary nutrients except fluoride and Vitamin D. o The iron content of human milk is low, but most normal term infants have sufficient iron stores for the first 4-6 months. Human milk iron is well absorbed. Nonetheless, by 6 months the breast-fed infant's diet should be supplemented with iron foified complementary foods. o The Vitamin K content of human milk is low and may cause hemorrhagic disease of newborn.

So the answer to this question is A


Instruction:
Adrenal medulla secretes all EXCEPT:
A. Epinephrine
B. Nor epinephrine
C. Dopamine
D. Coisol

Response:
Coisol REF: Ganong 22ed chapter20 "Coisol is secreted by adrenal coex not medulla" "Norepinephrine, epinephrine, and dopamine are secreted by the adrenal medulla"

So the answer to this question is D


Instruction:
A middle aged female repoed with dull diffuse progressive headache of 2 months duration associated with episodes of vomiting and blurred vision at times. Cough increases the headache.Likely patient has
A. Vascular headache
B. Intracranial space occupying lesion
C. Intracerebral hemorrhage
D. Acute pyogenic meningitis

Response:
A space-occupying lesion of the brain is usually due to malignancy but it can be caused by other pathology such as an abscess or a haematoma. Almost half of intracerebral tumours are primary but the rest have originated outside the CNS and are metastases Features of a headache indicating a high risk of a space-occupying lesion of the brain or idiopathic intracranial hypeension include: A new headache with features suggestive of raised intracranial pressure, including papilloedema, vomiting, posture-related headache, or headache waking the patient from sleep Ref Harrison20th edition pg 2456

So the answer to this question is B


Instruction:
The following is not a feature of Alzeimer's disease?
A. Neurofibrillary tangles
B. Senile (neuritic) plaques
C. Amyloid angiopathy
D. Lewy bodies

Response:
Ans. is d ' i.e.;Lewy bodies Impoant pathological findings in Alzheimer's disease. i) Coical atrophy with sidening of the cerebral sulci. ii) Compensatory ventricular enlargement Hydrocephalus exvacuo. iii) Neuritic (senile) plaques Made up of A f3,0 & A1342. iv) Diffuse plaques --> Contain Ab42. v) Neurofibrillary tangles --> Contain tau protein vi) Cerebral amyloid angiopathy. vii) Granulovascular degeneration Hirano bodies

So the answer to this question is D


Instruction:
The amino acid which is associated with atherosclerosis is
A. Lysine
B. Homocysteine
C. Cysteine
D. Alanine

Response:
Ref Harrison 19 th ed pg 1579 There is a strong positive correlation between atherosclerosis and circulating levels of homocysteine.

So the answer to this question is B


Instruction:
Splanchnic vessels and venules contain- % of blood volume:
A. 20-Oct
B. 20-30
C. 40-50
D. 60-70

Response:
Under normal resting conditions splanchnic circulation receives 25-28% of the cardiac output. It is also a large reservoir of blood containing about 20-25% of total blood volume. The splanchnic circulation consists of the vascular beds of spleen, GIT and liver. Splanchnic blood flow curses through Control over the splanchnic bed in response to stress is central. Stimulation of carotid and aoic baroreceptors cause causes sympathetic neural stimulation of splanchnic resistance and capacitance vessels and a large decrease in venous capacitance size. Ref: Moss and Adams' Hea Disease in Infants, Children, and Adolescents page 62.

So the answer to this question is B


Instruction:
This radiological appearance is seen with which medical disorder?
A. Rickets
B. Thalassemia
C. Osteopetrosis
D. Acromegaly

Response:
The image shows X ray of hand showing SPADE LIKE PHALANX. This is seen in Acromegaly. Signs Visual field defects Broad nose Large tongue Goiter Prominent supraorbital Ridge Prognathism Interdental separation Galactorrhoea Hirsutism Thick greasy skin Carpal tunnel syndrome Spade like hands Large feet Tight rings Proximal myopathy Ahopathy Hea failure Hypeension Oedema Glycosuria

So the answer to this question is D


Instruction:
Most common extra skin manifestation of varicella is involvement of ?
A. CNS
B. Lungs
C. Kidneys
D. CVS

Response:
Ans. is 'a' i.e., CNS The most common extracutaneous site of involvement in children is the CNS - Harrison Complications - The most common infectious complication of varicella is secondary bacterial superinfection of the skin, which is usually caused by streptococcus pyogenes or Staphylococcus aureus. - The most common extracutaneous site of involvement in children is CNS. - Varicella pneumonia is the most serious complication following chickenpox in adults. Complications CNS Pulmonary Others . Cerebellar ataxia . Pneumonia . Myocarditis . Meningitis . Nephritis . Encephalitis . Ahritis . G.B Syndrome . Hepatitis . Transverse Myelitis . Corneal lesions . Reye's Syndrome (with H/O salicylates) . Bleeding diasthesis

So the answer to this question is A


Instruction:
Intervertebral disc is which type of joint -
A. Primary cartilaginous
B. Secondary cartilaginous
C. Pivot
D. Ellipsoid

Response:
Ans. is 'b' i.e., Secondary cartilaginous Cartilaginous joints1) Primary cartilaginous joints (synchondrosis, or hyaline cartilage joint) : These are :-i) Joint between epiphysis and diaphysis of a growing long bone, i.e. physis.ii) Spheno-occipital jointiii) 1st costostemal joint (1st chondrosternal joint)iv) Costochondral joints2) Secondary cartilaginous joints (Symphyses or fibrocartilaginous joints) : These are:-i) Symphysis pubisii) Sacroccygeal jointiii) Manubriostemal jointiv) Intervertebral discv) Symphysis menti

So the answer to this question is B


Instruction:
Features of rheumatic carditis are all except ?
A. Aschoff nodule
B. Lymphatic infiltration
C. Myocardial fibrosis
D. Intramyocardial microemboli

Response:
Ans. is 'd' i.e., Intramyocardial microemboli

So the answer to this question is D


Instruction:
Pseudopolyps are typically seen in
A. Crohn's disease
B. Ulcerative colitis
C. Celiac disease
D. Tropical sprue

Response:
Ans. is 'b' i.e., Ulcerative colitis Pseudopolyps are typically seen in Ulcerative colitis. The involved mucosa in ulcerative colitis shows broad based ulcers are aligned along the long axis of the colon. Isolated

So the answer to this question is B


Instruction:
Secondary syphilis is characterized by the following except -
A. Occurs 6-8 weeks after development of chancre
B. Painful and itchy maculopapular lesions
C. Constitutional features are present
D. Meningitis, hepatitis, glomerulonephritis and uveitis may occur

Response:
The protean manifestations of the secondary stage usually include mucocutaneous lesions and generalized nontender lymphadenopathy. The skin rash consists of macular, papular, papulosquamous, and occasionally pustular syphilides; often more than one form is present simultaneously. The eruption may be very subtle, and 25% of patients with a discernible rash may be unaware that they have dermatologic manifestations. Involvement of the hair follicles may result in patchy alopecia of the scalp hair, eyebrows, or beard in up to 5% of cases. Constitutional symptoms that may accompany or precede secondary syphilis include sore throat (15-30%), fever (5-8%), weight loss (2-20%), malaise (25%), anorexia (2-10%), headache (10%), and meningismus (5%). Acute meningitis occurs in only 1-2% of cases. Less common complications of secondary syphilis include hepatitis, nephropathy, gastrointestinal involvement (hyperophic gastritis, patchy proctitis, or a rectosigmoid mass), ahritis, and periostitis. (Harrison's Principles of internal medicine, 20th edition, page 1382)

So the answer to this question is B


Instruction:
All are seen in primary extraglandular Sjogren syndrome except -
A. Rheumatoid ahritis
B. Raynaud's phenomena
C. Lymphoma
D. Splenomegaly

Response:
Ans. is 'a' i.e., Rheumatoid ahritiso Primary Sjogren syndrome is not associated with other autoimmune disorders, e.g. Rheumatoid ahritis. o Sjogren syndrome occurs in elderly (50-60 yrs)female.

So the answer to this question is A


Instruction:
Foot eversion is caused by
A. Extensor digitorum
B. Peroneus longus
C. Tibialis anterior
D. Tibialis posterior

Response:
Foot eversion occurs at subtalar joint by Peroneus longus, Peroneus brevis and Peronius Teius. Inversion of foot done by Tibialis anterior and Tibialis posterior.

So the answer to this question is B


Instruction:
Choristoma is
A. Dilated vascular malformation
B. Malignant stroma of stem cells
C. Normal tissue at abnormal site
D. Benign tumour in which normal elements become abnormally overgrown

Response:
Choristoma Ectopic rest of normal tissue Eg: pancreatic tissue in submucosa of stomach

So the answer to this question is C


Instruction:
All of following statements are true regarding Q fever except.
A. It is a zoonotic infection.
B. Human disease is characterized by an interstitial pneumonia
C. No rash is seen
D. Weil Felix reaction is very useful for diagnosis.

Response:
Ans. is 'd' i.e. Weil Felix reaction is very useful for diagnosis Q. Fever is caused by a Rickettsia, Coxiella BurnettiCoxiella burnetti is unique to Rickettsia because it has an endospore form. This endospore form confers properties to the bacteria that differ from other Rickettsiae :Resistance to heat and dryingExtracellular existence :- The spores resistance allows extended survival outside a host cell. However like chlamydiae and other Rickettsiae growth and division must occur intracellularly using the host's ATP.Non arthropod transmission: Coxiella burnetti grows in tick and cattles. The spores remains viable in dried tick faeces deposited on cattle hides and in dried cow placentas. These spores are aerosolized and when inhaled cause human disease. So spore inhalation rather than an arthropod bite causes Q fever.Pneumonia: Because the spores are inhaled into the lungs, a mild pneumonia similar to that of a mycoplasma pneumonia (interstitial pneumonia) often develops. Clinical features are :Abrupt onset of fever and soaking sweatsThis is the only rickettsial disease that causes pneumonia and in which there is no rash.Weil Felix is a simple and useful test for the diagnosis of some Rickettsial disease.It is positive in -Epidemic typhus*Endemic typhus*Brill Zinsser disease * (weekly positive)It is negative in -Rickettsial pox*Q. Fever*Trench feverPrinciple of Weil Felix test :Some Rickettsia share antigenic characteristics with certain strains of Proteus Vulgaris (0X19 and 0X2) and proteus mirabilis (OXK). It is purely coincidental that they have the same antigens. Proteus is not involved at all in rickettsial diseases.The Weil Felix reaction is a classic test that uses these cross reacting proteus antigens to help confirm diagnosis of a rickettsial infection.This test is done by mixing the serum of a patient suspected of having a rickettsial disease, with antigens from specific strains of proteus. If the serum has antirickettsial antibodies, latex beads coated with proteus antigens will agglutinate.

So the answer to this question is D


Instruction:
Which is NOT a function of gastrin?
A. Stimulation of gastric acid
B. Stimulation of pepsin
C. Stimulation of growth of the gastric mucosa
D. Stimulation of direct cholesterol absorption

Response:
Stimulation of cholesterol absorption is not a function of gastrin. Gastrin has been shown to have effects on gut motility (increase). Pepsin release by gastrin is for breakdown of food into smaller paicles for fuher digestion. Growth of the gastric mucosa is also dependent upon gastrin. Gastrin also causes concentration of the musculature that closes the gastroesophageal junction. It stimulates insulin and glucagon secretion, but only after a protein meal and not a carbohydrate meal. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 25. Overview of Gastrointestinal Function & Regulation. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.

So the answer to this question is D


Instruction:
Most common cause of empyema is
A. Bronchopleural fistula
B. Tubercular pneumonia
C. Bacterial pneumonia
D. Pleurisy

Response:
Empyema thoracic is collection of pus in pleural space and is synonymous with grossly purulent exudative parapneumonic effusions. Ref Harrison 19th edition pg 951

So the answer to this question is C


Instruction:
Ramesh 40 yrs male patient presenting with polyuria, pain abdomen, nausea, vomiting, altered sensorium was found to have bronchogenic carcinoma. The electrolyte abnormality seen in him would be:
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcaemia
D. Hypercalcemia

Response:
Answer is D (Hypercalcemia): Presence of polyuria, abdominal pain, and general symptoms such as nausea, vomiting and altered sensorium in a patient with bronchogenic carcinoma suggest a diagnosis of hypercalcemia secondary to paraneoplastic syndrome from PTII related peptide production.

So the answer to this question is D


Instruction:
Cancer management in which of the following malignancies has dramatically increase the survival:
A. Glioblastoma multiforme
B. Esophageal carcinoma
C. ALL in children
D. Cholangiocarcinoma

Response:
Ans. c. ALL in children (Ref: of the outcome of acute lymphoblastic leukemia in children Terzah M Horton, MD, PhD: http:// en. wikipedia. org/ wiki/ Acute_lymphoblastic_leukemia)"Acute leukemia is the most common form of cancer in children, comprising approximately 30 percent of all childhood malignancies. Of the acute leukemias, acute lymphoblastic leukemia (ALL) occurs five times more commonly than does acute myeloid leukemia (AML). Survival rates for ALL have improved dramatically since the 1980s, with a current five- year overall survival rates estimated at greater than 85 percent. This improvement in survival is due to treatment of a large number of children on sequential standardized research protocols."- style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif"> of the outcome of acute lymphoblastic leukemia in children Terzah M Horton. MD, PhD"Prognosis of ALL: The survival rate has improved from zero, four decades ago to 20-75 percent currently, largely due to clinical trials on new chemotherapeutic agents and improvements in stem cell transplantation (SCT) technology. New drugs, and matching treatment to the genetic characteristics of the blast cells, may improve those rates."- http:// en.wikipedia.org/wiki/Acute_lymphohlastic_leukemia;

So the answer to this question is C


Instruction:
A 63-year-old man presents to the emergency department because of transient symptoms of vertigo, slurred speech, diplopia, and paresthesia. He is symptom-free now, and clinical examination is entirely normal. His past medical history is significant for osteoarthritis, hypertension, and dyslipidemia. Which of the following is the most likely cause for symptoms?
A. posterior circulation transient ischemic attack (TIA)
B. anterior communicating artery aneurysm
C. hypertensive encephalopathy
D. pseudobulbar palsy

Response:
Posterior circulation TIA is suggested by the constellation of symptoms (vertigo, dysarthria, and diplopia and the transient episode of his symptoms. The basilar artery is formed by the two vertebral arteries and supplies the pons, the midbrain, and the cerebellum with vertebrobasilar TIAs, tinnitus, vertigo, diplopia, ataxia, hemiparesis, and bilateral visual impairment are common findings. This patient does not have occlusion of the middle cerebral artery since it results in cortical symptoms of motor and sensory loss on the contralateral side. This is also not hypertensive encephalopathy since it causes confusion, headache, nausea, vomiting, and focal neurologic signs.

So the answer to this question is A


Instruction:
Inheritance of Gardner syndrome is
A. Autosomal recessive
B. Autosomal dominant
C. X linked
D. None of the above

Response:
Gard*ner syn*drome Multiple polyposes predisposing to carcinoma of the colon; also multiple tumors, osteomas of the skull, epidermoid cysts, and fibromas; autosomal dominant inheritance, caused by mutation in the adenomatous polyposis coli gene (APC) on chromosome 5q. This disorder is allelic to familial adenomatous polyposisRef: Harrison &;so manual of Medicine 19th edition Page no: 325

So the answer to this question is B


Instruction:
Fracture of hyoid bone is indicative of: FMGE 09, 11; Maharashtra 09; AP 11; NEET 13
A. Manual strangulation
B. Ligature strangulation
C. Bansdola
D. Hanging

Response:
Ans. Manual strangulation

So the answer to this question is A


Instruction:
Disulfiram mechanism of action ?
A. Stimulates alcohol dehydrogenase
B. Stimulates aldehyde dehydrogenase
C. Inhibits aldehyde dehydrogenase
D. Inhibits dopamine oxidase

Response:
Ans. is 'c' i.e., Inhibits aldehyde dehydrogenase

So the answer to this question is C


Instruction:
1 part per million fluoride is:
A. 1 mg in 10 L of water
B. 1 mg in 1 L of water
C. 10 mg in 1 L of water
D. 100 mg in 10 L of water

Response:
ppm (or ppmm) is used to measure the concentration of a contaminant in soils and sediments. In that case, 1 ppm equals 1 mg of substance per liter of solid (mg/liter).

So the answer to this question is B


Instruction:
Flower 'Vase' pattern of the pelvis in an intravenous urogram is seen in -
A. Polycystic kidney
B. Renal carcinoma
C. Horse shoe kidney
D. Ectopic kidney

Response:
None

So the answer to this question is C


Instruction:
All of the following are associated with polycystic ovarian syndrome except:
A. Ovarian carcinoma
B. Endometrial carcinoma
C. Insulin resistance
D. Osteoporosis

Response:
Ans. is d, i.e. OsteoporosisRef: Leon Speroff 7th/ed, p470-480, 8th/ed, p500-518; Novak 14th/ed, p1082, 15th/ed, p1085Relationship between bone mineral density and Insulin resistance in PCOS Journal of Bone mineral metabolism vol 19, Number 4, July 2001, p 257-262This was definitely one of the most controversial questions in AIPG 2010. Endometrial cancer and insulin resistance are seen in PCOD. Osteoporosis is never seen in PCOD patients.What about ovarian cancer?The main theory for development of epithelial ovarian cancer (which accounts for 85-90% of all ovarian CA) is the "Theory of incessant ovulation" which means "more the ovulation, more the risk".But in PCOS there is anovulation and hence per say it is protective for CA ovary.But, PCOS patients are infertile and ovulation induction is required for treatment of infertility. Use of ovulation inducing agents like gonadotrophins, clomiphene letrozole, etc. is one of the risk factors for development of ovarian cancer. This is how PCOS can be associated CA ovary. So the studies are still going on whether ovarian cancer leads to PCOS or not:"The risk of ovarian cancer is increased two to threefold in woman with PCOS." - Ref: Novak 15th/ed, p1085

So the answer to this question is D


Instruction:
True about Apoptosis are all except
A. Inflammation is present
B. Chromosomal brekage
C. Clumping of chromatin
D. Cell shrinkage

Response:
Fragments of the apoptotic cells then break off, giving the appearance that is responsible for the name (apoptosis, "falling off"). The plasma membrane of the apoptotic cell remains intact, but the membrane is altered in such a way that the cell and its fragments become avid targets for phagocytes. The dead cell and its fragments are rapidly cleared before cellular contents have leaked out, so apoptotic cell death does not elicit an inflammatory reaction in the host. Apoptosis differs in this respect from necrosis, which is characterized by loss of membrane integrity, enzymatic digestion of cells, leakage of cellular contents, and frequently a host reaction.( Robbins Basic Pathology, 9 th edition, page 18 )

So the answer to this question is A


Instruction:
Vimal, a 70 years old male presents with a h/o lower GI bleed for last 6 months. Sigmoidoscopic examination shows a mass, of 4 cms about 3.5 cms above the anal verge. The treatment of choice is ?
A. Colostomy
B. Anterior resection
C. Abdominoperineal resection
D. Defunctioning anastomosis

Response:
Ans. is 'c' ie. Abdominoperineal resection Treatment of rectal cancer Surgical and oncologic management varies greatly depending on the stage and location of the tumor within the rectum. Superficially invasive, small cancers may be managed effectively with local excision. However, most patients have more deeply invasive tumors that require major surgery, such as Low anterior resection (LAR) or APR. a) Low anterior resection: This is sphincter saving procedure. In this procedure the sigmoid colon and proximal rectum are removed The descending colon is anastomosed to the distal rectum. Previously this sphincter saving LAR procedure was possible for lesions confined in upper 2/3'd of rectum. Lesions in lower third were treated with APR with permanent colostomy. With the introduction of stapling gun, the sphincter saving LAR operation can now be done even in lesions of lower 1/3 rectum, provided a margin of 2 cm or more of normal bowel can be resected below the lesion but above the dentate line. (some books write that even 1cm margin can be adequate, but provided the carcinoma is well differentiated) Devito Oncology writes- "Tumors within 1 to 2 cm of the dentate line, that is those that can be removed with at least a 1-cm distal margin, can be resected and intestinal continuity restored with a coloanal azzastomosis." b) Abdominoperineal resection (also k/a Miles procedure) : There is complete excision of the distal sigmoid colon, rectum and anus, by concomitant dissection through the abdomen and perineum with creation of a permanent colostomy. APR is performed when adequate distal margins for low anterior resection cannot be obtained i.e. for carcinomas in lower rectum. c) Local excision: In carefully selected patients with small, well differentiated, superficial, mobile polypoid lesions, a full thickness excision can be performed through the transanal route as the definitive therapy. Local excision can be done for selected T1 and T2 lesions without evidence of nodal disease. Transanal excision can spare the patient the morbidity of a more extensive rectal resection. However, it does not stage the nodal drainage areas and therefore cannot provide as complete staging and management of the tumor as a definitive resection. Tumors considered for local excision must meet a number of criteria to minimize the risk of local regional recurrence. Devita's Oncology writes- "Generally, local excision is limited to tumors within 8 to 10 cm of the anal verge, encompass less than 40% of circumference of the bowel wall, are of well or moderately well differentiated histology, and have no pathological evidence of venous or lymphatic vessel invasion on biopsy." Various technical approaches have been described to achieve transanal local excision, including use of a special proctoscope equipped with a magnifying camera (transanal endoscopic microsurgery). Transanal endoscopic microsurgery makes use of a specially designed proctoscope, magnifying system, and instruments similar to those used in laparoscopy to allow local excision of lesions higher in the proximal rectum. d) Palliative procedures: Unresectable rectal cancers can be palliated by fulgration (electrocoagulation) or laser photocoagulation. e) Chemoradiation: Chemoradiation can be given as adjuvant or neoadjuvant therapy. Also know: Haman's procedure This is a compromise type of resection in which the rectum and/or sigmoid colon are resected and an end colostomy done. Anastomosis and perineal dissection of the distal rectum and perineum are not done. This procedure is used - if there is too much obstruction or sepsis to allow a safe anastomosis. - for elderly or severly unstable pts. who would not stand a lengthy ant resesction or an APR procedure. In this pt. the tumor lies 3.5 cms above the anal verge (the lower limit is taken into consideration). Dentate line is 2 cm from the anal verge (Ref: Devito Oncology 8/e), so this lesion is just about 1.5 cm above the dentate line. A minimum margin of 2 cm is required below the tumor for sphincter saving LAR, so this patient will have to go an APR procedure to remove the tumor.

So the answer to this question is C


Instruction:
Tinea ungium affects:
A. Nail fold
B. Nail plate
C. Joints
D. Interdigital space

Response:
Tinea unguium is clinically defined as dermatophytic infection of the nail plate. Dermatophytic Skin Disease Location Of Lesions Tinea corporis Nonhairy, smooth skin. Tinea pedis (athlete's foot) Interdigital spaces on feet of persons wearing shoes. Tinea cruris (jock itch) Groin. Tinea capitis Scalp hair. Tinea barbae Beard hair (Note -Sycosis barbae is folliculitis of beard hair caused by Staphylococcus) Tinea unguium Nail Tinea Manuum Hand

So the answer to this question is B


Instruction:
Increased ICT is associated with all except:
A. Paraparesis
B. Abducent paralysis
C. Headache
D. Visual blurring

Response:
Increased intra cranial tension (ICT) is associated with headache, vomiting, visual blurring and diplopia (abducent paralysis). Paraparesis maybe a localizing sign but rarely associated with increased intracranial tension. Ref: API 6th Edition, Page 707, 708; Davidson's principles and practice of Medicine, 20th Edition, Chapter 26, Page 1235.

So the answer to this question is A


Instruction:
Cowden syndrome is commonly associated with
A. Renal cell carcinoma
B. Thymic Carcinoid
C. Cerebellar haemangioblastoma
D. Hamartoma

Response:
(D) Hamartoma # Cowden syndrome (also known as "Cowden's disease," and "Multiple hamartoma syndrome") is a rare autosomal dominant inherited disorder characterized by multiple tumor-like growths called hamartomas and an increased risk of certain forms of cancer.> Stauffer syndrome - paraneoplastic, non-metastatic liver disease is a sign of Renal cell carcinoma.> Thymic carcinomas are, for the most part, of epithelial origin, although a few other unusual cell types can be found. All these lesions are very uncommon, and several are rare. They include some with low malignant potential (eg, well-differentiated squamous cell carcinoma, basaloid carcinoma, mucoepidermoid carcinoma) and those with features of a more aggressive malignancy (E.g., Sarcomatoid carcinoma, clear cell carcinoma, neuroendocrine carcinoma, lymphoepitheliomalike tumors, anaplastic undifferentiated tumors).

So the answer to this question is D


Instruction:
A 10 years old female presented with recurrent attacks of cholangitis. CECT was done, the diagnosis on the basis of CECT is:
A. Type 1 choledochal cyst
B. Type 3 choledochal cyst
C. Type 4 choledochal cyst
D. Type 5 choledochal cyst

Response:
The CECT shows central dot; which is seen in type 5 choledochal cyst/ Caroli's disease Choledochal cyst.- Characterized by dilatation of bile duct. TODANI modification of ALONSO LEJ classification: -- Type I - dilatation of extra hepatic bile duct (MC)- Type II - diveicular dilatation of extra hepatic bile duct- Type III - dilatation of intraduodenal pa of bile duct (choledochocele)- Type IV (A) - dilatation of both intra and extra hepatic bile duct- Type IV (B) - multiple cyst involving only extra hepatic bile duct - Type V - multiple cyst involving only intra hepatic bile duct (Caroli's disease)

So the answer to this question is D


Instruction:
All of the following facts related to chronic inflammation are true, except:
A. It can be severe and progressive.
B. Granulomas are an example of chronic inflammation.
C. Dominant cells in chronic inflammation are neutrophils.
D. Chronic inflammation is involved in pathogenesis of metabolic syndrome and ceain cancers.

Response:
Chronic inflammation is of longer duration and is associated with:- Granulomatous reaction is a pattern of chronic inflammatory response. Presence of macrophages (dominant cells), lymphocytes and plasma cells. The proliferation of blood vessels, deposition of connective tissue. It is severe and progressive. Chronic inflammation is implicated in pathogenesis of neurodegenerative diseases, metabolic syndrome, type 2 diabetes and ceain cancers.

So the answer to this question is C


Instruction:
All are side effects of OC pills except -
A. Weight gain
B. Breast discomfo
C. Ovarian malignancy
D. DVT

Response:
park's textbook of preventive and social medicine 23rd edition. *cardiovascular effects:myocardial infarction, cerebral thrombosis,and venous thrombosis. *carcinogenesis:increased risk of cervical cancer with increased duration of use. *metabolic effects:elevation of blood pressure, alteration in serum lipid,increased blood glucose level ,breast tenderness,weight gain,head ache and migraine, liver disorder,premature cessation of lactation,ectopic pregnancy, delayed subsequent pregnancy, foetal developmental defect

So the answer to this question is C


Instruction:
Von-Meyenburg's complexes are seen in -
A. Brain
B. Liver
C. Kidney
D. Spleen

Response:
Von Meyenburg Complexes

Close to or within the portal tract, these are small clusters of modestly dilated bile ducts embedded in a fibrous, sometimes hyalinised stroma.
Although these "bile duct microhamartomas" may communicate with the biliary tree, they generally are free of the pigmented material tree.
They presumably arise from residual embryonic bile duct remnants. Occasionally, a triangular bile duct hamartoma may lie just under Glisson's capsule.

Polycystic liver disease

There are multiple diffuse cystic lesions in the liver.

Congenital hepatic fibrosis

Portal tracts are enlarged by irregular, broad bands of collagenous tissue, forming septa that divide the liver into irregular islands.
Variable numbers of abnormally shaped bile ducts are embedded in the fibrous tissue and are in continuity with the biliary tree.

Caroli disease

The larger ducts of the intrahepatic biliary tree are segmentally dilated and contain inspissated bile.

So the answer to this question is B


Instruction:
All are features off haemolytic uremic syndrome,EXCEPT-
A. Hyperkalemia
B. Anaemia
C. Renal microthrombi
D. Neuro psychiatric disturbances

Response:
None

So the answer to this question is D


Instruction:
A 45-year-old man presented with regurgitated food paicles eaten several days earlier. He has foul smelling breath and occasional dysphagia for solid food. What is the probable diagnosis
A. Gastric outlet obstruction
B. Zenker's diveiculum
C. Scleroderma
D. Diabetic gastroparesis

Response:
.OESOPHAGEAL DIVEICULUM can be of two types mainly, *Pulsion diveiculum: a. Pharyngeal pouch through Zenker's or Killian's dehiscence. b. Epiphrenic pulsion diveiculum occurs in the lower oesophagus, usually towards the right side, due to obstruction in the distal oesophagus or due to uncoordinated LOS relaxation. 2. Traction diveiculum: Occurs in mid-oesophagus or in the parabronchial region, is due to mediastinal granulomatous disease like tuberculosis. Investigations * A barium swallow is typical. * Oesophagoscopy and endosonography. * CT Chest as the final evaluation. Treatment * Treat the cause. * Excision of the diveiculum - epiphrenic diveiculectomy. * Cricopharyngeal myotomy or lower oesophageal myotomy with the antireflux procedure is usually required. Ref: SRB&;s manual of surgery,3 rd ed, pg no 751

So the answer to this question is B


Instruction:
Which structure resembles radiographically with PDL of maxillary 2nd molar?
A. Greater palatine foramen
B. Median palatine foramen
C. Zygomatic process
D. Angle of maxilla

Response:
Greater palatine foramen is seen as a radiolucent area (oval or round). Rarely, it is seen in the periapical film over the roots of first molar and sometimes at the apices of second premolar and second molar. This should not be confused with periapical pathologies.

So the answer to this question is A


Instruction:
Gettlers test is for
A. Hanging
B. Strangulation
C. Burns
D. Drowning

Response:
Ans. is 'd' i.e., Drowning Gettler test Gettler test is done for drowning. It estimates chloride content of blood from both sides of hea. Normally the chloride content is equal in the right and left chambers of the hea (600 mg/100 ml). In fresh water drowning due to hemodilution the chloride content is decreased and in salt water drowning due to hemoconcentration the chloride content is increased in left side of hea. A 25% difference in chloride is significant but the test is of doubtful value. Limitations of gettler test:? 1. No value in atypical drowning; congenital cardiac defects as shunts and patent foramen ovale; and if drowning medium contains same amount of chloride. 2. There is progressive loss of Cl- from blood after death. Therefore the test has to be made within a reasonably sho time after death

So the answer to this question is D


Instruction:
In osteomalacia which of the following biochemical feature is true?
A. Elevated serum calcium level
B. Elevated serum phosphate level
C. Elevated serum alkaline phosphatase
D. Elevated 25-hydroxyvitamin D3

Response:
In osteomalacia, serum ALP (alkaline phosphatase) levels are raised, 25(OH)D levels are low or undetectable, PTH is elevated, serum calcium and phosphate levels may also be low but normal values do not exclude the diagnosis. Reference : page 1127 Davidson's Principles and practice of Medicine 22nd edition

So the answer to this question is C


Instruction:
Treatment for motion sickness for a trip next morning?
A. Scopalamine patch a night before
B. Tab. Ranitidine one night before and then before the trip
C. Dimenhydrinate 1 hour before
D. Omeprazole

Response:
ANS. AFor the prophylaxis of motion sickness, apply scopalamine one patch behind ear at least 4-12 hours (preferably 12 hour) before anticipated exposure to motion.

So the answer to this question is A


Instruction:
A patient presents with unconjugated hyperbilirubinemia and elevated urobilinogen levels in urine. The most likely diagnosis is -
A. Hemolytic Jaundice
B. Crigler Najjar syndrome
C. Gilbert's syndrome
D. Dubin Johnson syndrome

Response:
None

So the answer to this question is A


Instruction:
Necrobiosis Lipoidica Diabeticorum is most marked on:
A. Forearms
B. Face
C. Front of legs
D. Back of legs

Response:
Necrobiosis Lipoidica Diabeticorum is an uncommon disorder, accompanying diabetes in predominantly young women. This usually begins in the Pretibial region as an erythematous plaque or papules that gradually enlarge, darken, and develop irregular margins, with atrophic centers and central ulceration. They are often painful. The etiology is microangiopathy.

So the answer to this question is C


Instruction:
The common cause of subarachnoid hemorrhage is-
A. Arterio-venous malformation
B. Cavernous angioma
C. Aneurysm
D. Hypertension

Response:
None

So the answer to this question is C


Instruction:
Which of laryngeal cailage is elastic?
A. Epiglottis
B. Corniculate
C. Cuneiform
D. Thyroid

Response:
The other cailages of the larynx, e.g. epiglottis corniculate, cuneiform and processes of the arytenoid are made of elastic cailage and do not ossify. Epiglottic Cailage/Epiglottis is a leaf-shaped cailage placed in the anterior wall of the upper pa of the larynx. Its upper end is broad and free and projects upwards behind the hyoid bone and the tongue. The lower end is pointed and is attached to the upper pa of the angle between the two laminae of the thyroid cailage. Ref: BD Chaurasia's HUMAN ANATOMY, Volume 3, 4th edition.

So the answer to this question is A


Instruction:
Enzyme alglucerase is used in the treatment of ?
A. Gaucher's disease
B. Galactosemia
C. Niemann Pick disease
D. Pompe's disease

Response:
Ans. is 'a' i.e., Gaucher's diseaseAlglucerase (ceredase) is used in the treatment of Gaucher's disease.

So the answer to this question is A


Instruction:
Masculinising tumours of the ovary :
A. Dysgerminoma
B. Embryonal cell carcinoma
C. Arrhenoblastoma
D. None

Response:
Arrhenoblastoma

So the answer to this question is C


Instruction:
All of the following is true about hydroxyurea except:
A. Cause myelosuppression
B. Oral bioavailability is very less
C. Used in CM L
D. Act as radiosensitizer

Response:
Ans: B (Oral...) HYDROXYUREA# Hydroxyurea is an analog of urea whose mechanism of action involves the inhibition of DAM synthesis by inhibiting the enzyme ribonucleotide reductase, resulting in depletion of deoxynucleoside triphosphate pools. This agent exerts its effects in the 5 phase of the cell cycle.The drug is administered orally and has nearly 100% oral bioavailability.It is mainly used in chronic myelogenous leukemia, blast crisis of acute myeloid leukemia , psoriasis & sickle cell anaemiaHowever, it is also effective as an adjunct with radiation therapy(as radiosensitizer) for head and neck cancer and in treating essential thrombocytosis and polycythemia vera.Myelosuppression is the dose-limiting toxicity, but nausea and vomiting, mucositis and diarrhea, headache and increased lethargy, and a maculopapular skin rash with pruritus are also observed.

So the answer to this question is B


Instruction:
Internal laryngeal nerve runs along which border of Pharyngeal muscle
A. Medial
B. Lateral
C. Superior
D. Inferior

Response:
Ref: BD Chaurasia&;s HUMAN ANATOMY, Volume 3, 4th edition. The superior laryngeal nerve arises from the inferior ganglion of the vagus, runs downwards and forwards on the superior constrictor deep to the internal carotid aery, and reaches the middle constrictor where it divides into the external and internal laryngeal nerves. The internal laryngeal nerve is thick. It passes downwards and forwards, pierces the thyrohyoid membrane above the superior laryngeal vessels. It supplies the mucous membrane of the larynx upto the level of the vocal folds.

So the answer to this question is C


Instruction:
A patient presented with 2 months history of increased ICP, with massive parietal edema, CT/MRI shows single and were circumscribed region lesion
A. Granuloma
B. Metastases
C. Glioblastoma
D. All of the above

Response:
(A) Granuloma > Granuloma usually presents with increased ICP, with massive parietal edema. CT/MRI shows single circumscribed region lesion. Gliomas include astrocytomas, oligodendrogliomas and mixed tumours. Common sites include the cerebellum, optic nerve and chiasma, hypothalamus and brainstem. Diffuse astrocytomas (WHO grade II) are most common in the fourth decade of life and often present with seizures or are incidental findings. CT scan shows enhancement which is often irregular around a centre of low density which may represent necrosis calcification may be present. Cerebral metastases are by far the most common intracranial tumours and will affect approximately one in every four cancer sufferers. They tend to occur in the fifth to seventh decades. The majority of patients with cerebral metastases have multiple lesions. Metastatic tumours show isodense on unenhanced CT and enhance vividly on intravenous contrast.

So the answer to this question is A


Instruction:
All are true about cancrum oris except -
A. Associated with malnutrition and vitamin deficiency
B. Follows chronic infection
C. Involves jaw
D. Treatment is excision and skin grafting with tubed pedicle graft

Response:
Answer is 'b' i.e. Follows chronic infection Cancrum oris (also k/a Noma and Gangrenous stomatitis) Cancrum oris is now rarely seen in developed countries, but is still not uncommon in many developing countries. It is a gangrenous process of the mouth, which stas suddenly, rapidly involve the adjacent tissues of the face, quickly becomes well demarcated, and then spreads no fuher. It most often affects one or both sides of the jaw, and occasionally the front of the face (mouth, lips, nose & chin). The gangrenous process may spread to destroy the bones of the face. This disease occurs primarily in severely malnourished child less than 5 yrs of age. Often they have had a preceeding illness such as measels, malaria, scarlet fever, tuberculosis, malignancy or immunodeficiency, which has weakened the general health of the child. The exact cause is not known, but may be bacterial. Fusiformis & Borrelia are largely responsible, but the ds. is not contigious. Untreated cancrum oris is almost always quickly fatal, due to associated illness or a complication, such as septicemia or aspiration pneumonia. Management involves a) correction of general condition b) antibiotics (Penicillin + Metronidazole) c) Excision of the dead tissue d) Plastic surgery Coming to the question, the best choice is option 'b' i.e. follows chronic infection, as the ds. not always follows an infection. The infectious ds deteriorates the general health of the child who becomes susceptible to cancrum oris because of his poor health.

So the answer to this question is B


Instruction:
Treatment of choice for prophylaxis in patients with repeated episodes of bipolar illness: March 2004
A. Lithium
B. Valproate
C. A + B
D. None of the above

Response:
Ans. C i.e. A + B Ref: Kumar and Clark's

So the answer to this question is C


Instruction:
Punishment for perjury is covered under section -
A. 191 IPC
B. 193 IPC
C. 195 IPC
D. 197 IPC

Response:
Ans. is 'b' i.e., 193 IPC Perjury, Hostile witness and false certificateo 191 IPC: (i) Giving false evidence (perjury) under oath and (ii) hostile witness.o 192 IPC : Fabricating false evidence (perjury).o 193 IPC : Punishment for false evidence (punishment for perjury) : imprisonment upto 7 years + fine,o 194 IPC: Giving or fabricating false evidence to procure conviction of capital offence.o 195 IPC: Giving or fabricating false evidence to procure conviction of offence punishable with imprisonment for life.o 197IPC: Issuing or signing (attesting) false certificate by a doctor is a criminal offence.o 201 IPC : Causing disappearance of evidence.

So the answer to this question is B


Instruction:
Cholera toxin:
A. Increases the levels of intracellular cylic GMP
B. Acts through the receptor the opiates
C. Causes continued activation of adenylate cyclase
D. Inhibits the enzyme phosphodiesterase

Response:
Ans. is 'c' i.e. Causes continued activation of adenylate cyclase Cholera toxin (CT) is a potent protein enterotoxin, chiefly responsible for the virulence of V. cholera.It is elaborated by the organism following its colonization of the small intestine .Effect of cholera toxin leads to watery diarrhoea, the characteristic feature of cholera.Mechanism of Cholera Toxin ActionCholera toxin consists of 2 subunits a monomeric enzymatic moiety (A subunit) a pentameric binding moiety (B subunit)The B-subunit, serves as a 'landing pad' and binds to GM1 ganglioside, a glycolipid on the surface of epithelial cells of the small intestine. This facilitates the entry of A-subunit into the epithelial cells.The entry of A-subunit into the cells leads to activation of its A1 fragment.Activated A1 interacts with cytosolic proteins called ADP-ribosylation factors (ARF)The ARF-A1 complexes catalyze ADP-ribosylation of a G-protein called GSa.The ADP-ribosylated Gsa in turn binds to and stimulates adenylate cyclase. Activated adenylate cyclase generates high levels of intracellular cyclic AMP (cAMP) from ATP.cAMP inhibits the absorptive sodium transport system (decreases sodium & chloride reabsorption) and activates the secretory chloride transport system (increases chloride and bicarbonate secretion)This leads to accumulation of sodium chloride in the intestinal lumen.Accumulated sodium chloride draws water into the lumen due to increased osmolality leading to watery diarrhoea.Cholera |Na+ &Cl- | Cl- & HC03-

So the answer to this question is C


Instruction:
A 58 year old lady is diagnosed to have carcinoma stomach. CT scan of abdomen showed a mass measuring 4 cm mass in the antrum with involvement of serosa. What is the treatment?
A. Total gastrectomy
B. Subtotal gastrectomy
C. Palliative
D. Chemotherapy

Response:
For tumours distally placed in the stomach, it appears unnecessary to remove the whole stomach. Distal gastrectomy is choiceFor proximal tumours total gastrectomy is done.Palliative, chemotherapy are choice in non operable cancers.Non operabilityHaematogenous metastases,Involvement of the distant peritoneum, N4 nodal disease and disease beyond the N4 nodes, and Fixation to structures that cannot be removed.Bailey and Love 27e pg: 1132

So the answer to this question is B


Instruction:
Most severely affected child in Rh-isoimmunization patients if:
A. Rh negative mother with Rh positive in 2nd child
B. Rh positive mother with Rh negative in 2nd child
C. Rh positive mother with Rh negative in 1st child
D. Rh negative mother with Rh negative in 2nd child

Response:
Rh negative mother delivering Rh positive child for the first time gets sensitized to the D antigen of the fetus and stas developing D antibody which is fully loaded in maternal circulation. When Rh negative mother delivers her Rh positive 2nd child the antibody in the fetal circulation causes hemolysis in fetal circulation and the child is most severely affected.

So the answer to this question is A


Instruction:
Automatization is:
A. Shift of hydrogen
B. Shift of carbon
C. Shift of both
D. None of these

Response:
The process of shifting a hydrogen atom from one carbon to another to produce enediols is referred to as automatization.

So the answer to this question is A


Instruction:
IQ of 98 is classed at which level of intelligence?
A. Idiot
B. Normal
C. Superior
D. Near genius

Response:
Explanation: Level of intelligence IQ range Idiot 0-24 Imbecile 25-49 Moron 50-69 Borderline 70-79 Low normal 80-89 Normal 90-109 Superior 110-119 Very superior 120-139 Near genius 140 and above Ref: Park's textbook of Preventive and Social Medicine, 21stedition, page-629.

So the answer to this question is B


Instruction:
Scrub typhus vector
A. Tromboculid mite
B. Louse
C. Tick
D. Reduvid bug

Response:
Tromboculid mite 8"/e, p. 574 (17th /e page 543)] Mites are vectors for the following diseases: Diseases Vector Scabies Itch mite Scrub Typhus Trombiculid mite Rickettsial pox Trombiculid mite This topic has been discussed in detail earlier. Mostly they keep on asking about Ticks and mites so remember the diseases caused by Ticks too. Vector Disease Vector (a) Soft tick * Q fever, Relapsing fever (b) Hard tick * Tick typhus * Viral encephalitis * Viral fevers * Viral hemorrhagic fever (KFD) * Tuleremia * Human babesiosis, Tick paralysis

So the answer to this question is A


Instruction:
The period of mixed dentition is between the ages of :
A. 2-5 years
B. 6-11 years
C. 12-14 years
D. 15-17 years

Response:
B i.e. 6-11

So the answer to this question is B


Instruction:
An 11 year old male patient complains that his upper front teeth appear to be sticking out. Intra-oral examination reveals a Class II incisor and molar relation. Fixed orthodontic therapy along with a high pull headgear was initiated. What type of anchorage does this appliance provide?
A. Cortical
B. Simple
C. Compound
D. Reinforced

Response:
Anchorage can be reinforced by having the patient wear an extraoral appliance (headgear) placing backward force against the upper arch. The reaction force from the headgear is dissipated against the bones of the cranial vault, thus adding the resistance of these structures to the anchorage unit.
Cortical anchorage: Rickets introduced the concept of cortical anchorage, which uses the denser alveolar cortical bone for anchorage.
Simple anchorage: Resistance of the anchorage unit to tipping.
Compound anchorage: Resistance provided by more than one tooth with greater support to move teeth with less support.
Contemporary orthodontics, William Proffit, 4th edition page 346, 380

So the answer to this question is D


Instruction:
Early strict toilet training can result in-
A. Nocturnal enuresis
B. Encopresis
C. Night terror
D. Temper tantrums

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

So the answer to this question is B


Instruction:
A 25 yr. old comes in emergency with 2 1/2 months amenorrhea and abdominal pain and bleeding from vagina for 1 day. Her vitals are stable. On per speculum examination, mild bleeding is seen coming from the os. On per vaginal examination, the uterus is 10-week size, os is open and admits one finger. The most likely diagnosis is?
A. Threatened abortion
B. Missed abortion
C. Inevitable abortion
D. Incomplete abortion

Response:
Ans. C. Inevitable abortionThe size of the uterus corresponds to the period of gestation, bleeding is mild, os is open, thus inevitable abortion.

So the answer to this question is C


Instruction:
A Person hearing two different tones in left and right ear when presented with a single tone. This condition is called
A. Monoaural diplacusis
B. Binaural diplacusis
C. Tinnitus
D. Increased sensitivity to sound

Response:
Ans. 'b' i.e., Binaural diplacusis Monaural diplacusis:- Inmonauraldiplacusis,alistenerhearstwotoneswhenasingletoneispresentedtoasingle ear, i.e. one ear hears two different tones when presented one.Binaural diplacusis :- In binaural diplacusis, a listener hears two different tones in right & left ear when a single tone is presented to both ears.Both monoaural and binaural diplacusis are caused by inhomogeneities in the cochlea that also give rise to spontaneous otoacoustic emissions.

So the answer to this question is B


Instruction:
Duration of treatment in multibacillary leprosy according to WHO is –
A. 6 months
B. 1 year
C. 2 years
D. 5 years

Response:
None

So the answer to this question is B


Instruction:
A reactant generated by neutrophils that plays an impoant role in bacterial killing is
A. NADPH oxidase
B. Hexose monophosphate shunt
C. G proteins
D. Superoxide anion

Response:
Superoxide anion is generated when oxygen is reduced by cytoplasmic NADPH. The reduction is carried out by the enzyme NADPH oxidase, which is not a reactant but a catalyst activated in cells responding to bacteria.

So the answer to this question is D


Instruction:
The reference protein is
A. Cow's milk
B. Hen's Egg
C. Meat
D. Fish

Response:
None

So the answer to this question is B


Instruction:
Half-life of carbimazole is
A. 4 hours
B. 8 hours
C. 16 hours
D. 24 hours

Response:
Carbimazole has a half-life of 5.3 to 5.4 hours. It is possible that the plasma half-life may also be prolonged by renal or hepatic disease. See section 4.2. Thiamazole crosses the placenta and appears in breast milk. Ref: kd tRIPATHI 8TH ED.

So the answer to this question is B


Instruction:
Which of the following is/are used as die material:
A. Gypsum
B. Epoxy resin
C. Electroplated silver
D. All of the above.

Response:
None

So the answer to this question is D


Instruction:
Best agent for premenstrual syndrome management is?
A. gesterone
B. Anxiolytic
C. SSRI
D. Vitamin E

Response:
SSRI are the first choice of drug for premenstrual dysphoric syndrome. REF KD Tripati 8TH ED

So the answer to this question is C


Instruction:
Which of the following conditions is diagnosed using Cozen's test?
A. Little leaguer's elbow
B. Tennis elbow
C. Golfer's elbow
D. Frozen shoulder

Response:
Cozen's test - In this test active extension of wrist against resistance produces pain at the point of common extensor origin. It is considered a positive finding for lateral epicondylitis or Tennis elbow.

So the answer to this question is B


Instruction:
BCG is-
A. Live vaccine
B. Kileld vaccine
C. Toxoid
D. None

Response:
BCG Live vaccine Aim- To induce a benign,aificial primary infection which will stimulate an acquired resistance to possible subsequent infection with virulent tubercle bacilli, and thus reduce the morbidity and moality from primary tuberculosis among those most at risk. WHO recommends the &;Danish 1331&; strain for vaccine production. Stable for several weeks at ambient temperature in a tropical climate and for upto 1 year if kept away from direct light and stored in a cool environment below 10 deg celcius. Vaccine must be protected from light ( wrapped up in a double layer of red/ black cloth). Normal saline is recommended as diluent for reconstituting the vaccine as distilled water may cause irritation. Reconstituted vaccine may be used within 3 hours. Dosage-0.1 mg in 0.1 ml volume. The dose of newborn below 4 weeks is 0.05 ml. Afministered intradermally using tuberculin syringe. Injected slightly above the inseion of left deltoid. If injected too high / too low adjacent lymph nodes may become involved and tender. The vaccine must not be contaminated with an antiseptic/detergent. If alcohol is used to swab the skin , it must be allowed to evaporate before the vaccine is given. Phenomenon after vaccination:/ 2-3 weeks after a correct intradermal injection of a potent vaccine, a papule develops at the site of vaccination. It increases slowly in size and reaches a a diameter of about 4-8 mm in 5 weeks. It then subsides or breaks into a shallow ulcer but usually seen covered by a crust. Healing occurs within 6-12weeks leaving a permanent,tiny, round scar (4-8 mm in diameter).This is a normal reaction. Normally the individual become mantoux postive after 8 weeks has elapsed. Adverse reactions: prolonged severe ulceration at the site of vaccination, suppurative lymphadenitis, osteomyelitis and disseminated BCG infection. Contraindications: BCG should not be given to patients with generalised eczema, infective dermatosis, hypogammaglobulinemia , those with history of deficient immunity, patients under immunosuppressive treatment and in pregnancy. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.196}

So the answer to this question is A


Instruction:
Capgras syndrome is?
A. Delusion of infidelity
B. Delusion of love
C. Delusion of double
D. Delusion of grandiose

Response:
Ans is 'c' i.e. Delusion of double Delusion of misidentificationA. Capgras syndrome (Delusion of double): - Belief that a familiar person has been replaced by an exact double i.e. an impostor.B. Fregoli syndrome: - Belief that a complete stranger is actually a familiar person already known to one.Also remember* Othello syndrome - delusion of jealousy (infidelity)* Declerambault's syndrome - delusion of love* Cotard's syndrome - Nihilistic delusions* Ekbom syndrome - Delusion of infestations.

So the answer to this question is C


Instruction:
Criteria for Brainstem death includes
A. Positive Doll's eye Reflex
B. Absent pupillary light reflex and delated pupils
C. Pinpoint pupils
D. Positive vestsibulo-ocular reflex

Response:
Harrison's principles of internal medicine 17th edition. *Cardinal signs of death are cessation of cardiac function and respiration,pupils become fixed,body becomes cool,muscles and incontinence may occur

So the answer to this question is B


Instruction:
Beta blocker with a-blocker capacity is ?
A. Atenolol
B. Labetelol
C. Propanolol
D. Metoprolol

Response:
Ans. is 'b' i.e., Labetelol Combined alpha & beta blockers o Carvedilol o Bucindolol o Nipradilol o Medroxalol o Labetalol o Bevantolol o Dilevalol

So the answer to this question is B


Instruction:
Catalase positive coagulase negative beta hemolytic bacteria -
A. Strep pyogens
B. Staph aureus
C. Coagulase negative staph
D. Enterococci

Response:
Staphylococci are catalase positive.

So the answer to this question is C


Instruction:
If a patient comes with complaints of post dated pregnancy what is the first thing that you will do:
A. USG
B. NST
C. Review the menstrual history once more
D. X-ray abdomen

Response:
Review the menstrual history once more

So the answer to this question is C


Instruction:
Which of the following is a TNF - a inhibitor?
A. Etanercept
B. Abatacept
C. Daclizumab
D. Toclizumab

Response:
Ans. is 'a' i.e., Etanercept BIOLOGIC RESPONSE MODIFIER (BRMs)* Several recombinant proteins/monoclonal antibodies that bind and inhibit cytokines, especially TNFa or IL-1 have been used succesfully in autoimmune diseases like RA, IBD, psoriosis or scleroderma.A. TNF-a inhibitorsa. Etanercept# It is a recombinant fusion protein of TNF - receptor and Fc portion of human IgG1'# It is administered by S.C. injection.b. Infliximab# It is a chimeral monoclonol antibody which binds and neutralizes TNF-a.# It is given by i.v. route.# It is indicated in RA, psoriotic arthritis, Crohn's disease, Wegener's granulomatosis and sarcoidosis.c. Adalimumab# This recombinant monoclonal anti-TNF antibody.# It is administered by S.C. route.B. IL-1 antagonistAnakinra# It is a recombinant human IL-1 receptor antagonist.# It is less effective than TNF inhibitors.# It is administered by S.C. route.C. T-cell costimulatory blockersAbatacept# It is a fusion protein that combines the extracellular domain of the molecule CTLA4 (CD 154) with the Fc portion of a human immunoglobulin.# It interfere with the interactions between antigen presenting cells and T lymphocytes. Therefore, it affects early stages in the pathogenic cascade of event in RA.D. B-cell depletersRituximab# B-cells are inflammatory cells with multiple functions in the immune response. The depletion of B cells has been shown to be effective in reducing signs and symptoms of RA and in slowing radiographic progression.# Rituximab is a chimeric monoclonal antibody that binds to the CD20 molecule on the B cell surface leading to the removal of B cells from the circulation.

So the answer to this question is A


Instruction:
Gas cylinder with single pin index -
A. Oxygen
B. Air
C. Nitrogen
D. Entonox

Response:
Ans. is 'd' i.e., Entonox GasPin indexOxygen2,5Nitrous oxide3,5Cyclopropane3,6Air1,5Nitrogen1,4Entonox (50% O2 + 50% N2O)Single central (7)Carbon dioxide (< 7[?]5%)2,6Carbon dioxide (>7[?]5%)1,6

So the answer to this question is D


Instruction:
Macular scar is formed in which of the following diseases:
A. Papillitis
B. Hypeension
C. Neuroretinitis
D. All of the above

Response:
Ans. All of the above

So the answer to this question is D


Instruction:
Mayer Rokitansky Kuster Hauser syndrome
A. Ovaries, uterus fallopian tubes present
B. Uterus absent, fallopian tube ovaries present
C. All absent
D. Uterus present tubes and ovaries absent

Response:
Mayer Rokitansky Kuster Hauser syndrome ; Mullerian Agenesis Disorder of genital development charecterised by absence of vagina, an absent or hypoplastic uterus and normal or hypoplastic fallopian tubes Typically ovaries are normal Secondary sexual charecters are well developed May be associated with urologic anomalies and Skeletal malformations Ref: Clinical Gynecologic Endocrinology and Infeility; Eigth Edition, Chapter 9

So the answer to this question is B


Instruction:
A 24-year-old man with a history of depression is brought to the emergency room because of a drug overdose. He is experiencing some nausea and vomiting, but no other symptoms. Physical examination and vital signs are normal. Six hours prior to presentation, he intentionally took 40 tablets of acetaminophen (500 mg/tablet). Baseline acetaminophen level, liver enzymes and function are drawn, and he is admitted to the hospital. Which of the following is the most appropriate next step in management?
A. give ethanol to compete with the parent drug for metabolism, therefore preventing formation of toxic metabolites
B. give Narcan to block its actions directly
C. give intravenous prostacyclin to maintain cellular integrity
D. give N-acetyl cysteine to allow binding of the toxic metabolite

Response:
TV-acetylcysteine probably acts by providing a reservoir of sulfhydryl groups to bind the toxic metabolite of acetaminophen. Narcan is effective for narcotic overdose, and ethanol is the antidote for methanol intoxication.

So the answer to this question is D


Instruction:
Role of selenocystein is important in -
A. Hydroxylation of dopamine
B. Oxidation of drugs
C. Antioxidant mechanism
D. None of the above

Response:
Ans. is 'c' i.e., Antioxidant mechanism o Selenocysteine is considered to 21st standard amino acid.o It is present at the active site of many enzymesGlutathione peroxidase - An antioxidant enzyme.Deiodinase - Converts T4 to T3iii) Thioredoxin reductase.Glycine reductase.Formate dehydrogenaseo Selenocysteine has a structure similar in cystein, but containing selenium in place of sulfur atom of cysteine,o Proteins that contain selenocystein residues are called selenoproteins.

So the answer to this question is C


Instruction:
Cobb’s angle is used to measure the degree of-
A. Kyphoscoliosis
B. Angular deformity of the knee
C. Extent of depression in calcaneal fracture
D. Extent of spondylolistheis

Response:
(Refer: Mohindra’s Fundamentals of Orthopedics, 2nd edition, pg no. 244, 245)

So the answer to this question is A


Instruction:
Avascular coat in eye is:
A. Sclera
B. Cornea
C. Retina
D. Choroid

Response:
Ans. Cornea

So the answer to this question is B


Instruction:
Which of the following does not change pH of stomach: September 2011
A. Sucralfate
B. H2 blocker
C. Omeprazole
D. Ranitidine

Response:
Ans. A: Sucralfate Sucralfate has very poor acid neutralizing capacity and it has no antisecretory propey Sucralfate It is a cytoprotective agent, primarily indicated for the treatment of active duodenal ulcers. Sucralfate is also used for the treatment of gastroesophageal reflux disease (GERD) and stress ulcers. Unlike the other classes of medications used for treatment of peptic ulcers, sucralfate is a sucrose sulfate-aluminium complex that binds to the mucosa, thus creating a physical barrier that impairs diffusion of hydrochloric acid in the gastrointestinal tract and prevents degradation of mucus by acid. It also stimulates bicarbonate output and acts like an acid buffer with cytoprotective propeies Sucralfate is a locally acting substance that in an acidic environment (pH < 4) reacts with hydrochloric acid in the stomach to form a cross-linking, viscous, paste-like material capable of acting as an acid buffer for as long as 6 to 8 hours after a single dose. It also attaches to proteins on the surface of ulcers, such as albumin and fibrinogen, to form stable insoluble complexes. These complexes serve as protective barriers at the ulcer surface, preventing fuher damage from acid, pepsin, and bile. In addition, it prevents back diffusion of hydrogen ions, and adsorbs both pepsin and bile acids.

So the answer to this question is A


Instruction:
A 65-year-old miner has lost 7 kg weight within two months, has presented with cough, and blood streaked sputum. He was treated for pulmonary tuberculosis 10 years ago. He also has drooping of his left eyelid for one month. On physical examination, there is ptosis of the left eye and papillary miosis. Chest X-ray revealed round opacification in the left upper apical lobe. What is the most probable diagnosis?
A. Secondary tuberculosis
B. Adenocarcinoma
C. Squamous cell carcinoma
D. Asbestosis

Response:
Squamous cell carcinoma MC in smokers, MC type in IndiaQ Central in distribution and prone to undergo central necrosis and cavitationQ MC variety associated with hypercalcemiaQ (produces PTH-rp) Pancoast tumor is histologically SCCQ Associated with best prognosisQ

So the answer to this question is C


Instruction:
Space between major and minor diameter is
A. Funnel shaped
B. Morning glory shaped
C. Hyperbolic
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
Clopidogrel inhibit platelet aggregation by?
A. Inhibit gp 2b 3a
B. Inhibits phosphodiesterase
C. Inhibits ADP
D. Inhibits cyclooxygenase

Response:
ANSWER: (C) Inhibits ADPREF: Goodman and Gillmans 11TH ed, Page 972TICLOPIDINE The agonists of purinergic receptors are extracellular nucleotides. Platelets contain two purinergic receptors, P2Y1 and P2Y12; both are GPCRs for ADR The ADP-activated platelet P2Y1 receptor couples to the Gq-PLC-IP3-Ca2+ pathway and induces a shape change and aggregation. Activation of the P2Y12 receptor by ADP couples via Gi to inhibit adenylyl cyclase, resulting in lower levels of cyclic AMP and thereby less cyclic AMP-dependent inhibition of platelet activation. Apparently; both receptors must be stimulated for platelet activation, and inhibition of either receptor is sufficient to block platelet activation. Ticlopidine (TICLID) is a thieno pyridine that inhibits the P2Y12 receptor.CLOPIDOGREL The thieno pyridine dopidogrel (PLAVIX) is closely related to ticlopidine and appears to have a slightly more favorable toxicity profile with less frequent thrombocytopenia and leukopenia, although TTP has been reportedABCIXIMAB Abciximab (REOPRO) is the Fab fragment of a humanized monoclonal antibody directed against the IIa3h receptor.ASPIRIN: In platelets, the major cyclooxygenase product is thromboxane A2, a labile inducer of platelet aggregation and a potent vasoconstrictor. Aspirin blocks production of thromboxane A2 by acetylating a Ser residue near the active site of platelet cyclooxygenase (COX-1).

So the answer to this question is C


Instruction:
During a surgery, the patient had sudden hypotension, which of the following will promptly increase & hence be used intramuscularly to increase the blood pressure in this patient?
A. Adrenaline
B. Mephenteramine
C. Noradrenaline
D. None

Response:
Ans. b (Mephenteramine). (Ref. Pharmacology by KD Tripathi 6th/pg.l27)MEPHENTERMINE# It produces both cardiac stimulation and vasoconstriction by directly activating a and (3 adrenergic receptors as wellas by releasing NA.# Cardiac output, systolic and diastolic BP are increased.# The direct positive chronotropic effect on heart is generally counter balanced by vagal stimulation due to rise in meanBP.# Mephentermine is not a substrate for either MAO or COMT: active orally with longer duration of action (2-6 hr).# It crosses blood-brain barrier to some extent-may produce excitatory effects at higher doses.# It is used -- To prevent and treat hypotension due to spinal anaesthesia and surgical procedures,- Shock in myocardial infarction and other hypotensive states.EPHEDRINE# Mainly acts indirectly but has some direct action on a and b receptors also.# Repeated injections produce tachyphylaxis, primarily because the neuronal pool of NA available for displacement is small.# It is resistant to MAO, therefore, effective orally.# It is about 100 times less potent than Adr but longer acting (4-6 hours).# It crosses to brain and causes stimulation, but central: peripheral activity ratio is lower than that of amphetamine.# Ephedrine can be used for a variety of purposes, but it lacks selectivity and efficacy in general is low.# Use is now restricted to that in mild chronic bronchial asthma and for hypotension during spinal anaesthesia; occasionally for postural hypotension; 15-60 mg TDS.PHENYLEPHRINE# It is a selective a1agonist, has negligible b action.# It raises BP by causing vasoconstriction.# Because it has little cardiac action, reflex bradycardia is prominent.# It is used as a mydriatic when cycloplegia is not required: tends to reduce intraocular tension by constricting ciliary body blood vessels.# It is a frequent constituent of orally administered nasal decongestant preparations, as well as used topically for this purpose.# Central effects are not seen with usual clinical doses.METHOXAMINE# Another selective a1 stimulant with no b actions (has weak b blocking action).# Resembles phenylephrine very closely.# Occasionally used as a pressor agent.

So the answer to this question is B


Instruction:
Kidney is covered by what fascia?
A. Sibson's fascia
B. Buck's Fascia
C. Gerota's Fascia
D. None

Response:
Ans. is 'c' i.e., Gerota's Fascia Renal fascia* There are four coverings around the kidney (from within outwords)i) True capsule (fibrous capsule)# It is formed by the condensation of fibrous stroma of kidney.ii) Perinephric fat (adipose capsule)# It occupies the interval between the fibrous capsule and renal fascia (false capsule or fascia of Gerata). This space (occupying perinephric fat) is called space of Gerota.iii) False capsule (renal fascia or fascia of Gerota)# It is formed by condensation of extra-peritoneal connective tissue around kidney and is continuous laterally with fascia transversalis. False capsule consists of two layers : anterior "fascia of Toldt" and posterior "fascia of Zuckerkendl".iv) Paranephric fat# It occupies the interval between the renal fascia and anterior layer of thoracolumbar fascia.

So the answer to this question is C


Instruction:
True about Multiple myeloma are all Except:
A. Bence Jones protein in urine
B. Hypogammaglobulinemia
C. Amyloidosis
D. Plasmacytosis < 10%

Response:
Answer is D (Plasmacytosis < 10%) Multiple myeloma is characteristically associated with Plasmacytosis >10%. Multiple myeloma may be associated with both Hypogammaglobulinemia and Hypergammaglobulinemia. Electrophoresis Pattern in Multiple Myeloma Monoclonal Hypergammaglobulinemia (M spike) This is the characteristic electrophoresis pattern in Myeloma Hypogammaglobulinemia About 10-20% of multiple myeloma patients present with Hypogammaglobulinemia on electrophoresis. This configuration is suggestive of light chain variant of multiple myeloma in which Bence Jones proteins are excreted into urine without a serum myeloma protein being evident with routine electrophoresis techniques. `Multiple Myeloma results in hypergammaglobulinemia of a specific class of immunoglobulins. Hypogammaglobulinemia also justifies a search for myeloma especially for the possibility of light chain disease. ' Multiple Myeloma may be with Bence Jones Proteins, Amyloidosis & Renal failure

So the answer to this question is D


Instruction:
What lies at midinguinal point?
A. Deep inguinal ring
B. Superficial inguinal ring
C. Femoral aery
D. Saphenous vein

Response:
MID INGUINAL POINT Midpoint of line joining anterior superior iliac spine to pubic symphysis. Femoral aery, continuation of external iliac aery, begins behind the inguinal ligament at the midinguinal point. Deep ring- oval opening in fascia transversalis.1.25 cm above mid inguinal point. Superficial ring: triangular gap in external oblique aponeurosis. Located just above and medial to pubic tubercle. Saphenous vein.:-Thigh- it inclines forward to reach the saphenous opening where it pierces the cribriform fascia, and opens into femoral vein. {Reference: BDC 6E}

So the answer to this question is C


Instruction:
Which of the following is not a component of Innate immunity?
A. Epithelial barriers
B. NK cells
C. Dendritic cells
D. Helper T lymphocyte

Response:
The major components of innate immunity are epithelial barriers that block entry of microbes, phagocytic cells (mainly neutrophils and macrophages), dendritic cells, natural killer (NK) cells, and several plasma proteins, including the proteins of the complement system.The adaptive immune system consists of lymphocytes and their products, including antibodies.Ref: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 6; Diseases of the Immune System; Page no: 186

So the answer to this question is D


Instruction:
A 3 year old child is expected to have all except ?
A. Speak in sentences
B. Copy a circle
C. Hobble 5 steps
D. Climb upstairs and downstairs

Response:
Ans. is 'c' i.e., Hobble 5 steps o Milestone development is a very impoant topic. Here I am explaning in details so that you will be able to solve all the questions on this topic. Age Milestone 1 month In ventral suspension, stas lifting his head. In prone position lifts the chinup momentarily in midline. Turns head to sound Regards a lighted torch or the face of mother. 2 months In ventral suspension, lifts his head in the horizontal plane (in the plane of the body) Social smile develops Follows object with steady movements of eye. 3 months In ventral suspension lifts his head above horizontal plance (Neck holding) In prone position lifts his head and upper pa of forearms. Stas cooing Recognizes mother Can follow an object upto 180deg 4 months Grasps rattle or rings when placed in hand and bring it to the mouth (mouthing). Can bear some weight of body with straight legs in the mother's lap. 5 months Gains control of head in supine position. Sits with suppo Reaches out to an object and holds it with both hands (bidextrous grasp). Turns from back to side Transfer the objects from one hand to another (between 5-7 months). 6 months In prone position lifts his head and greater pa of his chest while suppoing weight on extended arms. Produces monosyllable sounds like da, ma. Enjoys watching his own image in the mirror. Binocular vision develops (between 3-6 months). 7 months Holds the objects with crude grasp from palm (palmar grasp) Pivots Shows strangers anxiety Resists if a toy is pulled from his hand. Babbles 8 months Rolls from back to stomach and from stomach to back. Crawls in the bed. Sits without suppo 9 months Stand with suppo Makes early stepping movements when feet are placed on the surface of the table. Develops Pincer grasp with the index finger and thumb apposition. Develops finer and more Cooridinated hand skills ---> Can scoop on a pellet crudely with his palm. Waves bye-bye Produces bisyllable sound like baba, mama. 10 months Crawls and creeps, keeping his abdomen off the ground. Can pull himself up from the supine to sitting position. Walks with suppo Can understand spoken speech e.g., where is the light. Plays peek-a-boo game. Can be placed on the toilet seat. 1 year Stands without suppo Tries to feed himself with a spoon but spills the contents. Tries to remove his coat and attempts to wear his socks or shoes without success. Does mimicry. Plays a simple ball game. Can use 2 words with meaning. Tries to build a Tower of 2 cubes. Tries to scribble spontaneously (between 12-24 months). 13 months Walking without suppo Can turn two or three pages of a book at a time. 15 months Can take several steps sideways and takes a few steps backward. Creeping upstairs Can walk to the toilet (between 15-16 months). Learns to feed himself with spoon without spilling its contents. Makes a tower of 3 cubes. Vocabulary of 4 to 6 words Enjoy polysyllabic jargoning 18 months Stas running (runs stiffy) Can feed himself from a cup. Can use 10 words with meaning. o Name pictures Builds tower of 4 cubes Ready for staing toilet training. Copies parents in task. 2 years Walking up and downstairs, one step at a time i.e., brings both his feet up on one step before climbing to the next step. Can turn pages of book one at a time. Draws a veical or horizontal line. Is able to wear socks or shoes. Kicks ball on request Jumps of the floor with both feet. Builds tower of 7 cubes. Makes simple sentences and uses pronouns. Is trainable for toilet and verbalizes toilet needs. Can unscrew lids and turn door knobs. Points 3-4 body pas. 30 months Climbs stairs alternating feet. Makes tower of 9 cubes. Refers to self as 'I' and knows full name. 3 years Rides tricycle Stands momentarily on one foot. Draws a circle. Can dress or undress himself completely and succesfully buckles his shoes. Builds tower of 10 cubes. Knows his gender and age. Repeats a sentence of 6 syllables. Has a vocabulary of 250 words. Counts 3 objects correctly. Can withhold and postpone bowel movement. 4 years Hops on one foot Goes down stairs with alternating feet. Draws a cross (plus sign) Draws a rectangle Tells a story Counts 4 pennies accurately. Can identify left and right (left-right discrimination) 5 years Draws a tilted corss (multiplication sign) Draws a triangle Skips Name 4 colors Counts 10 pennies correctly Milestone

So the answer to this question is C


Instruction:
Superficial mallory weiss tear heals completely within:
A. 1 week
B. 48 hours
C. 24 hours
D. 72 hours

Response:
Mallory-Weiss tears Mucosal or submucosal lacerations that occur at the gastroesophageal junction. Patients present with hematemesis or coffee-ground emesis. All will have a history of recent non-bloody vomiting followed by hematemesis. The tear is due to increased intra-abdominal pressure, in combination with a shearing effect caused by negative intrathoracic pressure. The bleeding is self-limited and mild. Superficial Mallory-Weiss tears can heal completely within 48 hours. Ref: Sleisenger and Fordtran's, E-9, P-299.

So the answer to this question is B


Instruction:
A 22-year-old female student was found to have an anterior mediastinal mass on a chest x-ray for a persistent cough. What finding is true regarding the thymus gland?
A. It is located in the posterior mediastinum.
B. It arises from the first branchial arch.
C. It controls calcium metabolism.
D. It is usually excised through an incision along the anterior branch of the sternomastoid.

Response:
The thymus gland is removed in certain cases of myasthenia gravis. It is located in the anterior mediastinum and can be approached by a cervical or mediastinal approach. It arises from the third and fourth branchial arches. Pneumococcal infections are particularly likely to develop after splenectomy performed in children.

So the answer to this question is D


Instruction:
All trans retinoic acid is used topically for -
A. Acne vulgaris
B. Lupus vulgaris
C. Alopecia areata
D. Androgenic alopecia

Response:
Ans. is 'a' i.e., Acne vulgaris * All-trans retinoic acid (Tretinoin) is used topically, while 13-cis retinoic acid (Isotretinoin) is given orally for acne.

So the answer to this question is A


Instruction:
Most reliable marker for hypothyroidism:
A. T3
B. T4
C. TSH
D. Thyroxine binding globulin

Response:
Ans. (c) TSHRef : Harrison 19th ed. 12289* Best test for diagnosis of hypothyroidism is T.S.H (Thyroid Stimulating Hormone).* TSH can also be used for monitoring response to treatment.

So the answer to this question is C


Instruction:
Best test for Small intestine malabsorption of carbohydrates is -
A. Lund meal test
B. Shilling test
C. D-Xylose test
D. Follacin test

Response:
None

So the answer to this question is C


Instruction:
Which is the muscle that draws the scapula forward ?
A. Trapezuis
B. Rhomboides
C. Serratus anterior
D. Levator scapulae

Response:
Serratus anterior protracts the scapula, it acts as a main muscle in reaching and pushing movements. It also helps in raising the arm fully. The muscular digitations of serratus anterior can be seen and felt when the outstretched hand pushes against resistance. In case of paralysis, the lower angle of the scapula stands out prominently, there is projection of scapula also termed as winging of scapula.Must know: Seratus anterior is innervated by the long thoracic nerve also known as nerve of bell.Good to know:Dropped shoulder occurs as a result of paralysis of the trapezius muscle. With paralysis of the trapezius muscle a drop shoulder with rotation of the angle of the scapula towards the midline and restricted abduction of the arm is caused. Trapezius is supplied by accessory nerve.

So the answer to this question is C


Instruction:
All are true in Kawasaki except:
A. Exudative conjuctivits
B. Pedal edema
C. Strawberry tongue
D. Thrombocytosis

Response:
Ref: CMDT 2013, Pg 1417-1418Explanation: Kawasaki Disease (mucocutaneous lymphnode syndrome):Autosomal DominantAutosomal RecessiveX- linked dominantX-linked recessiveHuntington's disease, Neurofibromatosis type 1, Myotonic dystrophy, Tuberous sclerosis, PCKD, Familial polyposis edi, Hereditory spherocytosis, Von Wiflebrard disease. Marfan's, Osteogenesis imperfecta, achondroplasia, Familial hypercholesterolemia. Acute intermittent porphyriaHemochromatosis, cystic fibrosis, a-1 antitrypsin deficiency, thaiass emia, sickle cell anemia, CAH. F reidrick's ataxia, spino muscular atrophy. alkaptonuria, Wilson's disease. homocystinuriaVit-D resistant rickets Fragile X syndrome Alports, Charcot-marie tooth diseaseRett syndromeBeckers & Duchen's MD, Haemophila A & B,Fabry's diseaseLesch NyhanHunter's, Menke's Wiskott-AldrichColor blindnessG6PD deficiencyY - linked inheritance: Hairy pinnaMultisystem, medium vessel vasculitisChildren 3monihs-5yrsInfectious agents implicated- Corona virus, parvovirus, bocavirus, CMV, y.pseudotuber- culosis, meningococcusFever + 4 of the following for 5 days:1. Bilateral nonexudative conjunctivitis2. Mucous membrane -injected pharynx, erythema, swelling & fissuring of the lips, strawberry tongue3. Peripheries- edema, desquamation, erythema of the palms & soles, induration of hands & feet. Beau lines4. A polymorphous rash5. Cervical Ivmphadenopathy >1.5 cmRemember:Thrombocytosis may be present. Not ThrombocytopeniaCoronary vessel arteritis & aneurysms. MIEspecially in males, high fever, high CRP. anemiaHypoalbuminemia, hyponatremia, urticariaTreatment- IVIG, AspirinTNF blockers-linfliximab, Etanercept.Cyclophosphamide, methotrexate, plasmapheresisSurgical correction of the coronary aneurysms, oral anticoagulation in large aneurysms.Types of vasculitis:1. Ijargc vessel vasculitis:Takayasu's arteritisGiant cell arteritis2. Medium vessel vasculitis:Polyarteritis Nodosa (PAN)Kawasaki disease3. Small vessel vasculitis:Microscopic poly angitisWegner's granulomatosisChurg-Strauss syndromeHenoch Schoniein Purpura (HSP)Mixed essential cryoglobulinemia

So the answer to this question is A


Instruction:
ACOG defines arrest of the first stage of labour as completed latent phase with uterine contractions of strength > 200MVUs without cervical changes for______
A. 1 hour
B. 2 hours
C. 3 hours
D. 4 hours

Response:
Ans. b (2 hours) (Ref Williams Obstetrics 22nd/Ch, 22; p. 540)# The latent phase has been completed, with the cervix dilated 4 cm or more. A uterine contraction pattern of 200 Montevideo units0 or more in a 10-minute period has been present for 2 hours without cervical change.# Arrest of dilatation was defined as 2 hours with no cervical change, and arrest of descent as 1 hr without fetal descent.# Friedman and Sachtleben (1963) defined a prolonged latent phase as being greater than 20 hours in the nullipara and 14 hours in the multipara.Criteria for Diagnosis of Abnormal Labor Due to Arrest or Protraction DisordersLabor PatternNulliparaMultiparaProtraction disorderDilatation< 1.2 cm/hr< 1.5 cm/hrDescent< 1.0 cm/hr< 2.0 cm/hrArrest disorderNo dilatation> 2 hr>2 hrNo descent> 1 hr> 1 hrAbnormal Labor Patterns, Diagnostic Criteria, and Methods of TreatmentDiagnostic CriteriaLabor PatternNulliparasMultiparasPreferredExceptional TreatmentProlongation Disorder(Prolonged latent phase)> 20 hr> 14 hrBed restOxytocin or cesarean delivery for urgent problemsProtraction Disorders 1 Protracted active-phase dilatation< 1.2 cm/hr< 1.5 cm/hrExpectant and supportCesarean delivery for CPD2. Protracted descent< 1.0 cm/hr< 2 cm/hr Arrest Disorders 1. Prolonged deceleration phase>3 hr> 1 hrOxytocin without CPDRest if exhausted2. Secondary arrest of dilatation 3. Arrest of descent>2 hr>2 hrCesarean delivery with CPDCesarean delivery4. Failure of descent> 1 hr, with no descent in deceleration phase or second stage>1 hr

So the answer to this question is B


Instruction:
A patient in ICU developed stress related mucosal damage. MOST common site of stress ulcer is:
A. Ileum
B. Stomach
C. Duodenum
D. Esophagus

Response:
Stress-Related Mucosal Damage (SRMD): SRMD, also referred to as stress ulcers or stress-related erosive syndrome (SRES), is the result of multiple-organ-system failure in the critically ill patient. SRMD lesions are characterized by multiple, deeper, acute ulcerations, predominantly in the gastric lesser curvature or fundus, and these lesions can erode into the submucosa, causing massive hemorrhage. Ref: Subramanian R., McCashland T. (2005). Chapter 82. Gastrointestinal Hemorrhage. In J.B. Hall, G.A. Schmidt, L.D. Wood (Eds), Principles of Critical Care, 3e.

So the answer to this question is B


Instruction:
Most common type of supra condylar fracture in children -
A. Posteromedial extension
B. Posterolateral extension
C. Anteromedial flexion
D. Anterolateral flexion

Response:
Ans. is 'a' i.e., Posteromedial extensionSupracondylar fracture of humeruso Supracondylar humeral fractures are the most common elbow fractures in children. Most common age group affected is 5-8 years. Boys are affected more than girls. Left side is more common than right.Mechanism of injuryo Mostly it occurs due to hyperextension injury.o Fracture is caused by a fall onto the outstretched hand with hyperextension at elbow.Types of supracondylar fractureo Supracondylar fracture is broadly classified into extension type and flexion type.Extension typeIt is the most common type (97 - 99%).Distal fragment is extended (tilted backward/posteriorly) in relation to proximal fragment.Occurs due to hyperextension injury after fad on outstretched hands.Generally, displacement of distal fragment may be : -Posteromedial (70-80%)Posterolateral (20-30%)Flexion typeIt is less common type (1-3 %)Distal fragment is flexed (tilted forward/anteriorly) in relation to proximal fragments.The mechanism of injury generally is believed to be a fall directly onto the elbow rather than a fad on outstretched hand.o As the extension type fracture is more common (97 - 99%), the most common elbow injury in children is extension type of supracondylar fracture.Clinical features of supracondylar fractureo Following a fall, the child is in pain and elbow is swollen.o In extension type of injury, 'S'shaped deformity of the elbow is obvious,o There is loss of both active and passive movements of elbow,o Symptoms relating to vascular and nerve injury may be seen.o Unusual posterior prominence of the point of elbow (tip of olecrenon) because of backward tilt of the distal fragment.o Three point bony relationship is maintained as the fracture is above the level of condyles,o Dimple sign due to one of the spikes of proximal fragment penetrating the muscle and tethring the skin.

So the answer to this question is A


Instruction:
True about Impetigo is – a) Contagiousb) Bacterial infectionc) Non contagiousd) Honey coloured cruste) Viral infection
A. abd
B. bcd
C. abc
D. ab

Response:
Impetigo is -

Highly contagious
Gram positive bacterial infection of superficial layers of epidermis.

Honey coloured crust is seen in Impetigo contagiosa (Non-bullous impetigo).

So the answer to this question is A


Instruction:
In a patient, corneal scraping reveals narrow angled septate hyphae, which of the following is the likely etiological agent
A. Mucor
B. Aspergillus
C. Histoplasma
D. Candida

Response:
Aspergillus has non pigmented septate hyphae with characteristic dichotomous branching at an angle of approximate 45degrees. it causes superficial infections like sinusitis, otomycosis and mycotic keratitis. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition .

So the answer to this question is B