Instruction:
All of the following are true about fracture of the atlas veebra, except:
A. Jefferson fracture is the most common type
B. Quadriplegia is seen in 80% cases
C. Atlantooccipital fusion may sometimes be needed
D. CT scans should be done for diagnosis

Response:
B i.e. Quadriplegia is seen in 80% cases Jafferson fracture is burst fracture of ring of atlas (Cl) veebraeQ. In most cases it doesn't leads to neurological deficitQ. With the exception of pain or loss of sensation in the greater occipital nerve distribution neurological sequelae are uncommon and more likely to be related to associated injuries. It is most common type of atlas fractureQ. It is cause by axial compression forceQ (with or with out extension force), resulting from a fall on the head from a height or mass falling on head. This mechanism of injury results in a burst fracture of ring of atlas (C1) veebraeQ, that occurs secondary to the occipital condyles being driven into the interior poions of the ring of atlas and driving the lateral masses outwards. Lateral displacement of C1 lateral mass lateral the outer coex of the C2 lateral mass raises concerns for the structural integrity of the transverse atlantal ligament (TAL). The stability of atlas depends on TAL. Due to outward movement of lateral masses, there is no encroachment on the neural canal and, usually, no neurological damageQ. Classical Jafferson's fracture (as described by Jafferson in 1920) was four pa fracture of ring of atlasQ (2 pa of anterior ring & 2 pa of posterior ring). However more common are two pa or three pa fractures. It is tyically diagnosed on plain radiographs - pen mouth (odontoid) view may show asymmetry of the lateral masses of C1 on C2 with overhang. - A bilateral overhang > 6.9 mm suggest disruption of transverse ligament and potential late instability. - On lateral radiograph presumptive evidence of transverse ligament disruption is >4mm atlanto-dens interval. Coronal C T reformation provides the best method of evaluating impoant atlas fracture characteristicsQ. The treatment for isolated atlas injuries is typically nonoperative - Undisplaced stable injuries are managed by semi rigid cervical collar or halo- vest until fracture unites. - Unstable injury wit transverse ligament rupture (> 7mm displacement of lateral mass) is managed by halo traction f/b halovest immobilization for a total of 3 - 4 months. - If a late instability or nonunion is present, atlanto - axial (C1 - C2) ahodesis and atlanto - occipital (cervico- occipital) fusionQ. is done Fracture of atlas are associated with injury elsewhere in cervical spine in upto 50% of cases; odontoid fractures and hangman's fractures in paicular should be excluded.

So the answer to this question is B


Instruction:
Drug of choice for plague is:
A. Erythromycin
B. Tetracyclines
C. Ampicillin
D. Cotrimoxazole

Response:
TETRACYCLINES: These are a class of antibiotics having a nucleus of four cyclic rings. Tetracyclines are the first choice drugs. despite development of resistance by many organisms in: a)venereal diseases chlamydial non specific urethritis/endocervicitis: 7 day doxycycline treatment is as effective as azithromycin single dose. * Lymphogranuloma venereum: resolves in 2-3 weeks * Granuloma inguinale:Due to Calymm granulomatis: a tetracycline administered for 3 weeks is the most effective treatment. b) Atypical pneumonia: due to Mycoplasma pneumoniae: duration of illness is reduced by tetracycline therapy. Psittacosis is treated in 2 weeks by tetracyclines. &; c) cholera: Tetracyclines have adjuvant value by reducing stool volume and limiting the duration of diarrhoea. d)brucellosis: Tetracyclines are highly efficacious; cause rapid symptomatic relief; therapy of choice is doxycycline 200 mg/ day + rifampin 600 mg/ day for 6 weeks. Gentamicin may be combined with doxycycline in acute cases. e)plague: Tetracyclines are highly effective in both bubonic and pneumonic plague. They are preferred for blind/ mass treatment of suspected cases during an epidemic, though streptomycin often acts faster. (j) Relapsing fever* due to Borrelia recurrentis responds adequately. (g) Rickettsial infections: typhus, rocky mountain spotted fever, Q fever, etc. respond dramatically. Chloramphenicol is an alternative. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:714,715

So the answer to this question is B


Instruction:
A symptom of medullary sponge kidney disease is ?
A. Nocturia
B. Anemia
C. Azotemia
D. UTI

Response:
Ans. is 'd' i.e., UTI Medullary sponge kidney is a congenital disorder characterized by cystic dilatation of papillary collecting ducts of one or both kidneys. Urinary stasis in the dilated ducts, hypocitraturia, and, occasionally, incomplete distal renal tubular acidosis (dA) contribute to the formation of small calcium-containing calculi. Most cases are asymptomatic or are discovered during investigation of asymptomatic hematuria. Symptomatic patients typically present as young adults with: - Kidney stones with renal colic - Recurrent hematuria - Infection (UTI) Most cases are sporadic, while some show autosomal dominant inheritance Involvement is bilateral in most cases

So the answer to this question is D


Instruction:
A 4 year old girl has developed painful elbow after being jerked by forearm is it managed
A. Reassure the parents and Analgesics
B. Supinate the forearm
C. Elevate the limb
D. Open reduction to be done

Response:
Is the case of pulled elbow.
Managed by quickly supinating the forearm.

So the answer to this question is B


Instruction:
FALSE statement about potassium balance is:
A. Most of potassium is intracellular
B. Three quaer of the total body potassium is found in skeletal muscle
C. Intracellular potassium is released into extra-cellular space in response to severe injury
D. Acidosis leads to movement of potassium from extracellular to intracellular fluid

Response:
Acidosis leads to movement of potassium from intracellular to extracellular fluid. Ref: Harrisons principles of internal medicine, 18th edition, chapter: 45.

So the answer to this question is D


Instruction:
Forced alkaline diuresis cannot be done in which poisoning
A. Barbiturates
B. Salicylates
C. Alcohol
D. Methotrexate

Response:
Forced alkaline diuresis It is a method to achieve a urinary pH 7.5 to 9 and promote the excretion of the drug through urine, Eg: salicylates, barbiturates, chlorpropamide, methotrexate. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 403

So the answer to this question is C


Instruction:
Size of resting follicle :
A. 0.2 mm
B. 0.02 mm
C. 2 mm
D. 20 mm

Response:
Size of resting follicle -0.02 mm Size of follicle just before ovulation -20 mm.

So the answer to this question is B


Instruction:
Downward rotation, medial rotation and extortion of eye ball is facilitated by:
A. Superior rectus
B. Inferior rectus
C. Levator palpebrae superioris
D. Medial rectus

Response:
Actions of Individual Muscles

Levator palpabrae superioris
Elevation of upper eyelid

Superior rectus
Upward rotation, medial rotation and intortion

Inferior rectus
Downward rotation, medial rotation and extortion

Medial rectus
Medial rotation

Lateral rectus
Lateral rotation

Superior oblique
Downward rotation, lateral rotation and intortion

Inferior oblique
Upward rotation, and extortion

So the answer to this question is B


Instruction:
Most common intraocular tumour in adult:
A. Metastasis
B. Retinoblastoma
C. Malignant melanoma
D. Vitreous tumour

Response:
A i.e. Metastasis

So the answer to this question is A


Instruction:
Wide fixed splitting of the second hea sound is typical of-
A. Atrial septal defect
B. Ventricular septal defect
C. Patent ductus aeriosus
D. Coarctation of aoa

Response:
Wide fixed split of S2 is seen in ASD. Wide split : VSD, MR, LV pacemaker, WPW, PS, RVF, RBBB. Reverse split : RV pacemaker, WPW, Eisen menkers, AS, LVF, LBBB, TR Ref: Harrison&;s 20th ed

So the answer to this question is A


Instruction:
Keshan disease in due to deficiency of
A. Selenium
B. Copper
C. Zinc
D. Iron

Response:
Ans. is 'a' i.e., Selenium Keshan disease Cardiomyopathy associated with selenium deficiency. Wilson disease Autosomal recessive. Defective metabolism of copper leads to copper toxicity. Deficiency of ceruloplasmin. Presence of KF ring in cornea. Acrodermatitis enteropathica Deficiency of zinc. Dermatitis of extremities & around orifices.

So the answer to this question is A


Instruction:
A 32-year-old male underwent a lung transplant 1 year ago. Initially, he had an episode of acute rejection requiring increased immunosuppression. He now presents with symptoms of low-grade fever and generalized fatigue, fever, and weight loss. Chest x-rays are obtained.The most likely diagnosis of this patient is
A. Posttransplant lymphomatoid disorder (PTLD)
B. Squamous cell carcinoma
C. Aspergilloma
D. Phantom tumor or pseudotumor

Response:
The PA view shows a rounded opacity in the right lower zone. The horizontal fissure is seen distinctly through and separate from this opacity, suggesting that this is not a pseudotumor, i.e., fluid in the fissure. A double density shadow is seen in the subcarinal area. A band of linear atelectasis is seen in the right lower zone. The patient has posttransplantation lymphoproliferative disorder (PTLD) confirmed by a needle biopsy. The incidence of PTLD in lung transplant recipients is approximately 2% to 5% and is higher than in other solid organ transplants. It is closely associated with Epstein-Barr virus infection, and children are more prone to develop this disorder. The majority of PTLDs are non-Hodgkin's lymphomas and B-cell tumors. Typical radiographic features include multiple nodules, mediastinal adenopathy, airspace disease, and pleural effusions. Aspergilloma or mycetoma is a fungus ball that occurs in cystic or cavitary disease and is unrelated to lung transplant. Pseudotumor or fluid in the horizontal or oblique fissure occurs in cases of congestive hea failure and is seen radiographically within the confines of these fissures.

So the answer to this question is A


Instruction:
Protective value of vaccine is 95%. It means
A. All those vaccinated are protected
B. Among those vaccinated, 95% persons are not susceptible to the injections
C. 95% of persons do not get the disease, where as 5% get the disease
D. 5 among 100 have the probability of getting infected after vaccination

Response:
Vaccine is an immuno-biological substance designed to produce specific protection against a given disease It stimulates the production of protective antibody and other immune mechanisms Vaccines can be prepared from live modified organisms, inactivated or killed organisms, extracted cellular fractions, toxoids or combination of these Vaccine efficacy is the percentage reduction of disease in a vaccinated group of people compared to an unvaccinated group, using the most orable conditions Vaccine efficacy was designed and calculated by Greenwood and Yule in 1915 for the cholera and typhoid vaccines It is best measured using double- blind, randomized, clinical controlled trials, such that it is studied under "best case scenarios Ref : Park&;s Textbook of Preventive and Social Medicine; 23rd edition

So the answer to this question is D


Instruction:
Vibrio parahemolyticus food poisoning is caused by ingestion of -
A. Eggs and Poultry products
B. Raw vegetable
C. Catfish, shellfish, seafood
D. Milk products

Response:
Ans. is 'c' i.e., Cat fish, Shell fish, seafood . You know that v. parahemolyticus is a halophilic vibria --> so, most likely food responsible for its poisoning will be sea food. V. parahemolyticus . It is a halophilic vibrio. . Inhabits the coastal sea, where it is found in fishes ahopods such as shrimps and crabs and molluscs such as oyster. . It resembles the cholera vibrio except that: - It is capsulated - Shows bipolar staining - Produces peritrichous flagella when grown on solid medium (V. cholerae has polar flagella), in liquid medium polar flagella are formed. - It grows, only in media containing NaCl, optimum conc. is 2-4% . Its enteropathogenicity is closely linked to its ability to cause hemolysis on Wagatsuma agar --* the Kanagawa phenomenon. . V. parahemolyticus causes common source outbreaks of diarrhea after consumption of undercooked or improperly handled seafood or of other food contaminated by sea water. . It can result in two distinct gastrointestinal presentation.

So the answer to this question is C


Instruction:
Which of the following immunoglobulins shows homocytotropism -
A. IgG
B. IgA
C. IgE
D. IgD

Response:
IgE is an 8 S molecule. - resemble IgG structurally. - heat liable - an affinity for the surface of tissue cells paicularly mast cells of the same species. This feature is called homocytotropism. - the normal serum contains only traces of IgE ( a few nanograms per ml ) - greatly elevated levels in atopic conditions like asthma, hay fever. Reference : Anathanarayan & paniker's 9th edition, pg no: 98,98 <\p>

So the answer to this question is C


Instruction:
Mineralization inhibitors of calculus formation include
all of the following except
A. Triclosan
B. Pyrophosphate
C. Zinc salts
D. Diphosphates

Response:
None

So the answer to this question is D


Instruction:
True statement regarding depolarizing neuro muscular blocking drugs
A. The depolarized muscles fibres are unresponsive to other stimuli
B. Causes muscular fasciculation
C. Not reversed by neostigmine
D. All of the above

Response:
(All of the above) (204-Lee's 12th) (340-43-KDT 6th)Features of non-depolarizing neuromuscular blocking drugs1 Do not cause muscular fasciculation2 Mostly mono- or bis-quatemary salts with interonium distance of 0.7-1.7 nm and high electrostatic characteristics i.e. very hydrophilic3 Relatively slow onset (1-58 min)4 Reversed by neostigmine and other anticholinesterases5 Effects reduced by adrenaline and acetylcholine: Also by suxamethonium (but not in myasthenics)6 The relaxed muscle is still responsive to other (mechanical and electrical) stimuli7 In partial paralysis, neuromuscular monitoring shows 'fade': post-tetanic facilitation followed by exhaustion, and depression of muscle twitch8 Potentiated by volatile agents, Mg++ and hypokalaemia.9 Slow dissociation constant at receptors10 Greater cooling (below about 33degC) potentiates them11 Mild cooling antagonizes their effects12 Repeated titanic bursts cause their effect to wear off13 Acidosis increases duration and degree of non-depolarizing blocks.Features of depolarizing (Phase I) neuromuscular blocking drugs1 Causes muscular fasciculation (but not in myasthenic humans and in some other species). Extraocular muscles exhibit a tonic response2 The depolarized muscle fibres are unresponsive to other stimuli. The Na+ channels are blocked open.3 Repolarization is interfered with the resting membrane potential is held up until phase II block develops. When it returns to - 70 mV.4 Not reversed by neostigmine and other anticholinesterases.5 In partial paralysis the neuromuscular monitoring shows depression of muscle twitch, no 'fade' but a well- sustained response, and no post-tetanic fascilitation.6 Potentiated by isoflurane, Enflurane, Ach, respiratory alkalosis, hypothermia and Mg++7 Antagonized by ether, halothane, acidosis, and non-depolarizing relaxants8 Fast dissociation constant at receptors. There is little or no bond between drug and receptors.9 Repeated or continuous use leads to 'phase II blocks"

So the answer to this question is D


Instruction:
Mother to child transmission of HIV ?
A. 25%
B. 50%
C. 60%
D. 75%

Response:
Ans. is 'a' i.e., 25% . Probability of transmission of HIV from mother to infant/fetus ranges from 15 to 25% in industrialized countries and from 25 to 35% in developing countries.

So the answer to this question is A


Instruction:
Activity of which of the following enzyme increase in alcoholism?
A. Lactate dehydrogenase
B. Acid phosphatase
C. Alkaline phosphatase
D. Gamma-glutamyltransferase

Response:
Ans. d (Gamma-glutamyItransferase). (Ref. Harper's Biochemistry 26th ed. 212)# Increased hepatic gamma-glutamyltransferase (GGT) activity following chronic ethanol consumption has been attributed to enzyme induction, dietary carbohydrate imbalance, and/or to hepatic cell damage.# It is suggested that cellular damage following increased lipid accumulation, depletion of hepatic glutathione, or changes in biliary flow may be associated with the increased GGT activity.

So the answer to this question is D


Instruction:
Treatment in days for meningitis for strept pneumonia in children ?
A. 5 days
B. 7 days
C. 10 days
D. 21 days

Response:
Ans. is 'c' i.e., 10 days Child with bacterial meningitis shows improvement in 10 days and rarely necessary beyond 14 days. Staph meningitis and gram negative infection require treatment for 21-28 days. N. meningitis - Penicillin for 5-7 days. H. Influenze - for 7-10 days

So the answer to this question is C


Instruction:
Most common virus causing tumor in human ?
A. HSV
B. HPV
C. EBV
D. HTLV

Response:
Ans. is 'b' i.e., HPV Was are the most common tumor caused by viruses.HPV is the cause of was.

So the answer to this question is B


Instruction:
A 1-year-old child presented with involuntary movements which were choreoathetoid in nature, spasticity, dystonias and intellectual disability. The speech of the child was dysahric and mother also gave history of compulsive biting. Some inherited disorder was suspected. The child was normal at bih. Lab findings revealed increased uric acid levels. The enzyme deficient in the above condition catalyses which of the following reactions.
A. Guanine to GMP
B. GMP to guanine
C. Adenine to AMP
D. AMP to adenine

Response:
This is a case of Lesch-nyhan syndrome due to the deficiency of enzyme HGPase.

So the answer to this question is A


Instruction:
Which among the following is essential for wound healing:
A. Vitamin A
B. Vitamin D
C. Vitamin C
D. Carbohydrate

Response:
Deficiency of vitamin C causes reduced cross-linking of tropocollagen to collagen.

So the answer to this question is C


Instruction:
A 28 -year-old woman, G4P3L2A1 at 35 weeks of gestation with monochornionic monomniotic twin pregnancy was admitted for safe confinement. 3 days following admission, the NST showed the following finding: What is the finding shown in the NST?
A. Reactive NST
B. Variable deceleration
C. Early deceleration
D. Sinusoidal pattern.

Response:
The deceleration first shows a rapid rise and rapid fall. Secondly it is unrelated to the peak of uterine contraction. In early and late deceleration, there would be a slow fall and slow rise. Early would show an onset before or at peak of uterine contraction and the FHR would return to normal after the end of uterine contraction. VARIABLE DECELRATION Inconsistent time of onset when compared to uterine contraction The onset of deceleration commonly varies with successive contractions. The duration is less than 2 minutes. Represent fetal hea rate reflexes that reflect either blood pressure changes due to interruption of umbilical flow or changes in oxygenation. Significant variable decelerations are those decreasing to less than 70 beats/min and lasting more than 60 seconds. Causes: Umbilical cord entanglement like due to: - 1. - Umbilical around body or neck 2. - True knot in the umbilical cord 3. - Prolapsed umbilical cord

So the answer to this question is B


Instruction:
A 40-year-old male presented to surgery OPD with complaints of right loin pain which was also referred to right iliac fossa. Surgeon examined the patient & asked to have an USG abdomen, given below. Right kidney left kidney Then NCCT KUB was done and diagnosis of renal stone of 8mm was made. What is the most probable location of stone?
A. Renal pelvis
B. Upper ureter
C. Mid ureter
D. Lower ureter

Response:
USG shows normal kidneys. NCCT KUB showed a stone in the ureter. Pain of renal stone in renal pelvis refers to groin Upper ureter stone pain refers to medial aspect of thigh along with obturator nerve Mid ureter stone pains refer to iliac fossa along with iliohypogastric nerve Lower ureter stone pain refers to testicles along with ilioinguinal nerve

So the answer to this question is C


Instruction:
Non-parenteral hepatitis is :
A. Hepatitis E
B. Hep B
C. Hep C
D. Hep D

Response:
Answer is A (Hepatitis E) Hepatitis B, C and D are essentially spread by parenteral routes. Hepatitis A & E are non parenteral hepatitis.

So the answer to this question is A


Instruction:
Which of the following is not included in carcinoma in-situ category ?
A. DCIS
B. Paget's disease of nipple
C. LCIS
D. None of the above .

Response:
8thAJCC (Tis - in situ) It includes DCIS and Paget's disease of nipple . LCIS is removed from Tis . It is now considered as benign disease .

So the answer to this question is C


Instruction:
Ibuprofen acts by inhibiting:(1994)
A. Lipo oxygenase
B. Cyclo oxygenase
C. Resetting the hypothalamic thermostat
D. Increases the pain threshold

Response:
bRef: KDT, 5th ed, p. 176, 158 & 4th ed, p. 459, 460

So the answer to this question is B


Instruction:
In hirschsprung disease aganglionic segment is?
A. Normal or dilated
B. Normal or contracted
C. Dilated or contracted
D. Always dilated

Response:
ANSWER: (B) Normal or contractedREF: Sabiston Textbook of Surgery, 18th ed chapter 71Hirschsprung's disease occurs in 1 out of every 5000 live births and is characterized pathologically by absent ganglion cells in the myenteric (Auerbach's) and submucosal (Meissners) plexus. This neurogenic abnormality is associated with muscular spasm of the distal colon and internal anal sphincter resulting in a functional obstruction. Hence, the abnormal bowel is the contracted, distal segment, whereas the normal bowel is the proximal, dilated portion. The area between the dilated and contracted segments is referred to as the transition zone.

So the answer to this question is B


Instruction:
To increase resistance form of an excessively tapered preparation:
A. Reduce height of preparation to shorten arc of rotation
B. Increase cervical reduction to taper
C. Add groove
D. Use adhesive cement

Response:
None

So the answer to this question is C


Instruction:
A 6-month-old child is suffering from patent ductus arteriosus (PDA) with congestive cardiac failure. Ligation of ductus arteriosus was decided for surgical management. The most appropriate inhalational anesthetic agent of choice with minimal hemodynamic alteration fro induction of anesthesia is -
A. Halothane
B. Sevoflurane
C. Isoflurane
D. Enflurane

Response:
Ans. is 'b' i.e., Sevoflurane Sevoflurane is the agent of choice for inhalational induction of anesthesia in pediatric procedures.It is an excellent choice for smooth and rapid inhalational induction in pediatric procedures becauseIt has a sweet odor so induction is smoothThe rapid increase in alveolar anesthetic concentration (therefore rapid onset of action)It is low blood solubility's results in rapid fall in alveolar anesthetic concentration upon discontinuation and results in quicker emergence when compared to other inhalational agents.Cardiovascular effects of sevoflurane * Sevoflurane has minimal effect on cardiovascular system, it causes minimal hemodynamic alterations, therefore, it can be easily used as an induction agent in patients with PDA.The cardiovascular effects areMinimal cardiac depressionThe slight decrease in systemic vascular resistanceMinimal decrease in cardiac outputHalothane and isoflurane are usually avoided in children because they have a pungent odor and so the induction is not smooth.

So the answer to this question is B


Instruction:
Which of the following is primary glaucoma:
A. Juvenile glaucoma
B. Steriod induced glaucoma
C. Pigmentary glaucoma
D. All

Response:
Ans. Juvenile glaucoma

So the answer to this question is A


Instruction:
Not included in armamentarium of tests for malabsorption syndrome:
A. D - Xylose
B. 14 C triolein breath test
C. 13 C trioctanoin breath test
D. 13 C triclosan breath test

Response:
Test Characterstics D- xylose test Sugar malabsorption and tests jejunal damage or proximal enteropathy 14 C triolein test Fat malabsorption picked up by radiocarbon being tagged to the triglycerides 13 C trioactanoin Fat malabsorption due to pancreatic exocrine insufficiency SeHCAT ( 23-seleno - 25- homo tauro -cholic acid) (selenium homocholic acid taurine) To diagnose bile acid malabsorption Hydrogen breath test For sugar malabsorption as unabsorbed sugar is degraded by bacteria. 13 C acetate breath tests For stomach emptying

So the answer to this question is D


Instruction:
All of the following are tests to determine the stoppage circulation except –
A. Mirror held in front of a nostril
B. Diaphanous test
C. Icard’s test
D. Magnus’s test

Response:
Magnus test: Consists of tying a ligature tightly round the base of a finger, sufficient to cut off the venous channels without occluding the arteries. The finger remains white, if circulation has entirely ceased, otherwise the seat of the ligature is marked by a bloodless zone, and the portion beyond it becomes gradually blue and swollen. (b) Diaphanous Test: During life the webs of the fingers appear scarlet or very red and translucent, if the hand with the fingers abducted is held against a strong light, artificial or natural, while they appear yellow and opaque after death. (c) Icard's Test: The hypodermic injection of a solution of fiuorescin does not produce any discoloration of the skin, if circulation has stopped ; but it renders the neighbouring skin yellowish-green, if circulation is still going on.

So the answer to this question is A


Instruction:
Which of the following structure forms the medial border of Hesselbach's triangle?
A. Linea alba
B. Linea semilunaris
C. Inferior epigastric aery
D. Conjoint tendon

Response:
Boundaries of Hasselbach's triangle:Medial border: Lateral margin the rectus sheath, also called linea semilunaris.Superolateral border: Inferior epigastric aery.Inferior border: Inguinal ligament, sometimes Referred to as Poupa's ligament.

So the answer to this question is B


Instruction:
Standard error of mean is called as -
A. Standard detion
B. Mode
C. Median
D. Variable

Response:
.

So the answer to this question is A


Instruction:
All are used for the treatment of pulmonary hypeension EXCEPT:
A. Endothelin receptor antagonists
B. Phosphodiesterase inhibitors
C. Calcium channel blockers
D. Beta blockers

Response:
CCBs, ET antagonists are used in Pul.HTN apa from PGI2 analogues and PDE5 inhibitors No- nitric oxide - only therapeutic use is Pul. HTN in newborn betablockers- no role Ref: KD tripathi 8th ed.

So the answer to this question is D


Instruction:
Most common infection caused by streptococcus pneumonia ?
A. Otits media
B. Sore throat
C. Meningitis
D. Pneumonia

Response:
Ans. is 'a' i.e., Otitis media Impoant infections caused by streptococcus pneumoniae The source of human infection is the respiratory tract of carriers and less often, of patients. Pneumococci occur in the throat of approximately half of the population sampled at any time. Str. pneumoniae is the most frequent cause of pneumonia. The commonest pneumococcal infections are otitis media and sinusitis. Meningitis is the most serious of pneumococcal infections. Empyema is the most common complication of pneumococcal pneumonia.

So the answer to this question is A


Instruction:
Visual cut off for referral to nearest PHC?
A. <6/9 in either eye
B. <6/12 in either eye
C. <6/9 in both eye
D. none of the above

Response:
Visual cut off for referral to nearest PHC: <6/9 in either eye. Screening is done by school teachers. Female teachers are preferred. Focus on middle school(5-8th) covering 10-14 years age. 1,50,000 children to be screened per block One trained teacher to handle 150 students 1- day training for the teacher at nearest PHC Teacher Kit: Vision screening cards, referral cards, tape/rope to measure 20 feet

So the answer to this question is A


Instruction:
Daily energy requirement for reference female, who is sedentary (in Kcal) -
A. 1900
B. 2230
C. 2500
D. 2850

Response:
A women who is sedentary worker of body weight 55 kg require 1900Kcal per day. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 585,TABLE - 24)

So the answer to this question is A


Instruction:
which of the following is not a side effect of tri cyclic antidepressent
A. weight loss
B. weight gain
C. giddiness
D. sedation

Response:
TCA * MECHANISM This is an antidepressant with three rings. It acts by blocking the transpoers of neurotransmitters resulting in increased neurotransmitters in synapse DRUGS AMITRYPTILLINE IMIPRAMINE CLOMIPRAMINE DESIPRAMINE NORIPTILLINE DOXEPINE * USE AMITRYPTILLINE========PAIN WITH DEPRESSION IMIPRAMINE==========CHILDHOOD ENEURESIS CLOMIPRAMINE========OCD * SIDE EFFECTS ANTI HISTAMINERGIC==== sedation, weight gain ANTI MUSCURANIC=======dryness of mouth ANTI ADRENERGIC========hypotension, giddiness SWITCH TO MANIA when used in BIPOLAR DEPRESSION Ref. kaplon and sadock, synopsis of psychiatry, 11 thediion, 955

So the answer to this question is A


Instruction:
In carcinoma of lower lip secondaries are seen in -
A. Upper cervical LN
B. Supra clavicular LN
C. Axillary LN
D. Mediastinal LN

Response:
Submental and submandibular nodes are involved first in carcinoma of lips.
Submental and submandibular are included in upper cervical LN or level 1 lymph nodes.

So the answer to this question is A


Instruction:
All are manifestations of Kawasaki disease, Except-
A. Conjunctival congestion
B. Thrombocytopenia
C. Aneurysm of coronary aery
D. Pericarditis

Response:
Kawasaki disease is a vasculitis that mostly involves the coronary vessels. It presents as an acute systemic disorder, usually affecting children under 5 years. It occurs mainly in Japan and other Asian countries, such as China and Korea, but other ethnic groups may also be affected. Presentation is with fever, generalised rash, including palms and soles, inflamed oral mucosa and conjunctival congestion resembling a viral exanthema. The cause is unknown but it is thought to be an abnormal immune response to an infectious trigger. Cardiovascular complications include coronary aeritis, leading to myocardial infarction, transient coronary dilatation, myocarditis, pericarditis, peripheral vascular insufficiency and gangrene. Treatment is with aspirin (5 mg/kg daily for 14 days) and IV Ig (400 mg/kg daily for 4 days) . Ref Davidsons 23e p1041

So the answer to this question is B


Instruction:
Enzyme responsible for complete oxidation of glucose to C02 to water is present in which of the following structure?
A. Cytosol
B. Mitochondria
C. Lysosomes
D. Endoplasmic reticulum

Response:
Glycolysis, the major pathway for glucose metabolism, occurs in the cytosol of all cells. However, oxidization of glucose beyond pyruvate (the end product of glycolysis) requires both oxygen and mitochondrial enzyme systems: the pyruvate dehydrogenase complex, the citric acid cycle, and the respiratory chain. Ref: Bender D.A., Mayes P.A. (2011). Chapter 18. Glycolysis & the Oxidation of Pyruvate. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.

So the answer to this question is B


Instruction:
Prothrombin time (PT) of a patient is 26, control PT is 13 seconds and sensitivity index is 1.41. What will be the INR of this patient -
A. 26/13
B. (26/13) x 1.41
C. Both
D. None

Response:
Ans. is d None o A standardized system called the International Normalized Ratio (INR), which is the ratio of prothrombin time in patient to that in normal non-anticoagulated person, has been developed by WHO and it is based on the use of human brain thromboplastin.

So the answer to this question is D


Instruction:
Minor duodenal papilla is opening of
A. Hepatic duct
B. Hepatopancreatic duct
C. Accessory pancreatic ampulla
D. Bile duct

Response:
Minor duodenal papilla is the opening of the accessory pancreatic duct into the decending second section of the duodenum.It is situated 2cm proximal to the major duodenal papilla.and thus 5-8cm from the opening of pylorus. ref - BDC 6e vol2 pancreas imageref- netter atlas

So the answer to this question is C


Instruction:
Babesiosis is most commonly transmitted by:
A. Pigs
B. Rats
C. Sand fly
D. Ticks

Response:
o It is transmitted by ticks. o Babesiosis is caused by Babesia microti o It is an intraerythrocytic protozoa. o Half of all children and a quaer of previously healthy adults are asymptomatic with babesia infection. o M/C symptoms are fever, hemolytic anemia o A person infected with babesiosis gradually develops malaise, fatigue and fever. o Babesia maltese cross resembles plasmodium falciparum gametocyte arrangement. pig is intermediate host for tenia solium rats are the reservoir for rickettsia. Sand fly cause leshmaniasis (intermediate host)

So the answer to this question is D


Instruction:
Thymoma is associated with all EXCEPT:
A. Myasthenia gravis
B. Hyper /3-gamma globulinemia
C. Panhypopituitarism
D. Ulcerative colitis

Response:
Hyper fi-gamma globulinemia REF: Harrison's Principles of Internal Medicine 17th ed chapter-e12 "40% of patients with Thymoma have another systemic autoimmune illness related to the Thymoma" "About 30% of patients with Thymoma have myasthenia gravis (most common), 5-8% has pure red cell aplasia, and 5% have hypogammaglobulinemia" "Among patients with myasthenia gravis 10-15% has Thymoma. Thymoma more rarely may be associated with polymyositis, systemic lupus erythematosus, thyroiditis, Sjogren's syndrome, ulcerative colitis, pernicious anemia, Addison's disease, scleroderma, and panhypopituitarism. In one series, 70% of patients with Thymoma were found to have another systemic illness"

So the answer to this question is B


Instruction:
Pulmonary hypertension is caused by-a) Interstitial lung diseaseb) Myocardial infarctionc) Systemic hypertensiond) Thromboembolism
A. acd
B. bcd
C. abc
D. abd

Response:
None

So the answer to this question is D


Instruction:
Layers which are penetrated with trochar & cannula in production of pneumoperitoneum are
A. Skin & superficial fascia
B. Deep fascia
C. Rectus abdominis
D. Transversus abdominis

Response:
.CO2 is commonly used to create pneumoperitoneum as-* It is readily available * It is cheaper * It suppresses the combustion * It is easily absorbed by tissues * It has a high diffusion coefficient * It is quickly released respiration Other gases used are: Air, nitrous oxide, helium, argon.Pneumoperitoneum is created up to a pressure of 15 mmHg which distends the abdominal cavity adequately to have proper visualisation of the abdominal contents. Laparoscope is inseed through the umbilical po (10 mm). Abdomen is evaluated for any pathology. Liver, gallbladder, pelvic organs are visualised. Additional pos (3-4) through trocars are placed depending on the procedure to be done. It may be eitherm5 mm po or 10 mm po. These pos are placed in such a way to have a proper triangulation of instruments for dissection.To use clip applicator 10 mm po is required.Pneumoperitoneum is created using veress needle through umbilical incision. Access can be achieved by open method through an umbilical incision. ref:SRB&;S manual of surgery,ed 3,pg no 1140

So the answer to this question is A


Instruction:
All of the following statements regarding disposal of biomedical waste are true, EXCEPT:
A. Human Anatomical Waste is disposed in a Yellow bag
B. Contents from a Red bag may be a source of contamination
C. Block bags are used for disposal of ash from incineration
D. Blue bags contents are disposed in secured landfill

Response:
The blue or white translucent plastic bag is used for sharps (needles, syringes, scalpels, blades, glass etc. that may cause puncture or cuts) and solid wastes such as waste generated from disposable items like tubings, catheters, intravenous sets etc. These wastes are treated by autoclaving/microwaving/chemical treatment and destruction/shredding. The wastes in the black bags are treated by disposal in a secured landfill. Ref: Preventive and Social Medicine, By K.Park, 19th edition, Page 648, 649

So the answer to this question is D


Instruction:
Net Filtration pressure of glomerulus increases by
A. Increase in Hydrostatic pressure of glomerullar capillary
B. Increase in Oncotic pressure of glomerullar capillary
C. Increase in Hydrostatic pressure of  Bowman's space
D. All of the above

Response:
GC - Glomerular capillary
BS - Bowman's space
P - Hydrostatic Pressure
π - Oncotic pressure
Net Filtration Pressure = (P GC - P BS ) + ( π  BS +  π GC )

So the answer to this question is A


Instruction:
Endogenous triglycerides in plasma aremaximally carried in -
A. VLDL
B. Chylomicrons
C. LDL
D. HDL

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

So the answer to this question is A


Instruction:
. True about polio is all except:
A. Sabin vaccine is attenuated, oral vaccine
B. Salk is a killed formalized vaccine used
C. Vaccine induced polio is usually due to Type 2 virus
D. Most common type of virus in epidemics is Type 1

Response:
Vaccine induced polio" is usually due to Type 2 virus

So the answer to this question is C


Instruction:
All ofthe following are associated with normal pressure spontaneous CSF leaks, Except -
A. Pseudo tumor Cerebri
B. Empty Sella Syndrome
C. Encephalocele
D. Meningiocele

Response:
None

So the answer to this question is A


Instruction:
Features of restrictive lung disease is-
A. FEV1/FVC decreases and compliance decreases
B. FEV1/FVC increases and compliance increases
C. FEV1/FVC decreases and compliance increases
D. FEV1/FVC increases and compliance decreases

Response:
None

So the answer to this question is D


Instruction:
Which one of the following is not a type of virginal hymen
A. Cruciate
B. Imperforate
C. Cribriform
D. Septate

Response:
Ans. is 'a' i.e., Cruciate * The different types of hymen are1) Semilunar or crescentic (commonest type) the opening is placed anteriorly. Notches or clefts are seen at 10 and 11 clock position, which may be equal in size or more prominent on one side.2) Annular : opening is oval and situated near the centre of the membrane.3) Infantile : a small linear opening in the middle.4) Cribriform : several openings.5) Vertical the opening is vertical.6) Septate: two lateral openings occur side by side, separated partially or completely by thin strip of tissue.7) Imperforate: no opening.

So the answer to this question is A


Instruction:
HIFU stands for
A. High Intensity Fluoroscopic Ultrasound
B. High Intensity Focused Ultrasound
C. High Interval Fractionated Ultrasound
D. High Interference Fragmented Ultrasound

Response:
HIFU stands for High-Intensity Focused Ultrasound. HIFU uses High Intensity Focused Ultrasound beam in the treatment of uterine fibroids and other lesions. it acts due to the thermal, mechanical and cavitational effects of the high-intensity Ultrasound beam in tissues.

So the answer to this question is B


Instruction:
Which muscle is inseed into the floor of the inteubercular sulcus ?
A. Lattissimus dorsi
B. Teres major
C. Long head of biceps
D. Deltoid

Response:
Lattissimus dorsi is inseed into the floor of the inteubercular sulcus Inteubercular sulcus lies between the greater and lesser tubercles. Ref: Gray's Anatomy The Anatomical Basics of Clinical Practice 41 e pg 806.

So the answer to this question is A


Instruction:
Perioral pallor and dennie's lines are seen in
A. Atopic dermatitis
B. Chronic actinic dermatitis
C. Blood dyscrasias
D. Perioral contact dermatitis

Response:
Refer robbins 8/e p1187 Atopic dermatitis (eczema) is a condition that makes your skin red and itchy. It's common in children but can occur at any age. Atopic dermatitis is long lasting (chronic) and tends to flare periodically. It may be accompanied by asthma or hay fever. No cure has been found for atopic dermatitis. But treatments and self-care measures can relieve itching and prevent new outbreaks. For example, it helps to avoid harsh soaps, moisturize your skin regularly, and apply medicated creams or ointments.

So the answer to this question is A


Instruction:
Varicocele of pampiniform plexus of veins has all the following characteristics except -
A. Negative transillumination test
B. Reducible
C. Cough impluse is present
D. Frequently on right side

Response:
None

So the answer to this question is D


Instruction:
Pilonidal sinus position for treatment -
A. Jack knife
B. Sim's position
C. Prone
D. Supine

Response:
Ans. is 'a' i.e., Jack knife Jack knife positiono An anatomical position in which the patient is placed on the stomach with the hips flexed and the knees bent at a 90deg angle and the arm outstretached in front of the patient.Pilonidal diseaseo Pilonidal disease consists of a hair-containing abscess or chronic sinus, occurring in the intergluteal cleft.o It is an acquired disease,o More common in maleso Treatment of choice is surgeryy Pilonidal sinus should be excised along with the secondary openings. (But only after controlling acute infection). Acute pilonidal abscesses and sinus ds can be managed by simple incision and drainage (under local anaesthesia).

So the answer to this question is A


Instruction:
All of the following are true about MOA of anti hypertensive drugs EXCEPT:
A. Act by Na+ K+ ATPase inhibition
B. Thiazide Diuretics
C. Alpha adrenergic blockade
D. Beta adrenergic blockade

Response:
Ans. (a) Act by Na+ K+ ATPase inhibitionRef. KDT 6th ed. / 540* Thiazide and related drugs (chlorthalidone) are the diuretic of choice in uncomplicated hypertension. It acts by reducing plasma volume and by decreasing total peripheral resistance.* Alpha receptors are present on vessel wall, which upon stimulation constricts vessel wall and increase t.p.r. Alpha adrenergic blocking agents like Prazosin, terazosin, doxazosin and phentolamine inhibit the alpha receptor and decrease t.p.r.* b1 receptors are present on heart, which upon stimulation increase the heart rate. Beta adrenergic blockers like nebivolol, metoprolol, atenolol etc are some of the beta blockers which depresses myocardial contractility, and decreases the stroke volume.* Na+ K+ ATPase inhibition is done by Digitalis. Digitalis however has no role in control of hypertension. It is used in congestive heart failure and atrial fibrillation.Also Know* DIgitalis MOA in atrial fibrillation: decreases conduction.* M/c side effect of digitalis: nausea/vomiting.* MC cardiac side effect (arrhythmia) caused by digitalis: Ventricular Bigeminy.* DOC for digitalis induced arrhythmia: LIGNOCAINE

So the answer to this question is A


Instruction:
The lesions associated with recurrent dislocation of shoulder include all except:
A. Hill sach's lesion
B. Banka's lesion
C. Capsular laxity
D. Supraspinatus tear

Response:
Bony Banka lesion is a fracture of the anterior inferior glenoid Hill Sachs defect Is a chondral impaction injury in the posterosuperior humeral head secondary to contact with the glenoid rim * Capsular laxity as well leads to recurrent dislocation of shoulder.

So the answer to this question is D


Instruction:
Best investigation to diagnose H-type tracheoesophageal fistuala is:
A. X-ray
B. Esophagoscopy
C. Tracheobronchoscopy
D. CT scan

Response:
(Refer: OP Ghai’s Essentials of Pediatrics, 8th edition, pg no: 176)

The most reliable method of establishing the diagnosis of H type fistula is by a prone tube video esophagogram. Bronchoscopy with esophagoscopy will confirm the presence of a fistula
Esophagography and/or cine esophagography, or bronchoscopy and simultaneous methylene blue administration confirmed the diagnosis of H-type TEF.
Although cine esophagography is highly effective in demonstrating H-type TEF today, bronchoscopy must be used in every patient suspected of having fistula, especially when the radiological methods fail.

So the answer to this question is B


Instruction:
Which of the following helps in differentiation of follicular carcinoma from follicular adenoma of thyroid
A. Huhle cell
B. Lining of tall columnar and cuboidal cell
C. Vascular invasion
D. Increased mitoses

Response:
Ref Robbins 9/e p1094 Microscopically most follicular carcinomas are composed of uniform cells forming small follicles.follicular carcinomas may be grossly infiltrative or minimally invasive. The latter are sharply demarcated lesions on gross examination . This distinction requires extensive histologic sampling to exclude capsular or vascular invasion

So the answer to this question is C


Instruction:
Following are true about thyroglossal cyst EXCEPT
A. Often occur in children; they may also present in adults
B. Rarely may contain only functioning thyroid tissue
C. Treated surgically by Sistrunks operation
D. Moves downwards on tongue protrusion

Response:
None

So the answer to this question is D


Instruction:
Saturday night palsy is which type of nerve injury?
A. Neuropraxia
B. Axonotemesis
C. Neurotemesis
D. Complete section

Response:
Ans. is 'a' i.e., Neuropraxia Seddon's classification of nerve injuries Seddon identified three types of injuries 1. Neuropraxia There is contusion of the peripheral nerve which causes reversible physiological nerve conduction block. The axis cylinder (i.e., axon with its endoneurium) is preserved. Thus, there is physiological conduction block without anatomic disruption. The injury is temporary and recovery is complete. It is seen in crutchpalsy, tourniquet palsy, and saturday night palsy. 2. Axonotemesis There is injury to axon but endoneurium is preserved. Spontaneous recovery is expected in some cases. This is seen in closed fractures and dislocations. 3. Neurotemesis There is complete anatomical section of nerve. No recovery possible. It is seen in open wound.

So the answer to this question is A


Instruction:
Surveillance is:
A. Scrutiny of factors
B. Treatment of contacts
C. Both
D. None of the abov

Response:
Scrutiny of factors

So the answer to this question is A


Instruction:
Diopteric power is related -
A. Directly to square of focal length
B. Inversely to focal length
C. Directly to focal length
D. Inversely to square of focal length

Response:
Ans. is 'b' i.e. Inversely to focal length Optical powero Optical power (also referred to as dioptric power, refractive power, focusing power, or convergence power) is the degree to which a lens, mirror, or other optical system converges or diverges light. It is equal to the reciprocal of the focal length of the device: P = 1/f. High optical power corresponds to short focal length. The SI unit for optical power is the inverse metre (m 1), which is commonly called the dioptreo Converging lenses have positive optical power, while diverging lenses have negative power. When a lens is immersed in a refractive medium, its optical power and focal length change.

So the answer to this question is B


Instruction:
Weight transmission from upper limb to axial skeleton is done by
A. Costoclavicular ligament
B. Coracoacromial ligament
C. Coracoclavicular ligament
D. Interclavicular ligament

Response:
Ligaments involved in weight transmission connect one bone with the next bone, in line of weight transmission. Costoclavicular ligament transfers the weight of upper limb to axial skeleton.Coracoclavicular ligament transfer the weight of upper limb to clavicle bone.Note: Coracoacromial ligaments attach to bone scapula at different points and is not attached to the previous or next bone in line of weight transmission. They do not help in weight transmission.

So the answer to this question is A


Instruction:
A 35-yr old woman presents with primary infeility & palpable pelvic mass. Her Ca-125 level is 90 U/ml. diagnosis is aEUR'
A. Ovarian Ca
B. Endometrioma
C. Tuberculosis
D. Borderline ovarian tumor

Response:
Endometrioma Another clinical based question with insufficient information to make any confirm diagnosis. At the best we can try to make the most probable diagnosis. Let's first see CA-125. CA-125 This is a non-specific tumor marker. Cut off level of CA-125 is < 35 U/ml. Ca 125 levels, as described above, can be raised in all the four options, so not very helpful in reaching a diagnosis. But if we weigh CA-125 level in terms of significance then it is least significant in tuberculosis as it is neither used for diagnosis nor for follow-up in tuberculosis. Palpable mass may be present in all the four conditions. Infeility is a feature of both endometriosis and tuberculosis. But for ovarian cancers infeility is a risk factor, not a feature or presenting symptom. Coming to Age: Patient is 35 yrs old. Age of 35 yrs ours endometrioma most. Peak incidence of invasive epithelial ovarian cancer (most common ovarian cancer) is at 56-60 yrs of age and for border line tumor average age is 46 yrs approximately (Novak). Patients with tuberculosis are in their twenties commonly, the maximum age incidence at diagnosis being 28 yrs. So on the basis of age and infeility, the most probable diagnosis would be endometrioma

So the answer to this question is B


Instruction:
Which of the following represents the site of lesion in Motor Neuron disease?
A. Anterior Horn cells
B. Peripheral Nerve
C. Spinothalamic Tract
D. Spinocerebellar tract

Response:
Amyotrolic lateral sclerosisis the most common type of motor neuron disease. Pathologic hallmark of this disease is the death of lower motor neurons (which consist of anterior horn cells in spinal cord and their brainstem homologues innervating bulbar muscles ) and upper motor neurons (which originate in the motor coex and descend pyramidal tract to synapse with lower motor neurons). Ref: Harrisons Principles of Internal Medicine 18th Edition/Chapter 374; Molecular Neurology By Stephen G. Waxman, Page 308

So the answer to this question is A


Instruction:
An appropriate single antibiotic for the empiric treatment of presumed bacterial meningitis in a six month old child would be:
A. Ampicillin
B. Cefadroxil
C. Cefotaxime
D. Cefuroxime

Response:
Both cefotaxime and ceftriaxone are effective single agents for the empiric treatment of bacterial meningitis beyond two or three months of life, when Listeria monocytogenes and gram-negative enteric organisms are no longer a concern. Although cefuroxime does enter the CSF and was once thought to be acceptable treatment for bacterial meningitis, subsequent studies showed consistently poorer results than with other regimens. Ref: Roos K.L., Tyler K.L. (2012). Chapter 381. Meningitis, Encephalitis, Brain Abscess, and Empyema. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e

So the answer to this question is C


Instruction:
Number of (+) for tubercle bacilli if count in AFB sample is > 10 per oil immersion fields ?
A. +
B. ++
C. +++
D. Scanty

Response:
Ans. is 'c' i.e., +++ o The number of bacilli seen in a smear reflects disease severity and patient infectivity. o Therefore, it is impoant to record the number of bacilli seen in each smear.

So the answer to this question is C


Instruction:
Cystic medial necrosis responsible for aoic dilatation and rupture is seen in
A. Syphilitic aneurysm
B. Takayasu aeritis
C. Atherosclerosis
D. Marfan syndrome

Response:
In Marfan syndrome, a connective tissue disorder of autosomal dominant inheritance, the basic biochemical abnormality is a mutation affecting fibrillin. Most serious, however, is the involvement of the cardiovascular system. Fragmentation of the elastic fibers in the tunica media of the aoa predisposes affected patients to aneurysmal dilation and aoic dissection . These changes, called cystic medionecrosis, are not specific for Marfan syndrome. Similar lesions occur in hypeension and with aging. Loss of medial suppo causes dilation of the aoic valve ring, giving rise to aoic incompetence. Robbins Basic pathology,9th edition,pg no.221

So the answer to this question is D


Instruction:
Richest source of Vitamin D -
A. Milk
B. Egg
C. Halibut liver oil
D. Butter

Response:
Halibut liver oil contain 500-10,000 Microban per 100g . egg contain - 1 . 25microgram, Milk 0.1micrigram per 100g.REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 21ST EDITION. PAGE NO - 617

So the answer to this question is C


Instruction:
Hematemesis is not the most common symptom of
A. Esophageal varices
B. Gastric ulcer
C. Carcinoma esophagus
D. Zollinger Ellison syndrome

Response:
Clinical features of Carcinoma esophagus Early stage cancers: Asymptomatic or mimic symptoms of GERD MC symptom : Dysphagia >Weight loss Most patients with esophageal cancer present with dysphagia and weight loss, symptoms that usually indicate advanced disease Choking, coughing and aspiration from a tracheoesophageal fistula (In advanced cases) Hoarseness and vocal cord paralysis from direct invasion into the recurrent laryngeal nerve (In advanced cases) MC site of metastasis : Liver>lung>bone Paraneoplastic manifestation associated with adenocarcinoma : Motor neuropathy Ref: Sabiston 20th edition Pgno : 1038

So the answer to this question is C


Instruction:
Which is the teeth referred to if by haderup classification it is denoted as (- 4) ?
A. Upper canine
B. Lower first premolar
C. Upper second premolar
D. Lower first molar

Response:
Ans. is 'b' i.e., Lower first premolar

So the answer to this question is B


Instruction:
Early dumping is due to
A. Osmotically active substance
B. Hypoglycemia
C. Hyperglycemia
D. Hyperiglyceridemia

Response:
Early Dumping It occurs immediately after meals (after 15-30 minutes) Dumping of hyperosmolar contents into the small bowel results in rapid influx from the circulation into the gastrointestinal tract. This leads to acute intestinal distention and peripheral and splanchnic vasodilation This gives rise to vasomotor and abdominal symptoms : Epigastric fullness, sweating, light headed, tachycardia, diarrhoea Symptoms can be ameliorated by lying down and saline infusion Ref: Sabiston 20th edition Pgno : 1212

So the answer to this question is A


Instruction:
Vaccines that can be safely given during pregnancy are the following except -
A. Tetanus
B. Influenza
C. Rubella
D. Pneumococcus

Response:
None

So the answer to this question is C


Instruction:
In the treatment of undiagnosed megaloblastic anemia, vitamin B12 and folic acid should be given together because:
A. Vitamin B12 acts as a cofactor for dihydrofolate reductase
B. Folic acid alone causes improvement of anemic symptoms but neurological dysfunction continues.
C. Vitamin B12 deficiency may result in methylfolate trap
D. Folic acid is required for conversion of methylmalonyl-CoA to succinyl CoA.

Response:
Ans. (B) Folic acid alone causes improvement of anemic symptoms but neurological dysfunction continues(Ref: Katzung 10/e p532; KDT 8/e p656)Vitamin B12 is required for conversion of methionine to homocysteine and for formation of succinyl CoA from methylmalonyl CoA.Deficiency of vitamin B12 results in megaloblastic anemia, GI manifestations and neurological abnormalities (due to demyelination).Folic acid alone will correct the symptoms of megaloblastic anemia but it does not prevent neurological abnormalities, which continue to proceed.Neurological abnormalities manifests initially in the form of loss of posterior column sensations (vibration, proprioception etc.), but later on can result in subacute combined degeneration of spinal cord.

So the answer to this question is B


Instruction:
Following is a clinical feature of cerebellar disease
A. Paralysis
B. Sensory deficit
C. Ataxia
D. Resting tremors

Response:
. *Dysmetria and ataxia are the two impoant symptoms of cerebellar disease. Cerebellar ataxia can occur as a result of many diseases and may present with symptoms of an inability to coordinate balance, gait, extremity and eye movements.Lesions to the cerebellum can cause dyssynergia, dysmetria, dysdiadochokinesia, dysahria and ataxia of stance and gait. Deficits are observed with movements on the same side of the body as the lesion (ipsilateral). Clinicians often use visual observation of people performing motor tasks in order to look for signs of ataxia Ref Harrison20th edition pg 2756

So the answer to this question is C


Instruction:
Which of the following is associated with neutropenia?
A. Doxorubicin
B. Vinblastin
C. Cisplatin
D. Methotrexate

Response:
None

So the answer to this question is D


Instruction:
All of the following are the actions of b-adrenoceptor blockers in CHF except:
A. Decrease in moality associated with CHF
B. Antagonism of vasoconstriction due to sympathetic over activity
C. Prevention of pathological remodelling of ventricular myocardium
D. Prevention of dangerous cardiac arrhythmias

Response:
Beta blockers may actually increase vasoconstriction by antagonizing the vasodilator action of b2 receptors. Decreases moality by reversing LVH. Prevent dangerous cardiac arrhythmias.

So the answer to this question is B


Instruction:
HTLV-1 is also known as:
A. HIV
B. ATLV
C. RSV
D. ALV

Response:
Ans. b. ATLV

So the answer to this question is B


Instruction:
Most common non protein nitrogenous fraction of
blood:
A. Urea
B. Uric acid
C. Urobilinogen
D. Creatinine

Response:
None

So the answer to this question is C


Instruction:
Asteroid bodies are seen in:
A. Sarcoidosis
B. Syphilis
C. Chromoblastomycosis
D. Sporotrichosis

Response:
Asteroid bodies may be seen in the cytoplasm of epithelioid or giant cells in sarcoidosis as eosinophilic, stellate or spider-like inclusions. The radiating filamentous arms contain complex lipoproteins, calcium, phosphorus, silicon, and aluminum.

So the answer to this question is A


Instruction:
Intraoperative Radiotherapy is used in
A. Pancreatic Carcinoma
B. Gastric Carcinoma
C. Colorectal Carcinoma
D. All the above

Response:
Intra-op radiotherapy

Pancreatic, gastric, Colorectal carcinoma.
Head and neck cancers, Genitourinary cancers.
Retroperitoneal sarcomas.

So the answer to this question is D


Instruction:
All are true about thiopentone except
A. Na2CO3 is a preservative
B. contraindicated in porphyria
C. Agent of choice in shock
D. Has cerebroprotective action

Response:
In situations where the baroreceptor response will be blunted or absent (eg, hypovolemia, congestive hea failure, b-adrenergic blockade), cardiac output and aerial blood pressure may fall dramatically due to uncompensated peripheral pooling of blood and direct myocardial depression. So, sodium thiopental is contraindicated in shock. Ref: Morgan & Mikhail's clinical anesthesiology 6e

So the answer to this question is C


Instruction:
In surgical patient malnutrition is best assessed by
A. Serum albumin
B. Hb level
C. Mid arm circumference
D. Tricpes skin fold thickness

Response:
.* Weight loss more than 10% of individual's weight in 6 months is called as significant weight loss. * Body Mass Index (BMI) is body weight in kilograms divided by height in meters squared. BMI less than 18.5 signifies nutritional impairment and below 15 signifies severe malnutrition.in surgical patients malnutrition is best assessed by mid arm circumference. ref:SRB&;s manual of surgery,ed 3,pg no 86

So the answer to this question is C


Instruction:
Ipsilateral VI & VII nerve palsy with contralateral hemiplegia is known as
A. Weber's syndrome
B. Millard Gubbler syndrome
C. Lateral medullary syndrome
D. Benedict's syndrome

Response:
Site of disease: PonsAery involved is AICAStructure involved are: 6th and 7th cranial nerve and coicospinal tract, so patient presents with ipsilateral 6 & 7 cranial nerve palsy and contralateral hemiparesis.

So the answer to this question is B


Instruction:
Which of the following is the best medium to grow anaerobic bacteria exclusively?
A. Blood agar
B. Robeson's cooked meat medium
C. Thioglycollate medium
D. Sabouraud dextrose medium

Response:
Robeson's cooked meat medium is the most widely used fluid medium for the culture of anaerobes. It consists of fat-free minced cooked meat in broth. It permits the growth of even strict anaerobes and indicates their saccharolytic or proteolytic activities, by the meat being turned red or black, respectively. Ref: Textbook of Microbiology By Ananthanarayan, 6th edition, Page 41.

So the answer to this question is B


Instruction:
Which structure passes through foramen of langer?
A. Spermatic cord
B. 5th cranial nerve
C. 4th cranial nerve
D. Tail of Spence

Response:
Ans. D. Tail of SpenceThe tail of Spence is an extension of the tissue of the breast that extends into the axilla. It is actually an extension of the upper lateral quadrant of the breast. It passes into the axilla through an opening in the deep fascia called foramen of Langer.

So the answer to this question is D


Instruction:
Filgrastim is a :
A. T–cell stimulating factor
B. GnRH analogue
C. G–CSF
D. GM–CSF

Response:
None

So the answer to this question is C


Instruction:
Severity in acute hepatitis is best estimated by:
A. Serum bilirubin
B. Prothrombin time
C. a-glutaryl transferase
D. Alkaline phosphatase

Response:
Laboratory findings in Acute Hepatitis WBC count normal to low (pre icteric phase) Large atypical lymphocytes Mild proteinuria Bilirubinuria AST, ALT strikingly elevated Elevated Bilirubin and alkaline phosphatase Marked prolongation of prothrombin time.

So the answer to this question is B


Instruction:
Acquired intrinsic defect in Hymolytic anemia is seen in -
A. Sicicle cell anemia
B. Hereditary spherocytosis
C. Thalasemmia
D. Paroxysmal nocturnal hemoglobinuria

Response:
None

So the answer to this question is D


Instruction:
The average leeway space available in each half of mandible is
A. 3.8 mm
B. 1.7 mm
C. 2.4 mm
D. 0.9 mm

Response:
None

So the answer to this question is B


Instruction:
Mitral valve vegetations do not usually embolise to :
A. Lung
B. Liver
C. Spleen
D. Brain

Response:
Answer is A (Lung) Mitral valve vegetation would obviously not go to the lung, as that would involve a 'backward flow'.

So the answer to this question is A


Instruction:
Naturally occurring LA –
A. Cocaine
B. Lidocaine
C. Bupivacaine
D. Tetracaine

Response:
Cocaine is the only naturally occuring local anaesthetic, obtained from leaves of Erythroxylon coca.

So the answer to this question is A


Instruction:
Most specific test for organophosphorous poisoning is:
A. RBC cholinesterase level
B. Plasma cholinestrase level
C. RBC uroporphyrin level
D. Measurment of serum level of organophosphorous

Response:
B i.e. Plasma cholinesterase level

So the answer to this question is B


Instruction:
Phantom limb is based upon?
A. Law of projection
B. Weber s law
C. Munro kellie doctrine
D. Renshaw cell inhibition

Response:
ANSWER: (A) Law of projectionREF: Ganong's 22nd ed p. 125A phantom limb is the sensation that an amputated or missing limb (even an organ, like the appendix) is still attached to the body and is moving appropriately with other body part it is based upon law of projection:It states that no matter where a sensory pathway is stimulated along its course, the sensation produced is referred back to site of receptor.

So the answer to this question is A


Instruction:
Eagle effect is seen in
A. Staphylococcus aureus
B. Enterococcus faecalis
C. Pseudomonas aeruginosa
D. Streptococcus pyogenes

Response:
Some microbes demonstrate a curious response to b-lactam antibiotics known as Eagle-effect. Eagle-effect positive enterococci exhibit their greatest bactericidal response to penicillins at a concentration just above the MIC of the antibiotic, as concentration of P is increased above this value,bactericidal effect against enterococci is decreased. It is their unusual resistance to antibiotics - single outstanding characteristics.

So the answer to this question is B


Instruction:
Embryonic period is upto:
A. 8 weeks
B. 10 weeks
C. 12 weeks
D. 6 weeks

Response:
Embryonic Period Day of feilization ( 14th day post-ovulation) to 8 weeks* intrauterine life Fetal period 9 weeks to Bih Perinatal Period 28 weeks to 7 days of postnatal life

So the answer to this question is A


Instruction:
In a patient of unilateral loss of vision, the patient had injury to opposite eye leading to corneal opacification. The patient was operated by corneal grafting, he could see clearly again with one eye. The injury is said to be
A. Simple
B. Grievous
C. Dangerous
D. Hazardous

Response:
Ans. is 'b' i.e., Grievous This patient had permanent vision loss as it was corrected by surgery (corneal transplant). Permanent loss of sight of either eye is grievous hu. Injuries can be classified as 1. A simple injury is one which is neither extensive nor serious, and which would heal rapidly without leaving any permanent deformity or disfiguration. 2. A grievous injury is one (i) Which is extensive or serious (ii) Which does not heal rapidly, and (iii) Which leaves a permanent deformity or disfiguration. Section 320 IPC defines following injuries as grievous. Emasculation (cutting of the penis, castration; or causing loss of power of erection due to spinal injury). Permanent privation of the sight of either eye. Permanent privation of the hearing of either ear. Privation of any member (pa, organ, limb) or joint. Destruction or permanent impairing of powers of any member or joint. Permanent disfiguration of head or face. Fracture or dislocation of a bone or a tooth. Any hu which endangerous life or which causes the sufferer to be, during the space of twenty days in severe bodily pain, or unable to follow his daily routine. Section 319 IPC defines hu as bodily pain, disease, or infirmity, caused to any person. Grievous hu is a cognisable offence for which a police officer can arrest a person without a warrant from magistrate. 3. Dangerous injury is a variety of grievous injury. It is an injury whichposes an immediate danger to life and is fatal in absence of surgical aid, e.g. gun shot wounds, compound skull fracture, trauma to large blood vessel or rupture of internal organ like spleen.

So the answer to this question is A


Instruction:
If on primary dentition there is no pressure of successor teeth then the rate of resorption is:
A. More in primary dentition then secondary.
B. Equal in both the dentitions.
C. More in secondary dentition the primary.
D. None of the above.

Response:
None

So the answer to this question is B


Instruction:
Mallory bodies are composed of
A. Fat droplets
B. Mitochondria
C. Lysosomal enzymes
D. Intermediate filaments

Response:
Refer Robbins page no 843

So the answer to this question is D


Instruction:
Which of the following substance causes retrograde contraction during gut peristalsis?
A. NO
B. Vasoactive Intestinal peptide
C. Substance P
D. None of the above

Response:
Retrograde contraction by
Anterograde relaxation by

Acetycholine
Substance P
Serotonin

NO
Vasoactive Intestinal Peptide

So the answer to this question is C


Instruction:
A 55-year-old woman came to the emergency depament with complaint of severe headache. She also mention that this is the worst headache of her life. What is the most appropriate initial test for diagnosis?
A. Cerebral angiography
B. Computed tomography (CT) of the head with intravenous contrast
C. Computed tomography (CT) of the head without intravenous contrast
D. Lumbar puncture

Response:
By the above clinical history, probable diagnosis is Subarachnoid haemorrhage. Subarachnoid haemorrhage Investigation of choice for initial diagnosis is a computed tomography (CT) of the head without intravenous (IV) contrast( NCCT). On NCCT, blood in the subarachnoid space would appear whiter compared to the surrounding brain tissue. It can also demonstrate significant mass effect and midline shift, factors that increase the severity of the underlying hemorrhage. Other investigations: - Lumbar puncture: Bloody CSF seen in - Trauma - HSV encephalopathy - SAH RBC lysis (inside the CSF) - Bilirubin - give yellowish tinge to CSF (Xanthochromic CSF) Stas as early as 6-12 hours after the bleed and peak: 48 hours - CT angiography/ four vessel conventional X-ray angiography- to identify any other aneurysm - Electrolytes: Hyponatremia due to natriuresis

So the answer to this question is C


Instruction:
Lisch nodule seen in -
A. Sympathetic ophthalmitis
B. Neurofibromatosis
C. Chronic iridocyclitis
D. Trachoma

Response:
Bilateral Lisch nodules are seen in neurofibromatosis type 1. These are hamaomas that develop during second - third decades, seen as tiny nodular pigmented lesions protruding above the iris surface. Other uncommon iris lesions in type 1 NF include congenital ectropion uveae and mammillations. Ref: kanski's 8 th edition , page no. 840

So the answer to this question is B


Instruction:
Which of the following is an automsomal dominant metabolic disorder -
A. Cysticfibrosis
B. Phenylketonuria
C. a-1 antitrypsin deficiency
D. Familial hyperchol estrol emi a

Response:
Ans. is 'd' i.e., Familial hypercholesterolemia Single gene disorders (Mendelian disorders) typically follow one of the three patterns of inharitance ? Autosomal dominance Autosomal recessive C. X-linked Autosomal dominant disorders o Normally a gene pair has two alleles. o When one allele becomes abnormal due to mutation it is called heterozygous state. o When both the alleles become abnormal due to mutation it is called homozygous state. o Autosomal dominant disorders are manifested in heterozygous state, i.e. only if one allel is abnormal the disease will be manifested. Autosomal dominant disorders Nervous o Huntington disease o Neurofibro? matosis o Myotonic dystrohy o Tuberous sclerosis o Retinoblastoma Urinary o Polycystic kidney o Familial polyposis coli o Gardner's syndrome o Turcot's syndrome o Lynch syndrome o Peutz Jagher's syndrome o Juvenile polyposis Hematological Heriditary sph? erocyto s i s Von-Wil librand dis Skeletal Marfan syndrome EDS (some variant) Osteogenesis imperfecta Achondroplasia Metabolic Familial hypercholesterolemia Acute intermittent porphyri a Note - Ehlers - Danlos syndrome (EDS) has all three mendelian pattern of inheritance.

So the answer to this question is D


Instruction:
According to Gutman's classification periapical surgery includes all except:
A. Periapical curettage
B. Root end resection.
C. Root end preparation.
D. Perforation repair.

Response:
GOT MAN’S CLASSIFICATION
1. Fistulative surgery

I & D
Cortical Trephination
Decompression Pracedure

2. ieri Apical Surgery

Periapical curellage
Root end Resection
Root end Preparation
Root end Filling

3. Corrective Surgery

Performation Repairs

Pathological Performance Repair
Iatrogenic Performance Repair

Root Reseation

Radisection/ He

Hemi section – Bicuspidization
Intertional Replaniation.

So the answer to this question is D


Instruction:
In patients of acquired immunodeficiency syndrome, the commonest cause of space occupying lesion in brain is -
A. Non Hodgkin's lymphoma
B. Cytomnegalovirus infection
C. Cryptoccosis
D. Toxoplasmosis

Response:
None

So the answer to this question is D


Instruction:
Example of an immune complex hypersensitivity reaction is:
A. Atopic allergy
B. Serum sickness
C. Transfusion reaction
D. Contact dermatitis

Response:
None

So the answer to this question is B


Instruction:
Large doses of pyridoxine are of value in some cases of –
A. Phenylketonuria
B. Homocystinuria
C. Nonketotic hyperglycemia
D. Ketotic hyperglycemia

Response:
None

So the answer to this question is B


Instruction:
Isotonic urine is formed at the level of
A. PCT
B. DCT
C. Ascending loop of henle
D. Descending loop of henle

Response:
PCT ⇒ Isotonic urine
Decending loop of hanle ⇒ Hypertonic urine
DCT ⇒ Hypotonic urine.

So the answer to this question is B


Instruction:
Coccidioides immitis is identified in tissues on the basis of which of the following
A. Budding yeast cells with pseudohyphae
B. Yeast like forms with very large capsules
C. Chlamydospore
D. Endosporulating spherules

Response:
Laboratory diagnosis of coccidioidomycosis: 1. Demonstration of spherules containing endospores in: (a) sputum or smears from the lesion stained by calcofluor white and (b) in biopsy material stained by hematoxylin and eosin, silver, or PerIodic acid-Schiff stains. H & E staining

So the answer to this question is D


Instruction:
Pseudo resistant hypertension is seen in which situation?
A. Patient at office
B. Patient at home
C. Patient at Hospital
D. None of the above

Response:
Ans. A. Patient at officeResistant Hypertension1. It refers to patients with BP persistently >140/90mmHg despite taking three or more antihypertensive agents, including a diuretic, in reasonable combination and at full doses.2. Resistant hypertension may be related toa. "Pseudo resistance" (high office blood pressures and lower home blood pressures),b. Nonadherence to therapy,c. Identifiable causes of hypertension (including obesity and excessive alcohol intake) and use of any of a number of nonprescription and prescription drugs.d. Rarely, in older patients, pseudo hypertension may be related to the inability to measure blood pressure accurately in severely sclerotic arteries. This condition is suggested if the radial pulse remains palpable despite occlusion of the brachial artery by the cuff (Osier maneuver).3. The actual blood pressure can be determined by direct intraarterial measurement.

So the answer to this question is A


Instruction:
Basic lesion in tobacco amblyopia is:
A. Degeneration of ganglion cells especially of macular region
B. Degeneration of foveal cones
C. Ischaemia of optic nerve fibres
D. All of the above

Response:
Ans. Degeneration of ganglion cells especially of macular region

So the answer to this question is A


Instruction:
Telomerase activity is expressed in
A. Myocytes
B. Keratinocytes
C. Osteocytes
D. Germ cells

Response:
Telomeres are sho repeated sequences of DNA present at the ends of linear chromosomes that are impoant for ensuring the complete replication of chromosome ends and for protecting the ends from fusion and degradation. When somatic cells replicate, a small section of the telomere is not duplicated and telomeres become progressively shoened. As the telomeres become shoer, the ends of chromosomes cannot be protected and areseen as broken DNA, which signals cell cycle arrest. Telomere length is maintained by nucleotide addition mediated by an enzyme called telomerase. Telomerase is a specialized RNA-protein complex that uses its own RNA as a template for adding nucleotides to the ends of chromosomes. Telomerase activity is expressed in germ cells and is present at low levels in stem cells, but it is absent in most somatic tissues.Ref: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 2; Cellular aging; Page no: 67

So the answer to this question is D


Instruction:
Enzyme raised in obstructive jaundice is -
A. ALT
B. AST
C. Alkaline phosphatase
D. LDH

Response:
Features of obstructive jaundice include:high serum alkaline phosphatase Harsh mohan page 599 AST and ALT are raised in case of liver cell injury (Harsh mohan table 21.1)

So the answer to this question is C


Instruction:
After removal of the Parotid gland, patient is having sweating on cheeks while eating. In this complication seen after parotidectomy, the auriculotemporal nerve which contains parasympathetic secretomotor fibres to parotid gland is fused with which nerve?
A. Greater petrosal nerve
B. Facial nerve
C. Great auricular nerve
D. Buccal nerve

Response:
Gustatory sweating (Frey's syndrome or auriculotemporal syndrome) Frey syndrome, also known as auriculotemporal syndrome or gustatory sweating, is characterized by sweating and flushing of the facial skin over the parotid bed and neck during mastication (in the cutaneous distribution of the auriculotemporal nerve.)

It is caused by injury to auriculotemporal nerve, after surgical trauma to the parotid gland.
Frey syndrome is thought to be due to aberrant regeneration of cut parasympathetic fibers between the otic ganglion and salivary tissue, which leads to innervation of sweat glands and subcutaneous vessels. Frey syndrome is reported by approximately 10 percent of patients, although rigorous testing may detect gustatory sweating in as many as 95 percent of patients after parotidectomy.
Frey syndrome may occur from two weeks to two years after surgery due to a latency in the regeneration of parasympathetic nerve fibers; the area of involved skin may increase over time.
The incidence of Frey syndrome is reduced by minimizing the parotid wound bed, placing fascial grafts between the skin and the gland bed, reconstructive techniques such as thick skin flaps, and postoperative RT.
Intracutaneous injection of botulinum toxin A is an effective, well-tolerated, and long-lasting treatment for symptomatic patients; it may be repeated for recurrent symptoms.

So the answer to this question is C


Instruction:
Which of the following is false as physiological change in pregnancy
A. Increase cardiac output
B. Increase GFR
C. Increase total protein
D. Increase residual volume

Response:
Ref:- Williams obstetrics 25th Edition; Pg num:- 22/44

So the answer to this question is D


Instruction:
Calculate the median from the following values 1.9,1.9, 1.9, 2.1, 2.4, 2.5, 2.5, 2.9 -
A. 1.2
B. 1.9
C. 2.25
D. 2.5

Response:
None

So the answer to this question is C


Instruction:
Autosomal dominant Polycystic kidney disease is associated with aneurysm -
A. Fusiform aneurysm of abdominal aoa
B. Ascending aoa
C. Descending aoa
D. Berry aneurysm

Response:
ADPKD- Intracranial aneurysms occur four to five times more frequent than in the general population . About 20-50%of patients may experience warning headaches preceding the index episode of subarachnoid hemorrhage due to ruptured ICA . Other vascular abnormalities in ADPKD patients include diffuse aerial dolichoectasias of the anterior and posterior cerebral circulation which can predispose to aerial dissection and stroke. mitral valve prolapse occurs up to 30% of patients with ADPKD and tricuspid valve prolapse is less common . The prevalence of abdominal wall hernias and colonic diveicula are also increased . Ref:Harrison 20 th edition pg no 2153

So the answer to this question is D


Instruction:
Pathology in motor neuron disease is at?
A. Anterior horn cells
B. Posterior column tracts
C. Spinothalamic tract
D. Peripheral nervous system

Response:
None

So the answer to this question is A


Instruction:
Structures that passes through Foramen Magnum include all, EXCEPT:
A. Ascending cervical aery
B. Accessory nerve
C. Veebral aeries
D. Spinal aeries

Response:
The foramen magnum transmits the spinal accessory nerve, veebral aeries, the anterior and posterior spinal aeries, the membrana tectoria and alar ligaments. The foramen magnum is bounded laterally by the occipital condyles.Also Know:The foramen ovale, which transmits the third branch of the trigeminal nerve, the accessory meningeal aery, and (occasionally) the superficial petrosal nerve. Posterior to the foramen ovale is the foramen spinosum, which transmits the middle meningeal vessels. At the base of the styloid process is the stylomastoid foramen, through which the facial nerve exits. Ref: Waxman S.G. (2010). Chapter 11. Ventricles and Coverings of the Brain. In S.G. Waxman (Ed), Clinical Neuroanatomy, 26e

So the answer to this question is A


Instruction:
A patient undergoes thyroid surgery, following which he develops perioral tingling. Blood calcium is 8.9 meq/L Next step is:
A. Vitamin D orally
B. Oral calcium alone.
C. Intravenous calcium gluconate and serial monitoring
D. Wait for calcium to decrease to <7.0 before talking further action

Response:
Ans. (b) Oral calciumRef: Bailey and Love 26th edition Page 762* A case of Mild Hypocalcemia presents with perioral tingling - Only Oral calcium is enough in this case

So the answer to this question is B


Instruction:
Structure NOT passing through Aortic opening of diaphragm
A. Azygos vein
B. Aorta
C. Thoracic duct
D. Vagus

Response:
(D) VagusVena Cava (8 letters) - Passes through the diaphragm at T8.Oesophagus (10 letters) - Passes through the diaphragm at T10.Aortic Hiatus (12 letters) - Passes through the diaphragm at T12.OPENINGS THROUGH THE DIAPHRAGM & THEIR CONTENTSDescriptionVertebral levelContentsCava! opening lies in central tendon of DiaphragmT8 (to the right side of the median plane)Caval opening passes through the central tendon of the diaphragm. Contains Inferior vena cava, & some branches of the Right Phrenic nerve.Esophageal hiatuslies in Masseter part of diaphragmT10 (to the of the median plane)Esophageal hiatus is situated in the posterior part of the diaphragm, located slightly left of the central tendon through the muscular sling of the right crus of the diaphragm.Oesophagus & anterior & posterior Vagal trunks.Lymphatics from the lower third of the esophagusAortic hiatus OsseoaponeuroticT12 (in the median plane)Aortic hiatus is in the posterior part of the diaphragm, between the left & right crus.Aorta, Azygos vein & Thoracic duct.Two lesser apertures of right crusGreater & Lesser Right splanchnic nervesTwo lesser apertures of left crusGreater & Lesser Left Splanchnic nerves & Hemiazygos veinBehind the diaphragm, under the medial lumbocostal archSympathetic trunkAreolar tissue between the sternal & costal parts (Foramina of Morgagni)Superior epigastric branch of the internal thoracic artery & some lymphatics from the abdominal wall & convex surface of the liverAreolar tissue between the fibers springing from the medial & lateral lumbocostal archesThis interval is less constant; when this interval exists, the upper & back part of the kidney is separated from the pleura by areolar tissue only.OTHER STRUCTURES PASSING THROUGH DIAPHRAGMSplanchnic nerves - which pierce the cruraInferior hemiazygos - Vein which pierce the left crus.Psoas major Muscle.Sympathetic trunk (pass deep to the medial arcuate ligament).Quadratus lumborum.Subcostal Nerve, Vessels (pass deep to the lateral arcuate ligamentClinical Importance:Lumbocostal triangle or Bochdalek's foramen, Diaphragmatic hernia, Diaphragmatic paralysis, Congenital eventration of diaphragm, Hiccup.Aortic opening (Aortic hiatus) is one the three major apertures through the diaphragm & lies at the level of T12.A number of structures pass through the aortic hiatus: aorta, azygos vein, thoracic duct, greater splanchnic nerve.

So the answer to this question is D


Instruction:
A biopsy was performed for a patient with recurrent chalazion involving the upper lid. The most likely diagnosis on histopathology is:
A. Sebaceous cell carcinoma
B. Basal cell carcinoma
C. Squamous cell carcinoma
D. Malignant Melanoma

Response:
Ans. (a) Sebaceous cell carcinomaRef: Kanski 7/e, p. 21, 4Sebaceous Gland Carcinoma* Typically arises from meibomian glands or glands of ZeisQ* Most frequently arises from the upper eyelids[?] where meibomian gland are most frequent (in contrast to basal cell and squamous cell carcinoma)* Highly malignant with mortality of 5-10%* Elderly females are typically affected.* Nodular SGC masquerades a 'chalazion' and hence any patient with recurrent chalazion with an unusual consistency should undergo a full thickness resection and histological examination to exclude SGC.

So the answer to this question is A


Instruction:
Which of the following is false about fibroid :
A. Usually malignant
B. Rare before 20 years
C. Usually asymptomatic
D. More common in nulliparous

Response:
Usually malignant

So the answer to this question is A


Instruction:
Which of the following surgery is not contraindicated below 12 years of age?
A. Rhinoplasty
B. FESS
C. SMR
D. Septoplasty

Response:
FESS is the only surgery which can be perform before 17 years. In rarest circumstances, septal surgery is performed in children, septoplasty is also done and never SMR.

So the answer to this question is B


Instruction:
Which of the following aery is likely to be involved in 3rd cranial nerve lesion?
A. Anterior communicating
B. Posterior communicating
C. Posterior cerebral
D. Anterior cerebral

Response:
Answer is B (Posterior Communicating Aery): The occulomotor nerve (CNIII) courses in close relationship to the posterior communicating aery and is frequently compressed by an enlarging aneurysm of the posterior communicating aery.

So the answer to this question is B


Instruction:
Uterine blood flow at term:
A. 50 mL/min
B. 450 mL
C. 550 mL
D. 750 mL/min

Response:
Ans is d, i.e. 750 mL/minRef. Dutta Obs 8/e, p 61"Uterine blood flow is increased from 50 mL/min in non pregnant state to about 750 mL near term".Ref Dutta Obs 8/e, p 61

So the answer to this question is D


Instruction:
A 38-year-old woman complains to a physician because of having chronic pelvic pressure. On fuher questioning, she repos chronic lower back pain, constipation, difficulty in walking, and difficulty while intercourse. Pelvic examination showed uterine cervix lying low within the vaginal canal, but does not protrude through the introitus. Which of the following is the most likely diagnosis?
A. Cystocele
B. Femoral hernia
C. Rectocele
D. Uterine prolapse

Response:
Uterine prolapse is the term used for when the uterus descends from its normal position to one lower in the body. The prolapse is graded based on the level of descent. This woman has first degree prolapse, with descent of the cervix into the vagina. Second degree prolapse is characterized by protrusion of the cervix through the introitus. Third degree prolapse is characterized by complete eversion of the vagina. Uterine prolapse, rectocele, and cystocele are usually due to problems with the strength of the muscles forming the pelvic floor, and the lesions are classified as pelvic relaxation disorders. A history of trauma (notably related to multiple pregnancies) and hormonal changes (e.g., menopause) is frequently elicited. Cystocele refers to the descent of the bladder to a lower than normal position. It is usually due to problems with the strength of the muscles forming the pelvic floor, and the lesions are classified as pelvic relaxation disorders. A history of trauma (notably related to multiple pregnancies) and hormonal changes (e.g., menopause) is frequently elicited. A femoral hernia would present with a mass in the upper pa of the thigh, adjacent to the groin. Rectocele refers to descent of the rectum to a lower than normal position.

So the answer to this question is D


Instruction:
A 40 year old male, with history of daily alcohol consumption for the last 7 years, is brought to the hospital emergency room with acute onsent of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for few hours. There is history of his having missed the alcohol drink since 2 days. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behaviour, disorientation, impaired judgment and insight. He is most likely to be suffering from:
A. Alcoholic hallucinosis
B. Delirium tremens
C. Wernicke encephalopathy
D. Korsakoff's psychosis

Response:
B i.e. Delirium tremens

So the answer to this question is B


Instruction:
Which of the following is not a cardiovas-cular monitoring technique:
A. Transesophageal echocardio- graphy
B. Central venous pressure monitoring
C. Pulmonary aery catheterization
D. Capnography

Response:
D i.e. Capnography Capnography is a respiratory monitoring system (not cardiovascular). It is the determination of end tidal CO2 (Et CO2) concentration to confirm adequate ventilation. Cardiovascular monitoring techniques are - ECG, Echocardiography, BP, CVP, pulmonary aery catheterization.

So the answer to this question is D


Instruction:
Chalones are of cell division
A. Regulators
B. Promoters
C. Inhibitors
D. Initiators

Response:
Chalones are endogenous cell division inhibitorThey inhibit the division by acting on a number of events in cells cycleDue to inhibitory propey on cell division, it has a therapeutic action in cases like cancer.

So the answer to this question is C


Instruction:
True regarding sick euthyroid syndrome
A. Normal TSH, T3 , T4 level
B. Normal TSH, low T3, normal T4 level
C. High TSH, low T3, low T4 level
D. High TSH, low T3, high T4 level.

Response:
Hormone level in sick euthyroid syndrome usually of

Low T3 , nomal T4 , TSH – low T3 syndrome
Low T3, low T4 , normal TSH – low T4 syndrome- severe cases

So the answer to this question is B


Instruction:
All are alkylating agents, except :
A. 5–Fluorouracil
B. Melphalan
C. Cyclophosphamide
D. Chlorambucil

Response:
5-Fluorouracil is an antimetabolite whereas melphalan, cyclophosphamide and chlorambucil are alkylating agents.

So the answer to this question is A


Instruction:
Spontaneous release of acetylcholine at the neuromuscular junction produces
A. Miniature end-plate potential
B. Action potential
C. Post-tetanic potential
D. Resting membrane potential

Response:
Spontaneous release of acetylcholine in small amounts normally happens in synapses. This can result in miniature end plate potential.

So the answer to this question is A


Instruction:
Multifocal tumor of vascular origin in a patient of AIDS?
A. Kaposi sarcoma
B. Astrocytoma
C. Gastric Carcinoma
D. Primary CNS lymphoma

Response:
kaposi sarcoma commonly seen in patient with AIDS REF:ANANTHANARAYANAN TEXT BOOK OF MICROBIOLOGY 9EDITION PGNO.576

So the answer to this question is A


Instruction:
A neonate suffering from respiratory distress, chest x- ray showing multiple air filled spaces, the DD is A/E :
A. Congenital lobar aplasia of lung.
B. Congenital lung cysts
C. Congenital adnomatoid malformation
D. Congenital diaphragmatic hernia

Response:
Ans. is 'a' i.e. congenital lobar aplasia of lung All the given options are cause of respiratory distress in a neonate. All except labor aplasia of lung show multiple air filled spaces on chest x-ray.

So the answer to this question is A


Instruction:
A 2 year old boy with Vitamin A deficiency is treated with
A. 1 lakh IU on days 0,1,14
B. 1 lakh IU on days 0,1,6
C. 2 lakh IU on days 0,1,14
D. 2 Lakh IU on days 0,1,6

Response:
* Treatment for Vitamin A defiiency is given 3 doses. Days 0,1,14 with doses appropriate for the age. Less than six months of age-50000 IU per dose, 6-12 months of age-100000 IU and >1 year- 200000 IU per dose. Ref:- K Park, 24th ed; pg num:- 654

So the answer to this question is C


Instruction:
Erythropoietin is secreted by:
A. Coical interstitial cells
B. Cells in macula densa
C. Granular cells
D. Mesangial cells

Response:
JG apparatus Cells in macula densa Granular cells/ JG cells Mesangial cells Senses Na+ & Cl- in tubular fluids & initiate tubuloglomerular feedback. Synthesis & secrete renin Cells that can alternate the vessel diameter. Type I Coical interstitial cells : synthesize erythropoietin

So the answer to this question is A


Instruction:
The only excitatory neuron in the cerebellar coex is
A. Purkinje cell
B. Basket cell
C. Golgi cell
D. Granular cell

Response:
Granular cells are the only excitatory cells of cerebral coex, use glutamate as neurotransmitter, their axons from parallel fibres Ref: Ganong 25th ed/page 248

So the answer to this question is D


Instruction:
A 25-years old married male presents with infertility. He had undergone retroperitoneal lymph node dissection at age of 15 years for embryonal carcinoma of right testis. Semen analysis shows-quantity-0.5 ml, no. sperm, no fructose. Biopsy of testis shows normal spermatogenesis. Best treatment here would be:
A. Artificial insemination of donor
B. Penile-prosthesis
C. Micro testicular aspiration and intracytoplasmic injection
D. None of the above

Response:
Ans. (c) Microtesticular aspiration and intracytoplasmic injectionRef: Smith 17th Edition, Pages 710-711* For patients having normal spermatogenesis and problem in sperm transport we do Sperm aspiration from Vas or Epididymis or Testis and injected into cytoplasm. (In vitro Fertilization Technique- IVF)

So the answer to this question is C


Instruction:
The masseteric notch in distobuccal corners of the mandibular denture is due to
A. Action of buccinator on masseter
B. Action of masseter on buccinator
C. Palatoglossus on buccinator
D. Superior constrictor on masseter

Response:
None

So the answer to this question is B


Instruction:
1925. Causes of secondary polycythemia may include
A. Chronic cor pulmonale
B. Renal carcinoma
C. Cerebellar haemangioblastoma
D. All of the above

Response:
Secondary polycythaemia occur due to high altitude,cardiovascular disease ,pulmonary disease with alveolar hypoventilation,heavy smoking,inappropriate erythropoietin(renal cell carcinoma ,hydronephrosis,hepatocellular carcinoma ,cerebellar hemangioblastoma ,massive uterine leiomyoma.). Reference :Harsh mohan textbook of pathology sixth edition pg no 359.

So the answer to this question is D


Instruction:
Cause of Clostridium difficile associated diarrhea is
A. Trauma
B. Dairy products
C. Fried rice
D. Antibiotic use

Response:
Clostridium difficile causes acute colitis with bloody diarrhea and pseudomembranous colitis. A common cause of nosocomial diarrhea. The disease follows the use of broad-spectrum antibiotics to which it is resistant. Exotoxin A and B involved in the pathogenesis. An oppounistic organism that causes disease only when the normal mechanism is altered. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 270

So the answer to this question is D


Instruction:
Warthin's tumor is tumor of which gland?
A. Parotid gland
B. Submandibular gland
C. Lingual gland
D. Minor salivary glands

Response:
Ans. (a) Parotid glandRef: Bailey & Love 26th ed. / 733RememberWARTHIN TUMOUR* An exclusive tumor of parotid gland* Second most common benign parotid tumor (5%)* Most common bilateral benign neoplasm of the parotid* Marked male as compared to female predominance* Occurs later in life (sixth and seventh decades)* Presents as a lymphocytic infiltrate and cystic epithelial proliferation* May represent heterotopic salivary gland epithelial tissue trapped within intra-parotid lymph nodes* Incidence of bilaterality and multi-centricity of 10%* Malignant transformation rare.

So the answer to this question is A


Instruction:
True about typhoid vaccines are all except -
A. Vi polysaccharide vaccine is given in single dose
B. Storage temperature is +2 to +8degC
C. Typhoral vaccine is given in 3 doses
D. Typhoral vaccine cannot be given with other live vaccines

Response:
Ans. is 'd' i.e., Typhoral vaccine cannot be given with other live vaccines

So the answer to this question is D


Instruction:
Specificity measures:(1997)
A. True negatives
B. False positives
C. True positives
D. None of the above

Response:
Ans: aRef: Park, 17th ed, p. 112 & 18,h ed, p. 117

So the answer to this question is A


Instruction:
Which of the following is a reservoir for measles
A. Man
B. Soil
C. Fomites
D. Monkey

Response:
- Measles occurs only in humans. There is no animal reservoir of infection.The challenges of measles elimination include:1) weak immunization systems2) high infectious rate of measles3) Conflict regions4) refusal of immunization by some populations5) Changing epidemiology of measles (increased transmission among adolescents and adults) 6) Need to provide catch-up measles vaccination7) gaps in human and financial resources park 23e pg: 146

So the answer to this question is A


Instruction:
Ahlback Grade2 changes of Osteoarthritis of the knee means:
A. Joint space obliterated or almost obliterated
B. Minor bone attrition (<5 mm)
C. Moderate bone attrition (5-15 mm)
D. Severe bone attrition (>15 mm)

Response:
Ans. A. Joint space obliterated or almost obliteratedAhlback Radiographic Grading Scale of Osteoarthritis of the Tibiofemoral Joint:Grade of OsteoarthritisDescription0 =No radiographic findings of osteoarthritis1 =Joint space narrowing <3mm2 =Joint space obliterated or almost obliterated3 =Minor bone attrition (<5mm)4 =Moderate bone attrition (5-15mm)5 =Severe bone attrition (>15mm)

So the answer to this question is A


Instruction:
The substances present in the gall bladder stones or the kidney stones can be best identified by the following techniques -
A. Flourescence spectroscopy
B. Electron microscopy
C. Nuclear magnetic resonance
D. X - ray diffraction

Response:
None

So the answer to this question is D


Instruction:
What is the treatment of Rhinitis Medicamentos-
A. Withdrawal of nasal drops with short course of steroids
B. Antibiotics
C. Polypectomy
D. Increasing the dose of the nasal drops

Response:
Ans. is 'a' i.e., Withdrawal of nasal drops with short course of steroids o It is treated by withdrawal of nasal drops, short course of systemic steroid therapy and in some cases surgical reduction of turbinates, if they have become hypertrophied.

So the answer to this question is A


Instruction:
Which is a branch of internal iliac artery -
A. Inferior epigastric artery
B. Femoral artery
C. Renal artery
D. Uterine artery

Response:
Ans. is 'd' i.e., Uterine artery o Branches of anterior division of internal iliac artery are : (i) Superior vesical, (ii) Middle rectal, (iii) Inferior vesical (in males), (iv) Internal pudendal, (v) Vaginal (in females), (vi) Uterine (in females), (vii) Obturator, and (viii) Inferior gluteal.o Branches of posterior division are : (i) Iliolumbar, (ii) Lateral sacral, and (iii) Superior gluteal.

So the answer to this question is D


Instruction:
If severe bony undercut exist, best treatment
A. Remove both undercut so that no undercut exists
B. Remove undercut on one side
C. Nothing but do only alveolar ridge contouring
D. None of the above

Response:
None

So the answer to this question is A


Instruction:
Which of the following doesn't worsen angina?
A. Sumatriptan
B. Oxyfedrine
C. Dipyridamole
D. Thyroxine

Response:
Ans. is 'b' i.e., Oxyfedrine Drugs that exacerbate Angina o Amphetamines o Alpha blocker o Beta agonists o Beta blockers withdrawal o Dipyridamol o Vasopressin o Ergotamine o Decongestants o Excessive thyroxine o Hydralazine o Methysergide o Minoxidil o Nifedipine o Nicotine and cocaine o Oxytocin o Sumatriptan o Theophylline

So the answer to this question is B


Instruction:
True about dermoid cyst of ovary:a) It is teratomab) Frequently undergo torsionc) X-ray is diagnosticd) Invariably turns to malignancye) Contains sebaceous material and hairs
A. bcde
B. abce
C. acde
D. abde

Response:
Dermoid cyst: Dermoid cyst is a benign teratoma.
– It is most common benign tumour of ovary in reproductive age group.
– Most common benign neoplasm diagnosed during pregnancy.
Most common Germ cell tumor.
It is the commonest tumor to undergo torsion.
– Characteristically they are unilocular cyst containing hair and cheesy sebaceous material, teeth, bones, thyroid tissue and cartilage.
– If teeth or bone are seen in X-ray in adnexal mass, this finding is pathognomic for teratoma and thus X-ray is diagnostic.
– Malignant change in a dermoid cyst occurs in 0.5 – 2% cases in patients > 40 years. Most common malignancy which develops is, squamous cell carcinoma.

So the answer to this question is B


Instruction:
Which of the following antihypertensive drug does not alter serum glucose and lipid levels?
A. Propranolol
B. Prazosin
C. Thiazide diuretics
D. None of the above

Response:
None

So the answer to this question is B