Instruction:
Cauliflower ear seen in:
A. Hematoma of the auricle
B. Carcinoma of the auricle
C. Fungal infection of the auricle
D. Congenital deformity

Response:
Cauliflower ear (boxer's ear, wrestler's ear) is an acquired deformity of the outer ear. In this injury, the ear can shrivel up and fold in on itself and appear pale, giving it a cauliflower-like appearance, hence the term cauliflower ear. Wrestlers, boxers and maial aists in paicular are susceptible to this type of injury. When the ear is struck and a blood clot develops under the skin, or the skin is sheared from the cailage, the connection of the skin to the cailage is disrupted.

So the answer to this question is A


Instruction:
A 56 year old chronic smoker, mass in bronchus resected. What is the possible marker?
A. Cytokeratin
B. Vimentin
C. Epithelial membrane Cadherin
D. Leukocyte

Response:
Ans. is 'a' i.e., Cytokeratin o Squamous cell carcinoma is most commonly found in men and is closely correlated with a smoking history. o Histologically, it is characterized by keratinization and intracellular bridges. o Cytokeratin is a marker for keratinizing cells.

So the answer to this question is A


Instruction:
6/6 visual acuity is attained by the age of?
A. 6 months
B. 1 year
C. 6 years
D. 18 years

Response:
Ans. is 'c' i.e., 6 years Eye in postnatal period Fixation stas developing by 4-6 weeks. Critical period for development of fixation reflex is 2-4 months. Development of fixation is completed by 6 months. So there are three points to remember : ? Fixation stas developing - 4-6 weeks (1-11/2 months). Critical period for development - 2-4 months. Binocular vision and eye coordination are established - 3 months Fixation development is completed --> 6 months. Macula is fully developed by 4-6 months. Fusional reflex, stereopsis and accomodationis well developed by 4-6 months. Cornea attains normal adult diameter by 2 years of age. Lens grows throughout life. Full visual acuity (6/6) or (20/20) is attained by 6 years of life.

So the answer to this question is C


Instruction:
Complications of streptokinase are -
A. Myocardial rupture
B. Joint pain
C. Intracranial bleed
D. Anaphylaxis

Response:
Ref: R. Alagappan Manual for Medicine 4th Edition pg no:188-189 Thrombolytic agents for Myocardial Infarction Agents with fibrin specificity: 1. Alteplase (-PA) 15 mg IV bolus followed by 0.75 mg/kg IV infusion (upto 50 mg) over 30 minutes then 0.5 mg/kg (upto 35 mg) by IV infusion over 60 minutes (maximum dose 100 mg IV over 90 minutes) 2. Reteplase (r-PA) 10 mg IV bolus over 2 minutes followed by another 10 mg IV bolus after 30 minutes. 3. Tenecteplase (TNK-tPA) 0.5 mg/kg IV bolus (<60 kg-30 mg, 61-70 kg -35 mg, 71-80 kg-40 mg, 81-90 kg- 45 mg, >90 kg-50 mg) Agents without fibrin specificity: 1. Streptokinase - 1.5 million units IV infusion over 60 minutes 2. Urokinase Because of the development of antibodies, patients who were previously treated with strepto- kinase should be given an alternate thrombolytic agent. Contraindications for Thrombolytic Therapy Absolute contraindications: Active bleeding Defective haemostasis Recent major trauma Surgical procedures < 10 days Invasive procedures < 10 days Neurosurgical procedure < 2 months GI/genito-urinary bleeding < 6 months Stroke/TIA < 12 months Prolonged CPR > 10 minutes H/O CNS tumour, aneurysm, AV malformation Active peptic ulcer Aoic dissection Acute pericarditis Active inflammatory bowel disease Active cavitary lung disease Pregnancy Relative contraindications: Systolic BP > 180 mm Hg Diastolic BP >110 mm Hg Bacterial endocarditis Haemorrhagic diabetic retinopathy H/O intraocular bleeding Chronic warfarin therapy Severe renal or liver disease Severe menstrual bleeding

So the answer to this question is C


Instruction:
False regarding restrictive cardiomyopathy is-
A. Filling pressure is increased
B. Left ventricular hyperophy
C. Hea failure is not predominantly right sided
D. In early phase, systolic function is not impaired

Response:
Ref: Harrison's 19th E pg: 1566 Both atria are enlarged, sometimes massively. Modest left ventricular dilation can be present, usually with an enddiastolic dimension <6 cm. End-diastolic pressures are elevated in both ventricles, with preservation of cardiac output until late in the disease. Subtle exercise intolerance is usually the first symptom but is often not recognized until after clinical presentation with congestive symptoms. The restrictive diseases often present with relatively more rightsided symptoms, such as edema, abdominal discomfo, and ascites, although filling pressures are elevated in both ventricles.

So the answer to this question is B


Instruction:
Windkessel effect in large aeries perform what function -
A. Maintain intravascular volume
B. Provide peripheral resistance
C. Prevent fluctuation in BP
D. Exchange of respiratory gases

Response:
Ans. is'c'i.e., Prevent fluctuation in BPThe elastic walls of large elastic aeries prevent abrupt changes in BP, a phenomenon called windkessel vessels.

So the answer to this question is C


Instruction:
A mother comes with her 3 year old female child with complain of that child is not eating anything. Her weight is 11 kg (50thpercentile) and height is 88 cm (75lh percentile). What should be done next?
A. Vitamin rich tonic to be given
B. Forceful eating
C. Nothing should be done actively and assure the patients
D. Complete investigation for UTI

Response:
Ans. is 'c' Nothing should be done actively and assure the parents (Ref. : Parks, 16/e, p373, Ghai 6/e, p 5, Nelson 17/e, p 40-43)WHO prototype growth chart has 2 reference curves.The upper reference curve represents the median (50th percentile) for boys (slightly higher than that for girls).The lower reference curve the 3rd percentile for girls (slightly lower than that for boys).Thus the chart can be used for both sexes.The space between 2 growth curves has been called the road to health*.If the child is growing normally, its growth line will be above the 3rd percentile and will run parallel to the road to health curves.The girls in the question falls between these 2 reference curves that means that she is growing normally. Therefore she does not require anything.

So the answer to this question is C


Instruction:
Systolic BP of a group of person follows normal distribution curve. The mean BP is 120. The values above 120 are:
A. 25%
B. 75%
C. 50%
D. 100%

Response:
Ans. is 'c' i.e. 50% in the normal distribution curve 50% of values lies on either side of the mean .Therefore values lying above 120 (which is the mean B.R) are 50%

So the answer to this question is C


Instruction:
Massive bleeding per rectum in a 70 years old patient is due to:
A. Diveiculosis
B. Carcinoma colon
C. Colitis
D. Polyps

Response:
COLONIC DIVEICULA Mc cause of significant lower GI bleeding : Diveicula Bleeding occurs at the neck of the diveiculum and is believed to be secondary to bleeding from the vasa recti as they penetrate through the submucosa. Of those that bleed, more than 75% stop spontaneously, although about 10% rebleed within 1 year and almost 50% within 10 years. Although diveicular disease is much more common on the left side, right-sided disease is responsible for more than half episodes of bleeding. Best method of diagnosis and treatment: Colonoscopy Epinephrine injection, electrocautery, endoscopic clips to control the hemorrhage. If none of these maneuvers is successful or if hemorrhage recurs, Colonic resection is indicated. Moality rate of emergent subtotal colectomy for bleeding :30%

So the answer to this question is A


Instruction:
An infection becomes apparent only after a ceain incubation period. Shoest incubation period is seen in:
A. Hepatitis A
B. Hepatitis B
C. Rubella
D. Influenza

Response:
Incubation period is defined as the time interval between invasion by an infectious agent and appearance of the first sign or symptom of the disease in question. Incubation period of, Influenza - 18 to 72 hours Hepatitis A - 15 to 45 days (usually 25 to 30 days) Hepatitis B - 45 to 180 days Rubella (German Measles) - 2 to 3 weeks; usually 18 days Ref: Park's Textbook of Preventive and Social medicine, 19th edition, Page 93, 134.

So the answer to this question is D


Instruction:
Which is M.C. site for iatrogenic esophageal perforation?
A. Cervical poion
B. Abdominal poion
C. Below arch of aoa
D. Above arch of aoa

Response:
PERFORATION OF OESOPHAGUS AETIOLOGY Perforation or the rupture of oesophagus results from: 1. Instrumental trauma, i.e. oesophagoscopy or dilatation of strictures with bougies. The common site or rupture in these cases is just above the upper sphincter; sometimes it is the lower oesophagus near the hiatus. 2. Spontaneous rupture. This usually follows vomiting and involves mostly the lower third of oesophagus. Postemetic rupture of all the layers of oesophagus is called Boerhaave syndrome. DIAGNOSIS Early diagnosis is imperative, as mediastinitis, resulting from rupture, can rapidly prove fatal. All patients complaining of pain in the neck or interscapular region, following an oesophagoscopy, should be suspected of a perforation. The features of cervical oesophageal rupture are pain, fever, difficulty to swallow and local tenderness, along with signs of surgical emphysema in the neck. The features of thoracic oesophageal rupture are pain, referred to the interscapular region, fever 102-104degF (39-40degC), signs of shock, surgical emphysema in the neck, crunching sound over the hea (Hamman's sign, because of air in the mediastinum) and pneumothorax. X-rays of the chest and neck are essential. They may reveal widening of the mediastinum and retrovisceral space, surgical emphysema, pneumothorax, pleural effusion or gas under the diaphragm. Ref : ENT textbook by Dhingra 6th edition Pgno : 342

So the answer to this question is A


Instruction:
what is the root value of phrenic nerve?
A. C3,4,5
B. C2,3,4
C. C4,5,6
D. C5,6,7

Response:
* Phrenic nerve (C3,C4,C5)- It descends in front of scalenus anterior muscle . * Descends down to enters thorax where it lies between subclan vein(in front) and subclan aery lies behind it . * Fuher it descends in front of hilum of the lungs (whereas vagus nerve descends behind the hilum of lungs) * It is mixed nerve sensory and motor.(both motor and sensory to diaphragm)

So the answer to this question is A


Instruction:
Keratoconus is associated with all except –
A. Down's syndrome
B. Ehlers–Danlo's syndrome
C. Marfan's syndrome
D. Usher's syndrome

Response:
Systemic conditions associated with keratoconus are a marfan syndrome, osteogenesis- imperfecta, EDS, Down's syndrome, MVP, atophy (asthma, eczema, atopic keratoconjunctivitis, hay fever).

So the answer to this question is D


Instruction:
In the management of severe acute malnutrition (SAM) child, iron should be started
A. Immediately
B. On day 2 start of stabilization phase
C. In Rehabilitation Phase, after fever subside
D. Iron should never be given

Response:
Do not given Iron is Stabilization Phase. If given Iron releases free radical, causing injury to GIT.
Iron should be started in Rehabilitation Phase (after day 7)

So the answer to this question is C


Instruction:
Hepatotoxic drug used in tuberculosis is ?
A. Isoniazid
B. Streptomycin
C. Kanamycin
D. Ethambutol

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

So the answer to this question is A


Instruction:
All of the following are true about larynx in neonate except
A. Epiglottis is large and omega shaped
B. Tongue is small in comparison to oral cavity
C. Cricoid narrowest pa
D. Funnel shaped

Response:
PAEDIATRIC LARYNX The larynx of an infant differs considerably from that of an adult and has a great clinical significance. 1. Infant's larynx is positioned high in the neck level of glottis being opposite to C3 or C4 at rest and reaches C1 or C2 during swallowing. This high position allows the epiglottis to meet soft palate and make a nasopharyngeal channel for nasal breathing during suckling. The milk feed passes separately over the dorsum of tongue and the sides of epiglottis, thus allowing breathing and feeding to go on simultaneously. 2. Laryngeal cailages are soft and collapse easily. Epiglottis is omega shaped and arytenoids relatively large covering significant poion of the posterior glottis. 3. Thyroid cailage in an infant is flat. It also overlaps the cricoid cailage and is in turn overlapped by the hyoid bone. Thus cricothyroid and thyrohyoid spaces are narrow and not easily discernible as landmarks when performing tracheostomy. 4. Infant's larynx is small and conical. The diameter of cricoid cailage is smaller than the size of glottis, making subglottis the narrowest pa. 5. Submucosal tissues of infant's larynx are comparatively loose and easily undergo oedematous change with trauma or inflammation leading to obstruction. Ref:- Dhingra; pg num:-285

So the answer to this question is B


Instruction:
Complications of lobar pneumonia does not include
A. Lung abscess
B. Amyloidosis
C. Suppurative arthritis
D. Infective endocarditis

Response:
None

So the answer to this question is B


Instruction:
Pseudo-myxoma peritonei occur due to?
A. Dysgerminoma
B. Brenner s tumor
C. Theca cell tumor
D. Mucinous cystadenosarcoma

Response:
Pseudomyxoma peritonei (PMP) is a clinical condition caused by cancerous cells (mucinous adenocarcinoma) that produce abundant mucin or gelatinous ascites.
The primary tumor appears to arise from the MUC2 expressing goblet cells and most commonly from these cells in the appendix. The K-Ras and p53 genes may be involved in the oncogenesis. It may be diagnosed with a range of conditions.
While the majority of these cases are associated with appendiceal carcinoma other conditions may also be found, including disseminated peritoneal adenomucinosis (DPAM), peritoneal carcinomas, several mucinous tumors (mucinous adenocarcinoma, mucinous cystadenoma, and mucinous cystadenocarcinoma), as well as other disease states
This will result in compression of organs and will destroy the function of colon, small intestine, stomach, or other organs. Prognosis with treatment in many cases optimistic, but the disease is lethal if untreated, with death by cachexia, bowel obstruction, or other types of complications.

So the answer to this question is D


Instruction:
Bone within bone appearance is seen in?
A. CML
B. Osteoporosis
C. Osteopetrosis
D. Bone infarct

Response:
C i.e. Osteopetrosis In osteopetrosis, there is reduced osteoclastic bone resorption resulting in diffuse symmetrical skeleton sclerosis. Also k/a marble bone disease d/t its stone like quality of bones; however the bones are abnormally brittle & fracture like a piece of chalk. It can present radiologically as? Sclerosis of all bones more prominent at base of skullQ. Sclerosis of veebral end plate 1/t characteristic sandwitch or broad stripped (rugby jersey spine) Q Bone in bone appearanceQ d/t sclerotic foci within the bone.

So the answer to this question is C


Instruction:
A56 years old patient presents after three days of cataract surgery with a history of increasing pain and decrease of vision after an initial improvement the most likely cause would be
A. Endophthalmitis
B. After cataract
C. Central retinal vein occlusion
D. Retinal detachment

Response:
Pain which is increasing along with decrease in vision paicularly after only three days of cataract surgery strongly suggest endophthalmitis

So the answer to this question is A


Instruction:
Cofactor for lipoprotein lipase is
A. apo A-I
B. apo A-II
C. apo C-II
D. apo C-III

Response:
Both phospholipids and apo C-II are required as cofactors for lipoprotein lipase activity, while apo A-II and apo C-III act as inhibitors. Reference: Harper; 30th edition; Page no: 257

So the answer to this question is C


Instruction:
'Itch is disease' is true for –
A. Atopic dermatitis
B. Insect bites
C. Seborrheic dermatitis
D. Tinea cruris

Response:
Atopic eczema is one of the most itchy disorder.

So the answer to this question is A


Instruction:
Iron and folic acid supplementation forms
A. Health promotion
B. Primordial prevention
C. Specific protection
D. Secondary prevention

Response:
Specific protection is a part of primary prevention.
Specific protection includes protection of health by personal and community efforts such as enhancing nutritional status, providing immunizations and eliminating environmental risks.

So the answer to this question is C


Instruction:
Infant with no social smile, no eyebrows, protruded tongue. Diagnosis -
A. Cretinism
B. Down's syndrome
C. Mucopolysaccharidosis
D. Rickets

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

So the answer to this question is A


Instruction:
Which of the following is an example of intellectual disability?
A. Dyslexia
B. ADHD
C. Autistic spectrum disorder
D. Mental retardation

Response:
Ref. Oxford textbook of Psychiatry. Page. 488

So the answer to this question is D


Instruction:
In mid clavicular plane, lower border of lung lies at level of:
A. 4th rib
B. 6th rib
C. 8th rib
D. 10th rib

Response:
The lower border of the lung in midinspiration follows a curving line, which crosses the 6th rib in the midclavicular line and the 8th rib in the midaxillary line, and reaches the 10th rib adjacent to the veebral column posteriorly.

So the answer to this question is B


Instruction:
In the human body, the action of surfactant is done by-
A. Sugar & salt
B. Soap & water
C. Lipid and protein
D. Base and lipid

Response:
Ans. is 'c' i.e lipid and protein Approximate composition of a surfactantComponentPercentage compositionDipalmitoyl Phosphatidylcholine(DPPC)62Phosphatidylglycerol*5Other phospholipids10Neutral lipids13Proteins8Carbohydrate2DPPC and PG are types of phospholipids.Thus surfactant is made up of lipids and protein (and carbohydrate).Surfactant action by a molecule requires it to be amphipathic i.e. it should have both a polar group and a non polar chain; such a combination is possessed by lipids (phospholipids) & proteins.

So the answer to this question is C


Instruction:
In belladona poisoning, antidote is:
A. Physostigmine
B. Neostigmine
C. Anti histamine
D. Atropine

Response:
A i.e. Physostigmine Belladona Poisoning May occur due to consumption of seeds & berries of belladona / dhatura plant Clinical presentation are due to anticholinergic effects i.e. Dry mouth, difficulty in swallowing & talking, dry skin, difficulty in micturation, dilated pupil, photophobia etc.

So the answer to this question is A


Instruction:
Epidemic relapsing fever is transmitted by?
A. Louse
B. Soft tick
C. Hard tick
D. Rat flea

Response:
ANSWER: (A) LouseREF: Park textbook of preventive and social medicine 20th edition page 684 "Epidemic relapsing fever is transmitted by Louse"Always remember:Epidemic typhus Endemic typhus Epidemic relapsing fever Endemic relapsing feverLouse Rat flea Louse Soft tickDiseases transmitted by louse can be remembered as "PERT": Pediculosis, Epidemic typhus, Relapsing fever (Epidemic), Trench fever.Diseases transmitted by soft tick can be memorized as 'QRS": Q-fever, Relapsing fever (Endemic) by Soft tickDiseases transmitted by hard tick can be memorized as "Hard tick Takes Very Kind Babe": Tick typhus (Rocky Mountain spotted fever), Tick Paralysis, Tick fever, Tularemia, Viral encephalitis (Russian spring summer encephalitis), Viral hemorrhagic fever, Kyasanur Forest Disease, Babesiosis

So the answer to this question is A


Instruction:
Which of the following is a minor criteria for diagnosis of Rheumatic fever (RP) according to modified Jones criteria –
A. ASO titre
B. Past history of Rheumatic fever
C. Fever
D. Subcutaneous nodules

Response:
Fever is a minor criteria

So the answer to this question is C


Instruction:
Management of 1 week old baby with Imperforate anus and Meconuria is ?
A. Conservative
B. VY Plasty
C. Colostomy
D. ileostomy

Response:
Management of anorectal malformation in one week old baby is colostomy. Colostomy is done first at the later stages other surgeries are done inorder to correct the defect Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is C


Instruction:
A 2-year-old child attending daycare develops diarrhoea and gastroenteritis as a result of adenoviral infection. Which of the following adenoviral serotypes would most likely be responsible for this girl's illness?
A. Type 4
B. Type 7
C. Type 19
D. Type 41

Response:
Adenoviral types 40, 41, and 42 have been shown to be associated with gastrointestinal disease in infants. Adenoviral types 4 and 7, commonly cause upper respiratory infections in military recruits; adenoviral types 19 and 37 have been implicated in causing epidemic keratoconjunctivitis. Ref Robbins 9/e pg 567

So the answer to this question is D


Instruction:
Deforming force on proximal fragment in Benett's fracture ?
A. APL
B. APB
C. EPL
D. EPB

Response:
Ans. is 'a' i.e., APL Benett's fracture Benett's fracture is an intra-aicular fracture dislocation of the palmar base of first metacarpal bone of the thumb with either subluxation or dislocation of first carpometacarpal joint, i.e. trapezometacarpal joint. The common mechanism of injury is an axial blow directed against the paially flexed metacarpal, in most cases during "Fist fights". Patient complains of pain, swelling and tenderness over the base of the thumb. Movements of thumb are restricted. Displacing force in Bennett's fractures Following are the deforming forces in Bennett's fracture :- i) At the distal fragment, it is the adductor pollicis. ii) At the proximal fragment, it is the abductor pollicis longus. Base of the thumb metacarpal is pulled dorsally and medially by the abductor pollicis longus, while the distal attachment of adductor pollicis fuher levers the base into abduction.

So the answer to this question is A


Instruction:
DOC for lepra II reaction is –
A. Steroids
B. Thalidomide
C. Clofazimine
D. Dapsone

Response:
Treatment of ENL (Type II lepra reaction)

Mild → NSAID
Severe → Glucocorticoids
If 2 courses of glucocorticoids fail → Thalidomide.

So the answer to this question is A


Instruction:
Radiation injury to the haemopoietic system of the bone marrow occurs when the whole body exposure ranges between:
A. 50-100 rads
B. 200-1000 rads
C. 1000-5000 rads
D. 10,000 rads to more

Response:
None

So the answer to this question is B


Instruction:
All the following reactions are involved in generation of reactive oxygen species within neutrophils for killing intracellular bacteria except
A. Glutathione peroxidase
B. Superoxide dismutase reaction
C. Fenton's reaction
D. NADPH oxidase

Response:
Glutathione peroxidase catalyzes the destruction of hydrogen peroxide. Fenton's reaction generates hydroxyl radical from H2O2 Superoxide dismutase generates H2O2 from superoxide NADPH oxidase reaction generates superoxide from oxygen Reference: Harpers illustrated biochemistry 30th edition

So the answer to this question is A


Instruction:
When do we have to sta antibiotics to prevent post-operative infections
A. 2 days before surgery
B. After surgery
C. 1 week before surgery
D. 1 hour before surgery and continue after surgery

Response:
Prophylactic Antibiotics Antibiotics should be used when local wound defences are not established (the decisive period) Ideally, maximal blood and tissue levels should be present at the time at which the first incision is made and before contamination occurs IV administration at induction of anaesthesia is optimal If induction is not mentioned in the option go for 30 minutes to 1 hour before surgery In long operations, those involving the inseion of a prosthesis, when there is excessive blood loss or when unexpected contamination occurs, Antibiotics may be repeated 8 to 16 hours later The use of the newer, broad spectrum antibiotics for prophylaxis should be avoided Benzyl penicillin should be used if clostridium gas gangrene infection is a possibility Patients with hea valve disease or a prosthesis should be protected from bacteraemia caused by dental work, urethral instrumentation or visceral surgery Ref: Sabiston 20th edition Pgno :224,251

So the answer to this question is D


Instruction:
A 2 years male boy presenting with sudden severe dyspnoea, most common cause is
A. Foreign body
B. Bronchiolits
C. Asthmatic attack
D. None

Response:
For 2 years male boy presenting with sudden severe dyspnoea, the most common cause is a foreign body. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 334

So the answer to this question is A


Instruction:
Tooth with acute pulpitis will give response to electric pulp tester?
A. High reading than adjacent tooth only
B. High reading than adjacent and contralateral tooth
C. Lower reading than adjacent teeth
D. Higher reading than opposite tooth

Response:
None

So the answer to this question is C


Instruction:
nephrotic syndrome is caused by all except ?
A. renal cell carcinoma
B. minimal change nephropathy
C. diabetes mellitus
D. rheumatoid ahritis

Response:
Primary causes Primary causes include- Minimal-change nephropathy(70-90% children and 10- 15%inadult) Focal glomerulosclerosis (15%inadult) Membranous nephropathy (30%inadult) Mesangial proliferative glomerulonephritis . Rapidly progressive glomerulonephritis Secondary causes Secondary causes include- RA Diabetes mellitus Lupus erythematosus Amyloidosis and paraproteinemias Viral infections (eg, hepatitis B, hepatitis C, HIV ) Preeclampsia ref : harrisons 21st ed

So the answer to this question is A


Instruction:
A patient is on regular medication for medical illness. Which of the following drugs can be safely stopped with least adverse effects before an abdominal surgery
A. Stains
B. Steroids
C. Beta blockers
D. ARB

Response:
D i.e. ARB Whereas angiotensin receptor blockers (ARB) are stopped preoperativelyQ. ACE inhibitors (capto/enala /lisino/rami-pril, enalaprilat) and angiotension II receptor blockers (valsaan) are increasingly used as 1st line antihypeensive drugs and appear to improve quality of life of patients taking antihypeensive drugs. However, ACE inhibitor, angiotensin II receptor blockers and ACE receptor blocking agents may be a/w more peripheral vasodilation and hypotension on induction of anesthesia (than sympatholytic drugs are). These last 2 classes of drugs are a/w such severe hypotension with standard anesthetic induction that these are either discontinued or at least considered discontinuing preoperativelyQ.

So the answer to this question is D


Instruction:
For a bitewing X-ray angulation of cone should be:
A. 10° above horizontal
B. 15° below horizontal
C. 10° below horizontal
D. 15° above horizontal

Response:
None

So the answer to this question is A


Instruction:
The lung tumour responding best to radiotherapy?
A. Small cell anaplastic
B. Squamous cell CA
C. Adeno CA
D. All respond equally well

Response:
Ans. is 'a' i.e., Small cell anaplastic

So the answer to this question is A


Instruction:
Proteins are soed by :
A. Golgi Bodies
B. Mitochondria
C. Ribosomes
D. Nuclear Membrane

Response:
A i.e. Golgi bodies

So the answer to this question is A


Instruction:
A 10-month-old infant presents with acute intestinal obstruction. Contrast enema X-ray shows the intussusceptions, Likely cause is
A. Payers patch hypertrophy
B. Mekel's diverticulum
C. Mucosal polyp
D. Duplication cyst

Response:
Bailey writes - "The condition is encountered most commonly in children, in whom it occurs in an idiopathic form, with a peak incidence at 3-9 months. Between 70% and 90% of cases are classed as idiopathic, and an associated illness such as gastroenteritis or urinary tract infection is found in 30%. It is believed that hyperplasia of Peyer's patches in the terminal ileum may be the initiating event. This may occur secondary to weaning. In light of the seasonal variation, with a peak incidence in spring and summer, it may be related to upper respiratory tract infection pathogens such as adenovirus or rotavirus."
Intussusception associated with a known pathologic lead point is seen in older children. The most common lead point is Meckel's diverticulum.
This patient is 10 months old, so most likely the cause should be hypertrophy of Peyer's patches.

So the answer to this question is A


Instruction:
Internationally quarantinable disease are
A. Plague
B. Cholera
C. Yellow fever
D. All of the above

Response:
At the international level the WHO maintains surveillance of impoant diseases -eg influenza, malaria, polio and gives timely warning to all national governments. Surveillance if properly pursued can provide the health agencies with an overall intelligence and disease accounting capability. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 138

So the answer to this question is D


Instruction:
A term baby girl has two episodes of bile-stained emesis at 24 hours after bih. There is a history of excessive amniotic fluid volume. The most appropriate diagnostic test is? NOT RELATED - MEDICINE
A. Blood culture
B. Barium swallow and Gastrointestinal X rays
C. CT scan of head
D. Neurosonogram

Response:
.

So the answer to this question is B


Instruction:
A 19-year-old man has a long history of weight loss, abdominal distention, bloating, and diarrhea. Investigation reveals steatorrhea, and a small bowel biopsy reveals blunting and flattening of villi.
A. celiac disease
B. gastrinoma
C. hyperthyroidism
D. associated with skin pigmentation

Response:
This syndrome is likely celiac disease, but a clinical and histologic improvement with a gluten-free diet would be required for confirmation. The decrease in pancreatic enzyme production is secondary to decreased intestinal secretion of hormones that stimulate the pancreas. Dermatitis herpetiformis might be related to celiac disease. Although gross malabsorption is the classical description of celiac disease, it can present with isolated deficiencies such as iron deficiency anemia.

So the answer to this question is A


Instruction:
End product of purine metabolism is:
A. Creatinine
B. Uric acid
C. Xanthine
D. Phosphates

Response:
Ans. B. Uric acidUric acid is the end product of purine metabolism. "GOUT" is a metabolic disease associated with over production of uric acid.

So the answer to this question is B


Instruction:
Most common type of Onychomycosis
A. Proximal Subungual
B. Distal lateral subungual
C. Superficial white
D. Total distal

Response:
Onychomycosis is a fungal infection of nails MC site for onychomycosis: hyponychium Types 1. Distal lat.subungual onychomycosis- MC 2. Proximal subungual onychomycosis (rare)-In HIV+ patient 3. Superficial white onychomycosis4. Total dystrophic onychomycosis- it is the end result of either of the types. It is complete nail involvement.

So the answer to this question is B


Instruction:
Which is false regarding gram-positive cocci?
A. Staph. saprophyticus causes UTI in females
B. Micrococci are oxidase positive
C. Most enterococci are sensitive to penicillin
D. Pneumococci are capsulated

Response:
Ans. (c) Most enterococci are sensitive to penicillin Unlike streptococci, enterococci are not reliably killed by penicillin or ampicillin alone at concentration achieved clinically in the blood or tissues. Antimicrobial susceptibility testing should be performed routinely on enterococcal isolates. Enterococci resistance to penicillin is two mechanism: Penillin Resistance Penicilase production Altered penicillin binding protein Seen in E. faecalis Common in E. faecum Vancomycin, ampicillin/sulbactam, amoxicillin/clavulanate. Vancomycin plus gentamycin is usedimipenem may be used in combination with gentamycin Vancomycin plus gentamycin is used Other options Option 'a' Staph. saprophyticus specially causes UTI in sexually active young women. Option 'b' Micrococci are catalase and oxidase positive Gr +ve cocci. They are strict aerobes and are non-pathogenic. Micrococci are differentiated from Staphylococci by Hugh and Deifson oxidation fermentation test in which micro- * cocci shows oxidative pattern while staphylococci show fermentative pattern. Anaerobic Cocci Features Gram +ve Gram --ye Organism Peptostreptococci Intestine, vagina and mouth Veillonellae Inhabitation Puerperal sepsis Mouth, intestine and genital tract Diseases Visceral abscess No disease is identified till now. UTl, wound infection Gangrenousapendicitis Treatment Sensitive to penicillin, chloramphenicol and metronidazole

So the answer to this question is C


Instruction:
Choroidal vascularization is seen in-
A. Myopia
B. Hypermetropia
C. Presbyopia
D. Astigmatism

Response:
Cause of choroidal neovascularization *Age-related macular degeneration (ARMD)- most significant *Angioid streaks *Choroidal rupture (trauma) *Pathological myopia *Chorioretinal scars *Intraocular inflammation *Chorioretinal dystrophy Ref: Yanoff & Ducker 2nd/e p.919-920

So the answer to this question is A


Instruction:
A pregnant woman from bihar presents with hepatic encephalopathy. The likely diagnosis -
A. Hep. E
B. Hep. B
C. Sepsis
D. Acute fatty liver of pregnancy

Response:
A unique feature of HEV is it cause serious disease in pregnant women REF:ANANTHANARYANAN TEXTBOOK OF MICROBIOLOGY 9EDITION PGNO.550

So the answer to this question is A


Instruction:
Diathronol ointment is used for: March 2011
A. Pityriasis
B. Pyoderma
C. Psoriasis
D. Herpes zoster

Response:
Ans. C: PsoriasisDithranol (cytostatic agent) is used as a topical therapy agent in psoriasis Dithranol/ An thralinIt is a Hydroxyanthrone, anthracene derivativeApplied to the skin of people with psoriasis.It is available as creams, ointment or pastes in 0.1 to 2% strengthsThe terms dithranol and anthralin are sometimes used synonymouslyDithranol accumulates in mitochondria where it interferes with the supply of energy to the cell, probably by the oxidation of dithranol releasing free radicals.This impedes DNA replication and so slows the excessive cell division that occurs in psoriatic plaques. In addition Dithranol may act by reducing the elevated levels of cGMP that occurs in psoriasis.The anti-proliferative effects of anthralin appear to result from both an inhibition of DNA synthesis as well as from its strong reducing propeies.Unlike retinoids and PUVA, anthralin does not inhibit liver microsomal enzyme activityConsequently, the likelihood of adverse drug interactions is greatly reduced when other agents are administered concomitantly with anthralin.Dithranol has a slower onset of action in controlling psoriasis, typically several weeks, compared to glucocoicoid steroids, but is without the potential for rebound reaction on withdrawal.It cannot be used on the face or genitalia.It temporarily stains the skin a yellowy-brown and permanently stains clothing fabrics.It may cause a local burning sensation and irritation

So the answer to this question is C


Instruction:
The medial boundary of the anatomical snuffbox is formed by the:
A. Ext. Pollicus brevi
B. Ext Carpi radialis longus
C. Extensor pollicus longus
D. Ext Carpi radialis brevis

Response:
Ans. (c) Extensor pollicus longusGray's 41st ed./790* The anatomical snuffbox is formed by the tendons of extensor polloicis longus and brevis, and abductor pollicis longus.* The radial artery running in the floor of the snuffbox, and the radial nerve passing to the dorsum of the hand.* Boundaries of snuffbox:# Postero-medial border is the tendon of the extensor pollicis longus.# Antero-lateral border is a pair of parallel and intimate tendons of the extensor pollicis brevis and the abductor pollicis longus.# The proximal border is formed by the styloid process of the radius.# The distal border is formed by the approximate apex of the schematic snuffbox isosceles.

So the answer to this question is C


Instruction:
Migratory thrombophlebitis is associated with the following malignancies except:-
A. Lung cancer
B. Testicular tumor
C. Pancreas cancer
D. Gastro-intestinal cancer

Response:
Malignancies associated with migratory thrombophlebitis CA pancreas Prostate cancer CA lung Ovarian cancer GI malignancies Lymphoma Trousseau's syndrome: migratory thrombophlebitis Trousseau's sign: Carpopedal spasm in hypocalcemia Troisier's sign: Palpable left supraclavicular LN

So the answer to this question is B


Instruction:
What is the diagnosis in this infant with a large head?
A. Anencephaly
B. Hydranencephaly
C. Hydrocephalus
D. Hydrops fetalis

Response:
The given image shows absence of cerebral hemispheres, which are replaced with fluid filled sacs. This condition is known as 'Hydranencephaly' -Hydrocephalus:- condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain. -Anencephaly:- Absence of a major poion of the brain, skull, and scalp.

So the answer to this question is B


Instruction:
Not true regarding Nodular Episcleritis:
A. Pink nodule
B. Self limiting
C. Recurring
D. Aggressive treatment is required

Response:
Wait and watch is preferred mode as it is usually self resolving. Nodular Episcleritis Pink nodule Self limiting Recurring No treatment required or mild NSAID like ketorolac can be given.

So the answer to this question is D


Instruction:
Extensor hallucis longus is supplied by
A. Superficial peroneal nerve
B. Deep peroneal nerve
C. Tibial nerve
D. Sciatic nerve

Response:
DEEP PERONEAL:- Muscular branches to muscles of anterior compament of leg:Tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus teius.Extensor digitorum brevis Cutaneous: dorsal digital nerves for adjacent sides of big toe and second toe.Aicular branches:Ankle joint, tarsal joints, tarsometatarsal joints and metatarsophalangeal joint of big toe. SUPERFICIAL PERONEAL:-Muscular branches: peroneus longus and brevis Cutaneous branches:Digital branches to medial side of big toe, adjacent sides of 2nd and 3rd, 3rd and 4th, and 4th and 5th toes. TIBIAL NERVE:-Root value:ventral division of ventral rami of L4,L5,S1,S2,S3 segments of spinal cord.Beginning: largest subdivision of sciatic nerve.Course: descends veically in popliteal fossa. It continues in back of leg as the neurovascular bundle with posterior tibial vessels. Lastly passes deep to flexor retinaculum of ankle joint.Branches:Muscular branches to gastrocnemius,soleus, popliteus, plantaris, FHL, FDL and Tibialis posterior.Aicular branches to superior,middle and inferior genicular .Cutaneous and vascular branch: sural nerve ,medial calcaneal branch and branch to posterior tibial aery.Terminates by dividing into medial and lateral plantar nerves.MEDIAL PLANTAR NERVE:-Muscular branches: Abductor hallucis, flexor digitorum brevis, flexor hallucis brevis and first lumbrical.Cutaneous branch: skin of medial pa of sole and medial three and a half toes.LATERAL PLANTAR NERVE:-Main trunk: flexor digitorum accessorius and abductor digiti minimi ans skin of sole. Ends by dividing into superficial and deep branches.Superficial branch: lateral and medial branch Lateral branch:flexor digiti minimi brevis, 3rd plantar, 4th interossei and skin on lateral side of little toe.Medial branch :4th interdigital cleft. Deep branch:2nd,3rd,4th lumbricals1st,2nd,3rd dorsal interossei 1st,2nd plantar interossei andAdductor hallucis. SCIATIC NERVE:-Root value: L4,L5,S1,S2,S3 ventral rami Thickest nerve in the body.Terminal branch of lumbosacral plexus.Tibial pa and common peroneal pa. Tibial pa:ventral division of ventral rami of L4,L5,S1,S2,S3.Common peroneal pa: dorsal division of ventral rami of L4, L5, S1, S2. Course: arises in pelvis.Leaves pelvis by passing through greater sciatic foramen below pyriformis to enter gluteal region.In gluteal region, it lies deep to gluteus maximus and crosses superior and inferior gamellus, obturator internus, quadratus femoris to reach thigh.During its sho course, it lies between ischial tuberosity and greater trochanter.Gives no branches in gluteal region. Branches:--Muscular1. From tibial pa: semitendinosus, semimembranosus, long head of biceps femoris, ischial pa of adductor Magnus.2. From common peroneal :Sho head of biceps femoris. Aicular: hip joint Terminal: tibial and common peroneal. {Reference:BDC 6E vol2 ; pg 79,165,166}

So the answer to this question is B


Instruction:
Auditory hallucination is common in
A. schizophrenia
B. delirium tremens
C. cocaine bugs
D. temporal lobe epilepsy

Response:
this is the most impoant and repeted question in entrance examination hallucination is perception without stimulus there are several types of hallucinations based on the modality Auditory hallucination is more common in various psychiatric disorders especially schizophrenia other types of hallucinations are common among other various other disorders this is explained in the table below Ref. Kaplon and Sadock, synopsis of Psyhiatry, Pg. no 194

So the answer to this question is A


Instruction:
On barium swallow the grade III esophageal varices appear as:-
A. Mucosal folds above the carina
B. Mucosal folds below the carina
C. Mucosal folds at the carina
D. A thick band

Response:
Radiological grading of varices Grade I Straight varices seen only on inspiration Grade II Straight varices seen in all phases of respiration Grade III Touous varices in lower half of esophagus Grade IV Touous varices in entire esophagus

So the answer to this question is A


Instruction:
Which of the following leukemia almost never develops after radiation?
A. Acute myeloblastic leukemia
B. Chronic myeloid leukemia
C. Acute lymphoblastic leukemia
D. Chronic lymphocytic leukemia

Response:
Ref: Robbin's Pathology, 9th ed. pg. 324-325Cancers associated with radiation:* ALL, AML, CML* Thyroid cancer* Breast cancer* Lung cancer* Bladder, ovarian cancerCancers not seen with radiation:* CLL* Hodgkin's lymphoma* Prostate cancer, testis cancer and cervical cancer

So the answer to this question is D


Instruction:
What happens in hyperophy ?
A. Increase no. of cells
B. Increase size of cells
C. Increase protein in cells
D. Decrease in cell number

Response:
Ans. is `b' i.e., Increase in size of cells

So the answer to this question is B


Instruction:
A 9-year-old girl child developed a 10 mm area of induration on the left forearm 72 hours after intradermal injection of 0.1 ml of purified protein derivative (PPD). Which of the following is most likely to be seen on the X-ray of this patient?
A. Marked hilar adenopathy
B. Upper lobe calcifications
C. No abnormal findings
D. Reticulo-nodular densities

Response:
Most Mycobacterium tuberculosis infections are asymptomatic and subclinical infections. In most healthy people primary tuberculosis is asymptomatic, although it may cause fever and pleural effusion. Generally, the only evidence of infection, if any remains, is a tiny, fibrocalcific pulmonary nodule at the site of the infection. Viable organisms may remain dormant in such lesions for decades. If immune defenses are lowered, the infection may be reactivated, producing communicable and potentially life-threatening disease. Testing for latent tuberculosis is done by detecting T-cells specific for or delayed hypersensitivity to M. tuberculosis antigens. This can be detected by either IFN-g release assays (IGRAs) or the tuberculin (purified protein derivative , or Mantoux) skin test.

So the answer to this question is C


Instruction:
who gave the concept of preconsious in mind
A. freud
B. lorenz
C. seligman
D. bleuler

Response:
CONTRIBUTIONS OF FREUD o Father of psychoanalysis He founded a type of psychotherapy called psychoanalysis. It is nothing but analyzing the psych(MIND) o Interpretation of dreams According to Freud dreams are royal road to unconscious In dreams several conflicts that are present in the unconscious comes to the consciousness in the form of dreams Thus by analyzing ones dreams we could understand the unconscious conflicts o Psychosexual stages of life o Freud divided development into 5 stages namely psycho sexual development o It is divivded namely oral , anal , phallic, latent, genital phase. o Conversion disorders conversion disorder is conveing a psychological pain to physical symptoms present physical symptoms which has some connection with unconscious conflict is called SYMBOLIZATION present physical symptoms which has some resemblance with illness in family members, which is called MODELLING patient has illness like neurological deficit but they have apparent in concern towards their own illness which is known as LA BELLE INDIFFERENCE main defense mechanism in conversion disorder is REPRESSION o Repression defence mechanism * REPRESSION is called QUEEN of defense mechanisms o COUCH and FREE ASSOSIATION * He introduced a technique called as a couch technique where he makes the patient lie on the couch, he asks the patient to speak from 'cabbages to kings. This method is called FREE ASSOSIATION. By allowing the patient to speak whatever that comes to their mind randomly so that by analyzing their thoughts we could understand the conflict in the unconscious. o Topographical theory of mind Freud gave topographical theory mind It is divided into pre conscious, unconscious, conscious Later he disregarded topographical theory of mind and gave structural theory of mind o Structural theory of mind It is divided into id, ego, super ego Id= instinctual desires like anger, hunger, sexual instinct Ego= function of mind to work based on ego to avoid guilt from super ego Super ego= based on moral principle, obtained from family members and relatives, teachers Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition pg no. 845

So the answer to this question is A


Instruction:
Last discovered taste sensation -
A. Sweet
B. Sour
C. Bitter
D. Umami

Response:
Ans. is 'd' i.e., Umami o Umami taste sensation is the most recent one, discovered in early 1900s.Taste sensationso There are four basic tastes namely Sweet, bitter, Salty and Sour. There mechanisms of sensory transduction are:o There are different mechanisms of sensory transduction.1) Sweet receptor is a Gprotein coupled receptor and leads to an increase in cAMP concentration in the sensory cells which results in closure of K+ channels and depolarization.2) Bitter receptors are also G protein coupled receptors and causes rise in intracellular Ca+2 by IP3-DAG system. Rise in intracellular Ca+2 triggers neurotransmitter release.3) Salty-tasti ttg substances depolarize taste cells by activating amiloride-sensitive Na+ channels.4) Sour-tasting substances depolarize taste cells by raising the intracellular H+ ion concentration, which causes closure of K+ channels.o The umami taste is the fifth taste which is unique. The proposed mechanism of umami taste is through glutamate taste sensors (glutamate receptors) with release of neuronal glutamic acid.

So the answer to this question is D


Instruction:
Which of the following vasopressin receptors MOST likely mediates vasopressin antidiuretic action?
A. AQP6
B. Oxytocin receptor
C. V1a
D. V2

Response:
The vasopressin receptor family is unique among all classes of peptide receptors, since its members couple to different subsets of G proteins. Vasopressin binds to four distinct types of receptor subtypes V1a, V1b, V2 and the oxytocin receptor. The V2 receptors are located on the basolateral membrane of collecting duct cells. This receptor belongs to the seven-transmembrane domain, G-protein-coupled receptor superfamily. Stimulation of the V2 receptor by vasopressin leads to the activation of a G protein (Gs), resulting in the activation of adenylyl cyclase, the production of cAMP, and the stimulation of protein kinase A (PKA). PKA stimulates aquaporin 2, a water channel protein, which undergoes vesicular trafficking, inseing into the apical membrane of the duct cells, thereby increasing the water permeability of that membrane. At maximal ADH levels, less than 1% of the filtered water is excreted, with the minimum urine volume of 500 mL/day and osmolality of 1200 mosmol/L. Long term regulation by vasopressin involves the effects of cAMP on the cAMP-response elements in the 5'-flanking region of the AQP2 gene, which increases the abundance of aquaporin 2 protein in the target cells. The human V2 receptor gene, AVPR2, is located in chromosome region Xq28. The genetic form of nephrogenic diabetes insipidus is caused by mutations in the coding region of the V2 receptor gene. Note: AQP6 is a water channel protein that is localized exclusively in intracellular membranes in renal epithelia. Vasopressin has low affinity for oxytocin receptors. The oxytocin receptor is a typical class I G protein-coupled receptor, primarily stimulating phospholipase C beta activity. The V1a receptor mediates smooth muscle contraction (vasoconstriction in splanchnic, coronary, cerebral, peripheral, pulmonary, and intrahepatic vessels), platelet aggregation, hepatic glycogenolysis, and coagulation factor release by vasopressin. It is also proposed that brain V1a vasopressin receptors may mediate the effect of ADH on sho-term memory and learning, antipyresis, cardiovascular responsivity, and brain development. Ref: Reid I.A. (2012). Chapter 17. Vasoactive Peptides. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & Clinical Pharmacology, 12e.

So the answer to this question is D


Instruction:
At what stage neutrophil appears in peripheral blood
A. Myeloblast
B. Promyelocyte
C. Myelocyte
D. Band forms

Response:
In neutrophils this is the "dawn" of neutrophilia. Myelocytes are not normally found in the peripheral blood. Metamyelocytes (10-18m) are slightly smaller than myelocytes. They have kidney shaped indented nuclei and relatively dense chromatin, especially along the nuclear membrane. Refer robbins 9/e

So the answer to this question is D


Instruction:
Palpation of muscles of mastication is best accomplished bilaterally and
A. Simultaneously
B. Alternately
C. Intermittently
D. None of the above

Response:
None

So the answer to this question is A


Instruction:
All of the following statements about Zenker's diveiculum are true Except:
A. Acquired diveiculum
B. Lateral X-rays on Barium swallow are often diagnostic
C. False Diveiculum
D. Out pouching of the anterior pharyngeal wall, just above the cricopharyngeus muscle

Response:
Ans is D i.e. Out pouching of the anterior pharyngeal wall, just above the cricopharyngeus muscle Zenker's diveiculum is out pouching of the posterior pharyngeal wall, where pharyngeal mucosa herniates through the Killian's dehiscence (the weak area between the upper oblique fibres and the lower horizontal fibres of the inferior constrictor muscle). Zenker's diveiculum is an acquired diveiculum and not a congenital diveiculum. It's a false diveiculum as it does not contain all the anatomic layers of the oesophageal wall. Barium swallows are diagnostic. Lateral views are essential as these are posterior outpouchings.

So the answer to this question is D


Instruction:
Amount of ORS given in a 4 kg child with diarrhea with some dehydration:
A. 200 mL
B. 300 mL
C. 400 mL
D. 800 mL

Response:
For some dehydration, amount of ORS given is 75 ml/kg = 75 x 4 = 300 ml, over 4 hours

So the answer to this question is B


Instruction:
Which of the following is the most common malignant ovarian tumor?
A. Serous cysadenocarcinoma
B. Mucinous tumor
C. Endometrioid tumor
D. Mesonephroid tumor

Response:
Ans. is 'a' i.e., Serous cystadenocarcinoma o Serous cysadenomas or cysadenocarcinomas form about 50% of all the ovarian tumors. Of these 60 - 70 % are benign, 15% borderline malignant, and 20 - 25% malignant. Thus serous cystadenocarcinomas form the most common malignant tumors of ovary.

So the answer to this question is A


Instruction:
Joint between epiphysis and diaphysis of a long bone is a type of:
A. Plane Synovial joint
B. Fibrous joint
C. Symphysis
D. Synchondrosis

Response:
Epiphysio-diaphyseal joint is a primary cartilaginous joint – synchondrosis.
It is found in the growing bone, where the growth plate (hyaline cartilage) connects the epiphysis with the diaphysis, creating a hyaline cartilaginous joint.
At this site the fate of synchondrosis is synostosis (bony fusion) after the growth plate gets removed and replaced by the bone.

So the answer to this question is D


Instruction:
Premature rupture of membrane is rupture :
A. At less than 32 weeks
B. Before onset of labour
C. Before 2nd stage of labour
D. All of the above

Response:
Before onset of labour

So the answer to this question is B


Instruction:
All are consistent with Diabetogenic effects of pregnancy except ?
A. Insulin resistance
B. Decrease lipolysis
C. Changes in gluconeogenesis
D. Placental insulinase

Response:
Pregnancy has various diabetogenic effects: - Insulin resistance (By production of HPL, Coisol, Estriol, Progesterone and Placental insulinase) - Increased lipolysis (Mother uses fat for her caloric needs and saves glucose for fetal needs) and - Changes in gluconeogenesis.

So the answer to this question is B


Instruction:
For the prevention of human rabies, immediate flushing and washing the wound(s) in animal bite cases, with plenty of soap and water, under running tap should be carried out for how much time
A. 2 minutes
B. 1 minute
C. 15 minutes
D. 5 minutes

Response:
Local wound Treatment in Rabies Purpose of local treatment is to remove as much virus as possible, from site of inoculation, before it is absorbed on local nerve endings Local wound treatment can reduce chances of rabies upto 80% Immediate flushing and washing wound area with plenty of soap and running water for minimum 15 minutes is of paramount impoance Suturing : Not recommended ; if necessary, do 24-48 hours later under cover of Anti-rabies serum (Local application with prior sensitivity testing) Chemical treatment with virucidal agents (Alcohol, tincture, 0.01% aqueous iodine) Ref: Park 25th edition Pgno : 296

So the answer to this question is C


Instruction:
A 23-year-old presented with painless penile ulcer and painless lymphadenopathy. What is the diagnosis
A. Chancroid
B. Donovanosis
C. Syphilis
D. Herpes

Response:
In syphilis, the primary lesion is the chancre at the site of entry of the spirochete. In all but a few, the chancre is genital. Other common sites are the mouth and nipples. The chancre is painless, relatively avascular, circumscribed, indurated, superficially ulcerated lesion. It is known as 'hard chancre' to distinguish it from the non-indurated lesions of 'soft chancre' caused by H.dureyi. Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th edition; Pg:379

So the answer to this question is C


Instruction:
False about cystic fibrosis -
A. Associated with CFTR gene
B. Autosomal recessive inheritance
C. Associated with 7p chromosome
D. Recurrent respiratory tract infection

Response:
Ans. is 'c' i.e., Associated with 7p chromosome

So the answer to this question is C


Instruction:
The erectile disorder in males is more specifically treated with which of the following agents?
A. Sildenafil
B. Diazepam
C. Fluoxetine
D. Zolpidem

Response:
Sldenafil: Sildenafil acts by selectively inhibiting PDE-5 and enhancing NO action in corpus cavernosum. Penile tumescence during sexual arousal is improved, but it has no effect on penile tumescence in the absence of sexual activity. It does not cause priapism in most recipients. Oral bioavailability of sildenafil is -40%, peak blood levels are attained in 1-2 hr; also used for pulmonary HTN Side effects are mainly due to PDE-5 inhibition related vasodilatation- headache, nasal congestion, dizziness, flushing and fall in BP, loose motions. Sildenafil, in addition, weakly inhibits the isoenzyme PDE-6 which is involved in photoreceptor transduction in the retina. As such, impairment of colour vision, especially blue-green discrimination, occurs in some recipients. ESSENTIAL of medical PHARMACOLOGY SIXTH EDITION -KD TRIPATHI Page:295

So the answer to this question is A


Instruction:
A 30 year old female patient complains of weakness and fatigue. Patient gives history of consumption of antiepileptic drugs and is also a lactating mother. Lab investigation reveals Hb-8gm% and presence of macrocytic RBCs on peripheral blood smear. This patient may be suffering from deficiency of-
A. Vitamin C
B. Vitamin B1
C. Vitamin B2
D. Vitamin B9

Response:
The folic acid deﬁciency(vitamin B9) may be due to (one or more causes) inadequate dietary intake, defective  absorption, use of anti convulsant drugs (phenobarbitone, dilantin, phenytoin), and increased  demand.
The rapidly dividing cells of bone marrow are seriously aﬀected.
The macrocytic anemia  (abnormally large RBC) associated with megaloblastic changes in bone marrow is a characteristic  feature of folate deﬁciency.

Satyanarayana- Biochemistry, 3rd edition, pg-152

So the answer to this question is D


Instruction:
A patient presented with sudden onset on thunderclap headache & dilated pupils. Finding are consistent with:
A. Meningitis
B. Brain stem encephalitis
C. Acute ischemia of midbrain
D. Acute aneurismal hemorrhage

Response:
SAH- Thunder clap headache Cause- Rupture of berry's aneurysm If at post. communicating aery rupture-Involves oculomotor Nerve -So, Dilated pupils -Meningitis - Headache + fever + Nuchal rigidity -Brainstem encephalitis- Altered sensorium autonomic insufficiency -Acute ischemia of Brain/ Stroke - Aletred sensorium Quadri/ Para/ Hemiplegia. Prodromal symptoms suggest the location of a progressively enlarging unruptured aneurysm. A third cranial nerve palsy, paicularly when associated with pupillary dilation, loss of ipsilateral (but retained contralateral) light reflex, and focal pain above or behind the eye, may occur with an expanding aneurysm at the junction of the posterior communicating aery and the internal carotid aery. A sixth nerve palsy may indicate an aneurysm in the cavernous sinus, and visual field defects can occur with an expanding supraclinoid carotid or anterior cerebral aery (ACA) aneurysm. Occipital and posterior cervical pain may signal a posterior inferior cerebellar aery or anterior inferior cerebellar aery aneurysm ). Pain in or behind the eye and in the low temple can occur with an expanding MCA aneurysm. Thunderclap headache is a variant of migraine that simulates an SAH. Before concluding that a patient with sudden, severe headache has thunderclap migraine, a definitive workup for aneurysm or other intracranial pathology is required.

So the answer to this question is D


Instruction:
A 21 year old lady who is on an oral contraceptive pill presents with light brown pigmentation of the malar eminences. What is the likely diagnosis?
A. Haemochromatosis
B. Systemic Lupus Erythematosis
C. Melasma
D. Melanoma

Response:
Melasma is light brown pigmentation of the skin which is harmless. They are gradually blotchy macular hyperpigmentation especially of the malar surfaces, chin or forehead. Origin can be pregnancy related to the use of Oral Contraceptives. A good number of cases are idiopathic. They are self limiting after pregnancy and when OCP is discontinued. Ref: In a Page: Signs and Symptoms By Scott Kahan, 2004, Pages 81-82

So the answer to this question is C


Instruction:
Aoic opening is present at the veebral level of
A. T8
B. T10
C. T12
D. T11

Response:
The aoic hiatus is a opening in the diaphragm. It is the lowest and most posterior of the large apeures. It is located approximately at the level of the twelfth thoracic veebra (T12). ref - semantischolar.org

So the answer to this question is C


Instruction:
Which of the following is true about IgG antibody?
A. Produced in primary immune response
B. Cannot cross placenta
C. Provides local protection
D. Produced in secondary immune response

Response:
IgG contains 2 heavy chains and 2 light chains;heavy chains being of gamma type. It is the major antibody;it constitutes of 75 -80% of total immunglobulins in circulation. It is the antibody seen in secondary immune response. It can pass from vascular compament to interstiitial space. REFERENCE: DM VASUDEVAN TEXTBOOK SEVENTH EDITION ; PAGE NO : 688

So the answer to this question is D


Instruction:
Chemotaxis is
A. Unidirectional increase in movement
B. Random movement increase
C. Margintion of leucocytes
D. Increase of leucocytes

Response:
.

So the answer to this question is A


Instruction:
Treatment of choice in hairy cell leukemia is:
A. Steroid
B. Cladribine
C. Splenectomy
D. Pentostatin

Response:
Answer is B (Cladribine) "The treatment of choice is Cladribine Q (2 chlorodoxy adenosine) 0.14 mg /kg daily for 7 days" - CMDT This is a relatively non-toxic drug that produces benefit in 95% of cases, and complete remission in more than 80%

So the answer to this question is B


Instruction:
A 26-year-old man is having treatment with chemotherapy for Hodgkin's lymphoma. During his treatment, he has severe vomiting. Which location in the brain is responsible for his symptoms?
A. Area postrema
B. Tuber cinereum
C. Organum vasculosum Lamina terminalis
D. Median Eminence

Response:
Option B- Present in the ventral pa of hypothalamus, connects hypothalamus to the pituitary & transpos hormones from hypothalamus- pituitary Option C- used for osmoreceptors which makes us thirsty so we drink water. Question asks about the Chemoreceptor trigger zone (CTZ) which is present in area postrema

So the answer to this question is A


Instruction:
The following statements are true for bleaching powder, except -
A. It's action is slow and long acting
B. A fresh sample contains 33% of available chlorine
C. A strength of 1.3% will kill most organisms
D. It is used for disinfection of faeces

Response:
CHEMICAL DISINFECTION (1) Bleaching powder: Bleaching powder or chlorinated lime (Ca0Cl2 ) is a white amorphous powder with a pungent smell of chlorine. When freshly made, it contains about 33 per cent of "available chlorine". It is, however, an unstable compound. On exposure to air, light and moisture, it rapidly loses its chlorine content. But when mixed with excess of lime, it retains its strength; this is called "stabilized bleach." Bleaching powder should be stored in a dark, cool, dry place in a closed container that is resistant to corrosion. The chlorine content of bleaching powder stocks should be frequently checked. The principle in chlorination is to ensure a "free" residual chlorine of 0.5 mg/litre at the end of one hour contact. Highly polluted and turbid waters are not suited for direct chlorination Ref: Park 25th edition Pgno : 753

So the answer to this question is A


Instruction:
One of the following groups of enzymes does not exhibit stereospecificity
A. Oxidoreductases
B. Isomerases
C. Lyases
D. Transferases

Response:
All enzymes (except isomerases) exhibit stereospecificity, that reacts only with one set of stereoisomers.Whereas isomerases conve substrate from one isomerase to another. Harper 30th edition pg: 60

So the answer to this question is B


Instruction:
Disease highly transmitted during incubation period is -
A. Peussis
B. Cholera
C. Measles
D. Brucellosis

Response:
Whooping cough is most infectious during the catarrhal stage. The infective period may be considered to extend from a weak after exposure to about 3 weeks after the onset of the paroxysmal stage although communicability diminishes rapidly after the catarrhal stage. (refer pgno:163 park 23 rd edition)

So the answer to this question is A


Instruction:
Specific antibody for SLE is -
A. Anti-Ro
B. Anti-Jo
C. Anti ds DNA
D. Anti-La

Response:
None

So the answer to this question is C


Instruction:
Suboxone is a combination of
A. naloxone+ naltrexone
B. methadone+ buprenorphine
C. naloxone+ buprenorphine
D. .LAAM+ heroin

Response:
Bupenorphine (suboxone) It has paial agonist in mu receptor; thus, it has high affinity, less efficacy, slow dissociation. Thus, they have ceiling effect and hence there is no risk of respiratory depression and less chance of abuse As this drug has an increased first pass metabolism it is not given as oral route and given as sublingual route to improve absorption But some of the patients using substance rather than using it in a sublingual route they crush the drug used it as intravenous route To avoid the abuse of drug the drug was marketed as a combination of buprenorphine and naloxone which is called suboxone. If this drug suboxone is used by sublingual route the naloxone is not absorbed and buprenorphine alone is absorbed and thus it acts as detoxification regimen If suboxone is crushed and injected as IV naloxone is rapidly absorbed and acts as an opioid antagonist and results in severe withdrawal. Thus, it has a less chance of abuse and can be prescribed without license agreement Ref.kaplon and Sadock , synopsis of psychiatry, 11 th edition, pg no.660

So the answer to this question is C


Instruction:
Clinical features suggestive of congenital trachea-esophagal fistula are all, except:
A. Chocking and coughing
B. Regurgitation
C. Cyanosis
D. Fever

Response:
Ans. (c) CyanosisRef: Schwartz 10thEdition, Page 1608Clinical features of Infants with TEF:* Blind Fistulas presents with drooling of saliva, choking and; coughing after feeding* Abdominal distension due to air entry into abdomen via fistula*Atelectasis, chemical pneumonitis, respiratory infection* Inability to pass Ryles Tube (Coiling seen)* Cyanosis is not seen

So the answer to this question is C


Instruction:
Which hormone is required for late-stage development of antral follicles
A. Androstenedione
B. FSH
C. LH
D. Estradiol

Response:
FSH is required for development of large antral follicles in later stage, although not required for early follicular maturation.

So the answer to this question is B


Instruction:
Lactic acidosis  in  thiamine  deficiency  is  due  to which enzyme dysfunction?
A. Phosphoenol Pyruvate Carboxykinase
B. Pyruvate Dehydrogenase
C. Pyruvate Carboxylase
D. Aldolase

Response:
In Thiamine deficiency, PDH reaction is defective. So, pyruvate is converted to lactic acid.
Causes of inhibition of PDH leading to lactic acidosis:

Inherited PDH deficiency
Thiamine deficiency
Alcoholics due to thiamine deficiency
Arsenite and Mercury poisoning

Harper 30th edition

So the answer to this question is B


Instruction:
Drug that is safe in G6PD deficiency:
A. Primaquine
B. Acetanilide
C. Quinidine
D. Dapsone

Response:
c. Quinidine(Ref: Nelson's 20/e p 2335, Ghai 8/e p 339)Quinidine does not carry risk of hemolysis in persons with G-6-PD deficiency.

So the answer to this question is C


Instruction:
Myositis ossificans is most common around the -- joint
A. Knee
B. Elbow
C. Wrist
D. Hip

Response:
B i.e. Elbow

So the answer to this question is B


Instruction:
Non-appearance of social smile even after ..... weeks, is considered as abnormal: September 2011
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. 8 weeks

Response:
Ans. D: 8 weeks Child stas smiling back (social smile) when anyone talks to him or smiles at him by 6-8 weeks of age Impoant milestones: Head control: 1 month Sits with suppo: 5 months Transfer object from one hand to other: 6 months Crawls at: 8 months Says mama dada: 10 months Babies know his/ her gender: 3 years Can draw a circle: 3 years Self decisions: 7 years

So the answer to this question is D


Instruction:
Karyotyping is done in which phase of cell cycle
A. Anaphase
B. Metaphase
C. Telophase
D. S phase

Response:
Ans. is 'b' i.e., Metaphase o To produce a karyotype, one must obtain cells capable of growth and division as karyotyping is done by arresting mitosis in dividing cells in metaphase

So the answer to this question is B


Instruction:
Temperature of glass bead sterilizer is
A. 425°F-475°F for 5 secs
B. 475°F-525°F for 5 secs
C. 425°F-475°F for 10 secs
D. 475°F-525°F for 10 secs

Response:
Glass bead (hot salt) sterilizers used to consist of either hot salt or glass beads as a medium for dry heat sterilization.
The temperature range employed was between 425°F (218°C) and 475°F (246°C) for 5 seconds.
Ref :Grossman’s endodontics, 13th edition , pg no:198

So the answer to this question is A


Instruction:
Anti mitochondrial Ab seen typically in:
A. Primary Biliary cirrhosis
B. Hepatitis B
C. Hepatitis C
D. Hepatitis A

Response:
Primary Biliary cirrhosis is a disease characterized by chronic inflammation and fibrous obliteration of intrahepatic bile duclioles due to an unknown (primary) stimulus.

Etiology
PBC is believed to due to an autoimmune etiology as it is often associated with other auto immune disorders such as
CRCST syndrome: Calcinosis, Raynaud's phenomena, Esophageal dysmotility, Sclero-dactily. Telangiectasia

Sicca syndrome
Autoimmune thyroiditis
Renal tubular acidosis
Anti mitochondrial antibody (IgG is positive)

Clinical feature
Most patients arc asymptomatic.
Pruritis is commonest/earliest symptom
Jaundice
Deficiency of fat soluble vitamin due to malabsorption leads to:
Vit D deficiency → Bone pain—Osteomyelitis Vit K deficiency → bleeding bruising
Vit A deficiency~»Night Blindness IXanthelisma and Xanthomas arc due to elevation of serum lipids.Lab finding
Increased Serum alkaline phosphates.Positive mitochondrial antibody sensitive and specific.

So the answer to this question is A


Instruction:
Which of the following statements about lepromin test is not true -
A. It is negative in most children in first 6 months of life
B. It is diagnostic test
C. It is an impoant aid to classify type of leprosy disease
D. BCG vaccination may conve lepra reaction from negative to positive

Response:
LEPROMIN TEST The test is performed by injecting intradermally 0.1 ml of lepromin into the inner aspect of the forearm of the individual. As a routine, the reaction is read at 48 hours and 21 days. Two types of positive reactions have been described: (a) EARLY REACTION : The early reaction is also known as Fernandez reaction. An inflammatory response develops within 24 to 48 hours and this tends to disappear after 3 to 4 days. It is evidenced by redness and induration at the site of inoculation. If the diameter of the red area is more than 10 mm at the end of 48 hours, the test is considered positive. The early positive reaction indicates whether or not a person has been previously sensitized by exposure to and infection by the leprosy bacilli. In this sense, the early reaction is much superior to the late reactfon. The early reaction has been described as delayed hypersensitivity reaction to "soluble" constituents of the leprosy bacilli. The reaction corresponds to the Mantoux reaction in tuberculosis, caused by the soluble antigens (PPD) of the tubercle bacilli. (b) LATE REACTION : This is the classical Mitsuda reaction. The reaction develops late, becomes apparent in 7-10 days following the injection and reaching its maximum in 3 or 4 weeks. The test is read at 21 days. At the end of 21 days, if there is a nodule more than 5 mm in diameter at the site of inoculation, the reaction is said to be positive. The nodule may even ulcerate and heal with scarring if the antigen is crude. It may be noted that the diameter of the red area in the early reaction, and the diameter of the nodule in the late reaction are measured. The early reaction is induced by the soluble constituents of the leprosy bacilli; and the late reaction by the bacillary component of the antigen. It indicates cell-mediated immunity. In the first 6 months of life, most children are lepromin negative; some may become positive by the end of first year. Data obtained from different pas of the world indicate that in endemic areas, lepromin reaction is already positive in 20 per cent of children under 5 years of age, and this propoion increases to around 60 per cent or more in the 10-14 years age group, and to 80 per cent or more in persons over 19 years of age. BCG vaccination is capable of conveing the lepra reaction from negative to positive in a large propoion of individuals. Value of the lepromin test Lepromin test is not a diagnostic test. The two drawbacks that stand in the way of this test being used for diagnosis are : (i) positive results in non-cases, and (ii) negative results in lepromatous and near-lepromatous cases. The test has been generally accepted as a useful tool in evaluating the immune status (CMI) of leprosy patients. It is of considerable value in confirming the results ofclassification of cases of leprosy on clinical and bacteriological grounds. In other words, the test is widely used as an aid to classify the type of disease. The test is also of great value in estimating the prognosis in cases of leprosy of all types. The test is usually strongly positive in the typical tuberculoid cases, and the positivity getting weaker as one passes through the spectrum to the lepromatous end, the typical lepromatous cases being lepromin negative indicating a failure of CMI. It is known that lepromin negative individuals are at a higher risk of developing progressive multibacillary leprosy, but those who are lepromin positive either escape the clinical disease (the majority) or develop paucibacillary disease (the minority). Ref: Park 25th edition Pgno : 338

So the answer to this question is B


Instruction:
Acute opioid withdrawl is characterizedby
A. Rhinorrhoea
B. Piloerection
C. Insomnia
D. All

Response:
A, B, C i.e. Rhinorrhoea, Piloerection, Insomnia

So the answer to this question is D


Instruction:
All are true regarding Menetrier's disease, except-
A. Protein loss
B. Exophytic growth
C. Hypertrophy of gastric mucosa
D. Premalignant condition

Response:
None

So the answer to this question is B


Instruction:
Peripheral Smear showing the arrows is diagnostic of
A. Hemolytic anaemia
B. Macrothrombocytopenia with large platelets
C. Megaloblastic anemia
D. Pernicious anemia

Response:
(C) Megaloblastic anemia# HEMATOLOGICAL FINDINGS OF MEGALOBLASTIC ANEMIA:> The blood film can point towards vitamin deficiency: Decreased Red Blood Cell (RBC) count and hemoglobin levels. Increased mean corpuscular volume (MCV, >95 fl) and Mean Corpuscular Hemoglobin (MCH). Normal mean corpuscular hemoglobin concentration (MCHC, 32-36 g/dL) The reticulocyte count is decreased due to destruction of fragile and abnormal megaloblastic erythroid precursor. The platelet count may be reduced. Neutrophil granulocytes may show multisegmented nuclei ("senile neutrophil"). This is thought to be due to decreased production and a compensatory prolonged lifespan for circulating neutrophils, which increase numbers of nuclear segments with age. Anisocytosis (increased variation in RBC size) and poikilocytosis (abnormally shaped RBCs). Macrocytes (larger than normal RBCs) are present. Ovalocytes (oval-shaped RBCs) are present; Howell-Jolly bodies (chromosomal remnant) also present.

So the answer to this question is C


Instruction:
Not a branch of posterior cord of Brachial plexus
A. Axillary nerve
B. Thoracodorsal nerve
C. Radial nerve
D. Ulnar nerve

Response:
Long thoracic nerve arises from the nerve root of C5-C7 and it supplies serratus anterior muscle. The axillary nerve supplies the deltoid and teres minor muscles. The thoracodorsal nerve supplies the latissimus dorsi muscle. The radial nerve supplies 3 heads of triceps brachii and 12 muscles on the back of the forearm. Mnemonic Posterior cord - ULTRA U- upper subscapular nerve L-lower subscapular nerve T-thoracodorsal R-radial nerve A-axillary nerve B D Chaurasia 7th edition Page no: 58 Fig: 4.14,page no:55 BD chaurasia 6th edition.

So the answer to this question is D


Instruction:
Which of the following two muscles act together for climbing on a tree -
A. Latissimus dorsi & Serratus anterior
B. Serratus anterior & Teres major
C. Latissimus dorsi & Pectoralis major
D. Serratus anterior & Pectoralis major

Response:
Ans. is 'c' i.e., Latissimus dorsi & Pectoralis major * Climbing of tree is helped by:i) Latissimus Dorsiii) Pectoralis major* Latissimus Dorsi is also known as "climber's muscle" or "Tree climbing muscle".

So the answer to this question is C


Instruction:
A patient with a peptic ulcer was admitted to the hospital and a gastric biopsy was performed. The tissue was cultured on chocolate agar incubated in a microaerophilic environment at 37degC for 5 to 7 days. At 5 days of incubation, colonies appeared on the plate and were curved, Gramnegative rods, oxidase-positive. The most likely identity of this organism is
A. Campylobacter jejuni
B. Vibrio parahaemolyticus
C. Haemophilus influenzae
D. Helicobacter pylori

Response:
Helicobacter pylori was first recognized as a possible cause of gastritis and peptic ulcer by Marshall and Warren in 1984. This organism is readily isolated from gastric biopsies but not from stomach contents. It is similar to Campylobacter species and grows on chocolate agar at 37degC in the same microaerophilic environment suitable for C. jejuni (Campy-Pak or anaerobic jar without the catalyst). H. pylori, however, grows more slowly than C. jejuni, requiring 5 to 7 days incubation. C. jejuni grows optimally at 42degC, not 37degC, as does H. pylori. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition

So the answer to this question is D


Instruction:
Sencent cells are deficient in -
A. RNA polymerase
B. DNA polymerase
C. Telomerase
D. Helicase

Response:
Ans. is 'c' i.e., Telomerase o Telomers are short repeated sequences of DNA present at the end of eukary otic chromosomesQ.o In normal cells, telomeres get shortened in each replicated cycle.o After the telomers get shortened by a critical length, cell stops dividing and enters into Go phase (senscence).o However, germ ceilsQ, cancer cellsQ and stem cellsQ have an enzyme telomerase (telomerase activity ) which prevents telomer shortening.o Thus telomers are not shortened in these cells, and therefore these cells have ability to self replicate extensively,o Telomerase is a reverse transcriptase (RNA dependent DNA polymerase) and is responsible for telomer synthesis and maintaining the length of telomers (replication of end of chromosomeQ),o Thus, telomerase provide iongetivitv to the cellsQ which contain this enzyme.o Telomerase is absent from most of the somatic cellsQ and hence they suffer progressive loss of telomers and they exit the cell cycle.o Senscent cells lack telomerase so their telomers get shortened by critical length and these cells remains in Go phase.

So the answer to this question is C


Instruction:
Dendritic cell located in the stratified squamous keratinizing epithelium of the oral cavity include
A. Keratinocytes
B. Mast cells
C. Melanocytes
D. Myoepithelial cells

Response:
None

So the answer to this question is C


Instruction:
Psammoma body found in -
A. Papillary Ca thyroid
B. Follicular Ca thyroid
C. Medullary Ca thyroid
D. Anaplastic Ca thyroid

Response:
Ans is 'a' i.e. Papillary Ca Psammoma bodies found in: Ref. Papillary Ca of thyroid 8/e p1122 (7/e p1178) Serous cystadenoma of ovary 8/e 1044 (7/e p1096) Meningioma 8/e p1338 (7/e p1409) Papillary type of Renal cell carcinoma 8/e p966 (7/e p1018) Pitutary adenoma (Prolactinoma) 8/e p1103 (7e p1160) Appendiceal carcinoid (rarely) 7/e p868

So the answer to this question is A


Instruction:
Not a pathogenic mycobacterium -
A. M. paratuberculosis
B. M. kansasii
C. M. ulcerans
D. M. intracellulare

Response:
Ans. is 'a' i.e., M. paratuberculosis

So the answer to this question is A


Instruction:
If a 5-year-old child suddenly develops stridor, which one of the following would be the most likely diagnosis
A. Laryngomalacia
B. Acute laryngo-tracheobronchitis
C. Foreign body aspiration
D. Acute epiglottitis

Response:
Foreign body is a potential cause of stridor in children.Foreign body aspirated more are food and coins.Treatment consists of endoscopic visualisaion and removal by an experienced surgeon. Ref : Essential pediatrics,O.P.Ghai,7th edition,pg np:341

So the answer to this question is C


Instruction:
Most commonly used retarder in gypsum:
A. Na2 SO4
B. Nacl
C. Citrates
D. K2 SO4

Response:
None

So the answer to this question is C


Instruction:
A patient presents with bleeding from the ear, pain tinnitus and progressive deafness. On examination, there is a red swelling behind the intact tympanic membrane which blanches on pressure with pneumatic speculum. Management includes all except:
A. Radiotherapy
B. Surgery
C. Interferons
D. Pre-operative embolisation

Response:
With the symptoms provided, diagnosis is glomus tumour behind the intact tympanic membrane. It has presented with a reddish mass with profuse bleeding depending on the extent of disease and age of the patient. All other options are true.

So the answer to this question is C


Instruction:
The most common cause of parapharyngeal abscess in adults is?
A. TB
B. Tooth extraction
C. Tonsillitis
D. Lymphadenitis

Response:
The most common aetiology of parapharyngeal abscess is tonsillitis. The most common aetiology of parapharyngeal abscess in adults is dental caries or tooth extraction. Other causes of parapharyngeal abscess occur as a result of the spread of infection from parotid, retropharyngeal, preveebral and submandibular space. (Ref: Scott Brown, 8th edition, VOL 3 )

So the answer to this question is B


Instruction:
Mirrizi syndrome
A. Cyst present in CBD
B. Stone in cystic duct compressing CBD
C. Obstruction of pancreatic duct
D. Stone in Rt hepatic duct

Response:
Answer- B. Stone in cystic duct compressing CBDIt comprises obstructive jaundice due to stone impacted in the neck of gall bladder, which compresses the common hepatic duct and eventually ulcerates into common hepatic duct causing cholecysto-choledochal fistula

So the answer to this question is B


Instruction:
Asymptomatic, solid 4cm tumor of distal pancreas. Treatment
A. Observation
B. Distal pancreatectomy with splenectomy
C. Near total pancreatectomy with splenectomy
D. Distal pancreatectomy alone

Response:
Resectional Surgery for pancreatic Body and Tail Tumors Most body and tail cancers have already metastasized to distant sits or extended locally to involve nodes, nerves or major vessels by the time of diagnosis Splenic vein involvement or occlusion is not a sign of nonresectability Involvement of the splenic and SMV confluence generally precludes resection Resection involves a distal pancreatectomy either with or without concomitant splenectomy Splenectomy is usually performed with distal pancreatectomy in patients suspected of having carcinoma to obtain better margins, to remove the lymph nodes at the tip of the pancreas and hilum of the spleen, and to avoid tedious dissection of the splenic aery and vein Ref: Sabiston 20th edition Pgno :1547

So the answer to this question is D


Instruction:
The specific activity of an enzyme would be repoed in which of the following units of measures?
A. Millimoles per liter
B. Units of activity per milligram of protein
C. Micromoles per minute
D. Units of activity per minute

Response:
The specific activity of an enzyme is another common unit. This is the activity of an enzyme per milligram of total protein (expressed in mmol min-1mg-1). Specific activity gives a measurement of enzyme purity in the mixture.

So the answer to this question is B


Instruction:
Impoance of lepromin test are all except:
A. Only has epidemiological significance
B. Prognostic value
C. Tells about immunity status of leprosy patients
D. Differentiate between different types of leprosy

Response:
Answer: (a) Only has epidemiological significance (Ref: Park 23rd/320-21; Community Medicine with Recent Advances by Suryakantha 4th/539-40The test has predictive value as well. It gives an indication of the risk of the disease among contacts of open cases.The test has an epidemiological value as well. It indicates the incidence and prevalence of infection among children. In the first 6 months of life, most children are lepromin negative. They become positive progressively as their age advances.The two drawbacks that stand in the way of this test bring used for diagnosis are:(i) positive results in non-cases, and (ii) negative results in lepromatous and near-lepromatous cases

So the answer to this question is A


Instruction:
A total number of .......tablets of iron with folic acid is given to a pregnant women by the Health worker-
A. 70
B. 90
C. 100
D. 150

Response:
<p> 100 mg of elemental iron and 500 micrograms of folic acid are being distributed daily for 100 days to a pregnant woman through ASHA or antinatal clinic. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:527. <\p>

So the answer to this question is C


Instruction:
Cytochrome oxidase can be poisoned by all, EXCEPT:
A. Cyanide
B. Hydrogen sulphide
C. Carbon monoxide
D. Carbon dioxide

Response:
Cytochrome oxidase is a haemo-protein widely distributed in many tissues. It is the terminal component of the chain of respiratory carriers found in mitochondria and transfers electrons resulting from the oxidation of substrate molecules by dehydrogenases to their final acceptor, oxygen. The enzyme is poisoned by carbon monoxide, cyanide, and hydrogen sulfide. Ref: Harper 28thedition, chapter 12.

So the answer to this question is D


Instruction:
A 55-year-old woman with non-ischemic cardiomyo- pathy presents with this wide complex tachycardia. ECG shows?
A. Ventricular tachycardia
B. Bidirectional tachycardia
C. Torsades de pointes
D. PSVT

Response:
Ans. (a) Ventricular tachycardia.* This tracing reveals a wide complex tachycardia at a rate of approximately 150 beats/ min.* Most of the ventricular beats have identical morphologies; hence, this is a monomorphic wide complex tachycardia (in contrast to a polymorphic ventricular tachycardia where the majority of the QRS complexes have a varying morphology).* The differential diagnosis of a monomorphic wide complex tachycardia includes ventricular tachycardia or supraven -tricular tachycardia conducted with aberrancy. Several clues in this tracing suggest the diagnosis of ventricular tachycardia.* When ventricular tachycardia occurs, ventricular depolarization does not conduct through the normal His-Purkinje system but rather conducts slowly directly through ventricular myocardium. During some ventricular tachycardias, sinus node depolarization continues unabated, and most of the sinus impulses meet a refractory ventricle due to the dominant ectopic ventricular activity preventing conduction.

So the answer to this question is A


Instruction:
If the fetus has Down syndrome,quadruple marker will not show :
A. High hCG
B. Low Inhibin A
C. Low AFP
D. Low Estriol

Response:
Aneuploidies AFP Estriol hCG Inhibin A Down's Syndrome Low Low High High

So the answer to this question is B


Instruction:
Pentosuria is due to defect in which pathway?
A. Glycolysis
B. Polyol pathway
C. Uronic acid pathway
D. Kreb's cycel

Response:
Essential Pentosuria i. It is one of the members of the Garrod&;s tetrad. The incidence is 1 in 2,500 bihs. ii.It is an inborn error of metabolism, due to defect in glucuronic acid pathway of glucose. In the pathway, L-xylulose is conveed to D-xylulose by two enzymes, xylitol dehydrogenase and xylulose reductase absence of any of this enzyme lead to pentosuria.Ref: DM Vasudevan, 7th edition, page no: 134

So the answer to this question is C


Instruction:
Peritonsillar abscess is most commonly caused by
A. Streptococcus pneumonia
B. Staphylococcus aureus
C. Beta hemolytic streptococcus
D. Hemophilus influenza

Response:
Peritonsillar abscess ( Quinsy) is the collection of pus in the peritonsillar space which lies between the capsule of tonsil and superior constrictor muscle. A peritonsillar abscess usually follows acute tonsillitis. First crystal Magna is infected and sealed off. Culture of pus from the abscess May reveal beta-hemolytic streptococci, S.aureus, or anaerobic organisms. (Ref: Diseases of ENT, PL Dhingra, 7th edition, pg no.298)

So the answer to this question is C


Instruction:
Causative toxin for endemic ascites is
A. Ergot
B. Aflatoxin
C. Pyrrolizidine
D. Beta-oxylamino-alanine

Response:
It was noticed in the Kusmi block of Sarguja district of Madhya Pradesh during the years 1973 and 1976. There was an outbreak of rapidly progressing ascites and jaundice among the tribals. Moality rate was 40%. Investigation by the National Institute of Nutrition concluded that this outbreak was due to intake of Millet seeds contaminated with Crotalaria seeds which form their main diet. Crotalaria occured as a weed in areas of millet (Panicum miliare) cultivation. Crotalaria seeds contain pyrrolizidine alkaloids which are hepatotoxic. The methods suggested for preventing this were deweeding of farmlands and seiveing of millet seeds before use, as Crotalaria seeds were much smaller Ref : internet

So the answer to this question is C


Instruction:
A six-year old boy is schedules for examination of the eye under anaesthesia. The father informed that for the past six months the child is developing progressive weakness of both legs. His elder sibling had died at the age of 14 years. Which drug would you definitely avoid during the anaeshetic management?
A. Succinylcholine
B. Thiopentone
C. Nitrous oxide
D. Vecuronium

Response:
A i.e. Succinylcholine Boy is having some myopathy (probably duchenne's). So Sch may lead to life threatening hyperkalemia.

So the answer to this question is A


Instruction:
A 25-year-old man is brought to the emergency department after sustaining a stab wound to the lower back. Examination shows right leg weakness in all muscle groups and loss of vibration and proprioception on the same side. There is loss of pain and temperature sensation but preserved motor strength in the left leg. He has no problems with bladder or bowel retention. Motor strength is preserved in the upper extremities.
His presentation is most consistent with which one of the following spinal cord syndromes?
A. Anterior cord syndrome
B. Cauda equina syndrome
C. Central cord syndrome
D. Hemisection of the cord

Response:
None

So the answer to this question is D


Instruction:
Schaffer&;s sign is seen in -
A. Retinitis pigmentosa
B. Retinal detachment
C. CRVO
D. CRAO

Response:
Ans. is 'b' i.e., Retinal detachment o Tobacco dusting or Schaffer's sign. is seen in retinal detachment. Examination findings in retinal detachment o Following examinations are done : i) Ophthalmoscopy : Should be carried out both by direct and indirect ophthalmoscope. Retinal detachment is best examined by indirect ophthalmoscopy using scleral indentation. Freshly detached retina gives grey reflex instead of normal pink reflex, and is raised anteriorly. Retinal breaks (in Rhegmatogenous RD ) may be seen, mostly in the periphery (commonest in upper temporal quadrant). Vitreous show pigment in the anterior vitreous (tobacco dusting or Schaffer's sign.), with posterior vitreous detachment. ii) Perimetry (visual field charting) : Visual field defect corresponding to the area of detached retina, in) Goldmann three-mirror fundus lens and Indirect slit lamp biomicroscopy by high power lenses (commonly + 90 D or + 78D). Central fundus can be examined by 55D Hurby lens (e.g., for macular detachment). Electro-retinography : - Subnormal or absent. B-scan USG : - In patient with hazy media especially in the presence of dense cataract. Plane mirror examination : Altered red reflex in pupillary area.

So the answer to this question is B


Instruction:
Breslow's method of histological staging of Malignant Melanoma is:
A. Depth of penetration relation to layers of dermis
B. The vertical distance in mm from granular cell layer to deepest part of melanoma
C. The depth of invasion from stratum. corneum to deepest part of melanoma
D. Width of lesion measured in mm

Response:
Histopathological staging of malignant melanoma is done by 2 methods:
i) Breslow's method : The vertical distance in mm from granular cell layer to deepest part of melanoma.
ii) Clark method : Depth of penetration is described in relation to different layers of skin.

So the answer to this question is B


Instruction:
Delusion is the disorder of which of the following:
A. Thought
B. Perception
C. Always organic
D. Always psychiatric

Response:
Ans. A. ThoughtDELUSION is false belief in something that is not true.Types of delusions are:1. Primary delusions (autochthonous delusions): Arise Denovo, cannot be explained on the basis of other experiences or perceptions. They are characteristic of early schizophrenia.2. Secondary delusions: Commonest delusions seen in clinical practice and seen in many psychological disorders.Commonly seen delusions in schizophrenia are:1. Delusion of grandeur2. Delusion of persecution3. Delusion of reference4. Delusion of control

So the answer to this question is A


Instruction:
A child with an obvious rash presents with recurrent infections. The investigation revealed decreased platelet count and reduced IgM.  Which of the following is the most likely diagnosis –
A. Idiopathic Thrombocytopenic Purpura
B. Thrombotic Thrombocytopenic Purpura
C. Wiskott–Aldrich Syndrome
D. Di' George anomaly

Response:
The classical triad of rash, thrombocytopenia and recurrent infection (immunodeficiency; ↓-IgM) suggest a diagnosis of Wiskott-Aldrich Syndrome.

So the answer to this question is C


Instruction:
Which among the following drug is not used in the
treatment of Tetralogy of Fallot?
A. β blocker
B. α agonists
C. Calcium channel blockers
D. Morphine

Response:
Calcium channel blockers reduce systemic Vascular resistance which incsceases blood flow into Aorta and decreases blood to pulmonary vasculature. This adds to the pathology and worsens the condition.

So the answer to this question is C


Instruction:
Hemolytic anemia is associated with the following gall stones:
A. Pigmented
B. Mixed
C. Cholesterol
D. None

Response:
Ans. (a) PigmentedRef: Harrison 19th ed. 12078* Pigmented gall stones have composition of Calcium Bilirubinate and are seen in hemolytic anemia like hereditary spherocytosis, sickle cell anemia.* The pigment stones are themselves of 2 types.Black and brown pigment gallstones.* Black and brown pigment gallstones are morphologically, compositionally, and clinically distinct. Black stones form primarily in the gallbladder in sterile bile* Brown stones form not only within the gallbladder but also within the intrahepatic and extrahepatic ducts

So the answer to this question is A


Instruction:
Chargaff's rule state that, in DNA ?
A. Purines to pyrimidines ratio is 2
B. A+T=G+C
C. Purines = Pyrimidines
D. All of the above

Response:
[Ref : Harper 291h/e p. 344 & 28thie p. 302; Essentials of biochemistry p. 915[Chargaff's rule states that in DNA of all species quantities of ourines is the same as that of pyrimidines, i.e. A+G = T+C. In A + Gother words, ratio of purines to pyrimidines is one, i.e. T c - 1This is because one member of a base pair in a DNA must always be a purine and the other a pyrimidine.This base pairing restriction explains that in a double stranded DNA molecule, the content of adenine equals that of thymine(A=T) and the content of guanine equals that of cylosine (G=C). Therefore = 7 or AC = TG

So the answer to this question is C


Instruction:
Over expression of InhA gene can lead to cross resistance of Isoniazid with:
A. Rifampicin
B. Ethambutol
C. Ethionamide
D. PAS

Response:
InhA gene overexpression can lead to cross resistance of Isoniazid with Ethionamide.
KatA gene mutation : Severe form of Isoniazid resistance.

So the answer to this question is C


Instruction:
Sympathetic postganglionic neurotransmitter in sweat gland
A. Epinephrine
B. Nor- epinephrine
C. Serotonine
D. Acetylcholine

Response:
sympathetic postganglionic neurotransmitter in sweat glands is Ach Ref: Ganong's review of medical physiology, 23rd edition Page no:134

So the answer to this question is D


Instruction:
Rigor mortis first start in -
A. Upper eyelids
B. Lower eyelids
C. Lower limbs
D. Fingers

Response:
Among the given options, upper eyelid is involved first.

So the answer to this question is A


Instruction:
During exercise, increase in O2 delivery to muscles is because of all except
A. Oxygen dissociation curve shifts to left
B. Increased stroke volume
C. Increased extraction of oxygen from the blood
D. Increased blood flow to muscles

Response:
Hb-O2 dissociation curve shift to left indicates more affinity of Hb to O2 and thus less delivery of O2 to tissues. Exercise causes increased 2,3 DPG.
Shift to left seen in
-        Increased pH
-        Decreased 2,3 DPG, temperature, PCO2
-        HbF (Fetal)
Shift to right seen in
-        Decreased pH
-        Increased 2,3DPG, temperature, PCO2
-        HbS (Sickle cell)

So the answer to this question is A


Instruction:
Policeman’s tip hand is seen in
A. Erb's palsy
B. Klumpke’s paralysis
C. Axillary nerve injury
D. None of the above

Response:
ERB'S PARALYSIS:-
upper plexus injury.
Caused by forceful widening of the angle between the head and shoulder which may occur by traction of arm during the birth of a child or by fall on the shoulder.
Involves upper trunk - C5, C6 roots.
Leads to typical deformity in the limb- policeman's tip hand/ porter's tip hand. The arm hangs by the side, adducted and medially rotated, forearm is extended and pronated.
1. Adduction of arm due to deltoid paralysis.
2. Medial rotation of arm-paralysis of supraspinatus, infraspinatus and teres minor.
3. Extension of elbow- paralysis of biceps brachii
4. Pronation of forearm- paralysis of biceps brachi
5. Loss of sensation over outer aspect of arm due to C6 spinal nerve involvement.

So the answer to this question is A


Instruction:
When transfer factor is given, treatment results in
A. Natural active immunity
B. Artificial active immunity
C. Artificial passive immunity
D. Adoptive immunity

Response:
None

So the answer to this question is D


Instruction:
All of the following are causes of primary amenorrhoea with eugonadism, EXCEPT:
A. GnRH deficiency
B. PCOS
C. Mullerian agenesis
D. Congenital adrenal hyperplasia

Response:
GnRH deficiency is cause of primary amenorrhoea with low FSH levels. Causes of primary amenorrhea with eugonadism: Mullerian agenesis Vaginal septum Imperforate hymen Androgen insensitivity syndrome PCOS Congenital adrenal hyperplasia Cushing and thyroid disease Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 16. Amenorrhea. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.

So the answer to this question is A


Instruction:
Commonest ligament injured in ankle injury ?
A. Anterior talofibular ligament
B. Calcaneofibular ligament
C. Posterior talofibular ligament
D. Spring ligament

Response:
Ans. is 'a' i.e., Anterior talofibular ligament The ankle is one of the most common sites for acute musculoskeletal injuries. Sprains constitute 85% of all ankle injuries, and 85% of those involve a lateral inversion mechanism. Inversion Sprain - Inversion ankle sprains occur when the foot turns in or out to an abnormal degree relative to the ankle. The most common mechanism of an ankle sprain is a combination of plantarflexion and inversion where the foot is pointing downward and inward. The lateral ligaments are involved in an inversion ankle sprain and hence most commonly damaged. These ligaments are on the outside of the ankle, which includes the anterior talofibular (ATFL), calcaneofibular (CFL) and posterior talofibular ligaments (PTFL). Injury to the ATFL is the most common. When both the ATFL and CFL are injured together, ankle instability will be more noticeable. The PTFL is the strongest of the three ligaments and is rarely injured in an inversion sprain.

So the answer to this question is A