Instruction:
Causes of Hypercalcemia include all of the following except
A. Multiple myeloma
B. Lytic skeletal metastasis
C. Total parentral nutrition
D. Acute Pancreatitis

Response:
Answer is D (Acute pancreatitis): Acute Pancreatitis is a miscellaneous cause for Hypocalcemia (not hypercalcemia). Note that Hypercalcemia may cause Acute Pancreatitis but Acute Pancreatitis causes hypocalcemia Q. Multiple myeloma, Lytic skeletal metastasis and excessive calcium intake from Total Parentral Nutrition are all established causes of Hypercalcemia Causes of Hypercalcemia: Excessive PTH *roduction * Primary hyperparathyroidism (adenoma, hyperplasia, rarely carcinoma) * Teiary hyperparathyroidism (long-term stimulation of PTH secretion in renal insufficiency) * Ectopic PTH secretion (very rare) * Inactivating mutations in the CaSR (FHH) * Alterations in CaSR function (lithium therapy) Hypercalcemia of malignancy * Overproduction of PTHrP (many solid tumors) * Lytic skeletal metastases (breast, myeloma) Excessive 1,25(OH)2D production * Granulomatous diseases (sarcoidosis, tuberculosis, silicosis) * Lymphomas * Vitamin D intoxication Primary increase in bone resorption * Hypehyroidism * Immobilization Excessive calcium intake * Milk-alkali syndrome * Total parenteral nutrition Other causes * Endocrine disorders (adrenal insufficiency, pheochromocytoma, VIPoma) * Medications (thiazides, vitamin A, antiestrogens) CaSR, calcium sensor receptor; FHH, familial hypocalciuric hypercalcemia; PTH, parathyroid hormone; PTHrP, PTH-related peptide.

So the answer to this question is D


Instruction:
Non caseating granuloma is characteristically seen in
A. Syphilis
B. Sarcoidosis
C. TB
D. Histoplasmosis

Response:
ref Robbins 8/e p701 ,9/e p98 NONCASEATING GRANULOMA Sarcoidosis is characterized bynoncaseating granulomas. These are different than the caseating granulomasproduced by other diseases, especially tuberculosis. Caseous necrosis is destruction of cells which are conveed to amorphous greyish debris located centrally ingranulomas.

So the answer to this question is B


Instruction:
Incidence of rupture classical c-section is ?
A. 0.5 - 1.5%
B. 2-5%
C. 4-9%
D. >10%

Response:
4-9% REF: Dutta 6th ed p. 594 Risk of scar rupture in future pregnancy LSCS - 0.5 - 1.5% Classical - 4-9%

So the answer to this question is C


Instruction:
Atropine is indicated in all the following poisonings except:
A. Baygon
B. Tik 20
C. Parathion
D. Endrin

Response:
Atropine is a DOC for organophosphate and carbamate poisoning. Baygon is a carbamate, Tik 20 and Parathion are organophosphates; so in their poisoning atropine is used. Endrin is an organochlorine ; so atropine is not used here.

So the answer to this question is D


Instruction:
An old man who is edentulous, presents with squamous cell carcinoma in buccal mucosa that has developed and infiltrated to the alveolus. Following is not indicated in treatment:
A. Radiotherapy
B. Segment mandibulectomy
C. Marginal mandibulectomy involving removal of outer table only
D. Marginal mandibulectomy involving removal of upper half of mandible

Response:
Radiotherapy is absolutely contraindicated in carcinoma mandible because it can lead to osteoradionecrosis of mandible.

So the answer to this question is A


Instruction:
Which of the following conditions produce a positive Darier's sign?
A. Darier's disease
B. Uicaria pigmentosa
C. Hailey Hailey disease
D. Telangiectasia macularis eruptiva perstans

Response:
Uicaria pigmentosa is the most common form of cutaneous mastocytosis presenting as reddish-brown monomorphic maculopapules, plaques or nodules appear in asymmetrical distribution anywhere on the body except the face, head, palms and soles. They uicate within a fewminutes of gentle rubbing (Darier's sign) & subsides within an hour. Telangiectasia macularis eruptiva perstan is a form ofcutaneous mastocytosis in adults presenting with red, telangiectatic macules, especially on the trunk, which tend not to uicate on rubbing. Other forms are mastocytoma & diffuse cutaneous mastocytosis. NB: darier's sign is also positive in juvenile xanthogranuloma and acute lymphoblastic leukaemia of neonates. Ref: Rook's textbook of dermatology, Edition-8, Page-22.31-32.

So the answer to this question is B


Instruction:
FNAC is not diagnostic of which of the following thyroid lesions
A. Papillary carcinoma
B. Follicular carcinoma
C. Lymphoma
D. Anaplastic carcinoma

Response:
Extensive histological sampling is required for its diagnosis. Follicular carcinoma generally do not spread through lymphatics. Ref: Robbins and cotrans 9e Pg 1098

So the answer to this question is B


Instruction:
Most sensitive test for HIV infection -
A. Western blot
B. PCR
C. Agglutination test
D. CFT

Response:
repeat

So the answer to this question is B


Instruction:
A 57-year-old man is referred for assessment of his low serum sodium of 125 mEq/L. On examination, he has pitting edema and elevated neck veins. His urine sodium is 10 mEq/L and urine osmolality 350 mOsm/kg.For the above patient with hyponatremia, select the most likely diagnosis.
A. congestive heart failure (CHF)
B. extrarenal sodium and fluid losses
C. SIADH
D. polydipsia

Response:
Hyponatremia associated with nephrotic syndrome, cirrhosis, or CHF is characterized by edema. It is believed that the hyponatremia is caused by a decrease in "effective" circulating volume secondary to decreased cardiac output or sequestration of fluid.

So the answer to this question is A


Instruction:
The appliance used to treat thumbsucking:
A. Crib appliance
B. Frankel appliance
C. Bionator
D. Activator

Response:
None

So the answer to this question is A


Instruction:
Which is the most impoant sign of significance of renal aery stenosis on an angiogram?
A. Presence of collaterals
B. A percentage diameter stenosis > 70%
C. Post-stenotic dilatation of the renal aery
D. A systolic pressure gradient > 20 mm Hg across the lesion

Response:
The most impoant sign of significant renal aery stenosis on an angiogram is presence of bridging collaterals. Other signs of hemodynamically significant aerial stenosis are post stenotic dilation, pressure gradient >10mmHg or ipsilateral renal vein renin hypersecretion. Ref: Essentials of Surgery: Scientific Principles and Practice By Lazar J. Greenfield, page 560; Computed Body Tomography With Mri Correlation, Volume 1 By Joseph K. T. Le page 1288

So the answer to this question is A


Instruction:
In Dacryocystorhinostomy, opening is done into which of the following pa of the nose?
A. Superior meatus
B. Middle meatus
C. Inferior meatus
D. None of the above

Response:
Dacryocystorhinostomy is a surgical procedure performed to assist in the drainage of tears and secretions from the lacrimal sac into the middle meatus of the nose by forming a sho circuit through the lacrimal bone and the nasal mucosa. This procedure is performed when the nasolacrimal duct is obstructed by fibrous tissue or bone and has become impermeable in order to establish a new communication pathway between lacrimal sac and nose.

So the answer to this question is B


Instruction:
Smudge cell is seen in
A. Nodular sclerosis Hodgkin's lymphoma
B. Chronic lymphocytic leukemia
C. Lymphocyte predominant Hodgkin's lymphoma
D. Sezary syndrome

Response:
Lymphohistiocytic cells or L-H cells or popcorn cells are seen in lymphocyte predominant Hodgkin's lymphoma.
These cells are CD 45, CD 20 and epithelial membrane antigen positive. Lacunar cells are seen in nodular sclerosis Hodgkin's disease. They are positive for CD15, CD30 and PAX 5.
Smudge cells are seen in CLL.
Sezary cells are seen in Sezary syndrome.

So the answer to this question is B


Instruction:
Nerve depolarization is due to
A. Opening of sodium channels
B. Opening of chloride channels
C. Opening of potassium channels
D. Opening of calcium channels

Response:
When sodium ion enters a cell the potential goes positive side and this is depolarization phase. (REF: TEXTBOOK OF MEDICAL PHYSIOLOGY GEETHA N 2 EDITION, PAGE NO - 26)

So the answer to this question is A


Instruction:
Use of Siegel's speculum during examination of the ear provides all except:
A. Magnification
B. Assessment of movement of the tympanic membrane
C. Removal of foreign body from the ear
D. As applicator for the powdered antibiotic of ear

Response:
Correct answer : C. Removal of foreign body from the ear Uses of Seigel's speculum Assess movement of tympanic membrane Introduce medicine into the middle ear To have a magnified view of ear pathology To assess vestibular function by fistula test

So the answer to this question is C


Instruction:
A person developed sudden stridor, hoarseness of voice, tongue swelling, and edematous neck after eating a peanut. What is the likely diagnosis
A. Foreign body aspiration
B. Angioneurotic edema
C. Pharyngeal perforation
D. Parapharyngeal abscess

Response:
This is a case of Angioneurotic oedema characterized by tongue swelling and laryngeal oedema after ingestion of a peanut. It is a type I hypersensitivity reaction. Others options do not fit the clinical picture Ref : Diseases of ENT by Dhingra 6th edition Pgno : 446

So the answer to this question is B


Instruction:
Ectopic pregnancy is most commonly sociated with:
A. Endometriosis
B. Congenital tubal anomalies
C. Tuberculosis
D. Tubal inflammatory diseases

Response:
Ans. is d i.e. Tubal inflammatory disease Read the question carefully, it says ectopic pregnancy is most commonly associated with : "Pelvic inflammatory disease (RD) increases the risk of ectopic pregnancy by 6-10 fold." "The most common cause (of ectopic pregnancy) is previous salpingitis due to sexually transmitted disease such as gonococcal and chlamydial infection or salpingitis that follows septic aboion and puerperal sepsis. - After one episode of PID 13% After two episode of PID - 35% After three episode of PID - 75% Note : M/C cause of ectopic pregnancy is PID, Maximum risk of ectopic pregnany is after tubal damage, either due to previous ectopic pregnancy or tubal surgery. Incidence of ectopic pregnancy :

So the answer to this question is D


Instruction:
All the following wastewater contains human excreta EXCEPT
A. Sewage
B. Sullage
C. Faeces
D. None

Response:
Ans. b (Sullage). (Ref. Park, PSM, 22th/pg. 707)SULLAGEThe term "Sullage" is applied to waste water which does not contain human excreta. E.g. waste water from kitchen and bathrooms.SEWAGESewage is wastewater from community containing solid and liquid excreta, derived from houses, streets and yards, washing, factories and industries. It resembles dirt water with unpleasant smell. # The average amount of sewage, which flows through sewage system in 24 hours, is called "dry weather flow". # Composition of sewage is 99.9% water.# Strength of sewage is expressed in terms of BOD, COE, suspended solids.Also remember:# Average adult person excretes daily some 100 gm of faeces.# It is estimated that 1 gram of faeces may contain about 1,000 million of E. coli, 10-100 million of faecal streptococci, and 1-10 million spores of Cl. Perfringens besides several others.

So the answer to this question is B


Instruction:
Nerve of the 2nd branchial arch is -
A. Mandibular nerve
B. Maxillary nerve
C. Facial nerve
D. Vagus

Response:
Ans. is 'c' i.e., Facial nerve PharyngealArchMuscular ContributionSkeletal ContributionsNerveArteryCorresponding Pouch Structures1st (mandibular arch)Muscles of mastication, Anterior belly of the digastric, Mylohyoid, Tensor tympani, Tensor veli palatiniMaxilla, mandible (only as a model for mandible not actual formation of mandible), Incus and Malleus, Meckel's cartilage, Ant. ligament of malleus, Sphenomandibular ligamentTrigeminal nerve (V2 and V3)Maxillary artery, external carotid arteryEustachian tube, middle ear, mastoid antrum, and inner layer of the tympanic membrane.2nd (hyoid archMuscles of facial expression, Buccinator, Platysma, Stapedius, Stylohoid, Posterior belly of the digastricStapes, Styloid process hyoid (lesser horn and upper part of body), Reichert's cartilage, Stylohyoid ligamentFacial nerve (VII)Stapedial Arterymiddle ear, palatine tonsils3rdStylopharyngeusHyoid (greater horn and lower part of body), thymusGlossophar- yngeal nerve (IX)Common carotid/ internal carotidInferior parathyroid, Thymus4thCricothyroid muscle, all intrinsic muscles of soft palate including levator veli palatiniThyroid cartilage, epiglottic cartilage Cuneiform cartilage Cricoid cartilage Corniculate cartilageVagus nerve (X) Superior laryngeal nerveRight 4th aortic arch subclavian artery Left 4th aortic arch: aortic archSuperior parathyroid, ultimobranchial body (which forms the Para follicular C-Cells of\ thyroid gland).6thAll intrinsic muscles of larynx except the cricothyroid muscleArytenoid cartilagesVagus nerve (X) Recurrent laryngeal nerveRight aortic arch: pulmonary artery Left 6th aortic arch: Pulmonary artery and ductus arteriosusRudimentary structure, becomes part of the fourth pouch contributing to thyroid C-cells.

So the answer to this question is C


Instruction:
Drug that does not lead to osteoporosis
A. Alcohol
B. Thyroxine
C. Heparine
D. Warfarine

Response:
Drugs leading to osteoporosis -
Alcohol
Lithium
Anticonvulsants
Thyroxine
Heparine
Steroids

So the answer to this question is B


Instruction:
Mefipristone causes __________ on fibroid
A. Hyperplasia of fibroid
B. Atrophy of fibroid
C. No effect on fibroid
D. Varies with age

Response:
MIfepristone is anti-progestin, which induces atrophy in leiomyomas.

So the answer to this question is B


Instruction:
A person presents with the following parameters. pCO2 : 30 mm Hg, PO2 :105 mm Hg, pH : 7.45. He is having partially compensated -
A. Metabolic acidosis
B. Metabolic allcalosis
C. Respiratory acidosis
D. Respiratory alkalosis

Response:
Increase in pH suggests alkalosis

PCO2 is decreased, this suggests respiratory alkalosis.
The metabolic component cannot be evaluated as data is not provided. So the diagnosis seems to be respiratory alkalosis.

So the answer to this question is D


Instruction:
In a normal adult person the depth of anterior chamber in the centre is about:
A. 2.5 mm
B. 3 mm
C. 3.5 mm
D. 4 mm

Response:
Ans. 2.5 mm

So the answer to this question is A


Instruction:
Which branch of fascial nerve supplies muscles of lower lip (FMGE Dec 2018)
A. Temporal
B. Cervical
C. Buccal
D. Mandibular

Response:
-TEMPORAL BRANCH-Supply upper pa of orbicularis oculi and frontalis -ZYGOMATIC BRANCH-Supply lower pa of orbicularis oculi -BUCCAL BRANCH-Supply upper orbicularis oris, zygomaticus minor/major -MARGINAL MANDIBULAR BRANCH-Supply lower lip-Mentalis, lower orbicularis oris, depressor labii inferioris -CERVICAL BRANCH -Supply Platysma

So the answer to this question is D


Instruction:
Fetal hemopoiesis first occurs in :
A. Yolk sac
B. Liver
C. Spleen
D. Bone marrow

Response:
Ans. is a i.e. Yolk sac In the very early embryo, hemopoiesis is first demonstrable in the yolk sac. (It begins between the 10th" to 14th day of gestation, k/a mesoblastic period). The next major site is the dvei (Begins by 6-8 weeks of gestation and completely replaces yolk sac by 10-12 weeks and remain predominant till 20-24 weeks called as hepatic punuu of heinopoeiss) followed by the bone marrow (It stas taking over the liver by the second trimester called as myeloid period Erythropoiesis is regulated primarily by erythropoietin which increases along with gestational age. Extra Edge When hemopoiesis occurs in yolk sac - Hemoglobins Gower I, Gower 2 and Poland are made. Erythropoiesis in the liver, produces hemoglobin F Finally when hemopoiesis moves to bone marrow, normal hemoglobin A appears in fetal red cells and is present in progressively greater amounts as the fetus matures After 8th gestational week HbF is the predominant Hb. At 24 weeks of gestation it constitutes 90% of the fetal hemoglobin. At bih HbF is 70% of total hemoglobin and HbA is 30%. At bih HbA2 is less than 1% is seen but by 12 month of age the normal level of 2.0-3-4% is attained. Throughout life, the normal ratio of HbA to A. is about 30 : 1. Clotting factors in fetus : Fetal fibrinogen appears as early as 5 weeks of gestation. All the rest clotting factors are produced by 12 weeks of gestation. Factors low in cord blood are : Factor II, VII, IX, X, XI, XII, XIII and fibrinogens. Without prophylactic vitamin K treatment at bih. vitamin K dependant coagulation factors fuher decrease during the first few days of life and may lead to hemorrhage in newborn.

So the answer to this question is A


Instruction:
HPV oncogene expression is
A. E1E2
B. E1E3
C. E3E5
D. E6E7

Response:
The oncogenic potential of HPV can be related to production of two early viral genes E6&E7 Together they interact with variety of growth regulating proteins encoded by protooncogene and tumour suppressor genes E6- binds to and mediate the degradation of p53 E7-binds to Rb protein and release E2F transcription factor,also inactivates the CDKIs Robbins basic pathology 9th edition chapter 5 pageno. 202

So the answer to this question is D


Instruction:
Young's operation is done for-
A. Allergic rhinitis
B. Atropic rhinitis
C. Vasomotor rhinitis
D. Idiopathic rhinitis

Response:
Ans. is 'b' i.e., Atrophic rhinitis Treatment of atrophic rhinitiso It may be medical or surgicalMedical treatmento Nasal irrigation and removal of crusts by warm normal saline or warm nasal alkaline douche made up of sodium bicarbonatef sodium biborate and sodium chloride in water.o 25 % glucose in glycerine :Following removal of the crust the nose is painted with 25% glucose in glycerine.Glucose-Inhibits proteolytic organisms, Glycerine is a hygroscopic agent.o Other local antibiotics : Kemicetine antiozaena solution : 1 ml contains chloramphenicol (90 mg), estradiol dipropionate (0.64 mg), vit D2 (900 IU) and propylene glycol,o Potassium iodide : By mouth to increase the nasal secretion,o Human placental extract is given in the form of submucosal injections,o Other drugs :Rifampicin, Streptomycin to decreases the odour and crusts.Oestradiol spray to Tvascularity of nasal mucosa.Placental extract injected submucosally.Surgical treatmentYoung's operationo Closure of both the nostril following elevation of the nasal vestibular folds. They are opened after 6 months.Modified Young's operationo Partial closure of the nostril leaving behind a 3 mm hole,o This remains for a period of 2 years.Narrowing of the nasal cavity by (Lautenslagers operation) -o Submucosal injection of teflon pasteo Insertion of fat, cartilage, bone or teflon strips under the mucoperiosteum of floor & lateral wall of nose,o Section and medial displacement of lateral wall of nose.Lautenslagers operationo Surgical procedures aimed at medial izing the lateral nasal wall using substances like: Paraffin, teflon, Poly there cartilage.

So the answer to this question is B


Instruction:
Drug commonly used against enteric fever are all except-
A. Amikacin
B. Ciprofloxacin
C. Ceftriaxone
D. Azithromycin

Response:
Aminoglycosides are not given for enteric fever

So the answer to this question is A


Instruction:
Complications of acute sinusitis:
A. Orbital cellulitis
B. Pott's puffy tumor
C. Conjunctival chemosis
D. All

Response:
None

So the answer to this question is D


Instruction:
Kaposi's sarcoma is a tumour of:
A. Blood vessels
B. Reticuloendothetial system
C. Striated muscles
D. Smooth muscles

Response:
None

So the answer to this question is A


Instruction:
Gonococcal vaginitis occurs in :
A. Adults
B. Children
C. Infants
D. Adolescents

Response:
Premenarchal girls are vulnerable to vaginal infection due to : Very low circulatory estrogen leading to Lack of stratification of vaginal epithelium Lack of glycogen and doderlein's bacillus Alkaline vaginal PH Ref: D.C.DUTTA'S TEXTBOOKOF GYNECOLOGY; 6th edition; Pg no:544

So the answer to this question is B


Instruction:
Sling psychrometer is used for measuring –
A. Air velocity
B. Rain fall
C. Median radiant temperature
D. Relative humidity

Response:
None

So the answer to this question is D


Instruction:
With chronic use in seizure state, the adverse effects of this drug include coarsening of facial features, hirsutism gingival hyperplasia and osteomalacia:
A. Ethosuccimide
B. Carbomazepine
C. Gabapentin
D. Phenytoin

Response:
Gum hyperophy: Commonest ( (b) Hirsutism, coarsening of facial features (troublesome in young girls), acne. REF:KD TRIPATHI 8TH ED.

So the answer to this question is D


Instruction:
Relative Afferent papillary defect (RAPD) is characteristically seen in damage to
A. Optic nerve
B. Optic Tract
C. Lateral geniculate body
D. Occulomotor Nerve

Response:
A i.e. Optic nerve

So the answer to this question is A


Instruction:
Which of the following antimicrobial agent do not require reduction in dose in patient with renal failure-
A. Rifampicin
B. Fluconazole
C. Vancomycin
D. Imipenem

Response:
Ans. is 'a' i.e., Rifampicin Antimicrobials that do not require dose reduction in renal failure Cephalosporins Fluoroquinolones Cefoperazone o Trovafloxacin Ceftriaxone o Grepafloxacin Cefopiramide o Pefloxacin Macrolides o Moxifloxacin o Erythromycin o Clarithromycin o Azithromycin Other (Miscellaneous) Tetracycline o Clindamycin o Docycycline o Chloramphenicol Minocycline o Metronidazole Antitubercular o Linezolid o Rifampicin o Quinupristin/Dalfopristin o Rifapentine o Nafcillin/Oxacillin o Rifabutin o Penicillins

So the answer to this question is A


Instruction:
All of the following cause increased ESR except
A. Pregnancy
B. New born
C. Leucocytosis
D. Sickle cell anaemia

Response:
Sickle cell anemia - ↓ ESR.

So the answer to this question is D


Instruction:
Which of the following increases turbulence in blood flow
A. Reynolds number less than 2000
B. Decrease in velocity of blood
C. Decrease in density of blood
D. Increase in diameter of blood vessel

Response:
The flow of blood (Laminar or turbulent) depends on
-        Fluid density (S)
-        Tube diameter (D)
-        The velocity of the fluid (V)
-        The viscosity of fluid (n)
This can be expressed by Reynold’s number (R) = SDV/n
Normal flow is laminar. But if the velocity crosses a critical limit (Critical velocity) flow becomes turbulent. If R>2000, flow is turbulent.

So the answer to this question is D


Instruction:
Voriconazole is not effective against :
A. Candida albicans
B. Mucormycosis
C. Candida tropicalis
D. Aspergillosis

Response:
None

So the answer to this question is B


Instruction:
Which drug can be used in patient of CML with T315i mutation?
A. Imatinib
B. Nilotinib
C. Dasatinib
D. Ponatinib

Response:
Drugs against CML with T315I :* Omacetaxine* Ponatinib In CML there is BCR-ABL fusion , due to which there is hyperactivation of tyrosine kinase. ABL-BCR tyrosine kinase inhibitors:* First generation: Imatinib, * Second generation(active against Imatinib resistant cases): Dastanib, Nilotinib.* Third generation: Bosutinib, Ponatinib Ponatinib is the only TK inhibitor which is active against CML wth T315I mutation.

So the answer to this question is D


Instruction:
Jone's fracture is:
A. Fracture of base of 5th metatarsal
B. Fracture of base of 2nd metatarsal
C. Fracture of base of 1st metacarpal
D. Fracture of head of 5th metacarpal

Response:
Fig. Jone's fracture- Occurs at the base of fifth metatarsal at metaphysio-diaphyseal junction and Pseudojones/Dancers Fractures is an avulsion fracture of the tip of 5th metatarsal 5th metatarsal is the M/C metatarsal to undergo traumatic fracture. Base of 5th metatarsal is divided into three zones- Zone 1. Avulsion fractures (Pseudo Jones fracture/ dancer's fracture) of peroneus brevis(not longus) tendon. Zone 2. Fractures at the metaphysealdiaphyseal junction (Jone's fracture) Zone 3. Stress fractures of the proximal 1.5 cm of the shaft of the fifth metatarsal.

So the answer to this question is A


Instruction:
The interureteric ridge forming the base of trigonal structure is also called
A. Bell's muscle
B. Mercier's bar
C. Rice's bar
D. Toldt's bar

Response:
Interureteric fold: A fold of mucous membrane extending from the orifice of the ureter of one side to that of the other side. Also called Mercier's bar. Bell's muscle A band of muscular fibres, forming a slight fold in the wall of the bladder, running from the uvula to the opening of the ureter on either side, bounding the trigonium. * Toldt's fascia - fixation of fascial planes behind the body of the pancreas.

So the answer to this question is B


Instruction:
The characteristics of caput succedaneum include all of the following except :
A. Crosses midline
B. Crosses the suture line
C. It does not disappear within 2-3 days
D. It is a diffuse edematous swelling of soft tissues of the scalp

Response:
Caput Succedaneum It is a diffuse swelling of the scalp due to effusion of serum above the periosteum Not limited by suture line. There is obstruction of venous and lymphatic return due to pressure by the cervix. This causes stagnation of fluid and hence, that pa of the scalp becomes edematous It is present at the bih and disappears by about 24-36 hours aftr bih. Good prognosis. CEPHALOHEMATOMA: It is the collection of blood in btw the pericranium and the flat bone(sub periosteal) of the skull. Usually unilateral and over a parietal bone. Swelling is limited by the suture lines It is due to rupture of a small emmisary vein from the skull and may be associated with the fracture of skull bone. NEVER present at BIH but gradually develops after 12-24hrs. Disappears in 6-8wks due to absorption of blood. Good prognosis. TEXT BOOK OF OBSTETRICS,Sheila Balakrishnan,2nd edition,page no.33 DC DUTTA'S TEXTBOOK OF OBS,9th edition, page no.452

So the answer to this question is C


Instruction:
Nerve supply of nail bed of middle finger:March 2013 (c)
A. Radial nerve
B. Ulnar nerve
C. Median nerve
D. Axillary nerve

Response:
Ans. C i.e. Median nerve

So the answer to this question is C


Instruction:
All are congential myopathies exceptaEUR'
A. Central Core myopathy
B. Centronuclearmyopathy
C. Z band myopathy
D. Nemalin myopathy

Response:
Z band Myopathes Congenital Myopathies are characterized by Onset at bih or in early infancy with muscle Weakness and decreased muscle tone Very slowly progressive or non progressive course & long survival Specific histologic changes on muscle biopsy Congenital Myopathies Disease . Central core disease . Nemaline Myopathy . Centro Nuclear Myopathy Histological Characteristics Amorphous central core in myofibrils with absence of oxidative enzymes Elongated crystalline rods composed of Tropomyosin present beneath sarcolemma : shows periodicity on electron microscopy. Nuclei occupy the central pa of the myofibril. P Secondary Congenital Myopathy associated with Glycogen storage disease Glycolytic enzyme Deficiency Ceain disorders of lipid Metabolism e.g. Carnitine Deficiency Acquired Myopathy Endocrine - Thyrotoxicosis - Cushing disease - Acromegaly Familial periodic paralysis - Potassium deficiency or excess Malignant neoplasm - Paraneoplastic syndromes

So the answer to this question is C


Instruction:
A 5 year old child pulls penis skin while urinating. Upon examination there is erythema and edema over the prepuce. Diagnosis:
A. Hypospadias
B. Urethral Stone
C. Posterior urethral valve
D. Phimosis

Response:
Ans. (d) PhimosisRef Bailey 2&h ed. /1359PHIMOSIS* Phimosis is a condition in which the contracted foreskin cannot be retracted over the glans.* Chronic infection from poor local hygiene is its most common cause.* Most cases occur in uncircumcised males, although excessive skin left after circumcision can become stenotic and cause phimosis.Clinical features* Difficulty in micturition is the main symptom.* Ballooning of prepuce during micturition is suggestive of phimosis.* Edema, erythema, and tenderness of the prepuce and the presence of purulent discharge usually cause the patient to seek medical attention.* Inability to retract the foreskin is a less common complaint.HYPOSPADIAS* Hypospadias results when fusion of urethral folds is incomplete, and urethral meatus opens on the underside of penis or perineum (ventral surface of penis).* Because fusion of urethral folds is from posterior to anterior, Anterior forms are more common than posterior.* Associated pathology: in addition to ventrally placed ectopic meatus, hypospadias has:# Chordee: ventral curvature of penis due to contracture of fibrous cord which has replaced the distal urethra and corpus spongiosum.# Hooded prepurce: deficient on ventral aspect and excess on dorsal aspect# Stenosis of ectopic meatusEPISPADIAS* Urethra opens on the dorsum (upper aspect) of the penis in males, in females there is a fissure in the wall of the urethra which opens above the clitoris* Females: Bifid clitoris and separation of the labia. Most are incontinent because of maldevelopment of the urinary sphincters.* Males: Patients with glandular epispadias seldom have urinary incontinence. However, incontinence in penopubic epispadias is 95% and penile epispadias is 75%.POSTERIOR URETHRAL VALVE* Exclusively an anomaly of male urethra.* Symmetrical folds of urothelium extending distally from prostatic urethra to external urinary sphincter.* Newborns may present with palpable abdominal masses.* Sometimes, the valves are incomplete and the patient remains without symptoms until adolescence or adulthood.

So the answer to this question is D


Instruction:
The following structure represents which impression material?
A. Polyether
B. Polysulfide
C. Condensation silicone
D. Addition silicone

Response:
None

So the answer to this question is B


Instruction:
Earliest manifestation in hepatic encephalopathy is?
A. Asterixis
B. Alternate constriction and dilated pupil
C. Constructional apraxia
D. Psychiatric abnormalities

Response:
Earliest manifestation in hepatic encephalopathy is Psychiatric abnormalities.

So the answer to this question is D


Instruction:
Which of the following can be given safely to a patient of congestive heart failure
A. Aspirin
B. Paracetamol
C. Diclofenac sodium
D. Ibuprofen

Response:
None

So the answer to this question is B


Instruction:
One of the following is supplied by median nerve:
A. 1st and 2nd lumbricals
B. Hypothenar muscles
C. Palmar interossei
D. Dorsal in terossei

Response:
Ans: A (1st and 2nd lumbricals) Ref: Gray's Anatomy: Anatomical basis of clinical practice by Susan Standring,ChurchiU Livingstone, 40th edition, 2008, Pg. 895Explanation:BrachialplexusbranchOriginSpinal segmentFunctionMediannerveMedia) and lateral cordsC5 to T1Motor:* All muscles in anterior compartment of forearm (except flexor carpi ulnaris and medial half of flexor digitorum profundus)* Three thenar muscles* Two lateral lumbncal muslcesSensory:Skin over the palmar surface of the lateral three and one half digits and lateral side of palm and middle of wrist

So the answer to this question is A


Instruction:
Which of the following ACE inhibitor is not a prodrug
A. Fosinopril
B. Enalapril
C. Ramipril
D. Lisinopril

Response:
Refer katzung 11e 183 KDT 6/e p23, 24,487 All ACE inhibitor are prodrug except captopril and Lisinopril

So the answer to this question is D


Instruction:
Fluorescent dye for ophthalmological diagnosis is injected in:
A. Antecubital vein
B. Popliteal vein
C. Femoral vein
D. Subclan vein

Response:
A i.e. Ante-cubital vein In Fluorscein angiography for diagnosis of ophthalmological diseases dye is injected through Cubital VeinQ

So the answer to this question is A


Instruction:
\r\nA few months after receiving an IM injection a ladypresented to you with pain in both the shoulders. On examination there is sensory loss over bilateral shoulders with mild wasting of muscles. Which of the following vaccines is the likely cause?
A. Tetanus
B. Measles
C. MMR
D. BCG

Response:
This is a case of brachial neuritis following an injection of tetanus toxoid. Here there is dysfunction of the nerves supplying the arm or shoulder without involvement of the rest of the nervous system. The sensory loss is less prominent than the weakness. There may also be bilateral involvement of muscles with wasting. Ref: Park, Edition 21, Page 105.

So the answer to this question is A


Instruction:
A 20-year-old man complains of difficulty in reading the newspaper with his right eye, three weeks after sustaining a gun shot injury to his left eye. The most likely diagnosis is
A. Sympathetic ophthalmitis
B. Macular oedema
C. Optic nerve avulsion
D. Delayed vitreous haemorrhage

Response:
SYMPATHETIC OPHTHALMITIS Sympathetic ophthalmitis is a serious bilateral granulomatous panuveitis which follows a penetrating ocular trauma. Etiology : Predisposing factors: 1. It almost always follows a penetrating wound. 2. Wounds in the ciliary region (the so-called dangerous zone) are more prone to it. 3. Wounds with incarceration of the iris, ciliary body or lens capsule are more vulnerable. 4. It is more common in children than in adults. 5. It does not occur when actual suppuration develops in the injured eye. Clinical picture: I. Exciting (injured) eye: It shows clinical features of persistent low grade plastic uveitis, which include ciliary congestion, lacrimation and tenderness. Keratic precipitates may be present at the back of cornea (dangerous sign). II. Sympathizing (sound) eye: It is usually involved after 4-8 weeks of injury in the other eye. Earliest repoed case is after 9 days of injury. Sympathetic ophthalmitis, almost always, manifests as acute plastic iridocyclitis. Clinical picture of the iridocyclitis in sympathizing eye can be divided into two stages: 1. Prodromal stage: Symptoms: sensitivity to light (photophobia) and transient indistinctness of near objects (due to weakening of accommodation) are the earliest symptoms. Signs: In this stage the first sign may be presence of retrolental flare and cells or the presence of a few keratic precipitates (KPs) on back of cornea. Other signs includes mild ciliary congestion, slight tenderness of the globe, fine vitreous haze and disc oedema which is seen occasionally. 2. Fully-developed stage: It is clinically characterised by typical signs and symptoms consistent with acute plastic iridocyclitis. Ref:- A K KHURANA; pg num:-413

So the answer to this question is A


Instruction:
Which of the following is NOT TRUE about post - traumatic stress disorder?
A. The onset of illness may occur many months after the traumatic event
B. Individual debriefing and early counselling are most effective method of treatment
C. Eye movement desensitization and reprocessing is effective
D. There is high risk of alcohol abuse in patients suffering from this disorder

Response:
Treatment of choice for PTSD is psychotherapy in the form of cognitive behavior therapy often in combination with pharmacotherapy.
There is no evidence that single - session individual psychological briefing is a useful treatment for PTSD.
Eye movement desensitization and reprocessing (EMDR) is an effective treatment for PTSD.
Symptoms of PTSD develop within 6 months of the stressor, however, 10% patients have delayed onset.
PTSD patients are high risk for alcohol abuse.

So the answer to this question is B


Instruction:
Clinical manifestations of Lesch-Nyhan syndrome is due to the defective recycling of the following:
A. Purines
B. Methylcobalamin
C. Pyrimidines
D. Thiamine

Response:
Lesch-Nyhan syndrome is a genetic disease, affecting almost solely males, of excessive synthesis of purines because of defective recycling and, therefore, uric acid production from their breakdown. Lesch-Nyhan syndrome is characterized by gouty ahritis but, in addition, affects the brain, resulting in mental retardation, loss of control of arm/leg/face movements, aggressive behavior, and self-mutilation by biting and scratching. Ref: Janson L.W., Tischler M.E. (2012). Chapter 4. Nucleosides, Nucleotides, DNA, and RNA. In L.W. Janson, M.E. Tischler (Eds), The Big Picture: Medical Biochemistry.

So the answer to this question is A


Instruction:
Injury from application of fluid above 60 or from steam is called
A. Hypothermia
B. Frost bite
C. Burns
D. Scalds

Response:
Scalds A scald is an injury from the application of fluid above 60 or from steam. Because of the cooling of the liquid due to evaporation, the lesion due to scald is not very deep. However the latent heat of the viscid fluid is high and hence, the penetration capacity of heat of such liquids is more. Thus an injury caused by hot tar, syrup, oil, etc is comparatively deeper than that caused by hot water. Ref: TEXTBOOK OF FORENSIC MEDICINE AND TOXICOLOGY KRISHNAN VIJ FIFTH EDITION PAGE 169

So the answer to this question is D


Instruction:
Pinna calcification is seen in all except -
A. Gout
B. Ochronosis
C. Frost bite
D. Addison's disease

Response:
None

So the answer to this question is A


Instruction:
Bachleor plaster for children used for
A. Perthes disease
B. DDH
C. SCFE
D. Synovitis Hip

Response:
None

So the answer to this question is B


Instruction:
All of the following statements about bronchial circulation are true, Except:
A. Contribute 2% of systemic circulation
B. Contribute to gaseous exchange
C. Cause venous admixing of blood
D. Provide nutritive function to lung

Response:
B i.e. Contribute to gaseous exchangeBronchial circulation does not take pa in gaseous exhangeQ. Gaseous exchange takes place in pulmonary circulation.Bronchial Circulation- Bronchial aeries arise directly from aoa and provide nourishment/ oxygenated blood to lung parenchymaQ. Bronchial aeries are usually 3 in number, accompany the bronchial tree and divide with it.- The main function of bronchial aery is to provide oxygenated systemic blood & nutrition to lungs i.e. walls of conducting airways (bronchi, bronchioles) down to and including respiratory bronchioles, blood vessels (eg pulmonary aeries), nerves, lymph nodes and most of the visceral pleura.- Bronchial circulation receives 1-2% of total cardiac output, which increases as much as 10 to 20% (of CO) in cystic fibrosis. Approximately 1/3 of blood returns to right atrium bronchial veins; whereas the remainder drains into the left atrium pulmonary veins. The erosion of inflamed tissue into these vessels secondary to bacterial infection is responsible for hemoptysis.- Bronchial circulation causes venous admixingQ (i.e. mixing of un-oxygenated bronchial venous blood directly into oxygenated pulmonary venous blood) as its 2/3rd blood returns through pulmonary veins.- Gaseous exchange (i.e. removal of CO2 from deoxygenated blood and mixing of 02 = oxygenation) takes place in pulmonary circulation of lung.

So the answer to this question is B


Instruction:
What is the name for the form of caries, which is rapidly
progressing?
A. Rampant caries
B. Nursing bottle caries
C. Acute dental caries
D. Chronic dental caries

Response:
None

So the answer to this question is A


Instruction:
Which of the following is contrast sensitivity testing cha?
A. Pellirobsons
B. Snellen type cha
C. Regan cha
D. All of the above

Response:
Contrast sensitivity is affected by various factors like age, refractive errors, glaucoma, amblyopia, diabetes, optic nerve diseases and lenticular changes. Fuher, contrast sensitivity may be impaired even in the presence of normal visual acuity. Reference : A K KHURANA COMPREHENSIVE OPHTHALMOLOGY, Edition4 ,page-17

So the answer to this question is D


Instruction:
The axis of abduction and adduction of digits passes through the centre of
A. 2nd metacarpal
B. 3rd metacarpal
C. 4th metacarpal
D. 5th metacarpal

Response:
The third metacarpal is the longest and the axis of abduction and adduction passes through its centre.Ref: Chaurasia; Volume 2; 6th edition; Page no: 31

So the answer to this question is B


Instruction:
Soap bubble appearance at lower end of radius, the treatment of choice is:
A. Local excision
B. Excision and bone grafting
C. Amputation
D. Radiotherapy

Response:
Treatment for GCT at commoner sites is as given in Table Site Treatment of choice Lower end of femur Excision with Turn-o-Plasty Upper end of tibia Excision with Turn-o-Plasty Lower end of radius Excision with fibular grafting Lower end of ulna Excision Upper end of fibula Excision

So the answer to this question is B


Instruction:
True statements about parotid gland
A. Duct opens oppsite to upper 2nd molar tooth
B. Duct pierces Masseter
C. Develops from ectoderm
D. Secretomotor fibres come from facial nerve

Response:
The duct runs forwards for a sho distance between the buccinator and the oral mucosa. Finally, the duct turns medically and opens into the vestibule of the mouth(gingivobuccal vestibule)opposite the crown of the upper second molar tooth. Notes: Parotid abscess may be caused by spread of infection from the opening of parotid duct in the mouth cavity. <img src=" /> REF.BDC VOL.3,Sixth edition pg 110

So the answer to this question is A


Instruction:
A patient of Acute lymphocytic leukemia with fever and neutropenia develops diarrhoea after administration of amoxicillin therapy, which of the following organism is most likely to be the causative agent -
A. Salmonella typhi
B. Clostridium difficile
C. Clostridium perfringens
D. Shigella flexneri

Response:
Ans. is 'b' i.e., Clostridium difficile It is a case of Clostridium difficile - induced diarrhoea.Clostridium difficile should always be considered as a possible cause of diarrhoea in cancer patients who have received antibiotics.Two factor favours this diagnosis a) Cancer patient - Cancer patients are predisposed to the development of clostridium difficile diarrhoea as a consequence of chemotherapy alone, (do not always require antibiotics).This is much more common among patients with AML and ALL, than among those with other types of cancer. So these cancer patient may be positive in cl. difficile toxin tests even before receiving antibiotics, b) Ingestion of amoxicillin - Clostridium difficile induced diarrhoea is associated with antibiotic useAntibiotics associated with Clostridium difficile associated disease are -- Clindamycin}First antibiotics associated- Ampicillin}-with Clostridium difficile- Cephalosporins }associated disease2nd and 3rd generation cephalosporinsCefotaxime Ceftriaxone}These agents are now most- Cefuroxime}-- frequently responsible for- Ceftazidime}this condition- Penicillin/p lactamase combination - Ticarcillin/clavulanate}- Pose significantly less- Piperacillin/tazobactam}riskHowever all antibiotics including Vancomycin and Metronidazole have been found to carry a risk of subsequent Clostridium difficile associated diarrhoea.More about Clostridium difficile induced diarrhoeaAlso knowT/T of Clostridium difficile associated diarrhoea * Discontinuation of precipitating antibiotics and administration of following antibioticsMetronidazoleVancomycinTeicoplaninFusidic acidBacitracin

So the answer to this question is B


Instruction:
Verres needle is used for
A. Creating pneumoperitoneum
B. Liver biopsy
C. Bone marrow biopsy
D. Spinal anaesthesisa

Response:
Verres needle is used for creation of a pneumoperitoneum in closed method.Although this method is fast and relatively safe, there is a small but significant potential for intestinal or vascular injury on introduction of the needleRef: Bailey and Love 27e pg: 108

So the answer to this question is A


Instruction:
All of the following statements are true regarding the pudendal nerve, except:
A. It is both sensory and motor
B. It is derived from S2,3,4
C. It leaves the pelvis through the lesser sciatic foramen
D. It leaves through lesser sciatic foramen and enter pudendal canal

Response:
Pudendal nerve leaves the pelvis, to enter the gluteal region, by passing through the lower pa of the greater sciatic foramen. Pudendal nerve leaves the gluteal region by passing through the lesser sciatic foramen and enters the pudendal canal, and by means of its branches supplies the external anal sphincter and muscles and skin of the perineum. Ref: Clinical anatomy for Medical Students By Richard S Snell, 6th Edition, Pages 362-3 ; B.D.Chaurasia's Human Anatomy, 5th Edition, Volume 2, Page 365

So the answer to this question is C


Instruction:
The following are causes of face presentation in a foetus? 1. Anencephaly 2. Multiparity 3. Hydraminos 4. Contracted Pelvis 5. Placenta prae
A. 1, 2, 3 - False & 4, 5 - True
B. 2, 3, 4 - True & 1, 5 - False
C. 2, 3, 4 - False & 1, 5 - True
D. 1, 2, 4 - True & 3, 5 - False

Response:
Face presentation can occur due to maternal and fetal factors. Maternal factors includes multiparity, lateral obliquity of uterus and contracted pelvis. Fetal factors includes anencephaly, congenital goitre, dolichocephalic head with long AP diameter, congenital branchocele, twisting of the cord round the neck and increased tone of extensor group of neck muscles. Ref: Textbook of Obstetrics by D.C Dutta 6th edition page 389.

So the answer to this question is D


Instruction:
Which of the following is supplied by the abdominal aoa?
A. Accessory lung lobes
B. Bronchopulmonary segment
C. Sequestrated lung tissue
D. Base of lung

Response:
A pulmonary sequestration (bronchopulmonary sequestration or cystic lung lesion), is a condition wherein a piece of tissue that ultimately develops into lung tissue is not attached to the pulmonary aerial blood supply, as is the case in normally developing lung. As a result, this sequestered tissue is not connected to the normal bronchial airway architecture, and as a result, fails to function in, and contribute to, respiration of the organism. Sequestrated lung tissue receive it's blood supply from systemic circulation, directly from aoa or its branches Ref - pubmed.com

So the answer to this question is C


Instruction:
The organism most frequently related to mediastina fibrosis is
A. Actinomycosis
B. Histoplasma
C. Hansen's bacillus
D. Staphylococcus

Response:
Fibrosing mediastinitis or mediastinal fibrosis is the least common,but the most severe ,late complication of histoplasmosis.It is due to an abnormal immunological response to antigens released by the soil based fungus Histoplasma capsulatum.It is characterised by invasive calcified fibrosis centered at locations of lymph nodes,which occludes major vessels & airways.

So the answer to this question is B


Instruction:
Limb girdle muscle dystrophies include all of the following groups of disorders except:
A. Sarcoglycanopathies
B. Dystroglycanopathies
C. Dysferlinopathies
D. Calpainopathies

Response:
Ans. b. Dystroglycanopathies (Ref: Harrison 19/e p462e-6, 462e-6t. 462e-7t. 18/e pp 3492,3493, 3494)Calpain-J, Sarcoglycans (y,a,b and y) and dysferlin are all examples of defective gene/loeus in Limb girdle dystrophies. Dystrophin is associated with Duchenne's and Becker's type of muscular dystrophies and is not associated with Limb girdle dystrophies."The Limb girdle muscular dystrophies (LGMD) typically manifest with progressive weakness of pelvic and shoulder girdle musculature. Respiratory insufficiency from weakness of diaphragm and cardiomyopathy may occur. However unlike Duchenne dystrophies (Dystrophin) intellectual function remains intact."- Harrison 18/e p3492Progressive Muscular Dystrophies and Defective Gene/proteinDuchenne* DystrophinQBecker's* DystrophinQLimb girdle* Myotilin, Laminin A/c, Caveolin-3* Calpain-3, Dysferlin, y,a,B,y sarcoglycans* Telethonin, Fukutin related protein, Titin, TRIM 32 geneEmery Dreifuss* Emerin, LamininsMyotonic dystrophy* (DM1) Unstable expansion of a CTG trinucleotide repeat in a serine threonine protein kinase gene (named DMPK) on chromosome 19q 13.3 * (DM2) DNA expansion of a CcTG repeat in the ZNF9 gene on chromosome 3q 13.3-q24Fascioscapulohumeral* Deletion distal 4qOculopharyngeal* Expansion Poly-A RNA binding protein.

So the answer to this question is B


Instruction:
Toxic shock syndrome is mostly due to which vaccine?
A. Mumps
B. Measles
C. Salk
D. Tetanus

Response:
TSS occurs when Measles Vaccine is Contaminated or the same l is used for more than one session on the same day or next day. It reflects poor Quality of Immunization Services . It is totally preventable. Symptoms are severe watery diarrohoea, vomiting and high fever. Case fatality rates are high. It may cause death within 48 hrs.

So the answer to this question is B


Instruction:
False statement about macrophages -
A. Can harbor mycobacteria
B. Derived from blood monocytes
C. Involved in type III hypersensitivity reactions
D. Produce tumor necrosis factor and interleukins

Response:
Type III hypersensitivity occurs when there is an excess of antigen, leading to small immune complexes being formed that fix complement and are not cleared from the circulation. Large complexes can be cleared by macrophages but macrophages have difficulty in the disposal of small immune complexes.

So the answer to this question is C


Instruction:
Anti thyrogiobulin antibodies seen in -
A. Hashimoto thyroiditis
B. Graves disease
C. De quervain thyroiditis
D. Subacute lymphocytic thyroiditis

Response:
Ans. is 'a' i.e., Hashimoto thyroiditis

So the answer to this question is A


Instruction:
Transamination reaction requires -
A. Biotin
B. Folic acid
C. Pyridoxin
D. Niacin

Response:
Ans. is 'c- i.e., Pyridoxin o Transamination involves the reversible transfer of a-amino group of a-amino acid to an a-keto acidQ to form a new amino acid and a new keto acid.o The enzyme catalyze the reaction is called aminotransferase (transaminase).o Most transaminases use GL-ketoglutarate (a-keto acid) as a common acceptor of a-amino group of a-amino acids,o All transaminases require pyridoxal phosphate (Vitamin B6) as a coenzymneQ.VitaminActive form (coenzvmes)Reaction typeB1 (Thiamin)Thiamine pyrophosphate (TPP)Oxidative decarboxylation, TransketolationB2 (Riboflavin)FMNt FADOxidation / Reduction (Redox reaction)B3 (Niacin)NAD\ NADP"Oxidation / Reduction (Redox reaction)B6 (Pyridoxin)Pyridoxal phosphate (PLP)Transamination, deamination, decarboxylation, condensation, trans-sulfurationBp (cobolamin)Methylcobalamin, deoxyadenosylcobalaminIsomerization of methylmelonyl-CoA to succinvl-CoA, synthesis of methionine from homocysteineFolic acidTetrahydrofolate (THF)One carbon group transferBiotinBiocytinCarboxylationPantothenic acidPentothenate in CoA and ACPAcyl group transferVitamin KVitamin KCarboxylation of glutamic acid residue

So the answer to this question is C


Instruction:
Which anticonvulsive agent would be MOST appropriate as first-line therapy for a 21-year-old woman recently diagnosed with complex paial seizures?
A. Lamotrigine
B. Carbamazepine
C. Topiramate
D. Phenytoin

Response:
Since the women is in reproductive age group so option B (Carbamazepine) is C/I as it may l/t neural tube defects. Therefore, option A

So the answer to this question is A


Instruction:
All of the following drugs can cause SLE like syndrome Except
A. INH
B. Diltiazem
C. Procainamide
D. Penicillin

Response:
The most common drugs that cause Drug-induced lupus erythematosus are hydralazine, procainamide, isoniazid, quinidine, diltiazem, minocycline Drugs most commonly associated with drug-induced SCLE include calcium-channel blockers, angiotensin-conveing enzyme inhibitors, thiazide diuretics, terbinafine, TNF-alpha antagonists. Penicillamine (not penicillin) can cause Drug-induced lupus erythematosus Penicillamine is a chelating agent REF: KD Tripathi 8th ed

So the answer to this question is D


Instruction:
Retinal detachment in Eale's disease is
A. Exudative RD
B. Tractional RD
C. Rhegmatogenous RD
D. All of the above

Response:
Tractional RD  - Eale's disease ,Trauma,Sickle cell retinopathy.

So the answer to this question is B


Instruction:
Not true about aedes mosquitos -
A. Are recurrent day time biters
B. Eggs cannot survive more than 1 week without water
C. Transmits dengue fever
D. Prefer breeding in stagnant water

Response:
Even Under orable conditions, the egg stage of mosquitoes lasts for only 1-2 days. Aedes are fearless biters and chiefly bite during the day, Aedes prefer an aificial collection of water. Transmits dengue, dengue haemorrhagic fever. REFERENCE: PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE, 25TH EDITION, PG NO. 831

So the answer to this question is B


Instruction:
Escitalopram is a
A. Selective serotonin reuptake inhibitor.
B. Nonspecific norepinephrine uptake inhibitor
C. Atypical Antideppressants
D. MAO Inhibitors

Response:
(A) Selective serotonin reuptake inhibitor # Mechanism of action of Escitalopram: Highly potent blockade of serotonin reuptake transport mechanism S CT without its inactive R-enantiomer.> Selective serotonin reuptake inhibitors: include Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Venlafaxine. Norepinephrine uptake inhibitors: Amitriptyline, Clomipramine, Doxepin, Imipramine, Desipramine.Trimipramine, Amoxapine, Maprotiline, Nortryptalline, protyptalline. Atypical Antideppressants: Amoxapine. Atomoxetin, Maprotiline, Trazodone and Bupropion, Venlafaxine, Mirtazapine, Nefazodone, and Duloxetine. MAO Inhibitors: Tranylcypromineto phenelzine, Selegiline

So the answer to this question is A


Instruction:
Alcohol intoxication is a form of -
A. Psychosis
B. Anxiety neurosis
C. Dependence
D. Withdrawal syndrome

Response:
Alcohol-related psychosis is a secondary psychosis, with predominant hallucinations occurring in many alcohol-related conditions including intoxication.

So the answer to this question is A


Instruction:
A 34-yrs-old woman is trying for a pregnancy for 3 years. On p/V these is a nodular, tender uterosacral ligament, a retroveed but normal-sized uterus, and a right adnexal mass. A recent pelvic ultrasound reveals a 6-cm right complex ovarian mass. Her CA-125 is elevated. What is the initial next step in management?
A. GnRH agonist
B. Diagnostic Hysterosalpingography
C. Laparoscopy with cystectomy
D. Laparoscopy and right oophorectomy

Response:
The most likely diagnosis here is an endometrioma of the right ovary. Because this patient has been attempting to get pregnant, conservative surgery to remove the endometrioma while preserving ovarian tissue and to ablate any endometriotic implants may improve her chances. Medical therapy with a GnRH agonist may treat her symptoms, but it will not treat the ovarian cyst or help her get pregnant. CA-125 can be elevated with endometriosis and is not specific to endometriosis alone

So the answer to this question is C


Instruction:
Age group affected by Hepatitis 'A' virus ?
A. Children
B. Adult
C. Old age
D. Any age

Response:
Ans. is 'a' i.e., children Virus Age affected . Hepatitis A Children, young adults . Hepatitis B Young adults, babies, toddlers . Hepatitis C Any age (more common in adults) . Hepatitis D Any age . Hepatitis E Young adults

So the answer to this question is A


Instruction:
Pit viper beongs to -
A. Viperidae
B. Elapidae
C. Sea snakes
D. Crotalidae

Response:
Ans. is 'd' i.e., Crotalidae o Poisonous snakes are divided into six families:Viperidae - Russell's viper, gaboon viper, saw scaled viper, puff adder. They are found in all parts of world except America.Crotalidae - Rattlesnakes, pigmy rattlesnakes, copperheads, pit viper & bush master. They are found in Asia and America.Elapidae - Cobras, kraits, mambas, tiger snake, death adder, copperhead snakes and coral snakes. They are found in all parts of world except Europe.Hydrophidae or sea snakes - All sea snakes are poisonous but they seldom bite.Colubridae - Boomslangs, bird snake of the African continent.Atractaspididae - African & Middle Eastern burrowing asps or stiletto snakes.

So the answer to this question is D


Instruction:
A 4-year old boy presents with a history of left ankle joint swelling and pain for four days. It was preceded by an upper respiratory infection. On examination, the left ankle is swollen and tender. There is a petechial rash over the lower limbs. He is admitted two days later with bleeding per rectum. The most likely clinical diagnosis is:
A. Acute rheumatic fever
B. Juvenile rheumatoid ahritis
C. Pyogenic ahritis
D. Henoch-Schonlein purpura

Response:
Features of HSP are: 1. Aetiology is not known. 2. The hallmark of the disease is rash that progresses to petechiae or purpura. It is more prominent over the extensor aspect of lower extremities and buttocks. 3. Ahritis is seen in two-thirds of children and is localized to ankles and knees. 4. Abdominal pain and vomiting are common. 50% have occult blood in stool. Diarrhoea (with or without visible blood loss) or haematemesis are however' less common. 5. Renal involvement is seen in 25 to 50% of cases. 6. CNS involvement is rare but has potentially serious outcome.

So the answer to this question is D


Instruction:
Which of the following is the preformed toxin involved in mechanism of allergic rhinitis -
A. Histamine
B. Leukotriene
C. TXA2
D. PGD2

Response:
Ans. is 'a' i.e., Histamine Examples of immediate hypersensitivity reaction includeAnaphylaxis (drugs, bee sting, food)Bronchial asthmaAllergic, rhinitis/ sinusitis (hay fever)Food allergieso Mediators of Immediate Hypersensitivity: Mast cell activation leads to degranulation, with the discharge of preformed (primary) mediators that are stored in the granules, and de novo synthesis and release of secondary mediators, including lipid products and cytokines.o Preformed (Primary) Mediators. Mediators contained within mast cel! granules are the first to be released and can be divided into three categories:Vasoactive amines - Histamine (most important). Enzymes - Neutral proteases (chymase, tryptase) and several acid hydrolases.# Proteoglycans-Heparin and chondroitin sulfate.# Lipid Mediators-Arachidonic acid-derived products: leukotrienes and prostaglandins# Leukotrienes-Leukotrienes C4 and D4 are the most potent vasoactive and spasmogenic agents known. They are several thousand times more active than histamine in increasing vascular permeability and causing bronchial smooth muscle contraction. Leukotriene B4 is highly chemotactic for neutrophils, eosinophils, and monocytes.Prostaglandin D2Platelet-activating factor (PAF).o Cytokines - Mast cells are sources of many cytokines, which may play an important role at several stages of immediate hypersensitivity reactions. The cytokines include: TNF, IL-1, and chemokines, which promote leukocyte recruitment (typical of the late-phase reaction); IL-4. which amplifies the TH2 response.

So the answer to this question is A


Instruction:
All are true regarding Idiopathic edema of woman except-
A. It is due to estrogen mediated sodium retention
B. It is not related to menstrual cycle
C. There is increased water retention in upright position
D. ACE inhibitors can be useful in some cases

Response:
Idiopathic edema is a common cause of fluid retention and swelling (edema) in women. "Idiopathic" means that the cause of this condition is unknown. Idiopathic edema occurs in the absence of hea, kidney, or liver disease. It is often associated with diabetes, obesity, and emotional problems Ref Davidson 23rd edition pg 369

So the answer to this question is A


Instruction:
Chronic liver disease is caused by
A. Hepatitis B
B. Hepatitis A
C. Hepatitis C
D. Hepatitis E

Response:
None

So the answer to this question is C


Instruction:
Nissl substance is found in: March 2013
A. Neuron
B. Hepatocytes
C. Cardiocytes
D. ENterocytes

Response:
Ans. A i.e. Neuron Nissl body/Nissl or tigroid substance It is a large granular body found in neurons. These granules are rough endoplasmic reticulum (RER) with rosettes of free ribosomes, and are the site of protein synthesis. It was named after Franz Nissl, a German neurologist who invented the Nissl staining method

So the answer to this question is A


Instruction:
Kussmaul's sign is positive in
a. Restrictive cardiomyopathy
b. Constrictive pericarditis
c. Cardiac tamponade
d. Dilated cardiomyopathy
e. Pneumothorax
A. a,b,e
B. a,b
C. a,c,d,e
D. a,b,c,d,e

Response:
Kussmaul's sign is rise in JVP with inspiration.  It is seen in constrictive pericarditis  and Restrictive cardiomyopathy.

So the answer to this question is B


Instruction:
PCT secretes
A. Sodium
B. Glucose
C. Hydrogen ions
D. Amino acids

Response:
PCT secretes H+ into tubule thus helping in excretion . Ref: Ganong's review of medical physiology; 24th edition; page no: 685

So the answer to this question is C


Instruction:
Which is a pro-drug?
A. Cyclophosphamide
B. Lisinopril
C. Metochlopramide
D. Ranitidine

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

So the answer to this question is A


Instruction:
Man coughed and developed sudden severe headache and fainting. The most probable diagnosis is:
A. Subarachnoid hemorrhage
B. Migraine
C. Cluster Headache
D. Posterior fossa tumor

Response:
Ans: A (Subarachnoid hemorrhage) Ref: Harrison's Principles of Internal Medicine 18th editionExplanation:Subarachnoid HemorrhageExcluding head trauma, the most common cause of S AH is rupture of a saccular aneurysm.Other causes include bleeding from a vascular malformation (arteriovenous malformation or dural arterial-venous listula)Saccular ("Berry") Aneurysm2% of adults harbor intracranial aneurysmsThe three most common locations are theTerminal internal carotid arteryMiddle cerebral artery (MCA) bifurcationTop of the basilar artery.Mycotic aneurysms are usually located distal to the first bifurcation of major arteries of the circle of Willis.Most result from infected emboli due to bacterial endocarditis causing septic degeneration of arteries and subsequent dilation and rupture.PathophysiologySaccular aneurysms occur at the bifurcations of the large- to medium-sized intracranial arteriesRupture is into the subarachnoid space in the basal cisterns and often into the parenchyma of the adjacent brain.Approximately 85% of aneurysms occur in the anterior circulation, mostly on the circle of Willis.About 20%' of patients have multiple aneurysms, many at mirror sites bilaterally.Clinical ManifestationsMost unruptured intracranial aneurysms are completely asymptomatic.At the moment of aneurysmal rupture w ith major SAH, the ICP suddenly rises.This may account for the sudden transient loss of consciousness that occurs in nearly half of patients.Sudden loss of consciousness may be preceded by a brief moment of excruciating headache, but most patients first complain of headache upon regaining consciousness.Severe headache associated with exertion is the presenting complaint. The patient often calls the headache ''the worst headache of my life '; however, the most important characteristic is sudden onset.The headache is usually generalized, often with neck stiffness, and vomiting is common.Sudden headache in the absence of focal neurologic symptoms is the hallmark of aneurysmal rupture.Focal deficits can occur rarely.Anterior communicating artery or MCA bifurcation aneurysms may bleed enough to produce mass effect. The deficits that result can include hemiparesis, aphasia, and abulia.A third cranial nerve palsy, particularly when associated with pupillary dilation, loss of ipsilateral (but retained contralateral) light reflex, and focal pain above or behind the eye, may occur with an expanding aneurysm at the junction of the posterior communicating artery and the internal carotid artery.A sixth nerve palsy may indicate an aneury sm in the cavernous sinus, and visual field defects can occur with an expanding supraclinoid carotid or anterior cerebral artery aneurysm.Occipital and posterior cervical pain may signal a posterior inferior cerebellar artery or anterior inferior cerebellar artery aneurysm.Pain in or behind the eye and in the low temple can occur with an expanding MCA aneurysm.

So the answer to this question is A


Instruction:
The special tray which is used for agar impression material, has a water channel, which helps in setting of the material. The temperature of water flowing in channel is
A. 25 deg - 35 deg
B. 37 deg - 45 deg
C. 15 deg - 17 deg
D. 18 deg - 21 deg

Response:
None

So the answer to this question is D


Instruction:
Antipsychotic drug with maximum hypotensive effect is
A. Fluphenazine
B. Trifluperazine
C. Thioridazine
D. Haloperidol

Response:
low potency antipsychotics like thioridazine and chlorpromazine are associated with lot of systemic side effects as mentioned in the below table. They have side effects like hypotension, sedation, giddiness, dryness of mouth and cardiac side effects. High potency has lot of neurological side effects. Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 972

So the answer to this question is C


Instruction:
Presence of calcification in an intracranial lesion is best made out by:
A. CT
B. MRI
C. Ultrasound
D. Contrast study

Response:
Ans. CT

So the answer to this question is A


Instruction:
YAG laser capsulotomy is used in-
A. Retinal detachment
B. Diabetes
C. After-cataract
D. Refractive errors

Response:
*After cataract is treated by Nd-YAG laser posterior capsulotomy. *YAG laser is used to create holes e.g. posterior capsulotomy,irototomy. Ref: Khurana 7th/e p.212

So the answer to this question is C


Instruction:
A 25 yr old male having fever & malaise since 2 weeks, ahritis of ankle joint and tender erythematous nodules over the shin. Diagnosis is?
A. Erythema nodosum
B. Erythema marginatum
C. Weber Christian disease
D. Uicarial vasculitis

Response:
Erythema nodosum is most common on the shins, but it may also occur on other areas of the body (buttocks, calves, ankles, thighs, and arms). The lesions begin as flat, firm, hot, red, painful lumps approximately an inch across. Within a few days they may become purplish, then over several weeks fade to a brownish, flat patch. Other symptoms may include: a. Fever b. General ill feeling (malaise) c. Joint aches d. Skin redness, inflammation, or irritation e. Swelling of the leg or other affected area. Causes of erythema nodosum infections, such as Streptococcal pharyngitis or strep throat. bacterial infections, such as Mycoplasma pneumonia or tuberculosis. viral infections. deep fungal infections. sarcoidosis. cancer. antibiotics. oral contraceptives Ref Robbins 9/e pg 345

So the answer to this question is A


Instruction:
Muscle spindle is -
A. Receptor for a variety of multisynaptic reflexes
B. Receptor for myotatic or stretch receptor reflex
C. Occurs only in antigravity extensor muscles
D. Excited by both stretch and contraction of the muscles in which it is Located

Response:
B i.e. Receptor for stretch receptor reflex

So the answer to this question is B


Instruction:
Apoptotic bodies are -
A. Clumped chromatin bodies
B. Pyknotic nucleus without organelles
C. Cell membrane bound with organelles
D. No nucleus with organelles

Response:
Ans is 'c' i.e., Cell membrane bound with organelleso Apoptotic bodies are formed during the process ofApoptosis, by fragmentation of surface blebs of the apototic cell. These are membrane bound bodies composed of cytoplasm and tightly packed organelles, with or without nucleus.

So the answer to this question is C


Instruction:
Vestibulo ocular reflex is concerned with
A. Archicerebellum
B. Flocculonodular lobe
C. Neocerebellum
D. Occipital lobe

Response:
The flocculonodular lobe is phylogenetically the oldest pa of cerebellum has vestibular connections and is concerned with equilibrium and eye movements (vestibulo ocular reflex). Ref: Ganong&;s review of medical physiology; 23rd edition; pg:257.

So the answer to this question is B


Instruction:
Clostridium difficile causes -
A. Pseudomembranous colitis
B. Nosocomical diarrhea
C. Gas gangrene
D. Food poisoning

Response:
Ans. is 'a' i.e., Pseudomembranous colitis & 'b' i.e., Nosocomical diarrhea * Cl difficle causes Clostridium difficle - associated diseases (CDAD).* CDAD is the most commonly diagnosed diarrheal illness acquired in the hospital.* C. difficle is acquired exogenously, most frequently in the hospital.* C. difficle is the most common bacterial cause of nosocomial diarrhea.* Diarrhea is the most common symptom of CDAD.* Pseudomembranous colitis is the advanced form of CDAD.* CDAD is almost exclusively associated with antibiotic use. It is caused most commonly by 2nd generation cephalospirinsy clindamycin, ampicillin and fluoroquinolones.* Other important risk factors (beside antibiotic use) are old age, GI surgery, use of electrical thermometer, use of antacids and PPIs, and prolonged hospital stay.* Pseudomembranous colitis is caused by two large toxins of Cl difficle1) Toxin A (enterotoxin) : Causes disruption of cystoskeleton by glycosylation of GTP-binding proteins.2) Toxin B (cytotoxin) : Has effect similar to toxin A.

So the answer to this question is A


Instruction:
Blood agar is
A. Enrichment media
B. Enriched media
C. Selective media
D. Transport media

Response:
Ans. (b) Enriched media

So the answer to this question is B


Instruction:
Symptoms of narcolepsy are all except
A. Cataplexy
B. Catalepsy
C. Daytime sleepiness
D. hypnagogic hallucinations

Response:
NarcolepsyThe classic tetrad of symptoms is:i. Sleep attacks (most common): ii. Cataplexy: iii. Hypnagogic hallucinations: iv. Sleep paralysis (least common): Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 138

So the answer to this question is B


Instruction:
At birth, which of the following structures is nearest to the size it will eventually attain in adulthood?
A. Cranium
B. Mandible
C. Middle Face
D. Nasal capsule

Response:
Timing of Cranial Base Growth:

So the answer to this question is A


Instruction:
A young boy presented with high fever shows clinical features suggestive of Legionnaires' Disease. Treatment of choice is:
A. Amoxicillin
B. Azithromycin
C. Penicillin
D. Streptomycin

Response:
The macrolides (especially azithromycin) and the respiratory quinolones are now the antibiotics of choice and are effective as monotherapy. Compared with erythromycin, the newer macrolides have superior in vitro activity, display greater intracellular activity, reach higher concentrations in respiratory secretions and lung tissue, and have fewer adverse effects. Ref: Sabria M., Yu V.L. (2012). Chapter 147. Legionella Infections. 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 B


Instruction:
IUCD having the longest life span is
A. Progestase
B. Cu T 380A
C. Mirena
D. Nova T

Response:
The time periods for replacement for various IUDs are: - Copper T 200:3years- Multiload Cu 250:3 years - Multiload Cu 375: 5 years- LNG-IUS/Mirena : 5 years- Cu T 380A : 10 years ( also known as Paraguard)- Nova : 3years - Progestase : 1 years

So the answer to this question is B


Instruction:
All of the following cause visual loss in hypeension EXCEPT:
A. Occipital infarct
B. Anterior ischemic optic neuropathy
C. Papilloedema
D. Hemorrhage

Response:
Hypeension is a known cause of papilledema. Hemorrhage in the vitreous is caused by hypeension. Therefore by exclusion the answer is occipital infarcts. Fuher the aicle states that occipital infarcts are different from other infarcts because their etiology is also different and hypeension is not a usual cause. Causes of anterior ischemic optic neuropathy: *Idiopathic *Giant cell aeritis *Papilledema *Migraine *Malignant hypeension

So the answer to this question is A


Instruction:
During pregnancy, fibroid may have all of the following complications except: March 2009
A. Metastasis
B. Pain
C. Post paum hemorrhage
D. Preterm labour

Response:
Ans. A: Metastasis Pregnant women with fibroids are at increased risk for: Pain Breech presentation Malposition Higher incidence of cesarean delivery Preterm bih Premature rupture of the membranes Postpaum hemorrhage Placental abruption Submucosal, fibroids located beneath the placenta, and fibroids 7 to 8 cm in diameter had the highest risk for abruption.

So the answer to this question is A


Instruction:
Carcinoma cervix extends upto lateral pelvic wall. The stage would be :
A. Stage I
B. Stage II
C. Stage III
D. Stage IV

Response:
Ans. is c i.e. Stage III

So the answer to this question is C


Instruction:
Kupffer cells in liver are responsible for:September 2007
A. Lytic functions
B. Excretory functions
C. Absorptive functions
D. Phagocytic functions

Response:
Ans. D: Phagocytic functionsKupffer cells/Browicz-Kupffer cells are specialized macrophages located in the liver lining the walls of the sinusoids that form pa of the reticuloendothelial system.

So the answer to this question is D


Instruction:
Deep peroneal nerve supplies
A. 1st web space of foot
B. 5th web space of foot
C. Antero lateral dorsum of foot
D. Lateral pa of leg

Response:
DEEP PERONEAL:- Muscular branches to muscles of anterior compament of leg: Tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus teius.Extensor digitorum brevis Cutaneous: dorsal digital nerves for adjacent sides of big toe and second toe. Aicular branches: Ankle joint, tarsal joints, tarsometatarsal joints and metatarsophalangeal joint of big toe. {Reference:BDC 6E }

So the answer to this question is A


Instruction:
Peripheral cell membrane proteins are -
A. Pump
B. Channel
C. Adhesion molecules
D. Enzyme receptors

Response:
Ans. is 'c' i.e., Adhesion molecules Proteins in cell membraneo Most of the membrane proteins are glycoproteins. There are following types of membrane proteins : -Integral (Transmembrane or intrinsic) Proteins : -These proteins pass 'through and through', i.e., they run (span) the entire length of lipid bilayer. Integral proteins are globular and amphipathic, consisting of two hy drophilic ends separated by an intervening hydrophobic region that traverses the hydrophobic core of the bilayer. Integral proteins interact by non-polar (hydrophobic) interacts with the fatty acyl groups of phospholipids in the cell membrane and require the use of detergents for their solubilization. Integral proteins are asymmetrically distributed across the membrane bi layer.Integral proteins function as channels (pores), receptors, ion pumps, carrier proteins and enzyme.Peripheral (Extrinsic) proteinsPeripheral proteins are present on the surface of the membrane and do not penetrate all the way through. They are located on both surface of membrane, outer and inner. Peripheral proteins do not interact directly with the phospholipid in the bilayer. They bound to the hydrophilic regions of the transmembrane proteins through electrostatic and hydrogen bonds. However, some (not all) proteins bind to membrane via a covalentently attached lipid anchor, i.e., interaction with polar (hydrophilic) lipid head groups in the membrane,As they do not interact directly with hydrophobic core of phospholipids, they do not require use of detergents for their release. They can be released by treatment with salt solutions of high ionic strength. Peripheral proteins serve as cell adhesion molecules (CAMs) that anchor cells to neighboring cells and to basal lamina. They also contribute to cytoskeleton when present on the inside of the membrane, e.g., spectrin, ankyrin, band 4.1 in RBCs.

So the answer to this question is C


Instruction:
Aaron Beck's cognitive triad of depression includes all except
A. Negative thought of self
B. Negative thought of future
C. Negative thought of friends
D. Negative thought of environment

Response:
Negative thoughts about friends aren't included in triad.Environment, self and future -hopelessness, wohlessness, helplessness are only described as triad by Aaron Beck Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 604

So the answer to this question is C


Instruction:
Intra enamel depth preparation in porcelain laminate
veneer
A. 0.5 mm
B. 0.75 mm
C. 1 mm
D. 2 mm

Response:
None

So the answer to this question is A


Instruction:
Local lymph nodules are enlarged near the infected wound. Increased amount of macrophages, lymphocytes, lymphatic follicles in the coical layer and large amount of plasma cells were revealed on histological examination. What process in the lymphatic nodules represent these histological changes?
A. Antigen stimulation
B. Acquired insufficiency of the lymphoid tissue
C. Tumour transformation
D. Innate insufficiency of the lymphoid tissue

Response:
In the given question there is enlargement of local lymph nodes near the infected wound. Histologically:- Presence of Macrophages, Lymphocytes, Lymphatic follicles in the coical layer and large amount of Plasma cells. It is because the antigens from the wound are going to be drained to the lymph node. These antigens will cause B cell activation, once the B cell are going to be activated, they are going to get conveed into the Plasma cell and that is responsible for causing enlargement of the lymph node. Therefore, after any kind of infection or any kind of inflammation the reactive lymph node enlargement will occur and this is explained on the basis of Antigen stimulation.

So the answer to this question is A


Instruction:
(Weight = Height - 100) denotes which formula/ index-
A. Corpulence index
B. Broca index
C. Lorentz's formula
D. Ouetlef s index

Response:
Ans. is 'b' i.e., Broca index o Has been explained in All India Dec-15

So the answer to this question is B


Instruction:
A 12 hour old male child of a diabetic mother is brought to you with seizures, which of the following is the least likely cause?
A. Hypoglycemia
B. Hypocalcemia
C. Hypermagnesemia
D. Bih asphyxia

Response:
It is possible for babies of diabetic mothers to suffer from hypoglycemia, hypocalcemia & hypomagnesemia resulting in seizure. The exact mechanism of hypomagnesemia and hypocalcemia is not clear. Ref: Karla Philip, 3rd Edition, Page 296

So the answer to this question is C


Instruction:
The probable source of relaxin is:
A. Ovary
B. Adrenal cortex
C. Liver
D. Bartholins gland

Response:
• Relaxin is a peptide hormone. It is produced by the ovary to be specific by the corpus luteum of pregnancy If corpus
luteum is in options, it should be the answer of choice. It has also been identified in :
– placenta
– decidua
– chorion
• It is not detected in men and non pregnant women.
• Levels of Relaxin rise during 1st trimester when corpus luteum is dominant and declines in the second trimester. This
suggests a role in maintaining early pregnancy.
• In animals, relaxin softens the cervix, inhibits uterine contractions and relaxes public symphysis.
• It has no effect on prolactin secretion but enhances growth hormone secretion by the pituitary.

So the answer to this question is A


Instruction:
Housemaid's knee affects which of the following?(MH 2014)
A. Prepatellar bursa
B. Infrapatellar bursa
C. Suprapatellar bursa
D. Anserine bursa

Response:
Ans. a (Prepatellar bursa). (Ref. Maheshwari, Orthopaedics, 2nd ed., 255)The 5 main bursae around the knee joint are - Prepatellar, Infrapatellar, Suprapatellar and Anserine bursa. Housemaid's knee is prepatellar bursitis (Irritation bursitis, or Infective bursitis). Named bursal diseaseMeans1Housemaid's kneePrepatellar superficial bursitis2Clergyman kneeInfrapatellar superficial bursitis3Student's elbowOlecranon bursitis4Weaver's bottomIschial bursitis5BunionBursitis at the first Metatarsophalangeal joint of foot causing swelling atmmedial aspect to the great toe base and lateral displacement of the toe.Bursae:# Sandwiched between tissues that slide past each other, bursae decrease the frictional forces present.# They are endothelialined cushions and normally contain little fluid.# If they are overloaded they can become inflamed, swollen and very painful.# Common sites for bursitis to develop are:- Olecranon;- Psoas tendon;- Greater trochanter; - Iliotibial band;- Prepatellar;- Infrapatellar;- Retro calcaneal.# Avoidance of the aggravating mechanical factors and a short course or anti-inflammatories is usually sufficient.# Intractable cases require aspiration and steroid injections and, more rarely, excision of the indurated bursal wall.

So the answer to this question is A


Instruction:
All of the following lead to increased dissociation of O2 from Hb except
A. HbF
B. Increased CO2
C. Increase H+
D. Increase Temperature

Response:
Fetal hemoglobin or fetal hemoglobin, (also hemoglobin F or HbF) is the main oxygen transpo protein in the human fetus during the last seven months of development in the uterus and in the newborn until roughly 6 months old.Ref: Ganong&;s Review of Medical Physiology; 24th edition; page no:641

So the answer to this question is A


Instruction:
Foamy liver is found in
A. Drowning
B. Putrefaction
C. Adipocere
D. Abortion

Response:
(Putrefaction) (3.25-P)PUTREFACTION - Liver becomes softened and flaby* Owing to the evolution of gases in its substances. It becomes spongy and present a honey- combed appearance (foamy or Swiss Cheese liver)* The patch of greenish discolouration appears early and gradually extends to the whole organ which ultimately becomes black.

So the answer to this question is B


Instruction:
Most commonly involved organ in congenital tuberculosis is
A. Lungs
B. Liver
C. Lymph nodes
D. Skin

Response:
Ans. Answer is B (Liver): Most common primary site- LIVER (primary complex in liver is suggestive of congenital TB) Most common site is- LUNG The form of disease is usually miliary with multiple organ involvement. Lungs are involved in almost all cases. Other sites frequently involved are liver, spleen, lymph nodes, the gastrointestinal tract and kidney'. -Textbook of Pulmonary Medicine by Behera 2"a/495

So the answer to this question is B


Instruction:
Rubella vaccination is contraindicated in all except-
A. Patient on immunosuppressant
B. Girl with Leukemia
C. Girls between 11-14 years
D. Pregnancy

Response:
None

So the answer to this question is C


Instruction:
Primary health care, true are all except -
A. Essential health care for all
B. Health services are taken to the doors of people
C. Placing people's health in people's hands
D. Sectors like agriculture, animal husbandry, food industry & communication are involved

Response:
The Alma -Ata international conference gave primary health care a wider meaning.The Alma-Ata conference defined primary health care as follows "Primary health care is essential health care made universally accessible to individual and acceptable to them through their full paicipation and at a cost the community and county can afford "(refer pgno:891 park 23rd edition)

So the answer to this question is B


Instruction:
Most common site for trauma of spine is-
A. Cervical veebrae
B. Thoracic veebrae
C. Lumbar veebrae
D. Sacrum veebrae

Response:
*Traumatic spine injuries most commonly affect cervical spine (50-60%)followed by dorsolumbar junction. Ref: Clinical Ohopaedics maheswari 9th p.786

So the answer to this question is A


Instruction:
A patient complaints of sadness of mood, increased letharg, early morning awakening, loss of interest and repos no will to live and hears voices asking her to kill self. What is the diagnosis?
A. Schizophrenia
B. Major depressive disorder plus psychosis
C. Schizoaffective disorder
D. Schizotypal personality disorder

Response:
The symptoms of depression are there plus adding psychotic symptoms of hallucinations make it a diagnosis of MDD PLUS PSYCHOSIS. SymptomsOF DEPRESSION -(SIGECAPSS) S- Sadness of mood/ depressed mood (persistent & pervasive) I- Loss of interest / pleasure (Anhedonia) G- Guilt/ Feeling of wohlessness . E- Energy (loss)/ Fatigue C- Concentration loss, cognition (negative thoughts) A- Appetite (loss/ gain) with significant weight changes (>5% change in 1 month) P- Psychomotor Agitation/ Retardation S- Suicidal thoughts Note:Suicidal thoughts are fuher classified into 3: Death wishes (patient feels death should come to me ) - GRADE 1 Suicidal wish (patient says I wish I could commit suicide ) - GRADE 2 Suicidal intent (patient says I would be killing myself ) - GRADE 3 S - Sleep abnormalities (decreased/ increased) Early morning insomnia ( getting up >2 hrs earlier than the usual waking time ) Reduced latency of REM sleep Sleep is usually decreased but it might be increased also. Criteria for defining depression ( according to DSM - 5 ) : From the above 9 symptoms 5 must be present & at least 1 must be present out of first 2 for at least 2 weeks duration.

So the answer to this question is B


Instruction:
The stimulant drug is given to the child for -
A. Conduct disorder
B. Speech developmental disorder
C. Pervasive disorder
D. ADHD

Response:
Stimulants (like methylphenidate, dextroamphetamine) are the drugs of choice for ADHD.

So the answer to this question is D


Instruction:
In a detached retina, the site of detachment is found
A. Within the outer plexiform layer
B. Within the inner plexiform layer
C. Between the inner nuclear layer and the outer nuclear layer
D. Between the pigment epithelial layer and the layer of outer segments of rods and cones

Response:
The site of retinal detachment is between the pigment epithelial layer and the layer of outer segments of rods and cones; this corresponds to the intraretinal space between the inner and outer layers of the optic cup. Retinal detachment occurs when fluid from the vitreous compament passes through a retinal hole and separates the pigment epithelial layer from the layer of outer segments of rods and cones.

So the answer to this question is D


Instruction:
Drug of choice for rapid cyclers in manic-depressive psychosis is:
A. Carbamazepine
B. Valproate
C. Phenytoin
D. Lithium

Response:
uction in manic relapses is noted when valproate is used in bipolar disorder. It is now a first line treatment of acute mania in which high dose valproate acts faster and is an alternative to antipsychotic +- benzodiazepine. It can be useful in those not responding to lithium or not tolerating it. Patients with rapid cycling pattern may paicularly benefit from valproate therapy Ref: KD Tripati 8th ed.

So the answer to this question is B


Instruction:
Best investigation for BCR-ABL
A. Flow cytometry
B. Fluorescent in situ hybridization
C. EISA
D. Polymerase chain reaction

Response:
Ans. (b) Florescent in situ hybrdization(Ref: Robbins 9th/pg 170)In PCV: Reddening, swelling, and pain in the digits (erythromelalgia) may occur and are typically associated with extreme platelet elevations.

So the answer to this question is B


Instruction:
Conjunctivitis is caused by all EXCEPT :
A. CMV
B. Enterovirus 70
C. Coxsackies A 24
D. Adenovirus

Response:
Ans is 'a' i.e. CMV Enterovirus 70 causes - Acute hemorrhagic conjunctivitisCoxsackie A-24 causes - Acute hemorrhagic conjunctivitisAdenovirus causes - Epidemic keratoconjunctivitis (usually by type 8, 19, 37)Acute Follicular conjunctivitis (Type 3, 4 and 11 are commonly implicated)CMV does not cause conjunctivitis

So the answer to this question is A


Instruction:
A 55 year old female patient has carcinoma ovary with bilateral involvement with ascitic fluid in the abdomen. The stage is:
A. II
B. III
C. IV
D. IC

Response:
None

So the answer to this question is D


Instruction:
EYE strategy is developed for elimination of
A. Yaws
B. Yellow fever
C. Leptospirosis
D. Zika virus

Response:
Ref:Park's Textbook of Preventive and Social Medicine 25th Ed pg.310

So the answer to this question is B


Instruction:
Enzyme alpha naphtyl esterase is present in ?
A. Neutrophil
B. Eosinophil
C. Lymphocyte
D. Monocyte

Response:
Ans. is d i.e., Monocyte

So the answer to this question is D


Instruction:
Iron content of MALA-D -
A. 10 mg
B. 19-5 mg
C. 29-5 mg
D. 40 mg

Response:
An. is 'b' i.e., 19 5 mg o MALA-D contains -30 mg (0- 03 mg) of ethinyl estradiol.0-15 mg of desogestrel (D-norgestrel).o Each brown coloured film coated tablet contains 60 mg ferrous fu mar ate equivalent to ferrous iron 19-5 mg.

So the answer to this question is B


Instruction:
Surgery of choice for chronic acquired dacryocystitis
A. Dacryocystorhinostomy
B. Dacryocystectomy
C. Conjunctivo-cystorhinostomy
D. None

Response:
Ans. is 'a' i.e., Dacryocystorhinostomy Treatment of chronic dacryocystitis Congenital Adult (acquired) Massage over lacrimal sac with antibiotic eye drops Conservative :- Massage, antibiotic drops, probing, Syringing (irrigation) with normal saline & syringing antibiotic solution Dacryocystorhinostomy (DCR) :- Surgery of hoice Probing of nasolacrimal duct Dactyocystectomy (DCT) Intubation with silicone tube Conjunctivocystorhinostom Dacryocystorhinostomy (DCR)

So the answer to this question is A


Instruction:
Clue cells are seen in: March 2004
A. Gardenella vaginalis
B. Candida
C. Trichomoniasis
D. Gonorrhoea

Response:
Ans. A i.e. Gardenella vaginalis

So the answer to this question is A


Instruction:
Which of the following protein can't have quaternary structure?
A. Albumin
B. Immunoglobulin
C. Hemoglobulin
D. Collagen

Response:
For quaternary structure to be present you need more than one polypeptide chain Albumin is a single polypeptide. So, the highest structure it can have is teiary structure. Hemoglobin & Immunoglobulin are tetramer - option b and c are excluded. Collagen has the quaternary structure of quaer staggered arrangement - option d is excluded. fig:-Quaer stagger arrangement of tropocollagen

So the answer to this question is A


Instruction:
What is the pathology of edema in nephrotic syndrome
A. Reduced plasma protein
B. Sodium and water retention
C. Increased venous pressure
D. Hyperlipidemia

Response:
Ans. b. Sodium and water retention Sodium and water retention is the pathology of edema in nephrotic syndrome. The nephrotic syndrome is characterized by proteinuria, edema, and hypoalbuminemia. Renal sodium retention and changes in variables of the Starling equation are fundamental to the pathophysiology of nephrotic edema. There is evidence for both intravascular volume expansion (overfilling) and intravascular volume depletion (under filling) in patients with nephrosis. Microvascular fluid exchange is described using a formulation of the Starling driving forces (DP and Dp) and it is through this equation that nephrotic edema is conceptualized. Previous theories have focused on abnormalities in DP and Dp to explain nephrotic edema. Studies have shown that hypoalbuminemia (and thus Dp) is not a likely cause of edema formation in most nephrotic patients owing to a parallel decrease in interstitial fluid albumin and an increase in interstitial fluid pressure, both of which serve to maintain edema driving forces constant. There is limited evidence suggesting that abnormalities in vascular permeability (Kf and s) may contribute to edema formation. A major advance in our understanding of the pathophysiologic basis of edema formation in the nephrotic syndrome is the discovery that proteinuria can cause primary renal sodium retention through ENaC activation. This mechanism is likely active in all patients with nephrotic syndrome, regardless of their intravascular volume status. Other causes of primary renal sodium retention include increased renal efferent sympathetic nerve activity, ANPase, and in the expression and activity of the Ne--le in the collecting duct in animal models. Fuhermore, excess serum vasopressin levels have been found to contribute to free water retention in some patients with the nephrotic syndrome."- Eric Siddall and Jai Radhakrishnan. The pathophysiology of edema formation in the nephrotic syndrome Nephrotic Syndrome Manifestations of Nephrotic Syndrome 1. Massive proteinuria, with the daily loss of 3.5 gm or more of proteinQ 2. Hypoalbuminemia, with plasma albumin levelsQ 3. Generalized edemaQ 4. Hyperlipidemia and lipiduriaQ Pathophysiology: Renal sodium retention and changes in variables of the Starling equation are fundamental to the pathophysiology of nephrotic edema. There is evidence for both intravascular volume expansion (overfilling) and intravascular volume depletion (under filling) in patients with nephrosis. Nephrotic Syndrome Mechanisms of Sodium Retention in the Nephrotic Syndrome Increased angiotensin 11-independent afferent and efferent aeriolar tone because of increased efferent sympathetic nerve activity. Tubular resistance to atrial natriuretic peptide (ANP). Increased number of open epithelial sodium channel (ENaC) channels in the coical collecting duct due to proteolytic activation of ENaC by plasmin. Increased number and activity of coical collecting duct Na/K ATPase channels Most impoant facts about Nephrotic syndrome The lipid appears in the urine either as free fat or as oval fat bodies, representing lipoprotein resorbed by tubular epithelial cells and then shed along with the degenerated cells. Most proteins are decreased in nephrotic syndrome except Fibrinogen and lipoproteins, due to increased synthesis. Proteins decreased Consequence Albumin Edema due to hypoalbuminemiaQ Transferrin Iron resistant microcytic anemiaQ Cholecalciferol binding proteins HypocalcemiaQ Thyroxin binding globulin Decreased thyroxin (Hypothyroid state)Q IgG Increased susceptibility of infectionsQ Renal vein thrombosis is paicularly common (up to 40%) in patients with nephrotic syndrome due to membranous glomerulopathy, memranoproliferative glomerulonephritis, and AmyloidosisQ. As a consequence of hypercoagulability and changes in proteins, patients can develop spontaneous peripheral aerial or venous thrombosis, renal vein thrombosis, and pulmonary embolismQ

So the answer to this question is B


Instruction:
The weakness of Vastus Medialis causes
A. Patellar Clunk Syndrome
B. Medial dislocation of patella
C. Lateral dislocation of patella
D. Weakness in abduction at Hip joint

Response:
The fibers of Vastus medialis are attached medial to cafue half of patella. They prevent lateral displacement of patella.

So the answer to this question is C


Instruction:
True about mitochondrial DNA:
(A)Linear
(B)Circular
(C)Transmitted by mother only
(D)Transmitted by both parents
(E)Contains less gene than nuclear DNA
A. BCE
B. ABD
C. DAE
D. CAB

Response:
None

So the answer to this question is A


Instruction:
A 33 year old lady present! with polydipsia and polyuria. Har symptoms staed soon after a road traffic accident 6 months ago. The blood pressure is 120/80 mm Hg with no postural drop. The daily urinary output Is 6-8 liters. Investigation showed, Na 130 mEq/L, KJ.5 mEq/L, urea 15mg/dL, sugar-65 mg/dL. The plasma osmolality is 268 mosmol/L and urine osmolatity 45 mosmol/L. The most likely diagnosis is-
A. Central diabetes insipidus
B. Nephrogenic diabetes insipidus
C. Resolving acute tubular necrosis
D. Psychogenic polydipsia

Response:
here there is no thirst and polydipsia due to psychosis ( Harrison 17 pg 2219)

So the answer to this question is D


Instruction:
All are adulterants of heroin, except
A. Chalk powder
B. Quinine
C. Charcoal
D. Fructose

Response:
Adulterants of heroin are sucrose, dextrose, fructose, lactose, mannitol, starches, inositol, chalk powder, milk powder, talcum powder, flour, quinine, procaine, lidocaine, acetyl procaine, methaphyrilene and caffeine.

So the answer to this question is C


Instruction:
Extended spatulation of GIC:
A. Prolongs the setting time
B. Decreases the setting time
C. Does not alter the setting time
D. Any of the above

Response:
None

So the answer to this question is B


Instruction:
A 8-year old child was injected contrast in hand for CECT chest. Immediately he developed swelling in the arm which gradually increased. After 4 hours, there was numbness and pain, and he was not allowing the doctor to flex the hand. Pulse is present. What should be done?
A. High dose prednisolone
B. Arterial thrombectomy
C. Immediate fasciotomy
D. Angiography

Response:
Ans. c. Immediate fasciotomy (Ref: Rockwood 6/e p2127-2129; Apley 9/e p714, 8/e p728-729)Immediate development of swelling in the arm after contrast injection with numbness and pain is highly suggestive of compartment syndrome due to extravasation of contrast medium. Best treatment is immediate fasciotomy, so that contrast medium and fluid can be drained and patient can be relieved.Extravasation of Contrast and Compartment SyndromeExtravasation of contrast is a possible complication of imaging studies performed with contrast.Most cases of subcutaneous extravasation occur due to small volumes of extravasation of contrast causing pain, minimum swelling and localized erythema, that is rapidly resolved.If larger volumes are extravasated, extensive tissue and skin necrosis may occur. Compartment syndrome is a very rare complication.Acute compartment syndrome occurs when the tissue pressure within a closed muscle compartment exceeds the perfusion pressure and results in nerve and muscle ischemiaQ.It typically occurs subsequent to a traumatic event, most commonly a fractureQ.Clinical Features:Classic features: Pain (bursting sensation), altered sensibility and paresis (or more usually, weakness in muscle contraction).Ischemic muscle is highly sensitive to stretch.If the limb is unduly painful, swollen or tense, the muscles (which may be tender) should be tested by stretching them.Diagnosis:Confirmation of the diagnosis can be made by measuring the intra-compartmental pressure.Treatment:Emergency fasciotomyQ

So the answer to this question is C


Instruction:
The neotatal kidney achieves concertratiug ability equivalent to adult's kidney by -
A. One year of age
B. Eighteen months of age
C. Three to six months of age
D. Just before puberty

Response:
None

So the answer to this question is A


Instruction:
Drugs used in GTCS is/are:
A. Ethosuximide
B. Sodium-valproate
C. Lamotrigine
D. Propofol

Response:
Carbamazepine, phenytoin are the first line drugs in GTCS. Valporate, phenobarbitone are the second choice of drugs. Alternative/add on drugs are Lamotrigine, Gabapentine, topiramate, methadone, levetiracetam. Ethosuximide is used in absent seizures. Propofol is a general anesthetic. Ref: K D Tripati 8th edition Table 30.1

So the answer to this question is B


Instruction:
in sodomy passive agent adult is named?
A. catamite
B. paedophile
C. gerantophillia
D. peadestry

Response:
SODOMY: Other names: 1. Greek love 2. Buggery 3. grantophilia -- when passive agent is adult 4. Paederasty -- when passive agent is child. Paedophil - Active agent - sexual activity with children below sexual age Catamite -- Passive agent -sexual activity with children below sexual age ref : narayanareddy

So the answer to this question is C


Instruction:
When was ARDS first described?
A. 1962
B. 1967
C. 1965
D. 1964

Response:
ARDS was first described in 1967 by ashbaugh & petty. It was defined in 1994 by American European consensus.

So the answer to this question is B


Instruction:
Aspirin acts by
A. Cyclo oxygenase pathway
B. Lipo oxygenase pathway
C. Membrane phospholipases
D. Cyclic AMP

Response:
(A) Cyclo oxygenase pathway # ASPIRIN prduces its antithrombotic effect by irreversibly acetylating and inhibiting platelet cyclo-oxygenase (COX)-1, a critical enzyme in the biosynthesis of thromboxane A2. At high doses, aspirin also inhibits COX-2, an inducible COX isoform found in endothelial cells and inflammatory cells.> Analgesic action of aspirin is mainly due to obstructing of peripheral pain receptors and prevention of prostaglandin mediated sensitization of nerve endings.> Aspirin & some NSAIDs blocked PG generation by inhibiting cyclooxygenase (COX) enzyme.> Aspirin, even in small doses, irreversibly inhibit TXA2 synthesis> Aspirin resets the hypothalamic thermostat & rapidly reduces fever by promoting heat loss but does not decrease heat production

So the answer to this question is A