Instruction:
30 yr female with depressed mood, decreased appetite & no interest since one year. Diagnosis is?
A. Dysthymia
B. Depression
C. Anxiety
D. None

Response:
Ans. is 'b' i.e., Depression Depressed mood, decreased appetite and no interest since one year suggest the diagnosis of depression. o For diagnosis of dysthymia, depressive symptoms should be present for at least 2 years. Mood disorders According to ICD-10, mood (affective) disorders are grouped into six main categories. Manic episode: - Single episode of mania (not recurrent). Depressive episode : - Single episode of depression. Bipolar mood (affective) disorders : - Recurrent episodes of mania alone or recurrent episodes of mania & depression in the same patient at different times. Recurrent depressive disorder : - Recurrent (two or more) depressive episodes. Persistent mood disorder : - Persistent mood symptoms which last for more than 2 years (I year in children & adolescents). Example are dysthemia & cyclothymia. Other mood disorders : - Mixed episodes, i.e., picture of depression and mania is present at the same time intermixed (in contrast to bipolar disorders where depression and mania occur at different time). It also includes rapid cycling --> picture of mania and depression alternates rapidly with each other without a normal intervening period (in contrast to bipolar disorder where normal intervening is present between two episodes).

So the answer to this question is B


Instruction:
Cryoprecipitate contains all except -(
A. Factor VIII
B. Factor IX
C. Fibrinogen
D. VWF

Response:
Cryoprecipitate contains fibrinogen & coagulation factor concentrated from plasma by controlled thawing.10-20mL pack contains fibrinogen 150-300mg, factor VIII 80-120 U, von Willebrand factor 80-120U. Reference :Davidson's principle & practice of medicine 22nd edition pg no 1012.

So the answer to this question is B


Instruction:
What will be the effect on spirometry in case of lobectomy done for bronchogenic carcinoma?
A. Increased residual volume
B. Increased vital capacity
C. Increased dead space ventilation
D. Increased closing volume

Response:
In case of lobectomy, since the remaining lung tissue is lesser, all parameters like vital capacity, residual volume and closing volume will reduce. Hence, due to hypoxic stimulus post-operative patients of lobectomy will take rapid shallow breaths. This will lead to increased Dead space ventilation.

So the answer to this question is C


Instruction:
Steroid resistant nephritic syndrome is:
A. Nephrin
B. Alpha-actinin-4
C. Podocin
D. Transient Receptor Potential 6

Response:
. Podocin

So the answer to this question is C


Instruction:
Which of the following is true about direct filling gold?
A. Properly condensed mat gold has no voids
B. Whatever may be the type, voids are inherent
C. Voids can be avoided with manual condensation
D. None of the above

Response:
Porosity is likely to occur in all direct gold restorations. Each type of gold requires a slight variation in technique to avoid either closed pores or open pores that intersect the surface.
Ref: Phillips 12 ed page no 414,415

So the answer to this question is B


Instruction:
A quack gives a penicillin injection to a patient who dies due to it. Will the quack be relieved for his criminal responsibility by raising a plea of accident
A. Definitely
B. Likely to
C. Never
D. Deserves to be acquitted on the Strength of evidence

Response:
C i.e. Never

So the answer to this question is C


Instruction:
A cast is poured with polysulphide impression material, but details are not achieved in cast. For achieving that what should be done?
A. Adding surfactant to gypsum
B. Mixing surfactant to impression material
C. Spraying water to gypsum
D. Spraying water + mixing surfactant to gypsum

Response:
Absence of ﬁne details in cast poured with polysulﬁde impression materials indicates its hydrophobic property.
A nonionic surfactant can be added to the impression materials in the manufacturing process to produce a degree of hydrophilicity to the surface of the material.
The beneﬁcial eﬀect of optimal surfactant mixing at the time of manufacturing is not reduced by rinsing the impression prior to pouring, so ﬁne details can be achieved on cast too.

So the answer to this question is B


Instruction:
Sexual ambiguity may be seen in which of the following condition -
A. Androgen insenstivity
B. Pure gonadal dysgenesis
C. Swyer syndrome
D. Mixed gonadal dysgenesis

Response:
Ref - semantischolar.org

So the answer to this question is D


Instruction:
Graft from homozygotic twin is known as -
A. Autograft
B. Isograft
C. Allograft
D. Xenograft

Response:
Ans. is 'b' i.e., Isograft o Graft from homozygotic (identical) twin is called as isograft.Grafto A tissue graft is a medical procedure in which tissue from a donor is used to replace missing or damaged tissue on a patient ( recipient).Terminology of grafts :DonorNameSynonymsSelfDifferent individual, genetically identical with recipient (Identical twin or member of same inbred strain)Genetically unrelated member of same speciesDifferent speciesAutograftIsograftAutogenous or autogenic graft.Isologous or syngeneric graft or syngraftAllograftXenograftAllogenic graft. Formerly called homograftXenograft, Formerly called heterografto Orthoptic graft - Graft applied in anatomically normal site eg. skin graft,o Heterotopic graft - Graft applied in anatomically abnormal site.

So the answer to this question is B


Instruction:
Hanging cuain sign seen in?
A. Pityriasis rosea
B. Pityriasis Versicolor
C. Pityriasis rubra pilaris
D. Pityriasis lichenoides chronica

Response:
Pityriasis rosea REF: Dermatology. 1995; 190(3): 252. PubMed PMID: 7599393, Clinical Pediatric Dermatology - By Thappa page 104 PITYRIASIS ROSEA The primary eruption, herald patch (Mother spot) is a single oval or round patch with a central wrinkled salmon colored area and a darker peripheral zone separated by a "collarette of scales" (when stretched across the long axis, the scales tends to fold across the line of stretch, the so called Hanging cuain sign).

So the answer to this question is A


Instruction:
Energy producing enzymes are located in
A. Rough endoplasmic reticulum
B. Ribosomes
C. Golgi apparatus
D. Mitochondria

Response:
In mitochondria, enzymes for energy metabolism and protein synthesis can be found.

So the answer to this question is D


Instruction:
A congenital hydrocele is best t/t by -
A. Eversion of sac
B. Excision of sac
C. Lords procedure
D. Herniotomy

Response:
Congenital hydrocele are a special form of indirect inguinal hernia and are treated by herniotomy." Congenital hvdrocele In this condition, the process us vaginalis remain patent so there is direct communication of the tunica vaginalis with the peritoneal cavity. The communicating orifice at the deep inguinal ring is too small for the development of a hernia. It is present since bih*. In contradiction to assumption. a congenital hydrocele is not easily reducible* due to the narrowness of the deep inguinal ring but when the child lies supine, it disappears. Treatment methods of hydrocele For Congenital hydrocele - Herniotomy* For other types : Jaboulays method - for small & medium sized hydrocele * Lords procedure - for big size hydrocele * Excision of sac - for hematocele, infected sac. Also, Remember MC type of Primary hydrocele is - Vaginal type'''. Hydrocele en Basic* - this type of hydrocele has two intercommunicating sac, one above and one below the neck of the scrotum.

So the answer to this question is D


Instruction:
Vitamin D analogue calcitriol is useful in the treatment of –
A. Lichen planus
B. Psoriasis
C. Phemphigus
D. Leprosy

Response:
Drugs for psoriasis
Topical medications

Vitamin D (calcipotriene)
Cool tar
Corticosteroids
Tree bark extract (dithranol)
Topical retinoids

Systemic

Psoralens (Methoxsalen, trioxsalen)
Methotrexate
Acitretin
Etanercept
Cyclosporine
Alefacept
Tacrolimus
6-Thioguanine
Hydroxyurea
Tacrolimus
Adalimumab

Photo therapy

PUVA (oral psoralen plus UV-A)
Narrow - band UV-B (NB-UVB)

So the answer to this question is B


Instruction:
Common stain for fungal hyphae:
A. Methylene blue
B. Gomori Methanamine silver
C. Congo red
D. Oil red 0

Response:
Ans is b i.e Gomori Methanamine silver Ref. Chakraboy 2/e 617 "Gomori Methenamine Silver (GMS) and Periodic acid-Schiff (PAS) are the two most common stains used to look for fungi in tissues and in cytology specimens." The GMS stain is more sensitive than the PAS stain as it stains both ble and non-ble fungal elements (which are refractory to other stains) but it stains inflammatory cells (lysosomes) and tissue reticulin too (in addition to fungi.) PAS staining has the slight advantage that the morphology of the tissue adjacent to the fungi can be better visualized, but this can be addressed using a GMS stain and H and E counterstain (which stains only tissue).

So the answer to this question is B


Instruction:
A patient with alkaline urine which is cloudy with plenty of pus cells is suffering from infection with -
A. E. coli
B. Proteus
C. T.B.
D. None

Response:
None

So the answer to this question is B


Instruction:
High sensitive -
A. Low false positive
B. Low false negative
C. Low true negative
D. Low true positive

Response:
True positive is directly related to sensitivity
False negative is inversely related to sensitivity
True negative is directly related to specificity
False positive is inversely related to specificity

So the answer to this question is B


Instruction:
All of the following are true regarding Down's Syndrome EXCEPT;
A. Only found in female
B. Simian crease
C. Growth retardation
D. Epicanthus with oblique palpebral fissure

Response:
Down's syndrome (Trisomy 21): Mental retardation Epicanthic folds and flat facial profile Simian's crease Umblical hernia Hypotonia Gap between first and second toe Congenital hea defects

So the answer to this question is A


Instruction:
All are true regarding lupus anticoagulant except
A. Increased PT
B. Increased aboion
C. Rashes
D. None

Response:
Ans. is 'None'

So the answer to this question is D


Instruction:
Test for colour vision
A. Ishihara plates
B. Holmgren's wool test
C. City university test
D. All the above

Response:
Others
Edridge - Green lantern test.
Fans worth D 15 hue discrimination test.
Nagel's anomaloscope.
Hardy - Rand - Rittler plates.

So the answer to this question is D


Instruction:
Disinfection of water is not requihred if the source is from-
A. Tube well
B. Step well
C. Draw well
D. River

Response:
Park's textbook of preventive and social medicine 23rd edition. *Tube wells are usually machine dug and may be several hundred metres deep. Deep wells furnish the safest water and are often the most satisfactory sources of water supply

So the answer to this question is A


Instruction:
Which among the following drug is contra–indicated in renal failure ?
A. Pethidine
B. Morphine
C. Fentanyl
D. Atracurium

Response:
None

So the answer to this question is A


Instruction:
Jumping genes are also known as
A. Plasmids
B. Oncogenes
C. Transposons
D. Introns

Response:
Transposons are called as Jumping genes as they can jump from one chromosome locus to another.

So the answer to this question is C


Instruction:
Gleason Score is used to grade which cancer -
A. Prostate Cancer
B. Transitional Cell CA
C. Penile Cancer
D. Anal Cancer

Response:
Ans. is 'a' i.e., Prostate Cancer Gleason score and grading systemo Gleason score is the most commonly used histological grading system for prostate cancero The two most predominant histological patterns of the prostate cancer are assigned a Gleason grade ranging from 1-5.o Primary grade is assigned to the pattern of cancer that is most commonly observed in the histological slides of the specimen.o Secondary grade is assigned to the second most commonly observed pattern in the specimeno Gleason score is the sum of the two grades. Thus it is also known as Gleason sum.o If the entire specimen has only one pattern present, then both the primary and sencondary grades are reported as the same grade.o As Gleason grades range from 1 to 5, Gleason score thus range from 2 to 10. o The Gleason score is used to help evaluate the prognosis of men with prostate cancer. Together with other parameters, the Gleason score is incorporated into a strategy of prostate cancer staging which predicts prognosis and helps guide therapy.o A point of importance is that the primary Gleason grade is most important with respect to placing patients in prognostic groups. For example in patients with a Gleason score 7, a Gleason 4+3 is a more aggressive cancer than a Gleason 3+4.

So the answer to this question is A


Instruction:
509-IPC deals with -
A. Masturbation in public place
B. Inquest
C. Dowry death
D. Act intended to insult the modesty

Response:
Dowry death-S.304-B I.P.C. Inquest -S.174, Cr.P.C. is police inquest. S.176,Cr.P.C. is magistrate inquest. S.509, I.P.C.: Whoever intending to insult the modesty of any women. Ref: The synopsis of forensic medicine(Dr.K.S.Narayan Reddy), edition 28th page no: 149, 215.

So the answer to this question is D


Instruction:
Pale infarcts are seen at all of the following sites except-
A. Hea
B. Spleen
C. Kidney
D. Lung

Response:
Ans is 'd' i.e., Lung INFARCTION o An infarct is an area of ischemic necrosis by occlusion of either the aerial supply or venous drainage in a paicular tissue. Pathogenesis o Mostly it is caused by interrupted blood supply. o "Nearly 99% of all infarcts results from thrombotic or embolic events and almost all result. from aerial occlusion". o Other causes of interrupted aerial supply are local vasospasm, extrinsic compression of a vessel by tumor, twisting of vessel e.g., in testicular torsion, expansion of atheroma due to hemorrhage within the plaque. o Venous obstruction usually cause congesion, edema, infarction does not occur because bypass channels rapidly open after the thrombus, providing some outflow from the area, which inturn improves aerial inflow. Infarct cause by venous thrombosis is more likely in organs with a single venous outflow channel, such as in testis and ovary. Types of infarct o Infarcts are classified on the basis of their color. o Infarcts are classified into either Red (Haemorrhagic) or White or Pale (anaemic) infarcts, reflecting the amount of haemorrhage. Red infarcts (Haemorrhagic) : occur with : Venous occlusions (eg ovarian torsion); In loose tissues (such as lungs); In tissues with dual circulation (e.g. Lung & S. intestine) In tissues that were previously congested because of sluggish venous out flow. When flow is reestablilshed to a site of previous aerial occulusion and necrosis. White or Pale infarcts : occur with : Aerial occlusions, or In solid organs e.g. Hea, spleen, Liver, kidney and brain where the solidity of tissue limits the amount of haemorrhage that can seep into the area of ischaemic necrosis.

So the answer to this question is D


Instruction:
Painless effusions in joints in congenital syphilis is called -
A. Clutton' s joints
B. Banton's joints
C. Charcot's joints
D. Synovitis

Response:
Ans. is 'a' i.e., Clutton's joints

So the answer to this question is A


Instruction:
A 47-year-old female patient's right breast exhibited characteristics of peau d'orange; that is, the skin resembled orange peel. This condition is primarily a result of which of the following?
A. Shortening of the suspensory ligaments by cancer in the axillary tail
B. Blockage of cutaneous lymphatic vessels
C. Contraction of the retinacula cutis of the are ola and nipple
D. Invasion of the pectoralis major by the cancer

Response:
When cutaneous lymphatics of the breast are blocked by cancer, the skin becomes edematous, except where hair follicles cause small indentations of the skin, giving an overall resemblance to orange peel. Shortening of the suspensory ligaments or retinacula cutis leads to pitting of the overlying skin, pitting that is intensified if the patient raises her arm above her head. Invasion of the pectoralis major by cancer can result in fixation of the breast, seen upon elevation of the ipsilateral limb. Inversion of areolar skin with involvement of the ducts would also be due to involvement of the retinacula cutis.

So the answer to this question is B


Instruction:
For which one of the following tumours Gastrin is a biochemical marker:
A. Medullary carcinoma of thyroid
B. Pancreatic neuroendocrine tumour
C. Pheochromocytoma
D. Gastrointestinal stromal tumor

Response:
. Pancreatic neuroendocrine tumour

So the answer to this question is B


Instruction:
Forensic entomology:
A. Study of insects
B. Study of poisons
C. Study of death
D. Study of snakes

Response:
Ans. (A). Study of insectsThanatologyQDeath & its aspectsTaphonomyDecomposition of human remainsAnthropometrystudy of the measurements and proportions of the human bodyDactylographyQFinger printsCheiloscopyQLip printsPoroscopyQSweat poresQ in between fingerprintridgesRugoscopyQPalatal rugaeQ of hard palateQOdontologyQDentition pattern & bite marksPodographyQFoot printsCalligraphyHand writingMedical etiquetteLevel of courtesy between medical colleaguesMedical ethicsMoral principles guiding the doctorsEcotoxicologyPoisons in relation to environmentToxicologyPoisons & its effectsToxicologyToxins & its effectsHerpetologyReptilesOphiologyQSnakesEntomologyQInsects

So the answer to this question is A


Instruction:
Development examination should be fuher evaluated in child of 12 weeks if he ?
A. Does not vocalize
B. Does not babble
C. Does not change bright red ring from one hand to other even if given in hand
D. Does not hold head at 90deg

Response:
Ans. is 'a' i.e., Does not vocalize o Vocalization develops by 4 weeks. o Babbling develops by 7 months o A child transfer the objects from one hand to another by 5-7 months. o A child can hold head at 90deg (above horizontal plane in ventral suspension) by 3 months --> Neck holding develops by 3 months.

So the answer to this question is A


Instruction:
First line drug used for painful diabetic neuropathy is ?
A. Carbamazepine
B. Duloxetine
C. Venlafaxine
D. EMLA

Response:
Chronic, painful diabetic neuropathy is difficult to treat but may respond to duloxetine, amitriptyline, gabapentin, valproate, pre- gabalin, or opioids. Two agents, duloxetine and pregabalin, have been approved by the U.S. Food and Drug Administration (FDA) for pain associated with diabetic neuropathy, but no treatments are satisfactory. Reference : page 2427 Harrison's Principles of Internal Medicine 19th edition

So the answer to this question is B


Instruction:
Bowel can get strangulated in all of the following space, EXCEPT:
A. Rectouterine pouch
B. Ileocolic recess
C. Paraduodenal recess
D. Omental bursa

Response:
Omental bursa, paraduodenal recess and ileocolic recess are peritoneal recesses. Peritoneal recesses These are small pockets of the peritoneal cavity enclosed by small, inconstant folds of peritoneum. These are best observed in fetuses and are mostly obliterated in adults. Sometimes they persists to form potential sites for internal hernias and strangulation. These are: Lesser or omental bursa Duodenal recesses: includes superior duodenal recess, inferior duodenal recess, paraduodenal recess, retroduodenal recess, Duodenojejunal recess and mesenterico-parietal fossa (of waldeyer) Caecal fossa: Superior ileocaecal (or ileocolic) recess, Inferior ileocaecal (or ileocolic) recess and retrocaecal recess. Intersigmoid recess Ref: BDC Vol II, 3/e, Page 204.

So the answer to this question is A


Instruction:
Which of the following topical steroids is the most potent?
A. Halobetasol propionate
B. Fluticasone
C. Hydrocortisone
D. Triamcinolone acetonide

Response:
Ans. is 'a' i.e., Halobetasol propionate Classification of topical steroids based on potencyClass 1(Super potent)Clobetasol propionate ointment and cream 0.5%Betamethasone dipropionate ointment 0.05%Halobetasol propionate ointment and cream 0.05%Class 2(Highly potent)Mometasone furoate ointment 0.1%Class 3(Potent)Betamethasone dipropionate cream 0.05%Fluticasone propionate ointment 0.05%Class 4(Moderately potent)Fluocinolone acetonide ointment 0.025%Fluticasone propionate cream 0.05%Mometasone furoate cream 0.1%Class 5(Moderately potent)Betamethasone valerate cream 0.1%Hydrocortisone butyrate cream 0.1%Class 6(Mildly potent)Desonide cream 0.05%Fluocinolone acetonide solution 0.05%Class 7(Least potent)Dexamethasone cream 0.1%Hydrocortisone 1%

So the answer to this question is A


Instruction:
Which of the following is the most common origin of cerebral metastasis?
A. Lung cancer
B. Breast cancer
C. Melanoma
D. Colon cancer

Response:
Lung: 40%
Breast : 10 - 30%
Melanoma : 5 - 15%
Unknown : 15%

So the answer to this question is A


Instruction:
Which of the following drug is not used for Methicillin Resistant Staph. Aureus (MRSA).?
A. Cefaclor
B. Cotrimoxazole
C. Ciprofloxacin
D. Vancomycin

Response:
Ans- A Cefaclor Drugs used for MRSA Vancomycin Chloramphenicol Linezolid Minocycline Quinupristin/ dalfopristin Trimethoprim - sulfamethoxazole Fluoroquinolones

So the answer to this question is A


Instruction:
A patient experiences paralysis of the muscle that originates from the femur and contributes directly to the stability of the knee joint.Which of the following muscles is involved?
A. Vastus lateralis
B. Semimembranosus
C. Saorius
D. Biceps femoris (long head)

Response:
All of them contribute to the stability of the knee joint but The vastus lateralis muscles arise from the femur and all the other muscles originate from the hip (coxal) bone.

So the answer to this question is A


Instruction:
Toxigenicity of Corynebacterium diphtheria is determined by
A. Elek's gel precipitation test
B. Aselole reaction
C. Nagler's reaction
D. All

Response:
Elek's gel precipitation test: a rectangular strip of filter paper impregnated with diphtheria antitoxin is placed on the surface of a 20% normal horse serum agar in a Petri dish while the medium is still fluid. -when agar has set, the surface is dried and narrow streaks of strains are made at right angles to the filter paper strip. A positive and negative control should be put up. The plate is incubated at 37degC for 24-48 hours. The toxin produced by the bacterial growth will diffuse in agar and where it meets the antitoxin at optimum concentration, will produce a line of precipitation. The presence of such arrow headlines of a precipitate indicates the strain is toxigenic. No precipitate is formed in the case of non-toxigenic strains. Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 243

So the answer to this question is A


Instruction:
Which events occured before 1900 AD
A. Establishment of seat of social medicine at Oxford
B. Work on scurvy by james Lind
C. Epidemiological work on cholera by John Snow
D. Use of BCG vaccine

Response:
An english epidemiologist John Snow studied the epidemiology of cholera in London from 1848-1854 and established the role of polluted drinking water in spread of cholera.

So the answer to this question is C


Instruction:
Which of the following increases turbulence in blood flow?
A. Reynolds number< 2000
B. Decrease in velocity of blood
C. Decrease in density of blood
D. Increase in diameter of blood vessel

Response:
None

So the answer to this question is D


Instruction:
Most common site of lentigo maligna melanoma is:
A. Face
B. Legs
C. Trunks
D. Soles

Response:
"Lentigo maligna melanoma is usually confined to chronically sun-damaged, sun-exposed sites (face, neck, back of hands) in older individuals." Harrison
Most common site of melanoma

of melanoma in females → lower extremity (knee to ankle)
of melanoma in males → Trunk & back
of lentigo maligna melanoma → Face, neck
of acral lentiginous melanoma → Palms, soles, subungual region

So the answer to this question is A


Instruction:
CSF in meningococcal meningitis shows -
A. Gm '+ve' Diplococci, in pus cells
B. Gm '-ve' Diplococci in pus cells
C. Gm '-ve' bacilli
D. Gram '+ve' bacilli

Response:
None

So the answer to this question is B


Instruction:
Orchidopexy for undescended testis is recommended at which age ?
A. 3 months
B. 6 months
C. 2 year
D. 5 year

Response:
Orchidopexy is usually performed after the age of 1 year to avoid the risks of operating on a tiny patient. Testes should be brought down into the scrotum before the boy stas school.Orchidopexy during the second year of life is currently recommended by paediatric surgeons. Orchidopexy before 2 years of age improves feility, may reduce the risk of malignancy and has psychological benefits Reference : page1378 and 77 Bailey and Love's sho practice of surgery 25th edition

So the answer to this question is C


Instruction:
A 65 year old female presents with recurrent episodes of gross painless hematuria. What is the most common cause of gross painless hematuria?
A. Renal tuberculosis
B. Ca bladder
C. Urethral stricture
D. Intestinal nephritis

Response:
Gross painless hematuria is the most common presenting sign of bladder cancer. Other symptoms includes irritative voiding symptoms such as frequency, urgency and dysuria. Microscopic hematuria is mainly nephrologic in origin whereas gross hematuria is commonly urologic in origin. Reference: Conn's Current Therapy 2012, page 894.

So the answer to this question is B


Instruction:
A 65-year-old male develops the sudden onset of severe knee pain. The knee is red, swollen, and tender. He has a history of diabetes mellitus and cardiomyopathy. An x-ray of the knee shows linear calcification. Definitive diagnosis is best made by
A. Serum uric acid
B. Serum calcium
C. Ahrocentesis and identification of positively birefringent rhomboid crystals
D. Rheumatoid factor

Response:
(Braunwald, 15/e, pp 1995-1996.)The acute mono- aicular ahritis in association with linear calcification of the cailage of the knee suggests the diagnosis of pseudogout, also called calcium pyro-phosphate dihydrate deposition disease. The disease resembles gout. Positive birefringent crystals (looking blue when parallel to the axis of the red com- pensator on a polarizing microscope) can be demonstrated in joint fluid. Serum uric acid and calcium levels are normal, as is the rheumatoid factor. Pseudogout is about half as common as gout but becomes more common after age 65. Calcium pyrophosphate dihydrate deposition disease is diagnosed in symptomatic patients by characteristic x-ray findings or crystals in synol fluid. The disease is treated with NSAIDs or colchicine. Linear calcifications or chondrocalcinosis are often found in the joints of elderly patients who do not have symptomatic joint problems; such patients do not require treatment.

So the answer to this question is C


Instruction:
The adenylate cyclase system is mediated by
A. cAMP
B. Phosphodiesterase
C. GTP regulating proteins
D. Nuclear receptors

Response:
The cAMP-dependent pathway, also known as the adenylyl cyclase pathway, is a G protein-coupled receptor-triggered signaling cascade used in cell communication G protein-coupled receptors (GPCRs) are a large family of integral membrane proteins that respond to a variety of extracellular stimuli. Each GPCR binds to and is activated by a specific ligand stimulus that ranges in size from small molecule catecholamines, lipids, or neurotransmitters to large protein hormones. When a GPCR is activated by its extracellular ligand, a conformational change is induced in the receptor that is transmitted to an attached intracellular heterotrimeric G protein complex. The Gs alpha subunit of the stimulated G protein complex exchanges GDP for GTP and is released from the complex. In a cAMP-dependent pathway, the activated Gs alpha subunit binds to and activates an enzyme called adenylyl cyclase, which, in turn, catalyzes the conversion of ATP into cyclic adenosine monophosphate (cAMP). Increases in the concentration of the second messenger cAMP may lead to the activation of cyclic nucleotide-gated ion channels

So the answer to this question is A


Instruction:
Sustained neutropenia is seen with ?
A. Vinblastin
B. Cisplatin
C. Carmustine
D. None of the above

Response:
Carmustine Myelosuppression leading to neutropenia, thrombocytopenia and anemia is seen with most of the anticancer drugs. The characteristic feature of myclosuppression produced by carmustine is that it causes delayed myelosuppression that is prolonged too According to Goodman Gilman "It causes profound and delayed myelosuppression with recovery 4-6 weeks after a single dose. The myelosuppression leads to leukopenia and thrombocytopenia (may be prolonged)" More on Carmustine: Carmustine belongs to nitrosoureas class of anticancer drugs They have an impoant role in the treatment of brain tumours. It is highly lipophilic and thus it readily crosses the blood brain barrier. Other adverse effects of carmustine Delayed renal damage Reversible liver damage Leukemia Myocardial ischemia

So the answer to this question is C


Instruction:
Which one of the following features may not be seen in hypothyroidism?
A. Cold intolerance
B. Deafness
C. Pericardial effusion
D. Pretibial myxedema

Response:
(D) Pretibial myxoedema > Blood flow is diverted from the skin, producing the cool extremities.cold intolerance is seen. Pericardial effusions occur in up to 30% of patients but rarely compromise cardiac function. Increased dermal glycosaminoglycan content traps water, giving rise to skin thickening without pitting (myxedema). Typical features include a puffy face with edematous eyelids and nonpitting pretibial edema.> Impaired hearing is present, but not deafness.SIGNS AND SYMPTOMS OF HYPOTHYROIDISM (DESCENDING ORDER OF FREQUENCY)SymptomsSigns* Tiredness, weakness* Dry skin* Feeling cold* Hair loss* Difficulty concentrating and poor memory* Constipation* Weight gain with poor appetite* Dyspnea* Hoarse voice* Menorrhagia (later oligomenorrhea or amenorrhea)* Paresthesia* Impaired hearing* Dry coarse skin; cool peripheral extremities* Puffy face, hands, and feet (myxedema)* Diffuse alopecia* Bradycardia* Peripheral edema* Delayed tendon reflex relaxation* Carpal tunnel syndrome* Serous cavity effusions

So the answer to this question is D


Instruction:
All of the following are true of antrochoanal polyp except:
A. Common in young
B. Single and unilateral
C. Bleeds on touch
D. Treatment involves FESS

Response:
(c) Bleeds on touch(Ref. Scott Brown, 6th ed., 4/10/14)They have very poor blood supply because of which they do not bleed on touch.

So the answer to this question is C


Instruction:
A 3-year-old recently adopted Romanian boy is referred after his initial pediatrician's assessment for an undescended testicle. On exam his left testicle is normal and in place. He has no evidence of hernias. However, his right hemiscrotum is empty and there is a testicule sized mass plapable at the pubic tubercle. The most appropriate next step is
A. Observation until age 5
B. Right orchiopexy
C. Right orchiopexy and right inguinal hernia repair
D. Right orchiopexy and right testicle biopsy

Response:
Although waiting until age 1 is acceptable, there should be little further delay. Waiting until puberty would subject the child to a high probability of abnormal development. Abdominal USG can be useful to search for an intra-abdominal testicle but this child's testicle was palpable. Since all cryptorchid testicles are accompanied by an inguinal hernia; herniorrhaphy should always accompany an orchiopexy for cryptorchidism. Testicular biopsy is unnecessary and may be injurious. The risk of malignancy, although increased 20-fold, does not manifest itself until at least the early twenties.

So the answer to this question is C


Instruction:
Young female presents with hypeension with VMA >14 mg/day, associated with -
A. Medullary Ca Thyroid
B. Von Hippel Lindau disease
C. Sturge weber syndrome
D. All

Response:
Answer is D.)'a' i.e. Medullary Ca thyroid, 'b' i.e. Von-Hippel Lindau disease, ; 'c' i.e. Sturge-weber syndrome A young female patient with hypeension and VMA > 14 mg/24 hrs (Normal VMA excretion in urine is less than 7 mg/24 hrs) is suggestive of pheochromocytoma. Familial syndromes associated with pheochromocytomas include MEN 2A and 2B, neurofibromatosis (von Recklinghausen disease), and VHL disease.MEN 2A (Sipple syndrome) is characterized by the following: Medullary thyroid carcinoma Parathyroid adenoma Pheochromocytomas Hirschsprung disease. MEN 2B is characterized by the following: Medullary thyroid carcinoma Pheochromocytoma Mucosal neurofibromatosis Intestinal ganglioneuromatosis Hirschsprung disease Marfanoid body habitus. VHL disease is associated with the following: Pheochromocytoma Cerebellar hemangioblastoma Renal cell carcinoma Renal and pancreatic cysts Epididymal cystadenomas. Neurofibromatosis, or von Recklinghausen disease, is characterized by congenital anomalies (often benign tumors) of the skin, nervous system, bones, and endocrine glands. Only 1% of patients with neurofibromatosis have been found to have pheochromocytomas, but as many as 5% of patients with pheochromocytomas have been found to have neurofibromatosis.Other neuroectodermal disorders associated with pheochromocytomas include tuberous sclerosis (Bourneville disease, epiloia) and Sturge-Weber syndrome.

So the answer to this question is D


Instruction:
A 68-year-old woman with a history of left ventricular congestive heart failure has had decreased visual acuity for the past 5 years. She has no ocular pain. Her intraocular pressure is normal. Findings on funduscopic examination include arteriolar narrowing, flame-shaped hemorrhages, cotton-wool spots, and hard, waxy exudates. Which of the following underlying diseases is she most likely to have?
A. Advanced atherosclerosis
B. Cerebral edema
C. Diabetes mellitus
D. Hypertension

Response:
Hypertensive retinopathy results from long-standing hypertension, with progressive changes that begin with generalized narrowing of the arterioles and proceed to the changes seen in this case. The pressure load from systemic hypertension causes hypertrophy and failure of the left side of the heart. Arteriosclerotic retinopathy causes vascular changes, including arteriovenous nicking and hyaline arteriolosclerosis with "copper wire" and "silver wire" arterioles. Cerebral edema may result in papilledema. Various findings are associated with diabetic retinopathy, including capillary microaneurysms, cotton-wool spots, arteriolar hyalinization, and more severe changes of proliferative retinopathy with neovascularization. Retinitis pigmentosa describes a variety of abnormalities that arise as an inherited condition that may begin later in life (but usually earlier) and produce a waxy pallor of the optic disc.

So the answer to this question is D


Instruction:
A 62-year-old man presents to the OPD for an annual physical examination. After noting a PSA level of 12.3 ng/dL, you refer him to an urologist for fuher workup. Following a prostatic biopsy, the results show the presence of adenocarcinoma of the prostate, which is given a Gleason score of 8. The Gleason score is a measurement of:
A. The extent of cancer within the prostate gland
B. The extent of the cancer within the abdomen
C. The likelihood that the cancer will grow and spread
D. The number of cancer cells expressing prostate specific antigen (PSA) on their cell surface

Response:
Gleason grading system: Developed to provide a measurement of the potential for prostate cancer to grow and spread Prostate biopsies involve sampling of tissue from several different areas of the gland (normally at least six). Two samples that appear to be most heavily involved, then histologically graded on a scale from 1 to 5 numbers are combined to give a Gleason score of 2 to 10 Tumors graded from 2 to 4- Slow growing Tumors graded 5 to 6- Intermediate Tumour graded 7 to 10 considered highly aggressive. Gleason score has nothing to do with the: stage (extent) of the cancer, expression of prostate specific antigen estimated survival time.

So the answer to this question is C


Instruction:
Pain rating index is provided by –
A. Faces scale
B. Visual analogue scale
C. Mc Gill questionniare
D. CHEOP scale

Response:
↵
McGill questionniare provides three quantitative measure : -

Pain rating index (PRI),
Number of words used, and
Present pain intensity (PPI).

So the answer to this question is C


Instruction:
Regarding neonatal circumcision, which one of the following is true –
A. It should be done without anaesthesia, as it is hazardous to give anaesthesia
B. It should be done without anesthesia, as neonates do not perceive pain as adults
C. It should be done under local anaesthesia only
D. General anaesthesia should be given to neonate for circumcision as they also feel pain as adults

Response:
Neonates have immature brain, however they feel pain and analgesia is required.
Circumcision is a painful procedure, therefore the American Academy of Pediatrics recommends using some type of local anesthesia for newborn circumcision. Several types of anaesthesia are available, including numbing cream or injecting a small amounts of anaesthetic around the penis. These are generally considered safe.
Some text books (like S. Das operative surgery and Lee's have) different opinion. According to them neonatal circumcision should be done in general anaesthesia. But following statement will clear all doubts :-

"Local anaesthesia is all that is required for circumcision in neonate. General anaesthetics present unnecessary risks, including neurotoxicity that may affect the development of neuronal structures in brain. This adds to general advice that circumcision is best done using a local anesthetic".

So the answer to this question is C


Instruction:
A patient comes with history of unresponsive fever and cough. X-ray revealed pneumonia. Sputum examination showed gram positive, partially acid fast bacteria with branching filaments that grows on sheep blood agar. The most likely etiologic agents is:
A. Actinomycetes
B. Nocardia
C. Aspergillosis
D. Pneumococci

Response:
Ans. is 'b' i.e., NocardiaRef: (Ananthanarayan, 8th/e, p. 393; 9th/e, p. 394; Harrison, 18th/e, p. 1324; Jawetz, 24th/e, p. 182)The typical morphology of Nocardia is Acid Fast filamentous bacteria with right angle branching.

So the answer to this question is B


Instruction:
'Swinging flashlight' test can be helpful to elicit NOT RELATED-MEDICINE
A. Argyll Robeson pupil
B. Argyll Robeson pupil
C. Marcus Gunn pupil
D. Subtle inequality in pupil size

Response:
The relative afferent pupillary defect(RAPD) - Marcus Gunn pupil- can be elicited with the swinging flashlight test.

So the answer to this question is C


Instruction:
True regarding collagen synthesis is all except ?
A. Synthesized in ribosomes as preprocollagen
B. Hydroxylation of proline occurs in Golgi apparatus
C. Hydroxylation of lysine occurs in ER
D. Triple helix assembly occurs in ER

Response:
Ans. is 'b' i.e., Hydroxylation of proline occurs in Golgi apparatus

So the answer to this question is B


Instruction:
Treatment of choice for genital was in pregnancy?
A. Salicylic Acid with Lactic Acid Solution
B. Podopylin
C. Imiqi mod
D. Cryotherapy

Response:
D i.e. Cryotherapy

So the answer to this question is D


Instruction:
Activities of daily living to MR child can be taught by
A. Self instruction
B. Cognitive therapy
C. Contingency management
D. Cognitive remediation

Response:
Self -Instruction is used in substance abuse where the person keeps on instructing oneself for not taking the substance,Cognitive Behaviour therapy is based on correcting the faulty cognitive distoions and faulty ideas and belief ,,All needing normal IQ. Token economy is a component of Contingency management, wherein the Consequence is contingent upon the action done in aicular manner.

So the answer to this question is C


Instruction:
Patient presents with peritonitis and during surgery a diveicular perforation is seen with fecal peritonitis. What is the Hinchey's stages?
A. 1
B. 2
C. 3
D. 4

Response:
Hinchey classification of complicated diveiculitis. GRADE Grade I Mesenteric or pericolic abscess Grade II Pelvic abscess Grade III Purulent peritonitis Grade IV Faecal peritonitis

So the answer to this question is D


Instruction:
Rotation of a distal extension base around vertical axis is resisted by
A. Rigidity of major connector
B. Reciprocal clasp arms
C. Retentive clasp arms
D. All of the above

Response:
It is resisted by stabilizing components, such as reciprocal clasp arms and minor connectors that are in contact with vertical tooth surfaces. Such stabilizing components are essential to any partial denture design regardless of the manner of support and the type of direct retention employed. Stabilizing components on one side of the arch act to stabilize the partial denture against horizontal forces applied from the opposite side.

So the answer to this question is B


Instruction:
Which is false regarding Spaulding's criteria?
A. Non critical items require only decontamination
B. Semi critical items are those which come in contact with mucous membrane or non intact skin
C. Semi critical items need low level disinfection
D. Cardiac catheters are examples of critical items

Response:
Semitcritical items need low level disinfection . Non Critical - Objects that touch only intact skin require low-level disinfection processing; noncritical items are divided into noncritical patient care items and noncritical environmental surfaces. Critical Semicritical Noncritical Sterilization High-level disinfection Low-level disinfection Level germicidal action Kill all microorganisms, including bacterial spores Kills all microorganisms except high numbers of bacterial spores Kill vegetative bacteria, fungi and lipid viruses. Device Surgical instruments and devices; cardiac catheters; implants; etc Respiratory therapy and anesthesia equipment, GI endoscopes, endocavitary probes, Tonometers, Diaphragm fitting rings, etc Bedpans; crutches; bed rails EKG leads; bedside table, walls floors and furniture Method Steam, gas (ethylene oxide), hydrogen peroxide plasma or chemical sterilization High level disinfection (hydrogen peroxide, ohophthalaldehyde, Glutaraldehyde) Low-level disinfection (or detergent for housekeeping surfaces) High-level disinfection traditionally is defined as complete elimination of all microorganisms in or on an instrument, except for small numbers of bacterial spores. The FDA definition of high-level disinfection is a sterilant used for a shoer contact time to achieve a 6-log10 kill of an appropriate Mycobacterium species

So the answer to this question is C


Instruction:
A one-week-old baby develops nuchal rigidity and fever. A lumbar puncture is performed and the cerebrospinal fluid demonstrates large numbers of neutrophils. Which of the following is the most likely causative agent?
A. Coxsackievirus
B. Escherichia coli
C. Herpes virus
D. Mycobacterium tuberculosis

Response:
The nuchal rigidity (stiff neck) suggest meningitis. Numerous neutrophils in the cerebrospinal fluid suggests a bacterial pathogen. The best answer of those listed is Escherichia coli, which is normally a gut organism, but can infect neonates who acquire the organism during passage through the bih canal. Coxsackievirus is a cause of acute lymphocytic meningitis. Herpes virus is a cause of lymphocytic meningitis. Mycobacterium tuberculosis is a cause of chronic meningitis.

So the answer to this question is B


Instruction:
Which of the following is a common side effect of cisplatin?
A. Diarrhea
B. Vomiting
C. Pulmonary fibrosis
D. Alopecia

Response:
Common side effect of cisplatin is vomiting. Drug of choice for cisplatin induced vomiting is 5HT3 antagonist like ondansetron.

So the answer to this question is B


Instruction:
Best differentiating feature between ulcerative colitis and Crohn's disease is?
A. Distributions of pseudo polyps
B. Mucosal edema
C. Crypt abscesses
D. Lymphoid aggregates in the mucosa

Response:
Ans. is 'a' i.e., Distribution of pseudopolyps * Pseudopolyps (inflammatory polyps) can be seen in both crohn's disease and ulcerative colitis "Pseudopolyps (inflammatory pseudopolyps) can be seen both in ulcerative colitis and crohns disease". - Clinical pathology.* In ulcerative colitis the distribution of these pseudopolyps can be diffuse but in crohn's disease the distribution cannot be diffuse because a classic feature of crohn's disease is the sharp demarcation of diseased bowel segments from the adjacent uninvolved bowel. When multiple bowel segments are involved the intervening bowel is essentially normal (skip lesions).* Establishing the distribution and extent of disease is essential in differentiating Crohn's disease from ulcerative colitis, in guiding therapeutic decisions, and in assigning colorectal cancer risk. Biopsies must be obtained even from normal-appearing areas to evaluate for any histologic evidence of disease activity, because this approach is more sensitive than macroscopic evaluation for inflammation.

So the answer to this question is A


Instruction:
Bone marrow stem cells differ from differentiated progenitor stem cells in what respect?
A. Provide differentiated terminal cells
B. Reconstitution of Bone marrow
C. Formation of the ovum
D. Act as a repair system for the body

Response:
None

So the answer to this question is B


Instruction:
What does a positive schick test indicate?
A. Carrier of diphtheria
B. Immune to diphtheria
C. Susceptible to diphtheria
D. Hypersensitivity to diphtheria

Response:
Immune status of an individual to Corynebacterium diphtheria is assessed by the presence of antitoxin levels or schick test. This test is done by injecting 0.1ml of highly purified toxin into one forearm and 0.1ml of heat inactivated toxin into another forearm as a control. A positive reaction is characterized by a local inflammatory reaction that reaches maximum intensity in 4-7 days and reduces gradually. This indicates absence of immunity to C. diphtheriae. Negative reaction indicates presence of antitoxin in the individual which neutralizes the toxin injected. Such individuals are immune to C diphtheriae infection. Ref: Sherris Medical Microbiology By Kenneth J. Ryan, 5th Edition, Chapter 26 ; Textbook of Microbiology and Immunology By Parija, Page 224

So the answer to this question is C


Instruction:
In breast lactiferous ducts are formed under the influence of which hormone?
A. Estrogen
B. Progesterone
C. LH
D. FSH

Response:
Lactiferous ducts are one of the ducts, numbering 15-20, which drain the lobes of the mammary gland; they open at the nipple.Ref: Ganong&;s review of medical physiology; 24th edition; page no: 416

So the answer to this question is A


Instruction:
In sensorineural hearing loss, weber's test is lateralized to
A. Normal ear
B. Defective ear
C. Not lateralized
D. May alternate

Response:
In Sendeafness deafness: Lateralised to better ear. In conductive deafness: Lateralised to worse ear. Ref: Dhingra; 6th Edition; pg no 22

So the answer to this question is A


Instruction:
According to WHO, exclusive breast milk is given upto -
A. 6 months
B. 4 months
C. 8 months
D. 10 months

Response:
No other food is required to be given until 6 months after bih. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 489

So the answer to this question is A


Instruction:
All of the following statements about neural cells are true except
A. The human CNS contains about (10)11 neurons
B. Ependymal cells are involved in phagocytic functions
C. Both
D. None

Response:
Lining the CSF-filled ventricles, the ependymal cells play an impoant role in the production and regulation of CSF. Their apical surfaces are covered in a layer of cilia, which circulate CSF around the CNS. Ref: guyton and hall textbook of medical physiology 12 edition page number:813,814,815

So the answer to this question is B


Instruction:
A 10-day old neonate is brought by her mother to the OPD with complaints of sneezing. On examination, the respiratory rate is 40/minute and conducted sounds are heard on auscultation. There are no intercoastal retraction. The neonate should be treated with -
A. Normal saline nose drops
B. Oral antihistamines
C. Oral antibiotics
D. Parenteral antibiotics

Response:
Park&;s texbook of Preventive and Social Medicine 23rd edition Page no:172 Fast breathing is present when the respiratory rate is 60 breaths/ min or more in a child less than 2 months of age Since no fast breathing and chest indrawing present child is treated symptomaticaly. DONOT require treatment with antibiotics

So the answer to this question is A


Instruction:
Secondary attack rate of chicken pox is around:
A. 60%
B. 70%
C. 80%
D. 90%

Response:
Chicken pox is highly contagious with secondary attack rates of nearly 90%. The period of communicability ranges from 1 to 2 days before onset of rash to 4 to 5 days thereafter. Ref: Park 21st edition, page 134

So the answer to this question is D


Instruction:
Differential expression of same gene depending on parent of origin is referred to as –
A. Genomic imprinting
B. Mosaicism
C. Anticipation
D. Nonpenetrance

Response:
The phenomenon referred to as genomic imprinting leads to preferential expression of an allele depending on the parental origin.
Genomic imprinting
Human inherits two copies of each gene, i.e. two alleles, from homologous maternal and paternal chromosomes.
There is no functional difference between the genes derives from mother or the father.
But, with respect to some genes, there are functional differences between the paternal gene and maternal gene.
These differences result from an epigenetic process, called genomic imprinting.
In most cases, genomic imprinting selectively inactivates either the maternal or paternal allele.
Maternal genomic imprinting :
Selective inactivation of maternal allele.
Example is Angelman syndrome.
Paternal genomic imprinting :
Selective inactivation of paternal allele.
Example is Prader – Willi syndrome.

So the answer to this question is A


Instruction:
Epistaxis in elderly patient is commonest in
A. Nasapharyngeal carcinoma
B. Foreign body
C. Bleeding disorder
D. Hypeension

Response:
The major cause for epistaxis in an elderly person is hypeension. Ref: Dhingra 7e pg 198.

So the answer to this question is D


Instruction:
Triad of Plummer Vinson syndrome includes all of the following except:
A. Iron Deficiency Anaemia
B. Dysphagia
C. Atrophic Glossitis
D. Koilonychia

Response:
Koilonchyia is not pa of Plummer Vinson Syndrome. Plummer-Vinson syndrome (iron deficiency, angular stomatitis, glossitis and dysphagia) raises the risk of oral squamous cell cancer and esophageal cancer at all the post-cricoidal tissue web&;- Harrison Plummer Vinson Syndrome Plummer-Vinson syndrome typically describes iron-deficiency anemia and dysphagia caused by the formation of a keratinized web. Plummer-Vinson Syndrome Iron Deficiency anemia Dysphagia (due to Esophageal webs or Hypopharyngeal webs), and Atrophic glossitis/Angular stomatitis Plummer-Vinson syndrome, also known as the Paterson-Brown-Kelly Syndrome, predisposes to Hypopharyngeal squamous cell carcinoma. The condition is more common in women and is a recognized risk factor for post cricoid Hypopharyngeal carcinoma. Ref: Harrison&;s 19th edition Pgno: 237

So the answer to this question is D


Instruction:
Reciprocal anchorage is offered by
A. Activator
B. Inter maxillary elastics
C. Maxillary expansion appliance
D. Catalan's appliance

Response:
None

So the answer to this question is C


Instruction:
False statement about TX A2 is
A. It is formed in platelets
B. It is formed from PGG2/h2
C. It is having platelet anti aggregatory reactivity
D. Asprin can inhibit its production

Response:
TX A2 is produced inside the platelets with the help of TX A2 synthetase It is formed from cyclic Endo peroxidase(PGG2/H2) with the help of an enzyme, cyclooxygenase Aspirin inhibit its production by reversible inhibition of cyclooxygenase enzyme TX A2 causes aggregation of platelets, therefore is prothrombotic Refer kDT 6/e p174

So the answer to this question is C


Instruction:
Neurotransmitter depleted in Parkinson's disease: September 2007
A. Dopamine
B. Acetylcholine
C. Glutamate
D. GABA

Response:
Ans. A: Dopamine Parkinson's disease has both hypokinetic and hyperkinetic features. In this condition, which was originally described by James Parkinson and is named for him, the nigrostriatal dopaminergic neurons degenerate. The fibers to the putamen are most severely affected. Dopaminergic neurons and dopamine receptors are steadily lost with age in the basal ganglia in normal individuals, and an acceleration of these losses apparently precipitates parkinsonism. Symptoms appear when 60-80% of the nigrostriatal dopaminergic neurons are lost. Parkinsonism is also seen as a complication of treatment with the phenothiazine group of tranquilizer drugs and other drugs that block D2 dopamine receptors.

So the answer to this question is A


Instruction:
A 17-year-old girl had been taking a drug for treatment of acne for the last 2 years, which has lead to pigmentation. Which drug could it be?
A. Doxycycline
B. Minocycline
C. Azithromycin
D. Chlorpromazine

Response:
Ans. (B) Minocycline(Ref: Harrison 17th/e p327-328, CMDT-2010/121)Both minocycline as well as chlorpromazine can cause pigmentation on long-term use.However, as the patient in question is being treated for acne, the answer should be minocycline. Antibiotics used in acne are erythromycin, clindamycin, tetracycline, doxycycline and minocycline.

So the answer to this question is B


Instruction:
All are true about aneurismal bone cyst except ?
A. Eccentric
B. Expansile & lytic
C. Treated by simple curettage
D. Metaphysis of long bones

Response:
Ans. is 'c' i.e., Treated by simple curettage Aneurysmal bone cyst Aneurysmal bone cyst occur in children and young adults (5-20 years). The term aneurysmal is used because it causes expansion of overlying coex like vascular expansion of an aneurysm. The metaphysis of long bones is involved most commonly. Most common in femur and tibia; however any long bone can be involved. Other common sites are posterior elements of veebrae and pelvis. athology Cystic spaces of variable sizes & number which are filled with blood but not lined with vascular endothelium. The wall of vascular space is lined with fibroblast cells with collagen, giant cells, hemosiderin & osteoid (secondary to microfractures). Clinical features With expanding lesions, pain may be a presenting feature. Large cyst can also cause swelling Pathological fracture may occur (but less frequent than simple bone cyst). Radiological features of aneurysmal bone cyst Eccentric, expansile osteolytic lesion The characteristic feature is 'blown-out' distension of one surface of the bone. Overlying coex may be intact or disrupted. Extensive sclerosis at the interface between normal and expanded coex (buttersing) may be present. Delicate thin trabeculae is characteristic and an expansile ballooning lesion may produce a 'soap-bubble appearance'. Lesion occurs at metaphysis of long bones. Other common locations include the posterior elements of the spine(pedicle, lamina, transverse process, spinous process) and pelvis. Treatment Surgery is the treatment of choice. Curettage and bone grafting is the procedure commonly followed.

So the answer to this question is C


Instruction:
In- right lateral rectus palsy, head is turned to -
A. Right
B. Left
C. Up
D. Down

Response:
Compensatory head posture - It is adopted to avoid diplopia and confusion Head is turned towards the direction of action of the paralysed muscle. Ref;A.K.Khurana; 6th edition; Page no: 354

So the answer to this question is A


Instruction:
Coefficient of thermal expansion of amalgam is:
A. 7.2a(ppm k-1).
B. 10.0(ppm k-1).
C. 25.0(ppm k-1).
D. 48.5(ppm k-1).

Response:
None

So the answer to this question is C


Instruction:
An infant presented with erythematous lesions on cheek, extensor aspect of limbs, mother has history of bronchial asthma, the probable diagnosis is –
A. Air borne contact dermatitis
B. Atopic dermatitis
C. Seborraehic dermatitis
D. Infectious eczematoid dermatitis

Response:
Atopic dermatitis (Infantile form. i.e. Infantile eczematous dermatitis)

Starts at the age of 2-3 months
Itchy papules and vesicles, lesions are intensively prurititic
Distribution Begins on face but can involve rest of the body, sparing diaper area (napkin rash is absent)
After face, neck and extensor surfaces (of knee, elbow) and groin are involved
Personal or family history of other atopic conditions -f Asthma, Haye fever, allergic rhinitis or conjuctivitis, urticaria, food allergies.

So the answer to this question is B


Instruction:
Following grows in the cell free medium except -a
A. Rickettsia
B. M leprae
C. Syphilis
D. All

Response:
Ans. is 'a' i.e., Rickettsia; 'b' i.e., M leprae; 'c' i.e., Syphilis Obligate intracellular organisms . To grow in a medium which does not contain cells (cell free medium), organism should be capable of ATP synthesis. . Obligate intracellular organisms are not capable of the metabolic pathways for ATP synthesis. . So, these organisms are dependent on the ATP of host cells. . As they require host cell ATP, they can not grow in the media which do not contain cells (cell free media). . Such organisms are ? 1. Rickettsiae 2. Viruses 3. Pathogenic treponemes (syphillis) 4. Chlamydiae 5. M. leprae

So the answer to this question is D


Instruction:
Poor prognostic factors for Hodgkin&;s disease are all except -
A. Younger age
B. Systemic manifestations
C. Lymphocyte depletion
D. stomach involvement

Response:
According to the Hasenclever prognostic index for advanced Hodgkin lymphoma,risk factors are - age>45yrs,male gender,stage 4 disease(diffuse involvement of one or more extralymphatic tissues with/without constitutional symptoms ),lymphopenia etc. Lymphocyte depletion is having poor prognosis .

Reference :Davidson&;s principles & practice of medicine 22nd edition pg no1043.

So the answer to this question is A


Instruction:
Granular deposits of IgA is seen in:
A. Bullous pemphigoid
B. Linear IgA bullous disorder
C. Dermatitis Herpetiformis
D. Hailey-Hailey disease

Response:
Bullous pemphigoid : Linear deposition of IgA and IgG at DEJ
Linear IgA bullous disorder : Linear deposition of IgA at DEJ
Dermatitis herpetiformis : Focal granular IgA deposits at papilary tips.
Hailey-Hailey disease : DIF : negative

So the answer to this question is C


Instruction:
All are true about lidocaine except
A. It acts on sodium channels in both active and inactive state
B. It is most cardiotoxic local anesthetic
C. It is given IV in cardiac arrhythmias
D. Extensive first pass metabolism

Response:
Ans. b. It is most cardiotoxic local anesthetic

So the answer to this question is B


Instruction:
Iso osmolar urine is seen in -
A. ATN
B. Severe dehydration
C. Diabetes insipidus
D. PCKD

Response:
Acute tubular necrosis (ATN) is a medical condition involving the death of tubular epithelial cells that form the renal tubules of the kidneys. ATN presents with acute kidney injury (AKI) and is one of the most common causes of AKI. Common causes of ATN include low blood pressure and use of nephrotoxic drugs Acute tubular necrosis is classified as a "renal" (i.e. not pre-renal or post-renal) cause of acute kidney injury. Diagnosis is made by a FENa (fractional excretion of sodium) > 3% and presence of muddy casts (a type of granular cast) in urinalysis. On histopathology, there is usually tubulorrhexis, that is, localized necrosis of the epithelial lining in renal tubules, with focal rupture or loss of basement membrane. Proximal tubule cells can shed with variable bility and not be purely "necrotic".isosmolar urine is seen Ref Harrison20th edition pg 234

So the answer to this question is A


Instruction:
Tumour with perineural invasion:
A. Adenocarcinoma
B. Adenoid cystic Ca
C. Basaal cell ca
D. Squamous cell ca

Response:
Ans is 'b' ie Adenocystic Ca

So the answer to this question is B


Instruction:
Common was are caused by which virus:September 2006, March 2013 (h)
A. Cytomegalovirus
B. Human papilloma virus
C. Hepatitis B virus
D. Epstein-Barr virus

Response:
Ans. B: Human papilloma virusWas are common, and are caused by a viral infection, specifically by the human papillomavirus (HPV) and are contagious by contact with the skin of an infected person.It is also possible to get was from using handtowels or other objects used by an infected person. They typically disappear after a few months but can last for years and can recurWas are caused by a virus called human papilloma virus or HPV.Types 1, 2, and 3 cause most of the common was.Type 1 is associated with deep plantar (sole of the foot) and palmar (palm of the hand) was.Type 2 causes common was, filiform was, plantar was, and mosaic plantar was.Type 3 causes plane was, commonly known as flat was.Anogenital was are caused by types 6, 11, 16, 18, 30, 31, 33, 34, 35, 39, 40 and others.HPV types 6 and 11 cause about 90% of genital was cases.HPV types 16 and 18 currently cause about 70% of cervical cancer cases and also cause some vulvar, vaginal, penile and anal cancers

So the answer to this question is B


Instruction:
Watson and crick are known for:
A. Discovery of helical structure of DNA
B. Association of Helicobacter Pylori with Chronic Gastritis
C. Discovery of HIV virus
D. None of the above

Response:
Watson and Crick discovered helical structure of DNA and won a noble prize for it (Ref: TEXTBOOK OF MEDICAL PHYSIOLOGY - GEETHA)

So the answer to this question is A


Instruction:
The structures passing posterior to diaphragm are all except ?
A. Aoa
B. Azygous vein
C. Thoracic duct
D. Greater splanchnic nerve

Response:
The aoa passess posterior to the diaphragm.Accompanying the aoa through the aoic hiatus is the thoracic duct and the azygous vein.The greater and lesser splanchinic nerves passess through the crura on either side.

So the answer to this question is D


Instruction:
Treatment of choice in Gardenella vaginitis in pregnancy :
A. Clindamycin
B. Metronidazole
C. Ehromycin
D. Tetracycline

Response:
Metronidazole

So the answer to this question is B


Instruction:
Metal needed for function of enolase is:
A. Magnesisum
B. Calcium
C. Copper
D. Iron

Response:
Enolase is inhibited by fluoride, and when blood samples are taken for measurement of glucose, it is collected in tubes containing fluoride to inhibit glycolysis. The enzyme is also dependent on the presence of either Mg2+ or Mn2+. The phosphate of phosphoenolpyruvate is transferred to ADP by pyruvate kinase to form two molecules of ATP per molecule of glucose oxidized. Ref: Harper 28th edition, chapter 17.

So the answer to this question is A


Instruction:
Distal end of humerus develops from how many centres
A. 2
B. 5
C. 3
D. 4

Response:
OSSIFICATION OF HUMERUS: The humerus ossifies from one primary centre and seven secondary centres. The primary centres appears in the middle of diaphysis during the 8th week of development. The upper end ossifies from 3 secondary centres -one for head{first year}, one for greater tubercle {second year}, one for lesser tubercle {fifth year}. The three centres fuse together during 6th year to form one compound epiphysis, which fuses with the shaft during the 20th year. The epiphyseal line encircles the bone at the level of lowest margin of the head. This is the growing end of the bone . The lower end ossifies from 4 centres which form 2 epiphysis. The centre include one for capitulum and the lateral flange of the trochlea{first year}, one for medial flange of the trochlea{9th year}, one for lateral epicondyle {12th year}. All three fuse during the 14th year to form another compound epiphysis, the centre for medial epicondyle appears during 4-6 years, forms a separate epiphysis and fuses with the shaft during the 20th year. REF: BD Chaurasia 8th edition page no:16.

So the answer to this question is D


Instruction:
The gold standard test to diagnose PNH is:
A. Bone marrow study
B. Sucrose hemolysis test
C. Flow cytometry
D. Genetic study

Response:
The gold standard test to diagnose PNH today is flow cytometry. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 884

So the answer to this question is C


Instruction:
Increased Reid Index is used to characterized:
A. Chronic Bronchitis
B. Bronchiectasis
C. Bronchial Asthma
D. Emphysema

Response:
Answer is A (Chronic Bronchitis): Reid Index is a measure of hyperophy of the mucus secreting glands and is characteristically increased in Chronic Bronchitis. Reid Index: Measures Hyperophy of mucus glands Chronic Bronchitis is assoicated with hyperophy of the mucus secreting glands of the submucusa in the cailaginous airways. The histologic correlate of chronic bronchitis is the presence of mucus gland hyperplasia. This manifests as an increased percentage of bronchial wall occupied by submucosal mucus glands (This is classically defined by the 'Reid Index'.) Reid Index is the ratio of the thickness of the mucous gland layer to the thickness of the bronchial wall (between basal lamina of mucosa and inner perichondrium) The normal Reid Index is less than 0.4 Reid index > 0.4 (typically > 0.5) suggests mucous gland hyperplasia The Reid index is increased in chronic bronchitis usually in propoion to the severity and duration of disease. There is a direct correlation between the value of Reid Index and the volume of daily sputum production by the patient.

So the answer to this question is A


Instruction:
A lady has a lytic lesion in X-ray of the upper end of the humerus . The diagnosis is :
A. Osteosarcoma
B. Unicameral bone cyst
C. Osteoclastoma
D. Osteochondroma

Response:
Ans. is 'b' i.e. Unicameral bone cyst Unicameral bone cyst or simple bone cyst is the only true cyst of the bone. The most common site is the upper end of the humerus. Most common presentation - Pathological fracture* Also know MC site of aneurysmal bone cyst - lower end of the humerus MC presentation is - gradually increasing swelling

So the answer to this question is B


Instruction:
The risk of rhegmatogenous retinal detachment is increased in all of the following except:
A. Pseudophakia
B. Trauma
C. Hyperopia
D. Lattice degeneration

Response:
Ans. c. Hyperopia Rhegmatogenous Retinal Detachment A rhegmatogenous retinal detachment (RRD) occurs when a tear in the retina leads to fluid accumulation with a separation of the neurosensory retina from the underlying RPE MC type of retinal detachment Pathophysiology: Vitreoretinal traction is responsible for the occurrence of most RRD. As the vitreous becomes more syneretic (liquefied) with age, a posterior vitreous detachment (PVD) occurs. In most eyes, the vitreous gel separates from the retina without any sequelae. However, in ceain eyes, strong vitreoretinal adhesions are present and the occurrence of a PVD can lead to a retinal tear formation; then, fluid from the liquefied vitreous can seep under the tear, leading to a retinal detachment Rhegmatogenous Retinal Detachment Predisposing Factors: Myopia Aphakia or pseudophakia Vitroretinal degeneration Lattice degeneration Snail track degeneration Diffuse chorioretinal atrophy Macular holes Posterior vitreous degeneration Trauma Vitreous loss during cataract surgery

So the answer to this question is C


Instruction:
True about immunoglobulins-
A. IgE has maximum serum concentration
B. IgG has maximum serum concentration
C. IgA has minimum serum concentration
D. IgM has minimum serum concentration

Response:
None

So the answer to this question is B


Instruction:
Treatment of malignant glaucoma: March 2004
A. Atropine
B. Topical pilocarpine
C. I/V mannitol
D. Vitreous aspiration

Response:
Ans. A i.e. Atropine

So the answer to this question is A


Instruction:
All of the following are used in management of acute severe bleeding due to warfarin overdose except:-
A. Withhold the anticoagulant
B. Vitamin K1
C. Protamine sulphate
D. Fresh frozen plasma

Response:
Management of warfarin overdose is done as follows: *INR < 5 but above therapeutic range - Discontinue warfarin temporarily and resta at low dose. *INR 5-9 - Vitamin K1 (1 mg oral) *INR > 9 but no bleeding - Vitamin K1 (2 - 3 mg oral) *INR > 20 or bleeding - Four factor prothrombin complex or Fresh frozen plasma.

So the answer to this question is C


Instruction:
Calcium channel blocker which is usually used in subarachnoid hemorrhage is:
A. Nimodipine
B. Diltiazem
C. Verapamil
D. Flunarizine

Response:
Ans: A (Nimodipine) Ref: Goodman &Gillman's The Pharmacological Basis of Therapeutics, 20I1 12th Edition, McGrow Hill, Burton LL P 735-736 & Basic & Clinical Pharmacology, 2012, / 2th Ed. Tata McGraw hill, Katzung BG Masters SB. Trevor AJ. P 204.Explanation:Nimodipine is a cerebroselective Calcium Channel Blocker.This drug has found to reduce the morbidity after subarachnoid hemorrhage.It is also approved for patients with neurological deficits due to cerebral vasospasm after the rupture of congenital intracranial aneurysmOther CCBs used in stroke are verapamil and nicardipineNicardipine - intracerebral arterial infusion has found to prevent cerebral vasospasm associated with stroke

So the answer to this question is A


Instruction:
Mr. Ramu, a 49 yr old gentleman, undergoes a root canal procedure. Few days later he develops fever, weight loss, and anorexia. He is diagnosed with mitral valve prolapsed with mitral regurgitation. The most common organism implicated in causation of this condition is:
A. Streptococcus pneumonia
B. Staphylococcus aureus
C. Viridans streptococci
D. Providencia stuaii

Response:
Viridans streptococci. (Braunwald, 15/e, pp 809-814, 882-885, 959, 1009, 1620.) The 30-year-old-female with mitral valve prolapse has developed subacute bacterial endocarditis. The likely etiologic agent is a viridans streptococci. Viridans streptococci cause most cases of subacute bacterial endocarditis. No other agent listed is likely to cause this infection.

So the answer to this question is C


Instruction:
Large granular lymphocytes are ?
A. B cells
B. NK cells
C. T cell
D. Plasma cells

Response:
Ans. is 'b' NK cellsNull cells (Large granular lymphocytes) Null cells are called so because they lack features of surface markers of both B and T lymphocytes.The account for 5 to 10% of peripheral blood lymphocytes.They are also called "large granular lymphocytes (LGL)" as they contain large azurophilic cytoplasmic granules. Members of this group are:a) Antibody dependent cytotoxic cells (ADCC)b) Natural killer cells (NK Cells)

So the answer to this question is B


Instruction:
False about congenital rubella syndrome
A. High risk if infected after 16 weeks
B. Most commonly associated with CVS anomalies, cataract and hearing loss
C. IgG is diagnostic
D. IgM antibodies may be seen shortly after birth

Response:
None

So the answer to this question is A


Instruction:
Which antineoplastic drug is a peptide
A. Bleomycin
B. Aspaeme
C. Valinomycin
D. Dactinomycin

Response:
Refer Katzung 10th/895 KDT 6/e p 826 Bleomycin is a small peptide Bleomycin is a mixture of closely related glycolypeptide antibiotics having potent anti tumor activity

So the answer to this question is A


Instruction:
IUCD acts as contraceptive through all of the following mechanisms, except :
A. Impairs implantation of blastocyst
B. Increases tubal motility
C. Inhibits ovulation
D. Releases prostaglandins

Response:
Inhibits ovulation

So the answer to this question is C


Instruction:
The only reliable method for determining the mode of respiratory function is:
A. Butterfly test
B. Water test
C. Induction rhinomanometry
D. Halometer

Response:
Induction rhinomanometry or plethysmography is considered as gold standard for determining the mode of respiration in any given individual.

So the answer to this question is C


Instruction:
Chromosomal analysis of all of the following genotype shows Barr bodies, EXCEPT:
A. XO
B. XXY
C. XX
D. XXX

Response:
Routine microscopy of mammalian cell nuclei reveals a small, dense mass of heterochromatin present in females but not males. This "sex chromatin" (or Barr body or X-chromatin) is one of the two X chromosomes present in females. As a general rule, only 1 X chromosome functions in a cell at a given time. All other X chromosomes present in a cell may be seen as X-chromatin bodies in a resting nucleus. Thus, if one knows the number of X chromosomes, one can anticipate that the number of Barr bodies will be 1 less. If one counts the number of Barr bodies, the number of X chromosomes can be determined by adding 1. Hence Barr bodies are not seen in genotype XO. The male cell has one X chromosome and one Y chromosome, therefore no sex chromatin is visible in males. Ref: Manipalviratn S., Trivax B., Huang A. (2013). Chapter 3. Genetic Disorders & Sex Chromosome Abnormalities. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.

So the answer to this question is A


Instruction:
Mechanism of action of ciprofloxacin in gram negative bacteria:-
A. Inhibition of mycolic acid
B. Inhibition of topoisomerase IV
C. Inhibition of DNA gyrase
D. Inhibition of helicase

Response:
MECHANISM OF FLUOROQUINOLONES (FQ) In gram negative bacteria, FQ inhibit DNA gyrase by binding to its A subunit and interfere with cutting and resealing function. In gram positive bacteria, FQ inhibit similar enzyme DNA topoisomerase IV.

So the answer to this question is C


Instruction:
Drug of choice for lymphogranuloma venerum: March 2005
A. Tetracycline
B. Chloramphenicol
C. Erythromycin
D. Ampicillin

Response:
Ans. A: Tetracycline Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by unique serovars of Chlamydia trachomatis (L1, L2, L3) that are unlike those that typically cause urethritis, cervicitis, and proctitis (A-K). The hallmark of LGV is unilateral or bilateral tender lymphadenopathy that dramatically evolves 2 to 6 weeks after the primary lesion. The involved lymph nodes increase rapidly in size, and pain and erythema are common. If adjacent to one another, several involved lymph nodes may coalesce. The central areas of such lymph nodes can then undergo necrosis. Fluctuant and suppurative lymph nodes then develop, causing the classic 'bubo' of LGV. The bubo may then rupture and drain purulent material, which is associated with relief from symptoms. The 'groove sign' characteristic of LGV is seen if both the inguinal and the femoral nodes are involved. Tetracycline is the first choice drugs for LGV. Apa from LGV, tetracyclines are drug of choice for: STDs-Chlamydial non-specific urethritis/endocervicitis, granuloma inguinale Atypical pneumonia Cholera Brucellosis Plague Relapsing fever Rickettsial infections-typhus, rocky mountain spotted fever, Q fever etc.

So the answer to this question is A


Instruction:
A patient had seven irregular hyperpigmented macules on the trunk and multiple small hyperpigmented macules in the axillae and groins since early childhood. There were no other skin lesions. Which is the most likely investigation to support the diagnosis ?
A. Slit lamp examination of eye
B. Measurement of intraocular tension
C. Examination of fundus
D. Retinal artery angiography

Response:
Seven hyper pigmented macules on trunk with multiple hyperpigmented macules in axilla (freckling) point towards the diagnosis of neurofibromatosis. So, for supporting the diagnosis we need to see iris hamartomas (lish nodules) by slit lamp examination.

So the answer to this question is A


Instruction:
All the following are true about osteoporosis except
A. There is bending of long bones
B. There is hypercalcemia
C. There is veebral compression fractures
D. Milkman's fracture

Response:
Bending of bones and milkman's fracture is very much related to osteomalacia but they are also seen in osteoporosis. Whereas veebral compression fracture is related to osteoporosis but also seen in osteomalaciaOsteoporosis OOsteoporosis is defined as a reduction of bone mass (or density) or the presence of a fragility fracture. OSeveral noninvasive techniques are now available for estimating skeletal mass or density. These include *Dual-energy X-ray absorptiometry (DXA), *Single-energy X ray absorptiometry (SXA), *Quantitative computed tomography (CT), and *Ultrasound. The diagnosis of Osteoporosis is made when a patient has a characteristic osteoporotic fracture. In absence of such a fracture, evaluation of osteoporosis is done by T score measurement based on bone mass T scoreDiseaseT score > - 1Normal T score - 1 and - 2.5 Osteopenia T score < - 2.5 Osteoporosis (Refer: Mercer's Textbook of Ohopedics, 9thedition, pg no: 310-313)

So the answer to this question is B


Instruction:
Paraneoplastic syndrome not seen in renal cell cancer is?
A. Acanthosis nigricans
B. Amyloidosis
C. Polycythemia
D. Hypeention

Response:
A number of paraneoplastic syndromes due to ectopic hormone production by the renal cell carcinoma have been described. These include Polycythaemia(by erythropoietin), Hypercalcaemia(by parathyroid hormone and prostaglandins), Hypeension(by renin), effects of feminisation or masculinisation(by gonadotropins), Cushing's syndrome(by glucocoicoids), Eosinophilia, Leukemoid reactions, and amyloidosis. From Pathologic basis of disease Robbins, South Asian edition, pg no:955; Textbook of pathology Harsh Mohan,7th edition, pg no:683

So the answer to this question is A


Instruction:
Iris lesion is seen in
A. Utricaria
B. Scabies
C. Lichen planus
D. Erythema multiformae

Response:
Erythema multiforme(EM) is an acute ,self limiting skin disease charecterised by the abrupt onset of symmetrical target lesions. Erythema multiforme is a skin reaction that can be triggered by an infection or some medicines. The classic lesions are iris or target lesions which are less than 3 cm in diameter, rounded and have 3 zones:central area of dusky erythema, middle paler area of oedema and an outer ring of erythema with well defined margin. Sites: commonly the extremities and the face, but face,trunk ,oral and genital mucosa may be affected. There are two forms: EM major and EM minor. Ref Harrison 20th edition pg 1235, Fitzpatrick 8thednpg 434)

So the answer to this question is D


Instruction:
Flexible Bronchoscope contains holes for all of these functions EXCEPT?
A. Ventilation
B. Drainage of secretion
C. For biopsy
D. To remove foreign body

Response:
Ans. (d) To remove foreign bodyRef.: Harrison 19th ed. /1667Foreign body is removed by rigid bronchoscopy.Indications for Rigid Bronchoscopy* Bleeding or hemorrhage* Foreign body extraction* Deeper biopsy specimen when Fiber-optic specimen is inadequate* Dilation of tracheal or bronchial strictures, relief of airway obstruction, insertion of stents, and pediatric bronchoscopy.* It is also used for tracheobronchial laser therapy or other mechanical tumor ablation.

So the answer to this question is D


Instruction:
Anxiety is ?
A. Neurosis
B. Psychosis
C. Personality disorder
D. None

Response:
Ans., A. NeurosisImpoant neurotic disorders are Anxiety disorders (Panic), Phobia (Phobic anxiety disorder), obsessive compulsive Disorder & Dissociative conversion disorder.

So the answer to this question is A


Instruction:
Body temperature regulation centre is located at
A. Pituitary
B. Thalamus
C. Hypothalamus
D. Basal ganglia

Response:
Anterior hypothalamus, responds to heat;Posterior hypothalamus, responds to cold. Ref: Ganongs Review of medical physiology;25 th edition ; pg :309; table 17-1.

So the answer to this question is C


Instruction:
In head injury, first to be repaired is
A. Bone
B. Tendon
C. Muscle
D. Nerve

Response:
None

So the answer to this question is A


Instruction:
POEMS syndrome includes all except-
A. Polyneuropathy
B. Endocrinopathy
C. Ovarian dysgenesis
D. Monoclonal gammopathy

Response:
POEMS syndrome consists of polyneuropathy, organomegaly, endocrinopathy, multiple myeloma(monoclonal gammopathy)& skin changes.Reference :Harsh mohan textbook of pathology sixth edition pg no 383.

So the answer to this question is C


Instruction:
Complication of Colle's fracture include all of the following except :
A. Malunion
B. Nonunion
C. Sudeck's osteodystrophy
D. Rupture of EPL tendon

Response:
Amongst the given options nonunion is very rare complication because colle’s fracture occurs in cancellous area where the healing potential is very high.

So the answer to this question is B


Instruction:
The maintenance of posture in a normal adult human being depends upon:
A. Integrity of reflex arc
B. Muscle power
C. Type of muscle fibers
D. Joint movements in physiological range

Response:
A i.e. Integrity of Reflex arc'Postural Reflexes not only maintain the body in an upright balanced position but also provide the constant adjustments necessary to maintain a stable postural background for voluntary activity'- Ganong 22"V207Integrity of the postural reflex arc is therefore the single best answer of choice.

So the answer to this question is A


Instruction:
Conduction velocity is maximum in-
A. Bundle of His
B. Purkinje System
C. Ventricular muscles
D. Atrial pathway

Response:
Ans. is 'b' i.e., Purkinje System Cardiac tissueConduction velocity (meter/second)SA nodeInteatrial pathwaysAtrial muscleAV nodeBundle of HisPurkinje systemVentricular muscle0 [?] 0510 [?] 300 [?] 05 (minimumQ)14 (maximumQ)1

So the answer to this question is B


Instruction:
The triple P procedure for placenta percreta involves all except:
A. Pelvic devascularization
B. Placental localization using USG
C. Peripartum hysterectomy
D. Myometrial excision for placental nonseparation

Response:
Ans. is c, i.e. Peripartum hysterectomyRef Fernando Arias 4/e, p 396Triple P procedure has been developed for placenta percreta as a conservative surgical alternative to peripartum hysterectomy. It consists of following 3 steps:1. Perioperative placental localization and delivery of fetus via transverse uterine incision above the upper border of placenta.2. Pelvic devascularization3. Placental nonseparation is dealt with myometrial excision and reconstruction of uterine wall.

So the answer to this question is C


Instruction:
100% protection against conception in a lactating mother is for about :
A. 1 month
B. 2 weeks
C. 2 months
D. 3 months

Response:
2 months

So the answer to this question is C


Instruction:
An isolate from a wound culture is a Gram-negative rod identified as Bacteroides fragilis. Anaerobic infection with B. fragilis is characterized by
A. A foul-smelling discharge
B. A black exudate in the wound
C. An exquisite susceptibility to penicillin
D. A heme-pigmented colony formation

Response:
Bacteroides fragilis is a constituent of normal intestinal flora and readily causes wound infections often mixed with aerobic isolates. These anaerobic, Gram-negative rods are uniformly resistant to aminoglycosides and usually to penicillin as well.Reliable laboratory identification may require multiple analytical techniques. Generally, wound exudates smell bad owing to production of organic acids by such anaerobes as B.fragilis. Black exudates or a black pigment (heme) in the isolated colony is usually a characteristic of Bacteroides (Porphyromonas) melaninogenicus, not B.fragilis. Potent neurotoxins are synthesized by the Gram-positive anaerobes such as Clostridium tetani and C. botulinum.

So the answer to this question is A


Instruction:
Best indicator for nutritional status for a child is –
A. Mid arm circumference
B. Head circumference
C. Rate of increase of height and weight
D. Chest circumference

Response:
Health and development are intimately interconnected.
Proper nutrition of children is fundamental to the achievement of sustainable development.
Anthropometric measurements are the most widely used indicators of nutritional status in a community.
The commonly used anthropometric measurements are -
Weight
Length / height
Arm circumference
Chest circumference
Skinfold thickness

Measurement of weight and rate in gain in weight are the best single parameters for assessing physical growth.

The comparison of a child's height and weight with the standard growth chart helps to determine if the particular child is within the expected normal range for his age, sex and socioeconomic status.
It does not indicate if the rate of growth of child was normal in the recent past.
The point to stress here is that it is very difficult to recognize a recent disturbance in growth by comparing weight or height with the reference standards because a clearly abnormal percentile position on the growth chart becomes evident only when the factors retarding growth are profound or if they have persisted for a considerable time.
Measurement of the velocity of growth or increment in unit time is a better tool for early identification of factors affecting growth and also for assessment of the usefulness of social and remedial measures.

So the answer to this question is C


Instruction:
Commonest site of lung abcess is-
A. Post segment of right upper lobe
B. Lingula
C. Post segment of left lower lobe
D. Post segment of right lower lobe

Response:
None

So the answer to this question is A


Instruction:
Tinea incognito is seen with:
A. Steroid treatment
B. 1% BHi3
C. 5% permethrin
D. Antibiotics

Response:
A i.e. Steroid treatment Tinea incognito is extensive ring worm infection with atypical appearance due to inappropriate use of steroids.Q

So the answer to this question is A


Instruction:
Painful "hand - foot syndrome" is a manifestation of:
A. Malaria
B. Sickle cell Anemia
C. Autoimmune haemolytic anemia
D. Idiopathic Thrombocytopenic purpura

Response:
Ans. B. Sickle cell AnemiaSickle cell disease (SCD) and its variants are genetic disorders resulting from the presence of a mutated form of hemoglobin, hemoglobin S (HbS) caused by a single amino acid substitution within the hemoglobin A (HbA) gene, creating the abnormal HbS. Patients with sickle cell anemia can present with sickle cell crisis which can be of three types: vaso occlusive, sequestration and aplastic. Vaso occlusive crisis are painful episodes due to intravascular sickling and tissue anoxia, predominantly affecting bones, lung liver, spleen, brain and penis. Patients develop throbbing bony pain, sometimes accompanied by local tenderness, erythema, warmth and swelling. These attacks often get precipitated following infections, climatic changes and psychological stress. In small children under 5 years, hands and feet bones are often affected. Painful "hand-foot syndrome" may be the first clinical manifestation of sickle cell disease.

So the answer to this question is B


Instruction:
Cu-T 380A IUCD should be replaced once in:
A. 4 years
B. 6 years
C. 8 years
D. 10 years

Response:
10 years

So the answer to this question is D


Instruction:
Meyer pedicle graft used for?
A. Fracture through neck of the talus
B. Non-union fracture neck of femur
C. Fracture through the waist of the scaphoid
D. Inter-trochanteric fracture femur

Response:
* Meyer-pedicle graft is used to prevent avascular necrosis and non-union fracture in upper end of femur (neck of femur). In this procedure, Quadratus femoris is taken up and inseed into the head of the femur. * Inter-trochanteric of Femur does not result in AVN or non-union. It causes malunion.

So the answer to this question is B


Instruction:
The treatment of choice in annular pancreas is which of the following?
A. Whipple's operation
B. Duodeno-jejunostomy
C. Gastro-jejunostomy
D. Jejuno-cystostomy

Response:
Duodeno-Duodenostomy is also done in treatment of annular pancreas.

So the answer to this question is B


Instruction:
Hypothyroidism can cause all except:
A. Hoarseness
B. Dryness of mouth
C. Nasal stuffiness
D. Vertigo

Response:
Hoarseness is due to deposition of myxomatous tissue in the vocal cords. Nasal stuffiness is due to predominance of parasympathetic activity. Hypothyroidism also causes Meniere's like syndrome.

So the answer to this question is B


Instruction:
What is the significance of this triangle?
A. To put ports in VATS
B. To put ICD in pleural effusion
C. For Needle thoracostomy
D. For all the above

Response:
Ans. (b) To put ICD in pleural effusion* Above triangle is known as Safety triangle.* This is the triangle where ICD is inserted at 5th ICS for Pleural Effusion

So the answer to this question is B


Instruction:
HCV is associated with -a) Anti LKM-1 antibody b) Sclerodermac) Cryoglobulinemiad) Polyarteritis nodosa
A. a
B. ac
C. ad
D. b

Response:
Several studies have observed a relationship between hepatitis C virus infection and anti-liver/kidney microsome-1 (anti-LKM-1) positive chronic hepatitis.
It has been suggested that hepatitis C may induce an autoimmune phenomenon that leads to the development of a specific type (type II anti-LKM-1 positive) autoimmune chronic hepatitis- Journal- J Viral Hepat. 1995; 2(4):175-9.

So the answer to this question is B


Instruction:
Respiratory bronchiole proceed into ?
A. Terminal bronchiole
B. Bronchi
C. Teiary bronchiole
D. Alveolar duct

Response:
Respiratory tract anatomyNasal cavity, oral cavity, plarynx and larynx forms upper respiratory tract. Larynx opens into lower respiratory tract which stas from Trachea. Trachea bifurfactes into bronchi (principal bronchi). Progressive branching of bronchi forms bronchioles. Fuher branching of bronchioles leads to terminal bronchioles. Terminal bronchiole emnate into respiratory bronchioles. Respiratory bronchioles proceed into the alveolar ducts, wich immediately branch into alveolar sacs (alveoli).

So the answer to this question is D


Instruction:
Factor present in the final common terminal complement pathway is -
A. C4
B. C3
C. C5
D. Protein B

Response:
formation of C5 convease and finally the membrane attack complex is common in all the three pathways. Ref Robbins 9/e p 331_333

So the answer to this question is C


Instruction:
Biotin deficiency is due to
A. Avidin
B. Flavoproteins
C. Metallo flavoproteins
D. Oxireductase

Response:
(Avidine) (146 - U.S 3rd) (178- R.S. 7th)Biotin deficiency (anti egg, white injury factor, vitamin B7 or vitamin - H) is a sulfur containing B complex. It is directly participates as coenzyme in the carboxylation reactions* High consumption of raw egg. The raw egg white contains a glycoprotein - avidin. Which is highly binds with biotin and blocks its absorption from the intestine.

So the answer to this question is A


Instruction:
Concentration of sodium channel in nerve in per square foot is
A. 1.6 x 10-5 to 1.9 X-2 per square foot
B. 6.6 x 10-6 to 3.9 X-3 per square foot
C. 1.6 x 10-6 to 1.9 X-3 per square foot
D. 6.6 x 10-5 to 3.9 X-2 per square foot

Response:
In myelinated neurons most sodium channels are present at nodes of ranvier Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:72,73

So the answer to this question is D


Instruction:
Exposure to noise above ----- cause permanent hearing loss
A. 85 db
B. 90 db
C. 100 db
D. 160 db

Response:
Repeated or continuous exposure to noise around 100 decibels may result in a permanent hearing loss. In this, the inner ear damage may vary from minor changes in the hair cell endings to complete destruction of the organs of coi.Exposure to noise above 160dB may rupture the tympanic membrane and cause permanent hearing lossPark 23e pg: 742

So the answer to this question is C


Instruction:
Hypogastric sheath is a condensation of -
A. Scarpa's fascia
B. Colle's fascia
C. Pelvic fascia
D. Inferior layer of the Urogenital diaphragm

Response:
Ans. C. Pelvic fasciaCondensations of endopelvic fascia-a. Although types of endopelvic fascia do not differ much in their gross appearance, some parts of the endopelvic fascia haveva much more fibrous consistency, containing an abundance of collagen and elastic fibers, and a scattering of smooth muscle fibers. These parts are often described as "fascial condensations" or pelvic "ligaments."b. Hypo gastric sheath is a thick band of condensed pelvic fascia. This fascial condensation is not merelya barrier separating the two potential spaces namely the retropubic space and presacral space. It gives passage to essentially all the vessels and nerves passing from the lateral wall of the pelvis to the pelvic viscera, along with the ureters and, in the male, the ductus deferens.c. As it extends medially from the lateral wall, the hypogastric sheath divides into three laminae (layers) that pass to or between the pelvic organs, conveying neurovascular structures and providing support. Because of the latter function, they are also referred to as ligaments.d. The anterior most lamina, the lateral ligament of the bladder, passes to the bladder, conveying the superior vesical arteries and veins.e. The posterior most lamina (lateral rectal ligament) passes to the rectum, conveying the middle rectal artery and vein.f. In the male, the middle lamina forms a relatively thin fascial partition, the rectovesical septum, between the posterior surface of the bladder and the prostate anteriorly and the rectum posteriorly.g. In the female, the middle lamina is markedly more substantial than the other two, passing medially to the uterine cervix and vagina as the cardinal ligament (transverse cervical ligament).

So the answer to this question is C


Instruction:
Subperiosteal resorption and thickness of skull is increased in:
A. Rickets
B. Osteomalacia
C. Hyperparathyroidism
D. Thalassemia

Response:
Hyperparathyroidism

So the answer to this question is C


Instruction:
In the JVP, 'a' waves are absent in -
A. Atrial fibrillation
B. Mitral stenosis
C. Tricuspid atresia
D. myocardial infarction

Response:
The a wave reflects right atrial presystolic contraction and occurs just after the electrocardiographic P wave, preceding the first hea sound (S1).A prominent a wave is seen in patients with reduced right ventricular compliance; a cannon a wave occurs with atrioventricular (AV) dissociation and right atrial contraction against a closed tricuspid valve. In a patient with a wide complex tachycardia, the appreciation of cannon a waves in the jugular venous waveform identifies the rhythm as ventricular in origin. The a wave is not present with atrial fibrillation. Ref Harrisons internal medicine 20e p1668

So the answer to this question is A


Instruction:
Alkaline Nasal Douche does not contain
A. Sodium chloride
B. Sodium bicarbonate
C. Sodium biborate
D. Trisodium citrate

Response:
None

So the answer to this question is D


Instruction:
Salpingitis/Endosalpingitis is best confirmed by:
A. Hysteroscopy and laparoscopy
B. X-ray
C. Hysterosalpingography
D. Sonosalpingography

Response:
Ans. is a, i.e. Hysteroscopy and laparoscopyRef: Shaw 15th/ed, p451; William's Gynae 1st/ed, p74; Gynecology by Ostrzenski (Lippincott Williams 2(X)l/282); Dutta Gynae 6th/ed, p130Laparoscopy is considered the "gold standard". While it is the most reliable aid to support the clinical diagnosis but it may not be feasible to do in all cases. It is reserved only in those cases in which differential diagnosis includes salpingitis, appendicitis or ectopic pregnancy. Nonresponding pelvic mass needs laparoscopic clarification.Hysterscopy may also provide confirmatory evidence for salpingitis."Fallopian tube culture can be obtained laparoscopically and recently the hysteroscopic approach has been introduced. The specimen is obtained during hysteroscopy with a cytobrush." - Ref: Gynecology by Ostrzenski (Lippincott Williams) (200l)/282Also KnowSince laparoscopy is an invasive procedure for diagnosis of salpingitis/PID, diagnosis should first be made clinically.

So the answer to this question is A


Instruction:
Active form of folic acid
A. Dihydrofolate
B. Folinic acid
C. Tetrahydrofolate
D. Methylated folic acid

Response:
Active form of Folic acid is Tetrahydrofolate. A. The folic acid is first reduced to 7,8-dihydrofolic acid and fuher reduced to 5,6,7,8-tetrahydrofolic acid (THFA) . Both reactions are catalyzed by NADPH dependent folate reductase. B. The THFA is the carrier of one-carbon groups. One carbon compound is an organic molecule that contains only a single carbon atom. The following groups are one carbon compounds: i.Formyl (-CHO) ii.Formimino (-CH=NH) iii.Methenyl (-CH=) iv.Methylene (-CH2-) v.Hydroxymethyl (-CH2OH) vi. Methyl (-CH3) C.These one carbon compounds are attached either to the 5th or to the 10th or to both 5 and 10 nitrogen atoms of THFA. The one-carbon metabolism and their interconversions D.Methyl group in N5-methyl THFA is used for synthesis of active methionine, which takes pa in transmethylation reactions. Such transmethylation reactions are required for synthesis of choline, epinephrine, creatine, etc. Reference: Vasudevan Textbook of Biochemistry pg no. 401

So the answer to this question is C


Instruction:
An inexpensive and efficient method of sewage disposal for a small community is –
A. River outfall
B. Oxidation pond
C. Trickling filter
D. Activated sludge

Response:
None

So the answer to this question is B


Instruction:
Autoinfection is a mode of transmission in-
A. Trichinella
B. Cycticercosis
C. Ankylostoma
D. Ascaris

Response:
None

So the answer to this question is B


Instruction:
Use of tadalafil is contraindicated in:
A. Pulmonary arterial hypertension
B. Unstable/Symptomatic angina
C. Active infections
D. Hepatic dysfunction

Response:
Ans. b. Unstable/Symptomatic anginaRef: Goodman Gilman 12th e/P. 841Nitrates increase cyclic GMP production by stimulation of guanylate cyclase via NO. This cyclic GMP is responsible for vasodilation.Cyclic GMP is metabolized by PDE-5 and hence PDE-5 inhibitors like sildenafil and tadalafil can significantly increase cyclic GMP producing fatal hypotension.Thus tadalafil is contraindicated with nitrates and hence unstable/symptomatic angina is the best answer.

So the answer to this question is B


Instruction:
Which of the following would most likely be observed in the lung during an autopsy of a 2-week-old infant who died of neonatal respiratory distress syndrome?
A. Alveoli filled with neutrophils
B. Hyaline membranes and collapsed alveoli
C. Enlarged air space
D. Dense fibrosis of the alveolar walls

Response:
Neonatal respiratory distress syndrome is a disease of immaturity. The immature lung is not able to produce sufficient surfactant to prevent collapse of many alveoli. Severe diffuse damage to alveoli causes precipitation of protein (“hyaline membranes”) adjacent to many alveolar walls.
Abundant neutrophils (choice A) are seen in pneumonia.
Fibrosis (choice B) is a late, not early, feature of respiratory distress syndrome whereas the air spaces are collapsed, not enlarged (choice C), in this condition.

So the answer to this question is B


Instruction:
The defluoridations process of drinking water developed by the NEERI is popularly known as –
A. Activated sludge process
B. Recarbonation process
C. Nalgonda process
D. Double pot method

Response:
None

So the answer to this question is C


Instruction:
Function of reverse transcriptase:
A. RNA dependent DNA synthesis
B. DNA dependent RNA synthesis
C. DNA dependent DNA synthesis
D. RNA dependent RNA synthesis

Response:
Ans. a. RNA dependent DNA synthesis

So the answer to this question is A