Instruction:
Most common cause of infection and collection of fluid in the left subhepatic space?
A. Perforation at the lesser curvature of stomach
B. Perforation of posterior duodenal wall ulcer
C. Complicated acute pancreatitis
D. Ruptured abscess of the left lobe of the liver

Response:
Ans. c (Complicated acute pancreatitis) (Ref. Bailey and Love 26th/pg. 998).Left inferior (posterior) intraperitoneal space OR Left subhepatic space/lesser sac: The most common cause of infection here is complicated acute pancreatitis. In practice, a perforated gastric ulcer rarely causes a collection here because the potential space is obliterated by adhesions.ABDOMINAL ABSCESS# There are four peritoneal and three extraperitoneal spaces in which pus may collect.# Three of these spaces are on either side of the body, and one is approximately in the midline.# Left superior (anterior) intraperitoneal ('left subphrenic') = common came of an abscess here is an operation on the stomach, the tail of the pancreas, the spleen or the splenic flexure of the colon.# Right superior (anterior) intraperitoneal ('right subphrenic') = Common causes here are perforating cholecystitis, a perforated duodenal ulcer, a duodenal cap 'blow out' following gastrectomy and appendicitis.# Right inferior (posterior) intraperitoneal ('right subhepatic') lies in Rutherford Morison's pouch. It is the deepest space of the four and the commonest site of a subphrenic abscess which usually arises from appendicitis, cholecystitis, a perforated duodenal ulcer or following upper abdominal surgery.# Extraperitoneal. There are three of these:- Right and left extraperitoneal which are terms given to perinephric abscesses;- Midline extraperitoneal which is another name for the 'bare' area of the liver which may develop an abscess in amoebic hepatitis (commonest cause) or a pyogenic liver abscess.Educational Points:# The pelvis is the commonest site of an intraperitoneal abscess because the vermiform appendix is often pelvic in position and also the Fallopian tubes are frequent sites of infection. A pelvic abscess can also occur as a sequel to any case of diffuse peritonitis and is a common sequel of anastomotic leakage following large bowel and rectal surgery.# The most characteristic symptoms of a pelvic abscess are diarrhea and the passage of mucus in the stools.# It is no exaggeration to say that the passage of mucus, occurring for the first time in a patient who has, or is recovering from, peritonitis, is pathognomonic of pelvic abscess.# Left to nature, a proportion of these abscesses bursts into the rectum, after which the patient nearly always recovers rapidly. Laparotomy is almost never necessary.# Rectal drainage of a pelvic abscess is far preferable to suprapubic drainage (risks peritoneal infection).# Subdiaphragmatic abscess: remember the aphorism, 'pus somewhere, pus nowhere else, pus under diaphragm. 9# A swinging pyrexia is usually present, unless antibiotics or drugs (steroids) have interfered.# Ultrasound or CT scanning is the investigation of choice and permits early detection of subphrenic collections.# Ga67/Indium-111 white cell scanning may occasionally prove helpful when other imaging techniques have failed.

So the answer to this question is C


Instruction:
Structures lying deep to posterior belly of digastricare all. Except:
A. Retromandibular vein
B. Hypoglossal nerve
C. Hyoglossus muscle
D. Occipital aery

Response:
Retromandibular vein Ref: BDC Anatomy 4/e vol. III p157; Gray's Anatomy 40/e p441The Retromandibular vein lies superficial to the posterior belly of digastric.Structures lying deep to the posterior belly of digastric are:a.Transverse process of atlasb.Muscles- hyoglossus, superior oblique and the rectus capitis lateralisc. Aeries- internal carotid, external carotid, lingual, facial and occipital aeriesd.Vein- internal jugular veine. Nerves- vagus, accessory and hypoglossal cranial nerves.The digastric muscle (named digastric as it has two bellies) lies below the body of the mandible, and extends, in a curved form, from the mastoid process to the symphysis menti. C-,11.fvn-*/The digastric muscle consists of two fleshy bellies united by an intermediate rounded tendon. The two bellies of the digastric muscle have different embryological origins, supplied by different cranial nerves.Posterior belly- The posterior belly arises from the mastoid notch on the medial surface of the mastoid process of the temporal bone, and passes downwards and forwards.- The posterior belly is supplied by the digastric branch of facial nerve.Anterior belly- The anterior belly arises from the digastric fossa, on the base of mandible, close to the symphysis, and passes downward and backward.- The anterior body is supplied by the mylohyoid nerve, a branch of the inferior alveolar nerve, itself a branch of the mandibular division of the trigeminal nerve.Intermediate tendon- The two bellies end in an intermediate tendon which perforates the Stylohyoid muscle, and run in a fibrous loop attached to the body and the greater cornu of the hyoid boneAction- When the digastric muscle contracts, it acts to elevate the hyoid bone.- If the hyoid is being held in place (by the infrahyoid muscles), it will tend to depress the mandible (open the mouth).

So the answer to this question is A


Instruction:
All of the following are true about Drug induced Lupus; Except:
A. Anti histone antibody
B. Rare anti ds DNA
C. Renal involvement
D. Serositis

Response:
Answer is C (Renal involvement): Renal involvement is rare in Drug induced Lupus Drug induced lupus is associated with Antihistone antibodies, rare anti ds DNA and serositis. Drug induced Lupus: Features Syndrome of Positive ANA with symptoms such as fever, malaise, ahritis, intense ahralgia/myalgia, serositis and / or rash (ANA usually appears before symptoms) Predominant in Caucasians Less female predilection than SLE Commonly associated with Anti-Histone Rarely associated with Anti- ds DNA Rarely involves kidney or brain Syndrome usually appears during therapy with ceain medications and biologic agents Syndrome usually resolves over several weeks after discontinuation of the offending medication.

So the answer to this question is C


Instruction:
The frequency of beta waves (per sec) in EEG is
A. 0-4
B. 7-Apr
C. 13-Jul
D. 13-30

Response:
D i.e. 13-30

So the answer to this question is D


Instruction:
Which is not component of left isomerism?
A. Polysplenia
B. Midline liver
C. Left sided IVC
D. Duplication of gallbladder

Response:
Ans DDuplication of gall bladder, right sided liver, asplenia are part of right isomerism.Left isomerism :(polysplenia syndrome)# Multiple splenules without a parent spleen# Azygos or hemiazygos continuation of the inferior vena cava# Bilateral hyparterial bronchi# Bilateral bilobed lungs# Bilateral pulmonary/left atria# Midline/transverse liver# Intestinal malrotationRight isomerism (asplenia syndrome)# Severe cyanotic congenital heart diseases# Absence of spleen# Bilateral eparterial bronchi# Bilateral trilobed lungs# Bilateral right atria# Midline/transverse liver# Intestinal malrotation

So the answer to this question is D


Instruction:
Rarest type of thyroid carcinoma is
A. Papillary
B. Follicular
C. Medullary
D. Anaplastic

Response:
Undifferentiated (anaplastic) carcinoma
This is one of the most aggressive malignancies in humans.
Thankfully it is rare. It may develop de novo, or present as dedifferentiation of a papillary or poorly differentiated carcinoma. The disease is characterised by rapid growth, visceral invasion  and  distant  metastases. The  surgeon’s  role  in  this disease is crucial. Thyroid lymphoma can be incorrectly diagnosed as anaplastic cancer and so biopsy is critical. This can be done using a core or open technique.
Reference: Bailey & Love’s short practice of surgery , 27th  ed page no 816

So the answer to this question is D


Instruction:
Sacrotuberous Ligament is pierced by:
A. S1 Nerve
B. L5 Nerve
C. Coccygeal Nerve
D. None

Response:
The Sacrotuberous Ligament is pierced by the Coccygeal Branches of the Inferior Gluteal Aery, the Perforating Cutaneous Nerve (S2,3) and filaments of the Coccygeal Plexus (formed by S4,S5 & Coccygeal Nerve).

So the answer to this question is C


Instruction:
Which of the following does not have analgesic propey
A. Ether
B. Ketamine
C. Halothane
D. Morphine

Response:
Refer KDT 6 /e p 372 Halothane and newer flourinated inhalation anesthestic agent are devoid of analgesic propey

So the answer to this question is C


Instruction:
Patient on typical antipychotic develops restlessness typically of the lower limbs. Drug to treat this side effect is-
A. Propranolol
B. Trihexiphenoydol
C. Quetiapine
D. Datrolene

Response:
Ans. is 'a' i.e., Propranolol o This side effect is akathasia - Restlessness, feeling of discomfort, apparent agitation manifested as a compelling desire to move about, but without anxiety,o Treatment of choice is beta blockers - PropranololPatient is on antipsychotic||||||o Within 1-5 dayso Spasm of muscle ofy Tongue (Protrusion, twisting)y Face (grimacing)y Neck (torticollis)y Jaw (trismus)y Rye (oculogyric crisis)y Spine (opisthotonus)y Abnormal postureo Within 4 weeks (1-4 weeks)o Restlessness (inability to sit or stand quiet)o Persistent desire to move abouto Fidgety movementso Rocking movemento Within 1-4 weekso Bradykinesiao Rigidityo Tremero Mask facieso Shuffling gaito Within weekso Marked muscular rigidityo High fevero Autonomic instability| HR & BP, sweating|CPKo Myoglobinemiao Leukocytosiso Disturb consciousnesso Catatonia & stuporo Drug is taken for > 3 monthso Within 4 weeks of withdrawalo Involuntary movement of facial & limb musclesy Chewing, poutingy Puffing of cheeksy Lips lickingy Choreoathetoid movementso After months to yearso Perioral tremer||||||Acute muscular dystoniaAkathisiaParkinsonismNeuroleptic malignant syndromeTardive dyskinesiaPerioral tremer (rabbit syndrome)o Treatment of choice -o TOC - b-blockers central anticholinergico TOC - central - anticholinergicso DOC - Dantrolene

So the answer to this question is A


Instruction:
In acute myeloid leukemia, Auer rods are numerous in:September 2009
A. M2
B. M3
C. M4
D. M5

Response:
Ans. B: M3The diagnosis of AML is based on the presence of at least 20% myeloid blasts in the bone marrow. Myeloblast have delicate nuclear chromatin, two to four nucleoli, and more voluminous cytoplasm than lymphoblasts.The cytoplasm often contains fine, peroxidase-positive azurophilic granules.Auer rods, distinctive needle like azurophilic granules, are present in many cases; they are paicularly numerous in AML with the t(15;17) (acute promyelocytic leukaemia-M3).

So the answer to this question is B


Instruction:
The differential diagnosis of botulism includes all the following except -
A. Myasthenia Gravis
B. Guillain Barre syndrome
C. Polio
D. Clostridial myonecrosis

Response:
None

So the answer to this question is D


Instruction:
The composition of breast milk varies at different points of lactation to suit the baby&;s needs. Which statement is not true about breast milk composition?
A. Preterm milk has more proteins
B. Mature milk is thicker with all the essential nutrients for growth
C. Foremilk is watery and is rich in proteins and sugar
D. Hindmilk is richer in fat and provides more energy

Response:
Mature milk is thinner (not thicker) with all essential nutrients for growth. Colostrum In initial 3 to 4 days Small quantity, thick, and yellow in color Large amount of antibodies, immune component cells; and vitamin A,D,E and K Transitional milk: Secreted after 3 to 4 days until 2 weeks Immunoglobulin and protein content decreases, while the fat and sugar content increases. Mature Milk: Follows transitional milk Thinner and more watery Contains all the nutrients essential for optimal growth of the baby Foremilk: Secreted at the sta of the feed Watery and rich in proteins, sugar, vitamins, minerals, and water that quenches the baby&;s thirst Hind milk: Comes towards the end of the feed Provides more energy and sense of satiety and it is richer in fat. Preterm milk: Milk of mother who delivers before 37 weeks Contains more proteins, sodium, iron, immunoglobulins, and calories as per requirement of the preterm infant. Ref : Ghai Essential pediatrics 9th edition Pgno: 147

So the answer to this question is B


Instruction:
Shorest acting beta blocker -
A. Esmolol
B. Nodalol
C. Acebutolol
D. Sotalol

Response:
Ans. is 'a' i.e., Esmolol o Nodalol is longest acting b-blocker.o Esmolol is shortest acting b-blocker.o Acebutolol possesses all activities i.e., cardioselectivity, partial agonist activity, membrane stablizing activity and lipid insolubility.

So the answer to this question is A


Instruction:
Which drug interfers with pyridoxine metabolism -
A. INH
B. Tetracycline
C. Erthromycin
D. Rifampicin

Response:
Ans. is 'a' i.e., INH o Isoniazid reacts with pyridoxal to form a hydrazone, and thus inhibits gneration of pyridoxal phosphate.o Isoniazid also combines with pyridoxal phosphate to interfere with its coenzyme function. Due to formation of hydrazones, the renal excretion of pyridoxine compounds is increasedo Thus, isoniazid therapy produces a pyridoxine deficiency state.

So the answer to this question is A


Instruction:
Which of the following drugs do not produce active metabolites ?
A. Enalapril
B. Lisinopril
C. Prednisone
D. Sulfasalazine

Response:
None

So the answer to this question is B


Instruction:
Most common tumor of hand is ?
A. Enchondroma
B. Chondroblastoma
C. Giant cell tumour
D. Osteoid osteoma

Response:
.ENCHONDROMA - This is a benign tumour consisting of a lobulated ma s s of cailage encapsulated by fibrous t issue. The intercellular mat r ix may undergo mucoid degeneration. Frequently the fibrous septae dividing Enchondroma * Age group : 15-30 years * Bones: Small bones of the hand (phalanges, metacarpals etc., usually multiple. * Site : Diaphysis * Others features: Long duration, benign swellings. Swelling is the main complaint. ref:ESSENTIAL OHOPAEDICS,MAHESWARI,ed 3 ,pg no 331

So the answer to this question is A


Instruction:
Collagen contains amino acids Proline, Lysine and:
A. Glycine
B. Isoleucine
C. Cysteine
D. Methionine

Response:
Ans. (a) GlycineGlycine* In collagen every third amino acid is glycine* Glycine is considered as the simplest amino acid* Properties of glycine: Non-essential, Glucogenic and optically inactive amino acid* Acts as a conjugating agent:# Conjugation of benzoic acid# Conjugation of bile acid* As neurotransmitter, it has both properties excitatory and inhibitory.Other amino acids present in collagen are: Proline, Hydroxyproline, Hydroxylysine Lysine (K)* An essential amino acid which is predominantly ketogenic* It is an amino acid which is deficient in cereals* Functions:# Important for covalent cross linkingin collagen# Precursor of carnitine = Lysine +Methionine

So the answer to this question is A


Instruction:
Ramu, presents with recurrent attacks of cholelithiasis, U/S examination shows a dilated CBD of 1 cm. The next line of management is -
A. ERCP
B. PTC
C. Cholecystostomy
D. Intravenous cholangiogram

Response:
The first inv. for any pt. with cholelithiasis or jaundice is U/S.
Next inv. depends on U/S findings,
If the intrahepatic ducts are dilated without any extrahepatic dilatition
then the preferred inv. is → PTC
If the dilatation is in CBD → ERCP.
ERCP may provide direct diagnosis of the distal CBD pathology and may be therapeutic as well for a C stone or stricture.

So the answer to this question is A


Instruction:
In Conn's syndrome the following is true:
A. Diastolic HTN without oedema
B. Systolic HTN without oedema
C. Pseudotetany
D. Hyper K+

Response:
Answer is A (Diastolic hypeension without edema): Conn's syndrome is characterized by diastolic hypeension without edema.

So the answer to this question is A


Instruction:
Drug used for both attack as well as prophylaxis of angina:
A. Isosorbide dinitrate
B. Diltiazem
C. Verapamil
D. Dipyridamole

Response:
Ans. A. Isosorbide dinitrateIsorbide dinitrate is given for both acute attack as well as prophylaxis of angina, diltiazem is only used for prophylaxis. Dipyridamole worsens angina by coronary steal phenomenon.

So the answer to this question is A


Instruction:
Carcinoma tongue less than 2 cm is treated by -
A. Excision
B. Radiotherapy
C. Chemotherapy
D. Excision and Radiotherapy

Response:
None

So the answer to this question is A


Instruction:
Insulin dependent entry of glucose is seen in-
A. a) Liver
B. b) Brain
C. c) Hea
D. d) Kidney

Response:
- GLUT-4 occurs in Hea, skeletal muscle, adipose tissue.

So the answer to this question is C


Instruction:
Amiloride can cause hyperkalemia due to its action on :
A. Electrogenic K+ channels
B. Electrogenic Na+ channels
C. Non electrogenic Na+-C1- symporter
D. H+-K+ ATPase

Response:
Amiloride and triamterene are K+ sparing diuretics that act by inhibiting epithelial Na+ channels.
In the distal tubules and collecting ducts, three separate channels are present (one for Na+, K+ and H+ each). Aldosterone acts on DCT and CD to cause reabsorption of Na+. This generates a lumen negative potential difference across the membrane of this part of the nephron. To maintain the electric neutrality, K+ and H+ are secreted in the lumen.

So the answer to this question is B


Instruction:
Pleomorphic adenoma histology is characterized by-
A. Epithelial component
B. Endothelial component
C. Mesodermal component
D. Mixed epithelial and mesenchymal components

Response:
Robbins basic pathology 9th edition page no 556 Heading =pleomorphic adenoma Pleomorphic adenomas are benign tumors that consists of a mixture of epithelial and myoepithelial cells, so they exibit both epithelial and mesenchymal diffrentiation

So the answer to this question is D


Instruction:
what is the marker most predominant in gastrointestinal tumor is ?
A. CD 117
B. CD 34
C. CD 56
D. CD 24

Response:
Pathophysiology Tyrosine kinase receptor mutations in GIST * Over 85% of GISTs have activating KIT mutations * Commonly occur in * Exon 11(57-71%) * Exon 9 (10-18%) * Exon13 (1-4%) * Exon 17(1-4%) * One third of GISTs lacking KIT mutations have mutations in gene encoding PDGFRA, * Mutated KIT remain active in the absence of ligand binding resulting in unregulated growth and malignant transformation * Wild type GISTs are few that do not show KIT or PDGFRA mutations Surgical therapy * Complete en-block removal * Site specific * Avoidance of tumor rupture * Lymphadenectomy not advocated * Final goal: complete tumor resection with a negative margin, intact pseudocasule * Positive resection margin: Re-excision REF : BAILEY AND LOVE 27TH ED

So the answer to this question is A


Instruction:
A 52-year-old man comes to the physician with the chief complaint of feeling depressed for the past 2 months. He notes that he is not sleeping well, has lost 5 kg in the last 6 weeks, and is having anergia and anhedonia. In addition, in the past 4 weeks he has begun to hear the voice of his dead father telling him that he is a failure and he has begun worrying that his organs are rotting away. Which of the following statements is true?
A. The patient should be staed on an SSRI and an antipsychotic
B. The patient is having an acute schizophrenic episode
C. The patient is likely suffering from a factitious disorder with psychological symptoms
D. The patient is likely abusing alcohol

Response:
Sodium valproate is drug of choice in rapid cycling

So the answer to this question is C


Instruction:
Lymphogranuloma venerum is caused by :
A. Chlamydia trachomatis
B. Hemophillus ducrei
C. Human T cell lymphoma virus type II
D. Donovania granulomatis

Response:
Ans. is 'a' i.e Chlamydia trachomatis Lymphogranuloma venerum is caused by Chlamydia trachomatis type I, II and III.Other frequently asked questionsDiseaseOrganismChancroid(soft chancre)*Granuloma inguinale*Chance*LGV*Hemophilus ducreiCalymmatobacterium granulomatis,T. PallidumChlamydia trachomatis type I, II and III

So the answer to this question is A


Instruction:
Ludwigs angina usually begins in -
A. Submandibular space
B. Sublingual space
C. Parotid space
D. Retropharyngeal space

Response:
Ans. is 'a' i.e., Submandibular space o Ludwig's angina is a rapidly spreading bilateral cellulitis that involves the floor of mouth, under the tongue,o Floor of mouth is comprised of sublingual space, submandibular space and submental space,o Ludwig's angina usually begins in the submandibular space, and then rapidly spreads to involve the subligual space, usually on a bilateral basis.o Most common cause is infection of the root of the teeth (Dental infection), especially 2nd and 3rd mandibular molar.o Other causes are mouth injury, mandibular fracture, and submandibular sialadenitis.

So the answer to this question is A


Instruction:
Post spinal headache is due to –
A. Meningitis
B. Encephalitis
C. CSF leak
D. Increased ICT

Response:
Spinal headache (Post dural puncture headache) is due to CSF leak.

So the answer to this question is C


Instruction:
A young boy who has difficulty in getting up from sitting position was diagosed to have Duchene's muscular dystrophy. Which one is true regarding the mutation in the dystrophin gene in promoter region
A. Initiation of transcription to the dystrophin gene would be affected
B. Capping of mRNA of dystrophin gene would be affected
C. Tailing of mRNA of dystrophin gene would be affected
D. Premature termination

Response:
The promoter region of DNA is responsible for initiation of the RNA transcription, hence any mutation in this region is going to effect the initiation process of mRNA synthesis.

So the answer to this question is A


Instruction:
Example of Apoptosis is?
A. Councilman Bodies
B. Gamma Gandy Body
C. Russell bodies
D. None

Response:
ANSWER: (A) Councilman BodiesREF: Cell proliferation & apoptosis by David Hughes, H. Mehmet Page 211Repeat in December 2009See APPENDIX-25 below for "FEW IMPORTANT BODIES IN MEDICAL SCIENCE" APPENDIX - 25Few Important Bodies in Medical ScienceAschoff Bodies - Rheumatic feverAsteroid body - SarcoidosisBabes - Ernst Bodies - Metachromatic granulesBalbiani's Bodies - Yolk nucleusBamboo bodies - AsbestosisBodies of Arantius - Aortic valve nodulesBody of Highmore - Mediastinum testisBollinger bodies - FowlpoxBrassy body - Dark shrunken blood corpuscle found in malariaCall Exners bodies - Granulosa theca cell tumourChromatid bodies - Entamoeba histolytica precystCitron bodies - cl. SepticumCivatte bodies - Lichen planusCouncilman bodies - Yellow fever/viral hepatitisCoccoid X bodies - PsittacosisCreola bodies - AsthmaCystoid bodies - Degenerated retinal nerve fibres (seen in Cotton wool spots)Donnes bodies - colostrums corpusclesDonovan bodies - Granulose inguinale (LGV)Ferruginous bodies - AsbestosisGamma Gandy bodies - Congestive splenomegalyGuarneri bodies - Inclusion bodies of vacciniaHenderson Peterson bodies - Molluscum contagiosumHarting bodies - Calcospheritis in the cerebral capillariesHeinz bodies - G 6 PD deficiencyHerring bodies - NeurohypophysisHirano bodies - Alzheimer's diseaseLewy bodies - parkinsonismLevinthal coles lille bodies - PsittacosisMallory bodies - Alcoholic hepatitisMasson bodies - Rheumatic pneumoniaMichelis Guttman bodies - MalakoplakiaMooser bodies - Endemic typhusMoot bodies - Multiple myelomaNegri bodies - RabiesOdland body - KeratinosomeOken's body - MesonephrosPappenheimer bodies- Granules of iron found inside RBC on routine blood stain in sideroblastic anemia, hemolytic anemia, and sickle cell diseasePaschen bodies - vaccinia/variolaPacchonian bodies- Arachnoid granulationPick bodies - Picks diseasePsamomma bodies:papillary carcinoma of thyroidSerous cyst adenoma of ovaryMeningiomaPapillary type of renal cell carcinomaPituitary adenoma (Prolactinoma)Appendiceal carcinoid (Rarely)Reilly bodies - Hurler's syndromeRokitansky bodies - TeratomaRoss's bodies - SyphilisRush ton bodies - Odontogenic cystRussell bodies- RhinoscleromaSclerotic bodies - ChromoblastomycosisSandstorm bodies - Parathyroid glands

So the answer to this question is A


Instruction:
Which is not true about dengue hemorrhagic fever
A. Shock
B. Thrmbocytopenia
C. Hepatomegaly
D. Plasma leaking

Response:
None

So the answer to this question is A


Instruction:
Transverse section of Class V through the axial wall is
A. Convex
B. Concave
C. Kidney shaped
D. Straight

Response:
None

So the answer to this question is A


Instruction:
Smallest abdominal muscle is:
A. External oblique
B. Internal oblique
C. Transversalis
D. Rectus abdominis

Response:
The transverse abdominis is the smallest of the four abdominial muscles and lies deep to the others.

So the answer to this question is C


Instruction:
Which of the following test is unable to differentiate between 'in situ' breast cancer and invasive disease
A. Core needle biopsy
B. FNAC
C. Excisional biopsy
D. None

Response:
"FNAC is the least invasive technique for obtaining a cell diagnosis and is very accurate if both operator and cytologists are experienced. However false negatives do occur, mainly through sampling error, and invasive cancer cannot be distinguished from 'in situ' disease. A histological specimen taken by core biopsy allows a definitive preoperative diagnosis, differentiates between duct carcinoma in situ (DCIS) and invasive disease and also allows the tumor to be stained for receptor status. This is impoant before commencing neoadjuvant therapy." Bailey and Love Ref : Bailey & Love 26/e p 800

So the answer to this question is B


Instruction:
Cyclic trend is shown by ?
A. Polio epidemic
B. Rabies
C. Influenza pandemic
D. Malaria

Response:
Ans. is 'c' i.e., Influenza pandemic

So the answer to this question is C


Instruction:
Mugging is compression of neck by ?
A. Wooden sticks
B. Rope
C. Forearm
D. Hand

Response:
Ans. is 'c' i.e., Forearm Mugging (choke hold) : It is compression of neck by forearm or in the bend of elbow. Bansdola : Compression of neck with one or two wooden sticks or bamboo. Garrotting : It is compression of neck by a rope thrown from behind. Spanish windlass is a type of garrotting, which used to be the official mode of execution in spain. In this, an iron collor around the neck was tightened by a screw for strangulation. Throttling (manual strangulation) : Neck is compressed by one or both hands.

So the answer to this question is C


Instruction:
A viral infection causes damage to both hippocampi in a patient. This damage would cause the patient to exhibit functional deficits in (NOT RELATED)
A. Recalling an old declarative memory
B. Recalling an old procedural memory
C. Forming a new sho-term memory
D. Forming a new long-term memory

Response:
The hippocampus is crucial for the forma on of long-term (declarative) memory. Without the hippocampus, sho-term memory is intact but the conversion to long-term does not take place. The retrieval of stored declarative memory does not require the hippocampus. The hippocampus is not needed for the forma on or retrieval of procedural memory. Ref: Ganong - Review of Medical Physiology 23rd Ed Page 372

So the answer to this question is D


Instruction:
Breast feeding week is celebrated on?
A. 1st week of March
B. 1st week of July
C. 1st week of August
D. 1st December

Response:
Breast feeding week is celebrated from August 1-7 Reference: www.worldbreastfeeding.org

So the answer to this question is C


Instruction:
Which is not a feature of battered baby syndrome
A. Subdural haemorrhage occurs in 40 % of fatal cases
B. Nobbing fractures on the anterior angles of the ribs
C. Vitreous and subhyaloid hemorrhages in the eyes
D. Torn frenulum on the lower lip is a characteristic lesion

Response:
Battered baby syndrome/ Caffeys syndrome/ non accidental injury of childhood: Nobbing fractures occur on the posterior angles of the ribs in the paraveebral gutter region Subdural haemorrhage occurs in 40 % of fatal cases In the eyes, retinal detachment, retinal hemorrhages, Vitreous and subhyaloid hemorrhages are seen Torn frenulum on the lower lip is a characteristic lesion

So the answer to this question is B


Instruction:
18 month old child sign of severe pneumonia is -
A. Chest indrawing
B. Stridor in calm child
C. Inability to drink
D. All of above

Response:
Ans. is 'd' i.e., All of above o Severe pneumonia or very severe diseaseChest indrowing 'or'Stridor in calm child 'or'Any general danger signH/O convulsionInability to drink or breast feedUncousciousness or letharginessChild vomiting everything.Pneumoniao Fast breathing-defined aso Upto 2 month = > 60 breath/minuteo 2 month-12 month = > 50 breath/minuteo 12 months to 5 year = > 40 breath/minute

So the answer to this question is D


Instruction:
Fluorescein angiography of a patient shows 'Bull's eye' lesions on the retina. Bull's eye retinopathy is due to:
A. Infrared light
B. UV-light
C. Phenothiazines
D. NSAIDS

Response:
Phenothiazine derivatives may conjugate with the melanin of the pigment layer, resulting in degeneration of the outer layers of the retina and a characteristic "bull's-eye retinopathy" by fluorescein angiography. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 13. Disturbances of Vision. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.

So the answer to this question is C


Instruction:
Pulp chambers and root canals in deciduous teeth:
A. Wide and deep
B. Shallow and narrow
C. Wide and narrow
D. Shallow and wide

Response:
None

So the answer to this question is D


Instruction:
Thyroxine is synthesized from:
A. Phenylalanine
B. Tryptophan
C. Tyrosine
D. None of the above

Response:
In dopaminergic cells in the brain, tyrosine is conveed to levodopa by the enzyme tyrosine hydroxylase (TH).TH is the rate-limiting enzyme involved in the synthesis of the neurotransmitter dopamine.In the adrenal medulla, tyrosine is conveed into the catecholamine hormones norepinephrine (noradrenaline), and epinephrine.The thyroid hormones triiodothyronine (T3) and thyroxine (T4) in the colloid of the thyroid also are derived from tyrosine.

So the answer to this question is C


Instruction:
Which among the following is the safest antimalarial drug during pregnancy?
A. Mefloquine
B. Pyrimethamine
C. Proguanil
D. Quinine

Response:
Proguanil is a prodrug; only its triazine metabolite, cycloguanil is a selective inhibitor of the bifunctional plasmodial dihydrofolate reductase-thymidylate synthetase that is crucial for parasite de novo purine and pyrimidine synthesis. Proguanil is considered safe for use during pregnancy. It is remarkably safe when used in conjunction with other antimalarial drugs such as chloroquine, atovaquone, tetracyclines, and other antifolates. Quinine appears to be safe in pregnancy and is used commonly for the treatment of pregnancy-associated malaria but there is increased risk of hypoglycemia. There are increased rate of stillbihs with mefloquine use, especially during the first trimester. Pregnancy should be avoided for 3 months after mefloquine use because of the prolonged t1/2 of this agent. At high doses, pyrimethamine is teratogenic in animals, and in humans the related combination, trimethoprim-sulfamethoxazole, may cause bih defects. Ref: Vinetz J.M., Clain J., Bounkeua V., Eastman R.T., Fidock D. (2011). Chapter 49. Chemotherapy of Malaria. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.

So the answer to this question is C


Instruction:
Which method of contraception is not used in patient with active syphilis?
A. IUCD
B. Oral contraceptive pills
C. Barrier devices
D. Calendar method

Response:
Ans. is 'a' i.e.,IUCDSyphilis is a sexually transmitted disease.Use of IUCD is strictly contraindicated in patient with active genital tract infection thus use of IUCD is contraindicated in in patient with active syphilis

So the answer to this question is A


Instruction:
Acquired mutations in PIGA  gene gives rise to :
A. Paroxysmal Nocturnal Hemoglobinuria
B. Hereditary Spherocytosis
C. Isoimmune hemolytic anemia
D. Fanconi’s anemia

Response:
Paroxysmal nocturnal hemoglobinuria (PNH) is a hemolytic anemia that stems from acquired mutations in PIGA, a gene required for the synthesis of phosphatidylinositol glycan (PIG), which serves as a membrane anchor for many proteins. Because PIGA is X-linked, normal cells have only one active PIGA gene, a mutation of which is sufficient to cause PIGA deficiency.

So the answer to this question is A


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

Response:
*Lisch nodules are the most common type of ocular involvement in NF-1. These nodules are melanocytic hamaomas, usually clear yellow to brown that appear as well- defined, dome-shaped elevations projecting from the surface of the iris. Ref: Harrison 18th/e p.2964

So the answer to this question is B


Instruction:
A 45 day old infant developed icterus and two days later symptoms and signs of acute liver failure appeared. Child was found to be positive for HbsAg. The mother was also HBsAg carrier. The mother's hepatitis B serological profile is likely to be:
A. HbsAg positive
B. HbsAg and HbeAg positivity
C. HbsAg and anti-Hbe antibody positivity
D. Mother infected with mutant HBV

Response:
Most impoant risk factor that determines perinatal transmission of Hepatitis B is HBeAg HBsAg carrier mothers who are HBe Ag positive almost invariably (> 90%) transfer infection to their offspring.

So the answer to this question is B


Instruction:
When nitrates are combined with calcium channel blockers:
A. Aerial pressure will decrease
B. Hea rate will increase
C. Ejection time will decrease
D. End-diastolic volume will increase

Response:
Nitrates primarily decrease preload, while CCBs have a greater effect on afterload. Their concurrent use may decrease cardiac work to an extent not possible with either drug alone. This combination may be especially valuable in severe vasospastic angina. Eg for nitrates: GTN CCBs-amlo,felo,clevidipine, verapamil, diltiazem K D Tripathi: essentials of medical pharmacology; edition 6; pg no:533

So the answer to this question is A


Instruction:
'Nodding face sign' is seen in
A. Fracture of anterior cranial fossa
B. Fracture of middle cranial fossa
C. Hinge fracture
D. Orbital blow out fractures

Response:
Hinge/Transverse fracture: Transverse fracture of the base of the skull occurs on middle that completely splits it into two halves, creating hinge (nodding face sign) .This may result from an impact on either side of head or side to side compression of head as in run over by vehicle. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 165

So the answer to this question is C


Instruction:
Otitis and osteomyelitis is seen in?
A. Hepatitis B vaccine
B. BCG
C. Measles vaccine
D. IPV

Response:
Ans. (b) BCGRef : OP Ghai 8th ed./191BCG* Although BCG vaccination often causes local reactions, serious or long-term complications are rare. Reactions that can be expected after vaccination include moderate axillary or cervical lymphadenopathy and induration and subsequent pustule formation at the injection site; these reactions can persist for as long as 3 months after vaccination.* Most serious complication of BCG vaccination is disseminated BCG infection.* The most frequent disseminated infection is BCG osteomyelitis

So the answer to this question is B


Instruction:
Which of the following is a prodrug-
A. Neostigmine
B. Captopril
C. Esmolol
D. Enalapril

Response:
Ans. is 'd' i.e., Enalapril Prodrugo Few drugs are inactive as such and need conversion in the body to one or more active metabolites,o Such a drug is called a prodrug.o All the drugs in following table are very important, sorry, I can not shorten the listProdrugLevodopaEnalaprila - MethyldopaChloralhydrateDipiveffineOxcarbazepinePrednisoneBacampicillinSulfasalazineCyc lophospham ideMercaptopurineFluorouracilSulindacAzathioprineCortisoneBenorilateProguanilZidovudinTerfenadineProntosilo Advantages of prodrugs over active formMore stableBetter bioavailabilityLess side effects and toxicity.

So the answer to this question is D


Instruction:
Parathyroid glands develop from .............branchial pouches?
A. 1st & 2nd
B. 2nd & 3rd
C. 3rd & 4th
D. 5th & 6th

Response:
HUMAN EMBRYOLOGY-INDERBIR SINGH TENTH EDITION-PAGE NO:136The inferior parathyroid glands develop from endoderm of the third pharyngeal pouchThe superior parathyroid glands develop from endoderm of the fouh pharyngeal pouch

So the answer to this question is C


Instruction:
True about mesenteric cysts is -
A. Enterogenous cyst is commonest type
B. Recurrence is common after enucleation
C. Mensentric cyst are usually multiple
D. Enucleation is the treatment of choice of chylolymphatic cyst

Response:
Mesenteric cysts are of following types:

Chylolymphatic (most common)
simple (mesothelial)
Enterogenous
Urogenital remnan
Dermoid (teratomatous cyst)

Chylolymphatic cyst

Usually are congenital, resulting from developmental sequestration of lymphatics.
It is found most frequently in the mesentery of the ileum.
The cyst wall is thin, made up of connective tissue; lacks the muscular wall of enteric duplication cyst.
The cyst is not lined by mucosa.
It is filled with clear lymph or chyle.
A chylolymphatic cyst is almost invariably solitary, although in extremely rare cases, multiple cysts may be seen.
The cyst is more often unilocular than multilocular.
A chylolymphatic cyst has a blood supply independent of that of the adjacent intestine, and thus enucleation (resection) is possible without the need for resection of the gut.

Enterogenous cyst

Believed to be derived either from a diverticulum of the mesenteric border of the intestine which has become sequestered from the intestinal canal during embryonic life or from a duplication of the intestine.
An enterogenous cyst has a thicker wall than a chylolymphatic cyst, and it is lined by mucous membrane, sometimes ciliated.
The content is mucinous
The enterogenosu cyst and the adjacent bowel wall has a common blood supply, therefore, enucleation of the cyst is always done along with resection of the related portion of intestine followed by anastomosis.

Clinical features

painless abdominal swelling

the swelling moves freely in a plane at right angles to the attachment of the mesentery.

recurrent attacks of abdominal pain with or without vomiting due to obstructive symptoms.
acute abdominal pain due to

torsion of the mesentery containing cyst
rupture of cyst
hemorrhage into the cyst
infection of the cyst

Enucleation is the t/t of choice. An associated segment of bowel is removed along with enterogenous cyst. Other t/t modalities i.e. marsupialization, internal drainage, or aspiration are suboptimal and are almost always followed by recurrence.

So the answer to this question is D


Instruction:
Jamais vu is -
A. Illusion that what one is hearing, one has heard previously
B. A unfamiliar thought regarded as repetition of a previous thought
C. Unfamiliar situations or events feel strangely familiar
D. Feeling of strangeness to familiar situation

Response:
Ans. D. Feeling of strangeness to familiar situationfamais vu :- A feeling of strangeness to familiar situations or events.

So the answer to this question is D


Instruction:
Which of the following does not establish a diagnosis of congenital CMV infection in a neonate –
A. Urine culture of CMV
B. IgG CMV antibodies in blood
C. Intra–nuclear inclusion bodies in hepatocytes
D. CMV viral DNA in blood by polymerase chain reaction

Response:
None

So the answer to this question is B


Instruction:
Giant papillary conjunctivitis is associated with:
A. Hard Contact lens
B. Rigid gas permeable contact lens
C. Soft hydrophilic contact lens
D. INTACS

Response:
Ref: Kanski Clinical Ophthalmology 6th edition; page no 218. 234Explanation:Conjunctival papillae: Hyperplasic conjunctivalepithelium with fibrovascular core & subepithelial infiltration w ith inflammatory cells Thi 'ee types of papillae: Micropapillae - mosaic like red dotsMacropapillae - < 1mm in size Giant papillae - > I mm in size Causes of (iiant papillary conjunctivitisRepeated mechanical irritation of the conjunctivaOcular prosthesesExtruding scleral bucklesExposed ocular suturesFiltering blebElevated corneal scars- Giant papillary conjunctivitis symptoms and signs, such as papillary changes in the tarsal conjunctiva, have been associated w ith the use of all types of contact lenses (eg, rigid, hydrogel* silicone hydrogel, piggyback, scleral, prosthetic).Incidence of giant papillary conjunctivitis with various type of contact lensesSoft contact lens wearers: 1% to 45%.Conventional soft contact lens: 34%Extended wear disposable soft contact lens wearers -5%Frequent replacement contact lens (every one day to twrelve weeks): 21.27%Rigid gas permeable lens wearers: Very low (1 % to 5% ).TYPESSITECAUSESAnteriorInvolving part of the whole of the cornea; lined by irisSloughing corneal ulcerIntercalaryLimbus & 2mm from the limbus; lined by ciliary bodyPerforating injuries, marginal corneal ulcer, anterior scleritis, scleromalacia perforans, post surgical wound site, secondary glaucomaEquatorial2-8 mm from the 1mbus ; lined bv the choroidScleritis. pathological myopia, chronic uncontrolled glaucomaPosteriorPosterior pole; lined by the choroidSame as equatorial

So the answer to this question is C


Instruction:
Bacillus used to test efficacy of Sterilisation by Autoclave is?
A. Bacillus subtilis.
B. Bacillus pumilis.
C. Bacillus stearothermophilus
D. Coxiella burnetti.

Response:
ANSWER: (C) Bacillus stearothermophilusREF: Basic medical laboratory techniques 4th edition by Barbara H. Estridge, Anna P. Reynolds,Norma J. Walters Page 70Various bacilli are used to check efficacy of sterilisation methods are:Autoclave- Bacillus stearothermophilusHot air oven- Bacillus subtilis subspecies nigerIonising radiation- Bacillus pumilis

So the answer to this question is C


Instruction:
Histopathology of chronic hepatitis shows -
A. Ballooning of hepatocytes
B. Councilman bodies
C. Bridging fibrosis
D. All of the above

Response:
Ans. (c) Bridging fibrosis(Ref: Robbins 9th/pg 837)Hallmark of progressive chronic liver damage is deposition of fibrous tissue (scarring) Q bridgin fibrosis

So the answer to this question is C


Instruction:
"Lupus" is caused by all of the following drugs EXCEPT
A. Clofibrate
B. Penicillamine
C. Hydralazine
D. Chlorpromazine

Response:
(A) Clofibrate # DRUG-INDUCED LUPUS> This is a syndrome of positive ANA associated with symptoms such as fever, malaise, arthritis or intense arthralgias/ myalgias, serositis. and/or rash.> The syndrome appears during therapy with certain medications and biologic agents, is predominant in Caucasians, has less female predilection than SLE, rarely involves kidneys or brain, is rarely associated with anti-dsDNA, is commonly associated with antibodies to histones, and usually resolves over several weeks after discontinuation of the offending medication.> The list of substances that can induce lupus-like disease is long.> Among the most frequent are the anti-arrhythmics Procainamide, Disopiramide, propafenone; the antihypertensives hydralazine, several angiotensin-converting enzyme Inhibitors and beta-blockers; the antithyroid propylthiouracil; the antipsychotics chlorpromazine and lithium; the anticonvulsants Carbamazepine and phenytoin; the antibiotics isoniazid, inocycline, and macrodantin; the antirheumatic sulfasalazine; the diuretic hydrochlorothiazide; the antihyperlipidemics lovastatin and simvastatin; and the biologics interferons and tumor necrosis factor inhibitors.> ANA usually appears before symptoms; however, many of the medications mentioned above induce ANA in patients who never develop symptoms of drug-induced lupus> It is appropriate to test for ANA at the first hint of relevant symptoms and to use test results to help decide whether to withdraw the suspect agent

So the answer to this question is A


Instruction:
Radiographic finding of tooth shows radiolucency reaching the middle 1/3rd of dentin. Based on radiographic finding, this tooth will be categorised as _____ according to latest ICCMS guidelines.
A. RA2
B. RA3
C. RC5
D. RB4

Response:
The ICCMSTM classifies tooth surfaces radiographically as follows: (modified from Agustdottir et al ; Ekstrand et al (22]).
0 = No radiolucency.
RA: Initial stages
1 = radiolucency in the outer ½ of the enamel
2 = radiolucency in the inner ½ of the enamel ± EDJ (enamel-dentin junction) (this stage is recommended for restorative care in the US, if the radiolucency touches the EDJ)
3 = radiolucency limited to the outer 1/3 of dentin (in some countries, especially the US, this stage is classified as moderate).
RB: Moderate stages
4 = radiolucency reaching the middle 1/3 of dentin.
RC: Extensive stages
5 = radiolucency reaching the inner 1/3 of dentin, clinically cavitated
6 = radiolucency into the pulp, clinically cavitated.
ICCMSTM Caries Risk Likelihood Matrix

So the answer to this question is D


Instruction:
Which is not a method of gene therapy:
A. FISH
B. Transfection
C. Electroporation
D. Bacteriophage

Response:
FISH (Fluoresecent In Situ Hybridization) is used for diagnosis, Not for gene therapy or treatment. Gene therapy When a gene or DNA is introduced into a cell for the treatment of a disease. Methods of Gene therapy Transformation Transfection Transduction Electroporation Uptake and incorporation of naked DNA into bacteria from the external environment Transfer of non-viral genetic material into eukaryotic cells Uptake of chimeric DNA takes place Introduction of genetic material using viruses (bacteriophage). An electric field is applied which increases cell membrane permeability, allowing DNA, drugs or chemicals to be introduced into the cell

So the answer to this question is A


Instruction:
Snow blindness is caused by
A. UV rays
B. Infra red rays
C. Microwaves
D. Defect in mirrors

Response:
In snowblindness the cause and symptoms are similar to photophthalmia, for the ultraviolet rays are reflected from snow surfaces. Snow blindness, also called arc eye or photokeratitis, is a painful eye condition caused by overexposure to ultraviolet (UV) light. When too much UV light hits the transparent outer layer of your eyes, called the cornea, it essentially gives your cornea a sunburn. Snow blindness symptoms can be disorienting. Ref-Parson's; 21st edition; Pg No. 214

So the answer to this question is A


Instruction:
Which of the following is not administered by intradermal route?
A. BCG
B. Drug sensitivity injection
C. Mantoux
D. Insulin

Response:
Insulin is given through sub-cutaneous route

So the answer to this question is D


Instruction:
The relationship between sulphonamide and PABA is
A. Metabolic antagonism
B. Synergism
C. Intermediate compound formation
D. Chelation

Response:
Sulfonamides have structural similarity with PABA .therefore, they competitively inhibit the enzyme responsible for the incorporation of PABA into dihydropteroic acid, the immediate precursor of folic acidRef: DM Vasudevan, 7th edition, page no: 491, 61

So the answer to this question is A


Instruction:
Which among the following condition is positive for double stranded DNA antibody?
A. SLE
B. Sjogren's syndrome
C. Scleroderma
D. Mixed Connective Tissue Disorder

Response:
Serum antinuclear antibodies (ANAs) are found in nearly all individuals with active SLE. Antibodies to native double-stranded DNA (dsDNA) are relatively specific for the diagnosis of SLE. Anti-SSA or anti-SSB antibodies are seen in Sjogren's syndrome. Topoisomerase I antibodies (also known as Scl-70), Anticentromere antibodies, Fibrillarin antibodies and antibodies to ribonucleoprotein (RNP) are present in scleroderma. Anti-U1-RNP antibodies, and antibodies against U1-70 kd small nuclear ribonucleoprotein (snRNP) are characteristic of mixed connective tissue disorder (MCTD).

So the answer to this question is A


Instruction:
Repeated Transcranial Magnetic Stimulation (rTMS) of the brain is used in the treatment of -
A. Depression
B. Resistant Schizophrenia
C. Obsessive-Compulsive Disorder
D. Acute Psychosis

Response:
Somatic Therapies for depression

Electroconvulsive therapy (FDA approved)
Vagus Nerve Stimulation (VNS) (FDA approved)
Repeated Transcranial Magnetic Stimulation (rTMS) of the brain has recent FDA approved
Deep Brain Stimulation (DBS)
Phototherapy

So the answer to this question is A


Instruction:
Acute Hepatitis B infection is diagnosed by?
A. HbsAg
B. HbcAg
C. HbsAg + IgM anti-HBc antibody
D. HbsAg + HbcAg

Response:
HBsAg Anti-HBs Anti-HBcAg HBeAg Acute hepatitis B, High infectivity + - IgM + Window period - - IgM - Chronic Hepatitis B + - IgG + Cured - + IgG - Vaccination - + - -

So the answer to this question is C


Instruction:
Taste sensations from anterior 2/3rd of tongue are carried by:
A. Glossopharyngeal nerve
B. Chorda tympani nerve
C. Trigeminal nerve
D. Greater auricular nerve

Response:
Taste sensation from anterior 2/3rd of tongue is carried by chorda tympani (branch of facial nerve),  towards the facial nerve and geniculate ganglion.

So the answer to this question is B


Instruction:
Dental local anesthetics containing 2% lignocaine with adrenaline 1 : 80000:
A) In any dosage are contraindicated in patients with heart disease
B) May cause tachycardia
C) Can produce allergic reactions, in which lignocaine is usually responsible
D) Or even prilocaine with felypressin should not be used in the pregnant patient because of the oxytocic effects of adrenaline or felypressin.
E) Cause hypertensive reactions in patients on tricyclic antidepressants
A. Option B is true and ACDE are false
B. Option A true and BCDE are false
C. Option C is true and ABDE are false
D. Option D is true and ABCE are false

Response:
Adrenaline may cause tachycardia.

So the answer to this question is A


Instruction:
The proximal fragment of scaphoid after fracture is predisposed for Avascular Necrosis because:
A. Retrograde blood flow to the proximal fragment
B. Difficulty in immobilizing the proximal fragment
C. Fracture configuration of the proximal fragment is usually comminuted
D. Proximal Fragment aiculates with the radius

Response:
A i.e. Retrograde blood flow to the proximal fragment

So the answer to this question is A


Instruction:
True about saphenous opening
A. Transmits saphenous nerve
B. Lies 4 cm lateral and superior to pubic tubercle
C. Covered by cribriform fascia
D. Opening in fascia cruris

Response:
SAPHENOUS OPENING:- Oval opening in fascia lata.Centre of opening is 4 cm below and 4 cm lateral to the pubic tubercle.2.5cm long 2 cm broad. The opening has a sharp crescentic margin or falciform margin which lies in front of the femoral sheath.Saphenous opening is closed by the cribriform fascia formed by the modification of superficial fascia which covers the opening. <img src=" /> {Reference: BDC 6E pg no. 45}

So the answer to this question is C


Instruction:
Following are causes of unconjugated hyperbilirubinemia, except:
A. Hemolytic anemia
B. Large hematoma
C. Rotor syndrome
D. Megaloblastic anemia

Response:
Answer is C (Rotor syndrome) Rotor's syndrome is an Autosomal recessive inherited disorder characterized by a deject in biliary excretion leading to conjugated hyperbilirubinemia: Indirect hyperbilirubinemia Direct hyperbilirubinemia A. Hemolytic disorders A. Inherited conditions 1. Inherited 1. Dubin-Johnson syndrome a. Sperocyteosis, elliptocytosis 2. Rotor's syndrome Glucose-6-phosphate dehydrogenase and pyruvate kinase deficiencies b. Sickle cell anemia 2. Acquired _ a. Microangiopathic hemolytic anemias b. Paraoxysmal nocturnal hemoglobinuria c. Immune hemolysis B. Ineffective erythropoesis 1. Cobalamin, folate, thalassemia, and severe iron deficiencies C. Drugs 1. Rifampicin, probenbecid, ribavirin D. Inherited conditions 1. Crigler-Najjar types I and II 2. Glibe's syndrome

So the answer to this question is C


Instruction:
Fetal alcohol syndrome is characterized by
A. Large palpebral fissures
B. Thin vermillion border
C. Macrosomia
D. Hyperplastic philtrum

Response:
Fetal alcohol syndrome - dysmorphic facies

Small palpebral fissure
Thin vermillion border
Microsomia
Hypoplastic phltrum.

So the answer to this question is B


Instruction:
Canon 'a' waves in JVP represents: March 2007
A. Complete hea block
B. 1st degree A-V block
C. Sinus bradycardia
D. Tachycardia

Response:
Ans. A: Complete hea block

So the answer to this question is A


Instruction:
Which of the following is omega 6 fatty acid
A. α - Linolenic acid
B. γ - Linolenic acid
C. Timnodonic acid
D. Cervonic acid

Response:
Omega 6 fatty acids

Linoleic acid
γ Linolenic acid
Arachidonic acid.

Omega 3 fatty acids

α - linolenic acid
Timnodonic acid (Eicosapentaenoic acid)
Cervonic acid (Decosahexaenoic acid)

So the answer to this question is B


Instruction:
Which of the following is TRUE regarding classical spontaneous bacterial peritonitis ?
A. Ascitic fluid neutrophil count is > 250/mm'
B. Bowel perforation should be present
C. Multiple organisms are isolated from ascitic fluid
D. Board-like rigidity is present in abodmen

Response:
Spontaneous bacterial peritonitis (SBP) is one of the potentially lethal complications of cirrhosis and is defined as infected ascites in the absence of any recognizable secondary cause of infection. .UGI bleeding and abdominal pain were the most common presenting symptoms of SBP SBP is an acute ascites infection an ascitic fluid polymorphonuclear (PMN) cell count of >=250 cells/mm3 both with or without a positive ascitic fluid bacterial culture. SBP can be differentiated from secondary bacterial peritonitis by the absence of a surgically treatable intra-abdominal source of infection Ref Davidson edition23rd pg 811

So the answer to this question is A


Instruction:
Adrenoleukodystrophy is ?
A. AD
B. AR
C. X linked dominant
D. X linked recessive

Response:
Ans. is 'd' i.e., X Linked recessive Adrenoleukodvstrophy Adrenoleukodystrophy is an X-linked recessive disease associated with mutations in a member of the ATP-binding cassette transpoer family of proteins (ABCD1), which is involved in the transpo of molecules into the peroxisome. In the typical form of the disease, young males present with behavioral changes and adrenal insufficiency. The disease is characterized by the inabil- ity to catabolize very-long-chain fatty acids (VLCFAs) within peroxisomes, resulting in elevated levels of VLCFAs in serum.

So the answer to this question is D


Instruction:
Maximum cones are seen in
A. Limbus
B. Fovea centralis
C. Macula lutea
D. Blind spot

Response:
Optic disc, 1.5 mm in size, is responsible for blind spot of Mariotte Rods and cones are sensory end organs of vision Rods are absent in the foveal region. Ganglion cell layer is thickest in the macular region. Foveola is the most sensitive pa of retina. It contains only cones and their nuclei covered by a thin internal limiting membrane. There are 3 types of cones Red (maximum number) 65% Green Blue (least number) Cones are packed and tight mosaic hexagonal cells Visual acuity depends upon the density of cone mosaic

So the answer to this question is B


Instruction:
Tuberculosis in Pott's disease involves: September 2010
A. Hip Joint
B. Knee Joint
C. Spine
D. Wrist Joint

Response:
Ans. C: Spine Pott's disease is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of tuberculous ahritis of the interveebral joints. It is named after Percivall Pott. The lower thoracic and upper lumbar veebrae are the areas of the spine most often affected. Scientifically, it is called tuberculous spondylitis and it is most commonly localized in the thoracic poion of the spine. Pott's disease results from haematogenous spread of tuberculosis from other sites, often pulmonary. The infection then spreads from two adjacent veebrae into the adjoining interveebral disc space.

So the answer to this question is C


Instruction:
In muscle contraction all of the following occurs except
A. Z-lines become closer
B. H zone diappears
C. A band shortens
D. M line becomes more prominent

Response:
In muscle contraction

Z-line become closer
Sarcomere shorten
A-band remains unchanged
H-zone disappears
I-band shortens
M line becomes more prominent

So the answer to this question is C


Instruction:
Mechanism of action of propylthiouracil:
A. inhibition of organification of iodine
B. inhibition of oxidation
C. inhibition of coupling
D. all of the above

Response:
Ans. D. All of the aboveThyroid peroxidase enzyme is responsible for oxidation, organification and coupling of thyroid hormone. Thus, propylthiouracil is the inhibitor of thyroid peroxidase enzyme and modulate all the functions.

So the answer to this question is D


Instruction:
A 60-year old male has a long standing history of breathlessness. He has been a heavy smoker since the age of 20 years. Physical examination reveals an anxious male who is emaciated, puffing for breath but is not cyanosed. The chest is barrels shaped. The primary pathology of the lung in this patient is associated with which of the following pathogenetic mechanisms?
A. Type I hypersensitivity
B. Unabashed action of proteases
C. Deposition of immune complexes
D. Deficiency of a protein produced by the liver

Response:
From the history and clinical findings,the probable diagnosis is chronic obstructive pulmonary disease-emphysematous type.Severe alpha1 antitrypsin (protease inhibitor) deficiency is a proven genetic risk factor for COPD.The unopposed action of elastolytic proteases lead to destruction and enlargement of gas-exchanging air spaces,thus leading to the development of emphysema. Ref:Harrison's medicine-18th edition,page no:2152,2155.

So the answer to this question is B


Instruction:
In malignant hypeension, necrosis is of which type?
A. Caseous necrosis
B. Fibrinoid necrosis
C. Liquifactive necrosis
D. Coagulative necrosis

Response:
Types of necrosis Coagulative necrosis The most common type of necrosis Loss of nucleus with the cellular outline being preserved Associated with ischemia Seen in organs (hea, liver, kidney etc.) except in the BRAIN. Liquefactive necrosis Enzymatic destruction of cells dead cells are completely digested, transforming the tissue into a liquid viscous mass Abscess formation Seen in brain Caseous necrosis Caseous means "cheese-like," Combination of coagulative and liquefactive necrosis Characteristic of TB Fat necrosis focal areas of fat destruction typically the action of lipases on fatty tissue released fatty acids combine with calcium to produce grossly visible chalky white areas Fat necrosis is seen in acute pancreatitis. Fibrinoid necrosis Complexes of antigens and antibodies are deposited in vessel wall with leakage of fibrinogen out of vessels Seen in rheumatic hea disease and malignant hypeension ref robbins basic pathology 9th ed page 10

So the answer to this question is B


Instruction:
Anaesthetic of choice in asthma patients: March 2007
A. Halothane
B. Thipentone
C. Ketamine
D. Feanyl

Response:
Ans. C: Ketamine Ketamine is classified as an NMDA (N-methyl-D-aspaate) receptor antagonist, and at high, fully anesthetic level doses, ketamine has also been found to bind to opioid (mu) receptors and sigma receptors. Like other drugs of this class such as tiletamine and phencyclidine (PCP), it induces a state referred to as "dissociative anaesthesia" and is used as a recreational drug. Ketamine has a wide range of effects in humans, including analgesia, anaesthesia, hallucinations, elevated blood pressure, and bronchodilation. It is primarily used for the induction and maintenance of general anaesthesia, usually in combination with some sedative drug. Ketamine is usually injected intravenously or intramuscularly, but it is also effective when insufflated, smoked, or taken orally. When used at anaesthetic doses, it will usually stimulate rather than depress the circulatory system, so I/ V anaesthetic of choice for shock. Ketainine produces a dissociative state, characterised by a sense of detachment from one's physical body and the external world which is known as depersonalization and derealization. At sufficiently high doses users may experience what is coined the "K-hole", a state of dissociation whose effects are thought to mimic the phenomenology of schizophrenia.

So the answer to this question is C


Instruction:
Temporary contraceptive method of choice in a 37 year well educated, normal woman is: March 2005
A. Diaphragm
B. IUCD
C. Mala-D
D. Mala-N

Response:
Ans. A: Diaphragm The Planned Parenthood federation of America (PPFA) has described the ideal IUCD candidate as a woman: Who has at least one child Has no history of pelvic disease Has normal menstrual period Is willing to check the IUCD tail Has access to follow-up and treatment of potential problems So considering the conditions given, IUCD is the best contraceptive for the above mentioned lady. An Intrauterine Contraceptive Devices is usually made up of polypropylene impregnated with barium sulphate, for visualizing them on X-rays. The commonly used devices are "T" shaped with a horizontal and a veical arm. The veical arm has a copper wire wrapped around it and two colored threads at the lower end. These nylon threads (tail) which protrudes through the cervix into the vagina, allows to check IUCD whether in place or not. The frequently used IUD's is Copper T 200 (Cu T-200) which is available free through government and municipal hospital based programs the effective life span is a minimum of 3 years. However recent studies show it can be used up to 5 years.

So the answer to this question is A


Instruction:
Floating water lilly sign on chest x-ray is characteristic of-
A. Hydatid cyst
B. Lung abscess.
C. Empyema thoracis
D. Ruptured amebic liver abscess

Response:
Ans. is 'a' i.e., Hydatid cyst o Floatine Water Lily Sien on Chest X-ray is characteristic sien of pulmonary cvstic echinococcosis or pulmonary hvdatid cvst.o It is seen when there is detachment of the endocystmembrane which results in floating membranes within the pericyst that mimics the appearance of water lily.

So the answer to this question is A


Instruction:
Superantigens true is -
A. They bind to the left of the MHC
B. Needs to processed before presentation
C. They are presented by APC'S to T cells
D. Directly attached to lateral aspect of TCR b chain

Response:
Superantigens are a class of antigens that cause non-specific activation of T-cells resulting in polyclonal T cell activation and massive cytokine release. Superantigens bind first to the MHC Class II and then coordinate to the variable alpha or beta chain of T-cell Receptors . Reff: Ananthanarayan & Panikers textbook of microbiology 9th edition pg:90

So the answer to this question is D


Instruction:
Single stranded RNA with segmented genes is found in ?
A. Influenza
B. Rotavirus
C. Reovirus
D. Measles virus

Response:
Ans. is 'a' i.e., Influenza Some viruses have segmented nucleic acid (genome). These are (Mnemonic BORA) :? 1) Bunyaviridae : 3 segments of single stranded RNA. 2) Ohomyxoviridae (influenza) : 8 segments of single stranded RNA. 3) Reoviridae (rotavirus, reovirus) : 10-12 segments of double stranded RNA. 4) Arenaviridae : 2 segments of single stranded RNA.

So the answer to this question is A


Instruction:
All of the following are true for a screeing test except?
A. Less accurate
B. Forms the basis for treatment
C. Test results are arbitrary
D. Less expensive

Response:
Ans. is 'b' i.e., Forms the basis for treatment o Screening tests do not form the basis for treatment as a specific diagnostic test will need to be performed to confirm the diagnosis suggested by a screening test in order to sta a specific treatment. o For example, In HIV infection screening is done by ELISA. If the ELISA comes to be positive, western blot is done to confirm the diagnosis before staing treatment.

So the answer to this question is B


Instruction:
P. Carni causes infection of primarily -
A. Rats
B. Mice
C. Humans
D. Rabbits

Response:
Ans. is 'a' i.e., Rats [Ref: Harrison 18th/e p. 1671 & I7th/e p. 1267}o Although the organisms within the pneumocystis genus are morphologically very similar, they are genetically diverse and host specific - P. jirovecii infects humans, where as P.carinii infects rats.Pneumocystis jirovcci (P. carinii)o Pneumocystis is an opportunistic fungal pulmonary pathogen,o Developmental stages1. Pleomorphic trophic form2. Thick walled cyst3. Precyst - an intermediate stageo Risk factors1. HIV (CD4 T cell < 200 mL)3. Primary immunodeficiency diseases2. Immunosuppressive therapy (particularly glucocorticoids)4. Premature malnourished infants.Clinical features of P. carinii pneumonia# Dyspnea# Non productive cough# Tachycardia# Fever# Tachypnea# CynosisExtrapulmonary spreadCommon in patients with HIV to whom aerosolized pentamidine has been administered.Sites of involvement are:o Lymph nodeso Bone marrowo Livero Spleeno Eye (choroiditis) Chest X-rayBilateral diffuse infiltrates beginning in the peri hilar regions - classical finding.Upper lobe infiltrates - who receive aerosolized pentamidine.Pneumothorax.o Hypoxemia is most widely used prognostic factor for P. carinii pneumonia.

So the answer to this question is A


Instruction:
A 13 year old female patient presents to the dental clinic and requests to get braces. On intra-oral examination Class I molar and incisor relationship is seen along with mild lower anterior crowding. Further along the conversation, she reveals how she feels left out as the rest of her classmates have braces while she does not. Patient appears to be very conscious of her appearance and has an inferiority complex. This phenomenon is described by Elkind as:
A. Cognitive equilibrium
B. Constructivism
C. Imaginary audience
D. Centering

Response:
A new expression of egocentrism, presume that they and others are thinking about the same thing. Because young adolescents are experiencing tremendous biologic changes in growth and sexual development, they are preoccupied with these events. Arhen an adolescent considers what others are thinking about, he assumes that others are thinking about the same thing he is thinking about, namely, himself. Adolescents assume that others are as concerned with their bodies, actions, and feelings as they themselves are. They feel as though they are constantly "on stage," being observed and criticized by those around them. This phenomenon has been called the "imaginary audience" by Elkind.' The imaginary audience is a powerful influence on young adolescents, making them quite self-conscious and particularly susceptible to peer influence. They are very worried about what peers will think about their appearance and actions, not realizing that others are too busy with themselves to be paying attention to much other than themselves.

So the answer to this question is C


Instruction:
A boil is due to staphylococcal infection of -
A. Hair follicle
B. Sweat gland
C. Subcutaneous tissue
D. Epidermis

Response:
• Folliculitis, carbuncles and furuncles are all types of localized (superficial) skin infections that fall under the category of boils.
• Hair follicles serve as portals for a number of bacteria, although S. aureus is the MC cause of localized folliculitis.

So the answer to this question is A


Instruction:
All are true about diabetic ketoacidosis except?
A. Raging thirst
B. It is an early presentation in type 1 DM
C. Sodium Nitroprusside test is done to detect ketones
D. Serum bicarbonate > 15 mmol/L

Response:
In diabetic ketoacidosis, the elevated blood sugar due to osmotic diuresis leads to polyuria. The stimulation of osmo-receptors will lead to increased thirst. DKA can lead to early presentation of type 1 DM but more frequently occurs in patients with pre-existing diabetes. Serum ketones are present in DKA and detectable at dilutions of 1:8. Urine dipstick using sodium nitroprusside can help in detection but plasma beta hydroxybutyrate is preferred. Serum bicarbonate levels in DKA are <10mmol/L

So the answer to this question is D


Instruction:
In Raynaud's phenomenon which of the following change is seen in vessels in initial stage?
A. No change
B. Thrombosis
C. Fibrinoid necrosis
D. Hyaline sclerosis

Response:
Raynaud phenomenon results from the exaggerated vasoconstriction of aeries and aerioles in the extremities, paicularly in the fingers and toes. The restricted blood flow induces paroxysmal pallor or cyanosis; involved digits characteristically show " red-white -and-blue " color change most proximal to most distal Robbins 9 th edition page no. 355

So the answer to this question is A


Instruction:
Select the most common clinical sign or symptom for diagnosis PHACE syndrome
A. A 6-month-old child with blindness on the same side as a large facial lesion
B. An infant with infantile spasms, a hypsarrhythmic EEG pattern, and ash-leaf depigmentation on her back
C. An 18-year-old patient with a history of fractures and optic gliomas, who now has developed a malignant schwannoma
D. A 2-year-old child with multiple episodes of skin infection and failure to thrive

Response:
The child with a unilateral facial lesion and blindness suggests either Sturge-Webber or PHACE syndrome (posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta or other cardiac defects, and eye abnormalities). These patients can have seizures, hemiparesis, intracranial calcifications, and mental retardation.

So the answer to this question is A


Instruction:
In a completely charred body at autopsy, medical officer can say that the burns are antemortem if he can find -
A. Soot in respiratory passage
B. Cyanosis of finger nails
C. Congestion of kidney
D. Pale internal organs

Response:
One of the most important characteristic of antemortenri burns is, the finding of 'Soot and carbon particles' in larynx, trachea and may be in lungs.

So the answer to this question is A


Instruction:
Regarding vasomotor symptoms seen with menopause, all are true except
A. Most common symptom of menopause.
B. Fall in circulating oestrogen levels disrupts the body's thermostat.
C. Hot flush affects typically trunk and limbs.
D. 70 percent of women experience vasomotor symptoms at menopause.

Response:
Hot flush classically affects upper trunk and head and neck.

So the answer to this question is C


Instruction:
The finish edge used in anterior metal ceramic jacket crown is
A. Facially shoulder, lingually feather edge
B. Facially shoulder, Lingually shoulder
C. Facially shoulder with bevel, lingually chamfer
D. Facially shoulder, lingually chamfer

Response:
None

So the answer to this question is C


Instruction:
During the treatment of septic shock, a 28-year-old male remains hypotensive despite adequate volume replacement; PA occlusion pressure is 18 mm Hg. When dopamine is staed , ventricular tachycardia develops and this is unresponsive to lidocaine. The V-tach conves back to sinus rhythm once the dopamine is stopped. At this point, which of the following treatments are most appropriate for this hypotensive patient?
A. Amrinone
B. Dobutamine
C. Epinephrine
D. Phenylephrine

Response:
Dopamine activates b1-receptors and this was probably the reason for the arrhythmia. Amrinone will inhibit phosphodiesterase and result in an increased cyclic AMP level, producing the same result as b-receptor stimulation. Dobutamine and epinephrine also stimulate the b- receptors. The only choice which stimulates only a-adrenergic receptors is phenylephrine. Intraaoic balloon pump is invasive, therefore, less appropriate as a choice.

So the answer to this question is D


Instruction:
False about disaster management
A. Response in pre-disaster phase
B. Mitigation in pre-disaster phase
C. Gastroenteritis is commonest infection after disaster
D. Yellow color is for medium priority

Response:
None

So the answer to this question is A


Instruction:
Elevated AFP levels are seen in all of the following conditions, EXCEPT:
A. Hepatoblastoma
B. Seminoma
C. Teratoma
D. None of the above

Response:
AFP concentration is increased only in patients with nonseminoma. The presence of an increased AFP level in a patient whose tumor shows only seminoma indicates that an occult nonseminomatous component exists, and the patient should be treated for nonseminomatous GCT. AFP is normally produced by the fetal yolk sac and also exists in multiple isoforms. It is elevated in GCT cells derived from the embryological yolk sac, including endodermal sinus tumor and embryonal carcinoma. It has also been found to be elevated in other neoplasms such as hepatocellular carcinoma, pancreatic, gastric, and lung cancer. Ref: Motzer R.J., Bosl G.J. (2012). Chapter 96. Testicular Cancer. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.

So the answer to this question is A


Instruction:
The umbilicus is supplied by which spinal segment?
A. T4
B. T6
C. T8
D. T10

Response:
■ The skin around umbilicus is supplied by T10 segment of cord.
■ With reference to lymphatics and venous drainage, it is the watershed area. Educational point:
■ Dermatomes over:
-  The xiphoid process-T7
-  The umbilicus-T10
-  The pubis-L1
■ The remnant of the vitello-intestinal duct may form a tumor of umbilicus known as raspberry /cherry red tumor.

So the answer to this question is D


Instruction:
Nakayama strain used for which vaccine ?
A. Typhoid
B. Chicken pox
C. Japanese encephalitis
D. Yellow fever

Response:
Strains used for JE vaccines:-

Nakayama strain
Beijing strain

So the answer to this question is C


Instruction:
Knudson's two hit hypothesis is characteristically associated with?
A. Neuroblastoma
B. Melanoma
C. Retinoblastoma
D. RCC

Response:
Ans is 'c' i.e. Retinoblastoma * Retinoblastoma is a typical example of Knudson's two hit hypothesisKnudson hypothesis (two-hit hypothesis or multiple-hit hypothesis)* It says that cancer is the result of accumulated mutations to a cell's DNA. Knudson's hypothesis refers specifically to the heterozygosity of tumor suppressor genes.* RB gene is a tumor suppressor gene & typical example of this hypothesis.* Knudson noted that inherited retinoblastoma occurs at a younger age than the sporadic disease. In addition, the children with inherited retinoblastoma often developed the tumor in both eyes, suggesting an underlying predisposition & he suggested that multiple "hits" to DNA were necessary to cause cancer.* Retinoblastoma develops when both the normal alleles of the RB genes are inactive or altered. In Hereditary retinoblastoma first genetic change (first hit) in RB gene is inherited from an affected parent, where as second mutation (second hit) occurs in postnatal life and both alleles are lost. In non- hereditary retinoblastoma, both mutations (first and second hits) occur postnataly.

So the answer to this question is C


Instruction:
All are vasodilators except :
A. Procaine
B. Lidocaine
C. Cocaine
D. Chlorprocaine

Response:
None

So the answer to this question is C


Instruction:
Zinc is a cofactor for
A. Pyruvate dehydrogenase
B. Pyruvate decarboxylase
C. a-keto glutarate dehydrogenase
D. Alcohol dehydrogenase

Response:
More than 300 enzymes are zinc-dependent. Some impoant ones are carboxypeptidase, carbonic anhydrase, alkaline phosphatase, lactate dehydrogenase, alcoholdehydrogenase and glutamate dehydrogenase. RNA polymerase contains zinc and so it is required for protein biosynthesis. Extracellular superoxide dismutase is zinc-dependentand so, zinc has antioxidant activity.Alternatively, all-trans-retinal is transpoed to liver and then reduced to all-trans-retinol by alcohol dehydrogenase (ADH), an NADH dependent enzyme. ADH contains zinc, and therefore, zinc is impoant in retinol metabolism. The all-trans-retinol is isomerized to 11-cis-retinol and then oxidized to 11-cis-retinal in the liver. This is then transpoed to the retina. This completes the Wald&;s visual cycleRef: DM Vasudevan, Page no: 429

So the answer to this question is D


Instruction:
Investigation of choice for intermittent gastrointestinal obstruction:
A. X-ray
B. USG
C. Enteroclysis
D. Barium meal follow-through

Response:
SBO IOC for Dx: X-ray Abdomen ERECT | AIR-FLUID LEVELS SUPINE | SITE OF OBSTRUCTION supine > Erect Gold standard: Diagnostic unceainty High grade obstruction Etiology Strangulation IOC for Dx of low grade intermittent SBO: Enteroclysis

So the answer to this question is C


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

Response:
Tuberculosis represents infection with Mycobacterium tuberculosis, although atypical mycobacterial infections may mimic it. The Ghon complex includes parenchymal consolidation and enlargement of ipsilateral hilar lymph nodes and is often accompanied by a pleural effusion None of the other choices feature acid-fast organisms

So the answer to this question is D


Instruction:
A sea snake is:
A. Neurotoxic
B. Hemotoxic
C. Musculotoxic
D. All of the above

Response:
C i.e. Musculo toxic

So the answer to this question is C


Instruction:
A young man presents with an accident leading to loss of hearing in right ear. On otoscopic examination the tympanic membrane was intact. Pure tone audiometry shows an Air-Bone gap of 55 dB in the right with normal cochlear reserve. Which of the following will be the likely tympanometry finding -
A. AS type tympanogram
B. AD type tympanogram
C. B type tympanogram
D. C type tympanogram

Response:
This is also a very interesting question:

The question says. Pure tone audiometry shows an air bone gap of 55 dB in the right ear with normal cochlear reserve.
The air-bone gap in pure tone audiometry is a measure of total conductive deafness.
Hence – it means there is a conductive deafness of 55 dB in the right ear.
Next the question says – Patient has intact tympanic membrane so we have to look for a cause of this 55 dB conductive deafness.

Average hearing loss seen in different lesions of conductive apparatus

So the answer to this question is B


Instruction:
Which of the following is NOT involved in imparting rancidity to Fats?
A. Oxidation
B. Hydrolysis
C. Reduction
D. Cyclization of hydrocarbons

Response:
Ans. c (Reduction) (Ref. Vasudevan DM, Biochemistry 5th/pg. 76, Harper's 27th/Chapter 15)RANCIDITY OF FATSFats and oils have tendency to become rancid.Rancidity refers to appearance of an unpleasant smell and taste for fats and oilsThere are three mechanisms causing rancidity:# Hydrolytic rancidity# Oxidative rancidity# Polymerization of cyclic hydrocarbonsTypeCommentsHydrolytic rancidity Oxidative rancidity# Occurs due to partial hydrolysis of triacyl glycerol molecules due to traces of hydrolytic enzymes in naturally occurring fats and oils.# Occurs due to partial oxidation of Unsaturated Fatty Acids with resistant forms of epoxides and peroxidation of small molecular weight fatty acids by the peroxides and free radicals.# The same process if occurs in vivo will affect integrity of biomembrane, leading to cell death.# Many naturaly occurring fat cell oils may contain antioxidant (like Vitamin E) which prevents occurance of oxidative rancidity.# PUFA more easily oxidized, so vegetable oils with high PUFA are preserved by adding antioxidants.Polymerization of cyclic hydrocarbons# Fats and oils are preferred cooking media.# Overheating and repeated heating would lead to formation and polymerization of cyclic hydrocarbons, which imparts unpleasant taste and colour to the oil.# Coconut oil typically withstands this.Educational Points:# Naturally occurring antioxidants:- Vitamin E (tocopherol), which is lipid-soluble - prevents rancidity- Urate and vitamin C, which are water-soluble.- Beta-carotene is an antioxidant at low P02.# Antioxidants used as food additives:- Propyl gallate, butylated hydroxyanisole (BHA), and butylated hydroxytoluene (BHT)ANTIOXIDANTS FALL INTO TWO CLASSES# Preventive antioxidants, which reduce the rate of chain initiation- Catalase- Peroxidases such as glutathione peroxidase that react with ROOM;- Selenium, which is an essential component of glutathione peroxidase and regulates its activity and- Chelators of metal ions such asEDTA and DTPA.# chain-breaking antioxidants, which interfere with chain propagation.- Superoxide dismutase, which acts in the aqueous phase to trap superoxide free radicals (O2);- Urate; and- Vitamin E, which acts in the lipid phase to trap ROO radicals - prevents rancidity.

So the answer to this question is C


Instruction:
The substance that is a vasodilator elsewhere but causes vasoconstriction in kidneys (afferent aeriole) is:
A. Nitric oxide
B. Adenosine
C. Bradykinin
D. Endothelin

Response:
Adenosine has 2 receptors - A1 & A2 A2 vasodilation (elsewhere) A1 vasoconstriction (kidney) Adenosine is a ligand, pa of the tubuloglomerular feedback. Macula densa cells sense the Na+ level in tubular fluids. Excess Na+ reaching macula densa cells Na+ / K+ ATPase pump in basolateral membranes transpo Na & K+ by degrading ATP Adenosine formed as a by product Adenosine acts as a ligand on the A1 receptors of afferent aeriole Constriction of afferent aerioles

So the answer to this question is B


Instruction:
Which of the following statement is true regarding BMR?
A. Is not influenced by energy intake
B. Increases in response to starvation
C. May decrease up to 50% during period of starvation
D. Not responsive to change in the hormonal level

Response:
This is a pa of survival mechanism in starvation.Reduced energy intake reduces BMR and increased energy intake increases BMR. BMR changes in response to hormone level. Thyroid hormone, coisol etc increases the BMR.

So the answer to this question is C


Instruction:
Still born child is defined by -
A. > 20 wks
B. > 24 wks
C. > 28 wks
D. > 32 wks

Response:
Ans. is 'c' i.e., >28 wks "Still bih" includes death of a fetus weighing 1000 gm or more and this is equivalent to 28 weeks of gestation.

So the answer to this question is C


Instruction:
According to WHO, blindness is defined as a visual acuity of the better eye, less than
A. 6/60.
B. 5/60.
C. 4/60.
D. 3/60.

Response:
Blindness

WHO has proposed a uniform criterion and defined blindness as "Visual acuity of less than 3/60 or its equivalent".
In the absence of appropriate vision charts, the WHO has now added the "inability to count fingers in daylight at a distance of 3 meters" to indicates less than 3/60 or its equivalent.

So the answer to this question is D


Instruction:
All are true about entamoeba histolytica except:
A. Stool trophozoites are essential for diagnosis
B. Mostly asymptomatic
C. Cause disease in brain, liver
D. Infection does not provide immunity

Response:
Ans. (a) Stool trophozoites are essential for diagnosis Diagnosis of intestinal amoebiasis is suggested by presence of cyst or dead trophozoite in stool. A. Laboratory diagnosis of Intestinal amoebiasis Stool examination Stool Culture Media used Mucosal scrapings Serodiagnosis Molecular diagnosis Microscopy Macroscopy Iodine stained preparation preparations to demonstrate trophozoite or cyst Boeck and Drbohlav NIH polygenic Craig's Nelson's Robinson's Wet mount Stained preparation IHA ELISA Latex agglutination test DNA probe B. Laboratory diagnosis of amoebic liver abscess Microscopy of pus or aspirate Histopathological examination of pus or aspirate Serodiagnosis IHA ELISA Latex agglutination test Radiological examination X-ray USG CT scan MRI Stoolexamination

So the answer to this question is A


Instruction:
In conversion disorder, all are found except -
A. Jealousy
B. Paralysis
C. Anaesthesia
D. Abnormal gait

Response:
Sensory:- Anesthesia, paresthesia, hemianesthesia, deafness, blindness, tubular vision.
Motor:- Abnormal movement, paralysis, weakness, gait disturbances, aphonia, torticollis, opisthotonus, blepharospasm.

So the answer to this question is A


Instruction:
Not a contributing factors for ANUG
A. Pericoronal flap
B. Poor oral hygiene
C. Smoking
D. Apthous ulcers

Response:
None

So the answer to this question is D


Instruction:
A 27 year old patient presented with left sided abdominal pain to the emergency room, 6 hours after an A. He was hemodynamically stable and FAST positive. Contrast Enhanced CT (CECT) scan showed grade III splenic laceration. What will be the most appropriate treatment?
A. Splenectomy
B. Splenorrhaphy
C. Splenic Aery Embolization
D. Conservative Management

Response:
There are criterias for conservative mangement in splenic injured patients such as hemodynamical stability, minimal transfusion requirement, no other abdomen injuries and ablity to perform series of abdominal examination. A stable defect on repeat imaging also suppos. As this patient is hemodynamically stable, with no other abdominal injuries along with grade iii laceration of spleen will fit in this criterion. Ref: Surgery : Basic Science and Clinical Evidence By Jeffrey A. Noon, Philip S. Barie, Randall Bollinger, 2nd Edition, Pages 1116, 1117

So the answer to this question is D


Instruction:
All of the following immunosuppressives cause profound myelosuppression except:
A. Sirolimus
B. Cyclosporine
C. Azathioprine
D. Mercaptopurine

Response:
Ciclosporin&;s main effect is to lower the activity of T-cells; it does so by calcineurin-phosphatase pathway.Unlike cytotoxic immunosuppressants, it is free of toxic effects on bone marrow and RE system as it doesn&;t act on cell cycle.(ref: KD Tripathi 6/e p839)

So the answer to this question is B


Instruction:
Which of the following is not seronegative spondyloarthropathy?
A. Reiter's arthritis
B. Ankylosing spondylitis
C. Psorialic arthritis
D. Rheumatoid arthritis

Response:
Seronegative spondyloarthroparthies are group of disorders with involvement of sacroiliac joint and associated with HLA-B27.
Rheumatoid arthritis doesn't belong to this group.

So the answer to this question is D


Instruction:
Surgery is indicated in Ulcerative Colitis in all except?
A. Toxic megacolon
B. Colonic polyp
C. Colonic obstruction
D. Refractory fistula

Response:
-Indication for surgery in a patient of UC are: Intractability - refractory to medical management Dysplasia Carcinoma Massive colonic bleeding Toxic megacolon

So the answer to this question is B


Instruction:
All are true about Keloid EXCEPT:
A. May be familial
B. Appears mostly on sternum
C. Subsides over time
D. Hyperkeratotic

Response:
Ans: (c) Subsides over timeRef: Manipal Manual of Surgery 4th ed. / 9* Keloids can be remembered as uscars that dont know when to stop"* A keloid, sometimes referred to as a keloid scar, is a tough heaped-up scar that rises quite abruptly above the rest of the skin.* It can appear few day to few weeks after surgery.* It usually has a smooth top and a pink or purple color. Keloids are irregularly shaped and tend to enlarge progressively.* Unlike scars, keloids do not subside over time. Instead it spreads and includes normal skin also.* Keloid scars are made of dense collagen fibres.* Recurrence is possible after local excision.* It can be familial.* Most common site of keloid: sternum.* It can be treated by intrakeloid injection of Triamcinolone.* Best cure of keloid is achieved by excision and radiotherapy.

So the answer to this question is C


Instruction:
A dead body is having cadaveric lividity of bluish green colour. The most likely cause of death is by poisoning due to -
A. Hydrocyanic acid
B. Hydrogen sulphide
C. Ocleander
D. Sodium nitrite

Response:
Poison Color Nitrites Reddish brown Potassium chlorate Chocolate brown Phosphorus Dark brown Hydrogen sulphide Bluish green Cyanide Cherry red Carbon monoxide Pink Opium Blackish Ref: K.S.Narayan Reddy's Synopsis of Forensic Medicine and Toxicology, 29th edition, Chapter 35.

So the answer to this question is B


Instruction:
Renal vein thrombosis is most commonly associaed with -
A. Diabetic nephropathy
B. membranous glomerulopathy
C. Minimal change disease
D. membrano-proliferative glomerulonephritis

Response:
Membranous nephropathy Membranous nephropathy is the most common cause of nephrotic syndrome in Caucasian adults. It is caused by antibodies (usually autoantibodies) directed at antigen(s) expressed on the surface of podocytes, including the M-type phospholipase A2 receptor 1. While most cases are idiopathic, a propoion are associated with other causes, such as heavy metal poisoning, drugs, infections, lupus and tumours . Approximately one-third of patients with idiopathic membranous nephropathy undergo spontaneous remission, one-third remain in a nephrotic state, and one-third develop progressive CKD. High doses of glucocoicoids and cyclophosphamide may improve both the nephrotic syndrome and the long-term prognosis. However, because of the toxicity of these regimens, many nephrologists reserve such treatment for those with severe nephrotic syndrome or deteriorating renal function. Treatment of secondary membranous nephropathy is directed at the underlying cause. Ref Harrison20th edition pg 297

So the answer to this question is B


Instruction:
The accepted polymer to monomer ratio for packing of polymethyl methacrylate resin is
A. 3:01
B. 4:01
C. 10:01
D. 5:01

Response:
None

So the answer to this question is A


Instruction:
Energy expenditure in resting state depends on
A. Lean body mass
B. Adipose tissue
C. Resting hea rate
D. Exercise

Response:
Both basal metabolic rate and resting metabolic rate are usually expressed in terms of daily rates of energy expenditure. The early work of the scientists J. Ahur Harris and Francis G. Benedict showed that approximate values could be derived using body surface area (computed from height and weight), age, and sex, along with the oxygen and carbon dioxide measures taken from calorimetry. Studies also showed that by eliminating the sex differences that occur with the accumulation of adipose tissue by expressing metabolic rate per unit of "fat-free" or lean body mass, the values between sexes for basal metabolism are essentially the same. The Katch-McArdle Formula (BMR) , where LBM is the lean body mass in kg. The Cunningham Formula (RMR): , where LBM is the lean body mass in kgRef: Ganong&;s review of medical physiology;24th edition; page no-489

So the answer to this question is A


Instruction:
Amount of chlorine needed to kill cyclops in drinking water is: September 2007
A. 3 ppm
B. 4 ppm
C. 5 ppm
D. 6 ppm

Response:
Ans. C: 5 ppm Park's PSM, 21st ed., p- 723 states: Chlorine destroys cyclops and larvae of the guineaworm in a strength of 5 ppm Cyclops may be controlled by the use of the physical, chemical or biological methods: Physical methods - Straining - Boiling at 60 degree Celsius Chemical methods - Chlorine in a strength of 5 ppm - Lime - Abate Biological - Barbel fish and gambusia fish The most satisfactory and permanent method of controlling Cyclops in drinking water is to provide piped water supply or tube wells. Abolition of step wells and provision of sanitary wells should receive attention in rural areas.

So the answer to this question is C


Instruction:
Squamaus cell Carcinoma of bladder is predisposed by-a)  Urolithiasisb)  Persistent urachusc)  Schistosomiasisd) Polype)  Smoking
A. a
B. ac
C. ad
D. b

Response:
None

So the answer to this question is B


Instruction:
Not true about acdes mosquito
A. Boat shaped eggs
B. Also knows as tiger mosquito
C. Larvae has siphon tube
D. Has stripes on body

Response:
Eggs are cigar shaped.

So the answer to this question is A


Instruction:
Which among the following subtypes of Osteogenesis imperfecta is not associated with blue sclera?
A. Type I
B. Type II
C. Type III
D. Type IV

Response:
Ans. (d) Type IV(Ref: Robbins 9th/pg 140; 8th/pg 140)Classification of Osteogenesis Imperfecta (OI)TypeBone FragilityBlue ScleraAbnormal DentitionHearing LossInheritanceIMildPresentPresent in somePresent in mostADIIExtremePresentPresent in someUnknownS, rarely ARIIISevereBluish at birthPresent in someHigh incidenceAD, rarely ARIVVariableAbsentAbsent in IVA, present in IVBHigh incidenceADVModerate to severeAbsentAbsent ADVIModerate to severeAbsentAbsent UnknownVIIModerateAbsentAbsentAbsentAR

So the answer to this question is D


Instruction:
Patient with IQ of 60 has -
A. Mild mental retardation
B. Moderate M..R
C. Severe M.R.
D. Profound M.R.

Response:
None

So the answer to this question is A


Instruction:
LASIK is used in -
A. Myopia
B. Hypermetropia
C. Astigmatism
D. Presbyopia

Response:
Laser in-situ keratomileusis (LASIK), Currently this procedure is being considered the refractive surgery of choice for myopia of up to - 12 D. Patient selection criteria are:  Patients above 20 years of age,  Stable refraction for at least 12 months.  Motivated patient.  Absence of corneal pathology Reference : A K KHURANA OPHTALMOLOGY,Edition 4, Page-47

So the answer to this question is A


Instruction:
Motile spermatozoa found on a wet mount of vaginal secretions are indicative of intercourse within the past :
A. 6 hours
B. 12 hours
C. 24 hours
D. 48 hours

Response:
24 hours

So the answer to this question is C


Instruction:
Which of the following malignancy does not show lymphatic metastasis?
A. Squamous cell Ca
B. Basal cell Ca
C. Malignant melanoma
D. Kaposi's sarcoma

Response:
Basal cell Ca is a low grade malignancy which spread by local invasion and does not show lymphatic metastasis. It is a well defined, firm lesion with waxy beaded margin. The ideal treatment of choice is excision with 0.5cm of normal skin margin. Ref: Illustrated synopsis of Dermatology and Sexually transmitted disease 2nd edn, By Neena Khanna page 308.

So the answer to this question is B


Instruction:
Following are the clinical features of Leber optic neuropathy except -
A. Seen in the 2nd or 3rd decade of life
B. It is a example of gradual painless visual loss
C. Males can transmit the disease
D. No leak of dye is observed in fluorescein angiography

Response:
It is a type of hereditary optic neuritis which primarily affects males around the age of 20 years. It is transmitted by the female carriers. The condition is characterised by progressive visual failure. The fundus is initially normal or in the acute stage disc may be mildly hyperaemic with telangiectatic microangiopathy. Eventually bilateral primary optic atrophy ensues. Ref: AK Khurana 4thE pg 296

So the answer to this question is C


Instruction:
Restriction enzyme Type II
A. Methylates specific DNA sequences
B. Cleaves specific palindromic DNA sequences
C. Helps in protein digestion
D. Helps in keeping the nascent protein unfolded

Response:
Restriction enzyme type II identifies the palindromic sequences on the DNA and cuts the DNA strand at a ceain specific site. Types of Restriction EnzymesRestriction enzymes are traditionally classified into four types on the basis of subunit composition, cleavage position, sequence specificity and cofactor requirements. Type I enzymes are complex, multisubunit, combination restriction-and-modification enzymes that cut DNA at random far from their recognition sequences.Type II enzymes cut DNA at defined positions close to or within their recognition sequences. They produce discrete restriction fragments and distinct gel banding patterns, and they are the only class used in the laboratory for DNA analysis and gene cloning. Type III enzymes are also large combination restriction-and-modification enzymes. They cleave outside of their recognition sequences and require two such sequences in opposite orientations within the same DNA molecule to accomplish cleavage; they rarely give complete digests.Type IV enzymes recognize modified, typically methylated DNA and are exemplified by the McrBC and Mrr systems of E. coli.

So the answer to this question is B


Instruction:
Passive forcible dorsiflexion of foot with knee extended causes pain in the calf. This is called
A. Moses sign
B. Homan's sign
C. Schwartz sign
D. Fegan's test

Response:
Homan's sign is test for deep vein thrombosis. Passive dorsiflexion of foot with knee extended causes pain in the calf.

So the answer to this question is B


Instruction:
New word constructed by a patient or ordinary words used in a special way is called?
A. Tangentially
B. Illusion
C. Neologism
D. loosening of association

Response:
Ans. C. NeologismNeologism: It is a disorder of form of thought. Here either a completely new word/ phrase whose derivation cannot be understood is used by the patient or ordinary words used in special way. Presence of neologism is highly s/o of schizophrenia. E.g. Word "Pravitynat" may be used by a person for spectacles.

So the answer to this question is C


Instruction:
Not a common cause of meningitis in a child of age 8 years is:
A. S. pneumococci
B. H. influenza
C. S. aureus
D. Meningococci

Response:
S. aureus REF: Nelson 17th edition page 863, "Meningitis due to S. aureus is not common; it is associated with cranial trauma and neurosurgical procedures ( e.g. craniotomy, cerebrospinal fluid shunt placement) and less frequently with endocarditis, parameningeal foci (e.g., epidural or brain abscess), diabetes mellitus, or malignancy. The CSF profile in S. aureus meningitis is indistinguishable from that in other bacterial causes of meningitis" Causes of bacterial meningitis vary by age group and comorbid conditions: Age Group & conditions Causes Premature babies & New- horns up to 3 month Group B Streptococci (mc), Streptococcus pneumoniae, Escherichia coli (carrying K1 antigen), Listeria monocytogenes Infants Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae Children (2-29 years) N. meningitidis (mc), S. pneumoniae Adult S. pneumoniae (mc), N. meningitidis, Mycobacteria Impaired cellular immunity L monocytogenes, gram-negative bacilli, S pneumoniae Postsurgical or posttraumatic Staphylococcus aureus, S pneumoniae, gram-negative bacilli

So the answer to this question is C


Instruction:
IPV is given at
A. 6 weeks
B. 6 & 10 weeks
C. 6 & 14 weeks
D. 6, 10 & 14 weeks

Response:
As a pa of Polio endgame strategy, Inactivated Polio Vaccine (IPV) vaccine has been introduced across all the states of the country. IPV is provided either as a single dose at 14 weeks of age or as two fractional doses at 6 weeks and 14 weeks of age.Park 24e pg no: 218

So the answer to this question is C


Instruction:
Sourse of progesterone during normal mestrual cycle :
A. Corpus luteum
B. Stroma
C. Surface epithelium of ovary
D. None

Response:
Corpus luteum

So the answer to this question is A