Instruction:
Which of the following acts as coenzyme, not as co-factor?
A. Ascorbic acid
B. Biotin
C. Thiamine
D. Folic acid

Response:
None

So the answer to this question is A


Instruction:
Saw tooth retepegs are seen in
A. Lichen planus
B. Leukoplakia
C. Pamphigus vulgaris
D. Psoriasis

Response:
Histology of Lichen planus:

So the answer to this question is A


Instruction:
30 years old primipara in labour with transverse He- Treatment of choice is:
A. Internal cephalic version
B. Emergency cesarean section
C. Wait and watch
D. External cephalic version

Response:
caesarian is the best option in most cases of transverse lie.It is also indicated when external version fails or is contraindicated.If the membranes are intact a low transverse incision is usually possible.There may be difficulty in delivery of the baby at caesarian section in cases done late in labour after the liqour has drained away (refer pgno:385 sheila textbook of obstetrics 2 nd edition)

So the answer to this question is B


Instruction:
Cytokine that have pyrogenic activity is:
A. IL-6
B. IL-8
C. TGF beta
D. IL-3

Response:
Ref. Robbins Pathology. 9th edition. Page. 99

Easy and a straight forward question.
Most important interleukins are listed below

So the answer to this question is A


Instruction:
Which of the following characterizes pathological jaundice?
A. Jaundice on 3rd day
B. Jaundice upto the trunk
C. High colored urine
D. Jaundice accompanied by yellow stools

Response:
c. High colored urine(Ref: Nelson's 20/e p 871-879, Ghai 8/e p 172-176)Pathological Jaundice:May appear in 1st 24 hoursMay stain palms and solesHigh coloured urine and clay colored stools may be presentMay persist beyond 3 weeks

So the answer to this question is C


Instruction:
Macrophages are major source of?
A. IL-1
B. IL-5
C. IL-7
D. IFN- y

Response:
IL-1 REF: Jawett's microbiology, 24th edition chapter 8 Immunology Table 8-3 See APPENDIX-19 for list of "CYTOKINES"

So the answer to this question is A


Instruction:
Which of the following is an activator of LCAT
A. Apo B 100
B. Apo B 48
C. Apo E
D. Apo AI

Response:
Apo-Al

Apo A-I is an activator for lecithin : cholesterol acyl transferase (LCAT).

So the answer to this question is D


Instruction:
Crucible indicated for casting base metal alloys is:
A. Carbon crucible
B. Clay crucible
C. Quartz crucible
D. High melting plastic crucible

Response:
None

So the answer to this question is C


Instruction:
Which of the following drug is most likely to precipitate angina:
A. Diltiazem.
B. Verapamil.
C. Amlodipine.
D. Nifedipine.

Response:
None

So the answer to this question is D


Instruction:
All of the following are true about apolipoprotein, EXCEPT:
A. Apo A1 activates LCAT
B. Apo CI activates lipoprotein lipase
C. Apo CII activates lipoprotein lipase
D. Apo CII inhibits lipoprotein lipase

Response:
Apo CII is not an inhibitor of lipoprotein lipase rather it is an activator of lipoprotein lipase. Apo AII and Apo CIII acts as an inhibitor of enzyme lipoprotein lipase.

So the answer to this question is D


Instruction:
In Klinefelter syndrome, all are true except
A. Negative feedback on FSH and LH are lost
B. Decreased Androstenedione levels
C. Hypoplastic male external genitalia
D. Most common cause of primary testicular failure

Response:
In Klinefelter syndrome, since testosterone levels are decreased, negative feedback on FSH and LH is lost.
Increased FSH stimulates Leydig cells, thereby causing elevated levels of Androstenedione.

So the answer to this question is B


Instruction:
What is the survival rate in patients with unresectable gallbladder carcinoma?
A. 2-6 months
B. 8-10 months
C. 1 yr 8-10 months
D. 12-24 months

Response:
Survival rate in patients with unresectable gall bladder carcinoma is 2 - 6 months and therefore operative exploration should be avoided in such patients. In such patients palliative therapy can be given. Narcotics can be given, percutaneous celiac ganglion block helps in reducing the need for narcotics. Chemical splanchnicectomy can be performed in patients with unresectable lesions found at the time of surgery.

So the answer to this question is A


Instruction:
A man is given continuous testosterone.It would lead to:
A. azoospermia
B. increased sperm motility
C. increased spermatogenesis
D. increased gonadotrophins

Response:
azoospermia [Ref: Katzung Pharmacology 10/e p675; Guyton 11/e p1066; KDT 5/e p2911 "Replacement therapy in men may cause acne, sleep apnea, erythrocytosis, gynecomastia, and azoospermia. Supraphysiologic doses of androgens produce azoospermia and decrease in testicular size, both of which may take months to recover after cessation of therapy."

So the answer to this question is A


Instruction:
In sickle cell trait, number of bands found in Hb
A. 2
B. 1
C. 4
D. 5

Response:
Ans. is 'a' i.e., 2 In hemoglobin electrophoresis, various types of hemoglobin move at varying speed. In sickle cell trait (heterozygous state), there are two types of hemoglobin - HbS (40%) and HbA (60%). So, on electrophoresis two different bands are produced. In Homozygous state, almost all hemoglobin is HbS. So, single band is produced. Laboratory findings of sickle cell anemia Moderate to severe anaemia o Peripheral smear will show Sickle cells Howell - Jolly bodies because of autosplenectomy Target cells o A positive sickling test with a reducing substance like sodium metabisulfite.

So the answer to this question is A


Instruction:
Tubulointerstitial disease are all except
A. Hypokaelemic nephropathy
B. Lupus nehpritis
C. Hypercalcemic nephropathy
D. Analgesic nephropathy

Response:
Refer Robbins 9/e pg 929 iety of renal lesions and clinical presentations. The clinical manifestations can include recurrent microscopic or gross hematuria, the nephritic syndrome, rapidly progressive glomerulonephritis, the nephrotic syndrome, acute and

So the answer to this question is B


Instruction:
Length of naso lacrimal duct is:
A. 10 mm
B. 11 mm
C. 12 mm
D. 9 mm

Response:
Ans. 12 mm

So the answer to this question is C


Instruction:
Eosinophilic abscess in lymph node is characteristically
A. Kimura disease
B. Hodgkins lymphoma
C. Tuberculosis
D. Sarcoidosis

Response:
.

So the answer to this question is A


Instruction:
What is the action of anconeus?
A. Primary elbow extensor
B. Assists Extension of elbow
C. Wrist extension
D. Thumb Abduction

Response:
Ans. is 'b' i.e., Assists Extension of elbow Anconeus* Anconeus originates on the posterior surface of the lateral epicondyle of the humerus and inserts distally on the posterior surface of the ulna.* Anconeus is innervated by a branch of the radial nerve* Its role in elbow extension is trivial in humans. It assists in extension of the elbow, where the triceps brachii is the principal agonist, and supports the elbow in full extension.* It also prevents the elbow joint capsule being pinched in the olecranon fossa during extension of the elbow.

So the answer to this question is B


Instruction:
The first test to become positive in patients with Hemochromatosis is:
A. Increased Serum Iron
B. Increased Serum Ferritin
C. Increased Transferrin Saturation
D. Increased Liver Enzymes

Response:
Answer is C (Increased Transferrin Saturation):Transferrin Saturation is the first blood test to become elevated in Hemochromatosis.The first biochemical manifestation of hemochromatosis is an increase of transferring saturation, which reflects an uncontrolled influx of iron into the blood stream .from enterocytes and macrophages.The serum transferrin saturation and serum ferritin levels are the two most impoant indicators of hemochromatosis and body iron stores.Elevation of transferrin levels precedes elevation offerritin levels.The first biochemical manifestation of hetnochromatosis is an increase in serum transferrin saturation.Serum iron concentration per se is not a good indicator for iron overload states like Hemochromatosis.Liver Enzymes may be normal or elevated depending on the extent of hepatocyte damage.They are usually normal or only mildly elevated in the early stages of hemochromatosis.Laboratory findings in HemochromatosisTransferrin saturation is the first blood test to become elevated in hemochromatosis homozygotesThe sensitivity of elevated transferring saturation to identify a patient with hemochromatosis is 94 to 98% and its specificity is 70 to 98%.Transferrin saturation is usually > 60% in symptomatic men and >50% in symptomatic womenUnboundSerumLiverDNA testing by polymerase chain reaction may he used to detect mutations of the HFE gene.

So the answer to this question is C


Instruction:
A 26 year old female patient complains of tooth sensitivity while eating ice-cream. Intra-oral examination reveals Class V lesion with 23. She also gives a history of bruxism. Microfilled composite is most useful in this patient due to:
A. Increased viscosity
B. Low modulus of elasticity
C. Low filler content
D. None of the above

Response:
The low modulus of elasticity of microfilled composites allow them to flex with tooth and protect the bonding interface. This is most useful in bruxism, clenching and stressful occlusion where flexure forces are high.
Reference- Sturdevant 4th ed P:257

So the answer to this question is B


Instruction:
The most important clinical fmding in a case of head injury is -
A. Pupillary dilatation
B. Level of consciousness
C. Focal neurological deficit
D. Fracture skull

Response:
Conscious level determined on Glasgow coma scale.

So the answer to this question is B


Instruction:
Lalloo 50 yrs, a chronic smoker presents with a history of hemoptysis. He was having truncal obesity and hypertension. He had an elevated ACTH level which was not suppressible with high dose dexamethasone. What would be the most probable diagnosis -
A. Bilateral adrenal hyperplasia
B. Adrenal adenoma
C. Pituitary tumor
D. Ectopic ACTH producing lung cancer

Response:
None

So the answer to this question is D


Instruction:
In case of hepatic porphyria the safe anticonvulsant is
A. Clonazepam
B. Paraldehyde
C. Phenytoin
D. Carbamazepine

Response:
(A) Clonazepam > Seizures can be due to neurologic effects or to hyponatremia.> Treatment of seizures is difficult because virtually all antiseizure drugs (except bromides) may exacerbate> AIP (clonazepam may be safer than phenytoin or barbiturates).

So the answer to this question is A


Instruction:
Function of hepatic stellate cells are
A. Vitamin A storage
B. Formation of sinusoids
C. Increase blood perfusion
D. Phagocytosis

Response:
The hepatic cells are of mesenchymal origin , found in space of Dessie. The stellate cells play a role in the storage and metabolism of vitamin A and are transform into collagen producing myofibroblast when there is inflammation and Fibrosis of liver. Refer 9/e p436

So the answer to this question is A


Instruction:
Maximum fat is found in -
A. Buffalo milk
B. Goat milk
C. Human milk
D. Cow milk

Response:
Ans. is 'a' i.e., Buffalo milkNutritive value of milks compared (value per 100 grams) BuffaloCowGoatHumanFat(g)6[?]54[?]14[?]53[?]4Protein(g)4[?]33[?]23[?]31[?]1Lactose(g)5[?]14[?]44[?]67[?]4Calcium(mg)21012017028Iron(mg)0[?]20[?]20[?]3 Vitamin C(mg)1213Minerals(g)0[?]80[?]80[?]80[?]1Water(g)8108786[?]888Energy(kcal)117677265o Fat content of milt. Buffalo > Goat > Cow > Human.o Protein content of milk: Buffalo > Goat > Cow > Human,o Lactose content of milk: Human > Buffalo > Goat > Cow.o Energy> content of milk: Buffalo > Goat > Cow > Human.

So the answer to this question is A


Instruction:
According to resistance apex locators, the resistance offered by periodontal ligament and oral mucous membrane is:
A. 6.5 K ohms
B. 5.5 K ohms
C. 4.4 K ohms
D. 3.5 K ohms

Response:
FIRST-GENERATION APEX LOCATORS (RESISTANCE APEX LOCATORS)
They are also known as resistance apex locators that measure opposition to the flow of direct current, that is, resistance. It is based on the principle that resistance offered by periodontal ligament and oral mucous membrane is the same, that is, 6.5 K ohms. Initially, Sono-Explorer was imported from Japan by Amadent, (Port Jefferson, New York) but nowadays, first-generation apex locators are off the practice. Blood, pus, chelating agents, irrigants, and other materials used within the canal can give false readings.

So the answer to this question is A


Instruction:
Increased LAP score is seen in:
A. Chronic myeloid leukemia
B. Myelofibrosis
C. PNH
D. Megaloblastic anemia

Response:
None

So the answer to this question is B


Instruction:
Which one of the following characterizes a poal system of blood vessels?
A. The absence of a capillary bed, thus shunting aerial blood directly to venules
B. A capillary bed supplied and drained by a larger, non capillary vessel
C. Two capillary beds connected by a larger blood vessel
D. A continuous capillary bed that extends from one organ to another

Response:
A poal system of blood circulation is defined as two capillary beds that are joined by an aerial or venous blood vessel. An example is the poal vein connecting the mucosal capillaries of the small intestine to the sinusoids (i.e., capillaries) of the liver. While capillary beds may connect pas of an organ (e.g., adrenal coex, pancreatic islet), capillaries do not extend between organs. Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 10. Midgut and Hindgut. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy.

So the answer to this question is C


Instruction:
Lesion in Wernicke's area results in:
A. Global aphasia
B. Non-fluent aphasia
C. Conduction aphasia
D. Failure of comprehension of spoken or written words

Response:
The two areas concerned with language and speech are: (i) Wernicke's area (the sensory area for speech) in the superior temporal lobe and (ii) Broca's area (the motor area for speech) in the inferior frontal lobe. Wernicke's area: After understanding and comprehension of the word, the impulses are sent, arcuate fasciculus, to the Broca's area. Lesion: Speech production is normal (since motor area that finally produces actual words is not damaged). However, patients talk excessively; what they say is full of jargon and neologisms that make little sense. Patient fails to comprehend the meaning of spoken or written words. This is called fluent aphasia.

So the answer to this question is D


Instruction:
Parietal branch of middle meningeal artery, which is closely related to cerebrum,  it's involvement results:
A. Hemiplagia of contralateral side.
B. Ipsilateral drafness.
C. Contalateral deafness
D. All of the above.

Response:
Middle meningeal artery enters the middle cranial fossa through the foramen spinosun. In middle cranial fossa, it has an extradural course and divides into anterior frontal branch and posterior parietal branch.
The frontal branch is closely related to the motor area of cerebral cortex. It is the commonest source of extradural hemorrhage, and results in hemiplegia of opposite side. The parietal branch is closely related to cerebrum and its involvement results in contralateral deafness.

So the answer to this question is C


Instruction:
All are true about intermittent claudication except
A. Most common in calf muscle
B. Pain is positional
C. Atherosclerosis is impoant predisposing factor
D. relieved by rest

Response:
<p> Intermittent claudication: Crampy pain in the muscles seen in limbs. Due to aerial occlusion, metabolites like lactic acid and substance P accumulate in the muscle and cause pain. Site of pain depends on site of aerial occlusion. Most common site is calf muscles. Pain in foot is due to block in lower tibial and plantar vessels. Pain in calf is due to block in femoropopliteal segment. Pain in thigh is due to block in superficial femoral aery. Pain in buttock is due to block in common iliac aery. Pain commonly develops when muscles are exercising and relieved on rest. Beta blockers may aggravate claudication. {Reference: SRB&;s manual of surgery, 5th edition , page no. 170}

So the answer to this question is B


Instruction:
Oligohydramnios is seen in :
A. Renal agenesis
B. Oesophageal atresia
C. Exomphalos
D. Neural tube defect

Response:
Ans. is a i.e. Renal agenesis Oligohydramnios is a condition where liquor amnii is deficient (< 200 ml at term). Sonographically it is defined as : Absence of amniotic fluid pocket.deg Maximum veical diameter of amniotic fluid pocket less than 2 cm.deg Amniotic fluid index less than 5 cms.deg Causes of oligohydramnios : Mnemonic : Dil Mein Ppaar (read as pyaar) Dil - Drug( Prostaglandin Synthetase inhibitors and ACE inhibitors). IUGR Leaking of fluid following amniocentesis or chorionic villus sampling. Mein - Maternal conditions like hypeension and preeclampsia. Ppaar - Post term pregnancy - Premature rupture of membrane - Abruptio-chronic - Amnion Nodosum.deg - Renal anomalies of fetus(leading to decreased urine production) : Renal agenesisdeg Urethral obstruction (Posterior urethral valve) Prune Belly syndrome Bilateral Multicystic dysplastic kidneys. Also know : Non Renal Fetal anomalies leading to oligohydraminos : Triploidy Thyroid gland agenesis Congenital hea block Skeletal dysplasia Note : Most common complication of Oligohydramnios - Pulmonary hypoplasiadeg.

So the answer to this question is A


Instruction:
The best prognosis in carcinoma stomach is with -
A. Superficial spreading type
B. Ulcerative type
C. Linitis plastica type
D. Polypoidal type

Response:
Gastric Carcinoma is classified on the basis of →
1) Depth of invasion
2) Growth pattern
3) Histologic subtype

The depth of invasion -

The morphological feature having the greatest impact on clinical outcome ( prognosis) is the depth of invasion.
On the basis of the depth of invasion, stomach cancers are divided into -

A. Early gastric carcinoma (superficial spreading type)

Lesions are confined to the mucosa and submucosa regardless of the presence or absence of perigastric lymph node metastasis.
Has the best prognosis.

B. Advanced gastric carcinoma

A neoplasm that has extended below the submucosa into the muscular wall and spread more widely.

Growth pattern -

Based on a growth pattern, gastric carcinoma is divided into:-

Exophytic →  Protrusion of tumor mass into the lumen
Flat or depressed  → There is no obvious tumor mass within the mucosa
Excavated (ulcerative)  → Erosive crater is present in the wall of the stomach .

All the three types may be evident at early or advanced stage --> If evident at an advanced stage, prognosis is poor, and if evident at early stage prognosis is good.
An uncommon fourth type of growth pattern is:-

D. Linitis plastica ( Scirrhous Ca) → Abroad region of the gastric wall or entire stomach is extensively infiltrated by malignancy, creating a rigid, thicked leather bottle stomach. It has the worst prognosis.
Histologic subtypes -

The two most important histologic subtypes are

A. Intestinal type → Composed of neoplastic intestinal glands resmbling those of colonic adenocarcinoma.
B. Diffuse variant → Composed of gastric type of mucous cells, which generally do not form glands. The appearance of the cells is "Signet ring" appearance because the mucin in the cell pushes the nucleus to the periphery. It is seen more frequently with E-Cadherin mutation.

So the answer to this question is A


Instruction:
On electromyography, all of the following features suggest denervation, EXCEPT:
A. Less inseional activity is observed in denervated muscles
B. Giant polyphasic potentials arise from motor units
C. Presence of positive sharp waves
D. Spontaneous firing of motor units

Response:
Inseional activity refers to the burst of action potentials that is usually observed when the EMG needle is inseed into the muscle. Increased inseional activity is observed in denervated muscles. Relaxed muscle normally is electrically silent except in the end plate region, but abnormal spontaneous activity occurs in denervation or inflammatory changes in affected muscle. Giant polyphasic potentials arise from motor units containing more than the usual number of muscle fibers that are spread out over a greatly enlarged territory within the muscle. Fibrillation potentials and positive sharp waves (which reflect muscle fiber irritability) and complex repetitive discharges are most often. Ref: Waxman S.G. (2010). Chapter 23. Electrodiagnostic Tests. In S.G. Waxman (Ed), Clinical Neuroanatomy, 26e.

So the answer to this question is A


Instruction:
Prologed Post-op ileus is best treated by -
A. Long tube insertion
B. Calcium pentonthenate
C. Laporotomy and exploration
D. Peristaltic stimulants

Response:
Most patients develop a transient ileus after a major abdominal operation. Most of these cases resolve within 3 to 5 days.
Conditions like-extensive operative manipulation, major small bowel injury, heavy narcotic use, intraabdominal infection and pancreatitis - can prolong the ileus to 5 to 7 days. Ileus prolnged beyond this period is viewed with suspicion.

Management of post op. ileus

The essence of treatment is prevention, with the use of nasogastric suction and restriction of oral intake until bowel sounds and passage of flatus return.
Electrolyte abnormality, if any is corrected.
A battery of laboratory tests are conducted to look for primary cause, which if found is treated.
"If paralytic ileus is prolonged and threatens life, a laparotomy should be considered to exclude a hidden cause and facilitate bowel decompression" - Bailey

So the answer to this question is C


Instruction:
All are causes of dynamic intestinal obstruction except
A. Gall stones
B. Intussusception
C. Mesentric vascular occlusion
D. Bands

Response:
None

So the answer to this question is C


Instruction:
Swollen neurons that contain numerous lysosomes filled with lipid are typical of
A. Amyloidosis
B. Huntington Disease
C. Kuru
D. Tay-Sachs Disease

Response:
Swollen neurons that exhibit marked vacuolization of the perikaryon and contain lysosomes filled with lipid are found in TaySachs disease but could occur in other lipid-storage diseases as well. The correct diagnosis can be established by biochemical analysis of the stored material or identification of intermediary metabolites and missing enzymes. The other diseases listed do not produce such neuronal changes. Ref - Harrison's internal medicine 20e pg 3007

So the answer to this question is D


Instruction:
Hyperbaric Oxygen is not useful in
A. CO poisining
B. Veigo
C. Gas gangrene
D. compament syndrome

Response:
Hyperbaric oxygen is not useful in veigo.

So the answer to this question is B


Instruction:
The following are DDT resistant except -
A. Phlebotomus
B. Culex fatigans
C. Anopheles stephenci
D. Musca domestica

Response:
Resistance to DDT has not been demonstrated in Phlebotomus. Organochloride resistance is divided into Resistance to DDT and analogues Resistance to HCH-Dieldrin group of insecticides Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 845

So the answer to this question is A


Instruction:
Which of the following is a risk factor for developing Type 1 Diabetes mellitus?
A. Male Gender
B. Old age
C. Gestational diabetes
D. HLA DR3

Response:
Ref: Nelson's Textbook of Pediatrics. 19th EditionExplanation:Pathophysiology and Risk factors for Type I Diabetes mellitusType l DM is the culmination of lymphocytic infiltration and destruction of insulin -secreting beta cells of the islets of Langerhans in the pancreas.As beta-cell mass declines, insulin secretion decreases until the available insulin no longer is adequate to maintain normal blood glucose levels.After 80-90% of the beta cells are destroyed, hyperglycemia develops and diabetes may be diagnosed.Autoimmunity - Major determinantViral infection may stimulate the production of antibodies against a viral protein that trigger an autoimmune response against antigenically similar beta cell molecules.Approx 85% of type 1 DM patients have circulating islet cell antibodies, and the majority also has detectable anti-insulin antibodies before receiving insulin therapy.The most commonly found islet cell antibodies are directed against glutamic acid decarboxylase (GAD). an enzyme found within pancreatic beta cells.The prevalence is increased in other autoimmune diseases, such as:Graves diseaseHashimoto thyroiditisAddison diseasePolymorphisms of the class II human leukocyte antigen (HIA) genes that encode DR and I)Q are the major genetic determinants.Approximately 95% of patients with type 1 DM have either HLA-DR3 or HLA-DR4.HLA-DQs are also considered specific markers of type 1 DM susceptibility.Some haplotypes (eg, HLA-DR2) confer strong protection against type 1 DMRisk Factors for Type 2 Diabetes MellitusFamily history of diabetes (i.e., parent or sibling with type 2 diabetes)Obesity (BMI >25 kg/m2)Physical inactivityRace/ethnicity (e.g.. African American. Latino, Native American. Asian American. Pacific Islander)Previously identified with IFG, IGT, or an A1C of 5.7-6.4%History of GDM or delivery of baby >4 kg (9 lb)Hypertension (blood pressure >140/90 mmHg)HDL cholesterol ievel <35 mg/dL {0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)Polycystic ovary syndrome or acanthosis nigricansHistory of cardiovascular disease

So the answer to this question is D


Instruction:
0.1 to 0.2 mm nebular corneal opacity is treated by –
A. Penetrating keratoplasty
B. Lamellar keratoplasty
C. Enucleation
D. Evisceration

Response:
Central nebular opacity is treated by phototherapeutic keratectomy with an excimer laser (treatment of choice) or lamellar keratoplasty.

So the answer to this question is B


Instruction:
Which of the following is not a feature of Sipple syndrome?
A. Pheochromocytoma
B. Medullary carcinoma thyroid
C. Hyperthyroidism
D. Hyperparathyroidism

Response:
Ans. is 'c' i.e., Hyperthyroidism Multiple endocrine neoplasia (MEN)1) MEN-1 (Wermer syndrome)# It involves primarily three glandsa) Parathyroid (parathyroid hyperplasia/adenoma): Most common manifestation.b) Pituitary: Prolactinoma is the most common type of pituitary tumor in MEN-I.c) Pancreas: There is let cell hyperplasia/adenoma.# Less common findings are pheochromocytoma, foregut carcinoid, lipomas and dermal angiofibroma.2) MEN-IIA (sipples syndrome)# It consists of medullary carcinoma thyroid, parathyroid hyperplasia/adenoma and pheochromocytoma of adrenal medulla.3) MEN-1IB# It consists of medullary carcinoma thyroid, pheochromocytoma, GIT neuromas and marfanoid features.

So the answer to this question is C


Instruction:
Investigation of choice for invasive amebiasis is:
A. Indirect heamagglutination
B. ELISA
C. Counter immune electrophoresis
D. Microscopy

Response:
Answer is B (ELISA) In Extra-intestinal amebiasis, antibody detection by ELISA is the most sensitive test - Ghai 5th/221. ELISA : This test is positive in more than 90% of patients and it usually reves to normal with in 6-12 months. IHA : May also be done in invasive Amoebiasis or liver abscess. The interpretation of the IHA is however more difficult because titres may remain positive for as long as 10 years.

So the answer to this question is B


Instruction:
Ataxia telangiectasia is characterised by all of the following except –
A. Chronic sinopulmonary disease
B. Decreased level of α–fetoprotein
C. Chromosomal breakage
D. IgA deficiency

Response:
"Persistence of very high levels of oncofetal proteins, including alpha-fetoproteins and carcinoembryonic antigens is of diagnostic value" - Harrison

Ataxia telangiectasia

Ataxia Telangiectasia (AT) is an autosomal recessive disorder.
It is due to mutation of AT gene located on chromosome 11.
There is defective DNA repair that results in multiple chromosomal breaks.

Clinical manifestations

Present in the first decade of life.
Feature are : -

Oculocutaneous telengiectasia
Neurological → Ataxia, dysarthria, extensor plantar response, myoclonic jerks, are flexia, distal sensory deficit.
Immunodeficiency →Thymic hypoplasia with cellular and humoral (IgA and IgG2) immunodeficiency.
Recurrent pulmonary infections
Endocrine disorders → Type I DM
Premature ageing
Malignancies → Lymphoma, Hodgkin's disease, acute T cell leukemia, breast cancer.

α-feto protein and carcino-embryonic antigen are increased

So the answer to this question is B


Instruction:
Most common type of psoriasis is
A. Plaque
B. Guttate
C. Pustular
D. Inverse

Response:
Psoriasis is one of the most common chronic inflammatory skin disease charecterised by well defined erythematous plaque with silvery white scales. the distribution is variable, but mostly symmetrical and seen extensor areas. The scales are loosely adherent and on complete removal of scales, a red moist surface ( Burkeley membrane) is seen. On fuher scraping, punctate bleeding points are seen due to suprapapillary thinning and capillary dilation. it is called auspitz sign. Occasionally a surrounding zone of hypopigmentation is seen usually associated with treatment.It is called woronoff's ring and it is the first sign that patient is responding to treatment. The most common variety of psoriasis is called plaque-type. The other types are guttate psoriasis, inverse or flexural psoriasis ,pustular psoriasis, scalp psoriasis, palmoplantar psoriasis, nail psoriasis. Inverse psoriasis affects the interiginous regions, including the axilla, groin, submammary region, and navel; it also tends to affect the scalp, palms, and soles. Guttate psoriasis (eruptive psoriasis) is most common in children and young adults. It develops acutely in individuals without psoriasis or in those with chronic plaque psoriasis. Patients present with many small erythematous, scaling papules, frequently after upper respiratory tract infection with b-hemolytic streptococci pustular psoriasis, patients may have disease localized to the palms and soles, or the disease may be generalized. Regardless of the extent of disease, the skin is erythematous, with pustules and variable scale. Localized to the palms and soles, it is easily confused with eczema. Ref: Harrison 19e pg: 347

So the answer to this question is A


Instruction:
The following anti T.B. drug should not be given to AIDS patient :
A. Rifampicin
B. Ethambutol
C. Streptomycin
D. Pyrazinamide

Response:
None

So the answer to this question is A


Instruction:
D.latum transmitted by ?
A. Cercaria through cyclops
B. Cercaria through fish meal
C. Plerocercoid through fish meal
D. Metacercaria in cyclops

Response:
Ans. is 'c' i.e., Plerocercoid through fish meal

So the answer to this question is C


Instruction:
Commonest site of liquifactive necrosis is
A. Brain
B. Kidney
C. Liver
D. Spleen

Response:
Ans. a (Brain). (Ref. Robbins, Pathologic Basis of Disease, 8th/pg.7-13)NECROSIS# Enzymatic degradation of a cell resulting from exogenous injury.# Characterized by enzymatic digestion and protein denaturation, with release of intracellular components.# Morphologically occurs as coagulative (heart, liver, kidney), liquefactive (brain), caseous (tuberculosis), fat (pancreas), fibrinoid (blood vessels), or gangrenous (limbs, GI tract).# Kidney infarct exhibiting coagulative necrosis will be seen with loss of nuclei and clumping of cytoplasm but with preservation of basic outlines of glomerular and tubular architecture.# Liquefactive necrosis in the kidney can be caused by fungal infection, which will be seen filled with white cells and cellular debris, creating a renal abscess that obliterates the normal architecture.IRREVERSIBLE INJURY AND CELL DEATHMORPHOLOGIC PATTERNCHARACTERSTICSCOAGULATIVE NECROSISMost common type (e.g. Heart, liver, kidney)LIQUEFACTIVE NECROSISAbscesses, brain infarcts, pancreatic necrosisCellular destruction by hydrolytic enzymesCASEOUS NECROSISSeen in tuberculosisCombination of coagulation and liquefaction necrosis soft, friable, and "cottage-cheese-like" appearanceFAT NECROSISCaused by the action of lipases on fatty tissue (e.g. with pancreatic damage)Chalky white appearanceFIBRINOID NECROSISEosinophilic homogenous appearance - resembles fibrinGANGRENOUS NECROSISCommon sites: lower limbs, gallbladder, Gl tract and testesDry gangrene - coagulative necrosisWet gangrene - liquefactive necrosisAPOPTOSISA specialized form of programmed cell death, an active process under genetic control.Executed in mitochondria.Mediated by a cascade of caspases (digest nuclear and cytoskeletal proteins and active endonucleases).

So the answer to this question is A


Instruction:
Symbol 'X' denotes
A. Air conduction threshold for right ear
B. Bone conduction threshold for right ear
C. Air conduction threshold for left ear
D. Bone conduction threshold for left ear

Response:
.An "O" often is used to represent responses for the right ear and an "X" is used to represent responses for the left ear. A key on the audiogram, similar to one found on a map, identifies what the different symbols mean Hence, indicates air conduction test for left year Ref physiology textbook A. K Jain.. 3e

So the answer to this question is C


Instruction:
Trochlear nerve all true except-
A. Longest intracranial course.
B. Arises from the dorsum of the brainstem.
C. Supply ipsilateral superior oblique muscle
D. Enters orbit through sup. orbital fissure outside annulus of Zinn

Response:
Ans is 'c' i.e. Supplies ipsilateral superior oblique muscle Trochlear nerve is a crossed cranial nerve. The nucleus of the trochlear nerve supplies the contralateral superior oblique muscle. The trochlear nerve has certain unique features: It is the only cranial nerve whose fibers originate totally from the contralateral nucleus. It is the only cranial nerve to emerge from the dorsal surface of the brain stem. It is the smallest (thinnest) of the cranial nerves, (largest is trigeminal) It has the longest intracranial course and is thus highly susceptible to increased intracranial pressure, (shortest cranial nerve is olfactory) It supplies only one muscle- i.e. superior oblique (Abducent cranial nerve also supplies only one muscle i.e. Lateral rectus) Course: As the trochlear nerve emerges from the brainstem, it curves around the cerebral peduncle and proceeds anteriorly within the lateral wall of cavernous sinus to pass into the orbit via the lateral part of superior orbital fissure. Structures passing through the Superior orbital fissure Lateral part (lateral to the annulus of Zinn ) Middle part Medial part Lacrimal nerve Frontal nerve Trochlear nerve Superior ophthalmic vein Recurrent meningeal branch of Lacrimal artery Anastomotic branch of the middle meningeal artery {which anastomoses with the recurrent branch of the lacrimal artery) Oculomotor nerve (both upper and lower divisions) Nasociliary nerve (lies in between the two divisions of the oculomotor nerve) Abducent nerve Inferior ophthalmic vein Sympathetic nerves from the plexus around the internal carotid artery Structures passing through superior orbital fissure Also know Inferior orbital fissure transmits Zygomatic branch of maxillary nerve Rami of pterygopalatine ganglion Infraorbital nerve Infraorbital vessels Communicating vein b/w inferior phthalic vein & pterygoid plexus of veins

So the answer to this question is C


Instruction:
Half- life of cobalt-60:
A. 53 years
B. 5.3 years
C. 0.53 years
D. 7.8 years

Response:
Ans. (b) 5.3 yearsRef: Basics radiological physics 2nd ed. /180* Iridium-192, emits gamma rays. It has energy of 0.4MeV.* Tl/2 of iridium 192: 74 daysImportant Half Life of Radionuclides* Gold-198: 2.7 days* Iodine- 123: 13.3 hours* Iodine-131: 8 days* Phosphorus-32: 14.3 days* Yttrium 90: 64 hours* Cobalt-60: 5.26 years* Caesium-137: 30 years* Radium-226: 1620 years

So the answer to this question is B


Instruction:
Topical glucocorticoids in eyes causes:
A. Glaucoma
B. Optic atrophy
C. Retinal detachment
D. Corneal ulcer

Response:
Ans: A (Glaucoma) Ref: Parson's Diseases of the Eye Pg:358: Basok Diseases of the Eye 5th edition, pg no 50Explanation:STEROIDSSystemic and topical steroids - causes. Posterior subcapsular cataractTopical steroids - causes, Open angle glaucomaThere is no safe dosageWho is Steroid responder?After 6 weeks of topical steroids, if the IOP>30mmHg - high responders22-30mmHg - moderate respondersNo change - non respondersStrong steroids (dexamethasone. betamethasone, prednisolone] - more potent in increasing the IOPFluoromethalone - lesser propensity to increase IOPDifluprednate - strong steroid but least potent to increase IOPOther Local Side Effects:Increased risk of super infectionDelayed wound healingCorneal meltingIndications of steroids in eye:Sterile ocular inflammationDisciform keratitisEpiscleritisScleritisUveitisOptic neuritisAllergic problemsPhlyctenVernal catarrahAllergic blepharoconjunctivitisPost operativeFollowing cataract surgeryKeratoplastyVitrectomyTrabeculectomy

So the answer to this question is A


Instruction:
The blood supply of Anterior Cruciate Ligament (ACL) is primarily derived from:
A. Superior medial genicular aery
B. Descending genicular aery
C. Middle genicular aery
D. Circumflex fibular aery

Response:
The primary blood supply to the Anterior cruciate ligament comes from the middle genicular aery which pierces the posterior capsule and enters the intercondylar notch near the femoral attachment. Ref: Campbell's Operative Ohopaedics, 11th Edition, Page 2497;Operative Ahroscopy, 3rd Edition, Pages 67, 68; Current Concepts in ACL Reconstruction By Freddie Fu, 2008, Chapter 2, Page 28

So the answer to this question is C


Instruction:
The most common form of fetal traumatic injury incurred during breach extraction is:
A. Rupture of the liver
B. Rupture of the spleen
C. Intraadrenal hemorrhage
D. Intracranial hemorrhage

Response:
bih trauma intracranial haemorrhage due to uncontrolled delivery of the head and rupture of the veins of Galen or tentorial or falx tears Skull fractures Fracture dislocation of cervical veebra and atlantoaxial dislocation (refer pgno:377 sheila textbook of obstetrics 2 nd edition)

So the answer to this question is D


Instruction:
All of the following statements about Botulism are true except :
A. Botulism is caused by endotoxin
B. Honey ingestion causes infant botulism
C. Constipation is seen
D. Detection of antitoxin in the serum can aid in diagnosis

Response:
Cl. botulinum produce exotoxin (since endotoxin is usually produced by gram-negative bacteria) which differs from other exotoxin in that it is produced intracellularly and appears in the medium only on death/autolysis of cell.
Toxin production is determined by bacteriophage at least in types C and D toxin.
All toxin are neurotoxin except C toxin, which is cytotoxin.
Toxin acts by blocking production or release of Ach at synapse and Neuromuscular junction (= parasympatholytic = effect of atropine) so cause constipation, paralysis, etc.
Human disease is caused by type A, B, E and rarely F.
MC Type of botulism is ‘Infant botulism’ which is produced by eating of honey containing spores so toxin is produced inside.
Foodborne botulism and wound botulism are produced by preformed toxin.
Diagnosis may be confirmed by demonstration of bacillus or toxin in food or feces.
A retrospective diagnosis may be made by detection of antitoxin in the patient serum but it may not be seen in all cases.

So the answer to this question is A


Instruction:
All is true about flumazenil except:
A. Antagonist of benzodiazepines
B. Treat barbiturate poisoning
C. Given intravenously
D. Act GABA channel

Response:
Ans. B. Treat barbiturate poisoningFlumazenil is the competitive antagonist of benzodiazepines receptor. It acts as specific antidote of benzodiazepines poisoning. It is given intravenously and it inhibits GABA facilitatory action.

So the answer to this question is B


Instruction:
A 45-year-old was given steroids after renal transplant. After 2 years he had difficulty in walking and pain in both hips. Which one of the following is most likely cause?
A. Primary Osteoarthritis
B. Avascular necrosis
C. Tuberculosis
D. Aluminum toxicity

Response:
Ans. B. Avascular necrosisMnemonic for causes of avascular necrosis other than fracture - SCLERAa. S-Steroidsb. C-Caisson's diseasec. LE - Lupus Erythematosusd. R-Radiatione. A-Alcohol

So the answer to this question is B


Instruction:
Most common causative organism of acute pyelonephritis in pregnancy is?
A. E.coli
B. Klebsiella pneumonia
C. Enterobacter
D. Staphylococcus group

Response:
ANSWER: (A) E.coliREF: Dutta's textbook of obstetrics 6th ed page 296Incidence of pyelonephritis in pregnancy 1-3%Previous history of urinary tract infection increases chance by 50%Organisms associated are: E:coli (70%), Klebsiella (10%), Enterobacter, Proteus pseudomonas, Staphylococcus aureus

So the answer to this question is A


Instruction:
Lesion of Globus pallidus causes -
A. Chorea
B. Ballismus
C. Athetosis
D. Akinesia

Response:
Ans. is 'c' i.e., Athetosis Diseases of Basal gangliao Three distinct biochemical pathways in the basal ganglia normally operate in a balanced fashion : - 1 ) Nigrostriatal dopaminergic systemQ; 2) Intrastriatal cholinergic system; 3) GABAergic system which projects from the stratum to globus pallidus and substantia nigra.o When one or more of these pathways become dysfunctional, characteristic motor abnormalities occur. There may be two types of disorder: -Hyperkinetic: - There is excessive and abnormal movement, e.g., Chorea, athetosis and ballism.Hypokinetic : - There is paucity of movement, e.g., Akinesia and Bradykinesia.o The classical example of Basal ganglia disease is Parkinsonism in which there is degeneration of dopaminergic neurons in the substantia nigra pars compacta. The fibers to putamen are most severely affected. A patient with parkinsonism have both hypokinetic and hyperkinetic features : -Hypokinetic : - Bradykinesia, AkinesiaHyperkinetic : - Cogwheel rigidity, Resting tremorQ.DiseasePart of Basal ganglia involvedParkinsonismSubstantia nigra pars compacta - Nigrastriatal pathwayHuntington choreaStriatum (mainly caudate nucleus; may be putamen)BallismSubthalamic nucleiAthetosisGlobus pallidus (mainly)Q and Subthalamic nucleus.

So the answer to this question is C


Instruction:
Retrosternal goiter:
A. Causes stridor
B. Obtains its blood supply from thoracic vessels
C. Characteristically malignant
D. Must be removed by thoracotomy

Response:
None

So the answer to this question is A


Instruction:
All of the following are temporary social groups except:
A. Crowd
B. Mob
C. Herd
D. Band

Response:
TEMPORARY SOCIAL GROUPS (1) The Crowd : When a group of people come together temporarily, for a sho period, motivated by a common interest or curiosity (e.g., to witness a football match), it is known as a crowd. The crowd lacks internal organization and leadership. When the interest is over, the crowd disperses. (2) The Mob : The mob is essentially a crowd, but has a leader who forces the members into action. There may be a symbol in the shape of a flag or slogan. The mob is more emotional than a crowd. Like the crowd, it is unstable and without internal organization. When the purpose of the mob is achieved, the group disperses. (3) The Herd : This is also a crowd with a leader. Here the members of the group have to follow the orders of the leader without question, e.g., the tourist group under a guide. PERMANENT SPATIAL GROUPS (1) The Band: It is the most elementary community of a few families living together. Here the group has organized itself and follows a pattern of life e.g., gypsies in India. (2) The Village : The village is a small collection of people permanently settled down in a locality with their homes and cultural equipments. (3) The Towns and Cities : From a sociological point of view, a city or town may be defined as a relatively large, dense and permanent settlement of socially heterogeneous individuals. (4) The State: The state is an ecological social group * based on territory. It is more stabilized andformalized. It is heterogeneous in nature. The Indian Union is a large State.

So the answer to this question is D


Instruction:
Duration of immunity after typhoid vaccination is for -
A. 3 years
B. 5 years
C. 7 years
D. 6 months

Response:
Vi polysaccharide vaccine:- Composed of purified Vi capsular polysaccharide from Ty2 S. Administration- subcutaneous/ intramuscularly. Age group more than 2 years. Only one dose required. Confers protection 7 days after injection. Efficacy-85% Duration of immunity-3yrs. To maintain protection,revaccination recommended every 3 years. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.237}

So the answer to this question is A


Instruction:
TRUE about mycobacterium other than tuberculosis?
A. Causes disseminated infection
B. Occurs in persons with normal immunity
C. Causes decreased efficacy of BCG due to cross immunity
D. Person to person transmission is seen

Response:
Mycobacterium other than mammalian tubercle bacilli which cause human disease is called atypical, anonymous, unclassified, environmental, oppounistic. They have also been called para tubercle, tuberculoid, MOTT. They are of 4 groups: photochromogens, scotochromogens, non photochromogens, rapid growers. Widely distributed in the environment and are paicularly abundant in wet soil, marshland, streams, rivers and estuaries. Human beings are therefore regularly exposed to mycobacteria as a result of drinking, washing, showering and inhalation of natural aerosols. Ref: Ananthanarayanan & paniker's textbook of microbiology Ed 8th Page 359.

So the answer to this question is C


Instruction:
Primary hyperoxaluria is caused by defective metabolism of:
A. Alanine
B. Arginine
C. Glycine
D. All of the above

Response:
In nonketotic hyperglycinemia, a rare inborn error of glycine degradation presently known only in Finland, glycine accumulates in all body tissues including the central nervous system. The defect in primary hyperoxaluria is the failure to catabolize glyoxylate formed by the deamination of glycine. Subsequent oxidation of glyoxylate to oxalate results in urolithiasis, nephrocalcinosis, and early moality from renal failure or hypeension. Glycinuria results from a defect in renal tubular reabsorption. Ref: Harper 28th edition, chapter 29.

So the answer to this question is C


Instruction:
Advantage of fibreoptic bronchoscopy over rigid bronchoscopy is -
A. Foreign body removal
B. Good view
C. Better airway control
D. In a sick child it can be passed through endotracheal tube

Response:
None

So the answer to this question is B


Instruction:
Aspirin protects against all except?
A. MI
B. Stroke
C. Colorectal cancer
D. Liver cancer

Response:
Ans. (d) Liver cancerRef: Harrison 18th ed. Ch. 91* Aspirin suppresses cell proliferation by inhibiting prostaglandin synthesis.* Regular aspirin use reduces the risk of colon adenomas and carcinomas as well as death from large-bowel cancer.

So the answer to this question is D


Instruction:
The growth factor required for the growth of vibrio parahemolyticus is ?
A. Saline
B. Tryptophan
C. Bile
D. Citrate

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

So the answer to this question is A


Instruction:
What is the cause of glaucoma in retinoblastoma?
A. Blockge of trabecular network
B. Neovascularisation
C. Mass effect of the tumour
D. Lysis of the lens

Response:
Ans. is 'b' i.e., Neovascularisation Neovascular glaucoma (Rubeosis iridis)o It is a secondary angle closure glaucoma which results due to formation of neovascular membrane over the iris i.e., neovascularization of iris (rubeosis iridis).o Causes of rubeosis iridis arei) Common Diabetic retinopathy (most common cause), central retinal vein occlusion Eale's disease, sickle-cell retinopathy.ii) Rare causes: - Long standing retinal detachment, central retinal artery occlusion, intraocular inflammation (uveitis), intraocular tumors (choroidal melanoma, retinoblastoma), radiation retinopathy, ocular ischemic syndrome (carotid ar tery disease, carotid - cavernous fistula), Fusch's heterochromic iridocyclitis.

So the answer to this question is B


Instruction:
The egg which of the following parasites consist of polar filaments arising from either end of the ambrophore-
A. Taenia saginata
B. Taenia solium
C. Echinococcus granulosus
D. Hymenolepis nana

Response:
None

So the answer to this question is D


Instruction:
Synthesis of secretory proteins takes place in
A. Golgi complex
B. Endoplasmic reticulum
C. First in cytoplasm then in nucleus
D. First in endoplasmic reticulum then in cytoplasm

Response:
Secretory proteins are synthesized in EPR Reference: Harper; 30th edition

So the answer to this question is B


Instruction:
In the posterior wall of the stomach a perforation is seen at radiography in 36 year old female , in which the gastric contents spilled into the lesser sac. Surgeon open lienorenal ligament to reach the lesser sac and notes erosion of the ulcer into an aery. Which of the following vessels is most likely affeccted ?
A. Left gastroepiploic aery
B. Gastroduodenal aery
C. Left gastric aery
D. Right gastric aery

Response:
The left gastroepiploic aery runs through the lienogastric ligament; hence it is the aery most likely injured. The splenic aery is found in the lienorenal ligament. The right and left gastric aeries run within the lesser omentum. The gastroduodenal aery descends between the duodenum and the head of the pancreas.

So the answer to this question is A


Instruction:
Fetus was found to have a congenital hea block (CHB), what should be evaluated in the mother?
A. SLE
B. APLA
C. Diabetes mellitus
D. Haemolytic anemia

Response:
SLE is Pregnancy- SLE - causes - multi organ damage in the mother and antibodies against the antigens blood circulation enter the fetus causing multiple problems to the fetus mainly congenital hea block CHB is the most serious complication of neonatal lupus erythematosus. Transplacental transfer of maternal anti - SSA/RO or anti- SSB/LA antibodies is associated with development of CHB. CHB is mostly diagnosed between 18 -24th weeks of gestation.

So the answer to this question is A


Instruction:
Which of these is not a feature of C.M.L?
A. Pruritus
B. Infections
C. Shift to left
D. Autoimmune haemolytic anaemia

Response:
Autoimmune hemolytic anemia is a feature of CLL Features of CML: - - Increased Basophil count: i. Leading to release of histamine ii. Leading to itching, pruritis, flushing episodes, peptic ulcers, secretory diarrhea - Immature cell in P. Smear (Shift to left) - Infection: Neutrophil Alkaline phosphatase (NAP) score is lesser which is responsible for neutrophils to fight infections. - Normocytic Normochromic Anemia

So the answer to this question is D


Instruction:
In salmonolosis disease, isolation is done till
A. Fever subsides
B. Blood culture negative
C. Stool culture negative for three times
D. Spleen subsides

Response:
None

So the answer to this question is C


Instruction:
Schirmer's test detects abnormality of which nerve-
A. Oculomotor
B. Facial
C. Hypoglossal
D. Glossopharyngeal

Response:
This test measures total tear secretion and normal value is more than 15mm. Schirmer's test determines whether the eye produces enough tears to keep it moist. This test is used when a person experiences very dry eyes or excessive watering of the eyes. It poses no risk to the subject. A negative (more than 10 mm of moisture on the filter paper in 5 minutes) test result is normal. Ref. Ak khurana 6th edition

So the answer to this question is B


Instruction:
A 62-year-old woman undergoing chemotherapy for breast cancer presents with a 3-day history of fever and chest pain. Cardiac catheterization reveals a markedly reduced ejection fraction with normal coronary blood flow. A myocardial biopsy is obtained, and a PCR test for coxsackievirus is positive. Histologic examination of this patient's myocardium will most likely reveal an abundance of which of the followinginflammatory cells?
A. Eosinophils
B. Lymphocytes
C. Macrophages
D. Mast cells

Response:
This patient with viral myocarditis will show an accumulation of lymphocytes in the affected hea muscle. Naive lymphocytes encounter antigen-presenting cells (macrophages and dendritic cells) in the secondary lymphoid organs. The other choices are not characteristic responders to viral infections, although acute inflammation may be observed in lytic infections. Diagnosis: Viral myocarditis

So the answer to this question is B


Instruction:
Isolated hypoglossal nerve injuries are rare. If there is unilateral injury to hypoglossal nerve, all of the clinical manifestations are seen, EXCEPT:
A. Hemiatrophy of involved side
B. Detion of tongue towards the same side
C. Loss of taste sensation in one half of the tongue
D. Fasciculation of the tongue

Response:
In hypoglossal nerve lesions, there may be detion of the protruded tongue toward the weak side. Denervation of the tongue may be associated with wasting (atrophy) and twitching (fasciculation).Taste sensations are carried by the chorda tympani branch of the facial nerve from anterior two third of tongue and glossopharyngeal nerve from posterior one third of tongue. Ref: Greenberg D.A., Aminoff M.J., Simon R.P. (2012). Chapter 1. Neurologic History & Examination. In D.A. Greenberg, M.J. Aminoff, R.P. Simon (Eds), Clinical Neurology, 8e.

So the answer to this question is C


Instruction:
Which of the following is a non-invasive test used to diagnose fetal Rh genotype in Rh D alloimmunization?
A. Cell free fetal DNA
B. Chorionic villus sampling
C. Amniocentesis
D. Middle cerebral aery peak systolic velocity

Response:
Fetal Rh D genotype assessment from maternal blood offers several potential benefits. Administration of anti-D immune globulin to an Rh D-negative pregnant woman carrying an Rh D-negative fetus can be eliminated.In the setting of Rh D alloimmunization, early identification of an Rh D-negative fetus can avoid unnecessary amniocentesis and/or serial fetal middle cerebral aery Doppler assessment. Rh D genotype evaluation using cell-free fetal DNA is done using real-time PCR to target multiple exons of the RHD gene(Ref: William's Obstetrics; 25th edition)

So the answer to this question is A


Instruction:
The stapes is embryologically derived from the following pharyngeal arch ?
A. 1st arch
B. 2nd arch
C. 3rd arch
D. 4th arch

Response:
The second pharyngeal arch gives rise to Reiche cailage, which eventually forms:Manubrium of the malleusLong process of the incusStapes suprastructureTympanic poion of the stapes footplateThe vestibular poion of the stapes footplate derives from the otic capsule. Other structures which derived from the second pharyngeal arch mesoderm are:Facial nerveMuscles of facial expressionStapedius muscleThe upper poion of the hyoid boneStylohyoid ligament Ref: Brown K.D., Selesnick S.H. (2012). Chapter 48. Congenital Disorders of the Middle Ear. In A.K. Lalwani (Ed), CURRENT Diagnosis & Treatment in Otolaryngology--Head & Neck Surgery, 3e.

So the answer to this question is B


Instruction:
Putting profit ahead of health as a cause of disease is provided by which theory of Sac iolou -
A. Feminist
B. Parsonian
C. Marxist
D. Foucauldian

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

So the answer to this question is C


Instruction:
Fallopian tube dysmotility is in?
A. Marfan's syndrome
B. Noonan's syndrome
C. Kartagener syndrome
D. Turner's syndrome

Response:
Ans. C. Kartagener syndromea. Kartagener syndrome is the inheritable disorder of dextrocardia, infertility, chronic sinusitis (with the formation of nasal polyps), and bronchiectasis.b. Patients may also present with situs inversus.c. The disorder is due to a defect that causes the cilia within the respiratory tract epithelium to become immotile (Axonemal dynein).d. Cilia of the sperm are also affected.

So the answer to this question is C


Instruction:
Mechanism of oxygen toxicity is?
A. Direct DNA damage
B. Apoptosis
C. Nuclear fragmentation
D. Free radicals

Response:
ANSWER: (D) Free radicalsREF: Pulmonary physiology by Michael G. Levitzky page Page 245, Yao & Artusio's anesthesiology: problem-oriented patient management - Page 67"The mechanism of oxygen toxicity is controversial but probably involves the formation of superoxide anions or other free radicals""The biochemical basis for the toxicity of oxygen is the partial reduction of oxygen by one or two electrons to form reactive oxygen species"

So the answer to this question is D


Instruction:
True about adenocarcinoma of lung-
A. More common in female
B. Smoking is not associated with
C. Central cavitations
D. Upper lobe involvement is most common

Response:
Ref:Textbook of pathology (Harsh mohan) 6th edition,page no.500 Adenocarcinoma: Adenocarcinoma, also called peripheral carcinoma due to its location and scar carcinoma due to its association with areas of chronic scarring,is the most common bronchogenic carcinoma in women and isslow-growing. Recent estimates on adenocarcinoma place this as the most frequent histologic subtype of lung cancer. Adenocarcinoma is fuher subclassified into 4 types: i) Acinar adenocarcinoma which has predominance of glandular structure and often occurs in the larger bronchi. ii) Papillary adenocarcinoma which has a pronounced papillary configuration and is frequently peripherally located in the lungs and is found in relation to pulmonary scars (scar carcinoma). iii) Bronchiolo-alveolar carcinoma is characterised by cuboidal to tall columnar and mucus-secreting epithelial cells growing along the existing alveoli and forming numerous papillary structures. Ultrastructurally, these tumour cells resemble Clara cells or less often type II pneumocytes. iv) Solid carcinoma is a poorly-differentiated adenocarcinoma lacking acini, tubules or papillae but having mucuscontaining vacuoles in many tumour cells.

So the answer to this question is A


Instruction:
Atwoods classification Order IV corresponds to
A. Knife edged ridge
B. High well rounded
C. Low well rounded
D. Depressed

Response:
None

So the answer to this question is A


Instruction:
Epstein Barr virus is associated with:
A. Carcinoma larynx
B. Carcinoma bladder
C. Carcinoma nasopharynx
D. Carcinoma maxilla

Response:
Ans. (c) Carcinoma nasopharynx

So the answer to this question is C


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

Response:
None

So the answer to this question is C


Instruction:
A 70-year-old woman has a small-bowel fistula with output of 1.5 L/d. Replacement of daily losses should be handled using the fluid solution that has the following composition in mEq/L.
A. A
B. B
C. C
D. D

Response:
The composition of small intestinal fluid issodium, 140 mEq/L; potassium, 5 mEq/L; chlo-ride, 104 mEq/L; and bicarbonate, 30 mEq/L. Daily losses are best replaced by administra-tion of balanced salt solution (Ringer's lactate) whose composition is depicted in A. Brepre-sents normal saline (0.9%), C is half normal saline (0.45%), D is M/6 sodium lactate, and E is 3% sodium chloride.

So the answer to this question is A


Instruction:
All of the following are branches of coeliac aery except:
A. Right gastric aery
B. Inferior pancreaticoduodenal aery
C. Cystic aery
D. Left gastroepiploic aery

Response:
B i.e. Inferior pancreaticoduodenal aery

So the answer to this question is B


Instruction:
In senile nuclear cataract what type of myopia is seen-
A. Curvature myopia
B. Index myopia
C. Axial myopia
D. Positional myopia

Response:
Ans. is 'b' i.e., Index myopia o Nuclear changes of aging induce a modification of refractive index of lens and produce an index myopia."Nuclear cataracts cause a general decrease in the transperancy of the lens nucleus. They are associated with index myopia "-- Ophthalmic study guideCauses of errors of refractiono Possible causes of ametropia are : -AxialIt is the commonest form of ametropia (both myopia and hypermetropia). In hypermetropia, there is an axial shortening of eyeball. So, image is formed behind the retina. In myopia, there is an axial lengthening of eyeball. So, image is formed in front of the retina. 1 mm change in axial length leads to ametropia of 3D. For example 1 mm shortening in axial length causes hypermetropia of 3D.CurvatureChange in the curvature of cornea or lens will cause ametropia. In hypermetropiaf the curvature of cornea or lens is lesser than normal. In myopia, there is increase in curvature of cornea or lens./ mm change in corneal curvature leads to 6-7 D ametropia.IndexIf refractive index of optical system is low, it will result in hypermetropia and high refractive index will result in myopia.Positional (Due to relative position of the lens)A forward shift of lens causes myopia, backward shift result in hypermetropia. Absence of lens (aphakia) causes hypermetropia.Excessive accommodationExcessive accommodation due to spasm of accommodation causes myopia.

So the answer to this question is B


Instruction:
Infectionrate without antibiotic prophylaxis for clean contaminated surgery is
A. 1 - 2 %
B. 2 - 5 %
C. 6 - 9 %
D. 10 - 15 %

Response:
Type of surgery
Infection rate with prophylaxis
Infection rate without prophyloxis

Clean surgery
1 - 2 %
1 - 2 %

Clean contaminated surgery
3%
6 - 9 %

Contaminated surgery
6 %
13 - 20%

Dirty surgery
7%
40%

So the answer to this question is C


Instruction:
Which of the following regarding air abrasion is false?
A. No tactile sensation
B. It can be a substitute for acid-etching technique
C. Cannot be used for cavity preparation
D. All of the above

Response:
Roughening by air abrasion by itself is not a substitute for acid-etching techniques. Roughening improves bonding. Acid etching alone or after roughening, however, always produces a better bond than air abrasion alone.
Contemporary air abrasion equipment is helpful for stain removal, debriding pits and fissures before sealing and micromechanical roughening of surfaces to be bonded.
Ref: Sturdevant's art and science of operative dentistry. 4th edition page 328

So the answer to this question is B


Instruction:
The base of class III preparation is
A. Axial wall
B. Gingival wall
C. Facial wall
D. Lingual wall

Response:
None

So the answer to this question is A


Instruction:
In air-abrasive technology the abrasive particles used are
A. Iron oxide
B. Tin oxide
C. Aluminium oxide
D. Silicon oxide

Response:
None

So the answer to this question is C


Instruction:
In a patient of head injury which is more important to note first:
A. Pupillary light reflex
B. Pupillary size
C. Corneal reflex
D. Ability to open eye

Response:
None

So the answer to this question is D


Instruction:
Prosthesis at the head of the femur applied in -
A. 40 years young male with # head of femur
B. 40 years young male with # neck of femur
C. 40 years young male with posterior dislocation of hip
D. 65 years old male with nonunited fracture neck of femur

Response:
Non-united fracture means long-standing fracture which has not united. In terms of neck fract,ure non-union is considered when the fracture is not united even after 6 months.
For long-standing fracture in 65 years old male, the treatment of choice is prosthetic replacement either semi-replacement or total replacement depending upon the presence or absence of pre-existing arthritis.

So the answer to this question is D


Instruction:
Three bony point relationship is maintained in:
A. Supracondylar humerus
B. Dislocation of elbow
C. Lateral condyle
D. Intercondylar

Response:
A i.e. Supracondylar

So the answer to this question is A


Instruction:
Which of the following structures is not seen on bronchoscopy -
A. Trachea
B. Vocal cords
C. Subcarinal lymph nodes
D. First segmental division of bronchi

Response:
None

So the answer to this question is C


Instruction:
Ophitoxaemia refers to poisoning due to ?
A. Scorpion bite
B. Snake bite
C. Bee sting
D. Dog bite

Response:
Ans. is 'b' i.e., Snake bite Ophitoxemia is poisoning by snake venom.

So the answer to this question is B


Instruction:
True about mycobacterium leprae -
A. Transmitted by droplet infection
B. Phenolic glycolipid (PGL) is virulence factor
C. Generation time 12-13 days
D. All are true

Response:
Ans. is 'd' i.e., all are true o M. leprae is 'acid-fast' 'gram-positive' straight or slightly curved rod. It is less acid fast than M. tuberculosis, So 5% H2SO4 is used for discoloration (instead of 20% H2SO4 used for M. tuberculosis).o Bacilli are bound together by lipid-like substance, the glia. These masses of bacilli arc called globi. Parallel row of bacilli in globi gives 'cigar-bundle' appearance. Globi are seen in virchow's lepra cells or foamy cells which are histocytes (tissue macrophages)o 'Phenolic gly colipid-1 (PGL-1)' acts as a virulence factor.Cultureo M. leprae is obligate intracellular organism, thus cannot be grown in cell free culture medium. Two animals are used for cultivation1) Armadillo (Nine banded armadillo) is highly susceptible and provides sufficient bacilli for a number of studies and for production of skin test reagent, Lepromin A.2) Foot pad of mice has been used for testing of sensitivity of antileprotic drug (replication in foot pad of mice is limited and less numerous than armadillo).o Generation time of M. leprae is 12-13 days.o Lepra bacilli has affinity for schwann cells and R.L. cells.o M. leprae grows better in cooler tissues (the skin, peripheral nerves, anterior chamber of eye, upper respiratory tract and testis), sparing warmer areas of skin (the axilla, groin, scalp and mid line of the back).Transmission of lepra bacillio Leprosy is a highly infectious (communicable) disease with low pathogenicity (PGI 07). Attack rate among house hold contacts is 4.4-12%. An infectious patient can be rendered non-infectious by dapsone treatment in 90 days or by rifampicin treatment in 3 weeks. Local application of rifampicin destroy all the bacilli within 8 days.o Source of infection - Multibacillary cases (most important), subclinical infections. The role of individuals with tuberculoid forms of the disease sources of infection is not clear. The current view is that all patients with active leprosy must be considered infectiouso Modes of transmission arei) Droplet infection: Most common mode.ii) Contact transmission: Either direct (skin to skin) or indirect (contact with contaminated soil or fomite).iii) Other: Breast milk from lepromatous leprosy, by insect vector, by tattooing needles.

So the answer to this question is D


Instruction:
Humoral immunodeficiency is suspected in a patient and he is under investigation. Which of the following infections would not be consistent with the diagnosis
A. Giardiasis
B. Pneumocystis carinii pneumonia
C. Recurrent sinusitis
D. Recurrent subcutaneous abscesses

Response:
None

So the answer to this question is B


Instruction:
During surgery for aortic arch aneurysm under deep hypothermic circulatory arrest, which of the following anesthetic agent administered prior to circulatory arrest that also provides cerebral protection ?
A. Etomidate
B. Thiopental sodium
C. Propofol
D. Ketamine

Response:
Thiopental, etomidate and propofol, all three are cerebroprotective. However, thiopental has maximum cerebroprotective action.
"Propofol and etomidate appear to lack the same protective effects as thiopental in focal cerebral ischemia"   ─ Morgan

So the answer to this question is B


Instruction:
Hypoglossal nerve is related to -
A. Digastric triangle
B. Carotid triangle
C. Both
D. None

Response:
Hypoglossal nerve is a content of both digastric and carotid triangles.

So the answer to this question is C


Instruction:
Spiral valve is seen in which -
A. Neck of gall bladder
B. Cystic duct
C. Colon
D. Pylorus

Response:
The mucons membrane of the cystic duct forms a series of 5-12 crescentic folds, arranged spirally to form the so called spiral valve of Heister. This is not a true valve.

So the answer to this question is B


Instruction:
Contraindications to OC pills:a) Heart diseaseb) Uterine malformationsc) Menorrhagiad) Liver failuree) Epilepsy
A. acd
B. ade
C. abd
D. ad

Response:
None

So the answer to this question is B


Instruction:
Froment's sign is due to
A. Ulnar nerve injury
B. Median nerve injury
C. Radial nerve injury
D. Intercostobrachial nerve injury

Response:
Ans: A Ulnar nerve injury(Ref: Maheshwari 4h/e p. 65)Ulnar nerve injury:Adductor pollicis will be paralysed.Shows 'Froment's sign'or the'book test'.Procedure:The patient is asked to grasp a book between the thumb and index finger. Normally, a person will grasps book firmly with thumb extended, taking full advantage of adductor pollicis and the first dorsal interosseous muscles.Patient will hold the book by using the flexor pollicis longus (supplied by median nerve) in place of the inter-phalangeal joint of the thumb.This becomes more pronounced if the examiner tries to pull the book out while the patient tries to hold it.

So the answer to this question is A


Instruction:
Which of the following stage of Breast Ca corresponds with following feature? Breast mass of 6 x 3 cm. size Ipsilateral supraclavicular lymph node Distant metastasis cannot be assessed
A. T4 N3 MX
B. T4 N1 M1
C. T4 N0 M0
D. T3 N3c MX

Response:
According to TNM staging system for breast cancer, T3: Tumor >5 cm in greatest dimension N3c: Metastasis in ipsilateral supraclavicular lymph node(s) MX: Distant metastasis cannot be assessed Ref: Hunt K.K., Newman L.A., Copeland E.M., Bland K.I. (2010). Chapter 17. The Breast. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.

So the answer to this question is D


Instruction:
Tone decay test is done for:
A. Cochlear deafness
B. Neural deafness
C. Middle ear problem
D. Otosclerosis

Response:
(b) Neural deafness(Ref. Anirban Biswas, 5th ed. 56)Tone decay is a function of nerve fatigue.If the nerves are fatigued the patient stops hearing a sound given to him continuously before the completion of 1 minute.A tone decay of more than 30dB is suggestive of retrocochlear or neural deafness

So the answer to this question is B


Instruction:
Breast milk at room temperature stored for?
A. 4 hrs
B. 8 hrs
C. 12 hrs
D. 24 hrs

Response:
Ans. is 'b' i.e., 8 hrs

So the answer to this question is B


Instruction:
A 23-year-old woman with history of eating disorder, complains of vomiting, nausea & severe abdominal pain. Physical examination shows abdominal distension and constipation. An X-ray film of the abdomen reveals air-fluid levels and a hyperlucent shadow at the epigastric area. The material obstructing the gastrointestinal tract is removed surgically and shown. Which of the following is the most likely diagnosis?
A. Diveiculum of the stomach
B. Gastric lymphoma
C. Phytobezoar
D. Trichobezoar

Response:
- Given image shows hairball with gelatinous matrix, which point towards diagnosis of Trichobezoar - Bezoars are foreign bodies in stomach that are composed of food/ hair that have been altered by digestive process. - Trichobezoar is usually seen in long-haired girls/ young women who eat their own hair as a nervous habit (trichotillomania; also called "Rapunzel" syndrome). - Phytobezoars (choice C) are concretions of plant material, which usually occur in persons with conditions that interfere with gastric emptying.

So the answer to this question is D


Instruction:
The pleura that covers the surface of the lungs is the
A. Pleural Cavity
B. Pleural Fluid
C. Visceral Pleura
D. Parietal Pleura

Response:
C: The visceral pleura covers the surface of the lung.
A, B: The pleural cavity, between the parietal and visceral pleurae, is filled with a small volume of pleural fluid produced by the pleural membranes.
D: The parietal pleura lines the walls of the thorax, diaphragm, and mediastinum

So the answer to this question is C


Instruction:
Which of the following agents is likely to cause cerebral calcification and hydrocephalus in a newborn whose mother has history of taking spiramycin but was not compliant with therapy?
A. Rubella
B. Toxoplasmosis
C. CMV
D. Herpes

Response:
b. Toxoplasmosis(Ref: Nelson's 20/e p 2814, Ghai 8/e p 574)Cerebral calcification with hydrocephalus in seen in congenital toxoplasmosis.

So the answer to this question is B


Instruction:
Small fiber neuropathy is seen in?
A. HIV
B. Vitamin B12 deficiency
C. AIP
D. Cisplatin toxicity

Response:
Small unmyelinated peripheral nerve fibers, Categorized as C fibers, In skin and organs. Innervate the skin (somatic fibers) , Help to control autonomic function. Causes of Small Fiber Neuropathy: 1. Diabetes mellitus 2. Leprosy 3. Amyloidosis 4. Tangier's disease 5. Sjogren syndrome 6. HIV 7. Sarcoidosis

So the answer to this question is A


Instruction:
A patient was found to have pink coloured skin and mucosa, bitter almond smell from breath and frothy discharge. Cause of death in this patient;
A. Cyanide poisoning
B. CO poisoning
C. H2S poisoning
D. Datura poisoning

Response:
The above findings are suggestive of Cyanide poisoning Cyanide poisoning - Ideal suicidal poison (most rapid when inhaled) Cyanide is a rapidly acting, potentially deadly chemical that can exist in various forms. Cyanide can be a colourless gas, such as hydrogen cyanide (HCN) or cyanogen chloride (CNCl), or a crystal form such as sodium cyanide (NaCN) or potassium cyanide (KCN). Cyanide is released from natural substances in some foods and in ceain plants such as cassava, linseed plant, lima beans and almonds, apricots, apples, and peaches Cyanide inhibits Cytochrome oxidase leading to histotoxic Anoxia Signs and Symptoms: C.N.S.: Headache, veigo, faintness, perspiration, anxiety, excitement, confusion, drowsiness, prostration, opisthotonus and trismus, cramps, twitching, hypehermia, convulsions, paralysis, stupor, coma, and death. G.I.T.: Bitter, acid, burning taste, constriction or numbness of throat, salivation, nausea, rarely vomiting. R.S.: Odour of bitter almonds in breath. Initially tachypnoea and dyspnoea due to cyanide stimulation of chemoreceptors and the respiratory centre. Later rapid slowing of respiratory rate with severe respiratory depression and cyanosis. Frothy discharge from mouth C.V.S.: Initially hypeension with reflex bradycardia, sinus arrhythmia. Later tachycardia with hypotension and cardiovascular collapse. Skin: Perspiration, bullae. Pink coloured skin and mucosa Eyes: Glassy and prominent, pupils dilated, unreactive. Renal: Acidosis. Death occurs from respiratory failure. Fatal Period: 2 to 10 minutes; sometimes immediate. Potassium or sodium cyanide: half an hour. The patient may survive for several hours due to delayed absorption. Management - Lilly's antidote Vit. B12 Di cobalt EDTA Bright/Brick Red hypostasis is seen after death of patient Bedside test for Cyanide - Lee jones test

So the answer to this question is A


Instruction:
A 14-year-old boy is brought to OPD with c/o increasing weakness, easy fatigability, and weight loss over the past 3 months. In addition, he has recently developed nausea, vomiting, and abdominal pain. His blood pressure is markedly decreased, and he has increased pigmentation of his skin creases. These findings are suggestive of
A. Cushing syndrome.
B. Secondary hyperaldosteronism
C. Osteitis fibrosa cystica
D. Addison disease.

Response:
- The clinical findings are suggestive of Addison disease (primary adrenocoical insufficiency). - MCC cause - Tuberculosis ; Autoimmunity - Hyperpigmentation in Addison disease results from compensatory hypothalamic production of pro-opiomelanocoin, precursor peptide of both coicotropin & melanocyte-stimulating factor

So the answer to this question is D


Instruction:
Trismus is due to spasm of which of the following muscle (FMGE Dec 2018)
A. Buccinator
B. Lateral pterygoid
C. Medial pterygoid
D. Mentalis

Response:
M - Medial pterygoid - inseed to ramus of mandible from inner side T - Temporalis - inseed into coronoid process of mandible M -Masseter-- inseed to ramus of mandible from outside Lateral pterygoid - depressor of mandible - pull mandible antero-inferiorly and open the mouth Antagonize (MTM muscles) *Tetanus neonatorum - spasm of masseter *Trismus - spasm of muscles of mastication especially medial pterygoid muscle. Mentalis: Deepest muscle of lower group arising from mandible just inferior to incisor teeth, with fibers passing downward & medially to inse into skin of chin. It raises & protrudes lower lip as it wrinkles skin of chin Help position lip when drinking from cup / when pouting Buccinator: Compresses cheek against teeth & is used in acts like blowing

So the answer to this question is C


Instruction:
Duchenne&;s Muscular Dystrophy is a disease of
A. Neuromuscular junction
B. Sarcolemmal proteins
C. Muscle contractile proteins
D. Disuse atrophy due to muscle weakness

Response:
Duchenne and Becker muscular dystrophy are caused by loss-of-function mutations in the dystrophin gene on the X chromosome. The encoded protein, dystrophin, is a key component of the dystrophin-glycoprotein complex.Dystrophin is thought to provide mechanical stability to the myofiber and its cell membrane during muscle contraction.Robbins 9e 1242

So the answer to this question is C


Instruction:
LH peak occurs how many hours before ovulation -
A. 36-48hrs.
B. 12-24hrs
C. 48-72hrs
D. 72-96hrs

Response:
Events Hours Oestraiol rise 83 Onset of LH surge 34-36 Oestraiol peak 24-36 LH peak 12-24 Progesterone rise 8 Approximate time interval of events in menstrual cycle prior to ovulation

So the answer to this question is B


Instruction:
True about hand hygeine -
A. Betadine can cause irritation
B. Alcohol based preparation are used
C. Hot water is best
D. Gluteraldehyde is used

Response:
Ans. is 'b' i.e., Alcohol based preparation are used o Povidone iodine is the best skin disinfectant o Povidone iodine (Betadine) is less irritant and cause less staining.o Aqueous and alcohol-based povidone iodine preparations are widely used in skin disinfection including preoperative preparation of the skin.o Commonly used skin disinfectants for hand washing are-# Povidone iodine (Betadine) - Best# Chlorhexidine# Isopropyl alcohol

So the answer to this question is B


Instruction:
According to National Leprosy Elimination Programme, elimination of leprosy is defined as prevalence of Leprosy less than or equal to______.
A. 1 per 1000 population
B. 1 per 10000 population
C. 1 per 1,00,000 population
D. 2 per 10000 population

Response:
Ans. b (1 per 10000 population) (Ref. Text book of PSM by Park 22nd/ 391)NATIONAL LEPROSY ELIMINATION PROGRAMME# Only target India achieved as per National Health Policy 2002 that too only at National level, not at state or district level.# Current prevalence of leprosy is 0.72/10000 population (at one place it is mentioned as 0.74/10000).# 28 states and UT attained level of elimination.# 487 out of 611 districts in India have achieved level.# Annual new case detection rate--11.70/100000.# High prevalence (1-2)- Bihar, Chhatisgarh, Jharkhand, West Bengal, Chandigarh# Prevalence >2 is in Dadara & Nagar Haveli.

So the answer to this question is B


Instruction:
Stretch reflex of bladder is integrated at
A. Sacral poion
B. Lumber poion
C. Substantia gelatinosa
D. Sympathetic plexus

Response:
The bladder smooth muscle has some inherent contractile activity; however, when its nerve supply is intact, stretch receptors in the bladder wall initiate a reflex contraction that has a lower threshold than the inherent contractile response of the muscle. Fibers in the pelvic nerves are the afferent limb of the voiding reflex, and the parasympathetic fibers to the bladder that constitute the efferent limb also travel in these nerves. The reflex is integrated in the sacral poion of the spinal cord.Ref: Ganong&;s review of medical physiology,23rd edition, page: 662

So the answer to this question is A


Instruction:
The diluent used for BCG is -
A. Distilled water
B. Normal saline
C. Dextrose solution
D. Ringer - lactate

Response:
BCG Aim- To induce a benign,aificial primary infection which will stimulate an acquired resistance to possible subsequent infection with virulent tubercle bacilli, and thus reduce the morbidity and moality from primary tuberculosis among those most at risk. WHO recommends the &;Danish 1331&; strain for vaccine production. Stable for several weeks at ambient temperature in a tropical climate and for upto 1 year if kept away from direct light and stored in a cool environment below 10 deg celcius. Vaccine must be protected from light ( wrapped up in a double layer of red/ black cloth). Normal saline is recommended as diluent for reconstituting the vaccine as distilled water may cause irritation. Reconstituted vaccine may be used within 3 hours. Dosage-0.1 mg in 0.1 ml volume. The dose of newborn below 4 weeks is 0.05 ml. Administered intradermally using tuberculin syringe. Injected slightly above the inseion of left deltoid. If injected too high / too low adjacent lymph nodes may become involved and tender. The vaccine must not be contaminated with an antiseptic/detergent. If alcohol is used to swab the skin , it must be allowed to evaporate before the vaccine is given. Phenomenon after vaccination:/ 2-3 weeks after a correct intradermal injection of a potent vaccine, a papule develops at the site of vaccination. It increases slowly in size and reaches a a diameter of about 4-8 mm in 5 weeks. It then subsides or breaks into a shallow ulcer but usually seen covered by a crust. Healing occurs within 6-12weeks leaving a permanent,tiny, round scar (4-8 mm in diameter).This is a normal reaction. Normally the individual become mantoux postive after 8 weeks has elapsed. Adverse reactions: prolonged severe ulceration at the site of vaccination, suppurative lymphadenitis, osteomyelitis and disseminated BCG infection. Contraindications: BCG should not be given to patients with generalised eczema, infective dermatosis, hypogammaglobulinemia , those with history of deficient immunity, patients under immunosuppressive treatment and in pregnancy. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.196}

So the answer to this question is B


Instruction:
All of the following drugs are useful in nephrogenic diabetes insipidus except
A. Amiloride
B. Indomethacin
C. Chlorpropamide
D. Thiazide diuretics

Response:
The polyuria and polydipsia of nephrogenic DI are not affected by treatment with standard doses of DDAVP. Treatment with conventional doses of a thiazide diuretic and/or amiloride in conjunction with a low-sodium diet and a prostaglandin synthesis inhibitor (e.g., indomethacin) usually reduces the polyuria and polydipsia by 30-70% and may eliminate them completely in some patients. ref : Harrisons 20th ed 2279.

So the answer to this question is C


Instruction:
Psammoma bodies seen in A/E
A. Follicular CA of thyroid
B. Papillary CA of thyroid
C. Serous cystadenocarcinoma of ovary
D. Meningioma

Response:
Psammoma bodies are small, concentric , spherules of calcification, also called calcospherites, seen in Papillary carcinoma thyroid, Meningioma and Papillary serous cystadenocarcinoma of the ovary. Reference : page 52 Textbook of pathology Harshmohan 6th edition

So the answer to this question is A


Instruction:
Onycholysis is seen in all of the following, except:
A. Allergic dermatitis
B. Psoriasis
C. Antineoplastic therapy
D. Nephrotic syndrome

Response:
Nephrotic syndrome

So the answer to this question is D


Instruction:
Which of the following is a mechanical method of cervical induction?
A. PGE1 Oral Induction
B. PGE1 Vaginal induction
C. PGE2 vaginal Induction
D. Transcervical Foleys catheter

Response:
Techniques of labor inductionPharmacological PGE2 PGE1 or Oral MechanicalTranscervical 36F Foley catheter Hygroscopic dilators (Ref: William's Obstetrics; 25th edition)

So the answer to this question is D


Instruction:
Primary treatment of dacrocystitis -
A. Massage
B. Probing
C. Surgery
D. Antibiotic drops

Response:
Massage increases the hydrostatic pressure in the sac and help to open the membranous occlusions and it carried out 4 times a day to be followed by antibiotic drops. Ref Ak khurana 6th edition

So the answer to this question is A


Instruction:
Asteroid bodies are seen in?-
A. Sarcoidosis
B. Syphilis
C. Chromoblastomycosis
D. Sporotrichosis

Response:
Ref:Textbook of pathology (Harsh mohan) 6th edition,page no.774 CUTANEOUS SARCOIDOSIS. Sarcoidosis is a systemic granulomatous disease of unknown etiology . The lesions appear in the lungs, skin, eyes, nose and lymph nodes. Cutaneous manifestations appear as presenting feature in about a quaer of patients and include erythema nodosum, or brown-red jelly-like papules or plaques with central clearing. When these lesions are seen around nose, eyes and cheeks they are referred to as lupus perinio. Microscopically, Characteristic feature is the presence of non-caseating epithelioid cell granulomas having Langhans' giant cells but having paucity of lymphocytes, also called 'naked granulomas' . Fibrinoid necrosis and presence of intracellular inclusions such as asteroid bodies are some other features which may be seen.

So the answer to this question is A


Instruction:
Floor of middle ear cavity is in relation with:
A. Internal carotid artery
B. Bulb of the internal jugular vein
C. Sigmoid sinus
D. Round window

Response:
(b) Bulb of the internal jugular vein(Ref. Cummings, 6th ed., 1983)The floor of middle ear cavity is a thin plate of bone separating the middle ear from jugular bulb below.Internal carotid artery is in relation to the anterior wall of middle ear.Sigmoid sinus is not related directly with middle ear cavity. It lies posterior to the mastoid antrum.Round window lies postero-inferiorly on the medial wall of middle ear.

So the answer to this question is B


Instruction:
Undisplaced fracture of zygoma is managed by
A. Closed reduction
B. Open reduction
C. No specific treatment
D. Wiring to frontal bone

Response:
Zygoma is the second most common bone to be fractured after the nasal bone. Direct trauma is the usual cause. Treatment is required only for the displaced fractures. Open reduction and internal wire fixation is the best option.

So the answer to this question is C


Instruction:
Pyruvate forms alanine by:
A. Oxidation
B. Transamination
C. Hydroxylation
D. Hydroxylation

Response:
Transamination of pyruvate forms alanine. Similarly, transamination of oxaloacetate forms aspaate Ref: Harper 28thedition, chapter 27.

So the answer to this question is B


Instruction:
In the Nodal "N" staging of laryngeal carcinoma, extranodal invasion is indicated by
A. N2C
B. N3A
C. N3B
D. N3C

Response:
None

So the answer to this question is C


Instruction:
Veins communicating the cavernous sinus to pterygoid plexus pass through fossa of :
A. Scapra
B. Vesalius
C. Ovale
D. Langer

Response:
B i.e. Vesalius; C i.e. OvaleForamen Vesalius is an inconstant foramen that gives passage to an emissary vein that connects pterygoid venous plexus with cavernous sinus (vein of vesalius)Q. It is also k/a sphenoidal emissary foramen as its seen in the great wing of sphenoid, medial to foramen ovale, opposite the root of pterygoid process. When present it opens below near scaphoid fossa (in the pterygoid process of sphenoid & gives origin to tensor vali patatini)Langer's (Axillopectoral) muscle/ Axillary Arch: A muscle originating from coracoid- process of scapula, extending to long head of triceps and adhering to both triceps brachii & tendinous pa of latissimus dorsi muscle.

So the answer to this question is B


Instruction:
Not True about IMNCI
A. Includes early Neonatal care
B. Pink color code refers to urgent referral
C. Includes Home based care
D. Dedication of 75% training staff to Infants

Response:
Under IMNCI, the proportion of training time devoted to sick infant and other sick children is almost same.

So the answer to this question is D


Instruction:
Most common complication of sliding hernia is -
A. Esophagitis due to continuous reflux
B. Pneumonia
C. Hemorrhage
D. Perforation

Response:
Ans. is 'a'i.e., Esophagitis due to continuous reflux o There are 4 types of hiatal herniaType I: Sliding hernia (most common type ~ 70 - 80%)Type II: Paraesophageal or rolling hernia TypeIII: MixedType IV: These hernias are distinguished by the presence of other abdominal viscera wihin the defect i.e. omentum, transverse colon.o Type I or Sliding hiatal hernia# This is characterized by upward dislocation of the cardioesophageal junction into the posterior mediastinum.o Type II or Rolling Paraesophageal hernia# The cardioesophageal junction is undisplaced# The whole or part of stomach herniates into the thorax immediately adjacent and to the left of the undisplaced cardioesophageal junction.# Since the normally located gastroesophageal junction functions normally in most of these hernias, reflux is uncommon.Complications of hiatal hernia|||Sliding herniaRolling Paraesophageal herniao Esophagitis d/e reflux (most common)o Barrett's esophagous & adenocarcinomao Aspiration & pneumoniao Minor role in development of asthmao Hemorrhage, incarceration obstruction & strangulationo Respiratory complicationo Dyspnea from mechanical compressiono Pneumonia if aspiration occurs.

So the answer to this question is A


Instruction:
False about biliary cystadenoma
A. CT scan is used for diagnosis
B. CA 19-9 is elevated
C. Intra hepatic location
D. Common in males

Response:
Biliary cystic adenocarcinoma Incidence : Female : Male is 2:1. It is more common in females Ref: Sabiston 20th edition Pgno :1469

So the answer to this question is D


Instruction:
Contraindication for skin traction -a) Dermatitisb) Vascularity compromized status of limbc) Abrasionsd) Hypopigmentation (vitiligo)e) Bony deformity
A. ab
B. abc
C. acd
D. bcd

Response:
Contraindications of skin traction

Skin damage or sepsis in the area.
Deep vein thrombosis
Suspected vascular defecit
Anaesthetic limb (neurological deficit).
Force required is > 5 kg & for long duration due to changes of peeling off of skin.
In small abrasions it can be applied with proper padding but large abrasions are relative contraindications.

So the answer to this question is B


Instruction:
Third ventricle is derived from -
A. Mesencephalon
B. Rhombencephalon
C. Thalamecephalon
D. Telencephalon

Response:
Ans. is 'c' i.e., Thalamecephalon Part of brainSubdivisionsCavityo Forebrain (Prosencephalon)o Telencephalon (cerebrum)Cerebral hemisphereo Diencephalon (thalamencephalon) Thalamus, hypothalamus, metathalamus (including medial and lateral genialate bodies), epithalamus, sunthalamus.Lateral ventricle Third ventricleo Midbrain (Mesencephalon)o Crus cerebri, substantia nigra, tegmentum and tectumCerebral aqueducto Hindbrain (rhombencephalon)o Metencephalon pons, cerebellumo Mylencephalon medullaFourth ventricle

So the answer to this question is C


Instruction:
True about "Zero base budgeting" is?
A. Relies on data of previous budget
B. Proceeds from resources to target
C. Proceeds from target to resource
D. Not a priority based budgeting

Response:
Ans. (c) Proceeds from target to resourceRef: CIMA official Learning System Management According-Performance-p 209

So the answer to this question is C


Instruction:
A man developed swelling of face frequently with occassional laryngeal edema, most probable diagnosis is aEUR'
A. C-1 esterase deficiency
B. Allergy
C. Anaphylaxsis
D. Not esterase deficiency

Response:
C1 esterase deficiency (Ref: Harrison 17"Ve p. 2066; Robbin's 7"'/e p. 66, 671 Repeat from May 10 Q no.111

So the answer to this question is A


Instruction:
The cause of oedema in nephritic syndrome
A. Increase in plasma protein concentratn
B. Decrease plasma protein concentratn
C. Reduced plasma osmotic pressure
D. Sodium and water retention

Response:
Robbins page no p922 Glomerular diseases presenting with a nephritic syn- drome are often characterized by inflammation in the glomeruli. The nephritic patient usually presents with hematuria, red cell casts in the urine, azotemia, oliguria, and mild to moderate hypeension. Proteinuria and edema are common, but these are not as severe as those encountered in the nephrotic syndrome, discussed later. The acute nephritic syndrome may occur in such multi- system diseases as SLE and microscopic polyangiitis.

So the answer to this question is D


Instruction:
Which glycogen storage disease does not affect muscles?
A. Type 1
B. Type 2
C. Type 3
D. Type 4

Response:
a. Type 1(Ref: Nelson's 20/e p 715-725, Ghai 8/e p 655-657)Type 2 Pompe disease predominantly involves muscles, while type I GSD involves liver.Although type 2 and type 3 GSD are predominantly liver glycogenoses, skeletal muscle involvement may also be seen.

So the answer to this question is A


Instruction:
A rough / chalky surface of the cast is due to all of the following except:
A. Not waiting for 20 min before pouring
B. Excess wetting agent left on impression
C. Air incorporation in the mix
D. Improper powder/water ratio of stone

Response:
Air incorporation in the mix leads to bubbles.

So the answer to this question is C


Instruction:
Most common cause of infertility in females is due to the disorder of
A. Uterus
B. Ovarian
C. Vagina
D. Cervix

Response:
(B) Ovarian# Common causes of infertility of females include:> Ovulation problems (E.g. Polycystic ovarian syndrome, PCOS, the leading reason why women present to fertility clinics due to anovulatory infertility, tubal blockage, pelvic inflammatory disease caused by infections like tuberculosis> Age-related factors, Uterine problems, Previous tubal ligation, Endometriosis, Advanced maternal age

So the answer to this question is B


Instruction:
Protein is assessed by – a)  Protein energy ratiob)  BUNc) Per gm calories givend) Amino acid score
A. b
B. c
C. ad
D. ab

Response:
None

So the answer to this question is C


Instruction:
A farmer from central Asia presents with an acute onset of swinging pyrexia, rigor, sweating and monoarticular arthritis of the hip. He also complained of headache and insomnia. On examination he is found to have a small, firm splenom egaly and hepatomegaly. His counts showed leucopenia with relative lypmhocytosis.The most likely diagnosis is-
A. Brucellosis
B. Bagassosis
C. Byssinosis
D. Chikungunya fever

Response:
None

So the answer to this question is A


Instruction:
Irreversible ototoxicity is caused by -
A. Cisplatin
B. Cyclophosfamide
C. Bleomycin
D. Chlorambucil

Response:
Ans. is 'a' i.e., Cisplatin "Cisplatin induced hearing loss is usually bilateral and irreversible"Drugs causing ototoxicityA) Vestibular (primarily)o Aminoglycosides o Mustineo Quinidineo Quinineo Chloroquineo Vancomycino Furosemide o Ethacrynic acido Salicylates (high dose)B) Auditory (primarily)o NSAIDso Ethacrynic acido Vancomycino Aminoglycosideso Cisplatin

So the answer to this question is A


Instruction:
Why pyridostigmine is preferred in myasthenia gravis?
A. It doesn't cross BBB
B. Longer acting than neostigmine
C. It crosses BBB
D. Sho-acting than neostigmine

Response:
DOC FOR myasthenia gravis is pyridostigmine as it long acting than neostigmine.both are quaternanry coumpounds and so cant cross BBB Ref: KDT 6th ed pg 101-102

So the answer to this question is B


Instruction:
Enzyme dificient in alkaptonuria -
A. Kynureninase
B. Tyrosine hydroxylase
C. Homogentisate oxidase
D. Tyrosinase

Response:
Ans. is 'c' i.e., Homogentisate oxidase Metabolic diseaseEnzyme deficientMaple syrup urine diseaseBranched chain ketoacid dehydrogenaseMethyl-melonic aciduriaMethyl-malonyl CoA mutase (isomerase)Sweaty feet odor in bodyIsovaleryl-CoA dehydrogenaseTvrosinemia I (Tyrosinosis)Fumarylacetoacetate hydroxylaseTyrosinemia IITyrosine transaminase (Tyrosine aminotransferase)Neonatal tyrosinemiaHydroxyphenyl pyruvate hydroxylaseAlbinismTyrosinaseAlkaptonuriaHomogentisate oxidasePhenylketonuriaPhenylalanine hydroxylaseOrotic aciduriaOMP decarboxylaseHomocystinuriaCystathionine svnthataseLesh-Nyhan syndromeComplete deficiency of enzyme HGPRTCystinosisCystine reductase

So the answer to this question is C


Instruction:
A patient, Tina was anesthetized with halothane and nitrous oxide and tubocurarine was used for skeletal muscle relaxation. She became hypertensive along with marked muscle rigidity and hyperthermia. Lab reports showed that she has developed hyperkalemia and acidosis. This complication was caused by:
A. Block of autonomic ganglia by tubocurarine
B. Pheochromocytoma
C. Activation of brain dopamine receptors by halothane
D. Excessive release of calcium from the sarcoplasmic reticulum

Response:
The symptoms of the patient (muscle rigidity, hypertension, hyperthermia, hyperkalemia and acidosis) suggest the diagnosis of malignant hyperthermia.
Halothane can precipitate malignant hyperthermia in susceptible individuals. SCh increases this incidence.
Malignant hyperthermia is due to excessive release of Ca2+ from the sarcoplasmic reticulum.
Drug of choice for malignant hyperthermia is dantrolene that inhibits the release of Ca2+ (by blocking ryanodine receptors in the sarcoplasmic reticulum).

So the answer to this question is D


Instruction:
Hallucinations, psychosis, hypertension, and tachycardia are adverse effects typically associated with which of the following narcotics:
A. Morphine
B. Meperidine
C. Pentazocine
D. Buprenorphine

Response:
None

So the answer to this question is C


Instruction:
Conditions Which are relatively contraindicated for vacuum extractions are all; EXCEPT:
A. Face presentation
B. Extreme prematurity
C. Fetal coagulopathies
D. Occipito-posterior position

Response:
Vacuum avoids inseion of steel blades within the vagina, and provides the ability to rotate the fetal head without impinging upon maternal soft tissues and less intracranial pressure during traction. The relative contraindication are (1) face or other non veex presentation (2) extreme premautrity (3) fetal coagulopthies (4) known macrosomia (5) following recent scalp blood sampling.

So the answer to this question is D


Instruction:
Most common cause of infection caused by intravascular catheter ?
A. E coli
B. Coagulase negative staphylococci
C. Staph aureus
D. Pseudomonas

Response:
Ans. is 'b' i.e., Coagulase negative staphylococci "Staph. epidermidis is a coagulase negative staphylococcus, which has predilection for growth on implanted foreign bodies such as intravascular catheters, shunts, aificial hea valves and prosthetic appliances, leading to bacteremia".

So the answer to this question is B


Instruction:
What is Felanga?
A. Torture method of slapping over ears
B. Suspension by ankles
C. Tying plastic bag and cause suffocation
D. Beating over the soles

Response:
Felanga is a method of torture in which rods or sticks are used to beat on foot.

So the answer to this question is D


Instruction:
All of the following predispose to fibroid except.
A. Obesity
B. Early menopause
C. Nulliparity
D. African females

Response:
Ans. is b, i.e. Early Menopause-Fibroid is an estrogen and progesterone dependent tumor. Hence early menarrche and late menopause predispose to fibroid and not the vice versa.

So the answer to this question is B