Instruction:
Latest drug used for treatment of MDR TB patients is -
A. Bedaquiline
B. Amithiozone
C. Capreomycin
D. Linezolid

Response:
Ans. is 'a' i.e., Bedaquiline Bedaquiline* It is a diaryl quinolone.* It acts by inhibiting M. tuberculosis adenosine triphosphate synthase.* It demonstrates significant potency against M. tuberculosis infection, both drug susceptible and multidrug resistant strains as well as many other mycobacteria.* It has potential to shorten the duration of drug therapy for management M. tuberculosis infection.* It is associated with nausea, increased QT interval.* FT, has approved bedaquiline for the management of drug resistant tuberculosis with a black box warning, relating to possible cardiac toxicity and sudden death.Note:DELAMANID:* It is also a new agent derived from nitrodihydro-imidazooxazole class of compounds.* It inhibits mycolic acid synthesis, and has shown potent in vitro and invivo activity against both drug susceptible and drug resistant M. tuberculosis strains.

So the answer to this question is A


Instruction:
Pap smear test for detection of carcinoma of cervix is which level of prevention?
A. Primordial
B. Primary
C. Secondary
D. Tertiary

Response:
None

So the answer to this question is C


Instruction:
Agent which dissolves rubber
A. Halothane
B. Enflurane
C. Cyclopropane
D. Ether

Response:
A i.e. Halothane

So the answer to this question is A


Instruction:
All are treatable diseases of spinal cord EXCEPT:
A. ALS
B. Multiple sclerosis
C. Syringomyelia
D. A-V malformation

Response:
ANSWER: (A) ALSREF: Harrison's 18th ed ch: 377Option (A):ALS or amyotrophic lateral sclerosis : No treatment arrests the underlying pathologic process in ALS. The drug riluzole (100 mg/d) was approved for ALS because it produces a modest lengthening of survival.Option (B):Multiple sclerosis : Therapy for MS can be divided into several categories:treatment of acute attacks,treatment with disease-modifying agents that reduce the biological activity of MS, andsymptomatic therapy. Treatments that promote remyelination or neural repair do not currently exist but would be highly desirableOption (C):Syringomelia: Treatment of syringomyelia is generally unsatisfactory. The Chiari tonsillar herniation is usually decompressed, generally by suboccipital craniectomy, upper cervical laminectomy, and placement of a dural graft. Obstruction of fourth ventricular outflow is reestablished by this procedure. If the syrinx cavity is large, some surgeons recommend direct decompression or drainage by one of a number of methods, but the added benefit of this procedure is uncertain, and morbidity is common.With Chiari malformations, shunting of hydrocephalus should generally precede any attempt to correct the syrinx. Surgery may stabilize the neurologic deficit, and some patients improve.Syringomyelia secondary to trauma or infection is treated with a decompression and drainage procedure in which a small shunt is inserted between the syrinx cavity and the subarachnoid space; alternatively, the cavity can be fenestrated. Cases due to intramedullary spinal cord tumor are generally managed by resection of the tumor.Option (D): A-V Malformations: treatment of AVM is largely surgical.Although the text creates confusion, but a table in Harrisons 18th Ed solves the question. The questions seems to have been taken directly from itTREATABLE SPINAL CORD DISORDERSCompressiveEpidural, intradural, or intramedullary neoplasmEpidural abscessEpidural hemorrhageCervical spondylosisHerniated diskPosttraumatic compression by fractured or displaced vertebra or hemorrhageVascularArteriovenous malformationAntiphospholipid syndrome and other hypercoagulable statesInflammatoryMultiple sclerosisNeuromyelitis opticaTransverse myelitisSarcoidosisSjogren-related myelopathySystemic lupus erythematosusVasculitisInfectiousViral: VZV, HSV-1 and -2, CMV, HIV, HTLV-I, othersBacterial and mycobacterial: Borrelia, Listeria, syphilis, othersMycoplasma pneumoniaeParasitic: schistosomiasis, toxoplasmosisDevelopmentalSyringomyeliaMeningomyeloceleTethered cord syndromeMetabolicVitamin B12 deficiency (subacute combined degeneration)Copper deficiencyAbbreviations: CMV, cytomegalovirus; HSV. herpes simplex virus; HTLV

So the answer to this question is A


Instruction:
Which of the following are derived from mesoderm
A. Astrocytes
B. Oligodendrocytes
C. Microglial cells
D. Schwann cells

Response:
There is a third type of neuroglial cell called microglia. this type doesn't develop from the cells of the neural tube but migrates into it along with blood vessels.these cells are believed to be of mesodermal origin HUMAN EMBRYOLOGY-INDERBIR SINGH TENTH EDITION-PAGE NO:116

So the answer to this question is C


Instruction:
Left testicular vein drains into?
A. Left renal vein
B. Inferior vena cava
C. Common iliac vei
D. Internal iliac vein

Response:
ANSWER: (A) Left renal veinREF: Gray's anatomy 39th ed p.1307Repeat from June 2011Repeat (**)"The right testicular vein opens into the inferior vena cava at an acute angle just inferior to the level of the renal veins, and the left testicular vein opens into the left renal vein at a right angle"

So the answer to this question is A


Instruction:
Name the muscle group which opposes the buccinator mechanism:
A. Medical pterygoid
B. Lateral pterygoid
C. Masseter
D. Tongue muscles

Response:
None

So the answer to this question is D


Instruction:
Wound contraction is mediated by –
A. Epithelial cells
B. Collagen
C. Myofibroblasts
D. Elastin

Response:
"Perhaps the feature that most clearly differentiates primary from secondary healing is the phenomenon of wound contraction, which occurs in large surface wounds. Permanent wound contraction requires the action of myofibroblasts— altered fibroblasts that have the ultrastructural characteristics of smooth muscle cells. Contraction of these cells at the wound site decreases the gap between the dermal edges of the wound"- Robbins 7th/113
Healing By First Intention (Wounds With Opposed Edges) Robbins 7th/all-113
□ The least complicated example of wound repair is the healing of a clean, uninfected surgical incision approximated by surgical sutures. Such healing is referred to as primary union or healing by the first intention.
□ The narrow incisional space immediately fills with clotted blood containing fibrin and blood cells; dehydration of the surface clot forms the well-known scab that covers the wound.
□ Within 24 hours, neutrophils (Polymorphonuclear leukocytes) appear at the margins of the incision, moving toward the fibrin clot.
□ In 24 to 48 hours, spurs of epithelial cells move from the wound edges (with little cell proliferation) along the cut margins of the dermis, depositing basement membrane components as they move.
□ By day 3, the neutrophils have been largely replaced by macrophages. Granulation tissue progressively invades the incision space.
□ By day 5, the incisional space is filled with granulation tissue. Neovascularization is maximal
□ During the second week, there is continued accumulation of collagen and proliferation of fibroblasts The leukocytic infiltrate, edema, and increased vascularity have largely disappeared.
□ By the end of the first month, the scar is made up of a cellular connective tissue devoid of inflammatory infiltrate, covered now by the intact epidermis.

So the answer to this question is C


Instruction:
Which clinical feature of differentiates orbital apex syndrome (OAS) from superior orbital fissure syndrome (SOFS)?
A. Proptosis
B. Horner's syndrome
C. Loss of vision
D. Loss of ocular movements

Response:
Proptosis and loss of ocular movements can occur in both. Horner syndrome is more likely a feature of cavernous sinus syndrome which differentiates it from superior orbital fissure syndrome. As orbital apex syndrome affects optic canal , it causes loss of vision which differentiates it from SOFS.

So the answer to this question is C


Instruction:
Hilar markings in a normal chest X-ray is formed by all except:
A. Pulmonary aery
B. Bronchi
C. Upper lobe veins
D. Upper lobe veins

Response:
Ans. Upper lobe veins

So the answer to this question is D


Instruction:
Ciliocytophthoria is seen in:
A. Kartagener
B. Situs inversus
C. Acute Respiratory infection
D. Cystic fibrosis

Response:
Ans. (C) Acute Respiratory infection(Ref: Robbins and Cotran Pathologic Basis of Disease 10th ed; pg. 245)Ciliocytophthoria is seen in acute respiratory infection.Ciliocytophthoria (CCP) defines a degeneration of the ciliated cells sue to viral infection, which is seen in acute respiratory infection.

So the answer to this question is C


Instruction:
Drug that is radioprotective is :
A. Paclitaxel
B. Vincristine
C. Etoposide
D. Amifostine

Response:
None

So the answer to this question is D


Instruction:
30 year old primi with 36 weeks of pregnancy with blood pressure 160/110 & urinary albumin is 3+ & platelet count 80000/mm3. What will be the management?a) Betamethasoneb) MgSO4c) Labetalold) Urgent LSCSe) Labour induction
A. bce
B. abd
C. abcd
D. bce

Response:
None

So the answer to this question is D


Instruction:
Enzymes which are responsible for the synthesis of extracellular glucans and fructans:
A. Glucosyltransferase, fructosyl transferase.
B. Glucosylconvertase, fructosyl
C. Convertase.
D. Both of the above.

Response:
None

So the answer to this question is A


Instruction:
Inferior vena cava is formed at which level:
A. L2
B. L3
C. L4
D. L5

Response:
Ans. D L5Ref: Clinically Oriented Anatomy by Keith, Moore, 5th ed/340* The IVC begins anterior to the L5 vertebra by the union of the common iliac veins.* This union occurs approximately 2.5 cm to the right of the median plane, inferior to the bifurcation of the aorta and posterior to the proximal part of the right common iliac artery.* Renal vein at the level of L1* Portal veins form at L1* Hepatic veins form at T8

So the answer to this question is D


Instruction:
Most radiosensitive testicular tumour is: March 2008
A. Seminoma
B. Teratoma
C. Interstitial tumours
D. Lymphoma

Response:
Ans. A: Seminoma Tumours of the testis are classified according to their predominant cellular types: Seminoma (40%) Teratomas (32%) subdivided into: - Teratoma differentiated - Malignant teratoma intermediate - Malignant teratoma undifferentiated - Malignant teratoma trophoblastic (choriocarcinoma is the most lethal form and it is the least common at 1% of the non-seminomatous type) Combined seminoma and teratoma (14%) Interstitial tumours (1.5%) Risk factors include: Cryptorchidism or testicular maldescent. Klinefelter's syndrome. Family history. Male infeility (increases risk by a factor of three). Low bih weight, young maternal age, young paternal age, multiparity, breech delivery. Infantile hernia. Height - taller men are more at risk of developing germ cell tumours. Testicular microlithiasis (small intratesticular calcifications seen on ultrasound). Diagnosis is usually confirmed by ultrasound. Tissue histology can follow an inguinal orchidectomy. Disease can be staged by thoraco-abdominal CT scanning. Tumour markers are useful in staging and assessing response to treatment. Alpha-fetoprotein is produced by yolk sac elements but not produced by seminomas. Beta-human chorionic gonadotrophin is produced by trophoblastic elements and so may be elevated levels in both teratomas and seminomas. LDH should be measured. Tumour markers are present in 75% of teratomas. Royal Marsden staging of testicular tumours: Stage I - disease confined to the testis. Stage IM - as Stage I but with tumour markers rising after operation. Stage II - para-aoic lymph node involvement with fuher division into Stage IIA with nodes5 cm in diameter. Stage III - the disease has spread above the diaphragm with fuher subdivision into A, B and C as for Stage II. Stage IV - extra lymphatic metastases. - Stage L1 - - Stage L2 - >3 lung metastases but all Stage L3 - >3 lung metastases with 1 or more >2 cm in diameter. Stage H+ - liver metastases. Seminomas are radiosensitive.Teratomas are not radiosensitive:

So the answer to this question is A


Instruction:
Atherosclerosis causes fibroblast plaque formation by injury to?
A. Endothelium
B. Fibroblast
C. Macrophage
D. Smooth muscle cells

Response:
Ans. (a) Endothelium(Ref: Robbins 9th/pg 498-499; 8th/pg 505; Harrison 18th/pg 1503)Pathogenesis of atherosclerosis best explained by the 'Response to Injury hypothesis to endothelium

So the answer to this question is A


Instruction:
Early expanding stage is denoted by
A. Decreased birth rate and Decreased death rate
B. Increased birth rate and Increased death rate
C. Unchanged birth rate and Decreased death rate
D. Decreased birth rate and Increased death rate

Response:
None

So the answer to this question is C


Instruction:
Is 70 year old man was administered penicillin intravenous within five minutes, he developed generalized uicaria, swelling of lips, hypotension and bronchospasm. the first choice is to administer
A. Chlorpheneramine inj
B. Epinephrine inj
C. High dose hydrocoisone tablet
D. Nebulized salbutamol

Response:
Epinephrine (adrenaline) is a drug of choice for anaphylactic shock. it is given by subcutaneous or intramuscular route in a concentration of 1:1000. intravenous route is rarely used but at match but that much lower concentration(1:10,000) Refer kDT 6/e p128

So the answer to this question is B


Instruction:
Koeppe's nodules:
A. Are a feature of nongranulomatous iridocyclitis
B. Are situated at the pupillary border
C. Consist of polymorphonuclear cells
D. Do not initiate posterior synechiae formation

Response:
Ans. Are situated at the pupillary border

So the answer to this question is B


Instruction:
Satiety center is located at
A. Ventromedial nucleus of hypothalamus
B. Dorsomedial nucleus of hypothalamus
C. Peritrigonal area
D. Lateral nuclei

Response:
Ans. (a) Ventromedial nucleus of hypothalamus(Ref: Ganong, 25th ed/p.308)Feeding center - lateral nucleus of hypothalamusSatiety center - ventromedial nucleus of hypothalamus

So the answer to this question is A


Instruction:
The following drug is a synthetic choline ester (REPEAT)
A. Nicotine
B. Pilocarpine
C. Arecoline
D. Carbachol

Response:
Remaining all are naturally obtained from plants-alkaloids-the word ends with ''ine'' Ref: KDT 7th ed pg 101

So the answer to this question is D


Instruction:
................ are fundamentally dual monocular
telescopes with side by side lenses convergent to focus on the operative field
A. Loupes
B. Cameras
C. Spectacles
D. Lenses

Response:
None

So the answer to this question is A


Instruction:
A 16 years old female patient has abdominal lump that is movable and painless, upon exploratory laparotomy a cystic lump is found arising from mesentery, diagnosis is
A. Enterocele
B. Mesenteric cyst
C. Choledochal cyst
D. Pancreatic pseudocyst

Response:
Answer- B. Mesenteric cystMesentric cyst present asA painless abdominal swellingThe swelling moves freely in a plane at right angles to the attachment of the mesentry.Recurrent attacks of abdominal pain with or without vomiting due to obstructive symptoms.

So the answer to this question is B


Instruction:
All are indicated in a 30-year-old patient with increased serum cystine and multiple renal stones except:
A. Cysteamine
B. Increase fluid intake
C. Alkalinization of urine
D. Penicillamine

Response:
The clinical diagnosis of profile given in the question is CYSTINURIA . Cystinuria- AR,defect in re-absorptive transpo of cystine and the dibasic amino acids ornithine, arginine, and lysine from the luminal fluid of the renal proximal tubule and small intestine. Urinalysis- hexagonal shaped crystals: pathognomonic of cystinuria. The foundation of cystine stone prevention is adequate hydration and urinary alkalinization. When this conservative therapy fails, the addition of drugs, such as D-penicillamine and captopril. -The clinical profile should not be confused with Cystinosis which is treated with Cysteamine.

So the answer to this question is A


Instruction:
Which of these drugs can be a cause of rhabdomyolysis?
A. Statins
B. Salicylates
C. Antidepressants
D. All of these

Response:
Ans. D. All of theseMany drugs can cause rhabdomyolysis. They can cause rhabdomyolysis, both in therapeutic doses and in toxic doses. Some important drugs among these include antidepressants, antipsychotics, statins, corticosteroids, salicylates, many chemotherapeutic agents, and some anaesthetics.

So the answer to this question is D


Instruction:
Chronic Right Heart Failure the appearance of liver -
A. Congested
B. Shrinking
C. Fatty liver
D. Nodular

Response:
Ans. is 'a' i.e., Congested o Mallory bodies are eosinophilic intracytoplasmic inclusion bodies which are composed predominantly of keratin intermediate filaments.o They are also known as alcoholic hyaline.o These inclusions are characteristic but not specific feature of alcoholic liver disease, as they are also seen in other conditions.

So the answer to this question is A


Instruction:
Frame shift mutation DOESN'T occur in multiples of:
A. 2
B. 3
C. 4
D. 5

Response:
Ans: (b) 3Ref: Harper's Biochemistry 30th edn. / 417-18* Frame-shift mutations* The genetic code is read in form of triplets of nucleotides which are known as codons.* If one or two base pairs from the code are removed or inserted, the genetic code will be misread from that change onwards, because the genetic code is not punctuated. Therefore the amino acid sequence translated from the change onwards will be completely changed. This is known as frame shift mutation.* However if the removal /insertion happens in multiples of three, rest of the reading frame doesn't change and hence the amino acid sequence will not change.

So the answer to this question is B


Instruction:
Which one of the following perinatal infections has the highest risk of fetal infection in the first trimester?
A. Hepatitis B virus
B. Syphilis
C. Toxoplasmosis
D. Rubella

Response:
Ans. is 'd' i.e., Rubella * Rubella is one of the most teratogenic agents known. Eighty percent of women with rubella infection and a history of rash during the first 12 weeks have a fetus with congenital infection. At 13-14 weeks, the incidence is about 54%, and it is 25% by the end of the second trimester. As the duration of pregnancy increases, fetal infections are less likely to cause congenital malformations.* In order to prevent rubella during pregnancy and congenital rubella syndrome, ACOG recommends that the MMR vaccine should be offered to women of childbearing age who do not have evidence of immunity whenever they make contact with the health-care system. Vaccination of susceptible women should-1) Be part of routine general medical and gynecological care, including college health services.2) Take place in all family planning settings.3) Be provided routinely to unimmunized women immediately after hospitalization, childbirth, or abortion, unless there are specific contraindications.* Vaccination of all susceptible hospital personnel who might be exposed to patients with rubella or who might have contact with pregnant women is recommended. Rubella vaccination should be avoided 1 month before or during pregnancy because the vaccine contains attenuated live virus.* In toxoplasmosis, the incidence and severity of congenital infection depend on the gestational age of the fetus at the time of maternal primary infection. Infection increases with duration of pregnancy, with the risk the fetal infection rising from 6% at 13 weeks to 72% at 36 weeks. Fetal infection is more virulent the earlier the infection is acquired. Treatment of pregnant women is thought to prevent and reduce, but not eliminate, the risk of congenital infection. Spiramycin, used alone, is thought to reduce the risk of congenital infection but not to treat established fetal infection. When fetal infection in diagnosed by prenatal testing, pyrimethamine, sulfonamides and folinic acid are added to spiramycin to eradicate parasites in the placenta and fetus.* Transmission of syphilis from a syphilitic mother to her fetus across the placenta may occur at any stage of pregnancy, but the lesions of congenital syphilis generally develop after the fourth month of gestation, when fetal immunologic competence begins to develop.* Perinatal transmission of hepatitis B occurs primarily in infants born to HbsAg carrier mothers or mothers with acute hepatitis B during the third trimester of pregnancy or during the early postpartum period. Most infections occur approximately at the time of delivery and are not related to breast feeding.

So the answer to this question is D


Instruction:
Which of the following hypothesis was initially given for etiology of schizophrenia?
A. Serotonin Hypothesis
B. Dopamine hypothesis
C. Learned helplessness
D. Cognitive theory

Response:
Ans. B. Dopamine hypothesisThe dopamine hypothesis of schizophrenia or the dopamine hypothesis of psychosis is a model attributing symptoms of schizophrenia (like psychoses) to a disturbed and hyperactive dopaminergic signal transduction. The model draws evidence from the observation that a large number of antipsychotics have dopamine-receptor antagonistic effects. The theory, however, does not posit dopamine overabundance as a complete explanation for schizophrenia. Rather, the over activation of D2 receptors, specifically, is one effect of the global chemical synaptic dysregulation observed in this disorder.Some researchers have suggested that dopamine systems in the mesolimbic pathway may contribute to the 'positive symptoms' of schizophrenia (whereas problems with dopamine function in themes cortical pathway may be responsible for the 'negative symptoms', such as avolition and alogia.) Abnormal expression, thus distribution of the D2 receptor between these areas and the rest of the brain may also be implicated in schizophrenia, specifically in the acute phase. A relative excess of these receptors within the limbic system means Broca's area which can produce illogical language, has an abnormal connection to Wernicke's area, which comprehends language, but does not create it. Note that variation in distribution is observed within individuals, so abnormalities of this characteristic likely play a significant role in all psychological illnesses. Individual alterations are produced by differences within glutamatergic pathways within the limbic system, which are also implicated in other psychotic syndromes. Among the alterations of both synaptic and global structure, the most significant abnormalities are observed in the uncinate fasciculus and the cingulate cortex. The combination these creates a profound dissymmetry of prefrontal inhibitory signaling, shifted positively towards the dominant side. Eventually, the cingulate gyrus becomes atrophied towards the anterior, due to long-Term Depression (LTD) and Long-Term Potentiation (LTP) from the abnormally strong signals transversely across the brain. This, combined with a relative deficit in GABAergic input to Wernicke's area, shifts the balance of bilateral communication across the corpus callosum posteriorly.

So the answer to this question is B


Instruction:
The difference between leukemia and leukemoid reaction is done by -
A. Leukocyte alkaline phosphatase
B. Immature cells
C. Total leukocyte count
D. E.S.R.

Response:
Leukemoid reaction is defined as a reactive excessive leukocytosis in peripheral blood resembling that of leukemia in a subject who doesnot have leukemia. Leucocyte alkaline phosphatase (LAP) score in the cytoplasm of mature neutrophils is high in leukaemoid reaction whereas reduced in CML .It is very useful to distinguish between the two. Reference; Harsh Mohan textbook of pathology, 7th edition.Pg no.332

So the answer to this question is A


Instruction:
All are true about the trigone on the base of the urinary bladder, except:
A. Mucosa is loosely associated to the underlying musculature
B. Mucosa is smooth
C. It is lined by transitional epithelium
D. It is derived from the absorbed pa of the mesonephric duct

Response:
Trigone of the urinary bladder is a small triangular area located at the base of the bladder with apex towards the lower side. The mucosa is firmly attached to the underlying musculature giving it a smooth texture.Ref: Human Anatomy, B D Chaurasia, 4th Edition, Volume 2, Chapter 30, Page 347; Clinical Anatomy by Regions, Richard S. Snell, 9th Edition, Chapter 7, Page 272.

So the answer to this question is A


Instruction:
Oxygen saturation of blood in the umbilical aery is about:
A. 40%
B. 60%
C. 75%
D. 97%

Response:
PO2 Hb saturation (%) Umbilical aery 23 60 Umbilical vein 30 85

So the answer to this question is B


Instruction:
The best available treatment for poal hypeensive gastropathy is:
A. Beta blocker
B. TIPS
C. Surgical poacaval shunt
D. Liver transplantation

Response:
Poal hypeensive gastropathy (PHG) is the ectatic blood vessels in the proximal gastric body and cardia causing oozing of the blood. Less severe grades of PHG appear as a mosaic or snakeskin pattern and are not associated with bleeding. Severe PHG with diffuse bleeding is treated by b-adrenergic receptor blockers or possibly with placement of a TIPS or surgical poacaval shunt. The best treatment is liver transplantation Ref:Sleisenger and Fordtran's,E-9,P-300.

So the answer to this question is D


Instruction:
Characteristic Symptom in induced psychotic disorder is
A. Insomnia
B. Profound mood disturbance
C. Accepting delusions of other person
D. Suicidal Ideation

Response:
C i.e. Accepting delusions of other person

So the answer to this question is C


Instruction:
One of the following is not a 5–HT receptor antagonist :
A. Ketanserin
B. Lanreotide
C. Methysergide
D. Tropisetron

Response:
Lanreotide is a somatostatin analog used in acromegaly.

So the answer to this question is B


Instruction:
Boy with sickle cell trait.. what mode of anaesthesia will u avoid in him??
A. IVRA (intravenous regional anesthesia)
B. Supraclavicular brachial plexus block
C. Br plexus block infraclavicular approach
D. Br plexus block axillary approach (humeral) approach.

Response:
Intravenous Regional Anaesthesia or Biers block absolute C/I 1. Sickle cell trait 2. peripheral vascular Disease 3. Scleroderma

So the answer to this question is A


Instruction:
Which of the following is a poor prognostic factor in Acute Lymphoblastic Leukemia (ALL) -
A. Hyperdiploidy
B. t (9;22); t (4; 11)
C. 2-8 years of age
D. WBC count < 50,000

Response:
The high risk indicators in ALL includes age below 1 year & above 10 year, male ,initial white cell count more than 50,000/mm^3, massive hepatomegaly & splenomegaly, prwsence of mediastinal mass & central nervous system leukaemia , mature Bcell as phenotype , hypodiploidy, t(9;22),t(4;11), t(8;14).Reference :Ghai essential pediatrics 8th edition pg no 601.

So the answer to this question is B


Instruction:
Ixabepilone is used in:
A. Melanoma
B. Breast carcinoma
C. Oat cell carcinoma
D. Small cell carcinoma lung

Response:
Chemotherapy regimen in CA BreastMnemonic- CMF- C- cyclophosphamide- M- methotrexate- F -5- FUMnemonic-CAF- C- cyclophosphamide- A- Adriamycin (doxorubicin) (anthracycline derivative)- F - 5 - FU- The preferred form of chemotherapy for CA breast - CAF or Adriamycin or Anthracycline based Chemotherapy.- Usually 6 cycles are given- For Adriamycin resistant breast cancer - Taxanes are given (Docetaxel, Paclitaxel)- Chemotherapy agent given in Adriamycin & Taxane resistant breast cancer - IXABEPILONE- LAPATINIB - 2nd line agent for HER-2-NEU + ve breast cancer- HERCEPTIN /TRASTUZUMAB - 1st line agent for HER-2-neu +ve breast cancer Drug given in metastatic and refractory breast cancer - SUNITINIB 1st line agent for advanced and metastatic RCC - SUNITINIBDrug of choice for Imatinib resistant GIST - SUNITINIB.

So the answer to this question is B


Instruction:
Which of the following vitamins would MOST likely become deficient in a person who develops a completely carnivorous lifestyle?
A. Thiamine
B. Niacin
C. Cobalamin
D. Vitamin C

Response:
Ascorbic acid (vitamin C) is found in fresh fruits and vegetables. Deficiency of ascorbic acid produces scurvy, the "sailor's disease." Ascorbic acid is necessary for the hydroxylation of proline to hydroxyproline in collagen, a process required in the formation and maintenance of connective tissue. The failure of mesenchymal cells to form collagen causes the skeletal, dental, and connective tissue deterioration seen in scurvy. Thiamine, niacin, cobalamin, and pantothenic acid can all be obtained from fish or meat products. The nomenclature of vitamins began by classifying fat-soluble vitamins as A (followed by subsequent letters of the alphabet such as D, E, and K) and water-soluble vitamins as B. Components of the B vitamin fraction were then given subscripts, e.g., thiamine (B1), riboflavin (B2), niacin , pantothenic acid (B5), pyridoxine (B6), and cobalamin (B12). The water-soluble vitamins C, biotin, and folic acid do not follow the B nomenclature. Ref: Bender D.A. (2011). Chapter 44. Micronutrients: Vitamins & Minerals. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds),Harper's Illustrated Biochemistry, 29e.

So the answer to this question is D


Instruction:
Z-plasty ideal angle is
A. 30 degrees
B. 45 degrfees
C. 60 degrees
D. 90 degrees

Response:
Z-plasty is a plastic surgery technique used to improve the functional and cosmetic appearance of scars. It involves the creation of two triangular flaps of equal dimension that are then transposed. For a basic z-plasty, the triangular flaps are created using an angle of 60 degrees Theoretically, this angle can lengthen a contracted scar by about 75 percent and reorient the direction of the central wound by 90 degrees.

So the answer to this question is C


Instruction:
Hera Lal's 10 year old child present in casualty with snakebite since six hours. On examination no systemic signs are found & lab investigation are normal except localized swelling over the leg of < 5 cm. Next step in management would be :
A. Incision & suction of local swelling
B. I/V ply antivenum
C. S/cutaneous anti venum at local swelling
D. Observe the Patient for progression of symptoms wait for antivenum therapy

Response:
D i.e. Observe the patient for progression of symptoms and wait for anti venom therapy

So the answer to this question is D


Instruction:
Which of the following is an antipsychotic drug?
A. Flupenthixol
B. Rasagiline
C. Clobazam
D. Divalproex

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

So the answer to this question is A


Instruction:
A middle aged woman presented to the OPD with dull abdominal pain for 6 months. CT scan of pelvis showed a 7cm mass involving left ovary with irregular calcifications. The right fallopian tube & ovary are excised. What is the likely diagnosis?
A. Mucinous cystadenoma
B. Choriocarcinoma
C. Dysgerminoma
D. Mature cystic teratoma

Response:
.

So the answer to this question is D


Instruction:
Which of the following does not have a corresponding releasing hormone from the hypothalamus?
A. FSH
B. TSH
C. ACTH
D. Prolactin

Response:
Prolactin secretion is under negative feedback control of hypothalamus through the release of dopamine, which normally exerts a tonic inhibition. There is no known specific hypothalamic prolactin releasing hormone.
Hormones of the Anterior Pituitary :

So the answer to this question is D


Instruction:
26 year old male presents to OPD with a discrete thyroid swelling. On neck USG , an isolated cystic swelling of gland is seen. How much percentage will be the risk of malignancy?
A. 48%
B. 24%
C. 12%
D. 3%

Response:
- This is a case of an isolated cystic swellings. Risk of malignancy in this case is 24%. - Risk of malignancies in thyroid swelling can be expressed as a factor of 12 known as 'rule of twelve' - Isolated Thyroid swelling: Solid 24% Cystic 12% - Dominant Thyroid swelling: Solid 12% Cystic 6% - Generalized Thyroid swelling: 3%

So the answer to this question is B


Instruction:
In some old fractures, cartilaginous tissue forms over the fractured bone end with a cavity in between containing clear fluid. This condition is called as -
A. Delayed union
B. Slow union
C. Nonunion
D. Pseudoarthrosis

Response:
Pseudarthrosis develop after a fracture that has not united due to inadequate immobilization, i.e. Pseudarthrosis is a type of nonunion.
Inadequate immobilization permits constant movement at the fracture site which hampers the formation of normal callus, and fibroblast forms excessive fibrous tissue in this situation which results in non-union.
If the movement continues to occur at the non-union site, the fracture site develops features of a joint,i.e. Pseudarthrosis:-
Covered by a cartilage (fibrocartilage)
There is synovial lining
Space is filled with synovial fluid like clear fluid
Mobility

So the answer to this question is D


Instruction:
A drug 'X' is an a adrenergic blocker but paradoxically produces vasoconstriction. 'X' is:
A. Phenoxybenzamine
B. Ergotamine
C. Prazosin receptors
D. Tolazoline

Response:
Ergot alkaloids are the alpha-blockers that can cause vasoconstriction. The vasoconstriction caused by ergot alkaloids is due to stimulation of serotonin receptors. Ergotamine It acts as a paial agonist and antagonist at a adrenergic and all subtypes of 5-HT1 and 5-HT2 receptors, but does not interact with 5-HT3 or dopamine receptors. Sustained vasoconstriction , visceral smooth muscle contraction, vasomotor centre depression are produced, and the action of NA and 5-HT on smooth muscles is antagonized. It is a potent emetic and oxytocic. At high doses CNS stimulation and paresthesias can be seen.

So the answer to this question is B


Instruction:
True about zero order kinetics ?
A. Most of the drugs follow zero order kinetics
B. T1/2 of drug elimination remains constant
C. Constant amount of drug eliminated per unit time
D. Rate of elimination is dependent on plasma concentration

Response:
Ans. is 'c' i.e., Constant amount of drug eliminated per unit time

So the answer to this question is C


Instruction:
Recognized GIT infections in AIDS include all except
A. HSV
B. CMV
C. Cryptococcus neoformans
D. Atypical mycobacteria

Response:
Cryptococcus neoformans usually causes a meningitis. Some of the GIT diseases in HIV/AIDS are - Oesophageal candidiasis small bowel disease large bowel diarrhoea ref - Davidsons medicine 23e pg 316

So the answer to this question is C


Instruction:
Suppurating buboes are seen in infection with: March 2004
A. Chlamydia trachomatis
B. Haemophilus ducreyi
C. Gonococcus
D. Treponema

Response:
Ans. B i.e. Haemophilus ducreyi

So the answer to this question is B


Instruction:
The widest incisal embrasure is normally found
between which of the following permanent maxillary teeth:
A. Central incisors
B. Central and lateral incisors
C. Lateral incisor and canine
D. First and 2nd premolar

Response:
None

So the answer to this question is C


Instruction:
All are true about cryptococcus except
A. Polysaccharide capsule
B. Reproduces by budding
C. Pseudohyphae
D. Urease positive

Response:
Cryptococcus is a yeast having round or oval budding cell. Pseudohyphae is a characteristic feature of yeast-like fungi. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition

So the answer to this question is C


Instruction:
IOC for subarachnoid hemorrhage: September 2011
A. MRI
B. NCCT
C. USG
D. X-ray skull

Response:
Ans. B: NCCT Radiological signs in CNS: Bracket calcification: Corpus callosum lipoma (skull) Basal ganglia calcification: Hypoparathyroidism Suprasellar calcification: - Craniopharyngioma - Meningioma Rail road/ Tram track calcification: Sturge Weber syndrome Periventricular calcification: CMV infections Separation of sutures: Sign of raised intracranial tension in a child

So the answer to this question is B


Instruction:
Tacrolimus level is increased by all EXCEPT :
A. Erythromycin
B. Itraconazole
C. Danazole
D. Rifampicin

Response:
None

So the answer to this question is D


Instruction:
Stain for treponema
A. Fontanas method
B. Acid fast
C. Methenamine silver
D. PAS

Response:
None

So the answer to this question is A


Instruction:
Highest amount iron is seen in -
A. Milk
B. Meat
C. Spinach
D. Jaggery

Response:
Food rich in haem iron are liver, meat, poultry and fish. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 622

So the answer to this question is B


Instruction:
DLCO decreased in all,EXCEPT
A. Anemia
B. Interstitial lung diseases
C. Good Pasteur syndrome
D. Emphysema

Response:
In alveolar hemorrhage (good Pasteur syndrome) DLCO increased.

So the answer to this question is C


Instruction:
Edman's reagent is -
A. 2-4 dinitrophenol
B. 1 -fluoro-2, 4-dinitrobenzene
C. Phenyl-isocyanate
D. Cynogen bromide

Response:
Ans. is 6c' i.e., Phenyl-isocyanateo Determination of amino acid sequence (sequence analysis) is performed by Edman degradation method on automatic mechines, called cyclic sequentors. Edman's reagent is phenyl-isothiocyanate, and forms a covalent bond to N- terminal of amino-acid. This can be identified.o Sanger's reagent (l-fluoro-2,4-dinitrobenzene) can be used in place of Edman's reagent.

So the answer to this question is C


Instruction:
Primary injury is -
A. Due to flying debris
B. Due to blast wind
C. Due to shock wave
D. Due to complication

Response:
Ans. is 'c' i.e., Due to shock waveTypes of blast injurieso These are of following types1) Primary : It is due to shock wave which causes injury to hollow organs, e.g. ears, lungs, eyes, GIT etc.Secondary : These are due to flying debris (missiles). Classical Marshalls triad i.e. bruises, abrasions and puncture laceration is diagnostic of explosive injury.Tertiary : It is due to blast wind, i.e. victm is thrown into air and strikes other objects leading to fracture, blunt trauma etc.Quaternary : Any complicating factor (not in first three categories) causes quaternary injury, e.g. anoxia, respiratory problems etc.

So the answer to this question is C


Instruction:
Culture medium used for streptococcus pneumoniae
A. Human blood agar
B. Sheep blood agar
C. MacConkey's agar
D. Deoxycholate agar

Response:
Sheep blood agar

So the answer to this question is B


Instruction:
The gene for Wilson&;s disease is on
A. Long arm of Chromosome 13
B. Long arm of Chromosome 6
C. Sho arm of Chromosome 13
D. Sho arm of Chromosome 6

Response:
In Wilson&;s disease,the underlying defect lies in the long arm of chromosome 13 where there is a mutation in ATP7B gene,the normal hepatic copper- excreting gene.Eventually,capacity of hepatocytes to store copper is exceeded and copper is released into circulation which then gets deposited in extrahepatic tissues such as the brain eyes, and others. Reference:Textbook of pathology-Harsh Mohan,6th edition,page no:628

So the answer to this question is A


Instruction:
Imaging IOC for acute pancreatitis
A. CT scan
B. USG
C. X ray
D. MRI

Response:
Ans. (a) CT ScanRef: Sabiston Page 1530/ 20th edition* The imaging investigation of choice for acute pancreatitis is CECT scan.* CECT scan is done after 72 hours of onset- ideally on the 7th day.

So the answer to this question is A


Instruction:
Pathologically the deposits associated with lattice corneal dystrophy is
A. Glycosaminoglycan
B. Amyloid
C. Cholesterol crystals
D. Hyaline

Response:
None

So the answer to this question is B


Instruction:
All are the causes of neovascular glaucoma except
A. Central serous retinopathy
B. Diabetic retinopathy
C. lntraocular tumour
D. Central retinal vein occlusion

Response:
NEOVASCULAR GLAUCOMA (NVG) It is an intractable glaucoma which results due to formation of neovascular membrane involving the angle of anterior chamber. Etiology: It is usually associated with neovas cularization of iris (rubeosis iridis). Neovascularization develops following retinal ischaemia, which is a common feature of : 1) Diabetic retinopathy, 2)Central retinal vein occlusion, 3)Sickle-cell retinopathy and 4)Eales' disease. Other rare causes are chronic intraocular inflammations, intraocular tumours, long-standing retinal detachment and central retinal aery occlusion. Ref:- A K KHURANA; pg num:- 234

So the answer to this question is A


Instruction:
Irregular thigh folds are seen in -
A. Developmental dysplasia of hip
B. Pehe's disease
C. Slipped Capital femoral epiphysis
D. Congenital coxa vara

Response:
Answer- A. Developmental dysplasia of hip

So the answer to this question is A


Instruction:
Which of the statements is not true regarding Macleod\'s Syndrome –
A. It is not a true emphysema
B. Occurs before 8 years of age
C. It is unilateral emphysema
D. The pulmonary artery on the affected side is hyperplastic

Response:
Macleod syndrome

It is also known as Swyer - Janes syndrome
It is a cause of unilateral hyperlucent lung.
It may present as acute pneumonia, but most patients are discovered when a chest X-ray is obtained for an unrelated reason.
This not a true emphysema.
On examination there is hyperresonance and a small lung with mediastinum shifted towards the more abnormal lung.
There is no vascular abnormality.
No specific treatment is required, it may become less symptomatic with time.

So the answer to this question is D


Instruction:
A caretaker in a nursing home presents with pruritus of her trunk and extremities. On physical examination, she has several erythematous papules in her finger webs, axillae, umbilicus, and groin areas. Her scalp is clear. Which of the following is the best treatment for this woman?
A. Clindamycin solution
B. Oral erythromycin
C. Permethrin cream
D. Topical steroids

Response:
The patient has scabies, which is characterized by intense pruritus and erythematous papules, especially in the flexural and genital areas. Permethrin cream is the treatment of choice. Treatment with topical steroids will help reduce the pruritus but will not eliminate the scabies mite. Topical antibiotics can be used to treat folliculitis. However, given the distribution of the lesions, diagnosis of folliculitis would be less likely.

So the answer to this question is C


Instruction:
A 22 year old female, Neeta presented to you with complaints of headache and vomiting since 2 months. She is having amenorrhea but urine pregnancy test is negative. She also complained of secretion of milk from the breasts. A provisional diagnosis of hyper prolactinemia was made and MRI was suggested. MRI confirmed the presence of a large pituitary adenoma. Neeta was advised surgery, however, she is not willing to undergo surgery. Which of the following medications is most likely to be prescribed?
A. Sumatriptan
B. Bromocriptine
C. Ergotamine
D. Allopurinol

Response:
Ans. (B) Bromocriptine(Ref: KK Sharma 2/e p550, KDT 8/e p24)Bromocriptine is a D2 agonist and is useful in hyperprolactinemia by its action to inhibit the release of prolactin.

So the answer to this question is B


Instruction:
A young patient presents with fever with rash as shown below.Platelet counts are normal.The diagnosis would be:
A. Dengue hemorrhagic fever
B. Meningococcemia
C. Leptospirosis
D. Scrub typhus

Response:
These are cutaneous infarcts seen in menigococcal infection

So the answer to this question is B


Instruction:
In a chronic smoker, a highly malignant aggressive and metastatic lung carcinoma is -
A. Squamous cell Carcinoma
B. Small cell Carcinoma
C. Adenocarcinoma
D. Large cell carcinoma

Response:
None

So the answer to this question is B


Instruction:
A 68-year-old coal miner with a history of smoking and emphysema develops severe air-flow obstruction and expires. Autopsy reveals a "black lung," with coal-dust nodules scattered throughout the parenchyma and a central area of dense fibrosis. The coal dust entrapped within this miner's lung was sequestered primarily by which of the following cells?
A. Endothelial cells
B. Fibroblasts
C. Lymphocytes
D. Macrophages

Response:
Macrophages. Coal workers' pneumoconiosis reflects the inhalation of carbon particles. The characteristic pulmonary lesions of simple coal worker's pneumoconiosis include nonpalpable coal-dust macules and palpable coal-dust nodules, both of which are typically multiple and scattered throughout the lung as 1- to 4-mm black foci. Nodules consist of dust-laden macrophages associated with a fibrotic stroma. Nodules occur when coal is admixed with fibrogenic dusts such as silica and are more properly classified as anthracosilicosis. Coal-dust macules and nodules appear on a chest radiograph as small nodular densities. The other choices are not phagocytic cells.Diagnosis: Anthracosilicosis, coal workers' pneumoconiosis

So the answer to this question is D


Instruction:
Classical triad of global confusion, ataxia and ophthalmoplegia is seen in -
A. Alzheimer's disease
B. Delerium tremors
C. Wernicke's encephalopathy
D. Korsakoff psychosis

Response:
Ans. is 'c' i.e., Wernicke's encephalopathy o Wernicke's encephalopathy is characterized by a triad of global confusion (alteration in mental function),Ophthalmoplegia (Bilateral 6th nerve palsy) and ataxia.Wernicke's encephalopathyo It is an acute neurological disorder characterized by a classical triad of ataxia, ophthalmoplegia and confusion. The clinical findings include : -1) Ocular : - Nystagmus, bilateral lateral rectus palsy, conjugate gaze palsies. The most common ocular abnormality is nystagmus, not complete ophthalmoplegia. Less frequently noted are pupillary abnormalities such as sluggishly reactive pupil, ptosis, scotomas, and anisocoria.2. CNS (encephalopathy) : - Global confusion, disinterest, inattentiveness or agitation. Rarely stupor and coma may occur.3. Gait ataxia4. Peripheral polyneuropathy : - Weakness, foot drop, decreased proprioception.5. Other symptoms : - Autonomic dysfunction (tachycardia & postural hypotension). If there is coexisting cardiovascular beriberi; hypothermia; abdominal symptoms (nausea, vomiting, abdominal pain).

So the answer to this question is C


Instruction:
Rapid diagnosis of Rabies in a Rabid living dog is by?
A. Fluorescent antibody test
B. Corneal impression
C. Inoculation in mouse
D. None of the above

Response:
Flourescent Antibody Test : This is a highly reliable and the best single test currently available for the Rapid diagnosis of Rabies viral Antigen in Infected specimen. Corneal impression & Mouse inoculations are also used for diagnosis.

So the answer to this question is A


Instruction:
Surgical alteration or suturing of gunshot wounds may create problems in distinguishing entry from exit. This is called as:
A. Formication phenomenon
B. Gordon phenomenon
C. Cookie cutter phenomenon
D. Kennedy phenomenon

Response:
Kennedy phenomenon:- Iatrogenic surgical alteration or suturing of the entrance wound. The evaluation of whether the wound is entrance or exit becomes difficult. Cookie cutter phenomenon:- It is seen from the near shot entry wound of shot gun. Formication Patients feels the insects crawling under skin Seen in Cocaine & ergot Gordon Phenomenon Prinsloo and Gordon (1951) described aefactual extravasation of blood into theanterior neck structures at autopsy. It may be a source of confusion, resembling traumatic bruises. To eliminate this aefact, bloodless dissection of neck is recommended in asphyxial deaths

So the answer to this question is D


Instruction:
As menstruation ends, estrogen levels in the blood rise rapidly. What is the source of the estrogen?
A. Corpus luteum
B. Developing follicles
C. Endometrium
D. Stromal cells of the ovaries

Response:
In the nonpregnant female, the only significant source of estrogen is ovarian follicles or corpus luteum. Menstruation begins when the corpus luteum degenerates. Menstruation ends when developing follicles secrete estrogen sufficiently to raise circulating concentration to a level that stimulates regrowth of the endometrium

So the answer to this question is B


Instruction:
Endolymphatic duct drains into -
A. subdural space
B. Extradural space
C. Subarachnoid space
D. Sacculus

Response:
None

So the answer to this question is B


Instruction:
Clinical manifestations of bronchogenic carcinoma include the following except
A. Hoarseness of voice due to involvement of left recurrent laryngeal nerve
B. Horner's syndrome
C. Diaphragmatic palsy due to infiltration of phrenic nerve
D. Gastroparesis due to vagal involvement

Response:
Invasion of the mediastinum may result in hoarseness (because of recurrent laryngeal nerve involvement), dysphagia (because of the involvement of, or extrinsic pressure on, the oesophagus) and superior vena caval obstruction.It can also result in Horner's syndrome due to involvement of sympathetic chain.Infiltration of phrenic nerve occurs producing diaphragmatic palsy.

So the answer to this question is D


Instruction:
Contraindication of supraglottic laryngectomy is/are-a) Poor pulmonary reserveb) Tumor involving pyriform sinusc) Tumor involving preepiglottic spaced) Vocal cord fixatione) Postcricoid area extension
A. abcd
B. bcde
C. abde
D. ade

Response:
Supraglottic laryngectomy: Removal of the supraglottis or upper part of larynx.
It should be done if following conditions are fulfilled.

For tumors with a T stage of T1 , T2 or T3 by pre epiglottic space involvement only (Thus involvement of pre-epiglottic space is not a contraindication for supraglottic larynygectomy).
Vocal cords are mobile
Cartilage is not involved (which includes cricoid cartilage so option e is correct)
Anterior commissure is not involved
Patient has good pulmonary reserve (i.e. Poor pulmonary reserve is a contraindication)
Base of the tongue is not involved past the circumvallate papillae
The apex of the pyriform sinus is not involved. (i.e. involvement of pyriform sinus is a contraindication)
The FEV1 is predicted to be > 50)

So if above criteria are not filled it is a contraindication of supraglottic laryngectomy. Answer is further supported by following lines of : Bellinger
“Supraglottic laryngectomy should not be attempted if there is vocal cord fixation, extensive involvement of pyriform sinus, thyroids or cricoid cartilage invasion or extensive involvement of base of tongue (to or beyond circumvallate papilla)” –Ballenger otolaryngology and Head and Neck Surgery 16th/ed pg-1285

So the answer to this question is C


Instruction:
About the regulation of enzyme activity given in the diagram which of the following is true?
A. Substrate and modifier binds to same site
B. Substrate and modifiers are structural analogues
C. They exhibit cooperative binding
D. Regulate the enzyme quantity

Response:
Ans. C. They exhibit cooperative binding* In allosteric enzyme, modifier binds to a distinct site that of active site. Modifier and substrates are not structural analogues. This is an enzyme regulation of quality or intrinsic catalytic activity

So the answer to this question is C


Instruction:
The thoracic duct receives tributaries from all of the following except?
A. Bilateral ascending lumbar trunk
B. Bilateral descending thoracic trunk
C. Left upper intercostal duct
D. Right bronchomediastinal lymphatic trunk

Response:
Right bronchomediastinal lymphatic trunk.The thoracic duct is the largest lymphatic vessel in the body.It begins in the abdomen as a dilated sac, the cisterna chyli & ends at the root of neck,draining into the beginning of left brachiocephalic vein.It is about 45 cm long & has a beaded appearance because of presence of many valves in its lumenTributaries The thoracic duct receives lymph from roughly both halves of the body below the diaphragm & the left half above the diaphragm.In the thorax:Bilateral descending thoracic lymph trunks from intercostal lymph nodes of the lower six or seven intercostal spaces of both sidesBilateral ascending lumbar lymph trunks from the upper lateral aoic nodesUpper intercostal trunks draining the intercostal nodes in the upper five or six left intercostal spaces.Mediastinal trunks draining various nodal groups.At the root of neck:Left jugular trunkLeft subclan trunkLeft bronchomediastinal lymph trunkThe right jugular, subclan & bronchomediastinal trunks, which drain the right side of the head & neck, the right upper limb, and the right side of the thorax respectively may join to form the right lymphatic duct which opens into the beginning of the right brachiocephalic vein.

So the answer to this question is D


Instruction:
Impoant effects of aspirin include all of the following, EXCEPT:
A. Reduction of fever
B. Reduction of prostaglandin synthesis in inflammed tissues
C. Respiratory stimulation when taken in toxic dosage
D. Reduction of bleeding tendency

Response:
Aspirin clearly increases bleeding tendency (by its antiplatelet effects). EFFECTS OF ASPIRIN ON THE BLOOD: Irreversible inhibition of platelet function is the mechanism underlying the cardioprotective effect of aspirin. Patients with severe hepatic damage, hypoprothrombinemia, vitamin K deficiency, or hemophilia should avoid aspirin because, the inhibition of platelet hemostasis can result in hemorrhage. Care should also be exercised in the use of aspirin during long-term treatment with oral anticoagulant agents because of the combined danger of prolongation of bleeding time coupled with blood loss from the gastric mucosa. On the other hand, aspirin is used widely for the prophylaxis of thromboembolic disease, especially in the coronary and cerebral circulation, and is coupled frequently with oral anticoagulants in patients with bioprosthetic or mechanical hea valves. Ref: Grosser T., Smyth E. (2011). Chapter 34. Anti-inflammatory, Antipyretic, and Analgesic Agents; Pharmacotherapy of Gout. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.

So the answer to this question is D


Instruction:
Corbohydrate reserve of human body
A. 350 gm
B. 600 gm
C. 950 gm
D. 1500 gm

Response:
Ans. is 'a' i.e., 350 gmCarbohydrate store of body is approximately 350 grams (70 grams hepatic glycogen and 280 grams muscle glycogen).

So the answer to this question is A


Instruction:
Example of neuromuscular blocker causing hypotension is:
A. Rocuronium
B. Vecuronium
C. Pancuronium
D. Atracurium

Response:
The hypotension seen with the use of atracurium and mivacurium is due to release of histamine, whereas dTubocuranine causes hypotension histamine release and ganglion blockade. Ref: Miller's anesthesia-7th ed, Chapter 29.

So the answer to this question is D


Instruction:
All are true about principles of primary health care except?
A. Community participation
B. Intersectoral co-ordination
C. Unequitable distribution
D. Appropriate technology

Response:
Ans. (c) Unequitable distributionRef : K. Park 23rd ed. / 891-92* PHC is Primary Health Care outlined by Alma Ata in 1978.* It is defined as essential health care, which is characterized by 4 As# Acceptable (it should be acceptable by everyone)# Accessible (it should be accessible by everyone)# Available (it should be available to everyone)# Affordable (it should be affordable to everyone)8 Elements of PHC (Primary Health Care) (remembered as ELEMENTS)EEssential drugsLLocally endemic disease prevention and controlEEPI (Expanded program of immunization)MMCH (Maternal and child Health care including family planning)EEducationNNutritionTTreatment of common ailmentsSSafe water supply and sanitation* Equity of distribution is NOT an element of PHC, but it is one of the principles/pillars of the PHC.* 4 Principles/Pillars of Primary Health Care:# Equitable distribution# Community participation# Intersectoral coordination# Appropriate technology.

So the answer to this question is C


Instruction:
Preferred fuel for body in fasting state ?
A. Carbohydrates
B. Fats
C. Proteins
D. Amino acids

Response:
Preferred fuel for body in fed state is mainly Carbohydrates i.e. Glucose. But in Fasting state, preferred fuel is mainly Fats & Adipose tissues are broken down to give energy. But some exceptions are there you should learn: See the table below. Fed Fasting Starvation Brain Glucose Glucose Ketone Bodies Hea Fatty Acids Fatty Acids Ketone Bodies Liver Glucose Fatty Acids Amino Acids Muscle Glucose Fatty Acids Fatty Acids and KB Adipose tissue Glucose Fatty Acids Fatty Acids RBC Glucose Glucose Glucose

So the answer to this question is B


Instruction:
Most common cause of acute polyneuropathy is
A. Diphteria
B. Guillian Barre syndrome
C. Sarcoidosis
D. Charcot-Marie-Tooth disease

Response:
(B) Guillian Barre syndrome # Myocarditis & Polyneuropathy are the prominent toxic manifestations of diphtheria. The risk of each is proportional to the severity of local disease.> Polyneuropathy typically begins 3 to 5 weeks after onset of diphtheria and has a slow course. It appears earliest in patients who experience the most severe and prolonged neurologic abnormalities. Guillain-Barre syndrome (GBS) sometimes called Landry's paralysis, is an acute inflammatory demyelinating polyneuropathy (AIDP), a disorder affecting the peripheral nervous system. Ascending paralysis, weakness beginning in the feet and hands and migrating towards the trunk, is the most typical symptom. It can cause life-threatening complications, particularly if the breathing muscles are affected or if there is dysfunction of the autonomic nervous system. The disease is usually triggered by an acute infection. Guillain-Barre syndrome is a form of peripheral neuropathy. Rarely in Sarcoidosis, multiple lesions occur that mimic multiple sclerosis, spinal cord abnormalities, and peripheral neuropathy. Charcot-Marie-Tooth disease type 1, also known as hereditary motor sensory neuropathy type 1, is an uncommon autosomal dominant disease that causes destruction of peripheral nerves with a varied clinical course, but often leads to muscle weakness. If the peroneal muscle is involved, the patient may develop a characteristic slapping gait.

So the answer to this question is B


Instruction:
Nitrous oxide is contraindicated in patients with pneumothorax, pneumo pericardium or intestinal obstruction, because it:
A. Depresses an already compromised myocardium
B. Permits the use of a limited FIO2 only
C. Is less soluble than nitrogen
D. Causes the expansion of air filled body cavities

Response:
N20 is 35 times more soluble than N2 so when replaces N2O causes expansion of air containing cavity. Nitrous oxide has the potential to expand air containing cavities as it can diffuse into and accumulate in them. Hence it should be avoided in emphysema patients especially in those with bullae and pulmonary hypeension. Other Contraindication Pneumothorax, Acute intestinal obstruction with bowel distention, Intracranial air (pneumocephalus following dural closure or pneumoencephalograph cochlear implant surgery vitreo retinal surgery Tympanoplasty

So the answer to this question is D


Instruction:
Most often the first sign of involvement of opposite side in cavernous sinus thrombosis is:
A. Paralysis of opposite lateral rectus muscle
B. Proptosis of the opposite side
C. Paralysis of opposite 3rd nerve
D. All of the above

Response:
Ans. Paralysis of opposite lateral rectus muscle

So the answer to this question is A


Instruction:
In "poverty lines" the expenditure required for a daily calorie intake of in rural areas –
A. 2200
B. 2400
C. 2100
D. 2300

Response:
Wealth index

The "wealth index" is a composite measure of the cumulative living standard of a household.
The wealth index is calculated using easy-to-collect data on a household's ownership of selected assets, such as televisions and bicycles, materials used for housing construction, and types of water access and sanitation facilities.
Information on the wealth index is based on data collected in the household questionnaire.
After collecting data, various statistical procedures are used to create break points that define wealth quintiles as:-

Lowest (first) quintile
Second quintile
Third quintile
Fourth quintile
Highest quintile

The distribution of the population across wealth quintiles show large variation across states : -

Delhi has maximum population in highest wealth quintile (70% of population).
Jharkhand has maximum population in lowest wealth quintile (49.6% of population).

Social class and health

The national family health survey - III (2005-06) conducted in India shows the glaring differences in infant mortality rate among the household belonging to various wealth index brackets → Infant mortality rate by wealth index in India (2005-06)

So the answer to this question is B


Instruction:
All are true about Hypertrophic Obstructive cardiomyopathy, except -
A. β agonists are useful
B. Asymmetrical hypertrophy of septum
C. Dynamic L. V. outflow obstruction
D. Double apical impulse

Response:
None

So the answer to this question is A


Instruction:
Organ of locomotion in bacteria is
A. Fimbria
B. Flagella
C. Capsule
D. Cell wall

Response:
None

So the answer to this question is B


Instruction:
Once phaeochromocytoma is diagnosed, preoperatively following is given
A. Alpha adrenergic agonist
B. Alpha adrenergic blocker
C. Beta adrenergic blocker
D. Beta adrenergic blocker

Response:
Once a phaeochromocytoma has been diagnosed, an a- adrenoreceptor blocker (phenoxybenzamine) is used to block the effects of catecholamine excess and its consequences during surgery. A dose of 20 mg of phenoxybenzamine initially should be increased daily by 10 mg until a daily dose of 100-160 mg is achieved and the patient repos symptomatic postural hypotension. Additional b-blockade is required if tachycardia or arrhythmias develop; this should not be introduced until the patient is a-blocked. The infusion of large volumes of fluid or administration of noradrenaline can be necessary to correct postoperative hypotension in the presence of unopposed a-blockade.Ref: Bailey and Love 27e pg: 846

So the answer to this question is B


Instruction:
Which finding would be present following selective destruction of sertoli cells?
A. Increased plasma testosterone levels
B. Increased plasma inhibin levels
C. Increased plasma luteinizing hormone (LH) levels
D. Increased plasma follicle-stimulating hormone (FSH) levels

Response:
Sertoli cells are stimulated by follicle-stimulating hormone (FSH) to secrete the hormone inhibin. Inhibin is a polypeptide hormone with a structure that is similar to that of insulin (i.e., an A chain and a B chain connected by two disulfide bonds). Its physiologic function is to selectively suppress pituitaty release of FSH. Therefore, if Sertoli cells are destroyed, plasma levels of inhibin would decrease and plasma levels of FSH would increase as a result of loss of feedback inhibition. Luteinizing hormone (LH) is suppressed by testosterone of Leydig cell origin. Selective destruction of Sertoli cells with Leydig cells left intact would have no effect on circulating levels of testosterone or LH. Finally, Sertoli cells are vital for normal spermatogenesis. The spermatozoa mature within the folds of the Sertoli cells, which provide maturational factors that are required for spermatogenesis.

So the answer to this question is D


Instruction:
A 55-year-old woman is admitted to the emergency department with ear pain, ringing in her ear (tinnitus), dizziness, and vertigo. Radiographic examination reveals indications of Meniere's disease. Which of the following structures is most likely affected by the edema that is associated with Meniere's disease?
A. Middle ear
B. Endolymphatic sac
C. Semicircular canals
D. Cochlea

Response:
Hydrops (edema) results from accumulation of excessive fluid in the endolymphatic sac. Labyrinthine hydrops or endolymphatic hydrops is known as Meniere disease. This disease can result in hearing loss, roaring noises in the ear, and episodic dizziness (vertigo) associated with nausea and vomiting. About 10% of patients require surgical intervention for persistent, incapacitating vertigo; others are treated with diuretics, low salt intake, and reduction of stimulants like caffeine to lower the volume of body fluids and alleviate the symptoms of Meniere disease.

So the answer to this question is B


Instruction:
A 65 years old woman with known duodenal ulcer being treated by H2 blocker therapy is admitted with upper gastrointestinal bleeding. After blood replacement is begun the next step in her management should be:
A. Institute anti H. pylori treatment
B. Repeated gastric lavage
C. Endoscopy and coagulation of bleeding vessel
D. Pylor duodenotomy and oversewing of the bleeding

Response:
The patient may be treated by endoscopy. Several endoscopy devices can deliver thermal energy required to achieve coagulation. Transendoscopic bipolar electrocoagulation and heater probe therapy can decrease rebleedillg rates and the need for surgical intervention by up to 50%. Previously in aged patients surgery was done to stop bleeding. The bleeding vessels were ligated by non absorbable suture. With the advance of erdoscopic technique surgery is now done less commonly. However if endoscopic management fails to stop bleeding then surgery will be required.

So the answer to this question is C


Instruction:
Which of the following is an ocular side-effect of HAA therapy
A. Retinitis
B. Uveitis
C. Optic neuritis
D. Scleritis

Response:
Ans. b. Uveitis Impact of highly active antiretroviral therapy on ophthalmic manifestations in human immunodeficiency virus: Before the introduction of HAA, CMV retinitis affected 30-40% of HIV-infected individuals. At that time a study from our center documented CMV retinitis and cotton-wool spots caused by HIV-related microvasculopathy as the most frequently encountered ocular lesions. Additionally, a study conducted at our center in Indian children infected with HIV found a high prevalence of ocular and systemic lesions, most commonly anterior uveitis followed by CMV retinitis. Since the advent of HAA, immune recovery uveitis (IRU) has become an ocular manifestation described in patients with inactive CMV retinitis.

So the answer to this question is B


Instruction:
Which of the following cast gold alloys is used for fabricating partial denture frameworks
A. Type I - Soft
B. Type II - Hard
C. Type III - Hard
D. Type IV - Extra Hard

Response:
None

So the answer to this question is D


Instruction:
A middle aged man presented with blood in the sputum. Aery responsible for bleeding in hemoptysis is?
A. Bronchial aery
B. Pulmonary aery
C. Intersegmental aery
D. Intercostal collaterals

Response:
Aeriographic studies in patients with active hemoptysis have shown that the systemic circulation (bronchial aeries) is primarily responsible for the bleeding in approximately 92% of cases. The bronchial aeries, which originate either from the aoa or from intercostal aeries and are therefore pa of the high-pressure systemic circulation, are the source of bleeding in bronchitis or bronchiectasis or with endobronchial tumors. Ref: Irwin and Rippe's Intensive Care Medicine edited by Richard S. Irwin, James M. Rippe, 2008, Page 589 ; Harrison's 17th ed table 34-1

So the answer to this question is A


Instruction:
How will you differentiate between fibrous dysplasia and facial hemiatrophy?
A. Size of the face
B. Distance between the anatomical soft tissue landmarks from midline
C. Shape, size and difference in eruption pattern of teeth
D. Shape of tooth and supporting structures

Response:
None

So the answer to this question is C


Instruction:
Which is best used for sex differentiation?
A. Pelvis
B. Skull
C. Femur
D. Humerus

Response:
Ans: a (Pelvis) Ref: KS Narayan, Reddy 21st ed, p. 55Pelvis is the bone best used for sex determination. There are many differences between male and female pelvis. Listed below are some of the important points. FEMALEMALEBuiltBones thinner, markings less prominentThicker, markings more prominentPelvis Inlet: Large circularCavity: Short cylindricalWalls: VerticalOutlet: Wide sub pubicangle (80-85)Short pubic crestsLong conicalLess verticalNarrow(50-60)IliumVertical bladesCurved bladesIschial tuberosityEvertedLess evertedPre and post auricular sulcusProminentLess prominentGreater sciatic notchWider, shallowDeep narrowObturator foramenSmall triangularOval and largerIschiopubic index-100-83

So the answer to this question is A


Instruction:
Hereditary retinoblastomas develop the following chromosomal deletion -
A. 13q14
B. 13p14
C. 14pI3
D. 14p13

Response:
Ans. is 'a' i.e., 13q14 Deletion of a small number of tightly clustered genes result in a number of genetic disorders termed as microdeletion syndromes. Wilm's tumor - Aniridia complex (WAGR syndrome) Retinoblastoma Prader - Willi,syndrome Angelman syndrome DiGeorge's syndrome Velo-Cardiofacial syndrome llp 13 Pa of (deletion of sho arm of chromosome 11) 13q 14.11 (deletion of pa of long arm of chromosome 13) 15q 11-13 (deletion of pa of long arm of chromosome 15) 22q11(deletion of pa of long arm of chromosome 22) o Deletions involving the long arm of chromosome 22 (22q 1 I ) are the most common microdeletions identified to data. o Velo-cardiofacial syndrome*, is the most commonly associated syndrome.

So the answer to this question is A


Instruction:
Commonest site of oesophagus - squamous cell carcinoma is
A. Upper 2/3
B. Middle 1/3
C. Lower 1/3
D. Crico-esophageal junction

Response:
OESOPHAGEAL CARCINOMA,6 th most common carcinoma in the world, can be predisposed to dietary deficiencies, human papillomavirus infections, achalasia cardia, oesophageal webs etc.it is most commonly seen in middle third of oesophagus (50%)and also at lower third(33%) and upper third(17%).in the lower pa adenocarcinoma is common .in India 90%are squamous carcinomas.dysphagia, regurgitation, anorexia, loss of weight, ascites, palpable left supraclavicular lymph nodes are the clinical features. Ref: SRB&;s manual of surgery,5th ed, pg no 806.

So the answer to this question is B


Instruction:
All the following are causes of veigo by vestibular origin, except
A. Meniere's disease
B. BPV
C. Veebrobasilar insufficiency
D. Vestibular neuronitis

Response:
Veebrobasilar insufficiency is a central vestibular disorder. There is a transient decrease in blood flow. The main cause is atherosclerosis. Meniere&;s disease, BPV, vestibular neuronitis are the peripheral vestibular disorders. (Ref: DISEASES OF EAR, NOSE AND THROAT by PL DHINGRA - 6th edition)

So the answer to this question is C


Instruction:
All of the following Salmonellae are motile except?
A. S. typhi
B. S. enteridis
C. S. gallinarum pullorum
D. S. chester

Response:
Ans. is 'c' i.e., S. gallinarum pullorum * All salmonellae are motile with peritrichate flagella except S. gallinarum pullorum, which is non-motile.

So the answer to this question is C


Instruction:
Risk of subsequent preterm delivery with previous two preterm deliveries at < 34 weeks is?
A. 15%
B. 20%
C. 30%
D. 40%

Response:
Ans. D. 40%Recurrent Spontaneous Preterm BirthsAccording to Prior OutcomeBirth OutcomeSecond Birth <=34 Weeks (%)First birth >=35 weeks5First birth <=34 weeks16First and second birth <=34 weeks41

So the answer to this question is D


Instruction:
Regarding the anatomical snuffbox which of the following is true
A. Abductor Pollicis longus forms the posterior wall
B. Abductor pollicis longus and Extensor Pollicis brevis form the lateral wall
C. Basilic vein forms the roof
D. Floor is formed by Extensor carpi radialis longus and brevis

Response:
The anatomical snuffbox, or radial fossa, is a triangular deepening on the radial, dorsal aspect of the hand - at the level of the carpal bones, specifically, the scaphoid and trapezium bones forming the floor. The Boundaries The snuffbox is bordered by a pair of parallel and intimate tendons, of the extensor pollicis brevis and the abductor pollicis longus anteriorly by the tendon of the extensor pollicis longus posteriorly. Accordingly, the anatomical snuffbox is most visible, having a more pronounced concavity, during thumb extension. Neurovascular anatomy The radial aery is present in the box (as a content), which passes through the anatomical snuffbox on its course to form the deep palmar arch. The cephalic vein & the dorsal cutaneous branch of the radial nerve is present in the roof Pathology The anterior boundary of ASB (extensor pollicis brevis and the abductor pollicis longus) is involved in de Quervain's tenosynovitis. Scaphoid fracture: The radius and scaphoid aiculate deep to the snuffbox to form the basis of the wrist joint. In the event of a fall onto an outstretched hand, this is the area through which the brunt of the force will focus. This results in these two bones being the most often fractured of the wrist. In a case where there is localized tenderness within the snuffbox, knowledge of wrist anatomy leads to the speedy conclusion that the fracture is likely to be of the scaphoid. Interestingly, the scaphoid fracture is one of the most frequent causes of medico-legal issues

So the answer to this question is B


Instruction:
Boold volume in preterm neonate is
A. 90 ml/kg
B. 80 ml/kg
C. 70 ml/kg
D. 60 ml/kg

Response:
At the moment of bih the newborn infant was estimated to have a blood volume of 78 ml/kg with a venous hematocrit of 48 %. The average blood volume at bih was found to be 109 ml. per kilogram, a value slightly higher than in fullterm infants. In the first 2 1/2 months of life there was a tendency for the plasma volume to increase as the erythrocyte volume decreased. This had the effect of maintaining the total blood volume at a relatively high level. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is A


Instruction:
In Acromegaly All of the following are seen EXCEPT
A. Visceromegaly
B. Decreased sweating
C. Hypertension
D. Soft tissue and bone enlargement

Response:
(B) Decreased sweating # Features of Acromegaly: Acral bony overgrowth results in Frontal bossing, Increased hand & foot size, Mandibular enlargement with Prognathism, & Widened space between the lower incisor teeth.> In children & adolescents, initiation of GH hypersecretion prior to epiphyseal long bone closure is associated with the development of pituitary gigantism.> Soft tissue swelling results in increased heel pad thickness, increased shoe or glove size, ring tightening, characteristic coarse facial features, & a large fleshy nose.> Other commonly encountered clinical features include: Hyperhidrosis (Increased sweating), Deep & hollow-sounding voice, Oilv skin, Arthropathy Kyphosis, Carpal tunnel svndrome. Proximal muscle weakness & Eatigue. Acanthosis nigricans, & Skin tags.> Generalized Visceromegaly occurs, including Cardiomegaly, Macroglossia, Thyroid gland enlargement & Decreased libido.

So the answer to this question is B


Instruction:
The use of a temporary restoration or a treatment
restoration is
A. To interpret the vertical dimension of occlusion
B. To protect the gingival tissues
C. To simulate permanent restoration except durability
D. Means to determine the occlusal plane

Response:
None

So the answer to this question is C


Instruction:
Which of the following is the most widespread method of genetic transfer among bacteria?
A. Transformation
B. Transduction
C. Lysogenic conversion
D. Conjugation

Response:
Option a, b, c, d * There are three mechanisms of horizontal gene transfer in bacteria:- 1.Transformation 2. Transduction 3. Conjugation (Most common mechanism), It was discovered first by Lederberg and Tatum. * Conjugation plays an impoant role in the transfer of plasmids coding for antibacterial drug resistance and bacteriocin production . * R factor (or the resistance factor) is a plasmid which has two components. o Resistance transfer factor (F) is the plasmid responsible for conjugational transfer(similar to F factor) o Resistance determinant (r): Codes for resistance to one drug. An R factor can have several r determinants.

So the answer to this question is D


Instruction:
Sodomy comes under which section IPC -
A. 354
B. 375
C. 377
D. 378

Response:
Ans. is 'c' i.e., 377 o Section 377 IPC - it defines unnatural sexual offences as sexual intercourse against the order of nature with any man, woman or animal and lays down punishment for the same. Consensual sex between adults in a private space, which is not harmful to women or children, cannot be denied as it is a matter of individual choice. It is not a criminal offence if consent has been given. o Section 354 IPC -Indecent assault is any offence committed on a female with the intention or knowledge to outrage her modesty.o Section 375 IPC- Defines rape.o Section 376 IPC- Intercourse with his own wife living separately under a decree of separation or under any custom without her consent is punished with imprisonment upto 2 years and also fine.

So the answer to this question is C


Instruction:
True about mesenteric vein thrombosis ?
A. Peritoneal signs are always present
B. Invariably involves long length of bowel
C. I.V. Heparin is the treatment of choice
D. Surgery can lead to sho-bowel syndrome

Response:
Answer is 'd' i.e. Surgery can lead to sho-bowel syndrome Peritoneal signs are present in less than half the cases. Any length of bowel may be involved depending on the level and extent of thrombosis. Resection of the nonble bowel along with its mesentry is the treatment of choice. Heparin is given in all cases and along with bowel rest and fluid resuscitation is sufficient in patients without bowel infarction, but I am not sure whether it should be termed tit of choice.

So the answer to this question is D


Instruction:
On biopsy, characteristic finding of malignant mesothelioma is -
A. Myelin
B. Desmosin
C. Weibel-palade bodies
D. Branching microvilli

Response:
Ref:Textbook of pathology (Harsh mohan)6th edition, page no.506 Malignant (Diffuse) Mesothelioma Malignant or diffuse mesothelioma is rare. It is a highly malignant tumour associated with high moality. The tumour is significant in view of its recognised association with occupational exposure to asbestos (paicularly crocidolite) for a number of years, usually 20 to 40 years . About 90% of malignant mesotheliomas are asbestos-related. Mechanism of carcinogenicity by asbestos is not quite clear but it appears that prolonged exposure of amphibole type of asbestos is capable of inducing oncogenic mutation in the mesothelium. However, prolonged asbestos-exposure is considered more significant rather than heavy exposure as documented by occurrence of malignant mesothelioma in the family members of asbestos workers. Although combination of cigarette smoking and asbestos exposure greatly increases risk to develop bronchogenic carcinoma, there is no such extra increased risk of developing mesothelioma in asbestos workers who smoke. Recently, SV40 (simian vacuolating virus) antigen has also been implicated in the etiology of mesothelioma. Grossly, the tumour is characteristically diffuse, forming a thick, white, fleshy coating over the parietal and visceral Grossly Microscopically, malignant mesothelioma may have epithelial, sarcomatoid or biphasic patterns. SECTION III Systemic Pathology Malignant (diffuse) mesothelioma, gross appearance. The tumour is seen to form a thick, white, fleshy coat over the parietal and visceral surfaces. osteoahropathy or hypoglycaemia. Removal of the tumour is generally curative. Malignant (Diffuse) Mesothelioma Malignant or diffuse mesothelioma is rare. It is a highly malignant tumour associated with high moality. The tumour is significant in view of its recognised association with occupational exposure to asbestos (paicularly crocidolite) for a number of years, usually 20 to 40 years (page 492). About 90% of malignant mesotheliomas are asbestos-related. Mechanism of carcinogenicity by asbestos is not quite clear but it appears that prolonged exposure of amphibole type of asbestos is capable of inducing oncogenic mutation in the mesothelium. However, prolonged asbestos-exposure is considered more significant rather than heavy exposure as documented by occurrence of malignant mesothelioma in the family members of asbestos workers. Although combination of cigarette smoking and asbestos exposure greatly increases risk to develop bronchogenic carcinoma, there is no such extra increased risk of developing mesothelioma in asbestos workers who smoke. Recently, SV40 (simian vacuolating virus) antigen has also been implicated in the etiology of mesothelioma. Grossly, the tumour is characteristically diffuse, forming a thick, white, fleshy coating over the parietal and visceral surfaces . i)Epithelial pattern resembles an adenocarcinoma, consisting of tubular and tubulo-papillary formations. The tumour cells are usually well-differentiated, cuboidal, flattened or columnar cells. ii)Sarcomatoid pattern consists of spindle cell sarcoma resembling fibrosarcoma. The tumour cells are arranged in a storiform pattern with abundant collagen between them. iii)Biphasic pattern shows mixed growth having epithelial as well as sarcomatoid pattern. Usually, there are slit-like or gland-like spaces lined by neoplastic mesothelial cells separated by proliferating spindleshaped tumour cells . Asbestos bodies are found in the lungs of most patients with malignant mesothelioma of any histologic type On biopsy, mesothelioma is seen as branching microvilli like appearance.

So the answer to this question is D


Instruction:
Break bone fever is caused by:
A. Variola
B. Coxsackie
C. Dengue
D. Adenovirus

Response:
Ans. is 'c' i.e., DengueThe dengue virus causes classic dengue or break bone fever characterized by fever, muscle and joint pain, lymph - adenopathy and rash. In addition, it also causes dengue hemorrhagic fever, i.e., a much more severe disease than classic dengue fever with a high fatality rate.

So the answer to this question is C


Instruction:
The drug possessing antagonistic action at histamine, serotonin and muscarinic receptors is:
A. Promethazine
B. Terfenadine
C. Cyproheptadine
D. Hydroxyzine

Response:
-Cyproheptadine blocks 5HT2A, H1 and muscarinic receptors. -It increases appetite and can be used to promote weight gain in children.

So the answer to this question is C


Instruction:
The most impoant function of sentinel surveillance is -
A. To find the total amount of disease in a population
B. To plan effective control measures
C. to determine the trend of disease in a population
D. To notify disease

Response:
Ans. is 'a' i.e., To find the total amount of disease in a population The sentinel data is extrapolated to the entire population to estimate the disease prevalence in the total population. o So, it helps in estimating the total amount of disease in a community. Advantages of sentinel surveillance i) Repoing Bias is minimized ii) Feed-back information is simplified

So the answer to this question is A


Instruction:
Which of the following constitute grievous injury-
A. Incised wound of scalp
B. Incised wound of thigh
C. Fracture Tibia
D. Laceration of the scalp

Response:
None

So the answer to this question is C


Instruction:
Which of the following is not true about the Trochlear nerve:
A. Has the longest intracranial course
B. Supplies the ipsilateral superior oblique muscle
C. Only cranial nerve that arises from the dorsal aspect of the brainstem
D. Enters orbit through the superior orbital fissure outside the annulus of Zinn

Response:
B i.e. Supplies the ipsilateral superior oblique muscle

So the answer to this question is B


Instruction:
In a case control study, the most characterstic feature is -
A. Odds ratio estimation
B. Problem bias
C. Yield incidence rate
D. Expensive

Response:
Odds ratio is a measure of the strength of association between risk factor and outcome (refer pgno:73 park 23 rd edition)

So the answer to this question is A


Instruction:
All are true for sublingual route except ?
A. Escape first pass metabolism
B. All drugs can be given
C. Action can be terminated any time
D. Rapid absorption

Response:
Ans. is 'b' i.e., All drugs can be given Sublingual route of administration The tablet or pellet containing the drug is placed under the tongue or crushed in the mouth and spread over the buccal mucosa. Only the lipid soluble and non-irritating drugs can be administered by this route Absoption is rapid and action can be produced in minutes Action can be easily terminated by spitting the drug after the desired effect is achieved. Liver is bypassed with this route, thus the drugs with high first pass metabolism can be easily given by this route. Drugs given by this route are: GTN, buprenorphine, desamino-oxytocin.

So the answer to this question is B


Instruction:
All are seen in marasmus except?
A. Hunger
B. Wasting
C. Loose folds skin
D. Apathy

Response:
Ans. (d) ApathyRef: Nelson 18th ed., Chapter 43* Marasmus is characterized by weight loss and listlessness until emaciation results :MONKEY FACIES* The skin loses turgor and becomes wrinkled and loose as subcutaneous fat disappears from buttocks leading to BAGGY PANTS appearance.* Loss of fat from the sucking pads of the cheeks often occurs late in the course of the disease; thus, the infants face may retain a relatively normal appearance compared with the rest of the body.* Most patients are constipated, but some present with starvation diarrhea* These children are irritable and have a voracious appetite. Apathy is a feature of kwashiorkor.* The abdomen has muscle wasting leading to pot belly with the intestinal pattern readily visible.* As the condition progresses, the temperature usually becomes subnormal and the pulse slows.

So the answer to this question is D


Instruction:
A 20-year-old woman complains of headache and discomfort in both sides of her jaw. Physical examination reveals enlarged parotid glands that are slightly tender on palpation. There is reddening of the orifice of Stensen duct on intra oral examination; her temperature is 38.3degC, and the pulse rate is 80/min. Laboratory data show hemoglobin 14 g/dL; hematocrit 40%; WBC 11000/mL, with 33% segmented neutrophils, 7% monocytes, and 60% lymphocytes. Which of the following diagnostic tests will help to confirm the diagnosis of epidemic parotitis?
A. single blood sample for a specific immunoglobulin G (IgG)
B. blood cell count
C. blood culture
D. single blood test for a specific immunoglobulin M (IgM)

Response:
A single test revealing a specific IgM antibody can confirm the disease. Acute and convalescent titers of specific IgG antibodies will also confirm the diagnosis of mumps. Urine, saliva, and throat swabs will grow the mumps virus, but blood does not. Salivary amylase is elevated but is relatively nonspecific. Of course, a typical presentation during an epidemic probably does not require any confirmatory tests. Sporadic cases require more active confirmation. Other causes of parotitis requiring specific treatment include calculi, bacterial infections, and drugs. Tumors, sarcoid, TB, leukemia, Hodgkin disease, Sjogren syndrome, and lupus erythematosus can also cause parotid enlargement.

So the answer to this question is D


Instruction:
All of the following statements are true about obsession except:
A. It is a repetitive thought or image
B. Patient believes that the images or thoughts are imposed by others
C. Content of obsession can be about sex or god
D. Patient gets disturbed when unable to remove the thoughts or images

Response:
Obsessions are repetitive thoughts, images or impulses. Often the content of thoughts is about sex or god and patient tries to stop these anxiety provoking thoughts unsuccessfully. Please remember, that a patient with obsession identifies the repetitive thought as his "own thoughts" and not something that is imposed by others. if the patient indeed believes that the thought has been imposed by others, it would then be diagnosed as "thought inseion" and not an obsession.

So the answer to this question is B


Instruction:
BK virus infection - True statement is:
A. Causes nephropathy in transplant patients
B. Causes progressive multifocal leukoencephalopathy
C. 20 - 25% transplant cases associated with BK virus nephropathy
D. Single stranded DNA virus

Response:
Ans: (a) Causes nephropathy in transplant patientsRef: Harrison, 19th editionBK VirusBK virus is a non-enveloped double-strand DNA virus which belongs to family polyoma viridae.Primary BKV infection occurs by the upper respiratory route until age 10 without any obvious symptoms.80% of the population is infected by BKV, and approximately 50% of healthy native kidneys contain latent BKV.After renal transplantation, 35-60% of patients have BKV viruria, 5-30% of patients have BKV viremia.The prevalence of BKV nephropathy is about 10% of renal transplant patients.Progressive multifocal leukoencephalopathy is caused by JC virus (belongs to polyoma viridae).

So the answer to this question is A


Instruction:
Chromosomal mutation in low grade transitional cell cancer of bladder is?
A. P53
B. Rb gene
C. FGFR3
D. HRAS

Response:
Ans. (c) FGFR3(Ref: Robbins 9th/968)*Noninvasive high-grade urothelial carcinoma is associated with loss of the TP53 and RB tumor suppressor genes while Noninvasive low-grade papillary urothelial carcinoma is associated with gain of function FGFR3 and HRAS mutations.

So the answer to this question is C


Instruction:
A newborn vomits after each feeding of milk-based formula, and does not gain weight. Biochemical testing reveals a severe deficiency of galactose-1-phosphate uridyltransferase, consistent with homozygosity. If this condition goes untreated, what is the likely outcome for this patient?
A. Benign disease except for cataract formation
B. Chronic emphysema appearing in early adulthood
C. Chronic renal failure appearing in adolescence
D. Death in infancy

Response:
Galactosemia occurs in two very different clinical forms. Deficiency of galactokinase produces very mild disease with the only significant complication being cataract formation. In contrast, homozygous deficiency of galactose-1-phosphate uridyltransferase produces severe disease culminating in death in infancy. In addition to galactosemia and galactosuria, these patients have impaired renal tubular resorption leading to aminoaciduria, gastrointestinal symptoms, hepatosplenomegaly, cataracts, bleeding diathesis, hypoglycemia, and mental retardation. Pathologically, the CNS showed neuronal loss and gliosis and the liver shows fatty change progressing to cirrhosis. Benign disease with cataract formation is characteristic of galactokinase deficiency. Chronic emphysema is not associated with homozygous galactose-1-phosphate uridyltransferase deficiency, but rather with alpha 1-antitrypsin deficiency. Impaired tubular reabsorption (producing aminoaciduria) is seen within a few days or weeks of feeding milk to an infant with severe galactosemia, as opposed to chronic renal failure appearing in adolescence. Ref: Bender D.A., Mayes P.A. (2011). Chapter 21. The Pentose Phosphate Pathway & Other Pathways of Hexose Metabolism. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.

So the answer to this question is D


Instruction:
Fasting Blood Sugar (FBS) of a population is known to be normally distributed, with a mean of 105 mg% and standard deviation of 10 mg%. Thus 95% of the population will have FBS within -
A. 104 and 106
B. 95 and 115
C. 85 and 125
D. 75 and 135

Response:
95% of the population will have FBS within 2 Standard Deviation (±2SD) of the mean.
Since the mean FBS is 105 mg% and the standard deviation is 10 mg%, 95% of the population will have FBS between 105 ± 2SD i.e. 105 ± 20 i.e. 85 and 125.

So the answer to this question is C


Instruction:
Oculocardiac reflex is seen in which surgery: March 2007
A. Cataract surgery
B. Strabismus surgery
C. Ventricular Septemberal Defect surgery
D. Valvular surgery

Response:
Ans. B: Strabismus surgery The oculocardiac reflex/ Aschner phenomenon,/ Aschner reflex/ Aschner-Dagnini reflex, is a decrease in pulse rate associated with traction applied to extraocular muscles and/or compression of the eyeball. The reflex is mediated by nerve connections between the trigeminal cranial nerve and the vagus nerve of the parasympathetic nervous system. The afferent tracts derive mainly from the ophthalmic division of the trigeminal nerve. These afferents synapse with the visceral motor nucleus of the vagus nerve, located in the reticular formation of the brain stem. The efferent poion is carried by the vagus nerve from the cardiovascular center of the medulla to the hea, of which increased stimulation leads to decreased output of the sinoatrial node. This reflex is especially sensitive in neonates and children, and must be monitored, usually by an anaesthesiologist, during paediatric ophthalmological surgery, paicularly during strabismus correction surgery. However, this reflex may also occur with adults. Bradycardia, junctional rhythm, asystole, and very rarely death, can be induced through this reflex.

So the answer to this question is B


Instruction:
Iodine deficient population in the world is:
A. 20 million
B. 12 million
C. 9 million
D. 6 million

Response:
20 million

So the answer to this question is A


Instruction:
Inducing agent with maximum incidence of vomiting
A. Ketamine
B. Etomidate
C. Thiopentone
D. Propofol

Response:
Postoperative nausea and vomiting are more common following etomidate than following propofol or barbiturate induction. Propofol also possesses significant antiemetic activity with small (sub hypnotic) doses (i.e., 10 mg in adults). The median concentration of propofol with an antiemetic effect was 343 ng/mL, which also causes a mild sedative effect. This concentration can be achieved by an initial dose of propofol infusion of 10 to 20 mg followed by 10 ug/kg/minute. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e

So the answer to this question is B


Instruction:
A Bad prognostic indicator of Schizophrenia is -
A. Late onset
B. Family history of Schizophrenia
C. Positive precipitating factors
D. Prominent affective symptoms

Response:
Poor prognostic factors:
Insidious onset, early onset (before 20 years of age); absence of precipitating stressor; poor premorbid adjustment; hebephrenic subtype (worst prognosis), simple, undifferentiated and chronic catatonic subtype; long duration (chronic course → >2 years); single / divorced; Negative symptoms; absence of depression; family history of schizophrenia; past history of schizophrenia; asthenic (thin) physique; male sex; poor treatment compliance & poor response to treatment; poor social support; flat or blunted affect; ventricular enlargement on brain CT scan; hospitalization & indoor treatment.

So the answer to this question is B


Instruction:
Forced diuresis with acidification or alkalinization of urine is a common method for elimination of certain poisons/drugs from the body. The elimination of which of the following drugs is commonly enhanced by alkaline diuresis -
A. Amphetamines
B. Phenobarbitone
C. Phencyclidine
D. Theophylline

Response:
Amongst the give options, alkaline diuresis is used in barbiturate (phenobarbitone) poisoning.

So the answer to this question is B


Instruction:
Beta alanine is formed by
A. Biotin
B. Pyridoxal phosphate
C. Pantothenic acid
D. Folic acid

Response:
Reference: Harpers illustrated biochemistry 30th edition

So the answer to this question is C


Instruction:
All are endogenous catecholamines except :
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Dobutamine

Response:
Dobutamine ] Catecholamines are compound containing catechol nucleus and a side chain containing amine group.

So the answer to this question is D


Instruction:
Root value of nerve supplying small muscles of hand -
A. C5C6
B. C3C4
C. C8T1
D. C6C7

Response:
Ans. is 'c' i.e., C8Tl* All small muscles of hand i.e. thener, hypothenar, interossei & lumbricals are supplied by C8, T7 nerve roots.JointMovementSpinal segmentMovementSpinal segmentShoulderAbductionC5AdductionC6,7,8ElbowFlexionC5,6ExtensionC,7,8RadioulnarSupinationC6PronationC7WristExtensionC6FlexionC7FingersFlexion/ ExtensionC8Adduction/AbductionT1

So the answer to this question is C


Instruction:
Which of the following solution is recommended for TMJ Arthrocentesis:
A. Normal saline.
B. Ringer lactate.
C. Distilled water
D. None.

Response:
Liquid:

So the answer to this question is B


Instruction:
ARDS is characterised by all except
A. Decreased surfactant
B. Alveolar transudate
C. Decreased lung compliance
D. PaO2 /FiO2 < 200

Response:
In ARDS the type1 pneumocytes and alveolar capillary endothelial cells are injured leading to the loss of normally tight alveolar barrier for fluid and macromolecules. Edema fluid rich in protein accumulates in alveolar spaces leading to decrease in compliance of lung. source : Harrison 20TH edition page 2032

So the answer to this question is B


Instruction:
Mission Indradhanush 2014, does not include
A. Diphtheria vaccine
B. Pertussis vaccine
C. Hepatitis B Vaccine
D. Meningococcal vaccine

Response:
None

So the answer to this question is D


Instruction:
Specificity measures-
A. True negative
B. False positives
C. True positives
D. None of the above

Response:
Ref :Parks 23rd edition pg 139 Specificity = TN / (TN + FP) Specificity is defined as the ability of a test to identify correctly all those who do not have the disease, that is "true negatives".

So the answer to this question is A


Instruction:
Increased density in skull vault is seen in -a) Hyperparathyroidismb)  Multiple myelomac) Fluorosisd) Renal osteodystrophy
A. acd
B. ad
C. bc
D. bde

Response:
All the causes of generalized increased in bone density can cause increased density of skull vault — Practical imaging 2nd /e 73
Fluorosis and secondary hyperparathyroidism (renal osteodystrophy) cause increased density of skull vault.

So the answer to this question is A


Instruction:
DOC for acute attack of Hereditary angioneurotic edema
A. Danazol
B. Cl, inhibitor concentrate
C. Icatibant
D. Methylprednisolone

Response:
Medication C1 inhibitor concentrate (Plasma-derived) (Berine, Berine P, Cinryze. Recombinant C1 inhibitor Conestat alfa (Ruconest, Rhucin). Bradykinin Bzreceptor antagonist Icatibant (Firazyr). Kallikrein inhibitor Ecallantide (Kalbitor) REF : katzung pharmacology : 14th ed

So the answer to this question is B