Instruction:
Subepidermal bullae is seen in
A. Pemphigus vulgaris
B. Darriers disease
C. Bullous pemphigoid
D. HSV infection

Response:
Bullous pemphigoid is an autoimmune pruritic skin disease preferentially in elderly people, that may involve the formation of blisters (bullae) in the space between the epidermal and dermal skin layers. The disorder is a type of pemphigoid. It is classified as a type II hypersensitivity reaction, with the formation of anti-hemidesmosome antibodies Pathophysiology: The bullae are formed by an immune reaction, initiated by the formation of IgG autoantibodies targeting Dystonin, also called Bullous Pemphigoid Antigen 1, and/or type XVII collagen, also called Bullous Pemphigoid Antigen 2, which is a component of hemidesmosomes. A different form of dystonin is associated with neuropathy. Following antibody targeting, a cascade of immunomodulators results in a variable surge of immune cells, including neutrophils, lymphocytes and eosinophils coming to the affected area. Unclear events subsequently result in a separation along the dermoepidermal junction and eventually stretch bullae. Diagnosis: Diagnosis consist of at least 2 positive results out of 3 criteria (2-out-of-3 rule): (1) pruritus and/or predominant cutaneous blisters, (2)linear IgG and/or C3c deposits (in an n- serrated pattern) by direct immunofluorescence microscopy (DIF) on a skin biopsy specimen, and (3)positive epidermal side staining by indirect immunofluorescence microscopy on human salt-split skin (IIF SSS) on a serum sample. Routine H&E staining or ELISA tests do not add value to the initial diagnosis. Treatment: Treatments include class I topical steroids (clobetasol, halobetasol, etc.) , systemic prednisone and powerful steroid-free immunosuppressant medications, such as methotrexate, azathioprine or mycophenolate mofetil. Some of these medications have the potential for severe adverse effects such as kidney and liver damage, increased susceptibility to infections, and bone marrow suppression. Antibiotics such as tetracycline or erythromycin may also control the disease, paicularly in patients who cannot use coicosteroids. The anti-CD20 monoclonal antibody rituximab has been found to be effective in treating some otherwise refractory cases of pemphigoid. Ref Harrison 20th edition pg 1278

So the answer to this question is C


Instruction:
Self-stimulation is experimentally done from which pa of brain
A. Medial forebrain bundle
B. Area around aqueduct of sylvius
C. PV region of hypothalamus
D. Radical radiotherapy

Response:
Ans. a. Medial forebrain bundleMedial forebrain bundle is one of the areas responsible for self-stimulationResponsible Centres for Self-stimulationVentral tegmentumdegMedial forebrain bundleQNucleus accumbensQFrontal coex0Drugs that block post-synapticin creases it. The main site D3 receptors dopaminergic reduces the rate of self-stimu ation. Dopamine agonist of the relevant receptor is the nucleus accumbens located at striatum base.

So the answer to this question is A


Instruction:
A 38-year-old man with a history of fever associated with abdominal pain of 3-week duration presents now with a sudden onset of abdominal pain and copious vomiting. Plain abdominal x-rays reveal air under a diaphragm. A CT scan shows mesenteric lymphadenopathy and splenomegaly is found. Laparotomy is performed and 3 feet of ileum resected. The luminal aspect of the resected bowel shows marked ulceration of Peyer's patches. What is the most likely diagnosis?
A. Typhoid enteritis
B. Tuberculosis enteritis
C. Crohn's disease
D. Primary peritonitis

Response:
Typhoid fever typically presents with initial symptoms. Small intestine complications are related to involvement of Peyer's patches of the small intestine, which result in bleeding and/or perforation in the second and third week after symptoms are noted.

So the answer to this question is A


Instruction:
Which of the following indicates the most severe form of fetal distress -
A. Decreased S/D ratio
B. Reversal of diastolic flow
C. Absent diastolic flow
D. Increased S/D ratio

Response:
Ans. is 4b' i.e.. Reversal of S/D ratio Umbilical artery Dopplero It is used in the surveillance of the fetal well being in the third trimester of pregnancy.o Abnormal umbilical artery Doppler is the marker of uteroplacental insufficiency, and consequent IUGR and suspected pre - eclampsia.o Normal umbilical artery waveform shows a saw tooth pattern with flow always in the forward direction.Normal promotvpe waveform of the umbilical artery dopptero The highest point of the peak of each waveform denotes the Peak Systolic Velocity (PSV) while the lowest point of the trough represents the End Distolic Velocity (EDV) and TAV represents the Average i.e. Timed Average Velocity (TAV).o While analyzing the umbilical artery Doppler one should keep in mind that the normal flow in the umbilical artery is from fetal to maternal circulation the systolic and the diastolic phases studied are in relation to the fetal heart and the downstream vessel to the umbilical artery is the placenta and thematernal circulationo The commonly used parameters in the umbilical artery doppler are:SD ratio: systolic velocity/diastolic velocity.Pulsatility index (PI) (Gosling index): (PSV- EDV)/ TAVResistive index (RI) (Pourcelot index): (PSV - EDV) / PSVo Normally the parameters mentioned above should decrease progressively as the pregnancy advancesr as there is increase in the end diastolic velocity due to growth and dilatation of umbilical circulation.o Any deviation in the parameters is suggestive of either IUGR or pre - eclampsia ,o Thus, during progressive monitoring of the umbilical artery Doppler, as the severity of the disease increases, we observeFirst the decreased velocity in the end diastolic phase,Then absent flow in the end diastolic phase followedBy reversal of flow in the end diastolic phase.o Thus Reversal of diastolic flow is the indicator of most severe form offetal distress.

So the answer to this question is B


Instruction:
The following eye finding is not seen in which of the following diseases?
A. Galactosemia
B. Diabetes
C. Phenylketonuria
D. Wilson disease

Response:
The given picture shows bilateral cataract, can be seen in: Galactosemia Diabetes mellitus Wilson disease Peroxisomal disorders So, answer is option 3- phenylketonuria

So the answer to this question is C


Instruction:
All are true about type 1 renal tubular acidosis except:
A. Renal stones
B. Hypokalemia
C. Sodium bicarbonate requirement >4 mg/day
D. Urine pH > 5.5

Response:
Ans. c. Sodium bicarbonate requirement Renal Tubular Acidosis Feature Type I(Distal) Type II(Proximal) Type IV Normal anion gap Yes Yes Yes Minimum urine pH >5.5deg <5.5deg <5.5 A filtered bicarbonate excreted <10 >15 <10 Serum potassium Low Low Highdeg Fanconi's syndrome No Yesdeg No Stones/Nephrocalcinosis Yesdeg No No Daily acid excretion Low Normaldeg Low Urinary anion gap Positive Positive Positive Type 1 (Distal) A In distal A, the kidneys are unable to acidify the urine to pH Treatment Early initiation of alkali replacement at doses equivalent to 1-3 mmol/kg per day of bicarbonate in divided doses will usually correct the acidosis, hypokalemia, and hypocitraturia, maintaining growth and preventing bone disease in early-onset dA. Citrate is generally tolerated better than sodium bicarbonate and can be given as the potassium or sodium salt, depending on the severity of hypokalemia. In patients who present later with kidney stones. large fluid intake and sufficient alkali to restore normal acid-basebalance, correct the hypocitraturia and reduce hypercalciuria, thereby inhibiting the formation of new stones Treatment of Type 2 (Proximal) A It is difficult to restore normal acid-base balance in patients with proximal A despite large amounts of alkali. This is the case because they continue to waste bicarbonate (fractional excretion >15%) until the serum level falls below a threshold, usually about 15-17 mmol/L, at which time bicarbonate is completely reabsorbed distally and the urine is maximally acidified with pH <5.5. When the serum bicarbonate concentration is raised above the threshold with alkali therapy, bicarbonate wasting recurs and causes hypokalemia as potassium is secreted to maintain luminal electroneutrality. Thus, treatment of pA requires 5-15 mmol/kg per day of bicarbonate together with supplemental potassium

So the answer to this question is C


Instruction:
Non hormonal drug to prevent post menopausal osteoporosis is :
A. Alendronate
B. Estrogen
C. Raloxifene
D. Parathyroid

Response:
Ans. is a i.e. Alendronate Alenderonate, Etidronate, Pamidronate, Ibandronate are bisphosphonates which inhibit bone resorption, and are very effective for both osteoporosis prevention and treatment. Uses : * Postmenopausal osteoporosis Paget's disease Osteolytic bone metastasis. Caution : Patient should be instructed to take these drugs on an empty stomach with a large glass of water and then to remain upright for atleast 30 minutes as its major side effect is GI upset. Route of administration : Oral or I.V. infusion of Alendronate and risedronate can be given once weekly, whereas ibandronate is given once in a month. Now lets have a look at other options : Raioxitene : is a selective Estrogen receptor modulator which is also useful in management of osteoporosis. Parathyroid horrnope . is a novel therapy for osteoporosis. Unlike most of the treatments for osteoporosis that inhibit bone resorption, parathyroid hormone stimulates new bone formation. Parathyroid hormone is given by daily subcutaneous injection. Also know : Other non hormonal drugs used for treatment of osteoporosis : Calcium Vitamin D Calcitonin Slow releasing sodium fluoride.

So the answer to this question is A


Instruction:
Selective medium for Gonococci -
A. Thayer - martin medium
B. LJ medium
C. DCA medium
D. MacConkey's medium

Response:
None

So the answer to this question is A


Instruction:
Meaning of baby has 15th percentile of head circumference is-
A. 15% of children will have HC more than that
B. 15% of HC, the child is having
C. 15% of children will have HC less than that
D. None.

Response:
Ref:Parks 23rd edition Means 15% of children have HC less than that.

So the answer to this question is C


Instruction:
Natural uncoupler is ?
A. Thermogonin
B. 2, 4 nitrophenol
C. 2, 4 Dinitrophenol
D. Oligomycin

Response:
Ans. is 'a' i.e., Thermogenin Amongst the given options, a, b and c are uncouplers.However, only thermogenin, among these three is a natural (physiological) uncoupler.UncouplesAs the name suggests, these componds block the coupeling of oxidation with phosphorylation. These compounds allow the transfer of reducing equivalents in respiratory chain but prevent the phosphorylation of ADP to ATPdeg by uncoupling the linkage between ETC and phosphorylation. Thus the energy instead of being trapped by phosphorylation is dissipated as heat. Uncouplers may be :-Natural :- Thermogenin, thyroxineSynthetic :- 2, 4-dinitrophenol (2, 4-DNP), 2, 4-dinitrocresol (2, 4-DNC), and CCCP (chlorocarbonylcyanidephenyl hydrazone).

So the answer to this question is A


Instruction:
Emile Durkheim is linked with work on which condition in psychiatry?
A. Suicide
B. Obsessive compulsive disorder
C. Anxiety disorder
D. Schizophrenia

Response:
Ans. A. SuicideSuicide (French: Le Suicide)It was a groundbreaking book in the field of sociology.It was written by French sociologistEmile Durliiheim and pubtshed in 1897.It was ostensibly a case study of suicide, a publication unique for its time that provided an example of what the sociological monograph should look like.

So the answer to this question is A


Instruction:
Man is the only reservoir for
A. Salmonella
B. Campylobacter jejuni
C. E. histolytica
D. Y. enterocolitica

Response:
Entamoeba histolytica is predominantly found in primates (including humans) and occasionally in dogs, cats, cattle and pigs.
The parasite has a worldwide distribution and is prevalent in tropical and subtropical countries.
Salmonella - The most common are animal reservoirs are chickens, turkeys, pigs, and cows; dozens of other domestic and wild animals also harbor these organisms.
Campylobacter jejuni - C. jejuni is carried by most of these animal reservoirs and is the predominant species isolated from chickens and cattle.
Y. Enterocolitica - dogs, sheep, wild rodents, and environmental water may also be a reservoir of pathogenic Y. enterocolitica strains.
Ref : http://parasite.org.au/para-site/text/entamoeba-text.html#:~:text=Host%20range%3A%20Entamoeba%20histolytica%20is,in%20tropical%20and%20subtropical%20countries

So the answer to this question is C


Instruction:
Normal diurnal variation of intraocular pressure is:
A. 0-2 mm of Hg
B. 2-3 mm of Hg
C. 3-6 mm of Hg
D. 6-8 mm of Hg

Response:
Ans. 3-6 mm of Hg

So the answer to this question is C


Instruction:
Bipolar II disorder includes
A. Cyclothymic disorder
B. Dysthemia
C. Single manic episode
D. Major depression & hypomania

Response:
D i.e. Major depression & hypomania

So the answer to this question is D


Instruction:
Frotteurism:
A. Pleasure in watching intercourse
B. Pleasure in using article of opposite sex
C. Pleasure in touching opposite sex
D. Pleasure in wearing opposite sex clothes

Response:
Ans. (c) Pleasure in touching opposite 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 C


Instruction:
True about incentives given to ASHA worker in Janani Shishu Suraksha Karyakram:
A. 400 INR to ASHA and 1000 INR to mother in rural area in high performing states
B. 400 INR to ASHA and 1000 INR to mother in rural area in low performing states
C. 400 INR to ASHA and 1000 INR to mother in urban area high performing states
D. 400 INR to ASHA and 1000 INR to mother in urban area low performing states

Response:
Janani Shishu Suraksha Karyakram (JSSK) Incentives Category Rural area Urban area Mother's ASHA Mother's ASHA LPS 1400 600 1000 400 HPS 700 600 600 400

So the answer to this question is D


Instruction:
Which of the following statements about romosozumab is FALSE?
A. It is a monoclonal antibody against RANK ligand
B. It acts by inhibiting osteoclast
C. It acts by stimulating osteoblast
D. It is indicated in post menopausal osteoporosis

Response:
Romosozumab is a monoclonal antibody against sclerostin. Denosumab is monoclonal antibody against RANK ligand. Romosozumab has dual action in osteoporosis. It stimulates osteoblast as well as inhibits osteoclast. It is used for treatment of post menopausal osteoporosis.

So the answer to this question is A


Instruction:
Most common type of esophageal atresia is:
A. Type A
B. Type B
C. Type C
D. Type D

Response:
The most commonly seen variety is EA with distal TEF (type C), which occurs in approximately 85% of the cases in most series. The next most frequent is pure EA (type A), occurring in 8 to 10% of patients, followed by TEF without EA (type E). The latter occurs in 8% of cases and is also referred to as an H-type fistula, based on the anatomic similarity to that letter. EA with fistula between both the proximal and distal ends of the esophagus and trachea (type D) is seen in approximately 2% of cases, and type B, EA with TEF between the proximal esophagus and trachea, is seen in approximately 1% of cases. Ref: Schwaz's principle of surgery 9th edition, chapter 39.

So the answer to this question is C


Instruction:
A 38-year old homeless male develops sudden onset hematemesis following a bout of severe vomiting and retching. He had no complaints prior to the onset of his symptoms. On examination, he is pale and looks anxious. The vital signs are normal. Laboratory investigations show normal liver function tests, a low Hb and high MCV, chest X-ray is normal. The above problem on endoscopy would appear as -
A. Dilated veins in lower esophagus
B. Growth in the lower esophagus
C. Linear tear in the OG junction
D. Whitish plaques in esophagus

Response:
Potential Mechanisms for Mallory-Weiss Tears A Mallory-Weiss tear likely occurs as a result of a large, rapidly occurring, and transient transmural pressure gradient across the region of the gastroesophageal junction. Acute distention of the nondistensible lower esophagus can also produce a linear tear in this region Ref Davidson 23rd edition pg821

So the answer to this question is C


Instruction:
True about development all except:
A. Parathyroid glands develop from 3rd & 4th branchial arch
B. Tongue muscles develop from occipital myotome
C. Superior parathyroid gland develops from 4th branchial arch
D. Inferior parathyroid gland develop from 2nd branchial arch

Response:
D. i.e. Inferior parathyroid gland develop from 2^d branchial arch

So the answer to this question is D


Instruction:
MOST common mutation seen in heriditary hemochromatosis is:
A. C282Y
B. H63D
C. TFR2
D. SLC11A3

Response:
The most common mutation in hereditary hemochromatos is a homozygous G to A mutation resulting in a cysteine to tyrosine substitution at position 282 (C282Y). Another relatively common mutation (H63D) results in a substitution of histidine to aspaic acid at codon 63. Mutations like transferrin receptor 2 TFR2 mutation and ferropoin 1 gene, SLC11A3 mutation are rare. Ref: Harrisons principles of internal medicine, 18th edition, Page: 3162

So the answer to this question is A


Instruction:
The drug of choice for status epilepticus is ?
A. Propofol
B. Lorazepam
C. Thiopentone
D. Haloperidol

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

So the answer to this question is B


Instruction:
A 52 year old man presented with dysphagia diagnosed of having adenocarcinoma of esophagus. It mostly seen in:
A. Middle esophagus
B. Upper esophagus
C. Barrett's ulcer
D. None of the above

Response:
Barrett esophagus secondary to long-standing reflux disease is the single most impoant risk factor for adenocarcinoma. Patients with Barrett esophagus are 30 to 125 times more likely to have adenocarcinoma of the esophagus than the general population. Microscopically, adenocarcinoma almost always originates in metaplastic Barrett's mucosa, and resembles gastric cancer. Ref: Jobe B.A., Hunter J.G., Peters J.H. (2010). Chapter 25. Esophagus and Diaphragmatic Hernia. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.

So the answer to this question is C


Instruction:
Which rtf the following is true about Lambda phage?
A. It cause mad cow disease
B. Lysogenic to lytic conversion cannot occur
C. Lysogenic form incorporates in host DNA and remain dormant
D. Lytic phase incorporates in host DNA proliferate and causes rupture of cell

Response:
Ans. c. Lysogenic form incorporates in host DNA and remain dormant In the lysogenic phage the phage virus does not immediately cause the lysis of the cell, instead it integrates into the host genome."In (he lysogenic phase the phage virus does not immediately cause the lysis of the ceil, instead it integrates into the host genome. The phage D.XA in this repressed state is called a prophage (because it is not a phage but it has the potential to produce phage). The integrated state of phage D.XA is termed prophage, whereas, the process is known as tysogency and the bacteria harbouring the prophage are called lysogenic bacteria."Lambda Phage life Cycle in the HostVirulent or Lytic phaseLysogenic phase* The phage virus takes over the cellular machinery of the host and starts producing viral proteins necessary for the synthesis of new viruses.* In the lysogenic phase the phage virus does not immediately cause the lysis of the cell, instead it integrates into the host genome.* The phage DNA in this repressed state is called a prophage (because it is not a phage but it has the potential to produce phage). Lambda Phage life Cycle in the HostVirulent or Lytic phaseLysogenic phase* New viruses assemble in the host cell and the host bacteria lyse and release progencv virions.* The integrated state of phage DNA is termed prophage, whereas, the process is known as lysogencv and the bacteria harbouring the prophage are called lysogenic bacteria.* It replicates synchronously with the host virus causing no harm to it.* Two new daughter cells are formed each containing the host cell gene and the prophage gene.* On exposure to ultraviolet light or other agents the lysogenic phase undergoes induction, i.e. The phase DNA is excised from the host cell and it undergoes lytic cycle.

So the answer to this question is C


Instruction:
Which of the following is cariostatic?
A. Selenium
B. Magnesium
C. Cadmium
D. Molybdenum

Response:
None

So the answer to this question is D


Instruction:
Storage form of energy in liver is -
A. Glycogen
B. Triacylglycerol
C. Cholesterol ester
D. Protein

Response:
Ans. is 'a' i.e., Glycogen* Humans carry supplies of fuel within their body. Calories are stored in the body as fat (triglycerides), glycogen and some protein.Provider of energyGramsKilocaloriesPlasma glucose1248Hepatic glycogen70280Muscle glycogen2801120Fat (Triglyceride) in adipose tissue13,000117, 000Muscle protein10,00040,000* Thus, fat in the adipose tissue is the largest reserve of energy in the body, i.e. adipose tissue is the storehouse in the body. However, liver glycogen is the first main provider of energy, for example after absorptive period (when all the dietary glucose is utilized), liver glycogen is the first source of energy. Liver glycogen maintains the blood glucose level between meals.

So the answer to this question is A


Instruction:
Laboratory, test for lead poisoning?
A. Lead in urine
B. ALA in urine
C. Coproporphyrin in urine
D. All of the above

Response:
Ans. is 'd' i.e., All of the above Lead Poisoning ? Most common mode of absorption of lead is inhalation of fumes and dust of lead or its comppunds. Other less common mode of absorption are ingestion and absorption through skin (especially tetraethyl lead). A blood level 70 g/100 ml or more is generally associated with clinical symptoms. Lead exes its toxic action by combining with essential SH - groups of ceain enzymes. Lab tests for lead poisoning Coproporphyrin in urine (CPU) -4 In non exposed persons, it is less than 150 g/L. Amino levulinic acid (ALA) in urine If it exceeds 5 mg/litre it indicates clearly lead absorption. Lead in blood and urine : Lead in blood and urine are quantitative indicators of exposure. Lead in urine of over 0.8 mg/litre indicates lead exposure. Blood level of 70 micro g/100m1 is associated with clinical symptoms Basophilic stipling of RBC Is a sensitive parameter of the hematological response.

So the answer to this question is D


Instruction:
All of the following are seen in rickets except: September 2009
A. Frenkels line
B. Widening of epiphysis- diaphysis distance
C. Cupping and splaying of metaphysis
D. Rarefaction

Response:
Ans. A: Frenkels Line In rickets, the skeletal effects are due to lack of calcification of osteoid. The first changes of rickets appear in rapidly growing distal ends of ulna & radius (wrist & knee are commonly involved due to more use). Rarefaction of provisional zone of calcification with widening of epiphysis- diaphysis distance is first to appear. The most obvious change are at 'metaphysis'- where rapid growth is occurring. First change to appear is a 'loss of normal zone of provisional calcification' adjacent to metaphysis. This begins as an indistinctness of the metaphyseal margin, progressing to a 'frayed' appearance with widening of the growth plate, due to lack of calcification of metaphyseal bone. Weight bearing & stress on uncalcified bone gives rise to 'splaying' Sr 'cupping' of metaphysis. A similar but less marked effect occurs in subperiosteal layer, which may cause lack of distinctness of coical margin. Eventually a generalized reduction in bone density is seen. In the epiphysis - there may be some haziness of coical margin. Thus all findings in Rickets occur due to failure of calcification & abnormal demineralization i. Skull changes - Pronounced calvarial demineralization - Basilar Invagination - Indistinct sutural margin - Delayed tooth eruption Premature craniostenosis - Craniotabes - Calvarial thickening following treatment ii. Spine changes - Scoliosis - Biconcave veebral bodies - Triradiatic pelvis.

So the answer to this question is A


Instruction:
A 27-year-old male painter is admitted to the hospital after falling from a ladder. Physical examination reveals that the patient is unable to abduct his arm more than 15deg and cannot rotate the arm laterally. A radiographic examination reveals an oblique fracture of the humerus. He has associated sensory loss over the shoulder area. Which of the following injuries will most likely correspond to the symptoms of the physical examination?
A. Fracture of the medial epicondyle
B. Fracture of the glenoid fossa
C. Fracture of the surgical neck of the humerus
D. Fracture of the anatomic neck of the humerus

Response:
Fracture of the surgical neck of the humerus often injures the axillary nerve, which innervates the deltoid and teres minor muscles. Abduction of the humerus between 15deg and the horizontal is performed by the deltoid muscle. Lateral rotation of the humerus is mainly performed by the deltoid muscle, teres minor, and the infraspinatus. The deltoid and teres minor are both lost in this case. Fracture of the glenoid fossa would lead to drooping of the shoulder. Fracture of the anatomic neck of the humerus will similarly lead to a drooping of the shoulder but would not necessarily affect abduction of the humerus. It is also quite unusual. Fracture of the middle third of the humerus would most likely injure the radial nerve. The ulnar nerve would be potentially compromised in a fracture of the medial epicondyle of the humerus.

So the answer to this question is C


Instruction:
70 M presented to AIIMS OPD with fatigue. Fasting sugar was 110 mg%, PP was 180 mg%, Hbalc was 6.1 %. What is your diagnosis?
A. Prediabetes
B. Stress induced
C. Normal
D. Diabetes

Response:
Ans. (a) Prediabetes(Ref: Robbins 9th/pg 1106; 8th 1131)Diagnostic criteria according to ADA and WHO: Presence of any 1 or more of the following-CriteriaDiabetesImpaired glucose tolerance (pre-diabetes)* Fasting plasma glucose>=126mg/dLbetween 100 and 125mg/dL* Random plasma glucose>=200mg/dL-* 2-hour plasma glucose during oral glucose tolerance test (OGTT) with 75 g>=200mg/dLbetween 140 and 199mg/dL* Glycated hemoglobin (HbA1C) level>=6.5%between 5.7% and 6.4%.

So the answer to this question is A


Instruction:
What is the location of stricture in the given RGU?
A. Membranous urethra
B. Bulbar urethra
C. Penile urethra
D. Prostatic urethra

Response:
- IOC for diagnosing posterior urethral stricture - MCU- IOC for diagnosing anterior urethral stricture- RGU- Adequate evaluation of posterior and anterior urethral stricture- RGU+ MCU Retrograde urethrogram

So the answer to this question is B


Instruction:
Which of the following drugs does not cross placenta?
A. Heparin
B. Warfarin
C. Dicumarol
D. Nicoumalone

Response:
Heparin due to its large molecular size does not cross the placental barrier therefore can be used in pregnancy. From medical pharmacology padmaja 4th edition Page no 335

So the answer to this question is A


Instruction:
Primary prevention in coronary heart diseases-
A. Salt restriction
B. BP monitoring
C. Exercise in high risk area
D. Statins

Response:
primary prevention- health promotion and specific protection. Regular physical activity should be a part of normal daily life. It particularly important to encourage the children to take up physical activity that they can continue through out their life.

So the answer to this question is C


Instruction:
Which of the following drugs lack vasodilatory properties that is effective in angina?
A. Metoprolol
B. Verapamil
C. Isosorbide dinitrate
D. Nifedipine

Response:
Metoprolol: It is the prototype of cardioselective (β1) blocker; nearly 50 times higher dose is needed to block isoprenaline induced vasodilation. Some measure of inverse agonistic activity on β1 receptors has also been demonstrated. It is less likely to worsen asthma, but is not entirely safe. It may be preferred in diabetics receiving insulin or oral hypoglycaemics. Patients who complain of cold hands and feet while on propranolol, do better on metoprolol.
First pass metabolism of metoprolol is less marked than propranolol, but 90% or more is ultimately hydroxylated by CYP2D6 before excretion. There are 'extensive' and 'poor' hydroxylators of metoprolol (CYP2D6 alleles); the latter may require a lower dose.
Side effects of metoprolol are milder. It is generally given orally for hypertension, angina and CHF, but i.v. injection (5-15 mg) has been used in myocardial infarction provided bradycardia is absent.
Key concept:
Beta-blockers do not cause vasodilation.
Reference: Essentials of Medical Pharmacology Eighth Edition KD  TRIPATHI  page no 162

So the answer to this question is A


Instruction:
Radiological investigation shows sun ray appearance;diagnosis is -
A. Osteosarcoma
B. GCT
C. Osteomyelitis
D. Ewing's sarcoma

Response:
In exams like AIIMS and AI, only best option has to be chosen and here osteosarcoma is best option.

So the answer to this question is A


Instruction:
Most common cause of Abdominal aneurysm is:
A. Atherosclerosis
B. Trauma
C. Marfan's syndrome
D. Congenital

Response:
Answer is A (Atherosclerosis) Atherosclerosis is the major etiological factor in abdominal aoic aneurysm - Robbins Remember: Atherosclerotic aneurysms most frequently occur in the Abdominal aoa.Q Most common site of abdominal aoic aneurysm is above the bifurcation of aoa and below the renal aeries.Q Most common age group for abdominal aoic aneurysm depends is elderly(> 50 years). Risk' of rupture of an abdominal aoic aneurysm depends upon its size (aneurysm larger than 5 cm are classified as dangerousQ) Most common source of infection in a Mycotic abdominal aoic aneurysm is Bacteremia Q from a primary Salmonella gastro-enteritis.Q (Mycotic aneurysm are abdominal aoic aneurysm that have become infected by lodgment of circulating organisms in the wall)

So the answer to this question is A


Instruction:
Fever in burnt patient is caused by:a) Due to hypermetabolismb) Toxin released by dead tissuec) Infectiond) Dead tissue products
A. a
B. ac
C. ad
D. b

Response:
Long: Principles and Practice of Pediatric Infectious Diseases, (3rd ed chapter 91) writes-
"Diagnosis of infectious complications in a burn victim is challenging. Although fever and elevated peripheral white blood cell count with a left shift are usual indicators of infection, their positive predictive value for diagnosis of infectious complications in burn victims is very low because they are commonly seen in uninfected burned children whose wounds are uncovered. Neither severity of fever (frequently > 39°C) nor response to antipyretic therapy is a reliable indicator of infection. Peak fever in burned children without infection usually occurs on the second day after the burn, with a second peak around the sixth and seventh days.  Fever is probably the result of an increase in metabolic rate and an alteration of hypothalamic temperature regulation. Fever usually subsides without specific therapy, coincident with re-epithelialization of the burn wound or successful grafting of all open areas. Thus, fever alone in the burned child is not a reliable indicator of infection or of the need to investigate for infection or prescribe antibiotic therapy."

So the answer to this question is B


Instruction:
In which pa of Henle loop is tubular fluid hypotonic with plasma/GFR?
A. Thin descending limb
B. Thin ascending segment/limb.
C. Thick ascending segment/limb.
D. Thick descending segment/limb.

Response:
Thick ascending segment/limb.REABSORPTION IN THICK ASCENDING LIMB:Water reabsorption:Totally impermeable to water.Ascending segment also referred "Diluting" segment:Due to sodium & solute absorption without water.Resulting in tubular fluid dilution.Hence, Tubular fluid is hypotonic.Sodium, Potassium & Chloride reabsorption:By "Secondary active transpo" Through Na2+-K+-2Cl-- carrier transpoer.Transpos one Na2+, one K+, & two Cl-.Active sodium absorption occurs.30% filtered Na2+ reabsorbed.

So the answer to this question is C


Instruction:
Lithium directly affects which
A. Sodium
B. Potassium
C. Magnesium
D. Calcium

Response:
Ans. is 'a' i.e., Sodium Diuretics (paicularly thiazides) decrease the renal excretion of lithium and thus may result in toxicity. This is due to increased reabsorption of Na+ and lithium ions (as a compensatory response to excessive loss of Na+).

So the answer to this question is A


Instruction:
All of the following are true about the Herd Immunity for infectious diseases except :
A. It refers to group protection beyond what is afforded by the protection of immunized individuals
B. It is likely to be more for infections that do not have a sub-clinical phase
C. It is affected by the presence and distribution of alternative animal hosts
D. In the case of tetanus it does not protect the individual

Response:
Occurrence of clinical and subclinical infection in a community is responsible for herd immunity. Herd immunity is more for infections that have a subclinical phase. Ref: Park's Textbook Of Preventive And Social Medicine By K. Park, 19th Edition, Page 96; Park's Textbook Of Preventive And Social Medicine By K. Park, 18th Edition, Page 95

So the answer to this question is B


Instruction:
A 19-year-old man working as a driver comes to Psychiatrist with excessive anxiety and fear. He repos that every time he drives over a bump in the road, he is convinced that he has accidentally run over a small child. He has to pull over and check underneath his car for blood and retrace his driving route to look for any injured children. As a result, he is always late for work.He also has intrusive thoughts about stabbing his coworkers.He prays to try to erase these thoughts from his mind, but this rarely helps. First-line pharmacological treatment of this patient's condition primarily affects which of the following neurotransmitters?
A. Acetylcholine
B. Dopamine
C. Norepinephrine
D. Serotonin

Response:
Patient's behavior is suggestive of Obsessive Compulsive Disorder. Although multiple neurotransmitters and regulatory mechanisms are thought to contribute to the clinical expression of OCD ,serotonin is the primary pharmacological target. First-line treatment is a selective serotonin reuptake inhibitor(SSRI) antidepressant.

So the answer to this question is D


Instruction:
Loss of pulmonary surfactant in premature infant ?
A. Pulmonary edema
B. Collapse of alveoli
C. Elastic recoil of lungs
D. All

Response:
Ans. is 'a' i.e., Pulmonary edema; 'b' i.e., Collapse of alveoli & 'c' i.e., Elastic recoil of lungs Effects of surfactant deficiency o Decreased compliance Increased elastic recoil o Atelectasis o Interstitial edema o Hyaline membrane formation

So the answer to this question is D


Instruction:
Hotspot on Tc-99 is seen in which parotid tumour?
A. Pleomorphic adenoma
B. Adenoid cystic carcinoma
C. Acinic cell tumour
D. Wahin tumour

Response:
Wahin tumour, or papillary cystadenoma lymphomatosum, is the second most common benign parotid tumour and occurs most often in older white men. Because of the high mitochondrial content within oncocytes, the oncocyte-rich Wahin tumour and oncocytomas incorporate technetium-99m and appear as hot spots on radionuclide scans.Ref: Sabiston, 20e, page no: 830

So the answer to this question is D


Instruction:
All are cholinergic agents except I
A. Galantamine
B. Donepezil
C. Tacrine
D. Memantine

Response:
Refer kDT 6/e p 472,473 Donepazil, rivastigmine, gallantamine and tacrine are cholinergic drugs( due to inhibition of cholenesterase enzyme)useful for Alzheimer's disease Memantine is an NMDA blocker, used for Alzheimer's disease

So the answer to this question is D


Instruction:
A 13-year-old male presents with bilateral enlargement of his breasts. Physical exam is otherwise unremarkable, and the breast enlargement is thought to be a normal variation at pubey. Histologic sections of breast tissue would most likely reveal
A. Proliferation of ducts in hyalinized fibrous tissue with periductal edema
B. Atrophic ductal structures with increased numbers of lipocytes
C. Dilated ducts filled with granular, necrotic, acidophilic debris
D. Granulomatous inflammation surrounding ducts with numerous plasma cells

Response:
Gynecomastia (enlargement of the male breast) histologically reveals epithelial hyperplasia within the ducts that is surrounded by hyalinized fibrous tissue. It is caused by an increase in the estrogen-to-androgen ratio. This abnormality may sometimes be found in males at the time of pubey. Other causes of gynecomastia include Klinefelter's syndrome (decreased secretion of testosterone), testicular feminization (androgen insensitivity), testicular tumors, cirrhosis of the liver, alcohol abuse, increased gonadotropin levels (such as choriocarcinoma of the testis), increased prolactin levels, drugs (such as digoxin), or hypehyroidism. Testicular neoplasms that are associated with gynecomastia are tumors that secrete human chorionic gonadotropin (hCG), which increases the synthesis of estradiol. Testicular tumors associated with the production of hCG include germ cell tumors (choriocarcinoma and seminoma), Leydig cell tumors, and Seoli cell tumors Gynecomastia Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition

So the answer to this question is A


Instruction:
Veical transmission is by-
A. Mosquitoes
B. Direct contact
C. Droplet
D. Placenta

Response:
When the infectious agent is transmitted veically from infected female to her progeny in the vector is known as transovarial transmission.Transmission of the disease agent from one stage of the life cycle to another as for example nymph to adult is known as transstadial transmission (refer pgno:98 park 23rd edition)

So the answer to this question is D


Instruction:
According to ADA specification #1 for amalgam, what is the acceptable dimensional change?
A. -20 to +20 micron/cm
B. -10 to +10 micron/cm
C. -20 to +10 micron/cm
D. -10 to +20 micron/cm

Response:
According to ADA specification #1 for amalgam, the acceptable dimensional change is -20 to +20 micron/cm.
Reference: Marzouk Operative dentistry, pg-108

So the answer to this question is A


Instruction:
Which of the following skull fractures is called a Motorcyclist's fracture -
A. Ring fracture of base of skull
B. Hinge fracture of base of skull
C. Comminuted fracture of skull
D. Depressed fracture of skull

Response:
A transverse fracture across the floor of the skull, usually called a "hinge fracture", is sometimes referred to as motorcyclist fracture. At autopsy, the base of the skull may be appreciated to have divided into two halves, each moving independently of each other like a hinge, the so-called motorcyclist fracture.

So the answer to this question is B


Instruction:
Iron absorption is increased in -a) Iron deficiency anemiab) Pregnancyc) All types of anemiad) Malignancye) Macrocytic anemia
A. acd
B. bcd
C. abd
D. ab

Response:
None

So the answer to this question is C


Instruction:
A lymph node from a 10-year-old boy reveals large pleomorphic lymphocytes with CD30 positivity, frequent mitoses, and scattered cells bearing kidney-shaped nuclei. Which of the following statements is true?
A. t(2;5) translocation impas a worsened prognosis.
B. ALK protein immunostaining is seen in a minority of cases.
C. This tumor occurs exclusively in children
D. Hallmark cells are a feature.

Response:
This patient has anaplastic large cell lymphoma (ALCL). The constituent cells are positive for CD30. Scattered cells showing kidney or donut-shaped nuclei with an eosinophilic region adjacent to the nucleus are known as "Hallmark cells." The majority of cases in children shows a t(2;5) translocation which correlates with ALK positivity and improved survival. Bimodal incidence.

So the answer to this question is D


Instruction:
Which of the following statements about contrast in radiography is true -
A. Ionic monomers have three iodine atoms per two paicles in solution
B. High osmolar contrast agents may be ionic or non ionic
C. Gadolinum may cross the blood brain barrier
D. Iohexol is a high osmolar contrast media

Response:
option A is correct : Ionic monomers have three iodine atoms per two paicles in solution Ionic dimers and non ionic monomers have three iodine atoms per one paicle in solution Non ionic dimers have six iodine atoms per one paicle in solution option B is incorrect : High osmolar agents (ionic monomers) are only ionic low osmolar agents may be ionic or non ionic iso osmolar agents are only non ionic option C is incorrect : Gadolinium does not cross Blood brain barrier (BBB) option D is incorrect : Iohexol is low osmolar (non ionic monomer)

So the answer to this question is A


Instruction:
Bruxism causes the following Except
A. Attrition of primary & permanent teeth
B. TMJ disorder
C. Muscular tenderness
D. Caries

Response:
None

So the answer to this question is D


Instruction:
Deep vein thombosis occurs most commonly after:
A. Total hip replacement
B. Gastrectomy
C. Prostatic operation
D. Brain surgery

Response:
Ans. is 'a' ie Total hip replacement * "Pts receiving t/t in hospital are at increased risk of venous thrombosis. This includes pts being treated surgically or for medical conditions. The factors which result in increased risk of venous thrombosis include advancing age and greater complexity of surgical treatment. Orthopedic operations on the lower limbs (hip and knee replacements) are especially likely to result in venous thrombosis."

So the answer to this question is A


Instruction:
Cadaveric spasm affects the following muscles
A. Voluntary
B. Involuntary
C. Both
D. None

Response:
(A) Voluntary > Cadaveric Spasm or Instantaneous Rigor: Cadaveric spasm (cataleptic rigidity) is a rare condition.> In this, the muscles that were contracted during life become stiff and rigid immediately after death without passing into the stage of primary relaxation.> This is usually limited to a limited group of voluntary muscles and frequently involves hands> The whole body can be involved in soldiers who are involved in a war

So the answer to this question is A


Instruction:
Bi-zygomatic width divided by 16 gives approximate mesiodistal width of
A. Upper central incisor
B. Lower central incisor
C. Upper anterior teeth
D. Lower anterior teeth

Response:
None

So the answer to this question is A


Instruction:
A 22-year-old man with AIDS complains of persistent cough, night sweats, low-grade fever, and general malaise. A chest X-ray reveals an area of consolidation in the periphery of the left upper lobe, as well as hilar lymphadenopathy. Sputum cultures show acid-fast bacilli. Which of the following is the most likely diagnosis?
A. Bronchopneumonia
B. Pulmonary abscess
C. Sarcoidosis
D. Tuberculosis

Response:
Tuberculosis. Tuberculosis represents infection with Mycobacterium tuberculosis, although atypical mycobacterial infections may mimic it. The Ghon complex includes parenchymal consolidation and enlargement of ipsilateral hilar lymph nodes and is often accompanied by a pleural effusion. The sputum contains M. tuberculosis, which is acid-fast in smears stained by the Ziehl-Neelsen technique. After resolution of primary tuberculosis, reemergence may occur (secondary tuberculosis). None of the other choices feature acid-fast organisms.Diagnosis: Tuberculosis, Mycobacterium tuberculosis

So the answer to this question is D


Instruction:
Typhoid in first week of illness is best diagnosed by:-
A. Serum widal test
B. Stool culture
C. Urine test
D. Blood culture

Response:
Laboratory diagnosis of typhoid : 'BASU' mnemonic Test of diagnosis Time of diagnosis Remarks Blood culture 1st week Mainstay of diagnosis Antibodies (widal test) 2nd week Moderate sensitivity & specificity Stool culture 3rd week Useful for carries Urine test 4th week Useful for carries

So the answer to this question is D


Instruction:
The matrix band for restoring a Class-I with lingual extension is
A. Tofflemire
B. Ivory No.8
C. Barton
D. T band

Response:
None

So the answer to this question is C


Instruction:
Latest (most recent) oral direct thrombin inhibitor is -
A. Ximelagatran
B. Indraparinux
C. Dabigatran
D. Fondaparinux

Response:
Ans is 'c' i.e. Dabigatran o Ximelagatran was the first oral direct thrombin inhibitor approved; however, it was subsequently withdrawn from the market because of repos of liver failure. o Recently a new oral direct inhibitor, dabigatran, was approved for use in Europe for prevention of various thromboembolism in patients who have undergone hip or knee replacement surgery.

So the answer to this question is C


Instruction:
In beta thalassemia, there is –
A. Increase in beta chain, decrease in alpha chain
B. Decrease in beta chain, increase in alpha chain
C. Decrease in beta chain, decrease in alpha chain
D. Increase in beta chain, increase in alpha chain

Response:
Beta - thalassemia

The abnormality common to all P-thalassemias is diminished synthesis of structurally normal β-globin chains, coupled with unimpaired synthesis of α-chain.
The reduced supply of (β-globin chain diminishes production of hemoglobin tetramers, causing hypochromic and microcytic anemia.
The haematological consequences of diminished synthesis of one globin chain stem not only from low intracellular hemoglobin, but also from a relative excess of the unimpaired chain.

Consequences of thalassemia

In (β-thalassemia, anemia is produced by two mechanisms

Deficit in HbA synthesis produce hypochromic microcytic anemia.
Excess free α-chains aggregate into insoluble inclusions within red cells and their precursors (normoblasts). These inclusions cause membrane damage that results in apoptosis of normoblasts in the marrow → ineffective erythropoiesis. The red cells which escape death in bone marrow are prone to splenic sequestration and destruction due to cell membrane damage and decreased deformability, leading to extravascular hemolysis.

The second mechanism is more important in producing anemia.
Anaemia leads to several additional problems -

Increased erythropoietin secretion in response to anemia leads to massive erythroid hyperplasia in bone marrow that results in expansion of bone marrow and skeletal deformities.
Erythropoietin also induces extramedullary erythropoiesis in liver and spleen -p Hepatosplenomegaly.
Excessive absorption of iron (in response to ineffective erythropoiesis) along with repeated blood transfusion in severe β-thalassemia results in iron overload and secondary hemochromatosis → iron overload in heart, liver, endocrine glands, spleen -4 cardiac failure / endocrine deficiency → Death.

So the answer to this question is B


Instruction:
Riders cataract is seen in
A. Blue dot
B. Zonular
C. Anterior capsule
D. Coronary

Response:
Lamellar or Zonular cataract It is a developmental cataract in which the opacity occupies a discrete zone in the lens. It is the most common type of congenital cataract presenting with visual impairment. Characteristic features. Typically, this cataract occurs in a zone of foetal nucleus surrounding the embryonic nucleus. The main mass of the lens internal and external to the zone of cataract is clear, except for small linear opacities like spokes of a wheel(riders) which may be seen towards the equator. Occasionally two such rings of opacity are seen. It is usually bilateral and frequently causes severe visual defects. Ref;A.K.Khurana; 6th edition; Page no:184

So the answer to this question is B


Instruction:
Cell to cell permeability occurs through
A. Occludin
B. Zona adherens
C. Connexins
D. Zonulin

Response:
Ans. (c) Connexins(Ref: Robbins 9th/ pg 11)*Communicating junctions (Gap junctions): mediate the passage of chemical or electrical signals from one cell to another.*Consists of pores called connexions and formed by hexamers of transmembrane proteins called connexins

So the answer to this question is C


Instruction:
False about Barrett's oesophagus is
A. In sho - segment Barrett's there is less than 3 cm of columnar epithelium
B. Barrett's ulcer occurs just above the squamocolumnar junction
C. If a peptic stricture occurs in Barrett's oesophagus it always occurs at the new squamocolumnar junction
D. It is a premalignant condition

Response:
Barrett's ulcer is an ulcer in the columnar-lined poion of Barrett's oesophagus.These are distinct from the more usual erosions of reflux oesophagitis that always occur at or just above the squamocolumnar junction.

So the answer to this question is B


Instruction:
Commonest cutaneous eruption in systemic L.E. is:
A. Palmar erythema
B. Discoid lesions
C. Erythema of light exposed area
D. Diffuse morbiliform erythema

Response:
Erythema of light exposed area

So the answer to this question is C


Instruction:
Dorsum of first webspace is supplied by nerve
A. Superficial peroneal
B. Deep peroneal
C. Sural
D. Posterior tibial

Response:
Nerve supply to lower limb Thigh: Anterior compament - femoral nerve Medial compament - obturator nerve Posterior compament - tibial nerve (Sciatic nerve) Leg: Anterior - Deep Peroneal Nerve (DPN) Lateral - Superficial peroneal nerve (SPN) Posterior- Tibial nerve Foot: Dorsum of foot (except first web space)- superficial peroneal nerve Dorsum of first web space - Deep peroneal nerve (DPN) Plantar surface - Medial and lateral plantar nerve (terminal division of tibial nerve) Middle malleolus - Saphenous nerve (branch of femoral nerve) Lateral margin - Sural nerve

So the answer to this question is B


Instruction:
This cream is appropriate for all of the following procedures Except
A. Venipuncture
B. Laceration repair
C. Lumbar puncture
D. Myringotomy

Response:
EMLA (eutectic mixture of local anesthetics) is a eutectic mixture of 5 percent lidocaine and prilocaine that is used to produce anesthesia over intact skin. Its primary use is to produce anesthesia before venipuncture and lumbar puncture. In other settings, this cream has been used for anesthesia of split-thickness graft donor sites, curettage of molluscum contagiosum, cautery of genital was, and myringotomy. EMLA is not recommended for topical anesthesia of lacerations because it induces an exaggerated inflammatory response, thereby damaging host defenses and inviting the development of infection.

So the answer to this question is B


Instruction:
Characteristic features of Rokitansky -- Kuster Hauser syndrome are all of the following except :
A. Absent uterus
B. Absent vagina
C. Anovulation
D. 46 -- XX

Response:
Anovulation Mayer Rokitansky Kuser Syndrome (MRKH) is the complete failure in the development of the mullerian ducts resulting in absence of the fallopian tubes, uterus and most of vaginadeg (as of vagina is formed by Mullerian duct). Mayer Rokitansky-Kuster Hauser syndrome Karyotype = 46 XXdeg Phenotype = Female Associated abnormalities are : Renal ectopy and agenesis (Horse shoe shaped kidney)deg Skeletal abnormalitiesdeg (most common - scoliosis) Cardiac anomalies.deg Clinical features : Patient present between 15-18 years of age with primary amenorrhoea.deg (eugonadotropic amenorrhea). Secondary sexual characteristics are normaldeg as ovaries are normal (because of their separate embryonic origin, so ovulation is also normal.) P/V = Vagina is felt like a blind pouch and uterus is absent.deg Findings are confirmed by USG.deg Ideal method for demonstrating Uterine malformations is MRI.deg Management : Repair of vaginal agenesis done either by frank dilatation or vaginoplasty. Vaginoplast should onl be performed when the girls is just married or about to be marripri Frank Dilatation : This non-surgical procedure consists of a woman applying gradual pressure with progressively increasing dilators over the mullerian pit for 15 minutes twice a day. An indentation is created by the end of 3 to 6 month. Some have satisfactory intercourse, but in many, vaginal size is inadequate and they need a surgical procedure eventually. Surgical management : Vaginoplasty either by Mc Indoe operation Differential Diagnosis : Testicular feminization syndrome. Mayer Rokitansky-Kuster Hauser syndrome can be differentiated from testicular feminizing syndrome on the basis of :

So the answer to this question is C


Instruction:
Age estimation from teeth can be done by all the following methods, except: NEET 14
A. Gustafson's method
B. Miles' method
C. Boyde's method
D. Frame's method

Response:
Ans. Frame's method

So the answer to this question is D


Instruction:
The basis of Korotkoff sound is related to
A. Aoic valve closure
B. Production of hea sound
C. Aerial turbulence
D. Aerial valve expansion

Response:
At the point at which systolic pressure in the aery just exceeds the cuff pressure, a spu of blood passes through with each heabeat and, synchronously with each beat, a tapping sound is heard below the cuff. The cuff pressure at which the sounds are first heard is the systolic pressure. As the cuff pressure is lowered fuher, the sounds become louder, then dull and muffled. These are the sounds of Korotkoff. The sounds of Korotkoff are produced by turbulent flow in the brachial aery. Ref: Ganong&;s Review of medical physiology 25th edition. Page:577

So the answer to this question is C


Instruction:
Sarcoidosis causes all except -
A. Osteomalacia
B. Addison's disease
C. Diabetes insipidus
D. Hypercalcemia

Response:
None

So the answer to this question is A


Instruction:
Maximum shoening of lower limb is seen in:
A. shaft femur
B. Neck femur
C. interochanter
D. Transcervical

Response:
A i.e. Shaft femur Lower limb injures associated with maximum shoening are posterior dislocation of hip and fracture shaft femurQ

So the answer to this question is A


Instruction:
Abbey Estlander flap is based on:
A. Lingual artery
B. Facial artery
C. Labial artery
D. Internal maxillary artery

Response:
None

So the answer to this question is C


Instruction:
Carcinoma cervix presents with
A. Postcoital bleed
B. Abnormal vaginal bleed
C. Purulent discharge per vaginum
D. All of the above

Response:
Carcinoma cervix has a bimodal peak one at 30-35 yrs and a second peak at 50-55 yrs. Presentation is typically abnormal vaginal bleeding --- in reproductive age group with metrorrhagia and in postmenopausal women with postmenopausal bleeding. There can be a cervical growth which can lead to postcoital bleeding. If it undergoes necrosis then there can be purulent discharge per vaginum. Sometimes cancer cervix can present with VVF and with also with features of uraemia.

So the answer to this question is D


Instruction:
Substance that is completely reabsorbed from the PCT -
A. Na+
B. K+
C. Urea
D. Glucose

Response:
Ans. is 'd' i.e, Glucose Important educational points* 60-70% of glomerular filtrate is reabsorbed in proximal tubule.* Na+ reabsorption occurs in all segments of nephron excepting descending limb of loop of Henle. 60% (60-70%) of filtered Na+ is reabsorbed in proximal tubule. About 30% of filtered Na+ is reabsorbed in thick ascending limb of loop of Henle. About 7% of filtered Na+ is reabsorbed in early distal tubules and about 3% of filtered sodium is reabsorbed in late distal tubule and collecting duct.* About 65% (60-70%) of water is reabsorbed in the proximal tubule and about 15% of water is reabsorbed in the thin descending limb. Remaining 20% of water enters the distal tubules and is absorbed from distal tubule and collecting duct according to the homeostatic requirements of the body, under the control of ADH.* All substances (Na+, K+, HCO3, Cl -, Phosphate, Protein, Glucose, water) are maximally absorbed in proximal tubule.* Glucose and amino acids are completely absorbed from proximal tubules along with Na+ as secondary active transport contransport (symport).* H+ is not absorbed by nephrons anywhere it is only secreted (in proximal tubule, late distal tubule and cortical collecting tubules).* Substances which are both secreted and reabsorbed are K+, uric acid and creatinine.* On a normal diet maximum solutes are reabsorbed almost completely : Glucose : 100%, Aminoacids 100%, HCO3-: 100%, Water : 99.4%, Na+: 99.4%, Cl-: 99.2%, Uric acid: 98%, K+ : 93.3%, Urea: 53%, and Total solutes : 98.9%* Amount secreted per day of different filtered contents are : Na+ : 150 mEq/d, K+ : 90 mEq/d, Cl : 150 mEq/d, Glucose : 0, Amino acid : 0, HCO3 : 0, Uric acid: 5 mmol/d, Creatinine: 12 mmol/d, Urea: 410 mmol/d, Water: 1-1.5 L/d; and total solutes : 700 mOsm/d.

So the answer to this question is D


Instruction:
Cystoscopes and bronchoscopes are sterilized by
A. Orthophthaldehyde
B. Glutaraldehyde
C. Formaldehyde
D. Isopropylalchol

Response:
Both orthophthaldehyde and Glutaraldehyde are used
But Orthophthaldehyde > Glutaraldehyde.

So the answer to this question is A


Instruction:
Hypehermia
A. Temperature > 41.5
B. > 40 with autonomic dysfunctuion
C. >37.5-38.3 degC
D. 36.5-37.5 degC

Response:
Hypehermia is elevated body temperature due to failed thermoregulation that occurs when a body produces or absorbs more heat than it dissipates. Extreme temperature elevation then becomes a medical emergency requiring immediate treatment to prevent disability or death.Hypothermia<35.0 degC (95.0 degF)Normal36.5-37.5 degC (97.7-99.5 degF)Fever>37.5-38.3 degC (99.5-100.9 degF)Hypehermia>37.5-38.3 degC (99.5-100.9 degF)Hyperpyrexia>40.0-41.5 degC (104-106.7 degF)Ref: Ganong&;s review of medical physiology-24th edition; page no-317

So the answer to this question is C


Instruction:
Cilastatin is given in combination with Imipenem because:-
A. Cilastatin prevents degradation of Imipenem in kidney
B. Cilastatin increase absorption of Imipenem
C. Inhibits the enzymes that digest Imipenem in stomach
D. Reduces side effects of Imipenem

Response:
Carbapenems are synthetic Beta lactam antibiotic. Imipenem is compounded with cilastatin to protect it from metabolism by renal dehydropeptidase. Cilastatin is a dehydropeptidase inhibitor. High level of imipenem may provoke seizure, however other carbapenem like:- Meropenem Eapenem Doripenem Are less likely to do

So the answer to this question is A


Instruction:
Amphibolic cycle is ?
A. Citric acid cycle
B. Glycolysis
C. Protein synthesis
D. Lipolysis

Response:
Ans. is 'a' i.e., Citric acid cycleMetabolic pathways fall into three categories :?Anabolic pathways:- Involved in synthesis of larger and more complex compounds from smaller precursors, e.g. synthesis of protein from amino acids, triglyceride synthesis, cholesterol synthesis, etc.Catabolic pathway:- Involved in the breakdown of larger molecules, commonly involving oxidative reaction. They are exothermic reactions producing reducing equivalents and mainly the ETC, ATP. Example are glycolysis, 13-oxidation of fatty acid etc.Amphibolic pathway:- occur at the "crossroads" of metabolism, acting as links between the anabolic and catabolic pathways, eg. the citric acid cycle.

So the answer to this question is A


Instruction:
Hyperuricemia is seen with
A. Acetazolamide
B. Chlorthiazide
C. Mannitol
D. Triamterene

Response:
Chlorthiazide is a thiazide diuretic which can lead to hyper uricema, as Thiazide diuretics competitively inhibit excretion of uric acid.

So the answer to this question is B


Instruction:
Grey Turner's sign (flank discoloration) is seen in
A. Acute pylonephritis
B. Acute cholecystisis
C. Acute pancreatitis
D. Acute peritonitis

Response:
Sign seen due to enzyme seep across etroperitoneum causing hemorrhagic spots and ecchymosis in the flanks SRB,5th,683.

So the answer to this question is C


Instruction:
Burkitt's lymphoma is associated with which of the following gene anomaly -
A. t (9:22)
B. del. 5q
C. t (8:14)
D. t (17:15)

Response:
Ans. is 'C' i.e., t(8:14) o t(8:14) is the most common translocation seen in association with Burkitt's Lymphoma. # Demonstration of very high proliferative fraction and the presence of the t (8:14) or one of its variants t (2:8) or t(8:22) can be confirmatory of Burkiti s lymphoma/leukemia Translocation in Burkitt's Lymphoma Burkitts lymphoma/leukemias are associated with reciprocal translocations involving the c-myc gene on chromosome 8 | | | Most common translocation (70%cases) Less common translocations t (8:14): c- may gene on chromosome 8 and lgH heavy chain on chromosome 14 t (8 : 22) c- myc gene on chromosome 8 and l-light chain on chromossome 22 t (2 :8): c- mye gene on chromosome 8 and k-light chain on chromosome -2

So the answer to this question is C


Instruction:
Rough and Irregular surface produced on the impression is because of?
A. Improper application of pressure during impression making
B. Air incorporated during mixing
C. Too rapid polymerization
D. Presence of moisture in impression area

Response:
None

So the answer to this question is C


Instruction:
Respiratory depression is caused by NE
A. Opium
B. Barbiturate
C. Strychnine
D. Gelsemine

Response:
C i.e. Strychnine Strychnine is a CNS and respiratory stimulantQ. Alcohol, barbiturates, opioidsQ, benzodiazepines, chloral hydrate, paraldehyde, mandrax (melsedine), heroin (brown sugar), general anesthetics, sedative & hypnotics are CNS depressants. (However few may initially stimulate CNS). Hallucinogens (LSD = peyote = mescaline = phencyclidine), ecstasy, khat (catha edulis), cocaine and amphetamine are CNS stimulants (psychotropics).

So the answer to this question is C


Instruction:
Which of the following sources of cholesterol is most impoant for sustaining adrenal steroidogenesis when it occurs at a high rate for a long time
A. De novo synthesis of cholesterol from acetate
B. Cholesterol in LDL paicles
C. Cholesterol in the plasma membrane
D. Cholesterol in lipid droplets within adrenal coical cells

Response:
Cholesterol esters in LDL are the most impoant source of cholesterol for sustaining adrenal steroidogenesis when it occurs at a high rate over a long time. This cholesterol can be used directly after release from LDL and not stored. De novo synthesis of cholesterol from acetate is a minor source of cholesterol in humans.Ref: Harper&;s Biochemistry; 30th edition

So the answer to this question is B


Instruction:
Comprehension in intact with aphasia in
A. Wernicke's
B. Broca's
C. Global aphasia
D. Transcoical sensory

Response:
Ans. is 'b' i.e., Broca's

So the answer to this question is B


Instruction:
Technique of Cu-T inseion: March 2010
A. Surgery under local anaesthesia
B. Surgery under general anaesthesia
C. Pushing
D. Laparotomy

Response:
Ans. C: Pushing A thorough inspection of the pelvis is a must before IUCD inseion. The device is mounted on the introducer and stop is adjusted according to the length of uterine cavity. Introducer is pushed through the cervix and the plunger is pressed home.

So the answer to this question is C


Instruction:
Calcium channel blockers are used in all, except-
A. Angina
B. Supraventricular tachycardia
C. Sick sinus syndrome
D. Hypertension

Response:
Ans. is 'c' i.e., Sick sinus syndrome The electrophysiological properties of Verapamil enables it be used as an antiarrhythmic.Electrophysiological effects of verapamilo The basic action of verapamil is to depress Ca2+ mediated depolarization. This result in following actions -Decrease S.A. node automaticityDecrease ventricular automaticityIncrease A. V nodal ERP (This is the most consistent action of Verapamil and due to this A-V conduction is markedly slowed however intraventricular conduction is not slowed).Use of Verapamil as an antiarrhythmic -1.PSVT-It is effective in 80% casesIt should not be used if PSVT is accompanied with hypotension or CHF.2.To control ventricular rate in Atrial flutter or Atrial fibrillation (May be used as an alternative to or in addition to Digitalis).Verapamil is contraindicated in following arrhythmias-1 Ventricular arrhythmias - Injection of verapamil has precipitated ventricular fibrillation, therefore contraindicated.2 Digitalis toxicity - Verapamil is contraindicated in Digitalis toxicity because additive A-V block may occur.3.Heart block and sick sinus.Other uses of verapamil:Angina pectoris- All CCB's are effective in reducing frequency and severity of classical as well as variant angina.It is beneficial in angina in the following wayClassical angina - Reduces cardiac work, mainly as a result of reduced afterload.Variant angina - Prevent arterial spasm.HypertensionHypertrophic cardiomyopathySuppress nocturnal leg crampsMigraine

So the answer to this question is C


Instruction:
True statement regarding fracture base of the skull are all of the following except: March 2008
A. Prophylactic antibiotics are usually not required
B. Associated with 8 cranial nerve palsy
C. Early surgery is indicated for optimal outcome
D. May present with CSF otorrhoea

Response:
Ans. C: Early surgery is indicated for optimal outcome

So the answer to this question is C


Instruction:
Which one of the following is not an adverse effect of ACE inhibitors ?
A. Cough
B. Hypokalemia
C. Angioneurotic edema
D. Skin rash

Response:
None

So the answer to this question is B


Instruction:
A patient has IDDM diagnosed at age of 15 years. The most reliable indicator for diabetic nephropathy is -
A. Urine albumin <50 mg per day in 3 consecutive samples
B. Urinary protein >550 mg per day for 3 consecutive samples
C. Development of diabetic retinopathy
D. Hematuria

Response:
None

So the answer to this question is B


Instruction:
A female child has recently learned to eat with spoon without spilling; to dress and undress herself with supervision and to understand that she is a girl. These skills are FIRST mastered between the ages: September 2012
A. 2 and 3 years
B. 3 and 4 years
C. 4 and 5 years
D. 5 and 6 years

Response:
Ans. A i.e. 2 and 3 years Impoant milestones Copies circle: 3 years Crawls: 11 months Child smiles at familiar persons: 2 months Head control: 3 month Sits with own suppo/ tripod fashion: 6 months Sits without suppo: 8 months Transfer object from one hand to other: 6 months Says mama dada: 10 months Self decisions: 7 years Walks alone: 13-14 months Knows age & sex: 3 years Can draw a rectangle: 4 years Can draw a triangle: 5 years

So the answer to this question is A


Instruction:
Oncocytes are found in all except -
A. Thyroid
B. Panereus
C. Pituitary
D. Pineal

Response:
Ans. is 'd' i.e., Pineal Oncocytes are present in the acini and ducts of normal salivary gland.o They are also present in some benign tumors of salivary glands, thyroid, parathyroid, kidney, lung and pituitary -

So the answer to this question is D


Instruction:
Which one of the following is not a treatment of gastroesophageal variceal hemorrhage
A. Sclerotherapy
B. Sengstaken tube
C. Transjugular intra hepatic poocaval shunt
D. Gastric freezing

Response:
Treatment consists of beta blockers Treatments include beta blockers, medical procedures to stop bleeding, and in rare cases, liver transplant. Medications-Beta blocker, Synthetic hormones, Antibiotics, and Blood transfusion Medical procedure-Nasogastric intubation, Rubber band ligation, Therapeutic endoscopy, Sclerotherapy, Transjugular intrahepatic poosystemic shunt, and Balloon tamponade Suppoive care-IV fluids Ref: Sabiston 20th edition Pgno : 1444

So the answer to this question is D


Instruction:
Manganese deficiency leads to?
A. Parkinsonism
B. Impaired skeletal growth
C. Impaired glucose tolerance
D. Anaemia

Response:
Ans. (b) Impaired skeletal growthRef: Harrison /96e-9* Manganese deficiency leads to impaired growth and skeletal development whereas toxicity leads to parkinsonism like features. Impaired glucose tolerance is seen with chromium deficiency.Deficiencies and Toxicides of MetalsElementDeficiencyToxicityManganeseImpaired growth and skeletal development, reproduction, lipid and carbohydrate metabolism; upper body rashParkinsonism like symptomsEncephalitis-like syndromeCalciumReduced bone mass, osteoporosisRenal insufficiency (milk-alkali syndrome), nephrolithiasisCopperAnemia, growth retardation, defective keratinisation and pigmentation of hair, degenerative changes in aortic elastin, osteopeniaVomiting, diarrhea, hepatic failure, tremor, mental deterioration, haemolytic anemia, renal dysfunctionChromiumImpaired glucose toleranceOccupational: Renal failure, dermatitis,FluorideT Dental cariesDental and skeletal fluorosis, osteosclerosisIodineThyroid enlargement, nF T4, cretinismThyroid dysfunction, acne-like eruptionsSeleniumCardiomyopathy, heart failure, striated muscle degenerationAlopecia, nausea, vomiting, abnormal nails, emotional lability, peripheral neuropathy, lassitude, garlic odor to breath, dermatitisOccupational: Lung and nasal carcinomasZincGrowth retardation, >1 taste and smell, alopecia, dermatitis, diarrhea, immune dysfunction, failure to thrive, congenital malformationsReduced copper absorption, gastritis, sweating, fever, nausea, vomiting

So the answer to this question is B


Instruction:
Which are the cells of olfactory bulb that act as local integrator?
A. Sustentacular cells
B. Hair cells
C. Granular cells
D. Mitral cells

Response:
Ans. is 'd' i.e., Mitral cellsIn olfactory bulb axons of olfactory nerve synapse with dendrites of mitral cells to form the olfactory glomeruli.Mitral cells are the principal output neurons of olfactory bulb anil their axons form the olfactory tract

So the answer to this question is D


Instruction:
In trauma patient safe airway maneuver is:
A. Chin lift.
B. Head tilt.
C. Jaw thrust
D. Both A& C

Response:
Chin lift and jaw thrust don't lead to neck movement hence safe in trauma patient.
Among both the process jaw thrust is safest.

So the answer to this question is D


Instruction:
Not true about first referral unit
A. Covers 1 lakh population
B. Has 30 beds
C. Provides secondary care
D. Community health officer is medical graduate or post graduate

Response:
Use of Shakir's tape for meassuring arm
Circumference
Equitable distribution
Intersectoral co-ordination
Community participation
Appropriate technology

So the answer to this question is D


Instruction:
A poison which is luminescent and waxy and have a garlic smell: Al 11
A. Alphos
B. Ammonium bromide
C. Opium
D. Yellow phosphorous

Response:
Ans. Yellow phosphorous

So the answer to this question is D


Instruction:
Reactivation of TB is almost exclusively a disease of-
A. Bone
B. Lymph nodes
C. Lung
D. Brain

Response:
None

So the answer to this question is C


Instruction:
An 8-year old child was brought to you for a high grade fever of 3 days duration with vomiting headache and decreased responsiveness. Examination revealed a distressed child , in shock with maculopapular and ecchymotic rashes on the skin with bleeding from venepuncture sites and hepatomegly. Investigation showed PCV = 65%, WBC 4000, platelet 25000 & mildly prolonged PT. CXR revealing left sided pleural effusion. Diagnosis is ?
A. Meningococcemia with DIC
B. Dengue heamorrhagic fever
C. Leptosporisis
D. Complicated malaria

Response:
Generalized body aches, high grade fever followed by clinical deterioration and bleeding diathesis with raised hematocrit (65%) and low platelet and leucopenia strongly suggest dengue haemorrhagic fever, although meningococcemia is always a close diagnosis and many times requires serological confirmation. Complicated malaria usually has anemia and splenomegaly Leptospirosis may occur in icteric as well as nonicteric form. In nonicteric form shock and skin rashes are uncommon. Prominent features are severe myalgias and exquisite tenderness.

So the answer to this question is B


Instruction:
In patient of head injuries with rapidly increasing intracranial tension without hematoma, the drug of choice for initial management would be
A. Lasix
B. Steroids
C. 20% Mannitol
D. Glycine

Response:
Mannitol Mannitol is widely used to reduce ICP Commonly used preparation : 20% solution, 0.25-1 gm/kg is given IV as bolus Serum osmolality should not be allowed to go >320 mOsm/L, to avoid systemic acidosis and renal failure. Uses of mannitol To reduce increased ICT or intra ocular tension To maintain GFR and urine flow in impending renal failure Forced diuresis in hypnotic or other poisoning To counteract low osmolality of plasma/ECF due to rapid hemolysis or peritoneal dialysis Contraindications of Mannitol Acute Tubular Necrosis Anuria Pulmonary edema Acute left ventricular failure CHF Cerebral hemorrhage Ref :Harrison's 19th edition Pgno :1779-1780

So the answer to this question is C


Instruction:
Minimum antenatal visit as per MCH is ?
A. 1
B. 2
C. 3
D. 4

Response:
Ans. is 'd' i.e., 4

So the answer to this question is D


Instruction:
Two antihistaminics terfenadine and astemizole were withdrawn from the market following the occurrence of cardiac arrhythmias when they were present in high levels in the blood. These effects were explained by the fact :
A. Use of these drugs by addicts
B. Genetic predisposition to metabolize succinylcholine slowly
C. Concurrent treatment with phenobarbital
D. Treatment of these patients with erythromycin, a macrolide antibiotic

Response:
Astemizole and terfenadine are metabolized by microsomal enzymes. Erythromycin inhibits these enzymes and raises the plasma concentration of these drugs. At high levels, these agents block cardiac K+ channels leading to arrhythmias.

So the answer to this question is D


Instruction:
Chromosome for ABO gene is?
A. 9q
B. 10p
C. 11q
D. 12p

Response:
Ans is 'a' i.e. 9q * The ABO gene (Histo-blood group ABO system transferase enzyme) resides on chromosome 9 at the band 9q34.2.Also know* Gene for Rh antigen is located on Chromosome-1

So the answer to this question is A


Instruction:
In the international death certificate, one of the following is not true
A. Part I of of the certificate deals with the immediate cause and also the underlying cause
B. Part I of the certificate deals with the immediate cause only
C. Part II records significantly associated diseases
D. The certificate has been recommended by the WHO for international use

Response:
International Death Certificate:

Recommended by WHO for international use.
2 parts:
PART 1: deals with immediate cause, and the underlying cause which started the whole trend of events leading to death. The underlying cause of death is recorded on line (c).
PART 2: any significant associated diseases that contributed to the death but did not directly lead to it.

So the answer to this question is B


Instruction:
Definitive treatment of choice for Transposition of great vessels (TGA) is
A. Atrial switch
B. Aerial switch
C. Atrial septostomy
D. Medical management

Response:
The aerial switch operation is now established as the treatment of choice for TGA and most centers endeavour to offer this procedure for all infants with TGA. In this operation, the pulmonary aery and aoa are transected. The distal aoa is anastomosed to the proximal pulmonary stump (neo-aoic root) and the pulmonary aery to the proximal aoic stump (neopulmonary aery). The coronary aeries are moved along to the neo-aoic root along with a cuff of aoic tissue to allow suturing without compromise of coronary blood flow. There is a limited window of time for performing the aerial switch for TGA. Infants with TGA and intact septum should ideally undergo this procedure within the first 2-4 weeks of life. As pulmonary vascular resistance falls after bih the left ventricle regresses rapidly. In 1-2 months the left ventricle has the ability to adjust to the elevated systemic vascular resistance after the aerial switch through hyperplasia of the available muscle. After this, it is difficult for the left ventricle to adapt to an aerial switch. Later in infancy, the atrial switch operation (Senning operation) is the only option for TGA with intact ventricular septum. This is not an ideal long-term option because the right ventricle remains as the systemic ventricle for life. Over time, right ventricle dysfunction and severe tricuspid regurgitation sets in. Additionally, extensive restructuring of atria predisposes to atrial rhythm disturbances. Reference: Essential Paediatrics; O.P. Ghai; Page no: 426

So the answer to this question is B


Instruction:
Which of the following is true about Riedel's thyroiditis -
A. Fibrosis involves the thyroid and surrounding neck structures
B. Patient presents with hard fixed thyroid mass
C. It may be associated with retroperitoneal fibrosis
D. All the above

Response:
Ans. is 'd' i.e. All the above Riedel thyroiditiso A rare disorder characterized by extensive fibrosis involving the thyroid and contiguous neck structures,o The presence of a hard and fixed thyroid mass clinically simulates a thyroid carcinoma.o It may be associated with fibrosis in other sites in the body, such as the retroperitoneum, and appears to be another manifestation of a systemic autoimmune IgG4-related disease, which is associated with fibrosis and tissue infiltration by plasma cells producing IgG4.

So the answer to this question is D


Instruction:
Transitional epithelium is seen in
A. Esophagus
B. Vagina
C. Urinary bladder
D. Trachea

Response:
INDERBIR SINGH&;S TEXTBOOK OF HUMAN HISTOLOGY-PAGE NO:320

So the answer to this question is C


Instruction:
The ability to detect two points simultaneously applied to the skin is based on which physiologic mechanism?
A. Presynaptic inhibition
B. Feed-back inhibition
C. Feed-forward inhibition
D. Lateral inhibition

Response:
Lateral inhibition is the basis of ability to detect two points simultaneously applied to the skin. Every sensory pathway, when excited, gives rise simultaneously to lateral inhibitory signals; these inhibitory signals spread to the sides of the excitatory signal and inhibit adjacent neurons. Presynaptic inhibition: decrease release of excitatory neurotransmitter. Endogenous analgesia system Feed-forward inhibition: when excitatory neurons exciteinhibitorycells, which theninhibit a group of postsynaptic excitatory neurons. Seen in cerebellum (Cerebellar learning) Recurrent/Renshaw cell inhibition: Sho inhibitory interneuron Collaterals excites renshaw cell which in turn inhibits the same neuron Purpose: delays muscle fatigue, sharpens the signal to muscle

So the answer to this question is D


Instruction:
Material used in verterbroplasty is :
A. Isomethyl methacrylate
B. Isoethyl methacrylate
C. Polyethyl methacrylate
D. Polymethyl methacrylate

Response:
Ans. is 'd' i.e. Polymethyl methacrylate Vertebroplasty and kyphoplasty are interventional radiologic procedures for the treatment of the intense pain refractory to medical management or bracing caused by vertebral compression fracture associated with osteoporosis, tumors, and trauma.Vertebroplasty and kyphoplasty involve intraosseous injection of acrylic cement- polymethyl methacrylate under local anesthesia and fluoroscopic guidance.Pain reduction or elimination is immediate, and the risk of complications is low. Neither vertebroplasty nor kyphoplasty are intended for the treatment of intervertebral disc disease or arthritis.Vertebroplasty may also be applied prophylactically to an at-risk vertebra between 2 other abnormal vertebrae.Vertebroplasty does not restore the height of the compressed vertebral body. A related procedure, kyphoplasty, is intended to restore lost height by inflating a balloon pump within and between the fracture fragments prior to the infusion of the cement. Both procedures result in similar relief of pain due to vertebral compression fractures.The risks of the procedure are low and include extravasation of cement into the epidural space causing myelopathy, or fatal pulmonary embolism from extension of cement into paraspinous veins.

So the answer to this question is D


Instruction:
NARP syndrome is a pa of which of the following group of disorders?
A. Mitochondrial diseases
B. Glycogen storage diseases
C. Lysosomal storage diseases
D. Lipid storage diseases

Response:
NARP syndrome Neuropathy, ataxia, and retinitis pigmentosa Related to changes in mitochondrial DNA. Mutations in the MT-ATP6 gene cause NARP syndrome. This gene is located within mitochondrial DNA (mtDNA).

So the answer to this question is A


Instruction:
Periaicular calcification is seen in -
A. RA
B. Pseudogout
C. OA
D. None of the above

Response:
Ans. is 'b' i.e., Pseudogout Periaicular soft tissue calcification Haematoma Crystal ahropathy (Gout, Pseudogout) Dermatomyositis Tumoral calcinosis Myositis ossificans Scleroderma Synol osteochondromatosis Synol sarcoma

So the answer to this question is B


Instruction:
The preferred drug for controlling an acute exacerbation of ulcerative colitis is:
A. Prednisolone
B. Sulfasalazine
C. Mesalazine
D. Vancomycin

Response:
- Coicosteroids are the mainstay of treatment of acute exacerbation of ulcerative colitis. - so, among the given options prednisolone is best to be used in controlling acute exacerbation of ulcerative colitis

So the answer to this question is A


Instruction:
Maximum damage to pulp occurs during:
A. Intrusion
B. Avulsion
C. Both
D. None

Response:
None

So the answer to this question is B


Instruction:
LRS Institute of Tuberculosis and respiratory diseases is located at-
A. Chennai
B. Bangalore
C. Delhi
D. Chengalpettu

Response:
Tuberculosis Research Centre is located in Chennai. National Tuberculosis institute is in Bangalore.

So the answer to this question is C


Instruction:
A set of statements for monitoring progress towards goal completion is referred to as:
A. Targets
B. Objective
C. Programme
D. Procedure

Response:
Programme

So the answer to this question is C


Instruction:
Asymptomatic carriage of gonococcal infection in female is commonly seen in:
A. Endocervix
B. Vagina
C. Urethra
D. Fornix

Response:
None

So the answer to this question is A


Instruction:
Antirheumatoid drug has specific act on the T-cell is
A. Etanercept
B. Infliximab
C. Rituximab
D. Abatacept

Response:
(Abatacept) (514-Lippincott's pharmacology 4th)Abatacept is a costimulation -modulator that inhibits the activation of T-cells (629- Katzung 11th)* ABATACEPT - T. lymphocytes needs two interactions to become activated (1) The antigen- presenting cells (i.e. Macrophages or B cells) must interact with the receptor on the T cell (2) The CD80/CD86 protein on the antigen presenting cell must interact with the C.D 28 protein on the T.cell. the result activated T. lymphocytes responsible for the release of pro inflammatory cytokines and maintenance of inflammation in RAAbatacept is a soluble recombinant fusion protein made up of the extracellular domain of human CTLAA and it competes with CD28 for binding on CD80/ CD86 protein thereby preventing full T-cell activationUses- in moderate to severe RA who had an inadquate respose to DMARDs such as mothotrexate or TNa inhibitors* RITUXIMAB - B- lymphocyte are derived from the bone marrow and are necessary for efficient immune response however in RA, B-cell can perpetuate the inflammatory process in the synovium by1. activating T-lymphocytes 2. producing autoantibodies such as anti CCP (anti-cyclic citrullinated peptide antibody) and rheumatoid factor and3. producing pro-inflammatory cytokines such as TNF a and IL-1Rituximab is a genetically engineered chimeric murine (human monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B.lymphocytes resulting in B.cell depletionRituximab has been shown to reduce joint erosion and joint space narrowing in these patientsRituximab is a chimeric monoclonal antibody that targets CD20-B lymphocytes (632-Katzung 11th)Etanercept. Infliximab - TNFa- inhibitorsLEFLUMQMIDE - Immunomodulatory agent* Leflunomide is rapidly converted in tfye body to an active metabolite which inhibits dihydroarotate dehydrogenase and pyrimidine synthesis in actively dividing cells. Antibody production by B. cell may be depressed (204-KDP 6th)* Teratogenic in experimental animals and therefore is contraindicated in pregnancy and in women of child bearing potentialLeflunomide inhibits - T-cell proliferatin and production of autoantibodies by B-cellsImportant Points* COX-2 inhibitors show similar analgesic and anti inflammatory activity compared to traditional NSAIDs. They do not affect platelets - Like NSAIDs. COX-2 inhibitors may cause the development of ARF due to renal vasoconstriction. COX-2 inhibitors have the potential for increasing the risk of myocardial infarction*** DMARDs - the effects may take 6 weeks to 6 months to become evident although some biologies are effective within 2 weeks; generally they are slow-acting compared with NSAIDS

So the answer to this question is D


Instruction:
a 70 year old women refused to take influenza vaccine , dveloped flu. death happend 1 week after pneumonia.most common cause of post influenza pneumonia
A. staphyloccocus aureus
B. measles
C. legionella
D. cmv

Response:
m/c organism in post influenza decondary pneumonia is staph .auerus Staphylococcus aureus pneumonia * S. aureus is an impoant cause of secondary bacterial pneumonia in children and healthy adults after viral respiratory illnesses (e.g., measles in children and influenza in both children and adults). * Staphylococcal pneumonia is associated with a high incidence of complications, such as lung abscess and empyema. * Staphylococcal pneumonia occurring in association with right-sided staphylococcal endocarditis is a serious complication of intravenous drug abuse. ref : ananthanaryana 9th ed

So the answer to this question is A


Instruction:
Target health indicators of 12th five year plan are all except -
A. Reduce MMR to 100
B. Reduce TFR to 2.1
C. Reduce IMR to 20
D. Reduce prevalence of leprosy to < 1/10000

Response:
Ans. is 'c' i.e., Reduce IMR to 20 The twelfth plan will work towards national health outcome goals with following target health indicators :?Reduction of infant moality rate to 25.Reduction of maternal moality rate to 100.Reduction of total feility rate to 2.1.Prevention and reduction of under-nutrition in children under 3 years to half of NFHS-3 (2005-06) level.Prevention and reduction of anaemia among women aged 15-19 years to 28%.Raising child sex ratio in 0-6 years age group from 914 to 950.Reduction of poor household's out-of-pocket expenditure.viii)Prevention and reduction of burden of communicable and non-communicable diseases and injuries.

So the answer to this question is C


Instruction:
Judge can ask questions: Punjab 07
A. During cross-examination
B. Examination-in-Chief
C. Any time during trial
D. Re-examination

Response:
Ans. Any time during trial

So the answer to this question is C


Instruction:
Krukenberg tumour is most commonly from:
A. Lung
B. Breast
C. Stomach
D. Colon

Response:
Ans: c (Stomach) Ref:Shaw, 13th ed, p. 401Krukenberg ovarian tumoursPrimary sites - Stomach (70%),Breast (6%),Colon (15%)Involvement of ovary by - Retrograde lymphaticsAlways bilateral with smooth surface.Maintaining the shape of ovaryNo tendency of adhesion (i.e. capsule remain intact).Histology: Signet ring cellsBRIDGE:signet ring cells are seen in Krukenberg tumour but sideroblasts are seen in v myelodysplatic syndrome.

So the answer to this question is C


Instruction:
Post exposure prophylaxis is given in A/E
A. Rabies
B. Measles
C. Pertusis
D. Hepatitis B

Response:
Ans. is 'c' i.e., Pertussis Active immunoprophylaxis after exposure to disease is recommended for:RabiesTetanusHepatitisMeasles (within three days of exposure)*VaricellaMeasles vaccine can be given post exposure (within three days of exposure) because incubation period of measles is 7 days when the respiratory tract is bypassed (as with vaccine which is given subcutaneously) whereas normal incubation period is 10 days* from exposure to onset of fever (and 14 days to appearance of rash).

So the answer to this question is C


Instruction:
Red degeneration in uterine fibroid is most common in-
A. Second trimester
B. Third trimester
C. Puerperium
D. First trimester

Response:
Ans. is 'a' i.e.. Second trimester

So the answer to this question is A


Instruction:
Neurologic abnormalities have been noted in about one-third of patients with AIDS. Which of the following is NOT seen in HIV involvement of CNS?
A. Perivascular giant cell
B. Vacuolar degeneration of post column
C. Microglial nodule formation
D. Inclusion bodies

Response:
The main cell types that are infected in the brain in HIV infection are the perivascular macrophages and the microglial cells. A diffuse and multifocal rarefaction of the cerebral white matter accompanied by scanty perivascular infiltrates of lymphocytes and clusters of a few foamy macrophages, microglial nodules, and multinucleated giant cells. Vacuolar degeneration of posterior column is associated with the AIDS dementia complex. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 33. Viral Infections of the Nervous System, Chronic Meningitis, and Prion Diseases. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.

So the answer to this question is D


Instruction:
Which of the following is used to differentiate race in seminal stains?
A. Serum alkaline phosphatase
B. MHS 5
C. Peptidase A
D. Choline

Response:
Enzyme Typing: Enzyme markers commonly used in genetic profiling of semen are phosphoglutamase (PGM) and peptidase (Pep A). Pep A is polymorphic in many racial groups and is commonly employed as a racial discriminator. PGM is polymorphic in all populations and can be subdivided into 10 distinct subgroups.

So the answer to this question is C


Instruction:
Hyperophy is -
A. Increase in cell number
B. Increase in cell size
C. Decrease in cell number
D. Decrease in cell size

Response:
Ans. is 'c' i.e., Increase in cell size Hyperophy o Hyperophy refers to an increase in the size of cells without increase in the number, resulting in an increase in the size of tissue. o Hyperophy involves cell enlargement without cell division. o So, hyperophied organ has just larger cells, but no new cells (by contrast, in hyperplasia there is increase in number of new cells without increase in size). o Nuclei in hyperophied cells have a higher DNA content than in normal cells because the cells arrest in the cell cycle without undergoing mitosis. o Myocardium (hea muscle) and skeletal muscle undergo hyperophy. o The most common stimulus for hyperophy is increased workload. Mechanism of hyperophy o The increase in cell size is due to synthesis of more structural proteins. o The genes that are induced during hyperophy include those encoding transcription factors (C-fos, C-jun), growth factors (TGF-(3, TGF- 1, FGF); and vasoactive agents (a-agonists, endothelin-1, angiotensin II). o There may also be a switch of contractile proteins from adult to fetal or neonatal forms, e.g., during myocardial hyperophy, the a-myosin heavy chain is replaced by 13-form of the myosin heavy chain, which leads to decrease myosine ATPase activity and a slower, more energetically economical contraction. o In addition, some genes that are expressed only in embryonic life are re-expressed in hyperophied myocardium, e.g., in the embryonic hea, the gene for Atrial natriuratic peptide (ANP) is expressed in both atrium and ventricle. After bih, ventricular regulation of the gene is down regulated. Myocardial hyperophy is associated with reinduction of ANF gene expression. ANP induces salt excretion by kidney L blood volume & pressure, decrease work load. Why do these changes occur ? o As already explained, the most common stimulus for myocardial hyperophy is increased workload. o All the above morphological changes that occur in hyperophy either increase muscle activity (to handle the increased workload) or decrease the workload to hea.

So the answer to this question is C


Instruction:
Periodic acid whiff stain shows block positiveity In -
A. Myeloblasts
B. Lymphoblasts
C. Monoblasts
D. Megakaryoblasts

Response:
Answer is option 2, lymphoblasts. Reevaluation of the periodic acid-Schiff stain in acute leukemia with immunophenotypic analyses. Snower DP1, Smith BR, Munz UJ, McPhedran P. Author information Abstract To determine the sensitivity and specificity of the periodic acid-Schiff (PAS) stain in the diagnosis of acute leukemia in light of the finer characterization of this disorder now available through immunophenotyping, we examined the blasts from 51 patients with newly diagnosed acute leukemia by morphological, cytochemical, and immunophenotypic analyses. The 51 patients represented every new case of acute leukemia subjected to cytochemical stains and flow cytometry between July 1987 and February 1989. By cell-surface marker analysis, 29 exhibited lymphocytic lineage, while 21 were myelocytic. One was mixed lineage. The PAS positivity, defined by the presence of blocks or coarse granules in 5% or more of the blasts, was found in 15 of 29 lymphoblastic leukemias and in four of the myeloblastic leukemias. However, PAS-positive lymphoblastic leukemias were negative with the other cytochemical stains: myeloperoxidase, Sudan black B, and alpha-naphthyl butyrate esterase. The PAS-positive myeloblastic leukemias were positive with at least one other stain. Three cases of myeloblastic leukemia exhibited greater than 10% PAS-positive blasts, with all three being acute monoblastic leukemia. Thus, the sensitivity and specificity of the PAS stain alone for lymphoblastic leukemia was 52% (15 true positives of 29) and 81% (four false positives), respectively.

So the answer to this question is B


Instruction:
Professional disclosure is an offence in:
A. India and Pakistan
B. USSR
C. China
D. None of the above

Response:
Ans: a (India and Pakistan) Ref: Reddy, 27th ed, p. 28In India a doctor should not discuss the illness of the patient with others without the consent of the patient.It is called professional secrecy.Previlaged communication: These are exceptions to general rule of professional secrecy.In some conditions a doctor can disclose about the illness of patient without his/her consentExamplesA railway engine driver with colour blindness.A cook with infectious diseases like cholera

So the answer to this question is A


Instruction:
True about aphthous ulcer -a) Viral predispositionb) Recurrent ulcerc) Deep ulcersd) Involves the mucosa of the hard palatee) Steroids given as treatment
A. abe
B. bcd
C. cde
D. acd

Response:
Aphthous ulcer (Canker sores)

Aphathous ulcers are small ulcer craters in the lining of mouth that are frequently painful and sensitive.
Exact etiology is not known; it may be autoimmune process, nutritional deficiency (vitamin B1„ folic acid, iron), viral or bacterial infection, food allergies or due to hormonal changes or stress.
Aphathous ulcers typically starts in childhood or adolescence.,
Characterized by recurrent, small, round or oval ulcers with circumscribed margins, erythematous haloes, and yellow or gray floor.
They resolved spontanously in third decade.
The lesiosn may be single or multiple and usually involve movable mucosa, i.e., inner surface of lips, buccal mucosa, tongue, floor of mouth and soft palate, while sparing mucosa of hard palate and gingivae.

Treatment :  - If lesions do not resolve spontaneously, topical steroid and cauterization of base with 10% silver nitrate can be tried. In severe cases tetracycline mouth rinse can be given. For pain lignocaine viscous may be used.

So the answer to this question is A


Instruction:
Most cardiotoxic local anesthetic is:
A. Bupivacaine
B. Lignocaine
C. Lidocaine
D. Ropivacaine

Response:
Ref: L Mather LE, Chang DM. Cardiotoxicity with modem local anaesthetics: is there a safer choice ? Drugs. 2001;61(3):333-42. 2. Lied jam JJ. de la Coassay e JE, Bassoul B. Brugada J.Mechanisms of the cardiac toxicity of bupivacaine. Ann Fr Anesth Reanim. 1988; 7(3):204-10Explanation:Bupivacaine is the most cardiotoxic of all the local anaesthetics.Associated with sudden increase in the plasma concentration of bupivacaine.It involves both electrical and mechanical structures within the heart.The main site of action on cardiac conduction tissue is the Vmax of phase 0 of the action potential of fast-reacting structures tlNa current).Bupivacaine, like lidocaine and the other class I antiarrhythmic drugs, blocks the sodium channels, this block being more slowly reversible.The disturbance of sodium channels throughout the heart leads to a decreased conduction speed throughout the conduction system, thus explaining possible acute conduction disturbances originating below the bundle of His.The ventricular dysarrhythmias are due to a re-entry circuit secondary to a slowing in conduction speed.The sinus bradycardias and junctional disturbances seen in toxic accidents are probably due to an inhibition of the slow current of the atrial and atrio-ventricular nodes (Isi current!.Bupivacaine, at toxic levels, has a direct effect on contractility.The negative inotropic effects seem to be due to a fall in the intracytoplasmic calcium concentration on wrhich depends the excitation- contraction couple, as well as disturbed cellular energetic events dependent on the contraction.Bupivacaine is disproportionately more cardiotoxic than its shorter-acting counterparts like ropivacaine and levobupivacaine.While all local anaesthetics can cause direct negative inotropic effects, ropivacaine and levobupivacaine are less cardiotoxic than bupivacaine.

So the answer to this question is A


Instruction:
In precocious females, menstruation occurs :
A. After 13 years of age
B. At 13 years of age
C. Less than 10 years of age
D. Below 12 years of age

Response:
Less than 10 years of age

So the answer to this question is C