Instruction:
The commonest cause of intestinal obstruction in children between 3 months to 6 years of age
A. Intussusception
B. Meckel's diverticulum
C. Intestinal polyp
D. Nonspecific cause

Response:
Ans. a (Intussusception) (Ref. Nelson paediatrics, p. 1569)INTUSSUSCEPTION# Intussusception occurs when a portion of the alimentary tract is telescoped into an adjacent segment. It is the most common cause of intestinal obstruction between 3 mo and 5 yr of age.# Sixty percent of patients are younger than 1 yr, and 80% of the cases occur before 24 mo: it is rare in neonates.# The incidence varies from 1 to 4/1,000 live births.# The male:female ratio is 4:1. A few intussusceptions reduce spontaneously, but if left untreated, most will lead to intestinal infarction, perforation, peritonitis, and death.Etiology and Epidemiology# The cause of most intussusceptions is unknown.# The seasonal incidence has peaks in spring and autumn.# Correlation with prior or concurrent respiratory adenovirus (type C) infection has been noted, and the condition may complicate otitis media, gastroenteritis, Henoch-Schonlein purpura.# The risk of intussusceptions in infants <1 yr of age after receiving a no longer available tetravalent rhesus-human reassortant rotavirus vaccine within 2 wk of immunization was increased.# Lymphoid nodular hyperplasia is another related risk factor. Prominent mounds of lymph tissue lead to mucosal prolapse of the ileum into the colon, thus causing an intussusception.# In 2-8% of patients, recognizable lead points for the intussusception are found, such as a Meckel diverticulum, intestinal polyp, neurofibroma, intestinal duplication, hemangioma, or malignant conditions such as lymphoma. Intussusception can complicate mucosal hemorrhage, as in Henoch-Schonlein purpura or hemophilia.# Cystic fibrosis is another risk factor.# Postoperative intussusception is ileoileal and usually occurs within 5 days of an abdominal operation.# Lead points are more common in children >2 yr of age.Pathology# Intussusceptions are most often ileocolic, less commonly cecocolic, and rarely exclusively ileal.Clinical manifestations# Spasmodic intermittent abdominal pain;# "Red currant" jelly stools# Palpable lump.# Dance sign, n "Empty RIF" signDiagnosis# Ultrasound is investigation of choice.# Ba enema is now 2nd line investigation# USG signs:- "Doughnut or target" appearance in transverse images.- "Sandwich or hamburger" sign in longitudinal images- Pseudokidney sign# Ba emema signs:- "Claw"sign- "Coiled-spring" signRx# Hydrostatic reduction# Air reduction is associated with fewer complications and lower radiation exposure than traditional contrast hydrostatic techniques.# The success rate of radiologic hydrostatic reduction under fluoroscopic or ultrasonic guidance is =50% if symptoms are present longer than 48 hr and 70-90% if reduction is done in the 1st 48 hr.# If manual operative reduction is impossible or the bowel is not viable, resection of the intussusceptions is necessary with end-to-end anastomosis.# Corticosteroids may reduce the frequency of recurrent intussusception.

So the answer to this question is A


Instruction:
Vulval carcinoma metastasizes to :
A. Inguinal lymph nodes
B. Pre aoic lymph nodes
C. Para aoic lymph nodes
D. Pelvic lymph nodes

Response:
Inguinal lymph nodes

So the answer to this question is A


Instruction:
Negri bodies m/c seen in
A. Cerebellum
B. Hippocampus
C. Pons
D. Medulla

Response:
Negri bodies most abundant in Hippocampus followed by cerebellum and pons.

So the answer to this question is B


Instruction:
Most common fixative used in electron microscopy:
A. Glutaraldehyde
B. Formalin
C. Picric acid
D. Absolute alcohol

Response:
Ans. a. Glutaraldehyde

So the answer to this question is A


Instruction:
Delirium tremens is seen in -
A. Alcohol withdrawal
B. Alcoholoverdoses
C. Morphine poisoning
D. Atropine poisoning

Response:
Ans. is 'a' i.e., Alcohol withdrawal Delirium tremensDelirium tremens is the most severe alcohol withdrawal syndrome. It occurs usually within 2-4 days of complete or significant alcohol abstinence. This is an acute organic brain syndrome (delirium) with characteristic features of delirium.Clouding of consciousness with disorientation in time and place.Poor attention span and distractability.Visual (and also auditory) hallucination, and illusion. Tactile hallucination of insect crawling under the skin (formication) may also occur.Marked autonomic disturbances with tachycardia, sweating, hypertension, mydriasis, coarse tremers.Insomnia, psychomotor agitation, ataxia, anxiety.Benzodiazepines are the drugs of choice for delirium tremens. Chlordiazepoxide is the agent of choice w ith diazepam as an alternative.

So the answer to this question is A


Instruction:
Which of the following is given as live oral vaccine ?
A. B.C.G
B. Measles
C. Typhoid
D. Rabies

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

So the answer to this question is C


Instruction:
All are capsulated bacteria except -
A. Neisseria
B. Corynebacterium diphtheriae
C. Haemophillus
D. Streptococcus saliverius

Response:
The diphtheria bacillus are pleomorphic, nonsporing noncapsulated and nonmotile they are gram-positive .pleomorphic, nonspoing, encapsulated, nonmotile gram-positive bacteria REF:Ananthanarayan and Panikkar's textbook of microbiology 9th edition pg no 236

So the answer to this question is B


Instruction:
Under Insecticide Treated Bed Nets Program me, insecticide used is -
A. Deltamethrin
B. Malathion
C. Lindone
D. Fenitrothion

Response:
Inseccide Treated Bed Nets (ITBN) Programme (esp. deltamethrin) has resulted in significant decline in malaria incidence and API

Average decline in anopheline mosquito density - 68%
Average decline in cuicine mosquito density - 50%

Chemicals used in ITBN Programme : Synthec pyretheroids

Deltamethrin : 2.5% in dosage of 25 mg/m2
Cyfluthrin: 5% in dosage of 50 mg/m2
Other inseccides used : Permethrin, Lambdacyhalothrin, Etofenprox, Cypermethrin

Effecveness of pyrethroids: For 6-12 months (Retreatment every 6 months)
Long-lasng inseccidal mosquito nets (LLINs) : Also use pyrethroid inseccides, and a chemical binder that allows the nets to be washed > 20 mes, allowing use for > 3 years.

So the answer to this question is A


Instruction:
Which enzyme is inhibited by fomepizole
A. Alcohol dehydrogenase
B. Acetaldehyde dehydrogenase
C. Catalase
D. Peroxidase

Response:
None

So the answer to this question is A


Instruction:
Which of the following is not a clinical sign of atropine intoxication?
A. Flushing of the face
B. Dry skin
C. Increased bowel sounds
D. None of the above

Response:
Atropine is an anticholinergic drug. It will decrease GI motility.
PHARMACOLOGICAL ACTIONS of Atropine:
Atropine  blocks  all  subtypes  of  muscarinic receptors.
Tone and amplitude of contractions of stomach and intestine are reduced; the passage of chyme is slowed-constipation may occur, spasm may be relieved.  However,  peristalsis is only incompletely suppressed, because it is primarily regulated by local reflexes in the enteric plexus, and other neurotransmitters (5-HT,  enkephalin, etc.,) are involved.
Enhanced motility due to injected cholinergic drugs is more completely antagonised than that due to vagal stimulation, because intramural neurons which are activated by vagus utilize a number of noncholinergic transmitters as well.
Reference: Essentials of Medical Pharmacology Eighth Edition KD  TRIPATHI  page no 125,126

So the answer to this question is C


Instruction:
Biopsy of the parotid gland in Sjogren’s shows:
A. Neutrophils
B. Eosinophils
C. Basophils
D. Lymphocytes

Response:
"The earliest histologic finding in both the major and the minor salivary glands is periductal and perivascular lymphocytic infiltration." (Ref: Robbins)
Sjogren Syndrome

It is an immune-mediated destruction of the lacrimal and salivary glands characterized by dry eyes {keratoconjunctivitis sicca) and dry mouth (xerostomia)
It occurs as an isolated disorder (primary form), also known as the sicca syndrome, or more often in association with another autoimmune disease (secondary form).
Associated diseases
Rheumatoid Arthritis (Me)
SLE
Polymyositis
Systemic sclerosis
Vasculitis
Thyroiditis
The ductal epithelial cells of the exocrine glands are the primary target for autoantibodies.
There is also systemic B-cell hyperactivity, as evidenced by the presence of ANAs and RF.
Autoantibodies to the RNP antigens SS-A (Ro) and SS-B (La) (also present in SLE)
Other secretory glands like nasopharynx, upper airway, and vagina, may also be involved
Involved tissues show an intense lymphocyte (primarily activated CD4+ T cells) and plasma cell infiltrate.
Lacrimal gland destruction results in a lack of tears, leading to drying of the corneal epithelium, with subsequent inflammation, erosion, and ulceration (keratoconjunctivitis).
Similar changes may occur in the oral mucosa as a result of the loss of salivary gland output, giving rise to mucosal atrophy, with inflammatory Assuring and ulceration (xerostomia).
Dryness and crusting of the nose may lead to ulcerations and even perforation of the nasal septum.
When the respiratory passages are involved, secondary laryngitis, bronchitis, and pneumonitis may appear.
Approximately 25% of the patients (especially those with anti-SS-A antibodies) develop extra-glandular disease affecting the CNS, skin, kidneys, and muscles.
Renal lesions take the form of mild interstitial nephritis associated with tubular transport defects: Unlike in SLE. glomerulonephritis is rare.
90% of cases occur in women between 35 and 45 years
Extraglandular manifestations include synovitis, pulmonary fibrosis, and peripheral neuropathy.
There is a 40-fold increased risk of developing non-Hodgkin B-cell lymphoma.

So the answer to this question is D


Instruction:
All are abductors of thigh, except:
A. Gluteus medius
B. Gluteus minimus
C. Saorius
D. Piriformis

Response:
Piriformis

So the answer to this question is D


Instruction:
Vaccine can be stored at PHC for:
A. 2 days
B. 7 days
C. 15 days
D. 30 days

Response:
30 days

So the answer to this question is D


Instruction:
Cause of lid retraction include:
A. Graves' ophthalmopathy
B. Hypokalemic periodic paralysis
C. Cirrhosis of the liver
D. All of the above

Response:
Ans. All of the above

So the answer to this question is D


Instruction:
All are true about antemoem contusion except -
A. Sequential color change
B. No Inflammation
C. Raized enzyme levels
D. Blood cells in surrounding tissue

Response:
The synopsis for forensic medicine & toxicology ,Dr k.s.narayan reddy ,28th edition ; Pg no . 108 ; In antemoem bruising ,there is swelling ,damage to epithelium ,extravasation ,coagulation & infiltration of tissue with blood & colour changes .these points are absent in postmoem bruises . Hence it is seen that there will b swelling & inflammation in antemoem bruises.No inflammation in antemoem bruise is a wrong statement .

So the answer to this question is B


Instruction:
A pediatrician calls an ophthalmologist to examine baby if:
A. Baby born at 28 weeks gestation
B. Baby has respiratory distress
C. Birth weight of the baby is 2.3 kg
D. Jaundice

Response:
a. Baby born at 28 weeks gestation(Ref: Nelson's 20/e p 3050, Ghai 8/e p 666)Indications of Screening for Retinopathy of prematurity (ROP):Birth weight <1,500g or gestational age < 32 wk &Selected neonates with a birth weight between 1,500 and 2,000g or gestational age of >32 wk with an unstable clinical course, including those requiring cardiorespiratory support.

So the answer to this question is A


Instruction:
Transmission of R factor is by ?
A. Conjugation
B. Transduction
C. Transformation
D. Lysogenic conversion

Response:
Ans. is 'a' i.e., Conjugation Conjugation Bacterial conjugation is the transfer of genetic material between bacteria through direct cell to cell contact or through a bridge- like connection between two cells. Conjugation is process where by a donor (male) bacterium makes physical contact with a recipient (female) bacterium. Donor status is determined by the presence of plasmid. This plasmid codes for specialized fimbria (sex pilus) and for self transfer. Sex pilus (conjugation tube) helps in transfer of genetic material from male bacterium to female bacterium. The plasmid is known as transfer factor (sex factor or feility factor). Plasmid may be R factor, which codes for transferrable multiple drug resistance. The DNA of the plasmid replicates during transfer so that each bacterium receives a copy - Recipient becomes donor and the donor retains its donor status.

So the answer to this question is A


Instruction:
The patient presented with fever, coughing, headache. He developed a rash on the 4th day, what is the probable diagnosis?
A. Measles
B. Mumps
C. Small pox
D. Chicken pox

Response:
Measles Incubation period: 7-10 days Human beings only reservoir. Droplet infection Common in pre school age group Prodrome :lasting 4-5 days involvement of epithelial linings characteristic of measles . Koplik spots: whitish grayish spots on inner surface of cheeks opposite 2nd lower molar ,appear on 2-3 days and disappears on 2-3 day of rash. Rash appears on day 4 with increasing fever. Disappears in 4-5 days Histopathologically multinucleated giant cells in epidermis and Warthin Finkeldey cells in the reticuloendothelial system. Diseases associated with measles virus: SSPE Multiple sclerosis Crohn disease Complications: Respiratory tract :otitis media (most common complication) LAP Laryngitis Laryngotracheitis Interstitial pneumonitis resulting from measles virus takes the form of Hecht giant cell Pneumonia. Bronchopneumonia Bronchiectasis In the hemorrhagic type of measles (black measles), bleeding may occur from the mouth, nose, or bowel Neurological Encephalitis with 1 week of illness : 1/3rd die and 1/3rd left with severe neurological sequelae. SSPE: occurs 3-8 yrs after primary measles infection. Persistent measles infection or on autoimmune response. 100% fatality within 6 months of diagnosis. Presenting features include myoclonic jerks and mental deterioration. Measles virus cannot be isolated from CSF or blood. CSF ELISA for antibodies is positive. GIT: Persistent diarrhea Appendicitis Q Hepatitis Ileocolitis AGN. Malnutrition SJ syndrome DIC Treatment : Maintain hygiene Analgesics 1 age specific dose of vitamin A Fever and Rash : Mnemonic Based Approach Seven Killer Causes of Fever and Rash Mnemonic: SMARTTT Sepsis Meningococcemia Acute endocarditis Rocky mountain spotted fever Toxic erythemas Toxic epidermal necrolysis Travel-related infections Onset of Rash with "X" Days of Fever Mnemonic: Very Sick Person Must Take Double Eggs Varicella (Chicken pox): 1st day (rash is often 1st sign in children) Scarlet fever: 2nd day Pox (Small pox): 3rd day Measles (Rubeola or 14 day measles): 4th day (Remember: Koplik spots appear in pre-eruptive phase on 2nd day of fever) Typhus: 5th day Dengue: 6th day Enteric fever: 7th day Also remember, another similar mnemonic: Really Sick Children Must Take No Exercise Rubella (German measles or 3 day measles): 1st day Scarlet fever, Small pox: 2nd day Chicken pox (Varicella): 3rd day (prodromal symptoms 1-2 days before rash in adults) Measles (Rubeola or 14 day measles): 4th day Typhus: 5th day Nothing Enteric fever: 7th day Remember: Roseola infantum (Exanthem subitum, Sixth disease or 3 day fever): rash appears when fever disappears Erythema infectiosum (Slapped-cheek disease): no prodromal period and fever Drug rash: may appear anytime Exanthems - Numbered Diseases of Childhood Mnemonic: MS (Master in Surgery) and German MD (Doctor of Medicine) in ER (Emergency Room) 1st (First) disease: Measles (Rubeola, 14 day measles) Measles virus 2nd (Second) disease: Scarlet fever Streptococcus pyogenes 3rd (Third) disease: German measles (Rubella or 3 day measles) Rubella virus 4th (Fourth) disease: Duke's disease or Filatov-Duke's disease (now regarded as a variant of scarlet fever or SSSS) 5th (Fifth) disease: Erythema infectiosum or Slapped-cheek disease Erythrovirus (Parvovirus) B19 6th (Sixth) disease: Roseola infantum (Exanthem subitum, 3 day fever) Human Herpes Virus (HHV 6 more than HHV 7) Diseases Named by Numbered Days Three-day fever (3 day fever): Roseola infantum or Exanthem subitum or Sudden fever Three-day measles (3 day measles): Rubella or German measles Five-day fever (5 day fever): Trench fever or Quintana fever or Shinbone fever Seven-day fever (7 day fever): Weil's disease or Leptospirosis or Canicola fever or Nanukayami fever Fourteen-day measles (14 day measles): Measles or Rubeola or Hard measles Centripetal and Centrifugal Rash Distribution Centripetal (predominate or start on extremities) Hand, foot and mouth disease (caused by enterovirus i.e. coxsackie A16, enterovrius 71) Coxsackie A = more common but less severe Enterovirus 71 = less common but more severe Herpangina = caused by enterovirus; associated with oral enanthem but no exanthems Secondary syphilis Rocky mountain spotted fever Dengue fever Small pox Centrifugal (predominate or start on trunk) Viral exanthems: Measles, Rubella, Chicken pox, Scarlet fever Epidemic typhus Involvement of Palms and Soles Mnemonic: RED HANdS Rocky mountain spotted fever (R.rickettsi) Endocarditis Dengue (Palms and soles are spared by rash but swelling, itching and erythema is often seen) Hand-foot-mouth disease (Coxsackie) and Host vs Graft disease (GVHD) Autoimmune Kawasaki Disease (KD) Neisseria meningococcemia Stevens Johnson Syndrome and Syphilis (Secondary and Congenital) and Staphylococcal toxic shock syndrome Sparing of Face Mnemonic: SPaRES Scarlet fever (Flushing of face occurs but rash doesn't involve the face) Prowazekii caused Epidemic typhus Roseola infantum or Exanthem subitum or Sixth disease

So the answer to this question is A


Instruction:
A posteriorly perforating ulcer in the pyloric antrum of the stomach is most likely to produce initial localized peritonitis or abscess formation in the following:
A. Omental bursa (lesser sac)
B. Greater sac
C. Right subphrenic space
D. Hepato renal space (pouch of Morison)

Response:
Answer is A (Omentum bursa) "Gastric ulcers perforate into the lesser sac, which can be paicularly difficult to diagnose" - Bailey "A gastric ulcer perforates into the lesser sac, then no signs of generalised peritonitis can be seen but misleading symptoms may appear" - Schwaz As can be seen from the figure, a posteriorly perforating ulcer of the stomach will localize in the lesser sac or omental bursa only. (lesser sacis synonymous with omental bursa)

So the answer to this question is A


Instruction:
All of the following decrease bone resorption in osteoporosis except
A. Alendronate
B. Etidronate
C. Strontium
D. Teriparatide

Response:
Teriparatide increase bone mineral density. It stimulates bone formation. It is a recombinant parathyroid hormone bisphosphonates decrease resorption of bone strontium increase bone formation and decrease resorption (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 329)

So the answer to this question is D


Instruction:
What is the drug of choice for idiopathic intracranial hypeension (I.I.H)?
A. Acetazolamide
B. Glycerol
C. Mannitol
D. Dexamethasone

Response:
Acetazolamide -Most effective agent for lowering ICP in idiopathic intracranial hypeension. In Acetazolamide intolerance, furosemide may be used For headaches-Amitriptyline, propranolol. For progressive loss of visual field -High dose oral prednisone. -Some patients experience deterioration of their visual function, surgical intervention may be considered. 1. Optic nerve sheath fenestration (decompression) 2. Cerebrospinal fluid (CSF) diversion ( lumbo-peritoneal or ventriculo-peritoneal shunt)

So the answer to this question is A


Instruction:
According to a newer hypothesis Ewings, sarcoma arises from -
A. Epiphysis
B. Diaphysis
C. Medullary cavity
D. Cortex

Response:
Marrow tumors (medullary cavity tumors) : - Ewings sarcoma, Plasma cell tumor, multiple myeloma, Lymphoma.

So the answer to this question is C


Instruction:
Harlequins Skin change in the newborn is seen in -
A. Autonomic dysfunction
B. Icthyosis
C. Septicemia
D. Polycythemia

Response:
Ans. is 'a' i.e., Autonomic dysfunction Harlequin color change o This rare but dramatic vascular event occurs in immediate newborn period and is most common in low bih weight infants. o If reflects an imbalance in the autonomic vascular regulatory mechanism. o When the infant is placed on the side, the body is bisected longitudinally into pale upper half and a deep red dependent half. Note - The fetus in ichthyosis (option b) appears grostesque and the appearance is called harlequin fetus.

So the answer to this question is A


Instruction:
Which of the following is coding RNA
A. sn RNA
B. mRNA
C. Both sn RNA and mRNA
D. mi RNA

Response:
rRNA, Lnc RNA, sn RNA, mi RNA, tRNA are all non coding RNA.
Only mRNA is coding RNA.

So the answer to this question is B


Instruction:
All agents have been used in drug regimens for the treatment of breast carcinoma. Which one has specific activity in a subset of female breast cancers?
A. Anastrozole
B. Doxorubicin
C. Fluoxymesterone
D. Trastuzumab

Response:
Trastuzumab Each of the drugs listed has been used in drug regimens for breast cancer, but only trastuzumab has specificity in its actions. The drug is a monoclonal antibody to a surface protein in breast cancer cells that over express the HER2 protein. Consequently, trastuzumab has value in a specific subset of breast cancers.

So the answer to this question is D


Instruction:
A 28-year-old lady presented with, headache, kernigs sign positive, culture showed gram positive bacilli, most probable organism is:
A. Listeria monocytogenes
B. H. influenza
C. Meningococci
D. Streptococcus pneumoniae

Response:
Ans. (a) i.e. Listeria monocytogenes Among options provided listeria is the only Gr positive bacilli. Listeria accounts for 10% of cases of community acquired bacterial meningitis. For details see previous answers.

So the answer to this question is A


Instruction:
Streptococcus toxin which is responsible for connective tissue breakdown ?
A. Hyaluronidase
B. Streptolysin 0
C. Streptolysin S
D. Streptococcus pyogenic exotoxin

Response:
Ans. is 'a' i.e., Hyaluronidase Hyaluronidase splits hyaluronic acid, an impoant component of the ground substance of connective tissue. Thus, hyaluronidase aids in spreading infecting microorganisms (spreading factor).Hyaluronidases are antigenic and specific for each bacterial or tissue source. Following infection with hyaluronidase-producing organisms, specific antibodies are found in the serum.

So the answer to this question is A


Instruction:
Choose the appropriate lettered structure in this computed tomography scan of the male perineum and pelvis. A knife wound to the obturator foramen might injure which structure?
A. A
B. B
C. C
D. D

Response:
(d) The obturator foramen transmits the obturator nerve and vessels. Therefore, the knife wound in this foramen injures the obturator nerve and vessels.

So the answer to this question is D


Instruction:
Cancers caused by asbestosis include all except?
A. Laryngeal cancer
B. Mesothelioma
C. lung carcinoma
D. Bladder cancer

Response:
Asbestosis: Pleural plaque is the most common manifestation of asbestosis Involves base of the lung Clinical feature: thickened fibrotic pleura Presence of ferruginous bodies (long thin asbestos fibers coated with iron & calcium) cancers associated with Asbestosis- - Bronchogenic carcinoma (m/c) - Mesothelioma (most specific)

So the answer to this question is D


Instruction:
Posterior boundary of Epiploic foramen is formed by
A. L1 vertebra
B. T12 Vertebra
C. T11 Vertebra
D. T10 Vertebra

Response:
Posterior boundary of Epiploic foramen is formed by Inferior venacava, T12 Vertebra and Right Suprarenal gland

So the answer to this question is B


Instruction:
A female presented with loss of vision in both eyes and on examination has normal pupillary responses and normal fundus, Her visually evoked response (VER) examination shows extinguished responses. The most likely diagnosis is
A. Hysteria
B. Coical blindness
C. Optic Neuritis
D. Retinal Detacment

Response:
B. i.e. Coical blindness VER assess the functional state of the visual system beyond retinal ganglion cells. Since there is dispropoionately large projection of macular area in the occipital coex, the clinically measured VER is primary a response generated by macula & optic nerve. In any abnormality of macula, optic nerve or the remaining optic pathway (beyond optic nerve), there is increase in latency and decrease in amplitude (extinguished responseQ). The timing of onset of the response (latency) is a more reliable and generally more useful parameter than amplitude. In retrobulbar neuritis latency persists even when vision returns to normal. Delay is therefore an impoant sign of past attack of retrobulbar neuritis.

So the answer to this question is B


Instruction:
Which of the following salivary gland tumors has highest rate of malignant transformation?
A. Parotid
B. Submanidbular
C. Sublingual
D. Minor

Response:
None

So the answer to this question is D


Instruction:
Incremental lines of Salter are found closer in:
A. Cellular cementum.
B. Mixed fibers cementum.
C. Acellular cementum.
D. All of the above.

Response:
None

So the answer to this question is C


Instruction:
The antitubercular drug safe in liver disease is: September 2011
A. INH
B. Rifampin
C. Ethambutol
D. Pyrazinamide

Response:
Ans. C: Ethambutol Approximately 50% of the oral dose of Ethambutol is eliminated unchanged in the urine within 24 hours; 15% of the drug is excreted in the form of 2 metabolites Its serious toxicity is ocular Ethambutol/ EMB/ E It is a bacteriostatic antimycobacterial drug Adverse effects of ethambutol are: - Optic neuritis: Hence contraindicated in children below 6 yrs of age. - Red-green color blindness - Peripheral neuropathy - Ahralgia - Hyperuricaemia - Veical nystagmus - Milk skin reaction Ethambutol is bacteriostatic against actively growing TB bacilli. It works by obstructing the formation of cell wall. Mycolic acids attach to the 5'-hydroxyl groups of D-arabinose residues of arabinogalactan and form mycolylarabinogalactan-peptidoglycan complex in the cell wall. It disrupts arabinogalactan synthesis by inhibiting the enzyme arabinosyl transferase. Disruption of the arabinogalactan synthesis inhibits the formation of this complex and leads to increased permeability of the cell wall It is well absorbed from the gastrointestinal tract and well distributed in body tissues and fluids, 50% is excreted unchanged in urine.

So the answer to this question is C


Instruction:
The first step in the initiation of primary hemostasis for clot formation is?
A. Fibrin deposition
B. Vasoconstriction
C. Platelet adhesion
D. Thrombosis

Response:
Steps in hemostasis at the site of injury
i) Vasoconstriction
• Immediate hemostasis following injury is achieved by brief arteriolar vasoconstriction. It is due to the reflex neurogenic mechanism. This effect is transient.
ii) Primary hemostasis
• It is achieved by the formation of the primary hemostatic plug (platelet plug). Following an injury to endothelium, the thrombogenic subendothelial matrix is exposed and allows the platelets to adhere with collagen of ECM. These platelets are activated and recruit other platelets by their secretions.
iii) Secondary hemostasis
• Activation of coagulation (clotting) system leads to the formation of the secondary hemostatic plug (definitive plug or fibrin clot) which is composed of fibrin, platelets, RBCs, and thrombin.
iv) Dissolution of clot
• Activation of the fibrinolytic system results in dissolution of the clot.

So the answer to this question is B


Instruction:
Schizophrenia is associated..............personalities :
A. Atheletic
B. Psthesis
C. Asthenic
D. All

Response:
C. i.e. Asthenic

So the answer to this question is C


Instruction:
In NPCB, vision testing in school done by -
A. Teachers
B. Ophthalmologist
C. NGO
D. Optometrist

Response:
<p> NPCB:National programme for control of blindness Launched in the year 1976 as a 100% centrally sponsored programme and incorporate the earlier trachoma control programme staed in the year 1968. Objectives:- 1. Reduce the backlog of avoidable blindness through identification and treatment of curable blind at primary, secondary and teiary levels. 2. Develop and strengthen the strategy of NPCB for "Eye health for all" and prevention of visual impairment through provision of comprehensive universal eye care services. 3. Strengthen and upgrade the Regional institutes of ophthalmology to become centre of excellence in various sub specialities of ophthalmology. 4. Strengthening the existing infrastructural facilities and developing additional human resource for providing high quality comprehensive eye care in all districts of the country. 5. To enhance community awareness on eye care and lay stress on preventive measures. 6. Increase and expand research for prevention of blindness and visual impairment. 7. To secure paicipation of voluntary organisations or private practitioners in eye care delivery. School eye screening programme:- Children are first screened by trained teachers . Children suspected to have refractive error are seen by ophthalmic assistants and corrective spectacles are prescribed or given free for persons below povey line. {Reference-park&;s textbook of preventive and social medicine, 23rd edition, pg no.439}</p>

So the answer to this question is A


Instruction:
Recommended concentration of flouride in school water flouridation:
A. 4.5-6.3 PPm
B. 0.7-1.2PPm
C. 2.5-3.5PPm
D. None

Response:
None

So the answer to this question is A


Instruction:
A female has a hypopigmented lesion on the centre of the forehead. Drug responsible is?
A. Hydroquinone
B. Ether metabolite of hydroquinone
C. Para tertiary butyl catechol
D. Para tertiary butylphenol

Response:
Hypopigmented lesions in the centre of the forehead suggest chemical leucoderma with para tertiary butyl phenol. Which is a component of bindi. (Therefore hypopigmentation is on central head).

So the answer to this question is D


Instruction:
Which of the following fibres don't pass through the posterior limb of internal capsule
A. Sublentiform
B. Retrolentiform
C. Corticonuclear
D. Dorsal column

Response:
None

So the answer to this question is C


Instruction:
Fragmented medullary hair are found in
A. Negros
B. Mongols
C. Caucasians
D. Europeans

Response:
A i.e. Negro - Anteroposterior diameter (i.e. length) of skull is minimum in Brachycephaly4 (sho headed) and maximum in DolicocephalyQ. - The skull of Aryan's (Indians), Arborigines & Negroes is dolico-cephalic, with cephalic index between 70 - 75Q. Radio humeral index is80 in blacks. Tibio femoral index is83 in Blacks. - Cephalic Index, Height Index & Nasal Index are used for determination of raceQ - Mongols have maximum cephalic index ( 80) & height index (75) with rounded nasal openings, orbits & palateQ

So the answer to this question is A


Instruction:
Vagitus uterinus is -
A. An infection of vagina
B. An infection of uterus
C. A cry of unborn baby from uterus
D. Infection of both vagina and uterus

Response:
Cry in uterus is called vagitus uterinus and cry in vagina is called vagitus vaginalis.

So the answer to this question is C


Instruction:
All are true about fatty acid synthesis except
A. Requires NADPH
B. Requires NADH
C. Occurs in cytosol
D. Intermediately linked with glycolysis

Response:
DE NOVO SYNTHESIS OF FATTY ACIDS The process of fatty acid synthesis was studied by Feodor Lynen, who got Nobel prize in 1964. The pathway is referred to as Lynn&;s spiral. It is not a reversal of oxidation. Fatty acids are synthesized mainly by a de novo synthetic pathway operating in the cytoplasm. So it is referred to as extramitochondrial or cytoplasmic fatty acid synthase system. The major fatty acid synthesised de novo is palmitic acid, the 16C saturated fatty acid. The process occurs in liver, adipose tissue, kidney, brain, and mammary glands. Transpo of Acetyl CoA to Cytoplasm The staing material for de novo synthesis is acetyl CoA. It is formed inside the mitochondria from pyruvate. The inner membrane is not freely permeable to acetyl CoA. Hence the acetyl CoA units are delivered to the cytoplasm as citrate Citrate is transpoed from mitochondria by a tricarboxylic acid transpoer. In the cytoplasm, citrate is cleaved to oxaloacetate and acetyl CoA. The enzyme is ATP citrate lyase. The oxaloacetate can return to the mitochondria as malate or pyruvate net reaction of de novo synthesis of fatty acid may be summarized as 1 Acetyl CoA + 7Malonyl CoA +14NADPH +14H+ - 1Palmitate + 7CO2 +14NADP+ + 8CoA+ 6H2O Fatty acid synthesis is not an exact reversal of beta-oxidation. Co-enzymes of Fatty Acid Synthesis An impoant point to remember is that the co-enzyme utilised for de novo synthesis is NADPH. The sources of NADPH for fatty acid synthesis are 1. Pentose Phosphate Pathway This is the main source. Tissues having active lipogenesis (liver, adipose tissue, lactating mammary gland) have an active HMP shunt pathway also. 2. Malic Enzyme Malate + NADP+ - Pyruvate + CO2 + NADPH + H+ The reaction also helps to transfer cytoplasmic oxaloacetate to the mitochondria. For every molecule of acetyl CoA delivered to the cytoplasm, one molecule of NADPH is formed and reducing equivalents are generated in cytoplasmRef: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 136-139

So the answer to this question is B


Instruction:
ALL - L3 cells resembles
A. Mantle cell lymphoma
B. Burkitt's lymphoma
C. Hodgkin's lymphoma
D. Follicular lymphoma

Response:
None

So the answer to this question is B


Instruction:
Best stain for cryptococcal capsule -
A. Gram stain
B. India ink preparation
C. Giemsa stain
D. Methanamine-silver stain

Response:
Ans. is 'b' i.e., India Ink preparation * C. neoformans is best demonstrated in CSF by direct microscopy. The capsule is seen as a clear halo around the yeast cells in unstained wet preparations of CSF mixed with a drop of India ink or nigrosine. Methenamine silver stain would be the best choice for a tissue sample.

So the answer to this question is B


Instruction:
A person has been referred to you by the court. You find discrepancy between the history of examination findings. Which of these conditions you should be aware of in this situation?
A. Malingering
B. Factitious disorder
C. Somatization syndrome
D. Dissociative fugue

Response:
Patients with "Factitious disorder or munchausen syndrome" distact the history and there will be discrepancy between history, examination and reports termed as pseudologia fantastica.

So the answer to this question is B


Instruction:
Baroreceptor regulate the BP in the range of
A. 50-80 mmHg
B. 70-150 mmHg
C. 100-200 mgHg
D. At all BP levels

Response:
Baroreceptor mechanism is the most impoant mechanism for the sho-term regulation of BP in the range of 70- 150 mmHgRef: Textbook of medical physiology by N Geetha, 3rd edition, page no. 200

So the answer to this question is B


Instruction:
Thymoma is associated with -
A. Myasthenia gravis
B. Scleroderma
C. Oesophageal atresia
D. Hypergammaglobulinemia

Response:
None

So the answer to this question is A


Instruction:
Which is true about measurement of BP with sphygmomanometer versus intra-aerial pressure measurements?
A. Less than intravascular pressure
B. More than intravascular pressure
C. Equal to intravascular pressure
D. Depends upon blood flow

Response:
The reason for this is - "dissipation of pressure". When BP is measured by sphygmomanometry, the principle is 'balancing of pressure between the cuff and the brachial aery'. Suppose the pressure in the aery is, say, 100 mm Hg. When the pressure just outside the aery is 100 mm Hg, the aery will be occluded completely, or when the pressure outside the aery becomes just less than 100, the aery will open up and the flow will sta in the aery. However, for pressure just outside the aery to be 100, pressure in the cuff has to be about 106 mm Hg; about 6 mm Hg is dissipated in the intervening tissue (muscle, fat) between the cuff and the aery. Thus, if we are looking for a point at which the aery is just occluded (with aerial pressure being 100), the cuff pressure at which it happens is about 106 mm Hg Hence, by sphygmomanometry, the pressure measured is higher as compared to direct intravascular pressure measurement.

So the answer to this question is B


Instruction:
Auditory pathway passes through:
A. Medial geniculate body
B. Lateral geniculate body
C. Reciculate formation
D. Cerebellar fornix

Response:
Ans. A Medial geniculate body I. Auditory pathway: SC-SLIM-41,42 II. S- Spiral ganglia (cochlea) III. C- Cochlear nuclei (ponto-medullary junction) IV. S-Superior olivary nucleus (pons) V. L-Lateral lemniscus (brain stem) VI. I-Inferior colliculus (mid-brain) VII. M-Medial geniculate body (meta-thalamus) VIII. 41,42 - Brodmann area (cerebral coex)

So the answer to this question is A


Instruction:
Extrapulmonary restrictive defects lead to development of?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Increased DLco
D. Reduced DLco

Response:
Extrapulmonary restrictive defects: 1. M. gravis CO2 Retention | Respiratory acidosis 2. Kyphoscoliosis

So the answer to this question is B


Instruction:
Tendon are made up of:
A. Collagen fibres
B. Elastin
C. Keratin
D. Myofibrils

Response:
Dense Regular Connective Tissue In this type of tissue, the collagen fibres are densely packed, and arranged in parallel. This type of tissue is found in ligaments (which link bone to bone at joints) and tendons (connections between bones or cailage and muscle). These are powerfully resistant to axially loaded tension forces, but allow some stretch.

So the answer to this question is A


Instruction:
Best treatment for enuresis is –
A. Oxybutinin
B. Desmopressin
C. Bed alarm
D. Imipramine

Response:
None

So the answer to this question is C


Instruction:
A 45 year old male known case of diabetes presents with nausea , multiple episodes of vomiting and abdominal pain.He is stuporous , having blood glucoselevel of 402 mg% and on urine examination Ketone bodies are detected.He is having tachycardina along with ohostatic hypotension. On lab investigation,his potassium levels are 3 meq/L.The next best step in the management will be:
A. Manage hypokalemia-Repeat serum K+ levels- IV fluids and sta IV regular insulin
B. IV fluids-give IV regular insulin and lastly manage hypokalemia
C. Give IV regular insulin along with K+ - IV fluids after the K+ level is normal
D. IV fluids - give Lente insulin and side by side manage hypokalemia

Response:
This is a case of diabetic ketoacidosis (DKA)- Patient's serum K+ level is< 3.3 meq/L,In such cases K+ Level need to be corrected first, even before administering insulin. So next best steps in the management of this patient include: Correct hypokalemia-Repeat K+levels in serum-Give IV regular insulin after K+ level is> 3.3 meq/L Even during the treatment with insulin and fluids, Hypokalemia worsens because of: Insulin mediated potassium entry into cells Settlement of acidosis K+ loss in urine Therefore if we won't correct hypokalemia (<3.3 meq/L) in case of DKA, it will aggravate with the insulin and fluids if given initially. Note-Nausea and severe vomiting are due to the ketonemia which trigger vomiting center- CTZ

So the answer to this question is A


Instruction:
HIV infects most commonly:
A. CD4+helper cells
B. CD8+cells
C. Macrophage
D. Neutrophil

Response:
Ans. is 'a' i.e., CD4 Helper cells The receptor for the virus is the CD4 antigen on surface. The cells affected are:- CD4 T Cells (major target).- B lymphocytes.- Monocytes and macrophages.- Langerhans cells in dermis.- Glial cells and microglia in the CNS.- Follicular dendritic cells from tonsils can be infected by HIV without the involvement of CD4.

So the answer to this question is A


Instruction:
Mitochondrial DNA linked disease is
A. More common in males
B. Transmitted by females
C. Variable penetrance in families
D. Autosomal inheritance

Response:
(B) Transmitted by females# mtDNA inheritance is that it is transmitted strictly through the maternal line.> Low levels of paternal transmission of mtDNA have been observed in crosses between mouse species, but not within species41, although further studies showed that this paternal mtDNA was not transmitted to the subsequent generation.> Cytochrome c oxidase deficiency (mitochondrial DNA mutations), Kearns-Sayre syndrome (single, large deletion of mitochondrial DNA), Leber hereditary optic neuropathy (Mutations in four mitochondrial genes, MT-ND1, MT-ND4, MT-ND4L, and MT-ND6), Leigh syndrome (most commonly mutated mitochondrial gene in Leigh syndrome, MT-ATP6) are some of the examples for moitochondrial diseases.

So the answer to this question is B


Instruction:
HLA-B51 is associated with which disease
A. Lupus vulgaris
B. Psoriasis
C. Behcet disease
D. None of the above

Response:
MHC-associated diseases # Lupus (SCLE and SLE): HLA-DR3 # Psoriasis: HLA-Cw6 (most linked to psoriasis), B17 and B13 (guttate psoriasis), and B27 (psoriatic ahritis) # Reactive ahritis: HLA-B27 # Behcet's disease: HLA-B51 # Chronic idiopathic uicaria: HLA-DR4, HLA-DRB4, and HLA-DQ8 # Pemphigoid gestationis: HLA-DR3 and HLA-DR4 # Pemphigus vulgaris: HLA-DR4 and DRw6 # Dermatitis herpetiformis: Class I: HLA-A1 and HLA-B8; Class II: HLA-DR3 and HLA-DQ2 # Lichen planus: Class I: HLA-B57 and HLA-B8; Class II: HLA-DR1 and DR10 # Vitiligo: Class I: HLA-A33 and HLA-B13; Class II: HLA-B44, HLA-DRB1, and HLA-DR4. Ref:- Review of Dermatology by Alikhan; pg num:-25

So the answer to this question is C


Instruction:
Water intoxication occurs in all of the following except
A. TURP syndrome
B. Enema for colonic wash
C. Gastric lavage
D. Heroin Abuse

Response:
Answer- D. Heroin AbuseTransurethral Resection of Prostate (TURP) SyndromeEnemaGastric lavageSyndrome of Inappropriate ADH Secretion (SIADH)Ecstasy (MDMA) or Amphetamine useIntravenous Infusion of Hypotonic FluidsBeer PotomaniaPsychogenic PolydipsiaAttempt to Hide Drug Abuse

So the answer to this question is D


Instruction:
Space of Disse contains all except -
A. Microvilli
B. Blood plasma
C. Kupffer's cell
D. None of the above

Response:
Ans. is 'c' i.e., Kupffer's cell o The space of Disse (Perisinusoidal space) is a space between hepatocytes and hepatic sinusoids,o The exchange of substance between hepatocytes and blood takes place in the space of Disse.o Microvilli of hepatocytes extend into this space, increasing surface area for absorption,o Major constituent of space of Disse is blood plasma.Hepatic sinusoid, space of Disse and bile canaiicuii

So the answer to this question is C


Instruction:
Cornification Index is maximum in :
A. Early secretory phase
B. Late proliferative phase
C. Late secretory phase
D. Early proliferative phase

Response:
Late proliferative phase

So the answer to this question is B


Instruction:
Young lady presents with acute abdominal pain and history of 11/2 months amenorrhoea, on USG examination there is collection of fluid in the pouch of douglas and empty gestational sac. Diagnosis is
A. Ectopic pregnancy
B. Pelvic hematocele
C. Threatened aboion
D. Twisted ovarian cyst

Response:
Ans. is a i.e. Ectopic pregnancy

So the answer to this question is A


Instruction:
Medically important bacteria belongs to
A. Psychrophile
B. Mesophile
C. Thermophile
D. None of the above

Response:
Psychrophle grows best at -10oC to +10oC
Mesophile - 20°Cc to 40°C
Thermophile - >45°C

So the answer to this question is B


Instruction:
Favus is caused by:
A. Blockage of sebaceous duct
B. Staph aureus
C. Trichophyton schoenleinii
D. Trichophyton concentricum

Response:
Favus is a form of tinea capitis in which there is formation of crusting lesions (scutula) in the involved region of the infection. It is most often caused by T. schoenleinii.

So the answer to this question is C


Instruction:
What is the most characteristic symptom in a lady diagnosed with Pheochromocytoma?
A. Sweating attacks
B. Weight loss
C. Ohostatic hypotension
D. Paroxysmal hypeension

Response:
Pheochromocytomas and paragangliomas are catecholamine-producing tumors derived from the sympathetic or parasympathetic nervous system. These tumors may arise sporadically or be inherited as features of multiple endocrine neoplasia type 2. The "rule of tens" for pheochromocytomas states that about 10% are bilateral, 10% are extraadrenal, and 10% are malignant. However, these percentages are higher in the inherited syndromes. The clinical presentation is so variable that Pheochromocytoma has been termed "the great masquerader". The dominant sign is hypeension. Classically, patients have episodic hypeension, but sustained hypeension is also frequent.

So the answer to this question is D


Instruction:
Carbon dioxide is transported in blood mainly as:
A. Free carbon dioxide
B. Bicarbonate
C. Carbamino compound
D. Plasma protein

Response:
Ans. B. Bicarbonatea. The solubility of carbon dioxide in blood is about 20 times that of oxygen , so that there is considerably more carbon dioxide than oxygen in simple solution at equal partial pressures.b. The carbon dioxide that diffuses into RBCs is rapidly hydrated to H2 CO3 because of the presence of carbonic anhydrase.c. The H2 CO3 dissociates to H+ and H2 CO3 , and the AH+ is buffered, primarily by hemoglobin, while the HCO3 - enters the plasma 'Some' of the carbon dioxide in the ABCs reacts with the amino groups of proteins principally hemoglobin, to form carbamino compounds.

So the answer to this question is B


Instruction:
Side-effect (s) of inhalational steroid is/are all except:
A. Adrenal suppression
B. Cataract
C. Osteoporosis
D. Hypoglycemia

Response:
Answer- D. HypoglycemiaLocal side effects include hoarseness (dysphonia) and oral candidiasisgrowth retardation in children or to osteoporosis in adults.bruising, petechiaeHyperglycemia & pituitary- adrenal suppression

So the answer to this question is D


Instruction:
All of the following structures pass through aoic opening in the diaphragm, EXCEPT :
A. Azygos vein
B. Rt. phrenic nerve
C. Thoracic duct
D. Accessory Hemiazygos vein

Response:
Azygos vein pass to the right and thoracic duct passes to the left of aoa through its opening in the diaphragm. Accessory hemiazygos vein and hemiazygos veins pass behind the aoa and thoracic duct to join the azygos vein opposite the seventh and eighth thoracic thoracic veebral bodies. Aoic opening in the diaphragm lies at the lower border of body of T12. Oesophageal opening of diaphragm lies at the level of lower border of T10 veebrae. Structures passing through it are: oesophagus, oesophageal branches of left gastric aery, anterior gastric nerve and posterior gastric nerve. Right phrenic nerve passes through the vena caval opening in the diaphragm which lies at level of lower border of T8 veebrae. Ref: A New Approach to Dissection of the Human Body: A Thiy Week Schedule By R. Kanagasuntheram page 71. Anatomy, Combined Edition By S. Mitra page 1-43.

So the answer to this question is B


Instruction:
The first product of "Glycogenolysis" is:
A. Glucose- 6-phosphate
B. Glucose 1, 6 diphosphate
C. Glucose-1-phosphate
D. Fructose-l-phosphate

Response:
Glucose-1-phosphate

So the answer to this question is C


Instruction:
Ion ligand receptors are
A. Glycine receptor
B. b adrenergic receptors
C. V1 receptor
D. Insulin receptor

Response:
LikeGABA, glycine acts by increasing Cl- conductance.The ionotropic receptors of glutamate are ligand-gated ion channels that resemble nicotinic cholinergic receptors and GABA and glycine receptors. Catecholamines acting on b adrenergic receptors use cAMP mechanism.

So the answer to this question is A


Instruction:
Doughnut granuloma is a finding of :-
A. RMSF
B. Q fever
C. Lyme disease
D. Ehrlichiosis

Response:
A fibrin ring granuloma also known as doughnut granuloma is a histopathological finding that is characteristic of Q fever. On H & E stain, fibrin ring granuloma consists of a central lipid vacuole surrounded by a dense red fibrin ring and epithelioid macrophages Fibrin ring granulomas may also be seen in Hodgkin's disease and infectious mononucleosis. RMSF (Rocky Mountain Spotted Fever) is caused by Rickettsia rickettsii Lyme disease is caused by Borrelia burgdorferi Human monocytic Ehrlichiosis is caused by E. chaffenensis Human granulocytic Ehrlichiosis is caused by E. phagocytophilum.

So the answer to this question is B


Instruction:
All are included in Kangaroo Mother Care except
A. Skin to skin contact
B. Free nutritional supplements
C. Early discharge and follow up
D. Exclusive Breast feeding

Response:
KANGAROO MOTHER CARE for prevention of neonatal hypothermia in low birth weight/premature newborns:

Skin-to-skin positioning of newborn on mother’s chest.
Adequate nutrition through breast feeding.
Early discharge and ambulatory care.
Support for mother and family for child care.

So the answer to this question is B


Instruction:
Thumb print sign is seen in
A. Ileal atresia
B. Meconium ileus
C. Crohn's disease
D. Ischemic colitis

Response:
Thumb printing: Indentation in contrast or air-filled bowel lumen caused by sub mucosal infiltration and resembling a thumb printing; e.g. Ischemia Thumbprinting is a Radiographic sign of large bowelwall thickening, usually caused by edema, related to an infective or inflammatory process ('colitis'). The normal haustra become thickened at regular intervals appearing like 'thumb-prints' projecting into the aerated lumen.

So the answer to this question is D


Instruction:
In acute renal failure, metabolic acidosis is due to
A. Loss of HCO3
B. Increased H+ excretion
C. Diuretic therapy
D. Decreased production of bicarbonate

Response:
None

So the answer to this question is A


Instruction:
All of the following are causes of microvesicular fatty liver except -
A. Reye's syndrome
B. Obesity
C. Acute fatty liver of pregnancy
D. Valproic acid

Response:
None

So the answer to this question is B


Instruction:
Termination of all disease transmission by extermination of the infectious agents is known as:
A. Disease Control
B. Disease Elimination
C. Disease Eradication
D. Disease Prevention

Response:
Disease Eradication: It is the termination of all disease transmission by extermination of the infectious agents. Disease Elimination: It is the interruption of transmission of diseases. Disease Control: It is the control of disease agent to such reduced levels that it ceases to be a public health problem. Ref: Park, 21st Edition, Page 37-38

So the answer to this question is C


Instruction:
True regarding metapneumovirus is:
A. Segmented negative sense single stranded RNA virus
B. Incidence is 5% of total respiratory infection
C. Spreads through sexual contact and blood transfusion
D. Human metapneumovirus contains NS1 and NS2 antigens

Response:
Human metapneumovirus Belongs to family paramyxoviridae Contains negative sense single stranded RNA. Do not have any non structural proteins and contain 6 structural protiens Do not spread by sexual contact and blood transfusion Cause upper and lower respiratory disease in people of all ages, especially among young children, older adults, and people with weakened immune systems.

So the answer to this question is A


Instruction:
Accessory canals result from
A. Defects in cementogenesis
B. Dividing epithelial bridges
C. Break in Hertwig's root sheath
D. Adherent epithelial rests

Response:
Accessory canals may occur either due to loss of root sheath cells or due to inclusion of blood vessels during root development.

So the answer to this question is C


Instruction:
The single most useful clinical sign of severity of in a person without underlying lung disease Is
A. Temp more than 38.5degC
B. Hea rate more than 100/mm
C. Systolic BP less than 90 mm/Hg
D. none

Response:
CURB65 Each risk factor scores one point, for a maximum score of 5: Confusion of new onset (defined as an AMTS of 8 or less) Blood Urea nitrogen greater than 7 mmol/l (19 mg/dL) Respiratory rate of 30 breaths per minute or greater Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less Age 65 or older Ref Davidson edition23rd pg 583

So the answer to this question is C


Instruction:
Fluoroscein dye study is done to detect
A. Assess retinal function of babies
B. Retinal vascular pathology
C. Macular pathology
D. Posterior segment of eye

Response:
Ans. is 'b' i.e., Retinal vascular pathology Angiography for fundus examination Angiography is used for dynamic flow study of Iris, Retina or choroid. Following types of angiographies are used. Fluorescein Angiography :- Sodium fluorescein dye is used by injecting it into antecubital vein. It is primarily used for retinal vasculature, but iris & choroid can also be examined. Indocyanine green Angiography :- It is used primarily for choroidal vasculature, especially in choroidal neovascular membranes (CNVM). Therefore, it is used in - i) The identification and delineation ofpoorly defined or occult choroidal neovascularization, (ii) Retinal pigmented epithelium (RPE) detachments.

So the answer to this question is B


Instruction:
Sexual asphyxia is seen in cases of: AIIMS 06; NEET 13, 15
A. Masochism
B. Voyeurism
C. Sadism
D. Fetichism

Response:
Ans. Masochism

So the answer to this question is A


Instruction:
Liver biopsy of an icteric patient shows intensely eosinophilic objects called as Councilman bodies. What can be the diagnosis of this patient?
A. Hea failure
B. Acute viral hepatitis
C. Cirrhosis of liver
D. Wilson's disease

Response:
Councilman bodies (acidophil or apoptotic body) are individual hepatocyte necrosis, in which a dead hepatocyte is identifiable as a shrunken, intensely eosinophilic, round body with no or a pyknotic nucleus. They lie free in the sinusoid. They found in the liver of individuals suffering from viral hepatitis, yellow fever, or other viral syndrome. Ref: The Washington Manual of Surgical Pathology: Depament of Pathology and ... By Peter A. Humphrey, Louis P. Dehner, John D. Pfeifer, 2008, Page 209 ; Biopsy Interpretation of the Liver by Stephen A. Geller, Lydia M. Petrovic, Page 90

So the answer to this question is B


Instruction:
The levels of nicotine in 6 cigarettes were 13.0, 11.8,
15.4, 17.4, 31.2 and 24.3 mg. The mean of these values is
A. 14.9
B. 15.9
C. 18.6
D. 8.4

Response:
None

So the answer to this question is C


Instruction:
A patient at 28 weeks pregnancy presents with low grade fever, malaise, vomiting since 1 week. On examination she is icteric, Her Hb is 10 gm%, bilirubin is 5 mg/dL, SGOT and SGPT at 630 and 600 with normal platelet count. Most probable cause of her jaundice is
A. IHCP
B. Viral hepatitis
C. Hyperemesis gravidarum
D. HELLP syndrome

Response:
Patient here has presented with prodrome of viral hepatitis. Investigations to diiferentiate various causes of jaundice in pregnancy are IHCP AFLP HELLP Viral hepatiis Bilirubin (mg/dL) 1-5, direct 2-10, direct <2 >5 SGOT/ SGPT <200 <1000 <500 500-3000 ALP Raised Normal Normal Normal/raised Platelets Normal low Low Normal Prothrombin time Normal Prolonged prolonged prolonged

So the answer to this question is B


Instruction:
A 22-year-old man complains about his inability to conceive a child. On physical examination, the patient is noted to be tall (6 ft, 5 in) and exhibits gynecomastia and testicular atrophy. Laboratory studies demonstrate increased serum levels of follicle-stimulating hormone. Cytogenetic studies reveal a chromosomal abnormality. What is the most common cause of this patient's chromosomal abnormality?
A. Expansion of a trinucleotide repeat
B. Isochromosome formation
C. Meiotic nondisjunction
D. Nonreciprocal translocation

Response:
Klinefelter syndrome, or testicular dysgenesis, is related to the presence of one or more X chromosomes in excess of the normal male XY complement. Most persons with Klinefelter syndrome (80%) have one extra X chromosome (47, XXY karyotype). The additional X chromosome(s) arises as a result of nondisjunction during gametogenesis. In half of cases, nondisjunction occurs during paternal meiosis I, leading to a sperm containing both an X and a Y chromosome. Fertilization of a normal oocyte by such a sperm gives a zygote with a 47, XXY complement of chromosomes. Klinefelter syndrome occurs in 1 per 1,000 male newborns, which is roughly comparable to the incidence of Down syndrome. None of the other choices are associated with trisomy.Diagnosis: Klinefelter syndrome

So the answer to this question is C


Instruction:
Mode of transmission of Q fever is
A. Bite of infected louse
B. Bite of infected tick
C. Bite of infected mite
D. Inhalation of aerosol

Response:
Modes of Transmission of few important diseases:

So the answer to this question is D


Instruction:
Passive-active immunity is useful for the exposure of the following infection:
A. Rabies
B. Hepatitis B
C. Varicella-zoster
D. All of the above

Response:
Passive-active immunity is induced by giving both immunoglobulins to provide immediate protection and a vaccine to provide long-term protection. Rabies immune globulin (RIG) is used in the prevention of rabies in people who may have been exposed to the virus. Hepatitis B immune globulin (HBIG) is used in the prevention of hepatitis B in people who may have been exposed to the virus either by needle-stick or as a neonate born of a mother who is a carrier of HBV. Varicella-zoster immune globulin (VZIG) is used in the prevention of disseminated zoster in people who may have been exposed to the virus and who are immunocompromised. Ref: Levinson W. (2012). Chapter 36. Viral Vaccines. In W. Levinson (Ed),Review of Medical Microbiology & Immunology, 12e.

So the answer to this question is D


Instruction:
Rat tail file is also known as
A. Barbed broach
B. R file
C. H file
D. Rasp

Response:
None

So the answer to this question is D


Instruction:
Radiation exposure can leads to which thyroid carcinoma?
A. Lymphoma
B. Papillary carcinoma
C. Medullary carcinoma
D. Follicular carcinoma

Response:
ANSWER: (B) Papillary carcinomaREF: APPENDIX-111 for "THYROID CARCINOMA"Repeat Pathology 2008

So the answer to this question is B


Instruction:
A newborn has dribbling after feeds. He has respiratory distress and froths at the mouth. Diagnosis is -
A. Tracheoesophageal fistula
B. Tetralogy of fallot
C. Respiratory distress syndrome
D. None of the above

Response:
Ans. is 'a' i.e., Tracheoesophageal fistula Tracheoesophageal fistula and esophageal atresia o Esophageal atresia is the most common congenital anamoly of the esophagus. o More than 90% are associated with tracheoesophageal fistula. The most common variety is the one where upper pa of esophagus ends blindly and the lower pa is connected to trachea by a fistula. TEF should be suspected in all cases of hydroamnion. o There may be associated anomalies --> VACTERL (veebral, anorectal, cardiac, tracheal, esophageal, renal, radial, limb) syndrome. Presentations Frothing and bubbling at the mouth and nose. o Coughing, cyanosis and respiratory distress. o Feeding exacerbates these symptoms, cause regurgitation, and may precipitate aspiration. o Aspiration of gastric contents distal fistula can cause aspiration pneumonitis.

So the answer to this question is A


Instruction:
Which One of the following is NOT a cause of Secondary Postpartum Haemorrhage?
A. Placenta previa
B. Retained bits of placenta
C. Endometritis
D. Polyp

Response:
(A) Placenta previa[?]Secondary Postpartum Haemorrhage: The bleeding usually occurs between 8th to 14th day of delivery.The causes of late postpartum hemorrhage are:Retained bits of cotyledon or membranes (most common).Infection & separation of slough over a deep cervicovaginal laceration.Endometritis & subinvolution of the placental site--due to delayed healing process.Secondary hemorrhage from cesarean section wound usually occur between 10-14 days.-It is probably due to--(a) separation of slough exposing a bleeding vessel or (b) from granulation tissue.Withdrawal bleeding following estrogen therapy for suppression of lactation.Other rare causes are: Chorion-epithelioma occurs usually beyond 4 weeks of delivery; carcinoma cervix; placental polyp; infected fibroid or fibroid polyp and puerperal inversion of uterus.[?]Postpartum Haemorrhage (PPH): 15-30 min. after delivery, the uterus contracts to expel placenta from the deciduaUteroplacental spiral arteries thrombose (involution) as the myometrium continues contract1deg; atony of the uterus causes uteroplacental spiral arteries to partially thromboes. 2deg; subinvolution occurs due to placenta retention +- infection.Causes of secondary Postpartum Haemorrhage are:Retained bits of placenta; Postpartum infection; Infection of Cervical and Vaginal TearsPuerperal Inversion of Uterus; Uterine Polyp or Fibroid; Undiagnosed carcinoma of cervix; Chorion-epitheliomaRisk Factor Identified by Previous StudiesObstetrics HistoryCurrent PregnancyLabour complications*. Prior PPH*. Nulliparity clot*. History of retained placentaNon-obstetric factors*. Integrated bleeding disorder*. Age under 20 or over 40*. Anticoagulant therapy*. Fetal macrosomia*. Stillbirth*. Induction of labour*. Antepartum hemorrhage*. Chorioamnionitis*. Epidural anaesthetic*. Placenta accreta*. Multiple pregnancy*. Preedampsia*. HELLP syndrome*. Polyhydramnios*. Peterm birth*. Prolonged labour*. Prolonged third state*. Prlonged second stage*. Failure to progress*. Augmented labour*. Genital tract trauma*. Lacerations*. Episiotomy*. Retained placenta*. Mode of delivery*. Cesarean section*. Forceps*. Ventouse SUGGESTED CAUSESPosition of Placenta*. Placenta acereta*. Placenta praevia Genital tract trauma Spontaneous*. Uterine rupture*. Genital tract*. Lacerations Iatrogenic*. Episiotomy*. Caseseran delivery*. Ventous*. Forceps Retained placenta & ClotsUterine atony Labour-related*. Induction of labour*. Oxytocin use*. Chorioamnionitis*. Precipitous labour*. Prolonged labourOverdistension*. Multiple pregnancies*. Fetal macrosomia*. Polyhydramnios*. Placental abruption with large intrauterine dot*. Anaesthesia*. General anaesthesia with inhaled agentsCoagulation disordersThrombocytopeniaAnticoagulant therapyInherited bleedingdisorderDisseminatedIntravascularCoagulopathy*. Liver dysfunction*. Intrauter ne fetal demise*. Amniotic fluid embolism I*. Placental abruption Uterine inversionPostpartum HaemorrhageConsequencesMental mortality: The leading cause of maternal death worldwideMaternal morbidityCoagulopathy: After deliveryRespiratory failure; With an increased need for mechanical ventilationRenal failure: Resulting from hypoperfusionOther morbidity: Sepsis, Hysterectomy, Prolonged length of hospital stayCAUSES OF PRIMARY & SECONDARY POSTPARTUM HEMORRHAGEPrimary (early)Secondary (late)Uterine atony: Labor-related; Anaesthesia*. Over distension of uterusPelvic trauma: Iatrogenic; Spontaneous Retained products of conception: Coagulopathy: DIC; Thrombocytopenia, Inherited disorders Uterine inversion Abnormal placentation:*. Placenta previa; Placenta accreteAbnormal placentation*. Subinvolution of placental site*. Placenta accretaRetained production of conception*. Infection: Endometritis*. Infection of cesarean section scarCoagulopathyUterine pathology*. Fibroids, Cervical cancer PRIMARY PPH: CAUSESFour TsSpecific CauseRelative FrequencyToneAtonic uterus70%TraumaLacerations, hematomas, inversion, rupture20%TissueRetained tissue, invasive placenta10%ThrombinCoagulopathies1%

So the answer to this question is A


Instruction:
Pulsus paradoxus is seen in:
A. Pericardial tamponade
B. Pulmonary embolism
C. Hemorrhagic shock
D. All of the above

Response:
Pulsus paradoxus refers to a fall in systolic pressure >10 mmHg with inspiration that is seen in patients with pericardial tamponade, but also is described in those with massive pulmonary embolism, hemorrhagic shock, severe obstructive lung disease and tension pneumothorax.
Pulsus paradoxus is measured by noting the difference between the systolic pressure at which the Korotkoff sounds are first heard (during expiration) and the systolic pressure at which the Korotkoff sounds are heard with each heart beat, independent of the respiratory phase. Between these two pressures, the Korotkoff sounds are heard only intermittently and during expiration. The cuff pressure must be decreased slowly to appreciate the finding.
It can be difficult to measure pulsus paradoxus in patients with tachycardia, atrial fibrillation, or tachypnea. A pulsus paradoxus may be palpable at the brachial artery or femoral artery level when the pressure difference exceeds 15 mmHg. This inspiratory fall in systolic pressure is an exaggerated consequence of interventricular dependence.
Reference: Harrison’s P R I N C I P L E S   O F I N T E R N A L M E D I C I N E 20th edition page no 1670

So the answer to this question is D


Instruction:
Sister Mary Joseph nodule is most commonly seen with: March 2011
A. Ovarian cancer
B. Stomach cancer
C. Colon cancer
D. Pancreatic cancer

Response:
Ans. B: Stomach cancer Gastric tumour may spread the abdominal cavity to the umbilicus (Sister Joseph's nodule) Sister May Joseph's nodule: Periumbilical nodule/ hard mass Represents metastatin involvement of the paraumbilical nodes from intrapelvic or intraabdominal malignancies Seen with: - Stomach - Large bowel - Ovary - Pancreatic tumour Indicates poor prognosis

So the answer to this question is B


Instruction:
Corynebacterium diphtheriae can be grown within 6-8 hours on:
A. Potassium tellurite media with iron
B. McConkey’s agar
C. Dorset egg medium
D. Loeffler’s serum slope

Response:
On Loeffler’s serum slope, C. diphtheriae grows after 4–6 hours at 37°C producing small, circular, and white opaque colonies.
If no colonies are seen, the medium is reincubated further for 24 hours.

Parija SC. Textbook of Microbiology & Immunology. Elsevier Health Sciences; 2014. Page:218

So the answer to this question is D


Instruction:
Which of the following is a strategy used to increase the yield of protein produced in recombinant protein synthesis ?
A. Promoter induction
B. Genes for protease inhibitors
C. Translation initiation
D. Translation and transcription termination

Response:
Expression vector is a vector which synthesize the protein coded by a gene introduced via DNA recombination technology. To enhance the final yield of protein product, some expression vectors even contain genes that code for protease inhibitors.

So the answer to this question is B


Instruction:
Concept of multipurpose workers was given by -
A. Mudaliar committee
B. Srivastava committee
C. Kaar Singh Committee
D. Mukherjee committee

Response:
- Kaar Singh Committee was established in 1973. - it is also called as the committee on multipurpose workers under health and family planning. - the recommendation of the committee includes feasibility of having multipurpose workers in the field and training requirements of such workers. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:874 <\p>

So the answer to this question is C


Instruction:
The left suprarenal vein drains into:
A. Inferior vena cava
B. Lt. renal vein
C. Rt. renal vein
D. Portal vein

Response:
Ans: b (Lt. renal vein)Venous drainage of the suprarenals:Left suprarenal vein drains into the Lt. renal veinRt. suprarenal vein drains into the inferior vena cavaArterial supply.Each gland is supplied by:1) Superior suprarenal artery- Br. of inferior phrenic artery2) Middle suprarenal artery- Br. of abdominal aorta3) Inferior suprarenal artery- Br, of renal artery

So the answer to this question is B


Instruction:
Locord's system is ?
A. Podography
B. Dactylography
C. Poroscopy
D. Cheiloscopy

Response:
Ans. is 'c' i.e., Poroscopy Dactylography (Galton's system) --> Study of finger prints. Poroscopy (Locard's system) -4 Study of number, sizes and distribution of pores of sweat glands on ridges (used when only a pa of finger print is available). Podogram --> Study of foot print. Cheiloscopy (queiloscopy) --> Study of lip prints. Rugoscopy (Palatoprints) Study of anterior pa of palate.

So the answer to this question is C


Instruction:
Frotteurism is:
A. Sexual satisfaction by contact with articles of opposite sex like hanky, sandals, clothes
B. Sexual satisfaction by rubbing the genitalia with the body of the person of other sex
C. Sexual gratification by exposing one's genitalia.
D. Sexual satisfaction by watching the sexual act.

Response:
Ans. (b) Sexual satisfaction by rubbing the genitalia with the body of the person of other sexRef: The Essentials ofFSM by K.S. Narayan Reddy 31st ed. / 404* FROTTEURISM: rubbing the genitalia with the body of the person of other sex for sexual satisfaction.* Paraphilias: Abnormal 8c unorthodox sex play by using unusual objects or parts are know as paraphilia eg. Sadomasochism, Transvestism, Bestiality, Frotteurism, Homosexuality etc.* Bisexuality means hermaphrodite; an individual with both ovary 8c testis 8c external genitals of both sexes.Different Paraphilias/PerversionSexual perversionMode of sexual pleasureSadismPleasure in giving pain to sexual partnerMasochismPleasure on receiving painful stimulus from sexual partnerBondageSadism + masochism are found togetherFetischismSexual gratification by article of opposite sexFrotteurismSexual gratification by contact. Ex: rubbing genitalia on another personExhibitionismSatisfaction in exhibition of genitals with or without mastutbationTransvestism/ EonismPleasure in wearing clothes of opposite sexUranismSexual gratification by fingering, fellatio, cunnilingus etc.Buccal coitus or Sin of GomorrahFellatio is oral stimulation of penis by male or femaleCunnilingus is oral stimulation of female genitalsVoyeurism/ ScotophiliaAlso known as Peeping tomDesire to watch sexual intercourse or toobserve genitals of othersTrolismExtreme degree of voyeurism. Ex: A perverted husband enjoy watching his wife having sexual intercourse with another man.Urolangia/ CoprophiliaSexual excitement by sight or odor of urine or faeces.Tribadism/ LesbianismGratification of sexual desire of a women by another womenSodomy or Buggery of Greek Love* Anal sex* Gerantophilia -when passive agent is adult* Paederasty - when the passive agent is young boy (catamite)IncestSexual intercourse with close relativeBestialitySexual intercourse by a human being with a lower animal

So the answer to this question is B


Instruction:
Which of the following is true regarding myringoplasty:
A. In underlay graft is placed medial to the annulus
B. In underlay graft is placed lateral to the malleus
C. In overlay graft is placed lateral to the malleus
D. In overlay graft is placed medial to the annulus

Response:
(a) In underlay graft is placed medial to the annulus(Ref. Scott Brown, 8th ed., Vol 2; 1026)In both underlay and overlay, a portion of the graft is placed medial to the malleus.In underlay, graft is placed medial to the annulus, whereas in overlay graft is placed lateral to the annulus.

So the answer to this question is A


Instruction:
'Lacunar type' of Reed-Sternberg (RS) cells are seen in which type of Hodgkin's lymphoma?
A. Nodular sclerosis
B. Lymphocyte predominance
C. Lymphocyte depletion
D. Mixed cellularity

Response:
Ans a (Nodular Sclerosis) (Ref. Robbin's Pathology 8th/Table 12-8.; 7th/table 14-6)SubtypeMorphotogy and ImmunophenotypeTypical Clinical FeaturesNoduiar selerosisFrequent lacunar cells and occasional diagnostic R-S cells: background infiltrate composed of T lymphocytes, eosinophils, macrophages and plasma cells, fibrous bands dividing cellular areas into nodules. R-S cells CD15+, CD30+, EBV.Stage 1 or 2 disease most common. Ferquent mediastinal involvement F = M, most patients young adultsMixed cellularityFrequent mononuclear and diagnostic R-S cells; background infiltrate in T lymphocytes, eosinophils, macrophages, plasma cells. R-S cells CD15+, CD30+; 70% EBV+.More than 50% present as stage 3 or 4 disease. M>F. Biphasic incidence, peaking in young adults and again in adults older than 55.Lymphocyte-richFrequent mononuclear and diagnostic R-S cells; background infiltrate rivh in T lymphocytes. R-C cells. CD15+, CD30+; 40% EBV+.Uncommon. M>F. Tends to be seen in older adults.Lymphocyte depletionReticular variant: Frequent diagnostic R-S cells and variants with a paucity of background reactive cells; diffuse fibrosis variant; hypocellular fibrillary background with scattered diagnostic R-S cells and variants and few reactive cells. R-S cells CD15+, CD30+; most EBV+.Uncommon. More common in older males, HIV-infected individuals, and in developing countries. More likely to present with advanced disease.Lymphocytes predominanceFrequent 1 & II (popcorn cell) variants in a background of follicular dendritic cells and reactive B cells. R-S cells CD20+. CD15, C30; EBV.Uncommon. Young males with cervical or axillary lymphadenopathy. Mediastinal.SUMMARY OF THE MORE COMMON LYMPHOID NEOPLASMSEntityFrequencySalient MorphologyImmunophenotypeCommentsPrecursor B-cell lym- phoblastic leukemia/ lymphoma85% of childhood acute leukemiaLymphoblasts with irre- gular nuclear contours, condensed chromatin, small nucleoli, and scant agranular cytoplasmTdT+immature B cells (CD19+, variable expression of other B-cell markers)Usually presents as acute leukemia; less common in adults; prognosis is predicted by karyotypePrecursor T-cell leukemia/ lymphoma15% of childhood acute leukemia; 40% of child- hood lymphomasIdentical to precursor B-cell lymphoblastic leukemia/lymphomaTdT+immature T cells (CD2+, CD7+, variable expression of other T-cell markers)Most common in adolescent males; often presents as a mediastinal mass due to thymic involvement; asso with NOTCH1 mutationSmall lymphocytic lymphoma/chronic lymphocytic leukemia3% to 4% of adult lymphomas; 30% of all leukemiasSmall resting lymphocytes mixed with variable numbers oflarge activated cells; lymph nodes diffusely effacedCD5+B-cell expressing surface IgOccurs in older adults; usually involves nodes, marrow, and spleen; most patients have peripheral blood involvement; indolentFollicular lymphoma40% of adult lymphomasFrequent small "cleaved" cells mixed with large cells; growth pattern is usually nodular (follicular)CD10+BCL2+mature B cells that express surface IgOccurs in older adults; usually involves nodes, marrow, and spleen; associated with t(14;18); indolentMantle cell lymphoma3% to 4% of adult lymphomasSmall to intermediate- sized irregular lymphocytes growing in a diffuse patternCD5+mature B cells that express cyclin D1 and have surface IgOccurs mainly in older males; usually involves nodes, marrow, and spleen; GI tract also commonly affected; t(11;14) is characteristic; moderately aggressiveExtranodal marginal zone lymphoma<5% of adult lymphomasVariable cell size and differentiation; 40% show plasmacytic differentiation; B cells home to epithelium, creating "lymphoepithelial lesions"CD5- CD10- mature B cells with surface IgFrequently occurs at extranodal sites involved by chronic inflammation; very indolent; may be cured by local excisionDiffuse large B-cell lymphoma40% to 50% of adult lymphomasVariable; most resemble large germinal center B cells; diffuse growth patternMature B cells with variable expression of CD10 and surface IgOccurs in all ages, but most common in older adults; often arise at extranodal sites; aggressiveBurkitt lymphoma<1% of lymphomas in the United StatesIntermediate-sized round lymphoid cells with several nucleoli; diffuse tissue involvement associated with apoptosis produces a "starry-sky" appearanceMature CD10+B cells expressing surface IgEndemic in Africa, sporadic elsewhere; increased frequency in immunosuppressed patients; predominantly affects children; often presents with visceral involvement; highly aggressivePlasmacytoma/ plasma cell myelomaMost common lymphoid neoplasm in older adultsPlasma cells in sheets, sometimes with prominent nucleoli or inclusions containing IgTerminally differentiated plasma cells containing cytoplasmic IgMyeloma presents as disseminated bone disease, often with destructive lytic lesions. Hypercalcemia, renal insufficiency, and bacterial infections are commonMycosis fungoidesMost common cutaneous lymphoid malignancyIn most cases, small lymphoid cells with markedly convoluted nuclei; cells often infiltrate the epidermis (Pautrier microabscesses)CD4+mature T cellsPresents with localized or more generalized skin involvement; generally indolent. Sezary syndrome, a more aggressive variant, is characterized by diffuse skin erythema and peripheral blood involvementPeripheral T-cell lymphoma, not otherwise specified (NOS)Most common adult T-cell lymphomaVariable; usually a spectrum of small to large lymphoid cells with irregular nuclear contoursMature T-cell phenotype (CD3+)Probably spans a diverse collection of rare tumors. Often disseminated, generally aggressive

So the answer to this question is A


Instruction:
Prenatal diagnosis at 16 weeks of pregnancy can be performed using all of the following, except:
A. Amniotic fluid
B. Maternal blood
C. Chorionic villi
D. Fetal blood

Response:
All options given in the question are correct as all of them are used for prenatal diangosis.
But, read the question very carefully. It specifically says at “16 weeks of pregnancy”.
Cordocentesis in is done at 18–20 weeks therefore we cannot include fetal blood in this answer.

So the answer to this question is D


Instruction:
Which of the following types of mosquitos are now restricted to Andaman and Nicobar islands?
A. Anopheles Culicifacies
B. Anopheles Stephensi
C. Anopheles Flutilis
D. Anopheles Epiroticus

Response:
Some points about Anopheles species given in Park 21th edition 1) Anopheles Culicifacies - Vector in rural and peri urban areas 2) Anopheles Stephensi - Vector in urban and industrial areas 3) Anopheles Flutilis - vector in hilly areas and forests of east 4) Anopheles Minimus - Vector in foot hills of Noh-Eastern states 5) Anopheles Dirus - Vector in forests of noh east 6) Anopheles Epiroticus - Vector in Andaman and Nicobar Islands Ref: Park, Edition 21, Page 232.

So the answer to this question is D


Instruction:
A woman has a bilateral headache that worsens with emotional stress; she has two children, both doing badly in school; diagnosis is
A. Migraine
B. Cluster headache
C. Tension headache
D. Trigeminal neuralgia

Response:
A tension-type headache (TTH) is a syndrome characterized by bilateral tight, band-like discomfo, builds slowly, fluctuates in severity, episodic or chronic (present >15 days per month).Usually occurs without accompanying features such as nausea, vomiting, photophobia, phonophobia, osmophobia, throbbing, and aggravation with movement. Ref: Harrison's 18/e p121,122

So the answer to this question is C


Instruction:
Which of the following reflexes is not present at bih
A. Asymmetric Tonic Neck Reflex
B. Moro's Reflex
C. Symmetric tonic neck reflex
D. Crossed extensor reflex

Response:
Symmetric tonic neck reflex appears by 4-6 months and disappears by 8 - 12 months. Moro&;s reflex - hand opening appears by 28 wks, extension and abduction of the upper extremities by 32 wks and anterior flexion by 37 wks of intrauterine life and disappears by 3 - 6 months after bih. Asymmetric tonic neck reflex appears by 35 wks of intrauterine life and disappears by 4 - 6 months after bih. Crossed extension response begins at 28 weeks gestation and disappears by 1-2 month. Reference : page 142 Ghai Essential Pediatrics 8th edition and page 15 Paediatric Clinical examination A Santhosh Kumar

So the answer to this question is C


Instruction:
Steroid receptor superfamily is present in :
A. Vitamin D3
B. Insulin
C. Glucagon
D. All

Response:
A i.e. Vitamin D3

So the answer to this question is A


Instruction:
Median nerve lesion at the wrist causes all of the following, EXCEPT:
A. Thenar Atrophy
B. Weakness of Adductor Pollicis
C. Weakness of 1st and 2nd Lumbricals
D. Weakness of Flexor Pollicis Brevis

Response:
Median nerve lesion at wrist will lead to atrophy of thenar eminence, weakness to flexor pollicis brevis, 1st and 2nd lumbricals. Adductor pollicis is supplied by the ulnar nerve. Ref: Neurology, Marco Mumenthaler, Heinrich Mattle, 4th Edition, Page 749-783; Snell's Clinical Anatomy, 7th Edition, Page 482,483.

So the answer to this question is B


Instruction:
DMPA causes all the following Except
A. Weight gain
B. Irregular cycles
C. Amenorrhoea
D. Thromboembolism

Response:
Depomedroxyprogesterone AcetateDMPA, a suspension of microcrystals of a synthetic progestin. The regimen of 150 mg every 3 months is highly effective, producing pregnancy rates ofabout 0.3 per 100 women per year.The most impoant medical reason women discontinue use of DMPA and other progestin-only methods is persistent irregular vaginal bleeding. Eventually, total amenorrhea develops in most women who take DMPA; with continued administration, amenorrhea develops in 50% of women by 1 year and in 80% by 3 years.Ref: Berek and Novak&;s Gynecology; 15th edition; Chapter 10

So the answer to this question is D


Instruction:
Quantity of water available per capita considered adequate to meet the needs of all urban domestic purposes?
A. 100-150 L
B. 150-200 L
C. 200-250 L
D. 250-300 L

Response:
2 L is the amount of water required for meeting the physiological requirements of the body everyday. But water is also required for many other activities of daily life such as cooking, washing, bathing etc. Taking this into consideration, 150-200 L of water per capita is the amount considered adequate to meet the needs of all urban domestic purposes. Ref: Park's Textbook of Preventive and Social Medicine, 20th edition, p617

So the answer to this question is B


Instruction:
Management of third degree utero-vaginal prolapse in woman who wants to have a child in future is?
A. Le fort's repair
B. Shirodkar's Modified Sling Operation
C. Manchester operation
D. Fothergill's repair

Response:
ANSWER: (B) Shirodkar's Modified Sling OperationREF: Shaw 13th ed p. 329Repeat December 2008Abdominal sling operations have been designed for young women suffering from second or third degree uterovaginal prolapse and are desirous of having children.

So the answer to this question is B


Instruction:
Molis micrograbhic excision is used for the management of
A. Testicular cancer
B. Penile cancer
C. Prostate cancer
D. None of the above

Response:
None

So the answer to this question is B


Instruction:
Quarantine is related to -
A. Minimum incubation period
B. Maximum incubation period
C. Serial interval
D. Generation time

Response:
Ans. is 'b' i.e., Maximum incubation period Ouarantine o Quarantine is defined as "the limitation offreedom of movement of such well persons or domestic animals exposed to communicable disease for a period of time not longer the longest incubation period of the disease in such manner as to prevent effective contact with those not exposed". o In simple words "Quarantine separates people who have been exposed to a specific illness (but are not yet sick and don't have symptoms)" from those not exposed". Why would one be quarantined ? Some infection can be transmitted even before a person knows he or she is sick or has any symptoms. How long would one be quarantined ? o The individual and often the entire family will stay at home until the risk of developing the disease or its symptoms is over that means maximum incubation period, because following exposure symptoms develop after incubation period. So, if after maximum incubation period for a specific disease, exposed person does not develop disease that means that person has not acquired infection and the person should be allowed to move. What if one is in quarantine and becomes ill ? o A quarantined person who develops symptoms associated with the disease in question should immediately contact his/her personal physician and local public health depament. Once ill, the individual will be considered to be in isolation instead of quarnatine.

So the answer to this question is B


Instruction:
Which one of the following distinguishes ARDS (acute/adult respiratory distress syndrome) from cardiogenic pulmonary oedema ?
A. Normal PaO2
B. Normal pulmonary arterial pressure
C. Normal arterial-alveolar gradient
D. Normal PaCO2

Response:
None

So the answer to this question is B


Instruction:
Pseudounipolar cells
A. Sympathetic ganglia
B. Parasympathetic
C. Cranial nerve ganglion
D. Dorsal Root Ganglion

Response:
Ans. (d) Dorsal Root Ganglion(Ref: Ganong, 25th ed/p.86)Pseudo unipolar neuron* Are variants of bipolar cells in which one ends goes to the spinal cord and the other end goes to peripheral skin* Example- Dorsal root ganglion cell

So the answer to this question is D


Instruction:
The spaces involved in ludwigs angina are
A. Sublingual
B. Submandibular
C. Submaxillary
D. All of the above

Response:
LUDWIG'S ANGINA APPLIED ANATOMY :- Submandibular space lies between mucous membrane of the floor of mouth and tongue on one side and superficial layer of deep cervical fascia extending between the hyoid bone and mandible on the other. It is divided into two compaments by the mylohyoid muscle: 1. Sublingual compament (above the mylohyoid). 2. Submaxillary and submental compament (below the mylohyoid). The two compaments are continuous around the posterior border of mylohyoid muscle. Ludwig's angina is infection of submandibular space. Ref:- Dhingra; pg num:-263,264

So the answer to this question is D


Instruction:
Which of the following abolishes the therapeutic effect of levodopa:
A. Thiamine
B. Carbidopa
C. Pyridoxine
D. Benserazide

Response:
Pyridoxine abolishes therapeutic effect of levodopa by enhancing peripheral decarboxylation of levodopa, less is available to cross to the brain. Ref KD Tripathi 8th ed.

So the answer to this question is C


Instruction:
The Chorda tympani nerve arises from:
A. The vagus nerve
B. The trigeminal nerve
C. The glossopharyngeal nerve
D. The facial nerve

Response:
The facial nerve

So the answer to this question is D


Instruction:
A patient presents with features of ataxia. He gives a h/o a painless penile ulcer around 3 years ago that was followed by a maculopapular rash. He is staed on treatment. The MOST sensitive test to monitor him while on treatment is:
A. VDRL (Veneral Disease Research Laboratory)
B. RPR
C. TPI
D. CSF pleocytosis

Response:
This is case of Tabes dorsalis. It is a late manifestation of syphilis that presents as symptoms and signs of demyelination of the posterior columns, dorsal roots, and dorsal root ganglia. Symptoms: Ataxic wide-based gait and foot drop Paresthesia Bladder disturbances Impotence Areflexia Loss of positional, deep-pain, and temperature sensations. The activity of neurosyphilis (symptomatic or asymptomatic) correlates best with CSF pleocytosis, and this measure provides the most sensitive index of response to treatment. Efficacy of treatment in patients with primary or secondary syphilis assessed by clinical evaluation and monitoring of the quantitative VDRL or RPR titer for a fourfold decline. Must know: Involvement of the CNS is detected by examination of CSF for pleocytosis (>5 white blood cells/L), increased protein concentration (>45 mg/dL), or VDRL reactivity. Ref: Lukeha S.A. (2012). Chapter 169. Syphilis. 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 D


Instruction:
All of the following sections are related to "Dowry death" except
A. 113(A) Indian evidence act
B. 113(B) Indian evidence act
C. 304(A) IPC
D. 174(3) criminal procedure code

Response:
304A. Causing death by negligence Sections related to dowry death IEA 113A. Presumption as to abetment of suicide by a married woman. IEA 113B. Presumption as to dowry death. CrPC Section 174(3)(iii) the case relates to the death of a woman within seven years of her marriage and any relative of the woman has made a request in this behalf 304B. Dowry death Ref: Krishnan vij Textbook of Forensic Medicine and Toxicology; 5th ed; Page no: 169,206

So the answer to this question is C


Instruction:
Head engaged and reached the pelvic floor. The treatment indicated in this obstetric situation is :
A. Outlet forceps
B. High forceps
C. Mid forceps
D. Low forceps

Response:
Outlet forceps

So the answer to this question is A


Instruction:
A child presents with complaints of oliguria, abdominal distension and diarrhoea. On examination there is deep jaundice. Hepatomegaly was present measuring 4 era below the costal margin. Conjugated bilirubin in blood was 38 mg/dL, and there was urine urobilinogen and bile pigments. Hemoglobin was 4 mg/dL and serum creatinine was 3 mg/dL. Which of the following tests is of least impoance to diagnose this case?
A. G6PD level in blood
B. Serum ceruloplasmin
C. Reticulocyte count
D. Leptospiral antibody level

Response:
Severe anemia, jaundice, hepatomegaly are strongly suggestive of this child is suffering with severe hemolysis. Oliguria and elevated creatinine levels are pointing out to acute renal failure due to hemolysis. Hence the investigations should be towards the etiology of hemolysis. Serum ceruloplasmin determination is for finding out Wilson's disease. The above clinical picture does not correlate with Wilson's disease. Findings of Wilson's disease may include jaundice, hepatomegaly early in childhood, splenomegaly, and Kayser-Fleischer rings. Hepatic involvement may present as ALF, acute hepatitis, chronic liver disease, cholelithiasis, or as cirrhosis with poal hypeension. Serum ceruloplasmin levels (measured by the oxidase method) are usually less than 20 mg/dL. (Normal values are 23-43 mg/dL.) Ref: Sokol R.J., Narkewicz M.R. (2012). Chapter 22. Liver & Pancreas. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.

So the answer to this question is B


Instruction:
Imprisonment for a term extending to seven years and also fine as punishment for voluntarily causing grievous hurt : -
A. S. 321, I.P.C
B. S. 322, I.P.C
C. S. 325, I.P.C
D. S. 324, I.P.C

Response:
S.325, I.P.C
- Punishment for voluntarily causing grievous hurt: Imprisonment for a term extending to seven years and also fine

So the answer to this question is C


Instruction:
All cause fournier gangrene except-
A. Staphylococcus
B. Streptococcus
C. Clostridium
D. Bacteroides

Response:
None

So the answer to this question is C


Instruction:
ICD -11 has 3 volumes plus 26 chapters. Volume 2 contain:-
A. Tabulation list
B. Reference guide
C. Alphabetical index
D. Functional assessment

Response:
ICD-11 (International Classification of Diseases - 11th Edition, WHO) - Revised every 10 years, right now 11th edition - Released in June 2018 and it contains 3 Volumes & 26 chapters along with chapter X, V. Volume I - Tabulation List Volume II - Reference Guide Volume III- Alphabetical Index - Some impoant chapters to be remembered: Chapter 6 - Mental behaviour and Neurodevelopmental disorders Chapter 26 - Traditional Medicine Chapter X - Extension codes Chapter V - functional Assessment

So the answer to this question is B


Instruction:
Pancreatic secretions are a rich source of
A. Phospholipase A1
B. Phospholipase A2
C. Phospholipase C
D. Phospholipase D

Response:
Phospholipase A2 (PLA2) is elevated in cases of acute pancreatitis. Pancreatic sPLA2 serve for the initial digestion of phospholipid compounds in dietary fat. Ref: Biochemistry by U. Satyanarayana 3rd edition Pgno : 174

So the answer to this question is B


Instruction:
Which is/are not fetal complication of uncontrolled diabetes during pregnancy
A. Stillbih
B. Chromosomal anomaly
C. NTD
D. IUGR

Response:
The Fetal complications of GDM includes Miscarriages Congenital malformations Unexplained intrauterine deaths Prematurity Macrosomia IUGR Reference: Textbook of Obstetrics; Sheila Balakrishnan, 2nd edition, Page no: 243

So the answer to this question is D


Instruction:
What is the most common presentation in cystic fibrosis?
A. Lung infection
B. Meconium ileus
C. Malabsorption
D. Infeility

Response:
Feature Percentage of cases Acute or persistent respiratory symptoms 50.5 Failure to thrive, malnutrition 42.9 Abnormal stools 35.0 Meconium ileus, intestinal obstruction 18.8 Family history 16.8 Electrolyte acid-base abnormality 5.4 Nasal polyps; sinus disease 2.0 Hepatobiliary disease 0.9

So the answer to this question is A


Instruction:
Glucose increases plasma insulin by a process that involves
A. GLUT 1
B. GLUT 2
C. GLUT 3
D. SGLT 1

Response:
Ans. (b) GLUT 2(Ref: Ganong, 25th ed/p.432)The most important stimulus for secretion of insulin is glucoseGlucose enters pancreatic beta cells through glucose transporter- 2 (GLUT -2)

So the answer to this question is B


Instruction:
Commonest site of a rodent ulcer is
A. Limbs
B. Face
C. Abdomen
D. Trunk

Response:
Rodent ulcer is synonymous with basal cell carcinoma.
90% of basal cell carcinomas are seen in the face, above a line from the corner of mouth to the lobule of ear. The commonest site is around the inner canthus of the eye (also k/a Tear cancer).

So the answer to this question is B


Instruction:
Cells of stellate reticulum is:
A. Polyhedral.
B. Cuboidal.
C. Columnar
D. Star-shaped.

Response:
None

So the answer to this question is D


Instruction:
Withdrawal bleeding following administration of progestogen in a case of secondary amenorrhoea indicates all except:
A. Absence of pregnancy
B. Production of endogenous estrogen,
C. Endometrium is responsive to estrogen
D. Defect in pituitary gonadal axis

Response:
None

So the answer to this question is D


Instruction:
Which of the following statement regarding poal venous system is TRUE?
A. Valves are present at the junction of superior mesenteric vein and splenic vein
B. Whole system is valveless
C. Valves are present in the intrahepatic system
D. There are about 10-12 valves along the entire course

Response:
In adults, the poal vein and its tributaries have no valves. In fetal life and for a sho postnatal period valves are demonstrable in its tributaries, but they usually atrophy. Rarely some persist in an atrophic form into adulthood. Poal venous system comprises of poal vein and its 3 tributaries, splenic vein, superior and inferior mesenteric vein. Thses veins drain the blood from the intestinal tract, from the oesophagus to the rectum, from the spleen and pancreas to the liver. Poal vein carries 75% of total blood flow to the liver. Normal poal pressure is 5 - 10mmHg.

So the answer to this question is B


Instruction:
Criminal responsiblity of insane is defined in:
A. McNaughton's rule
B. Curren's rule
C. Durham rule
D. American law institute test

Response:
ANS. A

So the answer to this question is A


Instruction:
All of the following are true about Roll back malaria except:(AIIMS November 2013, Nov 2012)
A. Insecticide treated mosquito nets
B. Strengthening health system
C. Development of newer insecticide
D. Training of health workers

Response:
Ans. c. Development of newer insecticide (Ref; Harrison 19/e p14,18/e p14 WHO Roll Back Malaria Document] HTM_ MAL 2005. 1101.pdf (Roll Back Malaria)Roll Back Malaria:Messages on malaria case management, intermittent preventive treatment during pregnancy and insecticide- treated netsQ (ITNs) were promoted using volunteers, social marketing of unit-dose, prepackaged antimalarial medicines and trainingQ of patent medicine dealers (BASICS II, 2004).The key to the success of this programme was the shift from supply to demand creation for health servicesQ, increased access to medicines, and community ownershipRoll Back Malaria* In Nigeria, a communication strategy for behavioural change was initiated using both the public and private sectors.* Messages on malaria case management, intermittent preventive treatment during pregnancy and insecticide-treated nets (ITNs) wrere promoted using volunteers, social marketing of unit-dose, prepackaged antimalarial medicines and training of patent medicinedealers (BASICS II. 2004).* The channels used included interpersonal communication, traditional communication channels such as 'town criers' and local festivals, and social marketing through medicine packaging, radio spots and distribution of booklets to patent medicine dealers.* The strategy resulted in an increased knowledge of the role and benefits of ITNs in malaria prevention and an increased awareness of the danger signs of malaria and of the importance of seeking early treatment for febrile children through antimalarial medicines.* The key to the success of this programme was the shift from supply to demand creation for health services, increased access to medicines, and community ownership* The experience gained from such training programmes has demonstrated the need for training to address the following gaps in skills and knowledge, depending on the specific roles undertaken:- Knowledge and skills to recognize uncomplicated malaria, danger signs and when to refer the patient Knowledge and skills to manage malaria appropriately (recommended medications/dosages)- Awareness of the need for prompt and early treatment, and completion of the dose- Communication skills to counsel and offer health education on other aspects (e.g. ITNs. intermittent preventive treatment during pregnancy)- Recording/reporting tasks- Drug storage* The highest level of political commitment by the national government is required to ensure that the cross-ministerial activities beyond the purview of the ministry of health required for the implementation of HMM are facilitated at the policy level.Central and regulatory factors:* Regulatory status of recommended antimaiarial medicines.* Quality assurance mechanisms for medicine manufacture and Distribution, and their application.* Regulatory status of potential provider groups.* Current curricula for pre-service and in-service training for* Health providers and other stakeholders in the HMM programme (e.g. teachers) and for schools.

So the answer to this question is C


Instruction:
Drug of choice for fungal corneal ulcer:
A. Nystatin
B. Caspofungin
C. Natamycin
D. Amphotericin

Response:
Natamycin is a topical antifungal which is the drug of choice for fungal corneal ulcer.
Other topical antifungals : Nystatin, Clotrimazole, Tolnaftate, Ciclopirox

So the answer to this question is C


Instruction:
The triangular area bounded by clitoris, fourchette and labia minora is:
A. Fossa navicularis
B. Ventricle
C. Vestibule
D. Vulva

Response:
Ans. is c, i.e. VestibuleRef: COGDT 11th/ed, p26Vestibule is the triangular area bounded anteriorly by the clitoris, posteriorly by Fourchette and on either side by labia minora.

So the answer to this question is C